UIP Quotation/Request & Design Notification Form All the information in this form supplied by the individual, firm or company to Northern Gas Networks is confidential to that individual, firm or company and MUST NOT be disclosed to any other person, including any person employed in Northern Gas Networks Connections Service Provider, without the consent of that individual, firm or company.Your Ref. No.Has an Enquiry Form been submitted for this site previously? Yes No What is your Northern Gas Networks Ref No?Enquiring Company NameContact NameAddressPost CodeTelephone NoFax NoIs request on behalf of an individual customer owner or occupier? Yes No Proposed Site InformationSite ContactSite NameTelephone NumberSite Location Plans (If applicable)Max. file size: 20 MB. Site addressPost CodeEastingNorthingOS Map No. (eg. TA 1232 NE)Single or Multiple Premises?Type of works New Supply Alteration Disconnection Type of development Domestic Commercial Industrial Is this a Fuel Poor Extension? Yes No Proposed LoadMax instantaneous rate (kW).Max Annual Consumption (kWh)Predicted mains pressure drop at peak (mbarg)Predicted service pressure drop at peak (mbarg)Does the proposed load follow a normal space heating pattern? Yes No Connection and/or Service Disconnection DetailsConnection Point LocationParent Main Diameter & MaterialOfftake Diameter and MaterialLength and Diameter of PipeworkTermination PointEastingNorthingDoes your request fall within the parameters of the standard design pressure tables in NGN/SP/NP/14/E? Yes No If Yes, do you want to use the standard pressure? (Please note that if a network analysis service is requested this will be chargeable.) Yes No Do you wish to complete the Final Connection? Yes No Anticipated Connection DatePlease enclose site plans with meter locations marked X.Max. file size: 20 MB. Other InformationThe following section is for Industrial / Commercial premises onlyType of Load (e.g. modulating, constant, process/on-off/CHP)Will a compressor be fitted? Yes No For individual loads > 2,196,000 kWh please indicate if Northern Gas Networks is to take ownership of the system. Yes No Is the pressure at the inlet to supply meter installation required to be >20.7 mbar? Yes No Please specifyDo you require works to be carried out outside normal working hours? Yes No Do you require meter housing to be supplied and installed by Northern Gas Networks? Yes No Do you require additional conditions or site rules and regulations? (applicable to this project only) Yes No Please specify(Please note that the above three items may attract additional costs.)The following section is for Domestic premises onlyType: Private Local Authority Housing Association Mixed Are there any non- domestic properties (specify)Are there any exceptional loads (e.g. swimming pools)Developer DetailsPlease complete the remainder of the form for both Domestic and Industrial & Commercial propertiesProperty Type For domestic loads: FL = Flat TH = Terraced House SD= Semi Detached House DH = Detached House BU = Bungalow O =Other (specify) For non-domestic loads please indicate unit numbers. No. of premisesCentral Heating ? (domestic only) Yes No Estimated Annual Consumption (kWh)Peak Instantaneous Demand (kW)Is the development or the load growth phased? Yes No If Yes, please provide details (including number of proposed connections and their associated load per year)(On multiple developments please indicate the number of connections required within the site on a suitable scale drawing). Is growth beyond this site anticipated within the next 5 years? Yes No If Yes, please provide details (including number of proposed connections per year)Service Alterations and Disconnections or a connection on behalf of owner or occupier onlyRequester Name (ie. Gas Consumer/Supplier)Requester Company (if not Gas Consumer)Post CodeMPRN (where known)Attach site plan indicating exact location of works and point of termination.Max. file size: 20 MB. CAPTCHA Δ