HomeMy WebLinkAboutBLD2008-00045 TEMP ELEC - HEAT APPLS.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
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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 projec
BUD 200 9-0004y Job Title �c� -n r� # 3 r ]. ;C`- LJJyJSC 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. futility 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 CON I'INUITY TESTER SHALL BE FURNISHED BY ELECTRICAL CONTRACTOR AT THE 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
folio
billing of all renewals, if requir , to a ' g active
Catawba County billing ace t nu er
Official signature of Notary
Owner or GC Si lure
Notary 's Printed or Typed Name
V
(Official Seal)
Printed Name ti Title `
My commission expires:
4 6(s
As electrical contractor, 1 hereby certify that the electrical system
Date of acknowledgment
is ready O is not ready to be energizecUBranch circuits will be
�k
energized as stated above. --4 t
Official signature of Notary
Electrical Contractor Signature
-
��
Notary's Printed or Typed Name
,tom
- Printed Name �C /4' /KD'✓ Title 'S�
(Official Seal)
My commission expires:
As HVAC contractor I hereby certify that the HVAC equipment
( ) is ready ( ) is no[ ready to be placed in service. I am
Date of acknowledgment
aware tha( 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:
As lambing contractor 1 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 Z A
Notary's Printed or Typed Name
/(�
Printed Name J .,/H�J >`�i�iols Title L/AInP�
(Official Seal)
_
My com missio n expir
_
Ar8 1'1-zUJB 11'43 CATAWBA COUNTY 1 828 465 8962 P.001
Catawba County Buiiding Services Division
PO Bex 388, Newton, NC 28658
Permit Center 828486.8399 Newton Far 828- 4654375 Hickory Fax 828 - 322.8814
SERVICE AGREEMM TEMPORARY ELECTRICITY
NOTE: Each mlwrate ranter to be connected We conrhlered a A"rate regtrtt end subject to a sepaeata ter.
Please tart the total norther of eNCtricW waerc to be PoeraBcd on thh, pmjse—
KD:AB$_SZO ?-4C Job Titl eLCa c a Gf Bldg * --.___ unit#_..___
We do hereby release and agme To indettrify, saw: and hold harmbas Catnwta County and ;rs rmployees and Duke Poucr
Company from any and all liability doe to or ortsing from Catawba County causing the Ocunieal service +o the above- menritmed premises
being dlsconawilvd. Temporary service is iasned solely as a courtesy for the complexion of conwetu(ton and the building is nor M be
occupied until a cem irate of occupancy is IFlU+ed. Any violation of the above will automatically sold temporary senlee.
The use of the system before final impecrioo is anticipated to he days m less. If utility cQanection remains in use beyond
SO days CC wltl be billed monthly per County Fie; Schedule. The temporary two of the system is ne¢c�sary to operatc thr, H VAC and to
provide lighting for the completion of the finish work. Only those circuits that are necessary and/or love been inspand and approved by
the electrician and ele;nicn, inspector will be engirt Any ]25v Singlepaacc circuits temporarily crrergiztxl for coe4lruchtm purposes
wilt be ground fault inrczruprproaxtad. #Atli the exeepttm of lighting circuits in mewl conduit. The building will be corntamly super,isad
or wi8 be mmely locked wbm it is not slipervired. The electrician. HVAC, and P`umhing etmsa la ffv are testy tv the ryexom* to he
energized as roasted below.
The rempow le agent for the purgoae of signing this form may be the general contractorur owner. The (Xis responsible
for Adminlstretive tees unRG¢ otherwise ennagad and Agrees no set up a bMhm sconwit with Catawba Caenq Fi-ancc
Department fm renewal of agrmmmt, it needed. The eleetrid eontracler sigh coordinate this inspection with building service
oKhaa{. COlcM"6TY TB6TM MAIL UX FM%UMEY ZIECT11=1, CONr Mlt ATTR M- A`KVM'r.rnt�+.1FxZtt>n)
1. hereby apply for temporary use of the permanent amp
clectrical service to Om structure identified above. t amhoriee
Datc M ackwawIedgment
bgBrtg of all ceneweN, H regbi to a [olio+ active
C,atnwba County bB6ng ,t a r �.
