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Note: All Geothermal Systems will now require a Site Plan&Review by our Building Official. <br /> IS THIS GEOTHERMAL? ❑Yes <br /> No <br /> HEATING SYSTEMS <br /> Quantity: <br /> Make: Q*C&G <br /> Model: G6 rn scyp <br /> Fuel: rVOrf1^ <br /> Flue Size: <br /> -'e ? VC <br /> Input BTUs: 410 t d O 0 <br /> Output BTUs: i,,*'j yi f 00 <br /> CFM: ,20 Cid t O 0 <br /> COOLING SYSTEMS <br /> Quantity: <br /> Make: ✓J !�- <br /> Model: ��dyna <br /> Tons: <br /> H.Power J <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 /> ❑ / <br /> No. Kitchen Exhaust � � duct recirculating 3cs CD clin <br /> ❑ No. Bath Exhaust(must have duct outside) cf n <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 ❑ Underground ❑Inside ❑Outside <br /> LP Gas: gallons <br /> Other: <br /> GAS LINE ONLY <br /> ❑ Outdoor Grill ❑ Other/List What&Where: <br /> 2 <br />