Fillable Printable Certificate of Registration - New Jersey
Fillable Printable Certificate of Registration - New Jersey
Certificate of Registration - New Jersey
Multiple Dwellings, including condominiums and cooperatives,
which contain 3 or more units of dwelling space; Hotels which
contain 10 or more units of dwelling space or have sleeping
facilities for 25 or more persons or, are commonly regarded as
a hotel, motor hotel, motel, or established guesthouse in the
community in which they are located, and non-profit Retreat
Lodging Facilities must be registered with the Bureau of Housing
Inspection as required by the Hotel and Multiple Dwelling Law,
N.J.S.A. 55:13A-1 et seq.
Bureau records indicates that the above referenced building,
owned by you, is subject to these registration requirements.
If this information is correct, you are required by law to file a
Certificate of Registration with the Bureau of Housing Inspection,
using the attached form, within 30 days of receipt of this notice.
If this information is incorrect, please notify the Bureau
immediately.
If any of the information submitted on this form should change,
an owner must submit an amended Certificate of Registration
within 30 days of such change. No fee shall be charged for the
filing of an amended Certificate of Registration, except in the
case of a change in ownership wherein the submission of a new
Certificate of Registration is required.
Failure to comply with the term of this notice may subject you
to immediate entry of a docketed judgment against you, for a
penalty in the amount of $200.00 per building, pursuant to
N.J.S.A. 55:13A-12(d).
A fee of $10.00 is required for each building registered. Please complete and submit this form with
the required fee of $10.00, payable by money order, certified check or cashier’s check only, to: N.J.
Bureau of Housing Inspection, within 30 days of receipt of this notice.
If your property consists of a complex of buildings, you must complete this Certificate of
Registration for the first building and a Supplemental Certificate of Registration for each
additional building, and submit with the corresponding fee of $10.00 for each building registered.
Department of Community Affairs
Division of Codes and Standards
Bureau of Housing Inspection
101 South Broad Street, PO Box 810
Trenton, New Jersey 08625-0810
Telephone Number: 609-633-6225
DATE
REGISTRATION NO.:
RE:
New Jersey Department of Community Affairs
Bureau of Housing Inspection
CERTIFICATE OF REGISTRATION
FOR OFFICE USE ONLY
NOTICE OF VIOLATION AND ORDER TO REGISTER
Is This An Amended Certificate?
Previous
Registration
Number, If Any
BUILDING No:
of TOTAL BUILDINGS
BUILDING USE (mark one)
FORM OF OWNERSHIP (mark one)
Number of: STORIES
YEAR CONSTRUCTED
LIFE HAZARD Registered as Life-Hazard Use As per Uniform Fire Code
CONSTRUCTION
DATE OF TRANSFER
OF OWNERSHIP
TAXES PAID TO:
FOR OFFICE USE ONLY
1.
2.
3.
4.
5.
6. 7.
8.
9.
10.
11.
12.
Multiple Dwelling
Corporation
Masonry and Concrete
Transfer Initial Transfer amended
Exterior Masonry Wall and Frame
Masonry and Steel Frame
1.
0
1 3
2 4
2C.
4
3
Guest House/ Bed & Breakfast
Cooperative
Condominium
No
Yes
Yes
No
Yes No
Hotel
Private (Individual or Family)
2A.
1
2D.
5
Dormitory
Public Housing Authority
Season Hotel
Legal Partnership
2B.
2
3.
6
Retreat Lodging Facility
Limited Liability Company
Dwelling units
Rooming units
Total
NOTE: Attach Copy of Certificate
of Occupancy if issued after 1/1/1977.
If Yes, DFS Reg. No.:
month year
month
month
day
day
year
year
Lead exempt
Number of lead
exempt units
Municipality
County
13.
OWNER
15.
IN COUNTY
AGENT
(Must reside in
the same county
as the property)
16.
MANAGER
FED. ID NO. or SOC. SEC. NO. COUNTY, if in N.J. PHONE
NAME: 2
ADDRESS (P.O. Box not acceptable)
NAME: 1
CITY STATE ZIP CODE
COUNTY
COUNTY
PHONE
PHONE
NAME: 2
NAME: 2
ADDRESS (P.O. Box not acceptable)
ADDRESS
NAME: 1
NAME: 1
CITY
CITY
STATE
STATE
ZIP CODE
ZIP CODE
14.
BUILDING
2nd Address
if known by
another name
ADDRESS: STREET NUMBER STREET NAME
NAME OF BUILDING (if any)
SECOND ADDRESS
CITY
BLOCK NUMBER LOT NUMBER
STATE ZIP CODE
JN
17.
MORTGAGEE
18.
Net lessee
or any other
person in
control of
the property
(other
than record
owner)
19.
Corporations,
Condominiums
and
Cooperatives
(must list
officers or
general
partners)
NAME: 2
NAME: 2
ADDRESS
ADDRESS
NAME: 1
NAME: 1
CITY
CITY
STATE
STATE
ZIP CODE
ZIP CODE
TITLE (if any)
ADDRESS
NAME: 1
CITY STATE ZIP CODE
TITLE (if any)
ADDRESS
NAME: 1
CITY STATE ZIP CODE
TITLE (if any)
ADDRESS
NAME: 1
CITY STATE ZIP CODE
PHONE
20.
Registered
agent
(if under
corporate,
condominium,
or
cooperative
ownership)
21.
Multiple
dwelling
Janitor or
superinten-
dent
(if 9 or
more units)
22.
Individual who
can authorize
emergency
repairs and
expenditures
23.
Fuel oil
supplier
NAME: 2
ADDRESS
ADDRESS
ADDRESS
ADDRESS (P.O. Box not acceptable)
NAME: 1
NAME
NAME: 1
NAME
NAME: 2
CITY
CITY
CITY
CITY
STATE
STATE
STATE
STATE
ZIP CODE
ZIP CODE
ZIP CODE
ZIP CODE
PHONE
APT./ROOM NUMBER BUILDING NUMBER PHONE
PHONE
IF FUEL OIL IS USED, PLEASE FILL OUT ALL OF THE INFORMATION BELOW. GRADE OF FUEL FUEL OIL USED 2
Building is not heated by fuel oil. IF THIS BOX IS MARKED, ALL OF THE FUEL OIL SUPPLIER FIELDS MUST REMAIN BLANK.
RETURN CERTIFICATE AND $10.00 FEE
FOR EACH BUILDING TO:
Department of Community Affairs
Division of Codes and Standards
Bureau of Housing Inspection
101 South Broad Street, PO Box 810
Trenton, New Jersey 08625-0810
THIS FORM MUST BE SIGNED AND ALL INFORMATION MUST BE SUPPLIED INCLUDING
ALL PHONE NUMBERS. IF THIS APPLICATION IS NOT COMPLETE IT WILL BE RETURNED
TO THE OWNER.
Owner Signature
Print Name
Date
FOR OFFICE USE ONLY
BHI 4-Rev 4/05
