Meter Swap -�
f Request Number: 14951
Pubtic Works Division
Service Request
Problem Address: 124 Gibraltar Rd Requested By: Pat Cruz
Depsrtment: WA1ER Address: No�lress provided
Problem/Issue: INSTALL AMR METER Phone Number: 572-8786
Sc6edWed Date: 2017-04-27 Schednled'llme: 01:00:00
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ACIION NEEDED:
Created by: Wendy Hiatt Date Created: 2017-04-25
ACTION TAI� :
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Status: In Progress Sabmitter HAs Been r
Co�acted
D�te Compteted: Completed 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 employees 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 interior
plumbing. (Per City code 402.06) I also hold the City of Fridley and/its empioyees harmless for any damages that may o�r while doing this
operation. This to include,but not limited to valves�piping,walls,tloors or the curb stop box and service line. I�understand i am also required
to obtain a permit prior to any work,ff necessary.
FINAL METER READING(old meter)__ O�� — 1 ���
Name• ��� �� Address � v� lT���(�` �
Phone Number '"E? 6���� Date � v��
Signature � ��� i'" 1fYitriess Signature
OLD METER# �`i' � I �—I ��
OLD READING O��� � 1��V
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NEW METER# '�4�� ,E� I � �
NEW READING_�
ERT# � ���� � 1 l,,/
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FRIDLEY CITY CODE
CHAPTER 402.WATER,STORM WATER AND SANITARY SEWER
ADMINISTRATION
(Ref Ord Alo 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 building fw whkh the
application is made,the owner or wMractor shall be required to obtain 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 cover
any connecting tine until an inspection has been made and such connedion and the work incident thereto has been appro�d by the Citr as a
proper and suitable connection.
402.06 REPAIRS AND MAINTENANCE TO CONNECTION
After the initial connection has been made to the water service curb stop box or the sewer lead at the property line or a water service lead has
been extended to the property line for connection,the applicarrt,owner,or occupant or user of such 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. 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 mair�tenance and/or
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 maiMenance of the sewer service line from the premises to the main induding debrys 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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C�ty of FridleY
Water De artment
Address
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Name
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pate � � `.y_�.
Old Meter Num�er � y.;=
Old Meter Readinq � U
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Replacement No• �)
geplacement Reading f
Replacement Make "
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Remarks•
Signed