HomeMy WebLinkAboutpower release form 06-09-'21 12:13 FROM- 7728787656 T-152 P0007/0009 F-794
mn Planning Development Services
4 u, ;' Building &Co..le Regulation.Division
~; 2300 Virginia Ave
Fort Pierce,FL 34982.
772-462-2165 Fax 772=462-6443
Request for 30-Day Temporary Power Release
Date. \� Permit Nomber.
Project Address.; W:?�) +� �
THE UNDERSIGNED HEREBY REQUEST"RELEASE OF 1_LECTRTCAL POWER TO THE ABOVE DESCRMD
PROPERTY, FOR A PERIOD NOT TO EXCEED THIRTY.(�O)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 FOLLO NS:
I. This Vary tower release is requesied for the above stated purpose only,and them wiii be na
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 ten cis and conditions of this agreement,
including Building Division Policy,which is incorporated herein by refeiwce.
3. All conditions and requirements listed in the attached document entitled"Requirements for 30 Day
Power for Testing"have been fulfilled and the premise is,t:eady for Compliance inspection.
4. All requests for an extension beyond 30 days must be made in writing to the Building Offtcial stating
the reason-fbrthe 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 mquired to lift
the Stop Work Order.
WE HEREBY RELEASE AND AGREE TO HOLD HARMLESS, S-E 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
D=NNECTION OF ELECTRICAL RIB POWER 1-N THE EVENT OF VIOtATION OF THIS AGREEMENT.
OWNER SIGNATURE DATE '
CONTPAR DATE ^�
T1 d
ELECTRICAL CONTRACTOR SIGNATURE DATE