electrical inspection ,"� nu io. LU a r .. ,_,,, No. 4826 P. 2/2
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nt, MIDDLE DEPARTMENT INSPECTION AGENCY, INC. ;�
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��� that the electrical wiring to the electrical equipment listed below has been examined and is approved as
jj being in accord with the National Electrical Code, applicable governmental, utility and Agency rules in effect on the date r i
0 noted below and is issued subject to the following conditions. t j
jes,1 Owner: Rubin Ellsworth ��
Date: 08/21/2018 C'�
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t. Occupant: Location:.. <<'•?�
�� Pool n'S Ellsworth Road 0
0<- Occupancy- Queensbury,Warren Co. NY 1
J Swimming Pool ll-'��
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<<j Applicant: .
�� Thomas S. Hohman Electric • • .:. '%
it Thomas Hohman •
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. 1668 Ridge Rd. . ' . ::...__• .. ._ �;
�� L Queensbury, NY 12804' - • �>>
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{� Joseph A.Holmes • . (0
No. 146884104873EL - - - - - it
(t. Equipment: :... .. . • • r,0
1 -Chlorinator; 1 -Easy Touch Panel;-1--GFI-Rebeptable 2.-'Fixtures;'1"='Burner, Wiring &Control For Gas: 1 -Pool ..k..
J Pump . . <<;�
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�C� This certificate applies to the electrical wiring to the electrical equipment fisted immediately null and void. This certificate applies only to the use,occupancy and V.Z,
�`� above and the installation inspected es of the above noted date based on a visual ownership as indicated herein. Upon a change in the use,occupancy or ownership `J�
(4_A 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-
t', 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, `>.'
.'�, 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 4.
( 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 t i
ited to,the introduction of additional electrical equipment and/or the replacement of Department Inspection Agency, Inc.to initiate the inspection and revalidation 0
(tN 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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