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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 /> Make: Q rY41`1 <br /> -r <br /> ModeL• `�/ZS C <br /> Fuel: �A t <br /> Flue Size: `Z��P✓C <br /> Input BTUs: 6 G,O(�� <br /> output BTUs: �`i 60(� <br /> CFM: I�GO <br /> COOLING SYSTEMS <br /> Quantity: � <br /> Make: l�r�'4,�� <br /> Mode�: (3A i3�/A <br /> Tons: �-� � <br /> H.Power ��2-- <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. 3 Bath Exhaust(must have duct outside) ��cfin <br /> ❑ No. 1 Other Fans: Locations C�,.-�r0.1 �'�ca 4 sf i/o cfm <br /> FUEL STORAGE (Must be approved by Fire Marshall ijproposing 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: �u ture G�i�Qre (-��°'q�P/` �►�n � <br /> 2 <br />