HomeMy WebLinkAboutWORK ORDER SERVICE - 21-00459 - 1010 S 2ND E - INSTALL GAS SERVICEIA = If Applicable
SERVICE LINE NO. + PIPE DISTRICT
PREMISE ID
SPID
RATE CLASS
POTENTIAL BORE
SERVICE TYPE
MAIN SIZE / TYPE
INSTALL DATE
MATL
MATL
MATL
Y = PE / Plexco
DL = PE / Duraline A = Aldyl A
S = Steel
MATL
MATL
JDE WORK ORDER NO.
COMMENTS:
For Intermountain Gas Use Only
for the installation, maintenance, or removal of their materials and equipment.
I AGREE TO:
1. Reimburse Intermountain Gas$
2. Prepay service line costs of: $
authorized as per the approved Tariff with the Idaho Public Utilities Comission.
EQUIPMENT:
X
IRR
STUB
STUB EXT.
NEW SERVICE
RE-ACTIVATE
BRANCH
I,
METER SIZE
MANIFOLD
EFV / SIZE
REPLACEMENT
INSERTION
ABANDON
RELO
ABAN. STUB
MAIN PRESS.
SIZE
SIZE
SIZE
SIZE
SIZE
INSTALL ASSIGNED TO:
KV Const.
INTERMOUNTAIN GAS COMPANY SERVICE AND FACILITIES AGREEMENT
NO. METERS
PROJECT NO.
SERVICE ADDRESS
LOT
EST BILLING PRESS.
EMP NO.
RATE DESC.
THERMS RS
BLDG TYPE
BUILDER NO.
THMS COM
MAIN MAOP
0
BLOCK
EST. SERV FTG
ORIGINAL INSTALL DATE
TOTAL ORIGINAL LENGTH
TOTAL ORGINAL LENGTH
ABANDONED LENGTH
SUB-TOTAL
INSTALLED LENGTH
INSTALLED LENGTH
TOTAL LENGTH
540081
SERVICE OP. PRESS.
SUBDIVISION NAME
WELDER
52525252
EST DELIVERY PRESS.
, which is the difference between the on-property average cost of service installation and the investsment allowance
SERVICE LINE WORK ORDER
APPLICATION DATE
CLS NO:
for the service line if the equipment checked below is not operating within 6 months from install date.
PREV ENERGY
SQ FT.
MKT SEGMENT
LGTH ON PROP
TOTAL INPUT
CPT
/
SERVICE MAOP
FUSER
EXISTING LINE EXPOSURE
EXT. CORROSION
SERVICE DEPTH
STORES TICKET NO.
CONTACT
NAME:
NO CORROSION
SLIGHT PITTING
GENERAL PITTING
PLASTIC
NOT EXPOSED
/
METER LOCATION
UTG WALL THICKNESS
UNIVERSAL INVOICE
SERVICE ROUTE
CITY NAME
PIPE COATING
EXISTING COATING (IA)
SUB-INVENTORY
grant Intermountain Gas Company access to my property, located at
QNTY
CONTRACTOR INVOICE
GOOD
FAIR
BAD
PLASTIC
NOT EXPOSED
CROSS STREET
WEATHER PROTECTION
EQUIPMENT
Frcd Air Furn
Water Heater
Space Heater
Fireplace
Range
UTG SERIAL NO./EXP. DATE
SERVICE CYCLE
PREPARED BY:
sfine
INT. CORROSION
MAIN DEPTH
PAVING TICKET NO.
BTU IN / HR
FIELD OPS COORDINATOR
NO CORROSION
SLIGHT PITTING
GENERAL PITTING
PLASTIC
NOT EXPOSED
STATE
ID
WEATHER PROTECTION COMMENTS
/
LEAK SURVEY
POSTAL CODE
CONTACT
NUMBER:
QNTY
PERMIT INFORMATION
PERMIT NO
LINE LOCATE NUMBERS.:
EASEMENT NUMBERS
Grill
Clothes Dryer
See Comments
MANAGER PRE-APPROVAL
EQUIPMENT
UTG PERFORMED BY
ID
ISOLATION DISTRICT
COUNTY
MANAGER FINAL REVIEW
Service Line #
APPROVING AUTHORITY
GIS POSTED
BTU IN / HR
IN CITY?
