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� <br /> � <br /> ������r�;',�°� ���`'. ' <br /> r <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: <br /> Fuel: <br /> Flue Size: <br /> Input BTUs: <br /> Output BTLJs: <br /> CFM: <br /> COOLING SYSTEMS <br /> Quanhh': <br /> Make: <br /> Model: <br /> Tons: <br /> H.Power <br /> FIREPLACES <br /> pZ.,� Gas Factory Fireplace Brand Name: f I��'�"n � ( o <br /> Wood Buming Fireplace <br /> ❑ Wood Stove Model No.: CC�oc�a.3lo . '7S07�QS <br /> ❑ Wood Stove with Flue/Masonry <br /> VENTILATION <br /> ❑ No. Kitchen Exhaust duct recirculating cfm <br /> ❑ No. Bath E�chaust(must have duct outside) cfm <br /> ❑ No. Other Fans: Locations cfin <br /> F[JEL STORAGE (Must be appmved by Fire Marshall jproposing m abandon tank in plac�) <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 />