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RC-000692-2017 TOWN OF QUEENSBURY fT 742 Bay Road,Queensbury,NY 12804-5904 (518)761-8201 Community Development-Building& Codes (518) 761-8256 CERTIFICATE OF OCCUPANCY Permit Number: RC-000692-2017 Date Issued: Tuesday, August 28, 2018 This is to certify that work requested to be done as shown by Permit Number RC-000692-2017 has been completed. Tax Map Number: 296.13-1-55 Location: 147 MONTRAY RD Owner: STEPHANIE SMITH Applicant: Burke Bros. Builders,Inc. This structure may be occupied as a:Residential Alterations (due to fire) 1255 s, By Order of Town Board TOWN OF QUEENSBURY Issuance of this Certificate of Occupancy DOES NOT relieve the 4 property owner of the responsibility for compliance with Site Plan, .vf Variance, or other issues and conditions as a result of approvals by the Director of Building&Code Enforcement Planning Board or Zoning Board of Appeals. TOWN OF QUEENSBURY 742 Bay Road,Queensbury,NY 12804-5904 (518)761-8201 Community Development-Building&Codes (518)761-8256 BUILDING PERMIT Permit Number: RC-000692-2017 Tax Map No: 296.13-1-55 Permission is hereby granted to: STEPHANIE SMITH For property located at: 147 MONTRAY RD In the Town of Queensbury,to construct or place at the above location in accordance with application together with plot plans and other information hereto filed and approved and in compliance with the NYS Uniform Building Codes and the Queensbury Zoning Ordinance Tvne of Construction Owner Name: STEPHANIE SMITH Single Family-Alteration $200,000.00 Owner Address: 147 Montray RD Total Value $200,000.00 Queensbury,NY 12804 Contractor or Builder's Name/Address Electrical Inspection Agency Burke Bros.Builders,Inc. PO Box 105 Lake George,NY 12845 Plans&Specifications Residential Alterations(due to fire)1255 s.f. $188.25 PERMIT FEE PAID-THIS PERMIT EXPIRES: Friday,November 2,2018 (If a longer period is required,an application for an extension must be made to the code Enforcement Officer of the Town of Queensbury beforejdmiee 'ration daDated at the Town o ueensb4Thukovember 2,2017 SIGNED BY: for the Town of Queensbury. Director of Building&Code Enforcement Office Use Oniy ADDITION/ALTERATION PERMIT Permit#: Oc.- (9�2- - 2,(D l�- ' APPLICATION Permii Fee: $ 1`$b•25 Toon of(Lucensburc- 742 Bay Road,Queensbury,ivy 12804 Invoice#: 38 t':518-761-8256 www.gueensbury.net E0 Project Location: _1 4 i (zJ E D v D Tax Map ID #0 1-W. lav- l-`� Subdivision Name ► �g�� CONTACT INFORMATION' TOWN OF OUBBNSB URY BUILDING&CODES ® Applicant: Name(s): ��>— , T�f c Mailing Address, C/S/Z: R•o F,. K L--o" N� ('�L(; 14 Cell Phone: ( ,U b ) `7J(, - 0 3 ;;k-ef Land Line: sib GG 6 • 3 d S 1( Email:—Q-,-N io sr -s . b b b r k-o-t l . C. w" Primary Owner(s): ,'1r Name(s): S W� t Mailing Address, C/S/Z: 'I (ylo of , NV Cell Phone: Land Line: Email: r- S C i 6@ coo . Com• • Contractor(s): BusinessName: Contact Name(s): Mailing Address, C/S/Z: J. C3,;x 3 Q„ ti �.�`,��, My lad l `f Cell Phone: ( !Vb_) -i q ko '0 3 Land Line: Emai(:_ C�v.bux-ice C°' Q rv.r�.E l . C�w• ® Architect(s)/Engineer(s): Business Name: LA- j�j 6 o`s Contact Name(s): �,"_�{- b,4 b wS Mailing Address, C/S/Z: A be- i21.-� NY llmq Cell Phone: (SZ ) SDS - S q land Line: ( 51 6 Contact Person for Building & Code Compliance: ( v'- Cell Phone: ( Sly ) `l q k6 Land Line: ( Slb ) Email: co n., Town of Queensbury Building&Code Enforcement Addition/Alteration Application Revised February 2017 PROJECT INFORMATION, TYPE- Commercial /\ Residential WORD CLASS: Single-Family _Two-f=amily Multi-f=amily (#of units ) Townhouse Business Office Retail _ Industrial/Warehouse _Garage (# of cars ) Other (describe ) ADDITION SQUARE FOOTAGE: ALTERATION SQUARE FOOTAGE° 1st floor: 1st floor: 2" floor: 2nd floor: 3rd floor: 3rd floor: 4th floor: 4th floor: Total square