Meter Swap .
�. Request Number: 15943
Public works Division
Service Request
Problem Address: 8200 East RivEr Rd Requested By: Kevin Partlow
Department: WATER Address: No address provided
Problem/Issue: IN5TALL AMR ME1ER Phone Number: 651-283-0010
� ScheduledDate: 2017-06-13 SchedWedllme: 07:30:00
' �t
� ���� 1 �
.
ACTION NEEDED:
Created by: Wendy Hiatt Date Created: 2017-06-12
AC'I�bN TAI�N:
�.. 5 d� �� �
5tatus: In Progress Snbmitter Has Been �.,
Contacted
Date Completed: �^ I� y �� Completed by: ����
1 `,�` ��T
�a
��iy����aa'�� a�5 r ��PB�d rC1�
` water�De�artment ,j'� ,� ;(�'��~-]
`' �431 l�niv�rsc#y Avenue NE '' �
FerodOey, MN 55432
763-572-3566
�/"iVe hereby autfiorize the City of Fridley and/or its employees to slo what is necessary to
replace the water meter. 1 understand that the�roperty owner is Iiable for the water tine from#he main to the gremise and alt irnerior
plumbing. �Per�'rty code 402A6j 0 also hold the Crty of Frid►ey andrts employees harmless for any damages that may occur whi(e doing this
operation. 7his to inciude,but not limited to valves,piping,walis,flovrs or the curb stop hou and service line. In understand i�m aiso requirE
to o6tain a permit prior to any work,if necessary.
FINA!METER READING(ald meter) o ��o a 5 0
wame: �� �I�� (AC`��(�W Address (���� �S�` [,►`UCl` �.''�-
,('�`__1r � Phone�tumber� �! �U�" �� l � Date � ~ � � "`` � t
���.,.�
�� vS Signature Witness Sigaature
o`D M�E�# _ 3� � �����1
OLD READING ��� v v� �
NEW METfR# t��� � U 1 3
NEW READlNG �
E,�# `�23 ����q
FR[DLEY CITY CODE
CHAP'TER 4Q2.WATER,STORM WATER AND SANiTARY SEWER
ADMINISTRATION
(ttef Ord Nm 113,464,565,566,629,638,662,922,988,1144,1156,1191)
402.5 PERMIT FEE
Prior to�onstructing ar repair of any water of sewer fine mnnecting the existing municipa!system arid any house ar Iwifding for which the
app4ication is made,the owner or contractor shafl be required to obtain a permit for such rnnnectioa,and shal!pay a permit fee as provided in
Chapter iZ of this�ode. After such connection has been made,the Water artd Sewer Oepartmerit shali be notified. tt shal[I�untawful to coaer
any conneding line unti!an inspection has beert rnade artd such connection and the work inadent thereto has been approved by the C�ty as a
proper and suitable connection.
402.Ofi REPAIRS ATiD MAINTENANCE TO CONtYECfiON
After the initia[connection has been made Co the water service curb stop box or the sewer fead at the property line ar a water senrice lead has
been extended to the praperty line for connection,Che appticaRt,owner,or occupant ar user of such premises shall be ltable for all re(sairs
required to any water line and sewer tines necessary For conneetion of the premises from the main to the premises. fF the property awner
requests mairrtenance service or repairs be performed by the City,the property owner shall be charged for the�af the maintenance and/or
repairs,including necessary sCreet repairs at a rate set annua{ty by an administrative poliry. It shal!be the responsibility of the appiipnt,
owner,occupant or user to perform sCandard mair►tenance of ihe sewer service iine from the premises to the main tnduding�lebris dearing or
root cutting and+to maintain the water service curb stop box for operabitity and at sach height as wiii ensure that it remains above the tinished
grade af the land or property. (Ref 638,1156,1191j
/ � 3�'�
✓ /��!�s���
City of Fridley
Water Dei�artment
Address_��� ��.��(17_
F•U
Name �11 t T-► ��P1?�-[�..p� �
Date_�r6—�
Old Meter Number f �
Old Meter Reading ����
Replacement No. �
Replacement Reading Q�
Replacement Make p'�(7 ,
� Remarks: pLp ��--�-�r
Signed
___..-.�`�..,.
'�
i
,
.