1325 Eagandale Ct - Heat Test Recordti
AZIR E85 -?
' OCCUPANT ?
HEAT LOSS
SOLD BY ?
'Electrical Work By
HEATING TEST RECORD
CITY
.
INSTALLED BY
P ? Gas Line By
' TYPE OF HEAT GA FA ?HW STEAM SPACE HTR. UNIT HTR. OTH
G S DESIGN CONVE VStN ? w?-D?
MAKE MAKE OF BURNER _
' Model S Q 7 hbdsl
Sorial C y Max. BTU Rotiny -
INPUT r O a? MAKE OF FURNACE
Model
Limit Setting
Fan Setting -
Pilot Type ?
Pilot Make _
Pilot Model _
Pilof Timiny
L.W. Cut Off
rjTROL 5
Heat Plug
P?essure 1 151!C' Psreent CO,
Input CFH ? Peresnt 0,
Stack Temp. ? Pereent CO
Form 235
y pp???
Vent Sizs A; ?
KIND OF LINER SIZE NOyE
Droh Hood ? /l ? Rea.,leror ? ' ~
Filtsrs Sizslla,02s PeNumb Q,
Chimney Location / I side Outaide ?
Chimney Construefio?F .?
Smoks Bomb ?- 1Kiring 600"
Draft . - ? Test Tay ?
Door Pres:urs !!! ?__, Lighting Inst. ?l'
Date Tssted ?
Compony Testing
Nams of Testar _
HOUSE HEATING TEST RECORD
T. " FLOOR CITY ?SUBURB ? CJvI
ADDRESS 7CP
1 I ?
OCCUPANT OWNER , ?Q -?
HEAT LOSS _ ATE HTG. I ST. ? ?7
SOLD BY A? M a??d„.a, C,?, . INSTALLED BY
Eleetrieal Work By Gas Lins By
TYPE OF HEAT
I GA FA HW
GAS DESI STEAM SPACE HTR. UNIT HTR. OTHER
MAKE LA-A MAKE OF BURNER
Modsl Model
? Serial BTU Rating
Max
.
INPUT MAKE OF FURNACE
Model
? tCONTROLS
Valve?
Limit
Limit Settiny
Fan Setting -
Pilot Type _
Plug
Vent Si:e
KIND OF
SIZE NONE
Drah Hood RegulaTOr
Fi Itsrs Size ? V ° umber 1.. ?i
Chimnoy Location Inside Ovtside
Chimnsy Conslrucfion
Pilot Model v Smoks Bomb Wi?ing
Pilot Timing Draft Test Tap
L.W. Cut Off Door Prsssure Lightiny Inst.
Pressuro SiZ?Paresnt C0?
1-7 JRL
Dafe 7ested
Inpvt CFH ? 2kgh Parcent 02 Company Testing ICVUL
STaek Temp. Parcent CO Name of Tsster
Form 235
H0? ATING TES,? RECORD
ADDRESS APT.` FLOOR CITY SUBURB
OCCUPANT ? OWNER
HEAT LOSS DATE HTG. INST
SOLD BY ?]m??L .
l? M?ri?Oeeit
m? INSTALLED BY
Elsetrieal Work By Gas Line By
?
TYPE OF HEAT GA FA _THW STEAM SPACE HTR. UNI T HTR. OTHER _i
'
' GAS DESIGN CONYERSION
,MAKE MAKE OF BURNER L AGAN
Model ???
Serial Max
BTU Rating E D
.
INPUT MAKE OF FURNACE
AA BY
odsl
NTROLS
THERMOS AT
-A&IM
Meat Pluy
A b'ATE
Vont Sizs
Valve KIND OF LINER NONE
w
Limit
Draft Flood
Regularor
Limit Ssttiny
Fon Settina _
Pilot Type _
Pilot Make _
Pilot Model _
Pilot Timing
L.W. Cut Off
Filtsrs 5ize Number
Chimnsy Location Insids Outsida
Chimnay Construction
Smoke Bomb Wiring
Draft Test 1
Door Prsssure Lighti
Presaure :S•z Pereent COZ Date Testsd -
Input CFH 12km Pereent 02 Company Testiny
Staek Temp. -? Pwrcent CO Name of Testar _
Form 235
Inst. _
• \
HOUSE HEATING TEST RECORD
? .
ADDRESS APT. FLOOR CITY SUBURB
OCCUPANT OWNER
HEAT LOSS ,?. DATE HTG. NST.
SOLD BY rA& tLs ` INSTALLED BY
Eischical Work By Gas Line By
TYPE OF HEAT GA FA HW STEAM SPACE HTR. t1NiT HTR. GAS DESIGN CO VOT14iR_
S 01?.k
MAKE MAKE OF BURNER ?
Modsl ? Model
Sor1O I Max. BTU Roti ng `
INPUT p? MAKE OF FURNACE
Model
Valvs ?
Limit
Limit Settiny
Fan Setting -
Pilor Type _
Pilot Maks _
Pilot Model _
Pilot Timing
l.. W. Cut Off
Plug
Pressure 3. S Ps?eent C02
Input CFH 120 Percent 02
Stack Temp. Perunt CO iN?,
Form 235
Vsnt $izs so's_
KIND OF LINER-
Drah Hood
Filtsrs Size _
Chimnoy Loeation
Chimney Construction
lai
(nsids Outside
$moke Bomb Wiring _
Draft Tsst 7ag
Door
Lighting Inst.
Date Tasted ' R?q
Compony Testing
Name of Testsr - ae-
HOYSE htEATING TEST RECORD '
ADDRE55 APT. FL00 CITY SUBURB
OCCUPANT ?'?---? OWNER ?
HEAT LOSS
SOLD 6Y ?
Eleetr;cal Work By
TYPE OF HEAT
MAKE.
Modsl
Ssrial _
INPUT
DATE HTG.
GA FA
GAS DESIGN
1M STEAM ?
MAK
Moda
?Aa x.
INSTALLED BY P-'?-C-•-?C,'_' /2r'--?
Gas Lino By ' I
ACE HTR. UNIT HTR. OTHER
OF BURNER
CONVERSION
Ratiny -
FURNACE
TH E R MOS Tf4
Va Ive
Limit
Limit Settiny
Fan Setting -
Pilot Type _
Pilot Make _
Vsnt Size /?) !?
KIND OF LINER SIZE NONE
Draft Hood r --? -Regularor
Filters Sizs Number
Chimnsy Loeation Inside Outaide
Chimney Construction
Pilot Model Smoke Bomb Wiring
Pilot Timing i, `• ?'t , Draft Test Tay
L.W. Cut Off Door Pressurs Lighting lost.
r ;
Prossure Pereent COZ date Tsstsd
Input CFH Pereent 02 , T Company Testing 00C? A-/! .?-
51oek Temp. Peresnt CO ! Name of Tester r
Form 235 ?
?
HOUSE )HEATING TEST RECORD ?
?ADDRESS ? a? Y ?. „?,?rs 4?7 r - ?
--?' APT. FLOQR CITY SUBURB ?``-
OCCUPANT OWNER
HEAT LOSS DATE HTG. II?I$T.
SOLD BY ?7??.`_',
" INSTALLED BY `:---
Electrical Work By Gas Line By
TYPE OF HEAT GA FA HW STEAM SPACE HTR. UNiT HTR. OTHER
GAS DESIGN CONVERSION
MAKE MAKE OF BURNER
Model Model
Sxicl
-r Max. BTU Rating
INPUTMAKE OF FURNACE
Model
C,rONTROLS
THERMQSTAT Heat Plug
Valve ??--¢-------- ?
Limit r -?-??-
b
Limit Sefting U
Fan Setting
Pilot Type ?
Pilot Make
Pilot Model
Pilof Timing -'-'`?-
L.W. Cut Off
?, /• I? p
Vent Size E'S ? 1 /J
KIND OF LINER SIZE NONE
Drah Hood f' , __..0 -?- Regularor
Fi Itsrs Size Nvm6er
Chimney Location Inside F' Outside
Chimney Construetion
Smoke Bomb Wiring -
DraFt '~ ? Test Tag-
Door Pressure Lighting Inst.
Prossure Percent CO _? ' ('G` Oafe Tested
Input CFH Percent 02
I; 2 1 ?- Company Yesting ? 'z-
Steck Temp. -? ` Pereent CO Name of Taster
Form 235
? HOUSE ?+EATING TEST RECORD
ADDRESS
? APT. FLO R CITY SUBURB
OCCUPANT OWNER }?'G'i
HEAT LOSS DATE HTG. I ST.
50LD 8Y T' ? ?-J,
lNSTALLED BY ?,•^, --'-*-
Electrical Work By •.-??!-t- _? Gos Line By
TYPE OF HEAT GA FA HW STEAM SPACE HTR. UNIT HTR. OTHER ?4
GAS DESIGN
MAKE . ? MAKE OF BURNER _
Model Model
?
Ssrial Mox. BTU Rafing -
INPUT MAKE OF FURNACE
Model
C NTROLS
THERMOSTAT -? Heat Plug Vent Size
Valve -={-<11
: KIND OF LINE SIZE NONE
.
E
? Limit
Draff Hood
3
F Limit $etting % J U 6 Filters Sixe Number
Fan Setting Chimnay Loeafion Inside v Outsida
Pilot Type Chimney Construction ?
Pilot Miake ?
Pilot Modei Smoke Bomb Wiring ?
Pilof Timing ?r,->._???? . DraFt -) ? i T
t T
?
es
ag
L.W. Cut Off door Pressure Lighfing Inst.
Prossure Percent C02 pate Tssted r '_7
Inpvt CFH_ ?CJ C1 Percent 0 2 - Company Testing
Stack Temp. 36U Percent CO - n Name of Teafer ? Y'?..r?-??1_ F• -
,
Form 235
CONVERSION
HOUSE `#EATING TEST RECORD
Y
r°
ADDRE55 APT. FLO?Q R CITY SUBURB?
OCCUPANT OWNER ?`ll g
HEAT LOSS DATE HTG.,jN5T.
SOI.D BY
INSTALLED BY `•?"r- " `?2!' U?
Eleetricol Work B.. ?E Gas Line By
TYPE OF HEAT GA FA HW STEAM SPACE HTR. UNiT HTR. " OTHER
GAS DESIGN
MAKE •' ??' ? MAKE OF BURNER _
Modsl ' _ Madel
Serial Max. BTU Rating -
INPUT MAKE OF FURNACE
Model
C9'NTRQLS
THERMO?TAT?' ,"e Heat Plug Vent Size
Valre t?> -«-, KINQ OF LIhtE S1ZE NONE ?
Limit I ?« = Drak Hood Regularor
Limit SeNing Filters Size Number
Fan Setting /? Chimney Location Inside ?- Outside ?w {
Pilot Type " Chimney Construction j
Pilot Make 1
Pilot Model _
Pilot Timing
L.W. Cut Off
Smoke Bomb Wiring
Draft Test Tag
Door Pressure Liahtina InsL Pressure 4Percent C02 Date Tested
Input CFH 44 Percent O 2 i?, ? Company TesTing
Stack Temp. Peresnt C0 ?J Name oF Tester f?"L ?l-'" --'' • ?
Fwm 235 i
CONVERSION
? .. .
HOUSE kiEATING TEST RECORD
, .
• ?-_?
ADDRESS APT. F1x0QR C(TY SUBURB %
OCCUPANT OWNER
HEAT LOSS DATE HTG. INST.
SOLD BY INSTALLED BY
' ` .
Y
Elsetrical Work By '=''d`-•.t-?-- ?'%{--. Gas Lin• B ?
TYPE OF HEAT GA FA HYY STEAM SPACE HTR. UNIT HTR. ?OTHER
GAS DESIGN
MAKE MAKE OF BURNER _
Model 1? ?-? f..l ? Modsl
Sarial Max. BTU Rarin
9 -
INPUT MAKE OF FURNACE
. Modsl
b?
Heat Plug Venf 5ize
Yalve '
Limit ?
Limit $etfiny
Fan Setting _
Pilot Type _
Pilot Make _
KIND OF LINER `, SIZE NONE
Draft Hood "77"t -='- RayulaTOr
Filters Size Numbsr
Chimney Loeatian Inside
Chimnsy Construction
Pilot Model Smoke Bomh ? Wiring ?
Pilot Timing D?oft Test Tay
L.W. Cut Off Door Pressure Lightiny InsT. `
Prossure ' Percent C0 Oate Tested "
2
Inpvt CFH Percent O Company Testing
Stoek Temp. Pereeot CO2 c 44 Name of Teater
Form 235
CONVERSION "'
? .. .
HOUSE kiEATING TEST RECORD
, .
• ?-_?
ADDRESS APT. F1x0QR C(TY SUBURB %
OCCUPANT OWNER
HEAT LOSS DATE HTG. INST.
SOLD BY INSTALLED BY
' ` .
Y
Elsetrical Work By '=''d`-•.t-?-- ?'%{--. Gas Lin• B ?
TYPE OF HEAT GA FA HYY STEAM SPACE HTR. UNIT HTR. ?OTHER
GAS DESIGN
MAKE MAKE OF BURNER _
Model 1? ?-? f..l ? Modsl
Sarial Max. BTU Rarin
9 -
INPUT MAKE OF FURNACE
. Modsl
b?
Heat Plug Venf 5ize
Yalve '
Limit ?
Limit $etfiny
Fan Setting _
Pilot Type _
Pilot Make _
KIND OF LINER `, SIZE NONE
Draft Hood "77"t -='- RayulaTOr
Filters Size Numbsr
Chimney Loeatian Inside
Chimnsy Construction
Pilot Model Smoke Bomh ? Wiring ?
Pilot Timing D?oft Test Tay
L.W. Cut Off Door Pressure Lightiny InsT. `
Prossure ' Percent C0 Oate Tested "
2
Inpvt CFH Percent O Company Testing
Stoek Temp. Pereeot CO2 c 44 Name of Teater
Form 235
CONVERSION "'
HOUSE HrKATING TEST RECORD ?
,- .
ADDRESS eAPT. FLOQR CITY SUBURB
OCCUPANT ?-•-? _ r ? ?
OWNER ??? 3
HEAT LOSS DATE HTG. INST.
SOLD BY ' -
INSTALLED BY
Electrical Wark By i' c-.--„ Gos Line By -
TYPE OF HEAT GA FA HW STEAM SPACE HTR.
