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HOUSE HEATING TEST <br />ADDRESS _. rJA APT. — <br />OCCUPANT OWNER. <br />HEAT LOSS - SOLD BY <br />Electrical Work By <br />TYPE OF HEAT <br />GA FA Y HW STEAM <br />RECORD 13 S' <br />_FLOOR CITY SUBURB 10,9 <br />—INSTALLED BY _�'-- <br />r. <br />—Gas Lino By'-.'1�t-�-� <br />SPACE HTR. UNIT HTR. OTHER <br />AS DE GN <br />MAKE MAKE OF BURNER <br />Model Model -- <br />Serial Max. BTU Rating <br />INPUT MAKE OF FURNACE <br />CONTROLS <br />THERMOSTAT Hp, g1, <br />Valve (1( <br />Limit <br />Limit <br />Fan Si <br />Pilot' <br />Pilot I <br />Model <br />Vent Six* <br />CONVERSION <br />KIND OF LINER cQ_— SIZENONE <br />Draft Hood Regulator <br />Filters Size dumber <br />Chimney Location Outside <br />Chimney Construction 1X. Leleft <br />i r. <br />Pilot Model Smoke Bomb Wiring <br />Pilot Timing Draft L; Test Tag _ <br />L.W. Cut Off Dow Pressure ____L ightino Inst. <br />i <br />Pressure q, Percent Co Date Tested <br />Input CFH q Percent OZ Company To, <br />Stock Temp. — -Percent CO Name of Test <br />Form^,3S <br />