RC-0147-2018 TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5904 (518)761-8201
Community Development-Building&Codes (518) 761-8256
CERTIFICATE OF OCCUPANCY
Permit Number: RC-0147-2018 Date Issued: Monday, September 17, 2018
This is to certify that work requested to be done as shown by Permit Number RC-0147-2018
has been completed.
Tax Map Number: 289.10-1-14
Location: 23 JAY RD
Owner: Higley Lake Property, LLC
Applicant: Cifone Construction Co. Inc.
This structure may be occupied as a: Single Family Dwelling alterations 1530 s.:
Septic Alterations By Order of Town Board
TOWN OF QUEENSBURY
Issuance of this Certificate of Occupancy DOES NOT relieve the (# 444.0 4
lOt
property owner of the responsibility for compliance with Site Plan,
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
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742 Bay Road,Queensbury,NY 12804-5904 (518)761-8201
_ Community Development-Building& Codes (518) 761-8256
BUILDING PERMIT
Permit Number: RC-0147-2018
Tax Map No: 289.10-1-14
Permission is hereby granted to: Cifone Construction Co.Inc.
For property located at: 23 JAY 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
Tvae of Construction
Owner Name: Higley Lake Property,LLC Single Family-Alteration $60,000.00
Owner Address: 31 Chestnut Ridge RD Total Value $60,000.00
Queensbury,NY 12804
Contractor or Builder's Name/Address Electrical Inspection Agency
Cifone Construction Co.Inc.
PO Box 684
Glens Falls,NY 12801
Plans&Specifications
Single Family Dwelling alterations 1530 s.f.
Septic Alterations
$ 534.00 PERMIT FEE PAID -THIS PERMIT EXPIRES: Wednesday,April 10, 2019
(If a longer period is required,an application for an extension must be made to the code Enforcement Officer
of the Town of Queensbury before the expiration date.)
Dated at the Town ue bury; Tu s a i 10,2018
SIGNED BY: for the Town of Queensbury.
Director of Building&Code Enforcement
Office Use Only
ADDITION/ALTERATION PERMIT Permit#: a<^n W.'+-Za Vb
APPLICATION Permit Fee:$ 5eA•oiJ
Town of QueeusbuCy
742 Bay Road,Queensbury,NY 12804 Invoice#: 0 2q
P:518-761-8256 www.ciueensburv.net
Project Location: 23 Jay Road E n Re 2
D)
Tax Ma ID#: 289.10-1-14 Subdivision Nama: AF)s± n _cV-
p r+r R u a LUI�
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CONTACT INFORMATION: E OWN OF QUEENSBURy
BUILDING&CODES
• Applicant:
Name(s): Cifone Construction
Mailing Address, C/S/Z: PO Box 684, Glens Falls, NY 12801
Cell Phone: ( 518 ) ' 361-0626 Land Line: ( 518 ) 792-9242
Email: mcifone@cifone.com
• Primary Owner(s): `
Name(s): Higley Lake Property, LLC
Mailing Address, C/S/Z: 31 Chestnut Ridge Road, Queensbury, NY 12804
Cell Phone: ( 518 ) 796-3342 Land Line: ( 518 792-1497
Email: ghigley@gmail.com
• Contractor(s):
Business Name: Cifone Construction
Contact Name(s): Matt Cifone
Mailing Address, C/S/Z: PO Box 684, Glens Falls, NY 12801
Cell Phone: ( 518 ) 361-626 Land Line: ( 518 ) 792-9242
Email: mcifone@cifone.com
• Architects Engineer(st
Business Name: Engineering America Co.
