Meter Swap . Request Number: 13011
� Public Works Ikvision
Service Request
Problem Address: 1241 Norton Ave Requested By: Pam Reynolds
Depnrhnent: WATER Address: No adckess p�ovided
Problem/Issue: INSTALL AMR METER Phone Nnmber: ?63-222-9386
Schedaled D�e: 2012-01-27 Sc6ednled'Rme: 08:3Q:00
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ACTION NEEDED:
Created by: Wendy Hiatt D�e Created: 2017-01-23
ACTION TAKEN: �
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Statas: tn Pro ess ���r H�Beea r
� Coatacted
Dxte Completed: Cu�pleted iry:
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Water�e�artalte�at
6431 Univ�rsit�l�veroue 9VE
, Fridley,MP1 55432
753-572-3566
,'�� her�by authorize the�'riy af Fridley and/or its employees ta cio what is necessary to
. replace the wafier meter. 1 understand that the proper#y owner fis tia6te for the water{ine from the main to the premise and all iriterior
pluenbing. �Per Crty code 4p2.06; i also hold the City of Fridley andJits employees harmless#or any slamages that may occur whi{e doing this
operation. This#o include,but not limited to valves,piping,walis,floors or the surb stop box and service tine. In understand!am also require�
to abtain a permifi prior to any�ro�c,if necessary.
flNAL METER READIN6(otd meter}
fllame: U11111/� V6 -�! Address ��-.� 1 '"' � If1 �'C�.
Phone Number f f4 c'J �� _ ��� p�_,/" Z� �- k�
Signature �! 4V�tness Signature
Oi.D METER#
OLD READtNG
NEW METER#
NEW READIRIG �
ERT#
FRtDLEY CITVE CODE
CHAPTER 402.WATER,STQRM WATER AND SANITARY 5EWER
ADMINISTRATION
(Ref Ord No 113,464,565,566,629,638,662,922,988,I144,1156,1191j
402.5 PERMIT FEE
Prior to rnnstructing or e�epair of any water of sewer fine wnnecting the eicisting muniapaf system and arry fiouse or b+�flding fo�which t�he
apptication is made,the owner or corrtractor shall be required to obtain a perm'rt for such connection,and sFwll pay a permit fee as pravided irr
Chapter 11 of#his Code. After such connection has been made,the Water and Sewer Department shail be notified. It shall be unlaerful to ceaer
any wnnecting line until an iaspection has been made and such connection and the woric inade�rt thereto has been apprwred by the City as a
praper and suitabie connection.
�t32.05 REPAiRS AND MAIPITENANCE TO CONNECT{ON
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 senrice lead has
been extended to the property line for connection,the appiicam,owner,or accupant or user of such premises shall be liabie for ail repairs
required to any water{ine and sewer tines necessary fvr connection of the premises from the main to the prem"�ses. tf the property owner
requests main#enance service or repairs be performed by the City,the properLy awner shatl be charged for the casts of tfie mairnenance and/or
repairs,including necessary sCreet repairs at a rate sefi annualty by an administra#ive poficy. R shali be the responsbility of the applicarrt,
owner,occupant or user to perform standard mairitenance of the sewer service line from the premises to the main induding debris dearing or
root cutting and to maintain the water service cucb stop box for operability and at such height as will ensure that it remains above the finisfied
grade of the land or property. (Ref 638,1156,1191)
�o�ry/or rriaoey
Water Departrnent
6431 UniversityAvenue PlE � � �_���� �-��
� Fridley,MN 55432
. 763-572-3566 �b � � � �
1/We hereby authorize the Ciiy of Fridley and/or its empioyees to do what is necessary to
replace the water meter. !understand that the property owner is liable for the water line from the main to the premise and all iMerior
piumbing. {Per City code 402.06j i also hold the C'tty o#Fridley and/its employees harmless for any slamages that may occur while doing this
operation. 7his to include,but not limited to valves,piping,walls,floors or the curb stop box and service line. !n understand 1 am also required
to obtain a permit prior to any wor6c,if necessary. , �
F11VAL METER READING(oid meter) v V�� ` (
Name: Address 1� U I `�
Phone Number p� �,!'�� ' ��
Signature Witness Signature �
OLD METER#_
ci,V-_ �� ��( �
OLD READING ��`"�� G v
NiEW METER# �� �� TJ��✓ - . _ ..
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NEW READtNG � ��,. * A;;,
ERT# `-� �� � R� ` � � ��
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� FRIDLEY CIT,�`;�ODE
CH�4PTER 402.WATER,STORM 11{�ATER AND SANRARY SEWER
ADMINlSTRATIOAI
(Ref Ord NO�13,4C�4,565�66,629,638,662,922,988,1144,1156,1191)
402.5 PERMIT FEE '�
Prior to constructir�or repair of any water of sewer line conneccing the ercisting muniapai system and arry house or buildi�for which th�,;
application is made,the owner or corrtrador shali be required to obtain a permit for such connection,and shall pay a permit fee as provid+e�t'in��'
Chapter 11 of#his Code. After such connectivn has been made,tf�e Water and Sewer DepartmeM shafl be noNfied. tt shatt be untawful to cover
any connecting line untii an irtspection has been made and such connection and the wortc incident thereto has been approved by the City as a
proper and suitabte connection.
402.05 REPAIRS AND MAHYTENAAICE TO CONNECTION
After the initiat connection has been made to the water serviR curb stop b�c or the sewer lead at the property iine or a water senrice iead has
been extended to the property line for con�ecdon,the appiicartt,owner,or otcuparit or user af such premises shati be liabie for ail repatrs
required to any water line and sewer lines necessary for connection of the premises from the main to the premises. If tlie property owner
requesfis maintenance service or repairs be perFormed by the City,the property owner shaii be charged for the costs of the mairrtenance andJor
repairs,including�ecessary street repairs at a rate set annuaily by an administrafiive policy. It shafl be the responsibility of the applicant,
owner,occuparrt or user to perform standard mairitenance o�the sewer service line from the premises to the main including deb�is clearing or y ti,3
root cutting and to maintain the water service curb stop bac for operabil'rty and at such height as will ensure that it rernains above the finished �"
grade of the land or property. {Ref 638,1156,1191j