BENCHMARK BOILER INSTALLATION FORM

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BENCHMARK BOILER INSTALLATION FORM Please complete one (1) form for each site and return to AERCO for warranty validation within 30 days of start-up. After completion, e-mail this form to: STARTUP@AERCO.COM. Completed By: Date: Location Installation Name: Street Address: SST Technician: Company: City, State, Zip: Phone #: AERCO Sales Rep: Equipment Classification Unit Type: BMK750 BMK1000 BMK1500 BMK2000 BMK2500 BMK3000 BMK6000 Unit Serial Number(s) (Add additional in Notes if needed) General Installation 1. Is the condensate disposal system adequately sized and does it drain properly? Yes No 2. Is the condensate disposal system installed in accordance with the instructions in the latest version of the AERCO O&M? Yes No 3. Is the relief valve piped to drain or within 12 of floor? Yes No 4. Is there an electrical service switch at or near the unit? Yes No 5. Does any electrical conduit, ductwork or piping impede the serviceability of the unit or the ability to remove the sheet metal covers? Yes No 6. Is there an adequately sized condensate neutralizer kit installed? Yes No 7. Have all electrical components been verified for proper grounding? Yes No 8. Has all communication wire been properly shielded? Yes No 9. Are all units installed in accordance with the clearances defined in the Innovation O&M? Yes No a. If not, why not? Page 1 of 5

Gas Supply The questions below are related to the information in the Benchmark Gas Supply Design Guide, GF-2030 1. Type of Gas Supply Natural Gas (NG) Propane (LP) Dual Fuel (DF) 2. Are external gas supply regulators installed in accordance with the AERCO O&M requirements? a. If no, please confirm gas pressure Natural Gas: Propane: 3. What is the make and model number of the external gas supply regulators? Natural Gas: Make: Model: Propane: Make: Model: 4. What is the static gas supply pressure to the external supply regulator? NG: LP: Natural Gas: Yes No Propane: Yes No 5. Were the external gas supply regulators supplied by AERCO? Yes No a. If No, please attach regulator specification sheet and return to AERCO with this form. 6. Are the external gas supply vent regulator lines installed per local code & manufacturer s requirement? Yes No 7. What is the size & length of the gas supply header? Natural Gas: Propane: 8. Are there any other appliances connected to the gas supply line? Yes No a. If Yes, please indicate the total BTU connected load: MBH 9. Is the gas supply system installed in accordance with the AERCO BMK Gas Components & Supply Design Guide GF-2030? Yes No Venting The questions below are related to the information in the Benchmark Venting and Combustion Air Guide, GF-2050 1. What is the total vent length run? a. What is the total number of elbows in the ducting? 30 45 90 b. Are all elbows spaced 5 feet apart and 2 feet from the starter piece on the first elbow? Yes No 2. Is the vent pitched back toward the boiler (1/4" per ft. length) per the AERCO Venting Guide? Yes No 3. Venting material used is (choose one): AL29-4C Polypropylene PVC CPVC 4. Venting manufacturer is: 5. Please describe venting configuration (check all that apply): Individual Vent Sidewall Termination Roof Termination Damper/Fan Breeched/Common (Units Vented Together) 6. Does the layout (overall length, pressure drop, breeching calculations, vent pipe wall thickness, etc.) comply with GF-2050? Yes No Combustion Air The questions below are related to the information in the Benchmark Venting and Combustion Air Guide, GF-2050 1. Combustion air supplied through (check all that apply): Louvers to outside wall Horizontal ducting Direct or ducted combustion air Louvers to another room Vertical ducting Combustion air fan 2. What is the size of the ducting to individual units? a. What is the size of the common ducting, if applicable? b. What is the size of louvered opening? 3. Are there any draft inducers, combustion air fans or draft controllers on site? Yes No a. If Yes, list all that apply: b. Explain configuration: 4. Does the layout (overall length, pressure drop, breeching calculations, etc.) comply with GF-2050? Yes No Page 2 of 5

Hydronic Installation 1. If there are multiple units, are the units piped reverse-return? Yes No 2. Are balancing valves or circuit setters installed? Yes No 3. Are motorized isolation valves installed? Yes No 4. What are the maximum/minimum design flow rates through the unit? Max GPM, Min GPM a. Were the maximum & minimum flow rates verified? Yes No 5. Is the remote interlock connection on the C-More utilized? Yes No a. Please list all devices connected to the remote interlock: 6. Is the delayed interlock utilized & receiving external power: Yes No a. Please list all devices connected to the remote interlock: 7. Is the system (check all that apply): Water Source Heat Pump Primary/Secondary Pumping Other (Please specify) A Variable Flow System Reverse Return Used for Reheat Combination Control 8. What is the design system flow rate? GPM 9. What is the design plant delta T? F Remote Set Point (Analog) Remote Set Point (Network/MODBUS) Direct Drive Indoor/Outdoor Reset Constant Setpoint Constant Setpoint Indoor/Outdoor Reset Mode of Operation Individual Unit Control (choose one): Combination Boiler/Water Heater ACS (see below) BMS (see below) BMS II (see below) BST (see below) If BST, ACS, BMS or BMS II is used, the mode of operation is (choose one): Combination Control Panel (CCP) Network (MODBUS) Gateway ProtoNode If Network (MODBUS) is chosen above, the network type is (choose one): Other: (Please specify) If Building Automation System (BAS) Protocol is in use (choose one): BACNet (choose one): IP (ProtoNode Only) MS/TP PTP ARC156 (XPC Model Only) Johnson Controls - N2 LonWorks Page 3 of 5

Summary 1. Is the boiler plant installed in accordance with AERCO guidelines and industry best practices? Yes No a. If No, please describe the issues. 2. Is there any conflict between the Installation & the Engineer s Specification or Design Plans? Yes No a. If Yes, please describe the issues. 3. Are there any conflicts or physical restrictions that will prevent the boiler plant from receiving proper preventative maintenance in the future? Yes No a. If Yes, please describe the issues. 4. Please outline any exceptions that have been granted by AERCO Applications Engineering for this installation if necessary. a. AERCO Application Engineering Sign Off: Page 4 of 5

ADDITIONAL NOTES: Page 5 of 5