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� ,11,-30-'16 15:12 FROM- T-4$0 P0011/0016 F-583 <br /> * , �. <br /> ;;; ... ,,, . _ - - - <br /> . <br /> �y.=_} :.: .. : . . , . .. ;. _ �---: <br /> . . . . <br /> .. . <br /> .a , _.� _ . �• _r '., •. • Re . ' ' '.Y ,q F. . <br /> � . r .t `� ` <br /> '9._ �.r. •tni�.: •f�`-Tr•ef ._� _ t_ -`+�5. _ <br /> Note;All Creothermal Systems will now reyuire a S.ite Pian�Review by our Building Official. <br /> YS T�IIS GEOT�Y�YtMAY,? ❑Yes ❑Np <br /> �iEATiNG$YS'Y'�MS <br /> Quantity: ., <br /> Maka: <br /> Model: <br /> Fucl: <br /> Flue Size: <br /> Input BTUs: _ <br /> Output BTUs: <br /> CFM� , <br /> COQL�NG S'YST�MS <br /> Quantity: <br /> Makc: <br /> Model: <br /> Tons: <br /> H,Power <br /> FIREPY.AC�S <br /> � Gas Pactory�ireplace Brand Name: G7 r7 <br /> ❑ Wood�urning�'ireplace <br /> ❑ Wood Stove Modcl No.: �� (�� <br /> [] Wood Stove with Fluz/MAsonry <br /> V�IY I'T�,ATION <br /> ❑ No. Kitchen�xhaust duct recirculating cfm <br /> � No. �ath�xhaust(must have duct ouuide) cfm <br /> � No. Other Pans: Locations cfm <br /> FU�L,S7'ORACE (Must be apnroved by Flre Marslrn/1{/'proposing to abandon tank in pla�se,) <br /> ❑ Tnstallation ❑ Removal <br /> Fuel Oil: .. p,xllons ❑ Underground �,]Inside ❑Outsido <br /> LP Gas; gallons <br /> Other: <br /> GAS�,rN'�ONLY <br /> ❑ Outdoor Orill ❑ Other/�.ist What&Where; <br /> 2 <br />