Meter Swap �
Request Number: 13526
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r�n�wo�n;��on
Service Request
Problem Address: 1581 60th Ave Requested By: Sheldon
Department: WA1ER Address: 1581 60th Ave
Fridley,MN 55433
Problem/7ssue: INSTALL AMR METER P6o�Number: '163-571-4047
Sc6ednled Dat • 2017-02-2 Sc6edoled 1f�: 10:30:00
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�� ACIION NEEDED:
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Crexted by: Beth Ko�rick Date Created: 2017-02-16
ACl"ION TAI�EN:
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sr.�: In Progresg s.�nitter Has B�co �.
Contaeted
Date Completed: �� �� �� Completed by:
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�431 dlniv�ssity A�rer��ae N�
�rielle�, 6U16V ��4�32
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�/�P� hereby authorize the�'rty aE Fridley and�or its employees#o slo what is necessary t
re�s4se:e�he water�neter. !vnderstand tha#the property owner as liabie fac the water line from the main to the premise and aii iriterior
# 'plurralsing. (Per Crty�e 402.06� 1 also�hold the C'rty�F�ridley and/'rts em}sloyees harmiess#or eriy slamages that enay occur�rhile dning thi
operation. This#o�nclude,but not Bim3ted io va{ves,piping,waiis,fDoors ar the curb stop box and service lir�e. Iq�nderstand I 'aiso requ
to obtaiea a permit p�ioa to any�ror4c,if necessaey. ��\
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EINA�tiIAETER READING(oki meter)
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Name:_���d 1'� Address ��V! V�(/� �Ti
PhonelYum6er�" � l�''�_`� '"i� Date �'� �� `�� 1
S'�'�''� w;'trr,ess Signaa,re "�
o�D��-��� _ 3���v� 7��
OtD READt�IG I.� ✓,�Cy��
RiEW METER# � �q0 �VC��
NEW REQDlNG b
ERT'# i I V��VJ
FRIDLEY CIIY CODE
CHAPTER 4A2.WATER,STORM WATER AND SANt'TARY SEINER
ADMIAIlSTRATION
(Ref Ord 61io 113,464,565,366,629,635,662,922,988,1144,1156,1191)
402.5.PERMIT FEE
Prior#o constructing ar�epatr of ar�y wafier vf sewer�ine connecting the existing muniapai system and arry house oc building far which the
applicafiion is made,the awner or cornractor sha(!be required to a6tain a permit for sucfi coaaectiory and shali pay a permit fee as providec{6
Chapter 11 of this Code. After sucb co�nection has been made,tfre Water apd Sewer Departrnerrt shall be not'rf'ied. tt shall�unfawfui to cov
any con�ecting tine uatil an inspect'son has been made and such connection and the war6c inaderrt fihereto has been approved by the C�ty as a
proper and suitable connectiora.
40Z.Q6 REPAlRS QND�AtN'f ENAfUCE TO CONNECTIt?1Y
After the initiai connection has been made to the water service curb stop box or the sewer lead at the property line or a water senrice lead has
been axtended#o the p�operty fine for connection,the appiicarrt,owner,or accupant or user o#such premises sf�alt be IPable for a11 repairs
required to any water l�ne and sewer lines necessary for connection of the premises from#he main to the premises. if the property owner
requests mairrtenance service or repairs be perFormed by the City,ttae property owner shail be charged for the costs of ihe mairrtenar�ce and/u
cepairs,including necessary street repairs at a rate set annualfy by an administraftive poliry, tt sha8 be#�e responsbitity of the applicarrt,
owner,occupant or user to perform seandard maintenance vf the sewes senrice line from#he premises to the main dnctuding debris dearing or
root cutting�and to maintain#he water service curb stop box for�perability and at such height as will ensure that it remairis a6ove the finished
grade a##he land or prop�rty. (Ref 638,1256,1191)
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Address
Name ���vbu�.�•-
Date � � "" v`� �- !� �
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Old Meter Number � �� ��
Old Meter Reading � ��
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Replacement No.
Replacement Reading �
Replacement Makei� C'_-
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Remarks: ...���.-�, .�'�; �' �
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Signed ^