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, . <br /> ..�,.,�..3�: � ° ��.:t �:���`��� 3,, '� <br /> : ,_ <br /> � <br /> , u <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 BTL1s: <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: ��� ` <br /> � ❑ Wood Burning Fireplace <br /> ❑ Wood Stove Model No.: <br /> ❑ Wood Stove with Flue/Masonry <br /> VENTILATION <br /> ❑ No. Kitchen Exhaust duct recirculating cfin <br /> ❑ No. Bath Exhaust(must have duct outside) cfin <br /> ❑ No. Other Fans: Locations cfin <br /> FUEL STORAGE (Must be approved by Fire Marsha[Z if proposing to abandon tank in p[ace.) <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 />