Meter Swap '� �1��1�- � i��`�I�-�-�-r7�'1�J
� INSTALLATION
�.n� AUTOMATIC METER READER
FRIDLEY
Address ���� �JP�-.�x�..�
Name c��� t-t��=A-1��(
Date l �� �,�c.
OId Meter Number e �7���
Old Meter Reading � � �
Replacement No. � �� -
Replacement Reading (�
Replacement Make �
ERT# ��� a��_
Replacement ERT#
Remarks:
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City of Fridley
Water Department
6431 University Avenue NE
Fridfey,MN 55432
(763)572-3566
1/we hereby authorize the City of Fridiey and/or its
emp{oyees to do what is necessary to reptace the water meter. i understand that the property owner
is liable for the water line from the main to the premise and all interior plumbing. (Per City code
402.06) I also hold the City of Fridley and/its employees harmless for any damages that may occur
while doing this operation. This to include,but not limited to;valves,piping,walls,floors or the curb
stop box and service line. I understand 1 am aiso required to obtain a permit prior to any work,if
necessary.
Final meter reading(old meter) �� �-����
Name• Address• � G�/`'� v���
Phone Numb • Date• � 'r�—�
Signature•
Witness Signature: So"'��
FRIDLEY CITY CODE
CHAPTER 402.WATER,ST�RM WATER,AND SANITARY SEWER
ADMINISTRATtON
(Ref Ord IVo 113,464,565,566,629,638,662,922,988, 1144,1156,1191) •
402.05.PERMIT FEE
Prior to constructing or repair of any water or sewer line connecting the existing municipal system and any house
or building for which the appiication is made,the owner or contractor shalf be required to obtain a permit for such
connection,and shail 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 notified. It shall be unlawful to cover any connecting line until an
inspection has been made and such connection and the work incident thereto has been approved by the City as a
praper and suitable connection.
402.06.REPAIRS AND MA{NTENANCE TO CONNECTfON
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 or sewer lead has been extended tothe property line for connection,the applicant,owner,
or the occupant or user of such premises shalt 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 property owner requests
maintenance service or repairs be performed by the City,the property owner shatf be charged for the costs of the
maintenance and/or repairs, including any necessary street repairs,at a rate set annually by an administrative
policy. It shall be the responsibility of the applicant,owner,occupant or user to perform standard maintenance of
• the sewer service line from the premises to the main including debris clearing or root cutting and to maintain the
water service curb stop box for operability and at such height as will ensure that it remai�s above the finished
grade of the land or property. (Ref 638,1156,1191)
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Request for Service Report
Gity of Fridley
Reference No: 601-11-2958 Date: 04I05I11
Request Type= Turn water oFflon Enkered By: Wendy Hiatk
Department: Water Citizen Name: Corey
Address= 5725 JACKS 0 N S T M E Callback Phone: 651-248-6366
Scheduled Dake= 04I12111 �R�F�� Property Owner:
Location Details: Lockbox: Request Details_ Shut water ofFlGet reading
o p Call Corey when water is ofF_
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Action T aken:
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Responsible Person:
Appro�er. �
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Completion Date: _______� ❑ Citizen Notified
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