Meter Swap Request Number: 14473
Public Works Division
Service Request
Problem Address: 5171 St Imier Dr Requested By: Amie Sayler
Depnrtmeut: WA'IER Address: No address p�ovided
Problem/Issue: INSTALL AMR METER Phoee Number: 651-247-7516
Scheduled Date: 2017-04-10 Schedeled'Ilme: 08:00:00
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ACIION NEEDED:
Crested by: Beth Kondricic Date Created: 2017-04-03
ACT'ION TAI�N:
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Statua: In Progress Snbmitter Hns Been r..,
Co�acted
Date Completed: rJ �!' �� Completed by: �a�Lp
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City of Fridley
Water Department
6431 University Avenue NE
Fridley, MN 55432
763-572-3566
�/We hereby authorize the City of Fridley and/or its employees to do what is necessary to
replace the water meter. i understand tfiat the property owner is liable for the water line from the main to the premise and all interior
plumbing. (Per City code 402.06) 1 also hold the City of Fridley and/its employees harmless for arry damages that may ocwr while doing this
operation. This to include,but not limited to valves,piping,walis,floors or the curb 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) 1 � � ���O
Name: ��e �Gf- `� Address__ J� 1 I J-� ' ����� ��'
Phone Number �� `� v"� '�� �`-�' Date �� (v " � �
Signature Witness Signature
OLD METER# � D ��
OLD READING �v! (l ✓v
NEW METER# � I�O� V��
NEW READING �/
ERT# ���`d���D !
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 buildir�for which the
application is made,the owner or corrtractor shall be required to obtain a permit for such connedion,and shall pay a permtt fee as provided in
Chapter 11 of this Code. After such connection has been made,the Water and Sewer Department shall be notlfied. It shall be unlawful to cover
any connecting line until an inspection has been made and such connection and the work incident thereto has been approved by the City as a
proper and witable connedion.
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 line or a water senrice lead has
been extended to the property line for connedion,the applicant,owner,or occupant or user of such premises shall be liabie for all rcpairs
required to any water line and sewer lines necessary for connection of the premises from the main to the premises. If the property�rner
requests maintenance service or repairs be performed by the City,the property owner shall be charged for the costs of the maiMenance and/or
repairs,including necessary street repairs at a rate set a�nually by an administrative poliry. It shall be the responsibility of the applicaM,
owner,occupant or user to perEorm standard maintenance of the sewer service line from the premises to the main induding debris dearing or
root cutting and to maintain the water service curb stop box for operability and at such height as will enwre that it remains above the finished
grade of the land or property. (Ref 638,1156,1191)
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Nant�: ��G�t� l.t',�-`f" aT
Date �'"^�. � �
Old Meter Number � �-!'.�i'� �
Old Meter Reading �,�, GI��CJ
Replacement No. S(.� �� g ���l
Replacement Reading d
Replacement Make ���.�"'
Remarks:_ C.�rG� `yr P �P�''�
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Signed �