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08-26—' 14 16:43 FROM— T-879 P0002/0004 F-972 <br /> �. )_ ..,n ; p ��.' ,,� <br /> �. �� • i�s. � ni :�7k� i°y <br /> � ' '!�. �A.f�� . <br /> Note:All Creothennal S�stiems r�ill now require a Site plan dz Review by our 73ui1Cling Official. � <br /> E <br /> XS TT�TS G�OTHERMAL? ❑Yes �o � <br /> ��ATYIYG SYSTEMS <br /> � <br /> i <br /> Quantiry: —�,,...�.�.......�.:� �— � <br /> Make: <br /> _ ��� _ <br /> Model: _ I . �� —�� --- i <br /> Puel: _.w.,w..�r_ ,_ 1 <br /> � Flue Siz,�: <br /> Tnput B�'C1s: <br /> --�-�-r�---- <br /> Output BTCJs: ,,_,�� �.,, <br /> � <br /> CI'M: �..,. ' <br /> COOLfNG SYST�IVIS � <br /> Quantity� ---m <br /> Make: <br /> Model: _�.,w .,� <br /> i <br /> Tons; j <br /> I <br /> H,power ; <br /> _--_ ---- � <br /> FIREPLAC�S ' <br /> [� Gas Factory�ireplace BrandNa�ne: ��1��" "h�C IC: � <br /> ❑ VVood Buming Fireplace /� f �, ; <br /> ❑ Wood Stove Model No.: l._-��� L "I �� <br /> ❑ Woad Stovc with F[ue/Masonry ! <br /> 'V�NTY�ATIOiV I <br /> ❑ No. Kitchen Eschaust_ duct recirculaling �efin <br /> [] No. Bath Exhaust(must have duct outsidc) �cfm ( <br /> ❑ No. Other�ans; �ocations ___ __ cfm � <br /> � <br /> i <br /> FUEL STORAGE (Must be approved by Fire t�f[trsitall�f propos[ng lo abandon i�rnk in place.} � <br /> I <br /> 1 <br /> ❑ Installation ❑ 1Zemoval <br /> fiuel Oil: gxllons Q Undergrpund ❑Insii3e ❑Outsicle � <br /> �.P Gas� gallons ', <br /> Other: __ � <br /> GAS LINE ONY.,`Y �I <br /> ❑ Outdoor C�rill ❑ Other/List What&Where: I <br /> � <br /> i <br /> 2 � <br /> � <br /> i <br /> � <br /> � <br /> � <br />