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HOUSE HEATING TEST RECORD � <br /> ADDRESS l `" CCc�nCc�2 "' qpT. .FLOOR CITY SUBURB <br /> OCCUPA,NT '-' C— - � OWNER <br /> HEAT LOSS DATE TG. INST. — <br /> SOLD BY INSTALLED BY <br /> Electrical Work By Gas Line B � <br /> Y <br /> TYPE OF HEAT GA FA�HW STEAM SPACE HTR. UNIT HTR. OTHER <br /> GAS DESIGN CONVERSION <br /> MAKE � `— ��� MAKE OF BURNER <br /> Model Model <br /> $erial Max. BTU Rating <br /> INPUT ��� MAKE OF FURNACE <br /> Model <br /> �� CONTROLS � �� <br /> THERMOSTA ' v He�Plug Vent Size <br /> Valve KIND OF LINER SIZE N <br /> Limit Draft Hood Regularor�C� �.� ��— <br /> Limit Setting Filters $iz -J Number <br /> Fan Settin � <br /> 9 Chimney Location I�P � Outside <br /> Pilot Type Q � Chimney Construction v <br /> Pilot Ma;ce <br /> Pilot Model _ Smoke Bomb Wiring <br /> Pilot Timing �� Draft Test Tag <br /> L.W. Cut Off Door Pressure Lighting lnst. <br /> F'�.�'siy�._: <br /> Pressure ' - Percent COZ '� Date Tested _ <br /> 'Y - . ..i et_._.�"�,.� .. ..; , .; <br /> Input CFH Percent 02 � Company Testing _ _ . <br /> + . .i n :}.�,3 t , <br /> Stack Temp. Percent CO Name of Tester '� ' `"" � <br /> Form 235 ' �`�'�� <br /> ���. <br />