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HOUSE HEATING TEST RECORD <br />ADDRESS? �--_ <br />�� �� ar <br />_ APT. _ ._ - FLOOR — _. CITY _ SUBURB • <br />OCCUPANTL/ /_ ._� L4 _ _— <br />-- _ OWNER_ -- <br />NEAT LOSS DATE HTG. INST. <br />SOLD BY <br />.... - - -_ INSTALLEO BY -- — - ---- ---- — <br />Electricel Work_ <br />By <br />_.Gas Line By ___--__-- <br />TYPE OF HEAT GA _ FA _STEAM <br />_ SPACE HTR. _ UNIT HTR. ____OTHER <br />GAS DE N <br />CO4VE'RS10N(61.r <br />MAKE <br />,�T'� <br />OF BURNER.. <br />--MAKE <br />Mede)•SCI <br />_.._Model <br />SerleI trA -4 ________ <br />Max. BTU Rating .-- ' <br />INPUT IL C.l'e) L <br />MAKE OF FURNACE — <br />Model --- - i <br />CONTROLS <br />THERMOSTAT I Heat Plug <br />�� ��Ii'{ ,.._ . <br />Vent Sire <br />-_�_. <br />-- -_.__ <br />WI•e <br />7 <br />KIND OF LINER. S12� NONE <br />Limit <br />Dinh Hood .__ <br />Limit SeNing__ __ _-_ ._ -" _ __ <br />`^ _Regulator <br />Filters Sire �Se._NutttMr� <br />Fen Setting __ <br />Pilot Type '1�c.__.._. .____- —.._.— <br />Chimney Location Inside Outside <br />i <br />Chimney Construction -_.��_ / 1 <br />Pilot Wake ----- ---- -.-- - - --- <br />Pilot Model <br />Smoke Bomis _ - _.._ Wiring ___—_-__ <br />Pilot Timing __ _- .. <br />Draft - yI _Test To — <br />L.W. Cut OI( <br />Door Pressure _________ - _-_ Lighting Inst. <br />Prosore—_,?t%CCi _ __ Parcent CO2 — <br />Dote Tested <br />Input CFH _�QQ_7�_. _ Percent OZ -. �_. <br />Company Testing <br />Stock Temp. f2%�L`_--- -Percent CO ----. <br />Nome of Taste. ��.: -- LL- IWE <br />Form 23S <br />