Fillable RESIDENTIAL CONDITIONAL METER RELEASE OR CONSTRUCTION POWER

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RESIDENTIAL CONDITIONAL METER RELEASE OR CONSTRUCTION POWER

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Residential Conditional Meter Release or Construction Power Page 1 of 2 Revision Date: 04/27/2018
City of Palo Alto Development Services Building Division – 285 Hamilton Av. (First Floor), Palo Alto, CA 94301 – (650) 329-2496
DEVELOPMENT SERVICES – BUILDING INSPECTION
RESIDENTIAL CONDITIONAL METER RELEASE
OR CONSTRUCTION POWER
PLEASE REFER TO THE “PROCESS” SECTION ON PAGE 2 FOR INSTRUCTIONS.
Project Address: _______________________________________ Permit Number: ______________________________
Please provide explanation for request:
Electrical Service to advance construction activity and testing.
Gas Service to provide conditioned space and appliance testing.
Other:_________________________________________________________________________________________
Select only ONE of the following:
Conditional Gas Service
Conditional Electrical Service
Construction power using new or existing service
AGREEMENT/DISCLOUSURE
We fully understand and agree that this building will NOT BE OCCUPIED FOR ANY REASON until occupancy has been
granted. I further understand and agree that the City of Palo Alto reserves the right to disconnect the electric or gas
service if any violation of city codes or ordinances is not corrected immediately upon request or if any portion of the
structure is occupied prior to approval.
We are familiar with the California Electrical Code Article 590 (Temporary Installations) and Cal/OSHA Title 8 and will
comply with the requirements therein.
Contractor/agent, please initial and date here: ________________________________
We, the undersigned, have read this agreement and fully understand and agree to all conditions herein.
___________________________________________
Name of Owner/Tenant
___________________________________________
Signature of Owner/Tenant
___________________________________________
Contractor/Agent
___________________________________________
Signature of Contractor/Agent
___________________________________________
Field Contact Phone Number
___________________________________________
Field Contact Email Address
Please check with staff for the latest fee amount.
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Residential Conditional Meter Release or Construction Power Page 2 of 2 Revision Date: 04/27/2018
City of Palo Alto Development Services Building Division – 285 Hamilton Av. (First Floor), Palo Alto, CA 94301 – (650) 329-2496
PROCESS
INSPECTION
Date
Inspector
Number
Inspector
Initials
CONDITIONAL GAS SERVICE (INSPECTION 109)
All gas appliances are installed and functional (gas cook tops and free
standing ranges are not required to be installed), but the outlets must
have a valve and be capped.
Physical protection is in place to protect the gas meter from construction
activities.
Whole house gas test is witnessed by inspector.
Green tag (by WWG) is on gas stub out.
Date
Inspector
Number
Inspector
Initials
CONDITIONAL ELECTRICAL SERVICE (INSPECTION 108)
All receptacles and outlets are made up and covered.
Inspector has witnessed torqueing.
Date
Inspector
Number
Inspector
Initials
CONSTRUCTION POWER USING NEW OR EXISTING SERVICE IS SELECTED
(INSPECTION 108)
Grounding electrode system is complete.
Only GFCI circuit breakers are installed for construction use.
Inspector has witnessed torqueing.
ADDITIONAL CORRECTIONS/NOTES
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
Date: ______________ Inspector Number: ______________ Inspector Initials: ______________
RELEASE TAG STRING ______________________________________________________________________________
_________________________________________________________________________________________________
STEP 1
Schedule
•For electrical
conditional
meter release
or
construction
power,
schedule 108.
•For gas
conditional
meter release,
schedule 109.
STEP 2
Form/Inspection
•Complete this
form at the
job site with
the inspector.
•Make note of
corrections, if
any.
•Skip to STEP 5
if approved.
STEP 3
Re-schedule
•Re-schedule
Inspection 108
or 109 and
meet with the
inspector on
site.
•Corrections
should be
completed at
this stage.
STEP 4
Re-inspection
•Inspector
verifies items
below and
approves
inspection.
STEP 5
Fee
•Go to
Development
Services
Center with
completed
form and pay
fee.
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RESIDENTIAL CONDITIONAL METER RELEASE OR CONSTRUCTION POWER

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Completed 15 December 2021

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