Meter Swap '� o��� ������
INSTALLATION
c�.nroF AUTOMATIC METER READER
FRIDLEY
Address __�__I It�IJ �' T� "�
Name G,�'�i ��.�
Date ��- ��' i t
Old Meter Number ( �J' S�
Old Meter Reading � 4�
Replacement No. �d
Replacement Reading �
Replacement Make ���-I���
ERT# J�J� �3OS�
Replacement ERT#
Remarks:
��'� Signed: �
,�
Re�qu+e�t for Servfce �e�r�
� City af Fr�dley
t����: so�-rt7-�a ��a�: �0�22�oi�
�t�c�,e� ��e� �t�����.ecer Ern�ed B�r: we�y t��t
C�partmerrt: Wah� Crtizen Name: Lcari Br�soks
Ad�ess: ��60 4TH�T NE Ca�aac�c P�cme: �51-252-�
"sc�duf�d D�e: it�/"31f1Li11 i0:00 AM 1 1 l Pmperty 4)wner:
Locatic�n D�ails: Fie�iest D�tails= kMstall'AMR
Action Taken:
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Re�ans�e Persa�n: �
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' � City of Fridley
Water Department
6431 University Avenue NE
Fridley MN 55432
(763) 572-3561
Uwe .�.�G i/�'/ t' J�'�"c_�(�S hereby authorize the Ciiy of Fridley and/or its
employees to do what is necessary to replace the water meter. I understand that the
properiy 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 andlor its employees
harrnless for any damages that may occur while doing this operation. This to include,but
not li.mited to; valves, piping, walls, floors or the curb stop box and service line. I
understand I am also required to obtain a permit prior to any work, if necessary.
Name:
�U/'/t' Q �c�v �S Address: �� S� ,V �'-
Phone Number: -�2 7d -C�a-(� Date: /d `3l'//
Signature: `�
Witness Signature:
FRIDLEY CITY CODE
CI3APTER 402.WATER,STORM WATER AND SAIVITARY SEWER
ADM..INI�TRATION
(Ref Ord No 113,464,565,566,629,638,662,922,988, 1144, 1156, 1191)
402.05. PERMTT F'EE
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 shall 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 VJater and Sewer Department shall be notified. It shall be unlawful to cover
any connecting line until an inspection has been made and such connecrion and the work incident thereto
has been approved by the City as a proper and suitable connection.
402.06. REPAIltS AND MAINTENANCE TO CONNECTION
After the inirial 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 e�ended 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 any sewer lines necessary for connection of the premises from the main to the premises. If
the property owner requests maintenance services or repairs be performed by the City,the property owner
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 ens�e that it remains above the finished grade of the land or property. (Ref 638, 1156, 1191)