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ar 'J� t <br /> SYSTEM DESCRIPTTON - <br /> HEATING SYSTEMS <br /> Quantity: <br /> Make: <br /> Model: <br /> FueL• <br /> Flue Size: <br /> Input BTUs: <br /> Output BT`Us: <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 k z ❑ Installing a Gas Line Only <br /> Wood burning factory fireplace with flueh � <br /> ❑ Wood Stove <br /> ❑ Wood stove with flue <br /> ��;.r ti..i�c� �u,,,� — Ga� <br /> Brand Name ��ti Model Na --L��> H - ���=�� <br /> �i`�c���L�� �iis'��� �' G�� <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 />