HomeMy WebLinkAboutRequest for 30 day power release form i
1�1-02-'21 09:27 FROM- 7728787656 T-704 -P0.001/0001 F-431
Plen> 60—;&-Development Services
Building &erode°lie jul�tioa� �ivisioin
r y 2300: gi tla�ve
772-46Z4165 Fax 772-462-6443
Request for 30-Day Temporary Power Release
Date: _C).QS\0
ertr�N>:�mber.
Pmjeet Address:
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 TESMG SYSTEMS .
AND EQUIPMENT IN-PREPARATION FOR A:FINAL.INSPECIZON. IN CONSIDERATION OF APPROVAL OF THE
�REQUES WE H0EBY ACKNOWLEDGE AND AGREE AS FOLLOW:
1. Th1s tempmry Power release is requested for the above stated purpose only,and ter+e vA be,
occupancy of any type,.9ther than that permitted by ponstruction during this time perm.
2. As witnem by our signatures,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 conditions and requirements listed in d*attached document entitled"Requiremenim for 30 Day
Power for Testing,*vhave been'fulfilled and the premise is p inspection.ready for compliance i �
4. All requests for ari.ezbension 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
Me Final'Irpecbon has not been approved%ATM in 30'days. A fee of$100.00 will be required to lift
the Stop Work Order.
WE HEREBY RELEASE AND 'AGREE TO HOLD HARMLESS, S7• Wa. E COUNTY,AND THEIR EMPLOYMS FROM
ALL LIABILITIES AND.C.AIMS OF Vt ANY TYPE OF NATURE H16H MAY ARISE NOW OR IN THE FUTURE OUT
OF THIS 7PANSACTION,INCLUDING ANY DAMAGE-WHICH-MAY BE INCURRED DUE TO THE ;
DLSC0l%E MN OF ELEC MICAL POWER IN THE VENT OF VIOLATION-OF THIS AGREEMENT.
0W NER SIMT JRE ; ! DATE
I i
GEMRXiCONTl2ACT012' i; RE DATE
ELECTRICAL CONTRA=R SIGNATURE DATE
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