Meter Swap � Request Number: 12962
Public Works Diivision
Service Request
Problem Address: 7370 Hayes St Requested By: Melanie Popper
Department: WA1ER Addresa: No address provided
Problemllssue: INSTAI.L,AMR METER Phone Namber: 763-784-0986
Schednled Date; 2017-02-01 5c�ednled T1me: 10:00:00
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ACIION NEEDED:
G�eated by: We�y Hsatt Date Cres�ed: 2017-Oi-19
ACIION TAI�N:
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Status: In Frogress 5ebmitter Hat Heee �..
Coutacted
Date Completed: Co�eted by:
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wa���-���a►����,t �� �� :� � � �`,
5431 ilniv�rsi�tvf 1�ver�ue NE
Fridley,MN 55432 •� � I -`��' ���L'' �,'` �
753-572-3566
• 1Jwe hereby authorize the�ity�f Fridley andior its employees to do what ds necessary to
rep4ace the wafier rneter. 1 understand that the property owner�s liabie for the water line from the main to the premise and all iMerior
plumbing. (Per CFty code 402A6j i alsa hoid the Crty of Fridley and/°rts emp{oyees harmless tor any siamages that may occur white doing this
operation. This to include,bufi not Bimi#ed to vaives,piping,walls,floors or the curb stop box and service line. In understand!am also require�
to obtain a permst pr9or to arry wa�Rc,if necessary.
FIIYAL METER READi (o6d met ����� "' �
Name: `'�i �� � Address �U r, �
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Ptwsse Numbe �� `\���+�,J�F' Dace v� Y / /
Signature Witness Signature -
o�o nnFr�R�__ �� � ����
OLD READING_V c,.� V'�� G�O
NEW METER# �� YV � J�"7
NEW READING_�,!
ERT# ��p7� � ��
FRIDCkY C{TY CODE
CHAPTER 402.WATER,S'CORM WATER AND SANITARY SEWER
ADMH�ttSTRAT{OiN
{Ref Ord Mo 113,464,565,566,529,638,662,922,988,1144,1156,1191]
402.5 PERMIT FEE
Prior to cor�structing or repair of any water of sewer line connecting#he existing munitipaf sys�tem and any house o�buildi�for which the
appiication is made,the owner or corrtractor shall be requir�ed to obtain a perm'rt for such connection,and shalf pay a permit fee as pmvided irr
Chapter 11 af this Code. After such connection has been made,th¢Water and Sewer Departmerrt shail be rtot�f'ied. (t sha(1 be unlavvFul to correr
any tonnecting tine until an inspection has been made and such connection and the wor6c inaderrt thereto has been approved by the C'ity as a
proper and suitabte connectia�a.
402.06 REPAIRS AND MAIAITENANCE TO CONAlEC1'tOl�t
After the inifiial connectio�fias l�een made to the water servsce curi�stop pux or the sewer lead at the property fine or a water service lead has
been extended to the property line for connection,tfie applicarrt,owner,or accupant or user af such premises shali be IiaMe for aA repain
required to arry water line and sewer lines necessary for connection of the premises from the mai�to the premises. if the property orrner
requests mairrtenance service or repairs be perFormed by the City,ihe property owner shall be+charged far the costs af the matrrtsnar�ce and/or
repairs,inctuding necessary street repa�rs at a rate set annuaily by an administrative pol'sry. it sha(i be the respansbitity of the applicarrt,
owner,occupant or user to perforsn standard mairrtenance of tE�e sewer service line from the p�emises to the main inciuding debris dear�ng or
root cutting and to maintain#he water service curb s#op box for operability and at such height as wiil ensure that it remains a�ve the 8n�hed
grade of the land or property. �Ref 638,1156,1191)
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.. Cr..�./`��d ,n Ql�����
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� ,� City of Fridley
� � Water Deoartment
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Address �� � � � Ovt,-C s S T _
, Name�,e �cl v1 f C �OI'H ll1� � __
�ate � '" ��!'"'�6' _.
Old Meter Number H � ! �
Old Meter Reading � � 6 � �
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Replacement No. o� 3 Q ��
Replacement Reading 5�
� Replacement Make Q,� � , .
. ' Remarks• � . _
Signed '
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