Meter Swap , Request Number: 12679
Public Works Division
Service Request
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Problem A,ddress: 7593 Lyric Ln Requested By: Kathryn Meyer
Department: WA'IER Address: No address provided
Problem/Issue: INSTALL AMR METER Phone Number: 612-202-0404
Scheduled Date: 17-01-06 Scheduled'lime: 08:30:00
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ACTION NEEDED:
Created by: Wendy Hiatt Date Created: 2016-12-30
ACITON TAI�N:
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Status: In Progress Submitter Has Been r
Contacted
Date Completed: � -- � — l� Completed by:
,` 4� C��'�'`.�..�y-'-�-�`•-.
City of Fridiey
Water Department � � i g � �
6431 University Avenue NE �
� ' Fridley,MN 55432 ��������
763-572-3566 '� ( �
�lwe hereby authorize the City of Fridiey andJor its employees to do what is necessary to
replace the water meter. t understand that the properry owner is liable for the water line from the main to the premise and all interior
plumbing. (Per City code 402.06} I a{so hold the City of Fridley and/its employees harm{ess for any damages that may occur while doing this
operaiion. This to include,but not limited to vaives,piping,wails,floo�s or the curb stop box and service line. in understand I am also requtred
to obtain a permit prior to any work,if necessary.
FINAL METER READING(old meter) � ��� f �/ �� �"�`�
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Name: ��l�' ��Y L'L �v�,�y i�l,� Address � � � � b'�L�(�, �>�l;
Phone Numb. � ��~ ������C���L Date �` �� f I �
�'y ` ;j
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�Signat�fe ,�'���`` �--��:����� ��� � �� WitnessSignature � �-�'����
OLD METER# ��� ���!��
OLD READING �--L� ���� ��'��C1
NEW METER#_�� � � ���:�
NEW READING �
ERT# �� �'�'�' �'� f 3 � ,
FR{DLEY C{TY CODE
CHAPTER 402.WATER,STORM WATER AND SANITARY SEWER
ADMINISTRATION
(Ref Ord Na 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 tine connecting the existing municipal system and any house oc building for wfiich the
appiication is made,the owner or contractor shatl 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 unlawful to cover
any connecting line until an inspection has been made and sucfi connection and the work incident thereto has been approved by the City as a
proper and suitabie connection.
402.06 REPAIRS AND MAINTENANCE TO CONNECTlaN
After the initial connection has been made to the water service curb stop box or Che sewer lead at the property line or a water service lead has
been extended tp the property line for connedion,the applicant,owner,or accupant or user of such premises shall be tiab{e for al{repairs
required to any water line and sewer lines necessary for connection of the premises from the main to the p�emises. If the property owner
requests maintenance service or repairs be performed by the Gity,tfie property owner shail be charged for the costs of the maintenance and/or
repairs,inc{uding necessary street repairs at a rate set annua{ly by an administrative poliry. It shall be the responsibility of tfie 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 operability and at such height as will ensure that it remains above the�nished
grade of the fand or property. (Ref 638,1156,1191)
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City of Fridley �����J 151��
Water Department
Address_�5�� �y��' �`�
Name �'���
Date � �1�
Old Meter Number ��� `� � (�� ��
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Old Meter Reading � ,,� �
Replacement No. �E-av � `��"( `��
Replacement Reading
Replacement Make �
ERT#
Replacement ERT#
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Remarks: � ,+��` ��'�'r�'�r� v�J
_ Signed_��%�'�.,,.k-�.�.1
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