HomeMy WebLinkAboutBLDC-10-10-12127 TEMP ELEC APPL.tif 01/06/2011 09:05 704 -527 -8222 MANN BUILDERS PAGE 04/05
Catawba County Building Services Division
PO Box 388, Newton, NC 28658
Permit Center 828- 465 -8399 Plan Review 828 - 466-5130 I.
Newton Fax 828- 465 -8375 Hickory Fax 828-322 -6814
a
SERVICE AGREEMENT TEMPORARY HEAT
NOTE: Each separate teeter to be connected is considered a separate request and subject to a separate fee.
Please list the total number of gas meters to be installed an this project
L'SA %�. "Crt' 4, .. i
B)L1DW Job Title PiN # S - -:k1 a, AVA )LN � Bldg # unit #
In an effort to assist contractors in completing construction projects, this office will implement the following policy. The utilization of
permanently installed gas heating equipment to maintain environmental conditions necessary to facilitate the installation of
environmentally sensitive materials, or finishes in accordance with manufacturer's instructions is permitted by the North Carolina State
Administration and Enforcement Code with the fallowing local requirements. The owner, general contractor, and mechanical contractor
must sign this request form for temporary utility connections. The form must be filled out completely.
The following requirements will also apply
1. All heating units to be placed in operation shall have the following items inspected for compliance if applicable.
a. Vent tem.
sys (Products of combustion) 1
b. Appropriate amount of combustion air is provided.
c. Gas lines shall be pressure tested and inspected.
d. Water lines shall be pressure tested and inspected if geothermal or coil supplied by a hot water heater.
c. Condensate traps and lines in place and inspected. s
f. Electrical circuits installed with appropriate disconnect, over - current, equipment grounding, conductors and raceways.
g. Refrigeration lines shall be inspected with appropriate pressure certification tests.
h. All gas tubing shall be labeled er as code l
p g prior to temporary heat inspection,
i. Approved temporary electrical power is a prerequisite for temporary heat. (This can be scheduled simultaneously with
temporary electrical.)
2. No occupancy of any kind (persons, furnishings, etc.) shall be allowed during this period, without prior approval ofthe Code
Enforcement Official,
i
3. The use ofthe System before final inspection is anticipated to be days or less. Ifutility connection remains in use beyond
30 days general contractor will be billed monthly per County Fee Schedule.
4. If there is any violation of this agreement, this service shall be disconnected without prior notice to the participants. This shall be
done without any obligation of responsibility on the part ofthe Code Official or Catawba County. t
5. All processing fees are applicable as set forth in the Catawba County fee schedule.
I have read and agree to this procedure and guidelines as set forth by Catawba County and will abide by the conditions and qualifications
under which it is issued. I further agree that failure to comply with the procedure may result in disconnection ofgas, revocation ofpeiTnh, 1
and /or the refusal to consider further requests for temporary gas. I also agree to have a billing account set up with Catawba County
Finance Department so that any renewal fees of temporary service can be automatically Oiqed if needed.
I do hereby apply for temporary use ofthe permanent heating $
stem located at the
system structure identified a bove. )( authorize billing bate of acknoy�l�dgment ' 1:,: �, ,,;,. >�:,,• �,
of all renewals, if required, to the following. ctive Catawba `�► " ;ti
County billing account number % %e, OfiSci signature f No
Owner or GC Signature
re [+�+'�•+� Notary's Printed or Typed. Name _� ';'�. "i- ,;''.f' • l
Printed Na Q.�( Title
My commission expires:
As mechanical contractor, I hereby certify that the mechanical
system ( ) is ready ( } is not ready to be placed in service. Date of acknowledgment
Official signature of Notary
Mechanical Contractor Signature _
Notary's Printed or Typed Name
Printed Name _ Title (Official Seal)
My commission a ices• i
i
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r
01/06/2011 09:05 704- 527 -8222 MANN BUILDERS PAGE 04105
Catawba County Building Services Division
PO Box 389, Newton, NC 28658
Permit Center 828465 -8399 Plan Review 828466 -5130
U Newton Fax 828 -465 -8375 Hickory Fax 828- 322 -6814
SERVICE AGREEMENT TEMPOPARY REAT
NOTE: Each separate meter to be connected is considered a separate request and sul,ject to a separate fee.
