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! <br /> � �- � .��� �,S�f b <br /> 3��, '"vti /, v-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 /> Quantity: L. <br /> Make: ��i�'1.Y1,� <br /> ModeL• ��i ����{��]�X��Ol3 <br /> Fuel: <br /> Flue Size: <br /> Input BTUs: <br /> Output BTUs: <br /> CFM: <br /> COOLING SYSTEMS <br /> Quantity: Z' <br /> Make: XC aS' � <br /> Model: <br /> Tons: � <br /> H.Power <br /> FIREPLACES <br /> ❑ Gas Factory Fireplace Brand Name: <br /> ❑ Wood Burning Fireplace <br /> ❑ Wood Stove Model No.: <br /> ❑ Wc�od 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 -1�0 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 �f Other/List What&Where: ��,in , �,f`1 X Z,� �l _ <br /> �� 4�w x z , '�ir�t cu,� �,3, <br /> 2 11��'d-w✓ �w(it— <br />