london borough of barking and dagenham€¦ · web viewthe initial grant of a licence may be for up...

SPECIAL TREATMENT PREMISESLondon Local Authorities Act 1991 – Part II

APPLICATION FOR A NEWSPECIAL TREATMENT ESTABLISHMENT LICENCE

Please read the notes attached to this form carefully before completing your application.

Please complete all sections of this form using Black Ink.Please ensure that your answers are clear and legible.

New licences The initial grant of a licence may be for up to a maximum of 18 months where this brings the licence in line with the renewal period. The licensing year is from 1st April - 31st March.The fee for New licences issued during the year will be worked out on this basis.

SECTION 1 – THE PREMISES

Trading Name:

Full Address:

Contact Telephone Number:

Email Address:

Web Address:

Days of Operation:

Hours of Operation:

Are the premises commercial?

Are the premises residential?

What is the legal title of the applicant(s) to occupy the premises? (e.g. freehold, leasehold etc.)

If leasehold, please give details of the name and address of the landlord

Area of premises to be licensed (Whole/basement/ground floor/room or area within existing premises)

Line DrawingPlease provide a plan of the area of the premises to be licensed. See Line Drawing Guidance.

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Line Drawings

The Line Drawings should be up to date and shown on separate sheets for each floor of the building.The plan should include:

the intended use of each room external and separating walls internal walls and columns partition walls and partitions walls, doors, partitions and glazing which are fire resisting for not less than 30 minutes doorways and openings in external and internal walls and partitions indicating the direction of

opening of any doors (indicate whether any rear or side exits lead to an enclosed yard or the street)

all exit routes, showing doors, passageways, staircases, and final exits position of fire exit signage position of fire alarm call points and indicator panel, if provided all stairways indicating direction of rise any steps or number of steps or ramp at a change in floor levels, indicating the direction of rise all openings in floors or walls for lifts, escalators, elevators, conveyors, chutes etc. areas covered by emergency lighting, smoke detectors or automatic sprinklers the scale of drawings (minimum 1:100)

To help you, a simple example is given below. Line drawings may be hand drawn using just a pen and ruler – however if not drawn to scale, the exact dimensions for all rooms, passageways and areas must be given.

Remember to keep a photocopy of any plans – in case they get lost.

THE BEAUTY SPOT, 1 STATION PLACE, BARKING Scale 1:100 31 March 2016

SECTION 2 – THE APPLICANT

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Please confirm whether the application is being made on behalf of

An individual (please complete part 2A) YES / NO

A partnership (please complete part 2B) YES / NO

A business (please complete part 2C) YES / NO

A society (please complete part 2C) YES / NO

Other Organisation (please complete part 2C) Please state

2A – INDIVIDUAL APPLICANT

Mr/Mrs/Miss/Ms/other Surname:

First Name(s)

Full Home Address:


Email Address:

Date of Birth:

Place of Birth:

Will the applicant manage the premises on a day to day basis? YES / NO

2B –- PARTNERSHIP Please enter details of all partners

1st Partner


First Name(s):

Full Home Address:


Email Address:

Date of Birth: Place of Birth:


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2nd Partner


First Name(s)

Full Home Address:


Email Address:



PLEASE CONTINUE ON A SEPARATE SHEET IF NECESSARY

2C – BUSINESS / SOCIETY /OTHER

Full name of the organisation:

Company registration number:

Registered Office address:

Telephone Number:

Email address:

Name of Secretary


Full Home Address:

Telephone Number:


Email address:

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1st Director


First Name(s):

Full Home Address:




2nd Director


First Name(s)

Full Home Address:




3rd Director


First Name(s)

Full Home Address:





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SECTION 3A – SPECIAL TREATMENTS TO BE OFFERED Put a cross in the box against all treatments you will provide

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BATH/VAPOUR Category 3 MASSAGE & FACIALS Category 33 FLOTATION TANK 3 HOLISTIC MASSAGE3 HYDROTHERAPY 3 MANUAL LYMTHATIC DRAINAGE3 SAUNA 3 POLARITY THERAPY3 SPA 3 REFLEXOLOGY3 STEAM ROOM/BATH 3 REIKI (if with massage)3 HALOTHERAPY/SPELIOTHERAPY 3 SHIATSU3 OXYGEN BAR 3 SPORTS MASSAGE3 SPRAY TANNING 3 STONE THERAPY3 OTHER give details 3 SWEDISHCOSMETIC PIERCING Category 4 3 THERMO AURICULAR THERAPY4 EAR PIERCING

