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HOUSE HEATING TEST RECORD <br /> ADDRESS � � � jL-��'� ��y� ��� �� ��}�''��� ' � • APT. FLOOR GTY4�_ �.`��,�' SUBURB <br /> OCCUPANT� .� ; i i E q s � _�t t � i' t + -i 01MNER <br /> HEAT LOSS DATE HTG. INST. _ <br /> SOLD BY INSTALLED BY <br /> El�chical Work�By Cos Li�• By <br /> TYPE OF HEAT GA FA HW STEAM SPACE HTR. UNIT HTR. OTHER <br /> � GAS DESIGN CONVERSION <br /> MAKE � ` MAKE OF BURNER <br /> t ,..,,, <br /> Mod•I , + Mod•I <br /> S«ia 1 t� , � �� �� � ,�� _,.�: - Max. BTU Rotiny <br /> r.. <br /> INPUT ' �' ` MAKE OF FURNACE <br /> Mod�l <br /> CONTROLS <br /> THERMOSTAT�� � (�i,,;`. H•at Plu _ V•nt S;z• <br /> 1 �, <br /> Volv• '' ' � r ' ' KIND OF LINER ��G SIZE �-� � NONE <br /> Limit ' � %� " �� Droff Nood R�yvlawr <br /> Limit S�ttiny ���,L�� a Filhrs Si:�f '��c`� �lumb�r <br /> Fan S�ttiny Chimn�y Locotion Insid� Outsid� �/"��� <br /> ' , <br /> Pilot Typ� �� `i t Chimn�y Construction t �' f <br /> Pilot Make <br /> Pilot Mod�l Smok� BomJt W��i�O <br /> Pilot Timiny D►aft � ; : t � .' t T�st Toy il' <br /> L.W. Cut Off Dow P.•ssu.. Liphtiny Inst. 6,� <br /> Pressure ��� P�rc�nt CO� Dat� T�st�d ,i� " l t i-'' } � <br /> `W� / �^� <br /> Input CFH k,? �-/ P�rc�nt 02 Company T�sting �'��- !" '' <br /> Stock T�mp. �� P�rc�nt CO � %' Nam� of T�st�r -� <br /> Form 235 � <br />