Meter Swap �.�r
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Request Number: 14778
Public Works Division
Service Request
Problem Addresa: 5110 3rd St Requested By: Phyllis Ro�k
Depe�rtmeut: WA'IER Address: No addtess provided
Problem/Isaue: INSTALL AMK METER Phoae Number: 572-1891
Schedaied 2017-04-20 • Sehednled'time: 08:0(}:00
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Crested b�: Wenay Hi�t Date Creatsd: 2017-04-19
ACTION TA,KEN:
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Sebmitter Has Been �•'�'
Status: Iri Progi�ess Co�acted r .
Dxte Compteted: �_� �� Campleted by: ` �
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City of Fridley
Water Department
6431 University Avenue NE
Fridley,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. 1 understand that the property owner is liable for the water line from the main to the premise and atl iMerior
plumbing. (Per City code 402.06) 1 also hold the C'�ty of Fridley and/its employees harmless for any damages that may ocwr while doing this
operation. This to include,but not limited to valves,piping,walfs,floors or the curb stop box and service line. In understand 1 am atso required
to obtain a permit prior to any work,if necessary.
FINAL ME7'ER READING(old meter) O� `� ��� �
Name:��(6� '"V h�.•� Address 51 I � 3 r d J-�•
Phone Number � !�� � �V� I Date t � �� � ��
Signature Witness Signature
OLD METER# ��� CV�D�
OLD READING (���Y3� 1.�
NEW METER# � (�D V�� I
NEW READING v
ERT# ����� / �
FRIDLEY CITY CODE
CHAPTER 402.WATER,STORM WATER AND SANITARY SEWER
ADMiNISTRATION
(Ref Ord No 113,464,565,566,629,638,662,922,988,1144,1i56,1191�
402.5 PERMIT FEE
Prior to constructing or repair of any water of sewer line wnnecting the existing municipal system and any house or buiWir�for which the
application is made,the owner or corrtractor 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 shaii be not�ed. 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 appro�red by the City as a
proper and suitable connection.
402.06 REPAIRS AND MAINTENANCE TO CONNECTION
After the initial connedion has been made to the water service curb stop box or the sewer lead at the properly line or a water servke lead has
been extended to the property line for connection,the applicant,owner,or occupant or user of such premises shall be IiaWe for all repairs
required to any water line and sewer lines necessary for conneetion 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 ofthe maimenance and/or
repairs,including necessary street repairs at a rate set annually by an administrative poliry. 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 clearing or
root cutting and to maintain the water service curb stop box for operability and at such height as wiil ensure that it remains above the finished
grade of the land or property. (Ref 638,1156,1191)
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Name��l�� S� � /`t?�..,rx�
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Date �,.--����
O1d Meter Number ` �� ���
Old Meter Reading L 5'�
Replacement No. ' ,� !� �C��
Replacement Reading d
Replacement Make ,�'� �
Remarks r ��. ,�y�°'��
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S igned G'