iNSTALLER NAME:
CiTY
STATE
iNSTALLATiON ADDRESS:
CiTY STATE
UNiT MODEL #
UNiT SERIAL #
Minimum clearances
per Table 4 (page 7)?
Has the owner's
information been
reviewed with the home-
owner?
YES NO
I Has the literature
package been left near
EFFICIENCY
RA_ING
Electrical connections
YES NO
tight?
Line voltage polarity YES NO
correct?
Supply Voltage:
Has the thermostat
been calibrated?
is the thermostat
level?
is the heat anticipator
setting correct_
YES
YES
YES
VOLTS
NO
NO
NO
Gas Type: (circle one) Natural
Gas Propane
Gas pipe connections
YES NO
leak tested?
Gas Line Pressure:
is there adequate
fresh air supply for
combustion and
ventilation?
YES
(in - W.C.)
NO
Installation Altitude: (FT.)
Deration Percentage: (%)
Furnace Input: (Btuh)
Supply Air Temperature: (o F)
Return Air Temperature: (o F)
Temperature Rise: (o F_
Vent free from
YES NO
restrictions?
Filter(s) secured in
YES NO
place?
Filter(s) clean? YES NO
Flue connections
YES NO
tight?
is there proper draft? YES NO
NORD E
O'Falton, MO
IllIIIIIlilllillllllllIIIIII
708768C
708768C (Replaces 708768B)
Specifications and illustrations subject to change
without notice or incurring obligations
Printed in U.S.A (03/09)
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