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Fridley
Request Number: 17330
C P�c worka Diviaioe
Servke R�e�at
Preble�Addresa: 1604 b8th A� ReQncated By: T�sa or S�r�ha
Dapsrtmeat: WAT�dt Address: No addr�sa provided
Pra�em/Issee: INSTAL.L AMR ME1ER P�oae Namber: S71-0O10
Sc6edule�D�e: 2017-12-03 ScLednled 1lme: 10:{l0:00
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Cre�ed by: W�+I�Iiatt Date Created: 201?-11-29
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City of Fridley
Water Department � � Cj���„
6431 University Avenue NE
Fridley,MN 55432
763-572-3566
l/we hereby authorize the City of Fridley and/or its employees to do what is necessary to
replace the water meter. I understand that the property owner is liabfe for the water line from the main to the premise and all interior
plumbing. (Per City code 402.06) !also hold the City of Fridley and/'ns employees harmiess for any damages that may occur while doing this
operatlon. This to include,but not limited to valves,piping,wa{Is,floors or the wrb stop box and senrice line. In understand 1 am aiso required
to obtain a permit prior to any work,if necessary.
FINAL METER READING(old meter)
Name: 1�/���. Address �_���/ �!V� �
Phone Number J� I`� �d �v Date � �` �— � `
Signature Witness Signature
OLD METER# aa���� `o� SIZE & STYLE(Circle)
OLD READING aT,a37,3 C)� 5/8" HEX
NEW METER# ���� 6� � � 1" HEX
NEW READING V 1 i4 ELIPTICAL or HEX
ERT# �ace� � 5 �3 2" ELIPTfCAI or HEX
FRIDLEY CITY CODE
CHAPTER 402.WATER,STORM WATER AND SANITARY SEWER
ADMINISTRATION
(Ref Ord No 113,464,565,566,629,638,662,922,988,1144,1156,1191y
402.5 PERMIT FEE
Prior to constructing or repair of any water of sewer line connecting the existing municipal system and any house or building for which the
application is made,the owner or wM�actor shall be reguired to obtain a permit for such connection,and shaif pay a permit fee as provided in
Chapter 11 of this Code. After such connedion has been made,the Water and Sewer Departme�rt shall be natified. It shaif be uniawful to cover
any connecting line until an inspection has been made and such connectio�and the work incident thereto has been approved by the City as a
proper and suitable connection.
402.06 REPAIRS AND MAINTENANCE TO CONNEC710N
After the lnitial connedion has been made to the water service curb stop box or the sewer lead at the property line or a water se�vtc�lead has
been extended to the property line for connedion,the applicant,owner,or occupant or user of such p�emises shall be liable for att repairs
required to any water line and sewer lines necessary for connection of the premises from the main to the premises. If the property owner
requests maintenance service or repairs be perFormed by the City,the property owner shall be charged for the costs of the mair�tenance aed/or
repairs,including necessary street repairs at a rate set annually by an administrative poliry. It shall be the responsibility of the applicaot.
owner,occupant or user to perform standard maintenance 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 operability and at such height as will ensure that it remains above the�nished
grade of tfie land or property. (Ref 638,1156,1191)
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