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HOUSE HEATING TEST RECORD <br /> I r <br /> ADDRESS � � -�`� � APT. FLOOR CITY SUBURBi�i.�1' <br /> OCCUPANT ��1� -�- ���' ( � OWNER <br /> HEAT LOSS DATE HTG. INST. <br /> SOLD BY INSTALLED BY <br /> ,. � f".�,. ;'r;�, . <br /> Electrical Work'By Gas Line By - ' <br /> j '__ ' � ',� .--.:�', � <br /> TYPE OF HEAT GA FA�HW STEAM SPACE HTR. UNIT HTR. -- >. <br /> � � GAS D IGN COI�T�E��tSION �p� � ' <br /> MAKE � MAKE OF BURNER ��•1 <br /> Model ' Model ' <br /> � <br /> $erial � Max. BTU Rating � • ' _ :�"'"""'"`� <br /> INPUT � � MAKE OF FURNACE � i�' � ' <br /> Model �y� � <br /> CONTROLS � �j <br /> THERMOSTAT ���ff� Heat Plug � � Vent Size <br /> Valve /'��'� KIND OF LINER t� $IZE���NONE <br /> Limit �1�' Draft Hood Regulator <br /> Limit SeNing ��' �� Filters Size`G*x�� Number� <br /> Fan Setting Chimney Location I�ide t� Outside <br /> Pilot Type t�Cl�'�-�- c-�� Chimney Construction —f•%� L <br /> Pilot Make <br /> Pilot Model $moke Bomb Wiring <br /> Pilot Timing Draft _�- Test Tag � <br /> L.W. Cut Off Door Pressure Lighting Inst. �- <br /> f a g •- <br /> Prossure /� Percent CO2 Date Tested �� �'� � <br /> Input CFH /�� Percent 02 Company Testing �� � <br /> $tack Temp. ��� Percent CO Name of Tester � = } -- - '�- <br /> Form 235 <br />