(Lobe only)(Hopi Ear Candles) *(i.e. with a facial)

4 NOSE PIERCING (Nostril only) 3 THAI MASSAGEELECTRIC TREATMENTS Category 2 3 TRICHOLOGY (if with massage)2 FARADISM (i.e. Slendertone, Transion) 3 TUI-NA2 GALVANISM (i.e. Endermologie) 3 OTHER give details2 MICRO CURRENT THERAPY ONLY REQUIRED IF NOT STATE REGISTERED2 MICRO-DERMABRASION (NOT LASER) CHIROPODY2 NON-SURGICAL FACELIFTS CHIROPRACTIC2 RADIO FREQUENCY OSTEOPATHY2 SCENAR THERAPY PHYSIOTHERAPY2 THERMA VEIN SKIN PIERCING TREATMENTS

ACUPUNCTURE Category 22 ULTRA SONICELECTROLYSIS Category 2 2 ACUPUNCTURE2 ELCTROLYSIS 2 DRY NEEDLING2 ADVANCED ELECTROLYSIS 2 KOREAN HAND THERAPY

(moles warts skin tags red vein removal) 2 MOXIBUSTIONLIGHT TREATMENTS Category 3 BODY PIERCING Category 23 COLOUR THERAPY 2 BODY3 INFRA RED 2 FACIAL3 LUMI LIFT/LUMI FACIAL 2 GENITAL3 ULTRA VIOLET TANNING (SUNBED) 2 BEADINGMANICURE Category 3 2 MICRO-DERMAL ANCHOR3 MANICURE TATTOOING Category 23 NAIL EXTENSIONS 2 MICRO-BLADING3 PEDICURE 2 MICRO-PIGMENTATIONMASSAGE & FACIALS Category 3 (Semi-Permanent Make-up)3 ACCUPRESSURE (NOT SEATED) 2 TATTOOING3 ACUPRESSURE (SEATED) 2 TATTOO REMOVAL (Non-Laser)3 AROMATHERAPY 2 TEMPTOOING3 AYURVEDIC MEDICINE LASER TREATMENTS Category 13 BODY MASSAGE 1 LASERS/INTENSE PULSED LIGHT3 BOWEN TECHNIQUE 1 LIPOLASER3 CHAMPISSAGE (Indian Head Massage) 1 MICRO-DERMABRASION (LASER)3 FACIAL WITH MASSAGE 1 TATTOO REMOVAL (LASER)3 FOOT MASSAGE OTHER TREATMENTS give details3 GYRATORY MASSAGE – G5

Section 3B – PRACTITIONERS TO BE LICENSED TO PROVIDE TREATMENTS

A Details of Person Giving Treatment form must be completed for each practitioner intending to provide special treatments. Copies of Qualification(s)/photo ID/photograph must accompany this application.

Please list all proposed practitioners below together with the licensable treatments they intend to provide.

Name of Person carrying out the Special Treatments

Date of Birth Special Treatments

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Name of Person carrying out theSpecial Treatments

Date of Birth Special Treatments


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SECTION 4 – OTHER INFORMATION

4A – Managing the Premises

If not the applicant, provide details of the person who will manage the premises on a day to day basis.

Full Name:

Full Home Address:

Contact Telephone number:


4B – Licensing History

a) Has any person associated with this application ever been refused the grant, renewal, transfer or variation of a Special Treatment Licence? YES / NO

If yes, please provide full details

b) Has any person associated with this application previously been issued with a Special Treatment Licence by this or any other licensing authority. YES / NO

If yes, please provide full details


4C – Convictions

A Declaration of Convictions form must be completed for all persons or bodies whose names are given on this Application for a New Special Treatment Licence form.

