"Completed Construction Certification Letter for Architects & Engineers" - New York

Completed Construction Certification Letter for Architects & Engineers is a legal document that was released by the New York State Department of Health - a government authority operating within New York.

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  • Released on July 10, 2020;
  • The latest edition currently provided by the New York State Department of Health;
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LISA J. PINO, M.A., J.D.
ANDREW M. CUOMO
HOWARD A. ZUCKER, M.D., J.D.
Executive Deputy Commissioner
Governor
Commissioner
_________________________________________________________________________________________________
COMPLETED CONSTRUCTION CERTIFICATION LETTER
FOR
ARCHITECTS & ENGINEERS
Date:
CON Number:
Facility Name:
Facility ID Number:
Facility Address:
NYS Department of Health/Office of Healt h Systems
Management Center for Health Care Facility Planning, Licensure
and Finance Bureau of Architecture and Engineering Review
th
ESP, Corning Tower, 18
Floor
Albany, New York 12237
To The New York State Department of Health:
I hereby certify that:
1.
I have been retained by the aforementioned facility, to provide professional architectural/engineering services related to the
design and preparation of construction documents, including drawings and specifications for the aforementioned project.
During the course of construction, periodic site observation visits have been completed, and the necessary standard of care,
noting progress, quality and ensuring conformance of the work with documents provided for all regulatory approvals
associated with the aforementioned project.
2.
I have ascertained that, to the best of my knowledge, information and belief, the completed structure is designed and
constructed, in accordance with the programmatic requirements for the referenced construction project, in accordance with
design development drawings, and in accordance with any project definitions, modifications and or revisions approved or
required by the New York State Department of Health.
3.
The aforementioned construction project has been designed and constructed in compliance with all applicable
local, state and
federal
codes, statutes, and regulations, and
all
the applicable provisions of the State Hospital Code -- 10 NYCRR Part 711
(General Standards for Construction) and Parts (check all that apply):
a.
__712 (Standards of Construction for General Hospital Facilities)
b.
__713 (Standards of Construction for Nursing Home Facilities)
c.
__714 (Standards of Construction for Adult Day Health Care Program Facilities)
d.
__715 (Standards of Construction for Freestanding Ambulatory Care Facilities)
e.
__716 (Standards of Construction for Rehabilitation Facilities)
f.
__717 (Standards of Construction for New Hospice Facilities and Units)
PLEASE NOTE ANY EXCEPTIONS HERE:
_______________________________________________________________________________
_______________________________________________________________________________
4.
I understand that any components of this project that are inconsistent with the State Hospital Code (10 NYCRR Parts 711,
712, 713, 714, 715, 716, or 717), have been brought to the attention of the Bureau of Architecture and Engineering Review
(BAER) of the New York State Department of Health for compliance resolution.
ARCHITECTURAL AND ENGINEERING LETTER OF CERTIFICATION FOR COMPLETED CONSTRUCTION PROJECTS
Effective July 10, 2020
Page 1 of 2
LISA J. PINO, M.A., J.D.
ANDREW M. CUOMO
HOWARD A. ZUCKER, M.D., J.D.
Executive Deputy Commissioner
Governor
Commissioner
_________________________________________________________________________________________________
COMPLETED CONSTRUCTION CERTIFICATION LETTER
FOR
ARCHITECTS & ENGINEERS
Date:
CON Number:
Facility Name:
Facility ID Number:
Facility Address:
NYS Department of Health/Office of Healt h Systems
Management Center for Health Care Facility Planning, Licensure
and Finance Bureau of Architecture and Engineering Review
th
ESP, Corning Tower, 18
Floor
Albany, New York 12237
To The New York State Department of Health:
I hereby certify that:
1.
I have been retained by the aforementioned facility, to provide professional architectural/engineering services related to the
design and preparation of construction documents, including drawings and specifications for the aforementioned project.
During the course of construction, periodic site observation visits have been completed, and the necessary standard of care,
noting progress, quality and ensuring conformance of the work with documents provided for all regulatory approvals
associated with the aforementioned project.
2.
I have ascertained that, to the best of my knowledge, information and belief, the completed structure is designed and
constructed, in accordance with the programmatic requirements for the referenced construction project, in accordance with
design development drawings, and in accordance with any project definitions, modifications and or revisions approved or
required by the New York State Department of Health.
3.
The aforementioned construction project has been designed and constructed in compliance with all applicable
local, state and
federal
codes, statutes, and regulations, and
all
the applicable provisions of the State Hospital Code -- 10 NYCRR Part 711
(General Standards for Construction) and Parts (check all that apply):
a.
__712 (Standards of Construction for General Hospital Facilities)
b.
__713 (Standards of Construction for Nursing Home Facilities)
c.
__714 (Standards of Construction for Adult Day Health Care Program Facilities)
d.
__715 (Standards of Construction for Freestanding Ambulatory Care Facilities)
e.
__716 (Standards of Construction for Rehabilitation Facilities)
f.
__717 (Standards of Construction for New Hospice Facilities and Units)
PLEASE NOTE ANY EXCEPTIONS HERE:
_______________________________________________________________________________
_______________________________________________________________________________
4.
I understand that any components of this project that are inconsistent with the State Hospital Code (10 NYCRR Parts 711,
712, 713, 714, 715, 716, or 717), have been brought to the attention of the Bureau of Architecture and Engineering Review
(BAER) of the New York State Department of Health for compliance resolution.
ARCHITECTURAL AND ENGINEERING LETTER OF CERTIFICATION FOR COMPLETED CONSTRUCTION PROJECTS
Effective July 10, 2020
Page 1 of 2
5.
I understand that upon completion of construction, the costs of any subsequent corrections necessary to achieve compliance
with applicable requirements of 10 NYCRR Parts 711, 712, 713, 714, 715, 716 and 717, when the prior work was not
completed properly as certified herein, may not be considered allowable costs for reimbursement under 10 NYCRR Part 86.
This certification is being submitted to facilitate the pre-opening inspection for this project. It is understood that an electronic copy
of final Construction Documents on CD, meeting the requirements of DSG-05 must be submitted to PMU for all projects,
including limited, administrative, full review, self-certification and reviews performed and completed by DASNY.
Project Name:
Location:
Description:
Architectural or Engineering Professional
Stamp
Signature of NYS Licensed Architect/Engineer
Name of Architect/Engineer (Print)
Professional New York State License Number
Business Address
The undersigned applicant understands and agrees that, notwithstanding this architectural/engineering certification the
Department of Health shall have continuing authority to (a) review the plans submitted herewith and/or inspect the work
with regard thereto, and (b) withdraw its approval thereto. The applicant shall have a continuing obligation to make any
changes required by the Division to comply with the above- mentioned codes and regulations, whether or not physical
plant construction or alterations have been completed.
__________________________________________________
Authorized Signature for Applicant
_________________________
_________________________________________________
Date
Name (Print)
Title
Notary required for the Applicant
_______________________________________
.
___________________________________
STATE OF NEW YORK
)
) SS:
County of _______________
)
On the ____ day of ________20__, before me personally appeared ___________________________, to me known, who
being by me duly sworn, did depose and say that he/she resides at ______________________, that he/she is the
______________________________ of the ____________________________________, the corporation described
herein which executed the foregoing instrument; and that he/she signed his/her name thereto by order of the board of
directors of said corporation.
(Notary) _______________________________________________________________________
ARCHITECTURAL AND ENGINEERING LETTER OF CERTIFICATION FOR COMPLETED CONSTRUCTION PROJECTS
Effective July 10, 2020
Page 2 of 2
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