Meter Swap A
Request Number: 15798
Public Works Division
Service Req�st
Probtem Address: 573 Fairmoxrt St Requested By: Alarick
Depnrtment: WAZER Address: No address provided
Probiemllssue: INSTALL AMR METER Phone Number: 651-245-9248
Schednled ate:,� 2017-06-09 ,,,� 5c6ednled'Rme: U1:30:00
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ACITON NEEDED:
Creuted by: Wendy Hiatt Dste Created: ZU 17-06-06
AC'IION TAI�N: ,
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Statua: Tn Progress Submitter Hsis Be�n r,
Conitncted
Date Compteted: �,,_ � � ��j Completed by: ��(,�
� r��-
. �6�a��radley ��(� — ���� '" �7
' Water�epartsvaert� �j� �/D /�7
fs431 l�niversity Averoue NE ✓., c t /
Fradley,MN 55432
753-572-3556
t jwe hereby authorize the Crty of Pridtey and/or its employees to tfo what is necessary to
replace fihe water meter. l understand that the pro�erty owner is liabfe for the water line from the enain to the premise and afl irrte�ior
plumbing. {Per C'rty sode 4�02.06) 1 aiso hold the City of Fridley and�ts esnp9oyees harmless for arry damages that may ocaar while doing this
operation. This to include,but not limited to va(ves,psping,waNs,floors or the curb stop box and service line. in understand t artt aiso requin
to abtain e permit prior to any worEc,if necessasy.
FIPIAL ME7'ER RE�1DlNG(old meter) "' ��t " � ��
Name: �� a v�u�� �,a� _ � �3 ��C��f9�� J'� .
Phone Number � �` ���'—' lav�D � � � �— �— ��
i nature �� J
itness Signature
OLD METER# � W �✓ � �
OLD READtNG �� �� ` ��
N�WMETER# � �aa � ���.
�E���►D,�G e
E�# �z�3 � 5� `7 c� -
F��n�+�v c�rr conE
CHiXt�TER�t02.WATER,STORM WATER AND SANITARY SEWER
ADMINfSTRAT1pN �
(Itef Ord No 113,464,565,566,629,638,662,922,988,1144,1156,1191j
402.5 PEiiMil'PEE
P�ior to constructing or repair of any water of sswer tine connecting the existing municipal system and arty house or buitd(ng for which the
application is made,the owner or contractor shali be required to obtain a permit for such con�ection,and shalt pay a permit fee as provided in
Chapter 11 of this�ode. After such connection has been made,the Water and Sewer Department shali be notified. It shail be un(awfui ta cover
any connecting line urrtit an inspection has been made and such connection and the work incident thereto has been approved by the CRy as a
proper and suitab{e connection.
402.06 REPAIRS AND MAlNTENANCE TO CONAIECTION
After the initial connection has been made to the water service curb stop box or the sewer iead at the properly line or a water servFce fead has
been extended Lo the property line for connection,the app{isasrt,owner,or occupant or user of such premises shali be liable for a(I repairs
required to any water line and sewer lines necessary#or connection of the premises from the main to the premise.s. If the property owner
requests mairrtenance service or repairs be perforrned by the City,the property owner shali be charged for the casts of the mairrtenance and/or
repairs,including necessary streeC repairs at a rate set annually bg an administrative poliry. It shall be the respansibitiiy of the applicant,
owner,occupant or user to perform standard mairrtenance of the sewer seroice line from the premises to fihe main including Jebris clearing�o�
root cutting and to mairrtain the wa�Cer service curb stop box for opera6ility and at such height as wi{I ensure that it remains above the finished
grade af tfie tand or properCy. (Ref 638,1156,1191)
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� INSTALLATION
CIlYOE .� ,:, . ����`#�����
FIZlDLEY .
Address �� � ��'� s �`C'i1'�� �`�
Name ►� ` �- � TI�`J�y �'"
Date � ^ �� - � �
Old Meter Number ` �`�s �� �
Old Meter Reading � �� 3 �� �
Replacement No. � �� ����
Replacement Reading !
Replacement Make I��'� � _ __
Remarks: � �����
Signed: '
Request for Service Report
City of Fridley
Reference No: 607-7 7-ZSOS Date: 02104111
Request Type: Install regular meter Enkered By: Wendy Hiatt
Department: Water Citizen Name: Mr.Alaric
Address: 573 FAIRMONT ST NE Callback Phone: 763-786-5048
Scheduled Date: Property�wner:
Location Details: Request Details_ Change stopped meter
Action Taken:
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o �l�. rv,.� {-e,- � `� 3 �. �5�" 3 � `"1
6 l� r e�� �� r3 �I. $ 3� � �
r1 e� �-e�--e�' � Ll. D L1.�`a d d'"�
��w t-e��� r�� P�
R esponsible Person: �`�
,f�,�o
Approver:
Complekion Date: fi� itizen Notified
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