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r <br /> 1�rIECHA��CA�. 5''��°�T��EING IN�TALLEk3 <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 /> Ivtake: D � <br /> ModeL• y��(�i�D�p�p� � <br /> Fuel: �G <br /> fl <br /> Flue Size: <br /> Input BTUs: (`�, D� <br /> Output BTUs: � ��� �b� <br /> CFM: ��D <br /> COOLING SYSTEMS <br /> Quantity: � <br /> Ivtake: �b12�. <br /> Model: l�� ����s� <br /> Tons: � <br /> H.Power <br /> � <br /> FIREPLACES <br /> ❑ Gas Factory Fireplace Brand Name: <br /> ❑ Wood Buming Fireplace <br /> ❑ Wood Stove Model No.: <br /> ❑ Wood Stove With Flue <br /> VENTILATION <br /> ❑ No. Kitchen Exhaust duct recirculating cfm <br /> ❑ No. Bath Eachaust(must have duct outside) cfin <br /> ❑ No. Other Fans: Locations cfrn <br /> FUEL STORAGE (Must be approved by Fire Marshall ijproposing to abandon tank in place.) <br /> ❑ Installation � 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 />