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HOUSE HEATING TEST RECORD <br /> ADDRESS �- - � � � -" �%' " � <br /> � APT. FLOOR CITY SUBURB ���L�� <br /> OCCUPANT ��`� 7� ' OWNER <br /> HEAT LOSS DATE HTG. INST� <br /> SOLD BY INSTALLED BY <br /> Electrical Work By Gas Line By <br /> TYPE OF HEAT GA FA �� HW STEAM SPACE HTR. UNIT HTR. OTHER <br /> /r � GAS g�51GN =-� <br /> �,�r <br /> MAKE �-��ifw� � ��f� MAKE OF BURNER ' -' � ��' ,� �1\'�� <br /> Model �t�� .+ Model - ` �_. f <br /> 0 � �S'.)�.` �-�. <br /> Serial �/ �3�� Max. BTU Rating ' <br /> INPUT _!��n� MAKE OF FURNACE S - <br /> Model !�` � �`�� � � <br /> CONTROLS / ,� � �.�-r.;,.,.'.'`::. ... . .. <br /> THERMOSTAJT �'�r Heat Plug � T Vent Size +Z � -' <br /> Valve r�./�� KIND OF LINER SIZE NONE <br /> Limit ��•�j Draft Hood y� Regularor / <br /> Limit Setting Filters Size ��/� � 5 � Number / <br /> Fan Setting Chimney Location Inside '� Outside <br /> i� G� <br /> Pilot Type � �.�- Chimney Construction /Z T �,L <br /> Pilot Make <br /> Pilot Model Smoke Bomb �Wiring <br /> Pilot Timing Draft �G~`L'�C..l� Test Tag `—' <br /> L.W. Cut Off Door Pressure Lighting Inst. �- <br /> `_ `�' <br /> Pressure—� �` Percent CO2 �-`� Dote Testad . � l C � D /, <br /> Input CFH��y C' Percent OZ—_�� Company Testing ��'� j � <br /> $tack Temp. —L-� —Percent CO — — Name of Tester <br /> Form 235 <br />