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, � %,. <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: <br /> Model: <br /> Fuel: <br /> Flue Size: <br /> Input BTUs: <br /> Output BTUs: <br /> CF M: <br /> COOLING SYSTEMS <br /> Quantiry: <br /> Make: <br /> ModeL• <br /> Tons: <br /> H.Power <br /> FIREPLACES <br /> Gas Factory Fireplace Brand Name: H EAT & G LQ <br /> Wood Burning Fireplace (4) ESCAPE-42DV <br /> Wood Stove Model No.: <br /> Wood Stove With Flue <br /> VENTILATION <br /> No. Kitchen Exhaust duct recirculating cfm <br /> No. Bath Exhaust(must have duct outside) cfm <br /> No. Other Fans: Locations cfin <br /> FUEL STORAGE (Must be approved by Fire Marshal[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: GAS LINE BY OTHERS <br /> 2 <br />