MC-19-678Permit No.: MC -03-19-679
Miami Shores Village Permit Type: Mechanical - Residendal
10050 NE 2 Ave
Miami Shores FL 33138 Work Classification: A/ Replacement
305-795-2204 nom. .i..„•. A --.--A
Issue Date: 04/03/2019 1 Expiration: 09/25/2019
Location Address Parcel Number
102 NW 94TH ST, Miami Shores, FL 33150 1131010330740
Contacts
JOHN ROIG Owner SERVICE EXPERTS HEATING & AIR Contractor
102 NW 94 ST, MIAMI, FL 331502240 CONDITIONING
CAREY ZARM
1209 POTOMAC, MERRITT ISLAND, FL 32952
Business: 3052642020
Description: EXACT CHANGEOUT 4 TON A/C PACKAGE UNIT Valuation: $ 15,500.00 Inspection Requests:
4949
WITH 9 KW HEATER
Total Sq Feet: 0.00
Fees
Amount
Application Fee - Other
$50.00
CCF
$9.60
DBPR Fee
$8.14
DCA Fee
$5.43
Education Surcharge
$3.20
Permit Fee
$492.50
Scanning Fee
$9.00
Technology Fee
$13.56
Total:
$591.43
Payments
Date Paid Amt Paid
Total Fees
$591.43
Credit Card
03/29/2019 $50.00
Credit Card
04/03/2019 $541.43
Amount Due:
$0.00
Building Department Copy
In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations
pertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores
Village. In accepting this permit I assume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate
permits are required for ELECTRICAL, PLUMBING, MECHANICAL, WINDOWS, DOORS, ROOFING and SWIMMING POOL work.
OWNEAS AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws
regula4rlg cgrstruction avid zoning. Futhermore, I authorize the above named contractor to do the work stated.
re: Owner / Applicant / Contractor / Agent
Date
April 03, 2019 Page 2 of 2
Miami Shores Village RECF:jVF'D
Building Department M 2 9 2019
10050 N.E.2nd Avenue, Miami Shores, Florida 33138 BY.
Tel: (305) 795-2204 Fax: (305) 756-8972
INSPECTION LINE PHONE NUMBER: (305) 762-4949 /
FBC 20
BUILDING Master Permit No.
PERMIT APPLICATION Sub Permit No.
❑BUILDING
❑ ELECTRIC
❑ ROOFING ❑ REVISION ❑ EXTENSION
❑RENEWAL
❑PLUMBING
EdMECHANICAL
❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION
❑ SHOP
I
0 � NW
L� 'CONTRACTOR
� ���.,
DRAWINGS
JOB ADDRESS:
1
`
City:
Miami Shores
: Miami Dade Zip:
Folio/Parcel#:
I 1 10
1 ' Q
y�nCoun
' b (40 Is the Building Historically Designated: Yes
NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
I' ,^, C zz
OWNER: Name (Fee Simple Titleholder): '-Ta Vl �( Phone#: 6"5 ' T�? ' W 1n
q
Address:
�l o Z MW
/64
City: 1 �6 t a&-4iStater Zip: " r
/b
Tenant/Lessee Name: Phone#:
Emai I CW DS SaU fh, tje'
CONTRACTOR:•CQmpany Name:'
Address: G IN -1 IyW
City: D MS
�C/I VI C:QJ
• ,Phone# �`•���' �n
Qualifier Name: 1 11 - E��/++fza" n / Phone#:
State Certification or Registration
U. C, `/ J 91 ! I �� Certificate of Competency #:
DESIGNER: Architect/Engineer: Phone#:
Address: City: State: Zip:
Value of Work for.this Permit: $ ' J00� Square/Linear:Footage'of Work:
Type of Work: ❑ Addition 'A"I
yp ❑ Alteration New r Repair/Replace Demolition
T
Description of Work: c►' Ci
UJK( -f - W J !q Kw r
Specify color of color thru tile:
Submittal Fee $S�)' oz� Permit Fee $
Scanning Fee $ Radon Fee $
Technology Fee $ Training/Education Fee $
Structural Reviews $
(Revised02/24/2014)
CCF $_
DBPR $
CO/CC $
Notary $
Double Fee $
Bond $
TOTAL FEE NOW DUE $
Bonding Company's Name (if applicable)
Bonding Company's Address
City
State
Mortgage Lender's Name (if applicable)
Mortgage Lender's Address
City
State
Zip
Zip
Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation has
commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all laws regulating
construction in this jurisdiction. I understand that a separate permit must be secured for ELECTRIC, PLUMBING, SIGNS, POOLS,
FURNACES, BOILERS, HEATERS, TANKS, AIR CONDITIONERS, ETC.....
OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all
applicable laws regulating construction and zoning.
"WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY
RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND
TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING
YOUR NOTICE OF COMMENCEMENT."
Notice to Applicant: As a condition to the issuance of a building permit with an estimated value exceeding $2500, the applicant must
promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person
whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site
for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the
inspection will not be approved and a reinspection fee will be charged.
E
Signature -P, - -R '
OWNER or AGENT
The fore oing instrument was ack owI dged before me this
�da i q4 20 by
who is personally known to
me or who has produced as
identification and who did take an oath.
A{LY P& JESSICA ACOSTA
NOT?PUC:'����Commission#GG096T44
Expires May 13,2021petde80dedThmou NotarySe"b"
Sign:
PrintSSS I'-OS1
Seal:
Signature—
CONTRACTOR
ignatureCONTRACTOR
The foregoing instr4iment was acknowledged before me this
day of 2 by
L. w(o is personally know to
me or who US produced as
V*��
JESSICAACOSTA
identification and wa aOD946lon#GG 098744
3.2021
NOTAf)UBLIC• 1,gt1'OUmdedpTl uBudgetlNotaryseeMces
Sign:_
"I
Print:
Seal:
VIns
APPROVED BY Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)
3/29/2019 Property Search Application - Miami -Dade County
0 0
F.FICE F THE PROOP"'ERTY APPRAISER
.. .
Summary Report
Property Information
Folio:
11-3101-033-0740
Property Address:
102 NW 94 ST
Miami Shores, FL 33150-2240
Owner
JOHN R ROIG &W LEESA
Mailing Address
102 NW 94 ST
MIAMI, FL 33150-2240
PA Primary Zone
0800 SGL FAMILY - 1701-1900 SQ
Primary Land Use
0101 RESIDENTIAL - SINGLE
FAMILY: 1 UNIT
Beds / Baths / Half
2 / 1 / 0
Floors
1
Living Units
1
Actual Area
1,757 Sq. Ft
Living Area
1,379 Sq. Ft
Adjusted Area
1,631 Sq.Ft
Lot Size
10,017.12 Sq.Ft
Year Built
1938
Assessment Information
Year
2018
2017
2016
Land Value
$220,646
$220,646
$220,646
Building Value
$122,325
$113,518
$113,518
XF Value
$1,628
$1,646
$1,664
Market Value
1 $344,599
$335,810
$335,828
Assessed Value
1 $105,700
$103,526
$101,397
Benefits Information
Benefit
Type
2018
2017 2016
Save Our Homes
Cap
Assessment
Reduction
$238,899
$232,284 $234,431
Homestead
Exemption
$25,000
$25,000 $25,000
Second Homestead
Exemption
$25,0001
$25,000 $25,000
Note: Not all benefits are applicable to all Taxable Values (i.e. County, School
Board, City, Regional).
Short Legal Description
MIAMI SHORES SEC 6 PB 10-39
LOT 1 & E1/2 LOT 2 BLK 133
LOT SIZE 81.440 X 123
OR 9324 481
Generated On : 3/29/2019
Taxable Value Information
2018
2017
2016
County
Exemption Value
$50,000
$50,000
$50,000
Taxable Value
1 $55,700
$53,526
$51,397
School Board
Exemption Value
$25,000
$25,000
$25,000
Taxable Value
$80,700
$78,526
$76,397
City
Exemption Value
$50,000
$50,000
$50,000
Taxable Value
$55,700
$53,526
$51,397
Regional
Exemption Value
$50,000
$50,000
$50,000
Taxable Value
$55,700
$53,526
$51,397
Sales Information
Previous Sale Price OR Book -Page Qualification Description
04/01/1976 1 $37,500 00000-00000 1 Sales which are qualified
The Office of the Property Appraiser is continually editing and updating the tax roll. This website may not reflect the most current information on record. The Property Appraiser
and Miami -Dade County assumes no liability, see full disclaimer and User Agreement at http://www.miamidade.gov/info/disclaimer.asp
Version
A �® CERTIFICATE OF LIABILITY INSURANCE
DA��019W�
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(les) must have ADDITIONAL INSURED provisions or be endorsed. If
SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement A statement on this
certificate does not confer rights to the certificate holder in lieu of such endorsement(s).
