HomeMy WebLinkAboutREQUESTR FOR 30-DAY TEMP POWER RELEASE FORM 10-13-'21 11 :04 FROM- 7728787656 T-631 P0001/0008 F-348
Plainne*'.&Dlapment Seduces
T r09 & Code-tt lotion Division
9230 :Vii jin!�Ave
FoTI#��� - FL952
772-462-2165 Fax 772-462-6443
Rest forQ-0ay eirtoiry Power Reaease
Date; ��\\ `� ,Permit Nftber.
Per Address: \°r'1 0&1z,
THE UNDERSIGNED HEREBY REQUEST RELEASE OF ELECTRICAL POWER TO THE ABOVE DESCRIBED
PROPERTY, FOR A PERIOD NOT TO E.XCEED�THIM, (30)-DAYS, FOR THE PURPOSE OF TESTING SYSTEMS
AND EQUIPMENT IN PREPARATION FOR A.FINAL INSPECTION. IN CONSIDERATION OF APPROVAL OF THE
REQUEST 1AfE�3iF.�uw ACiCI�lo1�I u=ACID AGREE'AS FOLLOWS:
' 1. This temporary power release is ro-quested for the above stated purpose only,and fire w0l be.no
occupancy of any type,other than that perrtked by consuvctioon during this time period.
2. As witness by our signatures,we hereby agree to abide by all temts and conditions of this agreement,
Including Building Division Policy,witch is incorporated herein by reference.
3. All conditions and requirements listed in the attached doament entitled"ReqUirements for 30 Day
Power for Testing"hwe'bewfulfiged.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 sUting
the reason for the request Power maybe removed•'from.the site arid/or a Stop Work Order issued if
the FhW'Lnspecdon has not been-approved within 30 days. A fie of$100.D0 wip be required to lift
the Stop Work Omer.
WE HEREBY RELEASE AND AGREE TO HOLD HARMLESS,ST. LUC[E 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 TRAWACRION, INCLUDING ANY bAMAGE'UyHIC'l9 MAY BE INCURRED DUE TO THE
DISCONNECrIAN OF ELECMCAL POWER IN THE eJENi'OF V10iA7ION OF THIS AGREENUIT,
OU►I ER SIGNATU DATE
Gt 'CONTRACTOR s DATE
DATE
ELECTRICAL CONTRACTOR SIGNATURE