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, \ <br /> m l yg i-el . •,:,11,1% .rt. 1! : �. m.� . . of 3t ' - � :f <br /> Note: Alll##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 /> H.Power <br /> FIREPLACES <br /> El Gas Factory Fireplace Brand Name: <br /> ❑ Wood Burning Fireplace <br /> El Wood Stove Model No.: <br /> ❑ Wood Stove with Flue/Masonry <br /> VENTILAT ON "iit .. <br /> f 'U. �' <br /> rtchen E gust / duct recircula g cfm <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 fproposing to abandon tank in place) <br /> El Installation Cl Removal <br /> Fuel Oil: gallons 0 Underground El Inside ❑Outside <br /> LP Gas: gallons <br /> Other: <br /> GAS LINE ONLY <br /> ❑ Outdoor Grill ❑ Other/List What&Where: <br /> 2 <br />