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.f • <br /> Y"� t .��.�. .�� � .. � <br /> - �5 . - ��. ��'�� .��������� t ��.`., <br /> . ' e '�,.�� .,�;�� .lrv. <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 /> Quantity: <br /> Make: <br /> Model: Q <br /> Fuel: � ��S <br /> Flue Size: <br /> Input BTUs: Q r �� <br /> Output BTUs: � O <br /> CFM: <br /> COOLING SYSTEMS <br /> Quantity: <br /> Make: <br /> Model: <br /> Tons: <br /> H.Power <br /> FIltEPLACES <br /> ❑ Gas Factory Fireplace Brand Name: <br /> ❑ Wood Burning Fireplace <br /> a Wood Stove Model No.: <br /> ❑ Wood Stove With Flue <br /> VENTILATION <br /> ❑ No. Kitchen Exhaust duct recirculating cfm <br /> � No. Bath Eachaust(must have duct outside) cfm <br /> No. Other Fans: Locations cfm <br /> FUEL STORAGE (Must be approved by Fire Marshall ijproposing to abandon tank in place.) <br /> � Installation a 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 />