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MC-15-2394 Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-243861 Permit Number: MC-9-15-2394 Scheduled Inspection Date: October 14, 2015 Permit Type: Mechanical - Residential Inspector: Perez,JanPierre Inspection Type: Final Owner: TIMINSKY,JOHN Work Classification: A/C Replacement Job Address: 1285 NE 104 Street Miami Shores, FL 33138-2659 Phone Number (305)495-0055 Parcel Number 1122320300010 Project: <NONE> Contractor: ARS/RESCUE ROOTER Phone: (305)235-7223 Building Department Comments A/C REPLACEMENT( 6 TONS 10 KW)TWO" CARRIERS" Infractio Passed Comments FRECUENCY DRIVE COMPRESSOR WITH WIFI INSPECTOR COMMENTS False TECHNOLOGY Inspector Comments Passed up Failed Correction Needed ❑ Re-Inspection ❑ Fee No Additional Inspections can be scheduled until re-inspection fee is paid. October 13, 2015 For Inspections please call: (305)762-4949 Page 28 of 69 -'Pa�if � C 5-2394 Miami Shores Village permit Tyre M@C 0%rqq�7s ident[ai r 10050 N.E.2nd Avenue NE IN �laSSlfi�t� �l� aCll�nt £ Miami Shores,FL 33138-0000 tiewa Phone: (305)795-2204 PernitStetriS �'tor�iuA w Expiration: 03/22/2016 Project Address Parcel Number Applicant 1285 NE 104 Street 1122320300010 JOHN TIMINSKY Miami Shores, FL 33138-2659 Block: Lot: Owner Information Address Phone Cell JOHN TIMINSKY 1285 NE 104 Street (305)495-0055 MIAMI SHORES FL 33138-2659 Contractor(s) Phone Cell Phone �.._._...... �m. $ 27,068.00 27068.00 ARS/RESCUE ROOTER (305)235-7223 Valuation.. uaatiti on: Total Sq Feet: 2779 Tons:6 Available Inspections: Additional Info:A/C REPLACEMENT(6 TONS 10 KW)TWO Inspection Type: Classification:Residential Final Approved: In Review Review Mechanical Comments: Date Approved: : In Review Date Denied: Type of Work: Scanning:3 Fees Due Amount Pay Date Pay Type Amt Paid Amt Due CCF $16.80 DBPR Fee Invoice# MC-9-15-57150 $14.21 09/21/2015 Check#:8253012( $50.00 $979.60 DCA Fee $14.21 Education Surcharge $5.60 09/24/2015 Check#:8253012' $979.60 $0.00 Permit Fee $947.38 Scanning Fee $9.00 Technology Fee $22.40 Total: $1,029.60 In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations pertaining thereto and in strict conformity with the plans,drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In accepting this permit I assume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are required for ELECTRICAL, PLUMBING, MECHANICAL,WINDOWS,DOORS,ROOFING and SWIMMING POOL work. OWNERS AFFIDAVIT: I certify that all the foregoing information is accur t and that all work will be done in compliance with all applicable laws regulating construction and zoning. Futhermore, I authorize the above-name ontra r to do the work stated. September 24, 2015 Authorized Signature:Owner / Applicant / or A Agent ate Building Department Co September 24,2015 1 Miami Shores Village SEP 2 1 2015 Building Department 10050 N.E.2nd Avenue,Miami Shores,Florida 33138 Tel: (305)795.2204 Fax:(305)756.8972 INSPECTION'S PHONE NUMBER:(305)762.4949 BUILDING Permit No. PERMIT,APPLICATION Master Permit No._Mc is-- 234 FBC 20 Permit Type: MECHANICAL T OWNER:Name(Fee Simple Titleholder): yck V! 4�--nk(I 14e,1<�(. Phonek 9d05-495-00450;& Address: 12805 OF 1254 `'T. W&Al gAoWZ jai jsg City:.W&.1,11 OCb-S• State: 4:L• Zip: 3,913 s Tenant/Le§see Name: Phone#: Email: JOB ADDRESS: �2SS �� �� ✓� . City: Miami Shores County: Miami Dade Zip: Folio/Parcel#:1=-*Z2�'0SCD ' 10 Is the Building Historically Designated: Yes NO Flood Zone: CONTRACTOR:Company Name: A.F—G/0z00 CJ-t;- Phonek 30`5-2 -722 Address: X872 SW Q�8 G{,t]Q+ City: State: Zip: 31 S7 Qualifier Name: Phonek- State Certification or Registration#:_(11-e,124�i q'JOG Certificate of Competency#: Contact Phonek �JO$. 