HomeMy WebLinkAbout30 day power release Planning & Development Services llepartment
= = Building & Code Regulations Division
2300 Virginia Avenue ®�
6=1 Ft Pierce,FL 34982
Phone:772-462-2165
Fag:772-462 2522
Request for 30-Day Temporary Power Release
Date: J� �y7 Permit Number: / 70 3—
Project Address: -3 9 3 3 b
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 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.
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 listed in the attached document entitled"Requirements for 30 Day Power for
4. Testing"have been fulfilled and the premise is ready for compliance inspection.
5. 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 HARM LESS,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
ELECTRICAL PO OF VIOLATION OF THIS AGREEMENT.
1.-7 7
OWNE IGN DATE
A 7
GE RAL 905MACTM SIGNATURE DAT19
JL
ELECTRICAL CONTRACTOR SIGNATURE DATE
SLCPDSD Revised 06/14/2010