Navien CSD-1 Forms for boilers edited by Bob 060.15.2020 and JK 06.15.2020

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Unit Manufacturer Name Address Telephone

MANUFACTURER'S / INSTALLING CONTRACTOR'S REPORT FOR ASME CSD-1 Certification and Reporting (CG-500) for Controls and Safety Devices

Navien

20 Goodyear, Irvine, CA

Zip

1-800-519-8794

Fax

92618 714-616-2776

Unit Identification (Boiler) Manufacturer's Model # ASME UL # Boiler Serial Number Jurisdiction

Year Built

See Nameplate

NHB-110

Nat. Bd. #

See Nameplate

Section I

N/A

Section IV

54167

N/A

CSA Report #

2771375

See Nameplate

Enter State or County

Hot Water Maximum W.P. Maximum Temperature Minimum Safety Relief Valve Capacity

30

psig

203

0F

110,000

Btu

Boiler Unit Description (Type) If Modular (No. of Modules) Boiler Unit Capacity (Output)

NHB-110 Water Tube High Efficiency Condensing

Number of Cascaded Units

102,000

Btu/hr

Burner Manufacturer UL or CSA # Fuels (as shipped)

Navien, Inc.

Model

N/A

2771375

Serial #

N/A

Natural Gas

Gas Manifold Pressure (indicate units or "N/A" if not applicable) Oil Nozzle / Delivery Pressure (at maximum input) High Gas Pressure Switch Setting Low Oil Pressure Switch Setting

See Rating Plate N/A
See Rating Plate N/A

Installation Location

Customer Name

Address (Street)

Address (City)

Address (State)

Zip

Telephone

Fax

Control / Device
TO BE FILLED OUT BY CONTRACTOR Operating Controls Steam Pressure CW-310 (b) Water Temperature - CW-410 (b)

Manufacturer N/A

Model #

Operational Test Performed, Date

N/A

N/A

Safety Controls Low-Water Fuel Cutoff CW-120 (a), CW-120 (b),
CW-130, CW-140

Forced Circulation CW-210 (b)

High Steam Pressure Limit CW-310 (c)

N/A

High Water Temperature Limit CW-410 (b)

Fuel Safety Shutoff Valve, Main CF-180 (b) (2), CF-180 (b) (3)

Pilot Safety Shutoff Valve CF-180 (c)

Atomizing Medium Switch CF-450 (b)

N/A

Combustion Air Switch CF-220

High Gas Pressure CF-162

Low Gas Pressure CF-162

Low Oil Pressure CF-450 (a)

N/A

High Oil Temperature CF-450 (c)

N/A

Low Oil Temperature CF-450 (d)

N/A

Purge Air Flow CF-210

Flame Safeguard (Primary) CF-310, CF-320

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

Flame Detector CF-310, CF-320 Safety Relief Valve - CW-510 Safety Relief Valve (Capacity) (Btu/hr
Low Fire Start Low-Fire Start Switch CF-610
Safety or Safety Relief Valve(s) CW-510, CW-520
Manufacturer Model Number and Size Capacity
Representing Equipment Manufacturer, Name Signature

Watts Watts
Navien NHB-110 110,000 btu/hr
Type your name

Operational Test Performed, Date Date

Representing Installing Contractor, Name Signature

Type your name This form is a guideline and NOT part of ASME CSD-1

Date