512-A Legacy Long (Rev. 05/21)
JDE WORK ORDER NO:
MATERIALS
DESCRIPTION
STEEL PIPE
TEE - AP
ELL
STOP
MATERIALS
DESCRIPTION
METER BAR
PLASTIC PIPE
RISER
CAP
TEE
TEE - SPT
ELL
COUPLING
TRANS - FTG.
EFV
Construction Notes:
SIZE
SIZE
TYPE
TYPE
PART / ITEM NO.
PART / ITEM NO.
QUANTITY USED
QUANTITY USED
QUANTITY INSTALLED
QUANTITY INSTALLED
IGC PRESSURE TEST
TEST PRESSURE/DURATION
TESTED BY/DATE
JOINT TRENCH: YES NO
SEWER LOCATE INFORMATION(BORE ONLY)
LOT NUMBER
BORE:
COMPLETE FORM 860 - REF PROCEDURE 3208
ELECTRONIC LOCATE
POST CAMERA INSTALL
FOC APPROVAL
TIME ON/OFF
GAUGE SERIAL NO./EXP. DATE
/
YES
/
/
ft
LENGTH & DIAMETER TESTED
See attached for other materials tested
By:
By:
By:
NO
IA = If Applicable
SERVICE LINE NO. + PIPE DISTRICT
PREMISE ID
SPID
RATE CLASS
RS
POTENTIAL BORE
SERVICE TYPE
MAIN SIZE / TYPE
INSTALL DATE
MATL
MATL
MATL
Y = PE / Plexco
DL = PE / Duraline A = Aldyl A
S = Steel
MATL
MATL
JDE WORK ORDER NO.
COMMENTS:
For Intermountain Gas Use Only
I,
for the installation, maintenance, or removal of their materials and equipment.
I AGREE TO:
1. Reimburse Intermountain Gas$
2. Prepay service line costs of: $
authorized as per the approved Tariff with the Idaho Public Utilities Comission.
EQUIPMENT:
X
IRR
STUB
STUB EXT.
NEW SERVICE
RE-ACTIVATE
BRANCH
Customer Signature
METER SIZE
MANIFOLD
EFV / SIZE
REPLACEMENT
INSERTION
ABANDON
RELO
ABAN. STUB
MAIN PRESS.
SIZE
SIZE
SIZE
SIZE
SIZE
INSTALL ASSIGNED TO:
INTERMOUNTAIN GAS COMPANY SERVICE AND FACILITIES AGREEMENT
NO. METERS
PROJECT NO.
SERVICE ADDRESS
LOT
EST BILLING PRESS.
EMP NO.
RATE DESC.
THERMS
BLDG TYPE
BUILDER NO.
COM THMS
MAIN MAOP
0
BLOCK
EST. SERV FTG
ORIGINAL INSTALL DATE
TOTAL ORIGINAL LENGTH
TOTAL ORGINAL LENGTH
ABANDONED LENGTH
SUB-TOTAL
INSTALLED LENGTH
INSTALLED LENGTH
TOTAL LENGTH
SERVICE OP. PRESS.
SUBDIVISION NAME
WELDER
52525252
EST DELIVERY PRESS.
, which is the difference between the on-property average cost of service installation and the investsment allowance
SERVICE LINE WORK ORDER
APPLICATION DATE
CLS NO:
for the service line if the equipment checked below is not operating within 6 months from install date.
PREV ENERGY
SQ FT.
MKT SEGMENT
LGTH ON PROP
TOTAL INPUT
CPT
/
SERVICE MAOP
FUSER
EXISTING LINE EXPOSURE
EXT. CORROSION
SERVICE DEPTH
STORES TICKET NO.
CONTACT
NAME:
NO CORROSION
SLIGHT PITTING
GENERAL PITTING
PLASTIC
NOT EXPOSED
/
METER LOCATION
TEST PRESS. / DURATION
UNIVERSAL INVOICE
Date
grant Intermountain Gas Company access to my property, located at
SERVICE ROUTE
CITY NAME
/
PIPE COATING
EXISTING COATING (IA)
SUB-INVENTORY
QNTY
1
1
1
1
1
CONTRACTOR INVOICE
GOOD
FAIR
BAD
PLASTIC
NOT EXPOSED
CROSS STREET
WEATHER PROTECTION
EQUIPMENT
Frcd Air Furn
Water Heater
Space Heater
Fireplace
Range
SERVICE PRESS. (2-IA)
SERVICE CYCLE
PREPARED BY:
INT. CORROSION
Us
MAIN DEPTH
PAVING TICKET NO.
