Meter Swap �
f Request Number: 13505
Public Works Division
Service Request
Problem Addresa: 1150 Lynde Dr Requested By: Goya Dwyer
Departme�: WA1F.R ��.ess: 11 SO Lynde Dr
Fridlcy,MN 55432
Prohlem/�sane: INSTALLAMRMETER PhoneNumber: �63-571-5836
Scheduled Date: 201'7-02-22 Schcdnled'11me: 08:00:00
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AC"IION NEEDED:
Created by: BEth Kondrick Date Cres�ted: 2017-02-15
ACIION TAKEN:
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Status: In pragress Sabmitter Has Been r
Contncted
Date Completed: Completed by:
2- 2� I� ��. 1�Y-
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6431 Univ�rsit'/a4ve�,ue NE � �� �! C�
Fridley,MN 55432 �� � � � "' I �
,,� 753-572-35f 6 ��� � � �,� �j� � -�� �
✓ �0�� hereby authorize the City of Fridley and/or its ernpioyees to slo whaC is necessary to
replace+the water meter. 1 understand that dhe properky owner as liabie for the bvater line f�om the main to the premisQ and ait interior
plumbing. (Per Crty code 402.06j i also hold the C'rty of Fridley andJits employees harmless for any slamages that may occur while doing this
operation. This#o include,but not Bimrted io valves,piping,walis,floors�r the curb stop lrox and service line. In understand!am aiso requir
to abtain a permrt�rior to any wor4c,�f necessary.
FINAL METER READIING{otd meter) 1 � ( ���D
lllame: Addre�� � �O �� h� /�'
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� 3 �� �O �� 2- 2�- ��
Phone Number r
S�gnature Wi#ness Signature
OLD MET�R# ��� + �� /�
OLD READtlVG 1 � F �� �
RiEW METER# _� I ���� �2�
NEW READtIVG �
fRT# y I �� ` ��
FRIDLEY CITIf CODE
CHAPTER 402.WATER,STORM WATER AND SANITARY SEWER
ADMINISTRATION
(Ref Ord No 113,464,565,566,629,638,662,922,988,1144,i156,i191)
4025 PERMIT FEE
Prior to constructing or repair of any water aF sewer line connecting the existing municipal system and arry house or Fwilding fo�which the
application is made,the owner or corrtractor shalf be required to obtain a permit for such connection,and shall pay a permit fee as provided in•
Chapter 11 of#his Code. After such connection has been made,the Water and Sewer DepartmeRt shail be notified. R shaii be untawful to cove
any connecting Gne until an inspection has been made and such connection and the work inaderrt thereto has been approved by the CFty as a
psoper and suitab{e connection.
402.06 REP,�IRS AND MA1NTEfNqPiCE TO CONNECTION
After the fnitiai connection has been made to the water service curb stop box or the sewer lead at the property iine or a water serviae lead has
been extended to fihe property line for connection,the appiicarrt,owner,or occupartt or user o#such premises shali be tlabie for af{repairs
required to any arater line.and sewer lines necessary for connection of the premises from the main to the premises. If the property awner
requests mairrtenance service or repairs be performed by the Crty,the property owner shaii be charged for the costs af the mairrtenance and/or
repairs,including necessary street repairs at a rate set annuaity!ry an administra#ive poficy. it shafl be the sesponsibility of the appiicarrt,
owner,occuparrt or user to perform standard mairrCenance of the sewer service line from the premises to the main ineluding debris dearing or
root cutting and to mairrtain#he wate�service curb stop box for operability and at such heigfrt as wiil ensure that it remair�s above the finished
grade of the land or property. (Ref 638,1156,1191j