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, � <br /> � <br /> . MECH,ANI�AL���TEI��B�EI1�G INSTALi..EU : <br /> HEATING SYSTEMS <br /> Quantity: <br /> Make: � Vr <br /> Model: `� � <br /> Puel: � <br /> Flue Size: �JV , �aU <br /> ►„put BTUs: 5 b, u�e <br /> Output BTUs: <br /> CFM: a D <br /> COOLING SYSTEMS <br /> Quantity: ' <br /> Make: <br /> Model: <br /> �V 1 <br /> Tons: �,� �� <br /> H. Power <br /> FIREPLACES <br /> � Gas Factory Fireplace <br /> Wood Burning Fireplace <br /> ❑ Wood Stove <br /> ❑ Wood Stove With Flue <br /> Brand Name: Model No.: <br /> VENTILATION <br /> ❑ Na Kitchen Exhaust duct recirculating cfm <br /> � No. � Bath Exhaust(must have duct outside ��fin <br /> Na ( Other Fans: Locations V ( cfm <br /> FUEL STORAGE(MUST BE APPROVED BY FIRvE 1VIA1�ALLnS�YI� 1•'7 <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: �' \V`�,(, � <br /> � � <br /> 2 <br />