Meter Swap �
� Request Number: 15296
Pub�c works Division
Service Request
Problem Address: S27S St Imier Dr Requested By: Jeff Solz
Department: WA'IER Adaressc No address p�mvided
Problem/Issue: INSTALL AMR METER Pbone i�fumber: 763-286-6925
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Scheduled I�te:�2017-05-16 � Schedaled 11me: 08:00:00
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ACIION NEEDLD•:
Created by: Beth Kondrick Date Created: 2017-OS-11
ACIION TAKEN:
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Status: 1n Pro�ress 5nbmitter Ha�Been r,
Coht�ted
Ds�te Compieted: � � �/ _,� �� Completed by: C I
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" City of Fridley ZI� �. (� ' � 2� r�`�
- Water Department � � "�
6431 University Avenue NE � � (�,��
Fridley,MN 55432 �
763-572-3566
I/we hereby authorize the City of Fridley and/or its empioyees to do what is necessary to
repiace the water meter. 1 understand that the property owner is liable for the water line from the main to the premise a�d all interior
plumbing. (Per City code 402.06) I also hold the C"�ty of Fridley and/its employees harmless for any damages that may oixur while doing this
operation. 'rhis to include,but not timited to valves,piping,walls,floors or the wrb stop box and service line. In understand 1 am also required
to obtain a permit prior to any work,if necessary.
FINAL METER READING(old meter) � � ! v�� `�
Name:_ ��"'� �� ��, Address ���� � ���`e� �.
Phone Number 4�� �"`VVL �`�'��5 Date �'" ?�.Q � ��
Signature Witness Signature
OLD METER# J�� l � � �f
OLD READING " v ` � � V
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NEW METER# � I "����t v
NEW READING �
ERT# � ` ! ��a��
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 arry house or building for which�e
application is made,the owner or contractor shalf be required to obtain 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 shait be notified. It shall be unlawfui to cover
any con�ecting line untit an inspection has been made and such connection and the work incident tNereto has been appro�d by the Cty as a
proper and suitable connection.
402.06 REPAIRS AND MAINI'ENANCE TO CONNECTION
After the initia!connection has been made to ihe water service curb strip box or the sewer tead at the property line or a water service iead has
been extended to the property line for connection,the applicant,owner,or occuparrt or user of such premises shall be liable for all repairs
required to any water line and sewer lines necessary for connectton af the premises from the main to the premise�s. If the properry owner
requests mairitenance service or repairs be perFormed by the City,the property owner shall be charged for the costs of the rnai�rtenance and/or
repairs,including necessary street repairs at a rate set annaally by an administrative policy. It shall be the responsibilityr of the applicaM,
owner,occupant or user to perform standard maintenance of the sewer service line from the premises to the main induding debris clearing or
root cutting and to maintain the water senrice curb stop box for operability and at such height as will ensure that it remains above the�nished
grade of the land or property. (Ref 638,1156,1191)
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City of Fridley
water Department
Address _.��7J� ��_ �j���Qi- 1�y^
Name �Q� _)� E.-2
Date �i) � ��1
Old Meter Number � (��
old Meter Reading �Q r�-6Q
Replacement No. 3�,� �,(��.�
Replacement Reading C�
Replacement Make Gj.� �,r'
Remarks: S'���� Yh..e� �
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Signe
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