Meter Swap Request Number: 15461
Public works Division
Service Request
Problem Address: 91 Osbome Rd Requested By: Sandra Peterson
Department: WA'IER Address: No address Ixovi�d
Problem/Issne: INSTAL,L AMR METER Phone Number: 612-237-4201
Scheduled Dat��2017-OS-23 �Sched d 1Yme: 01:00:00
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ACTION NEEDED:
Created by: Wendy Hiatt Date Created: 2017-OS-19
ACTTON 'AI�N: �
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Status: In Progress Snbmitter Has Been r
Co�acted
Date Completed: Completed by:
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City of Fridley
Water Departrnent �,r� � � /�� �
6431 University Avenue NE v `��
Frid�ey, MN 55432
763-572-3566
1/we hereby authorize the Crty 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 ir�terior
plumbing. (Per City code 402.06) I also hold the City of Fridley and/its employees harmless for any damages tfiat may ocwr while doing this
operation. This to include,but not limited to valves,piping,waiis,floors or the curb stop box and service line. In understand 1 am also required
to obtain a perm(t prior to any work,if necessary.
FfNAL METER READING(oid meter)
Name• ������� \ �TV► ��� Address _1 � `.J���,� �
Phone Number V ������� � wl Date � �� � � 1
Signature Witness Signature
OLD METER# � �� ��� v� p
OLD READING O 5���
NEW METER �`g9U �O � I
NEW RE 0
E�r# �� �20 �� 36
FRIDLEY CITY CODE
CHAPTER 402.WATER,STORM WATER AND SANITARY SEWER
ADMINISTRATION
(Ref Ord No 113,4f�,565,566,629,638,662,922,988,1144,1156,1191)
402.5 PERMIT FEE
Prior to constructing or repair of any water of sewer iine conneding the existing municipal system and arry house or�iiding for whkh the
application is made,the owner or contractor shall be required to obtain a permit for such connedion,and shall pay a permit fee as provided in
Chapter li of this Code. After such connection has been made,the Water and Sewer Departmerrt shall be notified. it shall be unlawfui to cover
any connecting line until an inspection has been made and such connection and the work incident thereto has been approved by the City as a
proper and suitable connection.
402.06 REPAiRS AND MAINTENANCE TO CONNECTtON
After the initial connection has been made to the water service curb stop box or the sewer lead at the property Iine or a water service lead has
been extended to the property line for connection,the applicant,owner,or occupar�t or user of such premises shail be liable for all repairs
required to any water line and sewer lines necessary for connection of the premises from the main to the premises. If the property owner
requests maintenance service or repairs be performed by the�ty,the property owner shall be charged for the costs of the mairrtenance and/or
repairs,inciuding necessary street repairs at a rate set annual�y by an administrative poliry. It shall be the responsibility of the applicarit,
owner,occupant or user to perForm standard mair�tenance of the sewer service line from the premises to the main including debris dearing or
root cutting and to maintain the water service curb stop box for operability and at such height as wiil ensure that it remains above the ftnished
grade of the{and or property. (Ref 638,1156,1191)
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Address�1� �� �f�,e � c�
Name
Date �j--��a" �
Old Meter Number p�� )
Old Meter Reading ��C� � d�b(7
Replacement No. (�� 86��
Repla�ement Reading �
Replacement Make�( a�_�2.f�
Remarks: ,�D�tu Y11C�r �
Signe