BTU IN / HR
FIELD OPS COORDINATOR
NO CORROSION
SLIGHT PITTING
GENERAL PITTING
PLASTIC
NOT EXPOSED
STATE
ID
WEATHER PROTECTION COMMENTS
LEAK SURVEY
SERVICE MAOP (2-IA)
POSTAL CODE
CONTACT
NUMBER:
QNTY
1
1
1
1
1
PERMIT INFORMATION
PERMIT NO
LINE LOCATE NUMBERS.:
EASEMENT NUMBERS
Phone
Grill
Clothes Dryer
gas log
See Comments
MANAGER PRE-APPROVAL
EQUIPMENT
ID
ISOLATION DISTRICT
COUNTY
MANAGER FINAL REVIEW
TEST PRESS. / DURATION (2-IA)
Service Line #
APPROVING AUTHORITY
/
GIS POSTED
BTU IN / HR
IN CITY?
512-A Long (Rev. 09/20)
JDE WORK ORDER NO:
MATERIALS
DESCRIPTION
STEEL PIPE
TEE - AP
ELL
STOP
MATERIALS
DESCRIPTION
METER BAR
PLASTIC PIPE
RISER
CAP
TEE
TEE - SPT
ELL
COUPLING
TRANS - FTG.
EFV
Construction Notes:
SIZE
SIZE
TYPE
TYPE
PART / ITEM NO.
PART / ITEM NO.
QUANTITY USED
QUANTITY USED
QUANTITY INSTALLED
QUANTITY INSTALLED
JOINT TRENCH: YES NO
SEWER LOCATE INFORMATION(BORE ONLY)
LOT NUMBER
BORE:
ELECTRONIC LOCATE
POST CAMERA INSTALL
FOC APPROVAL
COMPLETE FORM 860 - REF PROCEDURE 3208
YES
ft
By:
By:
By:
NO
IA = If Applicable
SERVICE LINE NO. + PIPE DISTRICT
PREMISE ID
SPID
RATE CLASS
RS
POTENTIAL BORE
Yes
SERVICE TYPE
X
MAIN SIZE / TYPE
4"A
INSTALL DATE
MATL
MATL
MATL
Y = PE / Plexco
DL = PE / Duraline A = Aldyl A
S = Steel
MATL
MATL
JDE WORK ORDER NO.
COMMENTS:
Met Timm on site; Meter loc on South/Left 4ft back; Opposite garage/power
**Verified paid in full $737.89 via Speedpay Receipt # 11506 6/12/2021**
For Intermountain Gas Use Only
I,
1010 S 2nd E
Intermountains cost of installation is:
I AGREE TO:
1. Reimburse Intermountain Gas
2. Prepay service line costs of:
EQUIPMENT:
X
IRR
STUB
STUB EXT.
NEW SERVICE
RE-ACTIVATE
BRANCH
Timm Lyons
475.3488
Customer Signature
METER SIZE
250
MANIFOLD
1
EFV / SIZE
1100/1200 (3/4")
REPLACEMENT
INSERTION
ABANDON
RELO
ABAN. STUB
MAIN PRESS.
55
SIZE
SIZE
SIZE
SIZE
SIZE
Frcd Air Furn
INSTALL ASSIGNED TO:
KV Const.
as per the approved Tariff with the Idaho Public Utilities Comission.
3/4"
INTERMOUNTAIN GAS COMPANY SERVICE AND FACILITIES AGREEMENT
NO. METERS
PROJECT NO.
773-0197
SERVICE ADDRESS
1010 S 2nd E
LOT
EST BILLING PRESS.
EMP NO.
RATE DESC.
THERMS RS
BLDG TYPE
BUILDER NO.
THRMS COM
MAIN MAOP
60
475.3488
737.8912
1
BLOCK
EST. SERV FTG
152'
ORIGINAL INSTALL DATE
TOTAL ORIGINAL LENGTH
TOTAL ORGINAL LENGTH
ABANDONED LENGTH
SUB-TOTAL
INSTALLED LENGTH
INSTALLED LENGTH
TOTAL LENGTH
1213.24
Water Heater
540081
Residential
801.6
Single
SERVICE OP. PRESS.