DI flCial signamtt of Notary
Owner or GC S lure
NMary s 1'rinrd m 7ypod Namr
Printed Name !�J =_�_
Titk_
My commission cxpirrn;:
As Cincotta] Cemtraetor. I hereby certify that the Clectnoal system
( ) is nasty ( ) is not reedy M be energized- Branch eicuits wilt be
Date of xlcnpwid mart
eg
energized as sorted abovr..
4ffcia Agmturc of Notary v
FAeetrtcal Convector Slgnearre
No1ary'aprin(td or Typed tierce
17ibtcd Name Title
,,,.. _..___....._ _._._...
�.f Scan
. ``�wPlfT E"..
(/ { As H V AC uYmtroCUk 1 hereby certify that the HVAC cquipmert I ---- I
eft I ( ) to ready i ) is not ready M he placed in xrvl «. I am I+ Dan of o
y ayyue the the ekcmd sytecum wit b/ a a s a�tated alw�ve(/ /�,
^' ..` Sri I 4 ,
Mechanical; Coneeartor Signature
Name
As plumbing 0111flaor Lx l)Y CerBfy that the Plumbing equip.
( ) is ready ( is not rca4y to be placed no service. I am aware Dam of ackrutwledymnem
(hot the electrical syster Witt be xtivared art stated above. DR rignnmrc of Nnnry
Plutbl" Contractor Signature
Notiry'a Printed or Typed Name
NQTAAy' - x "'
O upo c-
Qn 4 r ( I ( Jk91)
IarWuNpo• _
(Moal Sea()
Printed Name
$� Catawba County Building Services Division
PO Box 389, Newton, NC 28658
U 'Z Permit Center 828 - 465 -8399 Plan Review 828 - 466 -5130
Y Newton Fax 828 - 465 -8375 Hickory Fax 828 -322 -6814
I 4 SERVICE AGREEMENT TEMPORARY HEAT
NOTE: Each separate meter 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 on this project
BLD200 -9- a09 Job Title Thu C PIN # ;OI b949LSL Bldg# Unit It
Tc. lot e_
In an effort to assist contractors I. 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:
I . All heating units to be placed in operation shall have the following items inspected for compliance if applicable.
u. Vent system (Products of combustion)
h 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.
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 he days or less. If utility connection remains in use beyond
30 days general contractor will be bitted 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 of the Code Official or Catawba County.
5. All processing fees are applicable as set forth in the Catawba County tee.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 billed if needed.
I do hereby apply for temporary use of the permanent heating
system located at the structure identified abo%K. I authorize billing
Data of acknowledgment
of all renewals, if required, to the fabr wn, ctive Catawba
County billing account no b r
Official signature of Notary
Owner or GC S* I re
{ ./����
Notary's Printed or Typed Name
(Official Seal)
1 � 1 �
Printed Name_ Title
My commission expires:
As mechanical amtractor, t hereby certify that the mechanical
Date of acknowledgment
System O is ready O is not ready to be placed in service.
Official signature of Notary
Mechanical Contractor Signature
Notary's Printed or Typed Name
Printed Name Title
(Official Sea[)
-
My commission expires:
ern- r� -euuo }asa> LA'JAWea WVN'l'Y 1 828 465 6962 ?.972
Catawba County Building Services Division
PO Box 989, Newton, NC 29658
Permit Center 628-486-8399 Plan neview 828 - 456 -5130
Newton Fax 626- 465$375 Hickory Fax 828.322.6814
SERVICE A .REEDfENT TEMPORARY HEAT
N Each separate meter to be connected is comidercel a separate request and subdeel to a separate tea.
