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city of Frialey
Water De�artment
Address �"'�"X/ �, �a�, 'S7
Name ��� �,,,,��3,.1
Date . /�0�� 1
Old Meter Number �' (�
OZd Meter Reading
Replacement No. d�' •
Replacement Reading �
Replacement Make ��^��-
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Signed,�r —
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v.�� AUTOMATIC METER READER
FRIDLEY
Address {�(�� l f'��J��
Name
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Date � `��"��- t�
Old Meter Number �� �
Old Meter Reading � � Jr "�'�
Replacement No. �,r+vr����5 �"�`L
Replacement Reading �
Replacement Make !�
ERT# �� �J��� V
Replacement ERT#
Remarks
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City of Fridley
Water Department
6431 University Avenue NE
Fridley, MN 55432
(763)572-3566
��We hereby autharize the City of Fridley and/or its
employees to do what is necessary to replace the water meter. 1 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 ta include,but not limited tv;vaives,piping,walls,floars or the curb
stop box and service line. I understand 1 am also required to obtain a permit prior to any work,if
necessary. � ��
Final meter reading(old meter)_� �� v
Name: Address: 4J�/�� ��`�' -
Phone Number: Date: �� `—�
Signature:
. Witness Signature:
FRIDLEY CITY CODE
CHAPTER 402.WATER�STQRM WATER,AND SANITARY SEWER
ADMIN ISTRATION
(Ref Ord No 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 anq house
or building for which the application is made,the owner or contractor shall be required to obtain a permit for such
connection,and shall pay a permit fee as provided in Chapter il 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
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 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 liabie 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 shall be charged for the costs of the
mainCenance and/or repairs, including any necessary street repairs,at a rate set annually by an administrative
policy. it shail be the responsibility of the applicant,owne�,occupant or user to perform standard maintenance of
the sewer service line from the premises to the main including debris clearing o�root cutting and to maintain the
water ser�ice curb stop box for operability and at such height as will ensure that it remains above the finished
grade of the land or property. (Ref 638,1156,1191)
' Request Number: 11390
Public Works Division
Service Request
Problem Address: 6271 Able St Requested By: Ruth Johnson
Department: WATER Address: No address provided
Problem/Issue: TURN WATER ON/OFF Phone Number: 763-571-1681
Scheduled Date: 2016-04-27 Scheduled 15me: 09:00:00
�2_ �� '
,
ACTION 1VEEDED:Turn offwater for repair.***BILL*'�*
Created by: Wendy Hiatt Date Created: 2016-04-25
ACTION TAI�N:
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Status: In Progress Resident Contacted C''!
Date Completed: Completed by:
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