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3005 Eagandale Pl - Electrical Inspections M 44306??,Q? Request Date //?? ire Rough-in Inspeclion Requiretl? '/ NOTICE: You Must Call Eleclrical Inspeclor Ii A Rough-in Inspec?ion ? Yes ?Yrvo IsFequired. I L?i'censed contractor ? owner hereby request inspection of above electrical work at: Jo0 Atltlreas (SYreet, Box or RoWe No.) 36,0 s, 4 CANo/)<.r pL. AcE Ciry EGA,( )ks Xv Seclion No. Township Name or No. Renge No. County D.4KorA Occupant (PRIM) Phona No. 7e11 S ,EG'RKDgtd' /*4 Rc? PowerSupplier Atltlress Electrical ContracNr (Gompany Name) Contractor5 License N0. IA E 14 )9 i'r/-'r,ve 4c TF- /-7 ,Lf C A oz??8 Mailing Adtlress (COnVaclor or Owner Making Installation) 77)1 ,='4 Y i,vG' a u fl- Aul rized SignaWre (COntracto M aking In slellation) r/O r Phone Numeer ? / ? . ZA ? (7 1/ z - MINNESOTA STATE BOARD OF ELECTHICITY WR` // N ry I NS THIS INSPECTION REQUESi WILL NOT Grigga-MiAwey BItlB. - Room 5?1]3 MB ?? BE ACCEPTED BY THE STATE BOAPD 1821 Univeraily Ave., St Peul, MN 55104 -? UNLESS PROPER INSPECTION FEE IS Phone (612) 602-0800 ENCLOSED. REQUEST FOR ELECTRICAL INSPECTION ? 44306 4 instmclions (o!?ompleting ihis form on back oi yellow copy. 'X" Below Work Covered by This Request Q EB-00n001-08/? ew Adtl Rep. Typeof8uilding AppliancesWired EquipmentWirad Home Range 7emporary Service Duplex Water Heater Eleclric Heating ? Apt. Building Dryer Load Management Comm./Indusirial Furnace Other (Speciry) Farm Air Conditioner Other (specily) Conirector§ Remarks: ,;C?V RACE on ?r xr?sre: ??u n.vq?,?c Compute Inspection Fee Below: iZ ! N # Other Fee # ServiceEntrance5ize Fee # Circuits/Feeders Fee Swimming Pool 0 to 200 Amps 0 to 100 Amps hansbrmers Above 200 _ Amps Above 100 _ Amps SIgnS Inspector's Use Onty: TOTAL Irrigation Booms i U Special Inspection ? ,? Alarm/Communication THIS INSTALLATION MAY BE ORDERE ISCONNECTED IF NOT Other Fee COMPLETED WITHIN 18 MONTHS. I, the Electrical Inspector, hereby R°uyn-in ? o??e certifY that the above insPection has been made. Final d' OFFICE USE ONLY This request witl 18 manihs irom '.?? ??? ? REQUEST FOR ELECTRICAL INSPECTION Eg-00007 '04 /? p -7&Y A, See im[rmtionslor co?letig this form on back of yallow capy. "?1 f ??X" " Below Work'Cove ? by This Request - g? ?`f Fdd ReO. TYDe o1 BuilEin9 APOlia?en Wiretl E9.ipmenl Wired Home Range Temporary Service Duplex Water Heater Lighting Fixtures Apt. 8uilding Dryer Electric HeaUn Catmercial Bldg. Furnace Silo Unloader Irdustrial 81dg. Air Conditioner Bulk Milk Tank Farm otner isre.cifyl iher (snecitv) -151FW-ir ecfly Other - Other Compu[e lnspectron Fee 8elow -tl Fee SeVvicaEniranee5izn Hii Feetlers/Subieeders H Fee Circuits UmZ00Am Oto30Am ? 0 to30Am s Above 200 Amps 31 to 700 Amps +„Qp 31 to 700 Arnp, $wimmirg Pool Above 100_Amps A6ove 700_Am s Transfortners ?rtigation Boorrs Partial-'Other Fee I Sig+s I I iSpecial Inspec!ion TOLA fL/E Bemerks j $J,6?70I (d1UA}lr/9PA?21/171tiNT,BUeLO//!?6 - -7- _ ? l.?c?_7 ?Y .eahuest w;a J °30 ?a ? o?!„?Y,m? Ll 6 i Llc Now ? Wfll Notify, Ins0ec- mr When Neady j?hLece Eleclrical Contractor 1 herebv re9uest inspection ol above ? Owner ' elecvical wark imlalled at Sireet Address, BoY or Route No. i1Y C - ? C Ln bA) ectmn o. T hup Name or No. Ringe No. ComIry o11fi.UTlZ OccupuntlPRINTI Phane No. E ffuTmkas S - 36 PowerSier Address-57;r ,e3er?y q o Fh ss Eleclrical Con[ractm Canvacw r' s License No. ' (C ovwaiW Name) ? r ? ? ¢ 1 U JI ?? IAailinB Address (COntmctor or Owrer MakinB Instoilationl t?h /lvD i a Aelyde. A or"zed SiB? 1 o racmr/ r G.ikinp Insia l tiuN ? PM1One Number ? 33a-r??s" YINNESpTp $7p7E gpppp OF ElECT1i1ClW THIS INSPECTION REUUEST WILL NOT Griggs-Ididwev Bldy. - Ropn N-191 BE ACGEPTED BY THE STATE BOARD 1821 Universitv Ave., SL Paul, MN 55104 LNLESS PROPER INSPECTION FEE IS Phpro 16121Zy7-2Ill I ENCLOSED. This repuest void ? 18 monihs from 's?' LaW4kd A ?Q 5;7 54 6!? ? Request Date Fi Aouph-in Inspe on '?/ ! ? r> Q Vee ? No ?Ready Now IYWUr'When' Raady eC icen5ed EIeC[rical Contractor I hereby roquast ins0ection of above • E? Owner electricel work installed at: Sveet Address, 8oz or Route No. CitY ? ?/? ecuon o. Township Name or No. Range o. County 06OW-k Occuu.i.t IPqINT1 ,LAtppTq t?" P Phona No?? ?? Power $upplier Adtlressl'?._ A?Q ' ?Rk ! G G Elechical ConVactor (COmpanY Name) Contracioi s license Na, ' l ? AI Me , ? - MailinB Address IContracmr r Owner Making Instailati nl Au horizetl Signat (CO ractor Ow r Making I stallation) Phone Number MINNESOTAtSTATE BOAND OF ELECTRICITV THIS INSPECTION REQUEST WILL NOT Griggs-Mitlwey Bldg. - floom N•797 BE ACCEPTEU BY THE STAiE BOAXD 1821 University Ave., St. Paul, MN 55704 UNLESS PHOVEN INSPECTION FEE IS Phone (812) 297-2111 ENCLOSEU. . REQUEST FOR ELECTRICAL INSPECTION Ee-oooot-w ' See instructions for completi- this form on baGk Of yellow copV? 57?