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HOUSE HEATING TEST RECORD <br />ADDRESS �'=�-� `ter* 0 " 'l -.----APT. ------- FLOOR _-.c----___ CI TY <br />OCCUPANT — -------- OWNER ----- - --- <br />SUBURB Nl__�.L_ r� <br />HEAT LOSS _ DATE HTG. INST. - — <br />SOLD BY —__--- _------_.-_-- _—INSTALLED BY A' <br />Electrical Work BY __—_—_—_--._-. __----Gas Line By u'�+ — <br />TYPE OF HEAT GA -- FA __ HW _STEAM - _ SPACE HTR. ___ __UNI HTR. _OTHER - <br />GAS DESIfN <br />MAKE u 14IJ I IZ7/ _MAKE OF BURNER <br />Model (f,rC2 /fon Model --_—_-- ---------- - <br />-- <br />Serial :2 7 7 Max. BTU Rating <br />INPUT : C2 t-�- '� MAKE OF FURNACE <br />M d 1 <br />CONVERSION <br />oe - -- - -- - -- - — -- - . -- - - _ <br />1 CO. ROLS <br />THERMOSTAT'''/ eat Plug - - Vent Size - ---1- ---�-- �- - - - - - <br />Valve ___ KIND OF LINER____ '______ SIZE _ _____. NONE <br />Limit ____ 1 — Draft Hood /Regulator - -- . - - <br />Limit Setting —� Filters Size <br />Fan Setting - - Chimney Location Inside ___ X _______. Outside _ <br />�! r O <br />Pilot Type 1�%�-�"�'��'' � Chimney Construction <br />Pilot Make <br />i <br />Pilot Model _ ? .r Q Smoke Bomb <br />I <br />Pilot Timing �Sp Draft _.Test Tag - <br />---_ <br />I _W_ C"t Off Door Pressure _ ---Lighting Inst. <br />Pressure — Percent CO2 Date Tested <br />Input CFH Percent 02 Company Testinc <br />Stack Temp. Percent CO C Nage of Tester <br />Form 235 <br />