Meter Swap ,
� Request Number: 12691
Publie Works Division
Service Request
Problem Address: 7506 Tempo Terr Requested By: Darae Jakubik
Dep�rtment: WATER Address: Na ad�tress provided
Problemtlssue: INSTAL.L AMR METEK Phome Number: 612-749-0768
ScheduiedDate: 2017-01-06 ,,,� 5c�dnied'Rme: 07:00:00
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ACTION NEEDED:
Created by: Wendy Hiatt Dnte Created: 2017-01-03
.�1CTION TAKEN: �
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St��: In Progress Submitter Hns Been r
Co�xcted
Date Compteted: Completed by:
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City of Fridley
Water Department ' � � �� �
6431 Universiiy Avenue NE �
Fridley,MN 55432 ������3 t�i�'��
. 763-572-3566
�i�+e hereby authorize the City of�ridiey andjor its emptoyees to do what is necessary to
replace the water meter. f understand that the property owner is liab4e for the water line from the main to the premise and all irrterior
plurr�bing. (Per�ty code 402.06) i also hoid the C'dy of Fridfey and/its employees harmless for any damages Chat maY occur while doing this
operation. This to inciude,but not limited to valves,piping,wafis,fioors or the curb stop hox and service line. in understand 1 am also required
to obtain a permit pcior to any work,if necessary.
FINAL METER READfN6(old meter) ��� �� `�-��
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Name•_��N� �,('�v �� V`^' Address � C�� �
PhoneN �� � ���" '"� "�� Date �� V^ `�
!Signature �tness Signature
OtD METfR# � �J c,J�� J �l -f
OLD READtNG �1��� �j�L/
NEWMETER#_ V t����� ��
NEW READiNG �
ERT#1�i' �/���� ���
FRIDLEY CI7'Y CODE
CHAPTER 402.WATER,STORM WATER ANO SANITARY SEWER
ADMINISTRATION
(Ref Ord No 113,4b4,565,566,529,638,662,922,988,1144,1156,1191)
402.5 PERMIT FEE
Prior to constructir�or repair of any water of sewer line wn�ecting tfie euisting municipat system and arry house or buildir�for which the
application is made,the owner or contractor shall be required to obtain a permit for such connection,and shalt pay a permit fee as provided in
Chapter 11 of this Code. After such connection has been made,the Water and Sewer Department shall be�otified. It sfiail be unfawful to co+�er
any connecting line uMil an irispectton has been made and such connection and the worlc inciderrt thereto has been ap�sroved by the City as a
proper and witabie connection.
402.06 REPAIRS AND MAINTENANCE 70 C�NNECTiON
After the initial connectioa has been made to the water service curb stop box or the sewer lead at the properLy iine or a waCer senrke kad has
been extended to the property line for connection,the appliqrrt.owner,or occuparrt or user of such premises shall be liable for ail repairs
required to anY water Itne and sewer{ines 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 City,the property owner shail be charged fo�the cosks of the mai�rtenance and/or
repairs,including necessary street repairs at a rate set annuaily by an administrative poliry. ft shaif be the responsibil'ity of tfie applicarrt,
owner,occupant or use�to perForrr�standard maintenance af the sewer service line from the premises to the main inclutling debris dearing or
root cutting and to maintain the water service curb stop box far operability and at such height as wiil ensu�e that it remains a6ove the flntshed
grade of the land or property. {Ref 638,1156.1191)
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City of Fridley
Water Department
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Address_ �sd �, ���� ��,��
Name- ��c�� �-�c�T v�i��
Date ��l/-o /
Old Meter Number G
Old Meter Reading 6� � �j �
Repl acement No._ �,S`�g'��'��
Replacement Reading d
Replacement Make ����5�-'
Remarks: �(� /l�r-� S
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