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, s . <br /> � � <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 SYSTENIS <br /> Quantity: <br /> Make: <br /> Model: <br /> Tons: <br /> H. Po�ver <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 /> Un�e�' <br /> No. ,�Kitchen Exhaust duct recalculating 3o O 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 /> `e.��a�e �,�bo���. h�� 2 <br />