Pleae,, IW tae total osotdser of gas atettes to be installed on this _—
BCDMJLJL b Title The, Cine nor r PIN a_y 3O1re,94<11SC, BWRIt Colt M___,,,�__,
T6401 e-
than effort to assist contractors in ompteting eonsune6on paoie Mthis office will:mplemeat the following p,l'my. Thetifihtanm,ot
prnnanen:IV iasWllrri gas healing Criniptaent m malalain Mviroamenlal edpolllJM MGeaeary'n fa<ili P:r ilia instal ;atinn nr
environroeetally sensitive mnkrals. ur 9trishes in accaniatxe ahth manufacturer's instrmncros is perminea by Iht \snlh C:eo!ina Stn:r
Admiaatraticn cad Esdrxceamrg Code with the following local requirements. The owner, gcncn i - hnactor, and ne.:hanieal asnusett,
must ,sign [nip request farm for irmpnmry mility connections, The form Trust be filled uul completely.
Tba rolbwbtg requlreteasde will also apply:
1, All heating units M be placed n opeaadon shell have the following iroms imxctd for compliaioa it applicable.
a. Vent system(PAducts Of combustion)
b. Appropriate apnount cl'combatted air is provided.
(his lines shall be pressure resld and inspected.
A. water liras shall be prmsstue his had and inspected if gWthmnel or Will supplied by a trot water healer.
Condensate raps and Imi in place and inspected.
f. Electrical drewis installed with appropriate dlscomwcl. ovur- current equipment groundirg, coo le,l.: +and race. Na,
g Aafin limber lines shad be irIsP5ci with appropriar prmsurc eertifi.:aiMp tests.
All gas tubing shall be labeled par gas code prior to temporary heat inspection.
I. a.pprevd terthxpra:y e:emrical power is a ptaequisitc fen tempotary hwt. i s Ai. can fie scheduled simulrnneouslr wuh
temporary eleemcal.)
No pedgxmpy of any kind (persons, fwnichiogs, etc.) Shall be allo%d during rhis petiod, Othnut prix aptwoval o. the Cede
Enfcrcc,rnere Of etal.
The use of the ayaem ba6tm final inspection is anricip.td to be dxrs Of less, If uthhy conneslien Na'a.ns in .nc begcnrd
30 days gtncral cvmnsetor will be bil led staunchly pa Coumy Pm Schedule.
d. Tf there is any violation of !his agetmna, this service shall lx discprrected without ;p-iru notice ru .he part ,ipant.. nt,s shall e_
done wthout any obhgs;ia� ol respomibiliry on die pan of the Code Official er Catawba Ceunry
5. Ali obsessing fees ate applicable as set forth in the Catawba County fee schedule.
1 Aare trod and ugrx to this proc.dtuo and gosdennes as set form by Catawba Coop and will abide by die cord inons and gaa!ifcad.a,•:
order whioh it is issued. ; fu-the, sgrm utal failure to compiy with the ptrsaahae may result m disconnection of 9., revtx;ation of Itcrmi:.
nndlot The octusal to comider'.unher requests for temporary gas. I also agree to have a billing account pct up •rich Cum , :bn 4owitp
Finance Department so that xny r- natal fees of temporary service can be auwsrn ivally billed If nodal.
1 do hereby apply mr temporary are ofthe
system located at the srucrure identified a
Uall txtscwals, if acgoircd, to tips fdbw
County bilhbg SCCMM BU4Mi)__,_4J.._
Owner or
Printed N
horse Whisip �Daro of acknowledgmert
Catawba
Offk4 siename of Notary
�� NdRy't Rinrnd ur 7yped ]amc
Title Uri My oominissinn expires:
As nw„hartcal conrtumr. 1 hereby xtuiv tltat The mechanical
eystem f 1 ie ready ( is not ready to be plated in semen
Mechanical Contractor Signatur /nrJa/ �d
Printed Na - i?'l E
(Official Snap
i�
�T� g
ed frame a pU9i.�E
tp -1F�Xy Bici
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