Notification of Construction Start Date - Astc - Illinois

This Illinois-specific printable "Notification of Construction Start Date - Astc" is a part of the legal paperwork issued by the Illinois Department of Public Health.

Download the up-to-date PDF by clicking the link below and mail it as per the guidelines provided by the department.

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State of Illinois
Illinois Department of Public Health
Notification of Construction Start Date - ASTC
(This form is to be completed and submitted at the start of construction.)
Facility Name
Address
ZIP
City
,IL
IDPH No.
Project Description
n accordance with the Illinois Ambulatory Surgical Treatment Center Licensing Act, Section 8,
I
"Final approval of the plans and specifications for compliance with design and construction
standards
shall be obtained from the Department before alteration, addition, or new
construction is begun."
Based on the above code citation, it has been determined that IDPH is required to record the
date when construction has started. Please provide the information requested below as soon
as possible.
Please fax this completed form to IDPH, Design and Construction Section at 217-782-0382 or
mail to:
Illinois Department of Public Health
Division of Life Safety and Construction
Design and Construction Section
525 W. Jefferson Street, Fourth Floor
Springfield, IL 62761
Date Construction Started
Name of Architect or Authorized Representative
Signature of Architect or Authorized Representative
Date
State of Illinois
Illinois Department of Public Health
Notification of Construction Start Date - ASTC
(This form is to be completed and submitted at the start of construction.)
Facility Name
Address
ZIP
City
,IL
IDPH No.
Project Description
n accordance with the Illinois Ambulatory Surgical Treatment Center Licensing Act, Section 8,
I
"Final approval of the plans and specifications for compliance with design and construction
standards
shall be obtained from the Department before alteration, addition, or new
construction is begun."
Based on the above code citation, it has been determined that IDPH is required to record the
date when construction has started. Please provide the information requested below as soon
as possible.
Please fax this completed form to IDPH, Design and Construction Section at 217-782-0382 or
mail to:
Illinois Department of Public Health
Division of Life Safety and Construction
Design and Construction Section
525 W. Jefferson Street, Fourth Floor
Springfield, IL 62761
Date Construction Started
Name of Architect or Authorized Representative
Signature of Architect or Authorized Representative
Date
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