electrical inspection RX Date/Time 05128/2021 06:18 15182731202 P,006
May. 28. 2021. 7:569 MDIR No, 6796 P. 6/7
MIDDLE DEPARTMENT INSPECTION AGENCY, INC.
WsW 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
noted below and is issued subject to the following nditions.
Owner: Date:
Richard &Ann Tougas 05/21/2021
Occupant: Location:
1St FI./Basement 84 Boulevard
Occupancy: Queensbury, Warren Co. NY
Single Family Dwg.
Applicant:
Ann Tougas
159 Deer Rd.
Hudson Falls, NY I. .
L J
I
No. Joseph A.Holmes
1484061473,61 EL
Equipment-
6-Switches; 59-Receptacles; 34-Fixtures;*1 -3 Amp-Water Heater, 1 -Bumet, Wiring &C6ntrols; 1 -30 Amp
eceptacle; 1 -Vent Fans;7-Smoke Detectors; 12 Arc Fault Breakers
pE -CEoW �
MAY 2 8 2021
TOWN OF QUEENSBURY
BUILDING &CODES
This certificate applies to the electrical wiring to the electrical equip ent 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.effi- of the property indicated above,this certiflcate shall be immediately null and void.
aeney or fitness of the equipment for any particular purpose. This cerliffeato shall In the event that this certificate becomes invalid based upon the above conditions.
be varid for a period of one year from the above noted date. Should tf♦e elecll'ical 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 rep acement of Department Inspection Agency, Inc. to Initiate the inspection and revalidation
any of the components installed as of the above noted date,this certific Me shall be process. A fee will be charged for this Sarvice.
I .