Engineering RFQ Specification Sheet
This form must accompany all non-standard packaged burner proposal requests and orders.

Date  Firm Quotation   Budget Quotation    Re-Quotation   Order 

Company Name   Ref.

Contact    Tel   Fax

Email      

Customer Job Name

Location

Burner Model        Hot Water        Steam 

Temperature    Pressure

Firing Rate (Btu/hr)             Max Min

Firing Rate (USgph)             Max Min

Operation         Gas  On-Off    2-stage     Full mod.       Oil  2 stage      Full mod. 

Fuel                 N.G      Propane      Oil#2            Other      

Low NOx Requirement        Yes     No       Target

Heater Make           Model No.  

Heater Type      firetube     watertube        cast iron         other specify

Furnace Dimensions    Length Width Height Dia.

Furnace Pressure     Altitude above sea level

Gas Train       UL   FM   IRI    Other Specify

Pressure at Valve Train         Inlet      Outlet

Valve Train Pre-Piped and Wired          Left Side                  Right Side

Special Requirements  
                                     

Electrical Service           Main Volts     Phase     Hz
                                       Control Volts  Phase Hz

Electrical Enclosure Class    None  Nema1   Nema12    Nema4   Other Specify

Location                   Indoors Outdoors
                                 Special Situation (corrosive or Humid Atmosphere, etc.) Specify

Flame Safeguard         Siemens         Fireye         Honeywell          
Model

Control Transformer       Yes No  

Remote Panel              Yes No

Modulating Control    Siemens RWF 40 supplied by Riello

Signal supplied by others   4-20mA     0-135ohm       0-10vdc        110v        RTD  ThermoCouple

Sensor Configuration  1/2NPT x 3"    1/2 Flange x 12"        Other 

Other Panel Requirements                           
Sheet Attached                     
                                                

Drawings Required        Piping Schematic      Electrical Schematic      Dimensional Drawing      Certified Drawing
                                                                                                                                                             (additional charge)

Drawing Approval             Yes No 
Required Before
Manufacturing

Other Special Instructions                   
 See Attached                                                                       
                                                            

Sketch Area
Sketch Attached

Salesperson's Signature   

Date                                  


                             If sent by fax or mail simple print form and fill out appropriate information.
 
                                                                       Fax. 804-236-3882
                                                                      Attn: Engineering Dept