Required fields are marked with asterisks (*)

Gas and Water Service Disconnect Request Form

Kitchener Utilities reserves the right to deny this request if property is not vacant upon arrival. Kitchener Utilities will not sign off on the Building Division’s Demolition Tracking Sheet until both water and gas services have been disconnected.

Gas

Gas abandonment fees will apply. Please see the City of Kitchener's 2024 fee schedule and reference page 49.

Water

Please see the City of Kitchener's 2024 fee schedule.

Property Owner Details

First name

Last name

Company name (if applicable)

Phone number

Email address

Property address

Billing Details

First name

Last name

Company name (if applicable)

Billing address

Contractor Details

Company name

Contractor name

Phone number

Email address

Is this a full or partial demolition?

Full

Partial

Are you adding an addition?

Yes

Water to be turned off at curbstop for reuse

Yes

Date contractor cut off water service (if applicable)

Gas will be disconnected

Yes

Property is vacant

Yes

Redevelopment is planned

Yes

Please explain scope of work being completed

Date range for gas/water to be shut off: (Provide a 10 day window)

Beginning of range

End of range

Demolition Tracking Sheet submission

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Allowed extensions pdf, doc, jpg, jpeg,

If demolishing your building, this form must be accompanied by a Demolition Tracking Sheet for authority sign off. This form must be completed in full, including both the applicant’s name and service address, and submitted with the application with a minimum of 30 days prior to disconnect.

Acknowledgement

By checking this box, I certify that I have read and comply with the water/gas disconnect criteria and all information in the application form is true and correct. If this form has been completed by a third party, I further certify that the disconnection process has been discussed with the property owner and they are aware of and agree to any applicable fees and charges.

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 to collect information for water/gas disconection services. 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, 131 Goodrich Drive, Kitchener, Ontario, N2C 2E8, (519) 741-2600.