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� 1VIECHA1vICAL SYSTEMS BEING INSTALLED � <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 <br /> ❑� Gas Factory Fireplace — i������1�\ G`Gt� <br /> ❑ Wood Burning Fireplace � J <br /> ❑ Wood Stove <br /> ❑ Wood Stove With Flue I <br /> � �,�1/i.�16� <br /> Brand Name: 3 TOWN&COUNTRY& Model No.: TC54.CE,TC36.CE(2),530XC <br /> VF,NTILATION <br /> ❑ No. Kitchen F,xhaust duct recirculating cfm <br /> ❑ No. Bath Exhaust(must ha��e duct outside) cfm <br /> ❑ No. Other Fans: Locations cfm <br /> FUEL STORAGE(MUST BE APPROVBD 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 />