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HOUSE HEATING TEST RECORD <br /> ADDRESS I � S�(S T-/�� ��r�_ <br /> � APT. FLOOR__CITY�+��CSSUBURB <br /> �CCUPAN7 -J�ln/�J����n,� OWNER ____�1�'7LS7`C�/t� <br /> HEkT LOSS DATE HTG. INS7. —GAS CO3 METER B�� � <br /> SOLD BY ��-��iSYI� Cif�/ /�(J�'�'��Ijf�';_ �NSTALLED BY _cvf_�-✓YJA� � �-�i � <br /> , //�L. /� Z�JI� <br /> El�ctricol K'ork By '�1�' � �/-�''(° Gas Lins By �T..�/�.J� <br /> TYPE OF HEAT GA FA �W STEAM SPACE HTR. _�_UNIT HTR. OTHER <br /> / GAS DESIGN CONVERSION <br /> MAKE d���✓v�� MAKE OF BURNER <br /> Model —����-�r'�Z� ��/ <br /> Model � t. <br /> Ssria l -� ` 7 � Q <br /> ' Max. BTU Ratin9 � <br /> INPUT Z5 � ' 7�G'�- MAKE OF FURNACE , <br /> Model _ <br /> CONTROLS <br /> THERMOST T� ✓�� �'�� Heat Plug �� Vont Size � `� <br /> V°�`'° —`""'��'�'2�- ��'d"l'� KIND OF LINER �/-�Lf�l �� <br /> Z-- SIZE�_WON� <br /> Limit ����'�� o Draft Hood t�OC`�E�i� _Regularor _�� 7��/-��— <br /> Limit S�ttiny Filters a � ��'— <br /> �-�—$ize-c'G��C��- _Number � <br /> Far $etting rn_�� Chimney Location Inzide L/ Outside <br /> �� � s'�n�i <br /> Pilot Type Gimney Co�struction <br /> Pilot Moke � �1r�i�l�CJ <br /> Pilot Model = Smoke Bomb <br /> Pilot Timing .��1�5�%j-�J�� --Wiri�g — <br /> Draft Te:t Toq <br /> L.W. �ut Off � Door Pressure Lighting Inst. <br /> .� <br /> Pross�re_�.��i PercentCO2 �� Dote Tested �.��r � <br /> Inp�t Cr=H�—��Percent 02— � y� ComPany Testin9 �L_-f�����i.G.���`� <br /> S^ack Tamp. --��� Percent CO �� �'/ Name of Tester ,� � ��j� _,_ <br /> Fo.rf� 235 <br />