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Meter Swap . " " ` Request Number: 12572 Public Works Division Service Request Problem Addrees: 73Z0 Co�erto Curve Requeated By: Gene Hegul�d Dep�rtmeat: WA1ER A�ddress: No address provid�ed Problem/Iss�: INSTALL AMR ME'IER Phoae Namber: 763-78A-3S68 Schedoled Date: 2017-01-(19 Schedal 11me: Ol:00:00 �� AG7ION NEEDED:AMR Cre�ed by: Wendy His�t l�te Created: 2016-12-27 ACIION TAtiJ:N: �� Status: In Progress SuMoitter H�u Beea �.., Coetaeted Dnte fompteted: Completed by: / � � � I ` City of Fridley ��'7 - 5��/5�a `-�J Water Department '` 6431 University Avenue NE Fridley,MN 55432 � � � �� 763-572-3566 �/We hereby authorize the City of Fridley and/or its empioyees to do what is necessary to repiace the water meter. 1 understand that the property owner is liable for the water line from the main to the premise and all irrterior plumbing. (Per City code 402.06) 1 also hold the C'ity of Fridley and/its employees harmless for any damages that may occur while doing this operation. This to include,but 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 to any work,if necessary. FfNAL METER READ{N6(oW eter) r � � � � Name: � j t�:- �� Address � �D �JUr'c�'� Phone Number �'~� Tl_��' � i �-- C� � `� �V Signature Witness Signature l� l� OLD METER# � � � � � {� � OLD READING_��I � � �� NEW METER# � � � � � �� NEW READING D ERT# � �� 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 am/house or buildtng for whic�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 provided irr Chapter 11 of this Code. After such connection has been made,the Water and Sewer Department shall be notified. it shali be unfavrful to cover any connecting line urrtil 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 arb stop box or the sewer lead at the property line or a water service lead has been extended to the property It�e for�nnect'son,the apptica►�t,oarner,or occuparrt or user o�f wcfi premises shall be tiable for afl 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 mairstenance service or repairs be performed by the City,the property owner shall be charged for the coshs of the mairrtenance and/or repairs,including necessary street repairs at a rate set annually by an administrative poliry. It shall be the responsibility of the applipnt, owner,occupant or user to perForm standard mairitenance of the sewer senrice 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 wili ensure that it remains above the�nished grade of the land or property. (Ref 638,1156,1191) �f,� � f' 4 I .,4 T" �:j .}`..d ;��{ i Ns i^ i T a v.I �,f � ��; y_ �. . . . . . . . . ' i �� - . . city af Fridley �ater Department Address / � �� C�P1 Cer"� �t�!"LE, Name �`�V�. ��.� ��rJ� Date �'-�. "C�3 � Old Meter Number � � � �v 1 ' Old Meter Reading � b 6� � Replacement No. � �� /� Replacement Reading Replacement Make �Cl.�-q� Remarks: �� . ' S igne ��'��