HomeMy WebLinkAbout30 day power releasePlerynlog; & Develo ment Services
BuiLdin:g -1k C0d4R till Lion Division
2300' Wrginia Av'e
Ford Pierce; 'FL 349SZ
772-462-2165 Fax '772-462-6443.
�1 Requestfor 30-Day Temporary'Power-Release l �.
Date; Pwciit Number; Nn_O.. "�>
ProiectAddress;
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 A FINAL INSPECTION. IN CONSIDERATION OF APPROVAL OF THE
REQUEST WE'HEREBY ACKNOWLEDGE AND AGREE AS FOLLOWS:
I. 7h1S temporary power release is requested for the above stated purer only, and 'tberE Wil be no
occupancy of any type, other than that permitted,by i5onstruction during this time period.
2. As'wittiess by our signatures, we. hereby agree to abide by all farms and conditions of this agreement:,
including Building 13NIslon Policy, which is incorporated herein by'ref&ence.
3. All conditions"and requirements listed in the attached document enticed -Requirements. for 30 Day
Power for Testing" Have been fulfilled .and the prernise is ready for compliance inspection.
4. All requests for an extenslon beyond 30 days must be•.rnade in writing to the Building 'Official stating
the reason fbr'the request Power may be, rerhoved'from.the site an(i/or.a Stop Work, Order issued if
the Fnal'InspedYon has not been approved within 30 days. A fee of $100.00 will be required to lift
the ftp Work Order.
WE HEREBY RELEASE AND AGREE TO HOLD HARMLESS; ST. LUCIE COUNTY, AND THEIR EMPLOYEES FROM
ALL LIAB3LMES AND CLAIMS OF ANY TYPE OF ivATURE WHICH MAY ARISE NOW 'OR IN THE FUTURE OUT
OF THIS -TRANSACTION, INCLUDING ANY DAMAGE WHICK, MAY BE INCURRED DUE TO THE
DISCONNECTION OF ELECTRICAL POWER IN THE EVEt - OF VIOLA-17ON OF THIS AGREEMENT.
OWNER SIGNATURE DA
GENn11111AC11DR N DAi'E
\L\a
ELECTRICAL CONTRACTOR SIGNATURE DATE
L01-J E000/ 000d 9 tZ-1 999L8L8ZLL
RECEIPD
JAN 019 2018
Permitting Department
St. Lucie Countv. 1~,