Meter Swap � Request Number: 12358
Public Works Division
Service Request
Problem Address: 7471 Jackson St Requested By: Leslie Rolstad
Depwrtme�: WATER Addresa: 7471 Jxkson St
Fridley,MN 53432
Problem/Issue: INSTALL AMR METER 1►6one Namber: 6S 1-249-3437
Sched�ed D�e: 2016-12-1 SeLeduled TYme: 01:3Q:00
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A�Z�N NF.ED):Dr Instatl AMii
Cre�ed by: Beth KondFick D�tte G�e�a: 2016-12-AS
ACI�t�i T�41�FEN:
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Stat�: Ia Pro�css Stbmitter Has Bce� �
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Date�ou�pteEed: I�, ��"�I � Cemple�d by:
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City of Fridiey �� � � I (�{
Water Department � < <
. 6431 University,Avenue NE
s Fridley, MN 55432 3 l� ��� �����I
763-572-3566
1/we �-p5�i�° �2�'��i'� C hereby authorize the City of Fridley and/or its emptoyees to do what is necessary to
replace the water meter. 1 understand that the property owner is liable for the water line from the main to the premise and all iMerior
plumbing. (Per City code 402.06) 1 aiso 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,fioors or the curb stop box and service line. In understand 1 am also required
to obtain a permit prior to any work,if necessary.
FINAL METER READING(old meter) `�v � � � "
Name• Ltyi���' ���t'�-� Address / � / ' J GiC �c3x�k 5��
Ahone Mum tiV"� 1� � 1 — � 1� 1 pate �Z� � —`� �
��Signature Witness5ignature �'�f
OLDMETER# �°'��� � � � �
OLD READING �� � � ` �
NEW METER# " 1� �� �7� �
NEW READING d
ERT# l,� � C� 7 I � 3�
FRIDLEY CITY CODE
CHAPTER 402.WATER,STORM WATER AND SANITARY SEWER
ADMINISTRATION
(Ref Ord No 113,464,565,566,629,638,662,922,98$,1144,1156,1191)
402.5 PERMIT FEE
Prior to corrstructing or repair of any water aF sewer lir�e connect�ng the existing municipal system and any house or building for wNich the
application is made,the owner or contractor shail be required to obtain a permit for such connection,and shail pay a permit fee as pr�ided in
Chapter 11 of this Code. After such connection has been made,the Water and Sewer Department shall be notified. it shaii 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 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 line or a water serrice lexl has
been extended to the property line for connection,the applicarrt,owner,or occupant or user of such premises shall be liabie for ali 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 costs of the maintenance and/or
repairs,including necessary street repairs at a rate set annually by an administrative poliry. It shali be the responsibility of the applicar�t,
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 wiii ensure that it remains above the�inished
grade of the land or property. (Ref 638,1156,1191)