Please list the total number of gas meters to be installed on this project -
-14 -
REiD Job Title � PIN 1 a.\ y( Wvj Bldg # Unit #
In an effort to assist contractors in completing construction projects, this office will implement the following policy, The utilization of
permanently installed gas heating equipment to maintain environmental conditions necessary to facilitate the installation of
environmentally sensitive materials, or finishes in accordance with manufacturer's instructions is permitted by the North Carolina State
Administration and Enforcement Code with the following local requirements. The owner, general contractor, and mechanical contractor
must sign this request form for temporary utility connections. The form must be filled out completely,
The following requirements will also apply:
1. All heating units to be placed in operation shall have the following items inspected for compliance if applicable.
a. Vent system (Products of combustion)
b. Appropriate amount of combustion air is provided.
C• Gas lines shall be pressure tested and inspected..
d. Water lines shall be pressure tested and inspected if geothermal or coil supplied by a hot water heater.
e. Condensate traps and lines in place and inspected.
f. Electrical circuits installed with appropriate disconnect, over- current, equipment grounding, conductors and raceways.
g. Refrigeration lines shall be inspected with appropriate pressure certification tests.
h. All gas tubing shall be labeled per gas code prior to temporary heat inspection,
i. Approved temporary electrical. power is a prerequisite for temporary heat. (This can be scheduled simultaneously with
temporary electrical.)
2. No occupancy of any kind (persons, furnishings, etc.) shall be allowed during this period, without prior approval of the Code
Enforcement Official,
3. The use of the system before final inspection is anticipated to be days or less. If utility connection remains in use beyond
30 days general contractor will be billed monthly per County Fee Schedule.
4. If there is any violation of this agreement, this service shall be disconnected without prior notice to the participants. Tbis shall be
done without any obligation of responsibility on the part of the Code Official or Catawba County,
5. All processing fees are applicable as set forth in the Catawba County fee schedule,
I have read and agree to this procedure and guidelines as set forth by Catawba. County and will abide by the conditions and qualifications
under which it is issued. I further agree that failure to comply with the procedure may result in disconnection of gas, revocation of permit,
and /or the refusal to consider further requests for temporary gas. I also agree to have a billing account set up with Catawba County
Finance Department so that any renewal fees of temporary service can be automatically i if needed.
L- ASMI-IL-W
I do hereby apply for temporary use of the permanent heating
system located at the structure identified above - I authorize billing )Date of acknodgment • ' •• ��.'';. � „��
of All renewals, if required, to the following active Catawba ► -
County billing account number .X�� „V� • '
�� �� �t r. Offlci signature gfNotary .yr;.�- :r
Owner or GC Signatur "
Notary's Printed or Typed. N
j r
Printed Name QM�N,r Title .(4TFiiri'9t1 :'
My commission expires: -, `�< .;. a;
As mechanical contractor, I hereby certify that the mechanical
system () is ready ( ) is not ready to be placed in service. Date of acknowledgment
Official signature of Notary
Mechanical Contractor Signature
Notary's .Printed or Typed Name
Printed Name Title (Official Seal)
My commission ex ices:
01/06/2011 09:05 704 - 527 -8222 MANN BUILDERS PAGE 03/05
01/05/2011 15:57 7047141358 REL ELECTRIC PAGE 02/02
01105/2611 13;55 704 ^8222 KWI 13UIL0EPS
PA3Z 02/02
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Catawba County Building 5erviwe Division
PO Sax 899, Nmftr, NC 28658
Pe[mit Crtinis!r 92866 - 8399 Newton Fax 828- 4654z7S Hickory Fax $28422
SERVICE AGREEMLi+i'1"1'iwM"pAjty EL18iMXG'M
7 0 TJL: Bach separate mater to be connected is aoagidared a "Mr a t^oqu 4t and suble�e# a separate fee.
�� �� Plane list the tvta! rtarrsba;r of eleatxical meters to be ar�It�eB on tlrb project
><d R@k Job Tdk P><1VtM:� 1Ejtdg Ii nit # '"""
We do ]tereby told¢ and AVft to iinddow - sxs►e pad hold hum ds`CftWft County 04 at!s asst fooyces and Dube ,power �
COmPI3' A cm any and All liaUlbr dft to or arls ng f= CMwba C akUIM4; the alectHMT service to tha above,- momfioned premises
being disconnected. Tempoftty servicc is imued solely as a courtesy for dsc co ritsleden of const, txi on and the building is slat to be
Oftupied uMfi a certificate of oCav=e8 i9 iem 3rd. Any violkion of the above vdil autotr W0&lly void temporary service.
