HomeMy WebLinkAboutTemp power release form 03-18-'21 09:23 FROM- 7728787658 T-904 P0008/0008 F-452'
titii S D v� ller� r�'iis
Sti>i d ri & ro a ReW chic n DI 1010in
: .31 iifa AVe
7-72=4W 65 6443
RegU4i--f4Dr-30-bay.TeiupoiTit y'Pdmier Reltaioe
Date: �� t Pernrtw4mben.
Projed Address. `" ,
THE UNDERSIGNED HEREBY REQUEST RELEASE of ELECTRICAL POWER TO THE-ABOVE DESCRIBED
PROPERTYr FOR A PLOD NOT Tp M--EED TWRTY PO).DAYS,FOR THE PURPM OFTES nNG SYSTEMS
AND EQUIPMENT IN PREPARA170.N FOR iA.FINAL.INSPECTION. IN CONSWERATION OF APPROVAL OF THE
R4U1=ST WE-HfftE iY AC(GNOWIMGE AND AG -AS-FOLLOWS:
1. This bamporary power rdaase is requested'fpr the above slated purpose only,and 1we m0 be,no
occupancy of any type,other than that permitted by consmiWon during this time period.
2. As'witness by our sigrrdturs,rnie hre agree do abide by all terrrms ar�tl earidlans of this agreement,
lrid40hg 13.0dirig Dvision.Policy,which is incorporated herein by reference.
3. Ali condiaons'and*uirernepts lislbd In the attkhed document entitled"Requirements fpr 30 Day
Power ter Testing"have-beer fulfilled grid the pro.ise pis ready for'cornplianbe inspecdon.
4. All requests for an a ctension beyond 30 days.must be.".made in writing W the•Building Official stating
the reason€or the request Power maybe removed from,the site and br a Stop Work.Order issued If
the FRal'Inspeciion has riot peen approved within 30 days. A iee of$100.00 will be required to lilt
the Stop Work Order.
WE HEREBY RASE-AND AGREE.TO HOLD HARMLESS,ST. WPE COUNTY,AND THEM EMPLQYEES FROM
ALL LIABILITM AND•CLAIMS OF ANY TYPE OF NATURE WH10i MAY ARISE NOW OR IN THE FUTURE OUT
OF THIS TR. SACTIaN,INCLUDING ANY DA(�IACyE'VS1t4ICF1 MAY BE IN�I7 E?UE TO'Y�
DIS NNECTION OF' ..N POWER Ifs THE-iV.NT 6F W4t ATION 01=TtffS AGREEV=q :
OWtVF�t SIGNATtJFtE DA']E
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, 'CON 1Cg' R DATE
ELECif2ICAL Co
kCTdR SIGNATURE DATE'