HomeMy WebLinkAboutOC_888 Halyard- Miscr
/ ,OUNTY 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 -4,
the site; may be required to be completed within 6 months. (Cash bond or
performance guarantee may be required.)
r
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�'f
� ing of equipment/ systems (3 aCyp;maximum).
PO.0R'S NAME: r
SOB ADDRESS:
BUILDING PERMIT NO.
(COMPLETE FOR PURPOSES A, B OR D) Following is the detailed expl
or other need for occupancy and/or utility release for the b lc
final completion of all work required by the ermit:
-2_ /V_ .
�I�T Nv
�O. //n
E n`�f`-(tfy prese� fls-
ip
/unit described prior to
1,
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 approvalofuse and
occupancy, or at the end of the 30 -day testing period.
NOTES: (1) 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
evidenfe to substantiate any statement indicated above..
ture - Principal (Owner) or Authorized Agent
Address
OCCUPANCY FEE (A, B or C) - $25.00 Received by:
�UTTIILL`IIT�Y �RJELEASEE FOR TESTING FEES (D) - Electrical $30
oXYq iS Y 2f� 061 1S��J rc?� � ��O �� Gas $15
CLEARANCES: Structural �° Grading
Dake
Business Phone
Date:
Received by:
/Date:
t&tff',&ffO,'kO!Z Elec
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COUNTY OF ORANGE - EMA/REGULATION
UTILITY SERVICES RELEASE APPLICATION
n�
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.)
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
OWNER'S NAME:
JOB ADDRESS:
BUILDING PERMIT NO.
CSM=
v�
(COMPLETE FOR PURPOSES A, B OR D) Following is the detailed
or other need for occupancy and/or utility release for the
final completion of all work required by the /�jermit:
eegdippment/systems (30 ay/maximum),
7I,T NO.
K' //,, yy
61V0 fy esent ha
/unit described priorr ip
to
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: (l.) 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
evideny,e-)to substantiate 3,ny statement indicated above..
ture -
Address
or Authorized Agent
OCCUPANCY FEE (A, B or C) - $25.00 Received by:
UTILITY RELEASE FOR TESSTING FEES (D),- Electrical
Gas
CLEARANCES: Structural%-��` Grad
Mechanical
APPROVAL OF MANAGER
NOTIFIED: Electrical
F0250-399(REV.)
/Z/�/4l
Dake
Business Phone
Date:
$30 _ Received by:
$15 _ Date:
Elec. G-'�Pr--.
-~ - Land Use - - -
Date: /— Wn