Meter Swap �"r" Request Number: 14754
� Public Works Division
Service Request
Problem Address: 4871 2nd St NE Requested By: Adlore Braaten
Department: WA1ER Address: No address provided
Problem/Issue: 1NSTALL AMR ME1ER Phone Number: 763-572-8945
Sc6edaled Date: 2 17-04-21 Schednled T3me: 10:30:00
w r Sr--
n �
ACIION NEEDED:
Created by: Beth Kox�rick Date Created: 2017-04-18
ACITON TAI�N:
._________._._ �i.r...�-s�-���......_........._.______���-
���:
Status: In Progress Submitter Has Been r,
Co�rtacted
Date Completed: f J ��I��� Completedby: �
��� `��
�
y 1
� � � � � ���� � � �
City of Fridley �
Water Department �`b��'��
6431 University Avenue NE
Fridley, MN 55432
763-572-3566
�/We hereby authorize the City of Fridiey and/or its employees to do what ts 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 all iMerior
plumbing. (Per City code 402.06) I also hold the City of Fridley and/its employees harmless for any damages that may o�r whlle doing this
operation. This to include,but not limited to valves,piping,walls,floors or the curb stop box and service line. In understand I am also required
to obtain a permit prior to any work,if necessary.
FINAL METER READING(old meter)_ t./ � L�� ✓�
Name• 1��0'r"e ��T�� Address � a� l � ��• � 'L
Phone Number ��� '"� l�� "' U � ,�Date �^ �� V 1
`�
Signature Witness Signature
OLD METER# �� D��� ` 7,D
OLD READING v � (, / � ��
NEW METER# I 1 o`v �� 1�
NEW READING �
ERT# l � el d��v ��
FRIDLEY CITY 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)
402.5 PERMIT FEE
Prior to constructing or repair of any water of sewer line connecting the existing municipal system and any house or buildir�for which the
appiication is made,the owner or contrador shail be required to obtain a permit for wch wnnection,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 shall be unlawful to cover
any connecting line until an inspection has been made and such connection and the work incident thereto has been approved by the City as a
proper and suitabie connection.
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 line or a water service lead has
been extended to the property line for connection,the applicant,owner,or occupant or user of such premises shall be liable for aii repairs
required to any water line and sewer lines necessary for connection of the premises from 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 mairrtenance and/or
repairs,including necessary street repairs at a rate set annually by an administrative policy. It shall be the responsibility of the applicant,
owner,occupant or user to perform standard maintenance of the sewer service line from the premises to the main induding debris clearing or
root cutting and to maiotain the water service curb 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)
� '�
���:L{�� �):. � .� r¢ „� b � �� 4X�� � F¢ �r � .
x ,� �s-q :k
,� i. ���',
city of Frid y
na r Dep.a�tment
�Zlress
8 � � `'� `�
Name /`���4�'{- i-a.�,���
Date o y ��� ��
Old Meter Number 7 � � � ��
Old Meter Reading a---r-'
Replacement No. � �a" � � 7 -�"'"'
Replacement Reading �
Replacement Make��'�.�r.-�
Remarks:
L:�.,,�, y,,,��
S igned —