Meter Swap � Request Number: 15767
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Public Works Division
Service Request
Problem Address: 280 Stoneybrook Way Requested By: David Kondrick
Department: WATER Address: No address}xovided
Problem/Iasue: INSTALL AMR METER Phone Number: 763-571-2359
Scheduled Date: 2017-06-06 5cheduled'lime: 02:00:00
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AGTION NEEDED:
Created by: Beth Kondrick Date Created: 201?-06-OS
ACTTON TAI�N:
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Status: In Progress Submitter Aas Been r
Contacted
Date Completed: Completed by:
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�iiy o�Fridley � '������_ O (
Water DepartPvaen�
_ . 6431 LBniversity Aerenue NE � � ����
Fr�dley, MN 55432 �
763-572-3566
��""�e hereby authorize the Cty of Fridley and/or its emp(oyees to do what is necessary to
replace the water meter. r understand that the g�roperty ouvner is liable for the r+rater line from the mair�to the premise and al{irtterior
p{umbing. (Per�"rty code 402.06j 1 also hold the City of Fridtey and/its employees harmless for arry damages that may occur while doing this
operafiion. This to include,but not limited to valves,piping,walis,floors or the curb stop box and serxice line. In understar�d!am also requin
to afrtain a permit p�ior to any work,if�ecessary,
FBNA!ME'TER READiNG(oid meter) ������V
Plame: �O�V 6� �`�cJ�,d„�(I�1� Address � O � � �
Phone lYumber ���� � ! �` ��J`% p� � --' �-' ��
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Signature Witness Signature
OLD METER#_ �J� `1��:��
OLD READtNG v�� �� / (,�
NEW METER#_ � r w 0� �L> � ! I
NEW READtNG v
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�R�o«vi cerr coDE
CHAP1'ER 402.WATER,STORM WATER AND SARIITARY SEWER
ADM{R/lSTRATfON '
(Ref Ord No 113,464,565,566,629,638,662,922,988,1144,1156,1191j
402.5 PERMIT FEE
Prior to constructing or repair of any water of sewer line conneding the existing municipal system and any house ar buiiding for whicfi the
application is made,#he owner or contrackor shalf be required to obtain a permit for such connedion,and shall pay a perm�t fee as provided in
Chapter 11 of this Code. After such connection has been made,the Water and Sewer Departmerrt shali be notified. Pt shall be unlawful to cover
any connecting line unti!ao inspection has been made and such connection and the work incident thereto has k�en approved by U�e City as a
proper and suitable connection.
402.06 REPAIRS AAtD MAINTERIANCE TO COPINEC7701V
After the initiat connection has been made to the water seroice curb stop boK or the sewer lead at the property lir�e or a water service tead has
been extended to the property(ine for connecCion,the applicant,owner,or occuparit or user of such premises shall be liable for ail repairs
required to any water line and sewer fines necessary for connection of the premises from the main to the premises. ff Lhe property orvner
requests maintenance service or repairs be performed by the Crty,the property owner shall be charged for ihe cosfis of the mai�enance and/or
repairs,inciuding necessary street repairs at a rate set annually by an administrative policy. It shall be the responsibii'rty of the applicam,
owner,occupant or user to perform standard maintenance of the sewer service line from the premises to the main incfuding debris dearing or
root cutting and to maintain the water service curb stop box for operabitity and at such height as will enwre that it remains above the finished
grade af the(and or property. (Ref 638,1156,1191)
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City of Fridley
Water DeQartment
Address�� �1d��$Q'���
Name T��lu�D �,�1���
Date ����
Old Meter Number � S�3
Old Meter Readin �y7
Replacement No. ���7�1 �
Replacement Reading �
Replacement Make JP��t�
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Remarks: C�lJ� M�" �� �G�--
Signed '' � �
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