Required fields are marked with asterisks (*)

Gas Meter Set Request Application

Before submitting this form, please ensure the following has been completed:

Gas piping into building and capped
Manifold and piping permanently labelled
Pressure test tag is present

Builder or property owner information

Name

Phone number

Fax number

Email address

Property owner billing address

Site contact's first name

Site contact's last name

Site contact phone number

Property 1

Civic number

Unit number

Street

Lot number

Closing date

Date required

Equipment to be lit

Future equipment

Total load

Manifold required (more than 1 meter)

Yes

Permit Number

Property 2

Civic number

Unit number

Street

Lot number

Closing date

Date required

Equipment to be lit

Future equipment

Total load

Manifold required (more than 1 meter)

Yes

Permit Number

Property 3

Civic number

Unit number

Street

Lot number

Closing date

Date required

Equipment to be lit

Future equipment

Total load

Manifold required (more than 1 meter)

Yes

Permit Number

Property 4

Civic number

Unit number

Street

Lot number

Closing date

Date required

Equipment to be lit

Future equipment

Total load

Manifold required (more than 1 meter)

Yes

Permit Number

Property 5

Civic number

Unit number

Street

Lot number

Closing date

Date required

Equipment to be lit

Future equipment

Total load

Manifold required (more than 1 meter)

Yes

Permit Number

Property 6

Civic number

Unit number

Street

Lot number

Closing date

Date required

Equipment to be lit

Future equipment

Total load

Manifold required (more than 1 meter)

Yes

Permit Number

Property 7

Civic number

Unit number

Street

Lot number

Closing date

Date required

Equipment to be lit

Future equipment

Total load

Manifold required (more than 1 meter)

Yes

Permit Number

Property 8

Civic number

Unit number

Street

Lot number

Closing date

Date required

Equipment to be lit

Future equipment

Total load

Manifold required (more than 1 meter)

Yes

Permit Number

Acknowledgement

There will be a meter set fee if we follow through with the request and we are unable to set the meter.

A one-time standard meter set will apply if everything is ready. Otherwise, the meter set fee will apply for each site visit.

We will require at least five (5) business days to process your request.

Acknowledgement

By checking this box, I certify that I have read and comply with the gas meter set criteria and all information in the application form is true and correct.

Personal information is being collected under the authority of s. 28(2) of the Municipal Freedom of Information and Protection of Privacy Act (MFIPPA) and will be used for gas meter set requests . This information will be shared with staff who require it for their work as part of Kitchener Utilities and will be stored on a server owned by a Third Party Service Provider (eSolutions Group) located in Canada. The personal information collected herein will be used only for the purposes relating to the program and will be protected in accordance with the requirements stipulated in the MFIPPA.

Inquiries about the collection, use or disclosure of your personal information should be directed to Kitchener Utilities 519-741-2529 or email to:utilities.dispatch@kitchener.ca