Bo 13 Form PDF Details

Ensuring the safety and compliance of boilers within New York City's diverse array of buildings is both a critical and complex task, underscored by the importance of the BO13 form, also known as the DOB Boiler Affirmation of Correction Inspection Report. This form plays a pivotal role in the maintenance, inspection, and regulation process, mandating that an inspection report be submitted within a span of 180 days following the inspection of a boiler. Aimed at a singular boiler per form, it encompasses a range of essential information starting from the property details where the boiler is housed, extending to details about the owner or representative for correspondence purposes. Furthermore, it delves into specifics about the boiler device itself, such as the inspection date, boiler number, pressure levels, make and model, alongside its location. A crucial part of the form is the boiler corrections summary, which requires a precise documentation of any defects found, the corrections made, and additional comments or notes for clarity. The form's completion is solidified by the signature of an authorized inspector who affirms under penalty of perjury that all documented corrections align with New York City and State codes. Late filings or inaccuracies can subject the boiler owner to civil penalties, reinforcing the seriousness with which these regulations are enforced to ensure public safety and compliance. From property owners to authorized inspectors, the BO13 form serves as a crucial checkpoint in maintaining the reliability and safety standards of boiler operations across New York City.

QuestionAnswer
Form NameBo 13 Form
Form Length1 pages
Fillable?No
Fillable fields0
Avg. time to fill out15 sec
Other namesnew york boiler affirmation, ny dob correction, how bo affirmation template, dob correction inspection online

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BO13: DOB Boiler Affirmation of Correction Inspection Report

Note: This inspection report must be filed within one-hundred eighty (180) days following the inspection date.

Only one form per boiler. Filing Fee Payment Required: Refer to Agency Fee Rule.

1Property Information (Address where the Boiler is Physically Located)

Borough:

Block:

Lot:

BIN:

Special Place Name:

 

 

 

 

House No.:

Street Name:

 

Zip

 

 

 

 

 

Multiple Dwelling

Commercial

Mixed Use

Other:

Total Number of Residential Units:

 

 

 

 

 

If Fee Exempt, check type of acceptable proof:

Real Estate $0.00 tax bill

Verification Letter from Department of Finance

2 Owner/Representative Information (for returned purposes)

 

Owner/Contact Name:

 

Day Phone:

Email

 

 

 

 

 

 

Address:

City:

State:

Zip:

 

 

 

 

3

Boiler Device Information

 

BO9 Boiler Inspection Date:

 

 

 

 

 

Boilers must be inspected in accordance with requirements of NY State Labor Law Sections 204, NY State Department of Labor Rules and Regulations 12 NYCRR 4, 12 NYCRR 14, New York City Code, Article 303 of Title 28 of the Administrative Code, and RCNY §§ 101-07 and 103-01/05

 

 

 

 

 

 

 

 

Inspection

 

DOB Boiler Number

 

 

Pressure

 

 

I = Internal

##### - ##

Boiler Make & Model

 

Hi/Lo

PSI

BTUs

Location/Floor

E=External

 

 

 

 

 

 

 

 

 

-

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

4

Boiler Corrections Summary Information

Affirmation of Corrections Inspection Date:

 

 

 

 

 

 

 

 

 

 

Detailed Defects Corrections Comments/Notes

 

 

 

 

 

 

5 Authorized Inspector Information, Statements and Signature

 

License Professional First / Last Name

 

 

License Number:

 

 

 

 

 

 

 

 

 

License Type:

Oil Burner Installer

 

Master Plumber

High Pressure Boiler Operator

Insurance Company

 

 

 

 

 

 

 

Company Name:

 

Business Telephone:

Email:

 

 

 

 

 

 

 

 

 

Company Address:

 

 

City:

State:

ZIP:

 

 

 

 

 

 

 

 

SEAL

 

 

Licensee Name:

 

License No.:

 

 

 

 

 

 

 

 

 

I am an authorized New York City Boiler Inspector and duly swear under penalty of perjury,

 

 

 

 

that I have reviewed the defects identified on the BO9 report and is in conjunction with all the

 

 

 

 

required corrections. I certify and affirm, that all defects identified have been corrected, and/

 

 

 

 

or did not exist at the time of my inspection, in accordance with New York City and Sate code.

 

 

 

 

The Department of Buildings’ Boiler Division must receive this form within 180 days of the

 

 

 

 

inspection date. If the report is not filed prior to deadline, the owner shall be liable for a civil

 

 

 

 

penalty, pursuant to Section 103-01(c) of Subchapter C of Chapter 100 of Title 1 of the Official

 

 

 

 

Compilation of the Rules of the City of New York.

 

 

 

 

 

 

 

 

 

 

I hereby state that the information above is correct and complete to the best of my knowledge.

 

 

 

 

Falsification of any statement is a misdemeanor under §§28-211.1, 28-201.2.1.2, and 28-

 

 

 

 

203.1.1 of the Administrative Code and is punishable by a fine, imprisonment, or both. It is a

 

 

 

 

crime to offer or give to a city employee, or for a city employee to accept, any benefit, mone-

 

 

 

 

tary or otherwise, either as a gratuity for properly performing the job or in exchange for special

 

 

 

 

consideration. A conviction of offering of a bribe or gratuity is punishable by imprisonment,

 

(to be sealed by Oil Burner Installer or Master Plumber only)

 

fine or both.

 

 

 

 

 

 

 

 

 

 

 

 

 

Licensee Signature:

 

Date:

 

 

 

 

 

 

 

INTERNAL USE ONLY—DO NOT WRITE

DOB Audit—Inspector’s Initials:

Badge Number:

Violation Issued

No Violation Found

 

 

Inspection Date:

Comments:

BO13 (2/15)

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