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, ' A��I�iT�AL:��'T�MS BEIl�if.�'r�'�`I`�I��:.� . . <br /> � Note: All Geothermal Systems will now require a Site Plan&Review by our Building 01�'icial. <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 /> �I <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 Buming Fireplace <br /> ❑ Wood Stove Model No.: <br /> ❑ Wood Stove with Flue/Masonry <br /> VENTILATION <br /> ❑ No. Kitchen Exhaust duct recirculating cfin <br /> 0� No. T Bath Exhaust(must have duct outside) �cfm <br /> ❑ No. Other Fans: Locations cfm <br /> � FUEL STORAGE (Must be approNed by Fire MarshaU if proposing to abandon tank in place.) <br /> ❑ Installation ❑ Removal <br /> i <br /> i, <br /> , Fuel Oil: gallons ❑ Underground ❑Inside ❑Outside <br /> �i LP Gas: gallons <br /> Other: <br /> GAS LINE ONLY � D _ �����Q, _I__ <br /> a �c�'�.f�tt� �� ��o <br /> ❑ Outdoor Cmll [� Other/List What&Where: � <br /> �v�.. • 1L ���� <br /> 2 <br /> �I <br />