Meter Swap FRQM :CITY �F FRIDLEY FAX Na. :763571128? Sep. 30 2013 03:1zPM P2
Request Numb�r� 7074
Public wo� pivi�km
. $ervicc�Requsst
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Proh►►�prn Add�ss; 99167fh Ave-ne Requested By: 7hmr�as Sv�sk
depsrtrnvM: WATER Adc�s�.s: f�b acidross prcrAAded
Pr'obletN�sus: INSYALLAAAR A�E'i�R{WATER} Phose M�xr�ber:
SoFwduMd Ds�e: ZQ1S-t�-44 S�uled Time: 01:�:�
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CreaMd Iky: Jeannie eensc� D�ate Crested; 2013-08-30
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_ City of Fridley
Water Department
6431 University Avenue NE
Fridley,MN 55432
(763)572-3566
I/we hereby authorize the City of Fridley and/or its owner
� employees to do what is necessary to replace the water meter. 1 understand that the property
is liable for the water line from the main to the premise and a���ss fo ran f dam'ages that ma�ur
402.06} i also hold the City of Fndley and/its employees harmle Y
while doing this operation. This to include,but not limited to;valves,piping,wa��s.floo�'s or the curb
stop box and service line. i understand I am also required to obtain a permit prior to any work,if
necessary. � �nj� r /�^� _
,-�� `"�� 1 v
Final meter reading{old metec) �
�a 1 - ��-r-� �.
Name: Address: ,
�L�,-�
Pho�e Number: D te:
Signature: s�r�/'t9�r�`'.cd '
Witness Signature: `` _ _
FRIDLEY CITY CUDE
CHAPTER 402.WATER,ST�RM WASER,AND SAN[TARY SEWER
ADMINISTRATION
(Ref Ord No 113,464,565,566,629,638,662,922,988,1144.1156,1191) _
402.05. PERMIT FEE
Prior to constructing or repair of any water or sewer line o�cont acto shall be equiredto ob ain a perm'd for such
or building for which the application is made,the owner
connection,and shall pay a permit fee as pro�be not f ed.tlt shall be unlawful to cover anyconneicti g lineeuntil an
made,the Water and Sewer Department shal roved by the City as a
inspection has been made and such connection and the work incident thereto has been app
propec and suitable connection.
402.06.REPAIRS AND MAINTENANCE TQ CONNECTION
After the initial connection has been made to the water service curb s�aP'ne forrconnectionl the appl cant owner,
line or a water service or sewer lead has been e�ctended to the property i
or the occupant o�user of such premises shall be liable for all repairs required to any wato�ner requ����nes
necessary for connection of;hs�pre erformed by the Citytthe ProPertY ow�ne shall be charged for Che costs of the
maintenance service or repa p
maintenance and/or repairs, including any necess aWner,o cupanttor ser to perfo m standa d main�ena'nce of
policy. It shall be the responsibility of the applican ,
- the sewer service line from the premises to th�main inciuding debris clearingor root cutting and to maintain t e
water senrice curb stop box for opecability and at such height as wili ensure that it remains above the finished
grade of the land or property. (Ref 638,1156,1191)