Meter Swap �-�ti k:� � ��-��s� -4(��3)�
� , INSTALLATION
�.N� ATER METER
::._
�n�.�r
Address E'���-3 ��j�- ��'
Name 2�ah.c�.�, ��. i,.ol�cySoy�
Date �~ ` � f �
Old Meter Number �C� ���" ��
Old Meter Reading 3�� �d
Replacement No. ���`" 8�� 3,�
Replacement Reading �
Replacement Make �'����-
Remarks: � �cj z,-i.c�e�..� ��inp/
� �
Signed; -�3t�� `
� � �� ;�� .
; . � �, /l, ,.� � (✓k3 7cJ
� ✓--'-'J``� INSTALLATION
u�nroF AUTOMATIC METER READER
Fwa�v ;
Address �� `� �. c�� �`�
Name������ l "�..)N�h���
Date ������� c� ,:
--,.
Old Meter Number �{ ���
\
Old Meter Reading � �
Replacement No. _ � �
Replacement Reading �
Replacement Make r���'%��
ERT# � t>�.��7�J
ReplacementERT#
Remarks
-•��Signed:
,
, R�ue�f f�r�er�r�ce R�p�
" �i�y c�fi �r�ci�
�: �t-�z-��� �: ���ezo�z
T�� �� �.
��: w�� ��: ��
�� +��t�et.�sr� . �-��
��= s���:�� � c�:
��: � �: a�
����
'c��d ���� # �C� � �`���
�
��Id re�din�; 1 � `-�
� � �
;�V�� �1+��r� ��4� �
�
�rl+�w F�eading� �
E�T�# �J��c`,}����
�
���� �
� i
� � � _ ___ �._.__ _.� _�__.._ .__. ___ _ �
�: � [ �
� _.������ w.. �
. '
City of Fridley
Water Department
6431 University Avenue NE
Fridley,MN 55432
(763)572-3566
��wQ hereby authorize the City of Frid{ey and/os its
employees to do what is necessary to replace the water meter. I understand that the property owner
is{iabte for the water line fcom the main to the premise and all interior plumbing. (Per City code
402.06) i alsn hold the City of Fridtey and/its employees ha�mless for any damages that may occur .
while doing this operation. This to include,but not limited to;valves,piping,walis,floors or the curb
stop box and service line. i understand I am also required ta obtain a permit prior ta any work,if
necessary. � ��� �Q
Final meter reading(old meter�
Addresr. � ' ` - '�
Name: .
Phane Numb : Date: �����^4� �
i
Signature:
Witness Signature: �
FRIDLEY CfTY CODE
CHAPTER 402.WATER,STORM WATER,AND SANITARY SEWER
ADMINISTRATION
(Ref Ord Na 113,464,565,566,629,638,662,422,988,1144r 1156,1191)
402.Q5. PERMIT FEE
Prior to constructing or repair of a�y 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 11 of this Code. After such connection has been
made,the 1Nater 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 wark incident thereto has been approved by the City as a
proper and suitable connection.
4U2.06.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 applicant,owner,
or the accupant or user of such premises shafl be{iable for a11 repairs required to any water fine and sewer lines
necessary for connection of the premises from the main to the premises. lf the property owner requests
maintenance service or repairs be performed by the City,the property owner shall 6e charged for the costs of the
maintenance and/or repairs, including any necessary street repairs,at a rate set annually by an administrative
polity. It shall be the responsibility of the applicant,owner,occupant ar user ta 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 property. (Ref 638,1156,1191j
Ftequest far Service Report
City af Fridley
R eference N o: 601-11-2794 Date: Ol!31!11
Request Type= Dld meter Entered By: Jeannie Benson
Department: Water Citizen Name: Rhonda Gunderson
Address: 6213 AB LE S T N E Callback Phane: 763-586-0575
Scheduled Qate= 02101f11 1:Q0 PM Property Owner: Matthew end Rhonda Gunderson
Location Details: Change ouk meter.Low consumption for 6 Requexk Details: Ghange out meter
months. No charge.
Action T aken:
/2�/�,�( G/�1 n.,.�-
o �d �..,��- -� �a 8' z y�-��
o.�� �a �.���'� � z� �� � �
� � �� �.��� �� ��� � �d � � �
�l v.�. �.�(,{�Y M"..�';� � � �
Responsible Person: �
Appro�er.
Campletian Date: �Citizen Notified
�� /�- �/