Meter Swap REQUEST FOR SERVICE REPORT
C{TY OF FRIDLEY
Reference No. Date: ` (j—� ( � �
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Request Type: Entered By:
Department: Citizen Name: � � � ��csC'�
Address: �1 � ����-�-��� Phone Number: (c,�v�` ��
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Scheduled Date: Property �wner:
location Details: Request Details:
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� Approver:
� Compietion Date: t ��,l,�_ �� Citizen Notified:
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- City of Fridley
- . ._ :.... W�#er Department
_ . .,._,. ._._.
6431 University Avenue NE
Fridley,MN 554�2
(763�5723566
I/we hereby authori=e 1he��Y��diey and/ar its
employees to do what is necessary tu replace the wat+er mete�, ��e���t��r0pe�°�
water line from the main to the premise and aa M����'P�umbing. (Per City code
� 402.Q6) I.alsa hQid the C�ty of Fridiey and/its empfoyees harmi�s.s or any amages a may "
while doing this operation. i'i�is to indude,but not!imlted to;va���►P�Pi�B.++���floors or the cu�b
stop box and service Ilne. I understand I am also required to d��a P���Prior tv any work,if
necessary.
. _ _ _ l � �I `�� _ _ _ � . _
Final meter reading(old meter) . .
: J � Address:,�!h '��G�i �l G��� �J��T" ! �
Name �r �
Pi�one Nam6e �
�127 tfate: �` —�` � � .
Signature:
Witness Si re:
�RIDI.EY CITY CODE
CHppTER eW�.WA7ER,STdRM WATER,AND SANITARY SEWER
ADMINISTRA7'�UN
(Ref Ord No 113,4fi4,565;566,6Z9,638,662,9Z2,988,1144,1156,1191)
402.05.PERMR FEE �
Prior to constructing or repair of any water or sewer line connectingthe e�dsting municipal system and any house
or building for which the appGcation is made,the owner or contrac�r shall be required to obtain a permit for such
conrrection,and shall pay a permit fee as provided in Chapte�11 of thi�Code. After sud�cannection has been
made,the Water and Sewer Department shaU be notified. it shall be unlawful to cover any connecting line until an
- inspection has been made and su�h cannection and the work inddentthereto has been approved by the C'ity as a
proper and suitahle connection.
402A6.REPAIRS AND MAINTENANCE TO CONNECfIaN
���� , _�___�,a.,+�tha WatPr service cur�stau 6ax urthe sewer lead atthe propert�
line or a water service ar sewer lead has been extended to the property I�ne for cunnecbon,the appllcan�uwner,
or the occupant ar user of such premises shall be liable for all�epa�required to arry water line and sewe�lines
necessary for connecdon of the premises ftom the main to the premises. If the propetty owner requests
maintenance 5ervice nr repairs 6e performed by the City,the propetty owner shall be charged for the costs of the
maintenance and/or repairs, including any necessaN street repai�,at a rate set annualiy by.an administradrre
policy. it shalt be the responsihi�itY of the appiicant,uwner,occuRant or user to perfarm�tandard meintenance of
• the sewer service line from the premise5 ta the main including deh�s ciearing ar raot cutting and to maintain the
water service cur6 stop box for operabil'rty and at such height as r�11 ensure that it remains abave the finished .
,,: . - � .. . .. . . . . .._..
grade of���lar+d or�rop�rty.��Ref 63�,1�55,-t���:) .�� . ._ ..._ .__ -- -.._ . ... . .._. _.... �