Meter Swap ,
' Request Number: 15810
Pubtic Works Division
Service Request
Problem Address: 528 Janesville St Requested By: Kim
Department: WA1ER Addreas: No address providcd
ProblemlIasue: INSTALL AMR METER PLone Namber: 571-1018
Schednle e: 2017- 6-07 Sc6eduled 1lme: 08:30:OQ
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AC'lION NEEDED:
Crexted by: Wendy Hiatt Date Creatad: 2017-06-06
ACIION TAI�N:
� �►n S���G�L-� ��►�-�---..
.........................._._._____.__________.___...._._ _.._..._....____.__.__........�.._._._................_.._ ._____._.__...______...�. ��
Status: In Progress 5ubmitter Has Been r
Conta�cted
Date Compieted: � _ �!, �� Completed by: ��
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�9�,����d'e� o -�� i 2`��� �0 2
Wa#er Departe�er�t � �
` 6431 i,�niversity Avenue NE �O ,� (� (���
Frodley,MN 55432
763-572-3566
��'iVe hereby authorize the City of�ridley and/o�its emptoyees to sio wf�a�t is�ecessary to
reptace the water meter. 1 understand that the pro�oerty owner is liab(e fo�the vaater line from the maire to the premise and ali irtterBor
plumbing. (Per C'�ty tode 402.06j 1 also hold the City of Frid{ey and/its emplayees harmless for any damages that�nay oc.cur while doing tfiis
operation. This to indude,but not limited to vafves,piping,walts,floors or the surb stop 6ax and senrice line. in understand t am aiso require
to abtain a permit priorto any work,if necessary.
FBNAL METER REApING(otd mete�) `�� ` �� �
Name• L��1� Address � V �J1� �V ' �'� J�.
Phone�lumber J� � '" �� �, Date___ LO'-'" � `—" � �
�Signature Witness Signature
O!D NlETER# J�J V(� ` V
OLD RfADING ��� � a"J v
N�,��E,-E�# � `�0�2 CQ I 1�
NEll4�READtMG �
E�# �a3� �1 � ��7
.
FRIDlEY CITY CODE
CHAi�TER 4fl2.WA�'ER,STORM WATER AND SANtTARY SEWER
ADMtNlS'�'RATION �
��tef Ord No 113,464,565,566,629,638,662,922,988,1144,1156,1191)
402.5 AERMiT FEE
Prior to sonstructing or repair ef any water of sewer line connecting the existing municipa(system and acry house or building for which the
appl�pCion is made,the awner ar contractor shall be required to abtain a permit for such conoection,and shali pay a p2rm�t fee as provided in
Chapter 11 of this Code. After such connection has been made,the Water and Sewer Departmerrt shall be notified. it shall be un4awful to cever
any connecting line urrtil an inspection has been made and such connection and the urork incident thereto has been approved by the City as a
proper and suitabfe connection.
�(12.06 REPA(RS AND NfAiNTENANCE TO COIYPlECTIOAI
After the initiai connection has been made to the water service curb stop box or the sewer lead at the property line or a water servi�lead has
been eactended ta the property line far connection,the applicarrt,owner,or accupant or user of such premises shaii be}iabie for all repairs
required to any water line and sewer lines necessary for connection of the premises from the main ta the premises. tf the property owner
requests maintenance sesvice or repairs be performed by the�ty,the property owner shall be charged for the casts of the mairrtenance andJor
repairs,inc{uding necessary street repairs at a rate set annuaUy by an administrative policy. it shaii be the responsibility of the applicant,
owner,occupant or user Yo perf'arm standard rnairrtenance of the sewer service line from the premises to the main including debris clearing or
root cutting and xo mairrtain the water senrice curb stop box for operability and at such height as wifl ensure that it remains above the�nished
grade of the iand or property. (Ref 638,1156,1191)
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fi �,. � �, �. ��,:': � ��x
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City of Fridley
�ater Department
Address ,��"(� �a.�,.�,.5 1�.1/,c
Name �n �,x. ��.S�.�.
Date �d`- �--�' 13�
Old Meter Number `� -��O �,.�
Old Meter Reading 3 � �Q
Replacement No. 3����� (�'�
Replacement Reading v
Replacement Make �4 �„�
Remarks: � 2 1�J,.�e�
Signed