Meter Swap � •
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REQUEST F�R SERVICE REPORT
CITY OF FRIDLEY
Reference No. , ^ � �3 Date: �� 1�'� { �
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Request Type: Entered By:
De artment: V�.��'�--- � Citizen Name: cll��� ���
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Address: � � � ��`��'��'`� � Phone Number:
Scheduled Date: Property Owner:
Location Details: Requesf Details:
Actio� Taken:
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Responsible Person: �
Approver:
Completion Date: � Citizen Notified:
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� City of Fridley � � l r���l
Water Department '�t b
6431 University Avenue NE
Fridtey,MN 55432
763-572-3566
ijwe hereby authorize the City 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 from the main to the premise and al!interior
plumbing. (Per City code 402.06) 1 also hold the City of Fridley and/its employees harmless for any damages that may 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.
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FINAL METER READING(old meter)
Name: �� � /r Address vl v v�" �► l ���
Phone Number r �Y �� � � � Date
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Signature �tness Signature
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OLD METER# °�
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OLD READING �"1 � �.��V ��
NEW METER# L� 1�V� �����
N�';I��ADfNG �
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FRIDtEY CITY CODE �'-,
CHAPTER 402.WATER,STORM WATER AND SANITARY SEWER �
ADMINISTRATION
(Ref Ord No 113,464,565,566,629,638,662,922,988,1144,1156,1191)
402.5 PERMIT FEE
Prior to constructing or repair of any water of sewer line connecting the existing municipal system and any hous�or building for wh�ch the
application is made,the owner or contrector shall be required to obtain a permit for such connection,and shall pay a permit fee as provided in
Chapter 11 of this Code. After such connedion has been made,the Water and Sewer Departmerrt sha{{be notified. It shali be unlawful to cover
any connecting line until an inspection has been made and such connection and the work incident thereto has been approved by the City as a
proper and suitable connedion.
402.06 REPAIRS ANQ MAINTENANCE TO CONNECTION
After the initial tonnection 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 wch premises shall be liable for all repairs
required to any water line and sewer lines necessary for connection of the premises from the main to the premises. If the property owner
requests maintenance service or repairs be perFormed by the City,the property owner shall be charged for the costs of the mairrtenance and/or
repairs,inciuding necessary street repairs at a rate set annuaily by an adminisirative policy. It shali be the responsibility of the applitant,
owner,occupant or user to perform standard maintenance of the sewer service line from the premises to the main induding debris clearing or
root cutting and to maintain the water service curb stop box for operability and at such height as will ensure that k remains afiove the finished
grade of the land or property. (Ref 638,1156,1191)
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