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� . � <br /> Note:All Geothermal Systems will now require a Site Plan&Review by our Building Official. <br /> IS TffiS GEOTHERMAL? ❑ Yes No <br /> HEATING SYSTEMS <br /> Quantity: � <br /> Make: /�d�/1� � <br /> Model: �V � <br /> FueL• +� . <br /> Flue Size: � (�C/ ���� <br /> Input BTLTs: �Z� �� �/ � <br /> Output BT'Us: / � <br /> CFM: � � <br /> COOLING SYSTEMS <br /> Quantity: Z <br /> Make: �� ' <br /> Model: � <br /> Tons: ` � <br /> H.Power <br /> FIREPLACES <br /> ❑ Gas Factory Fireplace Brand Name: <br /> ❑ Wood Burning Fireplace <br /> ❑ Wood Stove Model No.: <br /> ❑ Wood Stove With Flue <br /> VENTILATION <br /> ❑ No. Kitchen Exhaust �� duct recirculating �� cfin <br /> ❑ No. � Bath Exhaust(must have duct outside ��cfm <br /> ❑ No. _� Other Fans: Locations �Q�cfm <br /> FUEL STORAGE (Must be approved by Fire Marshall if proposing to abandon tank in p[ace.) <br /> ❑ Installation ❑ Removal }'� t, <br /> +.M 2 �.r Y G1i�,..D��i....• A� �.Y���d��� <br /> .;:t�ii C'�- <br /> Fuel Oil: gallons • ���+�(ct��rb�id��•,` �� ❑Outside <br /> LP Gas: gallons tL�g-Gi� .��' ��'�� + ��`�''��'�' <br /> Other: '" ��' •��« <br /> �'\�. -�. t-� , <br /> ��,,�t,.�,,,�t��;;;r.: �;•;�• <br /> GAS LINE ONLY <br /> ❑ Outdoor Grill ❑ Other/List What&Where: /� /� Q , <br /> 2 f— 1/n�� , <br />