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��3� ✓ <br /> ����� � ���� HOUSE HEATING TEST RECORD <br /> ADDRESS �C.0 -1-� �O � J 1 ���-�- � APT. FLOOR CITY SUBURB �,`���� v <br /> OCCUPANT OWNER <br /> HEAT LO55 DATE HTG. INST. <br /> SOLD BY INSTALLED BY O� — L I <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 � • i� ''7 MAKE OF BURNER <br /> Model v Model <br /> Serial �'" Mox. BTU Ratiny <br /> INPUT \7/�1 l. MAKE OF FURNACE <br /> Model <br /> ONTROLS �� <br /> THERMOSTAT Heat�lu —1 Vsnt Size <br /> Valve KIND OF LINER SIZE NON <br /> Limit Draft Hood —� �T�Reyulator � ' ��� �- <br /> Limit Sstting ' � � Filters Siza Nuy�ber <br /> Fan Setting �"� Chimney Location Inside—.C�—Outside <br /> Pilot Type `' � Chimnsy Construction �� <br /> Pilot Make �' V� �_ <br /> Pilot Model �� — Smoke Bomb Wiring <br /> Pilot Timing � :, �-� Draft Test Tap <br /> L.W. Cut Off �— Door Pressure Liyhtiny Inst. r <br /> � , � <br /> \ � -- <br /> Pressure ��-1 Peresnt C0� Date Tested <br /> Input CFH��� ��� Percent OZ Company Testing <br /> $tack Temp. ������ Perc�nt CO �� Name of Tester <br /> Form 235 n � � <br /> �-c��.� �-c� <br />