Meter Swap � ' Request Number: 16276
Public Works Division
Service Request
Prob[em Address: 567 Kimbatt St Requested By: Susan Golvant
Department: WA1ER Address: No a�ress provided
Problemllssue: INSTALL AMR METER Phone Number: 763-785-4031
Scded e ate: 2017-07-12 Schednled 1Yme: 01:30:00
I �
ACTION NEEDED:
Created by: Beth Kondrick Date Created: 2017-07-10
ACTION TAI�N: -
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Status: Tn Progress 5ab�itter Hss Been r
Co�acted
Date Completed: 'j I 1 I� Completed by: ���� �
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Ci�y o#Frielley �j��'� �j� ��O /� ��
� ' Water Department
6431 UniversityAvenue NE S�� ���
Fridley,MN 55432
7C3-5723565
i/we hereby authorize the City of F�idley and/or its employees 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 ali interior
plumbing. (Per City code d02.06) 1 also hold the City of Fridiey andrts employees harmless for arry damages that may occur while doing this
operation. This to include,but not limited to valves,piptng,walls,floors or the curb stop box and service line. In understand 1 am also required
to obtain a permit p�ior to any worlc,if necessary.
FINAL METER READING{o1d meter) O�� � � g O
Name:_��'�V� ��'�1A'�,� Address J�9� ����� (5�.
Phone Number �V� " 5 r l�`�'� �`r ��, `" ��
V Signature Witness Signature
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OLD METER# ��� �� /V V
OLD READING v� 1� ! �� �
NEW METER# {��iJ�� / 1 =
NE1M READING O �
ERT# ��� � U 1 �
FRIDLEY CITY CODE
CHAPTER 402.WATER,ST�RM 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 municipai system and any house or building for which the
application is made,the owner or contractor shalf be required to obtain a permit for such connedion,and shall pay a permit fee as provided in
Chapter 11 of this Code. After such connedion has been made,the Water and Sewer Department shai(be notified. it shall be unlawful to cover
any connecting line until an inspection has been made and such connection and the wor[c incident thereto has been approved by the City as a
proper and suitable connection.
402.06 REPAIRS AND MAINTENANCE TO CONNEC7'ION
After the initiai connection has been made to the water secvice curb stop box or the sewer lead at the property line or a water service lead has
been extended to the property line for connection,the applicant,owner,or occupant or user of such premises shall be liable for all repairs
required to any water line and sewer lines necessary#or connection of the premises from tbe main to the premises. ff the property owner
requests maiirtenance service or repairs be performed by the City,the property owner shall be charged for the costs of the maintenance and/o�
repairs,including necessary street repairs at a rate set annually by an administrative policy. It shall be the responsibility of the applicant,
owner,occupant or user to perform standard maintenance of the sewer service line from the premises to the main including debris ciearing or
root cutting and to maintain the water service curb stop box for operabil'rty and at such height as will ensure that it remains above the�nished
grade of the land or property. (Ref 638,1156,1191)
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City of Fridley
Water Denartment
�ddress � � �''���
Name L�r�r�ns '3c�v�A1-7-.
Date_ �' �4�-j�7
Old Meter Number �j � � ��
Old Meter Reading �j p� Q
Replacement No. L � b
Replacement Reading �
Replacement Make �j��'�
Remarks: _���� ���
Signed
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