Dismissal Request Form – Fill Out and Use This PDF

OHO/DCE FORM- DR-1	Docket No.: DR___________________
(Rev. March 2018)

The City of New York

DEPARTMENT OF HOUSING PRESERVATION AND DEVELOPMENT

Division of Code Enforcement

DISMISSAL REQUEST FORM

1. BUILDING TO BE INSPECTED

Building Address:					Borough:
Number of Dwelling Units:			Property Registration Number:

Violation Numbers to Be Inspected:

฀ALL

฀ONLY

2.REQUESTOR INFORMATION

Name (Print):

Requestor* is: (Check applicable box)

Address:

City:

State:

Zip Code:

Telephone Number: (

)

_____________ Email:

_______________

*The requestor must be a person designated on the Property Registration as the owner or managing agent..

I am requesting a reinspection of the violations pending at the property which I have selected above. As a residential property owner, I also understand that my property should be in compliance with all requirements of the Housing Maintenance Code (HMC) and Multiple Dwelling Law (MDL). I have reviewed the attached list of common violations and understand that, as part of this inspection, HPD Code Enforcement Inspectors may issue violations for these or any conditions which violate the HMC or MDL.

Name (Printed): _________________________________________________________

Signature:

Date:

3. CONTACT INFORMATION (TO SCHEDULE INSPECTION)

NAME ________________________________________

PHONE ____________________________________

EMAIL ____________________

CODE ENFORCEMENT BOROUGH OFFICES

Manhattan:

94 Old Broadway, 7th Floor, New York, N.Y. 10027

Bronx:

1932 Arthur Avenue, 3rd Floor, Bronx, N.Y. 10457

Brooklyn:

701 Euclid Avenue, Brooklyn, N.Y. 11208

210 Joralemon Street, Room # 809, Brooklyn, N.Y. 11201

Queens:

120-55 Queens Boulevard, 1st Floor, Kew Gardens N.Y. 11424

Staten Island:

Borough Hall, 10 Richmond Terrace, 2nd Floor, St. George, N.Y. 10301

THIS SECTION IS FOR CODE ENFORCEMENT USE ONLY

Date received:

Number of violations pending: ________ Inspection Report Due Date: ____________

Mail

Walk-In

Accepted

Rejected

Note:

This form was processed by:

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CONDITIONS FOR WHICH VIOLATIONS WILL BE ISSUED DURING A

DISMISSAL REQUEST INSPECTION

(This list is not exhaustive, but can serve as a guide for the most common violations. For more

information on requirements, see HPD’s ABC’s of Housing, which is available at our borough

offices or online at www.nyc.gov/hpd or by calling 311.)

∙Immediately hazardous violations, which represent an immediate hazard to any occupant

∙Inadequate heat or hot water

∙Missing/defective smoke detectors

∙Missing/defective carbon monoxide detectors

∙Missing/defective window guards if a child under 11 resides in the apartment

∙Missing/defective window guards in the public areas if a child under 11 resides in any apartment in the building

∙Lead-based paint if there is peeling paint in any apartment where a child under 6 resides

∙Illegal window gates

∙Double cylinder locks

∙Improper or defective egress from the building

∙Missing signage in the public areas (http://www1.nyc.gov/site/hpd/owners/required- signage.page)

∙Rodent or pest infestation

∙Mold

∙Self-closing apartment entrance and public area doors

Should violations be issued, you will receive the Notice of Violation at an address on your Property Registration (in most cases, at the address of your managing agent). In order to keep your violation record accurate, please correct and certify correction of the condition

to the Department in a timely manner, following the instructions on the Notice. For more information about how to eCertify the condition, see HPD’s website (www.nyc.gov/hpd).

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The City of New York

DEPARTMENT OF HOUSING PRESERVATION AND DEVELOPMENT

Division of Code Enforcement

DISMISSAL REQUEST FORM INSTRUCTIONS

The Dismissal Request Program provides owners and managing agents with an opportunity to have their property inspected for the purpose of having corrected violations dismissed and no longer listed as open violations in the

Department of Housing Preservation and Development’s (“HPD”) records.

A Dismissal Request form may be rejected by HPD when: there is no current or valid Property Registration for the building which is the subject of the form ("subject building"); there is an unpaid emergency repair charge for repairs performed by or on behalf of HPD; when the owner, managing agent, or subject building is the subject of pending HPD- related litigation; when the owner, managing agent, or subject building is the subject of an uncollected judgment arising from HPD-related litigation. If you are the owner of a one or two family home that is not required to register because you reside at the property, or you are a condominium or cooperative owner who is seeking violation dismissal only for violations in your apartment, please complete the Dismissal Request Affidavit of Ownership (the last page of this document) with your Dismissal Request.

