Meter Swap ' Request Number: 13419
PubLTc Works Division
Service Request
Problem Address: 5827 Central Ave Requested By: S�en
Deps�rtment: WA1ER Address: No add�ress provided
Problem/7ssue: INSTALL AMR METER Phone Number: 763-571-9014
Scheduled bate: 2017-02-17 Scheduled 11ine: 11:30:00
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ACIiON NEEDED:
CreAted by: Beth Ko�rick Date Created: 2017-02-10
ACTION TAi�N: ` ,
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Status: In progress Submitter Has Been �,
Cont�cted
D�te Completed: Completcd by:
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5431 l9niv��-sityf J�veraue 9YE � � � l ., �
Fradley, MN �5432
` " 753-�72-3566 �� b —L� `�j � �� '�� .� �
t0�f°� hereby authorize the Cifiy af Fridley and/or itsfempioyees to slo what ds necessary to
�eplace the wafier meter. f understand that#he property otivner as tiable for tfie water line frrom the main to the premise and a!1 irtterior
plumbing. {P�r Crty cocle 4Q2.06j 1 adso hold the City a�f Fridiey andJ'rts employees hae�nless#or any damages tfiat may occur white doing this
flperation. This to 9nclude,but not limited to valves,pip�ng,walis,floors or the cttrb stop box and seruice line. In understand 1 am also requir
to obtaira a permit pr"sor La�ny wprlc,if necessaey.
F81VAL METER READING{oFd meter] � C✓ �
Hame:-�� Addrnss� l�� �
Phone Numher ���" (��^ � 1 Date �� Y�� � `
Signature ��\ Witness Signature l�
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OLD ME7"ER# -` J U O `��� �
OLD READiitiG� �✓�� � 1��
NEW METER#_-1,��� �, �V ?�
NEW READIAtG �
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FRIDLEY CITY CODE
CHAPTER 402.WATER,STO[iM WATER AND SANTfA�RY SEWER
ADNItr11STRAl'ION
(Ref Ord No 113,�64,565,�66,629,fi38,662,922,988,1144,1156,1191)
4Q2.5 PERMIT FEf
Prior to constructing or repair of any�rater aE sewer tine cannecting the existing municipal system and arry house or building for which i�e
appiication ss made,the owner or contractor shatl be requi�ed to o6tain a permit for such connection,and shalt pay a permit fee as provided in�
Cfiapter 11 of thes Code. After such cvnnectivn has been rnade,fihe Watec and Sewer Departmerit shaii be notified. fk shall be uataarful to cflve
arry connecting line until an inspection has been made and such�nnection and#he wo�Ic inaderrt thereto has been approVed by the City as a
proper and suitabie connection.
R02.06 REPAIRS AfYD MAlL1tT¢A{qfyCE TQ CONNECTION
A�Fter the initiaf connection has been made#o#he water service curb stop box or the sewer lead at the property iine or a water servke lead has
beea extended to fihe property)fne fior connection,the applicarrc,owner,or occupar�t or user o#such premises shali be Iiabie for afl repairs
required to any water(ine and sewer lines necessary for con�ection of the premises from the main to the premises. if the property orvner
requests maintenance senrice or repairs be perFormed by the C'rty,the property owner shaU 6e charged for the costs oF the rnairrtenance and/or
repairs,includ`sng necessary str+eet repairs at a rate set annuaity!�y an administrative poPcy. tt shatl be�e responsibitity of the a�car�t,
owner,occuparrt or user ta perform standard maimenance of the searer service tine from the premises to the main i�cluding debrLs dearing or
root ca�tting and to maintain#he water service curb stop box for operability and at suci�height as will ensure that it remair�s above the flnished
grade a#the land or property. (Ref 638,1156.1191j