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: 1W1���� AT:�:S3��I�S����3�*7�'r'��'�'�`3�`E� . .'�,, ���_ , <br /> Note: All Geothermal Systems will now require a Site Plan&Review by our Building Official. <br /> IS THIS GEOTHERMAL? ❑Yes (�No <br /> i� <br /> HEATING SYSTEMS <br /> Q�tity: <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 /> FIItEPLACES <br /> ❑ Gas 1'actory Fireplace Brand Name: <br /> ❑ Wood Bwnu�g Fireplace <br /> ❑ Wood Stove Model No.: <br /> ❑ Wooci Stove v��ith Flue/Masonry <br /> VENTII,ATION �, �I.��.p�� �- �,,�,�t�%�Lj V�' `.G'�, � f C/1 V L Y i ! <br /> � <br /> � No. Kitchen Exhaust duct recirculating cfm <br /> No. �_ Bath E�chaust(musf have duct ouLside) �cfm <br /> No. Other Fans: Locations cfin <br /> F[TLL STORAGE (Must be apprm�ed by Fire McrrshaU if proposing to abandon tank in place.) <br /> ❑ Installation ❑ Removal <br /> Puel Oil: gallons ❑ Underground ❑Inside ❑Outside <br /> LP Gxs: gallons <br /> Other: <br /> GAS LINE ONLY <br /> ❑ Outdoor Grill ❑ Olher/List What bc VJhere: <br /> 2 <br />