Meter Swap � Request Number: 13705
� � Public works Division
Service Request
Problem Address: S94?Central Av�e Requested By: Amy
Departme�: WATER ��.�s: 5947 Central A�e
Fridley,MN SS432
Problemflssue: INSTAL,L AMR 1NETER Pho�Number: S 10-459-4T55
Sc�eduled Dats: 2017-03-07 Scheduled'Ilme: 01:30:00
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AGTION NEEDED:
Created by: Bcth Kondrick Date Cre�ed: 2017-02-28
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ACIION TAI�N: .
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Status: In Progress Snbmitter Haa Been �.,
Co�acted
Date Compieted: �" 7'� �7 Compteted hq: � c�,�
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�431�lna�rersit^�l�a�r,�ae 6V� 2.n S � y I �1 (� " � T
Fridteya N64�i 554�2
�s3-��z-3s�s So`# � ��5
pI'�°� hereby authorize the�ty�f�sidley and/or its empioyees to do whafi is necessarg t
replace the water meter. �vnderstand ciiat the propesty owner�s tiaBle for the+�vater line from the main to the premise and all irrterior
plurrabing. �Per Ciiy s.ode 4U2.06� 3 also hold the C'rty�F��idley and/'rts empioyees harmiess#oe any slamages that may occur�srhile doing thi
o�Oer�ition. This�o include,but not limc�ed to vaives,psping,walis,floors or ti�ee curb stop box anc(service lie�e. 9n understand i am aiso requ
to o6taira a permit priar ta arwy wor3c,�f necessary.
FltliAt bVSETER READiNG(okl meterj `.J O► V l � lJ�
Name• � ��"'y Address �/�_ r / �/L�i�� �l�e
Phone Number �l V , '�5 q v • f J� pate J ' / �""� t�
Signature w'stness Stgnatare
ozo�w�-E�� � �� 13 5��
OLD READtiVG � � � � (�U
�Ew��-��� '� qv� a��5
'N£W READi111�G �
ERT#__ � , - 1� � 0���.0 .
FRIDLEY Ct�'Y C�DE
CHAP�'Eti�02.WA7'ER,STORM WATER AND SAf11ITARY 5EWER
ADMMN45TRATIUf�I
(Ref Orst No 113,4�54,565,�65,629,638,662,922,988,1144,5156,1191j
402.5 FERMIi'FEE
Prior to constructing ar repair vf any wafier of sewer line connecting the existing muniapai syscem and arry hause o�building for�rhir�s the
app(ication is made,the owner oa cornractor shail be required to obtain a permit#os�sucb connedion,and shall pay a permit fee as proylded'n
�ha�ster 11 af this Code. After such co�nection has 6een made,tfie Water and Sewer Departmern shall be no#ified. It shai!be uniawfu!to cov
arry con�ecting line urrti�an inspection has been snade and such c+or�nection and tf�e worh inaderrt thereto has been approved by the City as a
proper and suttable connectiora.
402.06 REPAlRS A9V{D�AAI{YTE11�p�1�E TO CONNEC'fI0[ol
A1Fter the inittai connection has been made to#he water serrvice wrb stop box or the sewer Ieacl at fihe property iine or a w�ter servke lead has
been extended#o fihe property lir�e for connection,the apptisarrt,awner,or accapar�or�ser aF such premises sfiati be t4abie fvr ail repairs
required to any wates t�ne amt sewer lines necessary for connection of the premises from the main to the premises. !f tim propeKy oarner
requests main#enance service or repairs be perFormed by the City,the propertp owner shaN be sharged far the costs of the mairrtenance andju
repairs,inctud'sng necessary street repairs at a rate set annual(y by an administraitive pol'icy, tt shall be the responsi6i[ity o#the a�licant,
owner,oscupant vr user to perForm standard mairitenance of#he sewe�senrice iine from the premises to the main including debris dearing or
root cutting and to mairrtain#he water service curb sfiop box for operability and at such he�ght as vrili ensure Chat it remains above the finished
grade of The land or property. (ReF 638,1156,1191)
. � + Da-��s _ . _
�c�(o��s-`����o
� Ci�y of Fridley
Water Department
Address �� 1� �1;�a1" �n��-- �v�
Name t1VL1C ���� .
Date �Cj—���
Old Meter Number ��y��7p�
Old Meter Reading � �y ��
Replacement No. Cj (�� �]
Replacement Reading_�
Replacement Make f���,'2
Remarks• �-t°�� ��'"z�
Signed �
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