Meter Swap s� � Request Number: 13307
Public Works Division
Service Request
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Problem Address: 7529 McKinley St Requested By: Russell Hanson
Department: WATER Address: 7529 McKinley St
Fridley,MN 55432
Problem/Issue: INSTALL AMR METER Phone Number: 763-784-4503
Scheduled Date: 2017-02-0 � Scheduled Time: 08:00:00
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ACTION NEEDED:
Created by: Beth Kondrick Date Created: 2017-02-06
ACTION TAI�N: �
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Status: In Progress Submitter Has Been r
Contacted
Date Completed: Completed by:
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5431 i9nd�Qrsity'Ave�ue N� �p
Frac{ley,!t►!N 55432 /
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,�'�°� hereby authorize#he�ity af Fri,dley andJor its empioyees to slo wfiat ds necessary
* replace the wafier�neter. I�nderstand tha#the pro�aea�ty flwner is Siabte for ttae water line#rom the main to�he premise and all irrterior
P'�+�b�ng• (Pea'City coale 4�2.Q6� 1 also�otd tE1e C"sty�#F�idtey and/its employees harmless#or any damages that may occur while eloing t!�
vperation. This#o�nctude,bufi root limiteci to valves,piping,walls,#loors or the curb stoP box and service line. In understand 1 am also req
to obtain a permifi prior to any wor�c,�f a�ecessary.
�Fi1VALlIrtETER READING(oFd meter) � ��`�'�'
Name: �� „��� q�dress � G.��
Phone Number �rr,.7r ' � ./ Date �� �� �t�
S�gn�re Witness SignaturQ
OL�1WETE�#_ �j� - 1� ��
�LD ��A���G ��y��p
RIEVIO NIETER# _ ��Q I I �
NE11V t�EA1�1�1G
Ei��'# ` � fi�o `
FliIDLEY Ci��t)D�
Ct-ap►P�'E!8 402.1Ne41'EtZ,SCOR6V�Y1/AT�9�ANID SAAIITAl3Y SEWEFZ
ADN114YISTRAT80A1
{�Z�Or�!Sdo 113,�64y 565,5fi6,629,638,f62,922,988,i144,I156,1191}
402.5 PERMl7 FEE
Prior to constructing or repair of any water of sewer line connecting the existing municipa(system and any nouse or b�iiding for which the
applicafiion is made,the owner or corrtractor sha(I be required to abtain a permit for such connedion,and shall pay a permit fee as provided
Chapter 11 of#his Code. p►fter such connection has been made,the Water and Sewer Department shall be no#ified. It shall be un(awfui to co
any connecting tine until an inspection has been made and such connection and the wor(c inciderrt thereto has been approved by the City as a
proper and suitabte conneetion.
402.05 REPAIR�,4�ttfD�VipaNTENANCE TO CONWECi'IOAI
Ai�ter the initial connection has been made�o#he water service curb stop 6oK or the sewer tead at fihe property iine or a water seruice lead i�a
D�een extended to the property line for connection,the appiicarrt,owner,nr flccuparrt or user o#such premises shait be liable for all repairs
required to any water tine and sewer iines s�ecessary#or connection of the premises from the main to the premises. if the property owner
requests mairrtenance service or repairs be performed by the City,the property owner shall be charged for the tosts of ihe maintenance and/
repairs,including necessary street s�epairs at a rate set annuaiiy by an administrative policy. It shatl be the respansibitifiy of the applicarrt,
owner,ocsupant or user to perform standard mainten�ance of the sewer service line from the premises to the main dncluding debris clearing o�
root cutting and to maintain the water service curb stop box for operability and at such height as will ensure that it remains a6ove the finishec
grade of the�and or prqperty_ (Ref 638,1156,1191j
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City of Fridley
Water Department
Address S � �C- � � ��
Name K.V SJ'� r� T1S_h 50�-- '
Date � J !� � �v
Old Meter Number � �
Old Meter Reading a �� � ��
Replacement No. �
Replacement Reading �
Replacement Make �dG'`�@r
Remarks: �si(�Il ��tF F'YI-��`�
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S igned_
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