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Home My WebLink AboutTiago TrajanoTHE COMMONWEALTH OF MASSACHUSETTS TOWN OF YARMOUTH BOARD OF HEALTH PERMIT NUMBER: i 24-010 FEE: $55.00/ Technician This is to Certifu that Tiaso Traiano at SniIt Milk HAS BEEN GRANTED A LICENSE TO ENGAGE IN THE PRACTICE OF BODY ART (TATTOOING) This License is issued in conformity with the authority granted to lhe Board of Health, bv Chapter I40, Sections 51. ofthe General Laws, and amendments therdtoland is subject to the provisions ofihe t-aws ofthe Commonwealth ofMassachusetts relating thereto, and upon such terms and conditions, and to the rules and regulations in regard to the carrying on ofthe occupation so licensed as adopted by the Board of Health, and expires December 31.2024 unless sooner revoked. January I ,2024, BOARD OF HEALTH:Hillnrd Bosl,cy, M.D., Clnirman Maru Crnis, ViceChairman Charles Hold,nv, Clirk E"ic Weston Laurance Venezia, DVM (date) 4*-\a."A-t-7 1.-.'q-)d.-' Direcrorbfllealth TOWN OT YARMOUTH 1146 ROUTE 28, SOUTH YARMOUTH, MASSACHUSETTS 02664.2445I Telephone (50E) 39&2231, ext. l24l Fax (508) 760-3472 Board of Heahh Health Division Tlne of Aoolication D New fl Renewal ApplicationFee(s): $160 i Facility RECEIVED FEB O 1 ZO24 HEALTH DEPT $55 /Apprtnticc Type(s)ofBodyAru DTaBooFacility I Piercing FacilitY ESTABLISHMENT INFTORMATION f Tattoo Technician D APPrcntice tr Piercing Technician 0uft{8s B Name & (, ity State lp Ilpc of owuenhip: tr Sole Proprietor tr Corporation tr Parhership 11 establishment is orrned by a corporation, pafinenhip, or other combination of individuals, please attach the name, title, tax ID#, and home address of all owners. Ertablirhment Owner's / Techniclsnr Neme: First Last Middle Initial Z Bo Tax enly) +<z State p Emai I Phone 2 5a y't/foo , ct M lD4n023 PRIOR LICENSURE Has the owner or opemtor ofthe proposed establishment ever held a body art !q$lg!4 license or permit? If yes, please list the information below. Auach additional pages if necessary. E Yes trNo State/Municipality Lic./Cert./Reg. #Status (Active/Expired/Suspended) State/1r{unicipality Lic./Cert./Reg. #Status (Active/Expired/Suspended) ! Yes !No Has the owner or operator ofthe proposed establishment ever held a body art establishment license or permit? Ifyes, please list the information below. Attach additional pages ifnecessary. State/Municipality Lic./Cert./Reg. #Status (Active/Expire&Suspended) State/Municipality Lic./Cert./Reg. # Status (Active/Expired/Suspended) Town of Yarmouth taxes and liens must be paid prior to renewal or issurnce of your permits. Please check appropriately if paid: Yes_No EMPLOY EE INFORMAl'lOn- Please list and all Bo Art Technicians attoo,rcrct ntice Type of Body Art Performed cteated I D412023 Employee Name 2 Requirementr for Body Art Establlshment Pemit Submit thc following to complete your application: tr A copy of owner's valid identificatio-n car,{ with. pictue (stas;issued license, passporq or military-issued Io) tr Detailed floor and operation plans ofproposed body art establishment (new epplic.antr only) n A copy ofBlood Exposure Control Plan tr Proof of liability insurance / Worhan's Comp' hsurance E Client application and conseot forms D First Aid and CPR certifications tr Mgdi""l Waste Removal Contrsct tr Bloodbome Pathogen Training E Aftercare information and instuctions Applicrnt Strtement sf Conscnt I understrnd thet thir pcrmit lr v{td only in the Town of Yamouth and erpirce rt the end of the calendar yeer in wiich it wrs isrued. I also underctrrd that rny nodce to be mrilcd to me by the Town of iarmouth Board of Heslth will be melled to the eddresc indicrtcd on thi! applicotion. I have receivcd a copy of tte Yermoutt Boerd of Hcalth Body Art Regurrtiorr. I heve rced rnd understand the oilgrtionr rnd rcqulrtmentr imposed upon a licenccd Body lgt Ecbbtishment Ortrer/Operrtor by those rtgulationr. I elro agrce to comply with all of the rcgulrtion requirementcipecified in the Yamouth Borrd of Health Body Art Reguletionr while practicing in the Town of Yarmouth. I firrlter underctand thet it is my responsibitlty to ensulc ttat indMdual Body Art Technicirns worHng in thir cctrbtrlhmcnt hive r current vatiil Yrnnoutt Boerd of lledtt Dody Art Techhlan Liccnre end comply with all appliceble herhh, safety, sanltetion, rterilization, and woik pncticcc rcgUlrtiong ei ipecl6ed in the Yarmouth Board of Ilcelth Body Art Regulationr. I hereby certif, under pcnaltieo end pdne of periurT, that to the bect of my knowledge the informition p*riO"a on tnir applicetion ir compicte end accurete end in no wey mirr.gprerented' a ilv a^.10 A q 2 Date It lr your responsibility to rtncw your permit rt the end of each calendar yean & 3 Full Nam crcrfsa lD1n023 FEE: $55.00/ Technician This is to Certif,that Tiaso Traiano at SDilr Milk HAS BEEN GRANTED A L1CENSE TO ENGAGE IN THE PRACTICE OF BODY ART (TATTOOING) This License is issued in conformity with the authority granted to the Board of Health, by Chapter 140, Sections 51, ofthe General Laws, and amendments thereq and is subject to the provisions ofthe Laws ofthe Commonwealth ofMassachusetts relating thereto, and upon such terms and conditions, and to the rules and regulations in regard to the carrying on ofthe occupation so licensed as adopted by the Board ofHealth, and expires December 3 l, 2023 unless sooner revoked. laruarv 25.2023 BOARD OF HEALTH:Hillard. Boskeu, M.D., Chairman WfV CrnlS, Vice Cfuinnnn Chark s H.Ollpnu, LlerK DebraBruinoose Enc Weston ' (date) B D G.Murphy, Health PH, R .,q irector of THE COMMOITWEALTH OF MASSACHUSETTS TOWNOTYARMOUTH BOARD OF HEALTH PERMITNUMBER: # 23-0l l