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HomeMy WebLinkAboutBLDR-6-11-19066 Temp Elec Appl.tif 01/31/2012 14 :33 8283226814 CATAWBA COUNTY PAGE 01/01 Catawba County Building Services Division PO Box 389, Newton, NC 28658 � Permit Center 8 28 -465 -8399 Newton Fax a 828 -455 -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 numb of electrical meters to be installed on this pro.ject�� BLD TGWI/M � S Job Title e S,�1.7; PT W-7 ---�— --�— ( ` Bldg I_ Unit # _ We do hereby release and agree to indemnify, save and hold harmless Catawba County and it's employees and Dulce 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 cmpletion of construction and the building is not to be occupied until a certificate of occupancy is o issued. Any violation of he above will automatically void temporary service, The use of the system before final inspection is anticipated to be r 30 days GC will be billed monthly per County Fee Schedule. The temporary use of he system is n t connection provide HVAC b a yond provide lighting for the completion of the finish work. Only those circuits that are necessary and /or h operatc have been inspected and approved to t1Te electrician and electrical inspector will be energized. Any 125v single -phase circuits temporarily energized for conshttetion purpo will be ground fault intemrpt protected, with Tile exception of lighting circuits in metal conduit. The building will be constantly n purT visc 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 DepAI•tment for renewal of agreement, if needed. The electrical contractor shall coordinate this inspection with building service official. (A CO"NUTTY TESTER SHAD BE FURNISHED BV ELECTRICAL CONTRACTOR AT TiME OF SCFITDUt,1rD 1NSPt;C'T TON,) 1 hereby apply for temporary use of the permanent Ct.r am ...�_.._ p �- � - a o electrical service to the structure identified above. I authorize ` �� J \G til0 " billing of AN renewals, if re tired o the following active Dla; knowled meat Catawba County billing A cou, gnu be V Of ficial signature ofNota _ m ,L Owner or GC gignatur J Imo W N O = n 0 U _= Notary's Printed or Typed Name &1 3 1 G = Printed Name �✓N�` 9,.1 Title cial Seal �� Ps , : ( My commissi n ex ices: '� 11 p RG COv as ao U As electrical contractor, I hereby certify that the electrical system ( ) is ready ( ) is not ready to be energized. Branch circuits will be Date of acknowledgme energized as stated above. Electrical Contractor Signature Official signature of Notary Printed Name Nota� ry Printed or Typed Name Title M commission ex ires: (Official Seal) As I•IVAC 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. Mechanical Contractor Signature Official signature of Notary Printed Name Title Notary's Printed or Typed Name MI, commission expire (Official Seal) 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 acicnowiedgment that the electrical systems will be activated as stated above, Plumbing Contractor Signature Official signature ol'Notary Printed Name Title Notary's Printed or Typed Name My c ornrn ssion exp ires; (Official Scat) 0I/31I2912 14 33 8283226814= `GATAWBA COUNTY PAGE 81/01, , . z , �, ` Catawba County Building Services < ' I p Y � { en�lf Center 0 Kok 389, Newton, NC28fiS8 ' 1, ' - 465 8399 f�eWtorl FaX 829485 -8962 { :Hickory Fax . 