87 A. 23 5 FS Email Address: P,SQAA.-r k,2.Q Gt-.LS .ca t DESIGNER:Architect/Engineer: Phonek a , Value of Work for this Permit:$ i Square/Linear Footage of Work:-21 7`j�' Type of Work: OAddress ❑Alteration ONew *epair/Replace ODemolition Description of Work: I-AG oguerLw ir. (6 a6-I M eu) "i= "(6 Am ***************************** s*******Fees******************************************** Submittal Fee$ ��o o Permit Fee CCF$ CO/CC$ Scanning Fee$ Radon Fee$ DBPR$ Bond$ Notary$ Training/Education Fee$ Technology Fee$ Double Fee$ Structural Review$ TOTAL FEE NOW DUE$ Bonding Company's Name(if applicable) Bonding Company's Address t City State Zip Mortgage Lender's Name(if applicable) Mortgage Lender's Address City State 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 ELECTRICAL WORK,PLUMBING, SIGNS, WELLS,POOLS,FURNACES,BOILERS,HEATERS,TANKS and 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&seeding $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 appy ved and a reinspection fee will be charged. R Sig Signature - Owner or Agent Contractor The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this�(N day of ,20 ,by �VL Gl. 1�1 K _, day of � ,20 ,by who is personally known to me or who has produced V who is personally known to me or who has produced_` As identification and who did take an oath. as identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: Sign: ' Sign: Print: FMIRG Print: NC H EZ =o• _ oary u i -Male or n a My Commission Expires = _ Notary Public Slate of Flo Co "'' My Comm.Expires Jun 22,2016 i�a1y Comm. Expires Jun 22,2018 o •� Commission # FF 134896 Commission # FF 134896 o�,� "0F 7 APPROVED BY 21" aj,�xanriner Zoning Structural Review Clerk (Revised 07/10/07)(Revised 06/10/2009)(Revised 3/15/09) �cOFFICE SEP 2 Y 2015 MiamF'Shores Village VM MW COPIBuilding Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel:(305) 795 2204 AIR CONDITIONING REPLACEMENT DATA Fax:(305) 756.8972 PERMIT NUMBER: MC This form must accompany ALL air conditioning replacement permit applications. Each unit change-out must be on its own data sheet.Multiple units on single sheets are not acceptable. Job Address(where the work Is being done):_ /z 8`-v VW_ L,64,tg[". City: Miami Shores Village County: Miami Dade Zip Code: ALL CONDENSING UNITS MUST BE ON A 4 INCH SOLID CONCRETE SLAB ALL UNITS MUST COMPLY WITH F.E.M.A MINIMUM FLOOD ELEVATION A COPY OF THE CONTRACT IS REQUIRED WITH ALL SUBMITALS ARI(AHRI)DATA SHEET REQUIRED Change Disconnecting m6ana:YES ❑ NO 2( ARHI Sheet Attached:YES NO❑ Contract Attached:YES Q� UNIT BEING REPLACED DATA NEW UNIT MANUFACTURER 0=21EE AHU or PKG.UNIT MODEL# (.V COND.UNIT MODEL# Qs KW HEAT 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 I / PKG UNIT EER/SEER 1110_ 2 YES NO REPLACING DUCTS NO YES NO REPLACING THERMOSTAT E NO YES NO NEW 4"CONCRETE SLAB O*NO 00*0 YES NO NEW ROOF STAND YES.YES NO NEW RETURN PLENUM BOX ES .. .. ...... .... ...... 1. Minimum Circuit Ampacity(Wire Size): t5.4 A0.2. 2. Maximum Overcurrent Protection(Fuse/Breaker Size): 05 •• "• 3. Voltage of Circuit(208/240/480): 'Z40 ...... 