Meter Swap r--'
" Request Number: 12835
Public Works Division
Service Request
Problem Address: 1365 O�ndaga St Req�sted By: Harris
Department: WATER Addreaa: No adc�ess providcd
Proble�/Issues INSTALL AMR METER Phone Na�ber: 763-432-3209
Seheduled Date: 017-01-18 Schedaled 1lme: 1 I:30:OQ
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ACIION NEEDED:
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Crentedby: Wer�yHiatt DatcCreated: 201�-01-12
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St�us: In Progress Snbmitter Ha��een r,
Co��ted
Date Compteted: C�mpleted by:
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City of Fridley �u 2 I
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Water Department � �' J �
6431 University Avenue NE n
Fridley, MN 55432 "�, � �� a-�'���
763-572-3566 � I� � �
IJwe hereby authorize the City of Fridley and/or iu employees to do what is necessary to
replace the water meter. 1 understand that the property owner is liable for the water line from the main to the premise and all interior
plumbing. (Per City code 402.06) I also hold the City of Fridley and/its employees harmless for any damages that may occur while doing this
operation. This to include,but not limited to valves,piping,walls,floors or the curb stop boz and service line. In understand 1 am also required
to obtain a permit prior to any work,if necessary.
FINAL METER READING(old meter) � '�� � �
Name: 1'��"��, i `'� Address �� �"" �� ��• v
Phone Number�"'�_ ����� Date 1~ 1�� I 7 '
Signature ` � Witness Signature
OLD METER# ��� I O���
OLD READING ��� �
NEW METER#
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NEW READING v
ERT# ���� � � � �
FRIDLEY CITY CODE
CHAPTER 402.WATER,STORM WATER AND SANITARY SEWER
ADMINISTRATION
(Ref Ord No 113,464,565,566,629,638,662,922,988,1144,115b,1191)
402.5 PERMIT FEE
Prior to constructing or repair of any water of sewer li�e connecting the existing municipal system and any hou�or building for which the
application is made,the owner or contractor shall be required to obtain a permit for such connection,and shal)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 shalt be unlawful to cover
any connecting line until an inspedion has been made and such connedion and the work incident thereto has been approved by the City as a
proper and suitable connection.
402.06 REPAIRS AND MAINTENANCE TO CONNECTION
After the initial connedion has been made to the water service curb stop box or the sewer lead at the property line ar a water service lead has
been extended to the property line for wnnection,the applicaM,owner�or occupant or use�of wch premises shall be liable for aU repaks
required to any water line and sewer lines necessary for connection of the premises from the main to the premises. If the property orvner
requests maintenance service or repairs be performed by the City,the property owner shall be charged for the costs of the maintenance and/or
repairs,including necessary street repairs at a rate set annually by an administrative poliry. It shall be the responsibility of the applicarrt,
owner,occupant or user to perform standard maintenance of the sewer service line from the premises to the main i�duding debris clearing or
root cutting and to maintain the water service curb stop box for operabitity and at such height as will ensure that it remains above the finished
grade of the land or property. (Ref 638,1156,1191)
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City of Fridley
Water De artment
�ddress ' S
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Name
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Date 'y�7��
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Old Meter Number
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Old Meter Reading Q
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SI as
Replacement No• �
Replacement Reading
Replacement Make ��[
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Remarks: `e
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S igned �����
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