HomeMy WebLinkAboutREQUEST FOR 30-DAY TEMP POWER RELEASE FORM 10-13-'21 11 :06 FROM- 7728787656 T-631 P0006/0008 F-348
Plah-a t".&Ddi4ldpment Services
01U.11411•&Coctd-feguletion DiviWon
2360"ViI�fnia'Ave
Fort PWrce., FL 34982
!i 772-462-1165 Fax•772-462-6443
Requesffor 304by•Ternpora•ry'lower Release
Date: \'s�\� \2 Pernfit Mrnber:
Prq ct Address:
THE UNDERSIGNED HEREBY REQUEST RELEASE OF ELECTRICAL POWER TO THE ABOVE DESCRIBED
PROPERTY,FOR A PERIOD NOT TO EXCEED THIRTY(3.0)-DAYS, FOR THE PURPOSE OF TESTING SYSTEMS
AND EQUIPMENT IN PREPARATION FOR A FROL.INSP.ECTIQN. IN CONSIDERATION OF APPROVAL OF THE
REQUEST WE H Y ACKNov&EDGE AND AGREE AS FOLLMS:
I. This twrorary power release is requested for the above stated purpose winiy,and there vA be no
occupancy of any type.,9ther than that perrnitted by eohAmction during this time period.
2. As witness by our signatures,we hereby agree do abide by all terms and wndldons or this agreement,
induding Building Division Policy,which is incorporated herein by reference,
3. All condMons and requirements listed in the attached document er wed"Requirements for 30 Day
Power fnr Testing"have been ffulfrlled 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.Official stating
the reason•for the request Power may be removed from,the site and/or,a,Stop Work Order issued if
the Finai'Inspecbfon has not been approved within 30 days. A fee of$100.00 will be required to lift
the Stop Work Order.
WE HEREBY RELEASE AND AGREE TO HOLD <fARMLESS, S-17..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 ELECTP.TC AL POWER M THE EVENT OF VIOLATION OF THIS AGREEMi U.
OWNER SIGNATURE DATE
aN 'coNTRACraR DATE
ELECTRICAL CONTRACTOR SIGNATURE DATE