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� <br /> Note:All Geothennal Systems will now require a Site Plan&Review by our Building Off'icial. <br /> IS THIS GEOTHERMAL? ❑Yes �No , <br /> HEATING SYSTEMS <br /> Q��Ty: r _ <br /> Make: <br /> Model: <br /> Fuel: . / <br /> Flue Size: <br /> Input BTLTs: <br /> Output BT(Js: � <br /> CFM: <br /> COOLING SYSTEMS <br /> Quantity: <br /> Make: <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 /> ❑ Wood Stove with Flue/Masonry � <br /> VENTILATION <br /> ❑ No. Kitchen Exhaust iluct recirculating cfm <br /> ❑ No. Bath Exhaust(must have duct outside) cfm <br /> ❑ No. Other Fans: Locations cfm <br /> FITEL STORAGE (Must be approved'by Fire Marsha[l if proposing to abandon tank in plac�) <br /> ❑ Installation ❑ Removal <br /> �� Fr�el 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 />