You should also submit all documents required for violation clearance. See pages 4 and 5 for more instructions related to

required documentation. If the Dismissal Request form is accepted by HPD, the agency will use its best efforts to inspect the subject building and mail the results of the inspection to the requestor within 45 business days of HPD’s receipt of the Dismissal Request form when submitted between June 1st and September 30th or 90 business days of HPD’s receipt of the

Dismissal Request form when submitted between October 1st and May 31st. If an inspection report is not timely mailed, the Dismissal Request fee will be refunded and the inspection results will be provided to you as soon as possible thereafter. A maximum of two attempts will be made to inspect all violations that are part of the Dismissal Request. A Dismissal Request inspection may, if conditions warrant, result in the issuance of additional violations. CORRECTED

VIOLATIONS THAT ARE NOT INSPECTED WILL NOT BE DISMISSED AND WILL REMAIN AS OPEN VIOLATIONS IN HPD'S RECORDS. YOU MUST MAKE ALL EFFORTS TO ASSIST HPD INSPECTORS IN OBTAINING ACCESS.

Section 1: Provide the address of the subject building (house number, street name and borough) and the number of dwelling units it contains. If the subject building has more than two dwelling units or two dwelling units but neither the owner nor his/her family reside at the property, you must indicate the Property Registration number. (For more information on Property Registration, go to www.nyc.gov/hpd.) All violations on record will be inspected unless specific violations are indicated.

Section 2: Provide your name, mailing address, daytime telephone number, and e-mail address. The inspection results will be mailed via first class mail to this address. Indicate whether you are the owner or managing agent of the subject building by checking the appropriate box. A Dismissal Request form will only be accepted if signed by the owner or managing agent of the subject building. A Dismissal Request form may be submitted to the Code Enforcement Borough Office by mail or in person. Sign and date the form.

Section 3: If the inspection(s) should be scheduled with someone else, indicate your authorized person’s name, telephone

number and email address.

Fees: Each Dismissal Request must be accompanied by a fee for a scheduled amount based on the dwelling classification and number of open violations at the time the Dismissal Request form is submitted to the Code Enforcement Borough Office, as follows:

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Dwelling Classification		Fee
Private Dwelling (1-2 units)		$ 250
Multiple Dwelling (3+ residential units) with 1 - 300 open violations	............	$ 300
Multiple Dwelling with 301 – 500 open violations		$ 400
Multiple Dwelling with 501 or more open violations	.	$ 500
Multiple Dwelling Active in the Alternative Enforcement Program (AEP)		$1000

Submission: For buildings that are not in the Alternative Enforcement Program, mail or deliver the completed Dismissal Request form with a certified check or money order, made payable to the NYC Department of Finance, to the Code

Enforcement Borough Office in the borough where the subject building is located. Please indicate the Property Registration number on the check or money order. AEP Dismissal Requests require a different application and must be submitted (with the certified check or money order made payable to the NYC Department of Finance) to the Alternative Enforcement Program at 100 Gold Street, 4th Floor, New York, NY 10038. If you need that application, please contact AEP directly at 212-863-8262.

Post-Dismissal Request Inspection Self-Certification

During a Dismissal Request inspection, if Code Enforcement inspectors gain access to at least 50% of the violations AND

at least 75% of those violations are observed corrected, pending violations that were not inspected may be dismissed through a self-certification (“CV-1”) process, subject to the information concerning the self-certification process

described below.

Violations that were written as order numbers 80, 81, 81-b, 491, 495, 503, 521, 522, 526, 530, 555, 567, 610, 611, 612, 616, 617, 618, 701, 702, 703, 741, 746, 750, 761, 762, 790, 791, 803, 821, 822, 826, 830, 867, 1001, 1002, 1003, 1041, 1046, 1061, 1062, 1492, 1493, 1501, 1502, 1503, 1504, or 1505 or that exist in a public area CANNOT be dismissed through the self-certification process. Violations that require documentation (such as mold violations) may be dismissed through the self-certification process ONLY when required documentation is filed with HPD. Form DR-1a details

required paperwork that you must include with CV-1 documentation or specific violation types (order numbers). The self-certification “CV-1” form is available at each Code Enforcement Borough Office. All submissions of the CV-1 must

be completed within 45 days of the final date on the Dismissal Request inspection.

WARNING: Offering any type of benefit to a Housing Inspector in order to influence his or her official action is a crime. Housing Inspectors will report such offers to the City's Department of Investigation. Violators will be prosecuted.

