Hydrant Meter Rental Agreement Form - City Of Newberg printable pdf download

CITY OF NEWBERG

DATE:_____________________

HYDRANT METER AGREEMENT

Applicant Name:___________________________

Drivers License or SSN:______________

Mailing Address:___________________________

Phone Number:_____________________

____________________________

City of Newberg Business License Number: (Mandatory) _____________________

The above applicant hereby requests the City of Newberg to set a hydrant meter at the following

location ____________________________________________________________________ for

temporary water service pursuant to the following conditions:

FEES:

Payment of a $150.00 non-refundable application fee is due at the time of application. This fee covers

the meter installation (by the city), account set up, removal and the first 10,000 gallons of water used

within the first month. In addition, the applicant will pay a monthly billing fee of $10.00; rental fee of

$50.00 for each calendar month the meter is in use and the appropriate commercial volume rate. Water

used in excess of the first 10,000 gallons will be charged at a rate of $1.87 per one hundred cubic feet

(or $2.17 per 1,000 gallons). Failure to reimburse the city for usage on a monthly basis is considered a

violation of city code 134.06 (Theft of Services) which will result in immediate termination of hydrant

meter usage and/or a fine of $500.00 or more.

LOCATION OF METER:

The water used from a hydrant meter must be used inside the City limits. Violation of this provision

is a violation of City Code Section 52.10 and will result in a Class 2 civil infraction, which carries a

fine of $500.00 or more. It is your responsibility to notify the City when you have moved the hydrant

meter to a new location for monthly readings and inspections. Failure to do so may result in forfeiture

of the hydrant meter and indefinite suspension of hydrant water use privileges.

LIABILITIES:

The applicant assumes FULL RESPONSIBILITY for any and all damage to the hydrant meter,

hydrant and/or the City of Newberg’s water distribution system caused by the abuse, vandalism,

neglect, or misuse of the hydrant meter. Costs associated with damage will be billed to the applicant

by the City and could result in the denial of future use of a hydrant meter. The applicant should

remove and secure the hydrant meter nightly for protection. DO NOT use the hydrant valve as your

flow control valve. Turn the hydrant valve on completely and use the gate valve on the hydrant meter

to control your water flow. The applicant further agrees to provide an approved backflow prevention

device to protect the water distribution system.

Applicant Signature ____________________________

FOR OFFICE USE ONLY:

Status of Request: ___ Approved ___ Declined, Reason ___________________________________

Beginning Meter Reading _________________

Ending Meter Reading _________________

Meter Number________

Beginning date________________

End date: _______________

Hydrant Meter Rental Agreement Form - City Of Newberg