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OCT/28/2015/WED 01 : 26 PM Heating & cooling FAX No, P, 004 <br /> { � • ' :'Yi;,;; <br /> � - � ; c�..�sYs�������`Il�i�T�L$D.: � _ �:«::-,-::: . <br /> Note:.All Geothermal SysterA,s will now requize a Site Plau& evievv by�ur Building Officisl. <br /> �,5 Tffi3 GEOT'HERM.A�L.? �]Yes �,No <br /> I�.EA'I'YNG SYSTEMS � . <br /> Quantity: -- <br /> Make: l+n ����.r � <br /> Model; �n b <br /> �uel: t`-�� <br /> pltu Size: ��- <br /> Input BT'tJs: 0 G��[� <br /> Out�sut B'I'tTs; �S � <br /> CFM: � -- <br /> COOY,ING SYS'�MS <br /> Quantity: <br /> Make: - - - <br /> Model: <br /> .,. <br /> Tons: -- <br /> H.Power --- <br /> FIREPLAC�S <br /> � Gas Factory Fireplac� Brand Name: <br /> ❑ Wood Burning Fn'eplace <br /> ❑ Wood Stove Model No.: _ _— <br /> [] Wood Stove'with Flue/Masonry <br /> 1�'t'IIIIaAATI <br /> ❑ No. TCitchen Exhaust duct recuculating cfm <br /> 0 No. �ath�xhaust(musC hav�duct outside) c�► � <br /> ❑ No. � Other FaAs: Locations �� <br /> �UEL STORAG� (Must be apprvved by Fire Marshall{f propostng to abanuton tank!n place.) <br /> ❑ InstalZation ❑ Removal <br /> Futl Oil: gallons ❑ Undergravnd ❑Inside []Outside <br /> �,�'Gas: gallons <br /> Other: <br /> GAS L�ONL'Y' <br /> ❑ Qutdoor Gri)1 ❑ Other/List What&Whe�re: <br /> 2 <br />