Meter Swap �
REQUEST FOR SERVICE REPORT
C1TY OF FRIDLEY
� Reference Na �� ��� Date: ._. ,� �
� � 7
Request Type: �- ��'� Entered By: �
Department: � Citizen Name: ��p�1
--�,� 3�� �z-Z
Address: �]p�> �i � Phone Number. 1
Scheduled Date: Property Owner:
Location Details: Request Details:
Action Taken:
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Responsible Person:
Approver:
Completion Date: /'�,.Q��� Citix�n Notified:
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City of Fridley 3('�^ �/U �"���
Water Department � � ���
6431 University Avenue NE
Fridley,MN 55432
763-572-3566 ,
�/We hereby authorize the C'ity of Fridley and/or its employees to do what is necessary to
replace the water meter. 1 understand that the property ovrner is liable for tfie water line from tfie main to the premise and all iMerior
plumbing. (Per City code 402.06) I also hold the�ty of Fridley and/its employees harmless for any damages that may ocau whife doing this
operetion. This to include,but not limited to valves,piping,walls,floors or the curb stop box and senrice line. In understand I am also required
to obtain a permit prior to any work,if necessary.
FINAL METER READMG(old meter) ��� IV� �v
Name:�b�� /70.� f/t O wi t�Z Address_y�� ����
Phone Number -79 (�"+���7 Date "" �� ,
SignBture Witness Signature
OLD METER#�I�O?}� t�( Sf�'"�
OLD READING � � 1���
NEW METER#�l��O� �W
NEW READING „�
ERT# G � � L�r lj 1 .
FRIDLEY CITY CODE
CHAPTER 402.WATEI�,STORM WATER AND SANITARY SEWER
ADMINISTRATION
(Ref Ord No 113,464,565,566,629,638,662,922,988,1144,1156,1191)
402.5 PERMIT FEE
Prior to constructing or repair of any water of sewer line tonnecting the existing municipal system and arry house or building f�which the
application is made,the owner or contractor shall be required to obtain a permit for such wnnection,and shall pay a permit fee as provided in
Chapter 11 of this Code. After such connedion has been made,the Water and Sewer Department shall be notified. It shall be unlawful to cover
any connecting line until an inspection has been made and such rnnnection and the work incident thereto has been approved by the City as a
proper and suitable connection.
402.06 REPAIRS AND MAINTENANCE TO CONNECTION
After the initial connection has been made to the water service curb stop box or the sewer lead at the property tine or a water seroke lead has
been extended to the property line for connection,the applicant,owner,or occupant or user of such premises shall be liable fo�all repairs
required to any water line and sewer lines necessary for connection of the premises from the main to the premises. If the property owner
requests maintenance service or repairs be performed by the City,the property owner shall be charged for the cos�of the mairrtenance and/or
repairs,including necessary street repairs at a rate set annually by an admi�istrative poliry. 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 maiMain 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