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Meter Swap ,. Request Number: 14391 � P�b1ic works Division Service Request Problem Address: 5431 Madison St Requested By: Ms Granstra� Department: WATER Address: No address protided Problemllssue: INSTALL AMR METER Phone Number: 572-9239 5chednled 2017- -OS hednied'Ilme: I1:00:00 � � s`�' J �� ACTiON NEEDED: Created by: Wendy Hiatt Date CreAted: 2017-03-29 ACTION TAI�N: ���-'�� �� � � `��';' Statna: In Progress ��tter Ha8 Becn r Coutacted Date Completed: Completed by: �"r�� �� � t�1'` � ��G�_ ��� �l � ' t� 1 � Sa �- 3�0-� � City of Fridley Water Department 6431 University Avenue NE Fridley,MN 55432 763-572-3566 �lWe hereby authorize the City of Fridley and/or its employees to do what is necessary to replace the water meter. 1 understand that the property owner is liable for the water line from the main to the premise and all interior plumbi�g. (Per City code 402.06) 1 aiso hold the City of Fridley andjits employees harmless for any damages that may oaur whtte doing this operation. This to include,but not limited to vaives.piping,walls,floors or the curb stop box and service 1ine. in understand 1 am also required to obtain a permit prior to any work,if necessary. FIPIAL METER READING(oki meter} �� � �� � `� Name: t `�� • t Address ��� �1 �`'��� �� Phone Number���� � V�� Date �r�^ ` ` 8 Witness Signature Si nature OLD METER# �`�l C��� �� � OLD READING � J �7 ��� O NEW METER# � Y���� 1J � NEW READING � ERT# ������,) 1 FRIDLEY 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{ine connecting the eicisting municipal system and any house or buiiding for which ihe application is made,the owner or contractor shafl be required to obtain a permit for such connection,and shall pay a permlt fee as provided i� Chapter li of this Code. After such connection has been made,the Water and Sewer Department shall be notifted. It shali be uniawful to wver 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 connection. 402.06 REPAIRS AND MAINTENANCE TO CONNERION After the initiaf wnnection has been made to the water service curb stop box or the sewer lead at the pro�rty line or a water senrice lead has been extended to the property line for connection,the applicar�t,owner,or occupant or user of such premises shall be liable for aii 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 senrice or repairs be performed by the City,the property owner shall be charged for the costs of tfie maiMenance and/or repairs,including necessary street repairs at a rate set annuaily by an administrative poliry. It shall be the responsibility af the appliprrt. owner,occupant or user to perform standard maintenance of the sewer service line from the presnises to the main including debris dearing or root cutting and to maintain the water senrice curb stop box for operabil'�ty and at such height as will ensure that it remains above the finished grede of the land or property. (Ref 638,1156,1191) x �, � �� � � �rr} .a'Mfi '�'�'i r} �d f� . ��]��y�,'. { rg �'�`�� g4 �r,,,,, .. 1 M �§ k`.. � 5�'Y11R��� �' J�Y� y..'� �. � Date � � `��� "' �c� � Old Meter Number ��� 9 9�,a Old Meter Reading /� � 1� k � . Replacement Na �c� s� a �Y' Replacement Reading Replacement Make ���er _ Replacement ERT# _ ' G�I� �n.�� Remarks: { � � _, Signed �,�.