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HOUSE HEATING TEST RECORD <br /> ADDRESS �-��a� ��-���5�� �� APT. FLOOR CITY SUBURB ���� <br /> OCCUPANT OWNER <br /> HEAT LOSS DATE G. INST. <br /> SOLD BY INSTALLED BY ���-�/�,�{�' �� �-�-�� <br /> El�ehieol Wo►k By -_ �latv�S� �G t/L Gos Lin� By � <br /> TYPE OF HEAT GA FA�HW STEAM SPACE HTR. UNIT HTR. OTHER <br /> .��' GAS DESIGN CONVERSION <br /> MAKE !Lm � �S� MAKE OF BURNER r'rC�,�t� ��1�16 <br /> Mod•I �,5�/a S�� Modsl <br /> s.�,,, 9syaso3G y �x. BTU Ratiny <br /> INPUT �ardd� MAKE OF FURNACE <br /> Model <br /> CONTRO�S / �� <br /> THERMO�TAT ��� Hsat Pluy - S Vent Size � <br /> Valve � � KIND OF LINER /��uh+�er��� SIZE�NONE <br /> Limit � � Draft Hood Rsyularor / <br /> Limit S�Miny Filt�rs Siz� 0��-S� � �dumbsr I <br /> Fan Settiny � Chimn�y Location I�nsi"de � Outside <br /> Pilot Typs � Chimnsr Construetion�y.[, ��r�� <br /> Pilot Make `�� <br /> Pilot Model Smok� B�"b Wiriny <br /> Pilot Timiny �a �� Droft /9G� T�st Te� <br /> L.W. Cut Off Door Pressw� Liyhtl�p Inst. � <br /> Pros:ur� �S � P�reent COZ r/ Dats Tested Z_19-1n <br /> Input CFH ,�17 S Percent 0 8 Company Testing <br /> 2 <br /> Sfaek T�mp. .��U P�rc�nt CO d Nama of Tsat�r <br /> Form 235 <br />