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�� <br /> SYSTEM DESCRIPTION � <br /> HEATING SYSTEMS <br /> Quantity: <br /> Make: <br /> Model: <br /> Fuel: <br /> Flue Size: <br /> Input BTUs: <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 /> Brand Name �G � � �-3 Model No. �G SLF . ����yf� <br /> VENTILATION <br /> No. Kitchen Exhaust duct recalculating cfm <br /> No. Bath Exhaust(must have duct outside) cfm <br /> No. Qther Fans: Locations cfm <br /> FUEL STORAGE (MUST BE APPROVED BY FIRE MARSHAL) <br /> I ❑ Installation or ❑ Removal <br /> ❑Fuel oil: gallons ❑ underground ❑ inside ❑outside <br /> ❑LP Gas: gallons <br /> ❑ Other Gas opening <br /> 2 <br />