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FLOOR <br />HOUSE HEATING TEST RECORD <br />ADDRESS /ffT^vf <br />OCCUPANT ^ /£vy^f _______________ <br />HEAT LOSS____________DATE HTG. INST____________________ <br />SOLD BY--------------------------------------------------------------------------------------INSTALLED BY <br />APT._ <br />OWNER <br />CITY SUBURB <br />EUctrical Work By____ <br />TYPE OF HEAT GA <br />Gas Lino By <br />HW STEAM SPACE HTR.UNIT HTR.OTHER <br />PAS.PESIGN <br />MAKE <br />Model <br />Serial <br />1 A) n ifT <br />_____________________________ <br />INPUT___ <br />CONTROLS <br />THERMOSTAT . M. H'____ Heat Plug <br />Valve _____________________________ <br />Limit____/HH '_________________ <br />J. <br />Limit Setting--------------------- <br />Fan Setting -------------- <br />Pilot Type <br />Pilot Make ------------------------- <br />Pilot Model ______________ <br />Pilot Timing---------------------- <br />L.W. Cut Off ____________ <br />Input CFH--------------- <br />Stack Temp. <br />Form 235 <br />.Percent CO. <br />Percent 0, <br />Percent CO <br />if. <br />CONVERSION <br />MAKE OF BURNER <br />Model ___________ <br />Mox. BTU Rating___ <br />MAKE OF FURNACE <br />Model _____________ <br />Vent Size ___ <br />KIND OF LINER SIZE^- V NONE <br />Filfors Sixo /^ ^ 1 <br />Chimney Location Inside___ <br />Chimney Construction <br />Smoko Bomb V <br />Draft C K'm, <br />Door Pressure <br />Number <br />^ Outside <br />Wiriiring <br />Test Tog <br />/-■?- r<) <br />Compony Testing _ <br />------< <br />Date Tested <br />Compony Te <br />Nome of Tester