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HOUSE HEATING TEST RECORD <br />ADDRESS <br />OCCUPAN <br />HEAT LOSS <br />SOLD BY <br />Electrical Work By <br />TYPE OF HEAT <br />DATE HTG. INST. <br />GA FA,A HW STEAM <br />APT. FLOOR CITY—SUBURB�� <br />OWNER <br />INSTALLED BY <br />_ Gas Line By��i�� <br />SPACE HTR. UNIT HTR. OTHER <br />GAS DESIGN <br />MAKE - <br />— _ _MAKE OF BURNER _ <br />Model <br />Model <br />ZaSerial <br />Max. BTU Rating — <br />INPUT — <br />— MAKE OF FURNACE <br />Model <br />ONTROLS <br />THERMOSTAT Al— Heat Plug <br />Valve Ar__ <br />Vent Size _ <br />CONVERSION <br />KIND OF LINER-4 SIZEAA _4� NONE <br />Limit Draft Hood —_ Regulator _ <br />Limit Setting —_ Filters Size ZNumber <br />Fan Setting Chimney Location Inside Outside <br />Pilot Type �L�I_ _ _ Chimney Construction <br />Pilot Make � _ ^�— <br />P;lot Model — Smoke Bomb <br />t Timing Draft <br />L.N. Cut Off Door Pressure <br />Pressure Percent CO2 Date Tested . <br />Input CFH Percent 02 Company Tes, <br />Stack Temp. ercent CO © Name of Tester <br />Wiring __ <br />Test Tog <br />Liahtina Inst. Z__ <br />Form 235 <br />