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�r�,< � D ✓ <br /> HOUSE HEATING TEST RECORD (��� � �y�� <br /> t / r- -T--� � � ��' <br /> ADDRESS 1 �°��'-%� ►` ��X �-=T APT. FLOOR{=_CITY SUBURB���f� , <br /> OCCUPANT OWNER ���-� '�� <br /> HEAT LOSS DATE HTG. INST. <br /> SOLD BY INSTALLED BY �hC3T � E�I�I �E.��-, <br /> Electrical Work By Gas Line By <br /> TYPE OF HEAT GA FA�_HW STEAM SPACE HTR. UNIT HTR. OTHER <br /> GAS DESIGN CONVERSION <br /> MAKE ��ih�Pj � MAKE OF BURNER <br /> Model '�� lX�` (���-(C) �-� S�� Model <br /> $eriol �-� ���� �%:� n�'{ri�. Max. BTU Rating <br /> INPUT �� �'a�� MAKE OF FURNACE <br /> Model <br /> CONTROLS <br /> THERMOSTAT T� � Heat Plug Vent Size � 1I <br /> Valve � d (� � ��� KIND OF LI�ER SIZE NONE X <br /> Limit ��?��e � 5' Draft Hood —T � Reyulator <br /> Limit Setting��,�� Filters Siza � Number <br /> Fan Setting ` � �+'�r' n Chimney Loeation Inside � Outside <br /> Pilot TYPe N� `� 2:��s� � �I�) C`t 11'„ n1 Chimney Construction ��i i �l��, <br /> Pilot Make <br /> Pilot Model $moke�Bomb ' Wiring � <br /> Pilot Timing Draft 1.���� F�� tJ Test Tay � <br /> L.W. Cut Off Door Pressure —' Lightiny Inst.� <br /> Prossure n•��� �) Percent C0� ����� Date Tested � ~ ^--~-� <br /> Input CFH "l-�' Percent 0 �` � Company Testina � i���� �-� �f,�,'TJ,(V( <br /> Stack Temp. ^�I'�—Percent COZ �' �� Name of Tester —� 1 f'�1 '�� <br /> Form 235 <br />