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P <br /> ��r�T IOUSE HEATING TEST RECORD <br /> ADDRESS 90 ""LA k'4 kilt 20 APT. FLOOR CITY SUBURB <br /> OCCUPANT OWNER <br /> HEAT LOSS DATE HTG. INST. <br /> SOLD BY INSTALLED BY <br /> Electrical Work By Gas Line By <br /> TYPE OF HEAT GA FA HW STEAM SPACE HTR. UNIT HTR. OTHER <br /> GAS DESIGN CONVER*IbN <br /> MAKE V4,N Ll P, MAKE OF BURNER <br /> Model () Model <br /> Serial Max. BTU Rating <br /> INPUT �� �n MAKE OF FURNACE <br /> Model -- <br /> I/LdCONTROLS r1 LI 'JUN <br /> 2THERMOSTAT He t I Vent Size p� tY 9 � <br /> Valve KIND OF LIN SIZE ON <br /> Limit "rbDraft Hood Regularor �L <br /> u <br /> Limit Setting A,10 Filters Size Number <br /> - <br /> Fon Setting Chimney Location InsideEl0utsids <br /> Pilot Type Chimney Construction 12V C <br /> 1 <br /> Pilot MakeIdA l <br /> Pilot Model Smoke Bomb ` � Wiring <br /> Pilot Timing Draft (/ Test Tag <br /> L.W. Cut Off / Door Pressure Lightin Inst. <br /> ol- <br /> Pressure Percent CO2 ` Date Tested <br /> Input CFH Percent 0 (0 Company Testing <br /> / 2 <br /> Stack Temp. 1-U� Percent CO Name of Tester <br /> Form 235 <br />