Contact Name(s): George Yasenchack
Mailing Address, C/S/Z: 8 Fielding Street, Glens Falls, New York 12801
Cell Phone: ( 518 ) 421-9245 Land Line: ( 518 ) 615-0201
Email: georgeyas3@yahoo.com
Contact Person for Building & Code Compliance: Matt Cifone
Cell Phone: ( 518 ) 361-0626 Land Line: ( 518 ) 792-9242
Email: mcifone@cifone.com
Town of Queensbury Building&Code Enforcement Addition/Alteration Application Revised March 2019
PROJECT INFORMATION:
TYPE: Commercial X Residential
WORK CLASS:
X Single-Family _Two-Family _Multi-Family(#of units )
Townhouse Business Office Retail
_Industrial/Warehouse _Garage (#of cars ) _Other(describe )
ADDITION SQUARE FOOTAGE: ALTERATION SQUARE FOOTAGE:
1st floor: N/A 1st floor: 1530
2nd floor: N/A 2n1 floor: --
3rd floor: NIA 3rd floor: —
Basement (habitable space): N/A Basement(habitable space): None
Total square feet: N/A Total square feet: 1530
ADDITIONAL PROJECT INFORMATION:
1. Estimated Cost of Construction: $ $60,000
2. If Commercial project,what is the proposed use: N/A
3. Source of Heat (circle one): Gas Oil I Propane Solar Other
Fireplaces need a separate Fuel Burning Appliances&Chimney Application
4. Are there any structures not shown on the plot plan? YES NO xplain:
5. Are there any easements on the property? YES NO
6. SITE INFORMATION:
a. What is the dimensions or acreage of the parcel? .23 acres
b. Is this a corner lot? YES I NO
c. Will the grade be changed as a result of the construction? YES r NO
d. What is the water source? PUBLIC � VKIVA I t VVtLL J
e. Is the parcel on SEWER or a PRIVATE SEPTIC system? Private Septic
Town of Queensbury Building&Code Enforcement Addition/Alteration Application Revised March 2018
aDECLARATION:
1. 1 acknowledge that no construction shall be commenced prior to issuance of a valid permit and will be
completed within a 12 month period.
2. Ifthework is not completed by the 1 year expiration date the permit may be renewed, subject to
fees and department approval.
3. 1 certify that the application, plans and supporting materials are a true and complete statement and/or
description of the work proposed, that all work will be performed in accordance with the NYS Building
Codes, local building laws and ordinances, and in conformance with local zoning regulations.
4. 1 acknowledge that prior to occupying the facilities proposed I, or my agents, will obtain a certificate
of occupancy.
5. 1 also understand that I/we are required to provide an as-built survey by a licensed land surveyor of all
newly constructed facilities priorto issuance of a certificate of occupancy.
I have read and agree to the above:
PRINT NAME:
SIGNATURE: / DATE: �v
Town ofQueensbury Building&Code Enforcement Addition/Alteration Application Revised March 2018
l.
_ SEPTIC DISPOSAL PERMIT APPLICATION Office Use Only
-� 742 Bay Road,Queensbury,NY 12804
Town ofQacensburp p.518-761-8256 www.aueensburv.net Permit#: Q4' 8 l4 `'2-Q 11bo
Tax Map ID#: 289.10-1-14 Permit Fee:$ ; Invoice#: D 244
Project Location: 23 Jay Rd Septic Variance? Yes L" No
Primary Owner(s) Higley Lake Property LLC
Mailing Address 31 Chestnut Ridge Rd, �� _ s O b ury NY 12804
Phone & Email
518-792-1497 ghigley@gmail.com
.installer/Builder , Cifone Construction i
Mailing Address I PO Box 684, Glens Falls NY 12801
Phone & Email I 518-792-9242 mcifone@cifone.com
Engineer I Hutchins Engineering
1 Mailing Address I 169 Haviland Rd, Queensbury, NY 12804
Phone & Email ( 518-745-0307 tutchins@hutchinsengineering.com
Contact Person for Building&Code Compliance: Phone:
RESIDENCE INFORMATION:
Year Built #of bedrooms X gallons per bedroom =total daily flow Garbage Grinder Yes no
1980 or older Installed? (circle one)
1981-1991 Spa or Hot Tub Yes Oo
Installed? (circle one)
1992-Present Design to 3 I 110 330
PARCEL INFORMATION:
Topography V Flat Rolling Steep Slope %Slope
Soil Nature '/ Sand Loam Clay Other
Groundwater At what depth? See Plan
Bedrock/Impervious material At what depth? I See Plan See Plan
-Domestic Water Supply � _Municipal Well(if well,water supply from any septic system absorption is
Percolation Test I Rate: 3:40 per minut@ lamr inch (test to be completed by licensed engineer/architect)
PROPOSED SYSTEM FOR NEW CONSTRUCTION:
Tank size gallons(min.size 1,000 gallons,add 250 gallons for each garbage cylinder or spa/hot tub
System Absorption field with#2 stone Total length ft.; Each Trench ft.
