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� .. <br /> _ _ .. .. .._ r �. <br /> ,.. � y .;, �- . -, . �,�� <br /> � : . <br /> -' �'' <�;r,t.� ' ' - ��J�����`�� ' � � � �,. . <br /> �.,e;�� .�.t <br /> , <br /> Note:All Geothermal Systems will now require a Site Plan&Review by our Building Qfficial. <br /> IS THIS GEOTHERMAL? ❑Yes ❑No <br /> HEATING SYSTEMS � <br /> Q�mY� <br /> Make: <br /> Model: <br /> Fuel: <br /> Flue Size: <br /> Input BTUs: <br /> Output BTCJs: <br /> CFM: <br /> COOLING SYSTEMS <br /> Quantity: <br /> Make: <br /> Model: <br /> Tons: <br /> H.Power <br /> FIREPLACES <br /> � ($ Gas Factory Fireplace Brand Name: <br /> `�� ❑ Wood Buming Fireplace <br /> � � ❑ Wood Stove Model No.: <br /> ❑ Wood Stove with Flue/Masomy <br /> VENTILATION <br /> ❑ No. Kitchen Eachaust duct recirculating cfm <br /> ❑ No. Bath Exhaust(must have duct outside) cfn► <br /> ❑ No. Other Fans: Locations cfin <br /> FUEL STORAGE (Must be approved by Fire Marshall if proposing to obandon 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 8t Where: <br /> 2 <br /> � <br />