Meter Swap �� l ���1 i�-��3�
� G'�� INSTALLATION
crR,o� AUTOMATIC METER READER
FRIDLEY
Address ;0)1�` �' ���
Name I�IC��LL� V�p��;
Date `�'l�p"�`\
Old Meter Number
Ofd Meter Reading `�r` � �
Replacement Na �� �y��
Replacement Reading �
Replacement Make ����
E RT# ��� ��Z �
Replacement ERT#
Remarks:
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City of Fridley
Water Department
6431 University Avenue NE
Fridley MN 55432
(763) 572-3561
Uwe 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 all interior
plumbing. (Per City code 402.06) I also hold the City of Fridley andfor its employees
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 li.ne. I
understand I am also required to obtain a permit prior to any work,if necessary.
Name: Address: � 1�� 6 � ��-�'`r��
Phone Number: Date: `��
Signature:
Witness Signature:
C�J �11� ���� .
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FRIDLEY CITY CODE
CHAPTER 402.WATER,STORM WATER ANll SANITARY SEWER
ADMINISTRATION
(Ref Ord No 113,464,565,566,629,63$,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 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 Sewsr Departmant shall be notified. It shall be unlawful te cover
any connecting}ine until an inspecrion has been made and such connection and tl�e work incident thereto
has been approved by the City as a proper and stritable connection.
. ' 4�2.06. REPAIRS AND MAINTENANCE TO CONNECTION
ASer the'vutial 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
applicanx,owner,or the occupant or user of such premises shall be liable for all repairs required to any
watez line and any sewer lines necessary for connection of the premises from�e main to the premises. If
the property owner requests maintenance services or repairs be performed by the City,the property ow�ner
shall be chazged for the costs of the mai.ntenance and/or repairs,including any necessary street repairs,a#a
rate set annually by an adm.inistrative 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 cutti.ng and to maintain the water service eurb stop box for operability and at such
height as will ensvre that it remai.ns above the finished grade of the land or property. (Ref 638,1156, 1191)
� Request Number: 11440
Public Works Division
Service Request
Problem Address: 5901 4th St Requested By: Mike Trowbridge
Department: WATER Address: No address provided
Problem/Issne: TURN WA'IER ON/OFF Phone Number: 651-707-2528
SchedWe Date: 2016-OS-11 Scheduled'Iime: 09:00:00
� � � r `
ACTION NEEDED:Turn off water and leave key.***BILL****
Created by: Wendy Hiatt Date Created: 2016-OS-10
ACTION TAI�N:
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Status: InProgress ResidentContacted ❑
Date Completed: Completed by:
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