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QPRrNr't 0101 <br />ADDRESS y 300 �oi sTi <br />HOUSE HEATING TEST RECORD <br />OCCUPANT <br />HEAT LOSS DATE HTG. INST. — <br />SOLD BY — ---- <br />Electrical Work By <br />TYPE OF HEAT GA FA _&HW — <br />APT. FLOG CI <br />OWNER <br />SUBURB <br />* $a C?o <br />INSTALLED BY 6 <br />----._Gas Line By <br />STEAM __- SPACE HTR. ---UNIT HTR. OTHER - <br />GAS DESIGN DEC I 1 On1 CONVERSION <br />MAKE k ___—_ ____.MAKE O BURNER <br />Modal '" -- Model -- _ <br />Serial 3 -� Max. BTU Rating <br />INPUT --T- _ MAKE OF FURNACE — <br />THERMOSTAT <br />Volvo <br />Limit -- <br />Limit Setting <br />Fan Setting _— <br />Pilot Type <br />plot Make — <br />CONTROLS <br />�_ Hoot Plug �!~ <br />Pilot Model _ <br />Pilot Timing 1 2 <br />Modal <br />Vent Size <br />KIND OF LINE SIZE NON <br />Draft Hood _ V f I Regulator _— <br />Filters Silts _ _ Number <br />Chimney Location Inside r side <br />Chimney Construction <br />Smoke Bomb -- Wiring <br />Draft -- Test Tog _ <br />L.W. Cut Off Door Pressure — Lighting (nst. <br />Pressure _ 3� Percent CO? d Date Tested _— <br />Input CFH Percent 02 Company Testing <br />Stack Temp. ..___3X9j_y-- Percent CO Ci t — Name of Tester _ <br />Fwm 235 <br />S'(�va1)4 Co 6L0C-- <br />