electrical RX Date/Time 02/0912021 11:28 15182731202 P.005
Feb, 9. 2021111 :07ANMMDIA� No. 5780 P. 5/5
MIDDLE DEPA►RTm-zNT INSPECTION AGENCY, 1NC.
i r; �that the electrical wiring to the electrical equipment fisted below has been examined and is approved as
being in accord with the National Electrical Code, appficable''govemmental, utility and Agency rules in effect on the date
noted below and is issued subject to the following conditions.
Owner. date:
Dale Woodard 01/29/2021
Occupant: Location:
Modular 4 Richardson St.
Occupancy: Queensbury,Warren Co. NY
,Single Family Dwg. 7Applicant:)
Sean Breault
36 McCrea St
Fort Edward, NY 12323
L J
No.
.318014131423EL
Equipment: Q-C^ O V�D� - 2D LO
00 Amp. Service Equipment;4/0 Service Conductor, 1 -GFCI Receptacle; 1 - 100 Amp Feeder to Home
GC E 0 V E
FEB 10 2021
TOWN OF QUEENSBURY
BUILDING&CODES
This certificate applies to the electrical wiring to the electrical equipment listed immediately null and void. This cer,ificete applies only to the use,occupancy and
above and the instzllation inspected es of the above noted Oats based on a visual ownership as indicate0 herein. Upon a change in the use,occupancy or ownership
inspection. No warranty I-expressed or implied as to the mechanical safety,effi• of the property indicated above,this cer5icate shall be immediately null and void,
ciency or fitness of the equipment for any particuler purpose, This certlfio3ie 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
,system to which this certif+cate applies be altered in any way,including but not limit- Inspection Agency,Inc, An application for inspection must De submitted to Middle
ed to,the introduction of a00Nonal electrical equipment and/or 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 fee will be charged for this service.