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Meter Swap10/18/11 '� ��-.-,.C�C ��S�/SS'—�y��� � INSTALLATION unroF AUTOMATIC METER READER FRIDLEY Address ���� ��n �� Name �`s`I^-��}- ��''`�`�'+�-S c:'� Date � a ' [ �� "�j '� �'�� �l! Oid Meter Number Oid Meter Reading �� 6 d �� Replacement Na .5A � �� 6� Repfacement Reading � Replacement Make I��- � � ERT# _ ReplacementERT# '� �������_� � Remarks: ��� ���� S"�3.� Signed: 4 - � r R�qU�St f�r �efvic� R�p�ft City af Fn+d�;y ��r�: �rt-�t-:s� t���: �ar��:�zoy� ��est T�rpe� �stalt/WR met�r Fr�tereci Bg+: W�cfy F��i Clepartme�: W�ef f�iz�N,�ne: J;�#�c�+� /Iddneas� �D 4TH ST ME a€�c Whane: 7fi3-571-� �El�te_ 1t1�18J2ti11 �00!�1 �2� Pmpe�`tY(3wner. � I�et�7s; � [3reta�: krstaN A11R A�.#ic3n Taken: � � : ��� ,�,, n,5 •j-q. �(t'� � �v�. �, -�a T jt�V'V �•-}-�" !cl!,�/�-e..l�-.� I ' � �1 � i i i I � ! i € 1 i t�l c� �,i�e.�` # 7 � � 7 � `�' � � � �, �� �'`r � � c �� �'�� � 3 � +�3s�`� �s� 9; ; ;I�e.� �+�t� � � i ' re„�, ;��a�,�,,� gs 1 r ��P—� � '� 33v� 5���� ; � _ _ _ __ ________.__.__ _��____._______ ____� ��P�,: ; c��,�` ` A�Y�: �Off�P.�lt�l'i�E: � ��I�E►t� ' ��_ �� �lj �� _ . City of Fridley Water Department 6431 University Avenue NE Fridley MN 55432 (763) 572-3561 vW� hereby authorize the City of Fridley and/or its employees to do what is necessary to replace the water meter. I understand that the property owner is liable for the water line from the main to the premise and a11 interior plumbing. (Per City code 402.06) I also hold the City of Fridley and/or its employees harmless for any damages that may occur while doing this operation. This to include,but not limited to; valves,piping, wa11s, floors or the curb stop box and service line. I understand I am also required to obta.in a permit prior to any work, if necessary. Name: Address: Phone Number: Date: ,� Signature: �`' �' Witness Signature: ������� FRIDLEY CITY CODE CHAPTER 402.WATER,STORM WATER AND SANITARY SEWER ADMINISTRATION (Ref Ord No 113,464,565,566,629,638,662,922,988, 1144, 1156, 1191) 402.05. PERMIT F'EE Prior to constructing or repair of any water or sewer line connecting the e�sting 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 cannection has been made,the Water and Sewer Department shall be notified. It shall be unlawful to cover any connecting}ine until an inspecrion 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. REPAIItS 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 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 connecrion of the premises from the main to the premises. If the property owner requests maintenance services or repairs be performed by the City,tlie 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 sha11 be the responsibility of the applicant,owner,occupant ar user to perform standard maintenance of the sewer service line from the premises to the main including debris clearing or root cuiting 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 laud or property_ (Ref 638, 1156, 1191)