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x e� �,'A�',��,''.S�`��1+�5$�� x. >i ,.���� �;-' � ,;h: <br /> - � . <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 /> H.Power <br /> FIREPLACES <br /> ❑ Gas Fac�ory T�replace, p � , . . • Brand Name: � �` <br /> ♦ � �r <br /> ❑ Wood"Burrung Fireplace � <br /> ❑ .. Wood Stove Model Nq.: <br /> 'r``'°" � ❑ 'Wood Stove with Flue/Masonry . ' ' • � �� - ' <br /> y .��, . t�; <br /> , <br /> `F <br /> VENTILATION � , w <br /> �_ No. Kitchen Exhaust .duct recirculating cfin <br /> � ��.'` � + �� ^No.` � Bath Exhaust(must hav�duct oittsid��+ � +► '' � cfin <br /> ❑ No. Other Fans: Locations �� <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 Cmll ❑ Other/List What&Where: <br /> 2 <br />