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06-06-'16 11 :43 FROM- FIRESIDE T-083 P0402/0404 F-568 <br /> . , � <br /> x��,�°��_�„�r`�:�`��,����H'A`l�,�A�a 3,'���:�N�,a`:� - _�: :_. `�������`���,�,��-��':.'.� <br /> .SNti <br /> Notc:AU Geotherm�l Systems will now require a Site pian 8r Review by our Building Offci�l. <br /> IS T�XS G�OTT�ERMAL? ❑Y'es ❑No <br /> 1•1�A,'�'TNG SYSTEMS <br /> Quantiry: _ � <br /> Make: __ —�� <br /> Mod�L• <br /> Fuel: <br /> Plue Si2e: _ _ � <br /> Input�TUs; w - <br /> Output BTUs: _— <br /> CFM: _, r- ---- <br /> CUOT.yNG SYSTEMS <br /> � <br /> Qusntity: , <br /> Make: �-,— ! <br /> Mode►: r <br /> Tons: _�— <br /> H.Po�ver �, <br /> ��7�iEp�LACES� �-�iGz �lf�) <br /> � Gas fiactv�y Fireplace 'Btand Name: -_t"f �1�� ,.:_ <br /> ❑ Wood Bumirig FiYepiacS � �qQ � ���/ <br /> ❑ 'WoodSfd�ve, ModcSNo.: ��-t�l�w,�� / <br /> [� Wood Stove With TV lue(Masonry <br /> VF,hT1�,ATION <br /> [] No. Kitchen�xhaust duct rccirculatin� cfm ' <br /> ❑ No. Bath�xhaust(must hAve duct outside) cfrn ! <br /> ❑ No. Othe�'Fans: I,ocations_� __ cfm <br /> �YJ�r,STUXtA�� (Musl be ppproi�ed by�Yre Mnrsl:�tlC if proposing to ebandon tank J�t place.) <br /> ❑ Ynstallation ❑ Removal <br /> Fuel Oil: galfans ❑ �nderground ❑Inside ❑Outside <br /> L,P Gas: �gallons , <br /> Other: '� <br /> CAS LINE ON�.y' i <br /> r <br /> ❑ Outdoor Grill ❑ Other/List What 8c.Where: ', <br /> 2 I <br /> , <br /> � <br /> i <br />