Fillable NATURAL GAS SERVICE AGREEMENT (Central Hudson)

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NATURAL GAS SERVICE AGREEMENT (Central Hudson)

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Central Hudson Gas & Electric ● 284 South Avenue ● Poughkeepsie, NY 12601
Phone: 845.452.2700 ● Fax: 845.486.5657 ● email: newbusinessdesk@cenhud.com
NATURAL GAS SERVICE AGREEMENT
Please fill out completely and sign to ensure prompt service. J#:__________________
Customer Account Number_________________________________________ Please be specific or attach survey with meter location clearly marked.
Facing the building from the street, where should the meter be installed?
Name__________________________________________________________ * Central Hudson has ultimate decision on meter location.
Address for New Service __________________________________________ Opposite garage, ___________ feet back from front corner
City / State / Zip _________________________________________________ Other location, ____________________________________________
Legal Description Lot __________________ Block ____________________ Meter sets should be located away from potential damage from vehicles.
Meters exposed to potential vehicle damage will require guard posts.
Is this address a County Road or State Highway Yes No
Nearest Crossed Street ____________________________________________ Will meter be exposed to potential vehicle damage? YES NO
Company Name__________________________________________________ Please indicate the number of appliances that require natural gas:
Contact Name___________________________________________________ Furnace(s) or boiler(s) Total BTUs _______________
Tankless water heater (s) Total BTUs _______________
Phone BBBBBB______
____________________________________________ Water heater(s) Total BTUs _______________
Fireplac
e(s) Total BTUs _______________
Fax BBBBBB____________________________________________________ Range(s) Cooktop(s), or Oven(s) Total BTUs _______________
Dryer(s) Total BTUs _______________
Mobile _BBBBB_______
___________________________________________ 
Pool heater( Total BTUs _______________
Garage h
eater(s) Total BTUs _______________
Address ________________________________________________________
Generators Total BTUs _______________
City / State / Zip _________________________________________________
Please indicate other heat sources on your property:
Air source Heat Pump Yes No
Geothermal Heat Pump Yes No
Dwelling type: Oil Yes No
Townhouse Single family Commercial Other _____________ Propan
e Yes No
Founda
tion completed? Yes No
All exterior walls framed? Yes No What gas pressure is required for your home / business:
Graded to within 6” of final grade? Yes No
Requested install date _________________ Closing date _______________ 7” water column
7” – 12” water column
Estimated square footage _________________________
* Standard residential delivery pressure is 7” water column
Plumber/Customer requesting site meeting? Yes No which equals ¼ PSI.
When multiple meters (2 or more and larger) are installed, Central Hudson will label each meter with a house unit number using a permanent marker. The customer will be
responsible for labeling the house piping as stipulated in Central Hudson’s Gas Specification book connecting the correct meter to the appropriate house piping.
There is a basic customer charge per meter, per month. Billing for this basic charge will commence within 60 days of meter installation. Any additional
installation charges, not withstanding tariff are to be paid in full prior to construction.
Initials of applicant: _______________________
CUSTOMER INFORMATION
PREFERRED METER LOCATION
PLUMBER INFORMATION
GAS LOAD INFORMATION
CONSTRUCTION STATUS AT TIME OF APPLICATION
Central Hudson Gas & Electric ● 284 South Avenue ● Poughkeepsie, NY 12601
Phone: 845.452.2700 ● Fax: 845.486.5657 ● email: newbusinessdesk@cenhud.com
• Minimum of 3’ from property line (unless easement exists) Maintaining the 3’ clear zone is required.
• Approximately 6’ from building structure, if line will be parallel to it ● 3’ from fresh air intake or any opening to building
• Approximately 8’ from buried fuel tanks (varies by municipality) ● 3’ from opening doors or windows
• Approximately 10’ from wells and septic tanks ● 3’ from water spigots
• Installed in a straight line perpendicular to main when possible ● 3’ from ignition source
• Conduit crossings must be installed prior to service line Avoid locations directly below roof valleys, water downspouts,
Installation (if applicable) decks, stairs or partial overhangs to help prevent damage from
falling ice.
Banked meters are preferable for townhouse buildings.
Regulator and relief valve must be located where gas can escape
freely away from any opening into the building.
Gas appliances must be installed prior to meter being set.
• Site must be within 6” of final grade Meter sets should be located away from potential damage from
• Basement / Foundation in and backfilled vehicles. Meters exposed to potential vehicle damage will require
• Clear 8’ wide path from the gas main to service entrance guard posts.
• All exterior walls must be framed before meter can be installed Should there be a request to move the meter after the initial
• Request 7” or 7-12” water column installation, or the customer does not adhere to the minimum
• * Clearly mark / stake the location of all private underground clearance requirements detailed below, the customer will be
• utilities located on your property such as: responsible for all costs to relocate the meter.
○ Sewer lines ○ Underground sprinkler systems
○ Invisible fences ○ Sump pump extensions
○ Electric lines ○ Drain fields
○ Water wells ○ Buried fuel lines
○ Septic systems
