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ti <br /> Note:All Geothermal Systems will now require a Site Plan&Review by our Building Official. <br /> IS THIS GEOTHERMAL? ❑Yes [�No <br /> AEATING SYSTEMS <br /> Quantity: <br /> Make: <br /> Model: <br /> Fuel: <br /> Flue Size: <br /> Input BTUs: <br /> Output BTUs: <br /> CFM: <br /> COOLING SYSTEMS <br /> Qnantity: <br /> Make: <br /> Model: <br /> Tons: <br /> H.Power <br /> FIREPLACES �� <br /> Gas Factory Fiieplace� Brand Name: ��G�����V <br /> Wood Burning Fireplace � ��" //'� `�� <br /> Wood Stove Model No.: <br /> ❑ Wood Stove with Flue/Masonry / �- _n <br /> VENTILATION '"(��2����� l G�l�' <br /> ❑ No. Kitchen Exhaust duct recirculating cfm <br /> ❑ No. Bath Exhaust(must have duct outside) cfm <br /> ❑ No. Other Fans: Locations cfm <br /> FUEL STORAGE (Must be approved by Fire MarshaU ijproposing fo abandon tank in plac�) <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 />