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� � � <br /> � <br /> SYSTEM DESCRIPTION • z� <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 Uurning factory fireplace with flue <br /> ❑ Wood Stove <br /> ❑ Wood stove with flue <br /> Brand Name Model No. <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:�OQ � gallons �underground ❑ inside �outside <br /> ❑ LP Gas: gallons <br /> ❑ Other Gas opening <br /> 2 <br /> \ <br /> 1 <br /> � <br /> . " : � y .,�.�__ __ . , <br />