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� � <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 SYSTEMS <br /> Quantity: <br /> Make: <br /> Model: <br /> Tons: <br /> H.Power <br /> FIItEPLACES <br /> � Gas factory fireplace <br /> ❑ Wood burning factory fireplace with flue <br /> ❑ Wood Stove <br /> ❑ Wood stove with flue <br /> Brand Name /�/�//t�DiC' Model No. ��� % S�G <br /> VENTILATION <br /> No. Kitchen Exhaust duct recalculating cfm <br /> No. Bath E�chaust(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 />