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SECTION 5 – CHECKLIST

Please confirm that the following steps have been taken

Have you completed the application form in full? YES / NO

Have you paid the relevant fee? YES / NO

Have you completed a form for all Special Treatments to be licensed? YES / NO

Have you completed a Practitioner form for all those intending to carry out special treatments? YES / NO

Have you provided a copy of qualifications / training for each practitioner? YES / NO

Have you supplied 1 passport photograph and photo ID for each practitioner? YES / NO

Have you provided a Declaration of Convictions form for each person named in the application? YES / NO

Have you supplied photo ID and proof of address for persons named in the application? YES / NO

Have you included a plan of the premises? YES / NO

Have you exhibited the public notice at the premises? YES / NO

Have you supplied a current treatment list and price list? YES / NO

Have you provided a copy of third party insurance certificate? YES / NO

Have you supplied a current electrical inspection certificate/report? YES / NO(Condition/Periodic Inspection Report for Fixed Installations)

Have you provided a PAT Test Certificate for portable appliances at the premises? YES / NO

Have you provided a current gas safety certificate for gas appliances? YES / NO

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SECTION 6 – DECLARATION

Declaration and Signing Please read the Declarations carefully before signing

I/We understand that in accordance with Section 7(1) of the London Local Authorities Act 1991 copies of this form will be forwarded by the Council to other relevant statutory authorities on my/our behalf and that I/We give my/our consent for the details given on this form to be divulged to the police and fire authority.

I/We undertake to supply such plans and documents that the Council may require in connection with this application.

I/We hereby declare that the details contained in this application form and any attached documentation are correct to the best of my/our knowledge and belief.

Signing Where the application is made on behalf of an organisation, a director or secretary should sign. In case of a partnership, each partner should sign. If signing on behalf of an applicant, please state in what capacity you are acting.

Capacity:

Signature: Date:

Print Name:

Capacity:

Signature: Date:

Print Name:

Capacity:

Signature: Date:

Print Name:

Capacity:

Signature: Date:

Print Name:

Capacity:

Signature: Date:

Print Name:


SECTION 7 – THE FEE

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Paying the Fee

Please write the amount of the fee you are paying.

The licence fee can be found on our current fees list available from our website at https://www.lbbd.gov.uk/business/licenses-and-permits/special-treatment-licences/overview/

Credit/debit card payments can be made online at https://www.lbbd.gov.uk/online/pay-it/online-payments/ Please enter the online payment receipt number below.

PLEASE NOTE WE DO NOT ACCEPT PAYMENT BY CHEQUE OR POSTAL ORDER

Amount Paid £

Online Payment Receipt No:

Date of Payment:

The licence fee is non-refundable. In the event that you decide to withdraw your application the licence fee will be retained to cover administration costs.

Please submit completed forms by posting

Licensing TeamLondon Borough of Barking and DagenhamPondfield House, 100 Wantz Road, Dagenham RM10 8PP

Email: [email protected]

OFFICIAL USE ONLY Reference:

Date received

Fee paid

Online receipt no.

Officer

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DATA PROTECTION STATEMENT

This statement advises the applicant / person completing this form that it may be necessary to share the information contained in this form to other statutory consultees at the permission of the Council.

The information provided on this form may also be used for the prevention and detection of fraud. Certain information may also be passed to the UK Border Agency or HMRC if we are required to do so.

GUIDANCE NOTESPlease read these notes carefully before completing your application form.

GeneralThe application should be made by the occupier of the premises.

Section 1 – The PremisesPlease provide full details of the premises intended to be used to provide the special treatments.Where asked for ‘the parts of the premises to be licensed’ please indicate which floors of the property and which rooms the treatments will be provided from.

Section 2 – The ApplicantThis section on the form requests full details of the applicant. Alternative sections are provided for individual applicants, partnerships, companies, societies and other organisations. Please complete the relevant section.

Section 3 – Treatments to be offered / Practitioners providing treatmentsIn this section you are asked to indicate treatments to be offered and all proposed practitioners.Please specify each individual treatment. Do not include generic terms such as ‘beauty therapy’. See A – Z Treatments List.

Please list all practitioners intending to provide licensable treatments at the premises. Please note that a copy of the practitioner’s original relevant qualification must be provided. One passport sized photograph and photo ID must also be provided for us to process the application. Additional forms are requested.

Section 4 – Other InformationAsks further questions about the business operation.Additional forms are requested.

Section 5 – ChecklistThis is provided to help you ensure that you are properly submitting a completed application. Failure to provide all the requested information is likely to delay the processing of your application.

Section 6 – DeclarationThe application must be signed by the applicant or authorised representative. In the case of an application made on behalf of a partnership or company, the application must be signed by the company secretary or an authorised representative.

