Meter Swap LL Request Number: 12946
Public Works Division
Service Request
Problem Address: 1334 76th A� Reyuested By: Cynthia Loso
Departme�: WA1ER t4ddress: 1334 7bth Art
FricIley,MN 55432
ProWem/7ssue: INSTALL AMR METER Phone Number: 763-78S-9584
Scheduled 2017-01-27 Sc6ednledllme: 03:00:00
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ACIION NEEDED:
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Createdby: BethKondrick DateCre�ed: 2017-U1-19
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ACIION TAI�N: � ' ` -
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Status: In Progress ���er Hu Been r.,
Co4tacted
Date Completed: '` Compieted by:
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iNater�epartrnent
6431 llniv�rsit�Aver�ue AlE �f�`�;p ��,3 j�I �? • �� i
� FridLey,MN 55432 � J
753-572-3566 �� � � ) L�
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her�by authorize#he�iiy of Fridley and/or its empioyees to do what ds necessary to
replace the water�neter. �understand that the Qroperry flwner is liabte fo�the water line from the main to the premise and all i�erior
plumbing. {Per City cocle 402.06) i aiso hold the C'rty of�ridley and/'rts employees harmless#or any sJamages that may occur while doing this
operation. This to include,but not limrted to valves,piping,walis,floors�r the curb sto�o box and service line. In understand!am also require�
to obtain a permit prior to any worlc,if aecessary.
FINAL METER READING old meter) � ��� � ��
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Name: � Addre�
Phone Num v�(/��5 a�. _ � — �� ` � l
Signature ` �"'
Witness Signature Z�
OLD METER# � ✓� 1 1� �p ��p
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I�LD READtNG C� 6 C� 1�-� V
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NEWMETER#���V 1 �� V' "'`�
NEW READtt1fG �
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FRIDLEY�ITY CODE �
CHAPTER 402.WATER,STORM WATER AND SANITARY SEWER
ADMINISTRATION
(R2f O!-d NO 113�464�565�566r 629�638�662�922�9$8t�1144�1155�1191)
402.5 PERMIT FEE ,
Prior to constructir�g or repair of arry water ofi sewer line connecting the existing municipal system and arry house or buildirq�fur which the
application is made,the owner or corrtractor shall be required to obtain a permit for such conr�ection,and shall pay a permit fee as provided in•
Chapter 11 of this Code. After wch connection has been made,the Water and Sewer Departmertt shali be notified. Pt shali be unlawful to cover
any connecting line until an inspection has been made and such connection and the work inciderrt thereto has been appro�d by the City as a
proper and suitable connection.
402.06 REPAIRS AAID MAINTEIYANCE TO COfMAlECT10N
After the(nitial connection has been made to the water service wrb stop box or the sewer lea4(at the property li�e or a water service iead has
been extended to the property line for connection,the applicarrt,owner,or accupartt or user o#such premises shaii be liable for ali repairs
required fio any water line and sewer lines necessary#or connection of the premises from the main to the premises. Ff the property owner
requests maintenance service or repain be perFormed by the Crty,the proper#y owner shali be charged for#he costs of the mairrtenance and/or
repairs,including necessary street repairs at a rate set annuaily by an administrative policy. R shatl be the respons�bitity of the applicarrt,
owner,occupant or user to perform standard maintenance of#he sewer service line from the premises to the main including debris dearing or
root cutting and to maintain the water service curb sfiop box for operabil'rty and at such height as will ensure that it remains above the finished
grade of the land or property. (Ref 638,1156,1191)
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City of Fridley
Water Department
Address�� ��j���
Name �I►Sj�y �--��p
Date �'�� �$
Old Meter Number C �d
01d Meter Reading
Replacement No.
Replacement Reading�
, Replacement Make ����Cyt92. �
I, Remarks• L„��[�/ �t'es2
Signed� `