HomeMy WebLinkAbout30 day for testing office form 01-25-'21 14:31 FROM- 7728787656 T-732 P0001/0001 F-198
Planning .Sfc Development Services
r
3" Building &:Code 1UgulAtion Division
2300 Vi is Ave
Fort Pierce; FL 34982
772-46-2-21-65 Fax 772 462.6443
kequ1estfor 30-DayTemparary Pom er'Release
Date: \ Perrnit'NUmber.
P ert Address: q\,\ ct
THE UNDERSIGNED HEREBY RJEQUEST RELEASE OF ELECTRICAL POWER TO THE ABOVE DESCRIBED
PROPERTY, FOR A PERIOD NOT TO EXCEED TNZRTY,(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 w l 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 hraxelh by refWrence,
3. All conditions and requirements listed in the attached document entitibd"Requirements for 30 Day
Power far Testing"have been fulfilled and the premise is ready for compliance inspectton.
4. All requests for an extension beyond 30 days must,be made in writing tso.t he 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,SI: LUCIE COUNTY,AND THEIR EMPLOYMS FROM
ALL LIABILITIES AND CLAIMS OF ANY TYPE OF NATURE WHICH MAY ARISE NOW OR IN THE FUTURE OUT
OF THIS TRAANSACTION,'INCLUDING ANY DAMAGE WHICH MAY BE INCURRED DUE TO THE
DISCONN£CT'ION OF ELECTRICAL POWER IN THE ANT OF VIOLATION OF THIS AGREEM
OWNER SIGNATURE DATE'
O,EN CONTRACTORS DATE
ELECTRICAL CONTRACTOR SIGNATURE DATE