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/ � • . � � � . .. . <br /> Note: All Geothermal Systems will now require a Site Plan&Review by our Building Official. <br /> IS THIS GEOTHERMAL? ❑Yes 0 No <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 /> __ _ <br /> H.Power <br /> FIREPLACES � <br /> Gas Factory Fireplac��� Brand Name: ���C:.h-� <br /> Wood Burning Fire lace� <br /> p � � _ ��� -`�� <br /> Wood Stove Model No.: <br /> Wood Stove With Flue , <br /> VENTILATION <br /> Na Kitchen Exhaust duct recirculating cfm <br /> No. Bath Exhaust(must have duct outside) cfrn <br /> No. Other Fans: Locations cfm <br /> FUEL STORAGE (Must be approved by Fire MarshaU iJproposing 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 />