electrical inspection , Oct. 7. 2019. 8 : 55AM M 1A No. 1041 P. 3
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MIDDLE DEPARTMENT INSPECTION AGENCY, INC. c .
(ee/W es that the electrical wiring to the electrical equipment listed below has been examined and is approved as fa
,4 being in accord with the National Electrical Code, applicable governmental, utility and Agency rules in effect on the date Ar
noted below and is issued subject to the following conditions. ,
Owner: a�
Robert Carbognin Date gi
09/30/2019 rr'
-
t' Occupant: Locatio rr�
1st&2nd Floors n197 Assembly Point Road rd-
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'>'• Occupancy- Queensbury, Warren Co. NY F�)
(a p 'Single Family Dwg.
ra Applicant: t�)
�=' Barlow Electric 64,
tt•
e Wesley Barlow 4y'
•
43 46 Gillespie Road 4 j
0) L Middle Granville, NY 12849 ���
Joseph A.Holmes w.
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�j No. 145267108499EL 6ti
2 Equipment: k'R,
t,26 - Switches; 28 - Receptacles; 23 - Fixtures; 1 -30 Amp Oven; 1 -20 Amp Dishwasher, 1 - 30 Amp Dryer y6i
5i.•Receptacle
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OCT 0 7 2019 � �
TOWN OF G�UEEN5i3U2Y
BUI!niNG&COCi=S
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is certificate applies to the electrical wiring to the electrical equipment listed immediately null andvo d, This cer1t sate applies only to the use.occupancy and Gu
*') above and the installation inspected as of the above noted date based on a visual ownership as indicated herein. Upon a change in the use,occupancy or ownership '.
r ' inspection. No warranty is expressed or implied as to the mechanical safety. effi- of the property indicated above,this certificate shall be immediately null and void.
A clency or fitness of the equipment for any particular purpose. This certificate shall In the event that this certificate becomes invalid based upon the above conditions. ',
be valid for a penod of one year from the above noted date. Should the electrical this certificate may be revalidated upon relnspection by Middle Department ;x�
�, system to which this certificate applies be altered in any way.including but not limit. Inspection Agency. Inc. An application for inspection must be submitted to Middle tt
f`.) ed to, the introduction of additional electrical equipment and/or the replacement of Department Inspection Agency. Inc. to initiate the inspection and revalidation ff(••'y)
i0: any of the components Installed as of the above noted date,this certificate shall be process. A fee will be charged for this service. >�)
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