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Meter Swap '� � ��._�-� �r.�-'�.�"`��i�i°�G � �` INSTALLATION G.N�. AUTOMATIC METER READER FWDLEY Address�� \)�t`��-��Et� Name ��11J� t-�-j�Z��l Date ! —�_ ��. Old Meter Number t O �� Oid Meter Reading �� Replacement No. ��a5 Replacement Reading c/� Replacement Make � ERT# �� - Replacement ERT# Remarks ��,�� Siqned: _ _ `,�-i �,�:.. . / �� 7N" '�f� �� Q� F �: �i-12 . 5.�1,�12 Re�q�Tj�re� �� F�+� EDIVA . �1ta� � -,pw.�.w�+► J�dd�s: 6�'71 YA�1 BtIR�!ST tN"c {:�P�� 7�1-2�99 Scf�d�d t?ate= �ffi1217_3a 1iW �� Piaopedty tM�: ��: R�e�Iletai�s: t�i�R . �T'y T _ C�Id �e�r # �`�,CC�� ' �Id r��iin�� 1��v �le�r# j��1,�-" �+�wr �+eading: � E��-� �,�� t�� ; . �_ _� �__---��.�_-- -.___.._._�_�_---- --_ ; � , ��_ ____._. ___________ _��____ _....____________��____ - �: ; � � � ��!� ..__�.�� . � s - City of Fridley Water Department 6431 University Avenue NE Fridley,MN 5543t (763)572-3566 I/we hereby authorize the City of Fridley andJor its employees to do what is necessary to replace the water meter. I understand that the property owner is liabie for the water line from the main to the premise and all interior plumbing. (Per City code 40Z.06) i alsa hold the City af Fridley and/its employees harmless for any damages that may occur while doing this operation. This to include,hut not limited to;valves,piping,walls,fioors or the curb � stop box and service line. I understand I am also required ta obtain a permit prior to any work,if necessary. Final meter reading�old meter) Q�� Name: Address: �� +�� Phone Number: Date: ��'� . ,.;�. Signature: ��-!� � � Witness Signature: FRIDLEY CITY CODE CHAPTER 402.WATER,STORM WATER,AND SANITARY SEWER ADMINISTRATION (Ref Ord No 113,464,565,Sb6,6�9,638,662,922,988,1144,1156,1191) 402.05. PERMIT FEE Prior to constructing or repair of any water or sewer line connecting the existing municipal system and anq house or building for which the application is made,the owner or contractor shatl be required to obtain a permit for 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 shall be notified. It shall be unlawful to cover any connecting line until an inspection has heen made and 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 CONNECTIUN ARer 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 to the property line for connection,the applicant,owner, or the occupant or user of such premises shall be liable for all repairs required to any water line and sewer lines necessary for connection of the prernises from the main to the premises. tf the property owner requests maintenance service or repairs be perFormed by the City,the property awner shall 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 remains above the finished grade of the land or praperty. (Ref 638,1156,1191) Request for Senrice Report • � City of Fridley Reference No: 601-11-3144 Date: 06122111 Request Type= Turn water oFFlon Entered By: Wendy Hiatk Department: Water Cikizen Name: Joshua-Ben Franklin Plumbing Address= 6471 VAN BUREN ST NE Callback Phone: 612-822-5292 Scheduled Date= 06122111 2=00 PM �� , Property Owner: Edna Welch Location Details: Permit#2011-00997 Request Qetails= Shut water off lleave key x'xxBILL'"'% Ackion Taken: �_ _________._.............W______.-----___.. _.._. ._....______________ __ ��-i �� '� � �� I�,�'r� �� a� Y �' /�� Responsible Person: } G%-fi��.� �- � Approver: � Completion Date: � Citizen Notified , � .��/