HomeMy WebLinkAboutBLDC-12-07-3565 TEMP ELEC APPL.tif i
Catawba County Building Services Division
PO Box 389, Newton, NC 28658
Permit Center 828 - 465 -8399 Newton Fax 828 - 465 -8375 Hickory Fax 828 -322 -6814
SERVTCE AGREEMENT TEMPORARY ELECTRICITY
NOTE: Each separate meter to be connected is considered a separate request and subject to a separate fee.
lease list the total number of electrical meters to be 'installed on this project
13LD 200 _ — Job Title_I&Oso � PIN #, 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 o €occupancy is issued - Any violation of the above will automatically void tempomry 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 OC will be billed monthly per County Fee Scheduic- 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 anti electrical inspector will be energized. Any 1_5v 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 nor 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 CONrFiVWITY TESTER SHALI. HE FURNISHED BY ELECTRICAL CONTRACTOR AT TIME OF SCHEDULED L
i I, hereby apply for temporary use of the permanent amp
electrical service�to the structure identified above. I authorize to f acMowled gm.
e
billing of all renewals, if required, to the following active �i
Catawba County billing accoun number cial� sig�nat of Notary Julia A. Matthews
Owner or GC Si ature \ot s or r Ty Name N o tary Public, North Carolina
1=P y' P Surry County
i� i My Ciafifid9�l)Expire¢
Printed Name ,) Goy Title ' My commission expires: October 11, 201
o, 2
As electrical contractor, I hereby certify that the electrical system
llnt �Q�
( ) is ready ( ) is not ready to be energize Bch c' cults wiII ate of a be ledeme - ./
energized as stated above. Offc' of n0 ry
Electrical Con ' forSienatu e � T -�tx La �Notary'_ Printed or yped ?Name Lw
Printed Name 0LAV �ihle
\ y commission ex Tres: _
As HVAC contractor I hereby certify that the ITV AC equipment ' s
Date of acknowledgment OFFICIAL SEA
l ( ) is ready ( J is not ready to be placed in s en'ice. I air µmiry Pubt e . har h Carona
aware that the electrical systems will be activated as stated above. � ,yr f70V17APi COL,
W
NlY
eial sisnature ofNotary c
... r CARLA A ROS
Mechanical Contractor Signature �
�- ' _ ammission Expires .LL" ' ^°
Notary's Printed or Typed ltia
Printed tiame ';;r� c >c - Title A?,A. ; (Official Seal) f
_VIy commission expires:
i As plumbing contractor I hereby certify that the Plumbing equip.
1 g-mem
( ) is ready ( ') is not ready to be placed in service. I am aware Date of acknowie
i
l that the electrical systems will be activated as stated above.< ti z'~ i° >' '' }r OFFICIAL SEAL
- f � -- f Official signatureofNotary� I! 7Puie- North care-
,
I Plumbing Contractor Signature_ S- ' -�� � C :` Fl � ,�;,` =3 � i�OWAN! CCtlNTl�
j Notary's Printed or Typed 1\ CARLA A. p_�
I Printed Name C 4 f ` c i :� . '' - Y Commis_' :.
_ Title � d,�a:.,:',
L — I ivfY commission expires r • - �c ��