HomeMy WebLinkAbout30 DAY TEMPORARY POWER RELEASE01-29-' 19 13:31 .FROM-
7728787656
SCANNED
1,_ J-048 P0003/0005 F-047
230.0
Fort.
7'72-4
l-equast for
Date:
Project Address:
11WEDUftl0ment Services
& Cbdie It ulation DIVISIoln
giniai Ave- RECEIVEID
C.e; 'FL 34982
-2165 Fax 772-4�62-6 JAN 2 �19
ST. Luele ceunf;yr Permitting
Temporary Power Retease
Permit Number
THE UNDERSIGNED HEREBY REQUEST RELEASE OF ELECTRICAL POWER TO THE ABOVE DESCRIBED
PROPERTY,.FOR A PERIOD'NOTTO EXCEED TFIIRTY (30) DAYS, FOR THE PURPOSE OFTT:STING SYSTEMS
AND EQUIPMENT IN PREPAPATIaN FOR A FINAL INSPECTION. IN CONSIDERATION OF APPROVAL OF THE
REQUEST WF:'HERE33Y ACkNOW�GE AND ' I E'AS FOiLflWS:
1. 7his temporary power release is request
occupancy of any type, other than that �
2. As witness by our signatures, we herein
including Building Division Prolicy, which
3. All conditions and requirements listed in
Power for Testingo Have been fulfilledat
4. Alb requests for an. extension beyond 3o
the reason for the request. Power may
the Knal Inspection has not been appro,
the Stop Work Order_
WE MEREY RELEASE AND AGREE. TO HOLD HA
ALL LIABILITIES AND •CLAIMS OF ANY TYPE. OF
OF THIS TRANSACTION, INCLUDING ANY DAME
DISCONNECTION OF El_EC rRICAL POWER IN Ti
�d for the above sated purpose only, and there will be no
ermitted by .construction during this time period.
agree do abide by afl terms and conditions of this agreement,
s incorporated herein'by reference.
the attached docurnent entitled "Requirements for 30 Day
d the premise is ready for compliance inspaMon.
lays must be made in writing to the Building 'Official st2t9ng
in remoVed1rom the sb and/br a Stop Work Order issued if
ad within 30 days. A fee of $100.00 will be required to rift
ILESS, ST ME COUNTY, AND THEM EMPLOYEES FROM
tTURtw WHICH MAY ARISE NOW OR IN THE FUTURE OUT
WHIC i-'MAY BE INCUR
RRED DUE TO THE
EVENT OF VIOLATION OF THIS AGREEMENT
OWNER SIGNA DATE
7GF-N*CONTRACTORS S DATE
ELECTRICAL CONTRAIMR SIGNATURE DATE