feet: Total square feet- ADDITIONAL PROJECT INFORMATION- 1. Estimated Cost of Construction: $ 2. If Commercial project, what is the proposed use: la` r- 3. Source of Heat (circle one): � as Oil Propane Solar Other Fireplaces need a separate F urning Appliances & Chimney Application 4. Are there any structures not shown on the plot plan? YES (jN� Explain: 5. Are there any easements on the property? YES (� 6. SITE INFORMATION: a. What is the dimensions or acreage of the parcel? b. Is this a corner lot? YES c. Will the grade be changed as a res of e construction? YES d. What is the water source? PU LIC PRIVATE WELL e. Is the parcel on SEWER or PRIVATE SEPTI ystem? Town of Queensbury Building&Code Enforcement Addition/Alteration Application Revised February 2017 UECLAR ZION: 1. 1 acknowledge that no construction shall be commenced prior to issuance of a valid permit and will be completed within a 12 month period. 2. Ifthework is not completed by the 1 year expiration date the permit may be renewed, subject to fees and department approval. 3. 1 certify that the application, plans and supporting materials are a true and complete statement and/or description of the work proposed, that all work will be performed in accordance with the NYS Building Codes, local building laws and ordinances, and in conformance with local zoning regulations. 4. 1 acknowledge that prior to occupying the facilities proposed I, or my agents, will obtain a certificate of occupancy. 5. 1 also understand that I/we are required to provide an as-built survey by a licensed land surveyor of all newly constructed facilities prior to issuance of a certificate of occupancy. I have read and agree to the above: PRINT NAME: UN � ter tC--4e SIGNATURE: DATE: 11-2 -17 Town of Queensbury Building&Code Enforcement Addition/Alteration Application Revised February 2017 REScheck Software Version 4.6.4 c _£ Compliance Certificate o C6 N L0 L0 04 07 � CO Project Smith Residence o 0 0 Energy Code: 2015 IECC C1 C Location: Glens Falls,' a �r� tY O Construction Type: Single-fami CU U N Project Type: Alteration = I0 Climate Zone: 6 (7635 HD u NOV 0 2 2017 a Permit Date: Permit Number: TOWN OF QUEENSBURY r C/) C BUILDING&CODES M o a Construction Site: Owner/Agent. Designer/Contractor: T— ,� 2 147 Montray Road Stephanie Smith Curtis Dybas (1i Queensbury, NY 12804 147 Montray Road 19 Deer Run Queensbury, NY 12804 Lake George, NY 12845 N U) 518 668 5591 cdybas@yahoo.com Compliance: Passes g prescriptive requirements for alteration projects Envelope Assemblies Gross Area Assembly or Cavity Cont. U-Factor UA Ceiling 1: Flat Ceiling or Scissor Truss 1,248 19.0 19.0 0.026 32 Wall 1: Wood Frame, 16" o.c. __- ___ ___ Exemption: Framing cavity filled with insulation Window 1: Vinyl/Fiberglass Frame:Double Pane with Low-E 283 0.310 88 Door 1: Solid 59 0.077 5 Door 2: Glass 84 0.500 42 Basement Wall 1: Masonry Block with Empty Cells 1,255 0.0 15.0 0.046 58 Wall height: 7.2' Depth below grade: 6.3' Insulation depth: 7.2' Compliance Statement: The proposed building design described here is consistent with the building plans,specifications, and other calculations submitted with the permit application.The proposed building has been designed to meet the 2015 IECC requirements in REScheck Version 4.6.4 and to comply with the mandatory requirements listethe REScheck Inspection Checklist. f nX05; 1 . 