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� � <br /> � a <br /> SYSTEM DESCRIPTION � <br /> HEATING SYSTEMS <br /> Quantity: � <br /> Make: �.fC,� r 1'(Zi <br /> ModeL• �f��--� <br /> Fuel: l..? �).� <br /> Flue Size: <br /> Input BT[Js � <br /> Output BTUs: � <br /> CFM: <br /> COOLING SYSTEMS <br /> Quantity: <br /> Make: <br /> Model: <br /> Tons: <br /> H.Power <br /> FIREPLACES GAS LINE ONLY <br /> [�, Gas factory fireplace ❑ Installing a Gas Line Only <br /> � Wood burning factory fireplace with flue <br /> Wood Stove <br /> ❑ Wood stove with flue <br /> (� � `' <br /> Brand Name \ "�,(�� c� \1 f Model No. �V�� �� <br /> VENTILATION <br /> No. Kitchen Exhaust duct recalculating cfm <br /> No. Bath Exhaust(must have duct outside) cfm <br /> No. Other Fans: Locations cfm <br /> FUEL STORAGE (MUST BE APPROVED BY FIRE MARSHAL) <br /> ❑ Installation or ❑ Removal <br /> ❑Fuel oil: gallons ❑ underground ❑ inside ❑outside <br /> ❑ LP Gas: gallons <br /> ❑ Other Gas opening <br /> 2 <br />