55
SUBDIVISION NAME
WELDER
52525252
EST DELIVERY PRESS.
0.25
for it's invested amount if the equipment listed below is not operating within 6 months from the install date.
, which is the difference between the cost of installation defined above and the allowance of
SERVICE LINE WORK ORDER
APPLICATION DATE
5
CLS NO:
PREV ENERGY
SQ FT.
MKT SEGMENT
LGTH ON PROP
TOTAL INPUT
CPT
This project is a customer provided trench.:
/
SERVICE MAOP
60
25
FUSER
EXISTING LINE EXPOSURE
EXT. CORROSION
SERVICE DEPTH
STORES TICKET NO.
CONTACT
NAME:
NO CORROSION
SLIGHT PITTING
GENERAL PITTING
PLASTIC
NOT EXPOSED
/
METER LOCATION
Left
Electric
2400
Ex. Multi
98
120000
No
2021
UTG WALL THICKNESS
Timm Lyons
UNIVERSAL INVOICE
Date
request a new natural gas service line to be installed at my property located at
SERVICE ROUTE
CITY NAME
Rexburg
PIPE COATING
EXISTING COATING (IA)
SUB-INVENTORY
Rexburg
QNTY
1
1
CONTRACTOR INVOICE
GOOD
FAIR
BAD
PLASTIC
NOT EXPOSED
CROSS STREET
Sunrise Dr
WEATHER PROTECTION
No
EQUIPMENT
Frcd Air Furn
Water Heater
Space Heater
Fireplace
Range
UTG SERIAL NO./EXP. DATE
No
SERVICE CYCLE
PREPARED BY:
sfine
INT. CORROSION
MAIN DEPTH
PAVING TICKET NO.
BTU IN / HR
80000
40000
FIELD OPS COORDINATOR
NO CORROSION
SLIGHT PITTING
GENERAL PITTING
PLASTIC
NOT EXPOSED
STATE
ID
WEATHER PROTECTION COMMENTS
Under gable
LEAK SURVEY
/
POSTAL CODE
83440
CONTACT
NUMBER:
QNTY
PERMIT INFORMATION
PERMIT NO
LINE LOCATE NUMBERS.:
EASEMENT NUMBERS
ID
208-206-2709
Phone
Clothes Dryer
Grill
Other (see comments)
MANAGER PRE-APPROVAL
tt
EQUIPMENT
ISOLATION DISTRICT
COUNTY
Madison
UTG PERFORMED BY
MANAGER FINAL REVIEW
208-206-2709
Service Line #
APPROVING AUTHORITY
83440
GIS POSTED
BTU IN / HR
IN CITY?
Yes
512-A Long (Rev. 05/21)
JDE WORK ORDER NO:
MATERIALS
DESCRIPTION
STEEL PIPE
TEE - AP
ELL
STOP
MATERIALS
DESCRIPTION
METER BAR
PLASTIC PIPE
RISER
CAP
TEE
TEE - SPT
ELL
COUPLING
TRANS - FTG.
EFV
Construction Notes:
SIZE
SIZE
250
3/4"
3/4"
TYPE
TYPE
1200
PART / ITEM NO.
PART / ITEM NO.
QUANTITY USED
QUANTITY USED
QUANTITY INSTALLED
QUANTITY INSTALLED
IGC PRESSURE TEST
TEST PRESSURE/DURATION
TESTED BY/DATE
JOINT TRENCH: YES NO
SEWER LOCATE INFORMATION(BORE ONLY)
LOT NUMBER
BORE:
ELECTRONIC LOCATE
POST CAMERA INSTALL
FOC APPROVAL
TIME ON/OFF
GAUGE SERIAL NO./EXP. DATE
COMPLETE FORM 860 - REF PROCEDURE 3208
/
YES
/
/
ft
LENGTH & DIAMETER TESTED
See attached for other materials tested
By:
By:
By:
NO
For Intermountain Gas Use Only
I,
1010 S 2nd E
Intermountains cost of installation is:
I AGREE TO:
1. Reimburse Intermountain Gas $
2. Prepay service line costs of: $
$
EQUIPMENT:
X
Timm Lyons
475.3488
Customer Signature
1
Frcd Air Furn
as per the approved Tariff with the Idaho Public Utilities Comission.
