
Model Number: |
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| Serial Number: |
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| VENTING and COMBUSTION AIR |
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Vent Material: |
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| (CPVC – Water Heaters Only; | |||||||||||||||||||||||||||||||
Vent Diameter: |
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| inches; | Vent Length: |
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| feet | Vent Type: |
| Through Sidewall | ||||||||||||||||||||||||||||
Does vent have condensate drain? | Yes | No |
| Does vent have elbows? |
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| Yes; Qty |
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| No | ||||||||||||||||||||||||||||
Does vent contain any of these devices? Power Vent |
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| Draft Inducer |
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| Draft Regulator | Flue Damper | |||||||||||||||||||||||||||||||
Combustion air louvers or openings? |
| Yes; Qty: |
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| Size: |
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| No |
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| Interlocked? | Yes | No | ||||||||||||||||||||
Have |
| Yes; duct diameter |
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| inches, length |
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| feet. |
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| No | ||||||||||||||||||||||||
Duct Material: |
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| Does duct have elbows? |
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| Yes; Qty |
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| No |
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| GAS SUPPLY |
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Type of Gas: |
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| Natural | LP |
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| Inlet Static Gas Pressure: |
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| “W.C. (14”W.C. maximum) |
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Gas Supply Pipe Size: |
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| Inlet Flow Gas Pressure: |
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| “W.C. (see data label) | ||||||||||||||||||||
Combination Gas Pressure Switch Setting: | High |
| “W.C. | Low |
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| “W.C. |
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| COMBUSTION ANALYSIS |
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| Boilers |
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| Heaters |
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| 1st Stage | 2nd Stage |
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Pilot Gas Pressure
Manifold Gas Pressure
Carbon Dioxide CO2
Oxygen O2
Carbon Monoxide CO (less than 200 ppm)
Nitrogen Oxide NOX (if available)
Vent Pressure (+.25” to + 2.0” W.C.)
Gross Vent Temperature (maximum 230°F)
less Room Temperature °F
= Net Vent Temperature °F
Important: You must submit the original copy of the completed form to your PVI representative before the warranty will become effective on this product. Contact Customer Service for assistance at
Service Company Name: |
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Service Co. Address: |
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| Date: |
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Customer: |
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| Phone No.: | Date: |
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PV 413 8/05 |
| Page 2 of 2 |