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i <br /> . <br /> SYSTEM DESCRIPTION <br /> HEATING SYSTEMS <br /> Quantity: � <br /> Make: � ?� <br /> Model: V('1�' <br /> Fuel: <br /> Flue Size: <br /> Input BTUs: �v W� <br /> Output BTLJs: �Q(�O <br /> CFM: <br /> COOLING SYSTEMS <br /> Quantity: ��_ <br /> Make: 1( 1�1.Q�1/ <br /> Model: � ��t'I�a' <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 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 />