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Get Ny Oho/dce Form-dr-1 2013

The self-certification CV-1 form is available at each Code Enforcement Borough Office. 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 on-line at any Code Enforcement Borough Office see back or on-line at http //www. 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 a Dismissal Request inspection be mailed via first class mail to this address. Indicate whether you are the owner or managing agent of the requested and 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 Indicate the reason for the request. A Dismissal Request form may be rejected by HPD when there is no current or valid multiple dwelling 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 the Department when the owner managing agent or subject building is the subject of pending HPD-related litigation when the owner litigation. 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. Docket No* DR OHO/DCE FORM- DR-1 Rev* 1/07 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 Multiple Dwelling Registration Number Item Numbers To Be Inspected ALL ONLY Do you want to be notified to schedule the inspection YES NO 2. REQUESTOR INFORMATION Name Print Address City State Telephone Number Zip Code Email Requestor is Check applicable box Owner Managing Agent 3. REASON FOR REQUEST Building Sale Fire/Liability Insurance Refinancing Release of Escrow Participation in J-51 Program Other 4. REQUESTOR SIGNATURE Signature Date If this form is for a private dwelling condominium or cooperative apartment you are also required to submit the Dismissal Request Affidavit of Ownership* Manhattan Bronx Brooklyn Queens Staten Island CODE ENFORCEMENT BOROUGH OFFICES 94 Old Broadway 7th Floor New York N*Y. 10027 1932 Arthur Avenue 3rd Floor Bronx N*Y. 10457 701 Euclid Avenue Brooklyn N*Y. 11208 210 Joralemon Street Room 809 Brooklyn N*Y. 11201 120-55 Queens Boulevard 1st Floor Kew Gardens N*Y. 11424 Borough Hall 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 property inspected for the purpose of having corrected code violations removed from the Department of Housing Preservation and Development s HPD records. .

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