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� R <br /> SYSTEM DESCRIPTION � ' <br /> . <br /> HEATING S'1'STEMS <br /> Quantity: ( <br /> Nlake: C(�C �� <br /> Model: . �� <br /> Fuel: ��(�� <br /> Flue S' e: <br /> I ut BTUs: <br /> Output BTUs: � C'��� <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 ilue <br /> Brand Name 1„�.(,c� 1•.� ��.,17 Model No. <br /> ���� <br /> 'VEN'I'ILATION <br /> No. Kitchen Exhaust duct recalculating cfm <br /> No. �Bath Exhaust(must have duct outside) cfm <br /> No. Other Fans: Locations cfm <br /> FUEJL 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 i <br />