Meter Swap �
t
Request Number: 14868
Public Works Division
Service Request
Problem Address: 125 49th Ave Requested By: Chou
Depurtment: WA'IER Address: No address provided
Probiem/Issne: INSTALL AMIt METER Phone Number: 651-983-3321
Schednled Dat : 2 17-OS-03 � Schednied 1ime: 02:00:00
AGTION NEEDED:
Created by: Wendy Hiatt Dnte Crepted: 2017-04-21
AG7ION T.4I�N:
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Snbmitter Has Been `;�:
Status: In Progress Contaeted r
Dnte Completed: Compieted by:
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j City of Fridley V� � � �
Water Department � � ���-�
6431 University Avenue NE
Fridley,MN 55432
763-572-3566
�/We hereby authorize the City of Frid(ey and/or its employees ta do what is neassary 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 imerior
plumbing. (Per City code 402.06) 1 also hold the City of Fridley and/its employees harmless for any damages that may oaur 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 obtain a permFt prior to any work,if necessary.
FINAL METER READING(old meterj ���
Name•�`YUV Address ���J � b� �
Phone Number SC�c � � � {��d�c���ate �� � I�
Signature '�" \ � Witness Signature
OLD METER#��� ���'"{'�
OLD READING � ,'7�D� c,J JV
NEW METER# "4 O� 1 � �
NEW READING �
ERT# ` � � �VZ�'{�
FRlDtEY ClTY 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 cortnecting the existing murticipal system and airry house or lw11ding for whkh the
application is made,the owner or contractor shail be required to obtain a permit for such connection,and shail 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. It shall be unlawful to�r
any connecting line untit an inspection has been made and such connection and the work incident thereto has been approved by the City as a
proper and suitabie connection.
402.06 REPAIRS AND MAINTENANCE TO CONNECTION
After the initial connectFon has been made to the water service curb stop boz or the sewer lead at the property line or a water service lead has
been autended to the property line for connection,the applipnt,owner,or occupant or user of wch premises shall be liable 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 owner
requests maintenance service or repairs be perFormed by the City,the property owner shali be charged for the costs of the maiMenance and/o�
repairs,including necessary street repairs at a rate set annua!!y by an administrative poliry. It shall be the responsibility of the applicarn,
owner,occupant or user to perform standard maiMenance of the 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,Z191�
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City of Fridley
Water De�artment
Address �� J "�-1��G
Name�,1�A'v ' U�! -
Date �j-�n��-�(.�
Old Meter Number C �����_
Old Meter Reading
Replacement No.
Re�lacement Reading �
Re�lacement Make � -�6'� _
Re�narks• ���Y•1����s2���'1� _
" UG
Signed �� —