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HOUSE HEATING TEST RECORD <br />ADDRESS F95 ZZ-$? _. <br />OCCUPANT v L` 41V <br />HEAT LOSS DATE HTG. INST. <br />SOLD BY fE'C `'_'' <br />Electrical Work By <br />TYPE OF HEAT GA <br />APT. F OOR _ CITY49! ' L�SUBURB <br />OWNER <br />INSTALLED <br />Gas Line By <br />FA X HW STEAM —SPACE HTR. <br />GAS DESIGN <br />MAKE �'�" M-Xi" <br />Mode! Model <br />NER <br />_UNIT HTR. OTHER <br />CONVERSION <br />Serial Max. BTU Ra <br />INPUT I / 4MAK FURNACE ' `' <br />)00 <br />CONTROLS <br />THERMOSTAT 'C Heat Plug _— <br />Valve�O��ni'!T <br />Limit 6Aajot ��_lL-Z- 25"1 <br />Limit Settir <br />Fan Setting <br />Pilot Type <br />Pilot Make <br />Pilot Model <br />Pilot Timing <br />L.W. Cut Off �--- - <br />del <br />.Y <br />Vent Size <br />KIND OF LINER _ SIZE ir�NONE <br />Draft Hood Regularor <br />Filters Size r <br />Chimney Location I s' e _ Outside <br />Chimney Construction A <br />Smoke Bomb Wiring <br />Draft Tag <br />Door Pressure r� Lighting Inst. <br />Pressure r� — Percent CO2 Date Tested �3r <br />Input CFH Percent 0� Company Testing <br />Stack Temp. ?/ ' A,47 Percent CO "�'� Name of Tester <br />Form 235 <br />