1�`i�,b!G- � l l t/02 x201 Name-Title Signature Date Project Title: Smith Residence Report date: 11/02/17 Data filename: C:\Users\Curtis\Documents\REScheck\Smith residence fire rebuild.rck Page 1 of 9 CREScheck Software Version 4.6.4 �(J Inspection Checklist Energy Code: 2015 IECC Requirements: 0.0% were addressed directly in the REScheck software Text in the "Comments/Assumptions" column is provided by the user in the REScheck Requirements screen. For each requirement, the user certifies that a code requirement will be met and how that is documented, or that an exception is being claimed. Where compliance is itemized in a separate table, a reference to that table is provided. Section Plans Verified Field Verified # Pre-Inspection/Plan Review Value Value Complies? Comments/Assumptions & Req.ID 103.1, Construction drawings and ❑Complies 103.2 documentation demonstrate ❑Does Not [PR1)1 energy code compliance for the ❑Not Observable building envelope.Thermal envelope represented on ❑Not Applicable construction documents. 103.1, Construction drawings and ❑Complies 103.2, documentation demonstrate ❑Does Not 403.7 energy code compliance for [PR3)1 lighting and mechanical systems. ❑Not Observable Systems serving multiple ❑Not Applicable dwelling units must demonstrate compliance with the IECC Commercial Provisions. 302.1, Heating and cooling equipment is Heating: Heating: [ Complies :403.7 sized per ACCA Manual S based Btu/hr Btu/hr ❑Does Not [PR2)2 on loads calculated per ACCA Cooling: Cooling: Manual J or other methods Btu/hr Btu/hr ❑Not Observable approved by the code official. ❑Not Applicable I i I Additional Comments/Assumptions: 1 High Impact(Tier 1) 2 Medium Impact (Tier 2) 3 1 Low Impact(Tier 3) Project Title: Smith Residence Report date: 11/02/17 Data filename: C:\Users\Curtis\Documents\REScheck\Smith residence fire rebuild.rck Page 2 of 9 Section Plans Verified Field Verified # Foundation Inspection Value Value Complies? Comments/Assumptions & Req.ID _ _ 402.1.1 Conditioned basement wall R- R- ❑Complies See the Envelope Assemblies (FO4]1 insulation R-value.Where interior R- R- ❑Does Not table for values. insulation is used,verification ❑Not Observable may need to occur during Insulation Inspection. Not ❑Not Applicable required in warm-humid locations in Climate Zone 3. ----------------- 303.2 Conditioned basement wall ❑Complies [FO5]1 insulation installed per ❑Does Not manufacturer's instructions. ❑Not Observable ❑Not Applicable 402.2.9 Conditioned basement wall ft ft ❑Complies See the Envelope Assemblies [FO6]1 insulation depth of burial or ❑Does Not table for values. distance from top of wall. ❑Not Observable ❑Not Applicable 303.2.1 A protective covering is installed ❑Complies [FO11]2 to protect exposed exterior ❑Does Not insulation and extends a ❑Not Observable minimum of 6 in. below grade. _ ❑Not Applicable 403.9 Snow-and ice-melting system ❑Complies [FO12]2 controls installed. []Does Not ❑Not Observable _ ❑Not Applicable Additional Comments/Assumptions: 111 High Impact(Tier 1) 2 Medium Impact(Tier 2) 3 1 Low Impact(Tier 3) Project Title: Smith Residence Report date: 11/02/17 Data filename: C:\Users\Curtis\Documents\REScheck\Smith residence fire rebuild.rck Page 3 of 9 Section Plans Verified Field Verified # Framing/Rough-In Inspection Value Value Complies? Comments/Assumptions & Req.ID _ ---- - — — - - 402.1.1, Door U-factor. U- U- ❑Complies See the Envelope Assemblies 402.3.4 ❑Does Not table for values. [FR111 ❑Not Observable ❑Not Applicable 402.1.1, Glazing U-factor(area-weighted U- U- ❑Complies See the Envelope Assemblies 402.3.1, average). ❑Does Not table for values. 402.3.3, 402.3.6, ❑Not Observable 402.5 ❑Not Applicable [FR2]1 303.1.3 U-factors of fenestration products ❑Complies [FR4]1 are determined in accordance ❑Does Not with the NFRC test procedure or taken from the default table. []Not Observable ❑Not Applicable 402.4.1.1 Air barrier and thermal barrier ❑Complies [FR23]1 installed per manufacturer's ❑Does Not instructions. ❑Not Observable _ ❑Not Applicable 402.4.3 Fenestration that is not site built _ ❑Complies [FR20]1 is listed and labeled as meeting ❑Does Not AAMA/WDMA/CSA 101/I.S.2/A440 or has infiltration rates per NFRC []Not Observable 400 that do not exceed code ❑Not Applicable limits. 