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HOW TO APPLY FOR A SPECIAL TREATMENT LICENCE

Who needs to apply for a special treatment licence in Barking & Dagenham?If you own or manage premises in the Borough which offer any of the following treatments:

Massage, manicure, pedicure, nail extensions, facials, acupuncture, tattooing, body piercing, cosmetic piercing, chiropody, light, electric or other special treatment of a like kind such as sun beds, vapour, sauna, or other baths, then, unless you can claim one of the exemptions below, will need to apply for a licence.

When is a licence not required?There are a number of exemptions from the need to be licensed.

No gain or reward – all treatments are done free of any sort of charge or donation

No premises used – mobile service from a vehicle or in clients’ own homes

For treatments done by or under the supervision of medical practitioners, dentists, and professions supplementary to medicine in a hospital or nursing home

For treatments done by or under the supervision of a person who is a member supplementary to medicine in a hospital or nursing home

For treatments done by or under the supervision of a person who is a member of a body of health practitioners approved for exemption by this Council. Further details available.

Where a practitioner is exempt under the Act, then current details of their membership of the relevant body shall be kept at the premises.

A copy of the membership details should be submitted to the council at the time of application and a letter of registration will be issued to the applicant. There is a separate application form for exemptions.

Health and Safety at WorkEven if a licence is not needed, all businesses must still comply with the Health and Safety at Work etc. Act 1974 and associated regulations. See Health and Safety Made Simple pages at www.hse.gov.uk/simple-health-safety/index.htm

Do I need planning permission before applying for a licence?You will need to check with the Council’s Planners to confirm whether any planning consent or permission is required.

When domestic premises are to be licensed, you will need a letter from them to confirm that planning permission is not required.

Premises must have appropriate planning consent. For beauty salons and similar premises, the ‘Class Use’ required is ‘Sui Generis’.

It is the applicant’s responsibility to ensure that the premises have the correct planning consent.

The granting of a special treatment licence does not indicate that appropriate planning consent has or will be granted by the Council.

Do I need to tell my landlord?If you are a tenant, you may need to tell your landlord before you practice treatments in domestic premises. If you are a Council tenant, you will need a letter from Housing Services agreeing to this use of the premises.

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http://www.hse.gov.uk/simple-health-safety/index.htm

http://www.hse.gov.uk/simple-health-safety/index.htm

What conditions will be attached to the licence?The Council has standard conditions which are applied to every licence granted. Details of the conditions, which will apply to the licence, are available from Regulatory Services.

How do I apply for a special treatment licence?It is important that the steps listed below are followed. Where the procedure is not fully completed the processing of the application may be delayed and the Council might even have to ask you to apply again.

The completed application form, drawing of the premises, practitioner qualifications form, original copies of practitioner qualifications, photo ID of practitioner, photos of practitioners/ applicant/manager, current treatment list and price list, COSHH risk assessment, electrical inspection certificate (Periodic Inspection Report for Fixed Installations and Portable Appliance Test Certificate for portable appliances at the premises), current gas safety certificate for gas appliances and copy of third party insurance certificate, if applicable.

A photocopy of the application form and the drawings of the premises will be sent, by the Council, to:Fire Safety Regulation North East Area 2, London Fire Brigade, 169 Union Street, London SE1 0LL

A photocopy of the application form will be sent, by the Council, to:Metropolitan Police Licensing, Romford Police Station, 19 Main Road, Romford RM1 3BJ

Where a premise has not been licensed for special treatments, then a poster must be displayed on the premises for 28 days. The 28 days starts with the date of the full application being received or the date first displayed, whichever is the latest.

The poster is to be supplied by the Council and must be fully completed by the applicant. The poster is to be placed in a position where it can easily be seen and read by the public outside the premises. In case of roller shutter(s), a poster must also be displayed on the roller shutter in its closed position.

Standard of the PremisesThe premises must meet certain standards. Officers of the Council, Fire Brigade and possibly the Police may need to visit and check that standards are being met.

Regulatory Services will visit to check that the premises meet standards in relation to hygiene, infection control, health and safety etc. If you are in any doubt what standards may be required, then please ask for guidance at an early stage. If the premises do not meet the requirements, you may have to be put matters right before a licence can be granted.

Fire Authority. Any recommendations made by the Fire Authority will be sent to Regulatory Services. Notification will be given to the applicant of any items requiring attention before the licence can be granted.

