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r ' <br /> SYSTEM DESCRIPTION <br /> HEATING SYSTEMS <br /> Quantity: <br /> Make: <br /> Model: �l�~p k0 —/SS' <br /> Fuel: LAw <br /> Flue Size: 3 t/C <br /> Input BTUs: <br /> Output BTUs: r29a <br /> CFM: <br /> COOLING SYSTEMS <br /> Quantity: t <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 /> Brand Name Model No. <br /> VENTILATION <br /> No./Kitchen Exhaust l duct recalculating 3o n cfm <br /> No. Bath Exhaust(must have duct outside) 2aa cfm <br /> No. f _Other Fans: Locations lS/Lc% - 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 />