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Boiler Appointment Form

The Boiler First Test Appointment Form is the industry's tool for requesting an inspection from the Boiler Division to sign off a new Boiler Installation, Fuel Burner, Fuel Storage, or Minor Alteration/Repair.

In order to receive a Service Request number for this application, the Installer must
provide an email address so an appointment can be scheduled within 14 business days.

For Mac Users: This request form may not function property with your Safari web browser. We are hoping to resolve this problem soon. In the meantime, please download the free Mozilla Firefox web browser in order to use this form in the interim. For more information on Mozilla Firefox please visit http://www.mozilla.org/. To download the current version of Mozilla Firefox for Macs, please click on the following link: http://www.mozilla.org/en-US/firefox/all.html.


Date: All Fields are Required


1. Appointment Reference Information

A. Please indicate if this is a first request, duplicate request or a re-inspection:

 

2. Device Information

 

A. Borough  Address:
      Job No.:

 

B. Type of Work:      Boiler    Fuel Burner     Fuel Storage    LAA

 

C. Location of Equipment:       Basement    Floors    Roof

 

D. *List if there are two different types of equipment. Use Comments for additional equipment.

Make Num. of Devices Input (BTU’s) Fuel

E. Total Num. of Boilers to be inspected:  Enter (0) for Fuel Storage/Fuel Burner

 
F. Boiler's Type Low Pressure High Pressure
 

3. Installer Information

 
A. First Name:   Last Name: 
B. Company Name:
C. Street Address:  

City:   State:   Zip: 
D. Work Phone:   Email:  
E. Installer License Number: License Type:

4. Verification Documents:

Schedule C or LAA Applications must be accurate, complete and signed by the Installer in the required areas of the Schedule C or LAA. Upload the completed application to this request in order to schedule an appointment. Reports submitted inaccurate, incomplete or unsigned will be rejected. The department will be contacting the installer by email as soon as the appointment is assigned and scheduled with an inspector.

Please use the comments section if there are specific day(s)/time(s) within the 4 weeks of this request that an appointment should not be reserved so the department can try to make an accommodation. Accommodations are not guaranteed and may require a resubmission.

Upload Schedule C or LAA:



How to upload Schedule C /LAA: Upload instructions
Note: Upload file cannot be bigger than 3 MB.

 

5. Acknowledgements

 

I have inspected the device and the positioning of the device within the premises and I confirm that the installation is in conformance with New York State and city code requirements and the ASME code standards.

I understand that no boiler is to be put into operation until a certification is issued by a New York City Department of Buildings Boiler Inspector.


6. Comments/Notes

 


   
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