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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 <br /> Brand Name: '+ �L� <br /> � Wood Burning Fireplace <br /> � Wood Stove Model No.: <br /> � Wood Stove with Flue/Masonry <br /> VENTII..ATION <br /> ❑ No. Kitchen Exhaust duct recirculating c� <br /> � No. Bath Exhaust(must have duct outside) c� <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 />