Service Installation Record
Instructions: Complete and submit this form.If gas is required for the first time
for this location, please call 1-888-280-2938 between 8:00 am and 4:30 pm Monday
- Friday to determine if gas is available. Forms not legibly completed in their
entirety will be rejected.
PNG USE ONLY
  
 
 
 
   
   
   
   

NOTE: For NEW service line installations, this form will not be accepted until AFTER an application has been submitted by the responsible
party and received and approved by Peoples Natural Gas.
 Development/Project Name (Type or Print)
Date Service Line Installed
 
 Customer Name
 
 Phone Number for Tie In

 
 
 Street Address
Lot Number

 
 City
State
Zip
Municipality
County

 
 Building Type
 Installation Type
 

  Residential Commercial Mobile Home
  New Renewed Repaired Riser repair/replace ONLY Misc**
 ** Misc Activity  Manifold Repair Only Manifold Painted Other 

  For All installation types
  1. Has the service line been installed properly with a gauge (Kuhlman or spring)
           on and 90lbs of pressure?
  2. Has tracer wire been installed?
  3.a) Has the house line been installed?
  3.b) If so, are all open lines capped?
  4.a) Is the tie-in hole dug to the standard 4x4 foot area required for the
              service tech to perform the connection?
  4.b) If so, is the curb valve exposed with the customer’s service disconnected
              and 18” of company service exposed to prevent any damage?

  In addition, for New installation types only
  1. Is the riser secured and the spread set to 14” across x 16” down?
  2.a) Is the house line installed through the wall sleeve?
  2.b) If so, do all interior lines have valves installed and are they plugged or
              capped?
  3. If the line is CSST, has it been installed with proper grounding/bonding wire?





 Riser Manufacturer:
Central Plastics Factory Fit
 Riser Connection Type:
 Riser Material
 
  Honeywell/ElsterPerf–Factory
 
Honeywell/ElsterPerf–Field
  Perfection Stab Style   Butt Fusion
 
 
  Continental Factory Fit 
 
Energy Control System Factory Fit
  Continental Stab Style
 
 
 Customer Service Line (Curb to Meter) - Check All That Apply
 Material
 Size
 Minimum Test Pressure
 
 Indicate the type of test performed by
 
 
 checking the appropriate box:
 
 
 
 
 
  
 *** required for pipe diameter 2" and larger
 Plastic Manufacturer Lot/Serial #
 
 ASTM D2513
 
 Buried Line Type 
 Tracer Wire
  
  
 Installing Firm
 
 
 
 City
State
Zip
 
 
  (Type or Print)
 
 
 
 Note: By signing this form, the installer attests that they installed or repaired and tested the service line and/or meter in accordance
 with applicable codes and standards including, but not limited to:
INSTALLATION

 1. Material used in this installation meet Peoples Natural Gas' approved standards
 2. A tracer wire that is of 8 gauge solid copper wire with a yellow thermoplastic coating
     was installed (All services)
 3. Tracer wire was properly installed and checked for continuity across its entire length
 4. Service line is installed at a minimum depth of 12 inches or encased
 5. New service is not run under steps, porches or crawl spaces
 6. Meter manifold installed does not block a fire escape
 7. Meter manifold is properly supported

 8. Meter manifold is protected from vehicular damage
 9. Meter manifold is not closer than 3 feet from an ignition source
 10. Meter manifold service line is properly supported.
 11. Meter is accessible and as perpendicular to the main as possible
 12. New meter manifold valve installed
 13. Service must be run to the street to which the structure is
       addressed, unless given permission by Peoples Natural Gas
 14. All exposed piping must be suitably coated to prevent corrosion

INSTALLER

 1. He/She is Operator Qualified in accordance with the requirement set forth in 49 CFR 192, Subpart N. This means that the installer has been evaluated by a
     Peoples Natural Gas approved third party qualifier and has been deemed qualified to perform the various covered tasks associated with installation of natural
     gas service lines. (3 year re-qualification required)
 2. He/She has been evaluated and qualified by a Peoples Natural Gas approved third party qualifier to join plastic pipe utilizing mechanical couplings. (1 year
     re-qualification required)
 3. His/Her employer administers a Drug & Alcohol Testing Program that meets the requirements of 49 CFR 199, including random testing.
     The installer understands and agrees that by performing the inspection herein and accepting this form and stated qualifications of the installer, Peoples Natural
     Gas is not assuming nor accepting any responsibility or liability for the installation or repair work performed by the installer and that the installer remains solely
     responsible for any work performed. Further, installer agrees to indemnify, hold harmless, and, if requested, defend Peoples Natural Gas, its officers, employees
     and agents from and against any and all liabilities, costs, claims, demands, fines, penalties, suits (including cost of defense), proceedings, actions, and causes of
     of actions, including reasonable attorney's fees arising out of, or associated with, or related to the installation described herein.

I acknowledge that I have read and understand the Installation and Installer instructions.
     Note: A fee may be incurred if the site is not ready to the specifications cited above upon site visit.
Visit https://www.peoples-gas.com/plumbers for additional forms
 
 
 
 
 
 
 
 
 
 
Form No. 700116 (Oct 2024)