Time Received
Mi fyddwn yn recordio galwadau ac efallai byddant yn cael eu monitro
Other Please Specify:
Wales & West House, Spooner Close, Coedkernew, Newport NP10 8FZ Registered in England and Wales: No. 5046791
Self Build
□
Rhif ffôn ddihangfa nwy 24 awr
0800 111 999*
Afternoon
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Name
Organisation/Company
For further guidance on our minimum information requirements please refer to our attached Guidance Notes.
Best Time to Contact
Morning
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1.2
Capacity
in
Which
the
Customer
is
Acting
*
Please indicate your relationship to the site.
Owner
Organisation/Company
Address
Postcode
□
Architect
□
Project ReferenceAll fields marked with an * denote mandatory information which must be completed in order to satisfy minimum information requirements.
Name
ITEM
1
Customers
Details
Failure to provide the required minimum information will prevent the application being processed further. Date Received
1.1
Contact
Details
*
For
office
use
only
Non Domestic and Multiple Development
Application Form
Fax Number
Email Address
The contact details required provide Wales & West Utilities with all the necessary information regarding the requestor
Customers contact details.
Telephone Day
Mobile
Consultant
Landlord
□
Local Authority
□
Bill Payers Contact Details.
□
Builder/Developer
Occupier
□
1.3
Bill
Payer
Details
(if
different
to
requestor)
*calls will be recorded and may be monitored
Registered Office
Afternoon
□
24 hour gas escape number
Telephone Day
Address
Postcode
The contact details required provide Wales & West Utilities with all the necessary information regarding the bill payer.
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Housing Association
Morning
□
Wales & West Utilities Limited
Mobile
Fax Number
Email Address
Best Time to Contact
□
□
□
□
□
□
□
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Would you like your quotation to be sent via email?
0800 111 999*
Wales & West Utilities Limited
Registered Office
Wales & West House, Spooner Close, Coedkernew, Newport NP10 8FZ Rhif ffôn ddihangfa nwy 24 awr
24 hour gas escape number
If yes please provide previous Wales & West Utilities reference:
Single Commercial Gas Supply Alteration
Increase in Commercial Supply
3.2
Type
of
Quote
Required
Have you previously submitted a request to Wales & West Utilities for this site?
Yes
□
3.3
Previous
Quotation
Details
Multiple Residential Gas Supply Alteration
Firm Quotation
□
ITEM
3
Customer
Requirements
The job description that best describes your site.
Single Commercial Development
Multiple Commercial Gas Supply Alteration
Multiple Commercial Development
Mixed Commercial Residential Development
Multiple Residential Development
Yes
□
No
□
*calls will be recorded and may be monitored
ITEM
2
Site
Details
(if
different
to
Customer
Details)
The site details required provide Wales & West Utilities with all the necessary information regarding the location of the site .
Budget Indication
□
Please note a "Budget Indication" is for an estimated cost only and cannot be accepted.
□
No
3.1
Request
Type
*
Site address contact details.
Email Address
Position
Best Time to Contact
Postcode
Morning
□
Afternoon
□
Telephone Day
Organisation
Fax Number
Address
Mobile
Name
2.1
Site
Contact
Default
30kW
60kW
n/a
n/a
n/a
n/a
n/a
Mi fyddwn yn recordio galwadau ac efallai byddant yn cael eu monitro
Wales & West House, Spooner Close, Coedkernew, Newport NP10 8FZ Registered in England and Wales: No. 5046791
0800 111 999*
Wales & West Utilities Limited
Registered Office
Rhif ffôn ddihangfa nwy 24 awr
Yes
*calls will be recorded and may be monitored
Domestic
4.2
Property
Type
/
Gas
Load
Information
4.1
Type
of
Site
*
If you know your gas load requirements enter them in Table 1. If solely domestic you can utilise our default loads by filling in Table 2.
(i) Property Type
Number of Each Type
(ii) Demand
(ii) Annual Load
(KWh)
Existing Property
□
Please provide the number of each type of property:
Non-Domestic
24 hour gas escape number
Please tick all that apply to your site, whether it is a New Building, Existing Property or a Redevelopment of a building.
