Form POC1 "Professional and Owner Certification" - New York City

Form POC1 or the "Professional And Owner Certification" is a form issued by the New York City Department of Buildings.

Download a fillable PDF version of the Form POC1 down below or find it on the New York City Department of Buildings Forms website.

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Download Form POC1 "Professional and Owner Certification" - New York City

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Job Number
(Affix Label)
Professional and Owner Certification
Please file three (3) originals
1. Professional’s Certification
"I hereby state that I have exercised a professional standard of care in certifying that the filed
application is complete and in accordance with applicable laws, including the rules of the
Department of Buildings, as of this date. I am aware the Commissioner will rely upon the truth
and accuracy of this statement.
I have notified the owner that this application has been
professionally certified. If an audit or other exam discloses non-compliance, I agree to notify the
owner of the remedial measures that must be taken to meet legal requirements. I further realize
that any misrepresentation or falsification of facts made knowingly or negligently by me, my
agents or employees, or by others with my knowledge, will render me liable for legal and
disciplinary action by the Department of Buildings and other appropriate authorities, including
termination of participation in the professional certification procedures at the Department of
Buildings."
Professional’s Seal
______________________
_______________________________
Professional’s License No.
Professional’s Signature & Date
2. Owner’s Statement
“I have read and am fully aware of the applicant’s above statement that this job will be
professionally certified, and agree to bring into compliance any construction which is found
not to comply with all applicable laws and regulations.”
_______________________________
Owner’s Signature & Date
3. Applicant’s Contact Information
Fax Numbers
Email Addresses
Applicant
____________________
_____________________________
Owner
____________________
_____________________________
Filing Representative
____________________
_____________________________
POC1, dated 1/16/04
Job Number
(Affix Label)
Professional and Owner Certification
Please file three (3) originals
1. Professional’s Certification
"I hereby state that I have exercised a professional standard of care in certifying that the filed
application is complete and in accordance with applicable laws, including the rules of the
Department of Buildings, as of this date. I am aware the Commissioner will rely upon the truth
and accuracy of this statement.
I have notified the owner that this application has been
professionally certified. If an audit or other exam discloses non-compliance, I agree to notify the
owner of the remedial measures that must be taken to meet legal requirements. I further realize
that any misrepresentation or falsification of facts made knowingly or negligently by me, my
agents or employees, or by others with my knowledge, will render me liable for legal and
disciplinary action by the Department of Buildings and other appropriate authorities, including
termination of participation in the professional certification procedures at the Department of
Buildings."
Professional’s Seal
______________________
_______________________________
Professional’s License No.
Professional’s Signature & Date
2. Owner’s Statement
“I have read and am fully aware of the applicant’s above statement that this job will be
professionally certified, and agree to bring into compliance any construction which is found
not to comply with all applicable laws and regulations.”
_______________________________
Owner’s Signature & Date
3. Applicant’s Contact Information
Fax Numbers
Email Addresses
Applicant
____________________
_____________________________
Owner
____________________
_____________________________
Filing Representative
____________________
_____________________________
POC1, dated 1/16/04
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