INTERMOUNTAIN GAS COMPANY SERVICE AND FACILITIES AGREEMENT
475.3488
737.8912
1
$
Water Heater
1213.24
for it's invested amount if the equipment listed below is not operating within 6 months from the install date.
, which is the difference between the cost of installation defined above and the allowance of
This project is a customer provided trench.:
Date
request a new natural gas service line to be installed at my property located at
Rexburg
No
ID
208-206-2709
Phone
Service Line #
83440
IA = If Applicable
SERVICE LINE NO. + PIPE DISTRICT
PREMISE ID
SPID
RATE CLASS
POTENTIAL BORE
SERVICE TYPE
MAIN SIZE / TYPE
INSTALL DATE
MATL
MATL
MATL
Y = PE / Plexco
DL = PE / Duraline A = Aldyl A
S = Steel
MATL
MATL
JDE WORK ORDER NO.
Service Cost
COMMENTS:
IRR
STUB
STUB EXT.
NEW SERVICE
RE-ACTIVATE
BRANCH
METER SIZE
MANIFOLD
EFV / SIZE
REPLACEMENT
INSERTION
ABANDON
RELO
ABAN. STUB
MAIN PRESS.
SIZE
SIZE
SIZE
SIZE
SIZE
0
INSTALL ASSIGNED TO:
KV Const.
NO. METERS
PROJECT NO.
SERVICE ADDRESS
LOT
EST BILLING PRESS.
EMP NO.
RATE DESC.
THERMS RS
BLDG TYPE
BUILDER NO.
THRMS COM
MAIN MAOP
BLOCK
EST. SERV FTG
ORIGINAL INSTALL DATE
TOTAL ORIGINAL LENGTH
TOTAL ORGINAL LENGTH
ABANDONED LENGTH
SUB-TOTAL
INSTALLED LENGTH
INSTALLED LENGTH
TOTAL LENGTH
540081
SERVICE OP. PRESS.
SL Allowance
SUBDIVISION NAME
WELDER
52525252
EST DELIVERY PRESS.
SERVICE LINE WORK ORDER
APPLICATION DATE
CLS NO:
PREV ENERGY
SQ FT.
MKT SEGMENT
LGTH ON PROP
TOTAL INPUT
CPT
/
SERVICE MAOP
FUSER
EXISTING LINE EXPOSURE
EXT. CORROSION
SERVICE DEPTH
STORES TICKET NO.
CONTACT
NAME:
NO CORROSION
SLIGHT PITTING
GENERAL PITTING
PLASTIC
NOT EXPOSED
0
/
METER LOCATION
UTG WALL THICKNESS
UNIVERSAL INVOICE
SERVICE ROUTE
CITY NAME
PIPE COATING
EXISTING COATING (IA)
SUB-INVENTORY
QNTY
CONTRACTOR INVOICE
GOOD
FAIR
BAD
PLASTIC
NOT EXPOSED
CROSS STREET
WEATHER PROTECTION
EQUIPMENT
Frcd Air Furn
Water Heater
Space Heater
Fireplace
Range
UTG SERIAL NO./EXP. DATE
SERVICE CYCLE
PREPARED BY:
sfine
INT. CORROSION
MAIN DEPTH
PAVING TICKET NO.
BTU IN / HR
FIELD OPS COORDINATOR
NO CORROSION
SLIGHT PITTING
GENERAL PITTING
PLASTIC
NOT EXPOSED
STATE
ID
WEATHER PROTECTION COMMENTS
LEAK SURVEY
/
POSTAL CODE
CONTACT
NUMBER:
QNTY
PERMIT INFORMATION
PERMIT NO
LINE LOCATE NUMBERS.:
EASEMENT NUMBERS
Clothes Dryer
Grill
Other (see comments)
MANAGER PRE-APPROVAL
EQUIPMENT
ISOLATION DISTRICT
COUNTY
UTG PERFORMED BY
MANAGER FINAL REVIEW
APPROVING AUTHORITY
GIS POSTED
BTU IN / HR
IN CITY?
512-A Long (Rev. 05/21)
JDE WORK ORDER NO:
MATERIALS
DESCRIPTION
STEEL PIPE
TEE - AP
ELL
STOP
MATERIALS
DESCRIPTION
METER BAR
PLASTIC PIPE
RISER
CAP
TEE
TEE - SPT
ELL
COUPLING
TRANS - FTG.
