n Domestic and Multiple Development Application Form Project Reference For office use only Date Received Time Received All fields marked with an * denote mandatory information which must be completed in order to satisfy minimum information requirements. ITEM 1 Customers Details 1.1 Contact Details * Organisation/Company Address Failure to provide the required minimum information will prevent the application being processed further. For further guidance on our minimum information requirements please refer to our attached Guidance tes. The contact details required provide Wales & West Utilities with all the necessary information regarding the requestor Postcode Customers contact details. Telephone Day Mobile Fax Number Email Address Best Time to Contact Morning Afternoon 1.2 Capacity in Which the Customer is Acting * Please indicate your relationship to the site. Owner Occupier Builder/Developer Self Build Architect Consultant Housing Association Please Specify: Landlord Local Authority 1.3 Bill Payer Details (if different to requestor) The contact details required provide Wales & West Utilities with all the necessary information regarding the bill payer. Organisation/Company Address Postcode Bill Payers Contact Details. Telephone Day Mobile Fax Number Email Address Best Time to Contact Morning Afternoon Page 1 of 7
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. Organisation Address Postcode Site address contact details. Telephone Day Mobile Fax Number Email Address Best Time to Contact Morning Afternoon 2.1 Site Contact Position Telephone Number ITEM 3 Customer Requirements 3.1 Request Type * The job description that best describes your site. Single Commercial Development Single Commercial Gas Supply Alteration Increase in Commercial Supply Multiple Commercial Development Multiple Commercial Gas Supply Alteration Mixed Commercial Residential Development Multiple Residential Development Multiple Residential Gas Supply Alteration 3.2 Type of Quote Required Please note a "Budget Indication" is for an estimated cost only and cannot be accepted. Firm Quotation 3.3 Previous Quotation Details Have you previously submitted a request to Wales & West Utilities for this site? If yes please provide previous Wales & West Utilities reference: Budget Indication Would you like your quotation to be sent via email? Page 2 of 7
ITEM 4 Property Type / Gas Load 4.1 Type of Site * Please tick all that apply to your site, whether it is a New Building, Existing Property or a Redevelopment of a building. Existing Property Options: New Build Redevelopment 4.2 Property Type / Gas Load Information Please provide the number of each type of property: Domestic n-domestic 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 Default (Please Specify) Flat (Please Specify Floor Level) Terraced/Semi/Detached Industrial and/or Commercial 30kW 60kW Total (ii) Annual Load (KWh) Are there any additional load requirements on site? eg. swimming pools, If yes please provide details below:- Additional Load Peak Instantaneous Demand (kw) Annual Load (kw) Page 3 of 7
ITEM 5 Service Termination / Meter Housing 5.1 Meter Box Type * (If you require meter boxes/kiosks, please detail how many of each type) Surface Mounted 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 Surface Mounted WWU to supply meter box Built-In Meter Box (U6) The box is designed to be installed in a hole cut in the wall of Built In 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 WWU to supply meter box install the external supply pipe. The dimensions are as follows: Height 600m, Width 410mm, Depth 60mm. Recess Size Height 532mm, Width 366mm, Depth 160mm Semi-Concealed Meter Box (U6) Internal Meter Position (U6 & Above) Surface Mounted Kiosk (U16 & U25) Freestanding Kiosk (U16 & 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 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. 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 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. Internal Semi Concealed WWU to supply meter box:- Freestanding Kiosk WWU to supply Kiosk WWU to supply concrete base Surface Mounted Kiosk WWU to supply Kiosk 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. Page 4 of 7
5.3 Alteration Details (if Required) 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 Meter Location New Meter Location Existing Gas Loads Hourly (kw) Annual (kw) Increase in Gas Loads Hourly (kw) Annual (kw) Please indicate what type of reconnection is required. (Domestic Properties Only) Options: ne Meter Reconnection Only Meter & Outlet Reconnection ITEM 6 On Site Excavation 6.1 Excavation Details * Will you be excavating in private land yourself? Please briefly explain the preferred route in private land. ITEM 7 Development Type, Constraints and Enhanced Facilities * 7.1 Third Party Consent * Do you require any third party consents/easements to lay pipes along your desired route? If yes, please explain briefly the reasons why third party consent will be required. 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. 7.2 Any Site Anomalies * Are there any site anomalies on your site? If yes please use the following checklist, if one is not included please enter it in the 'other' field. Sites of Special Scientific Interests Church Property Listed Buildings Timber Frame Property Conversion Waterways Thick Walls (>600mm) Rail Crossing, specify below Special Password Required Restricted Access Traffic Sensitive Change in Ground Levels Contaminated Land Asbestos Bus Routes Conservation Area Page 5 of 7
7.3 Site Constraints * Are there any restrictions on times to carry out the works? If yes, please use this comment box to explain what time of day and the reasons behind this. 7.4 Additional Technical Specifications 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) Compressors, specify below Compressor/Booster If elevated pressure (>19mbar) is required, please specify below 7.5 Additional Information Please enter any relevant information concerning your application e.g. Shipper Information, elderly, disabled, floor levels for flats. ITEM 8 Proposed Development 8.1 Date Gas Required This will be the date on which gas is required. Date 8.2 Phased / Future Development Will the development be phased or are any future developments planned? If please complete the relevant boxes below. Phased Works Future Development ITEM 9 Site Plan Checklist Please make sure all relevant criteria are completed when providing attachments e.g. Scaled Site Plans. Is the site a new development? If, please ensure this checklist is fully completed prior to sending the application. 3. Site Boundary Clearly Identified 1. Plan Showing Scale 4. New Buildings Clearly Identified 2. Surrounding Geography 5. New Meter Positions Clearly Marked 6. Site Location Drawing Page 6 of 7
Is the site an Existing Property? If, please ensure this checklist is fully completed prior to sending the application. Is it a Disconnection? 2. Surrounding Geography 6. Site Location Drawing 5. Meter Positions Clearly Marked If, please ensure this checklist is fully completed prior to sending the application. 5. Existing Meter Positions Marked 6. Site Location Drawing Please note Wales & West Utilities will utilise your scaled site plans during the design process. New and/or Existing Meter Positions Proposed Site Layout and Building Location Site Boundary Clearly Indentified Surrounding Geography (Site Location) Plan Scale Please ensure all buildings are clearly named or numbered with coresponding floor levels (as applicable). It is vital that this section is completed fully and accurately as it is crucial to our Minimum Information Requirements Closing Section Once Completed, Please Return This Form by Email, Post or Fax to:- Email Fax Post frontdeskrequests@wwutilities.co.uk 0870 1650598 Wales & West Utilities Ltd, Wales & West House, Spooner Close, Coedkernew, Newport, NP10 8FZ Please note that scaled plans cannot be faxed. 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. & Position 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. Thank you for choosing Wales & West Utilities Page 7 of 7