Meter Swap Request Number: 15112
.�,
� Public Works Division
Service Request
Probiem Address: 4727 3rd St Requested By: David Westheimer
Department: WA1ER Address: No address provided
Problem/Issue: INSTALL AMR METER Phone Nnmber: 612-387-3684
Schednted te: 2017-OS-OS �� 5cheduled 1lme: Q8:30:OU
� S � �3 a
ACITON NEEDED:
Created by: Wendy Hiatt Date Created: 2017-OS-03
ACIION TAI�N:
�S �� le�'
5tatus: In Progress Snbmitter Has Been �.,
Contacted
Date Completed: �_ � ^ I� Completed by: Q���
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City of Fridley S � � ,`��2
• 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
repiace 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 hoid the City of Fridley andrts employees harmless for any damages that may occur 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 1 am also required
to o6tain a permit prior to any work,if necessary.
FINAL METER READING(old meter) `-' ��`� � `"
Name• 1r�Ml4 C ��S��/h,l�V Address t� �� �� J�'
Phone Number ��1~ ��� `�� p�e rj'� 'r'J 1' ��
Signature Witness Signature —�
OLD METER#_ � 6 U� �j � [ �P
OLD READING v 1 G �/ `✓ C D
NEW METER# ���� V ���
NEW READING �
ERT# / d��� 3���
FRIDLEY CITY CODE
CHAPTER 402.WATER,STORM WATER AND SANITARY SEWER
ADMINISTRATION
(Ref Ord No 113,464,565,566,624,638,662,922,988,1144,1156,1191j
402.5 PERMIT FEE
Prior to constructing or repair of any water of sewer line connecting the existing municipal system and any house or building for which the
appiication is made,the owner or coritractor shail be required to obtain a permit for such connection,and shall pay a permR fee as provided in
Chapter li of this Code. After such connection has been made,the Water and Sewer Department shall be notified. k 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 ns a
proper and suitable connection.
402.06 REPAlRS AND MAINTENANCE TO CONNECTlON
After the initial connection has been made to the water service aarb 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 liabk 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 maintenance service or repairs be performed by the City,the property owner shall be charged for the costs of the mair�tenance and/or
repairs,including necessary street repairs at a rate set annuaffy by an administrative poliry. tt shail be the responsibitity of the appiicaM,
owner,occupant or user to perform standard maintenance of the sewer service line from the premises to the main includi�debris clearing or
root cutting and to maintain the water service curb stop box for operability and at such height as will ensure that it remair�s above the fintshed
grade of the land or property. (Ref 638,1156,1191)