The use of the system Wore Ir}at 4"cat;on is uAlcipated to be _clays ar 109- Z� utii?�y ccmnaekion [tmafna in use beyond
days GC will be bitted atoslthly 1 tkY F44 SaltAduia The temporary ,cx *f the sytltesn is FmQWra[y ro ,oPt the MVAC ad to
. provide lighting for the aamplaft of tim 'fisuah work. Only those cirauic tbAt taro nece $ y and/or have boon itasPected and approved by
the e1aft1dan and Electrical i Wcctrn wilt be e nergiWd Mary 12$v s inglapf • U: cjrcaits ten, poratily cactg;zed ibr cvgst,vat;on pesepc,ses
V411 be gra+u+d &a intesenpt prototeel, with the exception of iightittg circuits Jim Rea b1 Qo[�dvit. The building will be 03 s�iArttly 3ulviSed
or will be s ly locicad often it is tuck attpavased, The eleafricitm, RVAC, ,md m=bissg �ormmdton ara ready !rr ft gygt.ams to be
energized ad attested below.
The'rwPonsibte Agent fbr N1e MOM Of signing this tbm may be the Merel ca7atra czar or Omer, The CC is responsible
a'ar A►dmtrif rafsve AW cmko otua vft arranged and agrees to Set up a b@tlWr reeoomt 74th Calowba i '
rfll%ef: fbtr t+�arwsl of C oo]' 1G'ii >aatrl5!
>� �g�orr�a,'r3 iiPnerded. The airsc'l;N�Ilt eo�tt5tasar snail
a cnardlaate this itlspe8ti,on butldittg r
E'faaial� (A GOIY75:�PtJt?1r Try _WALL S% ! V 1ttiF,.+w #'etrCAT -';0 -'4 VA A,T TINZ of 3C7ir7DW W TivSrECi RK)
7, hereby r ply fw umparm y Use of the VMgR x amp
ctcctt7eat service So the strrscture Identified above, i agtlao`rl'u
Date cl'koaledgtnent
biIDng o f all TONG llls, if re"rled to tba- Mowing salvo ,
Catwbv 1."0101 biUh* a mmont ntuntbar V;�t4'tA: St( &ten a Of JYQta�+
Owner or W ftamre , i
No titY'A.1 med fw 7�+p+�d Name i
rd aw 1111me Title Mxcisl Seal)
My cosnminion expim:
tfa= • w .
t�T aorttt~L�r hereby eerlri£y that the electrical s1►stem � � /..�� ,; • "`•r i,F, Y � ; �,
( ,s ready () is slot ready to be en af' ae3p
Ettergissed stated a Brtnah ofreu,ts will be
Elet�lcn] Comer gi�tstr't � 7?ri printed Name �' i~ o[ x'ypect xYEuna
Nil Y K r wmmiRSion '11:,*.
—•
As HVAC =atr I hereby certify that the HVA ,
) ts.rearly ( ) is not p C aN ptitcnt ''tiy cr,tckr,c `'
�3' to bo 1=d U service 1 4* adgtn�rt
awA,se that t1,e elcctrlc&l systems will be agvated as meted above. —•�� `
Of6ciat sifutac ofl4otary
.t<?acfianieal +GollttrRrk+px Stttere i '
%140 ry 7 nymd or Tkped l�tas:le E
7?rintdd Mama (codal Sal)
M aommi.� e ire
As phsn,bing te+- r I hereby ocrdff chat t h e pl a
( ) In ready ( ) is not ready TO be Placed fit esfertom, T n Z — D aknawkdgment
that the elox~trw 'Votems v0 be aetivs W ac awftd abovs.
lf'Au,"WMg Contracor StWMf* 6mKi tl siat OfT%Ibwy
li'rinted Name No�Y`s F';Q or TyPR Nate
title (�o�i Setd,)
M COtrefii. i[as: €
e
f
01/0612011 09:05 704 - 527 -8222 MANN BUILDERS PAGE 03105
01/05/201.1 15:57 7047141358 REL ELECTRIC PAGE 02/02
®110, 13, 704 527 ^8222 MA BUILDERS PAGE 02/02
Catawba County Building Services 131vision
PO Box 389, Nemftr, N1C 786ba
PermK Cprntor 928 86 -8399 Newton T:ax 128 - 465 -8:375 Hickory Fgx 828 -322 -0874
SERVICE AGREE+MEW1 TWIPOAARY'FLECTRICITV
WM: tach saparat,e rampr to br connected is con0dared it "lrnrnte ragvmt and subject o a mpar2te fee.
Please HA the total number of alectricai mctetts to be iixiaribed on this proiect��,�
BL11a Htf ,rob Ttle , y m •e s MN ��i,. ,' `A - 1�Irlg �# Unit
We dq hereby ttcicMc and agree to irrderrnif}, Bawd pad holld County an4 ;f$ omployees and Duke Powar
Company .fi+ont any And All U*HiTy due to or arisfng from CutA.wba t mVY rp witip; the olccMegi service to the above�rt trrfionred premises
being disconnected. Ternpoxary servicq io issued solely asp a courtesy for the ca ;ttpiction of'eansm,etiart and the building is rent to be
eeCVpied Mtii a certificate of oaoupattay io isuacd. Any vio]htiou of the above vrlll autr. mMieaTly void temporary service.