GAS DESIGN
MAKE : MAKE OF BURNER
Model Model
Ssrial ??
?-?
Max. BTU Rating
INPUT r'T MAKE OF FURNACE
-
Model
?CONTROLS
THERMOSTAT -?*--- HeatPlug Venf Size
Valve " -1 KIND OF LINER SIZE NONE
Limit Drah Hood `,.,,-F ?, _- Regulator ? ?'• ?
Limit Sstting %%-G'' Filters Size Number
Fan Setting Chimney Location
Pilot TYpe Chimney Construction _
Pilot Make
Pilot Model Smoke Bomb Wiring
Pilof Timing Draft /I Tast Tog
L.W. Cut Dff Door Pressure Lighting Inst. L?
Prossure Percent Cd Date Tesfed
,
Input CFH ' Pereent 0 2 b' Company Testing QC'•-
Stack Temp. Percent CO !? ?% Name of Tester
Form 235
UNIT HTR. ?,,"_OTHER
CONVERSION
Inside Outside
? . . . ,
` HOUSE HFATING TEST RECORD
ADDRESS
APT. FLOOR CITY SUBURB
OCCUPANT ?-" - - ? OWNER
HEAT LOSS DATE HTG. INST.
SOLD BY INSTALLED BY ?r ---? - ?
"??
Elechical Wnrk gy
Gas Lins By ?
TYPE OF HEAT GA FA HYV STEAM SPACE HTR.
i . GAS DESIGN
MAKE MAKE OF BURNER _
Model Model
$erial Mox. BTU Ratiny -
INPUT MAKE OF FURNACE
? ?ONTROLS
THERMOSTAT Heaf plug
Valve -Z-A-A,
Limit
Limit Ssttiny 1 Q?u ?
Fon Setting
Pilot Type '?`-•.-?+-?.??'
Pilo! Maks
Model
/
.
VeM Sizs ::?
17W
KIND OF LINER SIZE NONE
DraN Hood Regularor
Fi Iters 5ize Number
Chimnsy Location Insids Outsids' ?
Ohimney Consiruction ?
Pilot Model Smoks Bomb Wiring 1' ?
Pilot Timiny Draft -" f\ T
??
T
sst
ap
?
L.W. Cut Off Door Presswe Lighting Inst.
Prossure Percent CO2 Date Tested
Input CFH Pereent p i/ -. Company Testing
S t ac k Temp. Z
Pereent C O
?i Name of Tester
i
Form 235 ?
UNIT HTR. `- OTHER
CONVERSION
?
y{ HOUSE HFATING TEST RECORD
. . •
ADDRESS ?"-7' APT. FLO?R CITY SUBURBT
OCCIPANT OWNER
HEAT LOSSDATE HTG. INST. ?
SOLD BY INSTALLED BY
Elsctrical Work By Gos Line By ?TYPE OF HEAT GA , FA HW STEAM SPACE HTR. UN1T HTR. X-OTHER ?
_ GAS DESfGN CQNVERSION . ?
MAKE MAKE OF BURNER _
Model Model
Ssriol - '??/, - ?•'? Max. BTU Rating ?
INPUT L;-??'c' MAKE OF FURNACE
Model
CON TRal. S
3
? ?
THERMDSTAT Heot Plug !'71'
Vent Size ?
Valve KIND OF LINER t SlZE NONE
L imit `• -'' --x +-^ Droft Hood 1?'-•??' ?? -?-? RegulaTOr
Limit SeNing i-G 6 r Filfers Sizs - Number `
?
F°" 5°tt'"9 Chimney Location Inside Outside
PilotType Chimney Construction
Pilot Make
Pilot Model Smoke Bomb Wiring
Pilot Timing "- Draft Test Tag `
L.W. Cut Off Door Pressure Lighting (nst.
Prossure Percent CO ?• I r? Date Tested
Input CFH Percent Q2 ? Company Testing ?.. t
5tack Temp. Pereent CO Name of Tester
Form 235
. •
HOUSE HEATING TEST RECORD
ADDRESS APT. FLOOR CITY SUBURB
OCCUPANT Za ?,:z/' f OWNER nl' ?J
HEAT LOSS DATE HT6. INST.
SOLD BY 1 "),•O INSTALLED BY f' f s??
El.enicol we.k gy Gos Lin• Br_-??eo f
TYPE QF HEAT GA FA Li• Hw STEAM SPACE HTR. UNIT HTR. OTHER
GAS DESIGN ? CONVERSION
MAKE ?
MAKE OF BURNER
Mod•I KL Mbd•1
Swiv) L'?O :5- z Co IiAa:. BTU Rarinq ?
INPUT s MAKE OF FURN&Clii--- ?
Model
CONTROLS
THERMOSTAT H•at Plu
?
Valvo (1-11/X ? ''r>> : -?
Uml1
Lfmit Sottinp ?C) ?
Fan Settiny ?rl /j'1 Pp?
Pilot Trpe
Pflot Moke
i
Pilot Mod•1
Pilot Tfmin9
L.W. Cut Off ----
Prosswe Pereent CO2 7, s?
Input CFH 7?! PKeont p
Stoek Temp. Pereenf CO 2
`
,? -
Vent Si:e
KIND OF LINER ""Sil fE NONE
Drah Hood ?J? / % •'C L- Rpularor
Fl lfers Si:e ?%' = _Numb.. ?
ChimMy Loeation Insid', Outtide ? Chimney Construetion ?SL- ''~n /? % -1i2 i
Snak* Bomb Wiring
DraFt 142 ??z e, 0?' T•st Tay
Door Presawe `------ Liqhflnp Ins1.
Date Tesfod
Company Testing
Non» ef Tester
Fwm 235
HOUSE HEATING TEST RECORD
AODRESS APT. FLOOR CITY SUBUR ?_ ' Sf
OCCUPANT OWNER
HEAT LO55 ?•• D E HTG. T
SOLD BY ?INSTALLED Br•!?
?6???J
?
Elsehical 1ltork By Gas Line By C G
n
TYPE OF HEAT GA FA HW STEAM SPACE HTR. UNIT HTR. w G
r
7-GAS DESIGN C?H NI IC.O
MAKE MAKE OF BURNER ^
Model Model
Serial ?-S Irbx. BTU Ratin9 .
INPUT ? MAKE QF FURNACE
.?
Model ?'COTROLS S
THERMOS,.Tk?` Haat Pluy V*nt Size _
Valv
"'
? ?
'? KIND OF L N??t -
? ?
?? ?``
? SIZE? NQNE _
Limif •
'/ Droft Hood
,
- R?yulator?
Limit 5effinq - Filteis Siae, Numbsl"
Fan Settiny Chimney Location "An3id Outside ?
Pilot 7yps Qh{mney Construction
Pilot Mako - ?
~J
Pilot Model ? 1Miring
Smoke Bort?
Pilot Timin?
_ Draft
j Tssf Top
L.W. Cuf Off r Dow Pressure ? Liphtiny Inst. `?
d
Protsur• Peruni CO Dats Tesre
Inpuf CFH_
6 Psrc*nt OZ
7
? Company Testing
51oek T•mp. ? Pwc•nt CO Name ef Te:t*r '
Fwm 235
? -
' HOUSE HEATING TEST RECORD
?
ADDRESS APT. FLOOR CITY SUBURB '
OCCUPANT OWNER
HEAT LOSS -?_DA?TE HTG. INST. " ?? °' ?
SOLD BY .?'? J INSTALLED BY =
? Elechieol Work 6y T4' Gos Line Br
TYPE OF HEAT GA FA a,,,-HW STEAM SPACE HTR. UNIT HTR. OTHER
' -, GAS DESIGN CONVERSIOE
MAKE MAKE OF BURNER
Mod•I Model R
Seriol 1?111'4 2-4y6e 71 lMax. BTU Ratinp
INPUT MAKE OF FURNACE
Mod.l '
-? CONTROLS
'
'
'
?
THERM05TAT
-
VZ?A--Z
H*at Pl
- Vent Sizs c-, '??
•=f
:
uy
Valv
Limit •'3t?a?-?=.?? KIND OF LINER SIZE NONI?.?
? ? -
Draft Hood R.qulatorr
Limit 59ttiny Filte?s Si:o?,,e??' 24umber ?
Fan Settin9 !C-y.0,-.-ge a ,40.? Chimmoy Loeatioe Insid. Dutaide-`"=
Pilot Type = . , / Chimney Construction,- ^???5
Pilot Maks 1
Pilot Modsl --??12 ,tZ?CT -;
Pilot Timiny Smoke Bomb 1Miring Z
Draft y:: ,•_ •r-y 7 Tsst To9?-'
L.W. Cut Oif Door Presatirs ? Liyhtiny InstfL
Pressun Porc*nt C0
, Dote Testod
2
Inpuf CFH PereeM pZ --' G• Compony 7eatinq
Stock Temp
1:2 i;?, r Percenl CO
aj Nams oF TestK ?
.,
_
Fwm 235
HOUSE HEATING TEST RECORD
AODRESS
OCCUPANT
HEAT LO55 ---"'
SOLD BY
Elettrieal Work B
Y
TYPE OF HEAT GA
'
MAKE
Mod•I
1_.
DATE HTG. INST.
FA ??IW ' STEAM
GAS DESIGN APT. FLOOR CITY SUBUR1i, ??"?• "?'?
OWNER '
INSTALLED BY
Gos Lin* By od?
SPACE HTR, ? UNiT HTR: OTHER
CONVERSION
MAKE OF BURNER
Modei
Ssria l - ? • ? , " - ' Max. BTU Ratinq ,- " -
INPUT _T ,? c-' •? ' MAKE OF FURNACE '
Modal
THERMOSTAT`
? GONTROLS
Heot Pluq - -
T
Vent 5ize '
--
Volw
? - KIND OF LINER SIZE NONE?-_
Limit Oroft Mood Requlalor
Limit SoMiny Filfars $iss ? t•mbsr /f
--?---T- -
Fon Setting Chimney Location? : Inside Outsid• -?
Pilot Type Chimney Construction ?
Pilot Moke --
Pilof Model Smoka Bomb ---r" Wiring
Pilol Timinp
D?oft
:
.
'
Test Toq
L.W. Cut OFf - ,
.
Door Prossurs - Lightiny Inst. ?
? ? ; ;r:
' %
Prosswa Porcent COZ , = Dote Tested
Input CFH 14:/ Peroont O
r' Company Testing -? ?? ????? ''
Z
Stack Temp. PerceM CO Nam* oF T.stsr --'
Form 235
,
/
.
.
-
• i
L A •
HOUSE HEATING TEST RECORD
ADDRESS
APT. FLOOR CITY SUBUR$?
OCCUPANT d>- ' OWNER
HEAT LOSS- --? ` DATE HTG. INST. l -- ?
SOLD BY - ?.??? _? • INSTALLED BY
El.chicol work BY,, 5
Gas Lin• By /
`f
TYPE OF HEAT GA y FA HW STEAM SPACE HTR.
UNIT HTR:-_?_-?OTHER
?AS QESIGN CONVER510N
MAKE MAKE OF BURNER
Mod•I Model ?
Ssrial 34 11J_S 7 1? Max. BTU Rotiny
INPUT ? ?? ? MAKE OF FURNACE
Model ?
?
- ---/
CONTRU?S 3
.l
,
_/ J ?
?
"
THERMOST Y %?
t p??q Vent Si:s
Valv ? '- KIND OF LINER r SIZE NONE
Umit DraFt Hood Riqulafor
Limit SeMiny FilYers Siza Numbsr
Fan Ssffiny Chimmey Location Ip?ido Outsid•
Pilot Typs F %? - Chimnsr Construction
Pilot Moks ,??.-----'-"
P;lor Model
Smoke
Wi?ing
Jsst Tap
Li9htiny (nsf.
Pilot Timiny D?off -- l'f ''
L.W. Cuf OFF - - Door Pnssure_
i --
Pressur• f~ f Pere*nf COZ dafe Tooted
Inpuf CFH PKeonf OT Company Tutiny
Stock Tomp. T_b? ? Pereenf CO ? Nameoi T*stsr _
Fwm 235
r
'? • ?? ???/ ??
ADDRESS
OCCUPANT
HEAT LOSS f D TE HTG. INST.
SOLD BY d ? "
? Elaetrical Work By
TYPE OF HEAT GA
HDUSE HEATING
.
CITY
Gns Lin• By
STEAM SPACE HTR. UNIT HTR. OTHER
?-? GAS DESIGN CONVER510N
MAKE MAKE OF BURNER
Model . `'? 0v •- ? Model
Ssrial Max. BTU Ratiny
INPUT MAKE OF FURNACE
. . Modsl
THERM?T eat pl„g Vent Siz•
?z
Valve ? 7 ?J -r KIND OF LII?E SIZE N N
?
Limit Droft Hood ?_ R• ularo?.. ? "
?
Limit 5etting a Filters Sixe _1 umber 'Z k? Z
Fan Setting Chimnay Location ?sids Outside ???
Pilot Typs ' Chimney Construetior
?
Pilot Maks
Pilot Model Smoks Bo Wiring
Pilot Timing,- Draft-?r1- Test Tag
L.W. Cuf Off -?- Door Pressure ? r Lighting (nst.
?i ?
Pressure Psroent C0 Date Testsd
Input CFH ? 2
Perunt 0 ? Company Testing
2
Stock Temp. Percent CO Name of Tsster
Fwm 235
?
HOUSE? H EATING TEST RECORD
?ADDR ESS ?
APT. LOOR CITY SUBURB?
OCCUPANT OWNER
HEAT L0557`r- DA HTG. INST. ? ?SOLD BY ? INSTALLED BY
Electrical Work By-'' Gas Lins By.
TYPE OF HEAT GA? FA STEAM SPACE HTR. UNIT HTR. OTHER
GAS DESIGN CONVERSION
MAKE MAKE OF BURNER
Model ? f Model
Ssrial ? Max. BTU Ratiny
INPUT ??DiGG4 MAKE OF FURNACE
Model _/ -
? CONT 5
THERMONA ?_ t Plug Vent Size
Valvs KIND OF LImft SIZE NO??? ?
Limit Drak Hood eeejc? ulator __ --
L'imit S?Hing G Filters Sisd umbsr
Fan Setting ? Chimney Locction lnsida Outsids, ?l
Pilot Typs .. r- Chimney Construction ?
