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I <br /> •Ap�g 26 2011 10: 29AM Air Quality Services, Inc 952-929-1067 p. 2 <br /> III!loll <br /> Note:All Geothermal Systems will now require a Site Plan&$gave by our Building Official. <br /> IS THIS GEOTHERMAL? ❑Yes gNo <br /> HEATING SYSTEMS <br /> Quaadty: <br /> Mahe: M IT5 MA *I <br /> Model: M M Z. I g <br /> Fuel: IL EEC.. <br /> Flue,Size: <br /> Input BTUs: rm <br /> Output BTUs: <br /> CFM: 00 <br /> COOLING SYSTEMS <br /> Quantity: <br /> Make: <br /> Model; <br /> Tons: <br /> K Power \ko <br /> FIREPLACES <br /> ❑ Cies Factory Flreplace Brand Name: <br /> ❑ Wood Burning Fireplace <br /> ❑ Wood Stove Model No.: <br /> ❑ Wood Stove with Flue/Masonry <br /> VZNTILATION <br /> ❑ No, Kitchen Exhaust duct recirculating cftn <br /> e No. Bath Exhaust(must have duct outside) oft <br /> No. Other Fans: Locations c8n <br /> FUELL SSE(Must be approved by Fire Marshall tfpropoib B to obaxdon lank In placa.) <br /> ❑ Installstion [1 Removal <br /> Fuel Oil: gallons ❑ Underground ❑Wide ❑Outside <br /> LP Gem: gallons <br /> Other: <br /> CAflLINE ONLY <br /> ❑ Outdoor Drill ❑ Other/List Whet&Where: <br /> 2 <br />