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Note: All Geothermal Systems will now require a Site Plan &Review by our Building Official. <br /> IS THIS GEOTHERMAL? ❑ Yes MINo <br /> HEATING SYSTEMS <br /> Quantity: 1 <br /> Make: <br /> Model: L- let <br /> Fuel: f �T <br /> Flue Size. <br /> A <br /> Input BTUs: Oct& <br /> Output BTUs: <br /> 1 <br /> CFM: �yv <br /> COOLING SYSTEMS l <br /> Quantity: ` <br /> Make: <br /> Model: Jl <br /> Tons: <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 cf n <br /> No. - ;t Bath Exhaust(must have duct outside) cfm <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: OAAt lV , �f Ly 4164Zf <br /> 2 <br />