( l, ,Q (? A 0574? 46 ""X"' Below Work C?yered by This Request ? T 0/ FlwNAdtll Rep.I Type oi BuiiCing I Appliances WIraE I EquiDmen[ Wirad I # Fea ServiceEntrBncaSiza p Fee Feade1s/5ubfeadars A Fee Circui[s 0 to 200 Am s 0 to 30 Am s. 0 to 30 Am 'f Above 200 qm s. 31 to 100 Amps 37 to 100 Amps Swimmin Pool Above 700_Amps Above 700_P.m - 7ransiormers Irrigation Booms Partial-'Other Fee u I Signs I I ISpecial Inspection ? eemarks ?? TOTAL FFE I, tha Electrical InsDactor, hereby certiiy Ihet the above inapeetion hes be9. REQUEST FOR ELECTRICAL INSPECTION EB-00001-04 Sea instruc[ions !ar com0latirq lhis form on back of yel low copy. 0 Below Work Covered by 7his Request aw aaa aec. Tvoa o+ euiiaine Aaoiinn=es wirae Equipment Wired Home Range Temporary Service i Duplex Water Heater Lightiny Fixtures Apt. Building Dryer Electric Heatin Cominercial Bldg. Fumace Silo Unloade, Industrial Bidg. Air Conditioner Bulk Milk Tenk Fa?m ' Other Peci v therl5ner,ify) t er SUncily Other Other Ccynpute lnspectJon Fee Below p F¢a Service EntranceSiia ir iae Fexders/Sabtaeders k Fee Circuits 0 to 200 Am s- 0 to 30 qm s 0 tn 30 Am s Above 2D0 qmps 31 to 100 qinps 31 to 100 qy Swimmin Pool Above 100_Am s Above 100_Am s Transiormers Irrigation Booms Pdrtial.'Other Fee-. Signs Specia6 Inspection •v S (- T Aemarks . So O A PEE( t,? IS--.1-0 HouBh-in Date I, tha Elecfrical ( Inspecbr, hereby c f th t th b Final ? y er a e a ove pectionhasbean 0 ma e. Tliia repueat voiA 18 monihs Irom This rnquesl void 18 nwn[hs Irom '5y '. a: ` L K r.ca- 1` cJ L eqve [ 11.4e '/? ?p ` ? Pire No. I po uh-in InsOertion Rxqired? ]Ready Nuw QWill Notify, Inspec- Wh W Q ?Ves ?No r en qeadY 2-1ci[:ensed Electn cal Contracmr I hereb y request insoection ot ebovo . ? Own¢r electrieel work installed aC Sveet Address, Box or Route No. 6--?3 ? eFUOn o. Townshio Name or No. Range No. County / ? d'cuu?nt (PpINT) n -G? Phonc No. Poyrer $upplier Address Elecvical ContractorlCOmVan Namel Contractor's Li cense No. O 2 ' inB Address (COntractor or Owner Making 1. tailationl - ? s6oa Au or d Sign r ICont ctor/Owne! Maki y Installationl Phone Number ? - s bo MINNESOTA STATE BOARD OF EL4ETRICITV THIS INSPECTION NEQUEST WILL'NOT Griggs• g. - Noom N-191 gE ACCEPTED BY THE STATE BOARD Midwey Bld 7821 University Ave., St Peul. MN 55104 UNLESS PROPER INSPECTION FEE IS Phone 0612? 297-2111 ENCLOSED. i nis reQUest void 7drrwn(hs from f:l ?3?r I?s iired?V? I[:]FeaAy Nuw []Will Notity, InsOer.- Vt,s ?NO tor When ReadY `X ` T.?Licensed ElecVical ConVact?o,r(, .}-?? ? I hereby request inspaction of ahove 5 Owner -Q'l> [i_-i V alechicel work installad at Sveet Atldress, Boz or Route No. Cit ectmn o. Township Neme ur No. ange No. (,o nty ? af upent (PpINT) 4 7 ?c ?J Phone No. Power SuOOlier Atldress E eclrical Contraclor ICOmueny Name) Conhar,mr's Liconse No. Ez T - t? ? rN o 3VV aq AAdress ?Contrac[or or Owne MakinP Instailationl ?3 G ? -61 0 Am iz SiPna Conh tor/Owner Makiny Instillationl hone Number ". ?? 60 MINNESOTq STATE 80AND OF ELteTPICITY THIS INSPECTION REQUEST WILL NOT , Grigys-Mitlway Hldg. - floom N-t91 eE ACCEPTED BY THE STATE BOARD 1821 University Ava.. St. Peul, MN 55704 UNLESS PROPER INSPECTION FEE IS Phone 1812) 297-2111 ENCLOSED. REQUEST POR ELECTRICAL INSPECTION ee-ooooi_oa ' See instructiens tor completing this form on beck of Vellow copy. ??( ? ?, d 0 °q .2m_1 ni "X" Below Work Covered by 7his Request ?JMu?AAtll Rep.l TvPe of BuilCin9 ? Acaliancea Wired ? Equipmenl Wired ? n??Home Range Temporarv Service ?. ? commercial Bltly. r-umace aiio unioader__ ? Industrial 61Aa. A i r Conditioner Bulk Milk Tank ? q Fee ServieeEntmnce5ize # Fee Feaders/5ub(eeAers # Fon Circuits 0 to 200 qmps 0 to 30 Am s 0 tn 30 An! )s A6ove 200 q?npsi 31 to 100 Amps ' 31 to 100 A s Swimmin Pool Above 100-Amps Above 100_Amps Transiormers Irri ation Booms Partial-'Other Fee Si Final LTnrei GrC7' I, the Electrical InsDaclor, hereby ce tlfy thet the above inspeclimi has been This reQUeat voia 18 months tmm rnis reauest voia ? ? B,monthsfrom "? 