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Note:All Geothermal Systems will now require a Site Plan&Review by our Building Official. <br /> IS THIS GEOTHERMAL? ❑Yes ErNo <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 /> H.Power <br /> FIREPLACES <br /> ❑ Gas Factory Fireplace Brand Name: <br /> ❑ Wood Burning Fireplace <br /> ❑ Wood Stove Model No.: <br /> ❑ Wood with Flue/M� <br /> VENTILATION /h5 ��. l\� Z 5� 1.cs 4 r-t4-r..- A L r <br /> O No. Kitchen Exhaust •uct recirculating cfin <br /> ❑ No. Bath Exhaust(must have duct outside) cfm <br /> O No. Other Fans: Locations cfm <br /> FUEL STORAGE (Must be approved by Fire Marshall if proposing to abandon tank in place.) <br /> O Installation 0 Removal <br /> Fuel Oil: gallons 0 Underground 0 Inside 0 Outside <br /> LP Gas: gallons <br /> Other: <br /> GAS LINE ONLY <br /> ❑ Outdoor Grill 0 Other/List What&Where: <br /> 2 <br />