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03-16—'15 11 :39 FROM— T-606 P0002/0004 F-761 <br /> �s, ,t�V.�� c,:� , `N � NY�I��...Y,S"�E S,�$1��,. ;�'I'AYti�D.` , ,;�•', . : ;;-.. :,,, <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 /> - i <br /> H.Power <br /> FIREPLACES <br /> Gas Factory Fireplace Brand Name: H 1 <br /> ❑ Wood Burning Fireplace .r�u � <br /> ❑ Wood Stove Model No.: <br /> ❑ Wood Stove with Flue/Masonry <br /> VENTILATION <br /> ❑ No. Kitchen Exhaust duet recirculating cfm <br /> ❑ No. Bath Exhaust(must have duct outside) elm <br /> 0 No. Other Fans: Locations cfin <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 />