Loading...
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