HomeMy WebLinkAboutPower ReleaseiU, ICIT
COUNTY
F L O R I D A -
Planning & Development Services
Building & Code Regulation Division
2300 Virginia Ave
Fart Pierce, FL 34952
772-462-2165 Fax 772-462-6443
Request for 30 -Day Temporary POWer Release
Date: J012-0 2-0 Kermit Number:
+ _
Project Address: 512' 1
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;
I. This temporary Power release is requested for• the above stated l�rpos� only, and there will be n4
r�CuPancy of any hype, ether than that permitted by construction during this time Pernod.
2. As witness Lry our signatures, we hereby agree to abide by all terms and conditions of this agreement,.
it 8uJdin9 Division Policy, which is incorporated herein by reference.
3. Ali conditions and requirements fisted in the attached docu"nt entitled "Requirements for 3o pay
Power For Testing" have been fulfilled and the Premise is ready for compliance Inspection.
d. All requests for an extension beyond 30 days most be made in vmtirlg to the BUnlding Official stating
the reason for the request. Power may be removed from the site and/or a Stop Work Order issued if
the Final Inspection has not been approved within 30 days. A fee of gto0 oo will be required to lift
the Stop Work Order.
WE HEREBY RELEASE AND AGREE TO HOLD HARMLESS ST. LUCIE COUNTY, AND THEIR EMPLOYEES FROM
ALL LIABILITIES 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 INCURRED DUE TO THE
DISCONNECTION OF ELECTRICAL POWER IN THE EVENT OF VIOLATION OF THIS AGREEMENT.
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t rvtH SIGNATURE --
GENERAL CONTRACTOR SIGNATUPE
ELECTRICAL CONTRACTOR SIGNATURE
DATE
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