HomeMy WebLinkAboutRequest for power -30 Day Temp 12-13-'21 10:52 FROM- 7728787656 T-840 P0001/0001 F-594
r. Planning'.&Deveiopl 'ent Services
BuiXcfinj'&ode"e' 6WIation ®ewisidn
23601:-Inia'Ave
FBA Pierce; K 34 2
772-4462-4- iAS Fax 772-462-6443
Request-'for 30-Day'Tem. 09r' ary'Power Release
Date:��O \� \�. \ Pertrtit`Nim,bet'.
Project Address.
THE UNDERSIGNED HEREBY REQUES RELEASE OF ELECTRICAL POWERTO THE ABOVE DESCRIBED
PROPERTY, FOR A PERIOD NOT TO EXCEED THIRTY(30) DAYS,FOR THE PURPOSE OF TESTING SYSTEMS
AND EQUIPMENT IN PREPARATION FOR A J=NAL INSPECiTON. IN CONSIDERATION.OF APPROVAL OF THE
REQUEST VIA HEREBY ACKNOWLEDGE ACID.AGE AS FOLLOWS:
1. This temporary power release is requested for the above stied purpose only,and tie witl be no
ocwaancy of arty type,ether than that permitted by eohMcdon during this time period.
Z. As witness by our signatures,we hereby agree tb abide by all terms and conditions of this agreement,
including Building Division Policy,which is incorporated herein by reference.
3. All conditions and requirements Md in the attadied document entitled"Requirements for 30 Day
Power for Testine have.been fuifiged 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 Official stating
the reason for the request. Power maybe removed:from.the site and/or a Shop Work Order.issued If
the inal'Inspecdon has not been approved wrthin 30 days. A fee of$100.00 will be required to lift
the Stop Work 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'WHICH.MAY BE INCURRED DUE TO THE
DISCONNECTION OF ELEcMicAL POWER IN THE SMNT OF VIOLATION OF THIS AGREEMEW. .
OWNER SIGNATUR
�••• •••• DATE
M
CONTR AC OR RE DATE
ELEMC&CONTRACTOR SIGNATURE DATE