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lop <br />ADDRESS <br />OCCUPANT <br />HEAT LO� <br />SOLD BY. <br />Electrical Work <br />TYPE OF HEAT <br />HOUSE HEATING 1 EST RECORD <br />--APT. _ FLOOR--_ CITY(_1'• A t)(• SUBURB_Vd_ -- <br />�. _._OWNER_ •� ., — <br />DATE HTG. INST._ ____ 4' `� iL _ .—GAS CO. METER..B GE # --- — <br />�^' C.vn). INSTALLED BY �.:...r., <br />By ri)_ �(rL t C k 1JX _ _ ---Gas line By_ <br />GA— FA1e-- HW STEAM - SPACE HTR. . UNIT HTR. OTHER____ _. <br />GAS DESIGN <br />MAKE �APV a J4. MAKE OF BURNER <br />Model G /J..o LAV>i_ —__ _ Model <br />Serial Max. BTU Rating <br />INPUT «------- MANE OF FURNACE <br />Model <br />CONTROLS <br />CONVERSION <br />THERMOSTAT <br />Heat Plug._ • 3� _... - -__Vent Size - -- <br />SIZE NON <br />Volvo— <br />OF LINER <br />_ _ __ <br />Limit <br />—__—_--Draft HoodPi-e <br />egulator <br />Limit Setting <br />�__ —_ __Filters <br />—__ Number -2 <br />umber 2fon <br />fanSettin `" +' / <br />- -r---- -- -----Chimney location <br />Inside-._ __ae._' Outside <br />AW <br />Pilot Type_ <br />_ __ _—Chimney Construction____—.— <br />_ <br />Pilot Make- <br />--- <br />Pilot Mode <br />_ ___Smoke Bom <br />P_ <br />_.. Wiring ----- <br />Pilot liming <br />—.—_ .Draft___ <br />Test To- <br />L.W. Cut Off __ <br />—_— _ _ ___Door Pressure- _---____ <br />---Lighting Inst. _— <br />Prewwre — <br />Percent CO2. �• Date Tested:— <br />% <br />-' <br />Input CFM dolk,41 <br />Percent 02 —Company Testing.___ <br />Stack Temp. <br />Percent CO _ d —Name of Tester <br />