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� }� . a 6 ,`� F d �� '�`^,q"!��' �' o�- <br /> 1 <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: �..P.v► Y��x <br /> Mode�: EL,2,�6UIfo�iOXV�-1�3 �. <br /> FueL• , �i.. <br /> Flue Size: <br /> Input BTiIs: � 1 (�� 0 d � <br /> Output BTUs: <br /> CFM: <br /> COOLING SYSTEMS <br /> Quantity: ` <br /> Make: L Lvt.►'l O 7C <br /> Mocte�: �(C.�,O—c7t-lg 23 O <br /> Tons: 1 <br /> H.Power <br /> FIREPLACES <br /> ❑ Gas Factory Fireplace Brand Name: <br /> ❑ Wood Burning Fireplace <br /> ❑ Wood Stove Model No.: <br /> ❑ Wood Stove with Flue/Masonry <br /> VENTILATION C Ki i-G�r� °e�ti(t�Gj�' � �►^dU : cp�c� by �lo�.v�� t�l.v�e'�' <br /> W�e,l �-o �, �5 ��.i � ��,� k; �-c,laeh ,e.yc�a-u5f laoo�J , <br /> � No. �_ Kitchen Exhaust duct recirculating cfm <br /> ❑ No. Bath Exhaust(must have duct outside) cfin <br /> ❑ No. Other Fans: Locarions cfm <br /> FUEL STORAGE (Must be approved by Fire Marshall if proposing to abandon tank in place.) <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 />