1284 Corporate Center Dr - Heating Test RecordsHOUSE HEATING TEST REC,
ADDRESS ???
OCCUPANT OWNER
HEAT 1055 DATE HTG. INST.
bOLD BY -W7"'i /7r"rL7 INSTALLIED BY
Elsctrieal Work By _ 6 l' ?? i C Gas Line 8y _
TYPE OF HEAT GA FA HW STEAM SPACE HTR. UNIT HTR. OTHER 40?12
GAS DESIGN CONV SION
MAKE MAKE OF BURNER r A r ??
Model Model
Ssrial Max. BTU Rating ?
INPUT G i', ?• =, r- C'T/.1t MAKE OF FURNACE
Model
CONTROLS B G
THERMOSTAT s/4>Heat Plug Vent Size
Valve ? g'? KIND OF LINER SIZE NONE
Limif Droh Hood - egularor 17"a 41142? ?-7S - 3
Limit Seriin9 ? Filters 5ise?E?umbsr
Fan Settin ??1? ??'?c: ??1?- ?
9 ?- Chimnsy Loeotion Inside Outaids
Pilot TYPe Chimney Construetion
Pilot Make t_9 G,a/ S
Pilot Model Smoke Bomb Wiring (JPilot Timing praft 112 Test Tap ?
L.W. Cut Off - Door Pressure Lighting Inst.
Prossure ?, -5- Pereent CQ Uate Tested
07
Input CFH 3 2 o-?
? Pereent 02 ?! ! o Company TesTing
Staek Temp. ??% S Pereent CO U%U Name of Tester
Fwm 235
LZ B
2
-cirY "5uBURB
..
;011 ?
. HOUSE HEATING TEST RECORD
? ?? ? ? ? J ? ~ ? ?
?
? ? ?
ADDRESS APT. FLOOR CITY
!?7214UBURB .
OCCUPANT ?hi°? ss Tr°l' lOWNER C_JL?US _
? HEAT LO55 DATE HTG. INST.
SOLD BY ?G/?r° Sfi ?
INSTALLED BY
o/w c°-j"f/ r
Elschical Work By Q??f !r1 ??C' " Gos Line By
TYPE OF HEAT GA FA HW STEAM SPACE HTR. UNIT HTR. dTHER G4^7' o?
GAS DESIGN CONVERSION
MAKE_
Model _
Serial _
INPUT
THERMOSTAT L- ????"`''?}{eat Plug
Valve U
h 7L'/U
Limit
Limit Seffing 0
Fan $eHing Tim'?p !/S Sa r?(?
Pilot Type
Pilot Make Joh /1 S!]l1 r'r ?7 7i
MAKE OF BURNER
Model
Max. BTU Ratiny
MAKE OF FURNACE
Model ?
?
Vent Size
KIND OF LINER 172r7- SIZE NONE
Drah Hood --"'-"' Regularor
Fiftora Size Numbsr ?
Chimnay Loeation InsideT_Outside L?
Chimney Canstruetion l900 1' f O!> l/n
Pilof Model V 6 v76cv Smoke Bom ?-- Wiring ` v
Pilot Timing Draff GT U rc?? Tsat Tog 7
L.W. Cut Off Door Pressure Lightiny Inst. v
Prossure Pereent C0? Date Tested ?
Input CFH /00 Pertant 02 ' ?o?a Company Testing h7? t/ r<h '
5fock Temp. Percanf CO c'-)Name of Tsstar
Form 235
` HOUSE HEATING TEST RECORD
.• .
x r .I
nvuKLSS • ?° ^-- APT. FLOOR CITY ??'H_ UBURB
. OCNPANT OWNER
HEAT LOSS DATE HTG. INST.
SOLD BY INSTALLED BY ?C 7?S?'i ?/`1°?h •
Eleetrieal Work By ? f 4i_L(' Gas Line By
7YPE OF HEAT GA FA _?HW STEAM SPACE HTR. UN1T HTR. OTHER 1f-?,C) {??%??•
?
'
? GAS DESIGhI-
- CONVERSION
fAAKE.
Model _
5srial _
iNPUT
COJJTROLS
THERMOSTAT ?r1'?? = f?? fHeaf Plug
Valve t J I-!l
Limit
Limit Settiny 42 5 - - I - X
Fan Setting ?
S
Pilot Type
Pilot Make -Jnh n 5 Un C-c.-, 7
Pilot Model /, 60 Ir' 6 G -'
Pilot Timing 14S'?q 12 r.