Seepage Pit with#3 stone How many: ;Size:
V Alternative System Bed or other type: 15'X 25' Absorption Bed
Holding Tank System Total required capacity? ;tank size ;#of tanks
NOTES: 1.Alarm system&associated electrical work must be inspected by a Town approved electrical inspection
agency,2.We will no longer allow systems to be covered until such time as an as-built plan is received and approved.
The installed system must match the septic layout on file—no exceptions.
Declaration:Any permit or approval granted which is based upon or is granted in reliance upon any material
representation or failure to make a material fact or circumstance known by or on behalf of an applicant,shall be void. I
have read the regulations and agree to abide by these and all requirements of the Town of Queensbury Sanitary Sewage
Disposal Ordinance.
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PRINT NAME: o " �' I_T— CIA
1 � �\ DATE:1 5
SIGNATURE: DATE:(�8
i
Town of Queensbury Building&Code Enforcement Revised February 2017
4" MINIMUM TOPSOIL ON
O i APPROXIMATE ENTIRE BACKFILL AREA; P '
VERHEAD ELECTRIC SERVICE EXISTING GRADE 15' BED KIDTH SEED AND ESTABLISH TURF 1
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USH AND BACKFlLL WITH •Y .::.. :::::::':::::. ., FILL AS NECESSARY 4 SDR-35 PVC PERFORATED - .'
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GRANULAR MATERIAL f � . . ...... ._...._........... ......... .... .... .,. . � = FILTER FABRIC, �.. 9 Y P rtY�
y . :::::.: ;< A., ��w <:; :, �. : :. TO LEVEL AREA LATERAL INSTALLED NEAR
REMOVE STAINED OR _ ;
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ROUTE TO NEW DISTRIBUTION BOX
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ABSORPTION BED PROFILE
EXISTING FORCEMAIN- ` NTS (mow""3 ` - � y
dines,:3•_ t(> � 4€-- ?u^:- -2� >`�,x�:.:$r+�>•,
SEPTIC_ PLOT P PERMIT PLOT_ PLAN SETBACK _ "
I HAVE SE LAN, I HAVE PER 4 PERFORATED PVC LATERALS
LIMIT OF 15 x25 ,
PERSONALLY MEASURED THE DISTANCE �.�
� STONE BED r INSTALLED NEAR LEVEL 1N N, y�,. - 1 ,�,T'•EN OR OBSERVED ALL OB ECTS BED CONFIGURATION
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SUCH AS HOUSES, WELLS, TREES, FENCES, ETC FROM THE PROPERTY LINES, TO THE � PROPOSED
SHOWN ON THIS DOCUMENT.I HAVE PERSONALLY OPO D RUCTURE(S) 0 S G S) SITE LDG4TION NEIGHBORHOOD MAP
SUREDT CE SET FORTH ON THIS DIAGRAM. ,� DISTRIBUTION BOX
SIGN E �... .. TRANSITION FORCE
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SETBACK ✓ f . OUTSIDE OF D-BOX SHALL BE AS SHOWN ON THIS DRAWNG AND IN ACCORDANCE WITH THE N.Y.S. DEPARTMENT OF'j f, ::J.:r.:-,.f.,i-';.i:d+�i„:�=:is�%•:-�.;�:•�w.✓-.__:}::-k ..-:...�::i.:.'::..r.��d;�i..r _ ::x ,1�'.":.,H.1::: t:�Ky/t•�w:���:LAKE
{A� K ; , : CONSTRUCTION
L KE !N..., 1 l- l:r.J�i.✓�,:..�:.._\..i✓�.�:.�j S�.. .,.,�.:,.1-::,"%,;�,..'\;i....:\\t'.�.:.�;w:..J�.`..J�:t:,;l;_...:, S..:...J y:
s ✓ : :;� wf ' "n �` HEALTH INDIVIDUAL HOUSEHOLD SYSTEMS AND ASTM F481 INSTALLATION .OF THERMOPLASTIC PIPE AND
,dy ... ..,. .�+,.~S �- I R x t
�Ct>•.."..,�'.,.,'C!..,'�';�_\ \✓•..: ,..:':..-?,M!'....'\�..,:�,y1c_:,...\c,;.._,,iy.,y...:a;-.... .r"`,t ,' i�.:;.,.'.. i
\ 5_'� ,�, �` ✓ ✓ :✓ 'M'� ✓ CORRUGATED TUBING IN SEP71C TANK LEACH FIELDS.
