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ADDRESS <br />OCCUPAN <br />HOUSE HEATING <br />HEAT LOSS DATE HTG. INST. <br />SOLD BY L 0 C . <br />Electrical work By <br />TYPE OF HEAT <br />,<< <br />f-gwrr -yM'Fif <br />TEST RECORD <br />APT.3 FLOOR <br />OWNER <br />INSTALLED BY <br />Gas <br />GA FAy Hw STEAM SPACE <br />/ GAS DESIGN <br />MAK E ` /" '� `" ,x MAKE <br />Morel C/ `/ C S- c, - Me" <br />OF BURNER <br />CITY SUBURB <br />ago <br />Serial /C L /C/3 / Max. BTU Rating <br />INPUT J;�c' /`/ MAKE OF FURNACE rye A •ten• <br />CONTROLS <br />THERMOSTAT : t/fir Most Plop <br />Valve <br />Limit r <br />Limit Setting <br />Fen Setting `/C // (i <br />Pilot Type <br />Pilot Make <br />Pilot Meiei <br />Pilot Tis+ing <br />L.W. Cut Off <br />Pressure �)/G Percent CO2 L S <br />Input CFH Lc' Percent 02 ' <br />L <br />Stock Temp. /G y` Percent CO <br />Morel <br />Vent Size L <br />KIND OF LINER <br />Draft moor It"Vieter > > <br />Filters Size /AJ <r <br />Chimney Location Inside i/ Outside <br />Chimney Construction / V C <br />Smoke Berak Wiring <br />Deft 7X,941) Test Tog v <br />Doer Pressure Ligh"" I"L <br />Date Tester <br />Company Teo <br />Home of Tow <br />NONE <br />