Meter Swap � � Request Number: 12714
Pubtic Works Division
Service Request
Probiem Address: 7550 Sth St R�quested By: Joei Rice
Departmeat: WATER ARWress: No�ddresa provided
Problem/1e:ue: INSTALL AMR ME1ER Phone Nnmber: 612-968-4486
Sc�ed�itd Date• 2017-01-06 � Sc�edded 11me: 10:00:00
c� —� � � �C� c�r�
AG"lION NEEDED:
Created by: Wendy Hi�tt Dde Created: 201�-01-0�4
ACTION TAI�N:
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. $t��: In Progress Snbmitter Has Beoe �,
Co�aeted
Date Coe�pteted: Compteted by:
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City of Fridley
Water Department �f�/v�v3
6431 University Avenue NE �Z)v�}���
. ' Fridley,MN 55432 � � ' � � �
. 763-572-3566
�Iwe hereby authorize the Ciiy of Fridley and/or its emptoyees to do what is necessary ta
replace the water meter. t understand that the property owner is{iable for the water fine from the main to the premise and all ir►terior
plumbing. (Per City code 402.06} i aiso hold the City of Fridley and/its employees harmless for any damages that may occur while doing this
operation. This to include,but not limited to vaives,piping,walis,floors or the curb stop box and service iine. In understand i am also required
to obtain a permit prior to aoy work,�f necessary.
FINAL METER READING(otd meter) ���� � Q��
Name• � '�l {��—�, � dress ��� (��' ��
Phane f4umber � `�� l��✓ Date �-`•.. � y !
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�Signatu +iness Signature ,"� .
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OLD METER#��,� 1 ��--��
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OLD READtNG 1�, S C��(�
NEW MEfER# ��ti�� r ��
NEW READfNG �
ERT# �J � '�J� ����
FR{DLEY C{TY CODE
CHAPTER 4�2.WATER,STORM WATER AND SANITARY SEWER
ADMlNISTRATION
(Ref Ord No 113,464,565,556,629,638,662,922,988,1144,1156,1191)
40Z.S PERMIT FEE
Prior to constructing or repair aF any water of sewer line connecting the existing municipai system and arry house or building for which the
apptication is made,the owaer or contrector shati be required to obtain a permit for such eonnedion,and shall pay a permlt fee as provided ta
Chapter 11 of this Code. After such conoection has been made,the Water a�d Sewer Department shall be notified. It shall be uniawful to cover
any connecting line umal an inspection has i�een made and such connettion and the work incident thereta has been approved by the City as a
proper and suitabte connection.
402.06 REPAIRS AfYD MAINTENANCE TO CONNfCTION
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 service lead has
been extended to the property line for connection,tfie applicaM,owner,or accupant or user of such premises shal{be fiabfe for afl repairs
required to any water line and sewer ltnes necessary for connecfion of ihe premises from the main to the premises. if the��erty owner
requests mair►tenance senrice or repairs be perfarmed by the City,tfie properly owner shail 6e chargecl for the costs o�f the mai�rtenance and/or
repairs,including�ecessary street repairs at a rate set annuaify by an administrative poliry. It shall be the+�esponsibili#y of the applicant,
owner,occuparrt or user to perform staodard mai+rtenance of the sewer service line from the premises to the main including debris clearing or
root cutting and to maintain the water service curb stop box for operabil'�ty and ai such height as will ensure that it remains above the finished
grade of the(and or property. (Ref 638,1156,1191)