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HOUSE HEATING 7EST R�CORD B�� G�L�2�t� ���� <br /> ADDRESS ! �S^ �t�` �tiF.c�� U?� APT. FLOO CITY S BURB /� 4�nd <br /> OCCUPANT `�r Y1�SS OWNER ��� rL ' LOI(15�R�1, t(JY1 <br /> HEAT LOSS � AT H G. INST. GAS CO. METER BADGE <br /> SOLD BY S �Y�-� INSTALLED BY P-��S 5 <br /> Electrical Work By Gas Line By -�.-.�J� <br /> TYPE OF HEAT GA� FA�- HW STEA/vl— SPACE HTR.-- UNIT HTR. OTHER <br /> GAS DESIGN CONVERSION <br /> MAKE L���v� MAKE OF BURNER_ <br /> Model G !�f f� 3 4 o Model__— _ <br /> Serial ���3 �� �f _-----i�/�ax. �TU �ating— <br /> INPUT � �M __MAKE O� FURNACE <br /> Model <br /> CONTROLS <br /> `( !�v <br /> THERMOSTAT at Plug � � Vent Size �' — � <br /> Valve KIND OF LINER SIZE NO�(E ' <br /> Limit ���/=t-�` Draft Hood Regulator���� <br /> Limit Setting 'v'� � _ Filters Size/�X� Z--T�C /i Number ' � <br /> Fan Setting ��'— lZ- S Chimney Location Inside Outside <br /> Pilot Type ���-� Chimney Construction <br /> Pilot Make <br /> Pilot Model Smoke Bomb Wiring �� <br /> Pilot Timing ��- �a-�L«-/`� Draft Test Tag �� <br /> L.W. Cut Off Door Pressure Lighting Inst. � <br /> Pressure ' �� Percent CO2 '�fr� Date Tested —`f�' �`� <br /> Input CFH (o d Percent 02 � Company Testing � -�- <br /> Stack Temp.—,��-D'' Percent CO �—Name of Tester <br />