HomeMy WebLinkAboutpower releasePlanning & Development Services
Building &�Code Regulation Division
2300 Virginia Ave
Fort Pierre, FL 34982
772-462-2165 Fax 772-462-6443
Request for 30-Day Temporary Power Release
Date' _ �2 - ? 3 ' o Z I Permit Number; 2 / 03 68 y 8
Project Address; 531?18 A,
THE UNDERSIGNED HERE8Y REQUEST RELEASE OF ELECTRICAL POWER TO 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 FINAL INSPECTION. IN CO1%JSIO._RAri0N OF APPROVAL OF THE
REQUEST WE HEREBY ACKNOWLEDGE AND AGREE AS FOLLOWS
! This temporail- power release is requesters fo. the above stated purpose only, and there w,;l be na
occupancy of any type, other Uian that permitted by con,tru00-1 during th,; time period
2 As witness by our signatures, we hereby agree to abide by all ter,mi and conditions of thi; agreensent,
including Building Division Policy, whrh is incorporated herein be reference.
3 All conditions and rtquirenrents listed in the attached doLumeot entitled "Regxrement5 for 39 06a
Power for Testing" have been fulfilled arrd the premise is ready for complonce ,nsrv-Mon
4 All requests for an eYtensron beyond 30 days mErst be made to rrTrpn) to the Building Official staling
the reason for the request. Power may be removed fron, tee site and,-o a Star, Work Order issued if
the Final Inspection has not, be -en approved wthin 30 days. A fee of $I00 W will be required tG lift
;she Stop Wrark Order.
WE HERI=BY RELEASE AND AGREE TO HOLD HARMLESS, ST LUCtE COUrrrr, A'dD 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 ELECTRICAL POWER IN THE EVENT OF VIOLATION OF THIS AGREEMENT
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GENERAL COt{TRACTOR SIGNATURE T DATE
1 2-- ZY- ZOZ/
ELECTRICAL CONTRACTOR SIGNATIJRE DATE