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�''`"A'�,"��s�, . �$k . �r <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 /> Q�,antity: <br /> Make: <br /> Model: <br /> Fuel: <br /> Flue Size: <br /> Input BTils: <br /> Output BT[Js: <br /> CFM: <br /> COOLING SYSTEMS <br /> Q�tity: <br /> Make: <br /> Model: <br /> Tons: <br /> H.Power <br /> �PLACES <br /> ❑ Gas Factory Fireplace Brand Name: <br /> ❑ Wood Burning Fiteplace <br /> ❑ Wood Stove Model No.: <br /> ❑ Wood Stove with Flue/Masonry <br /> VENTII.ATION <br /> ❑ No. Kitchen Exhaust duct recirculating cfm <br /> ❑ No. Bath E�chaust(must have duct outside) cfm <br /> ❑ No. Other Fans: Locations cfm <br /> �I�E�,STORAGE (Mr�st b�e a,pproved by�re MarshaU if proposing to abandon tank in plac�) <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 />