1335 Corporate Center Cur - Heating Test RecordsHOUSE HEATING TEST RECORD
ADDRESS '? (?Gr`?'•P?+?( ?Ll?1?L? 6?.4V "
APT. FLOOR CITY SUBURB ?
OCCUPANT 2F5:« A- Je, r' OWNER -2 b i
HEAT LOSS DATE HTG. INST.
SOLD BY INSTALLED BY
Electrical Work By = tI N?icJhC,v„( Gos Lin• By L slQ?^"fl F , jr•a'<t-.
TYPE OF HEAT GA FA k HW STEAM SPACE HTR. UNIT HTR. OTHER
GAS DESIGN
MAKE LP„0't1A MAKE OF BURNER
Modsl =s?o/ ii Y' - -36G--?`5'!? -- c:b Atiodel
A .a.7
CONVERSION
Seriol ? Aiax. BTU Rariny -
INPUT 9? O?o MAKE OF FURNACE
CONTROLS
THERMO$TAT
Heot Plug
Valve ,j ?IvrWf!l
Limit r < <A
Limit S!ttine /?It LR\ srfG C
Fan Serring is 1eRj: ,yrc 1}, i? y_
Pilor Typs -3:..oCF:lIt 76dt.1??L
Pilot Moke Ir/1t.fa f Y
Madel
Vent Size
KIND OF LINER,
Drah Hood
Fi Iters Siz* _
Chimney Loeation
Chimney Construdion
SIZE NONE
Reyularor
Outside '?_
Pilot Model "I PDF)' Smoke Bomb Wiring
Pilot Timing -? "? 5P['o1JD3 Draft T.sr Tap
L.W. Cut OfF AVA Door Pressure Li9hting Inst.
' S ;?j "Ort
P
Z P
C
'
ressure
ercent
O
Z Date Tested
Input CFH Porcenf O
2 7' Company T?sting t a
Staek Temp. /?l V Percent C0 -' ??4m Noffte of Toster
Form 235
,* I
#-3 HOUSE HEATING TEST RECORD
r ADDRESS APT. FLOOR CITY SUBURB
OCCUPANT /'V" OWNER 1.3L
HEAT LOSS DATE NTG. INST.
SOLD BY ? ? t &-'L '"I 4H INSTALLED BY (EI•ctricol Wwk By .'11x J /'. .t"l'cl"o Gas Lin*By G7 Lar-X1
TYPE OF HEAT GA FA _<- HW STEAM SPACE HTR. UNIT HTR. OTHER
GAS DESIGN
MAKE LWLX MAKE OF BURNER _
Mod.l G iG1 M' W • %4e 4 - 650 - o(o Model
S«ial -5p11* 8 dzE Max. BTU Ratiny _
INPUT otio MAKE OF FURNACE
Mod.l
CONTROLS
TAERMOSTAT EIFt H.at plu9
vaiv. ,°b?"0';,kw
,Limit
Limit SeMiny {;_ l/
Fan Seftiny {- (w
Pilor Typa ;i^? uRtilci T"/ ,?: !vL
Pilot Maks fAlfrl+f
Pilot Modsl ?1itT.e'•/
Pilot Timing -Z• ? Stc[Nb5
L.W. Cut Off ?lA
Presswe-7•'r 1' f6Jb P's rcent CO
Input CFH &V_?0 P•re•nt 02 ?• ??
Stack Temp. l'b Dj Percent CO %PPAA
Form 235
CONVERSION
v.,,t s;:.
J" Put
KIND OF LINER SIZE NONE
Droh Hood R*yulowr
FiltNS Siz• Number
Chimney Location
Chimney Consfrudion
Smoke Bomb
Draft
Door
Dot. Tostrd J` ?? f L d(} ?D
Outside -L
wiriny -
T.st Tcp
Liyhtin9 Inst.
Compony Tesfing 1j;,,11,4C2'Y Ma?.