PRODUCER
Aon Risk Services southwest, Inc.
Dallas TX Office
CONTACT
NAME'
P�, E,): (866) 283-7122 FAR No.: (800) 363-0105
EMAIL
ADDRESS:
CityPlace Center East
2711 North Haskell Avenue
suite 800
Dallas TX 75204 USA
INSURER(S) AFFORDING COVERAGE NAIL #
INSURED
MSURERA: Westchester Fire Insurance Company 10030
Service Experts Heatinq
& Air Conditioning LLC
3820 American Drive, #200
INSURER B: ACE American Insurance Company 22667
INSURER C:
INSURER D:
Plano TX 75075 USA
INSURER E:
INSURER F:
MED EXP (Any amperson) Excluded
COVERAGES CERTIFICATE NUMBER: 570075386805 REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. Limits shown are as requested
INSR
LTR
TYPE OF INSURANCE
AUDI
IINSDWVD
POLICY NUMBER
LIMITS
X COMMERCUILGENERALLvaLrrY
XSLG A
EACH OCCURRENCE $500,000
CLAMSMADE ❑X OCCUR
SIR applies per policy to
& conditions
$500,000
PREMISES Ea ocarmnee
MED EXP (Any amperson) Excluded
X Includes CaMracUtal Liability
PERSONAL& ADV INJURY $500,000
GEN'LAGGREGATE LIMIT APPLIES PER:
GENERALAGGREGATE $10,000,000
POIJCY � JECT ❑Lac
PRODUCTS - COMPIOPAGG $2,000,000
OTHER:
SIR $5U0, 000
B
AUTOMOBILE LIABILITY
Y
Y
ISA H25276139
03/22/2019
06/30/2020
COMBINED SINGLE LOAMfEa accident) $2,000,000
BODILY INJURY ( Per person)
X ANY AUTO
BODILY INJURY (Per aoriderW
OWNED SCHEDULED
AUTOS ONLY AUTOS
HIRED AUTOS NON -OWNED
PROPERTY DAMAGE
ONLY AUTOS ONLY
A
UMBRELLA LIAB
XJ
OCCUR
Y
Y
646614094003
03 22 2019
06/30/2020
EACH OCCURRENCE S4,000,000
X
EXCESS LIAB
CLAIMS -MADE
AGGREGATE $4,000,000
DED I RETENTION
B
B
WORKERS COMPENSATION AND
EMPLOYERS' LY1BILnY
EMPLOYERS
ANY PROPRIETOR / PARTNER / EXECUTIVE Y I N
OFFICERIMEMBEREXCLUDED?
(Mandatory in NH)
NIA
Y
WLRC65893022
AOS
WLRC65896357
AOS
01/22/2019
03/22/2020
5372-272020
06/30/2020
TH-
X I SSTA7IJTE 10TH_
ER
E.L. EACH ACCIDENT $1,000,000
E.L. DISEASE -EA EMPLOYEE $1,000,000
D es, IPTIOe OF er
DESCRIPTION OF OPERATIONS below
O
E.L. DISEASEPOLICY LOU $1,000,000
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks SdmduK may be attached B more spa,, b: req dr m
License #CAC1817129 RE: A/C installation. Certificate Holder is included as Additional Insured in accordance with the policy
provisions of the General Liability, Automobile Liability and Excess Liability policies. General Liability and Automobile
Liability policies evidenced herein are Primary and Non -Contributory to other insurance available to an Additional insured, but
only in accordance with the policies provisions. A waiver of subrogation is granted in favor of Certificate Holder in
accordance with the policy provisions of the General Liability, Automobile Liability, Excess Liability and workers'
Compensation policies. see attached notice of cancellation endorsements.
CERTIFICATE HOLDER CANCELLATION
Miami Shores village Building Department
10050 NE 2 Avenue
Miami shore FL 33138 USA
SHOULD ANY OF THE ABOVE DESCRIBED POLICES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED N ACCORDANCE WITH THE
POLICY PROVISIONS
01988-2015 ACORD CORPORATION. All rights reserved.