* Central Hudson and our representatives are not responsible for damage
to these items if they are not clearly marked at the time of installation.
TERMS AND CONDITIONS OF SERVICE
Gas Service Equipment Ownership – The entire gas service facility, which includes the gas service line from the gas main to the exterior wall of
the dwelling, inclusive of the gas meter, will remain the property of Central Hudson. Maintenance of the gas service facility will be the
responsibility of Central Hudson at its expense.
Restoration Policy – It is understood that if the Company shall dig the gas service pipe trench, the Company will backfill the excavation required in
the installation of the gas service. All restoration work on the customer’s property thereafter, will be the responsibility of the customer.
Service supplied under this application will be taken and paid for by the customer in accordance with the rules and regulations, and at the rates,
contained in company’s tariffs and schedules as filed from time to time with the Public Service Commission of the State of New York.
Acceptance and Terms of Agreement - This application shall not be binding upon the Central Hudson Gas & Electric Corporation until accepted
by it through an authorized representative, and shall not be modified or affected by any promise, agreement or representation by any agent or
employee of Central Hudson made before or after signing, unless incorporated in writing herein before acceptance by Company. This application
shall remain in effect for a period not to exceed 180 days after acceptance by Central Hudson Gas and Electric Corporation (“Central Hudson”). The
customer shall be responsible to pay the cost of the installed natural gas service line for their dwelling if natural gas service is not completed within
180 days of this Natural Gas Service Agreement, and the delay is not in any way the responsibility of Central Hudson. The current cost for a natural
gas service line installation is estimated to be $4,500. In circumstances where by the customer has paid the applicable cost, the customer shall
receive a refund when gas service is activated (less depreciation as noted herein). Reference is made herein to the applicable Tariff agreement
(“Schedule for Gas Service”, leaf 18, section 5, paragraph D): “Whenever the Company installs facilities at the request of an applicant who does not
immediately desire service, the applicant shall bear the entire reasonable expense of facilities but shall be entitled to a refund whenever service is
begun for such part of the expense as the Company is herein before required to assume. The refund shall be cost of the facilities, less depreciation at
the rate of three percent per year”.
Applicants Signature: /s/________________________________________________ Date: ___________________________
Company Authorized Representative: _____________________________________ Date: ___________________________
NATURAL GAS SERVICE LINE GUIDELINES
NATURAL GAS METER REQUIREMENTS
INSTALLATION SITE READY CHECKLIST
Minimum clearances for gas meter installation (for illustrative purposes)
NATURAL GAS INSTALLATION
PROPERTY SURVEY
Central Hudson Gas & Electric (“Central Hudson” or the “Company”) requires a minimum 8 foot wide area throughout the
requested gas installation site. Please confirm, by checking YES or NO, if any of the following site conditions exist.
Important: This survey is required to expedite the processing of your request for gas service from Central Hudson.
The Company will use the information provided on this form to estimate, design and construct your gas service.
The Company is not responsible for damage to customer property/landscaping during the installation of the gas
service line. At the excavation site the ground will be restored to former grade and raked out. Seeding and straw
cover is the responsibility of the homeowner.
YES
NO
In the vicinity of the gas installation are there any:
Paved areas – Asphalt (driveway, sidewalks or v-ditch)
Concrete (driveway, sidewalk or v-ditch)
Brick or Flag Stone (patio, sidewalk or pathway)
Other
Is the ground:
Level to slightly sloped
Severely sloped, large drop offs, or terraced
Rocky
Is there any landscaping in the area that would interfere with our installation:
Bushes, Shrubbery or Large Trees
Plants / Bedding
Landscape Timbers or Retaining Walls etc.
Are underground utility lines present: (A utilities mark-out will be completed prior to the start of excavation)
Electric
Telephone
Cable
Water
Are any of the following in the area:
Well
Buried oil or propane tank and any associated pipes
Septic Field
Municipal Sewer lines
Underground Sprinkler System
Invisible pet fencing
Drainage systems, pool lines or any other buried systems
Are there any environmental concerns:
Soil treatments, tree save areas, etc.
Will the gas meter be exposed to traffic (near driveway, garage, etc.)
Will the proposed gas line run from the street through your property only?
Do you know of any issues that may prevent or make it difficult to install the gas line
within a minimum of an 8 ft. wide area?
Comment Area:
I have reviewed the above survey and have listed the site conditions for my property.
Customer Signature: /s/__________________________________ Date: _________________________
Address: ________________________________________________ J#: ___________________________
Print Customer Name: _____________________________________ Phone #: ______________________
Company Authorized Representative: _______________________________ Date: _________________________
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NATURAL GAS SERVICE AGREEMENT (Central Hudson)

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Completed 9 June 2021

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