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Mar 24 �014 1 : 58PM HP LRSERJET FRX page 3 <br /> . I <br /> Note.All Geothermal Systems'will now require a�ite Plan&Beview by ow Building Qi�'icial. <br /> �S THIS GEOTHERMAL? ❑Yos �No <br /> HEATING SYSTLMS �E�j(iL�t� �JL�Ir"1+�.C'�� t�$�+t-��' �' ""0 Y�k <br /> quentity: � <br /> Make: r <br /> Model: ^JG (p.� <br /> Puel: <br /> Flue Siae: '� <br /> Input BT'Us: [e�.h(� . <br /> —.— -- <br /> Output BTUs: 5�{ �0 U <br /> CFM: <br /> COOLING SY3TEMS � <br /> Quantity: <br /> Make: <br /> Model: <br /> Tona: <br /> H.Power <br /> FIREPLACES <br /> ❑ Gas Factory Firep�ace Brand Name: <br /> ❑ Wood Burning Fihplace <br /> ❑ Wood Stove Modet No._ <br /> ❑ Waod Stove wt�Flue/Masonry <br /> YEN N <br /> ❑ No. Kit.�hen Exhaust duct recirculating c�n <br /> ❑ No• Bat�Exhaust{must have duct outside) � <br /> ❑ No. Ot2tjerFans: Locntions c� <br /> (Must be appr�eal�y Fl�e Marslkall tfpro,poafng ta abandon Cank in plae�) <br /> ❑ Installation [] Removal <br /> Fuel Oil: gallons ❑ Unda�ground ❑Inside ❑Outside <br /> LP Gas: gallons <br /> Otha: <br /> GA5 LIN ON .V <br /> ❑ Outdoor Grt71 ❑ Other/List What&Whore: <br /> 2 <br /> i <br /> � <br /> h �� <br />