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Note: All Geothermal Systems will now require a Site Plan&Review by our Building Official. <br /> IS THIS GEOTHERMAL? ❑ Yes V1 No <br /> HEATING SYSTEMS <br /> Quantity: <br /> Make: R(A U <br /> Model: PGRA <br /> Fuel: C, 1 <br /> e� <br /> Flue Size: A PU c <br /> Input BTUs: )015CEJ Go Cc 0 <br /> Output BTUs: 9 5-6 5-(,�o0 <br /> CFM: <br /> COOLING SYSTEMS <br /> Quantity: <br /> Make: Ru (,t <br /> Model: U p m 9a <br /> Tons: �l a �Gn <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 Exhaust duct recirculating 3W c$n <br /> ❑ No. L— Bath Exhaust(must have duct outside) cfm ecc� <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 <br /> ❑ Outdoor Grill Other/List What&Where: P KPr. C4G(J G , rCI o nc.0 r <br /> 2 <br />