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.i:.'Am?ZZS+ck- '4may "4';-4- <br /> i..4- .VS 17"-i EKe _ ..' <br /> 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: <br /> Model: <br /> Fuel: <br /> Flue Size: <br /> Input BTUs: <br /> Output BTUs: <br /> CFM: <br /> COOLING SYSTEMS <br /> Quantity: <br /> Make: <br /> Model: <br /> Tons: <br /> H.Power <br /> FIREPLACES <br /> Gas Factory Fireplace Brand Name: )4C-3- <br /> ❑ Wood Burning Fireplace <br /> ❑ Wood Stove Model No.: (lp('CY^jc Ll(.= <br /> ❑ Wood Stove with Flue/Masonry <br /> VENTILATION <br /> O No. Kitchen Exhaust duct recirculating cfm <br /> ❑ No. Bath Exhaust(must have duct outside) cfm <br /> ❑ No. Other Fans: Locations cfm <br /> FUEL STORAGE (Must be approved by Fire Marshall if proposing to abandon tank in place.) <br /> ❑ Installation ❑ Removal <br /> Fuel Oil: gallons 0 Underground ❑Inside 0 Outside <br /> LP Gas: gallons <br /> Other: <br /> GAS LINE ONLY <br /> O Outdoor Grill ❑ Other/List What&Where: <br /> 2 <br />