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From:COUNTRYSIDE HEATING & COOLING 763 479 2518 10l09/2013 07:25 #823 P.002l003 <br /> M�C-�-TA��T�CAL.�Y'�TEIvIS BEING II+ISTALi.ED----n- - _�..�;. <br /> Note: AllGeott�etmal Systerts will na�c�reqtvre a Srte Plan�c Re�Ti�w by otv-Biulding Official. <br /> IS THIS GEOTHERMAL? ❑Yes �No <br /> HEATING SYSTEMS <br /> Qu�diy: "JQ( � <br /> Make: ���I � E`( � <br /> Model: <br /> Ft�el: __.�• �__. <br /> �,� <br /> Fhte Sizc: ;�T�i(i� <br /> Irq�ut B'I'ITs: _ <br /> Outpu[$T[J s: __ <br /> CFM: <br /> CO�LING SYSTEMS <br /> Quantiy: <br /> Make: <br /> Model: <br /> Tons: <br /> H.Power _...____ <br /> F1F2EPLACES <br /> ❑ Gas Factory Faep]ace Brand Narrne: <br /> ❑ W ood Biarm�Fu-ep]ace <br /> ❑ bVood Stove ModelNo.: <br /> ❑ Wood Stove w�hFh3e/Masoruy <br /> VENTILATIQIr� <br /> ❑ No. R�chen Fxhaust duct ____reci-cu�tu�g cfrn <br /> ❑ No. BaYhExhaust(zn�.�have duct outside) cfrn <br /> ❑ No. Other Fans: Locations cfin <br /> FZJEL STORAGE (Mrui be approved by Fire Ma�sball if p�nposing to abaxdon tn�k In placu) <br /> ❑ Itistailaiion ❑ Removal <br /> Fuel Oil: gallons ❑ UndcrgFow�d ❑Inside ❑Outside <br /> LP Gas: gallons <br /> Other: <br /> GAS IdNE ONLY <br /> ❑ Outdoor Grill ❑ Otkter/I,ist What&Where: <br /> 2 <br />