Meter Swap � ��' Request Number: 15299
Public Works Division
Service Request
ProMem Address: 4555 3rd St Requested By: Ly�and Mark Peterson
Department: WATER Addreas: No address provided
Proble�/Ls�: INSTALL AMR METFR P6one Number: 763-60'1-7256 "
Scheduled Date: 2017-OS-1 S 5c6ednled'Rme: 01:30:00
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AC1�ON 1�EEDED:
_ Crested by: Beth Kondrick Date Created: 2017-OS-11
ACIZON TAI�N:
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Status: In Progress �bmitter Aaa Been r
Contacted
DateComplsted: �_ / � � �� Completedby: ����
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+ City of Fridley I�� _ �/`�4�� �� [
r Water Department � �� �
6431 University Avenue NE �m � � 1�7
Fridley,MN 55432 l� �
763-572-3566
��We hereby authorize the City of Fridiey 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 interior
plumbing. (Per City code 402.06) I also hold the City of Fridley and/its employees harmless for any damages ihat may oocur while doing this
operation. This to include,but not limited to valves,piping,walis,fioors or the wrb stop box and service line. In undersqnd 1 am also required
Lo obtain a permit prior to any work,if necessary.
FINAL METER READING(old meter) ����� `� ��
Name• `-^I�� '� Uv� � �'��" Ju' `Address - t��� �- � .
Pho�e Number v��—��J /O��� Date � �`�'! � ��' � J
�-�
Signature Witness Signature
OLD METER# �� I ��"`��
OLD READING � I 1 V�w
NEW METER# I� I�W ����
NEW READING �
ERT# � ��, a �3 ��
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 arry house or building for which the
application is made,the owner 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. tt shall be unlawful to cover
any connecting line until an inspection has been made and such connection and the work incident thereto has been appro�red by the City as a
proper and suitable connection.
402.06 REPAIRS AND MAINTENANCE TO CONNECTION
After the initial connection has been made to the water service wrb stop box or the sewer lead at the property line or a water seroice tead has
been extended to the property line for rnnnection,the applicarrt,owner,or occupant or user of such premises 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 premisea ff the property owner
requests maintenance service or repairs be perFormed by the City,the property owner shall be charged for the wsts of the mairrtenance and/or
repairs,including necessary street repairs at a rate set annually by an administrative poliry. It shall be the responsibility of the applicarrt,
owner,occupant or user to perform standard maintenance of i�he sewer service line from the premises to the main including debris dearing or
root cutting and to maintain 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)