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I� ,�,s � �j�� �� fa,� ���:����c��, �����r����:����� �A� �� =�f s z� : <br /> � <br /> , . � � � � ., <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: �yei/`jiqit'/ <br /> Model: �`�'��� <br /> Fuel: ��U <br /> �i/ <br /> Flue Size: <br /> Input BTUs: /.�u,put% <br /> Output BTUs: j�j, ,�.c��1 <br /> —� <br /> CFM: <br /> COOLING SYSTEMS <br /> Quantity: <br /> Make: <br /> Model: <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 cfm <br /> ❑ No. 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 />