Nam* of T•st•r C. A)09`ro4
?---
???quaCn,
.iFCAV25
~?il: FAi@7J
TIME k+?: c0:57 am
DATE e5/10/2606
' FllEL
MA?GAS
TA4K- ;TEMP i 0O ' F
C498.-TEMP 53.5 °F
q '.S t.
s:;O2 7 . b /.:
Cp t7 ppm
t% COR GO 42 p.pm
FFFICIENCY 9e.0 .
EX. FIk 49.$1
4.RAFT 0.05 WC
--------------------
COMIMEMTS :
?f , • ,. .. ? ,?„?.r? :,-?. :. y-?, ?
HOUSE HEATING TEST RtCORD
r.
i' ADORESS
?•PtVI"
APT. FLOOR CITY SUBURB
OCCUPAN7 `` OwNER -= r2 L
HEAT LOSS DATE HTG. IN57.
SOLD BY INSTALLED BY
Electrica) Work By
` Gos Lin• 8y [-r746ET-''
TYPE OF HEAT GA
FA -'X.-HW STEAM SPACE HTR. UNIT HTR. OTHER
? GAS DEStGN
MAKE •^•'`, °-k bIAKE OF BURNER _
Model 1 1'14 Py'36 c-n4n -c?lb µodel
Serial Alax. BTU Ratiny -
INPUT MAKE OF FURNACE
Model
CONTROLS r
THERMOSTAT H.at Pluy NA V•ot 5;z. ?f
Volv• ',? KIND OF LINER
Limit DrahHood
Limit Settinq ???<<'• ?y Srl n/ :lri;-+v Filters Sise
Fan 5ettinq rA[ toR' r T,yu - Q[l,. y Chimney Locotion Inside
Pilot Typs 6;3V) -' f! '.: `vle rnlC Chimney Construetion ki
Pilot Make /-t-NZ lary
P i I ot Modsl r? . ia f v Smoks Bomb
Pilot Timiny *" D?aft
L.W. Cur Off 162 Z4 Dou Pr•ssuro
SIZE NONE
Reyularor
Outsid• \_
Wiriny -
.Tesf Tap
Liyhiinp Inst.
Prossure J. S f1?4rf.(•/.1
Percent CO? ?i•? ?
Date Tesfed ,5 - /i' " ? = ° ?o
Inpuf CFH T Percenf Q2 •?' ?? Company Testiny ?--? '- J'k 0 cL.
Stack Temp. Pe?cenf CO Nams oF Tester "^.?' c t cN
CONYERSION
Form 235
. . . . . . .
, ..+,?.. ? ??'.;? .. .. S
??••F _.
? L HOUSE HEATING TEST R
ECORD
ADDRESS elf P JC AP
L
OCCUPANT T. F
OOR CITY
OWNER 7 (3 L SUBURB
HEAT LOSS DATE HTG. INST.
SOLD BY /--? l ,>=;?f INSTALLEO BY E?• ?. ?'
Elocfrieal Work By ?-A)1f Gos Lino Br C.=.'T G?<•
TYPE OF HEAT GA FA _X_HW STEAl11 SPACE H7R. UNIT HTR. OTHER
GA5 DESIGN
MAKE MAKE OF BURNER _
Modsl {Y1 P V •- :b1 - ?'9 p- t 6 Modol
Ssriol -51048 3?POOy A4ax. BTU Roriny -
INPUT 'r D. ?o^ MAKE OF FURNACE
CONTROLS
THERMO,STAT 4L{( Hoat Pluy
Valve '`'nr?6MClr
Limit !', l, t? SHA? rlt !.?h
Limit SeHiny
Fan $sftiny
Pilot Type ?rlo1 SGrfi1le -'1`6,A , 1
Pilot Maka
Mod.l
CONVERSION
Vent Siz• ?
KIND OF LiNER SIZE NONE
Drak Hood Re4ulator
Filters Si:*
Chimney Loeotion Inside Outaide
Chimney Construetion 12 1) 1
Pilot Model -i'ttLtC(/ti Smok• Bomb Wiriny
Pilot Timiny ?1'?-fClc/uDf Droft Tosf Tay
L.W. Cut Off Door Prossur• Liyhtinp Insf.
