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Meter Swap Request Number: 13084 Pubtic works Division " Service Request Problem Address: 5695 Matterhorn Dr Requested By: Dave Hazris llepxrtment: WATER Address: No address provided Problem/Issue: INSTALL METER Phone Number: 763-26-6599 Schedaled Date: ` ,�2017-02-01 Schedaled 13me: U9:00:00 �,j� S f ACTTON NEIDED: � �� r . -.,,� Created by: Wendy Hiatt Date Created: 2017-01-26 ACTIO TAI�N• r� � � ? __ _...._......_...._.._.___ �_�_..__..._._. ___ ._.�....�.. Status: In Pro�ess Submitter Has Been r. Coirtacted ` Da�te Compieted: Completed by: � �� 2-- , -- �`� �-f Wate��e�aarta�r'�nt 5431 UniversitZr Avenue N� --� �J � ?, �l�"� I Fridleya MN 55432 �X I,�' 1 �J 763-572-3565 �� 3� �/We here6y authorize the City of Fridley and/or its employees to slo what is necessary to replac�+the water meter. 1 understand that the property owner is tiabie for the water line#rom the main to the premise and all enterior �pr�mbing. {Per Crty code 402.06j i also hold the City+of Fridley andJFts employees harmless#or eny damages ifiat may occur rrhile doing this nperation. This to inciude,but not limited to valves,piping,wails,floors or the curb stop box and service tine. In understand 1 am also require� to obtain a permit prior to any worlc,if aecessary. FINAL ME7ER READIN (old meter) O � � � ��.J � � 1 Name: Atldress Phone Num p� �j" �`��+� Signature - - Witness Signature OLD METER# _ �S� i� � , � OLD READING_ S �� v � NEW METER#_"1 t) 1D � ✓�� NEW READING ERT#� �/�IN � FRIDLEY CITY C(JDE CHAPTER 402.WATER,STORM WATER AAfID SANITARY SEWER ADMlTtI1STRAT10R1 (Ref Ord Mo 113,464,565,566,629,638,662,922,988,I144,1156,Z191y 402.5 PERMIT FEE Prior to constructing or repair of any water oF sewer{ine connecting the existing municipal syste�'n arnt arry house rn buildir�for which tite epplisafiion is made,the owner or corrtractor shall be required to obtain a permit for such connection,and shall pay a permit fee as provided irr Chapter 11 of this Code. After such connection has been made,the Water and Sewer Departmer�t shali be notfified. tt shait be unfa�aful to co�r any connecting line untii an irrspection has been made and such connection and the wor8c inciderrt thereto has been approved by the City as a proper and suitable connection. 402.06 REPAiRS AND lINAINTENANCE TQ CQRlMEC110W After the initia(connection h�been made to the water service curb stop box or the sewer tead at the property line or a rvater service le�ad has been extended to fihe property line for connedion,the appiicarrt,owner,or accuparrt or user of such premises sha(1 be liabie for all repairs required to any water liae and sewer lines necessary#or connection aF the premises from the main to the prem'�ses. tF the property awner requests main#enance service or repairs be perFormed by the City,the property owner shall be charged for the costs of the mairrtenance and/or repairs,including necessary street cep�irs at a rate set annuaify t�y an administrative poiiry. It shail be the responsibility of ffie applicar�t, owner,occuparrt or user to perform standard maintenance of the sewer service line from the premises to the main including debris dear�ng or root sutting and to maintain khe water service curb stop box for operability and at such height as wiil ensure that it remains above the finished grade of#he land or property. (Ref 638,1156,1191) ��`�1� . r �a� ��3��v City of Fridley Water De�artment Address ,�6q � Ma��'�� • �. Name �v�� r�� Date �� Old Meter Number � � � ` --- Old Meter Reading - ��'`�� Replacement No. � `, �� Replacement Reading 5/' Replacement Make '� �-`�-<�e� `)"�1��...kC;�,�k'� � Remarks: ` — . �� S igne �` '