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. � <br /> Note: All Geothermal Systems will now require a Site Plan&Review by our Building Of�cial. <br /> IS THIS GEOTHERMAL? ❑ Yes �No <br /> HEATING SYSTEMS <br /> Quantity: � <br /> Make: Z I�rJ7� <br /> Mode►: q a6 rA vao bo V� � <br /> FueL NR?. �i AS <br /> Flue Size: <br /> d �, <br /> Input BTUs: (�0� o 0 0 <br /> Output BTUs: s$� Obd <br /> CFM: 9/G^ !�vt o <br /> COOLING SYSTEMS <br /> Quantity: � <br /> Make: QQyA�T' <br /> � <br /> ModeL /�6 8/�A o 3� <br /> Tons: o� <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 Exhaust duct recirculating cfin <br /> ❑ No. Bath Exhaust(must have duct outside) cfm <br /> ❑ No. Other Fans: Locations cfm <br /> FLTEL 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 />