Fillable Plan Review Application

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Plan Review Application

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1
KENT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
700 Fuller Avenue N.E.
Grand Rapids, Michigan 49503-1918
Phone: 616-632-6900
Fax: 616-632-6892
Email: KCEHmail@kentcountymi.gov Adam London, RS, MPA
Website: www.accesskent.com Administrative Health Officer
BODY ART FACILITY PLAN REVIEW APPLICATION
Date: _______________
Facility Description: (check one) □ New □ Existing Remodel
Name of Facility: _____________________________________________________________________
Address of Facility: ___________________________________________________________________
Phone _______________________ Fax _________________ E-mail ___________________________
Name of Operator (owner and address):
___________________________________________________________________________________
Phone _______________________ Fax _________________ E-mail___________________________
Number of Technician Stations ______ Square Feet /Station _____
Total Square Feet of Facility _______
Date Construction will begin: ______________________
Date of Planned Opening: _________
Day(s) of Operation S M T W TH F SA By appointment: Y N
Hours of Operation ______ to ______
Number of body artists is the facility designed for ________
Number of body artists working in the facility at opening ________
Type of services provided (mark all that apply):
 Tattoo  Piercing  Permanent cosmetics  Scarification  Branding
2
Step 1:
1) Apply for a Michigan Body Art Facility License (visit michigan.gov/body art to download an
application)
2) Submit the on-line fee as instructed by the MDCH
Step 2:
1) Submit a Body Art Facility Plan Review Application request through Kent County Health
Department (616) 632-6900
2) Make a check payable to Kent County Health Department for $250 (this will cover the first three
hours of service time, $65/hour thereafter)
3) With your application, submit a scale drawing of the facility (e.g. 1” = 10 feet, etc.).
Step 3:
1) Once the plans are reviewed and approved, a pre-opening inspection will be scheduled.
2) When the facility pre-opening inspection has been completed, approved, and facility has been
found in compliance with law, you will be allowed to operate for 30 days (pending local permits
and approvals).
Step 4:
1) By no later than five days prior to the end of your interim period, you will need to apply for a
routine (annual) body art facility inspection.
2) Make a check payable to Kent County Health Department for $300.
3) Once our office approves your facility while you are in operation, an on-line recommendation for
licensure will be made to MDCH.
First routine inspection must be completed within 60 days of opening inspection.
Failure to comply will require a re-submittal of documents and associated
payments.
Fully review the “Requirements For Body Art Facilities” for more detailed
information on the documents below.
Sample documents and more information may be found at:
www.accesskent.com/Health/BodyArt or www.michigan.gov/mdhhs
3
Required Documents:
For Facility:
- MDEQ waste disposal
- Exposure control plan
- Client consent form
- Educational material
- Aftercare (for each type of procedure)
For EACH employee/worker:
- Confidentiality agreement
- History
- Hepatitis B declination
- Photo identification
- Bloodborne pathogen certificate
EQUIPMENT
MAKE AND
MODEL
SPECIFICATIONS
4
BODY ART
FACILITY FLOOR PLAN & EQUIPMENT LAYOUT Scale ¼” = 1 foot USING a STRAIGHT EDGE
If other scale- notify:________
BODY ART FACILITY NAME: __________________________________________________
Submitted by: ______________________________________________________ ________
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Plan Review Application

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Completed 3 July 2020

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