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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 <br /> ❑ Wood stove with flue <br /> Brand Name_��T}-Fc�� Model No. Q 1/ �l� �� <br /> VENTILATION <br /> No. Kitchen Exhaust duct recalculating cfm <br /> No. Bath Exhaust(must have duct outside) cfin <br /> No. Other Fans:Locations cfin <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 />