Meter Swap �
�� Request Number: 15032
Public Works Division
Seivice Request
Problem Address: 4514 3rd St Requested By: Cindy Golen
Depprtment: WA'IER Addrea:: No address provided
Problem/Isaue: INSTALL AMR ME1ER P�one Number: 572-1560
5che�uled Date: 2017-05-03 5c6ednled Tlne: 10:30:00
�d �3
ACTION NEEDED:
Created by: Wendy Hiatt Dste Cres�ed: 2017-04-28
ACIION TAI�N:
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Stsdtua: In Progress Snbmitter Has B�a �., '
Co�ncted
Dxte Completed:� ^ �� � Completed by: r� � �
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t City of Fridley � O � �r1 �f
Water Departrnent d``0
6431 University Avenue NE
Fridley,MN 55432
763-572-3566
�/We hereby authorize the City of Fridley and/or its empfoyees to do what is necessary bo
replace the water meter. 1 understand that the property owner is Itable 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/'rts employees harmless for any damages that may occur while doi�this
operation. This to include,but not limited to valves,piping,walls,floors or the wrb stop box and senrice line. In understand I am also required
to obtain a permit prior to any work,if necessary.
FINAL METER READING(oid meter) O V�����
Name: v�'�'�y v�� Address 1 � � ! `I^�y J'�^�
Phone Number ���� `��+'� Date � �� � — ��
Signature Witness Signature "�—�
OLD METER# ���l����
OLD READING ��/ G / � L�
NEW METER# ` �� � �v �
NEW READING �
ERT# ������ ✓
FRIDLEY CITY CODE
CHAPTER 402.WATER,STORM WATER AND SANITARY SEWER
ADMINISTRATION
(Ref Ord No 113,464,565,566,629,638,662,922,988,1144,1156,1191)
402.5 PERMIT FEE
Prior to constructing or repair of any water of sewer line connecting the existing municipal system and any house or�ilding for whi�the
application is made,the owner or contrector shall be required to obtain a permit for such connection,and shali pay a permit fee as provided In
Chapter 11 of this Code. After such connection has been made,the Water and Sewer Departmerrt shall be notified. It shall be unlawful to co�r
any wnnecting line until an inspectio�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 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 sen�ice lead has
been extended to the property line for connection,the applicant,owner,or occupar�t 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 premises. If the properly a�rner
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 annualiy by an administrative policy. It shall be the'responsibility of the applicaM,
owner,occupant or user to perform standard maintenance of the sewer senrice line from the premises to the main induding debris clearing or
root cutting and to mairrtain the water service curb stop box for operability and at such height as will ensure that it remains a�re the finished
grade of the land or property. (Ref 638,1156,1191)
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'L."�.�'�► C3�" !"�1$I.+Bty
Water �epartment ;
Aaar ss ���� ����'
Name�....� Nu� \7P�.t�N
Date ��.`"�-`�
Old Meter Number ` .� U��`
Old Meter Reading ��
Replacement No: ��� '��j a 1
Replacement Reading �
Repiacement Make ���?�
Remarks• �'P��7�5'�.,
Signed