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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 BTUs: <br /> Output BTLTs: <br /> CFM: <br /> COOLING SYSTEMS <br /> Quanrity: <br /> Make: <br /> Model: <br /> Tons: <br /> H.Power <br /> FIREPLACES <br /> Gas Factory Fireplace Brand Name: �—f.e s�—�-ti � P T o� <br /> ❑ Wood Burning Fireplace <br /> ❑ Wood Stove Model No.: �- �C }� � � ,L <br /> ❑ Wood Stove With Flue <br /> VENTILATION <br /> ❑ No. Kitchen Exhaust duct recirculating cfrn <br /> ❑ No. Bath Exhaust(must have duct outside) cfm <br /> ❑ No. Other Fans: Locations cfrn <br /> FUEL STORAGE(MUST BE APPROVED BY FIRE MARSHALL) <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 />