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HOUSE HEATING TEST RECORD <br />ADDRESSAPT. <br />R <br />FLOOR CITY SUBURBS <br />OCCUPANT--=� <br />��_ �- �r, �.�'_L1 <br />OWNER <br />HEAT LOSS <br />DATE HTG. <br />INST. <br />', �'' ; ` r.: --GAS CO. METER BADGE # <br />SOLD BY <br />` �►' - "t ` -� <br />INSTALLED BY <br />Electrical Work <br />By <br />is L <br />-Gas Line By <br />TYPE OF HEAT <br />GA_____ FA.�— HW <br />STE SPACE HTR. UNIT HTR. OTHER <br />GAS DESIGN CONVERSION <br />MAKE-` MAKE OF BURNER <br />Model ;• - ` � at' - t Model_ <br />Serial ' r ( __- --Max. BTU Rating. -_---.- <br />INPUT MAKE OF FURNACE <br />Model <br />CONTROLS <br />THERMOSTAT_ IL ' 1 H at_Plug �" Vent Size . _ t� <br />`` i ,10 �� KIND OF LINE t <br />Valve SIZE � - NONE <br />�.�----` • ' <br />r1Draft �(` �; Regulator <br />Limit <br />� ��1tE �����.�' �� -� . �► •� food �= ,L�� ��t <br />Seton L Filters}- Size �L Number--- <br />Limit� . <br />gOutside <br />►i -C,_� <br />Fan Setting _ .Chimney location Inside <br />ti <br />• --= Li'4 � � ` C' �`- �� himney Construction�-�`=-- <br />Pi lot Type ,�-_. �' - <br />Pi lot Make ' ' ' A - r� `�` <br />Pilot Model Smoke Bomb Wiring `- <br />Pilot Timing—. �; -�. , t ��+' - �� Draft �- ' - —Test Tag ''';91 <br />- - <br />or Pressure Lighting Inst._ <br />L.W. Cut Off <br />Pressure Percent CO2 Date Tested— <br />Input <br />ested Input CFH��I Percent 02 Company Testing <br />�•'- f <br />Stack Temp. c t Percent CO Name of Tester <br />