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Drive
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Service Experts b 110
Pak
1 HEATING &'AIR CONDITIONING Jupiter, FL93458
Customer Name:�`—
Street Address: IbZ
City: f_ti M i t r(r? e State: ,L Zip: Emall:
PrimaryPhone: 7 'cN LQ 77- Secondary Phone:
Service Address: L142
O Annual rgmlr and rnsintenerm camps O M bcffi end federal pemrs and code compl once
O Hundreds of dollars in average repair 9who O Fully bonded, focused NO Insured `
O No deductible O Mdm* Acrxedlted A+ BBB Rathg
-O T019-*M:L2 Yearfs)- - - — -- - - — --- - -- -- - - - ---- -
Equipment
Model/ADW
Desc i0on
Part Warranty
O Outdoor
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O Outdoor
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yaarts}
O Indoor
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O Indoor�reer(s)
O 1AQ
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O IAQ
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O Insulation
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MIN ■0749
West Palm Beach: 661.88 M41
Boca Raton: 581.285A949
Steart 712.286.1699
.hipper: 561.744.2790
1An
WI
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O Heconned mODI; duct work
OAdd SM*
O Add Realm
O Insuft dud work
O Seel dud work
O fiance air flow
-O RecOmw wising wking. -
O Clan NeScer
O Power dre dt
oconudwft
O Celrng sawn Idt w/auto mbff
O Gas PVM
O Rue PON O Ike Ural'
O o*simd re N@rsnd *fng
O Ardrifacbaal p ft cover
O condensate piping/pump
O Oondenser balstion pad
o VfbratiorlbIft bomiors
O con oft sir
O Gaon Wales' Her
O Replaced compmmras disposal
0 older
O Dmp dWAoor saver pmtecffon
O canplete cemlup A vacuundng
O Certflted mft% rand hwang
0 kMW ducts fa size and leakage
O t.cad micuistion rx www
o vertly Proper rebigeralrt dlerpe
Date of Sale w/ I i/ I I I I I Delivery Date i I
Dealer Number I I I I I I I I. r I I I I I I I I
O CASH O VISA O WC O AMD( O DISC O Check O Load $
Amount Financed . I r r I I I• r I I Loan Type
BY SIGNING BELOW, I AGREE TO THE TERMS OF THIS SERVICE ORDER, THE ATTACHED GENERAL
TERMS AND CONDITIONS, AND WHERE APPLICABLE, THE THIRD PARTY SERVICE NET WARRANTY,
UL TERMS AND CONDITIONS. I ALSO AGREE THAT I HAVE BEEN NOTIFIED VERBALLY OF MY RIGHT
TO CANCEL, THAT I HAVE RECIXD TWO COPIES OF THE NOTICE OF RIGHT TO CANCEL AND
WHERE APPLICABLE, ANYADDENDUDESC IBING�MjY RIGHTS UNDER STATE LAW.
Print CustDmhr Name o f a
Qualifying -
credH
'IIs6ales and Ited9e ate atrbjxt b appleelb ttterrlFa�ar Eetlla dMl codrjbtla
You, the buyer, may catoel this transaction at any time prior
Customer Stgn mala to mWrilTflt of the third business day ager the date of this
transacbt. See the notice of cancellation form for an
Custom gneture Date molar ldorl of ft right I
_4
Miami Shores Village
Building Department
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204
h Fax:(305) 756.8972
AIR CONDITIONING REPLACEMENT DATA
PERMIT NUMBER: MC
This form must accompany ALL air conditioning replacement permit applications. Each unit change -out must
•••Y
be on its own data sheet. Multiple units on single sheets are not acceptable. •
0000 0000..
Job Address (where the work is being done): 02- NLJ q+iJ `, •
0000..
City: Miami Shores Village County: Miami Dade Zip Colo f r% (9 ; • •..:
0000 YY . • •
•••• • •• •••••
ALL CONDENSING UNITS MUST BE ON A 4 INCH SOLID CONCRETE:j4�S••�••'
ALL UNITS MUST COMPLY WITH F.E.M.A MINIMUM FLOOD ELEVA�fli3�l. 00•• 0.00••
0000• .'
A COPY OF THE CONTRACT IS REQUIRED WITH ALL SUBMITAL$ ' : 0 0 0 * 0•:0
AHRI DATA SHEET REQUIRED • 0.0 .0
to -00
Change disconnecting means: YES M NO ❑ ARHI Sheet Attached: YES �NO El Contract Attach-d:YES
1. Minimum Circuit Ampacity (Wire Size): l>�
2. Maximum Overcurrent Protection (Fuse/Breaker Size): fl::� O
3. Voltage of Circuit (208/240/480): 2, T 0
4. Size Disconnecting Mea
Contractor's Company Name:
v (CZ.,
Phone: 305. 501+ 15; 3 0
State Certificate or Certificate of Competency No.
