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� <br /> - � <br /> �.� � <br /> �. ��� "��..,. �� '� �:�� ��.� ��� ��� �a � ��� ���,,�,�� <br /> F , <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: � Gy � <br /> Model: �(a � �/Ll�, fj <br /> Fuel: �' `i �- <br /> � � I <br /> Flue Size: <br /> Input BTUs: � L� b ��'= <br /> � <br /> Output BTUs: � ��� �= ��<� <br /> CFM: <br /> COOLING SYSTEMS <br /> Quantity: � <br /> Make: (�Gy y�;Z <br /> Model: 191t/.� �j <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 cfin <br /> ❑ No. 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 /> ' 1 <br /> ❑ Outdoor Grill �" Other/List What&Where: ( �� ) U�'y� ✓ , ��t S �,r c�f; �(�C;�' <br /> 2 �;,� ) �L,�., s� �,,ti�{r <br /> i <br />