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Note: All Geothermal Systems will now req 're a Site Plan&Review by our Building Official. <br /> IS THIS GEOTHERMAL? ❑ Yes No <br /> HEATING SYSTEMS ; <br /> Quantity: � / '� <br /> _— <br /> Make: � r�,Q► I� <br /> Model: �(J�, ������'`i`t'o�.{ � � <br /> Fuel: <br /> Flue Size: <br /> � �� � <br /> Input BTUs: �o O ��/� �LCJ <br /> Output BTUs: � �� ��/� <br /> CFM: <br /> COOLING SYSTEMS <br /> Quantity: � <br /> Make: r�,�� <br /> Model: ��� v � �.-1-�� <br /> Tons: � <br /> H.Power I <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 <br /> ❑ No. Kitchen Exhaust duct recirculating cfin <br /> � No. � Bath E�aust(must have duct outside) �-cfin <br /> ❑ No. Other Fans: Locations cfin <br /> FUEL STORAGE (Must be approved by Fire Marshall iJproposing to abandon tank in place.) <br /> ❑ Installation ❑ Removal <br /> Fuel Oil: gallons ❑ Underground ❑Inside ❑Outside , � <br /> LP Gas: gallons , J ' � � <br /> Other: (�s �ll1,Q__ ����IL� <br /> GAS LINE ONLY �-� (I �� ���r`� t�« <br /> c�s I�n�. tp ol � <br /> ❑ Outdoor Grill Other/List What&Where: � `�� <br /> 2 <br />