Meter Swap � Request Number: 14357
Public Works Division
Service Request
Problem Addreas: 6599 Channel Rd Requested By: Assia Hassan
Departme�: WA1ER Address: No address provided
Problem/Issue: INSTALL AMR ME1ER Phone Number: 763-614•0054
Scheduled Date: 2017-04-OS Schedoled 1tme: 10:30:00
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ACTION NEEDED:
Created by: Wendy Hiatt Date Cre�cd: 2017-03-28
ACIION TAI�N:
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Status: In Progress 5nbmitter Has Been r
Cont�ted
Date Completed: �� �,_1� Completed by: \„,k�
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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 employees to do what is necessary to
replace the water meter. 1 understand that the property owner is liable for the water line from the main to the premise and all inte�ior
piumbing. (Per City code 402.06) I also hold the City of Fridley and/its employees harmless for any damages that ma�occur while doing this
operation. This to include,but not limited to valves,piping,walis,floors or the curb stop box and service line. in understand I am also required
to obtain a permit prior to any work,if necessary.
FINAL METER READING(old meter) ,�Cy� ��V
Name: ��)��� 1 I G:S�e"�"' Address�ff�� `�'I�h'YF'PiY �'
Phone Number L �� � �`� ' ��� Date � � � '� `" �
Si nature �'
8 Witness Signature
OLD METER# �� �� v � 6 C�
OLD READING 6a`� � ��
NEW METER# `� q�� �a� S
NEW READING D
ERT# � 22Z3va �
FRIDLEY CITY CODE
CHAPTER 402.WATER,STORM WATER AND SANITARY SEWER
ADMINISTRATION
(Ref Ord No 113,464,565,566,629,638,662,922,988,1144,1156,1191j
442.5 PERMIT fEE
Prior to constructtng or repair of any water of sewer line connecting the existing municipal system and any house or building for which the
application is made,the owner or contractor shali be required to obtain a permit for such connection,and shall pay a permit fee as provided in
Chapter 11 of this Code. After wch connection has been made,the Water and Sewer Department shall be notified. k shall be unlawful to cover
any connecting line until an inspedion has been made and such connection and the work incident thereto has been approved by the City as a
proper and suitable wnnection.
402.06 REPAIRS AND MAINTENANCE TO CONNECTION
After the initial wnnedion has been made to the water service curb stop box or the sewer lead at the property line or a water service lead has
been extended to the property line for connection,the applicant,owner,or occupant or user of such premises shall be liable for all repain
required to any water fine and sewer lines necessary for connedion of the premises from the main to the premises. If the property aivner
requests maintenance service or repalrs be performed by the City,the property owner shall be charged for the costs of the maintenance and/or
repairs,including necessary street repairs at a rate set annually by an administrative policy. It shall be the responsibtlity of the appliqrrt,
owner,occupant or user to perform standard maintenance of the sewer service line from the premises to the main inciuding debris clea�ing or
root cutting and to maintain the water service curb stop box for operebility and at such height as will ensure that it remains above the�nished
grade of the land or property. (Ref 638,1156,1191)
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City of Ftidley �� '
Water De artmen
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' Name /�Q. �I��Ps1� , _: _
, Date ���}a-� , _.,
Old Meter Number � a� � � �
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Old Meter Readin � :
', Replacement No. ��J�j ��]�j � _
Replacement Reading � ,`
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. . , Remarks: ��Or1� � r _
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