1301 Corporate Center Dr - Heating Test RecordsHOUSE HEATING TEST RECORD83 L? C-_ac?w??,plaR.e ??
ADDRESS / ? D 1/+'. DX??pT. ? FLOOR CITY ?SUBURB
OCCUPANT ? - ?/OITl?D OWNER ?;% GIS
HEAT LOSS DATE HTG. INST.
SOLD BY INSTALLED BY
Elaehica) Work BY L Gas Lino By !C
TYPE OF HEAT GA FA HW STEAM SPACE HTR. UNIT HTR. OTNER l`TD
fJ GAS DESIGN CONVERSION
MAKE ?. f 25e OF BURNER
Model Model
Ssrial 29
y ?7/ Max. BTU Rating
INPUT MAKE OF FU
THERMQSTAT4'Nf--L?'7?YfHeat Pluy `r- VMt Size /K
Valve ?UL4,r"1- KIND OF LINER E NONE ?-
Limit ,L-5Droft Hood R lat s72
Limit Setting Filters Sixe
Fen Setting Chimney Location ? 'Outside
Pilot Type Chimnsy Consirudion
Pilot Make
Pilot Model Smoke Bomb Wiring „
Pilot Timing ' aft Test Tay
L.W. Cut Off sw ,? oor Prossuro Lightiny lnsf".?'`? - ?
Prossure ? ?'W"CPereentC02 7- rp,6 Date Tested
Input CFH Z?Q Pereent 02 Company Testing GS ? ? J
Stack Temp. p Pereent CO Name oF Tester
Form 235
ADDRESS
OCCUPANT _S,
HEAT L055
SOLD BY -?
Electrical Work By
TYPE OF HEAT
MAKE
Model
HOUSE H EA
HTG. INST.
?T RECORD ? , ?'..<?? :? '
. FLOOR CITY SUBURB
E R Q AL/S
IMSTALLED BY
Gas Line By
GA FA ?HW STEAM SPACE HTR. UNiT HTR. OTHER ??'nL -
CONYERSION
Seria l _
INPUT
Valve -w-.4
LimiY ?.?
Limit Setting
Fan Setting -
___---
Plug
Model '
Max. BTU Rating
MAKE OF FURNi
vent s;Ze _=:?
KIND OF LINER_
Oraft Hood Ae!??
Filters Siz
Chimnsy Location
?y
Pilot Type TLla/V /C4 Chimney Construc ?
i
Pilot Moke
Pilot Model oke Bomb
Pilot Timing ??-???-??? aft ?1?? ast Tag 3
L.W. Cut Off ?- Door Pressure J1 Lighting Inst. 1
/? ?i
Pressure 9-???•Percent COZ '•Q Date Tested
Input CFH Percent 02 • U?o Company Testing ?
Stack Temp. ? Percent CO e Name of Tester
Form 235
ADDR E55 0 ?
OCCtYPANT S t?1
HEAT LOSS?'?
SOLD BY -
Electrical Work By ?
TYPE OF HEAT G4
MAKE.
Model
Seria l _
INPUT
TH ERMO"STATf''?/(/ri/G
Va lve ?G! G?? /.1w ?
Limit ?? ? AZ,;f
Limit Setting
?-
Fan Setting ?
Pilot Type
PiloT Make
Pilot Model
Pilot Timing?
L.W. CuT OfF
Input CFH_
Staek Temp
Form 235
HOUSE HEATING! TE?S?T RECORD -77 APT.FLO R CITY SUBURB ?_
? OWNER ??us
' HTG.INST. -
? 1G AK- INSTALLED BY??C???ST/G
T
S ? Gas Line By
FA HW STEAM SPACE HTR. UNIT HTR. OTHER
E OF BURNER
Model
Mox. BTU Rating -
MAKE OF FURNAC
Plug Yent Size
KINO OF
Filfers - Size Number / v`
Chimnay Location Insida Outside L/
Chimney Construction
moke Bomb Wiring
aft ?/??./GC?J Test Tag
Door Pressure ?- Lightirtg In:*_ /
'Percent CO2 ' 49,p? Date Tested -
PercenT 02 ?/pd 7 Company Testing
Percent CO 0? ?/a Name of Tester _
HOUSE HEATING` TEST RECORD
ADDRE55 v,?5 APT.FLOOR CITY SUBURB
OCCUPANT E DODD OWNER ZpWs
HEAT LOSS - ATE HTG. INST. '-'
SOLD BY B?Al, INSTALLED BY
Electrical Work By _' rkQOfi <Gas Line By ?G +
TYPE OF HEAT GA FA --' HW STEAM SPACE HTR. UNIT HTR. OTHER
DESIGN C ?SION
MAKE M7fIE BURNER
Model Model
Serial 64/? Mox. BTU Rating
INPUT Z _aZF_? MAKE OF FURNA _ _ ;
/?
THERM05TAV?/?C-K--,,//T MeaT Plug Vsnf Size ?- czppr,
Volve KIND OF LINER F/j?-_? N NE
0N SIZ
?
--
-
?
Limif Drcft Hood ?
Rsgularor,//
?
"
?? -J
-!
LimitSetting e ?? ?
/
?
Filtero Size7- ?7XZSX? Number
Fan Settin9 b li??v
Chimney Location
Inside Outside d
Pilot Type A?_L.?TriL Chimne
Construetion
y
Pilor Make ?r
s
Pilot Model $moks B
omb-- Wiring ?
Pilot Timing ?
n,
Draft Test Tay ? a
-
L.W. Cut Off
Door Pressure ? ?
Lighting Inst.
P
p
C
7/ -5- 4?O D
T
d &?7
rossure
ercent
O
2 ate
este
Irtput CF pereent 02 tIO - Company Testing
Stock T4. Percent CO 10
Name of Tester
Form 235
HOUSE HEATING TEST IZECORD f- 1C' e3 3 C-AU. oFt=- PK
?? ? ?530 0? o pC --
ADDRE55 ?v APT. ' FLOOR CITY SUBURB_ST__T.
OCCUPANT} ?v`' ` OWNER
HL .4 LO55r DATE HTG_ INST. - t 'T' 4( _
JULL7tfT ' 14-11'1 `+ 1 :!!!2!!" INSTALLED BY
Electrical Work By Gas Line By ??+--?•
TYPE OF HEAT GA FA HW STEAM SPACE HTR. UNIT HTR.
7
A/U
GAS DESIGN
46 O CI
MAK E MAKE OF BURNER
Model Model
Serial ? 1 G 3? ?
, ??.7 Q? Max. BTU Rating ?
INPUT 1
70 0 Oa 0 MAKE OF FURNAC J
Model iIIV A
THERMHeat Plug Vent Size
Valve KIND OF LINE
Limit h Draft Hood _
Limit Setting
Fan Setting -
Pilot Type _
Pilot Make _
SIZE NONE
Filters Size Number -?r
Chimney Location Inside Outside
Chimney Construdion
Pilot Model Smoke Ba b Wiring
Pilot Timing Draft ?• (i Test Tag
L.W. Cut Off " Door Pressurs Lighting Inst.
Pressure ?1 +r Percent CO2 ' l Dote Testsd L? ??""
r
Input CFH Pereent 02 ' Company Testing
Stack Temp. '? V Percent CO ? Name of Tester
Form 235
"tiQUSE HEATING TEST RECORD
ADDRESS APT. ! FLOOR CITY SUBURB
OCCUPANT OWNER
HEAT LOSS DATE HTG. INST. 9_-Zf? 4
SOLD BY _ INSTALLED BY - '-- -*
Eleehical Work By Gas Line By ?,• A •`i ?- '
TYPE OF HEAT GA ' FA HW STEAM SPACE HTR. UNIT HTR. ! DTHER
GAS DESIGN CONVERSION
MAKE ?- --- MAKE OF BURNER
Model Model -
Seriol , I ?'`? ?? - r?; ,?' j• L? Max. BTU Ratiny
INPUT L.{"j' MAKE OF FURNACE
Model
CONTROLS
THERMOSTAT:? Heat Pluy Vent Size
VO11° KIND OF LINER
-
Limit Drah Hood
Limit SeHing k (-J Filter: Sizs?
