Meter Swap ` Request Number: 16590
Public Works Division
Service Request
Problem Address: 5960 Oakwood Manor Reqnested By: Allan Hoffer
Departmeirt: WATER Address: No ad�ess provided
Problem/Issue: INSTALL AMR METER Phone Number: 612-715-0330
Scheduled Date: 2017-08-21 Schednied 1lme: 10:00:00
ST
ACTTON NEEDED: �
Created by: Wendy Hiatt Date Created: 2017-08-0?
ACITON TAI�N: C�C..
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Status: In Progress Submitter Has Been �..
Contacted
Date Completed: ���`,� t� Completedby:
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�r''�� hereby acathorize the City o#�ridPey andPor its�mployees to�o what is necessary ta
�epiace tfie 4,vater�neter. �understand Chafi the�ropertyy awner is 8iable for the vNater line from the main Lo the�r�mis�e and atl Ir�terior
;�iurasbing. {Per�i�yy�ode Q�Z.�6� 4 also Poold the�ity af Fr9dley andjits employees harmless#or any�ara�oag�s that anay occur wfiite doing thi:
m�er�tian, 7'his to include,�aut not$imited to valves,pi�irt�uva8ls,f9oors�r tfse tvrb stop box and service 9ine. irt undecstand!arn also�qui
to oi�tain a perm're�sreor to aray�ror(c,i��ecessary.
�lMs�lL Me6"ER READ�wG(oia meter� ���� �� O
Narree: _PC��A,1/� ���L� Address 5 I Cfd l./ �-ktn�'�f3� '�`�.wY�-CJ`�
Phone�(umher � " � � "' ���D pate ���� � � 1
�Si�nature Witness5i�nature ��
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FRiD1.EY C6Tf�QDE
�HA�9'ER 4D2.WA�'ER,STORM VIIATER 1�t1iD SAN�1"AR1i SIE9NER
€I�MfNlSTRA7'ION
{t��#�rd No i13,454,565,56�,629,638,56�,9?2,988,1144,T9S6,2191�
dU2S PER9NiT�EE
� Prior to�onstructing ar repair af arn/watec of sewsr fine conrtecting the existing rr►unic�pa(system and arry house or buitding for which the
applicatian is made,the owner or cuntractor shali be required to obtain a permit for such connection,and shail pay a permit fee as provided ir
Chapter 11 of this Code. After such connection has been made,the INater and Sewer Departmerrt shail be notified. it shatl!�e unlawful tu�nn
any connecting line unti!an iaspecCion has been made and such connectian and tfie work inciderrt tftereto has been approved by#he City as a
proper and suitahle connectio�.
�02.06 REPAIRS�1S1iD�11A�M'EBIANCE 1�0 CONNEC110R1
After the initiai ooanection has been made fio the water s¢rvice curb stop box er the sewer tead at tHe propecCy�ine or a�►rater service iead has
been extended to the nroperty line for cannection,the applicarrt,owner,ar occupant or user of sucft premises shali be liabie for a!1 repairs
required to any water tine and sewer iines necessary fo�connection�f the premises from the main to the premises. if the property awner
requests mairrCenance service or repairs be perFormed by the City,the property owner shall be charged for the costs af the maintenance andjo
repairs,including s�ecessary street repairs at a rate set annual{y by an administrative poiicy. It sha(1 be the respa�siisility o�f the appiiprrt,
owner,occupant ar user to perform sCandard mairrtenance o�the sewer service iine from the premises ta the main induding debris clearing o�
rno#�utEing and to maintain 4he avater service curh stap laox f�r�perabifity and at such height as aviil ensare tl�at it remains ebove the finished
grade o#the land or property. (Ref 638,1155,a29zj
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City of� Fridley
Water Det�artment
Address �� �-✓'��`w�� ��
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Name�/ �� •
Date �� I �`�
Old Meter Number �� ��� —
Old Meter Reading `���?� ��
Replacement No. � 4
Replacement Reading ----
� Replacement Make ����'�`'`
Remarks:����'�'�� ��Z�
S igned �`^"�— —
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