Police. Checks on the applicant and staff will be made to ensure no previous convictions etc. give cause for concern.

TrainingChecks will be made to ensure that the practitioners at the premises are qualified for the treatments they are offering.

Practitioners who do not hold accredited qualifications or obtained abroad will need either to undertake a suitable course or apply for UK comparison through an organisation such as UK NARIC. www.naric.org.uk

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http://www.naric.org.uk/

In addition, we may require any product or equipment specific training by the manufacturers or producers, if applicable.

Photo IdentificationPlease note that photo identification of all practitioners working and their names to be included on the Special Treatment Licence will be required. The accepted forms of photo identification are:

o Photocopy of a valid passport

o Photocopy of a valid driving licence with photo

Right of persons to object to an application for a licenceThe Police, Fire Authority and members of the public have the right to raise objections to an application for a licence. The Council must consider any objections made within the period allowed for the receipt of objections.

Where an objection is received, it does not automatically mean that the licence will be refused. If an objection is received you will be notified of the objection, the reason for the objection and asked for your comments. Where possible, all attempts will be made to resolve any objections by a form of conciliation.

If this is not possible then in most cases the application will be determined by a meeting of the Council Licensing Sub Committee, followed by an oral hearing in public. No licence will be refused without the applicant having an opportunity to present a case before the Board. Should the application reach this stage, full details and explanations of all procedures will be provided.

Successful application for a licence.When an application has been made and the premises are satisfactory, then provided any objections have been resolved, the licence will be issued. The licence will be granted subject to the Council’s Standard Conditions.

Under certain circumstances it may be necessary to impose additional specific conditions to the licence if, for instance, problems have been noted. Should any such conditions be necessary, they would be fully explained to you at the time.

It is important that any person granted a licence operates within the conditions imposed on the licence.

It is an offence to provide special treatments at premises under any other circumstances.

Refusal of an application.An application may be refused on the grounds listed in Section 8 of the London Local Authorities Act 1991.Please see below.

Appeals against the refusal of, or the conditions imposed on a licence.A right of appeal to refuse an application may be taken to a meeting of the Licensing Sub Committee. At the meeting the applicant is given the opportunity to state why the licence should be granted. Any person who is aggrieved that either an application for a licence has been refused or feels that the conditions attached to the licence are unreasonable may further appeal to the Magistrates’ Court within 21 days of the decision being notified to them by the Council. Full details regarding appeal procedures will be supplied to any person whose application for a licence has been refused.

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Section 8 of the London Local Authorities Act 1991

Provides the Council with the power to refuse to grant, renew or transfer on any of the following grounds:

(a) the premises are not structurally suitable for the purpose;(b) there is a likelihood of nuisance being caused by reason of the conduct, management or situation of

the premises or the character of the relevant locality or the use to which a premise in the vicinity is put;

(c) the persons concerned or intended to be concerned in the conduct or management of the premises used for special treatment could be reasonably regarded as not being fit and proper persons to hold such a licence;

(d) the persons giving the special treatment are not suitably qualified;(e) the premises have been or are being improperly conducted;(f) the premises are not provided with satisfactory means of lighting, sanitation and ventilation;(g) the means of heating the premises are not safe;(h) proper precautions against fire on the premises are not being taken;(i) they are not satisfied as to the safety of equipment used in the special treatment or as to the

manner in which the treatment is to be given;(j) they are not satisfied as to the safety of the special treatment to be given;(k) satisfactory means of escape in case of fire and suitable means of fighting fire are not provided on

the premises;(l) the applicant has, within the period of five years immediately preceding the application to the

Borough Council, been convicted of an offence under this Part of the Act; or

the applicant has failed to comply with the requirement of Sub Section 4 or (6) of Section 7 (Applications under Part II) of this Act.

Further Information

Should you require any further information, please do not hesitate to contact the Licensing Team.

BY EMAIL [email protected]

For enquiries about planning consent, change of use or change to the outside appearance


For enquiries about building control, in case of structural alterations to the premises


For enquiries about fire precautions contact the Fire Brigade

WEBSITE https://www.gov.uk/workplace-fire-safety-your-responsibilities/


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mailto:[email protected]

https://www.gov.uk/workplace-fire-safety-your-responsibilities/




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