HomeMy WebLinkAboutREQUEST FOR 30- DAY TEMP POWER RELEASE FORM 10-20-'21 09:07 FROM- 7728787656 T-642 P0001/0001 F-367
Plenn1gq'&-Dever*pM- ent Services
Building $L Cbde f�eguDetio>ro Division
300: WW
nia eve
Fort.Pielria; FL,34982
772-462-2165 Fad 772-462-6443
Requdst.for 30-Day Temisorary'PowerRelease
Date: \a �^`� Perm"rt'Number: �J•O\� — O�°�
Project Addmss:
THE UNDERSIGNED HEREBY REQUEST RELEASE OF ELECTRICAL POWER TO THE ABOVE.DESCRIBED
PROPERTY, FOR A PERIOD NOT TO EXCEED THIRTY(30)-DAYS,FOR THE: PURPOSE OF TESTING SYSTEMS
AND EQUIPMENT IN PREPARATION FOR AFINAL INSPECTION. IN CONSIDERATION OF APPROVAL OF THE
REQUEST wE HERMY ACKNOWLEDitE AND AGREE AS FOLLOWS:
1. This temporary power release is requested for the above st ited purpose only,and there vA be no
occupancy of any type, ether than that perMitbad'by coi rsttuWon during this time period.
2. As witness by our signatures,we hereby agree to abide by all terns and conditions of this agreement,
Induding Building Division Policy,which is incorporated herein by reference.
3. .All conditions and reguirenn"listed in the'=died document entitled"Requiremer>fs for 30 Day
Power for Testing"have been fulfilled and the premise is ready for compliance inspection.
4. All requests for an extension beyond 30 days must be:made in wrrdng to the Building O. Mcal s=ng
the reason'for the request Power may be removed'from.the site and/or a Stop Work Order issued if
the Final Inspection has not bin 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. LUCIE COUNTY,AND THEIR EMPLOYEES FROM
ALL LIABAITiES 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 ELECTRICAL POWER iN THE EVENT OF VIOLATION OF THIS AGREEM&M
OWNER SIGN= DATE
CONT3t�►Cf0) RE DATE
ELECTRICAL CONTRACTOR SIGNATURE DATE
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Permitting DetmentSt. Lucie Co , FL