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. <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 <br /> Gas factory fireplace <br /> ' Wood burning factory fireplace with flue <br /> r Wood Stove <br /> Wood stove with flue <br /> Brand Name Model No. <br /> VENTILATION <br /> No. Kitchen Exhaust duct recalculating cfm <br /> r 1` 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 /> PkFuel oil: gallons underground inside or outside <br /> (' LP Gas: gallons <br /> Other Gas opening <br /> �,p� of ,,�oitic: oC <br /> 1«L /'��',E 444 pipe✓4 Al►c roil <br /> S .4sr✓�M /1 <br /> ARy¢w e.✓C. . <br />