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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 [ 10 <br /> HEATING SYSTEMS <br /> Quantity: i . <br /> Make: �c��c i<< <br /> Model: 5qfh�.1�lJ�t00�21 _ , __ <br /> Fuel: 1�1 a.f' ('j�.S _ _ <br /> Flue Size: <br /> Input BT'CTs: f O C�, O� O O _ • <br /> Output BTUs: <br /> CFM: <br /> COOLING SYSTEMS <br /> Quantity: � <br /> Make: ��. � r<<.r <br /> Model: 2�1 A P'A{��L <br /> Tons: '3. S <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/Masonry <br /> VENTILATION <br /> ❑ No. Kitchen Exhaust duct recirculating cfm <br /> ❑ No. Bath Exhaust(must have duct outside) cfm <br /> ❑ No. Other Fans: I.ocations cfm <br /> FUEL 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 />