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HOUSE HEATING TEST RECORD <br /> / i' {�/��� <br /> ADDRESS ` � / C�' C- �- C./'(,/V` APT. FLOOR CITY SUBURB (Uvl <br /> OCCUPANT OWNER " <br /> HEAT LOSS DATE HTG. INST. <br /> SOLD BY INSTALLED BY • <br /> Electrical Work By Gas Line By <br /> TYPE OF HEAT GA FA HW STEAM SPACE HTR. UNIT HTR. OTHER <br /> GAS D�SIGN CONVERSION <br /> MODEL ' � �(� � �r MAKE OF BURNER <br /> �O J MODEL <br /> SERIAL `-' t• � ��,� MAX. BTU RATING <br /> INPUT MAKE OF FURNACE <br /> MODEL <br /> CONTROLS <br /> THERMOSTAT �F�`� HEAT PLUG VENT SIZE <br /> VALVE t�-aJ`c we-� KIND OF LINER SIZE NONE <br /> LIMIT L5�1.!i✓L , DRAFT HOOD REGULATOR <br /> LIMIT SETTING �c�. FILTERS SIZE[[�(25�� ( NUMBER � <br /> FAN SETTIN�,nn°Z(J CHIMNEY LOCATION INSIDE �C OUTSIDE <br /> PILOT TYPE �LEC.TPc�NV C CHIMNEY CONSTRUCTION GL�S G l <br /> PILOT MAKE l.4.N 1� o 'I� <br /> PILOT MODEL SMOKE BOMB WIRING <br /> PILOT TIMING DRAFT TEST TAG <br /> L.W. CUT OFF DOOR PRESSURE r�� �"IT���N�10EC, li�!C. <br /> .— �y +�b�: GOL►�;_�d 1;'�`,LI f�';' i r i� ;:� ,^,�i3 <br /> PRESSURE � � S PERCENT CO2 o DATE TESTED � -� ;^ �� �, <br /> INPUT CFH `� � PERCENT 02 � COMPANY TESTING � '- - <br /> STACK TEMP. 3�, S PERCENT CO v NAME OF TESTER _ <br /> FORM 235 � -�----...�.._����� <br />