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'� t�'}��� INSTALLATION
G.��. AUTOMATIC METER READER
FRIDLEY
Address lL�' , �JF-�-�"��b�
Name �flV��� I�'���r
Date �-�l - ( c�h
Old Meter Number -t �a�
Old Meter Reading � � 6�
Replacement No. �5� a� �
Replacement Reading �
Replacement Make _�'��w��
ERT# �3����rj� V
Replacement ERT#
Remarks:
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City of Fridley
Water Department
6431 University Avenue NE
Fridley,MN 55432
(763)572-3566
I/we 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) 1 alsa hold the City of Fridley and/its employees harmless for any damages that may occur
while do�ng this operation. This to include,but not limited to;valves,piping,walls,floors or the curb
� stop box and service line. I understand 1 am aiso required to abtain a permit prior to any work,if
necessary.
Final meter reading(old mete�) „/`��� ��
Name• Address• ��� �
Phone Number: Date: �1 (� � I�
Signature�
Wltness Signature:
FRIDLEY CITY CODE
CHAPTER 402.WATER,STORM WATER,AND SANtTARY SEWER
ADMINISTRATION
(Ref Ord No 113,464,565,566,629,638,662,922,988,1144,1156,1191)
402.05. PERMIT FEE
Prior to constructing or repair of any water or sewer line connecting the existing municipal system and anj+house
or building for which the application is made,the owner or contractor shall be required to obtain a permit for such
connection,and shali 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 shali be unlawful to cover any connecting line until an
inspection has 6een made and such connection and the wark incident the�eto 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 tiable for all repairs required tb 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 shail be charged for the costs of the
maintenance and/or repairs, including any necessary st�eet repairs,at a rate set annually by an administrative
poticy. It shali be the responsibility of the applicant,owner,occupant or user to perform standard maintenance of
the sewer se�vice 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 638,1156,1191)
. .
Request Number: 11331
Public Works Division
Service Request
Problem Address: 6320 Jefferson St Requested By: Sandi H
Department: WATER Address: No address provided
ProblemlIssue: FINAL METER READING Phone Number:
Scheduled Date: Scheduled 13me:
ACTION NEEDED:Final reading.Closi g 4/11/16 T#33302353
Created by: Wendy Hiatt Date Created: 2016-04-07
ACITON TAI�N:
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Status: In Progress Resident Contacted C'"
Date Completed: Completed by:
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