FO^ SeN'^9 Chimney Loeation
Pilot Type 1n•??tnr,?.-c_ Chimney Construction
Pilot Maks
Pilot Model ' Smoks Bomb
Pilot Timing
L.W. Cut Off
Draft
Door Pressura
Outside
Wiring
Tsst Tag-
Lighting Inst.
E
Prossure Peresnt C02 Date Testsd Input CFH Pereent 02 ?1" +- Company Testing _
5tack Tsmp. _Peroent CO - Name of Tester
Form 235
HOUSE HEATING TEST RECORD
I ? " 1 ?,-?--? Crs-,?,.- 0-??-f `.?
ADDRESS AP7. ' FLOOft CITY SUBURB
..,- . .
OCCUPANT OWNER
HEAT LOSS ATE NTG.,?NST.
SOL? BY r'INSTALLED BY
Electrical Work By -Gas Line By
TYPE OF HEAT GA FA HW STEAM SPACE HTR. UNIT HTR. OTHER
GAS DESIGN
MAICE MAKE OF BURNER _
Model Model
5erial Max. BTU Rating -
1NPUT 000 MAKE OF FURNACE
Model
plu9 'f? N 0 Venf Size
CONYERSION
Valve KIND OF LINER-
Limit Draft Hood
Limit Setting 5 d Fifters Size-
Fan Setting Chimney Locction
Pilot Type Chimney Construcfian
Pilot Make
SIZE NONE
Regularor
Inside
Pilot Model Smoke B?j Wiring
Pifot 7iming I)?oft v• ` Test Tag-
L.W. Cut Off Door Pressure Lighting Inst.
?-,
Pressure 3' Percent C02 Date Tested
Input CFH Perceht OZ U. 5 Company Testing ?
Sfatk Temp. > p y Percent CO Name of Tester ?
Form 235 .
HOUSE HEATING TEST RECORD
AaDRESS 1??? i s ?' y?? FM1 ? Tf y R CITY SUBURB
,
OCCUPANT pTr
?' FLOd
? APT.
T -
ONfNE[t
HEAT LOSS DATE HTG. INST.
f-- ?
r
;i'i
'?C3r
00
SQLD BY ,.:
G.
,
"?'
INSTALLED BY
Eieetrical Work By I!
Gas Line By 1x 00
TYPE OF HEAT GA FA HW STEAM SPACE HTR. UNiT HTR. OTHER ?
G 5 DESIGN CONVERSION
MAKE MAKE OF BURNER
Model
Serial ?
4- Max. BTU Ratiny
.
q
INPUT V
%
MAKE OF FURNACE
,
Modei
? ,?CONTROLS
' THERMOSTAT
S
V
Heat Plug
Valve j G`' °`- ^' 7 fi32 d' ont
ize
KIND OF LINgR SIZE NONE
Limit i7 DraFt Hood I 'h,'' ' Rsgularor
Limit Sstting Filters Size I` % Numbsr ,
Fan Setting ?' ???' J ?-4 ?'? Chimnsy Location Inside Outside
PilotType lcL..:c- i''.it,? .
K • ?'
Chimney Construction
Pilot Make ' ? ", h ' " , "1
Pilot Model Smoke Bomb Wiring
Pilot Timing Draft ? f? Test Tap
L.W. Cut Off Doar Pressure Lightirtg Inst.
c t I
Pressure Pereent CO Dote Tested
?
Input CFH
Pereent 02 Company Testing er-
r
Stack Temp. Peresnt CO ir
Nome of Tsster
Form 235
HOUSE HEATING TEST RECORD
ADDR ESS ^
APT. FLOOR CITY SUBURB ?
OCCUPANT. T OWNER
HEAT LOSS DATE HTG. INST. 11' I1"?-
SOLD'dY
INSTALLED BY l
Elechicol Work By Gas Lins By
TYPE OF HEAT GA FA HW STEAM SPACE HTR. UNIT H7R.X_'OTHER
GAS DESIGN CONVERSION
MAKE MAKE OF BURNER
Model I. Model
Serial Max. BTU Roting
INPUT , ? ? U MAKE OF FURNACE
j Model
CONTROLS
THERMOST T Heat PIugT.$3(/ C Vent Size
VcIre eJ?.. KIND OF LINER SIZE NONE
L
Limit Draft Hood Reyuloror '?}
Limit 5otting
Fan Setting _
Pilot Type _
Pilot Iv4ake _
Pilot Model _
Pilot Timing
L.W. Cut Off
Filters Sizs
Chimney Location Inside Outside
Chimney Construction
Smoke Bomb Wiring
Draft ? ` Test Tag-
Door Presaure Lightiny Inst.
Prossurs 3u ? Peresnt CO '7? Date Tested `- ?
Inpuf CFH Peresnt OZ? 7e1- Company Testing
Stack Temp. Pereent CO Nome of Testsr
Form 235
HOUSE HEATING TEST RECORD
ADDRE5e BURB
S APT. FLOOR CITY SU
I OCCUPANT WNER
I HEAT LOSS DATE HTG. INST. W41
SOLD BY IHSTALLED BY
i•
? Eleetrical Work By Gas Line By
TYPE OF HEAT GA FA HW STEAM SPACE HTR. UN17 HTR. OTHER 1`7-? 0)X2
? GAS pE51GN
MAKE ? MAKE OF BURNER _
Modsl AAodel
Serial AAax. BTU Rotiny -
INPUT coo 0 7- MAKE OF FURNACE
Model
THERMOSTAT *at plug Vent Si:e
Valve - KIND OF LI R - SIZE NONE
Limit ? dq- Drah Hood ??'~ Royulamr
Limit Satting ?? Ffltara Size 3U ZSAI-Number J
?Fun Ssttin9 , Chimney Loeation Insido Ovtsida
Pilot TrPe Chimney Construefion `"-'-
Pilot Mak•
Pilot Model Smoks Bom6 Wiring
Pilot Timing Droft Test Taq
L.W. Cut Off Door Pressure Liyhtiny Insf.
Preasure Psresnt COZ 7' ? Date Testsd
I Input CFH Psreent O Companr Testiny
Stoek Temp. Pereont COZ b Name of Tester •?~-9-'"
Form 235 ? - -- - - - ._. ? _ _- -- - - - - ' .
CONVER510N
??6 -7,
HOUSE H
ADDRESS _
OCCUPAHT
TEST RECORD
?Y l/
APT. ?L(?aR??TY??SUBURB
OWNER
SOLD BY INSTALLEd BY
Elschical Work By Gas Line By
TYPE OF HEAT GA FA _<HW STEAM SPACE HTR. UNIT HTR. OTHER
MAKE.
Model_
Ssrial _
INPUT
10
Ir4odel
Oax. 8Tt! Rattng
CONVERSION
Valre ??
Limit
Limit SsMing
1---
Vsnt Sixe
KIND OF LIN SiZ -?- NONE.
Drah Hood N Regularor ? ? ?? -?
Fi Iters Size. Z- Sx umber
?_----- ?-•
Fan Setting v Chimney Location Insids Outside
Pilot Type l Chimney Conattuction J--
Pilor Nlake
Pilot Model Smoke Bo bWiring
Pilot Timing 1 Draft,/?/ Test Tap
L.W. Cut Off ? Door Pressurs r?iyhtinp l„s*-
Prossura Psrtent CO2 0 0 Date Tested 7
Input CFH 0 Psrcent 02 Company Tssting ? ?-
Stack Temp. Pere*nt CO Nome of Testar
Form 235
HOUSE HEATIMG TEST RECORD
ADDRESS
OCCUPANT OWNER
HEAT LOSS A HT
SOLD BY INSTALLED BY ?
