Application For Body Art Practitioner Permit
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1TOWN OF NORTH ANDOVER
Office of COMMUNITY DEVELOPMENT AND SERVICES
HEALTH DEPARTMENT
1600 OSGOOD STREET; SUITE 2035
NORTH ANDOVER, MASSACHUSETTS 01845
978.688.9540 – Phone
978.688.8476 – FAX
E-MAIL: healthdept@northandoverma.gov
WEBSITE:
Application for a Body Art
Practitioner Permit
Complete and return this form with a $210 permit fee; payable to the Town of North Andover and return
to the above address for processing. Note: All new applications must go to the Board of Health for
approval.
_____New Application
_____Renewal
_____Tattooing
_____Body Piercing
_____Other
1. Practitioner Name:
2. Home Address:
3. Home Phone #:
4. Email Address: _______________________________________________________
5. Date of Birth:
6. Identification: (State Drivers License or State ID Card): Attach a copy
7. Establishment Name:
8. Place of Employment:
9. Establishment Phone:
10. Provide the Items specified in Section 10.E.:
(E) Practitioner Training and Experience
(1) In reviewing and application for a practitioner permit, the Board may consider experience, training and/or certification acquired in
other states that regulate body art.
(2) Training for all practitioners shall be approved by the Board and, at a minimum, shall include the following:
(a) blood borne pathogen training program (or equivalent) which includes infectious disease control; waste disposal; hand washing
techniques; sterilization equipment operation and methods; and sanitization, disinfection and sterilization methods and techniques; and
(b) First Aid and cardiopulmonary resuscitation (CPR). Examples of courses approved by the Board include "Preventing Disease
Transmission" (American Red Cross) and "Blood borne Pathogen Training" (U.S. OSHA). Training/courses provided by professional body art
organizations or associations or by equipment manufacturers may also be submitted to the Board for approval.
(3) The applicant for a body piercing practitioner permit shall provide documentation, acceptable to the Board, that s/he completed a
course on anatomy, completed an examination on anatomy, or possesses an equivalent combination of training and experience deemed
acceptable to the Board.
(4) The applicant for a tattoo practitioner permit shall provide documentation, acceptable to the Board, that s/he completed a course
on skin diseases, disorders and conditions, including diabetes, or completed an examination on skin diseases, disorders and conditions, including
diabetes, or possesses a combination of training and experience deemed acceptable to the Board.
FEE: $210.00
PAYABLE TO: TOWN OF NORTH ANDOVER
LATE FEE – FEE WILL BE DOUBLED AFTER JANUARY 1ST
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BODY ART PRACTITIONER APPLICATION
TOWN OF NORTH ANDOVER, MA
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