2024 Gas Service Application

2024 Gas Service Application

Service Address*

City*

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Property Type*

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New or Change To Existing*

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Date Gas Service Required*

Applicant Name*

Applicant Email Address*

Applicant Phone #*

Company Name

Is Billing Information Different?*

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Are you the property owner or working for owner?*

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Owner/Landlord Name

Owner/Landlord Phone Number

Billing Company Name

Billing Phone #

Billing Contact Name

Billing Address, City and Postal Code

Billing Email Address

# of Meters Requested*

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LOAD - 1ST DROP (kBtu/hr)

TOTAL LOAD - 2nd DROP (Btu/hr)

Heating Load (Btu/hr)

Hot Water Tank (Btu/hr)

Make Up Air Unit (Btu/hr)

Other Loads (Provide Total in Btu/hr)

Detailed Description of Other Loads

Standard meter set pressure = 4 ozs. Set Pressure Requested?*

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Reason for Non-Std Pressure

Please briefly describe the work required:

Required Document Attachment Checklist

For Commercial and Multi-unit Residential:

Surveyed, drafted site plan(s)

Architectural / elevation drawings showing the exterior view where gas meter(s) will be installed. Gas meter location must be approved by the Gas Distribution Department

Proposed meter location (layout, clearances) if more than one meter is required

List of all gas fired appliances with peak load & pressure requirements

For Single Family Residential or Duplexes:

Site plan showing gas meter location(s), property boundaries, building corners, and street and lane orientation

File Upload*

Drag and drop files here or

Acknowledgements

By submitting this form, as the applicant I acknowledge:

The City of Medicine Hat will charge the actual costs of labor, materials and 3rd party costs (hydrovac, welding etc), not to exceed the quoted amount.

The applicant accepts and agrees to pay all costs to the City up to the quoted amount in a timely manner. Lack of payment may result in consequences including disconnection of gas service.

The property owner is responsible for hiring the required tradespersons and for all secondary gas piping, reconnections etc.

Gas meters will not be activated without completion of all required permits and after the property owner or applicant has signed on for utility billing at Medicine Hat City Hall (580 - 1st Street SE).

The Gas Distribution Department obtains locates for all primary underground facilities, but does not locate secondary lines. There may be additional charges to the applicant if locates are required to identify secondary lines. The Gas Distribution Department will not be held responsible for repair costs to damaged secondary facilities if they have not been identified prior to work starting.

ON THE READY DATE, THE SITE MUST MEET THE FOLLOWING CONDITIONS:

Site must be within 150mm (6in) of final grade with a backfilled foundation.

All aspects of building footprint (i.e. piles, foundation, curbing) must be visible.

Entry location of gas service has been marked on the foundation wall with an “X” and the word GAS. Meter location should not terminate more than 1.5m past the nearest corner of the building.

Work area around the gas service line must be clear of building material and other debris. All clearance requirements must be met.

If site is not ready when crew arrives, work will be rescheduled. Additional charges may apply

If the proposed service is a multi-unit building and individual metering has been approved by the Gas Distribution Department, each meter drop must be identified with a permanent tag.

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