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C3ty of Fridley
Nater Devartment
Address ��C� c���N ��
xame � R �.2���� —
Date �"`�'��
Old Meter Number `�'�� ►�V
OZd Meter Reading � �
Replacement No. ��Ic"��(����
Replacement Reading �
Replacement Make ��}(�
Remarks: ���
Signed _
FROM :CITY DF FRIDLEY FAX N0. :7635711287 Sep. 03 2@13 �2:25PM P2
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�iequest Nu�ber; f885
Pu�lic Wc�las Div�ion
S�e Reqtwst
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Prob�em Nddress: s-rta reckson str�er nrE rtsqus�ed By: �sir.ry Nroz� ....^ ._.__. ..._
�pertment: WAT'�R Address: No ad�reas provFded
Probbntfl�sue: INSTALLAMR METER(WA'IERj Pha�ne Nunibaur:
�chedu�d Dats„ 2t?19-t19-i6 8c�dupd'Tktts: 02:C10:00
/4C"I�ON N�DEQ: Ir�il ANIR Meter
Crsst4d bY� Je�mie Ber�son Date Cr�d; 2013-fl9.03
�1CT70N�'AKEN;
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ERT NO� �`�'�.._._�.�..� �--_-,,.w__________....._.._�..�.,......
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Dl�te 4"�mpl�:
CO�ted by:
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- City of Fridley
Water Department
6431 University Avenue NE
Fridley,MN 55432
(T63)572-3566
��We hereby authorize the City of Fridiey and/or its
empioyees to do what is necessary to replace the water meter. i understand that the property owner
is liable for the water line from the main to the premise and ail interior plumbing. (Per City code
402.06) i also hold the City of Fridley and/its empioyees harmless for any damages that maY occur
while doing this operation. This to intlude,but not limited to;valves,piping,walls,floors or the curb
stop box and service line. i understand I am also required ta obtain a permit prior to any work,if
necessary. ���
Final meter reading(old meterj i, �
Name: Address: G.� ` `v �\�`�—��
Phone Number: Date: �` �( �
Signature: �
Witness Signature:
' FRIDLEY CI'fY CODE
CHAPTER 402.WATER,STORM WATER,AND SANITARY 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 connecting the existing municipal system and any house
or building for which the application is made,the awner or contractor shall be required to obtain a permit for such
connection,and shall pay a permit fee as provided in Chapter 11 of this Code. After such connection has been
made,the Water and Sewer Department shall be notified. It shalf be unlawful to cover any connecting line until an
inspettion has been made and such cannection and the work incident thereto has been approved by the City:as a
proper and suitable connectian.
402.06.REPAIRS AND MAINTENANCE TO CONNECTION
After the initial connection has been made to the water service curb stop box or the sewer lead at the property
4ine or a water service or sewer lead has been extended to the property line for connection,the applicant,owner,
or the occupant or user of such premises shall be liable for ail repairs required to any water line and sewer lines
necessary far connection of the premises fram the main to the premises. If the property owner requests
maintenance service or repairs be performed by the City,the property owner shall be charged for the costs of the
maintenance and/or repairs, inciuding any necessary street repairs,at a rate set annualiy by an administrative
poticy. It shall be the responsibility of the applicant,awner,occupant or user to perform standard maintenance of
• the sewer service line from the premises to the main including debris ciearing or root cutting and to maintain the
water service cur6 stop box for operability and at such height as will ensure that it remains above the finished
grade of the land or property. (Ref 638,1156,1191)