Meter Swap _
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REQUEST FOR SERVICE REPORT
CITY OF FRIDLEY
Reference No. Date: �.-a,rp--��
Request Type: Entered By:
Department: Citizen Name: ���� �/��,(��1
Address: �3�� (������ � Phone Number: '7�,� - 3`Z7 ' bb�
Schedufed Date: Property Owner:
Location Details: Request Details: _
Action Taken:
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Responsible Person:
Approver:
Compfetion Date: _�Q Citizen Notified:
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City of Fridley � ��_i.-,�.�,.,�..d 3
Water Department J �
6431 University Avenue NE ��v�j
Fridley, MN 55432 SU �
763-572-3566
IJwe hereby authorize the City of Fridley and/or its employees to do what is necessary to
replace the water meter. I understand that the property owner is liable for the water line from the main to the premise and all iMe�ior
pfumbing. (Per City code 402.d6� 1 also hold the City of Fridley andJits employees harmless for any damages that may oaur while doing this
operation. This to include,but not limited to valves,piping,walls,floors or the curb stop box and service line. In understand I am also required
to obtain a permit prior to any work,if necessary.
FINAL METER READING(old meter) �� ��O
Name: �'��s vv� � Address � J 1� ������ �
Phone Num r __ Date �` �`l
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Signat e Witness Signature
OLD METER# I � l�� � l�-F� SIZE & STYIE(Circlel _ �
�a����-� 5�g�► H : '. �
OLD READING � �
NEW METER# ���3� "���() 1" , HEX
NEW READING � 134" ELIPTICAL or HEX
ERT# �{�� � . O� 2" ELIPTICAL or HEX
FRIDLEY CITY CODE
CHAPTER 402.WATER,STORM WATER AND SANITARY SEWER
ADMINISTRATION
(Ref Ord No 113,464,565,566,629,638,662,922,988,1144,1156,1191)
402.5 PERMIT FEE
Prior to constructing or repair of any water of sewer line connecting the existi'rtg municipal system and aoy house or building for which the
application is made,the owner or contractor shall be required to obtain a permit for such connection,and shall pay a permit fee as provided'+n
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 conneding line until an inspection has been made and such wnnection 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 initiai connection has been made to the water service curb stop box or the sewer lead at the property line or a water service lead has
been extended to the property fine for connection,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 wnnection of the premises from the main to the premises. If the property owner
requests mainte�ance service or repairs be performed by the City,the property owner shall be charged for the costs of the mair�tenance and/or
repairs,incfuding necessary street repairs at a rate set annually by an administrative policy. It shall be the responsibility of the applicant,
owner,occupant or user to perform standard mair�tenance of the sewer service line f�om the qremises to the main including debris clearing or
root cutting and to maintain the water service curb stop box for operability and at such height as will enwre that it remains above the fnished
grade of the land or property. (Ref 638,1156,1191)
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