Meter Swap .�
Request Number: 15274
� Public Works Division
Service Request
Problem Address: 6655 Fridley St Requested By: Bev Stark
Departmest: WATER Address: No ad�ess provided
Problem/Iesue: INSTALL AMR METER Phone Number: 571-4961
Scheduled 2017-06-01 Sekednled'Iime: 07:00:00
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AC'IION NEEUED:
Created by: Weady Hiatt Date Created: 2017-OS-11
ACTTON T N:
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Status: In Pragress Submitter H9s Been r
Contncted
Dnte Coa�pleted: Completed by:
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City of Fridley �� � �r��
�� Water Department ��
� 6431 University Avenue NE
Fridley,MN 55432
763-572-3566
��We hereby authorize the Ctty of Fridley and/or its employees to do what is necessary to
replace the water meter. i understand that the property owner is liable for the water line trom the mai�to the premise and all interior
plumbing. (Per City code 402.06) I also hold the City af Fridley and/its employees harmless for any damages that may occur while doing this
operation. This to include,but not limited to valves,piping,watis,floors or the curb stop box and service line. In understand 1 am aiso required
to obtain a permit prior to any work,if necessary.
FINAL METER READING(old meter) O�����
Name• Qiv ��r 1�. Address � �r��l S
1 {
Phone Num er�� ��' ��� p� — — 1� (p�� �- )�
xSignature � Witness Signature
OLD METER# ��� / �� �
OLD READING_�� Z J O J�
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NEW METER# "[ `Z� �� `
NEW READING �
ERT# ��.2-�� ��C�
FRIDL�If CITY CODE
CHAPTER 402.WATER,STO�tM 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 connecting the existing municlpai system and ar�y house or building for which the
application is made,the owner or co�rtractor shafl be required to ol�tain a permit for such rnnnection,and shall pay a permit fee as provided in
Chapter 11 of this Code. After such connection has been made,the Water and Sewer Department shall be notified. It shall be unlawful to cover
any connecting line urrtif an inspection has been made and wch connettion and the work incident thereto has been approved by the City as a
proper and witable connection.
402.06 REPAIRS AND MAINTENANCE TO CONNECTION
After the initial connection has been made to the water service curb stop box or the sewer lead at the properly line or a water servke kad has
been eutended to the property line for connection,the appiicaM,owner,or occuparrt or user of such premises shall be liable for ail repairs
required to any�nratec li�e and sewer lines necessary for connection of the premises from the main to the premises. tF the property awner
requests maintenance service or repairs be performed by the City,the property owner shali be charged for the costs of the maimenance a�d/or
re�airs,including necessary street repairs at a rate set annually by an administrative qoliry. tt shall be the responsibiiity of the appliqrit,
owner,occupant or user to perform standard maintenance of the sewer service line from the premises to the main including debris dearing or
root cutting and to maintain the water senrice curb stop box for operability and at such heigfit as wifl ensure that it remains above the finished
grade of the land or property. (Ref 638,1156,1191)
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Name � S�.
Date . ' �"�p�� 1
Old Meter Number �7� . ��5
Old Meter Reading �v� ; 1d
Replacement No. �
Replacement Reading. �
Replacement Make ���
Remarks• ���'1��
Signed �