Meter Swap � � Request Number: 13661
Public works Division
Seivice Request
Problem Address: 6128 Woody Ln Requested By: Andrew
Depart�e�: WATER Addreas: 6128 Woody i.,n
Fridley,MN 55432
ProMem/Isane: INSTALL AMR METER Phone Numbers 715-220-0545
Sc�ednled Date: 2017-03-06 Schedaled Tlme: 10:30:00
(Y�Cr,r � (�;
ACIION NEEDED:
Created by: Beth Kondiick Date Created: 2017-02-34
ACIION TAI�N:
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Statns: 1n Progress 5ubmitter A�Been �,
Couticted
Date Co�pleted: Completed by:
3- � - r� �' �
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�431�Jneversity Averacae N�
FrodBey, 11IS41i 55�.32
753-572-3556
�'�� hereby authorize the�iiy af Fa�idley andJor its empioyees#o s!o what is�ecessary 4
•. reg�lace#he meater sneter. i anderstand td�a#the�ropeaty owner is liable for the yvater line from the main to the premise and ail irrterior
{�lurrr9�ing. (Per City cosle 4�2.06j I also hold the�'�ty trf Fred�ey and/'rts errspioyees hacmless#or arry sJamages tE�at anay�vr+rhile daing thi
o�er�aYion. This to�ncfude,but nac Iianitecl io valves,piping,walls,floors or tfee curb stop�ox and service line. In understand I also requ
to obtaire a perani�prio�r io any rro�c,�f necessary. 7��'
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FINAt f1AEi'ER D1fYG(old meterj �� / �D �'� ' �
Alame• /tddress �� (/� \
Phone Wum6er� '�"'� ����5 Date__1J^�—,�
Signatur� Witness Signature
o�D���R#_3�2-.� I8�3
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OLD READtNG�� i0� � �� �
NEW METER# ��V� li 1�� � �
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NEW READ111(G � �
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ERT# � `� .
ERfDLEY+CITY CC�BDE
CHAP�'ER 402.WATER,STORM WATEI�AND SItNITARY SEWER
ADMI1�ItSTtiA7'ION
�Ref Ord NO 113,464,565,�66,629,638,�62,922,9$8,I144,115fi,1191)
4Q2.5 PERMIi'FEE
Prior to sonstructing or repair of any wa�er of sewer line connecting the exisfing municipat system and arry house oc buildirig fvr which the
eppiicafiion is made,the owner or cornractor shatt be required to obtain a permit for such�onection,and shali pay a permit fee as proy�ded n
Chapter 12 of this Code. After such connection has been made,the Water and Sewer Department shal!be not'�F"ied. ft shafi be untawful to cov
any connecting line until an inspection has been made and such connection and the wor�c inciderrt thereto has been approvet!6y the City as a
pmper and sisitable connection.
402.06 REP,O►iR5 AND MAIN't'Ell(q1yCE TQ Cp�1{gIECT10N
After the inifiial connection has been made to the water service curb stop box or the sewer Sead at tfie property iine or a water service lead(�as
been extended to fihe prvperty line for connectian,the applicarrt,owner,or occuparrt or user oF such premises shall be Ifable for a!I repairs
required to arty water line and sewer lines necessary#or connection of the premises from the main to the gremises. tf the proparty owner
requests mairrtenance service or repairs be performed 6y the C'rty,the property owner shail be charged for the sosts af the mairrtenance and/a
repairs,including ne+cessary sireet repairs at a rate set annually hy an adminiskrative policy. R shatl be tl�e responsi6ility of the agp6carrt,
owner,vccupan#or user to perform standard mairrtenance af the sewer service line from the premises to fihe main incfu�ng debris dearing or
root cutting and to maintain#he water service curh stop box for operability and at such height as wili ensure that�C remair�above the flnished
grade of the land or property. �Ref 638,1156,1191)
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Add�'�ss �' �� �o OCh�i� � �./�
Name �Y��Y4� L L4��Na A,T�'�
Date r� tv"��
Old Meter Number � � ���t
Old Meter Reading � � �
Replacement No. JT �D l � �
Replacement Reading
Replaceme�t Make-i�� �
Remarks• �
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Signe