HomeMy WebLinkAboutBLD2007-01674 TEMP ELEC APPL.TIFCatawba County Building Services Division
PO Box 3 Newton, 658
'< Permit Center 828-465 -8399 Newton 82 n Fax 828- 4-465 -8375 Hickory Fax 828- 322 -6814
SERVICE AGREEMENT TEMPORARY ELECTRICITY
NOTE: Each separate meter to he connected is considered a separate request and subject to a separate lee.
Please list the total number of electrical meters to be installed on this project
BLD 700 O Job Title 6660an Ku -.a't - PIN#
Bldg # Unit It
We do hereby release and asree 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. 'Iconpomry 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 Pee Schedule. The temporary use of the system is necessary to operate the IIV AC 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 he 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. (1 CON'I1NU11 Y'FES'FER SHALL BE FURNISIIED BY ELECTRICAL CONTRACTOR AT TIME OF SCHEDULED 1NSPF,( '1 ION.)
I, hereby apply for temporary use of the permanent A 6 amp
elechical service to the structure identified above. ) authorize
Date of acknowledgment
billing of all renewals, if required, to the following active
Catawba County billing ac count num/ber
Official signature of Notary
pp��99
Owner or GC Signature II WrXetptid
OAn "
Notary's Printed or Typed Name
Printed Name -d 0, Aa +s _Title Ole, Yao
My commission expires:
(Official Seal)
As lectrwal contractor, I hereby certify that the electrical system
(1 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 ee�Tille L /.P/ -SAP
(Official Seal)
My commission expires
As H AC contractor I hereby certify that the HVAC equipment
Date of acknowledgment
( is ready ( ) is not ready lobe placed in service. I am
aware that the electrical systems will he activated as stated above.
Official signature of Notary
Mechanical Contractor Signature d ��iu.H.
Notary's Printed or Typed Name
Title X
Printed Name 7E�`� Ma N� l � a
(Official Seal)
ei --
My commission expires:
plumbing contractor I hereby certify that the Plumbing equip.
As k
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 above.
Official signature of Notary
Plumbing Contractor Signature
Notary's Printed or Typed Name
Printed Name Title
(Official Seal)
My commission expires:
Catawba County Building Services Division
PO Box 389, Newton, 28658
Permit Center 828 - 465 -8399 Newton Fax 82 828 - 485 -8325 Hickory Fax 828 - 322 -6814 �
4
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 elect meters to be installed on this project
BLD 200 /� 7 y Job Title aop,~ lee PIN — Blilig*1 Unit #
We do hereby release and agree in 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 ofthe 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 crested 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 aresoged 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 OF FURNISHED nY ELECTRICAL CONTRACTOR AT TIafE 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 Scat)
Printed Name Title
My commission expires:
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 I I VAC 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 elech ired 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:
As plumbing coaclor 1 hereby certify that the Plumbing equip.
4
( ) is ready ( is not ready to be placed in service. 1 am aware
aowledg�nt
�D(�'{e of f act
ym� s
&'
that the electrical systems will be activated as stated above.
" ""'� ° `
O fficial signature of Note
Plumbing Contractor Signature Qn
ITNfIA n ROCIMS
Notary's Printed or Typed Name
Printed Name Title Y ya-'be?
( Official Send
comission expires_ NOV 1, 2010
M m _