L.W. Cut Off - --=M
Prossure 5- S Percent CO
2
I?ut CFH ??% v 670
Percent 0
2
$tack Tsmp. J? ?S Peresnt CO ? Z =
Form 235
.?.
MAKE OF BURNER
Modsl
Max. BTU Rating
MAKE OF FURN -'
Model
Vent Size
KIND OF LINER 4fn •>r° SIZEf- NONE ?"-
Drah Hoad Regulamr
Filtsrs SizL LU,A?S?_? Numbsr l
gmney Location Inside Outsids !--,
,
Chimney Conatruction f
Smoke Bomb `-_ ?Wiring -S?
Draft =
Test Tay
Door Pressure Lighting Inst.
Date Testsd ) ?f?i5 err
Company Testing r//G,i» C-S? Name of Tester
, •
i
HOUSE HEATING TEST RECORD ?
ADDRESS l_4f APT. FLOOR CITY SUBURB -
OCCUPANT OWNER
HEAT L055 DATE HTG. INST.
SOLD BY e2diYl,-f f,,L INSTALLED BY e?2 CLrrr?
Eleehical Work By ?9z///t10/e- Gos Line By r? IK
TYPE OF HE/1T GA FA _1GHW STEAM SPACE HTR. UNIT HTR. OTHER
GAS DESIGN CONVERSION - -
MAKE MAKE OF BURNER -
Model S 79 C/ 5-6 Modsl "
Serial s7?`" ?9y 1? Max. BTU Ratiny
INPUT MAKE OF FURNACE
Model ?
CONTRULS ?
THERMOSTAT L-Q Heat Pluy Vent Size
?, le' ('o9r'/
Valve f1
KIND OF LINER
SIZE NONE
Lireit Drah Hood ?'-- ReyulaTOr ??%}" 217 - ?
U
Limit Sstting
Fi Iters Size /Z XJ' ?X 2 Numbsr ?
Fan Setfin9 ?f Chimnsy Loeation Inaide Outside t?
Pilot Type Chimnsy Construction /Pa0 f?D />
Pilot Make
Pilot Model Smoke Bomb Wiring L?
Pilot Timing Draft Tsst Tay
L.W. Cut Off Door Pressurs Lightiny Inst. j?
Pressure S• S?Porcent CO Date Tssted
Z
Input CFH Psresnt Q 6Z-_ Company Testin
•-?•--•
Stock Temp. Pareent CO ?2'n Name of Tesror
Form 235
HOUSE HEATING
RD
ADDRESS APT. FLOOR CITY CQ
-r'3UBURB
OCCUPANT OWNER
HEAT LOSS DATE HTG. INST.
SOLD BY g?? INSTALLED BY
Elsctrieal Work B
Y---t Lf?-T
Gas Line By
TYPE OF HEAT GA FA _,Z_HW STEAM SPACE HTR. UNIT HTR. OTHER 10?-"Gp
GAS DESIGN CONVER510N
MAKE ?f w ?? t MAKE OF BURNER
Model _Sr3 S 1?() U Model
Ssrial FC) Go.?cS' Mox. BTU Rating
INPUT MAKE OF FURNACE
Modsl
CONTROLS
THERMOSTAT ;7e'/ SAa
4 ?
/
j,{
,
sof Plug ?
1
Vsnf Siz1
YalreI/ L_LL??yA -G Y? c KIND OF LINER r-- ? 51ZE NONE
Limit
0 Drah Hood Regularor
Limit Settin9 - f 72
Fan Setting %//w,' /a //
Pilot Type e' -
Pilot Maka J o,"f f?- /f
Pilot Model __-?;60 M6 ' ?
Pilot Timing 14 ?, Q
L.W. Cut Off
Filtsrs Size / -12G-u-? %' ! Numbar /
Chimney Location Inside Outside `
Chimney Construction l00{
Smoke Bomb Wiring I/
DraFt /-/9Test Tap !f
Door Presswe Lightiny Inst. ?
..
Prossure ?- f Percent CO 4L? ?wO
2 Date Tested '? ?s
Input CFH ?a Psresnt 02 ?X) Company Testing
$tock Tsmp. Psrcent CO ?C:Z? Name of Tester Z1`2?1
Form 235
HOUSE HEATING TEST RECORD ?
.
