Meter Swap ` Request Number: 15758
Public Works Division
Service Request
Problem Address: 190 Liberty St Requested By: Karen
Department: WATER Address: No address provided
ProblemiIssue: INSTALL AMR ME'TER Phone Number: 763-783-0020
Scheduled Date: 2017 6-09 � Scheduled'ISme: 10:00:00
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ACTION NEEDED:
Created by: Beth Kondrick Date Created: 2017-06-OS
ACTION TAKEN:
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Status: In Progress Submitter Has Been r
Contacted
Date Com leted: Completed by:
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Ci#y�#Fr6dley
, � w���r���a��e�� �l� � ���za_ ��
fs431 t�niversity Avenue NE L����
Fr6ci9ey, MN 55432 ///��/
7fi3-572-3566 `f�KJ (
�/°pre hereby authorize the City ofi Fridley and/or its employees to slo what is necessary to
replace the water meter, t vnderstand that the g�roperty ouvner is liable for the anrater iine from the main to the premise and all irrterior
plurnbing. (Per City code 402.06) i also hold the City of Fridley andjits employees harmless for arry damages that may occur while doing this
opeiration. This to include,but not limited to valves,piping,walts,floars or the turl�stop box and service line. In understand l am also requirE
to obtain a perrnit prior to any work,if necessary.
F6NAL METER READIIYG{oid meter) ��� \��
Name• Address�_�,� � ��� ��
Phone Number �—� � �ate � — 1���
�Signatu e Witness Signature �
;
OLD NlETER# ���—�1 ���
OLD FtEA�ING CJ� �— 1���
��w,��E�� �I �2�����T
NEW �EADING�
��T# "�2��52��
FRtDLEY CITY CODE
CFiAPTER 402eWATER,STORiVt WATER AN�SANtTARY SEWER
ADMINIS�tRAT90r!
�Ref Ord Na�113,464,�65, 5f 6,629,538,662,922,985, 1.144, 1156,1191 j
4Q2.5 PERflf1IT FEE
Prior to�onstructing or repair of any water of sewer line connecting the existing municipal system end any house or bui(ding for which the
appfication is made,the owner or contrador sha11 be required to obtairt a permit for such connection,and shall pay a permit fe2 as provided in
�hapter 11 af 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 beert made a�d such connection and the work incident thereto has been approved by the City as a
proper and suitable connection.
4Q2.06 REPAIRS AND MAINTENANCE TO CONNECTION
After the initiat connection has been made to the water service curb stop box or the sewer lead at the property line or a water service lead has
been extended to the p�operty line for connection,the applicant,owner,or occupant a�user of such premises shall be liable for all repairs
required to any�,vater line and sewer lines necessary for connection of the premises#rom the main to the premises. {f the groperty owner
requests maintenance service or repairs be performed by the City,the property owner shafl be charged fvr the costs of the maintenance and/or
repairs,inciuding necessary street repairs at a rate set annually by an admirtistrative policy. It shat!be the responsibitity of rhe applicarrt,
owner,occupant or user fio per#orm standard maintenance of the sewer service line from the premises to the main including debris clearing or
root cutting and to rnaintain the wvater service curb stop box for operability 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
wat---_ er De»artment
Address �q� l.�����"�
Name�v F ���-� _
Date � �� ��
Old Meter Number � � �� � � ��
Old Meter Reading � ��
Replacement No._ ���� �Q
I
Replacement Reading �
Replacement Make (�r
� Remarks;_L�"������
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Signed
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