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HOUSE HEATING TEST RECORD <br /> ADDRESS ✓� ��=��'��"6 � APTTFLOOR CITY�SUBURB <br /> OCCUPANT OWNE� L�I�� <br /> HEAT LOSS DATE HTG. INST. <br /> SOLD BY INSTALLED B <br /> Elsehical Work By Gas Line By <br /> TYPE OF HEAT GA FA HW STEAM SPACE HTR. UNIT HTR. OTHER <br /> GAS DESIGN ` CONVERSION <br /> MAKE MAKE OF BURNER <br /> Mod�l Model <br /> Seriol � Max. BTU Rating <br /> INPUT � MAKE OF FURNACE <br /> Model <br /> '�''�/� CONTROLS � <br /> THERMOSTAT L(11�w Heat Plug Vsnt Size � <br /> Valve (1,,���r6 �� KIND OF LI ER SIZE NONE <br /> Limit �S 0 Drah Hood Regularor <br /> Limit S�Hing Filters Size Number <br /> Fan Setting Chimnsy Loeution �Jr}Sids Outside <br /> Pilot Typs �' Chimnsy Construction��1�' <br /> Pilot Maks / � <br /> Pilot Modsl — Smoke mb Wiring <br /> Pilot TiminQ ' �� Draft ��� '�T���—Test Tap <br /> L.W, Cut Off �� Door Pressure Lightiny I�st_ <br /> /� r n ( <br /> Pressure V V �� P�reent COZ '� Date Tested �� N <br /> Input CFH Peresnt 02 Company Testing �L <br /> Staek Temp. ercent CO Nume of Tester � <br /> Form 235 <br />