Meter Swap Request Number: 12557
Public Works Division
Service Request
Problem Address: 7398 Tempo Terr Requested By: Donna McBrian
Department: WATER Address: 7398 Tempo Terr
Fridley,MN 55432
Problem/Issue: INSTALL AMR METER Phone Number: 763-784-6612
Schednled Date: 2016-12-29 Scheduled'ITime: 10:00:00
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ACITON NEEDED:Instail AMR
Created by: Beth Kandrick Date Created: 2016-12-23
ACTION TAI�N: ����� ` ��
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Status: In Progress 5ubmitter Has Been �,
Contacted
Date Completed: ��� a� ,t �(/� Compieted by:
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�_ V City of Fridley ��` � �,t�� �
Water Department ��
6431 University Avenue NE
Fridley,MN 55432 �l� '���'1� �v ���
763-572-3566
�/N+e hereby authorize the City of Fridley andjor its empioyees to do what is necessary to
replace the wate�meter. 1 understand that the property owner is liab{e for the water fine fro�the main to the premise and all interiar
plumbing. (Per City code 402.06j i afso hold the City of Fridiey and/its emptoyees harmiess for any damages that may occur whife doing this
operation. This to inciude,but not limited to valves,piping,walis,floors or the curb stop box and service line. In understand I am also required
to abtain a permit prior to any work,if necessary.
FINAL METER REA131NG(old meter) V �L�����
Name: ������. M��J'f'i,��iJ�. Address /� i C� ��-Wy�C;1 ��',r 1"`,
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Phone Number ?�� ~ 7 V l � �S[� �.�.. �ate �'p�CL r'"��
'�'�S•g �-'��""� �/ ��1 O u��L WiinessSignature '����V
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OLD METER# `� �� � ����
OLD READiNG a � �� d�`"'v
NEW METER# 1 � ( � V `�-' � �
NEW READfNG �
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FRIDLEY CITY CODE
CHAP'TER 402.WATER,STORM WATER AND SANffARY 5EWER
ADMINISTRATION
(Ref Ord No 113,464,565,566,629,638,662,922,988,i144,1i56,1191)
402.5 PERMIT FEE
Prio�to constructing or repair of any water of sewer line connecting the ex'�sting municipal system and any house or buiiding for which the
applir.ation is made,the owner or writractor shatt be required to obtain a permit for such cor+nection,and shaii pay a permit fee as provided in�
Chapter 11 of this Code. After such connection has been made,the Water and Sewer Oepartment shali be notified. It shalt be uniawful to co+rer
any connecting line u�til an inspedion has been made and such connection and the work incident thereto has been appro�ed by the City as a
proper and suitabte cannection.
402.06 REPAIRS AND MA{NTENANCE TO COMNECTION ,
After the initial connectian has been made to the water service cu�b stop box or the sewer lead at the property line or a water service lead has
been extended ta the properCy line for wnnection,the applicant,rnvner,or occupant or user of such premises shaH be tiable fw all repairs
requ[red to any warter fine and sewer tines necessary for connection of the premises from the main to the premises. tf the property owner
requests maintenance service ar repairs be performed by the City,the property owner shall be charged for the costss of the maintenance and/or
repairs,inciuding necessary street repairs at a rate set a�nually by an administrative policy. it shail be the responsibil'rty of the appiicarrt,
owner,occupant or user to perForm standard maintenance of the sewer service tine from the p�emises to the main inciuding debris dearing or
root cutting and to maintain the water s�rvice cucb stop bax for operability and at such height as wiif ensure that it remaim aberve the fin�hed
grede of the fand or property. (Ref 638,1156,1191�
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City of Fridley =,'���.,-�:. j
Water Department
Address �� 1� ��lY►-f'CO ��(Z,
Name �NNA I�IC3���
Da t e �"'�j�-�9
Old Meter Number ���� ro`��(
Old Meter Reading �p� �
Replacement No. '�j`(� -�j33 �
Replacement Reading �
� Replacement Make !�
Remarks• 5"T6PP��Cl+�-'Ze2- :
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Signed�'/Q""�_
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