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w <br /> � � ' <br /> T�`<d5 ��+�, .: e -:: f, y�:a <br /> x�;,� �� 'Z � .,`.s� �' <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: � <br /> Make: G/at����1� <br /> Model: /''��L 6�0� <br /> Fuel: �• G/°rs <br /> Flue Size: ��� �V� <br /> Input BTUs: 6 G G 4 <br /> �7asG <br /> Output BTUs: � <br /> CFM: ��0 6 <br /> COOLING SYSTEMS <br /> Quantity: � <br /> Make: C�9RRl�/L <br /> Model: � ( ����� 7 <br /> Tons: �'��~j <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 <br /> VENTILATION <br /> No. Kitchen Exhaust duct recirculating cfin <br /> No. � Bath E�chaust(must have duct outside) cfm <br /> No. Other Fans: Locations cfin <br /> �' �vG-�'c�atiK g S//�1 Y R/�1 <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 />