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a v <br /> Note: All Geothermal Systems will now require a Site Plan&Review by our Building Official. <br /> IS THIS GEOTHERMAL? 'Yes El No <br /> HEATING SYSTEMS <br /> Quantity: <br /> Make: '12,/* aufthK/VIet It//— �✓/ <br /> Model: ,5,LO J 75 moVor3'( WDt/O(' Wp'/d <br /> /V 6 7r - <br /> Fuel: jiiC <br /> 3 " <br /> Flue Size: <br /> Input BTUs: / 71;000 <br /> Output BTUs: /W ad O 10/,3rD 15,8er � co O <br /> CFM: f Crit it <br /> (c./COOLING SYSTEMS <br /> Quantity: <br /> Make: <br /> Model: <br /> Tons: 3 <br /> " til 3 y <br /> FIREPLACES <br /> ❑ Gas Factory Fireplace Brand Name: <br /> ❑ Wood Burning Fireplace <br /> ❑ Wood Stove Model No.: <br /> El Wood Stove With Flue <br /> VENTILATION <br /> ❑ No. Kitchen Exhaust duct recirculating cfrn <br /> ❑ No. Bath Exhaust(must have duct outside) cfm <br /> El No. Other Fans: Locations cfm <br /> FUEL STORAGE (Must be approved by Fire Marshall if proposing to abandon tank in place.) <br /> ❑ Installation El Removal <br /> Fuel Oil: gallons ❑ Underground El Inside ❑Outside <br /> LP Gas: gallons <br /> Other: <br /> GAS LINE ONLY <br /> ❑ Outdoor Grill El Other/List What&Where: <br /> 2 <br />