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� r �� y � ;�.s :s <br /> ``€� .�,�E�;I�a° �, � �; x4,'�. <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: ���cr7�C7,��X� <br /> Fuel: ���� <br /> Flue Size: <br /> a � � V'G <br /> Input BTUs: 7O � �d � <br /> ouc�ut BTus: �i .7 � -S c�v <br /> �FM: �a a o <br /> COOLING SYSTEMS <br /> Quantity: � <br /> Make: �O IM <br /> Model: �s� � <br /> Tons: � �0 ►v <br /> H.Power ��� V <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 /> � �� cfm <br /> ❑ No. �_ Kitchen Exhaust duct� recirculating <br /> ❑ No. �_ Bath Exhaust(must have duct outside) �cfm <br /> ❑ No. Other Fans: Locations �� <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 />