FORM H-3 MANUFACTURER’S DATA REPORT FOR WATERTUBE BOILERSAND ECONOMIZERS

As Required by the Provisions of the ASME Code Rules, Section IV

1. Manufactured and certified by(name and address of manufacturer)

2. Manufactured for(name and address of purchaser)

(name and address)3. Location of installation

4. Unit identification

6. (a) Drums:

6. (b) Boiler tubes:

7. Waterwall headers:

9. Nozzles, inspection, and safety valve openings:

*Indicate if (1) seamless, (2) fusion welded. **Indicate if (1) flat, (2) dished, (3) ellipsoidal, (4) hemispherical.

InsideDiameterNo.

No.

1

1

No. Size and Shape ThicknessMaterial

Spec. No. Gr.Material

Spec. No. Gr.Material

Spec. No. Gr.

ReinforcementMaterialMaterial

NA NA

TypeNo.Nom.

ThicknessHow

AttachedDiameter

or SizePurpose

(inlet, outlet, drain, etc.) Location

Hydro.TestThickness ThicknessDiameterShape

1

2

2

Inside LengthShell Plates Tube Sheets

Tube Hole LigamentEfficiency, %

Circum-ferential

Longitu-dinal

Radiusof Dish

Effi-ciency

HowAttachedNo.Thickness

Material Spec. No. GradeDiameter

Circum.Joints

LongitudinalJoints

Effi-ciency

No. &Type

No. &Type* Type**ThicknessMaterial Spec. Grade

Heads Hydro-staticTest

Material Spec. Grade Thickness Thickness Inside RadiusInside Radius

(manufacturer’s serial no.)(complete boiler, superheater, waterwall, etc.)

8. (a) Other parts or economizers (1) (b) Tubes for other parts or economizers(2)

HandholeManhole

(3)

6. (c) Headers no or

or

(box or sinuous or round, material spec. no., thickness)

6. (e) Mud drum

6. (d) Staybolts(material spec. no., diameter, size telltale, net area)

Heads or ends Hydro. test

Design pressureNet areaPitch

(shape, material spec. no.,thickness)

Heads or ends Hydro. test(shape, material spec. no.,

thickness)(for sect. header boilers state size,

shape, material spec. no., thickness)

(supportedby one bolt)

(drawing no.) (year built)(National Bd. no.)(CRN)

(07/17)

(year) (Code Case no.)[addenda (as applicable)(date)]

5. The chemical and physical properties of all parts meet the requirements of material specifications of the ASME BOILER AND PRESSURE

VESSEL CODE. The design conforms to ASME Code, Section IV,

23

123

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FORM H-3 (Back)

CERTIFICATE OF SHOP COMPLIANCE

CERTIFICATE OF SHOP INSPECTION

“H” Certificate of Authorization No. expires .

.

,Date Signed Name

(by representative)

(Authorized Inspector) (National Board Authorized Inspector Commission Number)

(Authorized Inspector) (National Board Authorized Inspector Commission Number)

(manufacturer that constructed and certified boiler)

the parts referred to as data items not included in the certificate of shop inspection, have been inspected by me

Boiler constructed by at

I, the undersigned, holding a valid commission issued by the National Board of Boiler and Pressure Vessel Inspectors and employed by

have examined Manufacturer’s Partial Data Reports for items

Commission

.

“H” Certificate of Authorization no. expires .,

.

have inspected parts of this boiler referred to as data items and

have compared the statements in this Manufacturer’s Data Report with the described boiler and state that

I, the undersigned, holding a valid commission issued by the National Board of Boiler and Pressure Vessel Inspectors and employed by

Date Signed

(by representative)Date Signed

(assembler that certified and constructed field assembly)Name

Date Signed Commission

CERTIFICATE OF FIELD ASSEMBLY COMPLIANCE

CERTIFICATE OF FIELD ASSEMBLY INSPECTION

We certify that the statements made in this data report are correct and that all details of design, material, construction, and workmanship of this

boiler conform to Section IV of the ASME BOILER AND PRESSURE VESSEL CODE.

We certify that the field assembly construction of all parts of this boiler conforms with the requirements of Section IV of the ASME BOILER

AND PRESSURE VESSEL CODE.

and state that, to the best of my knowledge and belief, the manufacturer has constructed this boiler in accordance with Section IV of the ASME

BOILER AND PRESSURE VESSEL CODE.

By signing this certificate neither the inspector nor his employer makes any warranty, expressed or implied, concerning the boiler described

in this Manufacturer’s Data Report. Furthermore, neither the inspector nor his employer shall be liable in any manner for any personal injury

or property damage or a loss of any kind arising from or connected with this inspection.

and that to the best of my knowledge and belief the manufacturer and/or the assembler has constructed and assembled this boiler in accordance

with Section IV of the ASME BOILER AND PRESSURE VESSEL CODE. The described boiler was inspected and subjected to a hydrostatic test

of

By signing this certificate neither the inspector nor his employer makes any warranty, expressed or implied, concerning the boiler described

in this Manufacturer’s Data Report. Furthermore, neither the inspector nor his employer shall be liable in any manner for any personal injury

or property damage or a loss of any kind arising from or connected with this inspection.

(07/17)

MAWP Shop Hydro. Test Field Hydro. TestMaximum

water temp.HeatingSurface Heating surface

to be stampedon drum heads.This heatingsurface not tobe used fordeterminingminimum safetyvalve capacity.

11.

a

b

c

d

BoilerWaterwall

Superheater

Other parts

e Economizers

13. Remarks

10.

12. Manufacturer’s Partial Data Reports properly identified and signed by Commissioned Inspectors have been furnished for the following itemsof this report

(name of part, item number, manufacturer’s name, and identifying stamp)

Manufactured by

Mfr’s Serial No. National Board No.

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