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� � <br /> r <br /> SYSTEM DESCRIPTION - <br /> HEATING SYSTEMS <br /> Quantity: <br /> Make: <br /> Modei: <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 x '` ❑ 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. �'����''l�--� <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 />