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08-10-' 16 13:21 FROM- FIRESIDE T-415 POOQ2/0004 F-961 <br /> • 3 <br /> Note:All Geothermai Systerns w'rll now require a Site Plart&Review by our Buildin�Official. <br /> IS THIS�EOTHERMA�.? ❑Yes ❑No <br /> H�ATIIVG SYSTEMS ' <br /> Quantity� <br /> Make: <br /> Modcl: <br /> Fucl� <br /> F(ue Sizt: <br /> Input STUs: <br /> Output�TC�s: <br /> C�'M: <br /> COOLING SYSTEMS ' <br /> i <br /> Quanti�y: <br /> Makc: <br /> r <br /> , <br /> ModeL <br /> TOns; � <br /> H.pawer <br /> FIREPLAC�S <br /> � Qas�actory�ireplace Brand Nama: ��J <br /> ' U ` Wood�urning Fi�+eplace / � <br /> ❑ 'Wood Stove Model No.: SL�� <br /> ❑ Wood Stove with Flue/Masonry <br /> VE1VTiLATIOI�! <br /> ❑ No. Kitchcn Exhaust duct recirculating cfm <br /> ❑ No. Bath Exh�ust(must have duct outside) efm <br /> ❑ No. Other Fans: Locations cfm <br /> ; <br /> FUEL STOC2AG� (Must be approved by Fire Mnrs/ra/l Pf proposing to abanrion tank in pince.) <br /> C] Tnstallation ❑ Re,noval � <br /> i <br /> Puel Oil: gallons ❑ Undergr�und ❑lnside ❑Outside � <br /> �.1'Gas: gallons � <br /> Other: � <br /> i <br /> CAS LINE ONLY � <br /> ❑ Outdoor Crrill ❑ Other/List What&Where: <br /> 2 � <br /> I <br /> i <br /> I <br /> I <br />