Meter Swap ,
� Request Number: 14463
Public works Division
Service Request
Problem Address: 1613 Berne Rd Requested By: Acm
, Department: WATER Address: No address provided
Problem/Issne: INSTALL AMR ME1ER Phone Number: 612-760-2139
_ ScheduledDate: 2017-04-11 Schedaledlime: ,�
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A�1ION NEEDED:
Createdby: Wend}+Hiatt DateCreated: 2017-04-03
ACCION TAI�N:
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5tatus: In Progress Submitter H�Been r
Contacted
Date Completed: � � ('�' � Completed by: (Q��
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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 empl�ees to do what is neassary to
repiace the water meter. I understand that the property owner is liable for the water line from the main to the premise and all irrterior
plumbing. (Per City code 402.06) 1 also hold the City of Fridley and/its employees harmless for any damages that may ocwr while doing this
operation. This to include,but not limited to valves,piping,walls,floors or the curb stop box and service iine. in understand i am also required
to obtain a permit prior to any work,if necessary.
FINAL METER READING old meter � ✓ � �� D
( 1 �
Name• �� Address "� I� v` � ��
Phone Number_��I�� 1����� 1 Date � � � ' `�
Signature Witness Signature
OLD METER# ��v �J �� /
OLD READING � �� 1 ��O
NEW METER# `��� r ���
NEW READING `�
ERT# 7a��.�o� v
FRIDLEY CITY CODE
CHAPTER 402.WATER,STORM WATER AND SANITARY SEWER
ADMINISTRATION
(Ref Ord No 113,464,565,566,629,638,662,922,988,1144,1156,1191)
402.5 PERMIT FEE
Prior to constructing or repair of any water of sewer line wnnecting the existing municPpal s�tstem and am hw�se or building for which the
application is made,the owner or contrador shall be required to obtain a permit for such connection,and shall pay a permit fee as provided in
Chapter li of this Code. After such connedio�has been made,the Water and Sewer Department sFwll be nottfied. k shall be ualawful to cover
any connecting line until an inspection has been made and such wnnection and the work incident thereto has been approved by the C'rty as a
proper and suitable connection.
402.06 REPAIRS AND MAiNTENANCE TO CONNECTION
After the initial connection has been made to the water senrice curb stop box or the sewer lead at the property line or a water seryice lead has
been extended to the property line for connedion,the appli�nt,owner,or occupant or user of such premises shall be liable for all repairs
required to any water line and sewer lines necessary for wnnection of the premises from the main to the premises. 1f the property owner
requests maintenance service or repairs be perFormed by the City,the property owner shall be charged for the costs of the maiMenance and/or
repairs,including necessary street repairs at a rate set annually by an administrative policy. It shall be the responsibility of the applicarrt,
owner,occupant or user to perform standard maiMenance of the sewer service li�e from the premises to the main induding debris clearing or
root cutting and to maintain the water service curb stop box for operability and at such height as wlll ensure that it remains above the finished
grade of the land or property. (Ref 638,1156,1191)
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Name_��.�'��2,r��e- �C� ��'.w S
Date L� 'a� �V ��
Old Meter Number � Q�� I
Old Meter Reading � � � � �
Replacement No. J � � � �f� �
Replacement Reading �
Replacement Make ��(� �,r
Remarks: ��r hQ1� � �'Llcli�
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