Elsehieal Work By Gas Line By
TYPE OF HEAT GA FA H1?h,_STE/?ffi SPACE HTR. UNIT HTR. OTHE 727
eq2AESIG? CONVERSION
MAKE-??-7?-?? ? EBURNER
Mod.l 7r, J U 1" „ ?\ ??' u., a1 --
Seriol _
INPUT
THER ' '--? ?
Val
Limit ?
Limit SeHing ?
Fan $stting ? /?-
Pilor Trpe c G/?/L/" C1 1
Pilot Make `.....-
Ma'x. BTU Rating
MAKE OF FURN,
Vent Sixe
KIND OF LIN SIZE NONE
Draff Hood ? L pulawr
Fi Iters Siss Z?J r._ ?
Chimney Loeation Inside Ovtside
Chimney Const?uction
?--
Pilot 4Aode1 Smoke Bo b M?irinq
Pilot Timinq Draft ? Test Top
L.W. Cut Off Door Prossure -? Liphtiny Inst.
Presswe -?' -? Percent C02 ' D ? Date Testrd
; '
Input CFH Psresnt 02 ? Company Teatiny
Stoek Tomp. Psrcent CO Nams of Tsster
Form 235 /
' HOUSE HEATIAIG TEST RECORD
ADDRESS APT. F?O CI SUBURB
?,??
OCCUPANT OWNER %f '?r_ ??
HEA'f ZQSS • TE H7?f !NS .
50LD BY ? ??? ?? / . , INSTALLED BY ??• ' =? " ? ????C
Electrical Work By Gaa Lins By f?? ,?l? r• f???/«?"
TYPE OF HEAT GA FA HW STEAM SPACE HTR. UNIT HTR. OTHE '`?`"
DESIGN ? • CONVERSION
MAKE CE OF BURNER
Modsl odel -- ?- -
Serea) ? Z Max. U Ratinp
INPUT J M E OF FURNA
?- odsl
CO ROL S ? ?-
THERMQ?Tf?y eat p ? ? Yent Si:e
Valve KIND OF LfN SlZE -140NE
Limit ? Drah Hood ? Rsqvlator
Limit Setting Filters Sizs 7444Ox Numbsr? _
Fan Setting ?G Chimney Location Inside Outside
/
Pilot Type G Chimner Construction
Pilot Make J? f-- - /
Pilot Modsl ? Smoke Bomb Wi?ing
Pilot Timinq Draft Test Tay
L.W. Cut Off? d Door Pressure Liyhtirty Inst.
Pressuro Peresnt CO2 Date Tssted
Input CFH Pereent 02 ' J U Company Teating
Staek Temp. G Rsresnt CO Name oi Tsstsr - ?
Form 235
• ' HOUSE HEATIMG TEST RECORD
?17"'L `i-r'
ADDRESS Y SUBURB
APT. F O ?-
C? T
?
OCCUPANT `
,
OWNER
HEAT LOSS AIySTj.
SOLD BY /G INSTALLED BY
Eleetrical Work By Gas Lins By -
TYPE OF HEAT GA FA H? ST M SPACE HTR. UNIT HT12. OTHER
/ ??;? G
?/-? ?1 AS ESIGN ?
Q CONVERSION
MAKE ( M4 -131.11MEl
--
Model ? `_ ---
M et
--
Seriol . . z. 8TU Rating
INPUT MAKE OF FU
Model
TROLS
?
?
C/
THERJAO - ? ? ? /
sat Plug ?
Vsnf Sixs
Volve` ~ KIND OF LINE - SIZE 'NONE
?
Limit Draft Hood a? ReyulaTOr
Limit Setting Filtsrs Z umber
Fan Setting ? Chimney Loeation Inside Ovtside
Pilot Type Chimnay Constniction
Pilot Make
Pilot Model Smoks Bopib VYiring
T
Pilot Timing
?- Qraff Test
ag
-
._
L.W. Cut Off
(/
J /
e Door Pressure LiyhtinQ Inst.
Z/
.
Pressuro -?' 7
Peresnt Cp Date Testad
Irput CFH 2
Pereent 02 ' S
?? Company Tasting
Stack Temp. Parcent C0 - Name of Tester
Form 235
I . . .
HOUSE HEATIMG TEST REGORD
ADDRESS =!1/ • /c- // APT. FI?O. R C TY SUBURB
?
-
OCCUPANT OWNER ?_. ??
?
HEAT LO55 DA E HTG, NSJ.
soLv sY j
INSTALLED BY :
..
Elaetrical Work Bq Gas Line B
' ;r;?
y
TYPE OF HEAT GA FA HW STEAM SPACE HTR. UNIT HTR. OTHE
DESIGN ? CONVERSIOht
MAKE AKE RNER
Model Modsi
Serial -7 $TU Ratiny
INPUT ??, ,,??, ,,A eKE OF FyR*
THERMOST e? 9 Vsnt Size
Volre KIND OF LIN?j /R?4L? `- SIZ NON
L i m i t l Drak Hood v"??f ? RayulaTOr AG
Limit Sstting J?L Filtsrs Size' -IV-7- umber
Fan Setting Chimnsy Location Inside Qutsida
Pilot T ?
ype ?_ t T Chimney Construdion
Pilot Make
Pi1ot Mode1 Smoks B?Tb n Wiriny ? -
Pilot Timing Draft L?/faL Test Yag
L.W. Cut Off ? Door Pressure Liyhtiny inst.
?/? i ,
Prossure ?? - D `/ v • r- Pareent CO ? Date TesNd
Input CFH Percent Q2 77 Company 7estin // IC
9 ,
Stock Tamp. --?? ? Percent CO ? Name of Tester
v • {
Form 235
- L c?r i o
AG"JRESS { ?() I C_
O&UPANT
EATING TEST RECORD
OWNER
FLOOR
CITY SUBURB
HEAT LOSS DATE HTG. INST.
QSrt ?- 11- b`(
SOLD BY INSTALLED B Y
Eleetrical Work By Gas Line By
X? ?? II
TYPE OF HEAT GA FA HW STEAM SPACE HTR. UNIT HTR. OTHER aa U?
GAS OESIGN CONYER510
,
P?? ?
' ?
MAKE
C MAKE OF BURNER
Model 4 C? t.f -` v?% C Model
Ssrial Max. BTU Ratiny V ` ?
INPUT ?c O hr.? U rJ MAKE OF FURNACF
Model
rCONTROLS
THERMOST
T B
?
I
Heat PI g Vent Size
Valve KIND OF LIN 1A IZE NONE
?
f-
T A
Limit d ? - , Droh Hood '? ` ? I
Regvlaror
Limit Settiny ?3_ Filters $ize ?V I Number ?
Fon Setting T??^ ?' ??? 1`/ '/ f ?'?'.:.'T? ?- (himney Loeation Insids Outside
Pilot Type Chimney Construction
Pilot Make
Pilot Model Smoke Bomb Wiring
T
?'? ?
--
Pilot
iming Droft
t Test Tag
L.W. CuT Off Door Pressvre Lightiny Inst.
?
Prossuro ? Pereent CO2 Date Tested , ? G?
^
Input CFH `3r `= Pereent 02 Company Testing ? ? ? < < l
$ioek Temp. Percent CO ? Name of Tester ?A--
Fwm 235 !
? ./
_,AdMeb#C. M£?aniCrt?
