Meter Swap + Request Number: 16040
Public works Division
Service Request
Problem Address: 8301 Ri�erview Terr Requested By: Ben Underlrill
Dep�rtment: WATER Address: No�dress provided
Problem/Issue: INSTALL AMR METER Phone Number: 1-435-659-6496
Scheduled Date: 2017-06-19 Schednl ed'Iime: 1130:00
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ACITON NEEDED:
Created by: Wendy Hiatt Date Created: 2017-06-16
ACTION TAI�N:
Status: In Progress Sabmitter Hna Been r,
Co�acted
Date Completed: Completed by:
' City of Fridley �!
Water Departrnent � f (� � �l�v ���3
6431 University Avenue NE
Frid{ey, MN 55432
� 763-572-3566 ��� ��i��
!/we �� �W,J f: �"�� �L L TS
hereby authorize the�ty of Fridley andjor its employees to do what is necessary to
replace the water meter. i understand that the p�operty owner is liable for the water line from the main to the premise and aN ir�terior
pium6ing. (Per City code 402.06) I aiso hold the City of Fridley and/its employees harmless for any damages that may occur while doing this
operation. This to include,but not{imited to vaives,piping,walls,floors or the curb stop box and senrice line. in understand t am also required
to obtain a permit prioc to any work,if necessary.
FIIYA!METER READING(old meterj �✓ ��� l�
Name:_��,c� ��rD�(� lt-L, /�ddress _ Z���I J� I t��/�tl/�� �0 ll•c t.� ��
Phone Number ������� ' � { F p Date �b �-`��
Signature Witness Signature ��
OLD METER# �-I l0���(U� � .�-�� /Y�' �
, � '
- OLD READING �S����5 O
NEW METER# OL� I'V(��C� �,t,�� /'►14�R'Gi' � �j ��o2S� � 1�
NEW READlNG__�
E�-r# �o�.��"SOl\
FRtDlEY CITIf CODE
CHAR'i'ER 402.WATER,STORM WATER AND SAN{TARY SEWER
ADMINISTRATfON
� (Ref Ord No 113,464,565,566,629,638,662,922,988,1144,1156,1],91)
402.5 PERMIT FEE
Prior to constructing or repair at'any water of sewer line connecting the existi�g municipai system and any hoase or buiiding for which the
application is made,the owner or contractor shall be required to obtain a permit for such connection,and sfiali pay a permit fiee as provided in
Chapter 11 of this Code. After such connection has been made,the Water and Sewer Department shall be not�ed. R shail be uniawful to cover
any tonnecting line untii an inspectton has been made and such connection and the wortc incident thereto has been approved by the C�ty as a
proper and suitable connection.
4Q2.06 REPAIRS AND MAiNTENANCE TO CONNEC170N
After the initial connection has been made to the water service curb sCop box or the sewer lead at the property line or a water servics lead has
been extended to the praperty line for connection,the applicant,owner,or occupant or user af such premises shail be liable for atl repairs
required to any water line and sewer fines necessary for connection of the premises from the main to the premises. if the property awner
requests maintenance service or repairs be performed by the City,the praperty owner shaii be charged fo�the costs vf ihe maintenance and/or
repairs,including necessary street repairs at a rate set annualty by an administ�ative policy. It shal{be the responsibitity af the applicarrt,
oarner,occupant or user to perform standard mairrtenance af 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 wili ensure that it remains above the finished
grade of the 4and or property. (Ref 638,1156,1191�
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Address d'��J �1�L�evv�'.¢t,�.� �� �'✓�.`
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Name ��L �. �k��.�..� �d/
Date /"� � ��'� � �
Old Meter Number / 9✓�'-/ �/
Old Meter Reading � �9 � ._
Replacement No. ���o-3 ��
Replacement Reading �
Replacement Make �•-o��,�.._.. ,
Remarks: ��� y�,,.�1.,�-�..� `(�J�
- � S igned
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