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Meter Swap , ` Request Number: 14773 Public Works Division Service Request ProMem Addreas: 143 Hori�on Circle Requested By: I�n Reinek Department: WA1ER Address; No address provided Probl�m/Isaue: INSTALL AMR ME1ER Phoae Nt�mber: 612-940-0401 Schedale�Date: 2017-04-21 Schednled 11me: 08:3U:00 • S � ' � � AC'IiON NEEDED: Created by: Beth Ko�ndrick Date Cre�ed: 2017-04-18 AC�TON TAi�N: �1 ��-5�- � C�l,� Status: In Progress Sabmitter Haa Beea r Coirtacted Date Complated: Completed by: ��f � I� � K�� r� _ « � f, �� 22�-0 � . �� 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 properly owner is liable for the water line from the main to the premise and all irKerior plumbing. (Per City code 402.06) 1 also hold the City of Fridley and/its employees harmless for any damages that may occur while doing this operation. This to inctude,but not limited to vaives,piping,waNs,floors or the curb stop box and service line. In undersWnd I am also required to obtain a permit prior to any work,if necessary. FINAL METER READIN (old meter) �� v� � ! � Name• b� �� w� Address � '�1 J �`C�,n � Phone Number Y' 12�'�l o'��d I Date `�l'�`✓ '� � Signature Witness Signature OLD METER# ��ov�� OLD READING �� 0 NEW METER# "1- 1 �lJ � � �� NEW READING O ERT# � � C�Z� I v � 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 FEE Prior to construding or repair of any water of sewer line connecting the existing municipal system and any house or building for v�id�the application is made,the owner o�rnntractor shall be required to obtain a permit for such connection,and shall pay a permit fee as provided in Chapter ii of this Code. After such connection has been made,the Water and Sewer DepartmeM shall be notif'ied. 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 Cky 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 properly line or a water service lead has been extended to the properly line for connection,the appi'�cant,owner,or occupant or user of such premises shall be liable for ail 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 mairrtenance service or repairs be performed by the City,the property owner shall be charged for the costs of the maintenance a�d/or repairs,includi�g 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 maintenance 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 such height as wili ensure that it remains above the finished grade of the land or property. (Ref 638,1156,1191) k g3 a`�e'.�` f�.. ��4�� 5�„�i° � �,A�`3� °, �r' g � s,�t e�, § .�. '� 1 � y: �� F�� r}; x_ i1�1Tt4E � '�'�� % Date � ` �`�� Old Meter Number� � � � Old Meter Reading �� Replacement No. � � oQ ��-�^ Replacement Reading Replacement Make � �� Remarks• `�`�'� �� Signed �ir.�%'�%'v "