HOUSE HEATING TEST RECORD
ADDRESS ? ? r ? ?- ???•}'-? :?"` APT. FLOOR CITY SUBURB
OCCUPANT N -- I OWNER
HEAT LOSS D, ?TE HT INST. I?'SLI
SOLD BY t?°Z' ? c ? ?? ?-ti ??O ?t't? ?- 9G'?G
INSTALLED BY
Eleetrical Work By Gas Line B ?
r
TYPE OF HEAT GA FA _r_HW STEAM SPACE HTR. UNIT HTR. OTHER
MAK E t-3O ? ? , en GAS DESIGN
MAModel ? ? ? ? ?- KE OF BURNER _
Model
Serial ~5 ", v Max. BTU Rating -
INPUT 80 MAKE OF FURNACE
Valvs
Limit F
Limit Sstting
Fan Setting _
Pilot Type _
Pilot Make _
Pilot Model _
Pilot Timing
..•- /CONTROLS
J5,' Heat Pli
Model
Vent Size
KIND OF LINE
SIZE NONE
Drak Hood Ragularor
Filters $izeNumbar
Chimney Location Inside Outside
Chimnsy Construdian
Smoke Bomb Wiring
Draft Tsst Tag
L.W. Cut OfF Door Pressurs Lighting Inst.
Prossure Percent CO Date Tssted
Input CFH Pereent 02 ? Company Testing
Stack Temp. Percent CD Name of Tester
Fum 235 r . ?
CONVERSION
HOUSE HEATING TEST RECORD
ADpRESS t'> -ri.92--,,,?, 'ApT.' FLQOR CITY St18t1RB v Y?
?
OCCU PAN T??"'? OWN E R ?
HEAT Ld55 DATE NTG. INST. ?^l ?A_"
?
}
SOLD BY-?,?_? INSTALLED BY fl ,*=3---Q'--nZ, L
Elscfrical Work By Gas Line By ? 1 t t
TYPE OF HEAT GA FA _?_'HW STEAM SPACE HTR. UNIT HTI2. OTHER
GAS DESIGN CONYERSION
MAKE ?- ?AiertmL MAKE OF BURNER
Model C15; k-, _ 4c, E •, :? [ '3 Model ?•'?P'G"'i" ?
Serial Max. BTU Rating
INPUT r•',a' n?
* .1 MAKE OF FURNACE
„
r
Model
CONTROLS
THERMOSTAT Heat Plug Vent Size
Valve ')I t'??Fe?+ l
` lli ? lKIND OF LINER SIZE NONE
Limit J!?• Drah Hood Regulator
LimitSetting-???? 0 +?_Ei
Filters Size?o)L--lW? Number ?
Fen Satting jI'•1' (=??/ 77 f Chemnsy Localion lnside Outside
Pilot Type f`?..y_ ?''?Y.?'?• Chimney Construction
PiloT Make ?y?y ?rq
?
Pilof Model ?(? ??
Smoke Bomb
Wiring
Pilvt Timing ?i ? L
Draft 0 i Test Tag
L.W. Cut Off "`----??" Door Pressure Lighting Inst.
P
e
P
C0
? ?`? D
T
d t"' r l
r
ssure
srcent
2
• ate
esfe
Input CFH Percent 0 ?• ? Company Testing '
2 ?
Staek Temp. Percent CO 4
C? Name of 7ester t
/
Form 235
' HOUSE HEATING TEST RECORD
ADDRESS APT.' FLOOR CITY SUBURB
OCCUPANT 17, IAtl 'S 14 C-2• OWNER
HEAT LOSS _DATE HTG. INST. (l
SOLDBY trct12A.rrftl:.. INSTALLEDBY I" ?" I-S? - t: r77L?GL
Electrical Work By Gas Line By j 1 4 k
TYPE OF HEAT GA FA HW STEAM SPACE HTR. UNIT HTR. OTHER
GAS DESIGN CONVERSION
MAKE 'L? r?; MAKE OF BURNER
Model '- ?3 • " :":7 ' t h` Model
Sxial u>? Max. BTU Rating
INPUT a MAKE OF FURNACE
Model
CONTROLS
THERMOSTAT
Heat 4y
Vsnt Size
g
Valve ?- i, 'c? b`t"? ?F 4?0? 1 KIND OF LINER SIZE NONE
Limit T\"• t '? t^ Draft Hood Regularor
Limit SaNing Fi Iters Si:e nlumbsr ?
Fan Set4ing ?'• Ns 91- Chimnsy Location lnside Outsids
?L'Lz,.1
Pilot Type t-
Chimney Construction
Pilot AAake ? ?'=` •'N. S
Pilot Model r=
?-? Smoke Bomb Wiring
f
Pilot Timin g 'U D r a f t ? T e s t T a
g
L.W. Cut Off Door Pressure Liyhtiny Insf.
,
'
Prossure
? Pereent C0 Date Tested
2
Input CFH Percent 0 Company Testing
$tcck Temp. 'A -Percent CO C) Name of Tester
? •.
Form 235 J "
HOUSE HEATING TEST RECORD
ADDRESS ? C IN 2 ?- 7 ,c ' d . • APT: FLOOR CITY SUBURB
OGCUPANT I? OWNER
HEAT LO55 DATE H G. INST. 42, ??
SOLD BY ? 'r-
r? i?4 Y, 4 T r'c- /`h ! r= L INSTALLED BY fh (k
Eleetrieol Work By Gas Line By
TYPE OF HEAT GA FA -'*_HW STEAM SPACE HTR. UNIT HTR. OTHER
GAS DESIGN CONVERSION
MAKE C 11 ei j? ..'? MAKE OF BURNER
Model Model
Serial ?.?5 7 4 Max. BTU Rating
INPUT MAKE OF FURNACE
CONTROLS
THERMOSTAT ~T Heat Plug
Yalve -iQ]i'c '1' 4=?
Limit ? t- . ~ •?TT'
Limit SaHing
Fan SeHing
Pilot Typs
Pi lot Make ; ?, • r+ ? 04 Z
P i I ot Mo de I
Pilot Timing ? =-?"•?
L.W. Cut Off
Prossure Percent C02
Input CFH Peresnt 02 ?• ?
Stack Temp. Peresnt CO
Form 235
Model
Vent Size
KIND OF LINE
Draft Hood
Fi Iters
SIZE NONE
RegulaTOr
Size fi $? L Number `
Chimnsy Loeation
Chimney Construetion
Outside
Smoke Bomb MYiring
Draft Test Tag-
Door Pressure Lighting Inst.
DaM Tssted ? - - I '
Company Tasting ' -
Name of Testsr
?,;
HOUSE HEATING TEST RECORD T
ADDRESS APT. FLOQR CITY SUBURB
OCCUPANT OWNER .
HEAT LOSSDATE HTG. INST. 55
SOLD BY ?. ? *?`-?, ,'-?- ? •, -? ?? ??..-1
INSTALLED BY
Electrieal Work By 1?" Gas Lino By
TYPE OF HEAT GA FA HW STEAM SPACE HTR. UNIT HTR. OTHER 4Zr?> ,
GAS DESIGN CONVERSION
MAKE MAKE OF BURNER
Modsl L J J rQ 3/ I/SL? Model ?
Ssria l IF,/ GU 3T? Max. BTU Rufiny
INPUT MAKE OF FURNACE
Mod•I
CONTROLS "
THERMOSTAT Heot Plug
Valve
Limit
Limit SeNiny % t; °
Fan Settiny c-fSc-?_
Pilot Type
Pilot Maks
Vsnt Size I
KIND OF LINER SIZE NONE ?
Draft Hood Regularor
Filtars Size Number -
Chimney Location Insids
Chimney Construction
Pilot Modsl Smoks Bomb Wiring
Pilot Timing " Draff Tsst Tap
L.W. Cut Off Door Pressure Lighting Inst.
-, /
Prossure 1' r Porcent CO2 Dats Tested
Input CFH Peresnt 02 Company Tesiing r-Staek Temp. 3Pareent Co -% Name of Tester
Fo?m 235
r . . . . _ . . . _ . . .