EFV
Construction Notes:
SIZE
SIZE
TYPE
TYPE
PART / ITEM NO.
PART / ITEM NO.
QUANTITY USED
QUANTITY USED
QUANTITY INSTALLED
QUANTITY INSTALLED
IGC PRESSURE TEST
TEST PRESSURE/DURATION
TESTED BY/DATE
/
JOINT TRENCH: YES NO
SEWER LOCATE INFORMATION(BORE ONLY)
LOT NUMBER
BORE:
ELECTRONIC LOCATE
POST CAMERA INSTALL
FOC APPROVAL
TIME ON/OFF
GAUGE SERIAL NO./EXP. DATE
COMPLETE FORM 860 - REF PROCEDURE 3208
/
YES
/
/
ft
LENGTH & DIAMETER TESTED
See attached for other materials tested
By:
By:
By:
NO
IA = If Applicable
SERVICE LINE NO. + PIPE DISTRICT
PREMISE ID
SPID
RATE CLASS
POTENTIAL BORE
SERVICE TYPE
MAIN SIZE / TYPE
INSTALL DATE
COMMENTS:
CONTACT NAME:
MATL
MATL
MATL
Y = PE / Plexco
DL = PE / Duraline A = Aldyl A S = Steel
MATL
MATL
JDE ACCOUNT NO.
MATERIALS DESCRIPTION
STEEL PIPE
TEE - AP
ELL
STOP
MATERIALS DESCRIPTION
MTR. BAR
PLASTIC PIPE
RISER
CAP
TEE
TEE - SPT
ELL
COUPLING
TRANS - FTG.
EFV
Sewer Locate(s):
BORE ONLY
Construction Notes:
IRR
STUB
STUB EXT.
NEW SERVICE
RE-ACTIVATE
BRANCH
SIZE
SIZE
METER SIZE
MANIFOLD
(Circle) Electronic Locate BY:______________________/ Post Install Camera , By:_____________________/ FOC Approval, By:________________________
EFV / SIZE
REPLACEMENT
INSERTION
ABANDON
RELO
ABAN. STUB
MAIN PRESS.
SIZE
SIZE
SIZE
SIZE
SIZE
TYPE
TYPE
INSTALL ASSIGNED TO:
PART NO.
PART / ITEM NO.
NO. METERS
PROJECT NO.
SERVICE ADDRESS
LOT
EST BILLING PRESS.
EMP NO.
RATE DESC.
THERMS RS
BLDG TYPE
BUILDER NO.
THRMS COM
MAIN MAOP
BLOCK
EST. SERV FTG
ORIGINAL INSTALL DATE
TOTAL ORIGINAL LENGTH
TOTAL ORGINAL LENGTH
ABANDONED LENGTH
SUB-TOTAL
INSTALLED LENGTH
INSTALLED LENGTH
TOTAL LENGTH
QUANTITY USED
QUANTITY USED
SERVICE OP. PRESS.
SUBDIVISION NAME
WELDER
EST DELIVERY PRESS.
QUANTITY INSTALLED
QUANTITY INSTALLED
SERVICE LINE WORK ORDER
APPLICATION DATE
CLS NO:
PREV ENERGY
SQ FT.
MKT SEGMENT
LGTH ON PROP
TOTAL INPUT
CPT
/
SERVICE MAOP
FUSER
LOT NUMBER
/
METER LOCATION
Joint Trench: Yes No
TEST PRESS. / DURATION
CITY NAME
UNIVERSAL INVOICE
SERVICE ROUTE
/
QNTY
CONTRACTOR INVOICE
CROSS STREET
WEATHER PROTECTION
EQUIPMENT
Frcd Air Furn
Water Heater
Space Heater
Fireplace
Range
SERVICE PRESS. (2-IA)
SERVICE CYCLE
PREPARED BY:
DOCUMENT NO. (EASEMENT)
BTU IN / HR
EXISTING LINE EXPOSURE
EXT. CORROSION
SERVICE DEPTH
STORES TICKET NO.
