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HOUSE HEATING TEST RECORD Q�Jv� � <br /> ADDRESS _ / `��''� l7l�t�CGF� � Y � ��iAPT. FLOOR�---CITY SUBURB <br /> OCCUPANT �� � ����"� � OWNER �� ��� <br /> HEAT LOSS DATE HTG. INST. <br /> SOLD BY INSTALLED BY �'� 1 ��-� f%��� «- <br /> Electrical Work By Gas Line By – �'/ �'� <br /> TYPE OF HEAT GA FA HW�STEAM SPACE HTR. UNIT HTR. OTHER <br /> GAS DESIGN r'� CONVERSION <br /> MAKE MAKE OF BURNER ��/f � <br /> Model Model <br /> $erial Max. BTU Rating � <br /> INPUT MAKE OF FURNACE k�<��� <br /> Model 5 � <br /> j���� CONTROLS // <br /> THERMOSTAT--l�1— Heat Plug � Vent Size , <br /> Valve L S �- � KIND OF LINER v�'�9 SIZE� NONE <br /> Limit ���Vj.�� Draft Hood Regularor �.�T`� <br /> Limit Setting j!� Filters Size Nu ber <br /> Fan Setting '��� Chimney Location Inside Outs�j�' <br /> Pilot Type � Q�'< < � 0/� f�.- Chimney Construction ��iC� ''� i��ti <br /> Pilot Make � t <br /> Pilot Model �°��' l— ��� <br /> � $moke Bomb Wiring <br /> Pilot Timing C Sh< Draft � Test Tag � <br /> L.W. Cut Off �� Door Pressure Lighting Inst. �� <br /> � <br /> Pressure Percent CO2 / Date Tested " � ' <br /> Input CFH � Percent 02 �7� Company Testing ,=_ , f F" <br /> $tack Temp. ���' Percent CO ���� Name of Tester � F- <br /> Form 235 <br />