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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: Tf'ghe_ n• <br /> Model: TololeD 7,,1/O� <br /> Fuel: /(/a / 'ct,&Jn <br /> Flue Size: 3 VL-L_ 34"! <br /> Input BTUs: /04 OW ,e-e;!'/e,t, <br /> Output BTUs: q 7 (&GD <br /> CFM: 4b (2-er° <br /> COOLING SYSTEMS <br /> Quantity: Z- <br /> Make: "i'Q'✓ie /ea Ne_ <br /> Model: grig-30VI 4/ .130 <br /> Tons: Z17 <br /> H.Power <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 /> EV-- Y No. / Kitchen Exhaust $ duct recirculating ‘,Ot cfm <br /> • No. 7 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 ❑ Underground ❑Inside ❑Outside <br /> LP Gas: gallons <br /> Other: <br /> GAS LINE ONLY <br /> Outdoor Grill ❑ Other/List What&Where: <br /> 2 <br />