HomeMy WebLinkAboutBLD2008-01699 TEMP ELEC - HEAT.TIF�\ N
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Catawba County Building Services Division
PO Box 389, Newton. NC 28658
Per-nit 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 project n _
BI.D 200 C t L Job Title
_ PIN# Bldg # Unit #
�Ve do hereby release and agree to indemnity, 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
occupies 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.'I he temporary use of the system is necessary to operate the TTVAC and to
piuvidc li ^_Ming for the completion of the finish work. Only those circuits that mn necessary and/or bane been inspecie -d ::nd apl?ro%cd by
Ili, electrician and cleclricel inspecior vJ11 be energisd. Any 125v singlo- -phase circcuts temporarily cncrized !il, : onsi: uc;i(.n pnrposc
mill be r.)urd fm_; 'I interr opt protected, with the esccl of Ii.'hli1W u;cuits in metal mnduiL The build ;iw will _ ; +r:,i.i; , 1:1I - % 'al
or wili be securely locked when it is not supervised. The electrician, HVAC, and Plumbing contractors are ready for the systems to be
energized as anumed 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. (A CONTLVUITY TES FER SILIML BE FUR.NISHEO BY ELECTRICAL, CONTRACTOR AT TIME OP' SCIIEDULEU INSPECI I0
I, hereby apphv for temporary use of the permanent amp
electrical service Lo I n: structure identified above. I authorize
Date of acknowledgment
billing of all renewals, if required, to I he following active
Catawba County billing account numbe _ __
Official signature of Notary
Y
Owner or CC Signature . 2.�, �', - �
Notary's Printed or Typed Name
/
Printed Name re� ��� ^; �� / Title ti � ^����'�
my commission ex ires�.
(Official Sea])
As electrical contractor, I hereby certify that the electrical system
Date of acknowledgment
-
(�) is ready ( ) is not ready to be cnergiacd. Branch circuits will be
energized as stated above.
°
Official signature of Notary
` %'1-
Electrical Contractor Signature .
Notary's Printed or Typed Name
-
-
_
Printed Name ,J �' `� "! (��� Title r'P tt- .' -grgrJ
(Official Sea])
_
My commission expires:
As HVAC contractor 1 hereby certify that the HVAC equipment
Date of acknowledgment
( . is not ready to be laced in service. lam
is ready ( p
j
aware that the electrical systems will beea�tivat asktatpd above.
__
Official signature of Notary
{{ �fl7
Mechanical ContractorSignature�Ll_ "�'�
i . �.
fttJiL/f "';fVt; l %4
--
Notary's Printed or Typed Name
(Official Sea])
fit /a /,.�5/(1•'f
Printed Nam e' f fttle
My commission expires:
As plumbing contractor I hereby certify that the Plumbing equip.
( �) is re,+dv ( 1 is not ready to be placed in ser%icc I am aware
'e.
Date of acknowledgment
i
• that the electrical systems will be acttw• led / s led
Official signature of Notary
ing Contractor Signature t
i't Yi( ��r� S� Cry
L
Notary's Printed or Typed Name
Name
(Official Scal i
-
Nfy commission expires:
J
`t Catawba County Building Services Division
� PO Box 389, NewtOa, NC 28658
Permit Ceotc 828 -465 -8399 Pan Revim'; 828 -466 5'.30
N9 Fax 828- 465 -8375 Hickory Fax 828 -322 6814
Sh:RV1CP: t(IZEEENII -N1'f E_1t Pf lit -utv tle.TT
NOFF: IC ILL: h separate nILI to he connected is considered a separate request and suh,iect to at separate cc
Please list t1 - .c total number of ga.c mclers to he installed on this pro,iccl
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1 3u1v- 2004