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• � i <br /> Note: All Geothermal Systems will now require a Site Plan&Review by our Building Official. <br /> I3 THIS GEOTHERMAL? ❑Yes �No <br /> HEATING SYSTEMS <br /> Quantity: <br /> Make: <br /> Model: <br /> Fuel: <br /> �lue Size: <br /> iinput BTUs: <br /> Output BTUs: <br /> CFM: <br /> COOLING SYSTEMS <br /> Quantity: <br /> �Make: <br /> �Model: <br /> !Tons: <br /> H.Power <br /> �'IItEPLACES (gas)Town and country 42 <br /> (wood)Orade 42" <br /> 0 Gas Factory Fireplace 'Q Brand Name: (gas)Montigo H series <br /> � Wood Burning Fireplace <br /> ❑ Wood Stove Model No.: <br /> ❑ Wood Stove with Flue/Masonry <br /> ENTILATION <br /> ❑ No. Kitchen Exhaust duct recirculating cfm <br /> ❑ No. Bath E�chaust(must have duct outside) cfin <br /> � ❑ No. Other Fans: Locations cfin <br /> ,�'[JEL STORAGE (Must be approved by Fire Marshall if proposing to abandon tank in p/ac�) <br /> ❑ Installation ❑ Removal <br /> Fuel Oil: gallons ❑ Underground ❑Inside ❑Outside <br /> LP Gas: gallons <br /> Other: <br /> GAS LINE ONLY <br /> ❑ Outdoor Grill ❑ Other/List What&Where: <br /> i 2 <br />