Meter Swap 4
' Request Number: 16015
Public Works Division
Service Request
Problem Address: 630 Hugo St Requested By: Jo Born
Department: WATER Address: No address�ovided
Problem/Lcsue: INSTALL AMR METER Phone Number: 21$-232-2315
Scheduled Date: 201 06-19 r.,� Schednled 1lme: 10:00:00
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ACITON NEEDED:
Created by: Wendy Hiatt DaEe Crexted: 2017-06-15
ACTYON T .
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Status: In Progess Submitter Has Been r
Co�acted
Date Completed: Completed by:
�o—I°I-11 `7� laY
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�i�ty of�a^iclB�y
w��er���a��,�n� 3�g j �����a ��
� f�3�l�niversity Avenue NE
� Fr�dley,MN 55432 /�
763-572-356i ��� `'r7Z2
t/we hereby autharize the Crty of Fridtey and/or its employees to do what is aecessary to
replace the water meter. f a�nderstand that the property mwner is liable for the water Iine from#he anain to the premise and ali interior
plumbing. (Per City code 402.06) I also hold the Crty of Fridiey and�ts emptoyees harmtess for arry damages that may occur while doing this
operation. Th1s to include,but not limited to vatves,piping,walis,floors or the curb sfiAp box and seswice{ine. In understand 1�m also requirE
to abtain a permit prior to any work,if necessary.
FINA!METER READIAtG(oid meter) cJ� l D�
Name• -��.?Y1l � V/�� �j� C�
Address_
Phone Num 11T 2�"L-'���`S pate �p `_ 1-1-r ��
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�Signature Witness 5igrtature
OLD METER#2'j-1�, ����
OLD READlNG� 3 �`'Ta �
NEW METER# `'"1��`v�S� 1
NEW READtNG Q
El�T# � `� ✓ ��- 1q
FRiDLEY CfTY CODE
�klAPTER 4UZ.WATER,STORMI WATER AND SARIITARY SEWER
ADMfNISTRATIOAt
{Ref Ocd No 113,464,565,565,629,638,662,922,988,1144,1156,1191)
4025 PERMIT FEE
Prior to constructing or repair of any water of sewer iine connecting#he existing municipal system and any house or bui(ding for which the
appfication is made,the owner or contractar shall be required to obtain a permit for such connection,and sha(I pay a perm'rt fee as probided in
Chapter 11 af this Code. After such conneccion has been made,the Water and Sewer Department shall be not'rF'ied. It shall be unlawFul to cover
any connecting line untii an inspection has been made and sucfi connedion and the work incident thereto has been approved by the Crty as a
proper and suitable co�nection.
402.06 REPAIRS AND MAINTENANCE TO CONNECTION
After the initia!connection has been made to the water senrice curb stop box or the sewer lead at the property line or a water service Iead has
been extended to the property line fo+�conriectian,the applicarn,owner,qr occupam or user of wch premises shall be liable for all repairs
required to any water li�e and server lines necessary for conneetion of the premises irom the main to the premises. ff the property owner
requests maintenance service or repairs be performed by the C'rty,the property owner shatl be charged for the cesks of the mairtitenance and/ar
repairs,inciuding necessary street repairs at a rate set annually by an administrative poliry. It shall be the responsibtlity of the applicarrt,
owner,occupant or user to perform standard mairrtenance of the sewer service line from the premises to the main including slebris clearing or
root cutting and to maintain the water service wrb stop box for operabifity and at such height as will ensure that it remains above the finished
grade of the iand or property. (Ref 638,1156,1191j
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city of Fridley
Water Department
Address ��� ��:
Name��lt"�►�l'�p�t ���"����3,i� �
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Date �� � ' p �
Old Meter Number !� r� � b+3� �
Old Meter Reading � � �`� �
Replacement No. � �� � �� �J
Replacement Reading
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Replacement Make �a�,q,��
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Remarks• �
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� Signed
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