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electrical inspection ;.,.:.,,;;Oct. 29. 2019 10: 25AM MDIA \o '!62 2/7
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MIDDLE DEPARTMENT INSPECTION AGENCY, INC. 1
that the electrical wiring to the electrical equipment listed below has been examined and is approved as
being in accord with the National Electrical Code, applicable governmental, utility and Agency rules in effect on the date s-
noted below and is issued subject to the following conditions.j Owner ��..� Date: (G9
i— PAC Man 10/23/2019
,- Occupant: Location i �
(.; 1St Floor S78 Aviation Rd. ��
is Occupancy: Queensbury, Warren Co. NY «V�
v' Non-Residential
r Applicant:r Cal
Mr. Electric of Queensbury 4,•
Jeanne Dion r
ill
(7j
&:...„. PO Box 4304 .
•
0 L Queensbury, NY 12804 y
V3 Joseph A.Holmes rr,
is :
�) No.
0 147269114508EL S <
Equipment: •
•
,��
•12 - Plug Mold; 1 -200 Amp Panel; 1 -75 KW Transformer; 4 - Switches; 16 - Receptacles; 29 -Fixtures; 1 - Exit th
Lights; 2 -Exit/Emergency Combos '
lea J G
r,
_ OCT 3.0 20'19 ----
. ,.Iv rikA
- 5 S.
TOWN OF QUEENSBURY K
a BUILDING& CODES
This certificate applies to the electrical wiring to the electrical equipment listed immediately null and void. This certificate applies only to the use,occupancy and 14
.
/j 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 y�
4r 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, f(.3.:a ciency 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. err.
Ng., be valid for a period of one year from the above noted date. Should the electrical this certificate may be revalidated upon reinspection by Middle Department
NCI 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 et
ed to.the introduction of additional electrical equipment and/or the replacement of Department Inspection Agency, Inc. to Initiate the inspection and revalidation �l�y
arty 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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