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, � <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: <br /> ModeL• <br /> Fuel: � <br /> Flue Size: r <br /> Input BTUs: �� <br /> Output BTUs: <br /> CFM: <br /> COOLING SYSTEMS <br /> Quantity: <br /> Make: <br /> Model: <br /> Tons: <br /> ' H.Power � <br /> FIREPLACES <br /> ❑ Gas Factory Fireplace Brand Name: LO p I <br /> ❑ Wood Buming Fireplace <br /> � Wood Stove Made,No.: 99600090 <br /> - ❑ Wood Stove with Flue/Masonry <br /> VENTILATION <br /> ❑ No. Kitchen Exhaust duct recirculating �� <br /> ❑ No. Bath Exhaust(must have duct outside) cfm <br /> ❑ No. Other Fans: Locations cfm <br /> FUEL STORAGE (Must be approved by Fire Marshall if proposing to abandon tank in place.) <br /> ❑ Installatiori ❑ Removal ._ <br /> Fuel Oil: gallons ❑ Underground ❑Inside ❑Outside <br /> LP Gas: gallons <br /> Other: <br /> GAS L1NE ONLY <br /> ❑ Outdoor Grill ❑ Other/List What&Where: <br /> 2 <br />