Meter Swap �
t Request Number: 15005
Public Works Division
Service Request
Problem Address: 4769 2 1/2 St Requeated By: Ms Halsey
Department: WA1ER Address: No address provided
Problem/tssue: INSTAL.L AMR METER Plrone Number: 612-670-031 S
ScLednled D�te: 2017-04-28 � Sc6edalcd 1ime: 07:QQ:QO
� ��
AC"IYON NEEDED:
CreAted by: Wend�y Hiatt Date Cre�ed: 2017-04-27
ACTI N TAI�N:
I/�7�(Jw 1 ,_ ` ""'
5tatus: In Progress 5ubmittcr Has Been �.,
Cout�ted
Dxte Coatpleted: Compltted by:
�.�`�q�- I^'1 � 1 o r
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s '�1 '1 ✓I v`.' `� O�
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City of Fridley �
Water Department
6431 University Avenue NE
Fridiey,MN 55432
763-572-3566 .
�/We hereby authorize the City of Fridley and/or its employees 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 all ir�terior
plumbing. (Per Ctty code 402.06) I also hold the City of Fridley and/its empioyees harmless for any damages that may oaur while doing this
operation. This to include,but not limited to vaives,piping,walis,floors or the curb stop box and service line. In understand 1 am aiso required
to obtain a permit prior to any work,if necessary.
FINAL METER READING(old meter) ��� � "�D
Name• ��� C��SC�� Address � l y"✓� � f`� ��
Phone Number �'�����^ O �I� Date _ `—��� ` f
Signature � �tness Signature
OLD METER# 2�"11� � �� �
OLD READING `7� ���
NEW METER# I " i ZO � `� l
NEW READING �
ERr# 22'L.�L..�( j"
FRIDLEY CITY COOE
CHAPTER 402.WATER,STORM WATER AND SANITARY SEWER
ADMIN ISTRATION
(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 tine connecting the existing municipal system and any house or butidtng for which the
application is made,the owner or contractor shall be required to obtain a permit for such connection,and shall pay a permR fee as provided in
Chapter 11 of this Code. After such connection has been made,the Water and Sewer Department shail be notified. It shall be unlawfui 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 suitable connection.
402.06 REPAIRS AND MAINTENAPICE TO CONNECTION
After the initial connection has been made to the water service curb stop box or the sewer lead at the qroperly ttne or a water sen�ice lead has
been extended to the property line for connection,the applicarrt,owner,or occupant or user of wch prernises shall be liabie for all 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 mair►tenance service or repairs be performed by the City,the property owner shall be charged for the cosls 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 including debris dearing or
root cutting and to maintain the water seroice curb stop box for operability and at such height as wili ensure that it remains above the finished
grade of the iand or property. (Ref 638,1156,1191j