STOPdo not complete until page 2 is reviewed and acknowledged
REQUIRED - I have read and understand service line
installation and billing requirements
defined on page 2 of this application.
KANSAS GAS SERVICE
SERVICE LINE AND METER SET APPLICATION
FORM 12159 (April 2019)
Please print and fill out form completely.
DATE
NAME (Requestor-see page 2) *
BUILDER
STAGE OF COMPLETION (Check one)
YES NO
Nothing Done/ Permit Only
Dirt Work Only
Foundation Complete
Framing
Framed-In
Garage/Outbuilding
Service Reconnect
Electric/Propane
Conversion (existing)
Meter Set Only
MAILING ADDRESS
EMAIL ADDRESS
CITY
ZIP CODE
PROPOSED BUILDING
COMPLETION DATE
DATE SERVICE LINE
NEEDED
WORK PHONE
CELL PHONE
HARD SURFACE IN PATH OF SERVICE LINE?
SITE SUPERINTENDENT or FOREMAN NAME
SITE SUPERINTENDENT or
FOREMAN PHONE#
YES NO
Additional charges may apply if hard surface is installed prior
to service line installation. Casing may be required.
NAME (MECHANICAL ENGINEER OR PLUMBER)
Residential Service
Multi-Unit Residential # of Units ____ #Meters___
Multi-Unit Commercial # of Units ____ #Meters___
Commercial (<200 Mcf Annual)
Commercial (200 1500 Mcf Annual)
Commercial (>1500 Mcf Annual - Transport Eligible)
Non-Residential Small Generator - ONLY
PHONE # MECHANICAL ENGINEER/ PLUMBER
EMAIL ADDRESS
SERVICE LINE INFORMATION
ADDRESS
UNIT NO.
CITY
ZIP CODE
MULTI METER MANIFOLD SETTING N/A YES
METER SET/ TURN-ON
The gas meter will be set upon completion of the service line
installation, provided we have received your inspection
verification. There will be a $10.00 plus taxes connection fee.
IF YES -LIST ADDRESSES WITH SUITE/UNIT NUMBERS BELOW:
PROPOSED APPLIANCES
NO. of UNITS
BTU’s
NO. of UNITS
BTU’s
SUBDIVISION or BUILDING NAME
Furnace
Dryer
Std Water Heater
Outdoor Grill
PHASE
LOT
BLOCK
Tankless WH
Pool Heater
Range/Oven
Generator
SECTION
TOWNSHIP
RANGE
Fireplace
Other
TOTAL NATURAL GAS LOAD
DELIVERY PRESSURE REQUIREMENTS
ADDITIONAL PROJECT INFORMATION
Please indicate if a higher delivery pressure is required ______________psig*
*Delivery pressures higher than 7 inches
water column (4 oz.) requires prior
company approval. Elevated Pressure form
available at www.kansasgasservice.com
SQUARE FOOTAGE
OFFICE USE

CUSTOMER NO.
PREMISE NO.
See page 2 of Application with New Service Line Installation Requirements and Notice of Construction Billing
This application may be faxed to our TOLL FREE FAX NUMBER: 1-866-643-1390,
or email KGSNewServiceApp@KansasGasService.com.
For all other inquiries, contact our Information Center at 1-800-794-4780.
Or visit our website www.kansasgasservice.com.
Page 1
Clear Form
Kansas Gas Service
Service Line and Meter Information Installation and Construction Billing Requirements
New Service Installation Requirements:
Existing natural gas main must be installed and available to serve this property;
Meters are placed outside along the front or at the corner of the building wall utilizing nearest natural gas main.
The meter needs to have a minimum of 3 feet of clearance, measured horizontally, from any ignition source (i.e.
electric meter, electric transformers, condensing or air conditioner unit, etc.). See gas meter clearance diagram below.
Pipe out must be installed or clearly marked.
No obstructions can be in the way of the work, including bricks, sand, scaffolding, etc.
Address must be clearly visible in front of home.
Lot must be at final grade
There must be a structure present to set gas service riser.
Notice of Construction Billing
for Service Line and Yard Line Installation or Replacement
Kansas Gas Service General Terms and Conditions section 7.04.03
The first 200 feet of 1 ¼ inch piping diameter or less service line will be at no charge; any additional footage will be
billed at $4.54 per foot.
Customer shall be billed for all extraordinary construction costs, such as, but not limited to rock removal, digging in
frozen ground, under pavement or obstructions, or padding dirt installation, will be billed after installation.
For piping greater than 1 ¼ inch in diameter, the customer receiving service shall be billed for actual construction costs
minus an allowance of up to $908 per service line. This allowance shall not exceed the actual construction costs.
Following completion of work, customer will be billed for actual construction costs including labor, overheads and
material used in situations noted above.
SERVICE LINE LOCATION
Kansas Gas Service prefers that new service lines extend
from the natural gas main to the meter set in a straight line
that is perpendicular to the street. For large
commercial/industrial customers, the service location can be
installed in a mutually agreed upon location.
PLUMBING REQUIRMENTS
A pipe out is a natural gas line coming out of the home above
ground and is required by code. Testing of customer piping
shall conform to state and city requirements for gas piping
inspection, testing and purging. The length of time and test
pressure shall meet local, city and/or state requirements
(some differ from city to city).
*If the individual requesting a service line on page 1, is the same individual requesting a meter set/turn on, a turn on order
will be generated after the service line has been installed and city inspection of the houseline, if required, has been
completed.
Page 2