, HOUSE HEATING TEST RECORD
ADDRESS qpT. FLOOR CITY SUBURB '- -
OCCUPANT OWNER
HEAT LOSS DATE HTG. INST
SOLD BY `--??-•?U ?` ?? INSTALLED BY
Elsetrical Work By `•t?- Gos Lin• By
TYPE OF HEAT GA FA HW STEAM SPACE HTR. UNIT HTR. OTHER ` ? GAS DESIGN CONVERSION
MAKE MAKE OF BURNER
M°d°l Modal
Ssrial k Mox. BTU Rating
INPUT ifoo
MAKE OF FURNACE ' j
Model
CONTROLS
THERMOSTAT ' 2LI "-y Heat Plug ' Vsnt Size
Valre KINO OF LINER SIZE NONE
Limit Draft Hood --?-4?-- Reyulamr
LimiT Sattiny y d ° Fihers Size 0 Y! Number
Fan Sstting Chimney Location Inside 0 t? side
Pilot Type • = Chimney Conshudion
Pilot Make
Pilot Model
Pilot Timing-
L.W. Cut Off _
Smoks Bomb Wiring ?
j
DraFt ? Test Tap ? -
Door Preasurs Liyhtiny Inst.
Prossure ? Peresnt CO f ? 2 Date Tested
Input CFH ? Peresnt 0 Company Testing *'+-`?- - -
2
Stack Temp. ? 7 ? 7 Pereent CO Nome of Tester
Form 235
HOUSE HEATING TEST RECORD
ADDRE55 APT. FLOOR
OCCUPANT OWNER
HEAT LOSS DATE HTG. INST
CITY SUBURB -
r• 'A
SOLD BY INSTALLED BY Electrica) Work By Gas Lin• By ' ?TYPE OF HEAT GA FA HW STEAM SPACE HTR. UNIT HTR. OTHER
. GAS DESIGN
MAKE ?MAKE OF BURNER _
Mod.l ?„-rti tiT l?i 1?Q Model
5xia l 4
Max. BTU Ratiny -
INPUT MAKE OF FURNACE
? CONTROLS -
THERMOSTAT Heaf plu9
Valve --'-L?
Limit
Limit Setting ? J C,
Fan Sefting
Pilot Type d 4
Pilot AAake
Pilot Model _
Pilot Timing
L.W. Cut Off
Model '
;
Vent Size .
KIND OF LINER SIZE
Drah Hood Regulator
Fiiters Size ' "Number 7
Chimnsy Location Inside Outside
Chimnay Construction
$moke Bomb Wiring
,c.
Draft Test 1
Door
Lightiny Inst.
Pressuro 3• ? Pereent C02 1' Date Tested S r
Input CFH Percent Q2 ? '-' Company Teating
Staek Temp. Percent CO ? Name of Tester Form 235
CONVERSION
HOUSE HEATING TEST RECORD
ADDRESS ? ? -> ? ?'?-Q ? << L?C°? 1 • APT. FLdOR CITY SUBURB -
OCCUPANT OWNER
HEAT lOSS _ DATE HTG. INST.
SOLD BY _ ` '-= , • INSTALLED BY
Eleetrical Work By Gas Lina By
TYPE OF HEAT GA FA HYif STEAM SPACE HTR. UNIT HTR. OTHER ' ?
!Z?, GAS DESIGN CONVERSION
MAKE MAKE OF BURNER
M°del Modsl
Ssrial Max. BTU Rating
INPUT MAKE OF FURNACE
Model
_ CONTROLS '
THERMOSTAT Heot Piug Vent 5ize
Valve KIND OF LINER SIZE NONE
Limit DrokHood Regularor
Limit Settin
g ??U Y Filt Size L Number ?
Fan Sertin
9 Chimna l.oeation Insi.da Outsid•
Pilof T %-' !? •- `' `?? YPe Chimney Construetion
Pilot Make
Pilot Model Smoke Bom6 Wiring
Pilot Timing
L.W. Cut Off
Draft
?
Door Pressu'-re-).
Pressure Pareent CQZ ? Data Tested Input CFH •'? ?? Percent 02 -7, ? Company Testing -?
Staek Temp. Percent CO Name of Tester
Form 235
.Test Tay
Lightiny Inst.
HOUSE HEATING TEST RECORD
AQDRESS Z
APT. FLOOR _
OCCUPANT OWNER
HEAT LOSS DATE HTG. INST.
SOLD BY INSTALLED BY
Electrical Work,By Gas Line By
TYPE OF HEAT GA FA HW STEAM SPACE H7R. UNIT HTR. OTHER . VAJ Ut.'111iN
MAKE MAKE OF BURNER _
Model Model
Sec1Ot Max. 8TU riating _
INPUT ? 4 MAKE OF FURNACE
CON7ROL5 ?
- -?
THERMOSTAT Hect Plug
ValVe • r?_!. i '
Limit ?
Limit Sefting
Fah Setting
?
Pilot Type - - `--'
Pilot Make
Pilot Model
Pilot Timing
L.W. Cut Off
Model -
Ysnt 5ize
KiND OF LINER SIZE NDNE
DraFt Hood Regularor ?
Filters Size <? y ! Number ..r
Chimney Loeation Inside Outside
Chimney Construction
Smoke Bomb Wiring -
Draft - r ' Test Tag
Door Pressure Lighting Inst.
Pressuro Percent CO 2 Date Tested ''S
Input CFH ' Pereent OZ " Company Testing
Stack Temp. Percent CO Nvme of Tester
CITY SUBURB -^--
CONVERSION
?
Fotm 235
ADDRESS
OCCUPANT ';5 f
HEAT LO55
SOLD BY ? ?,,
Elsetrical Work By '
TYPE OF HEAT GA
'ALLED BY
Line By r 1 ! II
FA HW STEAM SPACE HTR. UNIT NTR. OTHER
, GAS DESIGN
MAKE MAKE OF BURNER _
Model Model
Seria) Max. BTU Rating -
INPUT MAKE OF FURNACE
CONTROLS . ?'
THERMOSTAT Heat Plug y
Vo Ive
Limifi
Limit Sstting
Fan Setting CG
? U
Pilot Type
Pilot Meke
Pilof Model
Pilot Timing
L.W. c„r off
Pressure
Input CFH
Smck Temp. '
-'
? - '1 Percent CQ2
Pereent 02
Pereent CO
Form 235 ~
. . _ . .. . . . , ?_.., _ -
. HOUSE HEATING TEST RECORD
2-?APT. FLOOR CITY SUBURB
Vent Size
KIND OF LINER SIZE NONE
Draft Hood Regularor f
Fi Iters Si:e V 1 Number
Chimney Locafion Inside 4utside
Chimney ConStrucFion
Smoke Bomb Wiring
Draft Test Teg
door Pressuro Lighting Inst. ?
Date Tested
Company Testi ng ?'?
Name of Testar I
CONVERSION
HOUSE HEATING TEST RECORD
ADDRESS APT. FLOOR CITY SUBURB
OCCUPANT ' - OWNER
HEAT LOSS DATE HTG. INST.
SOLD BY ? ? ?' ?•.?r-c/ INSTALLED BY ::c
Elsctrical Work By Gas Line By
TYPE OF HEAT GA FA HW STEAM SPACE HTR. UNIT HTR. OTHER
I GAS DESIGN CONVERSION
MAKE MAKE OF BURNER ?
Model Model
SoriQI < Max'
BTU RaTin
INPUT .
g
MAKE QF FURNACE
Model
Y CONTROLS
Va tve i
Limit
Limit SetFing
Fan 5etting _
Pilot Type -
Pilot AAake -
Pilot Model _
Pilot Timing
L.W. Cut Off
Prossure- ? Percent C02
Input CFH Percent 02
Stack Temp. Percenf CO
Form 235
Plug
Vsnf Si:a
KIND OF LtNER SIZE NONE ?
a
Drak Hood ,?-?" ?---? Regulator
Fi Itars 5ize ? f? '? S X' Number
Chimney Location
Chimney Construction
Ovtside
Smoke Bomb Wiring ;
DrnFf Test Tag
door Pressure Lighting Inst. i
Date Tested s ti-
,
i,
Company TesTing --
Nome of Tsster
HOUSE HEATING TEST RECORD
r . .
