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Biological Safety Permit Renewal Application

  1. Biological Safety Permit Renewal Application

    Fee: $750.00

    You can pay this fee on our website through "Online Payments" or by check made out to "Town of Burlington" and mailed to: Burlington Board of Health 61 Center Street Burlington, MA 01803

  2. This Application is for (check all that apply)*
  3. This Application is for biosafety containment level (check all that apply)*
  4. On-Site Emergency Facility Contact Information

  5. Contact Information for Facility Officer in charge of Bisoafety (if different from above)

  6. Corporate Officer Authorized to Sign Application

  7. Check boxes below to confirm the following permit application requirements have been met/attached. Refer to the Burlington Board of Health Biological Safety Regulations for specific requirements.

  8. Renewal Applicant Required Checklist
  9. ***(Renewals) If changes were made to the prior year's submittal, check applicable boxes and provide only detailed changes from the prior year's submittal
  10. Please upload any additional attachments to include with application.

  11. FOR LABORATORIES USING BSL-3 CONTAINMENT OR RISK GROUP 3 AGENTS, SEE ADDITIONAL PERMIT APPLICATION REQUIREMENTS IN THE BOARD OF HEALTH BIOLOGICAL SAFETY REGULATIONS

  12. This is an electronic signature to submit your application, there is no need to print or download this form for a physical signature.

  13. Leave This Blank:

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