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TING TEST RECORD
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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'
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Elscfrical Work B
y ?' `I : ^.'•'
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Gaa Line BY .L1
?1L= 1•7t -C
' f'f
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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
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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
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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
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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