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< . <br /> 02-13-'15 15:06 FR4M- T-466 P0002/0004 F-610 <br /> a �l 5�-�-�-.� -..,,, .,-r s,,.. �. v�_ ,...�.M--�--�-T,--.,�--.,-.—. a� <br /> # ^�4 ��IJ� �<��c;b 1'f»��"',��f . i ��. � _ r c' � ":i r"��i� ° t <br /> tt4� -�� �.,.�..a .•��NT'��1���T����<I.NG�N�.��',A�.�:�I7�.., : �.,:� F � ` <br /> � <br /> Notc: All Geothermal Systems wiIl now rcquire a Site plan&R v�iew by our Building OffciaL � <br /> TS TIIIS G�OTHERMAL? � Y�s �]No <br /> r-IEATINC SYSTEMS <br /> Quantit�': ___�..,,, _,..�_.__�__� <br /> Make: <br /> Modcl: <br /> �uel: <br /> Flue Size: <br /> Input�TUs: _� , �,� <br /> Output 13TUs: _,,,,� � <br /> � <br /> G�M: .M___— �_ �,....�.�..._ C <br /> � <br /> COOI�TN�S�ST�MS <br /> Qu�ntiry: �w <br /> . Make: <br /> Model: _� <br /> Tons� w�._. _w_.�.-------- -- j <br /> �i.Power ' <br /> �m� � <br /> FIREPLACES <br /> � Gas Factory Fireplace Sranil Nsme: �O v V����� <br /> � VVood�urning Fircplacc � � � n�(� t <br /> ❑ Wood Stove Model No,: � �� "�{I'�l� <br /> ❑ Woad Stove wfth Flue/Masonry <br /> V ENTI LATIUIV <br /> ❑ No. �iitchen�xhaust duct recirculating w efm <br /> ❑ No. � �ath Exhaust(must havc duct ouiside) � cfm <br /> � iJo. Othcr Fans: Locations_�� cfm <br /> ! <br /> ��J��,STO�iAG� (Nlust be approvec!by Fire Mnrs/rall if proposing to rrbnrrdon fank in pince.) � <br /> �] Ynstallatian ❑ Removal � <br /> Fuei Oil: � �allons ❑ Underground ❑Fnside ❑Outsidc � <br /> L,P Cas; gallons <br /> pther. <br /> GAS LiNE ONLY <br /> ❑ Outdoor Grill � Other/�.ist What&Where: ,�_ <br /> 2 <br /> � <br />