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l�'ote:All Gep�zermal Systems wil�now rec�uire a Site�1an&Review by our Buildxzzg Official, <br /> �S THIS Gk:OTHER.;I�AL? ❑Yes ❑No <br /> FI�A,Ti�iG SYS�'EMS <br /> Quai�#jty; <br /> Make: <br /> Mod�1= <br /> Fuz�; <br /> Flue Size: <br /> Input�T[1s: <br /> Out�u.t BTUs: <br /> c�ti�: <br /> COOLING SXSTEMS <br /> Qnannry: <br /> Make: <br /> 11�ode1: <br /> To�as: <br /> H.Power <br /> �TRE�T,,ACES <br /> ❑ Gas�'actory FirepIace Bzaz�d Name: <br /> ❑ Waod Burnirzg k'ireplacc <br /> ❑ �ood Stove 1�ode1 No.: <br /> ❑ Wood Stove with Flue/Masonry <br /> '�ENT�,ATION <br /> ❑ 1Vo• Kitcbe��xhat�st duct recixcu�atang cfm <br /> ❑ No. Bath E�aust(must l7ave duct ou�side) ��� <br /> ❑ No. QEhez•Fans: Locations cfm <br /> iTEL STO GE (A7usr be approved by,F'ire ll�larshall if propnsing ro arbanr�on tank in,plac�) <br /> ❑ Ynstallatio�a ❑ Removal <br /> k�et Oil: ��allo��s ❑ Undergrouad j]Inside ❑Outside <br /> Lp Gas: gaIlons <br /> Ot.�er: <br /> GAS LL1�pN�,Y � ����� �/Cl �I��.�� <br /> ❑ Outdoo�Gz�zll � OtL�er/Lxst W;�at&'SNtiere:, G�.,S �r�i ��—�TD 1/2�� <br /> 2 <br />