402.4.5 IC-rated recessed lighting fixtures ❑Complies [FR16]2 sealed at housing/interior finish ❑Does Not and labeled to indicate s2.0 cfm leakage at 75 Pa. []Not Observable ❑Not Applicable 403.2.1 Supply and return ducts in attics ❑Complies [FR12]1 insulated >= R-8 where duct is ❑Does Not >= 3 inches in diameter and >_ R-6 where <3 inches.Supply and []Not Observable return ducts in other portions of ❑Not Applicable the building insulated >= R-6 for diameter>= 3 inches and R-4.2 _for< 3 inches in diameter. _ 403.3.3.5 Building cavities are not used as _—v — ❑Complies [FR15]3 ducts or plenums. []Does Not ❑Not Observable ❑Not Applicable 403.4 HVAC piping conveying fluids R- R- ❑Complies — [FR17]2 above 105 QF or chilled fluids ❑Does Not 3, below 55 QF are insulated to zR- ❑ 3 Not Observable ❑Not Applicable 403.4.1 Protection of insulation on HVAC ❑Complies [FR24]1 piping. ❑Does Not ❑Not Observable _ ❑Not Applicable 403.5.3 Hot water pipes are insulated to R- R- ❑Complies [FR18]2 >_R-3. ❑Does Not ❑Not Observable _ ❑Not Applicable 403.6 — Automatic or gravity dampers are— ❑Complies — [FR19]2 installed on all outdoor air ❑Does Not intakes and exhausts. ❑Not Observable ❑Not Applicable 1 I High Impact(Tier 1) 2 Medium Impact(Tier 2) 3 1 Low Impact(Tier 3) Project Title: Smith Residence Report date: 11/02/17 Data filename: C:\Users\Curtis\Documents\REScheck\Smith residence fire rebuild.rck Page 4 of 9 Additional Comments/Assumptions: 1 High Impact(Tier 1) 2 Medium Impact(Tier 2) 3 1 Low Impact(Tier 3) Project Title: Smith Residence Report date: 11/02/17 Data filename: C;\Users\Curtis\Documents\REScheck\Smith residence fire rebuild.rck Page 5 of 9 Section Plans Verified Field Verified # Insulation Inspection Value Value Complies? Comments/Assumptions & Req.ID 303.1 All installed insulation is labeled ❑Complies [IN13]2 or the installed R-values ❑Does Not provided. ❑Not Observable ❑Not Applicable 402.1.1, Wall insulation R-value. If this is a R- R- _❑Complies See the Envelope Assemblies 402.2.5, mass wall with at least 1/2 of the ❑ Wood ❑ Wood []Does Not table for values. 402.2.6 wall insulation on the wall ❑ Mass ❑ Mass [IN3]1 exterior,the exterior insulation ❑Not Observable requirement applies (FR10). ❑ Steel ❑ Steel ❑Not Applicable 303.2 Wall insulation is installed per ❑Complies [IN4]1 manufacturer's instructions. ❑Does Not ❑Not Observable [Not Applicable Additional Comments/Assumptions: 111 High Impact(Tier 1) 2 Medium Impact(Tier 2) 3 1 Low Impact(Tier 3) Project Title: Smith Residence Report date: 11/02/17 Data filename: C:\Users\Curtis\Documents\REScheck\Smith residence fire rebuild.rck Page 6 of 9 Section Plans Verified Field Verified # Final Inspection Provisions Value Value Complies? Comments/Assumptions & Req.ID 402.1.1, Ceiling Insulation R-value. R- — R- ❑Complies See the Envelope Assemblies 402.2.1, ❑ Wood ❑ Wood ❑Does Not table for values. 402.2.2, Steel Steel []Not Observable 402.2.6 [Fill' ❑Not Applicable 303.1.1.1, Ceiling insulation installed per ❑Complies 303.2 manufacturer's instructions. ❑Does Not [FI2]1 Blown insulation marked every 300 ft2. []Not Observable ❑Not Applicable 402.2.3 Vented attics with air permeable ❑Complies [FI22]2 insulation include baffle adjacent ❑Does Not to soffit and eave vents that extends over insulation. ❑Not Observable ❑Not Applicable 402.2.4 Attic access hatch and door R- R- ❑Complies [FI3]1 insulation >R-value of the ❑Does Not adjacent assembly. ❑Not Observable ❑Not Applicable 402.4.1.2 Blower door test @ 50 Pa. <=5 ACH 50 = ACH 50 = ❑Complies [FI17]1 ach in Climate Zones 1-2, and ❑Does Not <=3 ach in Climate Zones 3-8. ❑Not Observable ❑Not Applicable --- --------------- --------- ------------ --------- 402.4.2 Wood-burning fireplaces have ❑Complies [F[8]2 tight fitting flue dampers and ❑Does Not outdoor air for combustion. ❑Not Observable ❑Not Applicable 403.2.3 Duct tightness test result of<=4 cfm/100 cfm/100 ❑Complies — [FI4]1 cfm/100 ft2 across the system or ft2 ft2 ❑Does Not <=3 cfm/100 ft2 without air ❑Not Observable handier @ 25 Pa.For rough-in tests,verification may need to ❑Not Applicable occur during Framing Inspection. 