Form Af5 - Affidavit Of Compliance printable pdf download

Office of Enforcement and Neighborhood Services

Division of Code Enforcement

nyc.gov/hpd

LEAD-BASED PAINT AFFIDAVIT OF COMPLIANCE

(AF-5): VIOLATIONS CORRECTED AFTER AUGUST 1,

2004

Property owners must submit this affidavit (AF-5) with the documentation required by the affidavit for

lead-based paint violations corrected after August 1, 2004 and overdue (not timely or validly

certified). Violations corrected after August 1, 2014 would include:



All Local Law 1 of 2004 violations (ORDER NUMBERS 616 AND 617)



All lead-based paint hazard violations issued prior to August 1, 2004 if the actual repair

work was completed after August 1, 2004. This includes violations which HPD observed to

be not corrected after August 1, 2004. (ORDER NUMBERS 555, 610, 611 AND 612) .

Overdue LEAD-BASED PAINT HAZARD VIOLATIONS on record with the Department of Housing

Preservation and Development (HPD) can be dismissed ONLY IF:

 HPD has inspected and found the work properly completed. You can check HPD’s website at

and use HPDONLINE from the home page to determine if HPD has already

inspected.

o If the violation has not already been observed corrected by HPD and the violation is

marked as INSPECTION REQUIRED, a properly completed Dismissal Request form

with the appropriate fee must also be submitted to HPD. You can obtain a Dismissal

Request form at .

 The appropriate work practices were used to correct the condition. A detailed description of the

work practices that must be used to correct lead paint hazard violations after August 1, 2004 is

included in an HPD pamphlet – GUIDE TO LOCAL LAW #1 OF 2004 WORK PRACTICES -

available at the Borough Offices and on the HPD website (nyc.gov/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.

 The appropriate documentation regarding the work methods and cleanup process is submitted

with a properly completed Affidavit 5. The documentation must reflect that the work was

properly completed.

To properly complete this affidavit:



The validly registered owner or agent must complete the form (See

for

information about property registration.)



Indicate one or multiple violation sequence numbers for violations corrected and tested at the same

time within a single apartment.



Attach the following documents:



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)

Form Af5 - Affidavit Of Compliance

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