HomeMy WebLinkAboutPower release -Planning & Development Services
Building & IICode 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 Number: O� Da-0 as )
Project Address :---
THE UNDERSIGNED HEREBY REQUEST RELEASE OF ELECTRICAL POWER TO THE ABOVE DaSCR.IBED
PROPERTY, FOR A PERIOD NOT TO EXCEED THIRTY (30) DAYS, FOR THE PURPOSE OF TESTING SYSTEMS
AND EQJIPMEN 7 IN PREPARATION FOR A FINAL INSPECTION. IN COINSIDEPATION OF APPo ,O'.JAL 0P THE
REQUEST WE HER: --:BY ACKNOWLEDGE AND AGREE AS FOLLOWS:
! ~is temMrary power release is requested for the above stated purpose only, and there vi,�! be ,»
a:cupar,cY, of any type, other than that perrnitted by construction during this time period
A. vritness by our signatures, we hereby agree to abide by all term; and conditions of thi; afire?merit,
rlciuding KmGding Division Policy, which is incorporated herein by reference.
3 0 condrt ors and requirement; listed in the attached docurnent entit!ed "Requiremen1_5 fo, 3C ;-)ay
Power for jesting have been fulfilled and the premise is ready for compliance inspection
Ali request for an extension beyond 30 days must be made in writing to the BUIldma Gfficra! sta;
tie reason for the request. Power may be removed from the site and;!or a Stc)p Viork Order rs5jec
the Final Inspection has not bey approved within 30 days. A fee of $ 100 00 will be rea_r,re,. to ,
t*,e Stop 4!,'ark Order.
WE HEREBY RELEASE AND AGREE TO HOLD HARMLESS, ST. LUCIE COUNPY, AND THEIR EMP_C),''E;-S'R;,.�
ALL LIABILITIES AND CLAIMS OF ANY TYPE OF NATURE WHICH MAY ARISE NOW OR IN THE cJ T IIRE C.JT
OF THIS TRANSACTION, INCLUDING ANY DAMAGE WHICH MAY BE INCURRED DU` TO THE
DISCONNECTION OF ELECTRICAL POWER IN THE EVE11NT OF VIOLATION OF THIS AGREENIEN"
1GfJATUa
9-ze-2
DATE
9 26-2
GENERAL CONTPACTOR SIGNATURE DATE '- - - -
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ELECTRICAL CONTRACTOR SIGNATURE ���� V-AIE ----- ----