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02-09-'18 13:48 FROM- T-510 P0002/0007 F-948 <br /> Note:All Geothermal Systems will now require a Site Plan&Review by our Building Officifll. <br /> IS THIS GEOTHERMAL? ❑'Yes ❑No <br /> HEATING SYSTEMS <br /> Quantity: <br /> Make: _ <br /> Model: "IV X <br /> Fuel: <br /> Flue Size: <br /> Input BTUs: <br /> Output BTUs: <br /> CFM; <br /> COOLING SYSTEINIS <br /> Quantity: <br /> flake: <br /> Model: <br /> Tons: <br /> H.Power _ <br /> FIREPLACES <br /> Gas Factory Fireplace Bt-and Name; &T <br /> - <br /> Wood Burning Fireplace <br /> ❑ Wood Stove Model No.: -Wa=� <br /> ❑ Wood Stove with Flue/Masotlry <br /> VENTILATION <br /> ❑ No. Kitchen Exhaust duct _recirculating efin <br /> ❑ No. Bath Exhaust(must have duct outside) 0 f <br /> ❑ No. Other Fans: Locations cfm <br /> FUEL STORAGE (illnst be approved by fire Mat-shall if proposing to abondott tank Or 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 R Where: <br /> 2 <br />