The umc of the system before final inspaar on rg atltiCiWA d to be�) _ c la y s or less. ZI'U011y rono sexion rzmalns in use beyond
3b stays GC will be billed monthly per Caunfy Foe Sahaduic. The tcntparary ere cif the sy8tcm Is rresesaary to opamz the KYAC atn
the ci d to
provl ec tr lighting for the s eal Ins l ec o tlrc finish work. Only, ttwsn QirRnita tbltr rim necessary arrd/or hsvc been itlspected an d approved by
ec and x]ectt lent P pro c 1, will be energir°ed. Any 325 'v Singla c £kenits terrrporsriiy energized for cor)simation purposes
wi]l lsp ground tbn]r inte'iupf protected, witb the exception of 11gltti19 69=u£ts In mfftz] conduit. no bvilding will be catrstantiy supervised
or will be securely lorkod wbert it is not ttttpaTiMd, 'J a c]r_cttfeittn, F.VAC, arIA plumbing cotntractors are ready fbr the systems to be
MT917ed ad attested below.
The rinponsible went for the purpose of signing this f9 m may be the t enelral contra ctpr or owner. The CC is responsible
#at Adminfatrative foes rrnUess othcrwila arrnngcd and agrees to ,sat ups A b %; Account with Catawba Comrty PinAnca
TIAP trtMtpnt'Fbr rernearnl 0fagre4M4Mnt, it'aeetled. Thu Aletttit:4l eantraaror,enali coordinate thic inspeeb;ota with building ReT
atTcial. (h C0RTMFrr1"f R WALL M FM?4,T )fV 1t���rrtrrChx GOiYTRr�CI USt A,T TINA oy S1��0[J'f,�7p TrtSPF,CT7l?N.)
7, hereby RPpiy for tmporary use of the p Manety. amp
aicctrical service to the structure Identified above. 7 aathorke D n1'acG0 di e
billing of all fenewdls, if regWred, to the follortring ncove .
Cataw'bv Conttty billixrg agcQttrtt ntumbor �t�f icit stl3rtpture of Notary
f7wner or C+C 9igtinturr �•—
NAtar7 }`A,Pt'ittr ¢ rl vr'T'yped Name
7"
Printed rfa mom Title My commission f OfFcis] Seal)
c�rpires:
As ,aetneW contr�rwtor, I hamtry certify that tha electrical system ' -�:� ` "•r f Y
(Linn ready () is not ready M Dc energized. Branch circuits wiii be of aei
ctfcrgi�d sLq stats�d &shove. 'r , '�` - �� ti ':'i'+ e
can ffii T, ®fnYt: o .I�1a Q , A
Electrical Contractor Signstaire , � :,� •i/ �.!
Printed Nam &F�LtA- T
M �conttt 11 ion ex irea ,
Ass HVAC contractor I hembv comity that the T-TVAC equipment
( ) fs ready ( ) is oat reaely to bo pureed in acnriee. 14* Sate oFfc+rks,owie+dgmerrt
aware that the electrical systntts V411 be activated as stated abovc.
.MtDChanicAl Gontt�rAettit Sxgttatttre C�I'ar"taf sigltature oFNutary
pttintxd Nrtme
ratxtry'9 Printed arTyped Name T,pe (bf�cial 3cA1)
NI eommi jUi ex lees:
.At, plurnhing oc""tor I hereby cctlf,Y that the Plumbing equip,
( ) in ready { ) is not ready TD be plclocd in ftrvicm, i nrn rNaft Date o,faaknowled eat
tlt'a the electrical Systems will be &ctft+tttcd ttc atzEtcd above.
P[12 abirr Offlaiai siart,attare of Notary
t` Contractor Si�tratttrr,
Printed ,Pinola Ne7''s Fly or Typed Nat e
7itie (Official Seal}
my Qotm N ion ire
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01/05/2011 14:4 7948276160 PERRIGO WEAVING AC PAGE PA 01
F71le�l2F371 1'4:34 704 - 5278222 MANN BUILDERS PAGE 61102
4
Catawba County Building Sable" Division
PO Box 389, Awl NC 28668 j
Permft Oinfar 8284664599 Newton Fan 82846"378 KR*ary P'eu 828 -322 -6814
}
SERVKM Ao'RTEAM'TE 1RV TLEC." MCITT ,
NOTE: lheb separode gene, to 64 cuanKod is eonddered a aaparoe mVieat and subject to a zwparnto fee.
