HomeMy WebLinkAboutInspection Docs t
Planning .&Development Services
Building &Gbde-Regulation Division
2300-Virginia Ave.
Folrt'Pierce,, FL 34982
772-462-216 Fax 772-461-6443
Request for 30-Day'Temporary Power Release
Date: Penrf1-N6mber: N��� �
Project Address: . �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. HEREBY ACKNOWLEDGE AND AGREE AS FOLLOWS:
1. This temporary power release Is requested for the above stated purpose only,and here wall be no
i occupancy of any type,other than that permitted by construction during this time period.
2. , As witness by our signatures,we hereby agree to abide by.atl terms and conditions of this agreement,
incldding Building Division Policy,which is incorporated herein by reference.
3. All conditions and requirements listed in the attached document entitled"Requirements for 30 Day
Power for Testing"have been fulfilled and the premise is ready forcompliance inspection,
4. All requests for an extension beyond 30 days must be made in writing W the Building Official stating
the reason for the request. Power may be removed from the site and/dr a Stop Work Order issued if
the Final Inspection has not been approved within 30 days. A flee of$100.00 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 ELEMCAL POWER IN THE EVENT OF VIOLATION OF THIS AGREEMENT,
OWNER SIGNATURE DATE
GFN CONTRACTOR DATE
ELECTRICAL CONTRACTOR SIGNATURE DATE
R�CE\v Ep �
60 -d 6OA000d 696-1 999L8L83LL dJ 9 : �L L L L L-LOO a �
S les
Planning&Development
Building&Code Regulation Division
2300 Virginia Avenue
* Fort Pierce,FL 34982
772-462-2165 or 772-462-2172 r
Fax: 772-462-6443 _
i RECEIVE®
ROOF,NSPEU-l0N'AFFlDAV1T FEB 0 6 2017
PERMITTING
q St, Lucie County,FL
Re: Permit# _�_ ��1 r D,S7 1
1, DYE licensed as a(RQ9;&r*/Engineer/Arch1tect
(Please pri t name.&circle license type) *FS468 Building Inspector
*General,Building,Residential or a i anaa or any Individual cerfWed under 468 IS.to make such an inspection,
On or about, I did personally inspect the roof deck nailinl7
(Date) t
p ,
work;6t: �� � .Q11�� Vl '
(Job site address)
Based upon that examination I have determined the installation was done according to the current
edition of the Florida Existing Building Code Section 611 or the product approval submitted(whichever is
most strigent).
Ignature and Seal license#
STATE'OF FLORI
COUNTY OF
Sworn to and subscribed before me this_ day of 20_1,1
bq ( w� M �3AA&--Who is personally known to me or who has produced
zo V%jV-%A _ as identification.
Notary Public,State of Florid
Signature of Notary: .
Commission Number: PU 91.6 (Seal)
j -
En 01/19/2011 CiQLE
KicLL P
g l*a mycommisSIoN FFOg8H90`
EXPIRSS January
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