Pilot Make -
Pilot Model Smoke B Wiring ?
Pilot Timing Droft Test Tag v
L.W. Cut Off ---?" Door Prossuro-?J- Liyhtiny Init.
Prssaure ---? Pereent CO2 Dote Tested •??
?- ? Input CFH Peresnt 02 Company Testing
Staek Temp -?? c-Pereent CO Name of Tester
J .
Form 235 i ?
"' HOVSE HEATING TEST RECORD ?
/ _, • __G??
ADDRESS APT. FL OR CITY SUBUR?
OCGUPANT OWNER !? ? f •
HEAT LOSS ?TE HTG. INST.
SdLD BY - ? P INSTALLED B ?
Electrical Work B Gas Lins By
TYPE OF HEAT FASTEAM SPACE HTR. UNIT HTR. OTHER
? GAS DESIGN CONYERSION
MAKE f MAKE OF BURNER
Model Modei
Serial
Max. BTU Ratiny
INPUT MAKE OF FURNACE
1 Model
l. KULJ
THERMOSr#k Heat Pluy Vent Sizs
Valve KIND OF LINI-z SIZE NONE
Limit ? Drah Hood RegulaTOr 'Q
Limit S?ttiny FiltNS Size umb
Fan Settin9 Chimney Loeafion Inside Outside
Pilot Type ? Chimnsy Construction
Pilot Make ?
Pilof Model Smoke Bomb Ole Wiring v
Pilot Timing A D?aft Test Tay ?
L.W. Cut Off Dow Prossure Liyhtiny Inst. ?
?
/ -7
Prsssure Percent C02 _ / Dote Tested
Input CFH Percent 02 --2 Compony Testing
Stock Temp._ Q` Peresnt CO G Nams of Teater
Form 235
?
HOUSE? H EATING TEST RECORD
?ADDR ESS ?
APT. LOOR CITY SUBURB?
OCCUPANT OWNER
HEAT L0557`r- DA HTG. INST. ? ?SOLD BY ? INSTALLED BY
Electrical Work By-'' Gas Lins By.
TYPE OF HEAT GA? FA STEAM SPACE HTR. UNIT HTR. OTHER
GAS DESIGN CONVERSION
MAKE MAKE OF BURNER
Model ? f Model
Ssrial ? Max. BTU Ratiny
INPUT ??DiGG4 MAKE OF FURNACE
Model _/ -
? CONT 5
THERMONA ?_ t Plug Vent Size
Valvs KIND OF LImft SIZE NO??? ?
Limit Drak Hood eeejc? ulator __ --
L'imit S?Hing G Filters Sisd umbsr
Fan Setting ? Chimney Locction lnsida Outsids, ?l
Pilot Typs .. r- Chimney Construction ?
Pilot Make -
Pilot Model Smoke B Wiring ?
Pilot Timing Droft Test Tag v
L.W. Cut Off ---?" Door Prossuro-?J- Liyhtiny Init.
Prssaure ---? Pereent CO2 Dote Tested •??
?- ? Input CFH Peresnt 02 Company Testing
Staek Temp -?? c-Pereent CO Name of Tester
J .
Form 235 i ?
"' HOVSE HEATING TEST RECORD ?
/ _, • __G??
ADDRESS APT. FL OR CITY SUBUR?
OCGUPANT OWNER !? ? f •
HEAT LOSS ?TE HTG. INST.
SdLD BY - ? P INSTALLED B ?
Electrical Work B Gas Lins By
TYPE OF HEAT FASTEAM SPACE HTR. UNIT HTR. OTHER
? GAS DESIGN CONYERSION
MAKE f MAKE OF BURNER
Model Modei
Serial
Max. BTU Ratiny
INPUT MAKE OF FURNACE
1 Model
l. KULJ
THERMOSr#k Heat Pluy Vent Sizs
Valve KIND OF LINI-z SIZE NONE
Limit ? Drah Hood RegulaTOr 'Q
Limit S?ttiny FiltNS Size umb
Fan Settin9 Chimney Loeafion Inside Outside
Pilot Type ? Chimnsy Construction
Pilot Make ?
Pilof Model Smoke Bomb Ole Wiring v
Pilot Timing A D?aft Test Tay ?
L.W. Cut Off Dow Prossure Liyhtiny Inst. ?
?
/ -7
Prsssure Percent C02 _ / Dote Tested
Input CFH Percent 02 --2 Compony Testing
Stock Temp._ Q` Peresnt CO G Nams of Teater
Form 235
ti
AZIR E85 -?
' OCCUPANT ?
HEAT LOSS
SOLD BY ?
'Electrical Work By
HEATING TEST RECORD
CITY
.
INSTALLED BY
P ? Gas Line By
' TYPE OF HEAT GA FA ?HW STEAM SPACE HTR. UNIT HTR. OTH
G S DESIGN CONVE VStN ? w?-D?
MAKE MAKE OF BURNER _
' Model S Q 7 hbdsl
Sorial C y Max. BTU Rotiny -
INPUT r O a? MAKE OF FURNACE
Model
Limit Setting
Fan Setting -
Pilot Type ?
Pilot Make _
Pilot Model _
Pilof Timiny
L.W. Cut Off
rjTROL 5
Heat Plug
P?essure 1 151!C' Psreent CO,
Input CFH ? Peresnt 0,
Stack Temp. ? Pereent CO
Form 235
y pp???
Vent Sizs A; ?
KIND OF LINER SIZE NOyE
Droh Hood ? /l ? Rea.,leror ? ' ~
Filtsrs Sizslla,02s PeNumb Q,
Chimney Location / I side Outaide ?
Chimney Construefio?F .?
Smoks Bomb ?- 1Kiring 600"
Draft . - ? Test Tay ?
Door Pres:urs !!! ?__, Lighting Inst. ?l'
Date Tssted ?
Compony Testing
Nams of Testar _
HOUSE HEATING TEST RECORD
T. " FLOOR CITY ?SUBURB ? CJvI
ADDRESS 7CP
1 I ?
OCCUPANT OWNER , ?Q -?
HEAT LOSS _ ATE HTG. I ST. ? ?7
SOLD BY A? M a??d„.a, C,?, . INSTALLED BY
Eleetrieal Work By Gas Lins By
TYPE OF HEAT
I GA FA HW
GAS DESI STEAM SPACE HTR. UNIT HTR. OTHER
MAKE LA-A MAKE OF BURNER
Modsl Model
? Serial BTU Rating
Max
.
INPUT MAKE OF FURNACE
Model
? tCONTROLS
Valve?
Limit
Limit Settiny
Fan Setting -
Pilot Type _
Plug
Vent Si:e
KIND OF
SIZE NONE
Drah Hood RegulaTOr
Fi Itsrs Size ? V ° umber 1.. ?i
Chimnoy Location Inside Ovtside
Chimnsy Conslrucfion
Pilot Model v Smoks Bomb Wi?ing
Pilot Timing Draft Test Tap
L.W. Cut Off Door Prsssure Lightiny Inst.
Pressuro SiZ?Paresnt C0?
1-7 JRL
Dafe 7ested
Inpvt CFH ? 2kgh Parcent 02 Company Testing ICVUL
STaek Temp. Parcent CO Name of Tsster
Form 235
H0? ATING TES,? RECORD
ADDRESS APT.` FLOOR CITY SUBURB
OCCUPANT ? OWNER
HEAT LOSS DATE HTG. INST
SOLD BY ?]m??L .
l? M?ri?Oeeit
m? INSTALLED BY
Elsetrieal Work By Gas Line By
?
TYPE OF HEAT GA FA _THW STEAM SPACE HTR. UNI T HTR. OTHER _i
'
' GAS DESIGN CONYERSION
,MAKE MAKE OF BURNER L AGAN
Model ???
Serial Max
BTU Rating E D
.
INPUT MAKE OF FURNACE
AA BY
odsl
NTROLS
THERMOS AT
-A&IM
Meat Pluy
A b'ATE
Vont Sizs
Valve KIND OF LINER NONE
w
Limit
Draft Flood
Regularor
Limit Ssttiny
Fon Settina _
Pilot Type _
Pilot Make _
Pilot Model _
Pilot Timing
L.W. Cut Off
Filtsrs 5ize Number
Chimnsy Location Insids Outsida
Chimnay Construction
Smoke Bomb Wiring
Draft Test 1
Door Prsssure Lighti
Presaure :S•z Pereent COZ Date Testsd -
Input CFH 12km Pereent 02 Company Testiny
Staek Temp. -? Pwrcent CO Name of Testar _
Form 235
Inst. _
• \
HOUSE HEATING TEST RECORD
? .
ADDRESS APT. FLOOR CITY SUBURB
OCCUPANT OWNER
HEAT LOSS ,?. DATE HTG. NST.
SOLD BY rA& tLs ` INSTALLED BY
Eischical Work By Gas Line By
TYPE OF HEAT GA FA HW STEAM SPACE HTR. t1NiT HTR. GAS DESIGN CO VOT14iR_
S 01?.k
MAKE MAKE OF BURNER ?
Modsl ? Model
Sor1O I Max. BTU Roti ng `
INPUT p? MAKE OF FURNACE
Model
Valvs ?
Limit
Limit Settiny
Fan Setting -
Pilor Type _
Pilot Maks _
Pilot Model _
Pilot Timing
l.. W. Cut Off
Plug
Pressure 3. S Ps?eent C02
Input CFH 120 Percent 02
Stack Temp. Perunt CO iN?,
Form 235
Vsnt $izs so's_
KIND OF LINER-
Drah Hood
Filtsrs Size _
Chimnoy Loeation
Chimney Construction
lai
(nsids Outside
$moke Bomb Wiring _
Draft Tsst 7ag
Door
Lighting Inst.
Date Tasted ' R?q
Compony Testing
Name of Testsr - ae-
HOYSE htEATING TEST RECORD '
ADDRE55 APT. FL00 CITY SUBURB
OCCUPANT ?'?---? OWNER ?
HEAT LOSS
SOLD 6Y ?
Eleetr;cal Work By
TYPE OF HEAT
MAKE.
Modsl
Ssrial _
INPUT
DATE HTG.
GA FA
GAS DESIGN
1M STEAM ?
MAK
Moda
?Aa x.
INSTALLED BY P-'?-C-•-?C,'_' /2r'--?
Gas Lino By ' I
ACE HTR. UNIT HTR. OTHER
OF BURNER
CONVERSION
Ratiny -
FURNACE
TH E R MOS Tf4
Va Ive
Limit
Limit Settiny
Fan Setting -
Pilot Type _
Pilot Make _
Vsnt Size /?) !?
KIND OF LINER SIZE NONE
Draft Hood r --? -Regularor
Filters Sizs Number
Chimnsy Loeation Inside Outaide
Chimney Construction
Pilot Model Smoke Bomb Wiring
Pilot Timing i, `• ?'t , Draft Test Tay
L.W. Cut Off Door Pressurs Lighting lost.
r ;
Prossure Pereent COZ date Tsstsd
Input CFH Pereent 02 , T Company Testing 00C? A-/! .?-
51oek Temp. Peresnt CO ! Name of Tester r
Form 235 ?
?
HOUSE )HEATING TEST RECORD ?
?ADDRESS ? a? Y ?. „?,?rs 4?7 r - ?
--?' APT. FLOQR CITY SUBURB ?``-
OCCUPANT OWNER
HEAT LOSS DATE HTG. II?I$T.
SOLD BY ?7??.`_',
" INSTALLED BY `:---
Electrical Work By Gas Line By
TYPE OF HEAT GA FA HW STEAM SPACE HTR. UNiT HTR. OTHER
GAS DESIGN CONVERSION
MAKE MAKE OF BURNER
Model Model
Sxicl
-r Max. BTU Rating
INPUTMAKE OF FURNACE
Model
C,rONTROLS
THERMQSTAT Heat Plug
Valve ??--¢-------- ?
Limit r -?-??-
b
Limit Sefting U
Fan Setting
Pilot Type ?
Pilot Make
Pilot Model
Pilof Timing -'-'`?-
L.W. Cut Off
?, /• I? p
Vent Size E'S ? 1 /J
KIND OF LINER SIZE NONE
Drah Hood f' , __..0 -?- Regularor
Fi Itsrs Size Nvm6er
Chimney Location Inside F' Outside
Chimney Construetion
Smoke Bomb Wiring -
DraFt '~ ? Test Tag-
Door Pressure Lighting Inst.
Prossure Percent CO _? ' ('G` Oafe Tested
Input CFH Percent 02
I; 2 1 ?- Company Yesting ? 'z-
Steck Temp. -? ` Pereent CO Name of Taster
Form 235
? HOUSE ?+EATING TEST RECORD
ADDRESS
? APT. FLO R CITY SUBURB
OCCUPANT OWNER }?'G'i
HEAT LOSS DATE HTG. I ST.
50LD 8Y T' ? ?-J,
lNSTALLED BY ?,•^, --'-*-
Electrical Work By •.-??!-t- _? Gos Line By
TYPE OF HEAT GA FA HW STEAM SPACE HTR. UNIT HTR. OTHER ?4
GAS DESIGN
MAKE . ? MAKE OF BURNER _
Model Model
?
Ssrial Mox. BTU Rafing -
INPUT MAKE OF FURNACE
Model
C NTROLS
THERMOSTAT -? Heat Plug Vent Size
Valve -={-<11
: KIND OF LINE SIZE NONE
.
E
? Limit
Draff Hood
3
F Limit $etting % J U 6 Filters Sixe Number
Fan Setting Chimnay Loeafion Inside v Outsida
Pilot Type Chimney Construction ?
Pilot Miake ?
Pilot Modei Smoke Bomb Wiring ?
Pilof Timing ?r,->._???? . DraFt -) ? i T
t T
?
es
ag
L.W. Cut Off door Pressure Lighfing Inst.
Prossure Percent C02 pate Tssted r '_7
Inpvt CFH_ ?CJ C1 Percent 0 2 - Company Testing
Stack Temp. 36U Percent CO - n Name of Teafer ? Y'?..r?-??1_ F• -
,
Form 235
CONVERSION
HOUSE `#EATING TEST RECORD
Y
r°
ADDRE55 APT. FLO?Q R CITY SUBURB?
OCCUPANT OWNER ?`ll g
HEAT LOSS DATE HTG.,jN5T.
SOI.D BY
INSTALLED BY `•?"r- " `?2!' U?
