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, • <br /> _ . .:�fx��1-1�'4t�.�����'i�I��'�G'r�'N�T1���' , , v. <br /> Note:All Geothermal Systems will now req e a Site Plan&Review by our Building Offcial. <br /> IS TFiIS GEOTHERMAL? ❑Yes No <br /> HEATING SYSTEMS <br /> ���: P <br /> Malce: �!'N�J <br /> Model: �'��2 <br /> Fuel: G(et9t�L� <br /> Flue Size: �v <br /> Input BTUs: <br /> Output BTLJs: <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.: ��t�� <br /> ❑ Wood Stove with Flue/Masonry <br /> VENTILATION <br /> ❑ No. Kitchen Exhaust duct recirculating cfm <br /> ❑ No. Bath Eaihaaust(must have duct outside) cfm <br /> ❑ No. Other Fans: Locations cfm <br /> F[JEL STORAGE (Must be approved by F'rre Marshall if proposing to abandon tank�pl¢ce) <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 />