HomeMy WebLinkAbout30 day temp power form 05/31/2017 07 : 11 AM PDT TO: 17724626443 FROM:5616 09 Page: 2
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Planning & Development Services
Building & Code Regulation Division �
2300 Virginia Ave
Fort Pierce, FL 34982
772-462-2165 Fax 772-462-6443 �
Request for 30-Day Temporary Power Release
Date: �5�3/ /7 Permit Number: /7
Project Address: L3 100 13 e1l f
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 requested for the above stated purpose only, and there will be no
occupancy of any type, other than that permitted by construction during this time period.
Z. As witness by our signatures, we hereby agree to abide by all terms and conditions.of this agreement,
including 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 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 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$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 F ELECTRICAL POWER IN THE EVENT OF VIOLATION OF THIS AGREEMENT,
OWNER SIGNA RE DATE
GENERAL CONTR GNATURE DATE
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ELECTRICAL C NTRACTOR SIGNATURE DATE
RECEIVED JUN 0 g
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EI VED MAY 311017
RECEIVED JUN 1:3 2017 l:tl Vtu ,
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