Fill - Free fillable Salon Application (Commonwealth of Massachusetts) PDF form

Type 1 – Is for a cosmetology full service salon, which offers hair, skin and nail services. This

type of salon must employ a type 1 cosmetologist as a manager.

Type 2 – (Renter) is a single person who rents space in a type 4 salon. To be eligible for this

type of license, you must have a manager level license (type 1, type 3 or type 6). The owner

of the entire salon can only rent to one person per space (chair, table, room).

Type 3 – Is for a manicuring shop only (must be type 1 or type 3)

Type 4 – (Owner of entire space) is for a person who owns a salon and rents space/chair to

other licensees who are independent contractors. All Booth Rental Salons (type 4) must have

a single manager level licensee; no other employees of the shop owner may practice at this

type of salon. See below notes for more information.

Type 5 – Is for an aesthetic salon which can offer services such as facials and waxing. This

type of salon must employ a type 6 or type 1 manager.

Booth Rental Notes:

*If you rent out some of your booth space to others (Type 4) and you have employees in other booths (Type

1), you must hold both types of licensure and submit 2 applications.

*If you want to rent space in a salon you must have at least a Type 1 (cosmetologist), Type 6 (aesthetician), or

Type 3 (manicuring) personal license. Type 2 (operator) and Type 7 (aesthetician) licensees may not rent

space in a salon.

*If the Booth Renter’s (Type 4) License is not current, then an application for a Booth Shop (Type 2) license

will be denied.

*Booth Shop licenses – once you have received your booth shop license, it should be posted at the space you

rented at all times.

The Commonwealth of Massachusetts

Division of Professional Licensure

1000 Washington Street Suite 710

Boston, MA 02118-6100

Board of Registration of Cosmetology and Barbering

www.mass.gov/dpl/boards

617-727-9940

Cosmetology Salon License Type Guidelines

IMPORTANT INFORMATION FOR ALL SALON APPLICANTS

 The shop must be completely setup with signage and ready for business in order to

pass final inspection for licensing.

 The shop license is NOT Transferable. The shop license only covers the shop at the location/space it

was issued to. If you change location (even at the same address), you must submit a new application.

 Some locations may be required to obtain more than one shop license based on services or staffing.

If so, you must submit one application and fee per license required.

Examples: (1) If you are renting out some of your booth space to others (Type 4) and you have

employees in other booths (Type 1), you submit one application for a type 4 and one

application for a type 1.

(2) If doing manicuring and aesthetics, submit one application for a type 3 and one for

a type 5.

 Bathrooms must be within the confines of the salon on the same floor the salon is located. However, if

core facilities are on the same floor as the salon and are within 300 feet of the salon, those facilities can

be identified on the floor plan and used for purposes of 240 CMR. The salon owner/manager will

remain responsible for ensuring those facilities remain safe and sanitary.

 If you alter the floor plan submitted at any time you must submit an expansion/renovation application

with the board which can be found on the board’s website.

 If you are not choosing to provide all services allowed by your license type you are still required to

have all required equipment stated in the rules and regulations section 3:00.

 If you are changing ownership, you can remain open for 30 days while obtaining a new license.

 If you are a new business or changing location, you must remain closed until you are approved for

licensure at the final inspection.

Summary of major policies that apply to salon applications:

Dry sterilizers are no longer permitted as a method of sanitation.

Policy No. 06-01

Salons cannot use names incorrectly suggesting the salon provides healing or medical benefits. Names such

as “healing”, “medical”, “med”, “clinical” or “wellness” are prohibited.

Policy No. 06-02

Salon names using ethnic, gender, or age specific terms may violate Massachusetts law and may be rejected or

delay processing of an application.

Policy No. 06-03 – Prohibited Practices - Revised

Salons are prohibited from providing non-cosmetology services that may endanger public health or safety:

1. Medical services, teeth whitening, use of cutting blades, and other such services may not be provided

anywhere within a cosmetology salon. Applications with such services on them shall be denied.

2. Permanent makeup, electrology, tattooing, acupuncture, and tanning machines may be utilized in

separate, distinct areas identified on the floor plan.

3. Salons may be located in other businesses if independently owned, operated, and separate from those

businesses. Such circumstances must be clearly documented on the application for Board review.

4. Eyelash tinting may now be performed in licensed salons, using products that are not prohibited by the

Food and Drug Administration (FDA).

Policy No. 09-02 – Certain New Procedures

Intense Pulsed Light devices must be identified on the floor plan, may be used only by Aestheticians

who have been approved for IPL by the Board, and the manufacturer’s instructions and documentation

showing board-approved training must be on the premises at all times.

