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12/05/2614 10:26 7635354379 GOLDEN VALLEY HTG PAGE 03/04 <br /> � , t <br /> � `;., , ': .��GH:A�NICA;L;:.�XS'TEMS:BE�i+G;�NSTALLED <br /> ,;,;,. <br /> Note:All Geothermal Systems wiil now re uire a Site�)an&Review by our Buildir�g Official, <br /> IS Ti�iS GEUTHERMA,�.? �Yes o <br /> HEATING SXSTEMS <br /> Quan�ity: <br /> Ma2ce: �.-�2 h N C� <br /> Model: �iL��(D(�l(�l f�� <br /> Fuel: <br /> Flue Size: <br /> Input BTUs: b ��� 0 <br /> Output a'�'Us: "/ � <br /> CFM: <br /> COO[.1NG SYS'�'ENIS <br /> Quant�ty: ` <br /> Make: V1�0/l.d �- <br /> Model' L ,�"Q i I <br /> Tons: <br /> H.power <br /> FIRE�PLACES <br /> ❑ Gas Factoly Fireplaco Brapd Name: <br /> ❑ Wood 8uming Fireplace <br /> ❑ Wood$tove Nlodel No.: <br /> ❑ Wood 5tove with Flue/Masonry <br /> VENTIL V <br /> ❑ No. Kitchen Exhaust duct recirculazittg cfm <br /> ❑ No. Bath Pathaust(must have duct outside) cfm <br /> ❑ No. Qther Fans: i.ocations ��p <br /> F�)EL S'1'ORAGE (.A�us7 be approved by Fire Marskall if proposing tv abaRdan wnk[n place.) <br /> Q 1nstQllation [� Removal <br /> Fuel Oil' gallons ❑ Underg�r'ound ❑Inside ❑Outsidc <br /> _ LP Gas: gallons <br /> Othe�: <br /> JCrA,5 LINE ONLY <br /> ❑ Outdoor Grill ❑ pthe�/�,ist What&Where: <br /> 2 <br />