Name: Company Name:
Address:
City: State: Zip:
Phone: Fax: E-Mail:

Boiler Horsepower: Operating Criteria: 15-PSI Steam 150-PSI Steam Hot Water Other
Boiler Application:
State Boiler is Going To: Company Installing Boiler:
Startup By: Allied Boiler & Supply, Inc. Other
Operating Pressure: Operating Temperature (hot water):

Boiler Type: AB-4PV: 4-Pass Vertical Tubeless AB-2PDB: 2-Pass Dry Back AB-3PDB: 3-Pass Dry Back AB-3PWB: 3-Pass Wet Back AB-3PWBOS: 3-Pass Wet Back (Ohio Special) AB-4PWB: 4-pass Wet Back AB-3PFBM: 3-pass Fire Box (Modified) AB-3PFB4: 3-pass Fire Box AB-3PFB5: 3-pass Fire Box (5 sq. ft.)
Factory Mounted Blowdown Valves
Surface Blowdown Skimmer Tube w/Bushing
Surface Blowdown Metering Valve
Feed Water Valves (1 check valve, 1 stop valve)
Proportioning Feed Water Control
Proportioning Feed Water Valve & Actuator
Steam Header Valve
Night Fire (Low pressure switch for night fire)
Time Clock
Pump Contactor
Stack Thermometer
Alarm Bell / Horn for Low Water
Alarm Bell / Horn for High Water
Skid Mounting of Feed-Water System
Skid Mounting of Blowdown Separator
Other

Burner Type: Standard Burner Lo Nox Burner
Firing Sequence: On / Off Low / High / Off Low / High / Low Full Modulation Blower Voltage: If 3-phase blower is used, is control transformer desired? Yes No
Fuel Type: Natural Gas Propane #2 Oil Other
Pilot Type: Gas Pilot Direct Spark for #2 Oil Gas Pressure Being Supplied to Gas Train: " WC Lbs

Tank Type: Atmospheric Pressurized Deaerator Tank Orientation: Horizontal Vertical
Number of Pumps:
Voltage:
Are motor starters to be supplied with pumps? Yes No
Mount and Wire Motor Starters
Control Panel
Electronic Water Level Control
Preheat - Steam Injection (** must use if no return is supplying tank **)
Receptacle for Chemical Feed Pump
Chemical Feed Pump
Chemical Feed Tank
Other

Flanged Vent Line Connection
Flanged Drain Line Connection
After Cooler (Complete) **
After Cooler, Drain Pipe Only
Temperature Regulator, Self-Contained
Thermometer
Strainer
Check Valve
Electric Water Valve with Aquastat (used in place of self-contained Temperature Regulator)
Other