Eleetricol Work B.. ?E Gas Line By
TYPE OF HEAT GA FA HW STEAM SPACE HTR. UNiT HTR. " OTHER
GAS DESIGN
MAKE •' ??' ? MAKE OF BURNER _
Modsl ' _ Madel
Serial Max. BTU Rating -
INPUT MAKE OF FURNACE
Model
C9'NTRQLS
THERMO?TAT?' ,"e Heat Plug Vent Size
Valre t?> -«-, KINQ OF LIhtE S1ZE NONE ?
Limit I ?« = Drak Hood Regularor
Limit SeNing Filters Size Number
Fan Setting /? Chimney Location Inside ?- Outside ?w {
Pilot Type " Chimney Construction j
Pilot Make 1
Pilot Model _
Pilot Timing
L.W. Cut Off
Smoke Bomb Wiring
Draft Test Tag
Door Pressure Liahtina InsL Pressure 4Percent C02 Date Tested
Input CFH 44 Percent O 2 i?, ? Company TesTing
Stack Temp. Peresnt C0 ?J Name oF Tester f?"L ?l-'" --'' • ?
Fwm 235 i
CONVERSION
ti
AZIR E85 -?
' OCCUPANT ?
HEAT LOSS
SOLD BY ?
'Electrical Work By
HEATING TEST RECORD
CITY
.
INSTALLED BY
P ? Gas Line By
' TYPE OF HEAT GA FA ?HW STEAM SPACE HTR. UNIT HTR. OTH
G S DESIGN CONVE VStN ? w?-D?
MAKE MAKE OF BURNER _
' Model S Q 7 hbdsl
Sorial C y Max. BTU Rotiny -
INPUT r O a? MAKE OF FURNACE
Model
Limit Setting
Fan Setting -
Pilot Type ?
Pilot Make _
Pilot Model _
Pilof Timiny
L.W. Cut Off
rjTROL 5
Heat Plug
P?essure 1 151!C' Psreent CO,
Input CFH ? Peresnt 0,
Stack Temp. ? Pereent CO
Form 235
y pp???
Vent Sizs A; ?
KIND OF LINER SIZE NOyE
Droh Hood ? /l ? Rea.,leror ? ' ~
Filtsrs Sizslla,02s PeNumb Q,
Chimney Location / I side Outaide ?
Chimney Construefio?F .?
Smoks Bomb ?- 1Kiring 600"
Draft . - ? Test Tay ?
Door Pres:urs !!! ?__, Lighting Inst. ?l'
Date Tssted ?
Compony Testing
Nams of Testar _
HOUSE HEATING TEST RECORD
T. " FLOOR CITY ?SUBURB ? CJvI
ADDRESS 7CP
1 I ?
OCCUPANT OWNER , ?Q -?
HEAT LOSS _ ATE HTG. I ST. ? ?7
SOLD BY A? M a??d„.a, C,?, . INSTALLED BY
Eleetrieal Work By Gas Lins By
TYPE OF HEAT
I GA FA HW
GAS DESI STEAM SPACE HTR. UNIT HTR. OTHER
MAKE LA-A MAKE OF BURNER
Modsl Model
? Serial BTU Rating
Max
.
INPUT MAKE OF FURNACE
Model
? tCONTROLS
Valve?
Limit
Limit Settiny
Fan Setting -
Pilot Type _
Plug
Vent Si:e
KIND OF
SIZE NONE
Drah Hood RegulaTOr
Fi Itsrs Size ? V ° umber 1.. ?i
Chimnoy Location Inside Ovtside
Chimnsy Conslrucfion
Pilot Model v Smoks Bomb Wi?ing
Pilot Timing Draft Test Tap
L.W. Cut Off Door Prsssure Lightiny Inst.
Pressuro SiZ?Paresnt C0?
1-7 JRL
Dafe 7ested
Inpvt CFH ? 2kgh Parcent 02 Company Testing ICVUL
STaek Temp. Parcent CO Name of Tsster
Form 235
H0? ATING TES,? RECORD
ADDRESS APT.` FLOOR CITY SUBURB
OCCUPANT ? OWNER
HEAT LOSS DATE HTG. INST
SOLD BY ?]m??L .
l? M?ri?Oeeit
m? INSTALLED BY
Elsetrieal Work By Gas Line By
?
TYPE OF HEAT GA FA _THW STEAM SPACE HTR. UNI T HTR. OTHER _i
'
' GAS DESIGN CONYERSION
,MAKE MAKE OF BURNER L AGAN
Model ???
Serial Max
BTU Rating E D
.
INPUT MAKE OF FURNACE
AA BY
odsl
NTROLS
THERMOS AT
-A&IM
Meat Pluy
A b'ATE
Vont Sizs
Valve KIND OF LINER NONE
w
Limit
Draft Flood
Regularor
Limit Ssttiny
Fon Settina _
Pilot Type _
Pilot Make _
Pilot Model _
Pilot Timing
L.W. Cut Off
Filtsrs 5ize Number
Chimnsy Location Insids Outsida
Chimnay Construction
Smoke Bomb Wiring
Draft Test 1
Door Prsssure Lighti
Presaure :S•z Pereent COZ Date Testsd -
Input CFH 12km Pereent 02 Company Testiny
Staek Temp. -? Pwrcent CO Name of Testar _
Form 235
Inst. _
• \
HOUSE HEATING TEST RECORD
? .
ADDRESS APT. FLOOR CITY SUBURB
OCCUPANT OWNER
HEAT LOSS ,?. DATE HTG. NST.
SOLD BY rA& tLs ` INSTALLED BY
Eischical Work By Gas Line By
TYPE OF HEAT GA FA HW STEAM SPACE HTR. t1NiT HTR. GAS DESIGN CO VOT14iR_
S 01?.k
MAKE MAKE OF BURNER ?
Modsl ? Model
Sor1O I Max. BTU Roti ng `
INPUT p? MAKE OF FURNACE
Model
Valvs ?
Limit
Limit Settiny
Fan Setting -
Pilor Type _
Pilot Maks _
Pilot Model _
Pilot Timing
l.. W. Cut Off
Plug
Pressure 3. S Ps?eent C02
Input CFH 120 Percent 02
Stack Temp. Perunt CO iN?,
Form 235
Vsnt $izs so's_
KIND OF LINER-
Drah Hood
Filtsrs Size _
Chimnoy Loeation
Chimney Construction
lai
(nsids Outside
$moke Bomb Wiring _
Draft Tsst 7ag
Door
Lighting Inst.
Date Tasted ' R?q
Compony Testing
Name of Testsr - ae-
HOYSE htEATING TEST RECORD '
ADDRE55 APT. FL00 CITY SUBURB
OCCUPANT ?'?---? OWNER ?
HEAT LOSS
SOLD 6Y ?
Eleetr;cal Work By
TYPE OF HEAT
MAKE.
Modsl
Ssrial _
INPUT
DATE HTG.
GA FA
GAS DESIGN
1M STEAM ?
MAK
Moda
?Aa x.
INSTALLED BY P-'?-C-•-?C,'_' /2r'--?
Gas Lino By ' I
ACE HTR. UNIT HTR. OTHER
OF BURNER
CONVERSION
Ratiny -
FURNACE
TH E R MOS Tf4
Va Ive
Limit
Limit Settiny
Fan Setting -
Pilot Type _
Pilot Make _
Vsnt Size /?) !?
KIND OF LINER SIZE NONE
Draft Hood r --? -Regularor
Filters Sizs Number
Chimnsy Loeation Inside Outaide
Chimney Construction
Pilot Model Smoke Bomb Wiring
Pilot Timing i, `• ?'t , Draft Test Tay
L.W. Cut Off Door Pressurs Lighting lost.
r ;
Prossure Pereent COZ date Tsstsd
Input CFH Pereent 02 , T Company Testing 00C? A-/! .?-
51oek Temp. Peresnt CO ! Name of Tester r
Form 235 ?
?
HOUSE )HEATING TEST RECORD ?
?ADDRESS ? a? Y ?. „?,?rs 4?7 r - ?
--?' APT. FLOQR CITY SUBURB ?``-
OCCUPANT OWNER
HEAT LOSS DATE HTG. II?I$T.
SOLD BY ?7??.`_',
" INSTALLED BY `:---
Electrical Work By Gas Line By
TYPE OF HEAT GA FA HW STEAM SPACE HTR. UNiT HTR. OTHER
GAS DESIGN CONVERSION
MAKE MAKE OF BURNER
Model Model
Sxicl
-r Max. BTU Rating
INPUTMAKE OF FURNACE
Model
C,rONTROLS
THERMQSTAT Heat Plug
Valve ??--¢-------- ?
Limit r -?-??-
b
Limit Sefting U
Fan Setting
Pilot Type ?
Pilot Make
Pilot Model
Pilof Timing -'-'`?-
L.W. Cut Off
?, /• I? p
Vent Size E'S ? 1 /J
KIND OF LINER SIZE NONE
Drah Hood f' , __..0 -?- Regularor
Fi Itsrs Size Nvm6er
Chimney Location Inside F' Outside
Chimney Construetion
Smoke Bomb Wiring -
DraFt '~ ? Test Tag-
Door Pressure Lighting Inst.
Prossure Percent CO _? ' ('G` Oafe Tested
Input CFH Percent 02
I; 2 1 ?- Company Yesting ? 'z-
Steck Temp. -? ` Pereent CO Name of Taster
Form 235
? HOUSE ?+EATING TEST RECORD
ADDRESS
? APT. FLO R CITY SUBURB
OCCUPANT OWNER }?'G'i
HEAT LOSS DATE HTG. I ST.
50LD 8Y T' ? ?-J,
lNSTALLED BY ?,•^, --'-*-
Electrical Work By •.-??!-t- _? Gos Line By
TYPE OF HEAT GA FA HW STEAM SPACE HTR. UNIT HTR. OTHER ?4
GAS DESIGN
MAKE . ? MAKE OF BURNER _
Model Model
?
Ssrial Mox. BTU Rafing -
INPUT MAKE OF FURNACE
Model
C NTROLS
THERMOSTAT -? Heat Plug Vent Size
Valve -={-<11
: KIND OF LINE SIZE NONE
.
E
? Limit
Draff Hood
3
F Limit $etting % J U 6 Filters Sixe Number
Fan Setting Chimnay Loeafion Inside v Outsida
Pilot Type Chimney Construction ?
Pilot Miake ?
Pilot Modei Smoke Bomb Wiring ?
Pilof Timing ?r,->._???? . DraFt -) ? i T
t T
?
es
ag
L.W. Cut Off door Pressure Lighfing Inst.
Prossure Percent C02 pate Tssted r '_7
Inpvt CFH_ ?CJ C1 Percent 0 2 - Company Testing
Stack Temp. 36U Percent CO - n Name of Teafer ? Y'?..r?-??1_ F• -
,
Form 235
CONVERSION
HOUSE `#EATING TEST RECORD
Y
r°
ADDRE55 APT. FLO?Q R CITY SUBURB?
OCCUPANT OWNER ?`ll g
HEAT LOSS DATE HTG.,jN5T.
SOI.D BY
INSTALLED BY `•?"r- " `?2!' U?
Eleetricol Work B.. ?E Gas Line By
TYPE OF HEAT GA FA HW STEAM SPACE HTR. UNiT HTR. " OTHER
GAS DESIGN
MAKE •' ??' ? MAKE OF BURNER _
Modsl ' _ Madel
Serial Max. BTU Rating -
INPUT MAKE OF FURNACE
Model
C9'NTRQLS
THERMO?TAT?' ,"e Heat Plug Vent Size
Valre t?> -«-, KINQ OF LIhtE S1ZE NONE ?
Limit I ?« = Drak Hood Regularor
Limit SeNing Filters Size Number
Fan Setting /? Chimney Location Inside ?- Outside ?w {
Pilot Type " Chimney Construction j
Pilot Make 1
Pilot Model _
Pilot Timing
L.W. Cut Off
Smoke Bomb Wiring
Draft Test Tag
Door Pressure Liahtina InsL Pressure 4Percent C02 Date Tested
Input CFH 44 Percent O 2 i?, ? Company TesTing
Stack Temp. Peresnt C0 ?J Name oF Tester f?"L ?l-'" --'' • ?
Fwm 235 i
CONVERSION
? .. .
HOUSE kiEATING TEST RECORD
, .
• ?-_?
ADDRESS APT. F1x0QR C(TY SUBURB %
OCCUPANT OWNER
HEAT LOSS DATE HTG. INST.
SOLD BY INSTALLED BY
' ` .
Y
Elsetrical Work By '=''d`-•.t-?-- ?'%{--. Gas Lin• B ?
TYPE OF HEAT GA FA HYY STEAM SPACE HTR. UNIT HTR. ?OTHER
GAS DESIGN
MAKE MAKE OF BURNER _
Model 1? ?-? f..l ? Modsl
Sarial Max. BTU Rarin
9 -
INPUT MAKE OF FURNACE
. Modsl
b?
Heat Plug Venf 5ize
Yalve '
Limit ?
Limit $etfiny
Fan Setting _
Pilot Type _
Pilot Make _
KIND OF LINER `, SIZE NONE
Draft Hood "77"t -='- RayulaTOr
Filters Size Numbsr
Chimney Loeatian Inside
Chimnsy Construction
Pilot Model Smoke Bomh ? Wiring ?
Pilot Timing D?oft Test Tay
L.W. Cut Off Door Pressure Lightiny InsT. `
Prossure ' Percent C0 Oate Tested "
2
Inpvt CFH Percent O Company Testing
Stoek Temp. Pereeot CO2 c 44 Name of Teater
Form 235
CONVERSION "'
? .. .
HOUSE kiEATING TEST RECORD
, .
• ?-_?
ADDRESS APT. F1x0QR C(TY SUBURB %
OCCUPANT OWNER
HEAT LOSS DATE HTG. INST.
SOLD BY INSTALLED BY
' ` .
Y
Elsetrical Work By '=''d`-•.t-?-- ?'%{--. Gas Lin• B ?
TYPE OF HEAT GA FA HYY STEAM SPACE HTR. UNIT HTR. ?OTHER
GAS DESIGN
MAKE MAKE OF BURNER _
Model 1? ?-? f..l ? Modsl
Sarial Max. BTU Rarin
9 -
INPUT MAKE OF FURNACE
. Modsl
b?