ADDRESS 4?4-51 ?a447. qpT. FLDOR C1TY ?AUBURB
OCCUPANT e-?i.??„ T.-.h owNER
HEAT LOSS DATE HTG. INST.
SOLD BY 42r2 1-77 f' f f i< /?rr/I INSTALLED BY
Elsehical Mfork By <:? Gaa Lin• By
TYPE OF HEAT GA FZHW STEAM SPACE HTR. UNIT HTR.
GAS DESIGN
MAKE 16112X MAKE OF BURNER _
Model 5- 7 9/2 E~f ;70 Modsl
$wial .SS?/?D 9 ?XS Mox. BTU Rating -
n a a A TZ/?
INPUT 0 '0 MAKE OF FURNACE
7
CONTROLS
THERMOSTAT Sfa 1 Heat Pluy
Va Iva
Limit ,ZVG° f 0 ?
v
Limit Se»iny
Fon Setfing f•.mP 44t ?NfC1T
Pilot Type Pilot Make /lr? ,?rQ t? Tr r[?
Pilot Model ----?
Pilot Timing //7f,4 Q/l f
L.W. Cut Off
Prsssure z ' s Paresnt CO2 ? • ?? ?o
Inpuf CFH 2'7 ?Peresnt 02 ?i 7?Gy
Stack Temp. 3 3G Pereont CO 6!,2
Fwm 235
Mod.l
Vsnt Sixe ? X -2 KIND OF LINER -
SI
DroN Hood Regularor
Filfors Size ??, XPZ Number IV
Chimnsy Location Irisids?- Outside 1,/
7G "2'
Chimney Construetion ?do Z
Smoke Bom6 Wiring Ll
Draft LQ ?U< Test Taq I J
Dow Pressure Liyhtiny Inst. ?
Date Tested
Compony Testing r
Name of Tester ??? ? 12 14_.4
OTHER line-i f'r a
CONVERSION.
HOUSE HEATING TEST RECORD
ADDRESS 4?42419 APT. FLOOR CITY _4?UBURB
OCCUPANT <<°/-n f?'lLi • OWNER Of US
hIEAT LOSS DATE HTG. INST.
IOLD BY 16 ,wr'f/., l • INSTALLED BY A /neS7"i
E4ectrical Work By e-)?Ci Gas Line By /r ?r
TYPE OF HEAT GA FA _4/--HW STEAM SPACE HTR. UNIT HTR. OTHER
GAS DESIGN
? CONVERSION
MAKE ?? MAKE OF BURNER
Model 57)1 ' ?.l C 6 i: %.^r? Model
Sqrial Max. BTU Ratiny
INPUT ?)
nT. :.' MAKE OF FURNACE -
7
Model
CONTROLS
THERMOSTAT s'4 H
t Pl
Ve
t Si
ea
ug
ZL
l ?
Q ze
n
Valve l
(,
?i KIND OF LINER 120"7e SIZE NONE
Limit Droft Hood -?- Regulator ?qjk/ X/G? '2 r - j
Limit Settiny ? Fi Iters 5ize -.20 X1 r X ? ?lumber ?
Fan $atting /GY L.4 Chimney Loeation Inside Outside y
P'ilot Type Chimney Construcfion '000 4'7'0b
Pilot Make JohVjfc,)1 ?a?ltid/r
Pilot Modal G 6 G??? - 3 Smoke Bomb 7- Wiring ?
Pi)ot Timing ?? S fq 1? ? Draft Test Tag ?
L.W. Cut Off '?--~ Door Pressure Lightiny Inst. ?
Pressure Pareent CO ?" a
2 Date Tssted ?f
In ut CFH 160
p Psresnt 0
l70 Company Testing
2
Stvck Temp. -SY5 Psreent CO a yo Name oF Tester 4'?-/?7
235
HOUSE HEATING TEST RECORD
?
a
ADDRESS APT. FLOOR CITY i±-JGUBURB
OCCUPANT OWNER tZg_-
HEAT LOSS DATE HTG. INST.
SOLD BY INSTALLED BY-,?/????°1?
