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12l17-'14 12:43 FROM- T-289 P0042/4004 F-421 <br /> S <br /> �J ,y��. :r� � ` ��y �� rp�r�y � ,����+ �����������iii...��� 4'. a <br /> �.tr�'R .i..k ,a�i� ��EH� :•l:+ � � r��i.l' �. i;.�. .S".1'��.1.Jb�.�y��:Z7.(��F�+?i.y,�.�d� iY.'�U�.�.:�i�'.. Z <br /> Nate: All Geothermal Systems will npw requirc a Site Alan 8r Review by our Building OffiCiRl. <br /> � iS THIS GEOTHERMAL? ❑'Yes []No � <br /> H�ATYNG S'YSTEMS � <br /> Quantity: � <br /> r <br /> Make: <br /> Modzl: <br /> Fue1: -- i <br /> � <br /> Flue Si2e: <br /> Input�TUs: � <br /> Output BTCJs: ' <br /> � <br /> CFM: ` <br /> . � <br /> ! <br /> COO�,MN'�S'YST�MS <br /> Quantiry: <br /> Make: <br /> Model: <br /> Tons: <br /> H.Power { <br /> ------ , <br /> i <br /> FIREPLACES ; <br /> � �� ��L�� i <br /> Gas Factory Fireplace �rand Name: <br /> ❑ Wpod BUrntng FireplaGC � ; <br /> ❑ Wood Stovc Modtl No.: # <br /> ❑ Wood Stove with filue/Masonry <br /> 'VEN'T�Y.ATTQN' � <br /> �) No. Kitchen Exhaust duct recirculating �cfm <br /> i <br /> ❑ No. Bath�xhaust(must have duct outside) cfin ' <br /> ❑ No. Othcr Fans: Locations cfm r <br /> �C���.STOYiAG� (Must be approver!by�re Marsliall ijpropasing to nbandor�tank in place.) <br /> ❑ Installation ❑ Removal <br /> �uel Oil; gallons [] Underground �Inside �Outside <br /> �,P Gas: gallons � <br /> Othcr: <br /> GAS LIN�ON'T.'Y � <br /> ❑ Outdoor Grill ❑ Other/List What&Where: <br /> 2 <br /> { <br />