Meter Swap �,, Request Number: 13143
�
� Public works Division
Service Request
Problem Addreas: 5595 Matterhorn Lk Requested By: Jolm Perovich
Depsrtme�: WATER Address: 5595 Matterhorn Dr
Fridley,MN 55432
Problem/Isane: INSTALL AMR ME1ER Phone Number: 763-670-3365
Scheduled Dxte: Z 17-02-25 Schedeled Tlme: 1U:00:00
2S-� �� Q m
ACITON NEEDED:
Created by: Beth Kondrick Date Cre�ed: 2017-01-27
ACIION TAI�N:
Status: In Pro�ess Snbmitter Aua Been r
CoMncted
Dnte Compieted: Completed by:
2-- ZS � (� � 1�'r'
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Vvatea-�e�artment
5431 i�raiv�rsit�Avenaae NE �\ �
Fridtey, M9�i 55432 /j ��
7�3-572-3565 �� �
�/i�` her�eby authorize the C'ifiy�f Fridley and/or its empioyees to do what is necessary to
y -replace#he water meter. !�understand that�he property owner as liabie for the water line from the main to the premise and ail irnerior
plumbing. {Per�ty sode 4Q2.06j i a(so hold the C'tty of Fridiey andfats empioyees harmless#or eny damages that may occur while doing tFiis
operation. This to 9nclude,but not limrted to valves,piping,wa(Is,floors or the curb stop box and senrice line. In understand i am also requir
to obtairo a permrt prior#o arry�rorlc,sf aecessary.
c ��s- � � 3 � s o - a �
FlAIAL METER READING(oki meterj � ���`���
Name:�b� �J `C/'�► Address ��- 1.� ( �V �'� �
Phone Number�i! (D������ate !/���^ «
Signature ����"'' Wi#ness Signature
OLD METER#__ J��� � � v�
OLD READtrIG � �" . t����
NEW METER# "l 1� ` � KJ 3�
NEW READtNG �
E�r#-7 I `�� �o�j��
FRIDlEY CiTlf CODE
CHAPTER 402.WATER,STORM WATER AND SANITARY SEWER
ADMIN ISTRATIO'N
(Ref Ord llio 1130 464'S65�S6Ss 629�638�562�9Z2�9$$�1144�I156�1191)
402.5 PERMIT FEE
Prior to constructirig or repair of any water of sewer tine connecting the existing munidpat system and arry house oc buiidtn�for whit�#fle
application is made,the owner or wrrtractor sha(I be required to olrtai�a permit for such connection,and shall pay a permit fee�provided in
Chapter 11 of this Code. After such connection has been made,the Water and Sewer Department shall be no 'trf'ied. tt shail be uniawfui to cove
any connecting line until an inspection has been made and such connection and the work inciderrt thereto has been approved by the Crty as a
proper and suitabte connection.
402.06 REPAIRS AND MAINTEAtAl110E TO COMNECTION
After tFie initial cortnertion has been made to the water service curb stop box or the se�ver lead at the property line or a water servic�e lead has
been extended#o the property line for connection,the applicarrt,owner,or accuparrt or user of such premises sfiaii be{iable for afl repairs
required to arry water line and sewer lines necessary for connection of the premises from the main to the premises. If the property owner
requests mairrtenance senrice or repairs 6e perFormed by the Ctty,the property owner shail be charged for the costs o#the mairttenance and/or
repairs,including necessary street repairs at a rate set annuaily!�r an administrative policy. tt shali be the responsbil'rty of the applicarit,
owner,occuparrt or user ta perForm standard mairrtenance of the sewer service line from the premises to the main induding debris dearing or
roofi cutting and to mairrtain#he water service curis stop box for operahility and at such height as wili ensure that it remains ahove#he flnished
grade af the land or property. (Ref 638,1156,1191)
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City of Fridley
Water De artment
Address �� � `�''"" �� �
Name��' n troViG' �
Date � - I� � � �
Old Meter Number �' �
Old Meter Reading � j�
Replacement No. � 6 ��" a
Replacement Reading
Replacement Make ��Q r
Remarks: ��� t �
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C''�.
S igne �"'•^�
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