403.3.2 Ducts are pressure tested to cfm/100 cfm/100 ❑Complies [FI27]1 determine air leakage with ft2 ft2 ❑Does Not either: Rough-in test:Total leakage measured with a ❑Not Observable pressure differential of 0.1 inch ❑Not Applicable w.g.across the system including the manufacturer's air handier enclosure if installed at time of test. Postconstruction test:Total leakage measured with a pressure differential of 0.1 inch w.g. across the entire system including the manufacturer's air handler enclosure. 403.3.2.1 Air handler leakage designated — ❑Complies [F124]1 by manufacturer at<=2%of ❑Does Not design air flow. ❑Not Observable ❑Not Applicable 403.1.1 Programmable thermostats ❑Complies [Fl9]2 installed for control of primary ❑Does Not heating and cooling systems and initially set by manufacturer to ❑Not Observable _ code specifications. ❑Not Applicable 403.1.2 Heat pump thermostat installed ❑Complies [FI10]2 on heat pumps. ❑Does Not ❑Not Observable ❑Not Applicable 11 High Impact(Tier 1) 2 Medium Impact(Tier 2) 3 1 Low Impact(Tier 3) Project Title: Smith Residence Report date: 11/02/17 Data filename: C:\Users\Curtis\Documents\REScheck\Smith residence fire rebuild.rck Page 7 of 9 Section Plans Verified Field Verified # Final Inspection Provisions Value Value Complies? Comments/Assumptions & Req.ID 403.5.1 Circulating service hot water ❑Complies (FI11]2 systems have automatic or ❑Does Not accessible manual controls. ❑Not Observable []Not Applicable 403.6.1 All mechanical ventilation system ❑Complies A [FI25]2 fans not part of tested and listed ❑Does Not HVAC equipment meet efficacy and air flow limits. ❑Not Observable ❑Not Applicable 403.2 Hot water boilers supplying heat ❑Complies [F126]2 through one-or two-pipe heating ❑Does Not systems have outdoor setback control to lower boiler water ❑Not Observable temperature based on outdoor [Not Applicable temperature. 403.5.1.1 Heated water circulation systems u ❑Complies (F128]2 have a circulation pump.The ❑Does Not system return pipe is a dedicated return pipe or a cold water supply ❑Not Observable pipe.Gravity and thermos- ❑Not Applicable syphon circulation systems are not present. Controls for circulating hot water system pumps start the pump with signal for hot water demand within the occupancy. Controls automatically turn off the pump when water is in circulation loop is at set-point temperature and no demand for hot water exists. 403.5.1.2 Electric heat trace systems ❑Complies [F129]2 comply with IEEE 515.1 or UL ❑Does Not 515.Controls automatically adjust the energy input to the [--]Not Observable heat tracing to maintain the ❑Not Applicable desired water temperature in the piping. 403.5.2 Water distribution systems that s ❑Complies [F130]2 have recirculation pumps that []Does Not pump water from a heated water supply pipe back to the heated [:]Not Observable water source through a cold ❑Not Applicable water supply pipe have a demand recirculation water system. Pumps have controls that manage operation of the pump and limit the temperature of the water entering the cold water piping to 1049F. 403.5.4 Drain water heat recovery units ❑Complies [F131]2 tested in accordance with CSA ❑Does Not 855.1. Potable water-side pressure loss of drain water heat ❑Not Observable recovery units< 3 psi for []Not Applicable individual units connected to one or two showers. Potable water- side pressure loss of drain water heat recovery units< 2 psi for individual units connected to three or more showers. 