HomeMy WebLinkAboutReq for 30-day temp power formPlanning & Developirnent -services
Building & Code-Reguia#ion Division
2300 Virginia Ave
Fort Pierce, FL 34982
772-462-2165 Fax 772�-462-6443
Request for 30-Day Temporary Power Release
Date. Permit number:
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 j
AND EQUIPMENT IN PREPARATION FOR A FINAL INSPECTION. IN CONSIDERA'1 ION OF APPROVAL. OF THE
REQUEST WE HEREBY ACKNOWLEDGE AND AGPrzE AS' 'FOLLOWS:
I. This temporary poorer release is requested for the above.stated purpose only, and them Vvlll be no
occupancy of any type, other than that permitted by .construction during this time period.
Z. As witness by our signatures, we hereby agues 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 Tesfing" 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 ft Building official stating
Cite reason for the request. Power maybe removed from the site and/or a Stop Work. Order issued if
the Fnal Inspection has not been approved within 30 days.' A fee of $100.'00 will be required to 111t
the Stop Work Order.
WE HEREBY RELEASE AND AGREE TO HOLD HARMLESS, ST. LEICIE COUNTY, AND THEIR EMPLOYEES FROM
ALL LIABILITIES 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 INCURRED DUE TO THE
DISCONNECTION OF ELECTRICAL POWER IN T14E EVENT OF VIOLATION OF THIS AGREEMENT.
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OWNER SIGNATURE DATE
CONTRACTOR SIGNATURE
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RECEIVED SEP`2 2 2017
Z ES -A 3000/W00d 069-1
999L8L8ZLL d,io0 Bu i p [ i q euuAM - 0aJ £9=tr l L ZZ-60