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HOUSE HEATING TEST RECORD <br /> , �/�L,�-Y��; <br /> ADDRESS �E ✓ �+� ���'�''���� APT. F�0(�R CITY ��� yi SUBURB <br /> OCCUPANT OWNER . ����%,� � �"d./'' �'`" <br /> HEAT LOSS DATE�iTCi:,INST. <br /> SOLD BY �����- �'-=% � '��_ = ��-� � INSTALLED BY-���� � � I �� / <br /> Eleetrical Work By , Gas Line By '� � ' ��� ''�� �'��—r <br /> .,.,_ <br /> TYPE OF HEAT GA FA t'�^ HW STEAM SPACE HTR. / UNIT HTR. OTHER � � <br /> '' G�S DESIGN CONVERSION <br /> MAKE ���r' �'-i"�` MAKE OF BURNER <br /> Model 1/ % �' ? " Model <br /> $erial � ` � �� Max. BTU Rating <br /> INPUT � �����'� MAKE OF FURNACE <br /> Model <br /> ��-�. <br /> CONTROLS �.. i � . <br /> THERMO�TJIT� Heat Plug � x' � � Vent Size i <br /> Valve '��� KIND OF LINER � ,,.. '�'�SIZE NONE <br /> Limit ' � � Drah Hood� � Regularor =�3'"J <br /> Limit Se»i.,� Filters $ize � Z��� Number <br /> Fan Setting �� %'� "{� Chimney Location Ins� Outside <br /> Pilot Type � ''�" Chimney Construction � ���'" <br /> Pilot Make `2i-�r'' <br /> Pilot Model � $moke Bomb Wiring f� � 1 <br /> Pilot Timing ) L' � �� Draft �/'��''�` r� `'' LK Test Tag 'l �-t.i" -,r�� % <br /> L.W. Cut Off Door Pressure Lighting Inst. �y /' -�- <br /> �r _�- _C' �� _ <br /> Pressure � Percent CO2 ry Date Tested • <br /> �` ' l ,- J �'`/ �_ � �,, ; �� 7 <br /> Input CFH Percent 02 Company Testing <br /> $tack Temp. � �E ��� PercenT CO ' J ���t '�- Name of Tester .�-�'"` � l - ! y _----.__ <br /> Form 235 <br />