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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: (� �j <br /> Make: �Q�v � �� w � <br /> Model: ���f:J�4o�_�;���,�' <br /> Fuel: �Q�tt�� �f4,5 ��� <br /> Fhi�iz�: 11 <br /> Input BTUs: 101.)�_ <br /> Output BTUs: S��O�_ <br /> CFM: <br /> COOLING SYSTEMS <br /> Quantity: <br /> Make: <br /> Model: D � <br /> Tons: �\.J <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 E�chaust duct recirculating cfm <br /> � No. Bath Exhaust(must have duct outside) cfin <br /> No. Other Fans: Locations cfm <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 ❑ Other/List What&Where: <br /> 2 <br />