HomeMy WebLinkAboutBLDC-12-10-13735 TEMP ELEC-HEAT APPLS.tif A $ LoPCDG
�Z Catawba County Building Services Division
Q -3 PO Box 389, Newton, NC 28658
Permit Center 828 - 465 -8399 Newton Fax 828 -465 -8962 Hickory Fax 828 - 322 -6814
f 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 electrical meters to be in stalled on this project
BLD8 -L216 55 Job Title �
_ rdO6;r PIN # Z_1g 5 - A' 1 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 ermanent amp
electrical service to the structure iden ' d above. I authorize Date of acknowledgment
billing of all renewals, if required, o e following act* a �(}
Catawba County billing account u ber Official signature of Notary L.
Owner or GC Signature Notary's Printed or Typed Name
Z (Official Seal)
Printed Nam itle y 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 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:
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:
Too•d gV10
Catawba County Building Services Division 131ze - )3,75
PO Box 389, Newton, NC 28658
Permit Center 828 - 465 - 8399 Newton Fax 828.465 -8962 Hickory Fax 828422-6814
SERVICE ACREEMENT TEMPORARY ELECTRICITY
NOTE: Each separate meter to be connected is considered a separate request and subject to a separate ice.
Please list the total number of electrical meters to be installed on this project
BLD - Job Title ,(, ,& d PIN# r J /9 /- /�/� 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 2t) - 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 CC 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 WUITY TESTER SHALL BE FURNISHED BY ELECTRICAL CONTRACTOR AT T1MP OF SCHEDULED INSPEC OM)
I, hereby apply for temporary use of the permanent amp
electrical service to the structure identified above. I authorbee 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:
F ne6rg lectricaI contractor, I hereby cer that the electrical system Date of acknowledgment
s ready ( ) is not ready to be energized. Branch circuits will be f
tify As
as stated above.
Official signature of Notary
Electrical Contractor Signature Notary's Printed or Typed Name
Printed Name L� 1 t ` Title `u.� �e (Official Seal)
My commission exp ires.
As HVAC contractor I hereby certify that the 14VAC equipment 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
Mechanical Contractor Signature Notary's Printed or Typed Name
Printed Name Title (Official Seal)
My commission a ires:
As plumbing contractor I hereby certify that the Plumbing equip. 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
TOO /100'd 3968 99V 898 T AINfloo Tl8Mli1tt3 6V :VT TT03- 69 -Jfiv
08/25/2011 12:20 8282563449 TROUTMAN PLBG CO PAGE 01
Catawba County Building Services Division
0 Box 389, PermR Center 826- 465 -8398 Newton Fox 82046"982 Hickory Fox 828-322-6614
SERVECR AGREEMENT TEMPORARY ELRCrUICITY
NOTEt Each separate ■stir to be connected Is considered a separate request and subject to a separate foe.
�1. ,��� Plaue Wt ths' total "amber of electrical sisters to be fastened on this project
BLl>d _ Job Tltle 6' Bldg # Unit li
We do hereby release and agree to indemnify, save and hold harmless Catawba County and 11, employees end Duke power
Compass,+ from any and all liability due to or arising *m Catawba County causing the electrical service to the above - mentioned premises
being disconnected. Terrpxvy service is Issued solely as it courtesy for the completion of construction and the building is not to be
oceupled until a certifleate of oocupancy Is loaned. Any violation of the above will automatically void toraporary aervicc.
110 use of the systern before Mal inspection Is anticipated to be days or less, if utility connecti rtmuins in use beyond
30 days OC will be billed monthly par County Poe Schedule. Tho temporary use of the system is necessary to operate the HVAC and to
Provide lighting for the completion of the finish work. Only those cimults that are necessary and/or have been inspected and approved by
the electrician and electrical inspector will be energized. Any 125v aingls -phase circuits temporarily energized for construction poryoses
will be ground ftlt interrupt proto W4 with the exception of lighting circuits in MOW conduit. The building will be constaMly supervised
or will be securely kicked when it is not supervised, The electrician, HVAC, and Plumbing contractors are ready for the ay:zem8 to be
energized as attested below.
The reapotuible agent for the purpose of signing this form may be the geucral contractor or oMner. he CC h responstbk
for Adminktrative feea unless otberwiss arranged and agrees to set up a b"Ung account with Catawba Co sace
unty FYa
Department for renewal of agreement, if needed. Ths electrical eontructor shall coordinate this Impeetlon with bu ance service
ofBclaL (A f:ON 1 IIdt1I1y T1� LR SMALL BE I+URNt9ItED gy ELEC PICAL C<N�1'llACM AT TIME OF SCH&DULED rIw9RWnay.)
1, he:'eby aPPIY for temporary uses of the rmanent asst"
ckecMcW scryim to the otructuro W above. I authorize Date of aclosowledgmcnt •�
bilWtt of all reoewak, It required a following a e �
Catowba County billing account r bar Official signatr�re ofNotary .
