Meter Swap • Request Number: 15329
� Public works Division
� Service Request
Problem Address: 113 Hartman Circle Requested By: C}�arles Shola►
Department: WA1ER Addresa: No adc�eas provided
Problem/Issue: INSTALL AMR METER Phoee Number: 763-571-5489
Sched�iled Dste: 201'7-06 5 Scheduled 1ime: 09:OO:OU
AG7ION NEEDED:
CreAted by: �th Kosc�ick Uate Created: 2017-OS-12
ACITON TAI�N: �
Status: In Pro�rress Submitter Ii�Been �
Co�acted
Dgte Completed: Compieted by:
Honrs
o�:�-���-��6�
9f�ve hec�f�y autho�-ize tfae£' of FrFcii
regtlace�e aora�er snetea�. 1�aoderstanc!i8�a�fi tFae ro e � �ancBJoe-its emptoy�es to aio vvha�ss�eces
� €n �flavnea�s tiaisle fmr�lae�ratec lie���rom�he anais�fio�Cae premise and ati aarterio
�ataarra�sing. (g�ey-�'sty�oa9e��ZZ.Ofs� �a3.s��soi+d tfie�"rty��dle+�and/"rts em�isayees haamless�or any siaraiages tiaaC�aay occaxs rr4�aiie sia4i
� npea�a'tiore. �'iaFs���nclu�e,�x�t saca+c�asa�s�ee!�cca uaives,pipin�wa[Ts,�9�ors os�te caar3�sto�o box aead seavece lirse. Irn ur�derstand�am atso
� t�o otataiea a per�r►it prao�r�o aeay�ror�,if s�ecessarye
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' �F9RiAL�fEi'ER�tEADINC:�o(d meterj
+�ame:
Atfdress
Pi�one�tumber ��
S"egnatu�
�tness S'ignad�re
OLD MESER�
OLD}�EADt�11ti
tOf EiA��IIE�R#
NE���
��t�'# '
�4tIDtEY C!�'1l CODE
CH�'Eti�UZ.WA7'EFd,S�'ORN!illf��'E4$AfitD S�kNiTARY SE1NEf�
AD�►IRN�S6'FA77�lIt
�3tef Orc!31[v 113,�4,565,066,629,6380 SCZ,922,988,ig�4,1156,1191j
4Q2.5 PEFtrilflT�EE
Priorto cvnstructir�g or repair of any wa�er oF�ewer iirae connecting fihe e�r.istirsg rnunicipaf systera and arry Fts�use or buiWistg for whidt the
epplicatiflrs is artade,fifse owner or aorrtractar shall be required to o6fiain a pernsit for such c�onnediori,and s(�ali pay a permitfee as ptovidi
Cha#rter 3,Z of this Code. A�r sucf�connection has�een rnade,fihe dMell'ater and Se�ver Depaebnerrt�lta11 be reotified. it shall be untawfui tu
ar�y cv�nnecCing fine urriti7 an inspectiora has k�een snade and�ach cor�aeclaon and the wor�c tnaderrt thereto has been aPProved by the�ty a
proper and suitab(e sonnectaion.
4t72.06 ►tEP�li�s AND 9kiA1NTENA9YCE TO CONl�fEC7'tON
Ai`�er the inTtiaf sonnection has been made fio the water service wrii stop box or the searer iead at fif�e P+'aPe�l it�e or a water�ervice iead
been exfiended to the praperty line fvr connectiaa,the appiicarrt,owner,or accuparrt or�ser vf such premises s(�a(i 6e liataie fvrali repairs
required to arry�er rne and sewer lsnes necessary#or connection aF fihe premises from#he main to the prem�es. 1f tfie p�q�er
requests ma�rrtenance senrice ar regairs be perForrned by tfie C'ity,�ae p�roper[y owner sha11 be cfiarged for the�s af i�e mairrCenarrce an
repa�rs.inciudirag necessary street�pairs at a rate set ar�nuaily�y an administrative po�icy. 1t shaJf be the responsbii"rtj/o#the applic�,
owner,occuparrt or s�ser to perform standard mairrtenance of the seuver service line from the prem�ses�to the main�nduding debrts c�eari�g
roofi c�ting and�o mairrCain the water service aarb sfiop I�ox for opewabslity and at su+ch�eight as vaill ensure that it remaira a6we fihe flnisf:
grade of the�and or property_ (iZeif 538,1156,1191}
���/or rr�aoey
Water Department ��',� � / ( �� Q �
6431 University Avenue NE � � �
� Fridley, MN 55432 c /�//�
�`; 763-572-3566 `� `��t
�
��v�� hereby authorize the City of Fridley and/or its employees to do what is necessary to
replace the water meter. !understand that the property oarner is liabie for the+nrater line from the main to the premise and all interior
piumbing. (Per City code 402.06) i also hold the City of Fridley and/its empioyees harmless#or any siamages that may occur while doing this
operation. This to include,but not{imited to vaives,piping,wails,fifoors or the curb stop box and service line. In understand I am also requlred
to obtain a permit prior to any wordc,if necessary.
FITIAL METER READiNG(ofd meter) � � v� ���
Name: ��� '�Q,� Jf ��l�ddress ���) ��AJ`J��Lt,Y�, ����L{`�'
Phoae Number ��� �'� �`� �� Date J��Yr � l��
`. Si nature Witness Signature "—�
OLDMETER# _ 1 t������
1� ����V V/ .i{' � tp:
OLD READtNG �
NEW METER# �����VV
NEW READING ��
ERT# ���`jJ 'd � •
FRIDLEY CITY CODE
CHAPTER`�:�A"FER,STORN{WATER AND SANITARY SEWER
ADMtNlSTRQTION
(Ref Ord No 113,464,565,566,629,638,662,922,988,1144,1156,1191)
402.5 PERMIT FEE '
`` :. • �
^ - ' ;y
: Prior to constructing or repair of any water of sewer line connecting xhe existing municipal system and arty house or buiidirig for whic�
application is made,the owner or coritractor shall be required to obtain a permit for such connedion,and shall pay a permii fee as provided in
Chapter 11 af this Code. After such connection has been made,the Water and Sewer Departmerrt shall be noC�ed. it shall be un(awful to cover
any connecting line until an inspection has been made and such connection and the worlc inciderrt thereto has been approved by the Gty as a
proper and suitab4e connection.
402.06 REPAIRS AND MAIM'ENAlNCE TO CONNECTION
After the in�tial connectio�has been made to the water service curb stop box or the sewer lead at the property iine or a water service lead has
been extended to the property line for connection,the appiicant,owner,or accupaM or user af wch premises shaii be IiaWe for ell repairs
required to any water line and sewer lines necessary for connection of the premises from the main to the premises. Ff the property owner
requests mairrtenance service or repairs be perfarmed by the C'rty,the properly owner shall be charged for the costs of the mairrtenance and/or
repairs,inciuding necessary street repairs at a ra#e set annually by an administrative policy. It shall be the responsibility of the applicant,
owner,occuparrt or user to perform standard mairrtenance of xhe 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 finished .
grade of the land or property. (Ref 638,1156,1191)
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