Oho Dce Form Dr 1 – Fill Out and Use This PDF

OHO/DCE FORM- DR-1

Docket No.: DR_______

(Rev. 6/2013)

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:
Item Numbers to Be Inspected:
	฀	ALL
	฀	ONLY

Do you want to be contacted to schedule the inspection? ____YES ____ NO

2. REQUESTOR INFORMATION

Name (Print):

Address:

City:

State:

Zip Code:

Telephone Number: (

)

Email:

Requestor is: (Check applicable box)

Owner Managing Agent

3. REQUESTOR SIGNATURE

Signature:

Date:

The requestor must be a person designated on the Property Registration as the owner or responsible party. If this form is for a private dwelling that is occupied by the owner or his/her family, condominium or cooperative apartment, you are also required to submit the Dismissal Request Affidavit of Ownership.

		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: ________
		Mail			Walk-In		Accepted		Rejected

Inspection Report Due Date:

Note:

This form was processed by:

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 removed from 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 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 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 REMOVED FROM THE 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. You should indicate whether you would like to have HPD contact you to schedule the Dismissal Request inspection

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.)

Section 3: Sign and date the form.

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:

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 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.

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.

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 75% of those violations are observed corrected, pending violations that were not inspected may be dismissed through a self-certification (“CV-1”) process.

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, 1061, 1062, 1492, 1493, 1501, 1502, 1503, 1504, or 1505 will NOT be dismissed through the self-certification process. Violations that require documentation may be dismissed through the self-certification process ONLY when appropriate documentation is filed with HPD. Form DR-1a details required paperwork for 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 date on the Dismissal Request Results document which is sent to the owner at the conclusion of the Dismissal Request inspection.

OHO/DCE FORM- DR-1 Instructions (Rev. 6/2013)

OHO/DCE FORM-DR-1a (rev 6/13)

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://www.nyc.gov/html/hpd/html/owners/owner-forms.shtml.

LEAD-BASED PAINT HAZARD VIOLATIONS on record with the Department of Housing Preservation and Development (HPD) can be dismissed ONLY IF the appropriate additional documentation regarding the work methods and cleanup process accompanies a completed Dismissal Request form. Even if the lead paint condition appears to be repaired, the violation cannot be dismissed without this documentation. 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 appropriate documentation of work methodology. (A detailed description of the work practices that must be used to correct current lead paint hazard violations is included in an HPD pamphlet – GUIDE TO LOCAL LAW #1 OF 2004 WORK PRACTICES, which is available at the Borough Offices and on the HPD website, http://nyc.gov/html/hpd/.) If you have any questions, you may speak with the Public Interviewer at a Code Enforcement Borough Office, call the Lead Hotline at (212) 863-6458, or visit the HPD website at NYC.gov/hpd.

Order Number		In order to have lead-based paint violations dismissed, you must submit:
555 (“remove or cover			Form AF-3/4 (an affidavit certifying that work was performed correctly)
in	a manner approved	 A copy of the State-certified laboratory analysis of all surface dust samples
by	the department		taken (www.hud.gov provides a list of certified laboratories) which
peeling lead paint”)			indicates the method of analysis and preparation of the samples.
606, 607, 610, 611, 612			A copy of the Certificate of Training of the individual who took surface
(“correct the lead-based			dust samples.	The Certificate of Training must be valid for the period
paint hazard”)			when the test	was taken. NYC Department of Health and Mental
			Hygiene Certificates of Training are not valid as of August 2004.
			If section 3c is checked on the Form AF-3/4:
			 A sworn statement made by the agent or employee who performed
			the work to correct the lead-based paint hazard violation(s) stating that
			the work was performed in accordance with §27-2056.11 of Article 14 of
			the Housing Maintenance Code and §11-06 of Title 28 of the Rules of the
			City of New York, the start and completion date of the work and contact
			information (phone or fax) for the individual signing the statement; and
			 A copy of the EPA certification for the firm that performed the work
			to correct the lead-based paint hazard violation(s).

616 (“correct the lead-			 Form AF-5 (an affidavit certifying that work was performed correctly)
based paint hazard			 A copy of the State-certified laboratory analysis of all surface dust samples
- presumed lead			taken (www.hud.gov provides a list of certified laboratories) which
paint”)			indicates the method of analysis and preparation of the samples.
617 (“correct the lead-			 A copy of the Certificate of Training of the individual who took surface
based paint hazard			dust samples. The Certificate of Training must be valid for the period when
- paint that tested			the test was taken. NYC Department of Health and Mental Hygiene
positive for lead			Certificates of Training are not valid as of August 2004.
content”)			 A sworn statement made by the agent or employee who performed the work
			to correct the lead-based paint hazard violation(s) stating that the work was
			performed in accordance with §27-2056.11 of Article 14 of the Housing
			Maintenance Code and §11-06 of Title 28 of the Rules of the City of New
			York, the start and completion date of the work and contact information
			(phone or fax) for the individual signing the statement;
			 A copy of the EPA certification for the firm that performed the work to
			correct the lead-based paint hazard violation(s)
618 (“correct failure to			 Contact the Lead-Based Paint Inspection Unit’s COTA Unit at 212-423-
provide to the			5065 for details regarding the dismissal of this violation.
department within
45 days of demand
all records required
to be maintained
by owner”)
OTHER VIOLATIONS REQUIRING DOCUMENTATION FOR DISMISSAL
Order Number			Forms/Documents Required
703, 1003 (Smoke		File a “Smoke Detectors - Certificate of Installation” or a “Smoke and Carbon
Detectors)		Monoxide Detector - Certificate of Installation” form in accordance with HPD rules
		and regulations.
1504 (CO Detecting		File a “Carbon Monoxide - Certificate of Installation” or “Smoke and Carbon
Device)		Monoxide Detector - Certificate of Installation” form in accordance with HPD rules
		and regulations or complete the online filing at www.nyc.gov/hpd. If your building
		does not require carbon monoxide detectors in whole or in part, you may file an
		exemption form.
771, 772, 773, 774,		File with this department a “Property Registration" form. You can complete this form
775, 776, 777		online at www.nyc.gov/hpd, but the property owner and managing agent must sign
(Registration)		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 approved by
741,761, 762, 1041,		the Department of Buildings. If you have restored to the legal condition, you do not
1061, 1062, 1492,		need to provide documents.
1493 (Alterations)
550 (mold)		ONLY FOR ALTERNATIVE ENFORCEMENT PROGRAM (AEP) BUILDINGS.
		Contact AEP at (212) 863-8262 to obtain details about required documents.

BOROUGH OFFICES
Manhattan	Bronx	Brooklyn	Queens	Staten Island
94 Old Broadway, 7th Fl	1932 Arthur Ave.	701 Euclid Ave.	120-55 Queens Blvd.	Borough Hall
New York, NY 10027	Bronx, NY 10457	Brooklyn, NY 11208	Kew Gardens, NY 11424	St. George, NY 10301

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___

__________________________________________