Meter Swap Request Number: 12469
Public works Division
Service Request
r._ n Address: 7618 Jackson St Requested By: Jeffrey Buckley
Department: WA1ER Address: No address provided
Problem/Issue: INSTALL AMR METER Phone Number: 952-540-7742
Scheduled Date: 2016-12-31 Sc�edaled 1ime: 09:00:00
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ACTION NEEDED:Ai�IIt '
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Crested by; Wendy Hiatt Date Cres�ed: 2016-12-15
ACITON TAKEN:
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Statua: In Progress • Snl�itter Hu Beea C,
Coutacted
Date Compfeted: � � , � �_ � r,� Complated by: /��
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City of Fridley S 6 � g 3 L�
. Water Department
, 6431 University Avenue NE
Fridtey,MN 55432 �3 0� `S 1 �3`�a'`� �
763-572-3566
�/We hereby authorize the City of Fridley and/or its emptoyees to do what is necessary to
replace the wafier meter. f understand that the properry owner is liable for the water line from the main to the premise and alt imerior
ptumbing. (Per City code 402.06) i aiso hotd the City of Fridley and/i#s employees harmiess far arty damages t6at may occur while doing this
operation. This to include,but nat limited to valves,piping,walts,floors or the curb stop box and service line. tn understand 1 am also required
to obtain a permit prior to any work,if necessary.
FtAIAt METER READING(old meter) � � � � '" ��
Name: ��'-t�-V""�`� ��1C.�`�°`�f l�fdress_�lJ��� �(i-G��1 d��..
.
Phone Number����,_,:� �-'�,,, Date l L 1 ��` � � ,
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Signature .,�_`'��� Witness Signature
OLD METER# � (..����t � r
OLDREADtNG v��� `�U
NEW METER#�� �I �� r �
NEW READtNG �
ERT# �� ����' �
�RIDLEY C1°'1'Y�+CODE
CHAPTER 4Q2.WATER,STORM WATER AND SANITARY SEWER
ADMINlSTRATlON
(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 arry water af sewer tine connecting the existing rr�unicipa!system and arry house or�tWing for which f,he
application is made.the owner or contractor shall be required to obtaia a permit for such connection,and shall pay a�rmit f¢e as provided in
Chapter 11 of this Code. After such connection has been made,the Water and Sewer DepartmeM sha!(be notified. tt shait be urtlawful to cover
any connecting line until an inspedion has been made aad such connection and the work inciderrt thereto has been approved by the City as a
proper and suiqbte connection.
402.06 REPAlRS AND MAINTENANCE TO COlVNECTION
After the initial cortnection has been made to the water service curb stop box or the sewer lead at t�he property line or a water servi�lead has
been extended to the property tine for connection,#he applicarrt,owner,or ocwpartt or user of wch premi,sses shati be IiaWe for all repairs
requirec!to any water Iine and sewer lines necessary for connection of the premises from the main to the premises. If the property owner
requests mairrtenance service o�repairs be performed by the City,the property owner shali be charged for the costs of the maiMenance and/or
repairs,inctuding necessary street repairs at a rate set annually by an administrative policy. It shafl be the responsibility of the applicaM,
owner,occupant or user to perform standard mair�tenance of the sewer service line from the premises to the main including debris clearing or
root tatting and to maintain the water service curb stop box for operabiiity and at wch heFght as will ensure that it remairts above the�nished
grade of the land or property. (Ref 63$,1156,1191)