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, <br /> . <br /> � <br /> ., .... <br /> l �iP'� 34'Lp�H'''.. ����;�fi� _ S ;} <br /> 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 /> Qu��'� <br /> Make: <br /> Model: <br /> FueL• <br /> Flue Size: <br /> Input B1'Us: <br /> Output BTUs: <br /> CFM: <br /> COOLING SYSTEMS <br /> Quantity: <br /> Make: <br /> Model: <br /> Tons: <br /> H.Power <br /> FIRF,PLACES <br /> ❑ Gas Factory Fireplace Brand Na�: <br /> ❑ Wood Buming Fireplace <br /> ❑ Wood Stove Model No.: <br /> ❑ Wood Stove with Flue/Masonry <br /> VENTILATION <br /> ❑ No. Kitchen Exhaust duct recirculatmg cfrn <br /> ❑ No. Bath Exhaust(must have duct outside) c&n <br /> ❑ No. Other Fans: Locations cfm <br /> FUEL STORAGE (Must be opproved by F'ue Ma�shaU ijproposixg to abandon tank in place) <br /> ❑ Installatioa ❑ Removal <br /> Fuel Oil: gallons ❑ Underground ❑Inside ❑Outside <br /> LP Gas: gallons <br /> Olher: <br /> GAS LINE OA'LY <br /> ❑ Outdoor Grill ❑ Other/List What&Where: <br /> 2 <br /> --------� <br />