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• • <br /> l t <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: Lertih$ C <br /> Model: -?-96()E4 <br /> Fuel: NU <br /> Flue Size: 2- <br /> ').aC1C-d <br /> Input BTUs: !d i CO <br /> Output BTUs: (j`7 ZL9:J <br /> CFM: ZOD <br /> COOLING SYSTEMS <br /> Quantity: <br /> Make: <br /> Model: <br /> Tons: <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 /> 0 No. Kitchen Exhaust duct recirculating cfm <br /> 0 No. Bath Exhaust(must have duct outside) cfm <br /> 0 No. Other Fans: Locations cfm <br /> FUEL STORAGE (Must be approved by Fire Marshall if proposing to abandon tank in place.) <br /> ❑ Installation 0 Removal <br /> Fuel Oil: gallons 0 Underground ❑Inside ❑Outside <br /> LP Gas: gallons <br /> Other: <br /> GAS LINE ONLY <br /> ❑ Outdoor Grill 0 Other/List What&Where: <br /> 2 <br />