HomeMy WebLinkAboutTEMPORARY POWER RELEASE FORM RECEIVED
MAR 2 S 2022
` Planning and Development Services St.Lucie County
Building and Code Regulations Permitting
2300 Virginia Avenue
Fort Pierce,FL 34983
is o... . C _ a im� 772-462-I553
Fax 772-4162-6443
TEMPORARY EARLY POWER RELEASE
Name o errant or Owner)
The Tenant or Owner requests St Lucie County Development Services Department to release the
electrical power at.5 2C(, ':Wvc;�}' address,including suite number,
as posted on the electric meter and the building) for building permit-#21 t2= T for the
purpose of construction and testing building systems, including air conditioning, refrigeration,
lighting,power and control circuits with the following stipulations:
1.Incomplete or untested circuits are NOT to be energized without properly licensed electrical
personnel on the jobsite and no systems are to remain energized beyond the testinghemporary
purpose without proper inspection by the St Lucie County Building Department appropriately
licensed person(s).
2.All panels and disconnects not in use must be locked in the"OFF"position or fuses removed.
3.Proper procedures for lockoutttagout must be in place.
4_The electrical equipment room(where applicable)will remain locked at all times with the key in
the possession of the ciecirical contractor.
5: All final inspections relative to the closeout of this project must-W requeaed and passed in a
limelymanner as determined by.the Electrical Inspector and/or the Buddin?_Official.
G.The building may not be occupied belbri a Certificate of Occupancy(C.O_)is issued.
7:No stneking:of materials,other than those\required for construction is permitted by°this agrcenicni
S.No on-site occupuncy or training of personnel employed by the occupant,business entity or owner
is-pemtittcd by this agreement
9.No-furniturc.racks;furnishings or other personal or corporate property is permitted on site by this
agreement.
10. Constntction power remains covered by the requirements for GFCI protection and all other
requirements of the gowning Codes,see National Electrical Code(NEC)Article 590.
Violation of this agreement may result in the immediate termination of the electrical power without
prior notice or warning to the affected parties.This form requires all of the following signatures
prior to power being released.The undersigned acknowledge that the operation of air conditioning
equipment while construction is in progress may create or increase the risk of contamination or
premature failure of the equipment.
The undersigned acknowledges the above listed stipulalions.a!secg to the terms of this.acu•ecmcnt
and agrces t0 Bold St Lucie.County harmless from any dalttagc:s that ntay arise as a r.Ntill of the
release of power to the pmmises.The undersigned hereby requests power to be released for this
ch is al the discretion and ctrntri�l oi'the ilcctrical
prs ject.This form sloes not guarantee power.whi
utility.
1
AIL
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Important: The occupant of the property (or other appropriate party) shall have made proper
application to the electric utility,paid any applicable fees or deposits,and requested power in a
timely and informed manner. St Lucie County is not responsible for any delays in the receipt of
electric power.
We acknowledge and accept the terms of this permission.We further acknowledge that violation
of this agreement or a finding of unsafe conditions and/or practices found on the site or occupancy
of the site may result in immediate disconnection of this temporary power without warning and
hereby release St Lucie County and all representatives of any and all liability resulting from us not
abiding with this agreement
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!' 'Prin .'a e-Elecir'cab Co ractot Company Name
± /ij( .l ZtiJI —3 1Z--3l Z
Signature-Flectr}cal(''mlitrn to Date Signature-Ow rrr Date
P" t Name-Electrical Contractor Print Name-Owner
Phone Number-Electrical Contractor Phone Nu r-Owner,
License#=i -
actor
I-- - -3 Z z F `I �,� a:S� F"P1ts 5 �l l✓
f Signature- iim�e-Cont actor Date Print Name-Prime Contractor Company Name
7 Ps
Print Name-Prime Contrarior Phone Nutnbcr-Pnme Contractor
15Iq°l6q
License#Prime Contractor
Approved for St.Lucie County by:
Signature-Electrical Inspector/BO hvsp ID## Date
Inspector comments,limitations and restrictions:
2