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• • ` � � MI?C>`II�1�'IC:�LI. SYSTEIviS BEli�G INSTALI,F_,D <br /> HEATING SYSTEMS <br /> Quantity: �. � <br /> 'z �L Tu�� -- <br /> Make: <br /> �� �'i <br /> Model: _ � ��� O <br /> L✓�� <br /> Fuel: ��T �_ <br /> Flue Size: 3 "�/�G� �-- <br /> Input BTUs: �7_ .���l� /�o%Ge.h� � /'�'��"��i <br /> Output BTUs: ����v � l� l�cr� � u ' _�. ,_, <br /> cF�: �.S.�Tv � —-���� <br /> COOLING SYSTEMS <br /> Quantity: <br /> Make: � U <br /> Model: �����D <br /> Tons: ��(� <br /> H. Power <br /> FIREPLACES <br /> � ❑ Gas Factory Fireplace � <br /> ❑ «'ood Burnin�Fi:cplace <br /> ❑ �Vood Stove <br /> ❑ Wood Stove With Flue <br /> Brand Name: <br /> i�lodel No.: <br /> VENTILATION � <br /> � No. � Kitchen Exhaust � <br /> �duct recirculating �Zoe� �� <br /> � No. __�_ Bath Exhaust(must have duct outside) <br /> ❑ No. Other Fans: Locations �`f�Sd (� �:� cfm <br /> _ c fm <br /> FUEL STORAGE (MUST BE APPROVED BY FIRE MARSHALL) <br /> ❑ Installation ❑ Removal <br /> FuelOil: gallons <br /> LP Gas: ❑ Underground ❑ Inside ❑ Outside <br /> gallons <br /> Other: <br /> GAS LINE ONLY <br /> lL� Outdoor Grill [� Other/List W}iat R;�Vhere: � <br /> l C� <br /> 2 <br />