r a ft Ate.to'tel sumbor urn oel matem to be halted on this
BLIP Sob I7tle 1?T #�t`} unit #
,�
We do herdby valeaee and agm to ifs cmmtfy, s w4 no hold 1,era,teft awbs cbmtcy .W4 its dmplcyees and Duke Povmr
CanipasY Amm aw and all liability due to or miff from Cata"ba Comity xiWdg the eloouj=1 aorvloe to Ow a *4e�wfloned prmaisca
be*Z disconnected. Tvop wzy aaroltut is issued solely as a e& taey fox ttu; cotltpleiimt of oonovedon and an building is sec is be
Oct ;AQ oritil S t �xtifrCBtiC Of OCAtlp�tey 1S i Any vfolWm of the above *11 autcmaflcally vuid to vMrY Wvigp.
The we dtbe bdn final Inspection Is ittt dpaad to be days or lass. If utility aenpoodoo rewire In qsa bgond
30 days GEC w111 be billed Wftl pole Cot" rM 9chedale-111e tar}tparsry Use-Of the system is tWOOOM ,fir tD OPO the HVA,C and to
provide Hghtiag ibr the eomplatlee of the fmish work. Ottty urea• Sm bs $ist an tWOttaty *7or have bum bt*-atad and approved by
the eieeb iaan and elecViedl ill sot1T be wwrgnd. Any 125v singie -ph= *cWts tempoxatiily ener&W for consbvction proposes
will be ground !Mt>lt httmtupt prv�ed, with dw mcception of lighting t it'glt o in malal eOAdm� The bu ildittQ will be oottsteaat Y supervised
ar will be swurely loolcad pllsert it is not supervised. The alaotric ian, IiVAC, and Plumbing oonttartom eta for the systems to be
snared as , Imo 4 below.
i
The reaplat01e agent for the punme of APHOR diii n orm my be so it worm contractor or swain. TAe GCti� o>�ible
for Admintstrative fm u+tkas coorwiso arranged ad aO W t9 ja gp a bi76ng a#c9W W1* [J"n*W t '
Departdfedi hr M"01 of arearnmlt, if naadotl. The electrical cnntmtor shall coorinsta this lunleman
offtK (A COR 'JSfUW'IFISI'Fdt M411 U nMMMD WV 21 L I jCN1rft)M PW t� � +
x+ l+at'ebY RPPLV for lotnporery use aftho ponmeuma � imp 1 ,; • " ?
electrical service to the smut a ldaw ied above I 2vakorbe to ofi eat
tk'111ng of A10 renetVst� if t'etlllr'labd, to owl adiive
Catbwwba County bi>i9ng accogsrt *umber O cla s stole ofNotnry
14x ox GC Signataou+e + NOiary'sPtieted Ox'I�+riOd Nani , t, j
prfmted Nero ti +/ 'x"Rlte q TO eemt1114a1E n 04jiBS:
As eletsrleal eonftetoc, I hereby ON40 that the *ecHOW s yman
(�
is (� is nut toady to be energized. Breach d mite will be Dose ofacimotvledgMefit -
er►erglaed as stated ebm
OffWal 81POtwe ofl+lottrryr
Electrical Contro for Sigatnre _
Notary's Nit or TyPad Natde
Prinw Name _ 7Cdie (8F£cial Seal)
cwmniss+cu ira�
w
As IWAC cat*a*r I hereby certify that the.RVA.0 equipment
(4J'7 is trade ( ) 9s nat ready to bo ptaoad in seedce. 1 mnl °g �
aw
axo that 1116 oilatNul a �•
ysterus will be aativtltod stated above. Ofiieial, s! attn+e of N OTAR
r,
Mecltianleai G>tttraotor l�etamte 'R>, �� � _
Notaryms Nr.bad or Typed 1+wnc p pU9L1�'
Printed NaMm ' ltd
oomaniaetvn :
As plumbing Mum MtVr 7[ hereby cerdfy tba! tic 7Phm,bing equip.
( a is rr,{ ( ) is not ready to be placed er
d in vi at7� I eaare facloavlad om
that the electrical syscema will be sba r :.
7mial obi" coutract r ft
N aPr'rrtcdur Natga .� ,:'� ',.•,�q; ^ .' ,. i
Printed Rome t; �. Thk _ _ C3G.�•?Nt�Z_ � t81i-�b� `: �� .� 1
LAY
S
F.