0 6 ?1?' IPnue?a' Fp.e No. ' ouph-in Inspecti n ReUU?red? ?Neady Nnw Q Will Notify. lnspec- bo Wh R ?Yes ?No r en eady Licensed ElecVical Contraclor '/ 1 hereby mquest inspection ol abova ? Ownpr ??jI J&tU y eleclrical work installed at 3[reet Atldress, Bax or Route No. C'ty ? ecuon o. 7pK,nshi0 Name or No. Range No. Coun Q b Onl(PftlNT) Z1 ?I T, 7. Phone Nn. Power SupOlier Address EI eGical CoMractor IComOany ame) Conlracto r's License No. D3 ng Address IContraclor or Owner Makiny nst Ilati n1 Aut ori e Sig^at re ( omra or Own¢r Makinp Installation) Phone Number 44- -1-2 V? MINNESOTA STATE BOAND OF ELITY THIS INSPECTION REQVEST WILL NOT Grigga•Midway eldp. - Hoom N-191 BE ACCEPTED BV THE STATE BOAHD 1827 University Ave., St. Paul, MN 55704 UNLESS PXOVEN INSPECTION FEE IS Phone (812) 29]-2117 ENCLOSED. REQUEST FOR ELECTRICAL INSPECTION jffft ee-oooot-na , Sea instruetions for comoeline this form on heck ot vellow coDY• 5y S?,O X" Below Work Covered by This Request Adtl Rep. TypB oi euiltling APPlianceII WirW Equipment Wired Home Rangc Temporary Service Duplex Water Heater Lightin,y Fiztures Apt. BuilAing Dryer Electric Haatln Commercial Bldy. Fumace Silo Unloader Industrial Bldg. Air Conditioner Buik Milk Tank Fyfm Other .pec,W ther (SUecffy) [ er SVecify Other Other '/N ompute lnspectian Fee Below # Fea ServiceEntranceSize b Fee Fexders/5ubfeeders p Fan Cirouits 0 to200qm s 0 to30Am s 0 tn30Am s Above 200 qMps 31 to 100 Amps - 31 to 100 Am s Swimming Pool Above 100_Amps Above 100_AmPs Transiormers rrigation Boorc's Pdrtial.'Other Fee Signs Special Inspection f,06 $ / TOTALEE Rerryrks ?.b ,? ? /J ,, RouBh-in Oate I, x?e Elecbicnl ' Insuector, herpby rtily thet the above Final inspection has been rnade. Thls requeat void 18 monUe Irom Ihis repues[ void A/ 8 munlhs from 5y U U 1,1 ..__.,.. . / n RequireG. 08eady Nuw ? Will Notify, Ins- ? ? /?j - J{ t- ?yes ?No Io, When Heady b'Licensed ElecVical ConVfl tnr I hereby raquest inspectian oi above ? Owner '.*0 V/ electricel wark installed er Screet Address, Boa or Route Na. Ci , ecbon o. Township Name or No. Fangu o. Cob ?y / J /' ^ /\e /_/+ pam (PpINT) Phone No. Z e Power Supplier Atldress Electrical Conhacmr ICompany Namel Comrar.tor's License No. ? (a ilinB Address (COnhacmr or Owner Ma mA Instailat' n) ?I ' . Q YILJLJ?D th r ed Sienat re (Co hamor Owner Making Installationl PhoneNUmbor - 06o MINNESOTA SiATE 90AflD CTNICITV TMIS INSPECTIDN REQUEST Wlll NOT Grie9s-Midwey Bldg. - 0.oom N•191 BE ACCEPTED eV THE STATE BOARD 1821 UnivarEity Ave., St. Paul, MN 55104 UNLESS PflOPEH INSPECTION FEE IS Phone (612) 29]-2111 ENCLOSED. REQUEST FOR ELECTRICAL INSPECTION Ee-a°°°i.°° Qj o v: QlQ ' Sea ins,ructions tor completing this form on baek ot vellow copy. / f11 "X'- Below`erk 1L#ivered by lhis Request Add Rep. :e oi Builtling APPlianms Wiratl Equipment Wired Homt . ;. Range Temporary Service Duplez Water Heater Liyhtiny Fiztures Apt. Building Dryer Electric Heatin Commercial Bldy. Furnace Silo Unloader Industrial 81dg. Air Conditioner Bulk Milk Tank Farm other .Dew v ther l5ueclfyl t er Sueu y Other Other ampute Inspection Fee Below k fae ServiceEntrancaSize 0 Fee Fexders/5ubfeeders p Fue Circuits 0 to200Am s 0 to30Am s 0 ta30Am s Above 200 qr»py 31 to 100 qmps 31 to 100 qm s Swimming Pool Above 100-Amps Above 100_Amps Transrormers Irrigation Booms PartiaVOther Fee- Signs Speciallnspection D S?a av TOT ?J pem?rks AL fdF / - ? floueh-in Date I, the Electncal Inspecmq heraby certify that the above Final r D? ?-?` ' pection has baen ? a .reea. Thisrequeatvoi0lBmoniRSfrom + - - ` ThiS requesl void (? ? ? 18 months frOm ? ? 19.3_5 L-(,13'Q ?E. 6 16-.ov Reques Ua[e y ' ? ? Fire No. I Rou -in Inspec[io Reqwretl? ?Heady Nuw QWtII Nolify InsPec- tor Wh R d t ?Yes ?Nu en ea y (gLlcensed Elecvicai ConVactor . I hereby request Inspection of adove ? Owner elactrical work installed at Streat Address, Box or Houte No. . Ci ecuon o. Towrehip Name or No. Range No. Coun Occupani(PRINT) N? 9F honeNo." Power $upplier ? qddress . Electrical Cont nctor ICOmpa mel \ ? . ? Contracmr's License No. ? ,6 ilin0 Atlbress IContrector or Owner Making Instaila[i N D . /?J /?'J /1? ??a O 6 ?-- ? ut ri - Signa[ur I mha or/Owner Making Ins[allation) 1- 1 Phone Number o - ? a6 MINNESOTA STATE 60ABO OF ELEL?NM61iY THIS INSPECTION REQOEST WILL NOT Griggs-Mitlwey Bldg. - Roam N•197 ' gE ACCEPTED BY THE STATE 80AHD 7827 University Ava., St. Paul, MN 55104 UNLE55 PXOPER INSPECTION FEE IS Phona (612) 297-2117 ENCLOSED. . REQUEST FOR ELECTRICAL INSPECTION „ Es-ooooi-oa , See instructians for completing thia form on back oi val low cooV. J? p?• ????.?? '"X" Below WoiR Covered by This Request N Add fleD. Type of guiltling Appliencee Wired Equiumen[ Wired I i Home Range Temporary Service Duplez Water Heater Lightia, Fixtures 7PI Apt. 8uiiding Dryer EYectnc Hea(in Commercial 81dg. Fumaw Silo Unloader Indtistrial Bldg. Air Conditioner Bulk Milk Tenk Farm O[na, pecify Other (Speciiy) t er Sueci(y Othcr Othir o Compute lnspection Fee Belaw ' X Pee ServiceEntmnca5lze d Fae Feders/SUbteatlers a IX Fee Circuits 0 to 200 qm s 0 to 30 Am s 0 to 30 Am s Above 200 Amps, 31 to 100 Amps 31 to 100 A s Swimmin Pool Above 100_Amps Above i(10_/>mVs Transtormers Irrigation Boorris Partial!Other Pee? Signs . Special Inspection $!s(?. T ? ? Hemarks ? O?A FEE cu Roueh-in inal • ? / ' Dzte ?/Jc? I, the Electrical InSpBCtOI, here0y ce -Sy ibat the above nspection has baen maAe. Tpis reQuest voitl 18 montM fmm C?l2?HOUSE HEATING TEST RECORD , I ADDRESY. ppT.