HomeMy WebLinkAboutBLDC-9-11-21623 Temp Elec Appl.tif BA 1
G Catawba County Building Services Division �-
Q PO Box 389, Newton, NC 28658
Permit Center 828 - 465 -8399 Newton Fax 828 - 465 -8962 Hickory Fax �828 322 -6814 j
f842
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
BLD 7 Z� Job Title 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 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 f O o amp J - 7 -
electrical service to the structure identified above. I authorize Date of cknowI dgment
billing of all renewals, if required, to the following active OFFICIAL. -
Catawba County by account number Offici si nature of ota FDDIE R. CRUMP
g rY Notary ublic - North Card a
G l <0 BURKE COUNTY
Owner or GC Signature �Q Notary's Printed or Typed Na M r r $ n►t
Y 'n
s
Printed Nam /dr��J My commission expires: '� i / s
As electrical contractor, I hereby certify that the electrical system _ -7 -
( ) is ready ( ) is not ready to be energized. Branch circuits will be Date of acknowledg ent ° - -`- _ FFICIAL
energized as stated above. • EDDIC R. CRUMP
Official signature of Notary Notary Publ c - North Caro
COUNTY
n
BURKE
Electrical Contractor Signature Y l� �� Ct^k - My Co mis i
Notary's Printed or Typed N
Printed Name Sf�� ✓hc� Title 6 n ti Official Seal)
My commission expires:
9-- 7
As HVAC contractor I hereby certify that the HVAC equipment � _. UMP
Date of acknowledent IAL. R. CR EDpI� oFFIC
( ) is ready ( ) is not ready to be placed in service. I am W Notary f ;9Z1! c -North Care :�?
aware that the electrical systems will be ac 'vat s stated above. EKE COUNTY
Official signature of Notary ''y'
ales ion xp
Mechanical Contractor Signature _
Notary's Printed or Typed N
Printed Name Al �� _{ kAi Title Fortmo�r (Official Seal)
My commission expires: As plumbing contractor I hereby certify that the Plumbing equip.
( ) is read y p Date knowled ent FfIC IAL. . U
y ( ) is not read to be laced in service. I am aware �D�I� R. Cr�iina
that the electrical systems will be activated as s d a ove. Notify u - North
I c
Official signature of tary BU RKE COUNTY
Plumbing Contractor Signa re
fi e{, c M Co iss x 1;
Notary's Printed or Typed ; —
Printed Name ? itle (Official Seal)
My commission exp ires: '2 '�v�- � 7S .