Revised 9/25/2018
Electrical Power Temporary Connection Request
(Not Applicable to Single-Family Residences and Multifamily Structures)
This request is submitted to obtain authorization from Gwinnett County Department of Planning and Development for the
temporary connection of power to the electrical conductors located on the property at the following address in accordance
with Gwinnett County Construction Code Section 114.2:
Address: Project:
Building Permit Number: Space/Suite:
As a condition of this request, we agree to the following:
1. The electrical power temporary connection per this request is valid for a period of ninety (90) days from the date of the passed inspection
by the County building inspector authorizing electrical service or until issuance of a Certificate of Occupancy, whichever occurs first.
2. We assume all responsibility and liability for any damage or injury due to temporary connection of electrical power for the above
referenced project.
3. Occupancy is not authorized during the temporary connection of power and unauthorized occupancy will result in immediate
disconnection of electrical service.
4. We relieve Gwinnett County and its inspectors, and the utility company from any liability for damage or loss from requiring disconnection
of electrical service.
5. An electrician with a state of Georgia electrical contractor license shall be responsible for code compliance of the above referenced
project.
6. A court summons shall be issued due to violations of any of the agreements set forth herein and we agree to act as the responsible
agents of our respective companies in responding to said summons.
7. Any violation of the above will be taken into consideration regarding future Electrical Power Temporary Connection Requests.
Provide the following information in order to determine whether or not the electrical equipment for which temporary power connection is
requested complies with the requirements of the National Electrical Code (NEC 110-9, 110-10,) applicable to the available short-circuit
current.
Available Fault Current at line side of service disconnect:
Main panel overcurrent device: Type Size Interrupting Rating
Name of Electrical Contractor (Print)
Name of Owner or Designee (Print)
Signature (Electrical Contractor)
Signature (Owner or Designee)
GA Contractor License Number Expiration Date
Company Nam
e / Address & Telephone Number: Owner’s Name / Address & Telephone Number:
THIS SECTION FOR NOTARY USE ONLY
Subscribed and sworn before me on this the Subscribed and sworn before me on this the
day of , 20 day of , 20
Notary Signature Notary Signature
(Seal) (Seal)