Elsctrical Work By 64v??,_-91 L Gas Lins By ?TYPE OF HEAT GA FA _LHW STEAM SPACE HTR. UNIT HTR. OTHER
,p GAS DESIGN CONVERSION
MAKE MAKE OF BURNER
Model .s 7 9l / SU ?!'> O Model
Seria l ys 8?'G S' ??? r Max. BTU Rating
INPUT f00, 00 D/-f TC/r MAKE OF FURNACE
Model
CONTROLS
THERMOSTAT ?nr/S?QfHeat Plug
Valve LJ f? / f rZoCJ F,-s
Limit U• //t"yPQ
Limit Setting 1,20o
Fon Setting , ? Z"
Pitot Type rl e-e-
Pilot Make (Jh' 4
Pilot Model ?9v
Pilot 7iming
L.W. Cut Off
Vsnt Si:e -' /t x ? 1
KINO OF LINER SIZE NONE ?
Drah Hood Regularor S 2 ? -
Filtxs Size /A A 16 x 7- Number -T
Chimney Location Inside Outside 6Z
Chimney Construetion eo G tl_ t0 ?
5moke Bomb ? Wiring
DrafT Tast Tap _.-,
Dow Pressura Liyhtiny Inst.
/s
Proswre 3' s PeresnT COZ Date Testsd
Input CFH Percent 0 G% Company Tes*ina ?Om?S??
Stack Temp. Percent C02 U7, Name of Tester ,/?? ) /, A>
Form 235
.
HOUSE HEATING TEST RECORD
r.---
?A ?
?-a..
/I,- /'L
1?lT?
?
ADDRESS Zo2?L?Z 624•2• f?i APT. FLOOR CITY UBURB
OCCUPANT --,& ?', N Ai'rti OMfNER ;42- '
HEAT LOSS DATE HTG. INST.
SOLD BY ?,C?r '? f• !' /tlri'd? . INSTALLED BY f,G/?'I
Eleetrieal Work By Gas Lins By
TYPE OF HEAT GA FA k/ H1Y STEAM SPACE HTR. UNIT HTR. OTHER
GAS DESIGN CONVERSION
MAKE MAKE OF BURNER
Mod* l S?C 11i U Model
Serio1 3?? yG ? a 9 s? BTU Ratin
Max
g
.
INPUT S/OD? 4C? G MAKE OF FURNACE
Model
CONTROLS
THERMOSTA T I-.4L.?XQt Heaf Plug
Valve
Limit 4
; ZZ4 44 4/
,
Limit Setting / 9`/ U
Fan Setting P 12,- ??: [./t Cy?•?(?
Pilor Type Irl ?l •
Pilot Make n / fC
Pilot Model ? Sc ' /9s
Pilot Timing
L.W. Cut Off
Yenf Size J/i'. S( i-,
KIND OF LINER SIZE NONE
Droh Hood Regulator -ID S- j
Filtsrs Siza ?? Y-21- x " Number ?
Chimney Loeation Inside Outsids ?
Chimnsy Construetion "Vt, G 4' _-n,/J
Smoks Bomb ?7 -~ Wiring L" Draft , ' A' /1 ?? r C? To:t Tay i'!
Door Pressure "`? Liyhtiny Inst.
Pressure -3'-5-
Pereant COZ ' Oate Tssted
Input CFH Psrcent 02 ? 'Z?ye? Company Testing ;V
Stack Temp. Percent CO 0 Name of Tester ./4°4Z
Form 235
40? I/
HdUSE HEATING TEST RECORD
ADDRESS APT. FLOOR CITY &29-0-*lSUBURB
OCCUPANT r'f, =rr 70?_- L? OWNER 44 4/5'
HEAT LO55 DATE HTG. INST.
SOLD BY INSTALLED BY
Eleetrical Work By Gaa Lina By
TYPE OF HEAT GA I FA (L_HMf STEAAA SPACE HTR. UNIT HTR. OTHER
MAKE.
Modsl _
Sarial _
INPUT
GA5 DESIGN
CONVERSION
CONTROLS
THERMOS7AT C4lls?Gf?!eat Plug
Valve r7lj1J fl;s,f1
Limit L2i2 /O
Limi,t Seftiny
Fan Setting &°ZQ ?4
Pilot Type
Pilot Make
Pilot Model
Pilot Timin4 7,
L.W. cut ofF -
Pressure - ?!?? Percent C02
Input CFH ed Percent 02
Stoek Temp. -fsG a Percent CO
Form 235
MAKE OF BURNER
Modsl ?i
Max. BTU Rating
MAKE OF FURNACE ?
;
Modsl
V ~
Ysnt Sise
KIND OF LINER -' SIZE,y NONE
DraFt Hood Rsyularor
Filtsrs Size --70X 1 SX / Number ?
