Meter Swap Request Number: 13590
Public Works Division
Service Request
Problem Address: 560 Hugo St Requested By: Ronald Nordin
Department: WATER Address: No address provided
Problero/Issue: INSTALL AMR METER Phone Number: 763-443-0123
Scheduled Date: 2017-02-21 Scheduled Time:
ACTION NEEDED:
Created by: Wendy Hiatt Date Created: 2017-02-21
ACTION TAI�N:
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Status: In Progress Submitter Has Been r
Contacted
Date Completed: Completed by:
a-a �- ��1
, � City of Fridley �� C'i�s �b C'S� ��
' Water Department �
6431 University Avenue NE 5��?�'�5��jv p�
Fridley, MN 55432 5��
763-572-3566 �1 ��
I/we hereby authorize the City of Pridley and/or its employees 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 interior
plumbing. (Per City code 402.06) I also hold the City of Fridley and/its employees harmless for any damages that may occur while doing this
operation. This to include,but not limited to valves,piping,walls,floors or the curb stop box and service line. tn understand I am also required
to obtain a permit prior to any work,if necessary.
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FINAL METER READING(old meter) �
Name:�I�,/v f�.�� �r� �� I ;]�J Address ��✓V v V
Pho�e Numb�X,���"���� �� ��� Date �� �
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Signat�3r�' ��'ti`t�i;� ,7� l'�i�l:vC���'__" Witness5ignature� c..�,�+�;
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OLD METER# n����1() ����� ��c'.fi`� 1��j G�
OLD READING � l>� v�`..J
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NEW METER# C� 4 �+, � 6 �`} ` �
NEW READING �r���� �
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ERT# � � � � l5�' � vl.,� ���
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JITARY SEWER
(Ref Oi " ��G� g, 1144, 1156, 1191)
6ld � <<-f : W ��-,�rc��.S
402.5 PERMIT FEE _ r_
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Prior to constructing or repair of any tem and any house or building for which the
application is made,the owner or co �, �,4,2� iection,and shall pay a permit fee as provided in
Chapter li of this Code. After such c v�'��'` `J`r� ���!��� L��Y ient shall be notified. It shall be unlawful to cover
any connecting line until an inspectia ` ,, ��� �' A � ��� ent thereto has been approved by the City as a
proper and suitable connection. W ��,
402.06 REPAIRS AND MAINTENANCE
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After the initial connection has been n ;)' /` at the property line or a water service lead has
been extended to the property line fo� 1 such premises shall be liable for all repairs
required to any water line and sewer li ____...�„�rnain to the premises. If the property owner
requests maintenance service or repair ,__......�.cu U�/L�l@ Clt�/,the property owner shall be charged for the costs of the maintenance and/or
repairs,including necessary street repairs at a rate set annually by an administrative policy. It shall 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 finished
grade of the land or property. (Ref 638,1156,1191)