? ?
Pressursy -?'5, Percent C02 Dote Tested - 1. - e' `d
?'
Input CFH C Pereent O 2 Company Testin9 '- ` ?'3f"' .1
Stack Tomp. U? Percen1 CO l t ?M Norrw oF Testw iR -tilJ
Y
Form 235
1.3?JjJJ HOUSE HEATING TEST RECORD
ADORE55
OCCUPAHT OWNER
FIEAT LOSS DATE HTG. INST. ?? bd
FLOOR _CITY
erA
SUBURB <44
SOLD BY iNSTALLED BY
Elactricol W k By /km /00214Gf Gos L{nia By
TYPE OF HEAT GA _ FA _HW _STEAM SPACE HTR. _UNIT HTR. OTHER
GAS DESIGN
MAKE Leog'I MAKE OF BURNER _
Modal -1 (A An 4 f) p Modsl
Sarial / bb p (. Ma:. BTU Rotiny -
INPUT d-? MAKE OF FURNACE
CONTRDLS ? /
THERMO TAT Hear Plug ?q
Valva 1 r7
t ?-
Limit Setting
Fan Settiny _
Pilot Type ?
Pilot Make ?
Pilot Model _
Pilot Timing -J JAC,
L.W. Cut Off - T
PressurePercentCO T`S
Input CFH (00 Paresnt 02
Staek Temp. z?-? Percent CO ?
Form 235
Modal
Vont Siza
KIND OF LINER SIZE NONE
Dreh Hood Reyularar
Filter• $ize_
Chimney Location
Chimney Constructien
$moke Bomb
Draff
Wiring
Sesf "
Door Pressure Liqhfiny Inst.
Dats Testsd 3 z? /6,9
Company Testing
Nama of Tsster T• N0PI"ftl?4
CONVERSION
Insida Outside
, l33?
HOUSE HEATING TEST RECORD
ADDRESS APT._FLOOR ,CITY SUBIJRg?'
OCCUPANT OWNER
HEAT LOSS DATE HTG. INST. ?0?6
SOLO BY INSTALLED BY
Electrieal Work By 'ILEP /vQiggEQ Gas Line By GTC6N"il.?
TYPE OF HEAT GA _ FA _HW STEAM _SPACE HTR. UNIT HTR. 7S4;?bTHER
GAS DESIGN CONVERSION
MAKE 1? MAKE OF BURNER
Madal 60s Model
$erial ?7?K'l 46 Maa. B7U Ratinq
INPUT ?6- 606 MAKE OF FURNACE
Med•I
CO NTROLS
THERMO TAT ? Vent Siza
Heat Plu
g
Valva KIND OF LINER SIZE NONE
Limit Draff Heed RayulaTor
Limit S.ttiny ? Filfers Sizs Numbsr
Fan Setting 4 Chimney Location Insida Outsida
Pilof Type 6;C- Chimna
Conzfrucfion
y
Pilot Make
Pilot Model A;e-tzL?
i $moke Bomb Wiring
Pilof Timing X.__
= r¢C•_
Dra{f
Tast Taq
L.W. Cot Off -? Door Prossuro Liyhtiny InsT.
Pressura ?j•r11 Dcte Testsd -3 4 A C
psrcant CO2 7_J?
Input CFH60 'p
Percene 0
Compan
Tezting ?E'? ?.t,
g' 2?
y
j
$tvck Temp. !!
Parcant CO Name of TssTar x
Fwm 235
. i:335 HOUSE HEATING TEST RECORD
ADDRES5?C6!2P6MfE D/L- APT.-FLOOR CITY SUBURB
OCCUPkiJT OWNER
HEAT LO55 DATE HTG. INST.