Policy No. 2015-02 – Dual Use of Rooms for Cosmetology and Massage Therapy

4. A salon room may include massage therapy IF (a) the room is also licensed as a Massage Therapy

facility to the salon license-holder; and (b) any person providing massage is a licensed massage

therapist.

Salon Application Check List

Please use this checklist to ensure your application is complete

Incomplete applications will be returned and will delay your opening. You will be contacted by an

investigator with an inspection date within 10 business days from the application’s approval.

Your application must include:

 2 copies of a floor plan which must include the entire layout of the salon (8.5” x 11” Only). The

applicant must retain a copy of the floor plan on the premises at all times. The floor plan must include

all the following:

*All stations, chairs, manicure tables, aesthetic rooms. For a booth shop, circle the space you are renting.

*Additional sinks (cannot be located in the bathroom). Aesthetic and manicuring shops are required to

have an additional sink located in a space that is accessible at all times to all areas.

Example: Aesthetic shop with 3 rooms can either have a sink in each room or a minimum of one

sink in a common area that is accessible at all times.

*Shop sign

*Label all rooms whether cosmetology or other, such as medical room, dispensary, lunch room, etc.

*Bathrooms

 Original completed application signed by all required parties.

 Money order or check for $136.00 made payable to: Commonwealth of Massachusetts. *Application

fees are non-refundable.* All money orders must be signed and dated.

 Copy of price list stating all services being provided. Gender Pricing is prohibited.

Example: Cannot state Men’s cut $18, Women’s cuts $25.

 One 2x2 photo of each owner

 Copy of driver’s license or photo ID for each owner

 Copy of manager’s (if not owner) driver’s license or photo ID and current

cosmetology, aesthetic or manicuring license

 Copy of all employees’ cosmetology licenses (not applicable if applying for a booth rental license

unless the owner is not a licensee). For booth shop license, provide a copy of the booth rental license.

 Business Certificate from the city or town where the salon is located.

 An Original completed “plumbing and electrical” work form if work has been done. If no work has

been done, the “no work required” form must be completed by the applicant.

 If the business is incorporated, submit a copy of the Articles of Incorporation; if it is a partnership or

LLP, a copy of the partnership agreement; for LLCs, submit a copy of the Certificate of Organization.

 If a business is organized or incorporated, submit a copy of a certificate showing foreign registration

with the Massachusetts Secretary of State’s Office.

 Incomplete applications will only be held for a maximum of 30 days. After 30 days, the

application will be considered abandoned. If you still require the license, you will be required to

reapply.

The Commonwealth of Massachusetts

Division of Professional Licensure

Board of Registration of Cosmetology and Barbering

1000 Washington Street Suite 710

Boston, MA 02118-6100

www.mass.gov/dpl/boards

617-727-9940

Cosmetology New Shop Application

Type of Shop applying for (See guidelines for salon type descriptions):

 New Shop (Opening date:__________)  Change of Salon Type  Additional License

(Check one type only)

 Type 1 - Cosmetology (full service salon)

 Type 2 - Booth Shop (renting a space in a salon). Booth Renter Shop lic. #: _____________

 Type 3 - Manicure Only

 Type 4 - Booth Renter (owner of entire salon)

 Type 5 -Aesthetic Salon Only

 Change of Owner (was previously a salon):

Is previous owner’s license attached? Yes No

If no, list the shop name and license # of the previous owner: ________________________________________

 Change of Location: Previous location: ________________________________________________

Below to be answered and signed by person requesting the license:

Name of Applicant:

Last First Middle

Name, License # and exp. date of owner or manager: _______________________________________

Salon Address:

No. Street P.O. Box

City/Town Zip Code

Salon Name:

Contact Phone Number: Cell Phone Number:

Location of Shop:

 Store  Home  Office Building  Mall/Plaza name _______________________

Business Structure of Salon:

Individually Owned

Partnership or LLP - List the partners:________________________________________________________

Note: Partners not named on the license as the applicant must also sign below, and in signing, they agree that the named

applicant may represent all partners with regards to any Board business.



BOARD USE ONLY

Investigator:

Date of Inspection: Please attach one recent

2”X 2”

Received By:

License Number: passport photograph here

Type Class:___________________

Corporation – Name of Corporation: ______________________________

Name of Officer signing application: _____________________ Position held by Officer:______________________

Note: If salon owned by a corporation, be sure to have the officer attach the articles of incorporation.



LLC – Name of LLC:___________________________________

Name of Manager/Member signing application: _____________________

Note: If salon owned by an LLC, be sure to have the member/manager attach the articles of organization.

