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t a <br /> � � ta� ,�.�' �-a � ,��"�` a -� r t� 'E�� �. <br /> ,J,z� ',Yv`fg, air� '•i.� �' �. �. • <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 BTiJs: <br /> Output BTUs: <br /> CFM: <br /> COOLING SYSTEMS <br /> Quantity: <br /> Ma1ce: <br /> Model: <br /> Tons: <br /> H.Power <br /> FIItEPLACES <br /> ❑ Gas Factory Fireplace Brand Name: <br /> ❑ Wood Buming Fireplace <br /> ❑ Wood Stove Model No.: <br /> ❑ Wood Stove with Flue/Masonry <br /> VENTILATION <br /> ❑ No. Kitchen Exhaust duct recirculating c&n <br /> ❑ No. Bath Exhaust(must have duct utsid cfin <br /> � No. �— Other Fans: Locations � cfin <br /> FUEL STORAGE (Must be approved by Fire Marsha[I 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 />