4. Size Disconnecting Means: 7 ....:. Contractor's Company Name: .4Ktr--f ZiCoQ 72f`_ J l � "�Phone:• •••••. State Certificate or Registration N.U'W-1'4 c1 4 OG Certificate of Competency N. •"� Signature 9 Date: _�F'C-: ice. Z06� (Quaftes tfgnature only) Property Search Application-Miami-Dade County http://www.miamidade.gov/propertysearclV#/report/summary j OFFICE QF THE PROPERTY APPRAISER �urnrnary Report Generated On:9/9/2015 Property Information Folio: 11-2232-030-0010 " s Property Address: 1285 NE 104 ST Owner JOHN E TIMINSKY&W LISA E 1285 NE 104 ST Mailing Address MIAMI SHORES, FL 33138-2659 Primary Zone 1300 SGL FAMILY-2801-3000 SQ 9 Primary Land Use 10101 RESIDENTIAL-SINGLE to" FAMILY: 1 UNIT Beds/Baths/Half 3/2/0 Floors 2 Living Units 1 Actual Area Sq.Ft Living Area Sq.Ft Adjusted Area 2,779 Sq.Ft Lot Size 20,379.6 Sq.Ft Taxable Value Information Year Built 1939 2015 2014 2013 Assessment Information County Year 2015 2014 2013 Exemption Value $50,000 $50,000 $50,000 Taxable Value $411,990 $408,324 $401,551 Land Value $713,123 $503,891 $458,082 School Board Building Value $214,573 $209,725 $209,725 XF Value $38,973 $39,4541 $39,934 Exemption Value $25,000 $25,000 $25,000 Taxable Value 1 $436,990 $433,324 $426,551 Market Value $966,669 $753,070': $707,741 City Assessed Value 1 $461,9901 $458,3241 $451,551 Exemption Value $50,000 $50,000 $50,000 Benefits Information Taxable Value $411,990 $408,324 $401,551 Benefit Type 2015 2014 2013 Regional Save Our Homes Assessment Exemption Value $50,000 $50,000 $50,000 Cap Reduction $504,679 $294,746 $256,190 Taxable Value $411,990 $408,324 $401,551 Homestead Exemption $25,000 $25,000 $25,000 Sales Information Second Exemption $25,000; $25,000 $25,000 Homestead Previous Sale Price OR Book-Page Qualifiggg%Description Note: Not all benefits are applicable to all Taxable Values(i.e.County,School 06/01/1991 $0 00000-00000 Qual by e:emof d . eed ..•• •. Board,City,Regional). • • •• •� � � 0 Short Legal Description ������ ;..•.; • • • • • RIVER BAY PARK P641-55 • • • •••• LOT SIZE 169.830 X 120 % OR 15084932 TO 37 0691 4 • The Office of the Property Appraiser is continually editing and updating the tax roll.This website may not reflect the most current information on 4 ord.Thef1W. ftpraise*rand Mami-Dade County assumes no liability,see full disclaimer and User Agreement at http://www.miamidade.gov/info/disclaimer.asp • • • :0900: Version: •• • 1 of 1 9/9/2015 8:17 AM o This combination qualifies for a Federal Energy Efficiency Tax Credit when placed in service www.ahridirector .org between Feb 17,2009 and Dec 31,2014. Certificate of Product Ratings AHRI Certified Reference Number: 6938465 Date: 9/15/2015 Product: Split System: Heat Pump with Remote Outdoor Unit-Air-Source Outdoor Unit Model Number: 25VNA036A**30 Indoor Unit Model Number: FE4AN(B,F)005L+UI Manufacturer: CARRIER AIR CONDITIONING Trade/Brand name: CARRIER AIR CONDITIONING Series name: INFINITY SERIES HP WITH GREENSPEED INTELLIGENCE Manufacturer responsible for the rating of this system combination is CARRIER AIR CONDITIONING Rated as follows in accordance with AHRI Standard 210/240-2008 for Unitary Air-Conditioning and Air-Source Heat Pump Equipment and subject to verification of rating accuracy by AHRI-sponsored; independent,third party testing: Cooling Capacity(Btuh): 35000 EER Rating (Cooling): 14.00 SEER Rating (Cooling): 20.00 Heating Capacity(Btuh)@ 47 F: 33400 Region IV HSPF Rating (Heating): 12.00 Heating Capacity(Btuh)@ 17 F: 31000 Ratings followed b an asterisk indicate a voluntary rerate of previously ••�••• •••• ••• g y (')' ry p y published data,unless accompanied with a WAS,which indicates an