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09/12/2017 12:48 7635354379 GOLDEN VALLEY HTG PAGE 02/04 <br /> s S'�r•L.0-e`' .�-cam'-'1_ y ,�' ' �...'�` „. � SII <br /> ..' `' •. ,. �_ ._ `�-�.fir.» ._, c j <br /> Note:All Geothermal Systems will now require a Site Plan&Review by our Building Official. <br /> IS THIS GEOTI1ERMA,L? ❑Yes)No <br /> HEATING SYSTEMS <br /> Quantity_ <br /> Make: Lenox_ <br /> Model: 5LP9 U <br /> Flue Size: <br /> — I <br /> Input BTUs: <br /> Output BTUs; AP/44a ^ <br /> CFM: <br /> COOLING SYSTEMS <br /> Quantity: • I <br /> Make: Leionca x <br /> Model: -wolfI <br /> Tons: <br /> H.Power <br /> FIREPLACES <br /> ❑ Gas Factory Fireplace Brand Name: <br /> ❑ Wood Burning Fireplace <br /> d Wood Stove Model No.: <br /> ❑ Wood Stove with Flue/Masonry <br /> VENTTION <br /> ❑ Na- Kitchen Exhaust duct recirculating cfnn <br /> ❑ No. Bath Exhaust(must have duct outside) <br /> ❑ No. Other Pans: Locations —cfm <br /> cfrn <br /> I.. TO GE (Must be approved byFire Marshall[ <br /> fproposing to abandon tank in place.) <br /> ❑ Installation ❑ Removal <br /> Fuel Oil: gallons <br /> LP Gas ❑ Underground ❑Inside El Outside <br /> _ gallons <br /> Other: <br /> GAS LINE ONLY <br /> ❑ Outdoor Grill ❑ Other/List What&Where: j <br /> 2 <br />