HomeMy WebLinkAbout30 day temp power form Planning .&6&e(opment Services
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auildjn4 &Code Regulation Division
2300 Virginia Ave
Fort Pierce, FL 34082
772-462-2165 Fax 772=462-6443
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Request for 30-Day Temporary PowerRelease
Date: Q�� limit Number:
Project Address;
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THE UNDERSIGNED HEREBY REQUEST RELEASE OF ELECTRICAL POWER TO THE ABOVE DESCRIBED
PROPERTY, FOR A PERIOD NOT TO EXCEED THIRTY(30) DAYS, FOR THE PURPOSE OF TESTING SYSTEMS
AND EQUIPMENT IN PREPARATION FOR A FINAL INSPECTION. IN CONSIDERATION OF APPROVAL OF THE
REQUEST WE HEREBY ACKNOWLEDGE AND AGREE AS FOLLOWS:
1. This temporary power release is reyaesled ibr the above stated purpose only,and here WE be.no
occupancy of any type,ether than that permitted by consbutton during this time period.
2. As witness by our signatures,we hereby agree to abide by all terms and conditions of this agreement,
Including Building DIvision POiicy,which is incorporated herein by reference.
3. All conditions and requirements fished in the attached document entitled"Requirements for 30 Day
Power for Testing"have been fulfilied and the premise is ready for compliance inspection.
4. All requests for an extension beyond 30 days must be made in writing to the Building Official stating
the reason for the request. Power maybe removed'from the site and/or a Stop Work Order issued if
the Fnai'Inspecdon has not been approved within 30 days. A fee of$X00.00'wilf be required to lift
the Stop Work Order.
WE HSZEBY RELEASE AND AGREE TO HOLD HARMLESS,ST. LUCIE COUNTY,AND THEIR EMPLOYEES FROM
ALL LIABILIITES AND CLAIMS OF ANY TYPE OF NATURE WHICH MAY ARISE NOW OR IN THE FUTURE OUT
OF THIS TRANSACTION, INCLUDING ANY DAMAGE WHICH MAY BE INCUkRED DUE TO THE
DISCONNECTION OF ELECMCAL POWER Ili THE EVENT OF VIOLATION OF THIS AGREEMENT. �
OWNER SIGNATU DATE
:GENERXCONTRACTUR i2g DATE
-ELECTRICAL CONTRACTOR SIGNATURE DA7t �
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