-FLOOR CITYI;VlLSUBURB OCCt1PANT OWNER ? HEAT LOSS DATE HTG. INST. !' SOLD BY ZP06 4 r,!f' INS achical Work By Gus ?PE OF MEAT GA _ FA _HW '?' STEAM -SPACE TALLED BY Lina By HTR. -UNIT HTR. -OTH% GAS DESIGN MAKE MAKE OF BURNER ... Modal 611:?, - > >s Moa,i - - ; swioi rz,;2Mo:. BTU Rarinq ? INPUT 22 S . 07-o MAKEOF FURNACE Model - , ;%- CONTROLS THERMOSTAT Heat Plug Vent Si:e - ? Yolra 6l'r KIND OF LINE ?Limit DrahHood - ? Limit SsHing ??'UnG Filfers D _-SIZE Q NONE Regularar /L _,:-OD fSize Numbar Fan Sef}ing Chimney Location . Insids ? Outside + Pilot Type Chimney Consfruction Pilot Make Pilot Model Smoke Bom6 : Pilot Timing Draft • L.W. Cuf Off Door Preszure i ? 0 eq Pressure 3 5 IUC + pereent CQ? Dats Tested _ Inpuf CFH 312-5 Parcenf 0 2 J?1?2 h Company Tesfing Sfock Temp. 26f?G'u % Percent CO Name of Tesfar _ Form 235 Wiring _y Lightiny Inst. ? Z . HOUSE HEATING TEST RECORD , h ADDRESS ?° APT.-FLOOR CITY_SUBURB? OCCUPANT OWNER ? HEAT LO55 DATE HTG. IN?iT i' $OLD BY INSTALLED 8Y ,411 r ?. lectrical Work By Gas Lina By YPE OF HEAT GA _ FA _HW ?GSTEAM -SPACE HTR. _UNIT HTR. -OTHER GAS DESIGN :MAKE MAKE OF BURNER _ ?Modsl Modsl ; Sxial S G f'3'/3 Max. BTU Rating _ ' INPUT MAKEOF FURNACE Modal CONTROLS ? f THERMOSTAT Heat Plug Vent Size ? = Valva KIND OF LINER SIZE NONE ? Limif 2-Drak Hoed RWEto ' Limit Satting Fihers Size Num6er ? Fon Satting Chimney Locafion . Inside 0utside ? Pilet Type Qhimney ConstrucTion . Pilot Make , Pilot Model Smoke Bnmb Niring :Pilet Timin Draft z` Test Ta g p : L.W. Cut Off Door Pressure Lightiny Inst. Pressure Psreent CO ' DoM TesTad 2 Input CFH Peresnt OZ ? Company Testing .. -5 Stock Temp. ?oe V Percent CO ?q Nome of Tesbr RG1 CONVERSION Fwm 235 r k 0?-.3 HOUSE HEATING TEST RECORD . i, ADDRESS %?SE -e zes?,!V- ni°?- APT. -FLOOR CITY _ ?SUBURB ?AGv.r? i OCCUPANT iA/>%1 OWNER ( 1 HEAT LOSS DATE HTG N ST . . ? . iSOLD BY ,cfi?%G ? V ¢ / INSTALLED BY Iectricol Work By Gus Lins By ?YPE OF HEAT GA _ FA _HW 4---STEAM _SPACE HTR. -UNIT HTR. _07HER / GAS DESIGN CONVERSION mMAKE ("??-?yv MAKE OF BURNER . Model 56; '" 373 Modsl ?' „ ??? ? Serial SO'r??/r? Max. BTU Raeing INPUT MAKEOF FURNACE REv I Modal ? - CONTROLS THERMOSTAT Heot Plug Volva /?gD 4i0 70iOP7 ? Limit Limit Sotting r?OV011= Fan Setting Pilot Type Piloi ASake Vent Size ro KIND OF LINER ' Droh Hood Rag? Filters $izs Number Chimney Location . insida L?_ Outside Chimney Construcfion le?A`I! !_7 _ Pilot Model Smoke Bomb Wiring Pilot Timing ???GS • Draft Tezt Tap L.W. Cut Off Door Pressure Lightiny Inst. Pressum Parcent CO ? ?'s - Data Teated InputCFM Percent O Z Company Tea' o y S1ack Temp. ?gUpf? Percenf CO ?' Namm of Tester '? F«m 235 h HOUSE HEATING TEST RECORD NAaDkES}_?s`?` ?-???? 0•9.C .eO APT.-FLOOR_ ? OCCUPANT OWNER ? HEAT LOSS DATE HTG. INST. . ? SOLD BY Dom??; /'7'iN INSTALLED BY Elechical Work By Gas Line By # YPE OF HEAT GA _ FA _HW ?STEAM _SPACE HTR. -UNIT HTR. _OTHER GAS DESIGN CONVERSION ' MAKE MAKE OF BURNER ? Modsl Model ? Serial Max. BTU Roting ?A r??? INPUT MAKEOF FURNACE ` ? Model R E VI CON7ROL5 ? THERMOSTAT Heat Plug Vem Size -- ? Valve KIND OF LINER ?? ~ SIZE NONE ~ ? Limk L%/h re Draft Hood R?p eror SOOS ? Limif Sstting Filtars Si:e Numbsr ; Fon Setting Chimnay Lecation . Inside L-? Outsids Pilor 7ype .3T.K+.voiiv? Chimney Canstruetion ???5 s Q ; Pilot Make Pilot Model Smoka Bomb _ PilotTiming Droft L.W. Cui Off Door Presswe CITY,Z'??SUBURB 44"'.41 Wiring - Teat Tag Lightiny Inst. Prossurv PereeniCO2 Date Teated X'? A Irryut CFH -7 ? r Percent OZ ' Company Teating' $fick Temp. Percent CO 4,?" QYD Name of Tesfar Fxm 235 k? HOUSE HEATING TEST RECORD k• ADDRE55 7F u/i?E U4.C. iPr? APT. -FLOOR _ • OCCUPANT Zc/?'l?/?- ?PrS OWNER ? HEAT LOSS DATE HTG. INST. - + SOLD BY /?iii INSTALLED BY Elsctrical Work By Gos Lins By Z6e't?- YPE OF HEAT GA _ FA HW ` STEAM -SPACE HTR. - L1NIT HTR. _OTHER /? GAS DESIGN CONVERSION ? MAKE /??/A lh' MAKE OF BURNER r" ^ : Model Model ?" ? ; Serial .SO 19f Mox. BTU Rnting P FV I F 1N F n INPUT MAKE OF FURNACE -- Model ..'f CONTROLS + THERMOSTAT Heat Plu Vent Siza ?? - g • Valve 02dO KIND OF LINER SI ? Limit Draft Hood ? Regulowr : Limit Setting Filters $ize Number i Fan Setting ? 4iimns Location Inside 7'll/ Oui:ide y 1 Piloi Type L /?? Chimney Conztrueiion r-L? PI i ot Atake Pilot Model , $moke Bomb : Pilot Timing Draft L.W. Cut Off "?- Door Prossure parcenf C02 ?//,,ffyyC/? InputCFH -?_Pereenf OZ--C?`?s " ?? /? $tack Tamp. ? y? ? Percent CO Form 235 Dare Wirin9 - Test Tag Pressurs l.i9htiny Inat. Tested Compony Tezf' g Nama of Test CITY/,"?Z'Ar' SUBURB ??'T { ? . . ?v?ac Il?Al1f?V ICJI RCI.VRY . ? Y?.! ' C. ? E ADDRESS APT._FLOOR CITY 4192190-k-ISUBURS { OCdJPANT OWNER " { HEAT LOSS DATE HTG. IHST. r SOLD 8Y /12V? ?Al 6 ? INSTALLED BY 1 Elechical Werk By Gas Line Br ?d :TYPEOFHEAT GA_FA_NM STEAM_SPACEMTR.