\ �� „ .., �_ I ,: !. Pw•�`••x...°_G.:.in..,::;.-4,., ::H;�S::«./:.�,+...✓::,".,,��'"a-'ti�••�hfx�' � �j':".4
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� ✓ .�y . �� ✓ ✓ ✓ ✓ �� ✓ �; ;✓ � ✓ �✓ ✓ w✓ ,,,� ;�✓ ,� .,� ,� ::Y;�,, AFTER EXCAVATION OF 15 WIDE X 25 LONG ABSORPTION BED TO THE DEPTHS REQUIRED, THE WALLS AND
15' . .... ............................ .... .._..............._ ... _.
FLOOR SHALL BE CLEANED AND RAKED IN ORDER TO LOOSEN SMEARED AREAS OF SOIL.
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PLACEMENT OF CRUSHED STONE, PERFORATED PIPE AND FILTER FABRIC SHALL BE AS SHOWN, AND CARE SHALL
BE EXERCISED TO AVOID INCLUSION OF FINE GRAINED SOILS AND WASTE MATERIAL 1N THE STONE AND PIPE.
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THE PIPE SHOULD BE LAID AT THE GRADES INDICATED, MAINTAINING STRAIGHT CONTINUOUS GRADES WITHOUT
r - f- -> :� ,.aa=,..;t;A.:%: SAGS, HUMPS, SEPARATED JOINTS, OR OTHER UNSUITABLE CONDITIONS. PIPE SHALL BE LAID WITH HOLES DOWN
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WASTEWATER SYSTEM PLAN _ �--���:2.5' r .�.,•.w ;` h M,�...,.., d : ��-4 ; ,. ;\�::-� ,�;x...� d_ � , ..� j ; {
5.�• .,.. .}: >_.< ..- - "..;::: i �;..;,... IN ALL CASES
„— , :b.Y . . , .'].� .^w.� < k ., a„ 'T. \k
,..tr _s s ... _.e'"}_<' p_r" :, e'.`:. �'.i..s"*..i',..f x_f....
- - SCALE: 1 -20 �,.�. •,.. ,.�..��....3�:.�,:...:.. �,:.,`:..�� ;... .. a .. .,.,1. . F,;.i
25' ,{� ALL DISPOSAL FIELDS SHALL BE GRADED TO SHED RAINFALL AND DIVERT SURFACE RUNOFF AWAY FROM THE
GRAPHIC SCALE �� ABSORPTION BED PLAN DISPOSAL FIELD.
10 0 5 10 20 40 � NTS
DO NOT USE HEAVY EQUIPMENT WITHIN THE ABSORPTION AREA AFTER PIPING HAS BEEN INSTALLED.