SOLD BY t_1;7Z-664-4- INSTALLED BY
Electriwl Wor4 8y A&.-Tv /JDil?96eet) Gas Line By e!5-SLgTYPEOFHEAT GA_FA_HW-STEAM-SPACEHTR.-UNITHTR.-?C_OTHER
GAS DESIGN
MAKE MAKE OF BURNER
Model ? ?1 /F 060 ?a ? / Medel
CONVERSION
S«ial ??a ? Mo:. BTU Rofioa-
INPUT 6?GCD MAKE OF FURNACE
Modal
THER
Valve
Limit
?° CONTROLS
TAT `?elc' Haot Plug ? Vent Sixa _
glerWell KIND OF LINER
Limit SsHiny
Fan SeHing-
Pilot TYpe ?
Pilot Make _
Pilot Model _
Pilof Timing
'
L.W. Cut OFf f?
2 It
Prossure ParcantCOZ ? S
Input CFH?Peresnt 02 7
Stoek Temp.?i Percant CO
Form 235
Droh Hood Regula,or
FilNrs $ize Numbsr
Chimnoy Locafion Inside Oufaida
Chimnsy Gnsfrucfion
$moke Bomb Wiring
Drait Test Tay
Oooi Prassurs Lightiny Inst.
/
Dafe Tsstad 3 /
Company Testin ?'?*« 'f PA6%f`^
Na" af Ta:ter _;r AoRtor k
??? ?? ,AT}?1G TEST RECORD ?
ADDRESS J APT._FLOOR CITY ?SUBURB
OCCUPAiJT OWNER
FFEAT LOSS DATE HTG. INST. /Q_
SOLD 6Y c7neavl-INSTALLED BY 6T4,1192elt-
Elactrieal W.+.k 8.. 4STP IVOQ Gaa Line By TYPE OF HEAT GA _ FA _HW -STEAM _SPACE HTR. -UNIT HTR. ?OTMER
GAS DESIGN CONVERSION
MAKE 04 MAKE OF BURNER
Model /f /9t 1 Model
Serial 4, O5Yl'1/QOQ6 Mex. BTU Ratiny
INPUT
THER
Valva
Limit
MAKE OF FURNACE
Modal
? CONTROLS
TAT ?_ Heat Plug Vem $ize -
I{ic-xlJel/ KIND OF LINE
Limit $eMiny
Fon Satting _
Pilor Type -4
Pilot Make _
Pilot Model _
Drah Hood
Filfers Sixa_
C}himney Location
Chimnay Canzfrucfion
$moke Bomb
Wiring _
Pilot Timiny ;z'I ?ec' Draft Tast Taq
L.W. Cut 2Off ?.-?J[?/? Door Pnssura Liyhtinq Inse.
Preszuro?'? Parcan} COZ -7.3 Data Testsd dV y
Input CFH Ab Parcsnt 02 '? Campany Testing
Sfack Temp. Per<ent CO Name of Taster ?-/JO2'1'eI,
Form 235
SIZE NONE
Requloror
Inside Oufsida
ADDRESS HOUSE HEATING TEST RECORD
tit ? ?
4??
APL_FLOOR CITY SU12IURB
OCNPANT ! OWNER
HEAT LO55 DATE HTG. INST.
SOLD BY INSTALLED BY
Electrical W 4 B M.,zD-Ae4' Go: Line By ?`s:", aL'rVt'f
TYPE OF HEAT GA _ FA -HW _STEAM -SPACE HTR. _UNIT HTR. _ OTHER
GAS DESIGN
MAKE ?.?'1?lC?C -y-- IAAKE OF BURNER _
Modal • 6;; ? t7' '- ?%b Modsl
Serial 0 (Z4,53 Mex. 8TU Ratinq-
INPUT ' MAKE OF FURNACE
Mod.l
CDNTROLS
THERM?S?TAT ?L? ° Heat Plug Vent $ize ?
Valve -F[p??.vlti8,li KIND OP LINER-
Limit KkL&qA/ DroN Hood
Limit Sefling . fJ7 ? /
Fan Settin9
Pilor Type _ ?'LC L'?a ?-
Pilot Make
Pilor Medel
Pilot Timing - ' .?
