HomeMy WebLinkAboutREQUEST FOR 30-DAY TEMP POWER RELEASE FORM 10-13-'21 11 :06 FROM- 7728787656 T-631 P0005/0008 F-348.
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PlBitnift S1D opment Services
9 1 'BURDn, -g°&Jodie Regulaition Divisidn
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772-46Z-2 65• ' FaX 772-46Z-6443
Requestfor 30-Day Tampoary Powe r
!� Release
Date: ����3\ r Pemft NOmber.
Project Address; O\n
THE UNDERSIGNED HEREBY REQUEST RELEASE OF ELECTRICAL POWER TO THE ABOVE DESCRIBED
QU .
PROPERTY, FOR A PERIOD NOT TO EXCEED THIRTY(�0)•DAYS, FOR THE PURPOSE OF TESTING SYSTEMS
AND EQUIPMENT IN PREPARATION FOR A FINAL INSPECTION. IN CONSIDERATION OF APPROVAL OF THE
REQUEST WE H1151 ACIWOWLEDGE AND AGREE AS FOLLOWS:
I. This tanporary power release is requested for the above stated purpose only,and there will be no
occupancy of any type,.other than that permitted by con$ruction during this time period.
2. As witness by our signatu(es,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 oanditons and re ireihents listed in ttie aUad ed document entitled'Requirements for 30 Day
Power for Testing"have been futfiNted and the premise is ready for compliance inspection.
4. All requests for art extension beyond 30 days must be.made in writing to fhe Building Offulal stating
the reason for the request. Power may be removed from.the site anti/or a Stop Work Order issued if
the Rnai'Inspection 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 HARMLESS;ST, L,UaE 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-VUHICWMAY BE INCURRED DUE TO THE
DiSC6MEMON OF ELECTRICAL POWER Uq THE EVENT OF VIOtA71ON OF THIS AGREEMENT.
OWNER SIGNATURE DATE
GEN MRfiRAC?'Olt DATE
MECTRM CONTRACTOR SIGNATURE DATE