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Tanning Facility Application

  1. Application to Operate a Tanning Facility

    No permits will be issued until payment has been received in full and processed by the staff of the City of Gardner Health Department. The fee for this permit is $50 for one bed and $20 for each additional bed

  2. The undersigned business hereby applies for a license to operate a Tanning Facility in accordance with the provisions of Sections 207-214 and 31 of Chapter 111 of the General Laws of the Commonwealth of Massachusetts and the requirements of the Department of Public Health, 105 CMR 123.000 Tanning Facilities

  3. List names of officers if corporations, partners, and manager if partnership:

  4. (If Partnership)

  5. Please provide the name and address of the knowledgeable operator, present at all times at this facility, to assist the customer and provide sanitized protective eye wear and towels in conformance with 105 CMR 123. 003, C1

  6. Is the tanning facility mobile?*

  7. The tanning device will be protected so that the interior temperature does not exceed 100 degrees F. The timer shall have an accuracy of plus or minus ten percent (10%).

  8. For Renewal:

  9. No person under the age of 14 shall use a tanning device unless accompanied by a parent or legal guardian

  10. Under the Laws of the Commonwealth of Massachusetts, Chapter 233, Section 35, Acts of 1983, You are required to complete the following:

  11. Payment:

    No permits will be issued until payment has been received in full and processed by the City of Gardner Health Department. All checks must be made out to "City of Gardner" and sent to Gardner Board of Health, Gardner City Hall Rm 29, 95 Pleasant St. Gardner, MA 01440. The fee for this permit is $50.00 for one bed, and an additional $20 for each additional bed after that.

  12. Leave This Blank:

  13. This field is not part of the form submission.