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� <br /> � <br /> � <br /> Note: All Geothermal Systems will now require a Site Plan&Review by our Building Official. <br /> IS THIS GEOTHERMAL? ❑ Yes ❑No <br /> HEATING SYSTEMS <br /> Quanrity: ! <br /> Make: �`'�/��� <br /> Model: �d��//0 <br /> Fuel: /�i�- <br /> �U <br /> Flue Size: <br /> Input BTus: _�/D, ����� <br /> Output BTUs: D o �° <br /> CFM: l�� <br /> COOLING SYSTEMS <br /> Quantity: � <br /> Make: —�=—�—`f'-� • <br /> Model: ��� <br /> Tons: �,s. <br /> H.Power l�i- <br /> FIREPLACES <br /> ❑ Gas Factory Fireplace Brand Name: <br /> ❑ Wood Buming Fireplace <br /> ❑ Wood Stove Model No.: <br /> ❑ Wood Stove With Flue <br /> VENTILATION <br /> ❑ No. Kitchen Eachaust duct recircularing cfin <br /> ❑ No. Bath Exhaust(must have duct outside) cfm <br /> ❑ No. Other Fans: Locations cfm <br /> FLTEL STORAGE (Must be approved by Fire Marshall if proposing to abandon tank in place.) <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 /> 2 <br />