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Meter Swap � ' Request Number: 12531 Pubtic Works Division 5ervice Request Problem Addresa: ?350 Concerto Cun�e Requested By: Mic�lle O�rerhy Depxrtme�: WA'IER Addreas: 7350 Co�erto Cur� _ Fridlcy,MN 55432 Problem/Issue: INSTALL AMR METER P6one Number: 612-314-3699 Schednied Date: 2017-01-20 Seheduled Time: 10:00:00 � � ACIION NEEDED:�tall AMR Created by: Beth Kondrick Date C�e�ed: 2016-12-21 ACIION TAI�N: ___---._ �-�-5�. �� . ' Status: In Progress Submitter Has B�en �, Contactcd �.Date Completed: I—�O._ �� Completed by: ��,` � lJ��'�U 1 � �� `l� Ci�rcy of Fridley � (, Water Department 6431 UniversityAvenue PIE 3� y_ s�y�� " Fridley,MN 55432 � 763-572-3566 �/We hereby authorize the City of Fridley and/or its employees to do what is necessary to replace the water meter. 1 understand that the property owner is liable tor the water line from the main to the premise and all interior plumbing. (Per City code 402.06) I aiso hold the City of Fridley and/its empioyees harmless for any damages that may occur while doing this operation. This to include,but not limited to valves,piping,walls,floors ar the curb stop box and service line. in understand 1 am also required to obtain a permit prior to any work,if necessary. FINAL METER READING(old meter) v �� 1 ""'�� Name: M�L��"l, '�� Address 1 J�� V�GG�ir`� (�� Phone Number�,Q1�'al"" c/� ` �� Date l�� r� l `� �gnature Witness Signaiure OLD METER# � �� l U J(J� OLD READING �� NEW METER# V� � i V l V� NEW READING � E�#_C�� er� �� . FRIDLEY CITY CODE CHAPTER 402.WATER,STORM WATER AND SANITARY SEWER ADMINISTRATION (Ref Ord No 113,464,565,566,629,638,662,922,988,1144,1156,1191) 402.5 PERMIT FEE Prior to constructing or repair of any water of sewer line connecting the existing municipal system and a�►house or building for whid�the application is made,the owner or coritractor shall be required to obtain a permit for such connection,and shalt pay a permit fee as provided irr Chapter 11 of this Code. After such connection has been made,the Water and Sewer DepartmeM shali be notified. It shall be unlawful to cover any conneding line umil 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 MAINTENANCE TO CONNECTION After the initial connection has been made to the water service wrb stop box or the sewer lead at the property line or a water service lead has been extended to the property line for connection,the appliqnt,owner,or occupant or user of such premises shail be liable for all repairs required to any water line and sewer lines necessary for connection of the premises from the main to the premises. ff the property owner requests mair�tena�ce senrice or repairs be performed by the City,the property owner shall be charged for the costs of the maiMena�e and/or repairs,including necessary street repairs at a rate set annualiy by an administrative policy. It sha0 be the responsibility of the ap�icaM, owner,occupant or user to perform standard mair�tenance of the sewer service line from the premises to the main i�ciudir�debris dearing or root cutting and to mairrtain 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) � � -� �� City of Fridley ��5 Water Department Address �� C.Oh�@r�o l�ur�� Name �� Date � �� Old Meter Number 4b � � � ✓� Old Meter Reading � '.� Replacement No. �J 5 �� Replacement Reading Replacement Make ��t-��r' �.... _ �p Remarks: 6�� "'' ' ~ �`�'`� �`� / C Signed — � ;