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Shop Modication or Alteration (State of New Jersey, Dept. of Law & Pub. Safety, Office of the Attorney General)

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New Jersey Ofce of the Attorney General
Division of Consumer Affairs
New Jersey State Board of Cosmetology and Hairstyling
124 Halsey Street, 6th Floor, P.O. Box 45003
Newark, New Jersey 07101
(973) 504-6400
Instructions for Applying for
Shop Modication or Alteration
Pursuant to N.J.A.C. 13:28-2.1(h), a shop owner who makes a request to expand or make physical alterations to an existing
shop, or to expand or make physical alterations to a shop as a part of a transfer of ownership pursuant to N.J.A.C. 13:28-2.3,
shall submit an application to the Board for approval, an application fee, a detailed statement concerning the proposed changes,
the original oor plan, the new oor plan for the shop, and a statement of approval from the planning, zoning or construction
ofcial in the municipality where the shop is located. If municipal approval for the expansion or physical alterations is not
required, the applicant shall submit a statement from the municipality to that effect.
Please read the Board’s statutes and regulations at www.njconsumeraffairs/cosmetology/cos_rules.htm before completing the enclosed
application and have it notarized. Check with the post ofce regarding the correct address of the shop (including P.O. box
number). Mail the completed application to schedule an inspection date. Call seven (7) days after submission for a tentative
date of inspection. Inspections are conducted on Mondays. Any changes to the inspection date will be conrmed by the
Enforcement Bureau. Display/post licenses, the price list, consumer protection signs and make available for inspection the
employee les with two forms of identication provided for each employee (one with a photo).
Please attach to this original application copies of the following documentation (which must be signed and dated) to avoid
delay/rejection of the application:
1. The completed application which has been notarized by all of the owners.
2. A detailed statement concerning the proposed changes and explain why the address may need to be changed.
3. Obtain a new certication of occupancy/compliance or approval from the planning, zoning or construction
ofcial in the municipality where the shop is located. If municipal approval for modication/alteration is
not required, the applicant shall submit a statement from the municipality to that effect.
4. The proposed and original oor plans.
5. A reinspection fee of $150.00.
6. A copy of the Experienced Practicing Licensee’s (E.P.L./manager) personal license, along with a current
photograph. He/she must have at least three (3) years of experience.
7. A copy of the new lease or a letter from the landlord.
All documents and the application must show the same owner name(s).
Mail the completed application to:
New Jersey State Board of Cosmetology and Hairstyling
124 Halsey Street, 6th oor
P.O. Box 45003
Newark, New Jersey 07101
New Jersey Ofce of the Attorney General
Division of Consumer Affairs
New Jersey State Board of Cosmetology and Hairstyling
124 Halsey Street, 6th Floor, P.O. Box 45003
Newark, New Jersey 07101
(973) 504-6400
Application for Shop Modication or Alteration
Required fee: $150.00
A money order or certied check must
accompany this application. Do not
send cash or a personal check.
Assigned to: ______________
Inspection for: ____________
Do not write above this line.
Pursuant to N.J.S.A. 45:5B et seq. and N.J.A.C. 13:28 et seq., the undersigned hereby applies for a license to operate a shop. (Read
the statutes and regulations governing the practice of cosmetology and hairstyling before completing this application.)
All questions must be answered.
1. Check ( ) form of ownership:
Individual or sole-owner New Jersey corporation Out-of-state corporation Partnership L.L.C.
2. Every owner, partner or ofcer of the corporation, partnership or Limited Liability Company (L.L.C.) (with or without a
license) must provide his/her name, title, the type of license held (if applicable), the license number and his/her Social
Security number.
* Pursuant to N.J.S.A. 54:50-24 et seq. of the New Jersey taxation law, N.J.S.A. 2A:17-56.44e of the New Jersey Child
Support Enforcement Law, Section 1128E(b)(2)A of the Social Security Act and 45 C.F.R. 60.7, 60.8 and 60.9, the Board is
required to obtain the Social Security number of every owner, partner or ofcer. Pursuant to these authorities, the Board is
also obligated to provide these Social Security numbers to:
a. the Director of Taxation to assist in the administration and enforcement of any tax law, including for the purpose
of reviewing compliance with State tax law and updating and correcting tax records; and
b. the Probation Division or any other agency responsible for child-support enforcement, upon request.
Please print clearly.
Name ______________________________ Title _____________________________ Type of license _____________________
License No. _________________________ Social Security No. ________________ Telephone No. ____________________
(include area code)
Name ______________________________ Title _____________________________ Type of license _____________________
License No. _________________________ Social Security No. ________________ Telephone No. ____________________
(include area code)
Name ______________________________ Title _____________________________ Type of license _____________________
License No. _________________________ Social Security No. ________________ Telephone No. ____________________
(include area code)
Name ______________________________ Title _____________________________ Type of license _____________________
License No. _________________________ Social Security No. ________________ Telephone No. ____________________
(include area code)
Application No.
_______________
Shop ID No.
(Choose one and provide number.)
WE _______________
WD ______________
WM ______________
Please indicate the type of
modication or alteration you
seek:
Cosmetology
& Hairstyling
Manicuring
Skin Care Specialty
Beauty Culture
Barbering
3. If the shop is owned by a corporation or L.L.C., please provide the name and address of the corporation or L.L.C.
Name ___________________________________________________________________________________________________
Address: _________________________________________________________________________________________________
Street address City State ZIP code County
