TOWN OF CLAYTON
Engineering & Inspections
111 E. Second St., P.O. Box 879
Clayton, NC 27528
Phone: 919-553-5002
Fax: 919-553-1720
CONDITIONAL POWER APPLICATION
Please review carefully the conditions of the agreement. Violation of any of the terms will result in an immediate
revocation of the privilege. Reading these carefully, and by fully informing your staff and subcontractors, can eliminate
any possible conflicts.
Application Fee: $75.00
Residential Commercial
The undersigned agrees to abide by the aforementioned stipulations, and understands failure to comply may result
in the revocation of this contract.
APPLICANT AFFIDAVIT
By my signature to this document, I agree to the following conditions:
1. Full and complete responsibility of the energized electrical system, its use, and all equipment connected
thereto; and to maintain a safe working environment during the completion of the construction.
2. That service will be authorized for connection by the power utility only after the electrical final inspection is
approved (no partial approvals).
3. That the dwelling or building must be secured against unauthorized entry (al doors and windows installed).
4. That no furniture or personal possessions will be placed in the dwelling, garage or any other portion of the
dwelling.
5. That no occupancy will be permitted until a Certificate of Occupancy is issued.
6. Electrical service to be in the same name as the contractor/owner indicated above.
7. I agree that any violation of these terms will result in an automatic revocation of this privilege.
_______________________ __________________________ _____________
Print Name Signature of Applicant Date
APPLICANT/CONTRACTOR INFORMATION
Applicant:
Phone Number: Email:
SITE INFORMATION
Development Name:
Lot #:
Site Address/Location:
Utility Company:
Type of Project:
Project Permit Number:
click to sign
signature
click to edit
Version 10/01/2017 Conditional Power Application
Inspector:_________________________ Date of inspection:__________________
Staff Comments:
FOR OFFICE USE ONLY
Amount Paid: ______________
Permit Number: ________________
STAFF ANALYSIS (completed by staff)
Commercial Project
60 Days 90 Days
Residential Project
30 Days ONLY
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