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DISMISSAL REQUEST- VIOLATIONS REQUIRING DOCUMENTATION

Included among the outstanding violations for which you may request a Dismissal Request may be violations that require the submission of documents prior to dismissal. Below, please find outlined a description of these violations and an explanation of how you can comply with the violation. All HPD forms are available online at any Code Enforcement Borough Office (see back) or online at http://www1.nyc.gov/site/hpd/owners/compliance-clear-violations.page.

LEAD-BASED PAINT HAZARD VIOLATIONS

∙Lead-based paint violation dismissal requires: The correction of the conditions using appropriate work methods and workers. More information on how to correct lead-based paint violations is available at http://www1.nyc.gov/site/hpd/owners/Lead-Based-Paint.page.

∙The owner's submission of verifying documents about how work was done.

∙An HPD Inspector's verification that the condition has been corrected (physical inspection by HPD).

Lead-based paint violations have been issued under several different lead laws over the past 30 years. The laws required different methods of correction and different documentation to support the correction. If the deadline to correct and certify such a violation has passed, the owner cannot certify correction. The next steps that the owner must take will depend on whether the violation was certified and whether an inspection has already been conducted by HPD. For more instructions on how to proceed for your particular building, go to HPDONLINE. Enter your building address and select Overdue Lead-Based Paint Violations from the left hand column. You will be presented with the list of violations that are open and next steps. If the violation had not been certified or if the violation was certified but has been observed as peeling again by HPD, you must submit one of the following affidavits based on when the work was completed. The instructions for each affidavit indicate what additional documentation is required.

AF-5: Affidavit of Compliance: Lead-based paint violations – for work completed after August 1, 2004

AF-3: Affidavit of Compliance: Lead-based paint violations – for work completed prior to August 1, 2004

Both affidavits are available on-line at www.nyc.gov/hpd or by contacting a Borough Office or by calling the Lead Hotline at (212) 863-6458. In addition to submitting the affidavit, read the affidavit instructions carefully to understand what documentation must be submitted.

If you choose to proceed with your Dismissal Request without producing this documentation, HPD may commence further action to identify and address any remaining lead violation. Such action may include taking dust wipe samples from areas in units where pending lead-based paint hazard violations appear to have been corrected and contracting for cleaning and retesting if lead dust is found in those areas. You will be held responsible for any expense HPD incurs in the course of determining whether a lead-based paint violation still exists and correcting it if you do not provide necessary documentation of work methodology.

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OTHER VIOLATIONS REQUIRING DOCUMENTATION FOR DISMISSAL

Order Number	Forms/Documents Required
780	File with this department a “Property Registration" form. You can complete
	this form online at www.nyc.gov/hpd, but the property owner and managing
	agent must sign and date the form appropriately and submit a signed copy to
	HPD. There is a $13 fee associated with this form which can be paid to the
	Department of Finance. See HPD’s website at www.nyc.gov/hpd for more
	information about Property Registration.
491/494/495/	If you have legalized an alteration, you must provide plans and permits
741 (Alterations)	approved by the Department of Buildings. If you have remove the alteration
	and restored the area to the legal condition, you do not need to provide
	documents.
550 (mold)	For class B and class C mold violations issued after March 1, 2018, you are
	required to supply an Affidavit of Mold Assessment and Remediation, which
	is available at http://www1.nyc.gov/site/hpd/owners/mold.page or by contact
	our Borough Office. Depending on who completed the work, additional
	documentation is required as noted on the Affidavit. There are additional
	requirement for ALTERNATIVE ENFORCEMENT PROGRAM (AEP)
	buildings. Contact AEP at (212) 863-8262 to obtain details about required
	documents for that specific program.

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OHO/DCE FORM DR-AF-1 (Rev 4/2013)

The City of New York

DEPARTMENT OF HOUSING PRESERVATION AND DEVELOPMENT

Division of Code Enforcement

DISMISSAL REQUEST AFFIDAVIT OF OWNERSHIP

State of New York

County of _________________

I, _____________________________________, swear or affirm under penalty of perjury as follows:

That I am: (CHECK THE APPLICABLE BOX)

The owner of the private dwelling located at __________________________________. I or a family member

reside at the dwelling and therefore I am not required to file a Property Registration form.

The owner of a condominium unit located at ______________________________, apartment

# _____.

The owner of shares of a cooperative that owns the property located at

____________________________________, apartment # _____.

_______________________

Signature

Sworn to before me this _____________________

day of ___________________________, 20___

__________________________________________

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