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w <br /> • <br /> • <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: � `� (�te VuJO CU�r1'n\'�1C:� <br /> Make: � J C Q`� Q (� �1 V1e ���5 <br /> ModeL• 3�� �(��(V�L� (�,n� Q.vO <br /> FueL• �•d 1. \N�J��, � C�,���'��1/�C.� <br /> Flue Size: � " p, ,_ ��j��W(,� (-G�\C�,� <br /> Input BTUs: �J� �\,OG`C�`�✓W` •. <br /> Output BTUs: 3��G <br /> CFM: <br /> COOLING SYSTEMS <br /> Quantity: + <br /> Make: � Cy�y�.� <br /> Model: 3 <br /> Tons: � d� <br /> H.Power <br /> FIREPLACES <br /> ❑ Gas Factory Fireplace Brand Name: <br /> ❑ Wood Burning Fireplace <br /> B Wood Stove Model No.: <br /> ❑ Wood Stove With Flue <br /> VENTILATION <br /> ❑ No. Kitchen Exhaust duct recirculating cfin <br /> ❑ No. Bath E�aust(must have duct outside) cfm <br /> 0 No. Other Fans: Locations cfin <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 />