Meter Swap � Request Number: 15070
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Public works Division
Service Request
Problem Address: 5159 Horiwn Dr Requested By: Diane Ruiz
Department: WA1ER Addresa: No a�ress provic�d
Problem/Issue: INSTALL AMR METER Phone Number: 763-572-9510
ScheduledD�te: 2017-OS-OS 5c6eduled 1Ime: 01:00:00
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ACTION NEEDED:
Created by: Beth Kondrick Date Created: 2017-05•O1
ACTION T .
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5tatus: tn Progcess ���er Hs�Been �
Contacted
Date Compieted: Completed by:
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* City of Fridley �� ��j
Water Department
6431 University Avenue NE
Fridiey,MN 55432
763-572-3566
�/We hereby authorize the City of Fridley and/or its employees to do vrhat is necessary to
replace the water meter. I understand that tbe property owner is liable for the water line from the main to the premise and all iMerior
plumbing. (Per City code 402.06) I also hold the City of Fridley and/its employees harmless for any damages that may occur while doing this
operatioa. This to include,but not limited to valves,piping,walis,fioors or the curb stop box and service line. In unden�tand I am also required
to obtain a permit prior to any work,if necessary.
FINAL METER READING(old meter) r��� �
Name• `�r cw��� P"�V\ L._ Address � ' � ` \�- `<7-�r
Phone Number��������j� Date ��' V 1
Signature Witness Signature
OLD METER# � �O� J_1 ��j
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OLD READING � I����
NEW METER# y �a o-� � a �
NEW READING O
ERT# � t � � `"�l b� �
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, 1156,1191j
402.5 PERMIT PEE
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 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 notified. It shall 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 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 eutended to the property line for connection,the applicant,owner,or occupant or user of such premises shalf be fiable for aN repairs
required to any water line and sewer lines necessary for wnnection of the premises from the main to the premises. If the property o�rner
requests maintenance service or repairs be performed by the City,the property owner shall be charged for the wsts of the maiMenance and/or
repairs,including necessary street repairs at a rate set annually by an administrative po{iry. It shafl be the responsibil'�ty of the applicant,
owner,occupant or user to perform standard maintenance of the sewer senrice line from the premises to the main inciuding debris ckaring w
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 artment ���
Address 5� � q t l d r 1 Z,(3 ll Q r
Name C�.S b`l � IA:
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Date ol-'�-� 'C) �
Old Meter Number � �� 6� (�
Old Meter Reading d 6 6 �d
Replacement No. 3� 7) � ���
Replacement Reading �
Replacement Make ,�G,d�C2('
ERT# ��I b � �-1 J'�
Replacement ERT#
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Remarks: �'�°�ot'dc�'/la-cc� �
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Signed