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HOUSE HEATING TEST RECORD <br /> ADDRESS � �� d ��r� 5��� r �U/L APT. FLOOR CiTY '- '�- '`�- SUBURB <br /> OCCUPANT � � ' OWNER <br /> HEAT �OSS DATE HTG. INST. " " 7 � � <br /> /�- > � C INSTALLED BY ' ', '_' " - <br /> SOLD BY � ✓ <br /> ����.. . _ � <br /> Electrical Work By T' ' , ` '� r�' � Gas Line By - : ," '� — <br /> TYPE OF HEAT GA�_FA X• HW STEAM SPACE HTR. UNtT HTR. OTHER <br /> GAS DESIGN CONYERSION <br /> MAKE ? MAKE OFBURNER <br /> Model � i ' ` ____ Model <br /> Soriol ' : � �`� Mox. BTU Rating , <br /> INPUT - MAKE OF FURNACE <br /> Model � <br /> CONTROLS <br /> '�� <br /> THERMOSTAT Hea! Plug Vent Size �_ , <br /> Volve �°-� � `�= " � •_K1ND OF L1NER '� " � SIZE NONE <br /> Limit ,���' -`' ` ; � `� Draft Nood j ' RegulaTor <br /> Limit Setting ' ��� Filters Size Number <br /> Fon SeTting -�' ' C�imney Location Inside �` Outside <br /> Pilot Type �" Chimney Construcfion <br /> Pilot Make <br /> Pilot Model ' - <br /> Smoke Bomb Wiring <br /> " Droft Tesr �ag <br /> Pilot Timing - - <br /> L.W. Cut Off Door Pressure Lighting Inst. , <br /> . , .� . <br /> Pressure � Percenf CO2 '-� Date Tested <br /> lnput CFH - Pucent O2 ' �'"� Company Testing <br /> $tock Tcmp. �'` `"'' Percen! CO Q Nome of Testet <br /> Fo�m 235 . . . <br /> . . _�:. --- ----------- --- ----- <br />