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Note: All Geothermal Systems will nowreqre a Site Plan&Review by our Building Official. <br /> Yes N i <br /> IS THIS GEOTHERMAL? � o <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 /> c, <br /> FIREPLACES kw"A <br /> 6,4e, Loe-j <br /> Gas Factory Fireplace Brand Name: RoAarpTa6C7�,, <br /> El Wood Burning Fireplace <br /> El Wood Stove Model No.: <br /> M Wood Stove with Flue/Masonry <br /> VENTILATION <br /> ❑ No. Kitchen Exhaust duct recirculating cIrn <br /> ❑ No. Bath Exhaust(must have duct outside) cfm <br /> ❑ NO. Other Fans: Locations cfm <br /> FUEL STORAGE_(Must be approved by Fire Marshall ifproposing to abandon tank in place.) <br /> El Installation F1 Removal <br /> Fuel Oil: gallons ❑ Underground El Inside El Outside <br /> LP Gas: gallons <br /> Other: <br /> GAS LINE ONLY <br /> ❑ Outdoor Grill ❑ Other/List What&Where: <br /> 2 <br />