L.W. Cut OFF _
!( /
Pressure ?W?1?
6) perwnt Cp 4?
2 °
Inpur CFH IVP i Percent 02
Stack Temp. Percant CO ?
Form 235
G
SIZE NONE -
ularor
Filtors $ize Num6er
Chimney Lecation Insids Outaida
Chimney Construcfion
Smeka Bom6
Dra(t
Dow Praasure
Wiring
Test '
Lighrinq Inat.
Daro Tesesd ( - 13 ` 24e4
Campany Tasting -.}G.'tLAEA ? ?!P'?"'L?
Nome o{ Tsster _/ t4gQ'ftj
CONVERSION
HOUSE HEATING TEST RECORD f
ADDRESS ? L?or"°'? C& -..i!'ifz APT.-FLO?OR/ CITY SUBURB
OCCUPANT t '- OWNER ?L?JI 0I
HEAT LOSS DATE HTG. INST.
SOLD BY J-- INSTALLED BY L,7?+-L13L.C
Electrical Work 8y Akrb 4)Af2AEYY.ti Gos Lins By ?_-? -
TYPE OP HEAT GA _ FA _HW -STEAM SPAGE HTR. UNIT HTR. _OTHER
GAS DESIGN CONVERSION
MAKE ZJ3 MAKE DF BURNER
Model ? ?rp) r['? ???h Modsl ?' A{ox. B7U Ratinq
INPUT -A /104` MAKE DF FURNACE
Valva
Limit
Mod•I
CONTROLS fl nf?
AT Haat Plug r Vent Size ?f UG'
!w)861Y1 t KIND OF LINER SIZE NONE
Limif Sattinq
Fan Setring _
Pilor Type ?
Pilot Make -
Pilor Model _
Pilof Timing
L.W. Cut Off
Prozsure °-'1.. J l/W*l.ry(`n`Psrcent COZ
InpurCFHP'd Pereant OZ
Stack Temp. ??
.,r Percen} CO
Droh Hood
Filfers Si:a
Chimnay Locaeion Inside
Chimnsy Construction
Smoka 8omb
Draft
Door Prassure
Regulntor
-Numbsr
Oufside
_Wiring
_Tast Taq
-Lighlinq Insr. -
Date Tastad 9 'l?, 144b
Company 7esting &.17 L/3ElLlil- ?aG{^
Name of 7asror ? tj eA 'f'Oa
Fo.m 235
?I HOUSE HEATING TEST RECORD
ADDRESS 1335 - C6RF6P.A?E CENf6!` CGtQV ?
??
APT._FLOOR
CITY SUBURB
OCCUPANT N? ' OWNER 7434
HEAT LOSS DATE HTG. INST. 5
SOLD 8Y GZLW J$2tI.. INSTALLED BY 9;0'2-94?91 Med+
Elacirical Work ByM XQ -A)O Gas Line By Gxt4rR? MeC4 -
TYPE OF HEAT GA _ FA pV HW STEAM -SPACE HTR. UNIT HTR. _OTHER
L GAS DESIGN CONVERSION
?J`b<
MAKE MAKE OF BURNER
Model G'6 x v- bo- o o- ob Medel
s«?ai o M,x. aru eofin9
• INPUT ?.?.000 MAKE OF FURNACE
Model
CONTROLS I(
?j??.
' THERMO?STAT ? Haoe Plug ?
Vont Siza
Valve _ttoga4Wd1I KIND OF LINER SIZE NONE
Limit ? Drah Hood Reyularor
Limit San' y ?,,,?
c-a
? Filtvs Sizs Number
-` _
Fan Seftin9 m
? /?
T-t??°'&µ y L
Chimney Locaflen Insids Oufsida/?
r
Pilot Type f?? !?}" sV RFha Construction DV?
