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2. TOWNSHIP OF PLAINSBORO

   HOUSING DEPARTMENT
   641 Plainsboro Road
   Plainsboro, NJ 08536
   Tel: 609-799-0909 ext. 1214
   Email : housingdivision@plainsboronj.com

4. Type of Residence*
   -- Select One --Single Family/VillaTownhouseCondominium
6. Block:
7. Lot:
9. Rental Property Address:*
11. Owner's Name:*
    Contact Name Required if LLC is listed
12. Phone Number:*
13. Email Address:*
15. Owner's Address:*
    Cannot be the same as property address being rented or a P.O. Box.
17. Realtor Name:
18. Phone Number:
19. Email Address:
21. Attorney Name:
22. Phone Number:
23. Email Address:
27. Registration Statement

    (Pursuant to N.J.S.A. 46:8-28 and PHC 55 B.)

29. This form must be completed with all required information prior to issuance of Plainsboro Township Housing Certificate of Occupancy. All information must be completed or form will not be accepted.
31. 1. This Registration Statement pertains to rental property address:*
33. 2. Name, address (No P.O. Box), and phone number of recorded owners of the premises or corporate officers:*
35. PHC55B

    If the owner does not reside within 20 miles of Plainsboro Township, said owner shall provide name, address, and phone number of an agent appointed for the purpose of receiving service and responding in case of an emergency.

37. 3. Name, address (No P.O. Box), and phone number of person authorized to accept notices from tenant and to issue receipts therefore and accept the service of process:*
39. 4. Name, address (No P.O. Box), and phone number of person to render emergency or repair service and regular maintenance service:*
41. 5. Name and phone number of tenant(s):
    If tenant name and phone number are not known, this information must be provided within (10) ten days of occupancy.
43. Electronic Signature Agreement:*

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

    1. I agree.
45. Electronic Signature:*
47. Note:

    *An inspection is authorized in accordance with PHC 55 B of the Plainsboro Township Housing Code.
    *Correction of any violations will be the owner's responsibility. 
    *Due to the unpredictability of the inspection process, the inspector may be delayed beyond time noted.
    *Once the Housing Certificate of Occupancy is issued, it is valid for a period of 90 days or a new inspection is required.

51. Rental Inspection Fees:

    1. Condo Rental up to 1,000 sq. ft. - $125.00
    2. Condo Rental over 1,000 sq. ft. - $150.00

    1. Single Family / Townhouse - $250.00
53. Shipping Cost
54. Taxable
55. Name
    name
56. Quantity
Leave This Blank:


58. Calculate Totals Proceed to Checkout

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