01/06/2011 09:05 704 -527 -8222 MANN BUILDERS PAGE 02/05
01/05/2011 14:4" 704$276150 PERRIGO HEAPING AC PAGE 01
M1/E1517011 14:34 704 -527 -8222 MANN BUILDERS PAGE 01/02
Catawba County Building SI rviaos Division
PO Box 389, l+ alit n, NC 28568
Permit Cantpr 828- 4664999 Newton Fax 828.485 -8375 Hinkory Fax 829 -322 -6814
SERV1'CE AGREEMENT TEMPORARY ELEC171CM .
NOTE: EAch tmepor rte meter to b4 eottneeted is considered st separate request and subject to a seporate fee.
� a list the totRI aoMb er of ol�� eat meters to be installed on this projftf
RL,D m .Yob Title FxNO a," VA S1We1..... Bldg 4 Unit #?
We do hereby release and a2m ro indemnify, save apd hold hnAnleAs' Catavwba County and it; mployees and Duke Power
Company f1"om any and all liability due to or misiing from CaIA"ba Corxnty aavaitlg the electrical 90rvicC to the above- metri;oned ptamiems
beht8 disconnected. Tiempomry snlroia+i in inued solely as a eatat4sy for the contpietleb of oon&uetion mil Oa building it, mat to bo
occupied ant l a aertifcatc of ocoupwicy is isnued, Any violation of tAa above will autUmsticailly void temporary sorvioo.
The use of the system before final inspection. is anticipated to be „�P_ deya; or loss. If ut;lity eftne ation remains In Use boyopd
34 days OC will be billed Monthly per County Fee Schedule. The temporary use of the system is ficansmy to opoMe the HVA.0 and to
provide lighting fhr the completion of the finish work Only these biMUlts Ve necktsxtp ood/or have bMA Inapcated and approved by
the electrician and electrical instteetw wilt be energimd. Any 125v singlc -phase oirauita temporarily energized for construction purposes
will he ground fltu Inemmpt protected, with the Oxce0on of 411 AS airoui% is m tal aarlduit. Thm building �Ql be tN wtatltly supervised
or will ba aaLmrely loe'ked vulwn it it not supervised. no electrician, TiVAC, and Plumbing oosurau-tom an rat* for the system$ to be
Cnorgized, 3s at:tcstcd below.
The rospaasibie agent for the purpose of Aping thins forts may be tua a; mar2l contrncwr or owner. Tile G+C`:�
for Administrntive foes tentless otherwise arran ed
g and R gt'e4a to set up a billing atawgTkt wntix �'artRWbR Cowrty;;fS
Deparrttnant for Miami of agreement, if neadod. IMe cicctric2l contn4tor shall coordinate thin m�eedon wilb ' �
01�frGIAL (A CONTAKIIk i'Y'r�g'i'l;R SUALL U i'[ik1V'TST'Ti;:O AV iRLTtt:"TW MAIL `TC or ttt 1tO . r,
x, herby apply >f'oricalporary use oftho pammsnQUt
electrical service to the structure identiflod above. I authorize 4ate f ack now east billing of An ronEwnis, if required, to *0 110wiing active Cat�as ba County billing
account , number � signature ofNatary
r o r GC Signature Notary's Prim or Typod Name
Printed Name
ootntriisaiptt expires;
As electrical contractor, t herob
y e++ch,Ej+ that the eleGbrlca] systctra eat ;1
() In rftdY (7 i9 not ready to be energized. Branch cbvuits will be Darr of aclrnow]ed 9t"
ereergiaed as stated above.
Official signature of Notwy
Electrical Contracmr Sitmacturc
Notttrp'a Printed or Typed Nxme
PHnt NI Me I"„{tk „ (019dial Sell)
co�tnmissian ices'
As UVAC contractor I hereby certify that the TJVAC cquiptnent - L� I��r U. M(/ %,
( is ready ( ) is not ready to bo plawd in so-Ace. IM lent
$warn that tires 0laotHasl systems will be aotivaod u stated above.
Official signature of Notary TA R ,y
Mecltr,nleal Contrgetor &FpRture
N otary's Printmd or Typed 14ama'
I Printed NnMo +"�' I Title ^'� r" '*k/ OW Seal)
M commission expires:
As plumbing eentracttir I hereby certify that th Plumbing equip.