Chimne
y
Pilot Make &f*-L y
A-06
i v
l
Pilot Model $moke Bomb Wiring
Pilof Timiny 1'3- SP,Ldl??1 Droft Test Tay
L.W. <ur Off
/4 Lightiny Inst.
Door Prossuro
1,
r.
Pressure 'S Percent C0 [
Dote Tested ?''N' ?a6`
InputCFH 2
Psrcant OZ CompanyTesting G'?Eaf CG?n
Stock Tsmp. ? Parcant CO Name ef T?st?r S• ? OR'?'0
Fwm 235
!'/ADORESS HOUSE HEATING TEST RECORD I.°J-1S- CaROukfe ei"P APT. _FLOOR __1_CITY SUBURB
OCCUPANT IIJALLka OWNER T[3 L
HEAT LO55?- DATE HTG. INST. •?Om
SOLD BY /i?et,?+ INSTALLED BY 6r«afi cti.??.
Elactrical Work By M?a-NIl`'I?rR/'1 Ga.Lim,gy GXC('SE2./- ?Hea.L
TYPE OF HEAT GA _ FA -)C-'-HW _STEAM -SPACE MTR. _UNIT HTR. _OTHER
/,,,-'--y GAS DESIGN
MAKE ??? µAKE OF BURNER _
Modal 661 mov-36c-yyo_a Modal
s.,;al 59abR.3/aoo9 µox. BTU Rariny_
INPUT DDO MAKE OF FURNACE
Modsl
Volva ?
Limit
Limit Satting
Fan Settin9 _
Pilot Type ?
Pilot Make
Pilof Model ?
Pilot Timing
L.W. Cut Off
Input CFH-
Stack Temp.
Fw,n 235
?jll CONTROLS
? Heat Plug
tc
Vont Size J
KIND OF LINER SIZE NONE
Droh Hoed Regularor
Filters Size N?mbsr
Chlmnsy Location Insida Outside r
Chimney Consfrucfion IQV/_
$moks Bomb
0.aft _
Door Pressu
Wirin9
Tsst Tog
Lightiny Inst.
PercentCO ?'`% DateTested 5 '" ID'ZC6(.
?
Pertent 0 70f 9i Company Tazfing Gs4/3He f- vho cl,_
?
Percent CO -ZF O"M Nama ef Tssror
CONVERSION
?/ADDRESS HOUSE HEATING TEST RECORD
1??' -?/SR?AM/NE ? C(?RIJE APT.-FLOOR?CITY SUBURB ?GAA
OCCUPANT Nd.SH? - f2.FiAA OWNER 7934-
HEAT LOSS DATE HTG. INST. S ?a2
SOLD BY /?1?Gt. INSTALLED BY l'T«Rt" flier-4
Elactrieal Work By MXD - NOQlktj" Gas Line gY 6;ZL4E<7'
TYPE OF HEAT GA _ FA _K__HW STEAM _SPACE HTR. UNIT HTR. -OTHER
r GAS DESIGN
MAKE l?I??? MAKE OF BURNER _
Modsl &4 Modsl
Seriol t* 3 OZ Max. BTU Roriny-
INPUT 0666 MAKE OF FURNACE
Mod•I
? CONTROLS ?
THERMO?TAT ?Gr? Heor Plug N
Valrs bl?u?wNleu ,p
Limit
Limif SeMiny /ACIlAN f/y?l ??la+4
Fan Setting n'bPilot Type AC6?L_!C?'1LLE
Pilot Make I?{p6v
Pilot Model
Pilot Timing 2?3 RCAN'"
L.W. C.t Off AO(k
Pressuw3•S+/ "A; PereaM COZ 9b
Input CFH 74? Percant 02
Staek Temp• ??aF Psrcant CO a-7 Pfr%
Fwm 235
t?
V*nt Sizs 3 ivi'
KIND OF LINER SIZE NONE
Droh Hood
Filtera Sixa Numbsr
Chimney Locetion Insida Outsida'?r
Chimnay Construetion pVL
$moks Bomb Wiring
Draft Tasf '
Door Pressure / Liyhliny Inst.
