Meter Swap �
� Request Number: 16378
Public Works Division
Service Request
Problem Address: 6245 Central Ave Requested By: Julie Christensen
Dep�rtment: WATER Address: No address}�ovided
Problem/Iasue: INSTALL AMR METER Phone Number: 763-571-8276
Scheduled Date: 2017-07- 0 �„� Schednled Time: 09:00:00
� (�l/
ACITON NEEDED:
Created by: Beth Kon�ick Date Created: 2017-07-18
ACTqON TAI�N: ;
....._..�_....__ .._.._.._...,l�s�,�,i-e.�_....�._.. _.._._. ...._._......
Status: In Progress Submitter Has Been r
Contacted
Date Completed: � � � Completed 6y: � _j 1/�
r � �'l�yL
�Ci�jr�#Frielley �U (�� � / � 1 /(J � �
1�11/ater�epartrv�ere#
` C431 llr�iversity Avenue NE ��� �����
� Fridley,MN 55432
763-572-3566
��`Ne hereby authorize the Cafij of Pridley and/or its employees to do what is necessary to
replac2 the water meter. I understand#hat the property owner is liable for the water line from the main to the premise and alt ir�terior
plumbiag. (Per�ity code 402.06J !alsa hold the�ty af Fridley andJ'rts employees harmless#or arry damages that may occur while doing ihis
operation. This to include,6ut not limited to vahres,piping,walis,floors or the curb stop box and service iine. in understand(am also require
to obtain a permit pr6or to any work,if necessary.
FlNAL METER READIIYG(old meterj �� `� ���D
Name: J lA.�r� ��l��h. �Pih- ��'�1 5 (,,�,°N. �
S address �, �V L°,
Phorte�Yumber �� �"' ��'— ����Q Date l '� �v " ��
x Signature Witness Signature +-
OLD METER# _ v��Q V� � G (
OLD READIN�a _ d �� 8 ���
NEW MEfER#_ .1 I ��� ! ��
NEIAi READING Q
E�# �?� �ll $ 3 �t0
FRIDLEY CITY CODE
CHAPTER 402.WATER,STORM WATER AND SANtTARY SEWER
ADMINISI'RATiON
(ttef Ord Mo 113,464,565,566,629,638,6fi2,922,988,1144,1156,1191)
402.5 PERMtT FEE
� Prior to�constructing or repair of any water of sewer liae connecting the existing municipal system and arry house or buildir�g fo�which ifie
application is made,the owner or contractor shall be required to abtain a permit for such connection,and shali pay a permit fee as provided in
�hapter 11 of this Code. After such connection has been made,the Water and Sewer Departmerrt shall be notified. It shall be untawful to cover
arry connecting line until an inspedion has been made and such connection and the work inciderrt thereto has been appcoved by the City�a
proper and suitable rnnnectio�.
402.06 REPAIRS AiYD MAINTENANCE TO CONNECTION
After the initiai connection has been made fio the water senrice curb stop hox or the sewer lead at the property line or a water service iead has
been extended to the property 9ine for connection,the applicant,oarner,or occupartit ar user of wch premises shaN I�liable for ai1 repairs
required to any water tine and sewer lines necessary for connection of the premises from tf�e main to the premises. If the property owner
requests mair�tenance service or repairs be perFormed by the Gty,the property owner shall he charged for the costs of d�e mairrtertance and/or
repairs,inciuding necessary street repairs at a rate set annuafly by an administrative policy. It shail6e the responsifsi(ity aFthe applicam,
owner,occupant or user to perform standard mairrtenance of the sewer service line from the premises to the main including debris ciearing or
roofi cutting end to maFntain the water service curb stop box for operabii'�ty and at such height as will ensure that it remains above the finished
grade of the(and or property. (Ref 638,1156,1191)
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/ ��-0ss� --y�i�S�
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City of Fridley
Water Department
Address 6� y �J cQn �,,t �-�/�`
Name ��a� � A nv�S �� Se/)
Date J ���"" 1 � .
Old Meter Number 1 �CJ
Old Meter Reading S � l �
Replacement No. � o� ��7 �
Replacement Reading �
Replacement Make ��Q,r
Remarks: S�y���
Sign.
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