Conditional Gas Application

10 Date CONDITIONAL GAS FORM Johnston County Inspections Department 309 E Martket Street Smithfield , NC 27577 Phone 919 989 - 5060 Fax 919 989 - 5431 Gas Company Permit No Owner Project Address Type of Project Township Before the authorization to the utility company for gas connection to the above structure , a thorough inspection and checkout has been made by each of the trade contractors listed below to ensure to the best of their ability that the electrical , plumbing , and mechanical systems in this structure are complete enough and in safe working order to safely energize gas for temporary use as attested by the signatures below Conditional gas will be disconnected if Certificate of Occupancy has NOT been issued within the days approved Owner General Contractor Name Signature Electricical Contractor Name Signature Mechanical Contractor Name Signature Plumbing Contractor Name Signature This conditional gas certificate does not exempt a final inspection by the building code official for the issuance of Certificate of Occupancy and Compliance and the main disconnecting means may be deactivated in order to disconnect the gas to safely perform the final gas inspection If the final gas inspection is approved and a Certificate of Occupancy and Compliance is issued in accordance with GS 153A - 363 , the conditional gas certificate will be considered the approval for permanent gas to the structure OFFICIAL USE ONLY Date of Inspection Inspector Commercial Project 60 Days 90 Days Residential Project 30 Days ONLY Payment 75 Paid On Paid by Cash Check Visa Master CardPage