ADDRE55 APT. FLOOR CITY SUBURB
OCCUPANT -•-?- OWNER
HEAT LOSS DATE HTG. INST.
SOLD BY
INSTALLED BY
Electrical Work BY -- Gvs Line By rTYPE OF HEAT GA FA HW STEAM SPACE HTR. UNIT HTR. OTHER
GAS DESIGN
MAKE - - MAKE OF BURNER _
Model L Y LQ PC J!V Model
SeftOl r Max. BTU Rating _
INPUT I LI0C6 MAKE OF FURNACE
CONTROLS
, .
THERMOSTAT Heat Plug
Valve - _ _--,--4 ?
r
Limit
Limit SeHing
Fan Setting
Pilot Type
Pilot Make
Pilor Model _
Pilot Timing
L.W. Cut Off
Model
?
Vsnt $ize '
?
KIND OF LINER SIZE NONE
Draft Hood ='- -s- - Regulator
Filters Size Number Z .
Chimney Location Inside Outside
Chimney Construction
Smoke Bomb Wiring
Draft Test Tag-
Door Pressure Lighting Inst.
Prossure Psrcent COZ Date Testad
Input CFH Pereent 02 Compuny Testing
Staek Temp. 5 Percent CO Name of Tester
Form 235
CONVERSION
? .
HOUSE HEATING TEST RECORD
ADDRESS
, ?
APT. FLOOR CiTY
SUBURB?
OCCUPANT OWNER
HEAT LOSS..Y_ DATE HTGr_INST.
SOLD BY •?C,r?f2z? = /?..,;?._ ? ?_
INSTALLED BY J-? .
-n
Eleetricol Work By Gas Line By
TYPE OF HEA7 GA FA HW STEAM SPACE HTR. UNIT HTR. OTHER
J
(,? ? ? VAJ VCJIIPN
MAKE MAKE QF BURNER _
Modsl Model
Serial ?' ? ?S Max. BTU Rating -
INPUT MAKE OF FURNACE
Model
r`n?ironi c
CONVERSION
THERMOSTAT Hea'tPlug Vent Sixe ?
Valre KINQ OF LINER SiZE NONE ?
Limit ?' -`-4frrti Drak Hood Regulator
Limit Sstting Filters Size
, Number ?n
Fon Setting Chimney Loeation Insids Outside
Pilot Type L-+k -? ? -- Chimney Construetion
Pilor Make
Pilot Model Smoke Bomb Wiring
Pilot Timin9 Draft -} -t 7est Ta y^l-
9
L.W. Cut Off Door Pressure Lighting Inst. i
Pressure ' ?- Pereent C02 f^ Date Tested
Input CFH Percent OZ Company Testing
Stack Temp. Percent CO Name of Tester A
Form 235 ;
` HOUSE HEATING ,TEST RECORD
ADDRESS '- ? APT. FLOOR CITY SUBUR&? f
OCCUPANT 01MNER
HEAT LO55 -DATE HTG. INST. 1- -??, -'? 5
?' ?
SOLD BY INSTALLED BY '?
r `?"'
Eleetrieal Work 6y ? ? --- Gas Line By
TYPE OF HEAT GA FA HW STEAM SPACE HTR. UNiT HTR. OTHER
GAS DESIGN CONVERSION
MAKE - MAKE OF BURNER
Model Model
Serial ? Mox. BTU Rating
INPUT A;?v MAKE OF FURNACE
CONTROLS Model
THERMOSTAT Heat Plug Vsnt Sizs
Valve - KIND OF LINER SIZE NONE
Limit Draft Hood -' ? Rsgularor ,
Limit SeHing Filters Sixe '' '•' ? h Number --
Fan Setting Chimney Location Inside Outside
Pilot 7ype Chimney Consfruetion
Pi1ot Make
Pilot Model Smoke Bomb Wiring
Pilot 7iming c D?aft '--
Test Tag
L.W.
Cut Off Door Pressure Lighting Inst.
Pressure ? Pertent C0 ' Date Tested
2
Input CFH Pereent 02 Company Testing
Stack Temp. Percent CO - Name of Testei
Fwm 235
ADDRESS ?Qy?
OCCUPANT -?
HEAT LO55 DATE HTG.
SOLD BY _ 1.i^ -`•^.?`
Elsetrieal Work By r
TYPE OF HEAT GA FA _
HOUSE HEATING TEST RECORD,)-_ T,?????j3 Lmf /
? ? tf_P.
APT. FLOOR ? CI?? SUBURB?-??--OWNER
ANST. f ' 3 0 -8 s-
INSTALLED BY
Goa Line By 1? o--.-e..?! !t_
_HW STEAM SPACE HTR. UNIT HTR. _>_eOTHER
? 4? ?o? GAS DESIGN
MAKE MAKE OF BURNER _
Model XL 1-7 U? 3 Modal
Serial iq 4c 3 rA k/ 3 12 Max. BTU Ratiny -
(NPUT ?--) 01 n°d MAKE OF FURNACE
CONTROLS
THERMOSTAT ? }{eat Plug
Valvs_?h --?-??
Limit
?
Limit Settiny O
Fan Setting
Pilot Type
Pilot Make
Pilot Model
Pilot Timing
L.W. Cut OFf
Model
Vent Si:e - ._
CONVERSION
KIND OF LINE? SIZENONE
Draft Hood Regularor ?
Filters Size Number
Chimney Location
Chimney Consfrucfion
Smoke Bomb Wiring _
Draft f ? S Tasf Tay
Door
Fum 235 Outsids
Presswe Peresnt CO - ? ? Date Tested 'a ? ) '? -5 5- Q
2 .
Input CFH i7 V ' Pereent 02 ? Company Testing
Staek Tsmp. Percent CO ? lNams of Tester - '
Lighiinp Inst.
HOUSE HEATING TEST RECORD
ADDRE55 1??a1 APT. FLOd12 CI'T?=?''f'•???gURB
OCCUPANT ?~?? v
OWNER
HEAT LOSS
SOLD BY - ;7
Elsctrieal Work By
TYPE OF HEAT
MAKE.
Modsl _
5srial _
INPUT
THERMOSTAT.
Valve ,//,I
Limit
Limit Setting _
Fan Setting
Pilot Type ?
Pilot Make ?
Pilot Model _
Pilot Timing -
L.W. Cut Off _
TE HTG. INST.
INSTALLED BY - ?
Gas Lins By .' t2;Ll
FA ?HW STEAM SPACE HTR. UNIT HTR. _ZOTHER
I
i DESIGN U)r' `F,_' 6 3 CONVERSION
!? !?i1'"" MAKE OF BURNER '
4'7,?g?? ? Model
i/ U Max. BTU Ratiny
?lJ MAKE OF FURNACE
Modei
CONTRgLS /
Pluy Vent Size ,2 / -
?f KIND OF LINER - SIZE - NONE
Drah Hood Rsyularor ?
Filters _ Sizs Number.
Chimnay Location Insid/q _ Outside 3
- Chimney Consiruction
r
Smoke Bomb -` Wiring
D?aft Z Tast Tay y ?
Door Pressuro ?- Lightiny Inst. L
?r
Prossure 4dZ C, Percent COZ 7- it Date Tssted -
Inpuf CFH 4L4 Percent 02 Company Testing
Stack Tsmp. Percent CO L Name of Tester
jldL
.i
Form 235 ?
HOUSE HEATING TEST RECORD
ADdRESS ??9,? 'c?- ? ??12:e APT
FLOOR CITY
6
'4b'6URB
4
.