404.1 75%of lamps in permanent ❑Complies [FI6]1 fixtures or 75%of permanent ❑Does Not fixtures have high efficacy lamps. Does not apply to low-voltage ❑Not Observable lighting. []Not Applicable rl �High_Impact(Tier 1)� 2 Medium Impact(Tier 2) �3 Low Impact(Tier 3) Project Title: Smith Residence Report date: 11/02/17 Data filename: C:\Users\Curtis\Documents\REScheck\Smith residence fire rebuild.rck Page 8 of 9 �( 2015 IECC Energy j Efficiency Certificate Insulation Rating R-Value Above-Grade Wall 0.00 Below-Grade Wall 15.00 Floor 0.00 Ceiling / Roof 38.00 Ductwork (unconditioned spaces): Glass&Door Rating U-Factor SHGC Window 0.31 Door 0.50 CoolingHeating& Heating System: Cooling System: Water Heater: Name: Date: Comments Section Plans Verified Field Verified # Final Inspection Provisions Value Value Complies? Comments/Assumptions & Req.ID 404.1.1 Fuel gas lighting systems have ❑Complies [FI23]3 no continuous pilot light. ❑Does Not as: []Not Observable ❑Not Applicable 401.3 Compliance certificate posted. ❑Complies [FI7]2 ❑Does Not ❑Not Observable _ ❑Not Applicable 303.3 Manufacturer manuals for ❑Complies [FI18]3 mechanical and water heating ❑Does Not systems have been provided. [-]Not Observable ❑Not Applicable Additional Comments/Assumptions: 11 High Impact(Tier 1) 2 Medium Impact(Tier 2) 3 1 Low Impact(Tier 3) Project Title: Smith Residence Report date: 11/02/17 Data filename: C:\Users\Curtis\Documents\REScheck\Smith residence fire rebuild.rck Page 9 of 9 / Sep. 17. •2018•; •1 •40P .MDIA,.-. _ ,,;,_ ,:.. t., No. 5061 P, 5/18 .l=✓.✓•` i. \ ,,Ce'Jj_•::`.''••y`�•" «jam'\�CY� ' '' MIDDLE DEPARTMENT INSPECTION AGENCY, INC. za c, i 4l% that the electrical wiringto 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 ��`�. c noted below and is issued subject to the following conditions. \: \>> Owner: Stephanie Smith Date: 08/27/2018 ~': << Occupant: Same Locationt ; 147 Montray Road ,. - Occupancy Queensbury,Warren Co. NY '% y Single Family Dwg. �.,� Vie, Applicant: •,. William Bartholomew <:, %� 80 Brampton Road � Ganesvoort, NY 1283.1. - • • - . .I. • ,L J ;\ Joseph A.Holmes. . ,- , ?) No. - - - •0327081361581 EL• _ ' '_ .`:.._ • •_ . . �; 'c•; Equipment: , 200-Amp. Service Equipment 4/0-Service Conductor, 52•.-Switches; 74-Receptacl• • es; 58-Fixtures; 1 -30 Amp ;\? (�a Air Conditioner; 1 - Burner,Wiring & Control For Gas; 1 - 15 Amp Dishwasher; 1 -30 Amp Receptacle; 3-Vent Fans; re4 '7-Smoke Detectors; 17-:Arc Fault Breakers C% • • fie:) ,(.. . �, 'Vil H '$ � wiring ( \ ing to the electrical equipment listed immediately null and void. This certificate applies only to the use,occupancy and \:& ig This certificate applies to the electrical above and the installation inspected as of the above noted data based on a visual ownership as indicated herein. Upon a change In the use,occupancy or ownership 'rr>l k.i 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. 7C; (�) 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, r be valid for a period or one year from the above noted date. Should the electrical this certificate may be revalidated upon reinspection by Middle Department V%. -9 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 rid j) ad to.the introduction of additional electrical equipment anWor the replacement of Department Inspection Agency. Inc.to initiate the inspection and revalidation (('. any of the components Installed as of the above noted date,this certificate shall be process. A lee will be charged for thta seMce, ;<. .ri%;!-:ii , , %%:,*%.f.;i ..!:.;l:; ;;;/, 5. :•:i:•: `. ,_f? \i:`-f%;- '`;%. i.\;q;,7i.^>,;<- ;-:/', `GX\% %:•%.1 ;; • ': i:.x . C-C - 1CF2 1,0,19•- + ,----; I w /r_ ;7 I I • ,i ire ',; ; i I I' .a 4�JJ L'-•9 LJ ... 1 I'1 ij i{ i I lti SEP 1 $ 2018 li i . i. i TOWN OF (.)UEi...N•'t iJems,y i I .....,--...�1 EVt_7- ...—,...--._' i