The New York State Department of Health, Division of Environmental Health Protection, has created an essential document known as the DOH 2249 form, which plays a pivotal role for operators and establishments seeking to determine their required fee for plan review. At its core, this form provides a structured method for calculating fees associated with various establishment types, ranging from food service establishments and temporary residences to public water systems and individual sewage systems. Operators are required to specify the nature and capacity of their operation, then calculate the corresponding fee from a defined schedule. Additionally, the form accommodates requests for exemptions, applicable to entities operated by religious, educational, philanthropic organizations, or municipalities, under certain conditions. To streamline the review process, the DOH requires accurate completion and submission of this form, alongside the appropriate fee, to the relevant regional or district health office. Improperly completed forms or inaccurately calculated fees will lead to delays, underscoring the importance of attention to detail in this administrative procedure. Those found making false statements on this form face legal consequences, emphasizing the seriousness with which the Department of Health approaches this aspect of environmental health protection.
| Question | Answer |
|---|---|
| Form Name | Form Doh 2249 |
| Form Length | 1 pages |
| Fillable? | No |
| Fillable fields | 0 |
| Avg. time to fill out | 15 sec |
| Other names | doh 2249 doh2249 form |
NEW YORK STATE DEPARTMENT OF HEALTH Division of Environmental Health Protection
Plan Review Fee Determination Schedule
Name and Address of Establishment
Date
m m d d y y y y
Public Water Supply ID
N Y
FOR OFFICE USE ONLY
Cashline #
Amount $
Received by
Improperly completed forms or improperly calculated fees will be returned and may delay processing of your plans.
Instructions to operator for completion of this form: To determine what fee applies to your operation:
A. Exempt - no fee
A. Exemption Request |
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1. |
Is this facility operated by a religious, |
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|
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educational or philanthropic organization? |
Yes |
No |
2. |
Is this facility operated by a municipality |
|
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(city, town, village)? |
Yes |
No |
3.If the answer to questions 1 or 2 is "yes," you may request exemption from payment of the annual registration fee.
Please indicate documentation that will be made available upon inspection request.
Incorporation Papers Other (specify)
B. All others
B. Locate category type of your establishment on the list below (e.g., food service, temporary residence).
1.Locate the specific capacity which best reflects your operation.
2.Enter the amount indicated under "Fee Calculation" on the right side of the form.
3.Enter total at bottom of form.
4.Sign and date the fee determination schedule.
5.Submit this completed form with fee in the amount indicated under "Total Fee" to the appropriate NYS Department of Health Regional/District Office.
Type of Establishment
Fee
State Sanitary Code
Fee Calculation
Food service establishments, taverns, |
$75 |
Subpart |
bars, caterers, commissaries, etc. |
|
Food Service Establishments |
Hotels, motels,bungalow colonies, cottage colonies, cabins |
Subpart |
|
Number of stories or structures: |
|
Temporary Residences |
1 or 2 |
$50 |
|
3 or more |
$200 |
|
Campgrounds and travel trailer parks |
$100 |
Subpart |
Mobile home parks |
$100 |
Part 17 Mobile Home Parks |
Migrant labor camps |
$50 |
Part 15 Migrant Farmworker Housing |
Swimming pools and bathing beaches |
|
Subpart |
$100 |
Subpart |
|
5001 sq. ft. or more, |
$150 |
|
wavepools, slides, spa pools |
$150 |
|
Realty subdivisions (per lot) |
$25 x number of lots |
Sec. 1119, PHL (amended, 1989) |
Community and |
Subpart |
|
Cost of project: |
|
Public Water Systems |
Less than $10,000 |
$50 |
|
$100 |
|
|
More than $100,000 |
$200 |
|
Individual sewage system |
$50 |
Part 75 |
(alternative design) |
|
Individual Residential |
|
|
Wastewater Treatment Systems |
TOTAL
Certification Statement: I hereby certify that the statements made above are accurate to the best of my knowledge.
Signature of Operator |
Title |
Date |
.
Note: False statements on this form are punishable as crimes under Article 170 of the Penal Law
Make checks payable to: New York State Department of Health.