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05-18-'17 15:04 FROM- T-225 P0002/4004 F-492 <br /> ' �;;11�fECHANYCAY�. `Y'` .`� �,' <br /> . .S �'�1v�s.B�nJ�'�INs.T�i;ifip:��:'::�:;.,,;. <br /> Note:All Geothermal Systems will now require a SiCe plan&Review by our Building OffiCial. <br /> IS 7'HYS GEOTHEYt1VXAX.? ❑Yes ❑No <br /> HEATING SY�TEMS <br /> Quantity: <br /> Make: <br /> Model: <br /> �'uel: <br /> Flue Siz�: <br /> Znput BTUs: <br /> Output BTUs: <br /> CFM: <br /> COOLrNG SYSTEMS <br /> Quantity: <br /> Make: <br /> Modol: <br /> Tons: <br /> �T.power <br /> FI�tEP�,ACES <br /> � Gas Factory�'ireplace Brand Name: � � <br /> ❑ Wood Burning Farzplace 2/ <br /> ❑ Wood Stove Model 1Vo.: '"��V�'� l�10� <br /> ❑ Wood Stove with Plue/Masonry <br /> v�rr�r��arYorr <br /> ❑ No. TCitchcn�xhaust duct recirculatiag cfm <br /> ❑ No. Bath�xhaust(rnust have duct outside) cfm <br /> ❑ No. Other Fans: X,oca[ions cfm <br /> ��'��,S fdRAG� (Mi�st be approved by F}re Marsball ifproposireg to abaa�lo�1 tn»k i��pl�rce.) <br /> ❑ Installation [] R�moval <br /> �'uel Oil: gallons ❑ Underground ❑Tnside ❑Outside <br /> T,Y Qas: galions <br /> Other: <br /> GAS LINE ONY�'Y <br /> ❑ Outdoor Grill ❑ Other/List What&Whrre: <br /> 2 <br />