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11-01-'16 12:02 FROM- T-335 P0002/0004 F-415 <br /> , . ; <br /> Note:All GeotY�ermal Systems will now require a Site�Ian c�Review by our Building Of�icial. <br /> IS THIS GEOTHE�tMAL? ❑Yes ❑No <br /> HEATING SYST�MS <br /> Quantiry; <br /> Make: <br /> Model: <br /> Fuel: <br /> �lue S;ie: <br /> Input BTC7s: <br /> Output B7'CJs: <br /> CFM: <br /> COOLING SYS'rEMS <br /> Quantity: µ <br /> Ivfake: <br /> Model: <br /> Tons� <br /> �T.power <br /> �'TREPLACES <br /> r� � Gas Factory Fircplacc �rand N'Ame: <br /> L Wood l3tirnictg�ireplace <br /> ❑ �Vood Sto ve Model No.: ,��---�J D� �T��-��� �a d Q�G�J <br /> ❑ Wood Stove w�th�►ue/Masonry <br /> (2,u�"'�� <br /> VENTILATION <br /> �] No, TCitchen E�chaust duct recirculAting cfm <br /> ❑ No. $ath$xhaust(must havc duct outside) cfm <br /> ❑ No. Other Faiis: Locations cfm <br /> FUEL STORAG� (Mirst be t�pprove�l by 14`ire t�larsl:n/d ifproposirag to a6anrCor:ta►:k in place.) <br /> ❑ Instaltation ❑ Reta�aval <br /> �'uel 0i1: gallons ❑ Undergroi�nd ❑Tnside ❑Outside <br /> L�'Gas: �gatlons <br /> Other� <br /> GAS LINE ONLY <br /> Q Ou[door Orill ❑ Other/List What&Where: <br /> � <br />