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11-45-' 14 18:31 FROM- T-140 P0002/0407 F-255 <br /> ������r ,,�,�,;,w�%•&,' -- -., i . _� ';� a r y;: �L�e�Y������r ,t.�,r ,d,.! <br /> Note:All Geothermal Systertis will now require a Site Plan c�Review by our�uilding Official. <br /> IS THIS G�O'���l7MAY,? ❑ Yes ❑No � <br /> HEATYNG SYST�MS - <br /> QuantiCy; � _ <br /> Make: <br /> Mod�l: <br /> FueL <br /> Fhic Sizc: <br /> Tnput BTUs: ...�, <br /> � <br /> Output STUs: w^ ,,,, k <br /> CPM: � <br /> COOLING SYSTEMS � � <br /> � <br /> QUantitY' _ w..,.._, <br /> Make: <br /> � <br /> Model: � <br /> . �..`�.,,.,..._ � <br /> "I'ons: <br /> H.Powtr ! <br /> ���......_ � <br /> � <br /> FIREI'LAC�S <br /> � Gas Facrory�'ireplace Brand Name: `IJ,��'`'� � C��C� <br /> � �Vood�urning�ireplace � <br /> Wood Stove Model No.: _c� '"��� i <br /> ❑ Wo�d SCove With Flue/M�.sonry � <br /> I <br /> VENTiLATION <br /> ❑ No. Kitchen E�chaust duct recirculating cfm � <br /> ❑ No. Bath�xhaust(rnust have di�ct outside) cfm I` <br /> ❑ No. ,� Other Fans: �.ocations w �cfm ? <br /> FUEY.STOIiA.G� (n�ust be approver�by F�re Mnrshall ifproposing to abandon tank in place.) <br /> ❑ Installation [� �emoval <br /> Fuel Oil; gallons [� Underground Q�nside ❑4utsidc � <br /> LP Gas: gallons <br /> Other: � <br /> (�AS T�YN�ON�.'Y I <br /> ❑ Outdoor Grill ❑ Other/List What&Wher�: <br /> 2 <br /> , <br /> I <br /> 1 <br />