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k�,- <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 /> Mal:e: <br /> Model: <br /> Fuel: <br /> Flue Size: <br /> Input BTUs: <br /> Output BTUs: <br /> CFM: <br /> COOLING 5YSTEMS <br /> Quantity: � <br /> Make: �n'� <br /> Model: �✓v "` � <br /> Tons: � �'n <br /> H. Power <br /> FIREPLACES <br /> ❑ Gas Factory Fueplace Brand Name: <br /> ❑ Wood Burning Fueplace <br /> � Wood Stove Model No.: <br /> ❑ Wood Stove With Flue <br /> VENTILATION <br /> ❑ No. Kitchen E�aust duct recirculating cfm <br /> ❑ No. Bath Exhaust(must have duct outside) cfm <br /> ❑ No. Other Fans: Locations cfm <br /> FUEL STORAGE (Must be approved by�re Marshall ijproposing to abandon tank in place.) <br /> ❑ Installation a Removal <br /> Fuel Oil: gallons ❑ Underground a Inside �Outside <br /> LP Gas: gallons <br /> Other: <br /> GAS LINE ONLY <br /> ❑ Chitdoor Grill ❑ (�ther/List What&Where: <br /> 2 <br />