Heat Plug Venf 5ize
Yalve '
Limit ?
Limit $etfiny
Fan Setting _
Pilot Type _
Pilot Make _
KIND OF LINER `, SIZE NONE
Draft Hood "77"t -='- RayulaTOr
Filters Size Numbsr
Chimney Loeatian Inside
Chimnsy Construction
Pilot Model Smoke Bomh ? Wiring ?
Pilot Timing D?oft Test Tay
L.W. Cut Off Door Pressure Lightiny InsT. `
Prossure ' Percent C0 Oate Tested "
2
Inpvt CFH Percent O Company Testing
Stoek Temp. Pereeot CO2 c 44 Name of Teater
Form 235
CONVERSION "'
HOUSE HrKATING TEST RECORD ?
,- .
ADDRESS eAPT. FLOQR CITY SUBURB
OCCUPANT ?-•-? _ r ? ?
OWNER ??? 3
HEAT LOSS DATE HTG. INST.
SOLD BY ' -
INSTALLED BY
Electrical Wark By i' c-.--„ Gos Line By -
TYPE OF HEAT GA FA HW STEAM SPACE HTR.
GAS DESIGN
MAKE : MAKE OF BURNER
Model Model
Ssrial ??
?-?
Max. BTU Rating
INPUT r'T MAKE OF FURNACE
-
Model
?CONTROLS
THERMOSTAT -?*--- HeatPlug Venf Size
Valve " -1 KIND OF LINER SIZE NONE
Limit Drah Hood `,.,,-F ?, _- Regulator ? ?'• ?
Limit Sstting %%-G'' Filters Size Number
Fan Setting Chimney Location
Pilot TYpe Chimney Construction _
Pilot Make
Pilot Model Smoke Bomb Wiring
Pilof Timing Draft /I Tast Tog
L.W. Cut Dff Door Pressure Lighting Inst. L?
Prossure Percent Cd Date Tesfed
,
Input CFH ' Pereent 0 2 b' Company Testing QC'•-
Stack Temp. Percent CO !? ?% Name of Tester
Form 235
UNIT HTR. ?,,"_OTHER
CONVERSION
Inside Outside
? . . . ,
` HOUSE HFATING TEST RECORD
ADDRESS
APT. FLOOR CITY SUBURB
OCCUPANT ?-" - - ? OWNER
HEAT LOSS DATE HTG. INST.
SOLD BY INSTALLED BY ?r ---? - ?
"??
Elechical Wnrk gy
Gas Lins By ?
TYPE OF HEAT GA FA HYV STEAM SPACE HTR.
i . GAS DESIGN
MAKE MAKE OF BURNER _
Model Model
$erial Mox. BTU Ratiny -
INPUT MAKE OF FURNACE
? ?ONTROLS
THERMOSTAT Heaf plug
Valve -Z-A-A,
Limit
Limit Ssttiny 1 Q?u ?
Fon Setting
Pilot Type '?`-•.-?+-?.??'
Pilo! Maks
Model
/
.
VeM Sizs ::?
17W
KIND OF LINER SIZE NONE
DraN Hood Regularor
Fi Iters 5ize Number
Chimnsy Location Insids Outsids' ?
Ohimney Consiruction ?
Pilot Model Smoks Bomb Wiring 1' ?
Pilot Timiny Draft -" f\ T
??
T
sst
ap
?
L.W. Cut Off Door Presswe Lighting Inst.
Prossure Percent CO2 Date Tested
Input CFH Pereent p i/ -. Company Testing
S t ac k Temp. Z
Pereent C O
?i Name of Tester
i
Form 235 ?
UNIT HTR. `- OTHER
CONVERSION
ti
AZIR E85 -?
' OCCUPANT ?
HEAT LOSS
SOLD BY ?
'Electrical Work By
HEATING TEST RECORD
CITY
.
INSTALLED BY
P ? Gas Line By
' TYPE OF HEAT GA FA ?HW STEAM SPACE HTR. UNIT HTR. OTH
G S DESIGN CONVE VStN ? w?-D?
MAKE MAKE OF BURNER _
' Model S Q 7 hbdsl
Sorial C y Max. BTU Rotiny -
INPUT r O a? MAKE OF FURNACE
Model
Limit Setting
Fan Setting -
Pilot Type ?
Pilot Make _
Pilot Model _
Pilof Timiny
L.W. Cut Off
rjTROL 5
Heat Plug
P?essure 1 151!C' Psreent CO,
Input CFH ? Peresnt 0,
Stack Temp. ? Pereent CO
Form 235
y pp???
Vent Sizs A; ?
KIND OF LINER SIZE NOyE
Droh Hood ? /l ? Rea.,leror ? ' ~
Filtsrs Sizslla,02s PeNumb Q,
Chimney Location / I side Outaide ?
Chimney Construefio?F .?
Smoks Bomb ?- 1Kiring 600"
Draft . - ? Test Tay ?
Door Pres:urs !!! ?__, Lighting Inst. ?l'
Date Tssted ?
Compony Testing
Nams of Testar _
HOUSE HEATING TEST RECORD
T. " FLOOR CITY ?SUBURB ? CJvI
ADDRESS 7CP
1 I ?
OCCUPANT OWNER , ?Q -?
HEAT LOSS _ ATE HTG. I ST. ? ?7
SOLD BY A? M a??d„.a, C,?, . INSTALLED BY
Eleetrieal Work By Gas Lins By
TYPE OF HEAT
I GA FA HW
GAS DESI STEAM SPACE HTR. UNIT HTR. OTHER
MAKE LA-A MAKE OF BURNER
Modsl Model
? Serial BTU Rating
Max
.
INPUT MAKE OF FURNACE
Model
? tCONTROLS
Valve?
Limit
Limit Settiny
Fan Setting -
Pilot Type _
Plug
Vent Si:e
KIND OF
SIZE NONE
Drah Hood RegulaTOr
Fi Itsrs Size ? V ° umber 1.. ?i
Chimnoy Location Inside Ovtside
Chimnsy Conslrucfion
Pilot Model v Smoks Bomb Wi?ing
Pilot Timing Draft Test Tap
L.W. Cut Off Door Prsssure Lightiny Inst.
Pressuro SiZ?Paresnt C0?
1-7 JRL
Dafe 7ested
Inpvt CFH ? 2kgh Parcent 02 Company Testing ICVUL
STaek Temp. Parcent CO Name of Tsster
Form 235
H0? ATING TES,? RECORD
ADDRESS APT.` FLOOR CITY SUBURB
OCCUPANT ? OWNER
HEAT LOSS DATE HTG. INST
SOLD BY ?]m??L .
l? M?ri?Oeeit
m? INSTALLED BY
Elsetrieal Work By Gas Line By
?
TYPE OF HEAT GA FA _THW STEAM SPACE HTR. UNI T HTR. OTHER _i
'
' GAS DESIGN CONYERSION
,MAKE MAKE OF BURNER L AGAN
Model ???
Serial Max
BTU Rating E D
.
INPUT MAKE OF FURNACE
AA BY
odsl
NTROLS
THERMOS AT
-A&IM
Meat Pluy
A b'ATE
Vont Sizs
Valve KIND OF LINER NONE
w
Limit
Draft Flood
Regularor
Limit Ssttiny
Fon Settina _
Pilot Type _
Pilot Make _
Pilot Model _
Pilot Timing
L.W. Cut Off
Filtsrs 5ize Number
Chimnsy Location Insids Outsida
Chimnay Construction
Smoke Bomb Wiring
Draft Test 1
Door Prsssure Lighti
Presaure :S•z Pereent COZ Date Testsd -
Input CFH 12km Pereent 02 Company Testiny
Staek Temp. -? Pwrcent CO Name of Testar _
Form 235
Inst. _
• \
HOUSE HEATING TEST RECORD
? .
ADDRESS APT. FLOOR CITY SUBURB
OCCUPANT OWNER
HEAT LOSS ,?. DATE HTG. NST.
SOLD BY rA& tLs ` INSTALLED BY
Eischical Work By Gas Line By
TYPE OF HEAT GA FA HW STEAM SPACE HTR. t1NiT HTR. GAS DESIGN CO VOT14iR_
S 01?.k
MAKE MAKE OF BURNER ?
Modsl ? Model
Sor1O I Max. BTU Roti ng `
INPUT p? MAKE OF FURNACE
Model
Valvs ?
Limit
Limit Settiny
Fan Setting -
Pilor Type _
Pilot Maks _
Pilot Model _
Pilot Timing
l.. W. Cut Off
Plug
Pressure 3. S Ps?eent C02
Input CFH 120 Percent 02
Stack Temp. Perunt CO iN?,
Form 235
Vsnt $izs so's_
KIND OF LINER-
Drah Hood
Filtsrs Size _
Chimnoy Loeation
Chimney Construction
lai
(nsids Outside
$moke Bomb Wiring _
Draft Tsst 7ag
Door
Lighting Inst.
Date Tasted ' R?q
Compony Testing
Name of Testsr - ae-
HOYSE htEATING TEST RECORD '
ADDRE55 APT. FL00 CITY SUBURB
OCCUPANT ?'?---? OWNER ?
HEAT LOSS
SOLD 6Y ?
Eleetr;cal Work By
TYPE OF HEAT
MAKE.
Modsl
Ssrial _
INPUT
DATE HTG.
GA FA
GAS DESIGN
1M STEAM ?
MAK
Moda
?Aa x.
INSTALLED BY P-'?-C-•-?C,'_' /2r'--?
Gas Lino By ' I
ACE HTR. UNIT HTR. OTHER
OF BURNER
CONVERSION
Ratiny -
FURNACE
TH E R MOS Tf4
Va Ive
Limit
Limit Settiny
Fan Setting -
Pilot Type _
Pilot Make _
Vsnt Size /?) !?
KIND OF LINER SIZE NONE
Draft Hood r --? -Regularor
Filters Sizs Number
Chimnsy Loeation Inside Outaide
Chimney Construction
Pilot Model Smoke Bomb Wiring
Pilot Timing i, `• ?'t , Draft Test Tay
L.W. Cut Off Door Pressurs Lighting lost.
r ;
Prossure Pereent COZ date Tsstsd
Input CFH Pereent 02 , T Company Testing 00C? A-/! .?-
51oek Temp. Peresnt CO ! Name of Tester r
Form 235 ?
?
HOUSE )HEATING TEST RECORD ?
?ADDRESS ? a? Y ?. „?,?rs 4?7 r - ?
--?' APT. FLOQR CITY SUBURB ?``-
OCCUPANT OWNER
HEAT LOSS DATE HTG. II?I$T.
SOLD BY ?7??.`_',
" INSTALLED BY `:---
Electrical Work By Gas Line By
TYPE OF HEAT GA FA HW STEAM SPACE HTR. UNiT HTR. OTHER
GAS DESIGN CONVERSION
MAKE MAKE OF BURNER
Model Model
Sxicl
-r Max. BTU Rating
INPUTMAKE OF FURNACE
Model
C,rONTROLS
THERMQSTAT Heat Plug
Valve ??--¢-------- ?
Limit r -?-??-
b
Limit Sefting U
Fan Setting
Pilot Type ?
Pilot Make
Pilot Model
Pilof Timing -'-'`?-
L.W. Cut Off
?, /• I? p
Vent Size E'S ? 1 /J
KIND OF LINER SIZE NONE
Drah Hood f' , __..0 -?- Regularor
Fi Itsrs Size Nvm6er
Chimney Location Inside F' Outside
Chimney Construetion
Smoke Bomb Wiring -
DraFt '~ ? Test Tag-
Door Pressure Lighting Inst.
Prossure Percent CO _? ' ('G` Oafe Tested
Input CFH Percent 02
I; 2 1 ?- Company Yesting ? 'z-
Steck Temp. -? ` Pereent CO Name of Taster
Form 235
? HOUSE ?+EATING TEST RECORD
ADDRESS
? APT. FLO R CITY SUBURB
OCCUPANT OWNER }?'G'i
HEAT LOSS DATE HTG. I ST.
50LD 8Y T' ? ?-J,
lNSTALLED BY ?,•^, --'-*-
Electrical Work By •.-??!-t- _? Gos Line By
TYPE OF HEAT GA FA HW STEAM SPACE HTR. UNIT HTR. OTHER ?4
GAS DESIGN
MAKE . ? MAKE OF BURNER _
Model Model
?
Ssrial Mox. BTU Rafing -
INPUT MAKE OF FURNACE
Model
C NTROLS
THERMOSTAT -? Heat Plug Vent Size
Valve -={-<11
: KIND OF LINE SIZE NONE
.
E
? Limit
Draff Hood
3
F Limit $etting % J U 6 Filters Sixe Number
Fan Setting Chimnay Loeafion Inside v Outsida
Pilot Type Chimney Construction ?
Pilot Miake ?
Pilot Modei Smoke Bomb Wiring ?
Pilof Timing ?r,->._???? . DraFt -) ? i T
t T
?
es
ag
L.W. Cut Off door Pressure Lighfing Inst.
Prossure Percent C02 pate Tssted r '_7
Inpvt CFH_ ?CJ C1 Percent 0 2 - Company Testing
Stack Temp. 36U Percent CO - n Name of Teafer ? Y'?..r?-??1_ F• -
,
Form 235
CONVERSION
HOUSE `#EATING TEST RECORD
Y
r°
ADDRE55 APT. FLO?Q R CITY SUBURB?
OCCUPANT OWNER ?`ll g
HEAT LOSS DATE HTG.,jN5T.
SOI.D BY
INSTALLED BY `•?"r- " `?2!' U?
Eleetricol Work B.. ?E Gas Line By
TYPE OF HEAT GA FA HW STEAM SPACE HTR. UNiT HTR. " OTHER
GAS DESIGN
MAKE •' ??' ? MAKE OF BURNER _
Modsl ' _ Madel
Serial Max. BTU Rating -
INPUT MAKE OF FURNACE
Model
C9'NTRQLS
THERMO?TAT?' ,"e Heat Plug Vent Size
Valre t?> -«-, KINQ OF LIhtE S1ZE NONE ?
