HomeMy WebLinkAbout30 day for testing RECEIVED
APR e 6 2021
Permitting Department
St. Lucie Ccunty
Planning &Development Services
Building &Code Regulation Division
COUNTY2300 Virginia Ave
• • I D A Fort Pierce, FL 34982
772-462-2165 Fax 772- 62-6443
Request for 30-Day Temporary Powe IRelease
Date: Z'°Z/ Permit Number: 12- v// —0163
Project Address: 3 3
THE UNDERSIGNED HEREBY REQUEST RELEASE OF ELECTRICAL POWER T I 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 INSPECTION. INCONSIDERATION 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 durin6 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 entitle"Requirements for 30 Day
Power for Testing"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 the Building Offtcial stating
the reason for the request. Power may be removed from the site and/dr a Stop Work Order Issued if
the Final Inspection has not been approved within 30 days. A fee of$� lift 00.00 will be required to li
the Stop Work Order.
WE HEREBY RELEASE AND AGREE TO HOLD HARMLESS,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 POWER IN THE EVENT OF VIOLATION 0 THIS AGREEMENT.
OWNER SIGN RE DATE
GEN RAL CONTRACTOR S GNATURE DATE
hA4 � u�� Goldstar Electric, Inc. L///�Zo Z/
ELECTRICAL CONTRACTOR SIGNATURE DATE
!RECEIVED
APR - 5 2021
Permitting Department
St. Lucie-cunt•/