Meter Swap � � Request Number: 15146
Public VVorks Division
Service Request
Problem Address: 4625 2 1!2 St Requested By: Tom
Department: WATER Address: No�'ess pa�ovided �
Problemllssue: INSTALLAMRMEIER PhoaeN�smber: ?63-221-263$
Scheduled Date: 2017-OS-09 SchedulEd'Ilme: 1 Q:00:00
�- � �' CC� c�xY-�
ACITON NEEDED:
Crexted by: We�y Hiatt Dsite Crexted: 201T-US-04
ACIION TAI�N:
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Status: In Progress Sabmitter Has Been �.
Co�acted
Date Completed: C^ _ �"7 Completed by: ��1��
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� City of Fridley �� ���
Water Department
6431 University Avenue NE
Fridley,MN 55�432
763-5723566
�/We hereby authorize the City of Fridtey andjor its employees to do what is necessary to
replace the water meter. I understand that the property owner is liabie for the water line from the main to the premise and al{irrterior
plumbing. (Per City code 402.06) 1 also hold the City of Fridley and/its employees harmless for any damages that may oaur while 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 r►ecessary.
FINAL METER READtNG(old meter) t� � `� ��
Name:_ �v� Addreu_ �;t� �. � �l i�- J � .
n � �,�
Pfione Number �`('�J ` �`�"�t� d�J 'bat@ �"' l `r �
Signature Witness Signature
OLD METER# _ �✓ / v � � �
OLD READING _ �� � � ✓��
NEW METER# � `�� ��Lt �
NEW READING D
ERT# ` ��/`� G ���
FRIDLEY C17Y 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)
4Q2.5 PERMIT FEE
Prior to constructtng or repair of any water of sewer line connecting the ezisting municipal system and any house or buifdir�g for which the
appiication is made,the owner or corrtractor shall be required to obtain a permit for such connectlon,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 connectio�and the work incident thereto has been approved by the City as a
proper and suitable connecCion.
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 appficant,owner,or occupant or user of such premises shall be liable for all repairs
required to any water line and sewer lines necessary for connection of the premises from the main to the premises. ff 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 mairrtenance of the sewer service line from the premises to the main including debris clearing or
root cutting and to maintain the water service curb stop box fo�operability and at wch height as wiii ensure that it remains above the finished
grade of the land or property. (Ref 638,1156,1191)