Signature Date: 3 26 l
ualifier's signature)
(Revised02/24/2014)
UNIT BEING REPLACED
DATA
NEW UNIT
ra Ne_
MANUFA URER
jj y1
Ci
O 2 I Ob
AHU oPKG. UNIT MODEL #
COND.bmf MODEL #
KW HEAT
cl K uJ
NOM TONS
/-�
AHU
CU PKG
1) M.C.A
AHU
CU PKG
AHU
CU PKG
2) M.O.P
AHU
CU PKG
AHU
CU PKG
3)VOLTS
AHU
CU PKG
PKG UNIT / /
PKG UNIT
Eq/SEER
YES
NO
R,EMDTTlTG DUCTS
YES
NO
YES
NO
REPLACING THERMOSTAT
YE
NO
YES
NO
NEW 4"CONCRETE SLAB
S
NO
YES
NO
NEW ROOF STAND
YES
0
YES
NO
NEW RETURN PLENUM BOX
77S
NO
1. Minimum Circuit Ampacity (Wire Size): l>�
2. Maximum Overcurrent Protection (Fuse/Breaker Size): fl::� O
3. Voltage of Circuit (208/240/480): 2, T 0
4. Size Disconnecting Mea
Contractor's Company Name:
v (CZ.,
Phone: 305. 501+ 15; 3 0
State Certificate or Certificate of Competency No.
Signature Date: 3 26 l
ualifier's signature)
(Revised02/24/2014)
v
This combination qualifies for a Federal Energy Efficiency tax Credit when
ANs CERTIFIED - placed in service between Feb 17,2009 and Dec 31, 2016. S,13
Certificate of Product Ratings
AHRI Certified Reference Number: 9989614 Date: 11-02-2018 Model Status : Active
AHRI Type: HSP -A • • • •
• • •••• • •••
Outdoor Unit Brand Name: LENNOX • • • •
Outdoor Unit Model Number (Condenser or Single Package) : LRP16HP48P • • • • • • • • • • so 00*
•
The manufacturer of this LENNOX product is responsible for the rating of this system combinaWn.• • • •
• • • • •
Rated as follows In accordance with the latest edition of ANSIIAHR12101240 with Addenda 1 and 2. Performance fta iVJ Lnitery ;, • • • •
Air-ColMltlaMrg & Mr -Source Heat Pump Equipment and subject to rating accuracy by AHRI-sponsored, hldependark uloid party testing:• •
Cooling Capacity (A2) - Single or High Stage (95F), btuh : 47000 : : • •
SEER :16.00 ; •' •
EER (A2) - Single or High Stage (95F) :12.00
Heating Capadty (H12)- Slagle or High Stage (47F):46000
HSPF
-•Active• Model status are loft that an AHRI CerlEAcatian Program Padldpait is coffer y producing AND sailing or offartg for sale; OR now models that aro being
marketed but aro not yet being produced. Productibn Stopped' Model Status are those that an ANN CerYM1talion Program PartldpaM Is no knger producing BUr Is still
left or oftering for sale.. --
DISCLAIMER
AHRI does not endorse the products) listed an this Certificate and makes no representations, warrentles or guarenteas as to, and assumes no responsibllity far,
the product(s) Isted on this Cerdi vt& AHRI owessiy disciaims all IfabtiMy for damat)ea of any kind arising out of the use or perfomcance of the product(4 or the
uneudumbad •llerstion of data listed on this Certificate. Certirtel ratings we veld only for models and configurations listed In the
directory at www ahrhNreetory.org.
TERMS AND CONDITIONS
This Certificate and Its contents are proprietary products of AHRI. Thls CarWIcals shall only be used for indhidual, personal and
conAderoft reference purposes The contents of this Cerdli ate may not, in whole or lin past be reprod m4 coplad; di sendki i k
entered into a computer database; or otherwise utilaed, In any form or moaner or by any means, emept for the user's Individual,
personal and oonfidentlel reWs=4 1HRRaAMM OMM HEATING,
CERTIFICATE VERIFICATION StREWtleI 1101IN'TITM
The Information for the model cited on this certiPoats can be vadfied at www.shrhdreatory or{, qkk an %%ft Cortitieato• Ink vie made IEe boast"
and enter the AHRI Certified Reference Number and the date on vfikh the ceftilcate was Issued,
which Is listed above, and the Certificate No, which Is listed at bottom d&
®20180 -Conditioning, Heating, and Refrigemdon Institute �i�.: 1�1,f
• ••
:if••: