Meter Swap • Request Number: 13535
Public Works Division
Service Request
Probiem Address: 1523 S Tunber Ridge Requested By: Ken
Departmeat: WATER Address: No address provided
Problem/Issue: INSTALL AMR METER Phone Number: 612-200-63+97
Scheduled Datc: 2017-02-23 Sc6ednled'Rme: 08:30:00
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ACIION NEEDED:
Crcated by: We�iy Hiatt Date Created: 2017-02-16
ACIION TAKEN• ��
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Status: In Progress Submitter Hns Been r
Cont�ted
Date Com�eted: Completed by:
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6431�tnaversity Ave�cae R1�
Fridtey,!VlAi 554.32
T63-572-356�
9/'A°� her�I�y authorize the City af Feidley andJor its empioyees to do whafi is necessary t
� repiece#he water meter. i aanderstand tha#the property owner 6s liable for the serater line from 4he main to the premise and all infierior
plurrabing. {Per City code 4U2.06� 1 afso�ho1d the C'rty ofi�ridley andJ'rFs employees harrnless#or any damages tbat anay occur whi(e sloing thi
oper,aeion. This to include,#w�no,t 9iani#ed io vahres,piping,walls,floors or the curb stop boz and senrice line_ In understand t am also requ
to obtain a permit�arior To any�eror9c,if a�ecessaey. �I J `���� O ��
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P9NAL METER READING(otd meterj � ��� �� ��� ���
Aiame: � �
Address
Phone IYum6er � � p��^''� r �
Signature__ Witness Signatur�
oLn MtT�R# � �o`��-- � � 4 �
OLD READING D ��� ' � � — S}'1.D (�1.� �► ��l ►'l �
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NEW METfR#�� rV �� ��
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NEW READIPlG � — �------_
�p� � ,s �° Ge M�"� .
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P�G 3'�;���c.���-
FR1D O
CHA�CEI�402.WATER,STORM WA,TE � ��� :1/ER
ADM111115'1'RAT14lli ---
` �Ref Ord No Z13,464,565,�66,629,638,662,922,988,1144,I1S6,1I91)
402.5 AERMIT FEE
Prior to construcCing or repair of any water of sc�ver fine cannecting the eKisting municipat system and acry fiouse os buifding for whi�h#he
application is made,the owner or contractor shall be required to obtain a permit for sucl�connection,and staali pay a permii fee as proyic{ed ii
Chapter 11 af#his Code. After such connection has been made,the Water and Sewer Departmertt shall be notified. tt shall be unfaa�fui tu cov
arap connecting line uniil an inspection has been made and such connection and the wor9c inaderrt thereto has been approved by the City as a
proper and suitabte cortnection, f
402.06 REPA(RS AND lWAINTENANCE TQ COAflYECT10N
After the initial connection has been made to the water service curb stop box or the sewer lead at the property iine vr a water serrice�ead(�as
been extended to fihe property line fior connedion,the appiicarit,owner,or accuparrt or user of such premises shall be iFahle for a11 repairs
required to any water 1'sne and sewer lines necessary for connection aF the premises fram the mai�to the premises. if the property awner
requests mairrtenance service ar repairs 6e perFormed fry the City,the property owner shall be charged for the�msts of the mairrtenance and/o
repairs,inciuding necessary street repairs at a rate set annuai[y by an administrative porcy. tt shali be the responsbilel�r of the appGcarrt,
owne�,occuparrt or user to perform srandard maintenance of the sewer service iine from fihe peemises to the main including debris dearing or
root cutting and to maintain the water seraice�urb stop box fo�operability and at such heigPrt as will ensure that it remairis at�ove the finished
grade of#he land or property. �Ref fi38,1i56,1191)
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Ci�ty of Fridley
water Department
Address �j�� S, Ti Yl,�
Name � ��/"�'��/� 4J`{�v
Date � '_"c� '�-L � -
Old Meter Number y pZ �
Old Meter Reading Q� � ��
Replacement No. � �7 �
Replacement Reading
Replacement Make �4L�•e/'�
Remarks•
Signe
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