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� w <br /> 1 a <br /> SYSTENi DESCRIPTION <br /> HEATING SYSTEMS <br /> Quantity: I <br /> Make: ���"�C,�f��j <br /> Model: �/.1 �L�� �j�j✓I � <br /> Fuel: l4'i �S , <br /> 1► <br /> Flue Size: <br /> Input BTIJs: (�C��('jc,h7 <br /> Output BTUs: � <br /> CFM: <br /> COOLING SYSTEMS <br /> Quantity: � r`� S <br /> Make: <br /> Model: <br /> Tons: <br /> H.Power <br /> FIREPLACES GAS LI\E 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 />