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HOUSE HEATING TEST <br />RECORD <br />ADDRESS _�Y <br />A/�_____APT. ---- <br />FLOOR_-- <br />_ CITY kXZ9_Z_SUBURB <br />0CCJJPANT_ OWN E R <br />HEAT LOSS DATE HTG. INST. <br />_r <br />SOLD BY —_ INSTALLED BY <br />C2 C—C <br />El*cftical Work by --Gos Lino By <br />TYPE OF HEAT GA __ FA -Le—/-HW STEAM SPACE HTR. U141T HTR. —OTHER <br />MAK E �AS DESIGN CONVERSION <br />___-MAKE OF BURNER <br />Model Si41 g 110-2 <br />Serial 21ZZ 0 —Max. BTU Rating <br />INPUT ii2 /I MAKE OF FURNACE <br />Model <br />CONTROLS <br />THERMOSLTAT Meet Plug <br />Voles )� <br />Limit <br />Limit Selling <br />Fon Setting <br />Pilot Type T�k <br />Pilot Make XE <br />Joni Size <br />KIND OF LINER SIZE NONE <br />Draft Hood Requiato, <br />Filters Size <br />Chimney Location Inside - L--Outside <br />Chimney Construction ic <br />Pilot Model Smoke Bopb <br />Pilot Timing Draft <br />L.W. Cut Off Door Pressure <br />10, <br />Pressure <br />Input CFH - ko <br />Stock Tomp. ) <br />Form- 235 <br />"I �.� -%W - <br />A : - '31 -7- o <br />44' ow �. �'o Do to To s tod <br />. t"r <br />�wcont 0 0 Cc mpo n y Testing _11-10 <br />2 10 <br />—Percent CO Nome of Tester <br />Wiring -L-.ol/ <br />Test Tog —L--"' <br />Lighting Inst. <br />