Meter Swap �, '� Request Number: 15047
Public Works Division
Service Request
Problem Addreas: 172 Crown Rd Requested By: Ross Bleichr�er°
Department: WA'IER Addreas: No address provic�d
Problem/Issue: INSTALL AMR ME'IER Phone Number: 612-867•0382
Scheduled Date: 2017-OS-48 � 5c6ednled 1lme: 10:00:00
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ACIION NEEDED:
Created by: Beth Ko�-ick Date Created: 2017-04-28
ACTION TAI�N:
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.�___....���.
Status: In Progress Snbmitter H�s Been �
Coutacted
Date Completed: ���_ C� Completed by: �a��
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* City of Fridley c d � �� �
Water Departrnent v
6431 University Avenue NE
Fridley,MN 55432
763-572-3566
�/We hereby authorize the City of Fridley and/or its employees to do what ts necessary to
replace the water meter. i understand that the properly owner is liable for the water line from the main to the premise and ali ir�terior
plumbing. (Per City code 402.06) 1 also hoid the City of Fridley and/its employees harmless for any damages that may occur while doing this
operation. This to Fnclude,but not limited to valves,pipin&walls,floors or the curb stop box and service line. In understand 1 am also required
to obtain a permit prior to any work,if necessary.
FINAL METER READING(old meter) " � �� � ��
Name• '""JS iJ 1 ei � �/�h.�ii� Address � ��� �-
Phone Number ��'�"_ ��� v�l� Date �`"" v� V `
Signature Witness Signature
OLD METER# v�� � �� �
OLD READING O� ` � V 1�`�
NEW METER# ��a �a �5 �
NEW READING v
ERT#_ � � 4�LI � �
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 arry house or buiiding for which the
application is made,the owner or coirtractor shall be required to obtatn a permit for such 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 shall be unlawful to cov+er
any connecting line until an inspection has been made and such connection and the work iacident thereto has been approved by the City as a
proper and suitable connection.
402.06 REPAIRS APID MAINTENANCE TO CONNECTION
After the inttial connection has been made to the water senrice curb stop box or the sewer lead at the property line or a water servPce kad has
been extended to the property line for connection,the applicarrt,owner,or occupar�t or user of such premises shall be Ifable for all repairs
required ta any water line and sewer lines necessary for wnnection of the premises from the main to the premises. ff 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 andJor
repairs,including necessary street repairs at a rate set annually by an administrative poliry. It shaii 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 box for operability and at such height as will ensure that it remains above the finished
grade of the land or property. (Ref 638,1156,1191)
. —— -; — ----__���
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City of Fridley
Water Denartment
Address �� `-�'"'� �
Name �� ������
Date �� "'��
Old Meter Number 1(J�����
Old Meter Reading � ��
Replacement No._,��y � "�
Replacement Reading �
Replacement Make �P1��-�"�
r
Remarks: �"J�o� ���"�� �
S igned `�,'—�—� �_
Request Number: 7345
Public Works Division
Service Request
Problem Address: 172 Crown Rd Requested By: Ross Bleichner
Department: WAlER A�cfdress: No address provided
Probiemlissue: NO WATER(WATER) Phone Number: 5749778
Scheduled Date: 2014-01-06 Scheduled Time: 09:00:00
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ACTION NEEDED: No water.
Created by: Wendy Hiatt Date Created: 2014-01-06
ACTION TAKEN:
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_....................................................................................:............................................................:........................................................................._._........_.._..._..........................................................._..............._._.....................:._...............___................._.........._
Status: In Progress Resident Contacted �
Date Completed: � � �^ J� Completed by