Meter Swap Request Number: 14264
�� Public Works Division
5ervice Request
Problem Address: 1364 Skyw�ood Ln Requested By: Jermai�Kuglin
Department: WA1ER Address: No address provided
Problem/Issue: INSTALL AMR METER Phone Namber: 571-3903
Scheduled Date: 2017-03-28 � Schednled 1lme: 08:00:00
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AGTION NEEDED:
Created by: Wendy Hiatt Darte Created: 2017-03-23
ACTTON TAI�N:
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'T Status: In Pro ss Submitter Ha�Been �..
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DAte Compieted: Compicted by:
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. ' City of Fridley
' Water Department
6431 University Avenue NE
Fridley,MN 55432
763-572-3566
UWe hereby authwize the City of Fridley and/or its employees to do wMat is necessary to
replace the water meter. 1 understand tt►at the property owner is liable for the water line from the main to the premtse and all interior
plumbing. (Per City code 402.06) 1 afso hold the Clty of Fridley and/its employees harmless for any damages that may occur wfiile doing this
operation. This to include,but not limited to vahres,piping,walis,floors or the curb stop box aad service fine. in understand i am also required
to obtain a permit prior to any work,if necessary.
FINAL METER READING(old meter) �� �' ""'� �1�.J
Name• ' 1�^ Y1 Address '��� �1�t.( ��� [�Y ,
Phone Number � y'� J 6 Date [J� �� f�
Signature Witness Signature
OLD METER# I � �f 2 `�2� �
OlD READiNG � � ti� y �O
NEW METER# —{ I V � ��� �
NEW READlNG �
ERT# � � `2 l y � �
FR{DLEY CITY CODE
CHAPTER 402.WATER,STORM WATER AND SANtTARY SEWER
ADMINISTRATION
(Ref Ord No 113,464,565,566,629,638,662,922,988,1144,1156,1191j
402.5 PERMIT FEE
Prior to construding or repair of any water of sewer line connecting the existing municipal system and any house or building for whkh the
appltcatton is made.the aw�er or cor►trector shall be required to obtain a permlt for such connection,and shall pay a permit fee as provided in
Chapter 11 of this Code. After sucfi connection has been made,the Water and Sewer Department shali be notified. It shaii be unlawfuf to cover
any connecting tine until an inspedion has been made and such connection and the wark incident thereto has been approved by the City as a
proper and suitable connection.
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 properly line or a water service lead has
been extended to the property line for cflnnection,the applicarrt,owner,or occupant or user of such premises shall be liable for afl repairs
required to any water line and sewer lines necessary for connection of the premises from the main to the pcemises. If the properly a�rner
requests maintenance service or repairs be perFormed by the City,the p�operty owner shatl be charged for tfie costs af the maintenance and/or
repairs,including necessary street repairs at a�ate set annually by an administrative policy. it shall be the responsibility of the applicarrt,
owner,occupant or user to perform standard maiMenance of the sewer service line from the premises to the main inciuding 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 iand or property. (Ref 638,1156,1191)