Chimney Lacation Insids Outside ?
Chimney Consiruction &dY" 7g?
Smoks Bomb -? Wiring ?
/
Draft Test Tap
Door Pressure ----1 Lightiny 1.,:*_
Date Tested
Company Testing
/
Name of Tester ?j ?°-/
9?/?N
>: .?. . .
• ' HOUSE HEATING TEST RECORD
• ADDRESS APT. FLOOR CITY Af-99Q411BURB
OCCUPANT tiC,0" ?c'l/? OWNER L:3? US
HEAT LOSS DATE HTG. INST.
'S()LD BY INSTALLED BY
Electrical Work By Gos Line BY
TYPE OF HEAT GA FA HW STEAM SPACE HTR. UNIT HTR. OTHER
GAS DESIGN
MAKE ? MAKE OF BURNER _
Model -!r-X ?? L (L?j/.?(.1C! Model
Ssrial ?? ?V5?
, Max. BTU Rariny-
/ Ur
IWPUT 7 ,1Ln /t) MAKE OF FURNACE
CONTROLS
THERMOSTAT 1Z:44C--W-Heat Plug
Valve (lG l/ -?yX -G y-5
Limit ,4 ?d /n
Limit Setting
Fm, setrin9 T? r r
Pilot Type 6'Iec
Pilot Make ?G /'A ?s r7 Cor1 f/ [Z/
Pilot Model G6 U/F /3G - 3
Pilot Timing StC-e 1-7 f
L.W. Cut Off -
Prossuro Psrcent CO
2
, Input CFH gb Pareent 0 G
? L
Smek Tamp. ?60 ` Percent CO O%6
Model
I/ ri
Vsnf Size
KIND OF LINER SIZE NONE
Drah Hood -?+ RegulaTOr /70 , S- '
Fi Itsrs Sise -7U X.?SX t Number 14
Chimney Location Inside Outside
Chimnsy Construetion
Smoke Bomb ` Wiring -L?
Draft /U4 fU/ 9l Test Tag _a
Door Pressure Lightiny Inat.
Dote Tested
Company Testing r' J/ C .
Nome of Tsster 1?F? ?1 -, / / -7
CONVERSION
?°' ?y?y• ' HOUSE HEATING TEST RECORD
ADDRESS [ ? ?lL ? /'
?? • ? I APT. FLO R CITY -- SUBURB
OCCUPANT OWNER C1?N S
HEAT LOSS DATE HTG. INST. '-
SOLD BY INSTALLED BY ?'` S 7?? ?1/l?/'nL -
Elsetrieal Work By _' L:? Gas Lins By
TYPE OF HEAT GA FA HW STEAM SPACE HTR. UNiT HTit. ?i-OTHER
? GAS DESIGN
MAKE f 1? ?? BURNI
?
Mod* l Model
Ssriol r/ci c7'S1y
Mox. BTU Rating
INPUT MAKE QE-FtJif?ll
CONVERSION
CONTROLS
THERMOSTAT T??'??J6 ?Heat Plug Venf Sizs
Valvs nq / > 3r KIND OF LINER 1yr°?q l?r°sf??? SIZE Ir' NONE Limit Draff Hood Royulato? 112'1211 /714GZ-
Limit SeHing ae ? Fi Itsrs Size
Fan Setting Chimney Location Inside Ll Outside
Pilot Type Chimney Construcfion l' ?SS l?
Pilot AAake -'
Pilot Model •?? yG' l'?f?%' Smoke Bom6 Wiring
Pilot Timing ?? sn? Drafi e !/ Tsst Tae ..
L.W. Cuf Off Door Pressuro Liyhtiny I.,st_
Proswre ?• S? , Parcent C0? X, Dats Tested %?!
Input CFH =2? ? Peresnt 02 /2 Company Testing 7 ' ?' '?%' ?•
Stack Temp. _? Pereent CO G??, Nams of Tester
Form 235
?..
HOUSE HEATING TEST RECORD
ADDRESS APT. FLO CITY SUBURB
OCCUPANT OWNER C2. ?
HEAT LOSS -- DATE HTG. INST.
SOLD BY INSTALLED BY C42
.
Elechicol Work Gas Line By ,LcQ T /L
TYPE OF HEAT GA FA HW STEAM SPACE HTR. UNIT HTR. OTHER
MAKE.
