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• 1 ' <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: <br /> Model: <br /> Fuel: <br /> Flue Size: <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: �`=�(�� <br /> ❑ Wood Burning Fireplace /� <br /> ❑ Wood Stove Model No.: � <br /> ❑ Wood Stove with Flue/Masonry <br /> VENTILATION <br /> ❑ No. Kitchen E�chaust duct recirculating cfm <br /> ❑ No. Bath E�chaust(must have duct outside) cfm <br /> ❑ No. Other Fans: Locations cfm <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 <br /> Other: <br /> GAS LINE ONLY �\I ���{/'� <br /> �r <br /> ❑ Outdoor Grill ❑ Other/List What&Where: <br /> 2 <br />