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s V �,y/^A [f r��( '7 �ul9�"d'g�r"� r q '^ + �,r v I'^�: <br /> � �n� I���.�+mMA:! .�'.NIG�����'s�`4'#���� ��—�� ` 9 �'�� °� �,��+�.' ���.�#�'Hi'��,�.���i„�;�;..�a���..�I�i�ti�kk;,. <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 /> Mak�: <br /> Model: <br /> Fuel: <br /> Flue Size: <br /> Inp:it 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 Brand Name: � 5=T�'1 e <br /> Wood Burning Fireplace � 1 <br /> Wood Stove Model No.: g I�O�' '1��S <br /> ❑ Wood Stove with Flue/Masonry <br /> VENTILATION <br /> ❑ Na Kitchen Exhaust duct recirculating cfm <br /> ❑ No. Bath Exhaust(must have duct outside) cfm <br /> ❑ No. Other Fans: Locations cfm <br /> FiJEL 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 />