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06/28l2�12 11: 03 9529222434 SAVLER HVAC PAGE 03/04 <br /> Note: A,1] Geothermal Systems will now requ,ire a Site Plan 8c Review by our Building Official. <br /> IS THIS GEOTHERMAL7 ❑Yes �No <br /> HEA'��NG SXS'�EMS � ` <br /> Quant�ry: <br /> Make: <br /> Model: <br /> k'uel: <br /> Flue Size: <br /> ]nput BTUs: <br /> Output B�'Us: <br /> CFM: <br /> COOLING SYS'�EMS <br /> Qua�tity: <br /> Make: <br /> Model: <br /> �'ons: <br /> H.Power <br /> k`IREP�ACES <br /> ❑ Gas Factory Fireplace Brand Name: <br /> ❑ Wood Burning Firepiace <br /> ❑ Wood Stove Model No.: <br /> ❑ Wood Stove with Flue/Masonry <br /> VENTILATION <br /> ❑ No. Kttchen Exhaust duct recirculating cfim <br /> ❑ No. �atk��xbaust(anust have ducc outside) c� <br /> ❑ No. Othcr Fans: Locations cfrn <br /> FUEL STORA,G� (.Must be a.pp�oved by Fire Marsha!!cf propasing to ubandon tank in pJac�) <br /> ❑ Installation ❑ Removal <br /> �uel Oal: gallons ❑ Underground ❑inside ❑Outside <br /> LP Gas: ga��ons <br /> Other: <br /> GAS LINE ONLY <br /> ❑ Outdoor Grill � Other/�,ist Wk�at&Wk�ete: ��lZh��KrC <br /> 2 <br />