Limit I ?« = Drak Hood Regularor
Limit SeNing Filters Size Number
Fan Setting /? Chimney Location Inside ?- Outside ?w {
Pilot Type " Chimney Construction j
Pilot Make 1
Pilot Model _
Pilot Timing
L.W. Cut Off
Smoke Bomb Wiring
Draft Test Tag
Door Pressure Liahtina InsL Pressure 4Percent C02 Date Tested
Input CFH 44 Percent O 2 i?, ? Company TesTing
Stack Temp. Peresnt C0 ?J Name oF Tester f?"L ?l-'" --'' • ?
Fwm 235 i
CONVERSION
? .. .
HOUSE kiEATING TEST RECORD
, .
• ?-_?
ADDRESS APT. F1x0QR C(TY SUBURB %
OCCUPANT OWNER
HEAT LOSS DATE HTG. INST.
SOLD BY INSTALLED BY
' ` .
Y
Elsetrical Work By '=''d`-•.t-?-- ?'%{--. Gas Lin• B ?
TYPE OF HEAT GA FA HYY STEAM SPACE HTR. UNIT HTR. ?OTHER
GAS DESIGN
MAKE MAKE OF BURNER _
Model 1? ?-? f..l ? Modsl
Sarial Max. BTU Rarin
9 -
INPUT MAKE OF FURNACE
. Modsl
b?
Heat Plug Venf 5ize
Yalve '
Limit ?
Limit $etfiny
Fan Setting _
Pilot Type _
Pilot Make _
KIND OF LINER `, SIZE NONE
Draft Hood "77"t -='- RayulaTOr
Filters Size Numbsr
Chimney Loeatian Inside
Chimnsy Construction
Pilot Model Smoke Bomh ? Wiring ?
Pilot Timing D?oft Test Tay
L.W. Cut Off Door Pressure Lightiny InsT. `
Prossure ' Percent C0 Oate Tested "
2
Inpvt CFH Percent O Company Testing
Stoek Temp. Pereeot CO2 c 44 Name of Teater
Form 235
CONVERSION "'
? .. .
HOUSE kiEATING TEST RECORD
, .
• ?-_?
ADDRESS APT. F1x0QR C(TY SUBURB %
OCCUPANT OWNER
HEAT LOSS DATE HTG. INST.
SOLD BY INSTALLED BY
' ` .
Y
Elsetrical Work By '=''d`-•.t-?-- ?'%{--. Gas Lin• B ?
TYPE OF HEAT GA FA HYY STEAM SPACE HTR. UNIT HTR. ?OTHER
GAS DESIGN
MAKE MAKE OF BURNER _
Model 1? ?-? f..l ? Modsl
Sarial Max. BTU Rarin
9 -
INPUT MAKE OF FURNACE
. Modsl
b?
Heat Plug Venf 5ize
Yalve '
Limit ?
Limit $etfiny
Fan Setting _
Pilot Type _
Pilot Make _
KIND OF LINER `, SIZE NONE
Draft Hood "77"t -='- RayulaTOr
Filters Size Numbsr
Chimney Loeatian Inside
Chimnsy Construction
Pilot Model Smoke Bomh ? Wiring ?
Pilot Timing D?oft Test Tay
L.W. Cut Off Door Pressure Lightiny InsT. `
Prossure ' Percent C0 Oate Tested "
2
Inpvt CFH Percent O Company Testing
Stoek Temp. Pereeot CO2 c 44 Name of Teater
Form 235
CONVERSION "'
HOUSE HrKATING TEST RECORD ?
,- .
ADDRESS eAPT. FLOQR CITY SUBURB
OCCUPANT ?-•-? _ r ? ?
OWNER ??? 3
HEAT LOSS DATE HTG. INST.
SOLD BY ' -
INSTALLED BY
Electrical Wark By i' c-.--„ Gos Line By -
TYPE OF HEAT GA FA HW STEAM SPACE HTR.
GAS DESIGN
MAKE : MAKE OF BURNER
Model Model
Ssrial ??
?-?
Max. BTU Rating
INPUT r'T MAKE OF FURNACE
-
Model
?CONTROLS
THERMOSTAT -?*--- HeatPlug Venf Size
Valve " -1 KIND OF LINER SIZE NONE
Limit Drah Hood `,.,,-F ?, _- Regulator ? ?'• ?
Limit Sstting %%-G'' Filters Size Number
Fan Setting Chimney Location
Pilot TYpe Chimney Construction _
Pilot Make
Pilot Model Smoke Bomb Wiring
Pilof Timing Draft /I Tast Tog
L.W. Cut Dff Door Pressure Lighting Inst. L?
Prossure Percent Cd Date Tesfed
,
Input CFH ' Pereent 0 2 b' Company Testing QC'•-
Stack Temp. Percent CO !? ?% Name of Tester
Form 235
UNIT HTR. ?,,"_OTHER
CONVERSION
Inside Outside
? . . . ,
` HOUSE HFATING TEST RECORD
ADDRESS
APT. FLOOR CITY SUBURB
OCCUPANT ?-" - - ? OWNER
HEAT LOSS DATE HTG. INST.
SOLD BY INSTALLED BY ?r ---? - ?
"??
Elechical Wnrk gy
Gas Lins By ?
TYPE OF HEAT GA FA HYV STEAM SPACE HTR.
i . GAS DESIGN
MAKE MAKE OF BURNER _
Model Model
$erial Mox. BTU Ratiny -
INPUT MAKE OF FURNACE
? ?ONTROLS
THERMOSTAT Heaf plug
Valve -Z-A-A,
Limit
Limit Ssttiny 1 Q?u ?
Fon Setting
Pilot Type '?`-•.-?+-?.??'
Pilo! Maks
Model
/
.
VeM Sizs ::?
17W
KIND OF LINER SIZE NONE
DraN Hood Regularor
Fi Iters 5ize Number
Chimnsy Location Insids Outsids' ?
Ohimney Consiruction ?
Pilot Model Smoks Bomb Wiring 1' ?
Pilot Timiny Draft -" f\ T
??
T
sst
ap
?
L.W. Cut Off Door Presswe Lighting Inst.
Prossure Percent CO2 Date Tested
Input CFH Pereent p i/ -. Company Testing
S t ac k Temp. Z
Pereent C O
?i Name of Tester
i
Form 235 ?
UNIT HTR. `- OTHER
CONVERSION
?
y{ HOUSE HFATING TEST RECORD
. . •
ADDRESS ?"-7' APT. FLO?R CITY SUBURBT
OCCIPANT OWNER
HEAT LOSSDATE HTG. INST. ?
SOLD BY INSTALLED BY
Elsctrical Work By Gos Line By ?TYPE OF HEAT GA , FA HW STEAM SPACE HTR. UN1T HTR. X-OTHER ?
_ GAS DESfGN CQNVERSION . ?
MAKE MAKE OF BURNER _
Model Model
Ssriol - '??/, - ?•'? Max. BTU Rating ?
INPUT L;-??'c' MAKE OF FURNACE
Model
CON TRal. S
3
? ?
THERMDSTAT Heot Plug !'71'
Vent Size ?
Valve KIND OF LINER t SlZE NONE
L imit `• -'' --x +-^ Droft Hood 1?'-•??' ?? -?-? RegulaTOr
Limit SeNing i-G 6 r Filfers Sizs - Number `
?
F°" 5°tt'"9 Chimney Location Inside Outside
PilotType Chimney Construction
Pilot Make
Pilot Model Smoke Bomb Wiring
Pilot Timing "- Draft Test Tag `
L.W. Cut Off Door Pressure Lighting (nst.
Prossure Percent CO ?• I r? Date Tested
Input CFH Percent Q2 ? Company Testing ?.. t
5tack Temp. Pereent CO Name of Tester
Form 235
. •
HOUSE HEATING TEST RECORD
ADDRESS APT. FLOOR CITY SUBURB
OCCUPANT Za ?,:z/' f OWNER nl' ?J
HEAT LOSS DATE HT6. INST.
SOLD BY 1 "),•O INSTALLED BY f' f s??
El.enicol we.k gy Gos Lin• Br_-??eo f
TYPE QF HEAT GA FA Li• Hw STEAM SPACE HTR. UNIT HTR. OTHER
GAS DESIGN ? CONVERSION
MAKE ?
MAKE OF BURNER
Mod•I KL Mbd•1
Swiv) L'?O :5- z Co IiAa:. BTU Rarinq ?
INPUT s MAKE OF FURN&Clii--- ?
Model
CONTROLS
THERMOSTAT H•at Plu
?
Valvo (1-11/X ? ''r>> : -?
Uml1
Lfmit Sottinp ?C) ?
Fan Settiny ?rl /j'1 Pp?
Pilot Trpe
Pflot Moke
i
Pilot Mod•1
Pilot Tfmin9
L.W. Cut Off ----
Prosswe Pereent CO2 7, s?
Input CFH 7?! PKeont p
Stoek Temp. Pereenf CO 2
`
,? -
Vent Si:e
KIND OF LINER ""Sil fE NONE
Drah Hood ?J? / % •'C L- Rpularor
Fl lfers Si:e ?%' = _Numb.. ?
ChimMy Loeation Insid', Outtide ? Chimney Construetion ?SL- ''~n /? % -1i2 i
Snak* Bomb Wiring
DraFt 142 ??z e, 0?' T•st Tay
Door Presawe `------ Liqhflnp Ins1.
Date Tesfod
Company Testing
Non» ef Tester
Fwm 235
HOUSE HEATING TEST RECORD
AODRESS APT. FLOOR CITY SUBUR ?_ ' Sf
OCCUPANT OWNER
HEAT LO55 ?•• D E HTG. T
SOLD BY ?INSTALLED Br•!?
?6???J
?
Elsehical 1ltork By Gas Line By C G
n
TYPE OF HEAT GA FA HW STEAM SPACE HTR. UNIT HTR. w G
r
7-GAS DESIGN C?H NI IC.O
MAKE MAKE OF BURNER ^
Model Model
Serial ?-S Irbx. BTU Ratin9 .
INPUT ? MAKE QF FURNACE
.?
Model ?'COTROLS S
THERMOS,.Tk?` Haat Pluy V*nt Size _
Valv
"'
? ?
'? KIND OF L N??t -
? ?
?? ?``
? SIZE? NQNE _
Limif •
'/ Droft Hood
,
- R?yulator?
Limit 5effinq - Filteis Siae, Numbsl"
Fan Settiny Chimney Location "An3id Outside ?
Pilot 7yps Qh{mney Construction
Pilot Mako - ?
~J
Pilot Model ? 1Miring
Smoke Bort?
Pilot Timin?
_ Draft
j Tssf Top
L.W. Cuf Off r Dow Pressure ? Liphtiny Inst. `?
d
Protsur• Peruni CO Dats Tesre
Inpuf CFH_
6 Psrc*nt OZ
7
? Company Testing
51oek T•mp. ? Pwc•nt CO Name ef Te:t*r '
Fwm 235
? -
' HOUSE HEATING TEST RECORD
?
ADDRESS APT. FLOOR CITY SUBURB '
OCCUPANT OWNER
HEAT LOSS -?_DA?TE HTG. INST. " ?? °' ?
SOLD BY .?'? J INSTALLED BY =
? Elechieol Work 6y T4' Gos Line Br
TYPE OF HEAT GA FA a,,,-HW STEAM SPACE HTR. UNIT HTR. OTHER
' -, GAS DESIGN CONVERSIOE
MAKE MAKE OF BURNER
Mod•I Model R
Seriol 1?111'4 2-4y6e 71 lMax. BTU Ratinp
INPUT MAKE OF FURNACE
Mod.l '
-? CONTROLS
'
'
'
?
THERM05TAT
-
VZ?A--Z
H*at Pl
- Vent Sizs c-, '??
•=f
:
uy
Valv
Limit •'3t?a?-?=.?? KIND OF LINER SIZE NONI?.?
? ? -
Draft Hood R.qulatorr
Limit 59ttiny Filte?s Si:o?,,e??' 24umber ?
Fan Settin9 !C-y.0,-.-ge a ,40.? Chimmoy Loeatioe Insid. Dutaide-`"=
Pilot Type = . , / Chimney Construction,- ^???5
Pilot Maks 1
Pilot Modsl --??12 ,tZ?CT -;
Pilot Timiny Smoke Bomb 1Miring Z
Draft y:: ,•_ •r-y 7 Tsst To9?-'
L.W. Cut Oif Door Presatirs ? Liyhtiny InstfL
Pressun Porc*nt C0
, Dote Testod
2
Inpuf CFH PereeM pZ --' G• Compony 7eatinq
Stock Temp
1:2 i;?, r Percenl CO
aj Nams oF TestK ?
.,
_
Fwm 235
HOUSE HEATING TEST RECORD
AODRESS
OCCUPANT
HEAT LO55 ---"'
SOLD BY
Elettrieal Work B
Y
TYPE OF HEAT GA
'
MAKE
Mod•I
1_.
DATE HTG. INST.
FA ??IW ' STEAM
GAS DESIGN APT. FLOOR CITY SUBUR1i, ??"?• "?'?
OWNER '
INSTALLED BY
Gos Lin* By od?
SPACE HTR, ? UNiT HTR: OTHER
CONVERSION
MAKE OF BURNER
Modei
Ssria l - ? • ? , " - ' Max. BTU Ratinq ,- " -
INPUT _T ,? c-' •? ' MAKE OF FURNACE '
Modal
THERMOSTAT`
? GONTROLS
Heot Pluq - -
T
Vent 5ize '
--
Volw
? - KIND OF LINER SIZE NONE?-_
Limit Oroft Mood Requlalor
Limit SoMiny Filfars $iss ? t•mbsr /f
--?---T- -
Fon Setting Chimney Location? : Inside Outsid• -?
Pilot Type Chimney Construction ?
Pilot Moke --
Pilof Model Smoka Bomb ---r" Wiring
Pilol Timinp
D?oft
:
.
'
Test Toq
L.W. Cut OFf - ,
.
Door Prossurs - Lightiny Inst. ?
? ? ; ;r:
' %
Prosswa Porcent COZ , = Dote Tested
Input CFH 14:/ Peroont O
r' Company Testing -? ?? ????? ''
Z
Stack Temp. PerceM CO Nam* oF T.stsr --'
Form 235
,
/
.
.
-
• i
L A •
HOUSE HEATING TEST RECORD
ADDRESS
APT. FLOOR CITY SUBUR$?
OCCUPANT d>- ' OWNER
HEAT LOSS- --? ` DATE HTG. INST. l -- ?