-UNIT HTR._OTHER _ GAS DESIGN ) MAKE C?LRY/r ? MAKE OF BURNER CONVERSION Model e5-C>- 3>.G` Model . . t Swtol . SD Cl'A/J µus, gN RaHny INPUT MAKEOF FURNACE - Model ? THERMOSTAT ? Votve .;,? CONTROLS Heaf Pluy 40DOA 7oYJ : Umir 4vi5,i Z 1046/.2' 'Limi, s.nsn9 ! Fan SaMiny Pltot Type : Pilm Abke - Pilot Model Pilot Timinp Vant Si:* -*e y KIND OF LINER SIZF? NONF OrahHood /? Reyulamr //5409S Filtos Siz. 'f ChImner Location - . In:ide ? Oufsidt Ohimmr ConstrucTion Smeko Bom6 DraH Wirinp _ .T.:f Top : L.M. Cu1 OfF De« Pressw. Liyhfinq Inst. • Pressw 3l??la! C-. PareenTCp= ? Dab Testad Input CFH E75 Percent OZ oe Company Tefts..g Sbck Temp. percan/ CO Noms e( Taslw Fwe, 235 ?- •. nUuac ncnIInU itai KCI-vKu EADDRE;S APT._FLOOR CITY/1?/"SUBURB 1 OCCUPANT OYMER " I HEAT LOSS DAT HTG. ST. - ?' SOLD BY %?? 4 if' /fTi! INSTALLED BY ? Electr{cal Werk By Goa L{ne B Y ?? ? /• ?? kTYPE OF HEAT GA _ FA _NK Jef" STEAM _SPACE HTR. _ UNIT HTR. -OTHER GAS DESIGN CONVERSION ? MAKE J?. jr MAK£ OF BURNER ? Modd lsL- 3 74 ? Modd ? 5«sol _ S/ 900 2 Moa. BTII Rafinp ' - ' INPUT --- 3?? MAKE-OF FURNACE . . IMdeI . CONTROLS ? THERMOSTAT Haat Plyp Vanf Si:e ? Val. KIND DF LINER SIZ NONF ? LimR Dra9 Hood R.q..i..ra 60Of ? Limlt SeMinp Flllws Si:e Number 1 Fan SeMinO Chim"y Lecalion . . Inaid? L-'? Outaide - Pilot Typ. ?TA.fior//1G p,imn.y Gn:*maion /LAf/ .Q : Pilot Mok. Pilot Moda1 Smeka Bomb Wiriny : Pilot Timinp"= DraFt Test Te' : L.M.Cvl Off '-- Deer prosawe Liyhfiny Inst. ?? ?,?y • Preasun PercaMCO •?1(?- De}e TozNd f-?/ Z 7 Inpuf CFH Percent OZ Companr Te:Tinp 1 Swc4 T.mp, yny c` Percenf CO Numm ef TasNr ?? •s??? ? Zy? Fer.e 235 ? r } ADDRESS _ 1 OCq1PANT nVVJG f1CA1114V ICJI KCI.VKU ??LE APT.-FLOOR CI_ ?SUBURB ? .._ ( ON'NER I HEAT LOSS DATE HTG. INST. SOLD BY 2'=kV4 /ae 117-6 MSTALLED BY ? Elechical Wxk By Gcs Line Br ?' ? ?• ?? .TYPE OF HEAT GA _ FA _HW _4GSTEAM _SPACE HTR. _UNIT HTR. -OTHER s ? GAS DESip1 ' - CONVERSION , 1 MAKE AyY nT MAKE OF BURNER 4 Mod.l 3>.5- Model . j S?rlal .. !s Or1?A? Mox. BlU Ratinp ' : INPUT- MAKEOF FURNACE Model CONTROLS ? THERMOSTAT Heat Pluy Vant Sis* ?Q y ? Valw v?pUA 7D93 KIND OF UNER SIZFNONF ? Limit ???•Te ?ol.EiPf //B?' - ? t? Droft Heod JZ Ropularof ' Limlr Sexiny ?%U•, . Fllt«s Siz• uumbor 1 Fun SsMinp Ch{mMr Lotatien . . lnside ? Oufside Pibt Trpe Chimney Construction GL/111 B . Pilet Mak. . Pilm Model '- Smo4a Bemb Wirinp : Pilot Timinq _ a/ o?°tddi'?l Draft T?d Tap ? • L.W. Cut Of( `?- Ooer Pre:swe Liyhtiny Insf. • PrOssun ???? ?C • P*rcaniCO Date Tested ? Input CFH 31S Parcanf 02 Compony Taatinp Stac4 T. mp. 'a4e" Perant CO Noma o( Te:/et Fenn 235 E 7 . . ??v?oL 11G/1111?V ICJI RC{.VRV . . • ? ADDRESS . 34112J;_ A6d? APT.-FLOOR CITY?SUBURB . { OCCWPANT E /r?fis OWNER ' I HEAT LOSS DATE HTG. INST. -- SOLD BY INSTALLED BY ? Elechical Wor4 By Gaa Line Bp !TYPE OF HEAT GA _FA_HW _STEAM _SPACE HTR. _UNIT HTR. _OTHER t GAS DESIGN ' CONVERSION MAKE /AAK-E OF BURNER S Mod.l GG Abd.l j 5«fe1 c- Me:. sTU Rarcny INPUT- 3Z5???"?? MAKEOF FURNACE Medd CONTROLS ? THERMOSTAT Heat plup /Ol Q 70r/ ? V.I. i LimM ?+/ • ? . /?1?./ '+' 7L ' Limir Setliep 1 Fan SeMinp '- ? Pllw Typ. ._ ? : Pilot A4ulu -? PiIM Modal : Pilot Timinp L.W. cw oFF • Prossure, ZZ-11 PeruntCO_ • ?V Input CFM -7 7<- ? pereent O? ? j Stock Tamp. Percant CO 7 0 - n. Vant Si:o KIND OF LINER SIZE_ ? NONF Dmk Hood ? Roqulo*or /I.>C9CSS FINms Si:e uumber ChImnay Lecetien . . Inaide? ? Out:ide Chimney Cvns7ruelion Smoke Bemb 0.ah Wiriny T.st 1 Doer Preaaure Llyhtinp Inst. DaN Testsd - + Company TasTiny Namt oF Tsater 5,;fl7as '166 F. 235 IAUDRESS ?4100I OCCUPANT ? ? HEAT LOSS f SOLD BY ? El.chical Wwk By .TYPE OF HEAT ?. nvuJt 1"ItAIINti ItJI KtC.UKU APT._F CIIY •?OWNER D HTG.INST, INSTALLED BY Gaa Line Br GA _. PA _HW STEAM _SPACE HTR. _UNIT HTR. tOTHER ? GAS DE51GN CONVERSIO i MAKE -? ?"v"? MAKE OF BURNER ?? 'Mod•I ?010 ?7r Modd . ; 5«10l Lh:. BTU RoNny . • iQ86 iNrur ?2s o0 0 (!PR ?.-8 MAKEOF FURNACE A1ed•1 B?1aF? . rl?u.( CONTROLS t THERMOSTAT J? Heot Plup ? valw llqOd 7473 : limlt ?g 1/!? SC i ?b'Z ' Limit Ssniny ? Fan SsTtinp ? ? Pilet Trye *%K . Pilet Abb ? Pilot Abd.l : Pllef Tfminp 104Ae L.W. Cut O(( 7Y?-4617 7t PO'/• Pressun 3 -s- " WC Pereent C0 91?70 InpW CFH P.rcenf 02 `G 07O Sbck Tomp. 3-90 )i.P* Par CO. c?M 0 F. 235 V.n, S,=. !7f /,W 4 KIND OF LINER SIZFNONF Drah Hood ? R?pulnra Ftllms Si:e QhImrrr Lecation . . insido Oufside QireMy Cenahuefion Smo4e Bomb Wiriny ? D.oH • ? r T.st Tep ? Doa Preaswe LlphTiny Inat. ? DaN Tobd -, - Compenr Tesl{np NeA. ef T.:t.r / /W? ? HOUSE HEATING TEST RECORD , k, ADDRE55 APT. _F LO R O CITY SUBURB . AM ; OCCUPANT ? ?/ ? ? OWNER-r?