City of LaFayette

Gas Department

P.O. Box 89

LaFayette, Georgia  30728

Application for Natural Gas Service

Date of application:  ___________________________________________________

Name:  _____________________________________________________________

Address:  ___________________________________________________________

Location where service is requested:  _____________________________________

Social Security number:  ________________________________

Gas appliances installed:   _____ Heat      _____ Gas logs    _____  Hot water heater

_____ Cooking stove      _____ Barbecue grill        _____  Clothes dryer

Other (please, list) ____________________________________________________

It is the policy of the City of LaFayette that anyone requesting natural gas service must agree to install at least one gas appliance, which uses gas year round.  Failure to comply with this agreement will result in termination of gas service until requirement is met.

Notes:

1.  This is an application only and does not assure you of gas service

2.  Customers’ gas appliances, lines and other equipment shall be installed by a Georgia state licensed and bonded gas plumber.  As a courtesy, the Gas Department will furnish you a list of local gas plumbers.

3.  Installation shall be in accordance with the SBBCI Standard Gas Code in effect at the time of installation, including all amendments as approved by the Department of Community Affairs, State of Georgia and the City of LaFayette. It shall also be your responsibility to obtain a building permit and schedule the required inspections.

Notice:  The City of LaFayette des not maintain customers’ buried piping.

1.  If your buried piping is not maintained, it may be subject to the potential hazards of corrosion and leakage.

2.  Buried gas piping should be periodically inspected for leaks, periodically inspected for corrosion if the pipe is metallic, and repaired if any unsafe condition is discovered.

3.  When excavating near buried gas piping, the piping shall be located in advance and the excavation done by hand.

4.  Plumbers and heating contractors can assist you in locating, inspecting and repairing your buried piping.

It shall be understood that by signing this application that I have read, understood and agree to abide by the policy as stated above.

Applicant signature:  _______________________________          Date:  ________

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