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� <br /> . <br /> �. � <br />:�<, <br />�r n , <br /> SYSTEM DESCRIPTION <br /> HEATING SYSTEMS <br /> Quantity: � <br /> r (',.� <br /> Make: ��.�'j1� �1 'W r� l''�!�/1�i � �'t�� �� <br /> Model: � ��% �� <br /> Fuel: ;���1 � � rLl � C�{�l) <br /> � ,'/ <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 burning factory fireplace with flue <br />��' ❑ Wood Stove <br /> ❑ Wood stove with flue <br /> Brand Name Model No. <br /> VENTILATION <br />�:: <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 />'.2, <br />� <br />�::�� . <br /> kr> <br /> , . <br /> , � _ <br /> . <br /> -r, ae ., .... ��. � � - ., �� .� . . ,. . . . .....,��.. :..� ..,. c�.._.... ._,..d.� .ni ._ <br />