FIELD OPS COORDINATOR
NO CORROSION
SLIGHT PITTING
GENERAL PITTING
PLASTIC
NOT EXPOSED
STATE
ID
WEATHER PROTECTION COMMENTS
LEAK SURVEY
SERVICE MAOP (2-IA)
POSTAL CODE
Bore:
QNTY
PIPE COATING
EXISTING COATING (IA)
SUB-INVENTORY
Clothes Dryer
Grill
Other (comments)
Yes
MANAGER PRE-APPROVAL
EQUIPMENT
GOOD
FAIR
BAD
PLASTIC
NOT EXPOSED
ISOLATION DISTRICT
COUNTY
MANAGER FINAL REVIEW
LINE LOCATE NO.:
TEST PRESS. / DURATION (2-IA)
INT. CORROSION
MAIN DEPTH
PAVING TICKET NO.
/
ft
NO CORROSION
SLIGHT PITTING
GENERAL PITTING
PLASTIC
NOT EXPOSED
GIS POSTED
BTU IN / HR
IN CITY?
No
512-A Short (Rev. 09/20)
Qty
1
1
0
0
0
0
0
0
0
0
Therm Factor
Investment Factor
Investment Factor
Sq. Ft
Equipment
Frcd Air Furn
Water Heater
Space Heater
Fireplace
Range
Dryer
Grill
0
0
Other (see comments)
Customer is Providing the Trench
Size
LGTH ON PROP (property footage)
CPT (Cost per foot)
use when CPT is No
CPT Cost/foot
Variable Cost. use when CPT is YES
(LGTH ON PROP * CPT Cost/foot)
Fixed Cost. CPT Coordin Fee
use when CPT is YES
(variable + fixed cost)
answer for the tab: 'Legacy_11x17"
Customer is Providing the Trench
Size
1.Calculated cost for SL
Allowance Res
Allowance Com
0.234
0.593
0.445
Stand alone 11 x 17
2400
Allowance
240
50
23
28
15
Total
No
3/4"
98
12.38
1213.24
4.74
464.52
481.53
946.05
No
475.3488
0
Residential
Commercial
Therms
561.6
240
0
0
0
0
0
801.6
5.56
544.88
842.11
1386.99
3/4"
Input
80000
40000
0
0
0
0
0
0
0
0
120000
0
0
0
0
1213.24
Qty
0
0
0
0
0
0
0
0
0
0
Short_Blank Data
Sq. Ft
Equipment
Frcd Air Furn
Water Heater
Space Heater
Fireplace
Range
Dryer
Grill
0
0
Other (comments)
0
Allowance
240
50
23
28
15
Total
Therms
0
0
0
0
0
0
0
0
Input
0
0
0
0
0
0
0
0
0
0
0
Qty
0
0
0
0
0
0
0
0
0
0
Customer is Providing the Trench
Size
LGTH ON PROP (property footage)
CPT (Cost per foot)
use when CPT is No
CPT Cost/foot
Variable Cost. use when CPT is YES
(LGTH ON PROP * CPT Cost/foot)
Fixed Cost. CPT Coordin Fee
use when CPT is YES
(variable + fixed cost)
answer for the tab: 'Legacy_11x17"
Customer is Providing the Trench
Size
1.Calculated cost for SL
Legacy 11x17 Data
Sq. Ft
Equipment
Frcd Air Furn
Water Heater
Space Heater
Fireplace
Range
Dryer
Grill
0
0
0
Legacy
0
0
0
12.38
0
4.74
0
481.53
481.53
0
0
Allowance
240
50
23
28
15
Total
5.56
0
842.11
842.11
0
Therms
0
0
0
0
0
0
0
0
0
Input
0
0
0
0
0
0
0
0
0
0
0
Qty
0
0
0
0
0
0
0
0
0
11 x 17
Sq FT
Equipment
Frcd Air Furn
Water Heater
Space Heater
Fireplace
Range
Dryer
Grill
0
0
Other (see comments)
CPT
Size
On Prop
SL Cost
Use when No
CPT Cost/ft
Varaible Cost
Fixed CostCPT
Use CPT=Y
CPT?
size
Calc SL Cost
0
Allowance
240
50
23
28
15
Total
0
0
0
12.38
0
3/4"
4.74
0
481.53
481.53
0
Therms
0
0
0
0
0
0
0
0
2"
5.56
0
842.11
842.11
0
Input
0
0
0
0
0
0
0
0
0
0
0
0
Customer Provided Trench Materials
Fixed Cost - 3/4" Service
Eliminator 2x3/4"
Con-Stab Coupling
EFV 1200 CFH
Riser 3/4"x3/4"
Stores loading
Material OH
Loaded Fixed Material
Fixed labor
Coordination Fee
Construction OH
Loaded Fixed Labor
Total Fixed Cost 3/4" CPT
Cost
40.82
8.92
16.05
70.55
0.2015
Material Sub
0.1192
0.1192
Qty
1
3
1
1
Total
40.82
26.76
16.05
70.55
154.18
31.0673
185.2473
22.0815
207.3287
245
29.204
274.204
481.53
CPT Calculation 3/4
On Prop
Var Cost
Fx Cost
Total Cost
Std Cost
Savings
Variable Cost- 3/4" service
Variable Labor/install
Construction OH
Total Variable cost 3/4"
45
55
481.53
536.53
557.1
-20.57
wire
3/4" Pipe
Stores Loading
Materials Sub
Material OH
Total Variable Pipe Cost
0.2015
0.1192
0.1192
0.12
0.41
0.106795
0.636795
0.075905964
0.712700964
3.6
0.4291
4.0291
4.74
12.38
Cost per foot
= Ops Update
=Acct Update
= Enter to PCE
Customer Provided Trench Materials
Fixed Cost - 2" Service
Eliminator 2x2" Tee
Met Fit 2" Coupling
EFV 5500 CFH
Riser 2"
Stores loading
Material OH
Loaded Fixed Material
Fixed labor
Coordination Fee
Construction OH
Loaded Fixed Labor
Total Fixed Cost 2"CPT
Eliminator 2x3/4"
Con-Stab Coupling
3/4" Pipe
EFV 1200 CFH
Riser 3/4"x3/4"
200' service line
Eliminator 2x3/4"
Con-Stab Coupling
3/4" Pipe
EFV 1200 CFH
Riser 3/4"x3/4"
300' service line
Cost
40.82
46.61
66.03
175.64
0.2015
Material Sub
0.1192
0.1192
40.82
8.47
0.43
12.02
65.45
40.82
8.47
0.43
12.02
65.45
Qty
1
3
1
1
1
3
200
1
1
1
3
300
1
1
Total
40.82
139.83
66.03
175.64
422.32
85.0975
507.4175
60.4842
567.9016
245
29.204
274.204
842.11
40.82
25.41
86
12.02
65.45
229.7
40.82
25.41
129
12.02
65.45
272.7
CPT Calculation 2"
On Prop
VC
FC
Total Cost
Std Cost
Savings
Variable Cost-2" service
Variable Labor/Install
Construction OH
Total Variable cost 3/4"
125
695
842.11
1537.11
1547.5
-10.39
Wire
2" Pipe
Stores Loading
Materials Sub
Material OH
Total Variable Pipe Cost
Install
0.2015
0.1192
0.1192
0.12
1.02
0.22971
1.36971
0.163269432
1.532979432
3.6
0.4291
4.0291
5.56
12.38
Std Cost per foot
= Ops Update
=Acct Update
= Enter to PCE
EFV Sizes
NONE
400/450 (1/2")
775/800 (1/2")
300/400 (3/4")
700 (3/4")
1100/1200 (3/4")
1800 (3/4")
2600 (3/4")
1100 (1")
2600 (1")
1800 (2")
2600 (2")
5500 ( 2" )
10000 (2")
VALVE
HPSS
Bore
Yes
No
Unknown
MANIFOLD #
2
3
4
5
6
7
8
9
10
11
12
CPT
Yes
No
Rate Description
Residential
Small Comm.
Large Comm.
Industrial
Irrigation
Company
CNG
Rate Description
Residential
Small Comm.
Large Comm.
Irrigation
Company
CNG
Rate Class
RS
GS
CNG
LV
IS-R
IS-C
T-3
T-4
RS/IS-R
GS/IS-C
Pump
Gas Light
Inc. Fee
Previous Energy
Electric
Propane
No Primary
Wood
Coal
Oil
Market Segment
Ex. Multi
Ex. Sp Heat
Mfrd House
New Multi Use
New Sp Heat
Other
X-Account
Dwelling Description
Residential
Commercial
Other
X
Building Type
Single
Multiple
Master Meter
Meter location
Back
Front
Left
Right
Roof
Remote
Comments
Assigned To
Dasco
Track
IGC
KV Const.
Eureka
Pipe Type
Y
DL
A
S
Pipe Size
1/2"
3/4"
1"
2"
6"
8"