Meter Swap 1
R Request Number: 16389
Public Works Division
Service Request
Problem Address: 1555 Gardena Ave Requested By: Jerome Tiller
Department: WA'lER Address: No address provided
Problem/Issue: INSTALL AMR METER Phone Number: 612-803-0436
Scheduled at : 20 7-0 -19 � Scheduled'I�me: 08:00:00
0 .
ACTION NEEDED:
Created by: Wendy Hiatt Date Created: 2017-0?-18
ACTION TAI�EN:
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Status: In Progress Snbmitter Has Been r
Contacted
Date Completed: �_ Completed by: `Q�� �
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�i�gr��FraaOey
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� 1t1/a�ea-�epartm�nt cp� Cy�r �j
' S431 l�naversity Avenue NE J U� /U t `�I
Fridley,MN 55432
763-572-3566
�e'"�� hereby authorize the City of Fridley and/or its empioyees to do what is necessary to
re{�lace the water meter. !understand that the�troperty owner is liabte for the urater line from the main to the premise and all interior
plumbing. (Per�ity code 402.06) I also hold the City of Fridley andrts employees harmiess for arry damages that may occur while doing this
operatiort. This to include,but not limited to vaives,pipi�g,waNs,floors or the curb stop box artd service line. In understand 1 am aiso require
to obtain a permit prior to any wortc,if necessary.
FINAL METER READING(otd meterj 3 a� g��.a
Name• _ � (ro1M/� �'���`�.� Address_ 1 �J� V1�ll/�C'Q.I�l�0... #'�'1
Pho�e9Vumber �c�Z•' � - ��310 a� �'— '� �.s t`'�
� Signature Witness Signature
o�D fR �S g9 I �l q
OLD READ! �� 1 � 1�V
NEW MEfER# ` 1 �� J���
NE�l1l R£ADING �
ERT# ��� I ����
FRIDLEY CIiY CODE
CHAPTER 402.WATER,STORM WATER AND SANITARY SEWER `
ADMlAIISTRATION
(I�ef Ord No 113,464,565,566,629,638,662,922,958,1144,1156,Z191j
402.5 PERMtT FEE
� Prior to�constructing or repair of arry water of sewer line connecting the existing municipal system and arry house or bufiding for which the
appiication is made,the awner or coritractor shall be required to abtain a permit for such w�nection,a�d shali pay a permit fee as provided in
Chapter 11 of this Code. After such connection has been made,the Water and Sewer Departmerrt shall be notified. tt shall be unlawful to cover
any connecting li�e until an inspection has been made and such connection and the worbc incident thereta has been approved I�y the Crty as a
proper and suitable connection.
402.06 REPAtRS AND MAINTEPIANCE TO COMNEC7'{ON
After the in�tiai connection has been made to the water service curb stap box or fihe sevrer(ead at dte property[ine or a water service dead has
been extended to the property line for connection,the applicarrt,owner,or accuparrt ar user af such premises shall he liab(e for ail repairs
required to any water line and sewer lines necessary for connection of the p�emises from the main to the prem'►ses, if the property owner
requests mair�tenance service or repairs be performed by the C'rty,the property owner shall be charged for the�of the mairrtenance and/or
repairs,including necessary street repairs at a rate set annualty hy an administrative pol�ry. It shalt be the responsibiiity of#he appficant,
owner,occupant or user to perform standard mairitenance of the sewer service line from the premises to the main including debris dearing or
root cutting and to maintain the water service curb stop hax for operabitity and at such fseight as will ensure that it remains above the�inished
grade of the land or property. (Ref 638,1156,1191)