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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: <br /> Make: <br /> Model: <br /> Fuel: <br /> Flue Size: <br /> Input BTiJs: <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: lX��n'D <br /> Wood Burning Fireplace ��— ,�� �, n`�� , L,l <br /> � Wood Stove Model No.: `��( �.ur �T(J <br /> Wood Stove with Flue/Masonry <br /> YENTILATION <br /> ❑ No. Kitchen Exhaust duct recirculating cfin <br /> ❑ No. Bath Exhaust(must have duct outside) cfm <br /> ❑ No. Other Fans: Locations ��► <br /> FUEL STORAGE (Must be approved by Fi�e Marsha[[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 � � f���L� <br /> ❑ Outdoor�nll ❑ Other/List What&Where: <br /> 2 <br />