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. <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: <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 /> FIREPLACES <br /> � Gas Factory Fireplace Brand Name: Heat-N-Glo <br /> ❑ Wood Burning Fireplace <br /> � Wood Stove Model No.: SL-750 <br /> ❑ Wood Stove With Flue <br /> VENTILATION <br /> ❑ No. Kitchen Exhaust duct recirculating cfm <br /> ❑ No. Bath Exhaust(must have duct outside) cfm <br /> ❑ No. Other Fans: Locations cfm <br /> FOEL STORAGE (Must be approved by Fi�e Marshall if proposing to abandon tank in plac�) <br /> ❑ Installation a Removal <br /> Fuel Oil: gallons ❑ Underground 8 Inside �Outside <br /> LP Gas: gallons <br /> Other: <br /> GAS LINE ONLY <br /> ❑ Outdoor Grill � Other/List What&Where: <br /> 2 <br />