( ) is m4wy ( ) is not reedy to be placed in servi C airi Aw9tc of aaknowlcd ent
that the electrical systems will be activttta 2bo
el grrr ots+ry �x + •'r r •,
Plumbing Contractor Si a*A r 1
Notary % Fri tited or Typed Nar nQ -
PAntod blame : • „". 'Title C` W ISP
q a:u n ..647
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Catawba County Building ftn1iCeS Division �
PO Box 389, Newton, NC 28858
P@rrn t Comes 828 - 465-839 Plan Review 828- 40MI30
Newton f=sac 8R8 485 -9378 "OkOry Fax 828.32"814
SlIt"CE AORE- ImN'>L TWpjD EtA,,RX HEAT
tYOR'Er #each separate meter te, be +00 ts eanaiderad n aepatatc r equest grad s,ab�oat to a scm►Mate fee,
Please 1� We tow numb" ot f
y + .,wafers to be installed an this p %�t�
Job T tie 1Pnv # 1 2► �D�ti. R ag is i
Tn 0 4frorttD ss'dSt oe"bwt= in °et>>pW119 eonstmWon projeats, this office will implement the fo110
Pw'" ly ig M114d 3w lroat ng equipment to maintain oymmme� editions _ g p4udY• The at"iaation of
mrl
oronmet W3F sensitive materials, or &;ohm in mew daeae ndth manul6,cturae6 � to ��ftted a iattsllrmon of I
A4MWjsttatian Rnd T3R&ST4MOnt Code with ft Mowing loon) tegaimments. The owner P by the North Carrl State
must sign this request :form for taal;wvy tWipy oonnections. T'ho Form must be filled , SOW W, and mechanical contractor {
"Q f9l*"ltr9 reyluirnents will also apply: �ampleteiy. i
1. AN heatlog netts to be placed In operayoA shaU bffm the following iterria ins cosnp
inspe far Tiapoa i
RyrototfA ('Ptodaotr of aotnWse?an) >f applic able.
b. A,ppl axmmnt of combustion air is provided.
o. On lifts shall be pressure test%%) and inspected. �
d. Water lice %hall be prasurn tasted and 0jRp"tW i othcrmaT or coil %applied by a lint wafer heater, I
e. Condmssts trags and lines in place and inspected.
B aal ei 11 " [ ed 0 s 4411 bo in
yr s e apps % a p p over- ourn;rd, agnipr»ont Branding, conductors and raceways.
t3�tio " lino shall inspected with ap p r op r iate t, cetd8catlon tests. h. h. Ail gas tubing Dail be labeled per gas code prlar to temporary heat inspa oon, i
i. Approved tamporrWarV� al@Mcal power 9s a premgU" ste for 0MP0rW7 beat
temPOMY ekolrleaL) can be schedRlOd sinfuhamo Y with
Na otscttpangr of any lan8 (persona, fnmisliings, •) 511tH1 be allowed 4urin8 this period. 'M60%9 prier approval afthe Code
lrh famem"t offleial,
3. The ass of tba system before final inspeetian is arrticipaoat to bo
30 days general eontraefnr "I be billed dWs or Tess. Tf util t ity coonw A awr,w t" in vac bayend
4. if there is a ttaonthly per Covmy Pee oheduie,
any viotatlott ot`thts eu�aentarne, this serYiae shall be discouneatcd with at prior notice to f parlioipcanta, 7CMs shall bA i
done witiwut any obliswan of n*W"dbllttY an the
S. All processing parfi o 'ihe Code MOW ar tawba Coanty,
fbCR applicable R3 set .forth in the C slawba Cotatty tee sohednle.
i htwe read and 8" to Ibis procedure aW SWdafines & b Catawba f
under which it is fesuad. T £metier agree that failure to y Coua� and will abide by the oanditiotta and 4r7Rtificatlons
and/or ft mfml to consider further m9 &r aamply with the proeQpuro may t+osalt la digootmoomm of vo revocation ofpamT t,
Finsnwe> nr4rte�tt i0 that any tetrpga) of m Y PS. I also to kt4 m a bailing acootmt set up whit camwba Cou t
tcsRpor=y service ow be wbc)rnatioalby Kled ifneeded. �
FCWtM 14V, mby apply for tampo� ns of the p0manant haRTttg !
