HomeMy WebLinkAbout30 DAY TEMPORARY POWER RELEASEre
SCANNED
B y
P&hl wrt8(rt,%nVjj0PMent Serwices,
Building
C dde Regul
2300 Virg& -1, -ation... Division
f6it:9a9n a Ave
erte., FL,34m
772-4652-2165. -F., 772-4612-6443
I Rqu eest
Date: fdr 30-®ay.
Ten ' P'rary PdvVer'Regease
� /03 /1;
Permit Number:,
Project.Address:
go
THE UNDERSIGNED HEREBY REQUEST RELEASE
PROPERTY,FOR A. PERIOD NOT TO EXCEED THI OF ELECTRICAL POWER TO'- E ABOVE DESC 13ED
AND EQUIPME' RTY (30) DAYS, TH RI
EQUIPMENT IN PREPARATION FOR A FINAL INSPECTI YS1 FOR THE PURPOSE OF TESTING SYSTeMS
ON, IN CONSIDERATION OF APPROVAL OF
REQUEST WE HEREBY ACKNOWLEDGE AND AGREE AS FOLLOWS: THE
11 This temporary Power release is requested for the above stated pur
occupancy of any type, other than: that perrhftted'by,-5onstruction during this time phere, Pose,ohiy, and twill.be,nd
.
2. As wltness,by our 'signatures, ,We he'reby-pgr,.ee,to abide by all terms and.conditfO s of this agre&neht,
including Building Division Policy Which is. Incorporated herein by reference:n
3., All conditions and requirements listed in the, attached document entitled "Requirements for 30,Day
Power for TesHng" have been fulfilled and, the premise is ready for compliance inspection.
4. Alf requests for an extension beyond I
the reason for the request, Power-may30 dAys -must be on.
made In- writing to, the Building Offlclal stating
the'Final Inspecti be removed from the sitean ' on has not been approved within 30 days. .0/or'a Stop Wbrk:Order issued if
the Stop Work Order. Y�s- A fee $100,09, Will: be required to lift
IrE"HEREBY RELEASE AND AGREE To HOL&,kARMLESS; ST. ,!,UCIE COUNTY,
LL LIABILITIES AND CLAIMS OF ANY TYPE'OF N UNTY AND THEIR-6
NATURE WHICH , I MPLOYEES FROM-
ICH MAY ARISE NOW OR IN THE FUTIJRE OUT
FT -HIS -TRANSACTION,' INCLUDING ANY DAMAGE WHICH MAY BE INCURRED' DUE To THE
ISCONNEMON OF ELECTRICAL POWER IN THE EVENT OF VIOLATION OF THIS AGREEMENT.
SIGNATURE
DATE
DATE
a
�oro(�135
RECEIVED
Planning a burs&OP>r ent Services 4UG % 9 1n1Q
Building & Code R,!gugatjon DI'ASeo>ra
2300 Virginia Ave Permitting Department
r" Pierce, r'(L 349w> St. Lucie Count"
772-462- 2165 Fax 772-462-6443
�a�-St f0lr 30pDay Tt'?d� picnra�lryPOWer Release
Date: �G7z;•— _
Permit Number:
Project Address: 3s _
THE UNDERSIGNED HEREBY REQUEST RELEASE OF ELECTRI --�-
PROPERTY, FOR A PERIOD NOT TO EXCEED THIRTY (30) DAYS, FOR THE PURPOSE OF TE
AND EQUIPMENT IN PREPARATION FOR A FINAL INSPECTION IN CONSIDERATION OF APPROVAL OF THE
OWER TO THE ABOVE DESCRIBED
REQUEST WE HEREBY ACKNOWLEDGE AND AGREE AS FOLLOWS: STING SYSTEMS
1. This temporary power release is requested for the above statedPurpose
occupancy of any type, other than that permitted b ug this
be 2.. As witness by our signatures, we hereby agree to abide by all terms and conditiaonstof this al eeno
y construction during this time period.
including Building Division Policy, which is Incorporated herein by reference.
3. All conditions and requirements listed in, the attached dbcument entitled "Requirements for 30 agreement,
Power For Testing" have been fulfilled and the premise 4• All requests for an extension beyond 30 days must be made in writing to the -Building Day
P mise I, ready for compliance inspection.
the reason for the request. Power maybe removed From the site and/or a Stop Work Order issued
the Final Inspection has not been a 9 Official stating
the Stop Work Order. approved within 30.days. A Fee of $100.00 will be required t lift
f
WE HEREBY RELEASE AND AGREE, TO HOLD HARMLESS, S1'•,
ALL LIABILITIES AND CLAIMS OF ANY TYPE OF NATURE WHICH MAY ARISE NOW OR I
OF THIS TRANSACFION, INCLUDING ANY DAMAGE WHICH MAY BE COUNTY AND THEIR EMPLOYEES FROM
DISCONNECTION OF ELECTRICAL POWER IN THE EVENT OF VIOLATION OF N THE FUTURE OUT INCURRED DUE TO THE
�✓ � THIS AGREEMENT,
SIGNATURE
SIGNATURE
DATE - �!
DATE G
DATE