Minneapolis House Heat Test Record (Orsat Test) printable pdf download

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MINNEAPOLIS HOUSE HEAT TEST RECORD

(Orsat Test)

Leave form at the house

Property Address:_________________________________ Date: ______________

Owner: ____________________________ Address:__________________________

Sold by: ___________________________ Installed by:_______________________

Gas work by: ________________________ Electrical by:______________________

Date heating installed_________________ Heat loss: _________________________

Type of heat: Gas:______Oil:_______ Electric: _______ Other:____________

Gas Designed:

Forced Air: ______ Hot water: ______ Steam______ Space heater: _____ Other:______

Make: ________________Model: ___________________ Serial: __________________

Rated Input: _________________

Controls:

Thermostat: _________Anticipator setting: __________Valve: ____________________

Limit: ______________ Limit setting: ______________ Fan setting: _______________

Flame Sensor Type: _________ Pilot Make: __________ Safety Timing: ____________

L.W. Cut-off:______________

Vent System:

Vent Connector Size: ___________ Material: _____________ Supports: _____________

Vent: Size: __________ Plastic: _________ B-vent_________ Chimney: ___________

Chimney Type: ____________ Chimney Location: ____________ Liner: ____________

Other: ______________

Combustion Test Results:

(Use a separate form for multiple staged equipment)

If an Electronic Analyzer is used, staple print-outs to this form.

Manifold Pressure: _________________ Actual Input (clocked):_________________

Percent CO2:_____________ Percent O2:_______________ PPM CO: ______________

Draft: _____________ Ambient temperature (room temperature): ___________________

Flue gas (Stack) Temperature: Net:

Gross: _________ Efficiency: _________

Combustion Air Check:

Combustion Air Required? Yes________ No________ Size: _______________

If not needed, why not? (Show calculations or documentation):_____________________

________________________________________________________________________

Person(s) Performing Test:

Testing Co: __________________________Name of Tester: _____________________

Date: ________________ Tester’s Competency Card Number: __________________

Test Tag? ____________

Mpls House Heat Test Record (Orsat Test)

Rev 4/2012

Minneapolis House Heat Test Record (Orsat Test)