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. , <br /> � <br /> HEATING SYSTEMS <br /> , <br /> Quantity: _ <br /> Make: <br /> Model: <br /> Fuel: <br /> Flue Size: <br /> � <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 Factory Fireplace <br /> � ❑ Wood Burning Fireplace <br /> , ❑ Wood Stove <br /> ❑ Wood Stove With Flue <br /> ,� <br /> Brand Name: Model No.: <br /> VENTILATION <br /> Na � Kitchen Exhaust duct • recirculating cfm <br /> �' No. Bath Exhaust(must have duct outside) cfm <br /> ❑ No. Other Fans: Locations __ cfm <br /> FUEL STORAGE(MUST BE APPROVED BY FIRE MARSHALL) <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: <br /> 2 <br />