Meter Swap M1
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Request Number: 16124
Public works Division
Service Request
Problem Address: 540 Do�r St Requested By: Harriet
Depnrtment: WATER Address: No adidress p�ovided
, Problem/Issue: INSTALL AMR METER Phone Number: 763-784-6656
Scheduled Date: 2017-06-26 Scfieduled'Rme: 09:00:00
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ACTION NEEDED:
Created by: Beth Kondrick Date Created: 2017-06-23
ACTION TAI�N:
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Status: In Progress Sabmitter Has Been r,
Contacted
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Date Completed: _ Completed by: ��1�
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� City of Fridley �Y �' Y'O ��
Water Departrnent
6431 University Avenue NE
Fridley,MN 55432
763-572-3566
I/we hereby authorize the Crty of Fridley and/or its employees 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 irite�ior
plumbing. (Per City code 402.06) I also hold the City of Fridiey 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 or the curb stop box and senrice line. In understand 1 am also required
to obtain a permit prior to any work,if necessary.
FINAL METER READING(old meter) v 1.� 7�� �
Name: ��AN��`�'a Address J� U ����� ��►
Phone Number ��� � � J "�Q�5� Date �Q � �""� � 1
�Signature ���"'_"_'�' Witness Signature �
OLD METER# ������`�'�
OLD READING � � v 1 "'l� 6 �./
P1EW METER# ` 1 �� l0 33�
NEW READING O
ERT# � ��� / � D�
FRIDLEY CITY CODE
CFiAPTER 402.WATER,STORM WATER AND SANITARY SEWER
ADMINISTRATtON
(Ref Ord No 113,464,565,566,629,638,662,922,988,1I44,1156,1191)
402.5 PERMI7 PEE
Prior to constructing or repair of any water of sewer line connecting the existing municipal system and arry house or lwiiding for which the
application is made,the owner or contractor shail be required to obtain a permit for such connection,and shall pay a permit fiee as provided in
Chapter 11 of this Code. After such connection has been made,the Water and Sewer Department shall be not�ed. It shali be untawful 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 connedion.
402.06 REPAIRS A{YD MAINTEIVANCE TO CONINECTION
After the initial connection has been made to the water service curb 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 applicant,owner,or occupant or user of such premises shait be liable for all repairs
required to any water line and sewer lines necessary for conneetion of the premises from the main to the premises. If the property owner
requests maintenance service or repairs be performed by the C"ity,the properly owner shall be charged for the costs of the maiMenance and/or
repairs,including necessary street repairs at a rate set annually by an administrative poliry. It shail be the respo�sibility of i�e applicarit,
owner,occupant or user to perform standard mair�tenance 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 la�d or property. (Ref 638,1156,1191)
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City of Fridley
Water Department
Address �� ��� �"�
Name ��2'�1 ET �-I I.t�`���'C..yv�,
Date_ ��L ��
Old Meter Number � � � � � �
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Old Meter Reading -l ` Q Q
Replacement No. �_ � -��j �
Replacement Reading �
Replacement Make��1�-�'�Z
Remarks: ``�j`�(>�,� (1��� , �
Signed_�--�
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