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HomeMy WebLinkAboutBLD2007-01592 TEMP ELEC APPL.TIFe,A G .. 1842 Catawba County Building Services Division 61 PO Box 389, Newton, NC 28658 6 Permit Center 828 - 465 -8399 Newton Fax 828 - 465 -8375 Hickory Fax 828 - 322 -6814 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 roject . BLD 2oo Cis // 7 v �JR� Co e�L � r, C� n e e- �— �� Job Title fe feYPIN# 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 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 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 amp electrical service to the structure identified above. I authorize Date of acknowledgment billing of all renewals, if required, to the following tive Catawba County billing account number Official signature of Notary PQ Owner or GC Signat Notary's Printed or Typed Name ++ Printed Name l}�yY1�5C��1�1�/S Title /�CG My commission expires: (Official Seal) As electrical contractor, I hereby certify that the electrical system ( ) is ready ( ) is not ready to be energized. Branch circuits will be Date of acknowledgment energized as stated above. Official signature of Notary Electrical Contractor Signature _ Notary's Printed or Typed Name Printed Name Title (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 stated above. Official signature of Notary Mechanical Contractor Signature Notary's Printed or Typed Name Printed Name Title (Official Seal) My commission expires: equip. As plumbing contractor I hereby certify that the Plumbing Date of acknowledgment ( ) is ready ( ) is not ready to be placed in service. I am aware that the electrical systems will be activated as stated o Official signature of Notary Plumbing Contractor Signature l �� 1 21 Notary's Printed or Typed Name (Official Seal) Printed Name �� Title V e �. My commission expires: Catawba County Building Services Division ST��� =N C,,l °CwNCO'L Q PO Box 389, Newton, NC 28658 Permit Center 828 -465 -8399 Newton Fax 828- 465 -8375 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 y � P - Job Title I LVL- ^ � (� Z� S (D L 1 �� Bldg # PIN# 3 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 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 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 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 Owner or GC Signature Notary's Printed or Typed Name (Official Seal) Printed Name Title My commission expires: As electrical contractor, I hereby certify that the electrical system (k4s ready ( ) is not ready to be energized. Branch circuits will be Date of acknowledgment energized as stated above. //f )WO Official signature of Notary Electrical Contractor Signature .. _� " ) ­7 Notary's Printed or Typed Na // C Printed Name &)1/44/ ", 9 51 mo Title (Official Seal) My commission expires: As HVAC contractor I hereby certify that the HVAC equipment Date of acknowledgment ( ready ( ) is not ready to be placed in service. I am aware that the electrical systems will be activ4ted as stated abo e. - Official signature of Notary � f " Mechanical Contractor Signature Notary's Printed or Typed Name D Printed Name 7 � ��' �� �� Ti le ©�'',� e � (Official Seal) My commission expires: As plumbing contractor I hereby certify that the Plumbing equip. ( ) is ready ( ) is not ready to be placed in service. I am aware Date of acknowledgment that the electrical systems will be activated as stated above. Official signature of Notary Plumbing Contractor Signature Notary's Printed or Typed Name Printed Name Title (Official Seal) My commission expires: