Meter Swap �- ` Request Number: 15374
Public Works Division
Service Request
Problem Addresa: 5244 Capitol St Requested By: Lisa Renkin
Depxrtment: WATER Address: No address provided
Problem/Issue: INSTALL AMR METER Phone Number: 612-741-6068 ?�
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ScheduledD�te: �20I7-OS-24 Scheduled'llme: 09:00:00
'� �`c`�` ar�
ACITON NEEDED:
Created by: Wendy Hiatt Date Created: 2017-OS-16
ACTION TA[�N:
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Stntas: In Progress Sabmitter HAs Been r.
Contacted
Date Completed: Corapleted by:
5��� ` j � �G��r
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• City of Fridley `O� ' ���"��� ~O �
'� Water Department � (
6431 University Avenue NE �� �- "1 � ��
Fridley,MN 55432
763-572-3566
1/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 all ir�terio�
piumbing. (Per C'rty code 402.06) i atso hold the Crty af Fridley and/its empioyees harmiess for any damages that may oavr while doing this
operation. This to include,but not limited to valves,piping,wails,floors or the curb stop boz and service line. In understand 1 am atso required
to obtain a permit prior to arty work,if necessary.
FINAL METER READING(otd meter� �����
Name• ��� r�`�'�'Y�. Address � `�� � �
PhoneNumber��i I��� �� Date �`� "" ����
Signature —'� Witness Signature
OLD M�'t'ER# � ,��, 1 1 �t ��/ � �
O!D READING �����
NEW METER#_�— I�2'����
NEW RE�IDING �
ERT# � ���� I ��
FRIDLEY CITY CODE
CHAPTER 402.WATER,STORM WATER AND SANITARY SEWER
ADMtNISTRATION
(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 arry water of sQwer iine connecting the existing municipal system and any hause or butlding fcr which the
application is made,the owner or contractor shall be required to obtain a permit for such co`�ction, d shall pay a permit fee as provided in
Chapter 11 of this Code. After such connection has been made,the Water artd Sewer Depart t sh �notFfied. !t shall be unlawful to cover
any connecting line until an inspection has been made and such connection and the work incident ther� has been approved by the City as a
proper anc!suitable cor�nection. ,�
402.06 REPAIRS AND MAINTENANCE TO CONNECTION ��
After the initial connediort has been made to the water service curb stop box or the sewer lead at the propeRy line or a water service lead has
been extended to the property line for connection,the app(icant,owner,or occupar�t or user of such premises shall be Hable for all repairs
required to any water line and sewer lines necessary for connection of the premises frorn 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 maintenance and/or
repairs,including necessary street repairs at a rate set annually by an administrative poiicy. it shalt be the responsibil'rty of the applicant,
owner,occupant or user to perform standard mair�tenance of the sewer service line from the premises to the main induding debris ctearing or
roofi cutting and to maintain the water service curb stop box for operability and at such height as will enwre that it remains above the finished
grade of the land or property. (Ref 638,1156,1191)
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" City of Fridley ��
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Water De�artment
Address .��. y w c a��� � �f
'' Name ��S� � �1 ►1 K-�Il
. Date b ^` � � '0 6 �
.. _._
Old Meter Number
6 sSs 7 '
Old Meter Reading
' Replacement No._ ?��"l ��'
. � _ _ _
Replacement Reading '
; .
F.eplacement Make^���C� ,
Remarks: ,��
. . Signed l� I
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