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ALLEN COUNTY, INDIANA BUILDING DEPARTMENT 200 E. Berry Street/Suite 180 FORT WAYNE, INDIANA 46802-1299 PHONE: (260) 449-7131 Joseph Hutter, Allen County Indiana Building Commissioner FUEL GAS PIPING AFFIDAVIT FOR AIR PRESSURE TESTING INSPECTIONS OF GAS PIPING PRIOR TO UTILITY CONNECTION I HEREBY AFFIRM THAT AS PART OF THE AIR PRESSURE TESTING OF THE SYSTEM, ALL OTHER OPENINGS ARE EITHER CAPPED OR PLUGGED PRIOR TO REQUESTING AN INSPECTION. I ALSO AGREE TO THE FOLLOWING: • The air pressure test will only be up to the shut off valve for any appliance. • Appliance connection beyond the shut off valves will not be included in the air pressure test inspection. • It is the responsibility of the appliance installer to complete a leak check on the piping and fittings from the shut off valve to the appliance immediately after the gas service is turned on. • I understand the code reference below: G2417.6.3 (406.6.3) Leak check. Immediately after the gas is turned on into a new system or into a system that has been initially restored after an interruption of service, the piping system shall be checked for leakage. Where leakage is indicated, the gas supply shall be shut off until the necessary repairs have been made. TYPE OF STRUCTURE: Residential Commercial FUEL TYPE: NATURAL PROPANE_______ PERMIT HOLDER (COMPANY NAME OR OWNER OCCUPANT) Signature Printed Name Property Address