Meter Swap ' Request Number: 12412
Pubhc works Division
Service Request
Problem Address: 7676 Van Buren St Requested By: Jolm Stanford
Deputment: WATER Addreas: No address provided
Problem/Iaaue: INSTAL.L AMR ME'IER Phone Number: 763-443•8538
Schednled Dnte: 2016-12-13 Schedaled Time: 01:30:00
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ACTiON NEEDED:AMR
Crcated by: We�y Hiatt Date Created: 2016-12-09
ACIION TAI�N:
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St��: In Prog�ess Snbmitter HaB Been r,
Coetacted
Date Com�sted: �Z -.-"�!� .���j Completed by: �^�h+`���r�n
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City of Fridley ,� �
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. Water Department ��� � � �
4 6431 University Avenue NE
Fridley,MN 55432 �����a 3�y v�'!S I
763-572-3566
�/We �h� ��`��� hereby authorize the City of Fridley and/or its employees to do what is necessary to
replace the water meter. i understand that the property owner is liable for the water line from the main to the premise and all irrterior
plumbing. (Per City code 402.06) i also hold the C'ity of Fridley and/its employees harmless for any damages that may ouur while doing this
operation. This to include,but not limited to valves,piping,walls,floors or the curb stop box and service line. In understand 1 am also required
to obtain a permit prior to any work,if necessary.
FINAL METER READING(old meter) ��(� � � �
Name:S 1V�W ��G�Y�t�i � Address !��� \�� fJZ�� �1
Phone Numbe CO . "' � v�•� Date �� J �� r �,�v
� Signature � �tness Signature !
OLD METER# � � J � �S��'
OLD READING� 3 � J 1�O
NEW METER# � / �� ����
NEW READING C�
ERT# CO ��� �`, 7� �
FRIDLEY CITY CODE
CHAPTER 402.WATER,STORM WATER AND SANITARY SEWER
ADMINISTRATION
(Ref Ord No 113,464,565,566,629,638,662,922,988,1144,1156,1191]
402.5 PERMIT FEE
Prior to constructing or repair of any water of sewer line connecting the existing municipal system and any Fwuse or building for whid�the
application is made,the owner or contractor shall be required to obtain a permit for such wnnection,and shall 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 ootified. it shall be unlawful to cover
any connecting line untii an inspection has been made a�d such connection and the work incident thereto has been approved by the City as a
proper and suitable connection.
402.06 REPAIRS AND MAINTENANCE TO CONNECTION
After the initial connection has been made to the water service curb stop box or the sewer lead at the property line or a water service lead h�
been extended to the property line for connection,the applicaM,owner,or occupant or user of wch premises shall be liable for all repairs
required to any water line and sewer lines necessary for connection of the premises from the main to the premises. if the properly o�rner
requem mairKenance service or repairs be performed by the City,the property owner shall be charged for the costs of the maiMenance and/or
repairs,incfuding necessary street repairs at a rate set annuaf(y by an administrative polity. It shall be the responsibilFry of the applicarrt,
owner,occupant or user to perform standard mairrtenance of the sewer service line from the premises to the main including debris dearing or
root cutting and to mairrtain the water service curb stop box for operability and at such height as wiii ensure that it remains above the fintshed
grade of the land or property. (Ref 638,1156,1191)
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City of Fridley
Water Department
Address ��j� U U�+ri U v r e�L S,�
Name S oh n �'}'Q,1'1�0 1'dl
Date 3 S' ��
Old Meter Number g�6 ��� 1�
Old Meter Reading � �DD ��v
_ Replacement No. � � 0� ��'
_ Replacement Reading �
_ Replacement Make q.� e�
�-�L�1�#
_ Replacement ERT#
� ,d 1C3�.� �'c�
� Remarks: l� � '-
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_ Signed _
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