Owner or GC uislure otary's Printed or'[`ypod Name
Printed Naps rsu
y oonIasion (Official SOW
)
As elocu ieal contractor, I hereby cerdly that the electrical system
( ) is ready ( ) is not ready to be energised. Branch circuits will be late of acimawledgment
energized as stand above.
Oif'scial elgnslum of Notary
Ekctrkal Contractor signature
• Notary's Priuoed or Typed Name
Printed Name Title M (Official Seal)
commission ex tree:
As HVAC caatractor 3 hereby certify that the HVAC equipment Date of aclasowlad ant
( ) is ready ( ) is not ready to be placed in service. l t?
aware that the electrical Systems wilt be activated as stated above,
Official signature ofNotauy
Mechanical Contractor Signature Notary's Printed or Typed Name
Printed Novae Title (Official Seal)
my commission a ires:
Am plumbing comriottor I hereby certify that the PlViablog equip. R — 2 5 _ 2 01 1
(
)Is toady ( not ready to be placed in saviors. k am aware
Date of anwlodgmeu
that the cleotrimal systems will be isedvatod as stated above,
t?ffic' igo�uv ofNotary ,Gttofb.
Plumblet Contractor Signature Q4 /0 "010 .
Notary s ar Type ante r %1 � A W
Prbtted Name h u• Title ��
My commisgion a ices: -
Catawba County Building Services Division
-3 PO Box 389, Newton, NC 28658
Permit Center 828- 465 -8399 Newton Fax 828 - 465 -8962 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 ou this project
BL D e . ,, LN6' 13j0:5 Job Title !'U� ee) 6 PTN# ��?1 �� '�t� l ° r _ Bldg # T Unit 4
We do hereby release and agree to indemnify, save and hold harmless Catawba County and it's employees and Duko Power
Company front 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 inter 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 TINE OI SCHEDULED INSPECTION.)
I, hereby apply for temporary use of the permanent amp
electrical service to the stucture iden ' r d above, I authorize Date of acknowledgment
billing of all renewals, if required, o " following act ve
Catawba County billing account n ber Official signature of 'Notary
Owner or GC Si nature _ Notary's Printed or Typed Name
(Official Sea[)
Printed Nam ud 27 i , le 44y commission expires:
As electrical contractor, I hereby certify that the electrical system — bate of acknowledgment
( ) is ready ( ) is not ready to be energized. Branch circuits will be
energized as stated above. -
Official signature of Notary
Electrical Contractor Signature
Notary's Printed or Typed Name
Printed Name Title (Official Seal)
- -- '--- -' Ivry comm ission ex iros:
As HVAC contractor i hereby certify that the HVAC equipment
8/24/2011
Date of acknowled i.. ent
is ready ( ) is not ready to be placed in s wine, ab am �,� •
aware that the electrical systems will c v to as staitec ;ove, Official signature of Notary C7
Mechanical Contractors nature 1 � Patricia L. T _
{�
+ r - Notary's Printed or Typed Name
Printed Name � ��1 � 441 r1 f;1�S t Title tv Z.`.`� ti> Official Seal)
My commission expires: 7/1/2012
.
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 aclrowledgment
that the electrical systems will be activated as started above. Official signature of Notary
Plumbing Contractor Signature _ Notary's Printed or Typed Name
Printed Name Title (Official Seal)
YI commission expires:
Catawba County Building Services Division
PO Box 389, Newton, NC 28658
F `2 Permit Center 828465 -8399 Plan Review 828 - 466 -5130
Newton Fax 828465 -8962 Hickory Fax 828 - 322 -6814
1 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
BLD �t7
"IZ"-13 ob Title Q0_0(::5 PIN # 2 - I / � `fc✓1''IUq0 Bldg # Unit #
In an effort to assist contractors in 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 fmishes 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:
1. All heating units to be placed in operation shall have the following items inspected for compliance if applicable.
a. Vent system (Products of combustion)
b. 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.
g. 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.
L 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 be days or less. If utility connection remains in use beyond
30 days general contractor will be billed 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 fee 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 ide f d above. I authorize billing Date of acknowledgment
of all renewals, if required, tot e f Ilowing active C tawba C
County billing account numb Official signature of Notary
Owner or GC Si nature Notary's Printed or Typed Name
(Official Seal)
Printed Name a My commission expires:
As mechanical contractor, I hereby certify that the mechanical
system ( ) is ready ( ) is not ready to be placed in service. Date of acknowledgment
Official signature of Notary
Mechanical Contractor Signature
Notary's Printed or Typed Name
Printed Name Title (Official Seal)
My commission expires:
08/29/2011 10:21 8282563449 TROUTMAN PLBG CO PAGE 01
Catawba County Building Services Division
PO Box 389, Newton, NO 28858
POMR Conies 828.48ti-8386 Plan Review 828488 -5130
Newton Fax 828495 -8882 Kokory Fax 828 - 322.8814
SERVICE AGREEMENT TEMPORARY BEAT
NOTE: Eacb separate meter to be connected Is considered a separate request and subjett to a separate fee.