involuntary rerate. DISCLAIMER •••• •• • i•• AHRI does not endorse the product(s)listed on this Certificate and makes no representations,warranties or guarantees as to,arFb a%s�rp#s no resaon9iiggtf for, ••• the product(s)listed on this Certificate.AHRI expressly disclaims all liability for damages of any kind arising out of the use or performance of the product(s),or the • unauthorized alteration of data listed on this Certificate.Certified ratings are valid only for models and configurations listed in the••••• • • ••• directory at www.ahridirectory.org. •••••• ••••• ••• TERMS AND CONDITIONS This Certificate and its contents are proprietary products of AHRI.This Certificate shall only be used for individual,personal and •• • confidential reference purposes.The contents of this Certificate may not,in whole or in part,be reproduced;copied;disseminatetlI ••• entered into a computer database;or otherwise utilized,in any form or manner or by any means,except for the user's individual • personal and confidential reference. 0 •AAR-CONDITIONING,HEATING,*** CERTIFICATE VERIFICATION •• 8PREFRIGERIkTI"RSTITUTE0 The information for the model cited on this certificate can be verified at www.ahridlrectory.org,click on"Verify Certificate"link •• • • gee make li e bet�er°' and enter the AHRI Certified Reference Number and the date on which the certificate was issued, which is listed above,and the Certificate No.,which is listed at bottom right. 130868020183451745 ©2014 Air-Conditioning,Heating,and Refrigeration Institute CERTIFICATE NO.: FE4A, 1 Infinity(,' Series CommunicatingVariable—SpeedFanCoil PuronRefrigerant Sizes 002 thru 00. Carrier turn to the expert Data PREMIUM ENVIRONMENTALLY-SOUND FAN COIL The latest in technology makes the FE4A and FE5A fan coil models the most advanced air handlers available.With attention to Uig quiet,efficient,and comfortable operation,Carrier has developed a new benchmark for homeowner comfort and ease of installation. The FE4A and FE5A utilize the Infinity'& Control as a required accessory to enable state of the art smart-diagnostics capability. This enables faster troubleshooting, providing ease of service and repair.The FE4A and FE5A also provide a 4-wire hook up with matching outdoor unit and the Infinity'& Control. This makes installation simpler and a lot quicker than with conventional fan R coils.The FE4A and FE5A have advanced technology that allows t` the fan coil to self-configure with a matching outdoor unit and the rA Infinity' Control,cutting down on installation time. F The FE4A and FE5A feature Purone refrigerant,the chlorine-free alternate that is the future for the residential heating and cooling industry.The FE4A and FE5A using PuronO refrigerant maximize t Y performance for environmentally sound systems. In addition to environmental safety, these systems are 30 to 40% more efficient than standard heating and cooling systems, thereby combining excellence in efficiency and environmental safety. c The FE4A and FE5A provide these benefits due to Carrier's t � ak command of Electronically Commutating Motor (ECM) technology.These motors are extremely efficient at all speeds,and enable the FE4A and FE5A to operate at the correct speed to a deliver airflow precisely, ensuring proper performance across a wide range of duct static pressures. This adaptive efficiency also makes installation quality easier to achieve for today's demanding s, homeowner. 