( IN FEET )
1 WASTEWATER SYSTEM DESIGN THE WASTEWATER 7REA7MENT SYSTEM IS DESIGNED AND APPROVED BASED UPON THE INSTALLATION OF WATER
CONTRACTOR TO FIELD VERIFY LOCATIONS AND DISTANCES 2-BEDROOM RESIDENCE (DESIGN TO 3-BEDROOM) CONSERVING FIXTURES AND A DESIGN FLOW OF 110 GPD PER BEDROOM. THE SYSTEM IS NOT DESIGNED TO
THIS IS NOT A FIELD SURVEY. 1 DESIGN FLOW - 110 GPD/BEDROOM ACCOMMODATE EXTREME WATER USE FIXTURES, SUCH AS JACUZZI-TYPE SPA TUBS OR WATER TREATMENT
SYSTEM DESIGN FLOW - 330 GPD EQUIPMENT. THE INSTALLATION OF NON-CONSERVING WATER FIXTURES OR EXTREME WATER USE FIXTURES IS
SEPTIC TANK - EXISTING 1,000 GALLON PRECAST CONCRETE CONTRARY TO THE APPROVAL OF THIS WASTEWATER TREATMENT SYSTEM.
PUMP STATION - EXISTING 500 GALLON PRECAST CONCRETE
1 1 ROOF, FOOTING, GARAGE, CELLAR AND SURFACE WATER DRAINAGE MUST BE EXCLUDED FROM THE WASTEWATER
1 APPLICATION RATE TO EXISTING SOIL: .95 GPD/SF, BASED ON SYSTEM.
1-5 MIN/IN PERCOLATION RATE
CONSTRUCT DRAINAGE SWALE UPGRADE OF SYSTEM IN ORDER TO DIVERT SURFACE RUNOFF AROUND
ABSORPTION BED AREA REQ'D = (330 GPD)/(.95 GPD/SF) ABSORPTION FIELD.
= 348 SF
1 SYSTEM MATERIAL SPECIFICATIONS
1 1 ABSORPTION BED AREA PROVIDED - 15 X25' - 375 SF ABSORPTION BED AGGREGATE
STONE IS TO BE 3/4' TO 1-1/2' WASHED CRUSHED STONE.
POTABLE WATER SUPPLY IS ON-SITE WELL
FILTER FABRIC
MAINTAIN 50' MINIMUM SEPARATION BETWEEN SEP71C TANK & WELL FILTER FABRIC TO BE 4.8 OZ/SY NON-WOVEN SEPARATION FABRIC, TENCATE MIRAFI 140N OR EQUIVALENT
MAINTAIN 100' MINIMUM SEPARATION BETWEEN ABSORPTION FIELD & WELL TOPSOIL
1 SITE SOILS DATA PLACE 4" MINIMUM TOPSOIL OVER EN71RE BACKFILL AREA. SEED, MULCH, AND ESTABLISH TURF.
- 1
1 TEST PIT
TP-1 - 7/9/14 BY T• HUTCHINS, P.E. �-
I _ " -
1 0 18 DARK TOPSOIL {JEW y
1 18-36' - RED LOAMY FINE SAND, COBBLES & BOULDERS �� S HU APR 0 5 20% -�
36-70" - REDDISH BROWN COARSE SAND WITH BOULDERS 4� p�P 'Si
_ R0015 TO 48" c �� °C TO OF QUEENSBURY FAX MAP # 2'89..�0- -14
NO MOTTLING * C3 2 BUILDING&C0�{ -.�F THIS DOCUMENT EXCEPT BY A UCENSED PROFESSIONAL
ENGINEER IS A VIOLATION OF NYS EDUCATION LAW.
1 NO EVIDENCE OF SEASONAL HIGH GROUNDWATER TABLE
i 1
F� 7
1 PERCOLATION TEST
1 1 PT-1 - 7/9/14 BY T. HUTCHINS, P.E.
1 STABILIZED PERCOLATION RATE OF 3 MIN. 40 SEC. PER INCH
MAP REFERENCE: 0 ISSUED FOR PERMIT 415118
1. BASE MAP INFORMATION FROM "MAP OF A SURVEY MADE FOR DONALD E. No. Revisions Date
& MARILYN HIGLEY,' SITUATED IN THE TOWN OF QUEENSBURY, WARREN
COUNTY, NEW YORK. DATED APRIL 1Z 1982. PREPARED BY VAN DUSEN &
S7EVES LAND SURVEYORS WASTEWATER SYSTEM PLAN & DETAILS
2. ADD17IONAL INFORMATION FROM "MAP OF SURVEY OF LANDS OF VICTOR
H. CELADON," SITUATED IN THE TOW4 OF QUEEMSBURY, WARREN COUNTY, prepared for:
NEW YORK. DATED AUGUST ASSOGATES, LAND SURVEYORS.14, 2012. PREPARED BY W.J. ROURKE Higley Lake Property, .LLC
3 NORTHERLY NEIGHBORING WELL. LOCATION (ROURKE PARCEL) INFORMATION 23 JayRoad
Dig Safely. SITUATEDI N THEFROM P OF TOWOF QUEENSBURY, WARREN COUNTY, NEW YORK. Town of Queensbu Warren County, NY
VEY OF LANDS OF WWAM. & TORI ROURKE,
New York ry
®��Before You otg DAZED DECEMBER 4, 2014. LAST REVISED APRIL 24, 2017. PREPARED 8Y
■Wait The iredThne W.J. ROURKE ASSOCIATES, LAND SURVEYORS Drawn: JRS I Checked: GTH I Scale: NOTED I Date: 41312018
®Confirm uq�Rosimnse 4. S17E SOILS" INFORMATION FROM `WASTEWA TER REPLACEMENT PLAN,
■ftopeat The Marks PREPARED FOR VICTOR H. CELADON, JOB NUMBER 29759-01,' SITUATED 169 Haviland Road
■Dig With Care IN THE TOWN OF QUEENSBURY, WARREN COUNTY, NEW YORK. DATED Queensbury, NY 12804
800-962■7962 MARCH 24, 2014. LAST REVISED JULY 17, 2014. PREPARED BY HUTCHINS (518) 745-0307 Phone 291275-01
WW,,A ENGINEERING Hutchins Engineering (518) 745-0308 Fax
r; ,s Sep. 17. 2018- 1 43P MDIA.��, ^,„�_, N ..\:%?`/::\i..;;Ae;ssz,.�cam' ';•",c: •..
; MIDDLE DEPARTMENT INSPECTION AGENCY, INC. re
:\,,,
Ter that the electrical wiring to the electrical equipment listed below has been examined and is approved as ,'�
7:45 being in accord with the National Electrical Code, applicable governmental, utility and Agency rules in effect on the date -�;
r noted below and is issued subject to the following conditions. fir'.?
%` Owner: Higley Date: 09/10/2018 ••f j
`j Occupant: 1St Floor Locatio
a Jay Road r��)
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Occu anC Queensbury, Warren Co, NY <<%
C�) . -Single Family Dwg.
:;., Applicant: -�`
s Cifone Construction ___-.:•.•.._._,_-- , '
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>> PO Box 684 - , .. �;
;c) Glens Falls, NY 12801. ,. • (, )
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%. Joseph A.Holmes -'
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. •144005103822EL )
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Equipment: - '- (1
L.?)1 -200 Amp- Sub Panel; 26-Switches;48-Receptacie5;'52`-F',xtCfres;1 Bumer,Wiring &Control For Gas; 1 -Well
•� Pump; 1 -20 Amp Garbage Disposal; 1.-20 Amp Dishwasher; 1 -30 Amp Receptacle; 5-Smoke Detectors; 27-Arc �%
iC)Fault Breakers .)
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/. This certificate applies to the electrical wiring to the electrical equipment listed immediately null and void. This cer fiicate 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 nerx+n. Upon a change in the use,occupanorownership
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,')) inspection. No warranty is expressed of implied as to the mechanical safety.effi- of the properly indicated above,this certificate St1aP be immediately null and void, \(.
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ciency or fitness of the equipment for any particular purpose. This certifiicete shalt In the event that this certificate becomes invalid based upon the above conditions, r'i
��%. be valid for a period of one year from the above noted date. Should the electrical this certificate may be revalidated upon reinspeGtion by Middle Department
C.•) 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 l.;;)
s'=» ed to,the introduction of additional electrical equipment and/or the replacement of Department Inspection Agency, Inc. to initiate the inspection end revalidation \`
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/�) any of the components installed as of the above noted date,this certifCate Shalt be process. A lee will be charged for this service. '-;
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