Social Security Number: ___________________________________________________

Pursuant to G.L. c. 62C, s. 47A, the Division of Professional Licensure is required to obtain your social security number

and forward it to the Department of Revenue. The Department of Revenue will use your social security number to ascertain

whether you are in compliance with the tax laws of the Commonwealth.

Has any disciplinary action been taken against you by a licensing/certification board located in the United States or any

country or foreign jurisdiction? No:  Yes:  If yes, a notarized letter must be submitted with this application.

The letter should contain an explanation and description of the incident.

Are you the subject of pending disciplinary actions by a licensing/certification board located in the United States or any

country or foreign jurisdiction? No:  Yes:  If yes, a notarized letter must be submitted with this application.

The letter should contain an explanation and description of the incident.

Have you ever voluntarily surrendered or resigned a professional license to a licensing/certification board in the United States

or any country or foreign jurisdiction? No:  Yes:  If yes, a notarized letter must be submitted with this

application. The letter should contain an explanation and description of the incident.

Have you ever applied for and been denied a professional license in the United States or any country or foreign jurisdiction?

No:  Yes:  If yes, a notarized letter must be submitted with this application. The letter should contain an

explanation and description of the incident.

Have you ever been convicted of a felony or misdemeanor in the United States or any country or foreign jurisdiction, other

than a traffic violation for which a fine of less than $100.00 was assessed?

No:  Yes:  If yes, a notarized letter must be submitted with this application. The letter should contain

an explanation and description of the incident.

Salon owner or manager must notify the Board of Registration of Cosmetology and Barbering, thirty days

prior with a new shop application, of any change in ownership or location. Shop licenses are not

transferable. The new location cannot conduct business until approval at final inspection.

I certify, under the pains and penalties of perjury, that the information I have provided pursuant to this application for licensure is truthful

and accurate. I understand that the failure to provide accurate information may be grounds for the Massachusetts Board of Registration of

Cosmetology and Barbering to deny me the right to sit as a candidate or to suspend or revoke a license issued to me in accordance with

Massachusetts Law. I further attest that, pursuant to G.L. c. 62C, §49A, to the best of my knowledge and belief, I and/or the business

entity I represent have filed all state tax returns and paid all state taxes required by law. I further agree that I am responsible for ensuring

that the actions of the above referenced salon will adhere to all applicable Massachusetts laws and regulations pertaining to the practice of

cosmetology.

Signature of Applicant Date

Signature of Manager & License number Date

The Commonwealth of Massachusetts

Division of Professional Licensure

1000 Washington Street Suite 710

Boston, MA 02118-6100

Board of Registration of Cosmetology and Barbering

www.mass.gov/dpl/boards

617-727-9940

Plumbing Inspection Form

of Professional Licensure

Office of Investigations

Causeway St., Suite 400

Boston, MA 02114

www.state.ma.us/reg/boards/hd

617-727-7406

Plumbing Inspection Form

INSTRUCTIONS: This form should be completed only if plumbing work has been done in the

salon after purchase.

Date:

This is to certify that I am a Plumbing Inspector for ___________________________, and that the plumbing alterations or

Name of city or town

installations for :

Name of Salon Applicant

Street Number Street Name

City State

is in accordance with the specifications of the state plumbing code found at 248 CMR,

Name of Plumbing Contractor

License #

Exp. Date

Address

No. Street City/Town

Signed:

Plumbing Inspector License # Exp. Date

The Commonwealth of Massachusetts

Division of Professional Licensure

1000 Washington Street Suite 710

Boston, MA 02118-6100

Board of Registration of Cosmetology and Barbering

www.mass.gov/dpl/boards

617-727-9940

Electrical Inspection Form

tate.ma.us/reg/boards/hd

617-727-7406

Electrical Inspection Form

INSTRUCTIONS: This form should be completed only if electrical work has been done in the

salon after purchase.

Date:

This is to certify that I am an Electrical Inspector for ___________________________, and that the electrical alterations or

Name of city or town

installations for:

Name of Salon Applicant

Street Number Street Name

City State

is in accordance with the specifications of the state electrical code found at 527 CMR,

Name of City or Town Where Shop is Located

Name of Electrical Contractor

License #

Exp. Date

Address

No. Street City/Town

Signed:

Electrical Inspector License # Exp. Date

The Commonwealth of Massachusetts

Division of Professional Licensure

1000 Washington Street Suite 710

Boston, MA 02118-6100

Board of Registration of Cosmetology and Barbering

www.mass.gov/dpl/boards

617-727-9940

INSTRUCTIONS: This form should be completed only if no plumbing and/or no electrical work

has been done in the salon after purchase.

