West Haverstraw, NY · Rockland County
Gas Piping and Appliances – Downstream of the Gas Meter
This form certifies gas piping and appliance installation and leakage testing for plumbers or installers working at a West Haverstraw property.
What this form is
A plumber or installer uses this form to certify gas piping and appliance installations downstream of the gas meter. It records the property address, applicable appliances, leakage-test details, company and license information, and whether corrugated stainless steel tubing is present and properly bonded. The form also includes a section for recording whether the gas meter was installed or gas activated.
Who needs it
Plumbers or installers completing gas piping or appliance work at a West Haverstraw property may use this form to provide the installation certification.
How to submit it
Submit it to the city department named on the form; check the city website for current contact details.
About notarization
This document is signed without a notary; the plumber or installer signs and dates it, and the form mentions no notarized or sworn attachment.
How to submit this form
- 1
Download the Form
Download the Gas Piping and Appliances form for the installation.
- 2
Complete the Form
Enter the property and appliance details, leakage-test information, company details, and applicable license information.
- 3
Complete the Certifications
Indicate whether corrugated stainless steel tubing is present and complete the gas-meter or activation section.
- 4
Sign and Submit
The plumber or installer signs and dates the form. Submit it to the city department named on the form.
Frequently asked questions
- What does the Gas Piping and Appliances form certify?
- It certifies gas piping and appliance installations downstream of the gas meter and records that a satisfactory leakage test was performed.
- Who completes the gas piping form?
- The form says it is to be completed by the plumber or installer. It requests the property address, appliance details, test information, and installer credentials.
- Do I need a notary for the Gas Piping and Appliances form?
- No. This document is signed without a notary; the plumber or installer signs and dates it, and the form mentions no notarized or sworn attachment.
- How do I submit the Gas Piping and Appliances form?
- Submit it to the city department named on the form; check the city website for current contact details.