#,
,
_
OCCUPANT OWNER
HEAT LOSS .` D TE HTG. INST.
SOLD BY IOW INSTALLED BY
Elsctrical Work BY - Gas Line 8y
TYPE OF HEAT GA FA _?'e HW STEAM 5PACE HTR. UNIT HTR. l OTHER
?• GAS DESIGN CONVERSION
MAKE ' MAKE OF BURNER
Modsl Modsl
Sxial 1,' Max. BTU Ratinq
INPUT _47D MAKE OF FURNACE
Model
CONT?Ol.S ? ? -
Pluy Vent Sizs.Z
Valv ? KIND OF LINER SIZE - NONE -
L i m i t Drah Hood Reaularor
Limit 5etting
Fan Setting -
Pilot Tvoe _
Filters - Sixe-
Chimney Loeafion
Chimney Construction
Pilot Make
Pilot Model
Pilot Timing ? ji?G r .
L.W. Cut Off
?
Prossuro S r Percent COZ 2- Z
Input CFH / Percent 02 J? / e-7 e
Stack Temp. aZ:;?0 Percent CO 6/2 12 2l2
.
Form 235
Smoke Bomb Wiring v
Draft Ts:t Tay
Door Presswe i Lighting Inst. v
Date Tested
Company Tssting t-
Name of Tsster
?:
HOUSE HEATING TEST RECORD
ADDRESS APT. FLOOR CITYX&q??UBURB
OCCUPANT OWNER
HEAT LOSS DA E HTG. INST.
SOLD BY INSTALLED BY -
Electrical Work By ?w Gas Line By ?
TYPE OF HEAT GA FA s HW STEAM SPACE HTR. UNIT HTR. .?_OTHER
GAS DESIGN CONVERSION
MAKE ' r MAKE OF BURNER i
Modal „?7 Model Serio I4 S'?2?/' ?Q 942 </ Mox. BTU Rati ng
INPUT %Za MAKE OF FURNACE
Model
CONT OL5
THERMOSTA7, eat Plua Vent Size ?
Yalve
Limit
Limit SetFing ?
Fan Setting 0
Pilot Type
P;lot Make ?
Pilot Model --
Pilof Timing
L.W. Cut Off --
r
Pressure Percent C02
Input CFH .47a Percent 02
5fack Temp. Percant CO
Form 235
KIND OF L1NER
Drah Hood
Fi Iter: - Size-
Chimney Loeation
Chimney Construction
Regularor
NONEr_
Smoke Bomb ? Wiring
Draft Test Tag l'
Door Pressure Lightirtg Inat. ? Date Tested "
Company Testing
hlame oi Tester
.
?
HOUSE HEATING TEST RECORD
ADDRESS Z),w
APT. FLOOR CITY ?''? U9UR8
OCCUPAKT OWNER
HEAT LOSS DATLE HTG. INST. 4 ?
SOLD BY ?/ ,? INSTALLED BY XG
Elecfrical Work By '??,???t C Gas Line By 4??lt.4& -e: ,?.;
TYPE OF HEAT GA ? FA _?LHW STEAM SPACE HTR. UNIT HTR.?_-QTHER
_ GAS DESIGN
MAKE = MAKE OF BURNER _
Model AW)
. 7 2 Model
5sriai S4 //?_'? Max. BTU Rating -
INPUT MAKE OF FURNACE
Model
Valve ?
Limit -A
Limit Sertiny
Fan Setting -
Pilot Type ?
Pilof Make -
,LS Plug ` • Vent Size ?
KIND OF LINER
Draft Hood RegulaTOr I
Fi Iters - Size Numbe?
Chimney Location I i e Outside
Chimney Construction ???'? S I
Pilot Model Smoke Bomb J- Wiring v
Pilot Timing 7?e l" . Draft Z5,a,-41 Test Tag y
L.W. Cut Off
? Door Pressure '-- Lighfiny Inst. G?
i
Pressure Percant CO - 7
-2 ??
Date Testad
In ut CFH?
p
Percent 02 ? -2
Company Testing '
/
$tock Temp. ?5C11? Percent CO 0 ep C?;? Name of Tester ?
Form 235 :r
HOUSE HEATING TEST RECORD I
ADDRESS I-?l' ?'?,??;???? ?.c???'J ?'v• APT. FLOOR CITYIA ?UBURB I
OCCUPANT OWNER j
HEAT LOSS ? ATE HTG. INST i
SOLD BY -? - INSTALLED BY
Eleetrieal Work By Gas Lina B
y
TYPE OF HEAT GA FA ?HW STEAM SPACE HTR. UNIT HTR. )ZOTHER I
GAS DESIGN CONVERSION
MAKE Z,??. ? MAKE OF BURNER
Model ?,.1>'?Ll a,(? Model
Seriol Max. BTU Ratiny I
INPUT MAKE OF FURNACE I
Model I
THERMOSTAT,Q
Valve
Limit
Limit Setting ?
Fan Sstting 1
Pilot Type
Pilot Make
Pilot Model
Plug Vsnt Sise
Pilot Timing
L W C f
/I i
KIND OF LINER -` SIZE ? NONE--
Draft Hood Regulator
Fi Iters _- Size Number
Chimney Location Insi L?/ Outsid•
Chimney Construction e?z:!S: 1?
Smoke Bomb -- Wiring -
Draft Ta9
.. ut O f Door Pressure `- Lighting
.I
Pressure 4?=5--aLG Percent COZ ? Da» Tested ?
Input CFH'/ , Z4 Percent OZ oy Company Testing
Stock Temp. _ Percent CO Name of Tsster _
Fum 235
?
ADDR ESS , ; Y//
OCCUPANT
HEAT LOSS -
SOLD BY 2 - ,v
Elechical Work By z? f?[ 2
11
TYPE OF HEAT GA
FA IC __HW STEAM SP
GAS DESIGN
HEATING TEST RECORD
?, . ,
APT. FLOOR _
OWNER
INSTALLED BY
Gas Line By I
ACE HTR. UNIT HTR. ?OTHER ,
CONVERSION
MAKE MAKE OF
Model
? Model _
Seria l Max. BTU
INPUT MAKE OF
Model _
THERMOSTAT a eat `lug ?'-
Ya lve ??
Limit Setting
d
Fan Setting
Pilot Type
Pilot Make
Rating -
FURNACE
Vsnt Size - Z
KIND OF LINER_
Drah Hood
Filters - Sizi
Chimney Location
Chimney Construetion
Regularor
Pilot Model ? $moke Bomb Wiring L?
Pilot Timing Draft LQ;.f Z Test Tay
L.W. Cut Off '~--` Door Pressure Lightiny Inst.
Prossure ?.? Ld C Percent C02 -?Z-J ?a Date Tested
Input CFH f L ? Perceot O ?d Company Testing
Stack Temp. Percant C0 Name of Tester ?
2
Form 235 J
HOUSE HEATING TEST RECORD
ADDRESS L 4/'P100?4?,? 4::?? A4,/ FLOOR CITY ? BURB ?
OCGUPANT OWNER f I
HEAT LOSS ? D TE HTG NST. ?
SOLD BY INSTALLED BY
Elsctrieal Work By C Gos Line By
TYPE OF HEAT GA FA 1G_HW STEAlIti SPACE HTR. UN1T HTR. 72-_-OTHER
GAS DESIGN
MAKE MAKE OF BURNER
Model Modei
SQ?iol ?
Max. BTU Rating _
I N P U T MAKE OF I=URNA
Model
THERMOSTAT
Va Iva
Limit
Limit Satting
Fan Setting
Pilot Type
Pilot Make
Pilot Model ?
Pilot Timing ?
L.W. Cut OfF ?
