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HEATING SYSTEMS <br /> Quantity: <br /> Make: 1J1 1 f <br /> Model: 5412____-_—____ <br /> Fuel: l" </j ' <br /> Flue Size: (/�� <br /> Input BTUs: eU <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 Fireplace <br /> ❑ Wood Stove <br /> ❑ Wood Stove With Flue <br /> Brand Name: <br /> Model No.: <br /> VENTILATION <br /> ❑0 No. Kitchen Exhaust duct <br /> No. Bath Exhaust(must have duct outside) recirculating _c <br /> 0 No. Other Fans: Locations __cfm <br /> FUEL STORAGE(MUST BE APPROVED BY FIRE MARSHALL) cfm <br /> 0 Installation ❑ Removal <br /> Fuel Oil: gallons <br /> LP Gas: gallons ❑ Underground 0 Inside 0 Outside <br /> Other: <br /> GAS LINE ONLY <br /> 0 Outdoor Grill 0 Other/List What&Where: <br /> 2 <br />