HomeMy WebLinkAboutBLD2009-00021 Temp Elect agreement.tif
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Catawba County Building Services Division
PO Box 389, Newton, NC 28658
Permit Center 828-465-8399 Newton Fax 828-465-8962 Hickory Fax 828-322-6814
1842
SERVICE AGREEMENT TEMPORARY ELECTRICITY
NOTE: Each separate meter to be connected is considered a separate request and subject to a separate fee.
Please list the total number of electrical meters to be installed on this project /
BLD 200 4 OC6 'Z( Job Title Ttt«u A4pA PIN# Bldg # Unit #
We do hereby release and agree to indemnify, save and hold harmless Catawba County and it's employees and Duke Power
Company from any and all liability due to or arising from Catawba County causing the electrical service to the above-mentioned premises
s being disconnected. Temporary service is issued solely as a courtesy for the completion of construction and the building is not to be
occupied until a certificate of occupancy is issued. Any violation of the above will automatically void temporary service.
The use of the system before final inspection is anticipated to be 30 days or less. If utility connection remains in use beyond
30 days GC will be billed monthly per County Fee Schedule. The temporary use of the system is necessary to operate the HVAC and to
provide lighting for the completion of the finish work. Only those circuits that are necessary and/or have been inspected and approved by
the electrician and electrical inspector will be energized. Any 125v single-phase circuits temporarily energized for construction purposes
will be ground fault interrupt protected, with the exception of lighting circuits in metal conduit. The building will be constantly supervised
or will be securely locked when it is not supervised. The electrician, HVAC, and Plumbing contractors are ready for the systems to be
energized as attested below.
The responsible agent for the purpose of signing this form may be the general contractor or owner. The GC is responsible
for Administrative fees unless otherwise arranged and agrees to set up a billing account with Catawba County Finance
Department for renewal of agreement, if needed. The electrical contractor shall coordinate this inspection with building service
official. (A CONTINUITY TESTER SHALL BE FURNISHED BY ELECTRICAL CONTRACTOR AT TIME OF SCHEDULED INSPECTION.)
I, hereby apply for temporary use of the permanent /DOD amp
electrical service to the structure identified above. I authorize Date of acknowledgment
billing of all renewals, if required, to the following active
Catawba County billing account number Official signature of Notary
/yf • /nilG! f Co
Ommes-&P GC Signature ~y Notary's Printed or Typed Name
(O
Printed Name ~t Title c ✓l My commission expires: (Official Seal)
As electrical contractor, I hereby certify that the electrical system
( ) is ready ( ) is not ready to be energized. Br h circuits will be Date of acknowledgment
energized as stated above.
Official signature of Notary 1 p (o
Electrical Contractor Signatu
Notary's Printed or Typed Name
Printed Name I IAvtk Clp01 ffie (Official Seal)
My commission expires:
As HVAC contractor I hereby certify that the HVAC equipment
( ) is ready ( ) is not ready to be placed in service. I am Date of acknowledgment
aware that the electrical systems will be activated as state above.
Official signature of Notary
Mechanical Contractor Signature
Notary's Printed or Typed Name
Printed Name It _09rf)ef, Title O ~1 C (Official Seal)
My commission expires:
As plumbing contractor I hereby certify that the Plumbing equip. a-13- O
( ) is ready ( ) is not ready to be placed in service. I am aware Date of acknowledgment
that the electrical systems acti t as stated abov .
Official signature of Notary
Plumbing Contra for Signature
Notary's Printed or Typed Name
(Official Seal)
Printed Nam
My commission expires: