electrical inspection RX Date/Time. 03/2212021 09:43 15182731202 P.002
Ma.r, 22. 2021E 9:22AM AnCIA No, 6079 P. 2/3
MIDDLE DEPARTMENT INSPECTION AGENCY, INC.
%Wogs that the electrical wiring.to the electrical equipmen 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
noted below and is issued subject to the following conditions.
Owner. Date:
Hoffman 03/16/2021
Occupant: Same Location:
164 Cleverdale Road
Occupancy:,ngle Family Dwg. Queensbury,Warren Co. NY
Si I �
Applicant: '
Barlow Electric i
Wesley Barlow
46 Gillespie Road
L Middle Granville, NY 12849 I J
Joseph A.Holmes I l�
No. _14526711805§EL
Equipment:
200 Amp. Service Equipment:4/0 Service Cdndlictor"45'=Switches;', 6=Receptadds '49-Fixtures; 1 -Range; 1 -
Water Heater, 1 -Burner, Wiring &Controls; 1 -Pump; 1 -Oven; 1 -bishwa r -Dryer, 4-Vent Fans;7-Smoke
Detectors; 12-Arc Fault Breakers 2 n„
D L5P EA �V
'MAR 2 2 a021
j TOVVN..O1=QUEENSBURY
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
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
Inspection. No warranty is expressed or implied as to the mechanical safety,effl- of the properly indicated above,this certificate shall be immediately null and void,
ciency or fitness of the equipment for any particular purpose. This certificate shell In the event that this certificate becomes invarrd based upon the above contl'Rions,
Do 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
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
ed to,the introduction of additional electrical equipment and/or the replacement of Oeparh4tant inspection Agency,Inc.to initlate the inspection and revalidation
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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