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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 /> FIREPLACES GAS LINE ONLY <br /> ❑ Gas factory fireplace ❑ Installing a Gas Line Only <br /> ❑ Wood burning factory fireplace with flue <br /> ❑ Wood Stove �K i�ti S i£�� (�;T �1c:.1 s TiNU �,•,�-S <br /> ❑ Wood stove with flue 1 � �� /�o� 6 A-.5 � 2�c�. <br /> Brand Name Model No. <br /> VENTILATION <br /> ��,� T��1c�'c F��s �}-Q.�— <br /> No._�Kitchen Exhaust duct recalculating cfm <br /> No. _ C�Bath Exhaust (must have duct outside) cfm c�l�S 7'"��c: lx�� ��'_ <br /> No.�Other Fans: Locations ��yG� cfm <br /> u�V�Y G�7c—�D ��� ;-v <br /> FUEL STORAGE (MUST BE APPROVED BY FIRE MARSHAL) �vT S l.D` � F ��"`� <br /> /}-�7 r�-rr o,.� �.5"e R����=� <br /> ❑ Installation or ❑ Removal ����� <br /> ❑ Fuel oil: gallons ❑ underground ❑ inside ❑outside � <br /> ❑ LP Gas: gallons <br /> ❑ Other Gas opening <br /> 2 <br />