Options:
New Build
□
Redevelopment
□
ITEM
4
Property
Type
/
Gas
Load
Additional Load
□
No
□
If yes please provide details
below:-Other
Other
Other
Annual Load (kW) Peak Instantaneous Demand
(kW)
Flat (Please Specify Floor Level)
Terraced/Semi/Detached
Industrial and/or Commercial
Other
Total
Are there any additional load requirements on site? eg. swimming pools,
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□
□
□
□
□
□
□
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These types of freestanding meter box are designed to house larger meters. Wales & West Utilities can order and install
these on your behalf at an additional charge.
An alternative option would be for the customer to provide the concrete base and kiosk themselves. Sizes may vary
depending on the load selected.
Number Required -
Registered Office
24 hour gas escape number Rhif ffôn ddihangfa nwy 24 awr
0800 111 999*
Wales & West Utilities Limited
ITEM
5
Service
Termination
/
Meter
Housing
The meter can be sited internally, either on the front facing wall or side wall. The pipe will usually enter the building via an
above ground entry.
Meter boxes are not needed when an internal meter is chosen and must be positioned away from extreme heat sources and
liquids.
Internal
Please specify how many of these you would like
Please specify how many of these you would like Number Required -
5.2
Meter
Location
*
Please describe preferred meter location. The location should be on the front of the building or 2m along the side elevation.
WWU to supply concrete base Please specify how many of these you would like
Freestanding Kiosk WWU to supply Kiosk Semi-Concealed Meter Box (U6)
Please specify how many of these you would like Surface Mounted
The box is designed to be installed in a hole cut in the wall of a property. The fitting of the built-in box is the responsibility of the owner. It must be installed prior to the arrival of us to
install the external supply pipe.
The dimensions are as follows: Height 600m, Width 410mm, Depth 60mm. Recess Size Height 532mm, Width 366mm,
Depth 160mm Number Required -
5.1
Meter
Box
Type
*
(If
you
require
meter
boxes/kiosks,
please
detail
how
many
of
each
type)
Surface Mounted Meter Box (U6)
Built-In Meter Box (U6)
This is installed by Wales & West Utilities when we arrive on site. The box cannot be positioned above or within 150mm of the edge of drains, inspection covers, manholes, air bricks,
etc...
The dimensions are as follows: Height 497mm, Width 442mm, Depth 230mm
WWU to supply meter box Please specify how many of these you would like Number Required -
WWU to supply meter box
Number Required - Internal Meter Position (U6 & Above)
The semi-concealed meter box is partially buried against the wall of the house, protruding approximately 160mm above ground level. This installation may not be suitable for all types
of property.
The dimensions are as follows: Height 150mm, Width 478mm, Depth 330mm
Semi Concealed
WWU to supply meter box:- Built In
Surface Mounted Kiosk (U16 & U25)
These types of surface mounted meter box are designed to house larger meters. Wales & West Utilities can order and
install these on your behalf at an additional charge.
An alternative option would be for the customer to provide the concrete base and kiosk themselves. Sizes may vary
depending on the load selected
Surface Mounted Kiosk WWU to supply Kiosk Please specify how many of these you would like Number Required -
Hourly (kW) Annual (kW) Hourly (kW) Annual (kW)
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□
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Mi fyddwn yn recordio galwadau ac efallai byddant yn cael eu monitro
Wales & West House, Spooner Close, Coedkernew, Newport NP10 8FZ Registered in England and Wales: No. 5046791
5.3
Alteration
Details
(if
Required)
□
7.1
Third
Party
Consent
*
Will you be excavating in private land yourself?
___ ___ ___ ___ ___ ___ ___ ___ ___ ___
Existing Meter Location New Meter Location
ITEM
6
On
Site
Excavation
Increase in Gas Loads
6.1
Excavation
Details
*
Timber Frame
□
7.2
Any
Site
Anomalies
*
Please note that any involvement with third parties may result in a delay of works. Where consents are required, a consent form will
be provided with the quotation and must be completed if accepted.
Change in Ground Levels
If yes please use the following checklist, if one is not included please enter it in the 'other' field.Sites of Special Scientific Interests
Other, specify below
*calls will be recorded and may be monitored
0800 111 999*
Wales & West Utilities Limited
Registered Office
24 hour gas escape number Rhif ffôn ddihangfa nwy 24 awr
Do you require any third party consents/easements to lay pipes along your desired route?
Yes
Yes
□
No
Please briefly explain the preferred route in private land.
