Meter Swap Request Number: 15168
Public works Division
Service Request
,�28 Berne Rd Requested By: JeffGordon
_ J WATER Address: No ac�ress p�ovided
_aa["em/Issue: INSTALL AMR ME1ER Phone Number: 763-502-7725
/
/ Scheduled a�te: 2017-OS-08 `� Sc6ednled 1lme: 01:00:00
/
ACIION NEEDED:
Created by: Wendy Hiatt Date Created: 2017-OS-OS
ACTION TAI�N:
Status: In Progress Snbmitter Has Been r,
Contacted
Dxte Completed: Completed by:
�-f���-7 ^Ta�., �or—
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City of Fridley G� �
Water Department C�� Cc,/�✓
6431 UniversityAvenue NE v L�`�
Fridley,MN 55432
763-572-3566
�JWe 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 inte�ior
plumbing. (Per City code 402.06) 1 aiso hoid the City of Fridley and/its employees harmless for any damages that may oaur while doing this
operation. This to include,but not limited to valves,piping,walls,floors or the wrb 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: " "�� �`�� Address �� 2� �b�.Q, �--C
Phone Number �����" � �� wpate � � t�� ��
Signature Witness Signature
OLD METER#_ � ` �� V I � �, �
OLD READING ���� V�i Q
NEW METER# �� 1�`O� I ��
NEW READING O
ERT# � I f>�2--"`_'rj
FRIDLEY CITY CODE
CHAPTER 4fl2.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 arry water of sewer line connecting the existing municipal system and any house or buiiding for which the
appiication is made,the owner or contractor shall be required to obtain a permit for such connection,and shall pay a permit fee as pro�ided 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
a�y connecting line until an inspection has been made and such wnnectlon 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 wate�service curb stop box or the sewer lead at tfie property line or a water serv�ce lead has
been extended to the property line for wnnection,the applicant,owne�,or occupa�t or user of wch premises shalf be liable far afi repairs
required to any water line and§ewer lines necessary for connection of the premises f�om the main to the premises. If the property owner
requests mai�tenance service or repairs be pert'ormed by the City,the property owner shall be charged for the costs of the mairrtenance andjor
repairs,including necessary street repairs at a rate set annually by an administrative policy. It shall be the respo�sibility of the applicarrt,
owner,occupant or user to perform standard maintenance of the sewer service line from the premises to the main Indudtng deb�is 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 fl�ished
grade of the land or property. (Ref 638,1156,1191)