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Meter Swap ��- �� iop-- �� Request Number: 12360 Public works Division Service Request _ _ __._. 7420 Jackson St Requested By: Jan Perupsky - - 7420 Jackson St - DepArtmeut: WATF1t Address: Fridley,MN 55432 Problem/Issue: INSTALL AMR METER P6one Number: 763-786-3933 Sc6eduled Date: 2016-12-07 Schednled Tfine: 08:40:�0 ,ev�l c� � �' � ACTION NEEDED:I�tail AMR Createdby: BethKoc��ick DateCrented: 20t6-12-OS ACTION TAI�N: � n��e � � St�tus: In Progress Snbmitter Hns Beea C Contacted Date Completed: Completed by: Hours � � � � � IZ City of Fridley `� Water Department �� t� ( � , 6431 University.Avenue NE Fridley, MN 55432 �j�f-��-I G�� '�l 763-572-3566 I/we hereby authorize the City of Pridley and/or its employees to do what is neceuary 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) !also hold the tity of Fridley and/its employees harmless for any damages that may ocwr while dang this operation. This to include,but not limited to valves,piping,walls,floors or the curb stop box and service line. In understand I am aiso required to obtain a permit prior to any work,if necessary. FINAL METER READING(old meter) � � ` `-� � � � Name: �� V'Q S� Address— ` �, �� a��o� � PhoneNumber ��"� _�� Date I L — I � ' � xSignature t . Witness5ignature "�L__._..----^----�- OLDMETER# �� OtD READtNG ( / f � � �� V NEW METER# - ` � �I�Z� I NEW READING_ � — ERT# ��V � � VZ� FRIDLEY C17Y CODE CHAPTER 402.WQTER,STORM WATER AND SANITARY SEWER ADMINISTRATION (Ref Ord No 113,464,565,566,629,638,662,92Z,988�1144,1156,1191) 402.5 PERMIT FEE Prior to constructing or repair of any water of sewe�line connecting the ezisting municipai system and any house or buiiding for which the application is made,the owner or corrtrador shall be required to obtain a permit for such connection,and shall pay a permit fee as�ded in Chapter ii of this Code. After such connection 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 connection and the work incident thereto has been approved by the City as a proper and suitable connedion. 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 Itne or a water service lead has been extended to the property line for connection,the appiicarrt,owner,or occupant or user of sucM premises shali be tiabie for 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 a�rner requests mai�rtenance service or repairs be performed by the City,the property owner shatl be charged for the cvsts of the maiMenance and/or repairs,including necessary street repairs at a rate set annualiy by an administrative poliry. It shall be the respons�ility of the applicarrt, 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) �� ` � � h � ,� � � � � �� A � � °x � � �..:, r:� �. tr .4' r`� ,� �u��;. � v d�, �a�� ;� �� f x � � � � � .�, ,'}� City of Fridley ! Water Deuartment Address � �'/2� � �CL'lSd v� , Name ,�c��.T s�V Date � %d -�9 0 o1d Mete ��.��3� / � �•L . . �.�-""1 Y� Old Mete � ng � � Q ._._ — `' �, ��i�� Replacement No. � '" Replacement Reading C��C�d�[ �"'� s�,"�teplacement Make ,��rr �,o�"` R�marks: �f /yl�%�/'�� ,�,. ��, .� S igned � •'�-- . �-- " :. '��1� �� -��,�- � � ,��,�1� ��d Z;�.-�, ��`�� ,�,,�I�� o-vr�-�� "M'�' �'y�'�D'�/ �?' � �� °�' �'�°1 ��`� , � �� _ � �'��' �.�� . - �� .� ��. �,.�;� �--�.�'� ,n � � �� -�'�,� ��'�''�� b'a�'j � �,�� ,,�,� ---�� 0� �,.��-,.,1, �r;>-�,-,J r-� 1 r�rr��-,,, r�-/� ..(� � }-�-r�� (}') '�-Y?'-�.i�'C� r'� i.�' +� 1\ �� `�"�..:--S ? � ;�?'�"��?' ' �ti�-.�/�,l f �'� ./ tX-L"�-c=�� L�{ ,r/��t„U••T -'L"�'- , J `�. �Z-c..� ;2�.��' �vt� � �`i?�c"�-��i� l � , � ,� ^, � � a-� � ;�� e�` � � � � _ � � U.v, �'L+.tiC�'�- �J � ! ``'�" - �/�J�✓��N`-• � � � � l.,r`�`'o U�� ---�Q 7`_'[:�'�-�" �lJ� � � w'� ` -�'� + ��' U