No Work Required Form

Circle all that apply:

No Plumbing work done No Electrical work done

Date: _____________________________

This is to certify that all electrical and/or plumbing work on these premises complies

with the rules and regulations of state electrical and plumbing codes. There have been no

changes in the electrical or plumbing systems. No changes will take place unless I first

notify the Board of Registration of Cosmetology and Barbering and obtain and complete

the proper forms.

NAME OF SALON

NAME OF SALON APPLICANT

ADDRESS OF SALON

TELEPHONE NUMBER

SIGNATURE OF SALON APPLICANT

CRIMINAL OFFENDER RECORD INFORMATION (CORI)

ACKNOWLEDGEMENT FORM

The Division of Professional Licensure by itself and on behalf of boards of registration pursuant to

M.G.L. c. 13, §9 [hereinafter, “Division of Professional Licensure”] is registered under the provisions of

M.G.L. c. 6, § 172 to receive CORI for the purpose of screening current and otherwise qualified

prospective license applicants and current licensees.

As a license applicant or current licensee, I understand that a CORI check will be submitted for my

personal information to the Department of Criminal Justice Information Services (“DCJIS”). I hereby

acknowledge and provide permission to the Division of Professional Licensure to submit a CORI check

for my information to the DCJIS. This authorization is valid for one year from the date of my signature. I

may withdraw this authorization at any time by providing the Division of Professional Licensure written

notice of my intent to withdraw consent to a CORI check.

FOR LICENSING PURPOSES ONLY:

The Division of Professional Licensure may conduct subsequent CORI checks within one year of the

date this Form was signed by me. If subsequent CORI checks are necessary, the Division of

Professional Licensure will provide me with written notice of the subsequent CORI checks.

By signing below, I provide my consent to a CORI check and acknowledge that the information provided

on Page 2 of this Acknowledgement Form is true and accurate.

_________________________________ _________________________________

Signature Date

Please provide the name of the board of registration and license type for which you are applying or currently hold:

_________________________________ _________________________________

Board of Registration License Type

NOTE: DPL CANNOT ACCEPT THIS TWO-PAGE CORI ACKNOWLEDGMENT FORM UNLESS IT IS

EITHER (1) SIGNED IN PERSON AT THE BOARD'S OFFICES IN THE PRESENCE OF A DPL

EMPLOYEE WHO HAS VERIFIED THE APPLICANT'S IDENTITY THROUGH ACCEPTABLE

IDENTIFICATION, OR (2) SIGNED IN THE PRESENCE OF A NOTARY PUBLIC WHO HAS LIKEWISE

VERIFIED IDENTITY AND THEN MAILED OR OTHERWISE DELIVERED TO THE BOARD'S OFFICES

AT THE ADDRESS SET FORTH ABOVE.

Page 1 of 2

SUBJECT INFORMATION: (An asterisk (*) denotes a required field)

________________________ _________________________ _______________________ ______

*Last Name *First Name Middle Name Suffix

___________________________________________________________________________________

*Maiden Name (or other name(s) by which you have been known)

___________________ ____________________________

*Date of Birth Place of Birth

*Last Six Digits of Your Social Security Number: ______ - _____________

Sex: ______ Height: ____ ft. ____ in. Eye Color: ___________

Driver’s License or ID Number: ___________________ State of Issue: ________________________

Current and Former Addresses:

______ ____________________________________ ______________________ _____ ________

Number Name City/Town State Zip

______ ____________________________________ ______________________ _____ ________

Number Name City/Town State Zip

SECTION A: VERIFICATION BY DPL EMPLOYEE: I hereby certify that I verified the identity of the

above-referenced subject by reviewing the following form(s) of government-issued identification:

Passport State-issued driver’s license Military identification State-issued identification card

VERIFIED BY:

Name of Verifying DPL Employee (Please Print)

Signature of Verifying DPL Employee (Please Print) Date

SECTION B: VERIFICATION BY NOTARY:

On this ______ day of _____________, 20____, before me, the undersigned notary public, personally

appeared _________________________________ (name of document signer), and proved to me

through satisfactory evidence of identification, which was the following:

Passport State-issued driver’s license Military identification State-issued identification card

to be the person whose name is signed on the preceding or attached document, and acknowledged to

me that (he) (she) signed it voluntarily for its stated purpose.

Notary Public: Notary Commission Expires On:

If a subject does not have an acceptable government-issued identification, his or her identity shall be verified by the other

forms of identification documentation as determined by DCJIS. 803 CMR 2.09 (2).

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