
| Model Number: | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | Serial Number: | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | ||||||||
| 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | VENTING and COMBUSTION AIR | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | ||||||||||||||||||
| 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | ||||||||||
| Vent Material: | 
 | 
 | 
 | 
 | 
 | 
 | 
 | (CPVC – Water Heaters Only;  | |||||||||||||||||||||||||||||||
| Vent Diameter: | 
 | 
 | 
 | inches; | Vent Length: | 
 | 
 | feet | Vent Type: | 
 | Through Sidewall | ||||||||||||||||||||||||||||
| Does vent have condensate drain? | Yes | No | 
 | Does vent have elbows? | 
 | 
 | Yes; Qty | 
 | 
 | 
 | No | ||||||||||||||||||||||||||||
| Does vent contain any of these devices? Power Vent | 
 | 
 | Draft Inducer | 
 | 
 | 
 | Draft Regulator | Flue Damper | |||||||||||||||||||||||||||||||
| Combustion air louvers or openings? | 
 | Yes; Qty: | 
 | 
 | Size: | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | No | 
 | 
 | Interlocked? | Yes | No | ||||||||||||||||||||
| Have  | 
 | Yes; duct diameter | 
 | 
 | inches, length | 
 | 
 | 
 | 
 | 
 | 
 | feet. | 
 | 
 | No | ||||||||||||||||||||||||
| Duct Material: | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | Does duct have elbows? | 
 | 
 | Yes; Qty | 
 | 
 | 
 | 
 | 
 | No | 
 | 
 | 
 | 
 | ||||||||||||||||
| 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | |||||
| 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | GAS SUPPLY | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | |||||||
| 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | ||||||||||||||||||
| Type of Gas: | 
 | 
 | Natural | LP | 
 | 
 | Inlet Static Gas Pressure: | 
 | 
 | 
 | 
 | 
 | 
 | “W.C. (14”W.C. maximum) | 
 | 
 | |||||||||||||||||||||||
| Gas Supply Pipe Size: | 
 | 
 | 
 | 
 | 
 | Inlet Flow Gas Pressure: | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | “W.C. (see data label) | ||||||||||||||||||||
| Combination Gas Pressure Switch Setting: | High | 
 | “W.C. | Low | 
 | 
 | 
 | 
 | 
 | 
 | “W.C. | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | |||||||||||||||||
| 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | |||||||||
| 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | COMBUSTION ANALYSIS | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | |||||||||
| 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | Boilers | 
 | 
 | 
 | 
 | 
 | 
 | 
 | |
| 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | Heaters | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | |||||
| 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | ||||
| 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 1st Stage | 2nd Stage | 
 | 
 | 
 | 
 | |||||||||||||
| 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | |||||||||||
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: | 
 | 
 | 
 | Phone: | 
 | 
 | 
 | |||||
| Service Co. Address: | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 | ||
| 
 | 
 | 
 | 
 | Date: | 
 | 
 | 
 | 
 | ||||
| Customer: | 
 | 
 | Phone No.: | Date: | 
 | 
 | ||||||
| PV 413 8/05 | 
 | Page 2 of 2 | ||||||||||
