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Note: All Geothermal Systems will now require a Site Plan&Review by our Building Official. <br /> IS THIS GEOTHERMAL? ❑Yesf$No <br /> HEATING SYSTEMS <br /> Quantity: ' f <br /> Make: <br /> Model: C9 M P X O c0 <br /> Fuel: Nc+ Cc, <br /> Flue Size: 211 PV c <br /> Input BTUs: d0� <br /> Output BTUs: "000 <br /> CFM: 1000 <br /> COOLING SYSTEMS <br /> Quantity: I <br /> Make: Qay c M y�fi <br /> Model: C4A3 2-4 <br /> Tons: Z- <br /> H.Power 2, <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 Exhaust(must have duct outside) cfin <br /> ❑ No. Other Fans: Locations cfin <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 Q <br /> ❑ Outdoor Grill ® Other/List What&Where: Fi fe-RIA 2 g5KT <br /> `A prye-r <br /> 2 <br />