^^+ G V I HEATLOSS - ?DAT HTG. INST. ? ? SOLD BY - INSTALLED BY ? Elsctrical Work By Gos Line By LTYPE OF HEAT GA _ FA _HW STEAM -SPACE HTR. -UNIT HTR. OTHER ?E51 )1 _? CONVERSIO? `MAKE ?f ! ,.,?. ? MAKE OF BURNER ?v ?s+ Madel Model npc ; Sariol Mex. BTU Raring ' INPUT 3 ?s•??? MAKE-OF FURNACE DOODY r Model P CONTROLS l ? ?S F THERMOS TAT i Heat Plug fA Vent Si:s f ? ? Valve rt/W fl Co_7d4? KIND OF LINER SIZE NONE ? Limit Wp R IlgT:; DrakHood Ragulamr ? Limit Saffing e ?P-o C) - Fillers Size Number ? Fan Satting /Chimney Location ' Pilot Typs Chimney Construcfion ,.o , Ptlot Make " Pilm Model $moke Bomb Wiring ? .Pilot Timing _sy? Drafi • 0/ Test Tay ? L.W. Cut Off Door Presaure Lightiny Inst. - Prossuro 3•5 W?- ParcentC0 a?6' Date Tasted tL???/1 2 Input CFH Percent O Com an Testin Z Stack Temp. -35W X016- Percent CO ? p y g Name ef Tester Form 235 Insids Outside , HOUSE HEATING TEST RECORD AOORESS APT.._FLQOR CI.TT SUBURB OCNPANT --ON!NER ?SO?CA L V MEAT LOSS T ?OATE HT0. INST. S?O Q SOID BY Z IN57AlLED BY Electrieal Mw4 By Gas l{ae Br TYPE OF HEAT GA _ FA _HW _ STEAM _3PACE HTR. _UNIT HTR. _OTHER CONVERSI? ?° MAKE MAKE pF BURNER Med•1 ?slfi S r AAoMI J' 8 1226 i ? Swiol ^ ? 7 9I Me'x. 6TU Rafin 1!f f?-h. - INPUT MAKE OF FURNACE Abdal ? )')7A ryt.1 CONTROLS T}1ERM02T e ? Mwt Plup Vont Si:* O Valro Qf1 ? /(lN S -?' KIND OF LINER /I?S?3 - '/O ? SIZE NONE Limle • • Drah Hoed R ?.??? L{TII SeII{/19 -? ? F{I1Nf Slie WYTbff Fe7n Settfnq Ohimney Lecoflen Inside Oueside ' Pflo1 Typ? ? O?imnoy Gnsnucfion Pnar ?k. _d Spillage Q Pila Medel - - Sme4• Bem6 W;r;ny ? Pibt Timinq ! f 7.A[,, 0.aft • n / To?f Taq ,L.W. Cut Off + 2 Af-40Dow Pr*uwe lipMiny Inst. Pr•iswP.rcmeCO2? Det• T•stod Invut CFM:37 S Pwe.nl O ( Gmpeny T?a1in ? q Slnck Temp. 9 pw"nt CD 10 Name ef Tas1.. \ IMi1 ? 7£(J ?' . C_ertificate of Compentency # ?S /C{17.t.cJ ? ADDRE55 ?302.T-,f_,?i9r?,?.Q \?% LOOR 'CITY --??/?l .? SUBURB . / APT.-F : OLGUPANT OWNER ? I HEAT LO55 DATE HTG. INST. 'SOLD 8Y INSTALLED BY ':El&chieal Work 8y Goa Line Br ?OD ?r ? ;LTYPE OF NEAT GA _ PA _HW STEAM -SPACE HTR. -UNIT HTR. _OTHER GAS DESIGN ? MAKE .???i?TF ? .1T µpKE OF BURNER _ Model -375' Modsl i Sarial Max. BTU Rof{ny - - INPUT MAKEOF FURNACE Modal CONTROLS lI THERMOSTA T Heat Plu 'f Vant Si:e ? ? - q ? Valva KIND OF LINER SIZE NONE? ? Limit //? 2 '1L'?- Draft Hood Repulator ?0?%rP62 ? Limif tliny -'? n ? Fillara Siza ?? Numbar ? ? Fan Sattiap Oiimney Location . Insida Outsida ' Pilot Typs Chimnsy Consiruclion ? Pilet Meke Pilm Modsl ? Smoks Bomb ? Wiring '. Pilot Timinp s Draft Tsst Tap ?/ L.W. Cu1 Ofi Dow Presawe Lighlinp In.t. {C Prasswa 'psrceniCO2 Inpuf CFH Percent O? - 51oek Temp. .?? ? Parcenl CO d' Ferm 235 uote TH Cemponr Tsstiny Nams of T"W 2' J DOODY, INC. CON V ERSION ? ADDRESS ppT.._FLOOR CITYiS@SUBURB . ?OCCUPANT OWNER I HEAT LOSS DATE HTG. INST. SOLD BY INSTALLED BT ?G'o tcY > / T I Elactrieol Wwk 6y Gos Line By ?GO?? ?'TYPE OF HEAT GA _ FA _HW STEAM -SPACE HTR. -UNIT HTR. _OTHER GA/SD jESIGN : MAKE µpKE OF ?.wa.l GG - 3 ?S M,a,i _ ; s..iai Ma.. sru INPUT MAKE OF Abdel _ BURNER Ratiny - FURNACE CONVERSION CONTROLS ? THERMOSTAT Heat Plup Vent Si:s , ' Valve KIND OF LINER SIZE '-'- NONE ? t Limit l?l ??f -'?/72 Droh Hood Repulator ? LimiT tlinq Filfars $ise ? ` Numbsr '-? I Fan Settinp ?'- Qiimner Locafion . Insida L? Outsida Pilet Typa Chimns Construciien y Pibt Make Pilw Modal ?- Smoka : Pilot Timinp DraFt. L.W. Cu1 Off ?- Dow I Prosswe ' P,reant CO2 Inpu1 CFH- -?'s- Peresnt O 2 Spek Temp. Psranf CO Bemb '?- Wirinp Test Tay ? ..._. . . / Fam I35 - DOODY, INC. ? ADDRESS ppT. _FLOOR CtTz?%?UBURB ? OCCUPANT .5T° OWNER I HEitT LO55 DATE HTG. INST. -?-?- ' SOLD BY INSTALLED BY ?'Elecfiical Wwk 8y Goa Lina By ETYPE OF MEAT GA _ PA _HW -STEAM _SPACE HTR. _UNIT HTR. -OTHER /GAS qFdIGN ? MAKE ?"??/??'y' ••J??? /- ? 4AKE OF BURNER _ Model Medsl i Swial IAex. BTU RaHny - ; INPUT MAKE OF FURNACE Model CONTROLS :THERMOSTAT Heat Plup Vant Size '10// ? Valra ? KIND OF LINER SIZE? _NON ? Limit ? " ° ? DreN Hood Reyularor ?r?/ ? /?? '?UDS ' Limit k:na /f/y/__ -? F(hera Size Num ?? i . ? 1 Fan SeHinp Qhimnsy Location . O In zid° . ? Pilof TYpa Chimner Construclion / / ? Ul ? Pilet Abk. c? ?yTSU n y Pilot Modsl Smoke Bomb Wirinq ` S? N ? Pilot Timin9 11 DroFt ? Test Top L.W. Cw Off ' Dow Pressura liyhtinp Ins . ? Presswa ? ParcanTCO2 2 Dafe Tes/'d'? ' ?'?4 Inpuf CFHc y :?.Percenf OZ Company Ta:?%?? 51eck Tomp. ?Psrcent CO Nams of Tasl.. F«m 235 CONVERSION h ADDRESS 3? ? s 5 ? 701d?dt'E APT. _FLOOR CiT'f?SU6UR6 . : OCCIlPANT .? /?/?,(?!? y?tf • OWNER HEAT LO55 DATE HTG. IN57. i SOLD BY INSTALLED BY ?? 7J? ?> ' Elachical Werk By - Gos Lins 6y LTYPE OF HEAT GA _ FA _HW _I-" STEAM -SPACE HTR. _UNIT HTR. -OTHER 5 DESIGN - CONVERSION : MAKE r A?T MAKE OF BURNER Mod.l ? 