Meter Swap � '� Request Number: 15053
Public Works Division
Service Request
Problem Address: 133 53rd Av�e Requested By: Ste�e Paradise
Departme�: WATER Address: No address provided
Problem/Issue: INSTALL AMR METER Phone Nnmber: 612-799-2291
Scheduled Date: 2017-OS-02 Schednled 1lme: 11:OU:Ot1
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ACTION NEEDED:
Created by: Beth Kondrick Date Created: 2017-04-28
ACTION TAI�N:
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Status: In Progess Submitter Has Been r,
Contacted
Date Compieted: [ _� (� Completed by: ��1 _
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City of Fridley
Water Department
6431 University Avenue NE
Fridley, MN 55432
763-572-3566
�/We hereby authorize the�ty 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 all ieterior
plumbing. (Per City code 402.�) I also hold the�ty of Fridley and/its employees harmless for any damages that may occur while dang 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 permit prior to any wor�c,if necessary.
FINAL METER READING(old meter) � �� �� � �
Name• ✓ ` "U`Q� p�A,r��� Address �' �% ✓ ��� 1-�G .
Phone Number �� ����� � {�" ( Date � ��✓��
Signature Witness Signature �'
OLDMETER#_ ������ / �
OLD READING_ v� / !��
NEW METER#_�� ���� 0 1
NEW READING �
ERT# � � �I � � 1 I
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 buildi�for whkh 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 pro�rided in
Chapter 11 of this Code. After such connection has been made,the Water and Sewer Department shall be notified. It shall be unla�aful to cover
any connecting line urrtil an inspection has been made and such connection and the work incident thereto has been approved by the City�a
proper and suitable connection.
402.06 REPAIRS pND MAINTENANCE TO CONNECTION
After the initiai connection has been made to the water servtce curb stop box or the sewer lead at the property pne or a wate�service lead has
been extended to the property line for connection,the appiicant,owner,or occuparrt or user of such premises shall be Itabie for ali 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 maPntenance and/o�
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 bvx 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)
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, Name � J !�'�J���i'�5�
Date l-� �
Old Meter Number ( �
Old Meter Reading ���
Replacement No. ������
Replacement Reading
Reglacement Make �j���
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Remarks• ��Y��
Signed_� �
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