Meter Swap _ � C�a--iL-f f�1jv 3s--��a��J
'� INSTALLATION
� AUTOMATIC METER READER
c�nroF
FRIDLEY
Address ���� ��i S�n ���
Name ���l�� �� �e W
Date �� �� �"`
Old Meter Number G V 1 3 c5�
Old Meter Reading 3 � � 6�
Replacement No. �s � �
Replacement Reading � ����
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Replacement Make 3�� �
ERT# �� ��C7 Sy 3�
Replacement ERT#
Remarks: 5
. _ 4
�� Signed:
Request for Service Report
.
� City of Fridley
Reference No: 601-11-3270 Date: 08/01/11
Request Type: InstaII,AMR meter Entered By: Wendy Hiatt
Department: Water CitizenName: Ste�eVJacek
Address: 6811 MADISON ST NE Callback Phone: 763-639-7237
Scheduled Date: 08l03l11 9:OU AM �r��.,• Property Owner:
Location Details: Request Details= Change old meter
Action Taken:
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Approver: �
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Completion Date: � �� ��
�Citizen N otiiied
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City of�ric�ley
�,Tate�De�aa-fraeni
5�31 L?��ersity_�v�nue 1�aL.
Fndley ��i�l 5��32
(i6�) 572-a56I "
Uwe he�eby a�fl��� the �i-ta oz r��ley a�c'Jor iis -
employetis �� �o ��a�y�e��ssarv tu r;,p1a���.he�ai�:r�nete�-_ 1_un.de�stand thai i.�e
prope�y owner is 1_ia�le ior ihe�vater line fro�n�he mai�n to t�e p�erlis�, an� a.11 �.i�ror
plu�bia�. (�er�i� c�de 4t�2.0� I�sfl '�old i�e City of Frid.�ey audlor its e�lo�retis
harinl�ss ior any damaQes t�ai�a? o�.cu�r whi3e �oi��t�is operarifln. T�iis i�iu�la�i�;but
noi limite� to; valTaes, AiP�n� �.^'a.11�, f�ors or tiie c�'� sto�bo� and s����e ]i�e. 1
L��jL ij.P.TSI��"1C� 1 �iIL1 `�,SO I[�.C�11LTe'.1�i LO ODTr.�.iIl 3 i-.QJ-�7'1T Dl_Oi'LG�2Il�1 �iVO'1� lI 73C'S�i,SB3I'V-
��ame_ :4��ess:
�hone l��.ber: Date:
S��nnai�.re: � :
�`nTitness ,�i�ature:
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(kei Ordi�T.o 11�,1b�,�ti�, �oo, 0'25, o�o, 0'02, 92?,980, 11�a, 11��, I1�1)
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P�or to cansuuc�ng or rep2ir oz an r�,vaie:or sewer line con�ecriug the e<sisting municipal system asid any
house or building Tor whicn ihe a�pl�cation is made,the ot,vn�or contractor sha�be re�u3red io ootain a
pemiit for such conne��ion, a�d sha11 nay a per_nit iee as provideci i�CIlanier 11 oi-i�is Code. �',fter�sucfi
cannz�an has btien�ade,�e�7aizr�nd Sewe�j�epa.�-tme��sh�71 be no�e� it shall�e urlawn�i�L coT�er
any conne��n�iine until azi inspecrion has be�n�ade and su�h c�nneti�on and the woslc iucideni t�ereto
has been a�proVed by�e�i�T as a praioer��saitable canne�on.
�02.��. ���;<����C�i'�'��a�'T�;L'�'�3 ��i�������T
Afte�the i���l.conaec�on�as betin�ade tfl ihL�,�arer servicv c�.�b siop bo�or��e szwer lead a�iLe
propertyli�e or a wate:ser�rc�3r seurer!ead�as bevn s�rndea tfl�.e pr�e�ty 7ine f�r eanuec+�o�;�e
applican� o�ne.,or the oc�up�t or-�sei-or such�remises shall oe liable tar aii zep�rs rzquirzd to any
waier line �nct any sewer iines ne�essat,�zer co�uec�on ol�3ia nremises Tro��e main TQ �.he�remises. Lf -
the properiy o���er reauests�ainiez�ce serv�ces or re�,airs i�e perrorme�.oy?he :,iry,�e proper�;r ou�ner
shall be char�ed ior�e costs oi�he mainte�anca a�cVos:�pa�-s, inci�:dinQ any ne�ess�';J siT'eet repait-s, at a
,-ate se#an�ualiy b_v an aamir,is�aiiJa policy. ?�s�a37.�e t}ie r�spcnsibi�it�r of the a���ic�t, o�vner, oc�,up�?
or user to pe�.�rm st�dar���.nteuance nr he se��er service�e from i�e p?-e�ises io the�aan inc�u�g
de'�i-is clua.�-iug or root cni#i��;�d�o maiarain ih�wai�r ser�rie� Ci1r�J SI�Jj7 L�A]�1�P 6i3�t3�J7�1-LV aIlC� at su��
h�'�i us will:.�s�re;1-iat;t?-em�s abn�e the fiais�e��-ade oi�e land or zro�eriv_ �i 6��, i i��, 11�"!j