3 7S? Model i Ssrial !Py Max. BTU Rotinp INPUT 375??v MANE OF FURNACE , i Modal CONTROLS ? TMERMOS A Heoe Plu ? Vaive ? ? P . ? ? Limit ?l2_1 ' limlT Minp ?5*1 G . 1 Fan Settinp Pilor TYpe e?.?_ ??» ? Pilot Abke Pila Mod.l : Pilof 7iming L.W. Cw Ofi Vant Sixe KIND OF LINER NO N - SiZ Dtoh Hood G r ? ?o Rayulorory Fllfars Siza • Num r aimney Lowtion . Insida - Outsida Chimney Conseructien Smoks Bomb ` Wirin9 ' Draft ? ? Test 7ap Dow Prosaws - Lfphtiny Insf. , Proaaure Percent CO 2 Dats Tected Input CFH ? Pereenf O ? Company Tastinp n??1????a{???r 6 7 ? c? Sleck Tamp. ?? Parc?nt CO ' Q ? Nama ei Tasfw ?•? ? 9i? Fam 235 ? ?"soz5^ ??.d,Z>.acE ? ADURESS ApT.-FLOOR CITY`f''r'SUBURB . ? OCCUPANT OWNER I HEAT LOSS DATE HTG. INST. ? SOLD BY INSTALLED BY ? ?Electricol Work By Gas Line Br ?-'? i? ' ? ?+?rG :TYPE OF HEAT GA_FA_HW_L-?_ STEAM-SPACE HTR. -UNIT HTR. _OTHER ? MAKE ?A?-p.4l GAS DESIGN f° -???'% 9-7 MAKE OF BURNER _ : Mod?? GG - 37.5 Mpdal , Sarlol ?2_ ;2- Max. BTU Rotinp - ' INPUT MAKE. OF FURNACE Modsl CONTROLS CONVERSION F ? THERMOSTAT Heat Plug Vent Si:a G` '• Valva d±ZdP11' 7? , y3 KIND OF LINER SIZE NONE ? Limif C?/S/TF DttE"iEV ?--?OVDraN Hood ? Ragulamr ??X/???? l'?f ? LimN tlinp ,7/U b FiMen Size Numbsr i Fan Settinp -? Chimney Localion - Insids J Outsida ' Pilof Typa Chimney Censtrucfion ef??- ? ? Pilet Maka ? Piler Modal ? Pile1 TiminQ ?? CS L.w. c,n orr Proasun ?•`S ?' ? ` ParceM CO2 Z?q, n Inpu1CFH Paresnt 02 S?ock T?mp. ','?Q ? Percant CO F«m 735 DOODY, {NC. ? Smoka Bomb Wirinq Draft Test Top ? Door Presswa Liphtinp Inst. ?? .._,_ ??? HOUSE HEATING TEST RECORD , , F ADDRE55 -? APT._FLOOR CITY ` SUBURB? ; OCCUPAN7 Q022Z? OWNER ? "4 G I MEAT LO55 HAT NTG. INST.'_ ?& ---? ? SOLD BY ?NSTALLED BY ? Elechical Work By Gai Lyne gr I i CJ ?.'TYPE OF HEAT GA _ FA _HW _STEAM _SPACE NTR. _UNIT HTR. _OTHER AS, DESIGN ? MAKE MAKE OF BURNER _ -? Modd 6 ?9 375 Model ; smivi S"l9/o2? ?,b:. eru Reesno - ' INPUT_ 32S,00G MAKEOF FURNACE COHVERSION Modal CONTROLS p. iTHERMOSTA'JygAMA -HealPlup VsntSi:a ?ennv ?? vel.. ?y?? U(CDD 709 3 KIND OF LINER SIZF Il0 ;LimiT 6&29 //9 93 -?OL " DrahHood R-g••Iawr ' Limil SeMinp.200° Filtars Si:e ??umber ? Fan Settinp Chimrroy Locat{on ? Pilot Trps Chimney ConsfrucYion • Pilot Maka Pilot Medal Smoke Bom6 Pilot Timinp dPG Draff + L.W, Cuf Off 6B?'? 66170 Dom Prosaws_ it Ouf:ide Wiring ? .Tesf Tap Liyhtine Inst. Presswe -16 217G parcentC02 q? DateTasesd Input CFH 37s Psresnt 0 % Compeny Tastinp Smck 7amp. -TgOYl20" percenf CO? p Name of Tesfar ?#7uL? F°'m 235 Sbu?h l , HOUSE NEATING TEST RECORD F ADDRESS ?50 IOCCUPANT _S I HEAT LOSS _ 1 SOLD BY F Elachical Wark By :TYPE OF HEAT APT._FLOOR CITY SUBURB? OWNER _ ATE TG.INST.' SCIo . 0 INSTALLED BY /1r'FrQA? Gas Line By !l GA _ FA _HW STEAM -SPACE HTR. _UNIT HTR. _OTHER Y JJ//? ?AS DESIGN CONVERSION _ MAKE J??it w1 MAKE OF BURNER 0 20dEaa Me M-a.i fo G .37 ?,ba.i { S.rlel Max. BTU Rotinp ' 4P 2$ 1926 INPUT 37S.oao MpKEOF FURNACE _ ?,ba.l _ nnng-Y INC. CONTROLS FTHERMOS , ? ?? Hea1 Plup Vsnt Si:a ? V.I. _ LX+SUD 7093 KIND OF LINER SIZE ? ? NONE ??' 70Z ' ? Limit ? ?? DmkHood Repularor ? Limit SeHinp FIIMs Siza umber 1 Fan Settin9 dh{mney Location . . Insids Ovlside Pllot TYW Ulmner ConsTruefian ? . Pllot Maka / . P'lOt MOdQl Smoke Bomb Wiriny : Pilo} Timin9 IZ?Aae Draft Test Tay ? L.W. Cw Off 4949^-d //(! Prossuro 3-S GC? G p*rcentCO Dow Prosswe Dats 7asTed ,J Lighlinp Inst. ? Input CFH Percent O? G` % Compony TatN.... ?.vuO,u? t SLtdf?.C? Stock Tamp• 3?? ?? Percent CO ? Nama of Tast.. . -?--? \ JUVv1 l? ? f-/-/Ff/S Fwm 295_ Jr0 q-k ?, LJl111CC IlCAT1kl? TClT oC!`IIOe? HOUSE HEATING TEST RECORD • ? -? . I•ADDRESS ? n_ ' , ApL-FLOOR SUBURB?AM CITY 10CCUPANT' e2 OWNER ? L - I HEAT LO55 F ,y??. INST. ? C soLo er INSTALLED BY V Electriool Work By Gos Line Br . ?? : TYPE OF HEAT GA _ FA _HW STEAM _ SPACE HTR. _UNIT HTR. -OTHER DESIGN ' CONYERSION 7 MAKE MAKE OF BURNER . `: Mod.l Co Cr 37 -? Abdel ? SarYal 9?..? f Alex. BTU Rafiny ' INPUT 3 2S 0d0 MAKEOF FURNACE Llodal CONTROLS DOOD • F THERMOSTAT Heat Piuy - Vanf Siza ?3 , ? t Valva ??? v900 "709.3 KIND OF LINER ' SIZF NONF t Limit W? II?Si' Jb Z. Drafi Hood R.g..lemr ' Limit SeMin9 °Za0 O- Fihars Siza Num6ar Fan Settinp Chim"r Location . . Inside Outsida Pilot Typ ? _ Chimnsy Conctruciion : Pilm Abb c j / , Pilm Modal Smoke Bemb Wiring ? = Pilof Timinp 1O 4te- DrafT •fV7? Test Ta9 - - • L.W. CW Off ? ?? ?17d Door Prossure Liyhfinp Inst. rr ? Pressuro 3• s W L PareaM COZ 99'0 Doro Testsd _ Inpuf CFH Parceni OZ? Company Tes???? ? Sfock Temp.kLALf parcem CO Name of Tasl? ?GL?-L.?? ?? 7??; - F. 235_ ---- --? k HOUSE HEATING TEST RECORD HOUSE HEATING TEST RECORD , LADDRESS 32055 APT._FL00(??_CITY ' SUBURB? 1 OCQIPAN7 • ? ??? OWNER ?SE'hf4 G { HEAT LOSS IATE HTG INST. 47 -ci ? SOLD BY INSTALLED BY ? Elechicol Work By Gaa Line By :TYPE OF HEAT GA _ FA _HW _STEAM _SPAGE HTR. -UNIT XTR. -OTHER G S DESIGN CONVERSION ' MAKE L"? MAKE OF BURNER ? ?