Request to repair peeling paint and lead paint hazards

Date: ______________________________
To (owner or managing agent): ______________________________
Owner or agent address: ______________________________
From (your name): ______________________________
Building address: ______________________________
Apartment: ______________________________

I live in the apartment named above. The paint is peeling, chipped or damaged in these places:

____________________________________________________________
____________________________________________________________

[ ] A child under 6 lives in my apartment or spends 10 or more hours a week here.

The building was built before 1960, so under Local Law 1 of 2004 the paint is presumed to contain lead. Section 27-2056.6 of the New York City Administrative Code requires the owner to correct lead paint hazards using certified workers and safe work practices.

Please repair these conditions safely, keep the work area closed off and cleaned every day, and tell me in writing when the work will be done. When the work is finished, please do the dust wipe clearance test and give me a copy of the results.

If the repairs are not made, I will report the conditions to HPD by calling 311.

Signature: ______________________________
Phone or email: ______________________________

Keep a copy. Send it by certified mail with return receipt, or hand it over and ask for a dated receipt.