Meter Swap � - Request Number: 14703
Public Works Division
Service Request
Problem Address: 5940 Stinson Blvd Requested By: Lindsey Langness
Department: WATER Address: No address provided
Problem/Issue: INSTALL AMR METER Phone Number: 612-432-8872
Scheduled Date: 2017-04-21 Scheduled Time: 07:00:00
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ACTION NEEDED:
Created by: Beth Kondrick Date Created: 2017-04-14
ACTION TAI�N:
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Status: In Progress Submitter F�as Been �,
Contacted
Date Completed: Completed by:
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Y� � City of Fridley
Water Department
6431 University Avenue NE
Fridley,MN 55432
763-5723566
�/H►e hereby authorize the City of Fridiey aed/or its employees to do what is necessary to
replace the water meter. 1 understand that the property owner is liabie for the water line from the main to the premise and alt interior
piumbing. (Per City code 402.06) I also hold the City of Fridley and/its employees harmless for a�ry damages that may occur while doing this
operation. This ta include,but not Itmited to valves,piping,walls,floors or the curb stop box and service Iine. In understand 1 am also required
to obtain a permit prior to any work,if necessary.
FINAL METER READING(old meter) ���� I � �
Name: �1� d��-�{ l�(�'t� J J Address � / �L/ ���✓1,�6� �L�
Phone Number �J'�� l ,, �^ � �� `-1'"�l "'1�
Signature Witness Signature
OLD METER#__(..1 ` � I J���
OLD READING D 10� C 14
NFW METER# `� � "' �'"� ` �
NEW READING �
ERT# � 2��� ��� �
PRtOtEY CITY CODE
CHAPTER 402.WATEFt,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 arry water of sewer line connecting the extsting munlcipal system and eny haise or buildi�for whid�the
application is made,the owner or corrtractor shall be required to obtain a permit for such connection,and shall pay a permit fee as provided in
Chapter 11 of this Code. After such connection has been made,the Water and Sewer Departmeirt shall be notified. k shall be unlawful to cover
any connecting line until an inspection has been made and swch connection and the work incident thereto has been approved by the City as a
proper and suitable connedion.
402.06 REPAIRS AND MAINTENANCE TO CONNECTION
After the initial connedion has been made to the water service curb stop box or the sewer lead at Lhe property Itne or a water servke kad has
been extended to the property line for connection,the applipnt,owner,or ocwpant or user of such premises shali be IiaWe for ali repairs
required to any water line and sewer lines necessary for connection of the premises from the main to the premises. If the property rn�rner
requests mairrtenance service or re{�airs be perfarmed by the City,the property owner shali be charged for the costs of the maiMenance and/or
repairs,including necessary street repairs at a rate set annually by an administrative poliry. It shall be the responsibility of the appli�ant,
owner,occupant or user to perform standard maintenance of the sewer service line from the premises to the main including debris dearing or
root cutting and to maintain the water service curb stop box for operability and at such height as wiii ensure that it remains above the flnished
grade of the land or property. (Ref 638,1156,1191)
Reques# for Serv�e Repor#
Ciiy of Fridley
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