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f E%2V�tlT# `AGN 2 HOUSE HEATING TEST RECORD 4-Mo <br /> ADDRESS �y � OC D c�y.s y Ael) APT. FLOOR CITY SUBURB <br /> OCCUPANT OWNER <br /> HEAT LOSS DATE HTG. INST. <br /> SOLD BY INSTALLED BY \k( <br /> Electrical Work By Gas Line By <br /> 51. IL61- <br /> TYPE OF HEAT GA FA HW STEAM—_SPACE HTR. UNIT HTR. OTHER , 111 <br /> GAS DESIGN CONVERSION LE.__. <br /> MAKE LA,,,, MAKE OF BURNER <br /> Model V Model <br /> Serial Max. BTU Rating <br /> INPUT MAKE OF FURNACE <br /> Model ' <br /> CONTROL <br /> THERMOSTAT t Plug --_ Vent Size <br /> Valva U }seaKIND OF LINE SIZ NON <br /> Limit )U Draft Hood _ Regulator .� �� 7--S,i n yj <br /> Limit Setting U Filters Size Nu ber <br /> Fan Setting o Chimney Location Inside Outside <br /> Pilot Type Chimney Construction d u (] L <br /> Pilot Make LA.V14 i <br /> Pilot Model ���—�(�yy Smoke Bomb Wiring <br /> Pilot Timing Draft Test Tag <br /> L.W. Cut Off �— Door Pressure Lighting Inst. �- <br /> Pressure Percent CO2 Date Tested <br /> Input CFH C f^" Percent 02 71 Company Testing ulor-T A/ <br /> Stock Temp. a)4)J Percent CO Name of Tester <br /> Form 235 <br />