Dota Tasted ? /QJLod?
Company Testing 6.4TLV2'r M",
Nams ef Tastsr r, a04Z`bf{)
CON V ERSION
HOUSE HEATING TEST RECORD
ADORE55 I??? -C??ro?Tf: C-fR C{nRVE APT. FLOORJ-CITY SUBURB
OCCUPANT OWNER -1,13L
HEAT LD55 DATE HTG. INST. -? ??
SOLD BY 6.]1LQE2'I" `1y?-7?2,Ly?.. INSTALLED 8Y 6?148f4r ACc.1.
Electrical Work By MX-D"- Al Gas Line gy ,?SLselL'r-
TYPEOFHEAT GA_FA_'
,>1f,_HW_STEAM -SPACE HTR. UNITHTR._OTHER
GAS DESIGN
MAKE ? • ? MAKE OF
Model hbdel _
$erial S ??o.B.f?i?0 Max. BTU
INPUT ?D.OCp MAKE OF
,
Mod.l _
THERMOSTAT CIZe- Vulve ntlllvW-'Q
Limit C?tRV C?pp ?N4
Limif Ssttinq hRY .S?LA,/ A??W
Fan Setting 6L'{6CV Ti?YL?- hP.?w?/
Pilot Typa G/D? ?OF u?(.•R{ACE ?
Pilot Make ?L4Of?N
Pilot Model ??-??V
Pilot Timing ? "r
L.W, Cut Off ?/
Pressure 3.`? y mQn:t*?? Pereenf CO=
Input CFH ?o Peresnt 0
2
Stack Temp. 1t130? Percent CO ZsP?
CONTROLS ?
N
Heat Plug
3 AG
Vent Siz•
KIND OF LINER SIZE NONE
Drah Hood
Fileerc Si:e-
Chimnay locafion
aimney COnSfruC}ion
Smoke 8om6
Dfaft
wi,i„s -
Tesf Tag
Door Prassure Lightiny Inzt.
Date Tasiad S' - /0 ` Z a" ?O
Company Tesfing C'Z? ?eit A@cL
Nama af Tsster t- Na 1"0
6URNER
CONVERSION
Ratin9 -
FURNACE
Regularor
ids Outside
Fwm 235
HOUSE HEATIN ?T,k5rT RECORD
#'D,RESS sL?? Cu? C?QV??pT FLOOR CITY SUBURBK??j
, OCCUPANT OWNER
HEAT LOSS DATE HTG. INS . CO
SOLD BY INSTALLED BY
Elecfrieal Work By Coa Line By
TYPE OF HEAT GA _ FA HW _STEAM -SPACE HTR. _UNIT HTR. -OTHER
GAS DESIGN CONVERSION
MAKE LXAMOC MAKE
Model '? .3 b C - 6?0 - µodal
Ssrial ? n 6 ? O µn:
INPUT 7D?/JOO MAKE
Model
CONTROLS
THERMOSTAT Haat Plug
Valve ??tL?,?l/PI(
i _
Limit
Limit $sHing C t
Fan $etting /"j}G 7d.GY 77 I'tiL (?.
Pilot Type ? L ahi,
Pilot Make
Piloe Model _
OF BURNER _
BTU Roeiny _
OF FURNACE
Vent Sizs
KIND OF LINER-
Drah Hood
Filters Siza-
Chimnay locafion
Chimnay Cansfrudion
$moke Bomb
Pilot Timing 2--3 '5-YCod,41 Draft
Wiring -
Tesf Taq
L.W. Cut Off _ Door Pressure Lightinp Inst.
Proszure PercaM CO ? Duta Tosrod B Z
2
Inpuf CFH
Percant 0 Campan
Testing `r?'?'?"?- ?1^?
V?
2
Stock Tem Percent CO ?? y
Nam? ef Tast?r ?' Nd??
Form 235
SIZE NONE
Reqularor
Inside Outsida