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J <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 UNE ONLY <br /> Gas factory fireplace ❑ Installing a Gas Line Only <br /> ❑ Wood burning factory fireplace with flue <br /> ❑ Wood Stove <br /> ❑ Wood stove withrflue <br /> Brand NamB( V Q-Ib Y �r! ZD 1 Model No. a <br /> VENTILATION ' � `� �► �1 Y <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: gallons ❑ underground ❑inside ❑outside <br /> ❑ LP Gas: gallons <br /> ❑ Other Gas opening <br /> 2 <br />