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�� <br />�'`:� , , <br />�`'r, <br />�`�' � � - <br /> r <br /> a <br /> m�'- <br />�}^ <br /> SYSTEM DESCRIPTION <br /> HEATING SYSTEMS �� <br /> Quantity: �' <br /> Y.': <br /> Make: <br /> Model: <br /> Fuel: <br /> Flue Size: <br /> Input BTUs: <br /> �`'' Output BTUs: <br /> CFM: <br />�.: <br />�,� � <br />���: COOLING SYSTEMS �,'= <br />��.ti �,: <br /> r Quantity: �� <br />,�z <br /> Make: <br /> Model: <br /> Tons: <br />;�.t <br /> H.Power <br />,• <br />�?� FIREPLACES GAS LINE ONLY <br />��:;' <br /> :+;: <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 /> ��, <br />��� VENTILATION <br /> i <br />-�; �'; <br />� No. Kitchen Exhaust duct recalculating cfm '! <br /> No. Bath Exhaust(must have duct outside) cfm "� <br /> No. Other Fans: Locations cfm �K <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 /> . . <br /> � : ._ <br /> , � <br /> } � ; ' . i <br /> 7' ,�, <br />