HomeMy WebLinkAboutREQUEST OR TEMP POWER FORM 11-17-'21 11 :03 FROM- 7728787656 T-760 P0001/0003 F-508
Pl rmen -W opment services
t Wiffling.A Code.itegulation Divlstian
2300 -Ave
Y Mitt Pie rce; FL3 2
772-"b-Z Fax 772-"2-6443
Request-for 30-Day'Femportary'PowerRelease
Date: Permiti�r�ber:
Project Address;
THE UNDERSIGNED HEREBY REQUEST RELEASE OF ELECTRICAL POWER TO THE ABOVE DESCIMED
PROPERTY, FOR A PERIOD NOT TO EXCEED THIRTY(3.0) DAYS,FOR THE PURPOSE OF TESTING SYSTEMS
AND EQUIPMENT IN PREPARATION FOR A FINAL.INSPECTION. IN CONSIDERA RON OF APPROVAL OF'THE
REQUEST M HEREBY ACKNOV%Z)iGE MD AGA#AS FOLLOWS:
1. This t awwary power release is requested for the abm slated purpose only,and tie vA be no
occupancy of any type,odler than that permitted by cohstrucbon dialing this time period.
�, A5 witness by ow signatures,we banally agree to abide by all tears and condffwis of this agreement,
inducift Building Division Policy,which is incorporatad herein by reference.
3. All conditions and requirements listed in tkie c-6ched document entitled"Requirements-for 30 Day
Power for Testing"Have been ffUffiled and the premise is ready'flor compliance inspection.
4. All requests 1br an wtBrrsion beyond 30 days imust be:made in writing to the Building ftai Mng
the reason fvr the request. Power may be removed-from the site and/or a Stop Work Order Issued if
the Rnal lnspection has not been approved i�t hin 30•days. A fee of$100.00 will be required to lift
the Sbop Worts Order.
WE HEREBY RELEASE AND AGREE TO HOLD HARMLESS,ST..LUCIE 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 1f1/HICH*MAY BE INCURRED DUE TO THE
DISCOMECTION OF ELECTRICAL POWER IN THE T OF viovrit3N OF 7ws AGREEMENT,.
OWNER SIGNATURE DATE
'coNTPAcmR DATE
DATESECTRICAL CONTRACTOR SIGNATURE