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Meter Swap � Request Number: 14274 Public Works Division Service Request Problem Address: 5163 Rainer Pass Requested By: Linda Zdon Department: WA1ER Address: No ad�ess provided Problemilssue: INSTALI.AMR ME1ER Phone Number: 612-850.1971 Scheduled Date: 2017-03-30 Sc�edaled 11me: 07:30:00 r `�' ' , ACITON NEEDED: Created by; Beth Ko�rick DAte Created: 2017-03-23 ACTION TAI�N: �� Statua: In Pro�rress Sabmitter Hs�s Been r.. Couts�ted Date Complcted: Completed by: Honrs �_ �a_�1 � �r � 2(�`- �l.��l� « �� ' � �,.� � ��,I City of Fridley Water Department 6431 University Avenue NE Fridiey,MN 55432 763-572-3566 ��We hereby authorize the Ctty 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 premtse and all tnterior plumbing. (Per City wde 402.06) 1 also hold the City of Frid{ey andJits empfoyees harmless for any damages that may oaur while dang this operation. This to include,but not limited to valves,pipi�g,walls,floors or the curb stop box and service line. In understand I am also required to obtain a permit prior to any work,if necessary. FINAL METER READING(old meter) � �� '� �" Name: �l�nda. ��r� Address �� '�� r'-�5 Phone Number ��v �� i � Date �' �� Signaiure YV'rtness Signature l� —_— OLD METER# �� OLD READING _�� 1 � V NEW METER#__��D�� Z� NEW READING � ERT# � �� r � �� 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 line connecting the existing municipal system and any house or building for whkh the application is made,the owner or contractor shall be required to obtain a permit for such coonection,and shall pay a permit fee as provided in Chapter 11 of this Code. After such connection has been made,the Water and Sewer Department shall be notified. R shall be unlawful to cover any connecting line until an inspectton has been made and such connection and the work incident thereto has been approved by the City as a proper and suitable wnnection. 402.06 REPAIRS AND MAINTENANCE TO CONNECTION After the initial connection has been made to the water service curb stop box or the sewer lead at the property Ifne or a water service lead has been extended to the property line for connection,the applicant,owner,or occupant or user of such premises shall be liable for all repairs required to any water line and sewer fines necessary for connection of the premises from the main to the premises. ff the properly owner requests maintenance 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 repairs at a rate set annuaNy by an administrative policy. It shall be the responstbility of the applicarit, owner,occupant or user to perform standard snaintenance of the sewer senrice line from the premises tathe main induding debris clearing or root cutting and to maintain the water service curb stop box for operabi{ity and at wch height as will ensure that it remains above the�inished grade of the land or property. (Ref 638,1156,1191) � `,::: �� `�� ` ��'� x �� x,�:� � �, , ,�: �� ,,� � �� _"` ; ,_;� `� � �� ,�� city of Frialey � Water De�artment Address_ �, t b� �,�t}��.sQ.,�t�"� Name �� p'� Date ��"�e�'7^� Old Meter Number �� Old Meter Reading $ � Replacement No. '�� Replacement Reading_ � Replacement Make ��(� Remarks• '�"�f�� '� Signed