Please list the total number of gas wavro to be Installed an this project
3LnCJL -ik-- ; ob Title 10POLO(i pal - IQ��i• c�3 ald unfit 9
In an effort to assist oontraetors In completing construction projects, this office will implement the following policy, The utilization of
pernunoatly installed gan heating equipment to maintain environmental oondit erna neceaaary to facilitate the installation of
environmentally sendthm materlab, or finishes in aecordi mcc with menuflacturar's instructions is permitted by the North Carolina State
Administration and Raforoomont Code with the following local requirements. The owner, general contractor, and mechanical contractor
must alga this inquest form for temporary utility connection. The fbrm lnust be tilled out completely.
The tollowlag requirements will also apply:
1 All heating units to be plecod In operation shall have the following items inspected for compliance If applicable.
a. Vent system (Products of combustion,)
b. Appropriate amount of combustion air is provided.
c, Gas lines shall be pressure tested and inspected.
d, Weter litres shell be pressure tested and inspected if geothermal or coil supplied by a hot water heater,
C Cottdmuw traps and Una$ in place and inspected.
f, Elocnical eircults Installed with appropriate disconnect, over-currerrt, equipment grounding, oonductm and raceways,
g. Raftigeretian lures shall be Inspected with appropriate pressure certification teats.
h. All gas tubing shall be labeled per gas code prior to tomporary beat inspecdon.
L Approved temporary electrical power is a prMqub{to f�r temporary host. (This can be scboduled simultaneously with
tonparmy oleo riaal.)
2, No occupancy of any kind (persona, furnishings, etc,) shall be allowed during this period, without prior approve] of the Code
Befbmament Official.
3. The use of the system botom final Inspection is anticipated to be days or less. If utility connection reamins in use beyond
30 days general oontractor will be billed monthly per County Foe Schedule.
4. lfthere is any violation of this agreement, this service shall be disconnected without prior notice to the participants. This shall be
done wittiout any obligation of responsibility on the part of the Code OlSolal or Catawba County,
5, All processing fees are applicable as set forth in the Catawba County The schedule.
I have road and agree to this procedure and guidelines an set ftnth by Catawba County and will ablde by the conditions and quallflcations
under which It is issued. I turihor agree that Whin; to comply with the procoAn 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
Flumes Delrartmeant so that any roaewal fees of temporary service can be vAoanatieaily billed if needed.
I do hereby apply for temporary use of the permanent hosting
System located at the structure id above. I sathorize billing Ante of acknowledgment
of all renewals, If required, to f dossing active tawba
County billing account nurn Official signature of Notary
Owner or GC SI at Notary's Printed or Typed Name
Printed Name a My commission expires: (Official Seat)
As mecbarfl�aI contractor, I hereby certify that the mechanical 8-29-2 01 1
system (vv ff re ready {) is not ready to be placed in service, Date of acknowl em
iel signature ofN a� ' 1 A i
V1 r
J ,
Mechanical Contractor Signature Jeanette I. Hefne
Notary's Printed or Typed Name
l
Printed Name Tide P�i/1>1�F1�. ' Fleia� s• ��.
MY oonamissiao Tres:
t
t
i
Catawba County Building Services Division
PO Box 389, Newton, NC 28658
Permit Center 828- 465 -8399 Plan Review 828 -466 -5130
=. ►. Newton Fax 828 -465 -8962 Hickory Fax 828 - 322 -6814
s`►
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
BLD8 "'L" 10.. �j� ob Title _U2 /(i( _. PIN # � A - q• ���''( C� :t � Bldg # Unit #
In an effort to assist contractors in 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:
L All heating twits to be placed in operation shall have the following items inspected for compliance if applicable,
a. Vent system (Products of combustion)
b. 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 hoc water heater.
e. Condensate traps and lines in place and inspected.
f. Electc•ical circuits installed with appropriate disconnect, over- current, equipment grounding, conductors and raceways,
g. 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, tlzrnishings, etc.) shall be allowed during this period, without prior approval of the Code
Enforeernent Official,
3. The use of the system before final inspection is anticipated to be days or less. If utility connection remains in use beyond
30 days general contractor will be billed 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.
S. All processing fees are applicable as set forth in the Catawba County fee 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 tomporary use of the permanent heating
system located at the structure ide• fi d above, I authorize billing Date of acicnowledgmont
of all renewals, if required, to t e f !lowing active Catawba
County billing account nwnb r
O signature of Notary Ck fk
Owner or GC Si nature 1' Notary's Printed or Typed Name
/ (Official Seel)
Printed Name ZO 5 / e commission expires:
As mechanical contractor, I hereby certify that the nnrchanical _ 8 / 2 4/2011
system is ready O is not ready to be laced ' service. ; D acknowledgipeFlt . .
..�
Official signature of Notary
r �J
Mechanical Contractor Signature Patricia L. Trude
, � , y Y Notary's Printed or 7`yped Name v r r
e.! r
Printed Nam i 4 1 l � . 1f //
Title f T'Z`,.7 (+3fficial Seal)
_,
My conunission e fires: 7/1 /2012