HomeMy WebLinkAboutTemp power release form, (30 day) 11-18-'21 16:18 FROM- 7728787656 T-771 P0002/0002 F-520
PlonBrio.-t•I l- plment Services
Buffdin A C— de•#egulation Diwisi6n
- -�- 230�-i�illa�gmia A�►e, •
Fort•..Piece; FL 3 982
772-462-21" FaX 772-462-6443
Re0est•�fotr 30-Day Ttei�clr* ra•ry Power Release
Date: \ Permit'N(imber:
Prc gect Address. \�
THE UNDERSIGNED HEREBY REQUEST RELEASE OF ELECTRICAL POWER TO THE ABOVE DESCRIBED
PROPERTY, FOR A PERIOD NOT TO EXCEED THIRTY(3.6)-DAYS,FOR THE PURPOSE OF'7ESTING SYSTEMS
AND EQUIPMENT IN'PREPARATION FOR A FINAL INSPECRON. IN CONSIDERATION OF APPROVAL OF THE
REQUEST WE-JiSkEBY ACKNOWLEDGE AND AGREE AS FOLLOWS:
1. -fhls temporary power rejease is rt quested for the above SWW purpose drily,wW tee wM be no
occupancy of any type,.ptherthan that permiMed by eohstruction during this time period.
z. As wig by our signatures,we hereby,agree to abide by all terms and Conditions of this agreement,
inducing Buildng Division Poucyr which is indorporated herein by reference.
3. All conditions and requirertorrts listed in ft attached dOCUMent enticed 4Requlrements for 30 Day
Power for Testing"have been Jf jlftlled qnd the premise is ready for compliance inspection.
4 All requests for an extension 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
the Finat'Inspection has not been approved within 30 days. A:fee of$100.00 will be required to I-fit
the Stop Work Order.
WE HEREBY RELEASE AND AGREE TO HOLD HARMLESS,.ST. LUCdE COUNTY,AND THEIR EMPLOYS FROM
ALL LIABILITIES AND CL41MS OF ANY.TYPE OF NATURE WHICH MAY ARISE NOW OR IN THE FUTURE OUT
OF THIS TRANSACTION, INCLUDING ANY DAMAGEv-jgICH MAY BE INCURRED DUE TO THE
DISCONNECTION OF ELECTRICAL POWER 3N THE EVENT OF VIOLATION OF THIS AGREEMENT.
OWNER SIGNATURE DATE
GEN LOf�iTi2AC�'O}� RE DATE.
ELECTRICAL CONTRACTOR SIGNATURE DATE