Meter Swap 4
Request Number: 14966
Public works Division
Service Request
Problem Address: 120 Hartma�m Circle Requested By: Stephanie Ling'.
Department: WATER Addresa: No a�ress provi�cd
,,�� Problem/Issue: INSTALL AMR ME'IER Phone Number: 763-210-5598
Scheduled Date: 2017-OS-01 5chedoled'IIme: 11:00:00
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ACTTON NEEDED:
Created by: Beth Kondrick Date Created: 2017-04-26
ACIION TAI�N:
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Status: In Progcess Sabmitter Has Been r.
Ca�acted
Date Completed ,i.: Completed by:�
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City of Fridley �������O /O-Q�
Water Department (� � ��J,K
6431 University Avenue NE
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Fridfey,MN 55432
763-572-3566
�1�►e hereby authorize the City of Fridley and/or its empbyees to do what is necessary to
replace the water meter. i understand that the property owner is liable for the water line from the main to the premise and all intertor
plumbing. (Per City code 402.06) I also hold the City of Fridley and/its employees harmless for any damages that may oaur while doing this
operation. This to include,but not limited to vaives,piping,walls,floors or the wrb stop box and senrice line. In undeesWad!am also requtred
to obtain a permit prior to any work,if necessary.
FINAL METER READING(old meterj � � ��� �
Name: ��.� ��'��W CJ �` `Y Address_,��v �(,�"�Y,,�. �.41 l�v�
� Phone Number �����v ���� Date � ~ � � ` �
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'''����� Signature Witness 5ignature
OLD METER# �� �tSf ����
OLD READING �lL� � t ✓�
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NEW METER# �- �� _
NEW READING � '
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FRIDLEY CITY CODE
CHAPTER 402.WATER,STORM WATER AND SANITARY SEWER
� ADMfNiSTRATfON �
(Ref Ord No 113,464,5b5,566,629,638,662,922,988,1144,1156,1191)
402.5 PERMIT FEE
Prior to construcCing or repair of any water of sewer line connecting the existi�g muntcipat system and arry house or buildirig for which the
application is made,the owner or corrtractor shall be required to obtain a permit for such connection,and shal{pay a permit fee as pnwided in
Chapter li of this Code. After such connection has been made,the Water and Sewer DepartmeM shali be notified. R shall be uniawfui to cover
any connecting line until an inspection has been made and such connection and the work intident thereto has been approved by the City as a
proper and suitable connection.
A02.06 REPAIRS ANQ MAINTENANCE TO CONNECTION
After the initial connection has been made to the water service curb stop box or the sewer fead at the property line or a water servke lead has
been extended to the property line for connection,the appiicant,owner,or occuparrt or user af such premises shaii be liable for all repairs
required to any water fine and sewer lines necessary for connection of tfie premises from the main to the premises. ff the property owner
requests maintenance service or repairs he performed by the City,the property awner shall be charged for the costs of the maiMenance and/or
repairs,including necessary street repai�s at a rate set annuatly by an administrative paficy. It shati be the responsibility of the applicant,
owner,occupant or user to perForm standard maintenance 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�nished
grade of the land pr property. (Ref 638,1156,1191)