HomeMy WebLinkAboutREQUEST FOR 30-DAY TEMP POWER 11-05-'21 14:28 FROM- 7728787656 T-733 P0002/0002 F-470
Pl-ndiiit'.B .664 60ment krvices
Rei. '&1 ' ula ion DvsonSW Q*
S .23
OiD` gtn�a Ave
Md. Pierce; .L 3 2
772-462-2 6%5 Fax 772-462-6443
Rego E for 30-Day T��itpomry Power
Date: \� Permit Member:
Project Address:
THE UNDERSIGNED HEREBY REQUEST RELEASE OF ELECTRICAL POWER TO THE ABOVE DESatT6ED
PROPERTY, FOR A PERIOD NOT-TO EXCEED THIRTY'(30)-DAYS, FOR THE PURPOSE OF TESTING SYSTEMS•
AND EQUIPMENT IN PREPARATION FOR A FINAL INSPECTION. IN CONSIDERATION OF APPROVAL OF THE
nqueST WE-HEREBY ACKNOWLEDGE AND AGUE I OM:
1. This Crary power release is requested fo7
r the above state ti d purpose arty,and e will be no
oca:ipancy of any type,.other than that permitted by mil vcdon during'this.time period.
2. As witness,by our 4nbW es,.we.hereby agree to abide by all terms and conditions of this agreeTot,
indudlrig Sulding Division Policy,which is incorporated h'ere'in by reference.
3. Ail conditions and requimerP list in ttte attached doc- ent entitled-Requirements for 30 Day
Power for Testing"have'been fulfilled•and the prremise is ready'for compliance inspection.
4. All requests for an.ext�ejWon beyond 30 days�must be.made in wrtGng to the.Builcling ofRdal stating
the reason for the request: Power maybe removeditm.the site aridlor a Stop Work-Order Issued if
the Fm81'Inspection has riot been approved tnnthin 30 days. A fee of$100.00 win be required to lift
the Stop Work Order.
WE HEREBY RELEASE AND AGREE TO HOLD HARMLESS,ST.LUCIE COUNTY,AND THEIR EMPLOYEES FROM
ALL LIABII TITES AND.CLAIMS OF ANY TYPE OF NATURE WHICH MAY ARSE NOW OR IN THE FUTURE OUT
OF THIS TRANSACTION, INCLUDING ANY bAMAGE j1 fklICH AAY BE INCURRED.DUE TO THE
DISCONNEC17ON OF eLECFLtICAL POWER IN THE OF VIOLATION OF-RUS AGREEMI_NT.
OWNER SIGNA'N DATE
GE tON'Ti2ArOR DATE
ELECTRICAL CONTRACTOR SIGNATURE DATE
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