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Note: All Geothermal Systems will now require a Site Plan&Review by our Building Official. <br /> IS THIS GEOTHERMAL? ❑Yes C�Wo <br /> HEATING SYSTEMS <br /> Quantity: / <br /> Make: r-► L�� <br /> Model: <br /> Fuel: P. <br /> Flue Size: <br /> 3 " <br /> Input BTUs: ltd <br /> Output BTUs: ! �� <br /> CFM: 1rIJZ1 <br /> COOLING SYSTEMS <br /> Quantity: / <br /> Make: h'E <br /> Model: 7/rK <br /> 0 Z <br /> Tons: Z <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 /> ffj� No. �_ Kitchen Exhaust duct recirculating Z 00 cfin <br /> ffr No. Z Bath Exhaust(must have duct outside) cfin <br /> ❑ No. Other Fans: Locations cfm <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: <br /> 2 <br />