° `Med•I n 6 .Z7-5- Abdsl . j Seriel C> 9/.Max. BTU Rotinp ' AIRR 9?-8 ;9.96 ' INPUT .?7?OD0 MAKEOF FURNACE ,,bael nnv, ini_ yv u,,,y, CONTROLS ` ' . i THERMOSTAT Heat Plup Vent Si:a t Valw l?'W f DO 701?3 KIND OF LINER SIZENONF 1 Lfmit W? ????;' ?0 2 " Drak Hood be? _ Repulamr : Lfmit Settinp .242D° Filtars Size NumMr i Fan Ssttiny Oiimrroy Loeation . . Insids Outsid? Pllot Typ ? U?imna Construc}ion ? y ? Pilot Maka / , Pilot Alodsl Smoks Bomb Wirinp V = Pilof Timiny _10aec_ 0.oft Tasf Tap • L.W. Cue Of/ Dow Prasswe lfgh/iny I..:f. n Prosswe J, b LU G Percanf CO 2 '7 C/o Data Tasted Inpur CFH ,375 Paresnt O 6170 Company Testinq Shck Ts ? mp• 3?VY11?' Percenf CO -0 Nama of Tsstar Fam, 235 Sow/h Yf111fC IJCATIAI!_ TCGT OF('l1DI1 HOUSE HEATING TEST RECORD °' ' 3DS? 6?''..DDRESS ? ? S F? M ,? o? - ApT._FL?O QI? CITY ' SUBURB Fg? i OCCUPAN7 ? Qg2& OWNER I HEAT LO55-- - E G. INST. - - SOLD BY - ? ? INSTALLED BY EI•chicol Wm4 By ? Ges Lin• By RTYPE OF HEAT GA FA _ _HW _STEAM -SPACE HTR. _ UNIT HTR. _OTHER DESIGN . CONVERSION : MAKE MAKE OF BURNER ? ? ? ? ? ? d' ?¦ ? Mod•1 Cv rD ?77J''- Medel . . j Sarlal . ??q/-'3 D Mea. BTU Ratinp ' ? nn n R 1QRFi ' INPUT 3? Sf?OD MAKEOF FURNACE ' . Moaei r.nnnV InIC'. ? yN.A.. a.l CONTROLS ? ? THERMOSTAT L?? 2- Heat Plup - Vsnt Si:e ? Valvs ?? UE{OO -?IO ?I? KIND OF LINER SIZF- NONE I Limit 70 ? Drak Hood Rayulenr ? Limif 3oItiny-- .2 00, ' - Filfsrs Size Numbor 1 Fan Sattin ? 9 Chimney Location . . Inside Outsids Pilm Typa Qhimne Conatrucfion r : Pilet Mab . f , Pilot Modal Smoka Bomb Wiring : Pilot Timin9 Dra(t t9l Tast Tap ? L.W. Cu1 OF( 170 Dow Pre:swa LipMiny Inat. klf? q Prosaura-3 •J W? par<ent CQ 9%6 Dats Tastad ?I ? Inpw CFH 375 PeresnT O? Compony Taating Slack Temp. ??? n.l4` Percant CO 0 Nams of Tasfer ?6'13 . Fam 735_ t i ??Hf111SF HFATINR TFST RFff1Rn - . ?IVVJL ?)l/?111\V ICJI RCI..VI[V . ? . 6 ADORESS - ? ? ApT._FLOOR ' CITY?Er!° SUBURB ' j OCQlPANT ' OYfNER . " I HEAT LOSS DATE HTG. NST. SOID BY ?d INSTALLED BY- ? El.chical Wwk By Gas LiM Br . ?? ' ?• 0• : TYPE OF HEAT GA _ FA _HW STEA?A _SPACE HTR. _UNIT HTR. _OTHER _ GAS DESIGN ' ? CONVERSION ' MAKE 6,574 p-r,jt'. I,IAKE OF BURNER ? Model Alod•1 . ti 5«tal , Mox? BN Rotinq ' INPUT 22 j h[r3 AUKE-OF FURNACE Mod•1 CONTROLS f THERMOSTAT Heot Plup Vant Si:e ? V.I. ?90pq KIND OF LINER SIZE-NONF t Limlt Drafi Hoed LZ Reyuloror oJS ? Limit SeMiny ?OD 4 - FIITers Sia NumMr 1 Fen SaMiny '- QhImner Locatian . Inside Oufside ' Pllof Type -???/s'J/??Ei Chimney Censtruqien e?_ LqfTe 13 : Pilet Meb Pilm Modal Smoke Bomb Piim Timinp -21 . Sr r. Draft L.M. CW Off Dow Prasaure Wirinp .Teaf Tay ? liqMiny Inst. _ Preasw ?•?Poreen}CUZ Do/a Testad InpW CFM 315 ' P.rcanf 02 , Ccmpany TeaKny ' ' % Sfack Temp. Percant CO Nama oF Tastw ,,>, Farm 235 1. ADURE?SS APT..- - ?F-O?OR. CITY SUBURB ?. .? ?QCCUPANT? .?R?SP ?OWNER, L n-?!? e-; I HEAT LOSS DATE HTG. INS . !' SOLD BY INSTALLED BY ?:Elachical Werk By ? - Gus Lins By ?TYPE OF HEAT GA _ FA _HW STEAM _SPACE HTR. -UNIT HTR. -OTHER GAS DE516N : MAKE MAKE OF Mea.1 Co r'c ; se.iol Mox. e7u I INPUT MAKE OF yyw.,?; CONTROLS THERMOSTAT Heaf Plug Volra ?? (j Vao ?0 93 Limif D Z-- Limit tlinp BURNER Ratinp - FURNACE CONVERSIDN Model 1 Vant Siza ? ? KIND OF LINER SIZE NONF DraN Hood Reyularor Fllima Siza 1 Fan Settinp CXimney Location Insida Pilof Trps ?? ?400/P Uimney Consiruciion Outsida ? Pilor Mok. ? Pilm Model Pflot Timiny L.W. Cw OfF yk44&622 *901 Pres+uro 3+S W G Pareanf CO2 Input CFH 3 7-S? Perceni OZ- 7016 S1ack Tamp. ?Perc?nt CO ? Fain 235 Sme4e Bomb Wirinq Drafr ? 01 Te:t T-y ' Dow Pressure Liphtinq Inst. ? Data Taated Name oF T.:1?r J c'?"^ ? - fidz,24 w- / nuuJt IYtAIINIi ItJI KtCORD ?ADISRE55 ? APT._FLOO CITY ` SUBURB? 1 OCCUPANT, OWNER??? ? . I HEAT IOSS HTG. IHSL 616 f . C SOLD BY _ ??9''f?'?'' ' INSTALLED BY J El.cbimt Wmk By . ? Gaa Lin• By // ? TYPE OF HEAT GA_FA_NW _STEAM-SPACE HTR. _UNIT HTR. A;DESIGN CONVERSION a IMKE MAKE OF 6URNER n?R 2 9 1996 ? Mod•I ?'c CG ,? 7-<- hbd.l _ i S«fol CJ7 13 Mox. BTU Rarinq ?? tfLi-I'?7TO : INPUT .32 .OC70 MAKE. OF FURNAGE r . ? A1od•1 jrAA.t.t CONTROLS , THERMOSTAT ?? Neat Pltq V.nt Si:. 1 Valw KIND OF IINER SIZFNONF i Limlt .??R (/?S?i - 70Z 0.ohHood R?pulamr : Ltmit S?Miny - :?a0 - Filtws Sia Number 1 Fan SoMiny Qi{mrer Leeation . Inside Oulaide PiIM TrW Chim"r Cen:trucfion : Plloe Mab PiloT Model Smeke Bom6 Wirinp ? : Piter Timiny /t')Ak Draft -• O f ' T•sf To= L.W. cur ofr -'1'v? #90 l . Door Presaw. Liyhfinp Imt. ko?? J • Pn:sun J'.S 60 C P C .re•nf pZ puH T•sted _ C Input CFN3 ?.?L Porcant 02 7%a CompaMr Tesi;ng ____ ? S7ock Tomp. 3?O Parunt CO ? Name ef Tas1m - ? ?j /itnn b A4 :2,v 3 F.n. 475_ /'? ? ? .