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07/14/2009 13:25 FAX 9527587002 STASNEY MECH f�003/003 <br /> ` a}�Y'�".'t;ef��Y{(,' _ z (�` Q �sT o,�i r y'...:.•; � k'kS tR p,�, . <br /> T� ��3:.F�°::r`:��.'�l.'�.'�..'S v! '_��:M���g 1.1��.N+�:'4',�_I,'` ' �•.:4'Fv��.:�:V <br /> �� <br /> , Note:All Geflthermal Syst�ms will now require a Site Plan 8c eview by our Building Official. <br /> IS THIS GEOT�IE�RNIALY �`Yes ❑No <br /> HEATING 3YSTEMS <br /> Q��Ty: 3 <br /> Make: �'� <br /> Model: G✓ .�r.• �S <br /> Fuel: <br /> Flue Sizc: <br /> Input BTUs: �� <br /> Output BTUs: ��� <br /> � ,, �/.���/�-S �- - ��� �r� <br /> CFM: �--� <br /> COOWNG SYSTEMS <br /> Q,�rt;�y; 3 <br /> Make: �d/7 4r•%'4 . <br /> Model: •�� �Z/`�-'�.S <br /> Tons: �GL- �� <br /> H.Power <br /> FIRE�PLA---d--� <br /> ❑ Ge�s Factory Firepiace Srand Name: <br /> Q Wood Buming Fireplace <br /> � W�d�vc Model No.; <br /> � Wood Stove With Flue <br /> V�IY'I'II.ATION <br /> No. Kitchen F.xhaust duct v re;circulacing ,�"� <br /> No. � B�E��t(must have duct ouisidc) ' �� <br /> No. Other Fans: Locations <br /> FUEL STO__�AS'i�(M�!de approved by F4rc MarsbaU�lP���B�nbandon tank in placa) <br /> 0 Installation � Removal <br /> Fael Oil: _gallons ❑ Underground �Inside �Outsick <br /> LP Gas: gallons <br /> Other: <br /> �wc I.INE ONLY <br /> � Outdoor Grill 0 Other/List What&Where: <br /> 2 <br />