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r <br /> 1 � <br /> • , <br /> Note: All Geothermal Systems will now require a Site Plan&Review by our Building Official. <br /> IS THYS GEOTHERMAL? ❑ Yes [�No <br /> HEATING SYSTEMS <br /> Quantity: fi' <br /> Make: " <br /> Model: ,L�+a�-°'� <br /> —� <br /> Fuel: « <br /> Flue Size: <br /> Input BTUs: <br /> Output BTUs: " <br /> CFM: <br /> COOLING SYSTEMS <br /> Quantity: � <br /> Make: ..: :'�S�l <br /> Model: �ti D �i <br /> Tons: -3 � <br /> H. Power <br /> FIREPLACES <br /> ❑ Gas Factory Fireplace Brand Name: <br /> ❑ Wood Burning Fireplace <br /> ❑ Wood Stove Model No.: <br /> ❑ Wood Stove with Flue/Masonry <br /> VENTILATION <br /> ❑ No. Kitchen E�chaust duct recirculating cfrn <br /> ❑ No. Bath E�chaust(must have duct outside) cfm <br /> ❑ No. Other Fans: Locations cfm <br /> FUEL STORAGE (Must be approved by Fi�e 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 />