4a. Shop name: ______________________________________________________________________________________________
4b. Shop address: ____________________________________________________________________________________________
Street address City State ZIP code County
4c. Shop telephone number _____________________________ (include area code)
Home telephone number ____________________________ (include area code)
Cellphone number __________________________________ (include area code)
5. Name and license number of the Experienced Practicing Licensee (E.P.L. or manager, N.J.S.A. 45:5B-11 et seq.)
E.P.L.’s name __________________________________________ License No. _______________________________________
Note: All shops must employ an E.P.L. to oversee the management of the shop.
6a. Is this a new shop? Yes No
6b. Are you purchasing this business or otherwise acquiring it from a former owner? Yes No
6c. Provide the shop’s former name and its address.
Name: __________________________________________________________________________________________________
Address: _________________________________________________________________________________________________
Street address City State ZIP code County
6d. When will you acquire the business from its former owner? _______________________________
Month Day Year
7. In what type of building area is the shop located? ______________________________________________________________
8. What is the total size of the shop in square feet? ___________
(Note: N.J.A.C. 13:28-2.5 requires that all licensed premises shall contain at least 350 square feet of oor space if there are one
or two licensed operators working at two stations. For every additional licensed operator/station, an additional 50 square feet of
oor space is required.)
9. When will the shop be ready for inspection? _____________________________
Month Day Year
10. What is the proposed date to open for business? _____________________________
Month Day Year
11. How many people do you plan to employ? ________________
12. Please provide the name, shop license number and business address of any other shops owned by this corporation.
________________________________________________________________________________________________________
Shop/Trade name Business address License number
________________________________________________________________________________________________________
Shop/Trade name Business address License number
________________________________________________________________________________________________________
Shop/Trade name Business address License number
13a. N.J.A.C. 13:28.2.5 requires that every cosmetology and hairstyling, beauty culture or barbering shop contain the following minimum
equipment:
i. One lavatory that includes a toilet, hand-washing facilities and a door;
ii. One shampoo basin with hot and cold running water and a reclining chair;
iii. For barbering shops only, at least one chair with an adjustable headrest suitable for performing shaving services;
iv. A designated area for cleaning and disinfecting implements and tools;
v. One ultrasonic unit for cleaning metal implements and tools;
vi. A clean, closed receptale for storage of sanitized implements and tools at each work station;
vii. A closed container for clean linens;
viii. A closed container for soiled linens;
ix. Hair drying facilities;
x. A dispensary or place where supplies are prepared and dispensed;
xi. Permanent outside sign showing the trade name; and
xii. Such other equipment as is necessary to provide those services offered by the shop in a safe and sanitary manner.
13b. N.J.A.C. 13:28-2.6 and 2.6A require that every manicuring shop and every skin-care specialty shop contain the following minimum
equipment:
i. At least one sink in the work area with hot and cold running water;
ii. A designated area for cleaning and disinfecting implements and tools;
iii. One ultrasonic unit for cleaning metal implements and tools;
iv. A clean, closed receptale for storage of sanitized implements and tools at each work station;
v. A closed container for clean linens;
vi. A closed container for soiled linens;
vii. A closed waste container for each work station;
viii. A dispensary or place where supplies are prepared and dispensed;
ix. Permanent outside sign showing the trade name; and
x. Such other equipment as is necessary to provide those services offered by the shop in a safe and sanitary manner.
14. Have you attached to this application the required diagram/oor plan of the proposed shop premises? Yes No
Note
Every application to modify or alter an existing shop must be accompanied by documentation that the premises have
been approved by the local municipality for business use. For example, a Certicate of Occupancy issued by the
municipality’s Fire Department would meet this requirement.
Please remember that it is unlawful to operate a shop without rst having obtained a license to do so.
State of New Jersey Tax ID #: ______________________________________
County of ________________________________________
I / We, being duly sworn (or afrm) say that I / we have read and clearly understand all of the statements contained in this
application, that they are true and correct and said application is submitted to obtain authorization to modify or alter an existing
shop. I / We understand that cosmetology/hairstyling, manicuring or skin-care services will be offered upon these premises.
Print name: ____________________________________ Signature: _____________________________________
Print name: ____________________________________ Signature: _____________________________________
Print name: ____________________________________ Signature: _____________________________________
Print name: ____________________________________ Signature: _____________________________________
Sworn and subscribed to before me this _______
day of __________________________ , 20 _____
Month
_________________________________________
Name of Notary Public (please print)
_________________________________________
Signature of Notary Public
If a partnership, all partners must sign.
If a corporation or L.L.C., corporate ofcers must sign.
Afx seal here
Revised 12/12
Diagram/Floor Plan
All licensed premises shall contain not less than 350 square feet of space and one lavatory within the shop. (See N.J.A.C.
13:28-2.5, 2.6 & 2.6A).
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Shop Modication or Alteration (State of New Jersey, Dept. of Law & Pub. Safety, Office of the Attorney General)

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Completed 14 August 2020

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