HomeMy WebLinkAboutREQUEST FOR 30-DAY TEMP POWER RELEASE FORM 01-03-'22 09:50 FROM- 7728787656 T-886 - P0002/0002 F-653
PlanWho*06040opment Service's
BUN -` A t-bd ���it�eguhAt"ion Division
230Q;�r is Ave
T,,,... Farb P 004 K,34982
772-+ 2-ZiM Fax 772-462-6443
over R leas+e
R uest��for 30-Day Temporary... P e
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Perm t limber: -2Q O
Project Address:
THE UNDERSIGNED HEREBY REQUEST RELEASE OF ELECTRICAL POWER TO THE ABOVE DESCRIBED
PROPERTY, FOR A PERIOD NOT-TO DC4CEED*THIRTY'(30)-DAYS,FOR THE PURPOSE OF TESTING SYSTEMS
AND EQUIPMENT IN PREPARATION FOR A.FINAL.INSPECTION. IN CONSIDERATION OF APPROVAL OF THE
mQuim Wemev BY AcKNowLEDGE ANO A0t-E-A8 FLLOWS:
1. This tenporuy power rq!mse is mquested for the above sited purpose only,and tie will be 0o
=opancy of any type,other than that perrnUed by oWts uction during'this time period.
2 As witness by our signatures,we hereby agree bD abide by all terms and conditions of this agreement,
Including Building Division Policy,which is indorporated herein by reference.
3. All mrid bons and requirements listtd in ttie attached doaurnent entitled"Requirements for 30 Day
Power for Testing"have been fulfilled.acid the premise is ready for-complianee inspection.
4. All requests for an extension beyond 30 days must be-made In writing to the Building OfRaal stating
the reason'for the request Power maybe removed from,the site and/or a Stop Work Order issued if
the Final�Inspedian has riot been.approved within 30 days. A fee of$100.00 will be required to lift:
the.Sbap Work Osier.
WE HEREBY RELEASE AND AGREE TO HOLD HARMLESS,ST. LUCIE COUNTY,AND THEIR EMPLOYEES FROM
ALL LLABILITIES AND CLAIMS OF ANY TYPE.OF NATURE WHICH MAY ARISE NOW OR IN THE FUTURE OUT
OF THIS TRANSACTION, INCLUDING ANY DAMAC�-WHICH MAY BE INCURRED DUE TO THE
DISCONNECrION OF ELEC rRICAL POWER IN THE£VENT OF)aOlA 170N OF-MIS AGREEMENT.'
OWNER SIGNATU F DATE
'f�NTI?AL'�OTr DA
ELECTRICAL CONTRACTOR SIGNATURE DATE