SOLD BY - ?.??? _? • INSTALLED BY
El.chicol work BY,, 5
Gas Lin• By /
`f
TYPE OF HEAT GA y FA HW STEAM SPACE HTR.
UNIT HTR:-_?_-?OTHER
?AS QESIGN CONVER510N
MAKE MAKE OF BURNER
Mod•I Model ?
Ssrial 34 11J_S 7 1? Max. BTU Rotiny
INPUT ? ?? ? MAKE OF FURNACE
Model ?
?
- ---/
CONTRU?S 3
.l
,
_/ J ?
?
"
THERMOST Y %?
t p??q Vent Si:s
Valv ? '- KIND OF LINER r SIZE NONE
Umit DraFt Hood Riqulafor
Limit SeMiny FilYers Siza Numbsr
Fan Ssffiny Chimmey Location Ip?ido Outsid•
Pilot Typs F %? - Chimnsr Construction
Pilot Moks ,??.-----'-"
P;lor Model
Smoke
Wi?ing
Jsst Tap
Li9htiny (nsf.
Pilot Timiny D?off -- l'f ''
L.W. Cuf OFF - - Door Pnssure_
i --
Pressur• f~ f Pere*nf COZ dafe Tooted
Inpuf CFH PKeonf OT Company Tutiny
Stock Tomp. T_b? ? Pereenf CO ? Nameoi T*stsr _
Fwm 235
.. - „ _
. ??. '
AODRESS ?
OCCUPANT ?
HEAT L055 _
SOLD 8Y
Elselrieol Work E
TYPE OF HEAT
_-
SUBUR6
i
GAS DEStGN CONVERSION
MAKE MAKE OF BURNER
Mod.l Mod.l
Ssrial
, 1 Max. BTU Ratiny
INPUT '
`-'" -=?•-? -? MAKE OF FURNACE
Model
CO NTROLS
THERMOS.TAT'" ?
? W.ot PIu9 Vont Size
Volv K1ND OF LINER SIZE-NOt!1JE?-T--T
Limit '•? ? .? ?-?? ?j, ? , '! Draft Hood Reyylotor
Limit SsNing O
- ? j /`?•
Filtos Si:?f N'um6er
Fan 5etting Chimney Loeation Inside Outside
Pilot Type Chimney Con:truetion
PilotMoks ?.)t r??
Pilot Model
Smoke
Pilot Timing = ' ' r DraFt
L.W. Cuf Off Door Pnssure_
Pressure ' Pereent COZ Date Tested -
Inpuf CFH ° Psrcent OZ Company Teating
Stack Temp. Psrcent CO Name of Tosfsr _
-Wiring C?
Test Tay -
? Lightiny (nst.
_...?
rt ?. .
Form 235
HOUSE HEATING TEST RECORD
? ' .
HOUSE HEATING TEST RECORD
..
/ ?
f .
?J J
ADdRESS '7 APT. FLOOR GTY SUBURB-
OCCUPANT OWNER
HEAT L055 ATE?(7G.,
- INST. `~ •'?,
SOLD BY -?'f INSTALLED BY
El.cr.ical Wwk By Gas Lin. By
TYPE OF HEAT GA FA X HYY STEAM SPACE HTR. UNIT HTR. OTHER
r
G/,,&OESIGN
CONVERSION
MAKE MAKE OF BURNER
Modol Model
Se.ial Mox. BTU Ratioy ?
INPUT MAKE OF FURNACE
Model
C , TROLS
THERMOSTATA Heat Plug Venf Sizs
Volv•
7
• KIND OF LIN SIZE " ONE
?
;
,
..
Limlt ' '•' "
Draft Hood -' "?'? ????' `n F?,eyulator ??1
Limit Settiny ?•? Fi lt*rs Si:e ?`?? f y umb??
Fan Seffiny f Chimnoy Loeation Inaid? Out:ide
Pilot Trpe f'T''. f Chimney Conafruction `2
Pilot Maks
Pilot hbdel 5mok* Bomb Wiriny - V?
Pilot Timing D?oft T•st Tay ?
L.W. Cut Off - Dow Pnssure ??- Li finq Insf.
Prossurit ?-s Pereenf CQ2 7 "S Dah Tested "
7-7-77
Inpu1 CFH_ -- ? ???, - Percenf 02 Company Testing . " --e ' /4
Staek T?mp, P?re?nf CO ? Nonw of Tostor
Form 235 `
. . . • ,s .
HOUSE HEATING TEST RECORD
ADDRESS - APT. FLOOR CITY
OCCUPANT _? -"' `f ? ?,;,'-'? ? "" • -' ? . OWNER
HEAT LOSS --?-DATE H7G. INST.
SOLD BY - Y INSTALLED BY ? ? ='
Etectricol Work By ?--? -? Gas Lin+ By
TYPE OF HEAT GA FA - HW STEAM SPACE HTR. UNIT HTR. _
GAS qESIGN CONVERSION
MAKE MAKE OF BURNER
Model Mod.l
Seriol Max. BTU Ratinp e?-
INPUT MAKE OF FURNACE Mod•I
? CONTR
;•'q ?j
THERMOSTAT ?1up ; ?-^--?- Vent Size
Valw - '"` "? ? KIND OF LINER SIZE NONE
l.imit Draft Hood •,4 Reyvlator _
Limit SeHiny Filfers Sis• y "'Number
Fon Ssttiny Chimnoy Loection Inside Outaid• ?-
Pilot Type Chimr?ey Construction
Pilot Moks
Pilot Modal Smoke Bomb _?? -- ;/?_1Miring
Pilot Tlminy ?- Draff T*sf Sap
L.W. Cut OfF Daor Prossure -- - Liyhtinp Insf. ?
Preswrs _ Percent COZ Date Test*d
Ir+put CFH Pereent OZ ? Compony Testiny
Stock Temp. - Pertent Co Narro of Tesfer
Fwm 235 i` i"
AQDRESS
OCCUPAN??
HEAT LOSS ?
SOLD BY ?
Elae?ricol MYork BY 4_L??
TYPE OF HEAT GA
HOUSE HEATING TEST RECORD %--'? ?
APT. FLOOR CITY SUBURB'"?? ? ?
OWNE R
INST.
= ,?? INSTALLED BY 'F`? Ga: Llne By
?HMI STEAM SPACE HTR. UNIT HTR. OTMER
GAS,DESIGN
MAKE MAKE OF BURNER _
Model ?' ? •?" c? Model
Sorial Max. BTU Ratiny -
INPUT MAKE OF FURNACE
Model
?
y
THERMOSTAT'% "Hipt Plvy Vent Siza ?2?
Volw ? '? KIND OF LII+IER?
Limit s . !r? Drak Hood ??1s
Lim4t Setf{n9 Filhrs $fse
Fon Sstliny Chimney Loeation i
Pilot Mak• /-
Pilot Typa Chimney Construetioo
lesido J Ovtsid?J.k?
Pilot Model Smoke Bomb wi?in9
Pilot Timiny D?aft '
:
-
Tesf Tay `I
I
L.W. Cut Off Dow Pressure M Li9htin9 Inst. 1Z -
Prassura Pereent CO2 Dote Tos?ed
Input CFH PsreenT dZ _ Company Testing ? % -
Staek Temp. ,•?? -? Psrunt CO Namm of Tesror
CONYERSION
Form 235
AQDRESS
OCCUPAN??
HEAT LOSS ?
SOLD BY ?
Elae?ricol MYork BY 4_L??
TYPE OF HEAT GA
HOUSE HEATING TEST RECORD %--'? ?
APT. FLOOR CITY SUBURB'"?? ? ?
OWNE R
INST.
= ,?? INSTALLED BY 'F`? Ga: Llne By
?HMI STEAM SPACE HTR. UNIT HTR. OTMER
GAS,DESIGN
MAKE MAKE OF BURNER _
Model ?' ? •?" c? Model
Sorial Max. BTU Ratiny -
INPUT MAKE OF FURNACE
Model
?
y
THERMOSTAT'% "Hipt Plvy Vent Siza ?2?
Volw ? '? KIND OF LII+IER?
Limit s . !r? Drak Hood ??1s
Lim4t Setf{n9 Filhrs $fse
Fon Sstliny Chimney Loeation i
Pilot Mak• /-
Pilot Typa Chimney Construetioo
lesido J Ovtsid?J.k?
Pilot Model Smoke Bomb wi?in9
Pilot Timiny D?aft '
:
-
Tesf Tay `I
I
L.W. Cut Off Dow Pressure M Li9htin9 Inst. 1Z -
Prassura Pereent CO2 Dote Tos?ed
Input CFH PsreenT dZ _ Company Testing ? % -
Staek Temp. ,•?? -? Psrunt CO Namm of Tesror
CONYERSION
Form 235
HOUSE.HEATING TEST RECORD l 3? 3 ?, #?J ?
r'
ADDRESS APT. FL R CITY SUBURB ?
OCCUPANT OWNER ? , ?v f r
HEAT LOSS --?- DATE El G. JNST.
SOLD BY - b?d S C INSTALLED BY ?
Elsehical Work By,?? ?f Gas Lins B y
TYPE OF HEAT GA'' FA ktW STEAM SPACE HTR. UNIT HTR. OTHER
GAS DESIGN CONVERSION
MAKE MAKE OF BURNER
Model 4 ?v Model
So?iaI Max. BTU Ratiny
INPUT U d MAKE OF FURNACE
. ? Model
lacuL a
THERMOSTAT Heat Plup ?? Vent Size
Valve KIND OF LI,NER SIZE NONE
?
Limit P? Drah Hoo Rpularor X "
` ,?'D.t'?.C.r/N
Limit Sottiny ? Filters Size, umb?r:
Fan Ssttiny Chimney Loeation I?iide Outside
Pilot Type ? Chimney Construetion ?
Pilot Maka
Pilot Modsl 5moke kM? Wiring
Pilot Timing -' ?4 Tsst Tay
L.W. Cut OF t'' Door Pressure ? Lighting Inst.
Prossure 3- Psreent COZ Date Testsd a
I
nput CFH Pereent 02 ? n Company Teating, '
Stock Temp. ??? Pe?cent CO G.? Nome of Tsstsr
Form 235
r
'? • ?? ???/ ??
ADDRESS
OCCUPANT
HEAT LOSS f D TE HTG. INST.
SOLD BY d ? "
? Elaetrical Work By
TYPE OF HEAT GA
HDUSE HEATING
.
CITY
Gns Lin• By
STEAM SPACE HTR. UNIT HTR. OTHER
?-? GAS DESIGN CONVER510N
MAKE MAKE OF BURNER
Model . `'? 0v •- ? Model
Ssrial Max. BTU Ratiny
INPUT MAKE OF FURNACE
. . Modsl
THERM?T eat pl„g Vent Siz•
?z
Valve ? 7 ?J -r KIND OF LII?E SIZE N N
?
Limit Droft Hood ?_ R• ularo?.. ? "
?
Limit 5etting a Filters Sixe _1 umber 'Z k? Z
Fan Setting Chimnay Location ?sids Outside ???
Pilot Typs ' Chimney Construetior
?
Pilot Maks
Pilot Model Smoks Bo Wiring
Pilot Timing,- Draft-?r1- Test Tag
L.W. Cuf Off -?- Door Pressure ? r Lighting (nst.
?i ?
Pressure Psroent C0 Date Testsd
Input CFH ? 2
Perunt 0 ? Company Testing
2
Stock Temp. Percent CO Name of Tsster
Fwm 235
HOUSE.HEATING TEST RECORD l 3? 3 ?, #?J ?
r'
ADDRESS APT. FL R CITY SUBURB ?
OCCUPANT OWNER ? , ?v f r
HEAT LOSS --?- DATE El G. JNST.
SOLD BY - b?d S C INSTALLED BY ?
Elsehical Work By,?? ?f Gas Lins B y
TYPE OF HEAT GA'' FA ktW STEAM SPACE HTR. UNIT HTR. OTHER
GAS DESIGN CONVERSION
MAKE MAKE OF BURNER
Model 4 ?v Model
So?iaI Max. BTU Ratiny
INPUT U d MAKE OF FURNACE
. ? Model
lacuL a
THERMOSTAT Heat Plup ?? Vent Size
Valve KIND OF LI,NER SIZE NONE
?
Limit P? Drah Hoo Rpularor X "
` ,?'D.t'?.C.r/N
Limit Sottiny ? Filters Size, umb?r:
Fan Ssttiny Chimney Loeation I?iide Outside
Pilot Type ? Chimney Construetion ?
Pilot Maka
Pilot Modsl 5moke kM? Wiring
Pilot Timing -' ?4 Tsst Tay
L.W. Cut OF t'' Door Pressure ? Lighting Inst.
Prossure 3- Psreent COZ Date Testsd a
I
nput CFH Pereent 02 ? n Company Teating, '
Stock Temp. ??? Pe?cent CO G.? Nome of Tsstsr
Form 235
r
'? • ?? ???/ ??
ADDRESS
OCCUPANT
HEAT LOSS f D TE HTG. INST.
SOLD BY d ? "
? Elaetrical Work By
TYPE OF HEAT GA
HDUSE HEATING
.
CITY
Gns Lin• By
STEAM SPACE HTR. UNIT HTR. OTHER
?-? GAS DESIGN CONVER510N
MAKE MAKE OF BURNER
Model . `'? 0v •- ? Model
Ssrial Max. BTU Ratiny
INPUT MAKE OF FURNACE
. . Modsl
THERM?T eat pl„g Vent Siz•
?z
Valve ? 7 ?J -r KIND OF LII?E SIZE N N
?
Limit Droft Hood ?_ R• ularo?.. ? "
?
Limit 5etting a Filters Sixe _1 umber 'Z k? Z
Fan Setting Chimnay Location ?sids Outside ???
Pilot Typs ' Chimney Construetior
?
Pilot Maks
Pilot Model Smoks Bo Wiring
Pilot Timing,- Draft-?r1- Test Tag
L.W. Cuf Off -?- Door Pressure ? r Lighting (nst.
?i ?
Pressure Psroent C0 Date Testsd
Input CFH ? 2
Perunt 0 ? Company Testing
2
Stock Temp. Percent CO Name of Tsster
Fwm 235
.. - „ _
. ??. '
AODRESS ?
OCCUPANT ?
