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� <br /> - %:� _ � � � � y-� ���;q �� ��_ <br /> � :, �;:a�, �., <br /> � Note: All Geothermal Systems will now require a Site Plan&Review by our Building Official. <br /> IS THIS GEOTHERMAL? ❑ Yes �'I�To <br /> HEATING SYSTEMS <br /> Quantity: 1 <br /> Make: �✓I V�O <br /> Model: �L�g�u � I�j�J p(o(�� <br /> Fuel: �Q.�U-✓'�{ <br /> Flue Size: <br /> Input BTUs: � 5� (�!� � <br /> Output BTUs: t� � � �� � <br /> CFM: 7.0 �U' Q <br /> COOLING SYSTEMS <br /> Quantity: I <br /> Make: �-2,V�.Yl.(��C <br /> Model: �l�, - C��(� '2-�J� <br /> Tons: <br /> H.Power <br /> FIREPLACES <br /> ❑ Gas Factory Fireplace Brand Name: <br /> ❑ Wood Burning Fireplace <br /> ❑ Wood Stove Model No.: <br /> � Wo�d Stove with Flue�Masonry <br /> VENTILATION <br /> ❑ No. Kitchen E�chaust duct recirculating cfm <br /> ❑ No. Bath Exhaust(must have duct outside) cfin <br /> ❑ No. Other Fans: Locations cfin <br /> FUEL STORAGE (Must be approved by Fire Marshall 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 />