Model
5eria l _
INPUT
GAS DESIGN
Modsl
CONVERSION
CONTROLS •
THERMOSTAT 7_2.ZlL`F? --?
eat Plug
Valve L&Ln/,F
Limit
?.
Limit 5stting
Fan Setting
Pilot Type
Pilot Moks ?
Pilot Model t• ?? /9 ///?
Pilot Timing Sr"c
L.W. Cut Off
Proswre Peresnf CO
2 c`-
Input CFH Pereant 02 42 - ?o
Stack Temp. l9 S Percant CO L1 7-6
Max. BTU Ratiny
MA K E O F_F?j
Vsnf $ize
KIND OF LINER 12494LgiG? ' SIZE_ ?-NONE
Drah Hood L "' t =+ . C ?, Rpularor
Filters Sixe
Chimnoy Location Inside ? Outside
Chimney Consiruction l ?.,fr ?
---------
$moks Bomb Wiring _-?
Draft ':,4 Test Toy
Door Pressure l'--Lightiny Inst 1
?-
Date Tested n •
-Company Teating
Nome of Tester ?" •'?'`?G ?? ?,-'
Form 235
•` ' HOUSE HEATING TEST RECORD
• ` ? c? r-ri V
ADDRESS /???N /w?-/?/j '? APT. F 0 CITY SUBURB
OCCUPANT 7- OWNER ? 1?
HEAT LOSS DATE HTG. INST. "-
SOLD BY INSTALLED BY
Electrical Work By ? Gas Line By
TYPE OF HEAT GA FA HW STEAM SPACE HTR. UNIT HTR. -40THER
GAS DESIGN CONVERSION
MAKE Q
M NER
Model b Model
$ariol O•s0 ?.f/?r?v 11llox, BTll Rafing
INPUT °??S•, D U C MAKE OF FUR?
CONTROLS
THERMOS,3 ??`F{eat Plug
Valrs V ?\20?
Limit
Limif Setiin9 1770
?
Fan Settiny 7-' m e° ?
Pilot Type
Pilot Maks
Pilot Model O
Pilot Timing
L.W. Cut Off
Mrdaff ?
Vent Size '
KIND OF LINF!I2 <- SIZE?-NONE
Droh Hood Regulamr ???' ?!? :' - ?,-- •; ?
Fi Iters Size Number -~^~
Chimney Loeation Insida I= Outsida 6 `
,<?
Chimnsy Construction ;`
Smoke Bomb Wiring
Draft - 4' Test Top
Door Pressure `r Liyhting Inst.
Prossum s? Percent CO Uata Tesrod
Input CFH a? s Peresnt 02 Company Testing
Stoek Temp. Percent CO 0^ Name of Tsstsr _
Fwm 235
ADDRESS Jzn, OCCUPANT K&A
HEAT LOSS
SOLD BY
V.{.
1
W.
HQUSE HEATING TEST RECORD
C N?? Uf'!W APT. FLOOR CITY SUBURB
_OWNER
iNsT_ _ 0/ .
iNSTALLED BY wP111E (.,. f' .(/?? C
Gas Line sy I.cJP/1 Zt°L
_HW STEAM SPACE HTR. UNIT HTR. OTHER
GAS DESIGN
MAKE f??qne-- MAKE OF BURNER
Model ? I0C+ R Z E Model
Seriol 31COa $3U Max. BTU Rating _
INPUT 47,) MAKE OF FURNAC
CONVERSION
?yy? CONTROLS
HERM ST
T
'
J
? I' A
V
Si I,/
x/
A
-
T -
-
-
- Hspt Plug
F9 snt
ze
Valvs ? t ?
??
'"' r KIND OF L!NER 517F NANE
Limit Droft Nood 1,4 Regulator MAKIjnx-
Limit SeHing ? ???? , --- - - Filters Size b ?sk? NLmbsr
Fan $efting Chimney Location Inside Oufside
Pilot Type O
0f Ch'mney Construction
'`' 11 4-q4 /
'
Pilot Maka J
Pilot Model z $moke Bo
? 'b Wiring
Pllot Timing (
Droff i?fCe Test Tag
L.W. Cut Off Daor Prossure Lighting Inst..
Prsssuro ? Percent CO 2 ? n Dote Tested o D
l
Input CFH 0 / Pereant O2 ?' 7 Company Testing ,t/'
Staek Tamp. 7 u Percent CO h Name of Tester ,J
Form 235
Model _-