)canted At the sft 0 tum ;lentified above. I authorke Wi
vrcwats, if regnir+ed, to the fall" 940" Catawim )fats of acknowledgmortt
t o* amount ngmiieT
Official signatunC afNotary
Owner or GC Signature
No1Ary's ]?rinta or Typed Marne 4
Petaled lYamo
Title M (Of; ici tl 3°al)
Yrrmission ewes:
E
As mw pal Wnhractor, I heMby aerbtfy thAt the mechanical
system 's () is >aat awady to be placed in service. of so M(/
mecuank*1 coft"nor skvu tire, . offal sTg c of rosary + �ipTAR r
Printed Name rrw lJd�s1"*, Notary ° 91 itttetd or I<�rp� Name (.1, � � €
7�tte �F F p ULM 41 2
i
s
i
i
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Catawba County Building Services Division
PO BOX 389, Newton, NC 28f358
PermA Center 828 -465 -839$ Pfon Review 828- 48MI30
NsvAon Pax 828 -485 -9375 Hlokory Fax 828�32P.-6814
SEP -ViCE Ar-RE -EMENT T'rMPORA.RX ktYCAT
NOTE: E ach separate stater to be c prlentW t$ oonAidervtl n separate request and subjeee to A SCImrate fee
w ;plonsrr list the tots) rwvnarx+r of AP maters to be installed on this projeet,,,,��„�,;
M 11 ~' �� � l•�ll ��
B.Lt3 .r »b TRIP MN # 1 �► �o�a� Bldg fo T Unit #
rn an eltart to a°.,s3st eon" tar in oatnpleting oon *bon projcata, this office wi11 implement the fallowing poll*. The utili= - tlon of
parz++0.aottfiy fgstallad sw heating equipment to =dntain cnvironttyatrtal canditians necessary to facilitate the installs ldt: of
onviTOnmentrlly sensitive materials, or £fin in accordance wltit
Administration nufl�ctvr��r'o instructions is pcmritted 6 3'the North Carolina State
taisq rttiorr and l3niareamcrtt Code with the following 1oc�1 requirements. The owner, compgeneral ""water, and znerbaniaal contractor
must sign this request form for i also a utility aanneCtiont,. The form must be filled out letely.
7%Q following requirements will also apply:
i. All hca&9 tmtts to be piaoed in opemtion shad) have the following items inspected for aomplitmre if appfimblc.
*, vent synam (Product of combustion)
b. A amount ofcombitstion Air is pnovidod.
o. Gas lima shall be pressure tested and inspected,
d, Water linen alrAtl be pressure tuned and lslppmtrd if gee be mal or coil mrlapUtd by & hot water beater.
e. Condensate tffil" and lima in place and inspected.
f; lrlce�Hcal ChC'uits installed with sppropri4to disconnect, Ovet-O:urrenn, cquiprnent grounding, conductors and raoeways.
g, ltmfrigeration lines $ball bo inspected with appropriate pressure co ffGation tom.
h. All 1 tubing shall be labeled per gat code prior to ternpormy heat inspection.
temporary alcattrical.)a18au,Fal power ,$ a prerequisite for tetxparury heat (This Fan be schedulod simultaneously with
1 No accupnnay of any kind (persons, ff lin1tlngs, cte.) BHRII be allo�we_d 8urir
n1forcetrrcttt offleial, this period, without prier Approval ofthe Cade
3. The use of the system before final i nspection Is ardiaipated to bo Q s Or less. Tf utility onnwoon n'emaints it use b
34 days general contractor v411 be billed monthly per County A li d BaHedulc� ty cyond
4- there is any y obli gation of respon i of thie Erpsoo this servioe e disconnected withoat prior notice to the ani
poipanxa. 'Mih t shall be
S. All p ro o cessi Olcessi t a obli f�os sure ppli sibility Orr the Shall be
Ortlle C OdL' MOW nr wba County,
p acable m set forth in the Catawba County fee schedule.
I have read end age to this procedum and guidelinm ac set fords by Catawba Country and will abide b tiro aonditioOg and quslifcat{Ods
under whicll it is fmsued. T bitter agree that ;Failure m comply with the proceduro may rosait in d;Fepta y y th e c rditis, revoca tion is
and/or ft refusal to Consider further mquosts f temporary gas• I ,also egret, tO ltttve a billing account of perM t,
Piranoe Dapnraneni ass that any ronrowal ft w oftempomry service aAn be get up w Catarov y auromaticstjiy billed ifneedcd.
T dO hereby apply for tcmporney lam of the ptrrmanaet hegin;g
system located At the ttthxatum identified above. I authorize billing raze of ReInowled
of all renewaN if required, to the fhilewlyg q+atiWa Catawba SmClit
Conatty blillAg nccotr�,t nertnbet-
Official slgnature Of'votsxy
Owner or rX Si�ature .
NOttsry's Printed or Typed )?fame
PrtateQ Narne TY6p M (Offcird etas,))
Y d'ra' mis,9ion expires:
As mcch h cal Contractor, I hez,cby cert y that the , nechon icaT � �N.....,...,.Ma
system is M:Ndy () if not rrzdy to be placed In servion. of no gmarit Q► � ' M VtQ.o �•
1r, 'dC+Ctr 2111 0 1 conerlrctor $ig7,atur r.! —.,� Ta1al algrraskufic of,IciO 1 „
Printed Nn9do oo. riywTS r5d'.�, Notary "s Tin tted Or e G t.i
� L fll -� Intl+, '°�"^�.:�� Typ ed N ame GU tJ
F aiarttrl Sean
c lsslone ires: �
4 N+b� rMMw