HomeMy WebLinkAboutBLDR-2-10-4482SCOTTWTEMPPOWERONBLD.tif Catawba County Building Services Division
Q H PO Box 389, Newton, NC 28658
Permit Center 828 - 465 -8399 Newton Fax 828 - 465 -8962 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 project
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BLDR -' 2 `� Job Titl "P# 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- mentic;ned 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 permanent amp
electrical service to the structure identified above. I authorize 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 ) '
Printed Name aber-1 �.( °I rSN'« ` �!/L cialll)
fl'itle �/« • ��— My 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 N VNaoe
Electrical Contractor Signature Notary's Printed or Ty
_ 0'e Printed Name Title (Official Seal)
M commission ex ires:
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 hereby certify that the Plum ing equip.
Pw �ei�� NA T ��M)
( ) is ready ( ) is not r ady to be placed in service I am aware Date f aN o le men
that the electrical systems ill be activated as stated a ove. fficial signature of Notary n ��
Plumbing Contractor Sign tore Not s Printed or Typed Name
Printed Name Title (Official Seal)
M Comm' sion ex ires:
300'd U101
Catawba County Building Services Division
PO Box 389, Newton, NC 28668
Permit Center 828 -465 -8399 Newton Fax 828-466 -8375 Hickory Fax 828- 322 -6814
SERVICE AGREEMENT TEMPORARY ELECTRICITY
NOTE: Each separate meter to be connected is considered a separate request and subject t a separate fee.
Please list the total number of electrical meters to be installed on this project L
I H•290� Job Title PIN# 317 /q- 6,r Ob- /,b$b 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 -10 -__ days or less. If utility connection remains in use beyond
30 days CSC 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 whet) 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 $HALL BE FURNISHED BY ELECTRICAL CONTRACTOR AT TIME OF SCHEDULED INSPECTION.)
1, hereby apply for temporary use of the permanent amp
electrical service to the structure identified above. I authorize 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 the My commission expires:
Fnergize electrical contractor, f hereby certify that the electrical system Date of acknowledgment
is ready ( ) is not ready to energized. Branch circuits will be
/ d as stated above. Official signature of Notary
A Electrical C tractor Signature Notary's Printed or Typed Name
(Official Seal)
Printed Name
My commission ex ices:
As HVAC contractor 1 hereby certify that the HVAC equipment Date of acknowledgment
( ) is ready ( ) is not ready to be placed in service. 1 am
4
aware that the electrical systems will be activated as stated above.
Official signature of Notary �
Mechanical Contractor Signature 1 Notary's Printed or Typed Name
Printed Name tic � ` (Official Seal)
my co ion expires:
As plumbing contractor I hereby certify that the Plumbing equip. a of & dgrnent
( ) is ready { ) is not ready to be placed in service. ware
that the electrical systems will be activated as sta
Ofmcial " ure p
Plumbing Contractor Signature p r ype N e
Printed Name Ti (Official Seal)
M �b7t's
ission Tres:
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Catawba County Building Services Division j
PO Box 389, Newton, NC 28658
Permit Center 828 - 465.8399 Newton Fax 828 - 465.8962 Hickory Fax 828- 322 -6814
4
SERVICE AGREEMENT TEMPORARY ELECTRICITY
NOTE: Each separate meter to be connected is considered a separate request and subject to a separate ree.
Please list the total number of electrical meters to be installed on this project
E LDX— 2 - - ' Jub Titl t�i'k" #
Bldg !! Unit ►/
We do hereby release and agree to indemnity, save and hold harmless Catawba County and it's employeus 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 TESf£R SHALL BE FURNISHED BY 4.LECT1tICAL CONTRACTOR AT TIME OF SCHEDULED INSPECTION.)
t, hereby apply for temporary use of the permanent _ amp
electrical service to the structure identified above. I authorize to of acknawle enr
billing of all renewals, if required, to the following active
Catawba County billing account number cial si
gn31 ure . otary
Owner or GC Signature Notary's Printed or Typed Name
Printed Name J?a:aee L.t q � wct FTitle /ca • #
My commission c7�cpires:� —�
As electrical contractor, I hereby certify that the el 'scat system
( ) is ready ( ) is not ready to be energized. Branch cir 'ts will be Date of acknowledgment
energized as stated above.
Official signature of Notary
Electrical Contractor Signature
Notary's Printed or Typed Name i
Printed Name l (Official Seal)
My commission expires: �
As H AC contractor I hereby certi fy that the 1-1 equipment
is ready ( ) is not ready to be placed in service. T ate t of ackno m,.�� - ..�
aware that the electrical systems will be activated a toted above.
ial Sig) lure o N 'a y
Mechanical Contractor Signatur
Notary's Printed or Typed Name
Printed Na ,
f �itle ( vt[laia,
M commission ex ires:
As plumbing contractor hereby certify that the Plum ing equip. {�
( ) is ready ( ) is not ads to be laced in sarvicc 1 am aware Date of acknowledgment
p
that the electrical systems ill be activated as stated a v0.
fficial signature of Notary
Plumbing Contractor Sign ture i
No 's Printed or Typed Name
Printed Name Title (Official Seal)
M comet sion ex ires
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