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Home My WebLink AboutFrank ArmstrongTIIE COMMONWEALTH OF MASSACHUSETTS TOWN OF YARMOUTH BOARD OF HEALTH PERMITNUMBER:#24-0'12 FEE: $55.00/rechnician This is to Certifo that Frank Armstrong at Spilt 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 the Board of Health, by Chapter 140, Sections 51, ofthe General Laws, and amendments thereto, and is subject to the provisions ofthe Laws ofthe Commonwealth of Massachusetts relating thereto, and upon such terms and conditions, and to the rules and regulations in regard to the carrying on of the occupation so licensed as adopted bythe Board of Health, and expires December 3l , 2024 unless sooner revoked. Januarv 1,2024. BOARD OF HEALTH: (date) Hillard Boskty, M.D., Chairman Mnru Crais, Vice Chairmnn Amrks Holi,nu, 1erk Eic Weston Laurance Venezia, DVM J"..---Qa^l-..-7 ;; G=Xd"*./ Direc'lSEbtfrealth TOWN OF YARMOUTH Boartl of H€ahh I 146 ROUTE 28, SOUTH YARMOUTH, MASSACHUSETTS 02ffi24451 Telephone (50t) 398-2231, ex| 1241 Fax (508) 760-3472 H€d0t Division Tvoe of Aoolicetion ENew flRenewal ApplicationFee(s):$160i Fecility $S5/Technicirn $55/Apprentice Type(s) of Body ArI n Tattoo Facility / fattoo fecmician tr Appre,ntice tr Piercing Facility tr Piercing Teclmician ESTABLISHMENT INTOR,MATION s OUl< ,28 B Name & (? Statr rp Ilpc of ownenhip: tr Sole Proprietor tr Corporation ! Pabcrship If establishment is owned by a corporatio4 partnership, or other combination of individuals, please attach the name, title, tax ID#, and home address of all owners. Ertabfrhmcnt Owner'e / Technlclau N.Ee : ( First Last Middle Initial o tlt blr,g M Datdof Bhtli l4 7 ylwn ,<t^.t /)a Lld Gner @oE) tesalMEmEEF T T bnuiinu Cnu/l LU LlL t0lev-/ \\\ & State zip 6$ Y-tt'vn\ttrunq ta*tros can EffiIImess 1 Phone Nririber CrceEd lD4lA PRIOR LICENSURE Has the owner or operator of the proposed establishment ever held a body art pes technician license or permit? , n No e list the info tion below nal si cessarv.s 0 S Lic./Cert./Reg. #Status (ActivEiExpired/Suspended) State/Municipality Lic./Cert./Reg. #Status (Active/Expired/Suspended) ! Yes trNo Has the owner or operator ofthe proposed establishment ever held a body art establishment license or permit? Ifyes, please list the information below. Attach addrtional pages ifnecessary. State,{\,funicipality Lic./Cert./Reg. #Status (Active/Expired/Suspended) State,Municipality Lic./Cert./Reg. # Status (ActivelExpired/Suspended) Town of Yarmouth taxes and liens must be paid prior to renewal or issuance of your permits. Please check appropriately ifpaid: Yes_No EMPLOYEE INFORMATION Please list and s ct all Art Technicians attoo,lerct nlice Type ofBody Art Performed Employee Name 2 created l/24,20 I I I I I tr n ! ! n ! l E Requirements for Body Art Establishment Permit Submit the following to complete your application: A copy ofowner's valid identification card with picture (state-issued license, passport, or military-issued to) Detailed lloor and operation plaas ofproposed body art establishment (new applicants only) A copy of Blood Exposure Contol Plan Proof of liability insurance / Workman's Comp. Insurance Client application and consent forms First Aid and CPR certifications Medical Waste Removal Contract Bloodbome Pathogen Training Aftercare information and instructions Applicant Statement of Consent I understand thrt this permit is valid only in the Town of Yarmouth and expires at the end of the calendar year iu which it wes issued. I also understand that any notice to be mailed to me by the Town of Yarmouth Board of Health will be mailed to the address indicated on this application. I have received a copy ofthe Yarmouth Board of Health Body Art Regulations. I have read and understand the obligations and requirements imposed upon a licensed Body Art Esteblishment Owner/Operator by those regulations. I also agree to comply with rll of the reguletion requirements specified in the Yarmouth Board bf Health Body Art Regulations while practicing in the Town of Ysrmouth. I further understand that it is my responsibility to ensure that individual Body Art Technicians working in this establishment have a current valid Yarmouth Board of Health Body Art Technician License and comply with all applicable health, safety, sanitation, sterilization, and work practices regulations as specified in the Yarmouth Board of Health Body Art Regulations. I hereby certif, under penalties and pains of perjury, that to the best of my knowledge the infotmetion provided on this application is complete and rccurate and in no way misrepresented. Full e of Applicant It is your responsibility to renew your permit at the end ofeach calendar year. 3 hon L Creded I /24D0 am THE COMMONWEALTH OF MASSACHUSETTS TOWN OF YARMOUTH BOARD OF HEALTH PERMITNUMBER:#24-073 FEE: $55.00/rechnician This is to Certifu that Nicholas Sanoca at I Mitk 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 the Board of Health, by Chapter 140, Sections 51, ofthe General Laws, and amendments thereto, 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 3l . 2024 unless sooner revoked. Hillard Boskpv, M.D., Chnirmon Marv Craip, Vice Chairnan Charles Hohi'av, C[erk Eric Weston Laurance Venezia, DVM lart.tarv 1,2024, BOARD OF HEALTH: (date) J-."..-va:--/ I^ r"c. GaNiner/ Directoii-fHealth