HomeMy WebLinkAboutPower release form, 30 day P10 ning .&DeveloPmeht'-Semices
BAding-&-Code Regulation DiVision
s ; 2300 Virginia Ave
AI Fort Pierte, FL 34082
772-46 2-2165 Fax 772-462-6443
Request for 30-Day Ternp' orary Power:Ref°ease
Date: , Permit Num er•
Project Address: \ �
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 INSPECIZON. IN CONSIDERATION OF APPROVAL OF THE
REQUEST WE HEREBY ACKNOWIMGE AND AGE AS FOLLOWS:
II I,
1. 7his temporary power release is requested for the above stated purpose only,and there will be no
occupancy of any type,other than that permffted by construction 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 Policy,which is incorporated herein by reference.
3. All conditions and requirements fisted 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 exbension 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
time Fnal'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 LIASTLMES AND CLAIMS OF ANY TYPE'OF NATURE WHICH MAY ARISE NOW OR IN THE FUTURE OUT
OF THIS TRANSACTION,INCLUDING ANY DAMAGE'WHICH MAY SE INCUkRED DUE TO THE
DISCONNEM-10N OF ELECTRICAL POWER IN THE EVENT. OF VIOLATION OF`FHIS AGREEMENT.
OWNER SIGNATURE. DATE
:GEN, CONT#iACMR , RE [SATE.
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ELECTRICAL CONTRACTOR SIGNATURE DATE
RECEIVED SEP 2� z ;;
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