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HOUSE HEATING TEST RECORD <br />AVRESS ___Z 0-T <br />OCCUPANT 1����/( <br />HEAT LOSS — DATE HTG. INST. <br />SOLD BY <br />Electrical Work By -- _ -- -.-_-_- <br />TYPE OF HEAT GA ______ FA _ HW STEAM <br />I GAS DESIGN <br />MAKE-- <br />Model--- <br />Sorial ---—-:�-Q4-� - — <br />INPUT __----- -/.A-4;d j/ --- <br />CONTROLS <br />THERMOSTAT <br />Volvo <br />--� - _ Heat Plug <br />I — <br />Limit - -- <br />A A, rJ_ '' <br />j�rfs-s-�-%`/ <br />Limit Setting <br />Fan Setting <br />Pilot Type <br />Pilot Make <br />_. <br />Pilot Model <br />_. <br />Pilot Timing <br />L.W. Cut Off <br />Pressure <br />3_5� Percent CO2 <br />6-3 <br />, <br />) <br />9' <br />Input CFH <br />/ Percent 0? <br />Stack Temp. <br />�' �� Percent CO <br />Form 235 <br />APT. _._ __ FLOOR ---- CITY _ SUBURB <br />_ OWNER <br />INSTALLED BY IN <br />-- _-- Gas Lino By - <br />SPACE HTR. UNIT HTR. __y qq—._OTHF, <br />COIWERoom <br />MAKE OF BURNER <br />Model <br />Mos. BTU Rating <br />MAKE OF FURNACE <br />Model <br />� <br />Vent Sire - - . - — ------------ <br />KIND OF LINER SIZE ___ _ NONE <br />Draft Hood _ Regulator <br />Filters Sites �'f� C -- - _ Number _ 2f 1 ;r5.—_—_- -- <br />Chimney Location Inside _ _.___ _ Outside <br />Chimney Construction <br />Smoke Bomb _ Wiring <br />Draft i�e�C � - Test Top <br />Door Pressure Rom% Lighting Inst. _ <br />Dote Te.red �� s+ ✓ i _hh _ - - -- <br />Company Testing <br />Nome of Te+ter _ __----------_. _—� <br />