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R.._.,-.. Q.S.T. ,� �_,.,.�- ,�;-..-.4 ,,^.-�.-.,,-; -.. ,. _..- _, - z. - .1.,�. _ a -, - .- ..w.ryr.,�visrwvns:,:«.�....,..��r.a- �....-�r+r--..• <br /> If <br /> 1),,,, 4-,, . R HOUSE HEATING TEST RECORD <br /> ADDRESS ' A / APT. LOOR TY 1 U I SUBURB <br /> OCCUPANT OWNER //� S QOn./ / Y <br /> HEAT LOSS' DATE HTG. INST. r �►-` . /� <br /> SOLD BY '.3 )4".•1"........f...45-' INSTALLED BY tfff- S ,/ iJ�_aiiiir a-.`' <br /> Electrical Work By /071k Gas Line By <br /> TYPE OF HEAT GA FA HW STEAM SPACE HTR. UNIT HTR. OTHER <br /> yfri14.4"." <br /> CON ERSION <br /> MAKE 75.'16 S MAKE OF BURNER , <br /> Model 9 � �� Model <br /> Serial Max. BTU Rating <br /> INPUT / / a 0 MAKE OF FURNACE <br /> Model / <br /> NT �� <br /> THERMOSTAT Haat at Plug Vent Size y <br /> Valve KIND OF LINER /r SIZE NONE <br /> Limit Draft Hood / Regularor / <br /> Limit Setting Filters Size /���Q7( Nu er <br /> Fan Setting <br /> 11)41 <br /> Chimney Location 1 si4 /fr�� ) de <br /> PiIt Type imney Construction � <br /> Pilot Make <br /> /1/$) <br /> � t , <br /> Pilot Model iiffictio, Smoke Bomb Wiring- Pilot Timing Draft • Test Tag p <br /> L.W. Cut Off j 4' Door Pressure A_ Lig g Inst. <br /> ,,,,,,V <br /> '.Pressure Percent CO 2 ! ' Date Tested ! e t.11p5 / • / <br /> (Input CFH Percent 02 "JO Company Testing ,si '1!A► : �' <br /> / ` ) <br /> ,Stack Temp. 'r---r— V �f"� <br /> Percent CO Name of Tester !,'�` <br /> Form 235 <br /> I <br />