HomeMy WebLinkAbout30 Day Temporary Power ReleasePlanning & Development .Services.
Building & Code Reg:lulation Division
-2300 Virginia.Ave
Fort Pierce, FL-34982
772-462-2165 - Fax .772-462-6443 -
d1k%A4w�%V&& rvr %ow~away ramporary Power Release
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Date: �� Permit Number:_ 170 � (5a 3�2 m
Project Address:-E (� �/ ) ,t✓l ���
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�....:... ::� " _. :�w �� � z�, ��� ui7 L - TRICAL POWER TO THE ABOVE DESCRIBED
FROPEKi v, FOR .A PERIOD NOT TO -EXCEED THIRTY (30) DAYS,. FOR THE PURPOSE OF TESTING SYSTEMS
AND EQUIPMENT IN PREPARATION FOR A FINAL INSPECTION. IN CONSIDERATION OF APPROVAL OF THE
REQUES1 WE hEKLof-A s.,hIVV.VVLCUt7L AIVU HbhLL.HJ rVL.LVVVJ:
1. This temporary power release is requested for the above stated purpose only, and there will -be no
-` -- y pe, other than that ..___ ...... .,...., permitted: by construction during_thistime period:
2. As witness by our signatures; we hereby agree: to abide by all terms and conditions of this -agreement,
including Building Division Policy, which is incorporated herein by reference.
3.. All conditions and requirements listed in the attacl-Ed
Power for:Testing" have been fulfilled 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
me reason for the request. Power may be. removed from the site and/or a Stop Work Order issued if
the. Final Inspection has not been approved within 30 days. A fee of $100:00 will be required to lift
the Stop. Work Order.
WE HEREBY RELEASE AND AGREE TO HOLE
ALL LIABILITIES AND CLAIMS OF ANY TYPE OF. NATURE .WHICH MAY ARISE NOW OR IN THE FUYURE OUT
OF THIS NSACTION, INCLUDING ANY.DAMAGE.WHICH MAY BE INCURRED -DUE TO -THE
DISCON E ON OF'ELECTRICAL POWER IN THE:EVENT OF VIOLATION OF THIS AGREEMENT.
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SIGNATURE.
....... - :. DATE ' .
ELECTRICAL CONTRACTOR: IGNATiJRE:.. DA