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ADDRESS <br />OCCUPANT <br />HEAT LOSS <br />SOLD BY <br />Electrical Work By <br />TYPE OF HEAT <br />MAKE <br />Model _ <br />Serial _ <br />INPUT <br />HOUSE HEATING TEST RECORD <br />/►TE HTG. INS T. — <br />,�— � /_a . <br />GA FA L�HW STEAM <br />GAS DESIGN <br />„-1 -7+� <br />APT. FLOOR <br />OWNER <br />.f* /(I // <br />CITY <br />SUBURB <br />_INSTALLED BY <br />_Gas Line By /� �r <br />SPACE HTR. UNIT HTR. OTHER — <br />MAKE OF BURNER.- <br />Model <br />URNER._Model _ <br />Max. BTU Rating <br />MAKE OF FURNACE <br />Model <br />CONVERSION <br />CONTROLS <br />THERMOSTAT <br />• <br />V# <br />Heat Plug <br />Vent Size —�— <br />__ <br />Valve <br />—_ <br />KIND OF LINERl h. %`— ,� SIZE—NONE <br />Limit <br />( <br />Draft Hood '"� Regulator <br />� <br />Limit Setting _ <br />& ' � <br />Filters Size _ Nu or <br />Fan Setting <br />/ /�� <br />Chimney Location Inside_ Outside <br />Pilot Type <br />_ <br />Chimney Construction <br />Pilot Make <br />� <br />' <br />Pilot Model <br />.r <br />Smoke Bomb Wiring — <br />Pilot Timing <br />, 17 <br />'' <br />Draft ._ �� Test To <br />L. W. Cut Off <br />Door Pressure Lighting Inst. <br />- <br />Pressure <br />—. <br />Percent CO2y <br />Date Tested <br />Input CFH�►' <br />Percent 02_ <br />Company Testing <br />Stack Temp. <br />V <br />Percent CO f�� <br />Nome of Tester <br />Form 235 <br />