HomeMy WebLinkAboutRequest for 30- Day Temp Power Release Form 12-212 21 11 :12 FROM- 7728787656 T-865 P0001/0001 F-628
Ptarrnills§-&-'be461eprlr>lent Services
bfJlDivisionu�ation Divisio
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230.0:Vftlnla-Ave
Fob Piercer FL-3498.2
772-462-2165 Fax 772-462-6443
Request46r`30-Day Tennpo arty PowerRetease
Date.: "� '� '� PenT it NUm.ber.
cent Andre : `~�`? ,. .e
THE UNDERSIGNED HEREBY REQUEST RELEASE OF ELECTRICAL POWER TO THE A60VE DESCRIBED
PROPERTY, FOR A PERIOD NOT TO EXCEED THIRTY-(30) DAYS,FOR THE PURPOSE OF TESTING SYSTEMS
AND EQUIPMENT IN PREPARATION FORA FINAL INSPECTION. IN CONSIDERATION OF APPROVAL OF THE
REQUEST WE.HEREBY ACKNOWLEDGE AND AGREE AS FOU.Oli'►tS:
1. This tanporary power release is requesWd for the above shared purpose only,and there WIJ be no
occupancy of any type,other than that permitted byeonstiudzon during this time perm.
2. As Witness by'our signatures,we hereby agree th abide by all trams and conditions-of t'nis agreement,
Including Building Division Policy,which is incorporated herein by reference.
3. All condiedaAs and requkwients listed in the'attathed document entitled"Requirements fir 30 Day
Power for Testing"hm'been fulfilled and the premise is ready fir 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 ste and/or a Stop Work Order issued if
We Final'Inspe0on has not been approved within 30 days. A fee of$100.00 will be required to lift
the Shop Work Order.
WE HEREBY RELEASE AND AGREE TO HOLD HARMLESS,ST. LUCIE COUNTY,AND THEIR EMPLOYEES FROM
ALL.LTABnJTIES AND CL 41MS 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
DLcCO EMON OF ELECTRICAL.POWER IN THE EVENT OF V10LAIION OF THIS AGREEMENT.
C)WNER SIGNATUR DATE
CONTRAC MR RE DATE
EIFCfRiCAL CONTRACTOR SIGNATURE DATE