Bo 13 Form PDF Details

As a small business owner, you may be required to complete Form Bo-13 to report your company's activities. This form is used to provide information about the company's taxable sales and purchases in Quebec. The completed form will help the government assess your business' tax liability and determine any refund or credit that may be due. If you have any questions about completing this form, please consult a professional accountant.

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

Form Preview Example

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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