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Rooming/Boarding House Site License Board
Department of Health and Human Services
50 Winfield Scott Plaza, Room G-1
Elizabeth, NJ 07201-2462
(908) 820-4059
(Renewal Only)
  • Important
  • Property
  • Contacts
  • Tenants
  • Certification
Important Information
Note: This application is only for RENEWAL applications.

If you are trying to convert a home into a rooming house, you need to
1. Go to the Zoning / Construction Departments
2. Come into the Health Department to see Inspector Christina Nieves. 

Type *
# of Kitchens *
Dealer Address
Dealer Name
Attic? *
# of People *
Heating Details
Phone #
# of Labs *
# of Floors *
# of Sleeping Rooms *
# of Apartments *
Property Details
Basement? *
Heating Grade
City, State, ZIP
Email *
Property Owner
Type *
Room #
Mailing Address
Email *
Evening Phone #
Operator/Manager Information
Phone # *
If Other, enter the contact information below:
Name *
Name *
Daytime Phone # *
Phone # *
Emergency Contact Person Is
If there is a change in the partnership or corporate partnership information from last year, update accordingly.
Partnership Information
Emergency Contact
Email *
If there is a change in the tenant information from last year, update accordingly.
Tenant Details
Type Full Name :
Sign With Hand
Attachments *
Fee Schedule
Late Fee
Application Fee
• Fire Inspection Report
• Certificate of Occupancy
• Extermination Report
• Annual Certification of Heating Equipment Application
Pursuant to §211-6.C – All applications by a natural person, partnership or unincorporated association of natural persons shall be duly sworn to by each of the applicants. An application by a corporation shall be duly sworn to by the president or vice-president of the corporation. All statements in the application shall be deemed material, and any person who knowingly misstates any material fact therein shall be guilty of a crime of the fourth degree pursuant to N.J.S.A. 40:52-10.
Renewal Application Fee - $350.00
Late Fee (applications submitted after June 30th) - $25.00 
Fee Due
Have you ever been convicted of a crime involving moral turpitude or any crime
under NJ Law licensing or reguation a Rooming or Boarding House? *
Applicant Signature *