Meter Swap .
Request Number: 15359
Public works Division
Service Request
Problem Address: 188 71 st Way Requested By: Al�Roland
Department: WA1ER A+ddress: No address provided
Problem/Issue: iNSTALL AMR ME1ER Phone Nwnber: 763-571-6461
Scheduled Dnte: 2017-OS-17 �hednled Time: 01:00:0(1
AC1iON NEEDED:
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Crexted by: Betti Kondrick Date Crented: 2017-OS-1 S
ACTION TAKEN:
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Status: In Progress Submitter Hxa Been r
Co�acted
Dxte Completed: �_ f Completed by: ����
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City of Fridley
Water Department S�� �(��
6431 University Avenue NE
Fridley,MN 55432
763-572-3566
�/�+e hereby authorize the City of Fridley and/or its employees to do what is necessary to
reptace the water meter. 1 understand that the propertyr owner is liable for the water line from the main to the premise and all ir�terior
piumbing. (Per City code 402.06) I alw hold the City of Fridley and/Pts employees harmiess for any damages that may occur while doing this
operation. This to include,but not limited to vahres,piping,walls,floors or the curb stop Isox and seevice line. In understand I am also required
to obtain a permit prior to any work,if necessary.
FINAL METER READtNG(old meter� ` "v � � J `�
Name• ��G v� �O�G-�� Address �� C� 1 I� �a�{
Phone Number ��3— �� �"�� I w ' Date � '` `� ` 6�
Signature Witness Signature
OLD METER# ��5in �3�f
OLD READING � v� I , � Q
NEW METER# `���-J�
NEW READING d
E�# _ �11 � �. I15�
FRIDLEY CITY CODE
CHAPTER 402.WATER,STORM WATER AND SANlTARY SEWER
ADMINtSTRATiON
(Ref Ord No 113,464,565,566,629,638,662,922,988,1144,1156,1191)
,
402.5 PERMIT FEE
Prior to constructtng or repair of any water of sewer line wnnecting the existing municipal system and any house or bui�ding for which the
application is made,the owner or contractor shall be required to obtain a permit for such connection,and shall pay a permit fee as p�ovided in
Chapter 11 of this Code. After wch connection fias been made,the Water and Sewer Department shali be notified. It shail be unlawful to cover
any connecting line until an inspection has been made and such connection and the work incident thereto has been approved by the City as a
proper and suitable connection.
402.06 REPAIRS AND MAINTENAIVCE TO CONNECTION
After the initiaf connection has been made to the water service curb stop boz or the sewer lead at the property Iine or a water servkg lead has
been extended to the property line for connection,the applicar�t,owner,or occupant or user of such premises shait 1�liabie for all repairs
required to any water ITne and sewer lines necessary for connection vf the premises from the main to the premises. ff the property oyvner
requests maintenance service or repairs be performed by the City,the properly owner shaN be charged for the costs of the mairrtenance andjor
repairs,including necessary street repairs at a rate set annually by an administrative pofiry. ft shall be the responsibil'rty of the applicaM,
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 finished
grade of the land or property. (Ref 638,1156,1191)
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Qld Meter Number b ` � � o�?
Old Meter Reading LI o I� ��
_ Replacement No, �� � ��3 7
Replacement Reading
Replacement Make 1.� ��
�SD'�T J.t _ — � . . . _O .
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. Remarks�
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_ Signed ` — —'