Meter Swap Request Number: 13238
Public Works Division
Service Request
,ss: 5531 Regis Tr Requested By: Ron Morgan
WATER Address: 5531 Regis Tr
Fridley,MN 55432
Pr� Lsaue: INSTALL AMR ME'IER Phone Number: 612-670-8946
Sc6ed�led Drte: 2017-02-14 � Schedaled Time: 10:00:00
ACTION NEEDED:
Cre�ted by: Beth Kondrick Date Crexted: 2017-02-02
ACTION T��KEN:
�,S�,�l�o�
� �
Status: Ia Progress SnMmitter H�s Been r
Conts�ted
Date Co�pleted: 2— �� ,� �� Completed by:
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�rie(ley,Mf� 55432 / lt�
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lj�f� her�by authorize xhe Cifiy af�ridley and/or its empioyees to do wfrat ds necessary
, replace the water rnetes. 1 understand fi.ha#�he pro{aea�ty owner�s diabie for the�erater iine from the main to the�oremise and all ir�ter'sor
plumbing. (Per Crty�ode�2.p6� i adso hold the 2Pt�/c+#Fcidley andJ'rts employees harmtess for any slamages ifiat may�ccur rrhile doing th
operation. This�o include,but nott 9im�ted�o valves,p9ping,walis,floors or che curb sto�o boz arid service line, tn understand 3 am aiso req�
to obtaira a permit gr'sor ta any ieror4c,if�ecessary.
FBR(AB.AAETER ttEADING�old mefier) V�� l.Y f"V O
Name: �''� V�k'3Y�G�v�.. Address __ �� J � �V'� �1�,
Phone Kumber ��Z " v��V� � 1 l,� Date � r ��� y `
��� Wi�i7ess SigrtaCure _�
o�� ,��-�R�_ 3�0.�50�'��S
OLD READiNG�()'' F 1���
EVEIRV METER# 1'I ��� � � � —(
NEW REA.D111FG O
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FRiD1..�YY CiTY C(JDE
CHAFTER 402.WATER,SCORM YFlATER A1ND SANITARY SEWER
ADMlNiSI'RATION `�
(R�f Ord S�lo 123,4�64,565,566,6Z9,638,66Z,922,988,I].44,IL56,1191}
402.5 PERMIT FEE
Prsor to canstructir�g or repair of any water of sewer line connecting the existing municipat system and acry hause or fwiidir�for which#he
appl�cafiion is macte,the owner or contractor shalt be required tv abtain a permifi for such connection,and sh�li�y a pemu't fee as provided i
Chapter 11 af this Code. After sucf�connection has been made,the Water and Sewer Departmerrt shalt be norti�fied. it shail be untawful to crn
any connecting line ue�til an inspectson has 6een made and such connection and#he wos8c inciderrt thereto has been approved by the Cfty as a
prnper and suitable connection.
402.05 REPAIRS Al1ID lNAINTENANCE TO COWNECTIOIY
After the in'rtiai connection has been made to the water selvice curp stop bax or#he searer fead afi fihe propetty line or a water sennce lead�ta:
been e�ctended Co the property line for connedion,the appiicarrt,awner,or accuparrt or user of such premises s(�att be!(abie fa alf repairs
required to any water 6ine and sewer lines necessary#vr connedian crf the premises from the main to the premises. tF the properly owner
requests mairnenance service or repairs be performed by the C'ity,the proper[yy owrtes st�ati be charged for the costs af ihe mai�rGenarwe and/<
repairs,incfuding necessary street repairs at a rafie se#annuaily by an administrative poQcy. �t shatl be the sespons'bility o�f the appiican#,
owner,occupant vr user to perform standard mairrtenance a�F the sewer service line from the premises to the main�rsdudic�g debris dearing or
root cutting and to mairrtain the water service curb stop box for operabi4i#y and at such height as wili ensure that it remai�a6ove the finisheo
grade af the land or property. �ttef 63g,1156,1191j
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�C�C�x'@l��,���� � �
�`S �/a►�� �
Name�D�� �d�i h
Date�� 'Q �
Old Meter Number � S �Q _
Old Meter Reading O �" v� �
Replacement No. �(�
Replacement Reading (�
Replacement Make ����.�"'
Remarks•_ G��� �, �i�/'
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Signed .