electrical inspection RX Date/Time 09/11/2019 12:56 15182731202 P.012
Sep. 11. 2019 12:45PM MDIA _ I , No, 0558 P. 12/13
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' MIDDLE DEPARTMENT INSPE I ON AGENCY, INC. l 9\
. (e that the electrical wiring to the electrical equipment li4te below has been examined and is approved as (
C* being in accord with the National Electrical Code, applicable govemrriin I, utility and Agency rules in effect on the date ›A
(e�:� noted below and is issued subject to the following conditions. ;,j
�4Owner: Joel Mathews Date C;I�
;� 09/05/2019
(;'. Occupant• Loca,�o <<>>
,. ., Same 7 5 Allen Road <<,
�� it ueensbury,Warren Co. NY (>j
(-Z9 OccupancySingle Family Dwg.
•r`J, Applicant: Derricks Home Services LLC LE C E 0 � EE \*
� � 64 Sagamore St .
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<<� Glens Falls, NY 12801 :' isi-
SEA•16Lui
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I TOWN OF:QUEE\4SBURY
0 Joseph A.Holmes rr�j
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I BUILDING&COTES
' •144017.104452EL • •
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��'� Equipment: • II • �j
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.•1 -200 Amp Sub Panel; 1 -100 Amp'Sub Panel; 1 -Septic Pump;200 Amp.Service-Equipment;4/0-Service :y�
FY1 Conductor, 88-Switches; 102.-Receptacles; 92-Fixtures; 1 -50 Amp a ige;'1 -30 Amp Air.Conditioner, 1 -Burner, �<>>
Wiring &Control For 2-Well Pumps; 1 -40 AmpOven; 1 -20 Arn G 3rba e;Dis-osal; 1 -20,Am Dishwasher • ' ;.
Gas; p � 9. P �• p � �,.
§)1 -30 Amp Dryer Receptacle;3=Vent Fans;`8-•Smoke Detectors;29- rc Fault Breakers:
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-.. This certificate applies to the electrical wiring to the electrical equipment listed Immedlat nu�� and void, This certificate applies only to the use,occupancy and •.
�•) above and the installation inspected as of the above noted date based on a visuSi ownership it licatetl herein. Upon a change In the use,occupancy or ownership �JJ
*) inspection..No warranty is expressed or implied as to the mechanical safety,effi- oif ttie prop rty dic rated above,this certificate shell be immediately null and void. (C�1
%a ciency or fitness of the equipment for any particular purpose. This certificate shall In the even that this certificate becomes invalid based upon the above conditions.
be valid fora period of one year from the above noted date. Should the electrical this certifi to may be revalidated upon reinspection by Middle Department �,?
-k;) system to which this certificate applies be altered in any way.including but not limit- Inspection ge 1 .Inc. An application for inspection must be submitted to Middle 1C:)�
(� ed to,the introduction of additional electrical equipment and/or the replacement of Oepartme ' In pectIon Agency, Inc.to initiate the inspection and revalidation \�
i-. any of the components installed as of the above noted date,this certificate shell be process. A free 'II be charged for this service. 1-•5
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