Gas Integrity Test Form PDF Details

Ensuring the safety and functionality of gas piping systems within buildings is paramount, and the Gas Integrity Test & Turn-On Affidavit form plays a crucial role in this process. This document serves as a certification by a plumbing contractor that the gas piping system of the specified building has undergone and passed a leakage test, adhering to the standards set by local authorities. It outlines detailed information including the building address, contact information for immediate access, and specifics of the gas system such as lockable valves, test ports, and the types of gas equipment requested for turn-on. The form demands meticulous attention to corrective conditions and repairs carried out on gas equipment, ensuring that all gas piping is unbroken and ends at the appliance or use equipment appropriately. Furthermore, it requires verification that all necessary areas and appliances have been inspected, with gas valves securely closed or left open as required. This affidavit underscores a plumbing contractor's declaration of responsibility for the gas system's integrity, including any appliances not serviced by the utility company, thereby highlighting the significance of thorough inspection and testing in maintaining gas safety and compliance within buildings.

QuestionAnswer
Form NameGas Integrity Test Form
Form Length1 pages
Fillable?No
Fillable fields0
Avg. time to fill out15 sec
Other namesaffidavit formate of bharat gas kolkata in name, gas testing form 2019, turn affidavit printable, coned gas itegrity test

Form Preview Example

Gas Integrity Test & Turn-On Affidavit

This certifies that the gas piping in the building indicated below has successfully passed a leakage test as prescribed by the local authority having jurisdiction.

(Building Address / City or Town / Zip Code)

 

Complete All Sections That Apply

Blue Card No.

Lockable valves and test ports installed / exist at the base of each riser. YES NO (Circle One)

Gas Turn-On requested for the following equipment (Specify below):

CONTACT INFORMATION FOR IMMEDIATE BUILDING ACCESS :_________________PHONE:______________

RISER LOCATION

 

GAS END USE

 

METER LOCATION

 

NO. OF

 

 

(e.g. Cooking, Heating,

 

 

 

 

 

 

APTS

 

 

 

Hot Water, Dryer, etc)

 

 

 

 

 

 

 

 

 

 

 

Location # 1

Location # 2

Location # 3

Location # 4

Location # 5

Location # 6

Contractor to Check Appropriate Corrective Condition:

I have repaired and tested,

Leak at gas equipment (specify unit or equipment)

 

 

Control Valve

 

Pilot Valve

 

 

Appliance Valve

Hood Draft

 

Appliance Regulator

 

Flue Connection

Other (Specify) and provide details for above items checked

This certifies that all gas piping is complete and continuous up to the appliance, including appliance control valves, or

end of use equipment in affected apartments or areas.

YES

NO (circle one)

It is also certified that in the affected area(s):

All areas containing gas utilization equipment (e.g. boiler room, laundry room) have been inspected and that

the equipment gas valves have been closed.

YES

NO (circle one)

All apartments containing gas appliances have been inspected and the appliance valves have been closed.

YES

NO (circle one)

All open-ended valves, stubs test connections, purge connections, or any other piping or fittings which could

be left open, have been closed gas tight with a threaded plug or cap. For premises which have meters in the apartments, the meter valves have been left open, so that the integrity test is complete up to the

appliance valves.YES NO (circle one)

In addition, I accept responsibility for the gas-in of any end of use equipment or appliances not gassed-in by Con Edison and identified above for turn-on. YES NO (circle one)

(Plumbing Contractor Company Name / Address / Telephone #)

 

 

 

 

 

(Plumber’s Signature / License # / SEAL/ Date)

Rev. /

 

 

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Other Specify and provide details, All apartments containing gas, and NO circle one of soundex wireline ges integrity tool

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