Meter Swap t �
Request Number: 16457
Public works Division
Service Request
Problem Address: 1235 Hillwind Rd Requested By: Todd Hunter
Department: WA'IER Address: No address provided
Problem/Issue: INSTALL AMR METER Phone Number: 763-777-3118
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' Sc6eduled Date• 2017-07-28 �-L 5c6edWed 1lme: 10:30:00
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ACTION NEEDED:
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Created by: Wendy Hiatt Date Created: 2017-07-25
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ACTION TAI�N:
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Status: In Progress Submitter Has Been r.
Contacted
Date Completed: �,�� �� Completed by: ( ��
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' wat���e�a����t
6�31 l�niversity Avenes�NE
Fridley,MN 55432
7fi3-572-3566
!/we hereby authorize the Gty of Fridiey and/or its employees to do what is necessary to
repiace the wat2r meter. i unde�stand that the property owner is liabte for the water line from ihe main to the premise and a8 iriterto�
plumbing. (Per City code�02A6) i also hald the dC'ity of Fridiey and/its employees harmless#or arty damages that may occur while doing ihis
operation. This to include,but not limited to va(ves,pipirsg,walis,floors or the curb stop box and service line. in understand 1 am also require
to obtain a�ermit prdor to any wor&,ff necessary.
FlNAL ME7'ER READtRIG{o1d meter} `�' ` �`�' ��"'
Name• ���(', ��;+ l�� �1lddress ` c
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Phone Number Q��"' ��� "" 3i I�� � — �, S�- l�
�Si nature `�"'
g W�trress Signature
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OLD MEi'ER# U�� �� [ �
OLD READING �/� !. lI/ �V C�
NEW METER# � ! � ✓ � � I�
NEVV RfADING O
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FRtDLEY CITY CODE
CHAi�TER 402.WATER,STORM WATER AND SANITARY SEIA/ER
ADMlRtISTRATION
(�tef Ord No 113,464,565,566,629,638,662,922,988,1134,1156,1191j
402.5 PERMIT FEE
Prior to constructing or repair of any water af sewer line connecting the existing municipai system and arry house or buildin�for which the
appiication is made,the owner or corrtrador shail be required to obtain a permit for such connection,and shail pay a permit fee as provided in
Chapter 11 of�his Code. After such connection has been made,the Water and Sewer Departmerrt shai(be notified. It siwif be unlawful to cove�
any connecting line until an inspection has been made and such connection and the wortc incident thereto has been approved 6y the City as a
proper and suitable connection.
402.Q6 REPAIRS AND MAINTENANCE TO COAtNECT{OIY
After the initial connection has 6een made to the waCer service curb stop box or the sewer lead at the property line or a urater service(ead has
been extended to fihe property line for rnnnection,the applicant,aamer,or occupant ar user of such premises shalt be liai�te for aft repairs
required to any�rater line and sewer{ines necessary#or connection of the premises from the main ta the premises, ff the property owner
requests mairnenance senrice or repairs be performed by the�ty,the property owner shall be charged for the wsts of the mair�tenance andJa�
repairs,including necessary street repairs at a rate set annually by an administrative poliry. It shall be the responsibility af the appticarrt,
owner,occupant or user to perform standard mairrtenance af the sewer service line from fihe premises to the main including debris ciearing or
root cutting and to maintain the water service curb stop box for operability and at such height as will ensure that it remains above the finished
grade af the(and or propert/. (Ref 638,1156,1191'
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City of Fridley
Water Department
Address � ,� � � �
Name 1` u11��/`�
Date � d" „c. � -'t � .
Old Meter Number �{j �J �S
Old Meter Reading � / 7 � �
Raplacement No. � �� l
Replacement Reading �
Replacement Make__j�_`�`_�'
, Remarks: �� r�`vT-e`'
Signe ___ _ _`
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