FORM R-3 REPORT OF PARTS FABRICATED BY WELDING

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FORM R-3 REPORT OF PARTS FABRICATED BY WELDING Powered By Docstoc
					                                  FORM R-3 REPORT OF PARTS FABRICATED BY WELDING
                                  in accordance with provisions of the National Board Inspection Code


1.         Manufactured by
                                                                                           (name of manufacturer)                                                            (form “R” No.)


                                                                               (address)                                                                                 (PO No., Job No., etc.)

2.         Manufactured for                                                                                         (name of purchaser)


3.         Design Conditions specified by                                                                                                 Code design by
                                                           (name of organization)                                                                                    (name of organizations)
4.         Design Code
                             (code ty pe and section)                    (code year)                                  (addenda y ear)                      (formula on which MAWP is based)

5.       Identificat ion of Parts
                                 Line                   Manufacturer’s                                                                                         Shop
Name of Part           Qty.      No.                    Identifying No.                Manufacturer’s Drawing No.                                 MAWP         Hydro PSI          Year Bu ilt




6.Description of Parts
                            (a) Connections other than tubes                                         Heads or Ends                                            (b) Tubes
                         Size and     Material      Thickness                                        Thickness Material                       Diameter      Thickness Material
Line No.                 Shape        Spec. No.     (in.)                              Shape         (in.)       Spec. No.                    (in.)         (in.)       Spec. No.




7. Remarks




This form may be obtained from The National Board of Boiler and Pressure Vessel inspectors, 1055 Crupper Ave., Columbus, OH 43229                                           NB-230 Rev. 2
Form R-3 Back
                                                                                                                                      (Form “R” No.)


                                                      CERTIFICATE OF COMPLIANCE

I,                                    , certify that to the best of my knowledge and belief the statements in this report are correct
and that all material, fabrication, construction, and workmanship of the described parts conforms to the National
Board Inspection Code and standards of construction cited.
National Board “R” certificate of Authorization No.                                                  expires on                    ,

Date                     ,                                                                                   Signed
                                               (name of “R” Certificate Holder)                                              (authorized representative)




                                                       CERTIFICATE OF INSPECTION

I,                                               , holding a valid Co mmission issued by The National Board o f Boiler and Pressure
Vessel Inspectors and certificate of co mpetency issued by the jurisdiction of                                                and
emp loyed by                                                          of
have inspected the parts described in this report on                  ,                  and state that to the best of my knowledge and
belief the parts comply with the applicab le requirements of the National Board Inspection Code.
By signing this certificate, neither the undersigned nor my emp loyer makes any warranty, exp ressed or imp lied, concerning
the work described in this report. Furthermore, neither the undersigned nor my emp loyer shall be liable in any manner for in jury,
any personal property damage or loss of any kind arising fro m or connected with this inspection.

Date                     ,                  Signed                                  Co mmissions
                                                            (inspector)                                (National Board and jurisdiction No.)