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08-11-'14 16:32 FROM- T-840 P0005/0047 F-932 <br /> ���'� "'J��u��,'�,w'��'�e���Vs��G(a��ro�u�a�'`~{ 1�AI.F`�x�J J � .iA.v���,,. ���..�, ��,,p.� ;�. � <br /> Note: All Geothertnal Systems will now require a Site Plan&Review by our Building Offici�l. � <br /> IS THIS GEOTHERMA�,'.' ❑`Yes ❑No ' <br /> H�ATYN�SYS"1'�1vI5 ; <br /> QuantitY� ..�_,.r.w. _.,�._ � <br /> Make: . <br /> Model: � <br /> Fuel; ._�.. � v_.w_��..�. <br /> �lue Size: � <br /> Input STUs: � �, _ , <br /> r <br /> I <br /> Output BrCJ�s: � <br /> CFM: ' <br /> COO�,CNG SYST�MS <br /> Quantiry: <br /> . . Make� � <br /> ModeL _�___�___. — �—�,,._.�, ..._,�. � <br /> Tpns� i <br /> �. <br /> H.Po�ver <br /> �'1R�YY�ACES ; <br /> � Gas FacYory Fireplace Brand Namt: ���'� "� "���� � <br /> 0 Wood gurning�ireplace ip,�\ � ��,,,� ' <br /> ❑ 1YJood Stove Ivlodel No.: _��!`�V ,J�U� <br /> ❑ Wood Stove with Fluc/Masonry <br /> i <br /> VENTILAT[ON <br /> Q No. iCitche���xhaust duct recirculating cfin � <br /> ❑ No. �ath�xhausf(must hav�duct outside} cfin � <br /> ❑ No. Othcr Fans: LocBtions cfm � <br /> I <br /> FUEL STORAGE (Must be approt�ed by Flre Mnrshall If proposing to abandor:tank l►a pluce.) <br /> ; <br /> I <br /> ❑ insfallation ❑ Ttemoval �! <br /> i <br /> I <br /> Fucl Orl: �_ gallons �] CJnderground ❑Inside ❑Outside ! <br /> �,P Gas: �3Nlons <br /> Other: <br /> GAS LINE ONLY <br /> i <br /> ❑ Outdoor Grill ❑ Othcr/List What&Whcrc: f <br /> 2 � <br /> � <br /> il <br />