HomeMy WebLinkAboutBLD2007-02021 TEMP POWER APPL.TIFCatawba County Building Services Division t ms`s 1
PO Box 389, Newton, NC 28658 F��
Permit Center 828- 465 -8399 Newton Fax 828- 465 -8375 Hickory Fax 826- 322 -6814
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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
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BLD 200 Z L Job Title PIN qaL -O I l L BI g # 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 Pee 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 cnnsnucii on purposes
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will be ground fault inteupt protected, with thconduit. e exception of lighting circuits in metal cond The building will be cnn.r,oniv wperci.ed
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
OMcial. (A CONTINUITY TESTER SHALL BE FURNISHED BY ELECTRICAL CONTRACTOR AT TRAM OF SCHEDMED INSPECTION.)
1, hereby apply for temporary use of the permanent _ amp
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electrical service to the structure identified above. 1 authorize
Date ofknOwledgment
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billing of all renewals, if required, to the I llowtn active
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Catawba County billing account nu
Official signature of Notary
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Owner or GC Signature
Notary's Printed or Typed Name
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(Official Seal)
Printed Name r Title
M commission expires:
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As electrical contractor, I hereby certify that the electrical system
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( ) 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
Date of acknowledgment
( ) is ready ( ) is not ready to be placed in service. I am
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aware that the electrical systems will be activated as stated above.
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Official signature of Notary
Mechanical Contractor Signature
Notary's Printed or Typed Name
Printed Name Title
(Official Seal)
My commission expires:
As plumbing contractor I hereby certify that the Plumbing equip.
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( ) is ready ( ) is not ready to be placed in service. I am aware
Date of acknowledgment
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that the electrical systems will be activated as stated above.
Plumbing Contractor Signature
Official signature of Notary
Notary's Printed or Typed Name
Printed Name Title
(Official Seal)
My commission expires: