Meter Swap Request Number: 14511
Public Works Division
Service Request
_ __.
Amem Address: 5397 Horizon Dr Requested By: Thornas Forsythe
— �"_ . Departmeut: WATF,R Addressr 5397 Horiwn Dr
Fridiey,MN 55432
Problem/Issue: INSTALL AMR METER Phone Number: 763-572-4583
Scheduled Date: 2017-04-10 Scheduted'Rme: 01:00:00
� I `r` r-,
AC IION NEEDED:
a.
Created by: Beth Kondrick DAte Created: 2017-04-04
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ACTiON TAI�N:
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Status: tn Progress Submitter Has Been r.,
Contacted
Date Completed: �_,+O ��y Compieted by: ���
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or
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. 1 understand that the property owner is liable for the water line from the main to the prernise and ali interior
plumbing. (Per City code 402.06) I also hold the City of Fridley and/its employees harmless for any damages that may occur while dang this
operation. This to include,but not limited to vahres,piping,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• ����'7 �� Address_ ✓�� ��r�-L-C�J�� ��
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Phone Number l�� � ��o�— -!�� Date �`� �v v ��
Signature Witness Signature !_
OLD METER#�� � � v
OLD READING "cJV V ��O
NEW METER# � I�v ����
NEW READING v
ERT# c ��� ` � v�
FRIDLEY CITt(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 co�necting the existing municipal system and any house or buiiding for whidr the
application is made,the owner or contractor shall be required to obtain a permit for such wnnection,and shall pay a permit fee as provided in
Chapter ii of this Code. After such connection has been made,the Water and Sewer Department shall be notified. k shall be unlawful to cover
any connecting line until an inspedion 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 initial connection has been made to the water service curb sto�!b�iic or the sewer lead at the property line or a water se�lead has
been extended to the property line for connection,the applicant,owner,or occupant or user of wch premises shall be liable 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 maintenance senrice 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 policy. It shall be the responsibility o�f the applicant,
owner,occupant or user to perform standard maintena�ce of the sewer service line from the premises to the main including debris dearing or
root cutting and to maintain the water service curb stop box for operability and at wch height as will ensure that it remains above the finished
grade of the land or property. (Ref 638,1156,1191)