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• <br /> pififirlifi;047,r, , <br /> J <br /> molook <br /> HOUSE HEATING TEST RECORD <br /> ADDRESS 2f? b� 1'Y' Y 1.- � lS j9 APT. FLOOR CITY SUBURB <br /> OCCUPANT---eriL 1G>;t r h OWNER <br /> HEAT LOU DATE HTG. INST. <br /> SOLD BY .44, 6-- sT A ✓ INSTALLED BY L- at(-02 1 r <br /> Electrical Work B, Gas Line By <br /> TYPE OP NEAT OA S;: i.._FA- —HW STEAM SPACE HTR. UNIT HTR. OTHER <br /> ,A GAS DESIGN CONVERSION <br /> MAKE -I v !'ic-' MAKE OF BURNER <br /> Ma4o1 _ QQ_Val.//7//(/ /irI• Model - - — <br /> Serial __,2 71ie .-_ Max. BTU Rating _ ___ <br /> INPUT f0.cy-er-2 — MAKE OF FURNACE __� _ <br /> Model ___ _ ____.__—_— <br /> CONTROLS --T - <br /> THERMO TAT s')''...1. -Just Plug .- Vent Size—,.- - .'—Volvo_E -� `� ' _ KIND OF LINER_.—. SIZE._ -NONE_ — <br /> Limit k �:�GG\ _-_ . \\ —. Draft Hood ._ Regularor <br /> Limit Settittg._.... G7Filters Size_ Number-... <br /> Fan Setting...--,..L� S U —_ Chimney Location Insy.11e ;.Y <br /> Outside <br /> Pilot Type _-.4=1.-"' _ Chimney Construction ._ (.."C _ —. <br /> Pilot Make '� y Li"' L. 1/ <br /> Pitot Model -I* , Smoke Bomb Wiring <br /> Pilot Timing , Y - "-- Draft Test Tag <br /> L.W. Cut Off _ Door Pressure - Lighting Inst. <br /> Pressure /-) _ Percent CO2 i{ Date Tested _ ,...--.7- i 3 <br /> Input CFH �� a Pereent 02 2 y'' Company Testing L-U"-'T_4, <br /> Stock Temp. 4- -.,-.- -Percent CO n° 6r.'/‘'a''..- Name of Tester 2.c. G <br /> Form 235 <br />