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. �- �,.. <br /> AL�Y�TEIuI�� .�, ` �ir I�T��,-,��.Ell ' <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 /> CFM: <br /> COOLING SYSTEMS <br /> Quantity: <br /> Make: <br /> ModeL• <br /> Tons: <br /> H.Power <br /> FIREPLACES <br /> � Gas Factory Fireplace Brand Nam��—►1/�� <br /> ❑ Wood Burning Fireplace � <br /> ❑ Wood Stove Model No(:'j� �,Q,�p/�,�3l'rC�/ <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. Other Fans: Locations cfin <br /> FUEL STORAGE (Must be approved by Fire Marshall if proposing to abandon tank in p[ace.) <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 />