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02-08-'18 12:07 FROM- 1-499 P0002/0004 F-934 <br /> ,-y-c,...^Ct F'�WV7 M...i,-'7- aT r <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: H r <br /> W 1 <br /> tri Wood Burning Fireplace p <br /> • Wood Stove Model No.: -1�l F-' q <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 Pans: 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 ❑ Underground ❑Inside ❑Outside <br /> LP Gas: gallons <br /> Other: <br /> GAS LINE ONLY <br /> ❑ Outdoor Grill ❑ Other/List What&Where: <br /> 2 <br />