Premise Type - Check All That Apply

Service Characteristics

Furnace

Water Heater

Tankless Water Heater

Range/Oven

Dryer

Fireplace/Logs

Generator

Other

Other

Other

By signing this application, the party below represents that s/he is the owner or an authorized agent of the property stated above and that the above information is accurate. The information provided in this document, and the accuracy thereof, is critical to determine the size of the gas service line and metering equipment, and path of installation. This application expires 12 months from the date of receipt. The customer shall notify Dominion Energy of any gas load changes prior to the installation and use of future equipment/appliances to avoid additional fees. I understand that if I do not complete any required upgrades to my gas service line and/or meter and install new or upgraded natural-gas-powered equipment on the premises, I may experience insufficient pressure and an interruption in service. Furthermore, if the addition of new or upgraded equipment results in a loss of pressure or other service issues, I understand that Dominion Energy Ohio may disconnect my service until the necessary upgrades are completed at my expense. Dominion Energy reserves the right to designate or approve the location of all metering equipment and gas service lines. Dominion Energy Ohio must approve all proposed metering arrangements. It is the sole responsibility of the property owner to mark or otherwise identify any obstructions as soon as practicable and at the latest prior to construction, including but not limited to all privately owned underground facilities on the property (e.g., sanitary and storm sewers, water lines, electric lines, septic systems, irrigation, invisible fences, geothermal systems, etc.). I understand that this application is a request to obtain natural gas service and it does not guarantee gas availability or service.

Questions? Call us at 888-619-0786 or email us at OhioConstructionSupport@DominionEnergy.com.