Meter Swap � Request Number: 12705
Public Works Division
Service Request
Problem Address: 347 76th A�e Requested By: A�i Bachazd
Departme�: WATER Addreaa: No address provided
Problem/Iasue: INSTALL AMR ME'IER Phone Number: 763-807-8656
Scheduled Ih�te: 2017-01-06 � &Le�ialed 1lme: 01:30:00
\
AGTION NEEDED:
CYeated by: Wendy Hiatt Date Creatad: 2017-01-03
ACTION TAI�N:
���.s�.����, ��..�
Stxtns: In Progress ���er Hat Been �, .
CeMacted
Date Completed: �^ ��1� Completed by:
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City of Fridley � �
Water Department � (,r 1 �/
6431 University Avenue NE U � D
" Fridley,MN 55432 � �3 _�3-33�z,�
• 763-57Z-3566
1/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 liable fo�the water line from the main to the premise and al{iMerior
piumbing. (Per City code 402.06) i also hold the City of Fridley and/its empioyees harmless for any damages that may occur while doing this
operation. This to include,bufi not limited to valves,piping,walls,floors or the curb stop box and service line. In understand i am also required
to obtain a permit prior ta any work,if necessary.
FINAL METER READING(old meter) ��� � � ��
Name���`� ��G�� Address ��� / � �
Phone Number ��3 — ��7 ����W Date_ �'— �' ��
�—
,.�( Signatvre Witness Signature
✓�
OLD METER#_ � �—f����r
OLD READING ��� � 1 L'JO"
NEW METER# " l 1 1 I � lU� �
NEW READtNG �
ERT# C�S ���} O � � �
FRIDLEY CITY GODE
CHAPTER 402.WATER,STORM WATER AND SANITARY SEWER
ADMINISTRATION
(Ref Ord No 113.464,565,566,629,638,662,922,988,1144,i156,1191)
402.5 PERMIT FEE
Prior to wnstructing or repair of any water of sewer line connecting the existing municipal system and arry house or buildir�for afiich the
application is made,the owner or corrtractor shali be required to obtain a permit for such connection,and shall pay a permit fee as provided i�
Chapter 11 of this Code. After such connection has been made,tfie Water and Sewer Departmer�t sha11 be notified. It shaD be unlawful to crnrer
any connecting line until an inspection has been made and such connectioo and the worbc Inaderrt thereto has been approved by the City as a
proper and suitabie wnnection.
402.06 REPAIRS AND MAINTENANCE TO CONNECTION
After the initial connection has been made to the water service curb stop box or tfie sewer lead at the property line or a water service lead has
been eactended to the property line for wnnection,the applicarrt,owner,or accupant or user af such premises shall be lia�e for aii repairs
required to any water line and sewer lines necessary for con�ection of the premises from the main to the premises. If the property owner
requests mai�tenance service or repairs be performed by the City,the property owner shali be charged for the cos#s of the mairrtenance and/or
repairs,includin�necessary street repairs at a rate set annually by an administrative poliry. It sbatl be the responsibility o#the applicant,
owner,occupant or user to perform siandard mairrtenance 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 operahility and at such heigfit as wili ensure that it remains above the finished
grade of the land or property. (Ref 638,1156,1191j