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HOUSE HEATING TEST RECORD W krl2 # / <br />ADDRESS APT. LOOR ..SUBURB <br />OCCUPANT OWNER ems— ���. <br />HEAT LOSS T HTG. INS �t <br />SOLD BY �, �,L INSTALLED BY _tb((V t1d- <br />Electrical Work By —Gas Line By-.-I-litilw4 <br />TYPE OF HEAT GA FA HW STEAM SPACE HTR. UNIT HTR. OTHER <br />GAS DESIGN <br />CONVERSION <br />MAKE <br />_ MAKE OF BURNER <br />Model <br />Model <br />Serial <br />Max. BTU Rating <br />INPUT <br />MAKE OF FURNACE <br />Model <br />CONTROLS <br />THERMOST <br />Heat Plug Vent Size <br />Valve <br />KIND OF LINER- <br />4SIZE NONE <br />Limit jr <br />W_Draft Hood <br />Regulator <br />Limit Setting— <br />Filters Size <br />ber <br />Fan Setting <br />1 Chimney Location Ins* <br />Outside <br />Pilot Type <br />Chimney Construction t, <br />Pilot Make <br />Pilot Model Smoke B b _Wiring AJ <br />Pilot Timing ,Q..Q.(_ Draft � Test Toq <br />L.W. Cut Off Door Pressure-. Lighting Inst. <br />4 <br />Pressure_3 T Percent CO2 Date Tested /;Tj Of <br />Input CFH Percent 02 Company Tasting <br />Stack Temp. Percent CO Name of Tester <br />Form 235 <br />HOUSE HEATING TEST RECORD <br />ADDRESS <br />y1 J� GOAPT. FLOOR I SUB . <br />OCCUPANT OWN <br />E <br />HEAT LOSS ATE TG.¢T. <br />SOLD BY (-� INSTALLED BY 4�A1-" <br />Electrical Work By Gas Line By t 4� <br />EAT GA FA 1GHW STEAM SPACE HTR. UNIT HTR. —OTHER.- <br />IT r-r- OF H <br />GAS DESIGN <br />MAKE <br />MAKE OF BURNER <br />Model <br />Model <br />Serial <br />Max. BTU Rating <br />INPUTAT <br />MAKE OF FURNACE — <br />Model _ <br />CONVERSION <br />CONTROLS <br />THERMOS T <br />Heat Plug <br />Vent Size (p <br />- <br />SIZE NONE <br />Volvo <br />KIND OF LINER <br />Limit <br />A. --Draft Hood / <br />Regulator <br />Limit Setting <br />C/O <br />Filters Size_— <br />Nun "r <br />Fan Setting <br />Q <br />Chimney Location <br />I idsOutside <br />ir— <br />Pilot Type <br />�iJ <br />Chimney Construction liz <br />Pilot Make <br />Pilot Model <br />_Smoke Bo b <br />Wiring <br />Pilot Timing <br />`S <br />Draft — <br />Test Tog <br />L.W. Cut Off <br />- <br />- Ono► Pressure <br />—Lighting lnst.�E� <br />Pressure CO2 <br />--T— Date Tested <br />CFH <br />�—Percent <br />Percent 02 <br />J Company Testing <br />Input <br />Stock Tem- <br />Percent CO <br />or . <br />Name of Tester <br />Form 235 <br />