HomeMy WebLinkAboutOC_93626 - MiscCOUNTY OF ORANGE - EMA/REGULATION
UTILITY SERVICES RELEASE APPLICATION
Application -for utility services release for the following indicated purpose (check one):
A. Final occupancy of a single family dwelling prior to completion of all work on
the site; may be required to be completed within 6 months. (Cash bond or
performance guarantee may be required.)
i \ B. Temporary occupancy of a portion of a multi -family or commercial/industrial
building (6 months maximum, may be extendible); cash bond or performance
guarantee may be required.
C. Temporary occupancy of a single family dwelling(s) for model complex purposes
(initial one year maximum, may be extendible); cash bond or performance
guarantee may be required.
D. Temporary release of util• ies ±2L.Sesti g o equipment/s tems (30 day maximum).
OWNER'S NAME • G PH
v•
SOB ADDRESS:
BUILDING PERMIT NO.
LOT/UN N0.
(COMPLETE FOR PURPOSES A, B OR D) Following is the detailed explanation of my present hards
or other need for occupancy and/or utility release for the building/unit described prior to
final completion of all work required by the /permit:
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I understand that I must comply with all County regulations and conditions of approval relating
to this building/unit. I understand that any utility service granted only for utility test
purposes is not authorization to occupy, stock or furnish the structure. I authorize EMA to
request discontinuance of service without further notice to me for any violation of the
regulations or conditions pertaining to this building/unit prior to final approval of use and
occupancy, or at the end of the 30 -day testing period.
NOTES: (7-) For temporary occupancy of a portion of multi -family or commercial/industrial
building, the owner shall submit 4 copies of the floor plan of the building, identifying
thereon the portion or area to be occupied. (2) The owner may be required to submit additional
eviden e�o substantiate any statement indicated above..
ure - Principal (Owney4 or Authorized Agent
AQnress
OCCUPANCY FEE (A, B or C) - $25.00 Received by:
Business Phone
Date:
UTILITY RELEASE FOR TESTING FEES (D) - Electrical $30 Received by:
CLEARANCES: Structural
Mechanical
APPROVAL OF MANAGER
Gas $15,__Date,
j/Q Grading T_ ) lc/ lec,FED 4 - 199
Plumbing Land Use
Date:
NOTIFIED: Electrical Gas
F0250-399(REV.)
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