3 { "i Carrier's command of ECM technology may be most evident in the comfort advantages that an ECM can deliver.For true comfort,the homeowner can achieve command of both temperature and humidity in cooling and heating modes. ' Another feature which sets the FE4A and FE5A apart is the factory-installed TXV, which enhances efficiency and provides compressor-protecting operation at all recommended conditions. Grooved tubing, louvered aluminum fins,and the lar a face areas t of the FE4A and FE5A refrigerant coils also prde esurerior efficiency,for high SEER and HSPFperfor4nce. "" ••"�' Carrier leads the way in condensate control,a hallmark•ofethese •• multipoise fan coils.All of these featurect�,omponents are protected within a rugged,pre-painted metal dffl li ted with supoer-thick, • • high-density insulation. For neat, ftglt*g8j1ity ins:Alatidhs, the • • unit exterior features sweat refrigerant"afflections for simple leak ••••• free performance, and multiple elecvicalemw y for booth high and ••:•• low voltage service. .. .. ;•••' • ••.• For superior technology and •■amat•hed comfort, the • environmentally sound and efficient FEIA;and FFy5A f4p coils ....;. can't be beat. ••••'• Product Registration https://productregistration.carrier.com/Public/RegistrationConfirnVZ... PRODUCT REGISTRATION ' turn to the expertsr` Today's date: September 15, 2015 CONFIRMATION JOHN TIMINSKY, Thank you for registering your new air conditioning and/or heating equipment from the CARRIER family of brands. Your registration confirmation number is Z001910083762C Please print this screen, as it'll be your only record of this registration. Equipment Owner Equipment Location JOHN TIMINSKY, 1285 NE 104TH ST, 1285 NE 104TH ST, MIAMI SHORES, FL, 33138 MIAMI SHORES, FL, 33138 USA USA (305) 495-0055 (305) 495-0055 Email not provided Type of purchase Dealer Information Replacement of existing equipment AMERICAN RESIDENTIAL SERVICES, Application Type 18720 SW 108th Ave, Residential Single Family Cutler Bay, FL,33157 USA (305) 235-7223 JPARRALES@ARS.COM Installed Products Serial Number Model Number Installation Date 1114EO6011 25VNA036AO03 09/09/2015 3115A90609 FE4ANF0051-00 09/09/2015 Each piece of equipment has unique warranty coverage. Please print a copy of this product registration confirmation and retain it with a warranty certificate for each product and your proof of purchase records. If you do not have.p•copy of the warranty certificate(s), please contact your installing dealer or visit the product manual pagg to print a copy,•• •••••• If your new system ever needs a repair, ask your servicing dealer to only use FactoEy*Auttlorized Rar{sTM •• 0000.. Designed for Easy Install &Service, Engineered for Quality •••••• • 0000 .. 0000.. Factory Authorized Parts TM have been designed and built specifically for CARRIER® egt+ipRient. These•parts aneofho perfect fit, restoring equipment to its original performance. •••••• ••••• 0000.. .. .. . 0000.. • U.L. &C.S.A. qualified 0000.. .• • Preserves the original manufacturer's warranty 0000.. • Preserves the original efficiency of the system 0000.. . . .0000. • Meets rigorous factory run life design specifications •• • • 000 • 11.6 . 