I / r
vsnt siZe - 7'
KIND OF LINER J""
NONE " i
Drak Hood Regularor
Filters 5ize Number
Chimney Location lnsicia v Outside
Chimney Construetion
Smoke Bomb - --i Wiring
Draft /
Test Tag
Door Pressure Lighti
Proswre ?SGL%G pereent COZ , Abl, 2r Date Tested ?
InpuY CFH Percent 02 Company Testing
Stnck Temp. Parcent CO Name of Tester
Form 235
Inst.
HOUSE HEATING TEST RECORD I
ADDRESS 7k?1/,
k?T. FLOOR CITY?-'BURB I
OCCUPANT T I
OWNER
HEAT L055 DATE HTG. INST. ? I
SOLD BY . -' INSTALLED BY i - ? Elsctritol Work By 4,-2 /,• f ??„?'? , Gcs Line By .? ?/17 "F
TYPE aF HEAT GA " FA HW STEAM SPACE HTR. UNIT HTR. Z OTHER ?
, y
,_? ? GAS DESIGN
M A K E / ? - MAKE OF BURNER _
Model A,4
Model
Sxial 4 Max. BTU Rating-
INPUT _? 7A,??ZJ MAKE OF FURNACE
Model
Plug .
Valve
Limit
Limit Settiny
Fan Settin
Pilot Type
Pilot Make ?
Pilot Model
Pilot Timing
L.W. Cut Off
i?
Prossure __ y e-I Pereent C02
Input CFM ? 7G Psrcent OZ l,
Staek Temp. Percent CO
Form 235
Vsnt Sizs I/
KIND OF LINER -
Drah Hood
CONVERSION
SIZE ? NONE 'I
RegulaTOr
Filtsrs -Sizs Num r
Chimney Location I,ntl -Outsida i,
Chimney Construdion i ???5 ? I
Smoke Bomb Wiring
Draft /f?,,/? Tesr Tay v'
I
Door Pressure ' Lightiny Inst. Z/
I
Uate Testsd `
Company Tesrir,g Name oF Taster
HOUSE HEATING TEST RECORD
ADDRESS Ar/;" 4--5;d5d64_??-`?? FLOOR CITI(/,,??BURB
n['[`t i p s N r ' .,,.,.. ...,
HEAT LOSS DA E HTG. INS .
SOLD BY
Elsctrical Work By
TYPE OF HEAT GA FA )4_HW STEAM
-INSTALLED 8Y - Gas Lins By s
SPACE HTR. UNIT HTR. ?.,_-'OTHER
. GAS DESIGN
MAKE MAKE OF BURNER _
Modsl Modsl
Serial Max. BTU Ratiny -
INPUT MAKE OF FURNACE
Model
? Vsnt Size ?
Yalve
Limit
Limit Ssiting
Fan 5etting /
Pilot Type
Pilot Make ?qll
Pilot Model
Pilot Timing _? 3« ?
L.W. Cut Off '-
Prossuro 5 Peresnt CO2
1 ut CFH Peresnt OZ '
Staek Temp. Pereent CO
Form 235
CONVERSION
KIND OF LINER SIZE NONE
Droft Hood Reyulamr
Filters - Size - Num r '
Chimney Loeation In jJq,, SOutside
Chimnsy Construdion I
Smoke Bo'm/b Wiring ?
Draft Te:t Taa
Door Prossuro ? Lighting Inst. ?-
Date Testsd ?
Componr Testing
Name of Tester _
?
HOUSE HEATING TEST RECORD
ADDRE55 ? .? ??- ? ?
p;, FLOOR
CITYA_'-&LSUBURB
OCCUPANT OWNER
HEAT LOSS DAT HTG. IN .
SOLD BY ` INSTALLED BY
'
Elechical Work B
Y ir
' Gas Line BY L? ,L,,L C_ I
?? ,,
TYPE OF HEAT GA ?,
FA HW STEAM SPACE HTR. I_UNIT HTR. ?,OTHER
CAS DESIGN CONVERSION
MAKE--? ?? MAKE OF BURNER ?
Model ?4A Model I
Ssrral 1 9,ey Max. BTU Rating 'i
1NPUT 22 1_11? fL MAKE QF FlJRNACE I
Model '
CONTROLS
THERMOST Plug Vsnt Size ?
Valve KIND OF LINER - SIZE ` NONE `
Limit Draft Hood Regularor
Limit Sattin9 FilYers Size Numb r
Fan Setting ? Chimney Location In id Outside I
Pilot Type himney Construction
Pilot Make
Pilot Model " Smoka Bomb J? Wiring
Pilot Timin9 A
Draft 4C•a, oa,,
Test Tog j'
L.W. Cut Off Door Pressuro LighTing Inst. G
Prossure ;Cf Pereent C0
Date Tested - `
Input CFH ??? 2 ?y?
Pereent 0
C?? Com
1/
an
Testin ?
2_
,
y
g
p
Stack Temp. ?,? l? _ Percent C? _i?r /?? Nama of Tester
Form 235
?v-?2530,Wo
HOUSE HEATING TEST RECORD (?? ?uI
?
ADDREtS d c,12QoP_,4T APT. FLOOR CITY SUBURB
OCQJ PAN T OWN E R
HEAT LOSS DAT H G. INST.
SOLD BY ? - ?Qt• _INSTALLED BY
Elechical Work By Gas Line By ?
TYPE OF HEAT GA FA HW STEAM SPACE HTR. UNIT HTR. OTHER zmm±-
GAS DESIGN
MAKE MAKE OF BURNER _
Model Model
Swiol Max. BTU Ratiny -
INPUT G'G I r MAKE OF FURNACE
Model
I Valve
Limit
Limit Suttiny
Fan Settiny -
Pilot Typs _
Pilot Make _
Pilot Modsl _
Pilot Timing
L.W. Cut Off
Stoek Tamp.
Form 235
VenT Sizs
KIND OF LI?I?ER SIZE NONE
Draft Hood ? 11 -10- Ragulator
Fi itKS Size aV J( ZS)4 Number ?
Chieaeey Location Inside Outsido
Chimnoy Construction
- ? 3 Smoks Bomb Wiring
Draft C7A-4? Test Tap
Door Prossws Lightinp Inst.
7. Dare T.:r.d - - f
?
L
? • Company Testing m?., jc
0 Noms of Tesfer
...rr'
,?-..
CONVERSION
HOUSE HEATI. G TEST RECORD
ADDRESS
AP7. OOR CITY SUB
UR
OCCUPANT OrINER '`?? ?--5
HEAT LOSS tp? 0 TE
HTG. INST.
SOLD BY . INSULLED BY 1?Jf? ? 5? I r
Eioctrieel 1Merk Bp u U y' -? ' Gas Line Br
TYPE OF HEAT GA FA ?Hw STEAM SPACE HTR. UNIT HTR. OTHER
? GA ESIGN ' CONVERSION
MAKE MIAKE OF BURNL4
Mod.l del
S«iel ? ? d ?"? IiAsx. BTU Ratiny
INPUT MAKE OF FURNACE
! . Msd•I
''/ ?CONj?bLS
?r
THERhIQSTA7- Pluo Vent Sise
Valw /-"'' KIND OF LINERSIZE NONE ?
Liontt c!? ? Droh Hoed V Ryuloror 3
Llmft Suettlnp Fllters Si:e Numbw
Fan SeHiny ? Chimner Lecalien (nside Outaido
Ptlot Trp. ? - Chimn.r Constn,ceion
Pilot Make
P i I w Modal
Wirin
Smoke Bomb ,?-- 0 `
?
Pflot TIwin9 Tesf Tay
D?afts
L.W. Cut OF( Deor Pnsaure '?- Liyhtiny Inst.
Preswn ` Poreint CO? ` 3 Deh TosNd
Inpvt CFH Petairf 0 2 Company Testiny
J
Sfaek T?mp. P?ranf C0 ? Nanw of Tesfer
Fwm 235
/