Meter Swap . ` Request Number: 13320
Public Wo�ts Division
Service Request
Problem Addreas: 1503 S Timber Ridge Requested By: Kim
Departme�: WATER Address: No ad�ess provided
Problem/fssue: INSTALL AMR METER Phone Numbcr: 651-775-1152
Scheduled Date: 2017-02-09 Sc�d�led 1lme: 07:OO:Of1
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ACIION NEEllED:
Crexted by: Wendy Hiatt Ihte Created: 2017-02-07
ACIION TAKEN:
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Stxtus: In Progress 5aba�itter H�Betn r
Coat�ted
Date Compieted: �_C�` 1 Campleted Ly:��
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643�.iOniwQa-sitvf/�ven�ae N�
Fric!ley,MN 55432
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r ,,'A°� here6y authorize lthe�'rty of Frid ley andJor its empioyees to slo what ds necessary
replace the water meter. 1 e�nderstand tt►a#�he property owner u liabte for the aratee line from 4he main to�he premise and aii imerioc
plumbing. (Per Cicy cosfe 402.06� i also hold 2he C'rty af Fcidley andJ'rts empioyees harmless#or eny�lamages that may occur whiie doing tF
operation. This�o include,but not limi#ec1 to valves,piping,walls,floors or the curb stop box and service line. In understand 9 am also req
to obtain a permit�arios to any rrorlc,�f necessary. ��� �^�� _
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FI91tAL IIAETER READIAIG(old mefier) `� � �"' ��� -
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l�iame: - �'� Address l J0?j �. �1�.•4j�e✓' e C+�,',C
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Phone Ntumber��� � l�5� �I�d� Dace —' -( — (�
S'�gnnature W�tne�Signatvre ��
o�.n a�Ea-ER# �3�� C¢� ��--_
OLD READtAtG `-���� ����
NEW MEfER# � `� `� / / ��
NEW READI9VG �
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FRIDLEY Ct'TY CODE
CHAPTER 402.WA'fER,STORM WATER AND SANITAEtY SEWER
�►unnisrrs�tanoti
(Ref Ord NO 113,464,565,566,629,638,662,92Z,988,1144,I155,1191}
402.5 PERMI'C FEE
Pr�or to constructing or repair of any water of sewer rne connecCing the eacisting munia{tal system and arry house or buiidir�g for arbiefi the
appiication is made,the owner or corrtractor shalt be required to abtain a permit for such connection,and shali pay a permit fee as prrnrided
Chapter 11 of#his Code. After such connection has been made,the Water and Sewer De�artmerrt shall be not#ied. k shall be unlawfs�t to co
aray connecting tine until an inspection has been made and such connection and the worlc in+ciderrt thereto has been approued by the Gty as a
proper and suitabte connection.
402.05 REPAIRS AND MAtRII'EfMAt110E TD C4MNECTION
After the initial connectiort h�been made to the water service curb stop 6ox or the�wer lead at the property line or a water se�vice lead F�a
been extended#o the property line for connecCion,the appiicarrt,owner,or occupani or user of such premises shatl be tiabie far a0 repairs
required to arry water line�nd sewer lines necessary for connectFon of the premises frorr+#he rrrain to#he premi�s. 1f the pro�rerty owner
requests mairrtenance service or repairs be performed by the City,the property owner shall be charged for the custs o#the mairrteoance and/
repairs,including necessary street repairs at a rate set annuaily by an administra#ive policy. Ifi shatl be the responsibility of the applicar�,
owner,ocsuparrt or user tv perForm sta�dard maintenance of the sewer service line from tF�e premises to the mai��nclufiirig debris dearing w
roat cutting and to mairrtain the water service curb stop box for operabifity and at such height as wiil ensure thaC fit remains above#he finisfiec
grade of the land or property. (Ref 638,1156,1191)
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City of Fridley
Water Denartment
Address_ ISD3 S• Ti1M�e�- �,i�q�
Name I�:(�'� � I; 5`�o t� - C r�1'�'1
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Date �D ' 1 -0 6
Old Meter Number / t l � � � �
Old Meter Reading � � d I �
Replacement No. o y 6 s�a
Replacement Reading ��_
Replacement Make�adl er �
Remarks: Vc�'�/G �}�'�u�Pe M�-�-�r r� (�c��;j,�
Signe �