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� �� <br /> . . . • <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 /> Quantity: ( <br /> � <br /> Make: G <br /> Model: �l U G� � <br /> FueL• ��J�--�" <br /> �l <br /> Flue Size: �� C <br /> Input BTLJs: U U-vr/' . <br /> Output BTUs: S ?� D� d <br /> CFM: �i �� �- <br /> —� <br /> � COOLING SYSTEMS <br /> Quantity: <br /> Make: <br /> Model: <br /> Tons: <br /> H.Power <br /> FIItEPLACES <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 cfm <br /> ❑ No. Bath Exhaust(must have duct outside) cfrn <br /> ❑ No. Other Fans: Locations cfm <br /> FLJEL STORAGE (Must be approved by Fire MarshaU if proposing to abandon tank in plac�) <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 />