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From:COUNTRYSIDE HEATING & COOLING 763 479 2518 09/16l2016 15:22 #167 P.002/003 <br /> � , a <br /> =NiECHANIC.�SXS�VIS;BEING:`�I�TS�'AL3.ED <br /> Note:All Geothermal Systems will now require a Site Plan&Review by our Building Official. <br /> IS THIS GEOTHERMAL? ❑Yes ❑No <br /> HEATJNG SVSTEMS <br /> Quantity: <br /> Make: (�-I(Jf.�J�'J� <br /> Model: <br /> Fuel: �� � <br /> Flue Size: <br /> Input BTUs: � op� <br /> Output BTUs: "'1 OU� <br /> CFM: <br /> COOLING SYSTEMS <br /> Quantiry: � <br /> Make: � <br /> Modei; <br /> Tons: <br /> H.Power <br /> FIREPLACES <br /> ❑ Gas Factory Fireplace Brand Name: <br /> ❑ Wood Burning Fireplace <br /> ❑ Wood Stove Model No.: <br /> ❑ Wood Stove with Flue/Masonry <br /> VENTILATION <br /> ❑ No. Kitchen Exhaust duct recirculating cfin <br /> ❑ No. Bath E�chaust(must have duct outside) �� <br /> ❑ No. �_ Other Fans: Locations �� <br /> FUEL STORAGE (Must be approved by Fire Marshal!ijproposing to obandon tank in p/ace.} <br /> ❑ [nstallation ❑ Removal <br /> Fuel Oil: gallons ❑ Underground ❑Inside ❑Outside <br /> LP Gas: gallons <br /> Other: <br /> GAS LINE ONLY <br /> ❑ Outdoor Grill � Other/List What&Where: U, �/ •.� <br /> 2 �'��-S <br />