□
ITEM
7
Development
Type,
Constraints
and
Enhanced
Facilities
*
No
Rail Crossing
Conservation Area
Special Password Required
Restricted Access
Traffic Sensitive
Contaminated Land
Thick Walls (>600mm)
Are there any site anomalies on your site?
Yes
Bus Routes
Waterways
Church Property
Listed Buildings
Property Conversion
□
Asbestos
If yes, please explain briefly the reasons why third party consent will be required.No
□
If you have an existing meter please specify all known details in this section - information can be obtained from a Gas Safe Register engineer. Existing MPRN/Serial Number (located on gas bill)
Existing Gas Loads
Please indicate what type of reconnection is required. (Domestic Properties Only)
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□
□
□
□
□
Mi fyddwn yn recordio galwadau ac efallai byddant yn cael eu monitro
Wales & West House, Spooner Close, Coedkernew, Newport NP10 8FZ Will the development be phased or are any future developments planned? If Yes please complete the relevant boxes below.
Yes
□
*calls will be recorded and may be monitored Future Development
Wales & West Utilities Limited
If Yes, please ensure this checklist is fully completed prior to sending the application.
3. Site Boundary Clearly Identified
ITEM
9
Site
Plan
Checklist
No
24 hour gas escape number
2. Surrounding Geography
5. New Meter Positions Clearly Marked
Rhif ffôn ddihangfa nwy 24 awr
0800 111 999*
Registered Office
6. Site Location Drawing
Please make sure all relevant criteria are completed when providing attachments e.g. Scaled Site Plans.
1. Plan Showing Scale
4. New Buildings Clearly Identified
Is the site a new development?
Compressor/Booster
Compressors
Phased Works
□
No
□
If yes, please use this comment box to explain what time of day and the reasons behind this.
7.4
Additional
Technical
Specifications
Date
7.3
Site
Constraints
*
Are there any restrictions on times to carry out the works?
Yes
8.1
Date
Gas
Required
This will be the date on which gas is required.
Please tick all that apply to your site, if there are any that are not listed please specify under other.
Combined Heat and Power (CHP)
Yes
□
If elevated pressure (>19mbar) is required, please specify below
□
8.2
Phased
/
Future
Development
Other, specify below
………
7.5
Additional
Information
No
□
ITEM
8
Proposed
Development
□
□
□
□
□
Mi fyddwn yn recordio galwadau ac efallai byddant yn cael eu monitro
Wales & West House, Spooner Close, Coedkernew, Newport NP10 8FZ Registered in England and Wales: No. 5046791 Please note Wales & West Utilities will utilise your scaled site plans during the design process.
□
No
□
Thank
you
for
choosing
Wales
&
West
Utilities
Confirmation
Signature
Please note by signing this section you have confirmed that all details provided are accurate. If the information provided proves to be incorrect then a variation may be required thus resulting in a delay of works and a possible change in cost.
Signature
Date
Wales & West Utilities publish a Privacy Policy which outlines how we will use and protect the data you provide us. This is available on our website www.wwutilities.co.uk following the Privacy Policy link. A copy is also available upon request.
Name & Position
Post
0870 1650598
Wales & West Utilities Ltd, Wales & West House, Spooner Close, Coedkernew, Newport, NP10 8FZ
0800 111 999*
Wales & West Utilities Limited
Registered Office
Closing
Section
24 hour gas escape number
Please note that scaled plans cannot be faxed. Once Completed, Please Return This Form by Email, Post or Fax
to:-Email
Fax
No
□
Is it a Disconnection?
It is vital that this section is completed fully and accurately as it is crucial to our Minimum Information Requirements
Please ensure all buildings are clearly named or numbered with coresponding floor levels (as applicable).□
Yes
5. Existing Meter Positions Marked
6. Site Location Drawing
If Yes, please ensure this checklist is fully completed prior to sending the application.
Rhif ffôn ddihangfa nwy 24 awr
*calls will be recorded and may be monitored Is the site an Existing Property?
Yes
If Yes, please ensure this checklist is fully completed prior to sending the application.
2. Surrounding Geography
6. Site Location Drawing
5. Meter Positions Clearly Marked
Plan Scale
Surrounding Geography (Site Location) Site Boundary Clearly Indentified
Proposed Site Layout and Building Location New and/or Existing Meter Positions
