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07/14/2017 11:51 7635354379 GOLDEN VALLEY HTG PAGE 03/04
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<br /> Note:A11 Geothernaal Systems wiZ1 z�ow re�uire a S't�Pi�&Review by our Buildin,g Official.
<br /> TS THI,S GEOT�IE�tMAL? ❑Yes �No
<br /> HEATING SXSTE�VI,S
<br /> Quantity: �
<br /> Melce: � ��
<br /> ]vlodel_ S�. ��
<br /> k'ue1:
<br /> F1ue Siae:
<br /> Xnput B�'Us: (1
<br /> Output BTUs: ! U(�v f 1..,- ^.
<br /> CFM:
<br /> COQI.,�iG SXSTEMS
<br /> QuaAtlty: �
<br /> Mske: (/1nU�
<br /> Model: "��}�,(� 0
<br /> �'ons: �• J
<br /> H.�ower
<br /> �PL �S
<br /> ❑� Gas Factory Fireplace B�d Name: ,�
<br /> Wood Buzz�i�ng Fireplace
<br /> � WQod Stove Model No_:
<br /> � Wood Stove with Plue/Maso�ary
<br /> VEN TId
<br /> ❑ No. _,� Kitchez�Exhaust duct reoircularing cfzzl
<br /> ❑ No_ Batk►Exhaust(�ust have duct outside) ��
<br /> � No. Othex Fans� �,ocations ��
<br /> FUE O � {Must be p,pproved by Fire.b,farsh¢Q if proposin.g to abandon tank irr place.)
<br /> ❑ Instaltatio�a � Rexx�oval
<br /> Fuel Oxl: gak�ons ❑ Undergrouud []Insxde ❑Ou'tside
<br /> Lp Gas: gallons
<br /> Othe�:
<br /> G�S�.INE O1V'X,X
<br /> � Outdopx Crrill [] Ocb,er/List Wb�at&Where:
<br /> 2
<br /> I
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