HomeMy WebLinkAboutrequest for 30-day temp power release formPlanning .& Developmelnt Services
Buili ing & Code Regulation DiiW idn
2300 Virginia Ave
Fort• Pierre, FIL 34982
772-462-2166 Fax 772-462-6443
. Ctequest for 30-Darr Temporary PowLer Release
Date: 1XV
Project Address;
Permit •Number• ` o
THE UNDERSIGNED HEREBY REQUEST RELEASE OF ELECTIJC-4L POWER 70 THE ABOVE DESCRIBED
PROPERTY, FOR A PERIOD NOT TO EXCEED THIRTY (30) DAYS, FOR THE PURPOSE OFTESTING SYSTEMS
AND EQUIPMENT IN PREPARATION FOR A FINAL INSPECTION. IN CONSIDERATION OF APPROVAL OF THE .
REQUEST WE HEREBY AClKNOWLEDGE AND AGREE AS FO1 LOWS:
1, This temporary power release is requested for the above stated purpose only, and there wil3 be no
occupancy of any type, other than that permithed by construction during this time period.
Z. As witness by our signatures, we her6by 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 fuifiiled •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 removedfrom. the site and/or a Stop Work Order issued if
the Final Inspection has not been approved within 30 days. A fee of`$X00,00 will be required to I"rft
the Stop Work Order.
WE HEREBY RELEASE AND AGREE TO HOLD HARMLESS, Si ; LUCIE COUNTY, AND THEIR EMPLOYEES FROM
ALL LiABILMES AND CLAIMS OF ANY TYPE' OF MATURE WHICH MAY ARISE NOW OR IN THE FUTURE OUT
OF THIS TRANSACTION, INCLUDING ANY DAMAGE WHICH -MAY BE INCUR -ED DUE TO THE
DISCONNECTION OF ELECTRICAL POWER IN THE EVENT OF VIOLATION OF THIS AGREEMENT.
OWNER SIGNATURE DMAE
7ia>`J11E CONT;RAC OR SIS DATE
•-ELECTRICAL CONTRACTOR SIGNATURE DATE
RECEIVED SEP-22 2017
US-d 3000/ 000d 069-1
999L8L8ZLL
dao0 Buiplina euuAM -WOU 69:tL LL7-60