HomeMy WebLinkAboutREQUEST FOR TEMP POWER FORM 11-17-'21 11 :04 FROM- 7728787656 T-760 P0003/0003 F-508
P1;tnn1n9:&--be lopment Services
�uildin�S-Code"itegulation (Division
I N- im.
�.
?. 0 :'1iTln�a Ave
Filth Pierce; FL 3419,82
. 772-462-2165 Fax 772-462-6443
Request for 30-Day Ten>sp'oil`alry'PowerRe#ease
Date: \ \ ` Perrrfit number: \ r
Pmject Addmss: Q N ys
THE UNDERSIGNED HEREBY REQUEST RELEASE OF ELECTRICAL POWER TO THE ABOVE DESCRIBED
PROPERTY,FOR A PERIOD NOT TO EXCEEaTHIRTY(30)-DAYS, FOR THE PURPOSE OF TESTING SYSTEMS
ANO EQUIPMENT IN PREPARAI ION FOR,A OINAL INSPECTION. IN CONSIDERATION OF APPROVAL OF THE
REQUEST we HE Y ACK"NOWLEDGE AND AGREE AS FOU.OWS:
3: This WmPorary Power release is requested for the above steed Purpose only,and there wXl be w
0=pancY of any type,other than that permitted by construction during this time period.
Z. As witness by our signbwres,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 the'attathed document entitled"Requirements for 30 Day
Power for Testing"Have been'futfilled 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 Vidal stating
the reagori for the request. Power may be removed'from.the site and/or a Stop Work Order issued if
the Fina1'Inspection has not been approved within 30 days. A fee of$300.00 will be wired tb lift
the Stop Work Order.
WE HEREBY RELEASE AND AGREE TO HOLD HARMLESS,5T. LUQE 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 WHICHMAY BE INCURRED DUE TO THE
DISCOMECTTON OF ELECTRICAL POWER IN THE EVENT OF VIOLA71ON OF THIS AGREEMW,
\ 1
OWNER SIGN WPE DATE
GEN CONiRA+CrOR RE DALE
ELECTRICAL CONTRA=R SIGNATURE DATE