Meter Swap �
� Request Number: 15922
Public Works Division
Service Request
Problem Address: 200 Ely St Requested By: Jaclde
Department: WA1ER Address: No address provi�d
Problem/Lcsue: INSTALL AMR METER Phone Number: 612-122-4022
Scheduled Date: 2017-06-1 Scheduled 1lme: 10:30:00
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ACIION NEEDED:
Created by: Wendy Iiiatt Date Crented: 2017-06-09
ACIiON TAI�N:
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Status: 1n Progress 5ubmitter Has Been r,
Contacted
Date Completed: � — 13 � � � Completedby: �
a.���,
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,. bVa#er Department 2
t431 l�niversi#y Avera�ae NE �p�� ���
Fradley,MN 55432 f�
763-572-3566
1/we hereby authorize the Crty of Fridley and/or its employees to do what is necessary ta
replace the water meter. I understand that the property owner is liabte for the water line from the main to the premise and all iMerior
piumbing. (Per�ty code 402.06j I also hold the City of Fridley and/its employees harmless for any damages that may occur while doing this
operation. '!'his to include,but not 6imited to vatves,piping,walis,floors or the curb stop box and senrice line. In understand 1 am also require
to oirtain a permit prior to any work,if necessary.
FINAL MErER READING(oid meter� � � �� ��O
Name• _ \(�C���`� Address �_�� tali� �':
Pho�e 9Yum `r��` `���-- !.v p�� Date �.Y '- �� ��
.
/ 7�Si�aature Witness Signatuse a'
l! -
OI.D METER# �� "^�'�D ,
OLD READING ��� I �OW
NEW METER# - ` 4� p�, � V G �
NEW READING v
��#_ -�a35 �o ��
FRIDLEY CITY CODE
CHAPTER 402.WATIER,STORM WATER AND SANtTARY SEWER
ADMINISTRATION
(Kef Ord No 113,464,565,566,629,638,562,922,988,Z144,1156,1191j
402.5 PERMIT FEE
Pnor to cvnstructing or repair of any water of sewer line connecting the euisting municipal system and arry house or building for which tfie
appiication is made,the owner or corrtractor shall be required to abtain a permit for such connection,and shatl pay a permit fee as provided in
Chapter 11 of this Code. After sucb connection has been made,the Water and Sewer Department shali be notified. tt shaii be unfarvFut to cover
any connecting line ur�ti!an inspection has been made and wch connection and the wor[c incident thereto has been approved by#he City as a
proper and witable connection.
4AZA6 REPAIRS AMQ MAINTENANCE TO COfl{NECT{ON
After the initial connedion has been made to the water service curb stop box or the sewer lead at the property line ar a water�rvite lead has
6een extended to the property line for connection,the apptica�,owner,or occupant or user of such premises shalt t�tiabie for ail repairs
required to any water line and sewer lines necessary for conneetion of the premises from the main to the premises. ff the property owner
requests maintenance service or repairs be performed by the City,the property owner shaU be charged for the costs of the rsiais�tenance and/or
repairs,inctuding necessary street repairs at a rate set annually by an administrative poliry. It shall be the responsibiiFty of the applicarit,
owner,occupant or user#o perForm standard mair�tenance of the sewer senrice line from the premises to the main induding debris deartng 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 af the iand or property. (Ref 638,1155,1191)
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j�4 SS`�7��v
City of Fridley
Water Department
Address__� ��;� �`�
Name��C� � Z'�(k�'"'. '
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Date_ �"JC'_' d�
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Old Meter Number L �
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Old Meter Reading � p 'S��
Replacement No. �.�
Replacement Reading
Replacement Makef �
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Remarks;_ � ��� ��,'(��
Signed
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