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HOUSE HEATING TEST RECORD <br />ADDRESS 1CLle �f�Lr,eQN ? APT. FLOOR CITR7&—) SUBURB <br />71161160� <br />OCCUPANT #L_� <br />HEAT LOSS <br />DATE HTG. INST. <br />OWNER _ <br />SOLD BY INSTALLED BY fZ <br />Electrical Work By Gas Line By <br />TYPE OF HEAT GA FA HW STEAM SPACE HTR. UNIT HTR. OTHER <br />G S DE <br />MAKE MAKE OF BURNER <br />Sof Model Model <br />1OI Max. BTU Rating <br />INPUT MAKE OF FURNACE _ <br />CONTROLS <br />THERMOSTAT + Heat PIL <br />Valve <br />Limit <br />Limit Setting <br />Fan Setting _ <br />Pilot Type _ <br />Pilot Make — <br />Pilot Model <br />Pilot Timing SOr� <br />L.W. Cut Off <br />Model <br />Vent Size <br />CONVERSION <br />KIND OF LINER SIZE NONE <br />Draft Hood _ Regularor <br />Filters Size 1Z_�j,_Number <br />Chimney Location Inside Outs' e <br />Chimney Construction /i1P< S' <br />Smoke Bomb Wiring <br />Draft o Test Tag <br />DP <br />offoor ressure i hting Inst. <br />Pressure Percent CO2 • OnDate Tested <br />Input CFH Percent 02 7• ?• I Company Testing <br />Stack Temp. Percent CO Name of Tester _ <br />Form 235 <br />