828- 322 -BS1q `z { .SE)f+:�iCE AGREEMENT T�Mp RARY E '` j = NOTE,;Each separate meter to be connected �5 considered a yeparate r nest And�� ° " f Please list the total numb o{ eicctricAl iiietcrS to -bb o e i RLD tills p��eCtfect to a s eparate fee ��t,� , t lynir � doFhere yi4 elease and agree to tndemmfy, save and tioid hartniess, CatawU .: � . ' Company from any and all habittty due to or arising from Catawba Coun , a Cosintyxand Its ..employees and puke ,power be ingr; tsconiiected, T ' porary service is issued solely as a co tY ceusm the electrical service to the above tnenftone re s occupied unerl a ccrtif :c�'of occupancy is Isseed ,And` ,viola ' i 'y for the cample in hon of canstruetton ai►d,the bu(ldtn ic.not: ''` g, tabe i Y ion of the aboewilt automatically vord fern or The use of the system before finer inspection is snttcipated to be ; � �, , P ",� sernee 30 days GC will be billed monthly per, County Fee Schedule Theae �' �© days or less ; If utility cannectlaEy remains In;usc be "� provide lighting for thc�complehon ofthe finish work � mp °�' use ofthc , rystem n is ary too elAtG g Yo d -- tlto electnciaii - 'and etectrteal.tn eet `r: -" Onty those ctrcitits that;aro necessary and /or leave U P die NVAC an necess "a to _5P q+ili tie energized Any .125v :logic phase circtf�a'rQrri o een inspected and approval by will be ground�faultlncer `ruptp'otected with 1)xe;oxce tha of =ti' h :-� •' -�` � ,f ,:; P_: ranly energtyea'fot construfion n' = _ or',yvtttbe securely locked whep it is oat su on+ �' .,g tmg ctrcutts to metal canduit.;The bui,tdin wilt be con P rposcs ene'rgiied as attested bisltiw � P iced 7'he elcli, HVAC,.and Pl u mbin e retart g iontractorc arc ready for the systems: to �'he responsiblc�afient For tEle purpose of signing tht_s�tarr,l may be the g �ncral contrac for Adin ilfigtraltiye {e nnle99 OflioTwise eTringea and Agrees t 0 s'et' -U > tO ar OWnOr The GC iJ 1 eS ponsi6le Departriient f o r rencwat{'of Agr'ecincnt, I t h Catawba Gbunty 1M manse ;°ffiClal :µ CQNTINt1ht'y7'E.S'2tt SHAT L; IIE Pt1RNISFIED BY ELECTRiCAI CQpl�t'RA A C't'OR AT TtML 4F SCt�! Dutton Wa ltdlt lt huAg service XD". hereby aPP for tempos "ry ttse aftbe permanent P ( I electrical sciViet to the striieture �dena�ed above I autlorize � bd[ing 1f all renewats,.f ie ' d the following active bat of acknowledgment CatAwbfi Cptrntiy t�dGn g a eou� u lie ' £ Ot�cial stgrtaturc of Notary Owner or�CC $ignatgr � 4 ( `Notary's panted or Typed Name Printed (�1Ame �ry►D � 9r3 Title es ► '. � ' � (dfficiai Seat) z � t MY co � mtssioz� cx l ires { As electrical contractor, l hert:by ceittify'H1at trio e]ecmca! system Y � ready; to be ariergt2ed, 8ranolt evcurte will ue k `o energized as Stated above I 8 91 Elcctrlc�fContracttar Signabti e � ,lure PMnted I�TA �' � � '� � .�. Notaiy,s printod or ypetl ' , k o nleX lres ` ' M cotnmiss { p As HVAC; contractor LYiereby ccrpfy that the HVAC u: eR pmenr O is ready ( ) rs net ready i to be placed in service , .I e ra; Date of tacknowledgrrtenf aware that'the eicctrtcal syatcros will he aetrvated as stated -above a S i Official signetuce of Notary Mechanicnt Contrticlol 5igriaturc '' S T i Note 's Panted r T r prtnfed Na 5 rY t o, Yped Name_ , itle , � Offf al , i , � cominisslon:e ires, t S M ' {c aalj As plumbing contractor1l hereby certify that the PfUmbing eRuip � I.. reacljr ) is; °t`tot reedy i to be placed`in service I atrt aware; Date of acknowlod eat h ( 1 that the electrical sst entc w y ,*�I,be acttvated.as statcda ' k � ,hove ! Plumbing Contractor 3[gnnture Otlict f clgnatt)rc of No #ary i Printed Name ., t � N0 tar}1'9 pin nte of !Typed Natne�; , i Title E 'd 'Co tree N( (Oftictal Scat) ' 4 s , i � i