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! <br /> . <br /> , , , <br /> , <br /> ;: , � „ , �� , ...��`�` ��� <br /> 3, f '�'r �,,,y- � �� <br /> Note: All Geothermal Systems will now require a Site Plan&Review by our Building Official. <br /> IS THIS GEOTHERMAL? ❑ Yes (�No <br /> / <br /> HEATING SYSTEMS <br /> Quantity: � <br /> Make: <br /> Model: <br /> Fuel: <br /> Flue Size: <br /> Input BTiJs: <br /> Output BTUs: <br /> CFM: <br /> COOLING SYSTEMS <br /> Quantity: <br /> Make: <br /> Model: <br /> Tons: <br /> H.Power <br /> FIREPLACES <br /> ❑ Gas Factory Fireplace Brand Name: <br /> ❑ Wood Burning Fireplace <br /> ❑ Wood Stove Model No.: <br /> ❑ Wood Stove With Flue <br /> VENTILATION <br /> ❑ No. Kitchen Exhaust duct recirculating cfm <br /> � No. Bath Exhaust(must have duct outside) cfm <br /> � No. Other Fans: Locations cfm <br /> FUEL STORAGE(MUST BE APPROVED BY FIRE MARSHALL) If proposing to abandon tank <br /> ❑ Instal lation ❑ Removal i n p 1 a c e. <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 />