1 of 1 9/15/2015 10:39 AM http://cactaxcredits.info/carrier-tax/hp_certified view2.php?id=351297 CARRIER CORPORATION 7310 West Morris Street Indianapolis, IN 46231 1-800-CARRIER Manufacturer's Certification Statement turn to the expert Split System Heat Pump The below identified split system heat pump (when matched with the below identified indoor unit and furnace, if applicable) achieves a seasonal energy efficiency ratio (SEER) of 15 or higher, an energy efficiency ratio (EER) of 12.5 or higher, and a heating seasonal performance factor(HSPF) of 8.5 or higher, and qualifies for the tax credit allowed under Section 25C of the Internal Revenue Code. The installation date and the make, model number, and other appropriate identifiers of the split system heat pump and matching equipment, as listed in the Air-Conditioning, Heating& Refrigeration Institute (AHRI) directory, are as follows: Make: Carrier Model: 25VNA036A*030 Matching Indoor Unit: FE4AN(B,F)005+U1 Matching Furnace (if applicable): N/A AHRI Number: 7974570 Install Date: 1 191 1 5 A taxpayer claiming a credit for Residential Energy Property Expenditures should retain this certification statement and the receipt of purchase as part of the taxpayer's records and should consult with a tax professional to determine eligibility for and application of the credit. Under penalties of perjury, I declare that I have examined this certification statement, and to the best of my knowledge and belief, the facts presented are true, correct, and complete. •••• David Meyers •• • V.P., Sales—Residential Systems • •••• • •• ••••• • •••••• • • ••••• •• •• • •••••• • • • • • •••••• w• • 1 of 1 9/15/2015 11:04 AM (305)235-7213 Corporate Customer DISPATCH Chu ?) 18720 S.W.108TH AVENUE Relations TIME WINDOW MIAMI,FL 33157 (866)803-0879 ARRIVAL INVOICE: `� American Residential Services of Florida,Inc.CFC1427670,CAC039629 www.ARS.com 8253- • � • •••' ! � NAME - PH# BILL T JA -' TE C ADD "f Fl PH# BILLAD I'&- LL#C/ST/ZP S EMAIL C/ST/ZP CH/# Q A. B. SUCTION PSI SUPERHEAT LIQUID PRESS SUB-C COMP AMPS ODB OWEI IWB IDB FAN AMPS GAS PRESSURE ELECTRIC HEATAMPS TEMP RISE RECOVERED REFRIGERANT LBS/ LBS DAMAGE? ❑ NO ❑ YES-See separate"Report".Tech initials ORIGINAL SERVICE REQUESx:1k, Recommendations Addendum Option# - - e ritten customer authorization will be SUBTOTAL obtained before beginning any unforeseen additional or extended work. WAWNTY ITEM(S) DIAGNOSTIC • ANYCLAIMS FOUCOMSIRjJgrlp MFM C,;1SAREPARTS: BOR: FEE Q �pN �R� PFiQV'ISIONS (+ SALES H TIC I%C ORIG.EST. SALES TAX PARTS: LABOR: SUBTOTAL OF CHAPTER 558, OR1JW4Sjr1R,j-FEj : ..• Est.date of comp. x¢ • BUYER'S RIGHT O �,gNICELL__ p "` E 9 ❑ RENEW HSP 'i 7 'This is a home solicitation sale, and if you do ❑ CASH ❑ CHECK# PO# ❑ PURCHASE not want the goed"o servicesryou maycancel this agreement by providing TRUCK OPERATING written notice&fhe teller irk erzon,b*#el' Nam,orb mail.This notice must ❑ VISA ❑ M/C ❑ DISC ❑ AMEX ❑ OTHER $9 95 P a9 Y SUPPLIES indicate that yoNdo3wf wdat the dobd$ dr f ervices and must be delivered CC LAST 4#—___EXP AUTH# COMM TAX or postmarked bVforg midnight bf the Third'business day after you sign this My signature below acknowledges that the work has been completed agreement. If you cancel this agreement, the seller may not keep all or part Z! Z of an cash clow " and I agree to the sum t tal of the ch es and payment meth TOTAL l en Y �D�Yp� • I acknowledge thpt ray rigcegcethas been explained to me orally and in Print—Na" -"-- n Please contact me about writing, and withopt vgjivjIg". right$p• cel, I authorize the performance a e • future offers. of the work, subject•to all terms acrd con rtions set forth on the reverse side hereof, plus any taxes upon completion. ©2015American Residential Services LLC.All rights reserved.(L 07/2014)Rev 033015 ARS1001 Signature:X Date: