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1960 Cliff Lake Rd - Heating Test Records ??G'? ?I ?? ?? ? ? HOUSE H ? ; • - EA TING TEST RECORD .?? p ` V (? % G 4c???J ?SLGG? a? PS ? 0 ' c,j ADDRESS ? APT.-FLOOR CITY SUBURB OCCUPANT ` OWNER HEAT LO55? DATE HTG. INST. 1?""Y ----, 't -t a?l SOLD BY 42Z) INSTALLED BY ? •r : : ? EZ LI?i l' ` Elscfrical Work B y ?' `I : ^.'•' i_ Gaa Line BY .L1 ?1L= 1•7t -C ' f'f i TYPE OF HEAT GA _ FA _X_HW -STEAM SPACE HTR. UNIT HTR. _OTHER Kc{' °+1 GAS DESIGN CONVERSION MAKE MAKE OP BURNER ? -].l 1 /4' p Model 7. Model ?? Sarial Jg[1U+'? 3`ry.3 1 Max. BTU Rating . INPUT MAKE OF FURNACE Model CONTROLS ' THERMOSTAT Hea1 Plug Vent Size -1-3"3 Valve •"??? "}'ti-,'i :% 1 KIND OF LIN ER SIZE NONE Y "t}?.i0, 7G i.1tSC. Limit ? Draft Hood /5?=% / '?''-'? '?-2?> - 3 ,-,_ 1T . ? Regulator Lfmit $etting Filrors Siza- Num6er .1`" Fun Sstting Chimnsy Location Inside Oufside -r' PilotType ChimneyConstrucfion XjV Pilot Make ?Cti`J y PiloT Model ?J?c, Smoke Bomh Wiring Pilot Timing '17AI 5-TAA/71`/ Draft Test Tog L.W. Cut Off Door Pressure -- Lightiny Inst. ' Prossure PercentCO1 ?•S%• Data Testad InputCFH 57? Peresnf O c?S •^ ? Company Testing Stock Temp. Parcent C0 4-?3 Zt. Nome of Tester Farm 235 ' HOUSE HEATING TEST RECORD 664 ?t `14 ADDRE55 7 - /?u ? APT.-FLOOR CITY SUBURB OCCUPANT OWNER HEAT LO55 DATE HTG. INST. SOLD BY `•r' .i7 -C-> /J ??? INSTALLED BY 64'v?t' Elettrical Work By Gas Lina By - TYPE OF HEAT GA -)L._ FA Y HW STEAM SPACE HTR. _UNIT HTR. _OTHER 6-1'i?M , i ? ,? GAS DESIGN CONVERSION MAKE L? MAKE OF BURNER , Modsi J'j:>C-6DSG4+1lJV 0-5-A Modal .' - Sarial N k(V i'Z °/3 W-)'7 Moz. BTU Rating ? f INPUT MAKE OF FURNACE ' Model ? i CONTROLS THERMOSTAT ?al 9'C-' Heat Plug ''"- - Vent Size 3 Valve KIND OF LINER SIZE NONE k Limit DraftHaod Regularor ' Limit SeMing ^ Filters Size ? vX'f??Numbari Fon SeMin9 ? Chimney Loeaffon 1 sida Oufside r _ Pilai Typa Chimney Consiruction ? rAs S e?. . Pilot Moke PilofModel I'a SmokeBomb Wiring Pilot Timing Y-??ST.?^' rllf DrafT Test Ta ` - 9 L.W. Cu1 Off ' Door Pressure - Lighting InsT. P `+? s?• u*J( P C D T d ??"•? srcent ressuro O Z 7 - ate este - ! Input CFH C' Pereent 0 Z Company Testing ?}? ,'!C Stack Temp. Parcent CO v?rC Name ef Testar ?7?/? ?l .??/=???6-L'i!% ="r Form 235 OUSE HEATING TEST RECORD ADDRE55 •' 10lG APT. FLOOR CITY SUBURB _ OCCUPANT OWNER HEAT LOSS 1- - DATE HTG. INST. SOLD BY INSTALLED BY ? Y Elsctrical Work By Gas Line By. ??77t-C`ff TYPE OF HEAT GA Y1:_ FA k_HW -STEAM -SPACE HTR. -UNIT HTR. _OTHER i GAS DESIGN CONVERSION MAKE MAKE OF BURNER ? Modsl LC?3?.Ne)?t Model sa.iai?ll,CUrh 4?•1?112- Max. aTU Rann9 r INPUT MAKE OF FURNACE Model CONTROLS ? THERMOSTAT Heat Plug -"-- Vent $ize 3 Valve KIND OF LINER S1ZE NONE .? Limii lr?4X/?1G sSL DrohHood a'Ji T f?,? Regulator LimitSetting Filtsra Size Number 2 Fan Setting Chimney Location Inside Outside x Pilof Type -?'?f???? Chimney Construcfion PilorMake .r?-'?•i'LC^:J Ct'?::ii?+''?S Pilot Model Smoke Bom6 Wiring ? Pilot Timin9 a?isT??rra Drafr .-7-A1 JZ' ?,/2 Tsst Tag L.W. Cut Off ?--- Door Pressure ° Lighting Inst. ' 7 Prossure ?"ri?'"Z PercentC02 ' ?,¢y? ;f•? DaM Tested _-Z" -h7? ' InpuT CFH 'TrI' Percent OZ--?? Company Tsting ?? c?sC i 7srG / $tack Temp. ,?n?? Percenf CO 6-4;? Name of Tesror Form 235 OUSE HEATING TEST RECORD ? 0 ? ADDRESS // ? L SZAPT._FLOOR CITY SUBURB OCCUPANT OWNER HEAT LO55 DATE HTG. INST. SOLD BY ' r??' ct INSTALLED BY 15 1141 Elsetrical Work By G-. Gas Line By TYPE OF HEAT GA FA V' HW - STEAM -SPACE HTR. - UNIT HTR. _ OTHER c?+?' )?z= GAS DESIGN CONVERSION MAKE MAKE OF BURNER . i Model Model ? ? Sxial q,3r7 '4 3 Ma:. BTU Rating ? ? INPUT C'er_ MAKE OF FURNACE .r Model L " . CONTROLS THERMOSTAT -? f'????- Heat Plug Vent Size ;?Y3 yalye KWD OF LINER SIZE NONE X Limii Jf i&'l2c"k:' Z) t Sf Droh Hood f? f•'"? Regularor Limit SsMing Filtars $ize/umber Fan Setfing Chimney Location Inside Outside PibtType Chimney Conztruction Pilot Moke ^ °?"vr0;•`? ' „+? % /'. Pilot Modsl ?Smoke Bomb '?- Wiring L Pilof Timing .=t='tiSTtNTI?/ Draft !_r\/ L,3 oC Test Tag L.W. Cuf Off Door Pressuro Lighting Inst. Prossuro -7,r?" /"-IL" Pereent CO G r/,- Input CFH Percent OZ Stock Tsmp. Percent CO Fwm 235 DcM Tested -.),"•=?! ? Company Testing ?'"??`?? ?SL ? '?(c r ? ?/ Name % :?f'a'? ADDRE55 ?9(?G00?SC4d? ?ApT.ST RF OORD OCCUPANT OWNER CITY SUBURB HEAT LO55 " DATE HTG. INST. / f` ? SOLD BY ?t?a/?„- d l'ILYd INSTALLED BY Ll?1GC• -[' f tiltf /`? Elechical Work By ? ?pN`?.{7 [=%?• ? Gas Line By ' 7 u? C' /'??l"C ? i TYPE OF HEAT GA?FA_A?__HW-STEAM SPACE HTR. -UNIT HTR. -OTHER / / ? ? GAS DESIGN CONVERSION MAKE ??? ? MAKE OF BURNER ? Model .?.?L (Q'.• 'C' Model • Ssrial ? V?? v`)'1 7 Max. BTU Raring ?? INPUT !t,"qCY'AC ' MAKE OF FURNACE ` Model ? CONTROLS > THERMOSTAT ???>y( Heat Plug Vem Size <J?'l yaI,e KINDOFLINER SIZE NONE 24 Limit Draft Hood l7J.; T- t?^? Regularor f-?•Y '? Limit Ssttir Filters Size : Y J? 1' fy y?x-? ! Num6er Fan Setting Chlmney Location Inside Outside ? Pilot Type Chimnay Construdion E?."1 S S f4 Pilof Make Pilot Modal Pilot Timin L.W. Cut Off ,s Smoke Bomb ~ Wiring Draft -JM b V'f ei-) Test Tag` '? - Door Lighting Inst. i , Preasure PeresntCO? 1° fa= Oafe Tested '?' InputCFH Pereenf 0 ?? CompanyTesf'na O:`Sl' {'??'?(?• Stack Temp. `??'??'f Percent C02 Name of Tester x?? ?L'}iT Ferm 235 HOUSE HEATING TEST ADDRESS APT._ OCCUPANT OWNER. HEAT LO55 DATE HTG. INST. -77 SOLD BY-]?Qt ?<<• r. H INSTALLED 8Y >U54 /? Z.H ,4JVAi?7- Elscirical Work By -l'>'t'- Gas Line By TYPE OP HEAT GA-\-_FA.ZL_HW-STEAM -SPACE HTR. l1NiT HTR. _OTHER kCr / GAS DESIGN CONVERSION MAKE MAKE OF BURNER Model Model Smial Max. BTU Rating ' INPUT or)r-? MAKE OF FURNACE S? Model CONTROLS y? 3 THERMOSTAT HaatPlug VentSize Valre •"L?-4'?/ KIND OF LINER SIZE NONE ? Limit G f?>iSC DraftHood ['=??ii / ci'-' Rsgularor `%??.1 Limit Sstting Filters Size ? Number ? Fan Sattin9 Chimney Location Inside Outside Pilot Type Chimney Consirudion ('11)s ?t/SoN 7S PilotMake -r'tl 7 Pilot Model Smake Bom6 -- '- Wiring Pilot Timing Draft --rM?"CCiJ Tsst Tag ' L.W. Cut Off "f Dow Pressure Lightiny Ins}. ` Prossurc 21 ? Pereent CO ? Date Tested -1 "? ? Cf ! Z Input CFH /G Peresnt 0 Y Company Testing 7 ./. Staek Temp. 3`??rPerront CO? av- Name of Tesfer RECORD FLOOR CITY SUBURB Fwm 235 OUSE HEATING TEST RECORD ADDRESS ? L APT.-FLOOR CITY SUBURB OCCUPANT ? OWNER HEAT LO55 -? DATE HTG. INST. SOLD BY -LY-'<?>? ? ?"?«' INSTALLED BY - J!^ Elschicol Work 6y ir?K Gaa Lina By _ TYPE OF HEAT GA -V_ FA ?,_HW -STEAM -SPACE HTR. _UNIT H TR. _OTHER ? r GAS DESIGN ? CONVERSION MAKE e?"i<<? MAKE OF BURNER ? Model P ?c (- P-4 C/\J C', [,,„21s- ,{' Model ? f . Sxiol fNK-UI Ll `I+r>/ 7/G Max. BTU Rating :? INPUT MAKE OF FURNACE Model CONTROLS . • ?., , THERMOSTAT 4, Heat Plug Vent Size j" Valve jt4%L4' T k? t! KIND OF LINER SIZE NONE Limit Druh Hood Regulator i x s.: x / LimitSaNing 2. Fflters SizeNumber Fan Sstting Chimnsy Locatlon Inside Outaide Pilof TYpe ? Chimney Construction !'40-S' ( L'/f Piloe Make ?r•?/,il?c.;! ?c'.^.?i !- PiloT Model Smoka Bom6 ?-' Wiring Pilot T{ming li0 57114ivT ?v ) Draft ??:J/?C•'('F'f Test Tog ? a L.W. Cut Off Door Pressure Lighting Inat. ? Prossure PertentC0 DaM Tasted 1'?? Input CFH tCr) Pereanf 0 2 Company Testing ?-'<•??= /' ?j[.l.' f:?. Stack Tamp. ??G ?? Percent C0 Name of Tester !liY ?e? ??t'b?t%ifC.. Form 235 . HO SE HEATING TEST RECORD & /Q ? ADDRE55 ? >_APT.-FLO , OR CITY SUBURB OCCUPANT OWNER HEATLOSS DATEHTG.INST. SOLDBY ." ?•?SL-^ •LYN INSTALLEDBY Eleehical Wuk By ' Gas Line 8y TYPE OF HEAT _ GA FA A HW STEAM _SPACE HTR. UNIT HTR. _ OTHER,??k?' ? ? /'? GAS DESIGN Z CONVERSION t MAKE d?? e + MAKE OF BURNER ? Model f?.?-C. G!'>(?O i11 t3ff,7.lti`I`? Model t 1 Smiol ?Kl/•'V ! YlJ7 7 ? Max. BTU Rating INPUT MAKE OF FURNACE ? Model . Valve ri'L Limit ? Limit Setting Fan SeHin9 _ Pilor Type - Pilof Make _ Pilot Model _ CONTROLS r Heat Plug Vent Size '- KIND OF LIILER SIZE NONE Droh Hood gulator Filters Size y r? ; ?? - Num6er ! Chfmney Locatian Inside Outside ? Chimney Construction +-ii-, S S 'L Pilot Timing -Z.;?"i??•?V?l! L.W. Cot Off Pressure ? ?-S ?i < • Percent COZ InputCFH Pereent OZ g^, $fack Temp. ?r?r' Peresnt CO Fwm 235 Smoke Bomb Wiring v Draft T_ v L•'s? Tast Ta . r 9 Door Pressure ? - Lighting Inaf. ? r Dafe Tested Company Tesiing K.C:d1 (' _ ':. ?C ? f Name of Tester N O ? ADDRE55 Z Z APT.-FLOOR CITY SUBURB OCCUPAN7 R ??. OWNER HEAT LOSS ?-- ' DATE HTG. INST. •? h?,°/ .-? SOLD BY i% c' INSTALLED BY Elechicol Work 8y ? rY:?"'f? //Ir ??t•!_ Gos Lina By TYPEOPHEAT GA k _FA1--HW-STEAM- SPACEHTR.-UNITHTR._ OTHER i GAS DESIGN CONVERSION MAKE MAKE OF BURNER ? Modsl Y?u DI .3.1 Y"i=} Model ? Ssrial Max. BTU Ratiny INPUT ar[?'G? MAKE OF FURNACE ? i . Model t r,...? CONTROLS .., ; THERMOSTAT' Heat Plug Valve Limit Limit SaMir Fan Setting Pilot Type Vent Size KIND OF LItiER SIZE NONE •X Draft Hood 4?L'1/ 7Rsgulaior > > S? ' ? Filtsrs $izal-Y,(,L--,y.? Num6er Chlmnsy Lacation Inside Oufaide.-Lr Chimney Construetian CPTrS L- Pilot Make Pilot Model Smoke Bomb ? Wiring Pilot Timin Draft -t.i1.'dUtc- '[1 Test Tap L.W. Cut Off '- y Dow Pressure Lighfiny Inat. Prossure PercentCO??- Date Tested Input CFH ?? . Percent O ?- Company Testing ,i Stock Temp. Z Percent CO Name of Tssfer ?'?? j?? S?e= %/c',/-•''1[1 i./ _ )JOUSE HEATING TEST RECORD Form 235 a HOUSE HEATING TEST RECORD ADDRESS A*v__ ?Qw'^h WS APT. _ FLOOR CITY SUBURB OCCUPANT ?2`2LZ2??r v OWNER HEAT LOSS ? DAT E HTG INST. SOLD BY INSTALLED BY A' Elachieal Work By Gos Line By .r. ,?Sc - /?ilCT I1? TYPE OF HEAT GA.,•r. FA-HW-STEAM_SPACE HTR. _UNIT HTR. _OTHER ? •!?;?_ ? ?J? ? GAS DESIGN CONVERSION MAKE / ?'•</ MAKE OF BURNER Model ?..?,3( C? C??G?C?AJS]??Z.15`it{ Model ? Serial ????`t y-?/77C Max. 8TU Rating INPUT MAKE OF FURNACE i Model t • CONTROLS THERMOSTAT V ( • ? _3 • Hear Plug Valve.zii'!..`.' Limit Limit Sariing ? Fan Setting Pilor Typs PilotMoke -'l'??.t/?i:0.1/ Ci+?i.??C Pilot Model > Pilot Timing ?/'1`•y?"l?? L.W. Cuf Off Prossure -Z s Percenf COZ 'S,KG I'ryutCFH LtIPercent 02 • g Stock Temp. ??'r''?? Percent CO A7 %i? Fwm 235 Vsnt Size „/ X S KIND OF LINER SIZE NONE ? Draft Hood U Ragularor ?G.??- Z' Filfers Sizs I r. - Number Chimney Location Inside Outside ?g Chimney Consfrucfion Smoke Bomb - - Wiring Drafr Tesr " ? ?.. Door Pressure Lighting InsT.Date Tested 2.- J'?-X'7 ? ? f Z IL7. 1 Company Testing faZV41J & Name ef Teafer n?I?, 4,?c%rL'".{?S?`?'-? HOUSE H'EATING TEST RECORD ADDRESS APT._FLOOR CITY SUBURB , OCCUPANT AA'.u?rf? ,?e• OWNER HEAT LO55 ? DATE HTG.INST. SOLD BY INSTALLED BY Electrical Work By -r' Gas Line By f`.l 't'L< -- TYPE OF HEAT GA )L FA ?HW STEAM SPACE HTR. -UNIT HTR. -OTHER Ca-' GAS DESIGN CONVERSION MAKE MAKE OF BURNER l Modsl Model Sxi al "4'??:'? A1ax: BTU Rating •{ MAKE OF FURNACE ? Model ?_.-?l"?,„,? ??? CONTROLS A ' ? V S t THERMOST T J_S / Y?? Heot Plug ent ize Valve,r"? KIND OF LI R $IZE NONE.? Limit DraH,Hood ?T 4'?''J Regularor ?11 ` 3 Limit Sst(ing , i FI Iters ?-". Size / YX,7-nY l ? Number ? ? Fon Setting ?l. Chimney Location Insids Outside Pilof Type Chimney Consiroction PilotMake .i ,ia: ? •J ?_?= ' ?^?r Pilot Model ` ?• Smoke Bomb `-- Wiring ?-' 'Pilot Timing -'?uS 1rl,syl" l,,r Draft.?1lG`!J[t'/? Tesi Tag ? L.W. Cut Off -" ' Door Preseura -- LighTing Inst. ?' Proszurs Percent CO 2 Date Tested InputCFH ?5r Psrcent O Company Tes*i..g Z $tack Temp. Percent CO Name of Tsster ZZ4?.a ? 7????L-il? ti%? Form 235 I" HOUSE HEATING TEST R/?/L!OR??-y .. ADDRESS ?Sd:?c- %02?/ APT._ L?R ?CI ??A? SUBURB OCCUPANT OWNER HEAT LO55 DATE HTG. INST. 1-&? . SOLD BY -MSTALLED BY :?nu>^r mrC!-f Elechical Wnrk Bv Gaa Line 8y U:nC- Ml'C C TYPE OF HEAT GA __X?FA _,?__HW STEAM -SPACE HTR. -UNIT HTR. _OTHER le?r3k 7; GAS DESIGN CONYERSION MAKE MAKE OF BURNER Model . C L-. 1' ? Model Ssrial V35321 Max. BTU Rating INPUT S('?Srt"l MAKE OF FURNACE Model J CONTROLS 1 ? THERMOSTAT - Heat Plug Yalve AsUC- K%?Jt- /1 Lim(t ' . 2>5e_ Limit SeHing Fan Setting % Pilot Type sPs? ? Pilot Make JBf' ?N.ios?/ C N%.?.c: 5 Pilot Model Pibt Timing -??/? -?T/rY[-'T/c?r L.W. Cut Off ' Vsnt $ize KIND OF LINER - SIZE NONE X" Drak Hood ZJi/T Regularor Filfers Size Num6er } Chimnay Locatfon Inside Outsida X Chimney Gonsfructian /'47Si C. Smoke Bom6 - y/iriny ? Draft _Za&X'. -Y1 Test Tap ? g Door Prossuro - Lighting InsT. _ Prossuro G???? G• Psrcent COZ '?lDoro Tested Z- 7'-C?9 InputCFH S?Percent OZ CompanyTesting1?3'/ri`_ ?Ztf? ? Stack Temp. ?'pd Percent CO ?? Name oF Tester rr?i4// c??-y/c"il/ICyV Form 235 HOUSE HEATING TEST RECORD ?Q/ ?v:T" f?8 ? ADDRESS ApT -FLOOR CITY UBURB OCCUPANT OWNER HEAT LOSS ? DATE HTG. INST. SOLD BY INSTALLED 8Y ?D[JSC? ?C Elechical Work By Gos Line By' ?dysc= c G TYPE OF HEAT GA A FA ?HW -STEAM -SPACE HTR. -UNIT HTR. _OTHER ? GAS DESIGN CONVER51 N MAKE Y MAKE OF BURNER Model Model saiai NK?;•ti ?F3t/?.lS? Max. BTU Rating INPUT MAKE OF FURNACE Model CONTROLS THERMOSTAT Heat Plug ?- Vent Size pX3 Valve KIND OF LIN E R SIZE NONE X Limit 5c- - ^? DrofiHood ?.SJoTw? Ragularor 3,2s -3 LimitSetting- Fiifers Size umber ? ? Fan Setting Chimney Location Inside Outaida X Pilot Typa Chimney Construction Cl/9SS ?--- Piler Make Pilot Model Smoke Bomb Wiring Pilot Timing =kSTNT/? DraFt __T/1 1) 0C C.-/') Test Tag L.W. Cut Off '?- Door Prassure -' Lighting Inst. Pressute??%? Percenl CO2 dgnl?e' DoM Tested InputCFH ? Paresnt 02 e4!21?gr Company Testing Slack Temp. Percant CO tvg Name of Tester 17Ji4??? .*t` L7/CK/517'L/ Fwm 235 ' HOUSE HEATING TEST RECORD ? ADDRE55 ???? ??elll 4?1C'WAPT.-FLOOR CITY "?" $UBURB OCCUPANT DWNER HEAT LO55 4-?' DATE HTG. INST. /'e77 SOLD BY fjdtnf' _1-17z'. f/ INSTALLED BY -;? 0(fSr ??ICC Electrical Work By _6 47- Gas Line By I^ u5C i_?C2 TYPE OF HEAT GA _3A_ FA JL_HW -STEAM -SPACE HTR. _UNIT HTR. _OTHER )Eu4r2i? i ? v h ? GAS DESIGN CONVERSION MAKE I ???? MAKE OF BURNER Model - L. C' C- 10 Model $erial ? ?U??l ?•j 575- Max. BTU Rating INPUT?c C-0 MAKE OF FURNACE Model CONTROLS THERMOSTAT .??C?--Heat Plug " VClVe ?,i/C-/[Uh' l? Limit y? ?.?i'ao &rSC Limit SeMing 122typ ?Y Fan Setfing Pilot Type Pilot Make Pilot Model Piloi Tfming Vent $ixe -,'+r.3 KIND OF LINER SIZE NONE X Drak Hood Regulaim Filters Siza mber ? Chimney Loeofion Inside Outside X Chimnsy Construction CI*$S L- $moke Bomb - Wiring , Drafr T-n??CG /D Te:r Tap ? L.W. Cu} Off Door Pressure Liyhtiny Inst. - Prossure -31u?L PercentCO? ?19 Date Tested t-? Irryut CFH U? Percent 02 14pljl;? Company Testing Sfack Temp. ?-? Pertant CO 42/?' Name of Testar l77?1-??'Z?,SC112? Form 235 [ HOUSE HEATING TEST RECORD ADDRE55 `??o C+IiFI LK ?5V,Ic:- 1?G APT.-F1.00R CITY C?'? 00 SUBURB OCCUPANT OWNER HEAT LOSS DgE HTG. INST. SOLD BY U??SG- /??F/ y INSTALLED 8Y Elactrical Work By ?^`=T -?k'T Gas Lins By .UJ $t -=H TYPE OF HEAT GA ->L_ FA k_HW - STEAM -SPACE HTR. UNIT HTR. _OTHER < <? / GAS DESIGN CONVERSION MAKE MAKE OF BURNER Modsl ho =1-C C?t S t..0 NUF1t1s-A Model $xial l,\j KUi/"1 q.1? Re,,, % Mox. 9TlJ Ref'no . INPUT 1 <4 CVD n MAKE OF FURNACE ,J?? CONTROLS THERMOSTAT ? Heat Plug ? Valve Limit - limit Sstting Fan Seffin9- Pilot Type _ PiloT Make - Model Ven1 Size °?'X 3 KIND OF LINER SIZE NONE? Dmfr Hood R.aUd..ror Filtera Size Number Z Chimney Lotation Inside Outside ?d' Chimney Construction S L-- Smoke Bomb ?- Wiring Pilot Model _ Pilot Timing L.W. Cut Off Draft - --XAjb Test Tag- Door Pressure ? Lighting Inst. Prossure Percent COZ DaM Tasted InputCFH?Percent OZ {?' Company TesY g Stack Temp. Percent CO 0?1' Name of Tesfer Form 235 HOUSE HEATING TEST RECORD ADDRESS Z/eo. jC/d? L.A /d-?7APT._FLOOR CITY42?SUBURB OCCUPANT OWNER HEAT LOSS ? DATE HTG. INST. SOLD BY INSTALLED BY US?^ CC Elechical Wk g, Gns Line By TYPE OF HEAT GA-Y-ZFA_.?HW-STEAM SPACE HTR. -UNIT HTR. _OTHER GAS DESIGN CONVERSION MAKE Z51rt? MAKE OFBURNER Model Model ???j Ssrial 1ti?V?'1 3cr Y?/.c' i Max. BTU Rating INPUT MAKE OF FURNACE Model ' CONTROLS THERMOSTAT l17Heae Plug '-?-Vent Size Valva KIND OF LI. SIZE NONE ? Limit c- Dmft Hood Reguloror 3e?5 -3 Limit LH' o Filtars Size ?y???_Number Fon Set}ing Chimney Location lo??s' C_ Outaide k Pilot Type Chimnay Cons}ruefion e PilotMake Pilot Modal ??•7?? -? Smake Bomb Wiring Pilot Timing Draft 'G(/Z? O" t L? Test Tag L.W. Cut Off ?-- Door Pressuro Lighting Inst. ? Ss ! Preasuro 1`?u/4 PereeniCO? Dote Tested `?? InputCFH 5! Peresnt 0?/? Company Testing ??? Stcck Temp. ?Percent COZ Name of Teseer ??? Form 235 HOUSE HEATING TEST RECORD ? rV ADDRESS FLOOR Q Y5q& - T SUBURB , OCCUPANT OWNER HEAT LOSS /- • INST QgE HTG SOLD 8Y _ L INSTALLED BY ? Elsctricol Work By p Ga: Line By L?7Z _ TYPE OF HEAT GA y)(_ FA _X_HW _STE AM SPACE HTR. -UNIT HTR. -OTHER T-_4t?,E % 1? GAS DESIGN CONVERSION MAKE (???K MAKE OP BURNER Modal Model Ssrial N???'? Max. @TII Rer',.o INPUT 7S-/m i MAKE OF FURNACE Model CONTROLS THERMOSTAT Hear Plu Valve ? -` Limit $ C Limit Sttina Pan Sefting Piiot Type S _ l -- PilotMake Pilot Model Pllot Timing L.W. Cot Off - '??T t1 Prossuro ?`" ?C? Parcent CO ° Z ?qS ? InpuT CFH 7!?__ Percent 0 Stoek Temp. .Percent COZ Vsn}$ize 1111X? KIND OF LIKER SIZE NONE ? Draft Hood Ragularor Filters Size ?yX_Number ? Chimney Location Inside Outaida ?lwl_ Chimnay ConsTruaion eZ?"SS C- Smoke Bom6 Wiring ? Draft Test Tap? Dow Prassure -? - Lighting Ins+- DaTe Tested Company Tesfing Name of Tasror -, ?? lJ .£trG?Pl4"X? Fwm 235 HOUSE HEATING TEST RECORD ADDRESS ?4? CY17'04e, C/??'?? APT.-FLOOR CITY a SUBURB OCCUPANT OWNER HEAT LO55 ? ATE HT6. INST. ? SOLDBY ?^?-L=SC.? ! `? INSTALLEDBY &^ Elechical Work 8y Z?]:Nrf'CT Gas Line By _ - TYPE OF HEAT GA _714- FA _,?LC_HW -STEAM-SPACE HTR. -UNIT HTR. OTHER J dc) ? GAS DESIGN CONVER510 MAKE //?F k MAKE OF BURNER Modsl ! .f-l 6 UqR/L`ntd,?i-1SA Model Serial ?' fClim 3 7' ?%GY Max. BTU Rating INPUT MAKE OF FURNACE Modal THERMOSTAT Valve Limit Limit SetYing - Fan Sefiing - Pilot Type - Pilot Make - PiIM Model - Pilot Timing - L.W. Cur Off _ Vsnt Size "W 1? KIND OF LI E??r SIZE NONE x - Draft Hood Regulaior Filtars Sizs?( Number y Chimney Location Insida Outside x Chimnay Construction C-I?l55 c Prossuro Psrcent CO2 b? Input CFH? ., Percent OZ Stock Temp.???_Percent CO Form 235 Smoke Bomb Wiring Draft -7-AL? UC . _ Test Tag Door Pressure -? Lighting Inst. ' Date Tested 3??-• ,? Company Testing Nome of Tesfer z vrfr ? - HOUSE HEATING TEST RECORD CIi?l LK RCl Sa/Tc ?_' ;I`- e2V" ADDRE55 ppT.-FLOOR t CITY d SUBURB OCCUPANT OWNER HEAT LO55 DATE HTG. INST. --'P% SOLD BY INSTALLED BY ?? ?- Elscirical Work By 01C Gas Line By OUS? /?CG ? TYPE OF HEAT ? GA _;X__ FA _,l_HW _ STEAM -SPACE HTR. _UNIT HTR. _pTHER // ? GAS DESIGN CONVERSION t MAKE C`? Y µAKE OF BURNER Modal r'.?'fvC) p?-:}q'fi Modal ' $arial ?-` ?V ?? • 7? % ? Y Mox, BTU Raring ?C INPUT ? ??? MAKE OF FURNACE _ Model THERMOSTAT C-Heat Plug Vent Size -_dF-X __,? Valva KIND OF LINER SIZE NONE -? Limi} DroftHood v l ? Regularor Limit Setting ????T? ? . _ Fil}ers $ize ?_6?1 1A,.),-q Number f Fan Setting Chimney Lacation Inside Outside X PilotType Chimney ConsMUCtion G- Pilot Pilot Model a,,; 726 -C/ $moke 8om6 Wiring Pibt Timing Draft zn ?/7UC? i7 Test Tag L.W. Cuf Off Door Pressure Lightiny Inst. q Prossure ParcentCO Date Tested InpuT CFH 4 -?Percent O2 Company Testing cG/yG Stack Temp-- Psrcenf CO ?,.? Name of Tester ?/?,?[.A?? - L7/?C???.Sd?' Form 235 HOUS HEATING TEST RECORD ADDRESS e4l" /2/ APT. -FLOOR CITY SUBURB OCCUPANT OWNER HEAT LO55 ? ATE HTG. INST. `e9 SOLD BY ?e??5? s'?1 "T H INSTALLED BY ?OVSC Electrical Work By ' ? Gaa Lina 8y . OF HEAT TYPE GA ? FAHW -STEAM _SPACE HTR. UNIT HTR. _OTHER T? ? . GAS DESIGN CONVERSION MAKE MAKE OF BURNER Model C-.l')??+ n?, -t-15Y1 'V Model ' Serial • , ?23 Max. BTII Retino INPUT MAKE OF FURNACE Model THERMOSTAT CONTROLS Vent Size ,? Valve Limit Limit Selfing _ Fan Senin9 - Pilot Type - Pilot Make - Pi1M Model - Pilot Tfmin9 - L.W. Cnt Off _ Pressure PercentCOL ? Input CFH 7 5- Percenf 02 $tack Temp. ?- Percent CO d,-4 Form 235 KIND OF LINER SIZE NONE X' Draft Hoad 2?1i ?To ? Regulator .L- Filters $ize mber ? Chimney LocaTion Insida Outaide J?e, Ghimney Construetion C-/fisS C- Smoke Bomb Wiring ? Draft ?iT?nvC? D Test Tag ? Door Pressure -r " Lighting Inst. Dote Tested ?? ?r Company Tasr'.. frSC.- O'?Gt Name of Tsafer ? ? ???-?'7l[-7•f/X??-? HOUSE HEATING TEST RECORD -,/ ADDRESS I'CWC '`-?'09 LK ?? "?? A?IK? ppT. -FLOOR CITYSUBUR6 OCCUPANT OWNER HEAT LOSS ? DATE HTG. INST. -- SOLD BY ? vuSf ruK? INSTALLED BY 2?2VSe- K - , Elechical Work By Gas Line By TYPE OF HEAT GA FA k-HW - STEAM -SPACE HTR. - UNIT HTR. _OTHER ? GAS DESIGN CONVERSION MAKE MAKE OF BURNER Model ?C l°( L Model 7 Serial ?AUV?h .) 1 / ? f te?f Maz. @TI1 R.,r'..a INPUT !7Sa'p MAKE OF FURNACE Model THERMOSTAT ???'C- ?-Heat Plu Veni Size Valve ?u?-'r KIND OF LI R ? SIZE NONE?- Limit -. ..?/ 4^74%r? L Drafr Hood ' d"? Regulator Limit Seff' a Filters Size ?y?_ "umber Fon Setfing Q Chimney Locatien Insid e Outside K Pilot Type L ' Sf/¢2 Ghimnay ConslruNion c?r/S s L--. Pilot Make o SdN ??'? S f Pilot Model Smoke Bomb ? Wiring - Pilot Timing =744S /?'/ ?? Draft :;Z? bL-r,-l:> Tazf Tag L.W. Cut Off Door Pressute '?- Lighting Insf. 3 i T d '5 ?S D Prossure - ate ests Psrcent C02 lnput CFH ? Peresnt 02 ? Company Tesfing ? Stnck Temp. ?Psrcent CO <:Meg- Name of Tester Fwm 235 HOUSE HEATING TEST RECORD ?'? ADDRE55!??D CI/"?" APT._FLOOR CITYI ' "?SUBURB OCCUPANT OWNER - HEAT LOSS D TE HTG. INST. SOLD 8Y ?!?"?'?e INSTALLED BY dt?Sr y,-L Elsctrical Work 8y i Gos Lina By '?0 U5K - TYPE OF HEAT . GA ? FA _S_HW STEAM SPACE HTR. _ UNIT HTR. - 7 OTHER I/ GAS DESIGN CONVERSION MAKE ?OK ? MAKE OF BURNER Model .,L (- Model _ Seriol 1: )?Vr^') Max. BTU Rating _ INPUT ?5•?"?r= MAKE OF FURNACE ' Model THERMOSTAT Valre y ! imif Limit SeMing _ Fun Settin9- Pilot Type - Pilot Make - PiIM Model - CONTROLS Heae Plug ? Vent Size KIND OF LI ER SIZE NONE .sA10 L5 C-- Draft Hood ku Regularor ? 2.? -3 5-OL Filters Size f umber 07 Chimney Location Insida Outside k o? Chimney Construdion (:j.-ts S C--Pilot Timing L.W. Cut Off Pnasuro Xs ?1JC PercentCO? Input CFH Perean} O Z $Mck Temp. a?Percent CO Form 235 ?f Smoke Bomb Wiring Draft ??d?UCL".C? Test Tag f Door Pressure Lighting Inst. ? Date Tssted Company Testing ?CSc Name of Teafar / ?HJOUSE HEATING TEST RECORD . '/ ' ADDRE55 176" S?tT? APT.-FLOOR CITY -" SUBURB OCCUPANT OWNER HEAT LOSS TE HTG. INST. SOLD 8Y T??N INSTALLED BY Elaehieal We.k F_S; Gaa Line By r TYREOFHEAT GA-k?Fd_X_HW_STEAM-SPACEHTR._UNITHTR._OTHER GAS DESIGN CONYERSION MAKE 7 L?P?k MAKE OF BURNER Model Model S«,al luX?M -37 yy7,L Max. BTU Raring INPUT 7MAKE OF FURNACE ! Model .,i/CONTROLS THERMOSTAT / Heat Plyg- - Vant Size ?2x-Y Volva Limit - Limit SeMtng Ae-ffA _ Fan Setting Pilot Typa Piiot Maka GPilot Model Pilot Timing -????ST?X/ S? L.W. Cut Of?fj ProssurePareentCOZ Inpuf CFH 7 Percent Oz Stack Temp.Peresnt CO Form 235 KIND OP LINER SIZE NONE_54,_ Dmff Hood ????To?'? Re ulator??_"- 3 Filters Size Num6er-t• 7rv.iJ? Chfmney Lacafion Insida Oufsida ? Qhimney Construefion ? <= $moke Bomb Wiring Draft -2??IJ '? Test To g Door Pressura Lighting I.+st- Date Tsatsd .7? ^- Company TeSYna /TfJiJS Z" ? Name of Tesro. /?G7/Q ? ?'?Q{/ Shc OUSE HEATING TEST RECORD H ?J ADDRE55 Z/ ? Clit'! LLC ? q ? ?1 APT.-FLOOR GTY?SUBURB OCCUPANT OWNER HEAT LO55 DATE HTG. INST. SOLD BY XB[JS[= /"Y c?FI INSTALLED BY ?- Electrical Work By k22Y4? Gos Line By A nr2sc- TYPE OF HEAT GA ? FA ?__HW -STEAM -SPACE HTR. -UNIT HTR. -OTHER q? ? ' / GAS DESIGN CONVERSION p \ MAKE [ ?` MAKE OF BURNER Model 1 O ? Model Seriol U m Max. BTU Rating INPUT :J,? QPIQ MAKE OF FURNACE Model ' CONTROLS ?j THERMOSTAT Heat Plug ?- Vant Size Valve KIND OF LWER SIZE NONE h Limit Drafr Hood v?rTOi`? Regulotor 3 ;2.5-2 Limit SsNing ?j ?Y Filtars Siza /_ Number ?= Fan Setting Chimney Lacation I nsid p - Outside ' ! _ , Pilat Type ? A Chimney Construcfion Piloi Make ?0 ti -? C??? 6 S Pilof Model A G?70G-? $moka Bomb `?? Wiring `J Pilot Timing Draft _Ty4!>C/C 4:57-10 Test Tog L.W. Cut Off Door Pressure '?- Lighfing Inat. ? / . Prossuro ParcenT COZ Date Tssfed Input CFH ?Percent O ? Cumpany Testing ?S? Perce?t C0 $tack Temp 5;??Z? Name of Tester !_?? c21c7??7d?Ot? . Form 235 HOUSE HEATINGyTEST RECORD ADDRESS 2??6 ?/1Ar CK G .??[T/_//epT.-FL00R CITY ?? 6tqSU8UR6 OCCUPANT OWNER HEAT LO55 DATE HTG. INST. ' SOLD 8Y ?"OU,i(= INSTALLED BY UVSE- Elachical Work By es,7- Gas Line 6y - d - TYPEOFHEAT GA_XFA__Y_HW-STEAM-SPACEHTR..-UNITHTR._OTHER_ 54 'i (??/ GAS DESIGN CONVERSION MAKE //?RK MAKE OF BURNER Modal ??vDL:.oNo _R?A Model sKiai N 13w.^'i re ?L a8s Ma:. BTU Rariny INPUT MAKE OF FURNACE Model THERMOSTAT Heat P ug Vsnt Size Valve KIND OF LINER SIZE NONE ? Limit- DraftHoodRegularor LimitSetting Pilfera Siz?/ ?,,V.)Jumber ? Fan SeNing Qiimney Location Inside Outside V PilotType ChimneyConstrucfion ?- Pilot Make Pilot Model /5t Smoke Bomb ?- Wiring Pilot Timing Droft ?c?[?Jl E' ? Test Tag L.W. Cut Off Door Pressure Lighting Inst. Prossuro SW C- Percent C02 60` Sld? Date Tested -:K _;z-o Input CFH Percant OZ ? Company Tesf??o o(t.$?f-7---- LY $Tack Tsmi Percenf CO Name Fwm 235 H/?OUSE HEATING TEST.RECORD "? •/ ADDRESS /2v0 CIIr? L?C Kf/-S!!T[ fIGAPT.-FLOOR CITY SUBURB OCCUPANT OWNER HEAT LOSS --' DATE HTG. INST. /"cq? _ SOLD BY INSTALLED BY u Electrical Work By Gas Line 8y t5nizsi- .r TYPE OF HEAT GA ? A_?4__HW -STEAM -SPACE HTR. UNIT HTR. OTHER U ? GAS DESIGN CONVERSION MAKE 0+'f ? MAKE OF BURNER Model Model Ssrial 1'JA(Jr"'\ L}j % y/fj' Maz. BTU Rating INPUT MAKE OF FURNACE Model p' ????l..Vry1RVLJ THERMOSTAT JSLi! 7L.. Heat Plug Venf 5{ze Valve •f/ KIND OF LI ER SIZE NONE -"t Limit 1 CKitt? 2'>e SG- Droft Hood ' 1 Regulamr 3a?-3 Limit Saxing ? Filters Size L e, r? Number Fcn Sstting ' Chlmney Locotion Insi e ? ?-Outside ?K K Pilof Type 1! Chimney Constmdion ?---? •S '? ? Pilof Make ?•J??ff.vSaN ?G'f???P_d?? Pilot Model S?726 ? Smoke Bomb Wiring Pilot Timin9 ?a6L77c/ Draft .?N UC E? Test Tag L.W. Cut OfF Door Pressure - Lighting Inst. ? P _? I S ° ?C D T d 7= 9 erceniCO Pressure - - •L este ote 4 InputCFH 5-2.1 Percenf DZ ? Company Testing _ Staek Temp. ` -SU Percenf CO ? Name of Tsster 2i?? ?.1 Fwm 235 HOUSE HEATING TEST RECORD ? ADDRE55 ?7,/V ?d IS$?Ic^APT.-FLOOR CITY UBURB OCCUPANT OWNER HEAT LOSS _??.DATE HTG. INST. '- SOLD BY ?vV? ??L?r?? INSTALLED BY dUSL--/r?IG?/ Elschical Work By ?= Gos Line By ?PU S f= ??-"-G _ TYPEOFHEAT GA L FA?L_HW-STEAM -SPACEHTR.-UNITHTR._OTHER U ? GAS DESIGN Ll? CONVERSION MAKE ?R 1? MAKE OF BURNER Model J-C6G' O/jA Model Sxial t? Uly y.13 Max. BTU Rating INPUT ?V MAKE OF FURNACE Model CONTROLS y 2 ?J THERMOSTAT Heat Plug Vent Size - - Valve KIND OF LINER SIZE NONE X Limit DrohHood j/?? ?Regulaior 3?5-3 ? Limit Setting . FilPors SizeNumber Fon Setiing Chimney Location Inside Outside X Pilot Type ? Chimney ConsTruction - ?' l7?'S3 ?- f/.C<<tl'U?i'?t'C/%F'n S Ptlot Make -?r9 ! Pilot Modsl C5 7e?? Smoke Bomb Wiring ? ? Pilot Timing ZN.s 72n!/ / Draft Test Tag L.W. Cut Off Door Pressure "?- Liqhting Inst. -----? i/ P CO P D t T ted 2! -?-? ? sresnt ressura 2? - a e ss InPuf CFH? S U Percanf 0 ? Z Company Test'na Stack Tamp. ,;`? ` Perceni CO Name of Taster Form 235 HOUSE HEATING TEST RECORD E //C, 0 C??IF L/t ;?4 5J7Tc-?IS ADDR 55- APT.-FLOOR CITY SUBURB OCCUPANT OWNER HEAT LOSS ?, DATE HTG. INST. SOLD BY INSTALLED BY 10 U-S4-J Elsctrical Work By LiC)2/7?iT Goz Line By U C" tT . TYPEOFHEAT GA_,k__FA-Y,-HW -STEAM-SPACEHTR.-UNITHTR._OTHER ? i GAS DESIGN CONVERSION MAKE MAKE OF BURNER Model b.1CHIdi,(ttj dY (JYA Model Sxial 44 3 %V a' Max. BTU Rating INPUT 510.f%0 '() MAKE OF FURNACE Model THERMOSTAT ?U??T ?Heat PJug ?- Vent Size ?2/r3 Volve KIND OF LINER SIZE NONE? ve.-f-9 bISL Lfmit 7A o DraftHood gularor p LimitSeMing !.G?S Filfers $ize y_Number ? Fon Se}fing Chimney Location Insida Outside X Pilof Type ? - Chimney Construetion C4?-S C-. Pilot Maks ??So?c( C'GN/ /,Pn?S ? Pilot Model (6 Smake Bom6 Wiring Pilot Timing ?ws -4N?? Draft c=?) Test Ta ? g L.W. Cut Off ?- Dow Prossuro - Lighting Inst. Prossuro G- Percent C02 ? DoTe Tsated '?- ?-8r Input CFH PercenT OZ uSC?? /TJGZ Company Test'ng U S1ack Temp. ? ?? PeresnT CO P? ? Name oF Tester Fxm 235 HO USE HEATING TEST RECORD ADDR£SS / e,JU:-7c /IS? ppT.- FLOOR GTY ?'?? UBURB OCCUPANT OWNER HEAT LO55 DATE HTG. INST. J cPr7' SOLD BY INSTALLED BY ElecM1ical Wark By Gos Line By TYPE OF HEAT GA _,ZL FA -k-HW STEAM SPACE HTR. UNIT HTR. OTHER GAS DESIGN CONVERSION MAKE MAKE OF BURNER Madal • U01/a O? )+Mq Model Sxial ? Vv?3 ? ?G? Mox. BTU Rating INPUT ???'? MAKE OF FURNACE Model 74 THERMOSTAT Heat Piug Vent Size ?L>,? 1 Volve KIND OF LINER SIZE NONE?S- Limit Dwh Hood -Regularor 3-Z1`- 3 Limit ?kl.. FiMers Si:e ?A-??Number F ! ?•?? Fon Settingg Chimney Lowtion Insida Outside x Pilot Type -5?P, Ckiimney Construction ?-- Pilor Mak< T?^-S°", Pilot Model ?`^Ge./'Ay V - 7 Pilot Timing . S/V5,;?t,1T/?,- L.W. Cuf OfF Prassure a•?Gl??'- PeresntCOZ ? InputCFH Percent 0 -f'75;?r $foek Temp. Pereent CO2 !::2?zr Form 235 Smoke Bom6 Wiring DrofT - -.Y/V/JVC Tesf " Door Pressure ?+ Lighting Inst. '"- Date Tested / / Cqmpany Testing eiTooSC i?Ce /e7 Name of Tesier HOUSE HEATING TEST RECORD `D "Su,Tc?_ 01/V AX I fr ADDRESS I ppT.-FLO OR CITY SUBUR6 OCCUPANT OWNER HEAT LOSS DATE HTG. INST. -/ 2'?`'' ? a-; SOLD BY --Ly ", ',w •'?<<' // INSTALLED BY ?7y -- ??•d%??`?- J? r -L Elschical Work By l- ??14%1K'i Gas Lina By TYPE OF HEAT GA b._ FA HW STEAM -SPACE HTR. - UNIT HTR. _OTHER ? GAS DESIGN CONVERSION ? MAKE MAKE OF BURNER Model L%?i i:^f1,/El ql ?5 Madel / ' Swiol ?t{ ??t'?1 t??, V'?'7r Max. BTU Rating INPUT ? ?-'e=` ? ' MAKE OF FURNACE i Model ? .- CONTROLS ? THERMOSTAT Heat Plug Vent Size '-? ~ ? yalve KIND OF LINER SIZE NONE'r Lim{} DraftHood ? Regulamr LimitSetting /?'•?'? ?f Pilfen Size?-? l11 Numbar ? Fon $ettin9 Chimnsy Location Inside Outside -t -? . Pilof Type Chimney Construction PibfMaks Pilof Modsl Smoke Bomb Wiring Pilot Timing it;' Draft Z??.e.e.ll?-? ?l Test Tag f L.W. Cut OFf ? Door Pressure -? LighHng Inat. Prossure ?Peresnt CO ? Z Date Tsarod q -- 4 : Inpot CFH - Percent 0 )C1J$C'.? /?C? Company Testing 2 Siock?Temp. Psrcent CO Name of Tesrer 777rr 5?7,L;i'r%VS? Fwm 235 SE HEATING TEST RECORD HOU r LY J /C/a S i/C??II ? ? ADDRE55 c? ppT,_FLOOit CITY.4_ UBURB OCCUPANT OWNER HEAT LO55-? ?DATE HTG. INST. SOLD BY /7? c:1 1K INSTALLED BY ? n?5?' /'?1c-Zf? Elschical Work By Gaa Line By. ? TYPE OF HEAT GA k FA _A HW -STEAM -SPACE HTR. -UNIT HTR. -OTHER ?2-, 714i2 . / GAS DESIGN , CONVERSION MAKE MAKE OF BURNER ! . Model ? ?•l- Abdel Serial ?'<ui1S?? Moz. 8TU Rating f INPUT ??•?? MAKE OF FURNACE Model ? ./ CONTROLS THERMOSTAT ??S?f?` HeatPlug Valvs Limif ?'??? _ ?•.? ? Limit SsMing Fan Safting ! (z Pilor Type Pilot Make -j??%rv Gc:W Pilm Model Pilot Timing ,X???l2?!j?? Vsnt Siza -13'X 3 KIND OF LI!!ER SIZE NONE ? Drah Hood ??•J? ? r 01' Regulamr ? y,? wx r Fihers Size ??R?r 3-r• Number E Chimney Locaffon Insifle Outaide er Chimney Conserucfion C IW5 5 C- Smoke Bom6 -?- Wiring ? Draft S/V,0Test Tag L.W. Cut Off / Door Presaure_ Prossum percenf COZ v? Date Teatsd ? InputCFH Percenf Oz?y ?mpany Testing Stack Temp. Psrcenf CO l?l?0 Name of Tesror _ Lighting Inst. Form 235 HOUSE HEATING TEST RECORD ADDRESS APT.-FLO OR CITY SUBURB OCCUPANT OWNER HEAT LOSS ? DATE HTG. INST. SOLD BY INSTALLED BY !'!' Electrital Work By ???'42T Gaa Lina By TYPEOFHEAT GA ?Z FA?_HW- STEAM-SPACEHTR. UNITHTR. OTHER!?`'•f? ?Q ? ) n? J GAS DESIGN CONVERSION MAKE `?t?•?-C. MAKE OF BURNER ! 1[; A Modsl 1\J n Modsl ? ' Sarial hhA?J,?I Y W3ef4":' L v Ma:. BTU Rating ' i INPUT S C/Y Y' MAKE OF FURNACE ? . • Model THERMOSTA Valre ? Llmlf ? LimiT Sotting Fan Setein9- Pilot Type - Pilot Make - Pilot Model _ Pilot Timing. L.W. Cuf Off ? CONTROLS Heat Plug Vent Si:e --A-A J KIND OF LINER SIZE NONE y Drok Hood 75' Ragulator 2-? 7 ? Filfsra Sizef Number? Chimney Location Inside Outside X Chimney Construcfion L-. Smoks Bomb Wiring Draft 'ZN/2UeG ? Test Tag ? Door Pressure -? Lighfing Insf. Prossure-;- Parcent COZ% DaN Tssfed Input CFM ? U Pereset OZ Company Testing $lack Temp. _;xnW ? Parcent CO n?' Name of Teshr ??? ???=?f?/???J Form 235 . HJOUSE HEATING TEST RECORD ADDRE55 ?26"D C1?FT .CK !(1 ?iJ+?-`I/3 ppT._FLOOR CITY Cl ?f URB OCCUPANT OWNER HEAT LO55 DATE HTG. INST. ?1-1610 SOLD BY INSTALLED BY /' dvSC /`'1cr17? Elechical Work By G? Gas Lina 8y CJU r_? /`T ?-'Z`"{ TYPE OF HEAT GA __,?k FA _X_HW _STEAM -SPACE HTR. - UNIT HTR. -OTHER - ? • i' , ?.•' GAS DESIGN CONVERSION MAKE MAKE OF BURNER Model Model ? s„i,i ; I{iv.`i 3 r y `•'s ` Ma:. BTU Ratiny INPUT 2 MAKE OF FURNACE Model CONTROLS 7 THERMOSTAT ? Heat Plug Vent Size yalVe KIND OF LINER SIZE NONE X Limit DraftMood 7'?1 T17'"? Regulaior 1 :A ?T ? Limit SM• o Filters SizeI Y*-Number pon $eHin9 Chimnsy Location Inside •Outside ?Y Pilot Type Chimney Construclion f- Pilot Make Pilm Model Smoke Bomb Wiring Pilot 0.aft ??:?v?-?= ?? Teat Tag L.W. Cut Off Door Pressure Lighting Inaf. I( ? , ?/ co Preasuro 3_5 ParesntCO I ?1 Daro Teafsd Iriput CFH 75 Peresnt OZ ?'5''Sy ? Company Test' ?c..?,t3!1 Stock Tamp. Psr?ent CO <2/?' Nome of Testar 7 F«m 235 / HOUSE HEATING TEST RECORD ADDRESS ppT.-FLOOR CITY ? r'" ??$UBURB OCCUPANT OWNER HEAT LO55 DATE HTG. INST. 11-e?& SOLD BY INSTALLED BY Elschical Work By ?T C Gaa Lins 8y TYPE OF HEAT GA 2- FA ?HW -STEAM -SPACE HTR. - UNIT HTR. _OTHER ? • / + ? ' GAS DESIGN CONYERSION MAKE MAKE OF BURNER Model n a C? ??? v(..1_}5 Modsi ? r ' Seriol Pi t??:"? 1 t Max. 8TU Roring INPUT J S?_J C`) MAKE OF FURNACE Model THERMOSTAT Heat Plug ' -?'- Vent Sizs ?"f } yolYe .?sit/e'? Yccit-?l'? KIND OF LINER SIZE NONE x Limk '-' Jb?--- Drak Hood ? o? Regularor 3 ZS 3 LimiT Sett+ng Filters Size ? -?rNumber Fan Satfing T? Chimney Location Insido Outsida K Pilof Type /, S S Chimnay Construction c Pilor Maks ???3v,? ??, U?/?% 5 Pilot Model $moke Bomb ?- Wiring Pilot Timing --,-A- I57;?u7/? Draf1 Test Tag L.W. Cu1 Off Door Pressure "! Lighfiny Insf. ? L S_,u? q >-?? Pressuro - Percent CO - z Date Tested - ? InpuT CFH Percent O ? Z Company TesTing '? vv ??s «- ? S1ock Tsmp. Percenf CO Nome of Tesfsr n7?( S ??L ?-1e. ? Form 235 HOUSE HEATING TEST RECORD !\l ADDRESS Z??? CI/l- LK .CCr .SvrT? /{3 APT.-FLOOR CITY /.?_? UBURB OCCUPANT p? OWNER HEAT LOSS?-f DATE HTG. INST. SOLD BY INSTALLED BY 13 U SG'- r'2 (-f Elechical Work By Gaa Line By ,u SC TYPE OF HEAT GA FA _?__HW -STEAM -SPACE HTR. -UNIT HTR. -OTHER A?? GAS DESIGN CONVERSION MAKE rMAKE OF 6URNER Modal i) ???a PYWrlI i.:.)-.)7 Model ? ' Sedal t-{ L.0??1 `ry'S 7z( 7 Max. BTU Rating INPUT MAKE OF FURNACE ` " Model CONTROLS `? THERMOSTAT ? Heat Plug Venf Size -? 3 yalve v=,?u KIND OF LINER SIZE NONE Limit DrahHood A?ljr v:?? Regularor 3 Limit Satting ,t?• ? '? Filtars $ize?? _Number ? Fcn $etting ?' ?= Chlmney Location Insids Oufside k Pilof Type Chimney Construcfion G" SS t-, Pilor Maks Pilot Modsl ;;7/?? ? Smolce Bom6 Wiring ?? Pilot Timing Draft Test Tog ? L.W. Cut Off '! - Door Presaurs "- Lightiny Inst. ? ?.--r? •,? Preasuro PercentCO `- c= Doro Tested / InPutCFH Petesnt 02 3 'rp CompanyTesring Stuck Temp. Percent CO 4,G.n Noms of Tearor %??? 5??7??iUi/"? Form 235 HOUSE HEATING TEST RECORD ? ADDRE55 / /? ?)ff f K V -5?1/4 13 ?'ppT.-FLOOR CITY t?A""" SUBURB OCCUPANT OWNER HEAT LO55 ?-? DATE H7G. INST. ? SOLD BY ?i?'Y?St`- /?CL/-? INSTALLED BY ?1t? /?'JL'LI Elechical Work By Gas Lina By •i1,5l-- ?ICL.N TYPE OF HEAT GA _,L FA X HW -STEAM -SPACE HTR. -UNIT HTR. _OTHER L;19 k ? . -,1? , GAS DESIGN CONVERSION MAKE ???"? MAKE OF BURNER Model C-.oy(?IYLModel Sxial A - WVf1( ..?i 1 Y%.3Maz. BTU Rafing INPUT 754??0 MAKE OF FURNACE Model CONTROLS THERMOSTAT Heat Plug - Valve Limit YNc"?S'?l? v?SG L imi r sexin9 pa„ Sett;,,9 TiJiZ Pilot Type PfbtMake Vent Size °'ZX 3 KIND OF LI EN`R 512E NONE X Draft Hood 4?,lr Regularor Filters Size k? "'w f Number ?j . Chimney Locatton Inside Outside X' Chimney Construetion C-1-4s3- L. Pilot Model 6 67,36 ' y $moke Bomb Wiring Pibt Timing _2=57- Draft SiVQ( JGC.' Test Tag L.W. Cut Off Door Pressura Lightfng innt. Preasure -7 , S?(U? PercentCO 4 Daro Tested Input CFH 75- Percent OZ Company Tesfing F icNJSG -??CL Stock Temp. TcG Percent CO Name of Teater Ferm 235 HOUSE HEATING TEST RECORD ADDRESS ? FCdb C! ? F6 kIC RcI S?er- /22 APT. -FLOOR CITY &'A°' BURB OCCUPANT OWNER HEAT LOSS L/ DATE HTG. INST. SOLD BY /L1ir1-1 INSTALLED 8Y d?1SE ?'C Elechical Work By e-,46!?IeT Gos Line By 9 - _. - TYPE OF HEAT GA _-)LFA _X HW -STEAM -SPACE HTR. _UNIT HTR. _OTHER ;P4W ? GAS DESIGN CONVERSION MAKE MAKE OF BURNER Modei Model Sxfal Max. BTU Rating INPUT / MAKE OF FURNACE Model CONTROLS ? THERMOSTAT ? Heat Plug ` Veni Size ?2x? yalve r-' r/ KIND OF LINF?2 _ SIZE NONE Limit Draft Hood_Reguloror Limii Sstting Filfers Size ?Number Fan Setfing Chimnsy Location Inside ' Outaide X Pilot Type Chimney Construdion ?' M 5 S ?-- PibrMoke aW7-a-,l Pilot Model 'S 4'7?36 Smoke Bomb Wiriny +?^ Pilot Timing DraFt Test Tag L.W. Cut Off Dow Prossure Lighting Inst. Prossure ?3?5 /VL- PerceniCOZ ?a' Dote Tesrod InOutCFH?Percent OZ ?r ? Company Testing ?'ICG? ? cC Stoek Tamp. Percent CO az Name of Tesfer -_177-f/7 -57z-cW .?i? Fwm 235 HOUSE HEATING TEST RECORD ? •,I ADDRESS f/? L?%// L? ?"- S`I`T?'j?APT. _FLOOR CITY L?/ ` SUBURB OCCUPANT OWNER HEAT LO55 ?lDALE HTG. INST. c SOLD BY INSTALLED BY u W?`L °Z Elechical Work By e-,??N/?? r Gas Lina By _ 05 ' 1-774c TYPE OF HEAT GA FA 1L_HW -STEAM -SPACE HTR. - l1NIT HTR. _ OTHER ? Li c / GAS DESIGN CaNVERSION u MAKE MAKE OF BURNER Model Model Max. BTU Rating . INPUT MAKE OF FURNACE i Model l THERMOSTAT ? CONTROLS = Heae Plug Vsnt Size ?X J Valve Limit 7?f'r:?• Limit Setting 1)C19 Fan Settin9 725, Pilor Type . Pilot Moke joi PilotModal 6? Pilot Timing . L.W. Cut Off ? n Prossure PercentCOZ-406, Iriput CFH /00 Percent 02 145V S1ock Temp. 24V Percent CO _ ?L- Form 235 KIND OF LI ER SIZE NONE X? Drah Hood Regularor ZIL _Z Filtars Size?W,),O A / Number ?- Chimnay Location Inside Outaide Chimney Construdion C lA5 S C-- Smoke Bomb -- Wiring v Draft _?7_AIPULt?Test Tag ? Door Pressure Lighting Inst. 1 Date Tested Company Testing Name of Tester 1117,q HOUSE HEATING TEST RECORD ? ADDRESSC'J/F? ?d?WT-/.3%APT._FLOOR CITY?SUBURB OCCUPANT OWNER HEAT LOSS DATE HTG. INST. - I-e,9' -D SOLD BY 7? p,nvlt-?7?y INSTALLED BY Elsefrieal Work By Caas Line By OVst- L'tz TYPEOFHEAT GA_X? FAd_HW -STEAM-SPACEHTR. UNITHTR. OTHER /V4) zj n GAS DESIGN CONVERSION MAKE MAKE OF BURNER Madel f??:"?J??L Model $srial J% Max. BTU Rating INPUT MAKE OF FURNACE Madel ?- CONTROLS THERMOSTAT ?- Heat Plug Valre Limlf Limit Satting Fan $etfin9 _ Pilot Type - Pilot Make _ Pilee Model _ Pilof Timing L.W. Cur OfF Vsnt Size KIND OF IINER SIZE NONE Dmft Hood T3,ui/T :7?? Regularor -??-5 3 Filters Sizs7r? .. Number ? Chimnay Locotion Inzide Outside lk? Chimney Constructian r /,4 S,5 L Smoke Bomb Wiring ..? Draft Test Door Pressure Lighting Insf. ( Prossuro ?•'y t??CPercent CO 2 ?? b ` DaM TesMd ?- ' IrtputCFH Percent OZ Cf ? Company Tesfing Stack Temp. Percent CO Name of Tester Form 235 HOUSE HEATING TEST RECORD ???/ ADDRESS ??? L K?? ?l'Tr` 13Y4PT. -FLDOR CITY "' ' SUBURB OCCUPANT' OWNER HEAT LO55 DATE HTG. INST. SOLD BY ^,%?x z INSTALLED BY Elschical Work 8y 7- Gaa Line By j`y /`? TYPE OF HEAT GA -?? FA ?HW -STEAM -SPACE HTR. - UNIT HTR. -OTHER Zv GAS DESIGN ? CONVERSION MAKE ? f k MAKE OF BURNER Modsl L LC.Lt Model Serial )?Jit/.'1 4??J 7iY Max. BTU Rating INPUT ???Y"l?? MAKE OF FURNACE Model THERMOSTAT ' Valve ? ' Limit -? Limit Setting _ Fdn Setting - ?Pilot Type - Pilot Maks - Pilot Model - Vent Size KIND OF LINEI SIZE NONE DraftHood ?Reguloror %aJ-3 Filters Size ? X?x?i.?1_Number Z' ' 10 Chimney Location Inaide Outside X Chimney Construction CJA5f ? Smoke Bomb Wiring ? Pilot Timing Draft .-TNQUC?l? Test Tog-? L.W. Cut Off Dow Prassure Lighting Inat. Pressure ti'S-ELG^ zercent COZ Date Testsd ;?'- °Z?' l? y InputCFH?Percenf OZ a ° CompanyTesting Stack Temp. Pereent CO C2? Name of Tester f?????Form 235 HOUSE HEATING TEST RECORD J ADDRESS.I/?V ??Cl APT._FLOOR CITY tE) SUeURB OCCUPANT OWNER HEAT LO55 _DATE HTG., ?INS?T..?.` 'I-C95? SOLD BY INSTALLED BY ???G' Electrical Wwk By Gas Lins 8y /°\r3U SG ? G TYPE OF HEAT GA FA ?LHW -STEAM SPACE HTR. _UNIT HTR. -OTHER + v ' ?J GAS DESIGN CONVERSION MAKE MAKE OF BURNER Model Model Ssrial Max. BTU Rating INPUT MAKE OF FURNACE Madel CONTROLS THERMOSTAT ? Heat Plug Vent Size :x 7 Valve- -4'?d KIND OF LINER SIZE NONE Limit DrafrHood 4-- Rsgularor Limit SeMing Filters Size Number Fan Setting ? Chimney Location Inzi?e Oufaide ? Pilot Type s ? Chimney Construciian Pilot Make PilotModel SmokeBomb Wiring Pilot Timing `???5%?bt??? Draft . :72V TX.%e_C4_ Test Tag V_?_ L.W. Cut Off ? Door Prossure Lighting Inst. Prossure Psrcsnt CO ? Z DaM Tssted Input CFH Pertent O 2 Company Testing 1*70KJ '2'E' d?1?f $tack Temp. Percsnt CO Name of Tester ;:;t Form 235 , ^ HOUSE HEATING TEST RECORD A? ADDRESS /790 C lI ??` F LI ??<Ie S-i' Tc 1.3 / APT. -FLOOR CITY ?A?'rn"SUBURB OCCUPANT OWNER HEATLOSS DATEHTGI SlT. ???J SOLD BY ?•? ?X ? ? ? °^?? INSTALLED BY ? r . 77 EleefAcal Work. By +?e?il"G'.j Gas Lina By - ?- TYPE OFHEAT GA?FA?-HW STEAM-SPACE HTR. _UNIT HTR. _OTHER ? (,r GAS DESIGN CONVERSION MAKE ' ;iMAKE OF BURNER _ Model k ti LU!'j'I?G`'I/ Model Serial '•`? ?F? ?? ,!`,• L'? ? 5? Max. BTU Rating INPUT MAKE OF FURNACE Model - ??p??? CONTROCS THERMOSTAT L?S-L- -- Heat Plug - Valve ' ?wC-T7?u'4'y/ Limit 4L7/SG. Limit Ss»ing !n` - Fan $etring Tb,E Pilot Type S Pilot Make ?? • ????' Pilm Model ? G?71 Pilot Tlming L.W. Cut Off - Veni Size > x? KIND OF LINER SIZE NONE Drak Hood ?,?k?r?Regularor Filrors Size /;41,2P8/ Numbar j? Chlmney Location Inside * Outside X ChimneyConstruction CI*SS L Smoke Bomb Wiring ? 0.aft Test Tap ?Door Pressura Lighting Insf. l Prossure Peresnt COZ G? Dote Tested y CompanyTesTing <'1UJ'C'.. Cl InporCFH?Percant 0 Z Stack Temp. Percent CO ?.Gt- Name of Tester /? ?%t ?/G?t/?%cd? Form 235 HOUSE HEATING TEST RECORD dve CI' W CA? ?d 15047 - 134 c,`0 ADDRE55 P APT.-fL00R CITY i SUBURB OCCUPANT OWNER HEAT LOSS 6" DATE HTG. INST. SOLD BY ;R? 271SC' /1'Icz.N INSTALLED 8Y Elecirical Work By &?????R'?y' Gns Line By j0 G ' TYPE OF HEAT GA X FA k HW STEAM -SPACE HTR. -UNIT HTR. _ OTHER ? y?? / ) P, ? GAS DESIGN CONVERSION MAKE MAKE OF BURNER Modal ;?1.. ? .• +/ (i ? r ?'J. , Model Smial ;?j??V•? ? .. c¢;`?? Max. BTU Rating INPUT MAKE OP FURNACE r Model CONTROLS THERMOSTAT Heat Plug ? Vent Size KIND OF LINER SIZE NONE ? Limit n b? SC_. Droft Hood 1"/7` Regulotor e Limit Setting Ffltero $ize , ;if?Number y Fan $etting ? Chimney Locatlon . Inside Oufzide X Pilot Type Chimney Construdion (5/?S S G- Pilot Make .TOf"fNS[.'+? .. ?l/!(!%?El S ? Pilot Model G` & °:1/ Smoke Bom6 '`- Wiring Pibt Timin9 Draft -7--Vbz/C L' l? Test Tog L.W. Cut Off Door Pressure Ligh}ing Inst. ? ?•// Pressurs 3•`5"?'?"` percenfCO2 q DafeTasted Input CFH -50 Percent OZ Ozp ?LIS&' .14?C,- Company Testing f ' 'Stack Tamp- ?? Percent CO / ??<-7t?.??"? Nama of Tesfer -E -•/? Ferm 235 ?.?o?.„l.? HOUSE HEATING TEST RECORD ADDRESS 41 CKZ 5217_/3`SAPT.-FLOOR ,kl CITY L" "! SUBURB OCCUPANT OWNER HEAT LO55 ? • ?DA?TE HTG. INST. SOLD BY /? -rG X-- INSTALLED 8Y Elechical Work By Gus Lins By TYPE OF HEAT GA __)L!FA _A-_HW - STEAM -SPACE HTR. -UNIT HTR. -OTHER -?- ?? ? GAS DESIGN CONVERSION MAKE MAKE OF BURNER _ Modal Model - Sarial 04Vl/"? J 1 ?T Max. BTU Rating INPUT ??- MAKE OF FURNACE Model - - THERMOSTAT Valve Limit Limit Setting _ Fan Settin9 - Piloe Type - Pilot Make - Pilm Model - CONTROLS _ Heer PL,e ..?-- - Vent Size k Y KIND OF LINER SIZE NONE k G Drah Hood Regularor 3a5__.3 Filters Size Number ? Chimney Location de Outsida 1e Chimnay Construction ?-1435 c- Pilot Timing L.W. Cut Off - v /- C Preasure PercenT COZ Inpur CFH Peresnt O 2 Siock Temp. Percenf CO Fwm 235 Smoke Bomb ?- ng Drn{t _7:wDocr_? Test Tag Door Pressuro Lighfing Inst ? Date Tested 3-.;L -,qf Company Testing ?,,?'Apc?SG-'? ?:y Name of TesM• / "/?'?.t-"'???°??"? HOUSE HEATING TEST RECORD ,J ADDRE55 APT.-FLOOR CITY $U8UR6_ OCCUPANT OWNER HEAT LO55 DA7E HTG. INST. 1` SOLD BY INSTALLED BY Elechical'W 4 6 C?[=? ?'?T Gos Line By ?avSG- ??Ir?- 1-74 TYPE OF HEAT GA ? FA ?HW -STEAM -SPACE HTR. UNIT HTR. p ? OTHER ?!'_?/ i ' p ? GAS DESIGN CO VERSION MAKE C MAKE OF BURNER . Model Model s„„i tv u.'? V 3 iNlL nb:. sru Ratiri9 INPUT ??%{Ck•'' MAKE OF FURNACE Model CONTROLS THERMOSTAT >??Heat Plug Valve r7c?NL-"%GtJC\S // Limif -7? N2•?t!'?/U:5 ?- Limit Setting Fan Sstting Pilot Type S ?? Pilot Mnke Pilot Madel PilatTiming 7/vS7rP'U7-ly L.W. Cut Off Prossure Percent COZ 6 PG Inpuf CFH PeresnT OZ $tack Temp. PereenT CO form 235 Vent Size _?"K3 KIND OF LINER SIZE ? NONE X Drof1 Hood 30 1 1Tu"? Regularor ?( y Fileers Sizeum6er Chimney Location Inside Outside XChimney Construttion Cl1'f5s L-. $moke Bom6 Wiring - Draft ..TN fJ fJC C%J Test Tag ? Doar Prossure Lighting Inst. Dote 7esTed 3_-;? -161g Company Testina IYJJ$Ls/?c-? Name o{ Tesfar ???'T S! C 7?Lk;5drt1 HOUSE HEATING TEST RECORD //? ' Sue% v'" ? ADDRESS, ( c ppT--FLOOR CITY SUBURB . OCCUPANT OWNER HEAT LOSS DATE HTG. INST . SOLD BY INSTALLED BY Electrical Work By l??•'y??'?"c r Gos Lina By w Sl= -.Nlc r14 TYPE OF HEAT GA _X?FAr,_HW _STEAM SPACE HTR. -UNIT HTR. OTHER `_ ? GAS DESIGN CONVERSION MAKE MAKE OF BURNER Model t.?I-F"3 Model Seriol Max. BTU Rating INPUT MAKE OF FURNACE Model THERMOSTAT CONTROLS Vent Size -.)L X 3 Va Ire - l imit Limit Sstting Fan Setting _ Pilot Type - Pilot Moke _ Pilm Modsl _ Heat Plug Pilot Timing r;/ L.W. Cut Off '? ? Pressure ??(u?? Percent COZ -v,5,7 Input CFH S? Percent OZ , Stock Temp.?Percent CO pZForm 235 KIND OF LINER $IZE NONE ? Dmft Hood ??!f v.? Regularor ?'?S -3 r y?x?x i y FilTets Size 1 y?r??tS;zr Num6ar Chimney Location Insids Outaide x Chimney Construetien C1/f-`'S A!n- Smoke Bomb "- Wiring Draft =?z> o CL%;? Test Tag Dow Pressure Lighting Inst. ? Date Teatsd Company TesHng Name of Teshr HOUSE HEATING TEST RECORD ? ADDRE55 !U0 C?/?/` C-A? 41 S?/7r I-33 ppT. _FLOOR CITY ? SUBURB OCCUPANT OWNER HEAT LOSS - DATE HTG. INST. k`&? SOLD BY ???s?' AT? INSTALLED BY _ GG?SC c-G? Electrical Work By ' 4'? Gas Line By o?%[' .c'cr?/ TYPE OF HEAT GA 2 FA ?LHW _STEAM SPACE HTR. - UNIT HTR. _ OTHER GAS DESIGN CONVERSION MAKE MAKE OF BURNER Model EC7 Model $erial Max. BTLI Rot'na INPUT v MAKE OF FURNACE Model CONTROLS THERMOSTAT Heat P4 Valve hLUGl / Limit { ??-`??'lP Limit Satting F Fan SeMing ? Pilot Type ? Pilot Make ? ???'"V ? PilmModel 4:?- [<7R& •-y Pilot Timing S?S79',v? L.W. Cut Off Prossure PereenfCO 7 ?^_ Input CFH5? Percent 02 4f:9 SMCk Temp. Pereent CO 0 Vent Siza -Z?J KIND OF LINER SIZE NONE ? Drah Hoad Reguloror JV`" Filters Size Num6er ( Chimnay Location Insida Oufside X ChimneyConsfrucfion ClT5f r---. $moke Bomb Wiring Draft Test Tag Door Pressure ?-q Lighting Inst. Date Tssted Company TesK..g Name of Taster / JlI?? /C??d/? Ferm 235 ADDRESS /f HOUSE HEATING TEST RECORD oSwT ?I3Y ppT._FLOOR CITY G`'" SUBURB OCCUPANT OWNER HEAT LO55 DATE HTG. INST. l ? ? SOLD 8Y e-zelke-y INSTALLED BY Elscfrieal Work By l3 7 Gas Lina By __ TYPE OF HEAT GA _)e- FA HW - STEAM SPACE HTR. -UNIT H7R. _OTHER i ? GAS DESIGN CONVERSION MAKE MAKE OF BURNER Modal l??-CCoc>.'J4 AsC' Model Seriol Y??i,"1 ? 37 l y Max. BTU Rating INPUT y4?C'???y MAKE OF FURNACE Model THERMOSTAT Va lve ? Limit / Limit Satting _ Fan Setfin9- Pilot Type - Pilot Make _ Pilot Medel - Pibt Timing- L.W. Cur Off _ pl„g ? Ven} Size 17? f KIND OF LIN!z_R SIZE NONE -L ??- DroA Hood dv/lTr»? Regularor /?/`3?'r/ Filfers Sizs Numbsr Z Chimney Lacation Inside Outaide ? Chimney Construdion c- .? Prassure Pereent COZ InPuf CFH s s? Percent OZ efls;?ep Staek Temp.?Percenf CO Fwm 235 $moke Bomb ?- Wiring Draft --?Nd Test ' ? ? Door Pressure Lighting Inst. DaM Tested _jp Compony Testing 4474 Name of Tesror HOUSE HEATING TEST RECORD ADDRE55 / /Go 6J/!/? ?? L? ?d S)iTc•APT.-FLOOR CITY?/?SUBURB OCCUPANT OWNER HEAT LO55-.f:?'_DATE HTG. INST. l g'`1 SOLD BY INSTALLED BY ?vs?^ ls??Zy Elscirical Work By e-, gXkV&lf r Gaa Line 8y - Z?a af e- ewc'z TYPE OF HEAT GA -,Y-_ FA _?e__HW -STEAM -SPACE HTR. -UNIT HTR. _OTHER ? ? GAS DESIGN CONVERSION MAKE MAKE OF BURNER Model A/C.' Model Serial 1v??U ?'\ ? 7J11 1C' Max. BTU Rating . INPUT MAKE OF FURNACE , Model CONTROLS THERMOSTAT Heat Plug Valvs- Lfmit Limit SeNing Fan Settin9- Pilor Typo _ Pilot Make _ Pilot Model _ Pilot Timing L.W. Cue Off Venf Size -.1)? KIND OF LINER SIZE NONE h DmhHood Regularor Filters Size ? uumber Chimney Loeotion Inside Outside X Chimney ConstrucYion c - Smoke Bomb Wiring ? Drah Test Tag Daor Pressure Lighfing Inst. ? Pressure?? PsreenT CO Date Tested -1147e Inpuf CFH z, ? Percenf Oz? Company Testi.+o ?USc- S1ock Temp. ?? Pereenf CO djO Name of Teste. ?1? -?7/G'iil•SOv'? Form 235