Meter Swap ` Request Number: 15062
Public works Division
Service Request
Problem Address: 140 Hartman Circle Requested By: Lindsey
Department: WA1ER Addreas: No adchess provi�d
Pro6lemlIasue: INSTALL AMR METER Phone Number: 612-247-3504
Scheduled Date: 2017-05-04 Schedeled 1lme: 09:00:00
I �f�` C�v�^ �
ACIION NEEDED:
Created by: Wendy Hiatt I1ate Created: 2017-OS-01
AC'IION TAI�N:
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___._......___.__... ........_....__�.........._______.______ _ _ _. __............__..____...__.._._.__�...____ -�� :
Sta4ss: In Progress Submitter Has Been �..,
Contacted
Date Compteted: � ,��,_'� Completed by: � ��
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City of Fridley �j� � J��
Water Department
6431 University Avenue NE
Fridley,MN 55432
763-572-3566
�/We hereby authorize the C�ty af Fridley and/or its employees t�do what ts necessary to
replace the water meter. 1 understand that ihe property owner is liabie for the water line from the main to the premise a�xl af{irrterior
plumbing. (Per City code 402.06) I aiso hold the City of Fridiey and/its employees harmless for any damages that may occur while doing this
operation. This to incfude,but not limited to valves,piping,waiis,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.
FINAL METER READING(oid meter)_ O� � - L v � �
Name• l"���%5�i/ Address ��� ��'filVlult� ��i�`l'�
Phone Number ��2--� ��6 " 3��1 Date �� t� ��
Signature Witness Signature
OLD METER# W� ����
OLD READfNG � l � 1 U�O
NEW METER# �q a o 8 03�
NEW READING �
ERT# ��� � � � ( v/
FRfDLEY CITY CODE
CHAPTER 402.WATER,STORM WATER AND SANiTAR1t SEWER
ADMINISTRATION
(Ref Ord No 113,464,565,566,629,638,662,922,988,1144,1156,1191)
402.5 PERMIT FEE
Prior to tonstructing or repai�of any water af sewer line conoecting the existir�g municipai system and any house or building for which the
appiiption is made,the owner or contractor shall be required to obtain a permit for wch connection,and shaU pay a permit fee as provided in
Chapter 11 of this Code. After sucfi connectio�has been rnade,the Water and Sewer DepartmeM shail be notified. It shalt be unlawfu)to cover
any connecting fine untii an inspection has been made and such connection and the work incident thereto has been appraved by tfie City as a
proper and suitable connection.
402.06 REPAIRS AND MAINTENANCE TO CONTIECTION
After the initiai connection has been made to the water service curb stop box or the sewer fead at the property line or a water senrice lead has
been extended to the property fine for connection,the applicant,owner,or occupant or user of wch premises shali be IiaWe for all repairs
required to any water line and sewer(ines necessary for connection of the premises from the main to the premises. If the property owner
requesis maintenance service or repairs be performed by the City,the properly owner shafl be charged for the costs of tfie maiMenance andjor
repairs,inciuding necessary street repairs at a rate set annually by an administrative poliry. {t shall be the responsibillty of the applicaM,
owner,occupant or user to perform standard maintenance of the sewer service line from the premises to tfie main induding debris dearing or
root cutting and to maintain the water service arb stop box for operability and at such height as wiil ensure that tt remains above the finished
grade of tfie land or property. (Ref 638,1156,1191j
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City of Fridley
Water Devartment
Address �'�'�O r"'��"� C�'�(�
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Name s
Date / � C�~ ��
Old Meter Number `� 1 �� ��—
old Meter Reading � � � 2 a
Replacement No. � � l 3 ���
Replacement Reading �
Replacement Make
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Remarks• ��'�� ��
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S igned -�"� z
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R�q�e�t for �rvi+� �tepart
City af Fndley
r��t�: s�-�2-� o��: s���72
F� T�e: Se��ador 6rter�ci�y: �lendy F��
Qepartment: Sew� ta`t�'z�x,t�a�ne: lindsey�z�
l4d�ess� 14[!FlNFtTMAN CIR NE C�ac�t Phone: 612-2'47-35U4
Sc��� [}�e: Prcxperiy Uwn�r:
Location C�t�: � Deta�a= Qrec�se�s�lt'
,4cti�Tai�en:
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