Meter Swap � �
Request Number: 14789
Public Works Division
Service Request
Problem Address: S 108 Clearview St Requested By: Terri
Department: WATER Address: No address provided
Problero/Iesue: INSTALL AMR METER PLo�e Namber: 763-218-063�
Scheiuled . 2017-04-21 Sc6ednled'I�me: 07:30:00
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� AG7TON NEEDED:
CreaE�d by: Wendy Hiatt Dnte Crented: 2U 17-04-19
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ACIION TAI�N:
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Status: In Progress Submitter HHne Beea r,
Contacted
Date Gompteted: �^. _ CompteMd by: ��`,�
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City of Fridley
Water Department
6431 University Avenue NE
Fridley,MN 55432
763-572-3566
�/We hereby authorize the City of Fridley and/or its empbyees to do what is necessary 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 i�rterior
plumbing. (Per City code 402.06) I also hold the City of Fridley and/its employees harmless for any damages that may ocar while doing this
operation. This to include,but not limited to valves,piping,walls,floors or the wrb stop box aod service li�e. In understand 1 am also required
to obtain a permit prior to any work,if necessary.
FINAL METER READING(old meter) v ���� 4 �
Name: ��� 0 L Address _ � I V� �l�C�.U�'�A-J �.- -
Phone Number F�� �" �l�{J� V��� Date__ �r �� � ` �
Signature Witness Signature
OLD METER# ,�)�7 I� ✓ `�
OLD READING � ! �lY ✓ �O
NEW METER# � I�V ��DO
NEW READING �
ERT# �� o'�p�����
FRIDLEY CITY CODE
CHAPTER 402.WATER,STORM WATER AND SANlTARY 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 building for which the
application is made,the owner or contractor shall be required to obtatn a permit for wch connection,and shall 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 not�ed. It shali 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 as a
proper and suitable connection.
402.06 REPAIRS AND MAINTENANCE TO CONNECTION
After the initia{connection has been made to the water service curb stop box or the sewer lead at the properly line or a water seroice lead has
been extended to the property line for connection,the applicant,owner,or occupant or user of wch premises shall be Itable for all repairs
required to any water line and sewer lines necessary for connection of the premises from the main to the premises. ff the property owner
requests mai�tenance service or repairs be performed by the City,the property owner sfiall be charged for the costs of the maintenance and/or
repairs,including necessary street repairs at a rate set annually by an administrative policy. It shall be the responsibillty of the applicant,
owner,occupant or user to perform standard maintenance of the sewer service line from the premises to the main including deb�is clearing or
root cutting and to maintain the water service curb stop box for operability and at such heigfit as wili ensure that it remains above the finished
grade of the land or property. (Ref 638,1156,1191)
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Na1ne ��°� ��,o' ._'_ '���
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Date -/ `"� �`c� /
o1d Meter Number � •�.G ��
Old Meter Reading , � � T��
Replacement No. c�
Replacement Reading �
Replacemen� Make �'�
Remarks• �"/��' 6/!'!'�}�l/'��
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S igned����---
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