PEOPLES GAS SERVICE PIPE APPLICATION
PLEASE FILL OUT THE ATTACHED INFORMATION AND EMAIL BACK TO:
NewServiceApplications@peoplesgasdelivery.com
TEL: 773-542-7923 FAX: 920-430-6070
Section 1
Account name Federal ID # / Social Security #
Business description
Proposed service address Zip Contact name
Account phone Contact phone Contact fax Contact email
Account billing address City State Zip
Description of building Construction status
# of residential units # of commercial units Total number of meters needed
For single meter only: complete section 2 and 3
For additional meters breakdown: see page 2 and complete section 3
Section 2
Gas burning equipment Quantity BTU input/each Gas burning equipment Quantity BTU input/each
Furnace(s) Fireplace(s)
Water heater(s) Unit heater(s)
Range(s) Make-up air heater(s)
Dryer(s) Other - please describe
Other - please describe Other - please describe
Choose a desired meter location (which side or wall): N S E W Front
Section 3
The undersigned (herein designated as “Customer”) hereby requests the
Company to provide gas service facilities at the address shown on this application,
and hereby consents and agrees to such installation and to the maintenance of
such facilities, all in accordance with the applicable provisions of the Orders of
the Illinois Commerce Commission and the Terms and Conditions of Service of,
and Riders to, the Company’s Schedule of Rates on file with the Illinois Commerce
Commission, and Customer further agrees to pay the Company on a jobbing
contract basis all costs incurred by the Company installing or relocating gas
service facilities not borne by the Company pursuant to such provisions or this
application.
The Company agrees to make, at its own expense, ordinary concrete floor repairs
and Customer agrees to make, at his own expense, any floor repairs occasioned by
service pipe installations involving a type of flooring other than ordinary concrete.
Customer further agrees (a) to provide a suitable space, satisfactory to the
Company, for the installation of the Company’s regulators, meters and metering
equipment and, if the meter is not temperature compensated, the temperature in
such space shall be maintained at all times by Customer at not less than 40° F;
(b) to reimburse the Company for the cost of furnishing and installing any special
equipment required by City Ordinance or by the Board of Underwriters, if located
along the service pipe installed under this application; (c) to pay for any estimated
amount of additional service installation costs occasioned by existing abnormal
obstructions which impede normal construction procedures; and (d) to hold the
Company harmless from any and all damages to sidewalks, driveways, lawns or
other buildings, necessarily caused by the work provided for herein.
MUST draw a diagram of the building below
showing windows, doors and the desired meter location
THIS APPLICATION IS SUBJECT TO APPROVAL OF THE CREDIT SECTION OF THE COMPANY
ACCEPTED:
SIGN HERE:
X
DATE
X
CONSENT OF OWNER OF BUILDING
The owner of the building at the address shown above hereby consents
to the installation of the service pipe upon the conditions stated in the
above agreement.
(CUSTOMER)
PRINT
TITLE
ADDRESS
X
ZIP CODE OWNER DATE
Indicate
direction
Street name:
Lot line
click to sign
signature
click to edit
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