Meter Swap � Request Number: 15946
Public Works Division
Service Request
Problem Address: 159 Longfellow St Requested By: Mr McCauley
Department: WATER Address: No address provided
Problero/Issue: INSTALL AMR METER Phone Number: 612-802-7169
Scheduled Date: 2017-06-13 .� Scheduled Time: 11:00:00
1
ACTION NEEDED:
Created by: Wendy Hiatt Date Created: 2017-06-12
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ACI70N TAKEN:
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Status• In Progress Submitter Has Been r
' Contacted
Date Completed: Completed by:
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�o�.y���raaie�
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1lVa�er De}�artm�ent C�h,�L '
� �431 l�raiarersity A�enue NE JV-h1- ��p�
► Fradley,MN 55432
7fi3-572-3565
d�"'�e hereby authorize the City af�ridley and/or its empfoyees to�to what is necessary to
replace Lhe water meter. t understand that the�roperty uwner is liable for the water 9ine from Lhe maoee to Lhe premise and all interior
�Bumbing. (Per�ity eode 402.06) !also hold ihe City of Fridley and/its employees harmless for any damages that rnay occur while doing this
operation. This to include,but not limited to valves,piping,wafls,floors or#he curb stop box and service line. In understand I am also requirE
to obtain a permit orior to any work,if netessary.
FiNAL METER READING(old meter) `� � � � � �lr
6Vame: �_� ��! � �L����/ Address_ 1 JC� �i'l.c� �,�,C)l,-� `�,�"
Phone Numb�r� ��...` ��� ���(,[f �� Date �..F` '-" � 3 — ��
X Signatur n (/liTj�,� "�
� � Witness Signature
P)lD tU1ETER# � �� � J � �
OLD READIIVC; ��� ` �C��
IVE�11/ IVtETER# t C��c�S � 1 C�
6VEW READING �
E���_ ��r � 3 �� 5 �ca -
FRtDL�Y CI'f`(CODE
CI�Ad�'ER 402oWA�'EBt,ST�RMI WATER AND SANITARY SEWER
AIDMINIS�'ltA�"90N
��tef Ord No 113,464,565, 566,629,538,662,922,988, 1144, 1156,119�j
402.5 PERMIT FEE
Prior to�onstructing or repair of any water af sewer line connecting the existing municipal system and any house or Building for which the
application is made,the owner or contractor shall be required to obtain a permit€or such connection,and shall pay a permit fee as provided in
�hapter 11 of this�Code. After such connection has been made,the Water and Sewer Departmerrt shall be notified. It shall be unlawful to cover
any connecting line until an inspection fias been made a�d such connection and the work incident thereto has been approved by the City as a
proper and suitable connection.
4A2.06 liEPAIRS AIVO MAINTENANCE TO CONNECFION
Aftec the initia(connection has been made to the water seroice curb stop box or the sewer(ead at the property line or a water service lead has
been extended to the property line for tonnection,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 for connection of the premises from the main to the premises. If the property owner
requests maintenance service or repairs be performed by the City,the properh/owner shall be charged for the costs af the maintenance and/or
repairs,including necessary street repairs at a rate set annually by an administrative poliry. It shal!be the responsibility of�he applicant,
owner,occupant or user to perform standard maintenance of the sewer service line from the premises to the main inciuding debris clearing or
root cutting and to maintain the water service curb stop box for operability and at such height as wil!ensure that it remains above the finished
grade af the iand or property. {Ref 638,1156,1191j
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� f� �� � � INSTALLATION � ��, � ;,,
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GTYOF _„
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FRIDLEY '
Address ! .� i ���1.�1 �Q ���� ��
Name C�l�!'� ��'@ h � C Gc.t�.� ��y
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Date � ^ -` ' � (
Old Meter Number I��� � f J b
Oid Meter Reading ��6 �a"�
Repiacement No. _ `�y � �S$ a
Replacement Reading �
Replacemen# Make ��� e-�
Remarks:
Signed:�
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