Request for Service Cut-Off and Demo Sign-Off form

CM9199 MA (2/23)

Request for Service Cut-Off

and Demo Sign-Off

The following information is necessary before National Grid can initiate a service cut-off or can provide a gas utility

signoff for a demolition request. Please provide the information listed below. The lead-time required for cut off of

gas services is typically 7 weeks (weather permitting) from the time we process it. All disconnects must be cut off at

the main per National Grid pipeline safety guidelines. This requires a street opening permit from town, city or state

and their permit turnaround time varies including winter moratoriums. The customer will assume the cost of service

reconnection, service installation, or any town requirements for restoration. Before service is cut off customer must

notify Customer Service at 1-800-732-3400 to have the meter removed. Please note meter removal does not

indicate that the service line was cut off. Requests can be emailed to [email protected].

Home or Business Name/Property Owner (if applicable)___________________________________________________

Name of Contact_____________________________________________________________________________________

Phone Number of Contact____________________Email of Contact__________________________________________

Meter Number______________________________Earliest Cut-Off Date (See Note)___________________________

(NOTE: Because National Grid must obtain a permit approval for any excavation work required, the requested cutoff

may require additional time for permitting or moratoriums.)

Address of demolition and/or service cut-off__________________________________________________________

City/Town___________________________________________________________________________________________

Is the service cut-off request due to a demolition? r Yes r No

Is this the only building located at this address? r Yes r No

Have you contacted customer service to have your meter removed? r Yes r No

Are you requesting gas be reconnected in the future? r Yes r No

Please include a photo or google map of the property where gas will be removed.

Please circle the building on a map if there is more than one building.

By signing below, I certify that I am the owner of the property or that I have been authorized by the owner of the

property to act as the owner’s agent in requesting this cut-off. If it is determined that I was not, in fact, authorized to

request this cut-off, I shall defend, indemnify, and hold National Grid harmless against any costs and liabilities arising

out of or related to this cut-off request, including, without limitation, reimbursing National Grid for its costs related to

cutting off and reinstating service.

Homeowner Signature:_____________________________________________________________Date:________________

Builder Signature:_________________________________________________________________ Date:________________

Massachusetts