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� � <br /> Note: All Geothermal Systems will now r�quire a Site Plan &Review by our Building Official. <br /> IS THIS GEOTHERMAL? ❑Yes „�No <br /> HEATING SYSTEMS ! <br /> Quantity: 1 <br /> Make: �~ :._ ��Q.�1VlO <br /> Model: � � ,�■�"����` <br /> Fuel: � I�✓�,�: ��l 5 <br /> Flue Size: �n Z <br /> i ' <br /> Input BTUs: _ ; <br /> Output BTUs: � <br /> CFM. I Z'ZS� <br /> COOILING SYSTEMS <br /> Quantity: � <br /> Make: ,� <br /> i <br /> Model: �_ <br /> Tons: � <br /> H.Power � <br /> FIItE�'LACES <br /> ❑ Gas Factory Fireplace Brand Name: <br /> ❑ Wood Burning Fireplace <br /> ❑ Wood Stove Model No.: <br /> ❑ Wood Stove with Flue/Masor�ry � <br /> VEN'I�LATION I' <br /> � ❑ No. Kitchen Exhaus duct recirculating cfin i <br /> ❑ No. Bath Exhaust( ust have duct outside) cfin j <br /> ❑ No. Other Fans: Lo tions cfin j <br /> , <br /> FUEL�TORAGE (Must be approved by Fire arshal!if proposing to abandon tank in p[ace.) � <br /> ; <br /> ❑ Installation ❑ Re val I <br /> � <br /> Fuel Oil: gallons � ❑ Underground ❑ Inside ❑ Outside I <br /> LP Gas: gallons ' <br /> Other: <br /> GAS L�NE ONLY <br /> ❑ Outdoor Grill ❑ Othe /List What&Where: <br /> 2 <br />