Meter Swap '� G��.-a- i 4��37s- `f��;��v,
� INSTALLATION _
GTYOE
FRIDLEY
Address C� l � �`�► `� �� 1�Il1
Name ��G�2 �le ��'u�o� �O� -S
Date � r �� V `�
Old Meter Number J � [ vv ���
Old Meter Reading � � � � �
Replacement No. ��� v � Q ' �
Replacement Reading �
Replacement ake � �r
Remarks:
Signe .
�t R'��'�- /4�-(�°`l� �/�'!(�1�,��;
� (� INSTALLATION
�.n,�. AUTOMATIC METER READER
FRIDLEY
Address G��1� ��"�t�i liJ� L��
Name ! 4��C��l.t.� ������1�
Date �—� ( "' �c�
Old Meter Number � � �p
�
Old Meter Reading ��
Replacement Na +�}MI���SS�b��
Replacement Reading Q�
Replacement Make �X��l�
ERT#
Repiacement ERT#
Remarks:
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T�re� ANIR� �te,�d E#�r: �
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�: G:i1t!WA�1�!€iT+Di+I'.�"T NE . fi�2-
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City of Fridley
Water Department
6431 University Avenue NE
Fridfey,MN 55432
(763)572-3566
I/we hereby authorize the City of Fridley and/or its
empioyees to do what is necessary to repiace 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 hoid the City of Fridley and/its empioyees harmless for any damages that may occur
while doing this operation. This to intlude,but not limited to;valves,piping,walls,floors or the curb
� stop box and service line. 1 understand I am aiso required to obtain a permit prior to any work,if
necessary.
Final meter reading(old mete�)
�v�� � .
Name: Address: CJ�L� �' '�"�"��N
Phone Numbe : Date: � �V�`��
f
Signature:
_ Witness Signature:
FRIDLEY CITY C�DE
CHAPTER 402.WATER,STORM WATER,AND SANITARY SEWER
ADMINISTRATION
(Ref Ord No 113,464,565,5b6,629,638,662,922,988,1144,1156, 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 11 of this Code. After such connection has been
made,the Water and Sewer Department shall be notified. It shail 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.
4�2.06. 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 senrice 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 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
maintenance and/ar 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 cu�b 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 for Service Report
� �it}+ of Fridley
R eference N o: 601-11-2750 D ate: Ol 104111
Requext Type= Leaking meter Entered By: Wendy Hiatt
Department: Water Citizen Name: Michelle Grandbois
Address= 6310 WASHINGTON ST NE Callback Phone: 763-7$8-6345
Scheduled Dake: 011l Ofl l 7=30 AM ���� Properry Owner:
Location Details: Requexk Details: Change leaky meter
Action T aken:
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Responsible Person: �
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Approver: �-
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Completion Date: ! � �.,Citizen Notiiied
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City of Fridley
�h'at�T De�art�eyi
5�31 U�.versi�ty�venue�L.
Fnaley�i�l 5��32 �
�%6�� J7�-���J�
Uwe��C��� lP �('����-� �e;e�v au�o��;, th� Ci-�{oz r�ipley a�d/or its .
em�loye;,s tfl do �u�a��s�e�;,ssary to r:.-�lac��.he wai�,r met�r_ �_unde�st�nd thai i.�e
properiy o��ex i� liable ior the wafer]ine�o�the mai�to t�e prer�is�, a,n�all;�t�r-;or
�lu�bi;_ig. (Per�i� c�de 40.2_�0� I a?s� �old�.e �;ty oi Fridley andfor its e�lo=�etis
�arinless icr any damages t�ai na1 o��u�r while �oinT ti�is ope�aiion_ This �a incla�i�_bui
noi]i�nite�.to; va3.ves, pip�n� walls, f�ors or t'�e c�'� sto� b�x and s���ice Ltae_ I
�.dersr�d I am als� requir�� �o flbt� a�ti-.�'"1T Di_OI iL� �Il;j `�iTO�i�.�, lI Il�:,�ssary.
�`lame: 1 II I 1_�.C�1 '�1_'__t n IY� rl� [�l� -4��ess;-�� S. �'�
t none 1��be������� Date: t ��"��/���
_ - �� �5�3.�
Si�lat�re: -
�idit.ness �i�ature: _
�;�� '.'� ,�����'3`���� -
- L; �����=��2_'��J��'��, ��'�'�����'-��+'��'1�133 Sr�1�i.��S��r���.�
:�1�I�^��1��'�'1���'��I�
(kei OrdiV-o lli,4b�?,�b�, ��b, 0'2�, a'3fl, 0'02,922,°88, 11�4, ll��i, 1191)
�i�2.�5. ��'�T��'I'� .
P�or to consiruc�n� or rep�ir or any�,vate;or sewer]ine conaeciiug the e<Yisiing mu�icipa.l system and any
house or�uiIclin�_or��hica i�e anpl�cation is m�de,the o�er or caniractor shal�be re:�uire�.to ob'rain a
pemit for such connec�ios, a�d sha11 nay a per_nit fee as providea i�Cha�ie, 11 oi u'�is Code. ,Sf�er�such
cannzctitan has otien macie,,�e�Taier��Szwei�eaa�--tme���all be no�e� i#shall oe urlawnti tL co��er
any c�nne��ng iin�until�iuspe�iion has be�n�ade and su�h conneti�on and the woil�i��iden;.t�ere#o
has been aapre�ed by�e Ci�=as �proaer ar�ct s�i�ble canne�`aon.
=�02.fla. �.�=��<�I�i�r:��i'T'�'�a�'T�:��'� �.�ldl'di':�'�'I�1°T
.�fie:�he iaii7�l.c3n3e��on ias been�ade t��i z,�arer servic� c�.�;� stop bon or��e�ewer iead ai�e
propeztyline a�a wate:ser�rca or seuzer'ead has b�Un z:�ynd�a�fl the pr�e�-ty line for canr,ec�o�,;t.�a
applican�, o�vner,or the oc�up�t or aser 3r sac��remises shall be liable tar aii repa�s requizzd�o any
•Nater line and any sewer]ines ne�essat�zer ca�nection Qr t���Femises�o��e main ta the premises. Lf -
the property o�,��er rEauesrs�ainizr�nce services or re�,airs�e perrorme�oy the �iry,�e prop�ow�er
shall be c�arged ior u�e costs oi�.,mainte�aneti a�cUor��a�s, inci�ctina any ne�essaz;�sire�#repairs, at a
rate set an�ualiy bv an acimi�is�a�iJa policy. I�s�a31�e t}le r�spLnsibiit�T of the a��l�c�r, otivner, occa�anT
�r uier tD peri�rr�sta.�dar�m��ntzuanc�az ihe se�vez s�rvic�'�e from t}ie a�er�ises io the�ain�nclaicting
de'�rs c1Qa�-ins or root c�srti;���d�o maiatain i�e war�r ser�rie� curb s�p b��iar o�erabi7itw an�1 at suca
hei�a7i us�i3I ess¢re�}-i�;�rem�ins abfl�re'�ue fi�is��a�ade o3�i e laud or�rc�periv_ �:,i 6�4, 1��•o, 11�?