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. - i <br /> i Ai!n f�t 6 Y Z +�` .. <br /> . .yky, y C µy <br /> "��.tt�4'!b�: <br /> Note: Al] 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: � r <br /> Model: 3SS�/�/�'//Ol0/UC) <br /> Fuel: �(� <br /> Flue Size: <br /> Iuput BTlis: ,�DD, UUU <br /> � <br /> Output BTUs: <br /> C F:�1: ��Q <br /> COOLING SYSTEMS <br /> Quantiry: I � <br /> Make; �c�Cc.z � _ <br /> / <br /> Model: %�� �Iv�Uy� ��/V�/�`���/ <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) cfm <br /> No. Otl�er 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 Q Inside❑Outside <br /> LP Gas: gallons <br /> Other: <br /> GAS LI?�'E ONLY <br /> � Outdoor Grill ❑ Other/List What&Where: <br /> 2 <br />