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� j <br /> >ff' t r �i'4�1���''l�ii�f'\T�;7S'�l�c`��, ` ' �_� ° • , <br /> d-°� "...�+i�<,P,k ,tr�:i..,�u�t� <br /> Note: All Geothermal Systems will now require a Site Plan & Review by our Building Official. <br /> IS THIS GEOTHERMAL? ❑ Yes �No <br /> HEATING SYSTEMS <br /> Quantity: <br /> Make: �YVl�O)C <br /> Model: ���� <br /> Fuei: ��' <br /> Flue Size: 3 ����L <br /> Input STUs: � �v,��� <br /> Output BTUs: �� �c`)`J <br /> CFM: Zf�� <br /> COOLING SYSTEMS <br /> Quantity: � <br /> Make: ��N�%� <br /> Mode1: ��-��'�O� <br /> � <br /> Tons: 5 <br /> H. Power <br /> FIREPLACES <br /> ❑ Gas Factory Fireplace Brand Name: <br /> ❑ Wood Burning Fireplace <br /> � Wood Stove Model!�(o.: <br /> ❑ Wood Stove With Flue <br /> VENTILATION <br /> ❑ No. Kitchen Exhaust duct recirculating cfm <br /> ❑ No. Bath Exhaust(must have duct outside) cfin <br /> ❑ No. Other Fans: Locations cfm <br /> FUEL STORAGE (Must be approved by Fire Marsha[l ijproposing to abandon tank in place.) <br /> ❑ Installation a Removal <br /> Fuei Oil: gallons ❑ Underground a [nside �Outside <br /> LP Gas: gallons <br /> Other: <br /> GAS LINE ONLY <br /> ❑ Outdoor Griil � Other/List What& Where: <br /> � <br />