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JUL-27-2910 01:11P FROM:STATEWIDE GAS SERVIC 9524674605 TD:2494616 P.4 <br /> M�CHANICAL SYSTEMS B.�ING INSTALI.ED <br /> Note:All Geothermal8ystems will now require a Si e Pl &Review by our Buifding Official. <br /> TS TAIS GEOTHERMALY ❑Yes�No <br /> HEATING SYSTEMS Rt.��l.c,s t,JG�.�},'y•I <br /> Quantity. <br /> M�e: � <br /> M���: 35'�'c.9�/o/�O/a� <br /> Fuel: �N� <br /> �� <br /> Flue Siza: �o�_, <br /> Input B1'Us: d O <br /> Output BTUs: S� ID ' <br /> CFM: <br /> COOLING SYS7'EMS �� �.Kr S�i� <br /> QuantitY: � <br /> Make: �� <br /> Model: ,��/� �.�ip � <br /> Tons: � <br /> H.Power <br /> �REPLACES <br /> Gas Factory Fireplace Brand Name: <br /> Wood Burning Firepface <br /> Wood Stove Model No.: <br /> Wood Stove With Flue <br /> VENTiLAT[ON <br /> No. Kitchen Exhaust duct recirculating cfin <br /> No. Bath Exhaust(must hsve duct outside) cfin <br /> No. Other Fens: Locations cfm <br /> FUEL 3TORAG� (Mpai be approved by F7re MarsbaU jpropasing fo abaAdon 1aRk Jn plac�) <br /> � Jnstallation � Removal <br /> Fuel Oit: gallons ❑ Underground ❑Inside ❑Outside <br /> LP Gas: gallons <br /> Other: <br /> �AS LiNE QNLY <br /> � Outdoor Grill � Other/List What 8c Where: <br /> 2 <br />