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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 /> Quantiry: <br /> Make: <br /> Model: <br /> Tons: <br /> H.Power <br /> FIREPLACES <br /> � Gas Factory Fireplace Brand Name: KOZY HEAT <br /> ❑ Wood Burning Fireplace <br /> � Wood Stove Model No.: 936 <br /> ❑ Wood Stove With Flue <br /> VENTILATION <br /> ❑ No. Kitchen E�chaust 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 Marshall iJproposing 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 />