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INSTALLATION
U.N� AUTOMATIC METER READER
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Address ���� ��
Name �G�►��� ��'1�h.
Date ���— ��
Old Meter Number � ��"f
Old Meter Reading ���
Replacement No. �''�
Replacement Reading �
Repiacement Make ~
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Replacement ERT#
Remarks:
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City of Fridley
Water Department
5431 University Avenue NE
Fridley,MN 55432
(T63)572-3566
I/we hereby authorize the City af Fridiey and/or its
employees to do what is necessary to replace the water meter. i understand that the property owner
is liabie for the water iine firom the main to the premise and ali interior plumbing. (Per City code
402.06) 1 also hold the City of Fridley and/its empioyees 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{ine. 1 understand 1 am aiso required to obtain a permit prior to any work,if
necessary.
Final meter reading(old meter) � �
Name: Address: � `� ��+ �T
Phone Number: Date: cJ V'V'I�
Signature•
Witness Signatu :
FRIDLEY CITY CODE
CHAPTER 402.WATER,STORM WATER,AND SANITARY SEWER
ADMINISTRATION
(Ref Ord No 113,4fi4,565,566,629,638,662,922,988,1144,1156, 1191)
402A5. PERM{T 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 application is made,the owner or contractor shalt be required to obtain a permit far such
connection,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 sha�l be notified. It shall be unlawful to cover any connecting line until an
inspection has been made and such connection and the wark incident thereto has been approved by the City as a
proper and suitable connection.
402.06. REPAIRS AND MAINTENANCE TO CONNECTION
After the initiel connection has been made to the water service curb stop box or the sewer lead at the property
line or a water senrice or sewer lead has been extended to the property line for connection,the appiicant,owner,
or the occupant or user of such premises shall be liable for ali repairs required to any water line and sewer lines
necessary for connection of the premises from the main to the premises. !f the property owner requests
maintenance service or repairs be perFormed by the Eity,the property owner shail be charged for the costs of the
maintenance and/or repairs, including any necessary st�eet repairs,at a rate set annually by an administrative
policy. ft shall be the responsibi{ity of the applicant,owner,occupant or user to perform standard maintenance of
' the sewer service line from the premises ta the main inciuding debris clearing or root cutting and to maintain the
water service curb stop box far operabi{ity and at sueh height as wifi ensure that it remains above the finished
grade of the land or property. (Ref 635,1156,1191j
Request Number: 5910
Public Works Division
Service Request
ProblemAddress: 548 Mississippi St Requested By:
Department: WATER Address: No address provided
Problemllssue: READ METER(WATER) Phone Number:
Scheduled Date: Scheduled Time:
ACTION DED: Read meter. Closing was March 1, 2013. ERT#33382272 `a
Created by: Wendy Hiatt Date Created: 2013-03-19
ACTION TAKEN:
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Status: In Progress Resident Contacted ❑
Date Completed: Completed by:
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