Meter Swap `*' " - `
` Request Number: 12432
Public Works Division
Service Request
ProMem Ad�dress: ?631 Jackson St Requcsted By: Fric Evans
Departmeirt: WA1ER Address: 7631 Jackson St
Pro�em/Tsaue: INSTALL AMR ME1ER Phone Number: 612-704-1120
Sc6ednledDate: 2016-12-19 Scl�ei�llme: t0:0U:00
1 �
ACIION NEEDED:Tnstall new AMI�Meter
Createdby: Jea�mic Benson Date Created: 2016-12-12
ACIION TAI�N:
�-�n-5�,. '-��t� ��—
Statns: Tn Progtess Submitter Hos Beea r
Contacted
D�e Completed: l� Com�eted by:
Honrs ����� `�"'
City of Fridley
, Water Department � �'� �� ��
' � 6431 University.Avenue NE � '
Fridley,MN 55432 '�...3��� .�
763-572-3566 `�(�� —�
�/we_!"%�'1(�L ��t��i� hereby authorize the City of Fridley and/or its employees to do what is necessary to
replace the water meter. i understand that the property owner is liable for the water line from the main to the premise and ail iMerior
plumbing. (Per City code 402.06) I also 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,floors or the curb stop box and service line. In understand 1 am also required
to obtain a permit prior to any work,if necessary.
FINA4 METER READING(old meter)��V � I ��
� (
Name: �"'�� lAC �v�LN� Address ���� J�`(,��VI S-�',
Phone Number l!�l� ��� � Date ��'� ` / � � �
�5ignature Witness Signature� �G'✓�
OLD METER# � / l�7�� � lp�
OLD READING ���� � ;)�
NEW MECER# " t / �� �� �7
NEW READING v'
ERT# � �� � o t {� ,
FRIDLEY Cf'iY CODE
CHAPTER 402.WATER,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 connecting the existing municipal system and arry house or building for which the
application is made,the owner or contractor shall be required to obtain a permit for such connection,and shall pay a permit fee as provided in
Chapter 11 of this Code. After such connection has been made,the Water and Sewer Department sfiall be notified. It shafl be uniawful to cover
any connecting line untii an inspection has been made and such connection and the work incident thereto has been approved by the Gty 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 servke lead has
been extended to the property line for wnnection,the appiicant,owner,or occupant or user of wch premises shali be Itable for all repairs
required to any water line and sewer tines necessary for connection of the premises from the main to the premises. If the property owner
requests mair�tenance service or repairs be performed by the City,the properly owner shall be charged for the costs of the maiMenance and/or
repairs,including oecessary street repairs at a rate set a�nually by an administrative policy. 1t shati be the responsibility of the applicarrt,
owner,occupant or user to perform standard maintenance of the sewer service line from the premises to the main including debrls clearing or
root cutting and to maintain the water service curb stop box for operability and at such height as wilf ensure that it remains above the finished
grade of the land or property. (Ref 638,1156,1191)