Meter Swap .
Request Number: 15601
PuWic Works Division
Service Request
Problem Address: 204 Liberty St Requested By: Tim Zembal
Department: WATER Address: No address provided
Problem/Issue: INSTALL AMR METER Phone Number: 763-786-6908
ScheduledDa�i ' f017-06-01 ScheduledTime: 10:00:00
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ACTION NEEDED:
Created by: Beth Kondrick Date Created: 2017-OS-26
ACTION TAI�N:
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Status: In Progress Submitter Has Been r
Contacted
Date Completed: Completed by:
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City of Fridley � ` �� �� ��� � D �
' Water Department
' 6431 llniversity Avenue NE S Q�- �-�'`�'
FrBdley, MN 55432
763-572-3566
!/we hereby autfiorize tfie C"rty of Fridtey andjor its emptoyees to do what is necessary to
replace the water meter. t understand that the property owner is liabie for the water line from the main to the premise and ali interior
piumbing. (Per City code 402.06) 1 also hold the City ot Fridley and/its employees ha�mless for any damages that may occur whi(e doing this
operation. This to inc{ude,but not limited to valves,piping,walls,floors or the curb stop box and service line. In understand I am also required
to abtain a permit prior to any work,if necessary.
FINAL METER READING(oid meter) � ��� ��
Name• �� Address _ w � l��F�{' �"�"�
Phone Number�����. �^ ��te � � V� �
�Signatu Witness Signature
OLD METER# ��� { ����
OLD READINC'a � ��� �CN
NEW METER# `-1�- 1 Z� �� � �
NEW READING �
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FR6DLEY�ITY CODE
CHAPTER 402.WATER,STORIVf WATER AND SANITARY SEWER
ADMINISTRATfOiV
(Ftef Ord Plo 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{ine connecting the existing municipal system and any house or building for which the
application is made,the owner or contractor shaif be required to obtain a permit for such connection,and shali pay a permit fee as provided in
Chapter 11 of this Code. After such connection has been made,the Water and Sewer Department shall be notified. It shall be unlawfuf to cover
any connecting line until an inspection has been made and such connection and the arork incident thereto has been approved by#he City as a
proper and suitable connection.
402.06 REPAIRS AND MAINTENAIVCE TO CONNECI'fO1V
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 service lead has
heen extended to the property fine fior sonnection,the applicant,owner,or occupant or user of such premises shall be liable for a0 repairs
required to any wafier line and sewer lines necessary#or connection of the premises from the main to the premises. If the properry owner
requests maintenance service or repairs be performed by the City,the property owner sfiall be charged for the costs of the maintenance and/or
repairs,including necessary street repairs at a rate set ar►nua{ly by an administretive policy. It shall be the responsibility of the applicant,
owner,occupant or user to perform standard maintenance of the sewer service line f�om the premises to the main including debris clearing or
root cutCing and ta maintain the water service curb stop box for operability and at such height as will ensure that it remains above the finished
grade of the land or property. (Refi 638,1156,1191j
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Cit of Fridley
Wat�r Department
Address Oi L. ,ljx,� �(,
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Name � �
Date d�
Old Meter Nu er �dCJ 7,�.�
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Old Meter Re ding � �
Replacement o. � b-�
Replacement eading � _
Replacement Make � tn/
Remarks• �
Signed �