HEAT L055 _
SOLD 8Y
Elselrieol Work E
TYPE OF HEAT
_-
SUBUR6
i
GAS DEStGN CONVERSION
MAKE MAKE OF BURNER
Mod.l Mod.l
Ssrial
, 1 Max. BTU Ratiny
INPUT '
`-'" -=?•-? -? MAKE OF FURNACE
Model
CO NTROLS
THERMOS.TAT'" ?
? W.ot PIu9 Vont Size
Volv K1ND OF LINER SIZE-NOt!1JE?-T--T
Limit '•? ? .? ?-?? ?j, ? , '! Draft Hood Reyylotor
Limit SsNing O
- ? j /`?•
Filtos Si:?f N'um6er
Fan 5etting Chimney Loeation Inside Outside
Pilot Type Chimney Con:truetion
PilotMoks ?.)t r??
Pilot Model
Smoke
Pilot Timing = ' ' r DraFt
L.W. Cuf Off Door Pnssure_
Pressure ' Pereent COZ Date Tested -
Inpuf CFH ° Psrcent OZ Company Teating
Stack Temp. Psrcent CO Name of Tosfsr _
-Wiring C?
Test Tay -
? Lightiny (nst.
_...?
rt ?. .
Form 235
HOUSE HEATING TEST RECORD
I r - . _.. . • , . . . ?.?; :? /, ?-?-? ?a? ? k
#7
i3,j5
ADDRESS
ef HOUSE HEATING TEST RECORD
APT. FLOOR CITY SUBURB
HEAT LOSS _= - -- ` DArtE HTG. INST.
SOLD BY - '%-!.•`? • ?; -- INSTALLED BY?ZU,??
Elscnieol work Br Gos Lino Br
TYPE OF HEAT GA -FA HMf STEAM SPACE HTR. UNIT HTR. ?rOTHER
.?
GAS D; SIGN CONVERSION
MAKE ?? ?l?f ?? MAKE OF BURNER
Mod•I Model
Serial ? ?--- Mox. BTU Rafinp ?
INPUT ' ? - MAKE OF FURNACE
Mod•I
%.V
' r?
u ?7 RVLJ
? - / A /?
.
THERMO?TATr Nsot Plvy Venl Sizs
Valvo ?? KIND OF LINER? , z 3 - SIZE<J_NONE
Limit 7 Y'_1`.?.? •?' Draft Hood' j 2 'j
Limit S*itiny Filters Siz* -- `---" Number
Fan Ssttiny Chimney Lotation I naide,N Ovtside
Pilot Typs ''??? •?? " Chimnay Construction
Pilot Make
Pilm Modsl Smoke Boynb wi?in9
Pilot Timiny J Z' Draft Tsst Taq
L.W. CW Off --?? DooF Prsssuro -'-*
- Liqhtiny lnst.
•
,.
?
? ` / , _. ,
?,
Proswrs Percont C02 Date Tested
In
u1 CFH PereeM 0 Testin
Com
on
p 2 p
q
r
Staek Tomp Pereent C0 NoaN oF Tostor
.
Form 235
? ' .
HOUSE HEATING TEST RECORD
..
/ ?
f .
?J J
ADdRESS '7 APT. FLOOR GTY SUBURB-
OCCUPANT OWNER
HEAT L055 ATE?(7G.,
- INST. `~ •'?,
SOLD BY -?'f INSTALLED BY
El.cr.ical Wwk By Gas Lin. By
TYPE OF HEAT GA FA X HYY STEAM SPACE HTR. UNIT HTR. OTHER
r
G/,,&OESIGN
CONVERSION
MAKE MAKE OF BURNER
Modol Model
Se.ial Mox. BTU Ratioy ?
INPUT MAKE OF FURNACE
Model
C , TROLS
THERMOSTATA Heat Plug Venf Sizs
Volv•
7
• KIND OF LIN SIZE " ONE
?
;
,
..
Limlt ' '•' "
Draft Hood -' "?'? ????' `n F?,eyulator ??1
Limit Settiny ?•? Fi lt*rs Si:e ?`?? f y umb??
Fan Seffiny f Chimnoy Loeation Inaid? Out:ide
Pilot Trpe f'T''. f Chimney Conafruction `2
Pilot Maks
Pilot hbdel 5mok* Bomb Wiriny - V?
Pilot Timing D?oft T•st Tay ?
L.W. Cut Off - Dow Pnssure ??- Li finq Insf.
Prossurit ?-s Pereenf CQ2 7 "S Dah Tested "
7-7-77
Inpu1 CFH_ -- ? ???, - Percenf 02 Company Testing . " --e ' /4
Staek T?mp, P?re?nf CO ? Nonw of Tostor
Form 235 `
. . . • ,s .
HOUSE HEATING TEST RECORD
ADDRESS - APT. FLOOR CITY
OCCUPANT _? -"' `f ? ?,;,'-'? ? "" • -' ? . OWNER
HEAT LOSS --?-DATE H7G. INST.
SOLD BY - Y INSTALLED BY ? ? ='
Etectricol Work By ?--? -? Gas Lin+ By
TYPE OF HEAT GA FA - HW STEAM SPACE HTR. UNIT HTR. _
GAS qESIGN CONVERSION
MAKE MAKE OF BURNER
Model Mod.l
Seriol Max. BTU Ratinp e?-
INPUT MAKE OF FURNACE Mod•I
? CONTR
;•'q ?j
THERMOSTAT ?1up ; ?-^--?- Vent Size
Valw - '"` "? ? KIND OF LINER SIZE NONE
l.imit Draft Hood •,4 Reyvlator _
Limit SeHiny Filfers Sis• y "'Number
Fon Ssttiny Chimnoy Loection Inside Outaid• ?-
Pilot Type Chimr?ey Construction
Pilot Moks
Pilot Modal Smoke Bomb _?? -- ;/?_1Miring
Pilot Tlminy ?- Draff T*sf Sap
L.W. Cut OfF Daor Prossure -- - Liyhtinp Insf. ?
Preswrs _ Percent COZ Date Test*d
Ir+put CFH Pereent OZ ? Compony Testiny
Stock Temp. - Pertent Co Narro of Tesfer
Fwm 235 i` i"
AQDRESS
OCCUPAN??
HEAT LOSS ?
SOLD BY ?
Elae?ricol MYork BY 4_L??
TYPE OF HEAT GA
HOUSE HEATING TEST RECORD %--'? ?
APT. FLOOR CITY SUBURB'"?? ? ?
OWNE R
INST.
= ,?? INSTALLED BY 'F`? Ga: Llne By
?HMI STEAM SPACE HTR. UNIT HTR. OTMER
GAS,DESIGN
MAKE MAKE OF BURNER _
Model ?' ? •?" c? Model
Sorial Max. BTU Ratiny -
INPUT MAKE OF FURNACE
Model
?
y
THERMOSTAT'% "Hipt Plvy Vent Siza ?2?
Volw ? '? KIND OF LII+IER?
Limit s . !r? Drak Hood ??1s
Lim4t Setf{n9 Filhrs $fse
Fon Sstliny Chimney Loeation i
Pilot Mak• /-
Pilot Typa Chimney Construetioo
lesido J Ovtsid?J.k?
Pilot Model Smoke Bomb wi?in9
Pilot Timiny D?aft '
:
-
Tesf Tay `I
I
L.W. Cut Off Dow Pressure M Li9htin9 Inst. 1Z -
Prassura Pereent CO2 Dote Tos?ed
Input CFH PsreenT dZ _ Company Testing ? % -
Staek Temp. ,•?? -? Psrunt CO Namm of Tesror
CONYERSION
Form 235
AQDRESS
OCCUPAN??
HEAT LOSS ?
SOLD BY ?
Elae?ricol MYork BY 4_L??
TYPE OF HEAT GA
HOUSE HEATING TEST RECORD %--'? ?
APT. FLOOR CITY SUBURB'"?? ? ?
OWNE R
INST.
= ,?? INSTALLED BY 'F`? Ga: Llne By
?HMI STEAM SPACE HTR. UNIT HTR. OTMER
GAS,DESIGN
MAKE MAKE OF BURNER _
Model ?' ? •?" c? Model
Sorial Max. BTU Ratiny -
INPUT MAKE OF FURNACE
Model
?
y
THERMOSTAT'% "Hipt Plvy Vent Siza ?2?
Volw ? '? KIND OF LII+IER?
Limit s . !r? Drak Hood ??1s
Lim4t Setf{n9 Filhrs $fse
Fon Sstliny Chimney Loeation i
Pilot Mak• /-
Pilot Typa Chimney Construetioo
lesido J Ovtsid?J.k?
Pilot Model Smoke Bomb wi?in9
Pilot Timiny D?aft '
:
-
Tesf Tay `I
I
L.W. Cut Off Dow Pressure M Li9htin9 Inst. 1Z -
Prassura Pereent CO2 Dote Tos?ed
Input CFH PsreenT dZ _ Company Testing ? % -
Staek Temp. ,•?? -? Psrunt CO Namm of Tesror
CONYERSION
Form 235
HOUSE.HEATING TEST RECORD l 3? 3 ?, #?J ?
r'
ADDRESS APT. FL R CITY SUBURB ?
OCCUPANT OWNER ? , ?v f r
HEAT LOSS --?- DATE El G. JNST.
SOLD BY - b?d S C INSTALLED BY ?
Elsehical Work By,?? ?f Gas Lins B y
TYPE OF HEAT GA'' FA ktW STEAM SPACE HTR. UNIT HTR. OTHER
GAS DESIGN CONVERSION
MAKE MAKE OF BURNER
Model 4 ?v Model
So?iaI Max. BTU Ratiny
INPUT U d MAKE OF FURNACE
. ? Model
lacuL a
THERMOSTAT Heat Plup ?? Vent Size
Valve KIND OF LI,NER SIZE NONE
?
Limit P? Drah Hoo Rpularor X "
` ,?'D.t'?.C.r/N
Limit Sottiny ? Filters Size, umb?r:
Fan Ssttiny Chimney Loeation I?iide Outside
Pilot Type ? Chimney Construetion ?
Pilot Maka
Pilot Modsl 5moke kM? Wiring
Pilot Timing -' ?4 Tsst Tay
L.W. Cut OF t'' Door Pressure ? Lighting Inst.
Prossure 3- Psreent COZ Date Testsd a
I
nput CFH Pereent 02 ? n Company Teating, '
Stock Temp. ??? Pe?cent CO G.? Nome of Tsstsr
Form 235
r
'? • ?? ???/ ??
ADDRESS
OCCUPANT
HEAT LOSS f D TE HTG. INST.
SOLD BY d ? "
? Elaetrical Work By
TYPE OF HEAT GA
HDUSE HEATING
.
CITY
Gns Lin• By
STEAM SPACE HTR. UNIT HTR. OTHER
?-? GAS DESIGN CONVER510N
MAKE MAKE OF BURNER
Model . `'? 0v •- ? Model
Ssrial Max. BTU Ratiny
INPUT MAKE OF FURNACE
. . Modsl
THERM?T eat pl„g Vent Siz•
?z
Valve ? 7 ?J -r KIND OF LII?E SIZE N N
?
Limit Droft Hood ?_ R• ularo?.. ? "
?
Limit 5etting a Filters Sixe _1 umber 'Z k? Z
Fan Setting Chimnay Location ?sids Outside ???
Pilot Typs ' Chimney Construetior
?
Pilot Maks
Pilot Model Smoks Bo Wiring
Pilot Timing,- Draft-?r1- Test Tag
L.W. Cuf Off -?- Door Pressure ? r Lighting (nst.
?i ?
Pressure Psroent C0 Date Testsd
Input CFH ? 2
Perunt 0 ? Company Testing
2
Stock Temp. Percent CO Name of Tsster
Fwm 235
HOUSE.HEATING TEST RECORD l 3? 3 ?, #?J ?
r'
ADDRESS APT. FL R CITY SUBURB ?
OCCUPANT OWNER ? , ?v f r
HEAT LOSS --?- DATE El G. JNST.
SOLD BY - b?d S C INSTALLED BY ?
Elsehical Work By,?? ?f Gas Lins B y
TYPE OF HEAT GA'' FA ktW STEAM SPACE HTR. UNIT HTR. OTHER
GAS DESIGN CONVERSION
MAKE MAKE OF BURNER
Model 4 ?v Model
So?iaI Max. BTU Ratiny
INPUT U d MAKE OF FURNACE
. ? Model
lacuL a
THERMOSTAT Heat Plup ?? Vent Size
Valve KIND OF LI,NER SIZE NONE
?
Limit P? Drah Hoo Rpularor X "
` ,?'D.t'?.C.r/N
Limit Sottiny ? Filters Size, umb?r:
Fan Ssttiny Chimney Loeation I?iide Outside
Pilot Type ? Chimney Construetion ?
Pilot Maka
Pilot Modsl 5moke kM? Wiring
Pilot Timing -' ?4 Tsst Tay
L.W. Cut OF t'' Door Pressure ? Lighting Inst.
Prossure 3- Psreent COZ Date Testsd a
I
nput CFH Pereent 02 ? n Company Teating, '
Stock Temp. ??? Pe?cent CO G.? Nome of Tsstsr
Form 235
r
'? • ?? ???/ ??
ADDRESS
OCCUPANT
HEAT LOSS f D TE HTG. INST.
SOLD BY d ? "
? Elaetrical Work By
TYPE OF HEAT GA
HDUSE HEATING
.
CITY
Gns Lin• By
STEAM SPACE HTR. UNIT HTR. OTHER
?-? GAS DESIGN CONVER510N
MAKE MAKE OF BURNER
Model . `'? 0v •- ? Model
Ssrial Max. BTU Ratiny
INPUT MAKE OF FURNACE
. . Modsl
THERM?T eat pl„g Vent Siz•
?z
Valve ? 7 ?J -r KIND OF LII?E SIZE N N
?
Limit Droft Hood ?_ R• ularo?.. ? "
?
Limit 5etting a Filters Sixe _1 umber 'Z k? Z
Fan Setting Chimnay Location ?sids Outside ???
Pilot Typs ' Chimney Construetior
?
Pilot Maks
Pilot Model Smoks Bo Wiring
Pilot Timing,- Draft-?r1- Test Tag
L.W. Cuf Off -?- Door Pressure ? r Lighting (nst.
?i ?
Pressure Psroent C0 Date Testsd
Input CFH ? 2
Perunt 0 ? Company Testing
2
Stock Temp. Percent CO Name of Tsster
Fwm 235