HomeMy WebLinkAbout0020 BEARSE ROAD - Health 20 Bearse Road' s rSewer Ac& # 2639.
- - _ - Hyannis
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YOU WISH TO OPEN A BUSINESS?
For Your Information: Business Certificates cost $40.00 for 4 years. A Business Certificate ONLY REGISTERS YOUR NAME in the .
Town (WHICH YOU MUST DO according to M.G.L. - it does not give you permission to operate). You must first obtain the
necessary signatures on this form at 200 Main St., Hyannis. Take the completed form to the Town Clerk's Office, Vt FI., 367 Main
St., Hyannis, MA 02601(Town Hall) and get the Business Certificate that is required by law.
DATE �—
Fill in please:
APPLICANT'S YOUR NAME/CORPORATE NAME _j, 1 BUSINESS TYPE: (/Val T),
BUSINESS YOUR HOME ADDRESS: 7,-LU d loci 6v- ItIA 0'L66 7
S"U 7—3 b;X O S 7 3
TELEPHONE Home Telephone Number 7 6R- ®.37 mail Address e +- a ej le arnc))! .
NAME OF NEW BUSINESS EIN:
Have you been given approval fro the buildi g divi ion? YES NO
ADDRESS OF BUSINESS a i J =MAP/PARCEL NUMBER // 37
When starting a new business there are several things you must do in order to be in compliance with the rules and regulations of the Town of
Barnstable. This form is intended to assist you in obtaining the information you may need. You MUST GO TO 200 Main St. — (corner of
Yarmouth Rd. & Main Street) to make sure you have the appropriate permits and licenses required to legally operate your business
in this town.
1. BUILDING COM SION 'S OFFICE
This individu I ha b nfraFr d f er 't require ents t at pertain to this type of business. �
Autho i ed Signatu ** I , /I ,,''
COMMENTQ — S �Gl
2. BOARD OF HEALTH
This individual has be nformed o e perm equirements that pertain to this type of business. GOMp�Y jjUkFl A�
o.e—f�� HA;zARD:-OU-4—AATERIAL•S,R
Aut orized Signature
* EGUATtQIS.
COMMENTS:
3. CONSUMER AFFAIRS (LICENSING AUTHORITY)
This individual has been informed of the licensing requirements that pertain to this type of business.
Authorized Signature**
COMMENTS:
TOWN OF BARNSTABLE Date:/Z/
x
i
TOXIC AND HAZ RDOUS MATERIALS REGISTRATION FORM -F
NAME OF BUSINESS: 0 S69L C
BUSINESS LOCATION: 20 T-;e-, Q.9 56-
0A 01 INVENTORY
MAILING ADDRESS: TOTAL AMOUNT:
TELEPHONE NUMBER:
CONTACT PERSON: I <c
EMERGENCY CONTACT TELEPHONE�UMBER: MSDS ON SITE?
TYPE OF BUSINESS: AW-0
INFORMATION / RECOMMENDATIONS: Fire District:`
Waste Transportation: Last shipment of hazardous waste:
Name of Hauler: Destination:
Waste Product: Licensed? Yes No
NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws of MA, hazardous material use,
storage and disposal of 111 gallons or more a month requires a license from the Public Health Division.
LIST OF TOXIC AND HAZARDOUS MATERIALS
The Board of Health and the Public Health Division have determined that the following products exhibit toxic or
hazardous characteristics and must be registered regardless of volume.
Observed / Maximum - Observed / Maximum
Antifreeze (for gasoline or coolant systems) Miscellaneous Corrosive
❑ NEW ❑ USED Cesspool cleaners
Automatic transmission fluid Disinfectants
Engine and radiator flushes Road salts (Halite)
Hydraulic fluid (including brake fluid) Refrigerants
Motor Oils Pesticides
❑ NEW ❑ USED (insecticides herbicides, rodenticides)
Gasoline, Jet fuel,Aviation gas Photochemicals (Fixers)
Diesel Fuel, kerosene, #2 heating oil ❑ NEW ❑ USED
Miscellaneous petroleum products: grease,
Photochemicals (Developer)
lubricants, gear oil ❑ NEW ❑ USED
Degreasers for engines and metal Printing ink
Degreasers for driveways &garages Wood preservatives (creosote)
Caulk/Grout Swimming pool chlorine
Battery acid (electrolyte)/Batteries Lye or caustic soda
Rustproofers Miscellaneous Combustible .
Car wash detergents Leather dyes
Car waxes and polishes Fertilizers
Asphalt& roofing tar PCB's
Paints,varnishes, stains, dyes Other chlorinated hydrocarbons,
Lacquer thinners (including carbon tetrachloride)
�_ Any_other products with "poison'labels_
0-N EW-----�O-US E D-= ---- - _ : ._ -
(including chloroform, formaldehyde,
Paint&varnish removers, deglossers hydrochloric acid, other acids)
Miscellaneous. Flammables Other products not listed which you feel
Floor&furniture strippers may be toxic or hazardous (please list):
Metal polishes
4
Laundry soil &stain removers
(including bleach)
Spot removers &cleaning fluids
(dry cleaners)
Other cleaning solvents
Bug and tar removers
Windshield wash
WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS Applicant's Signat a Staff's Initials
F`
YOU WISH TO OPEN A BUSINESS?
For Your Information: Business Certificates cost $30.00 for 4 years. A Business Certificate ONLY REGISTERS YOUR NAME in
town (which you must do by M.G.L. - it does not give you permission to operate.) Business Certificates are available at the Town
Clerk's Office, 1st FL., 367 Main Street, Hyannis, MA 02601 (Town Hall and 200 Main Street Offices at the Licensing counter.
DATE: �E C>
7i L
Fill in please:
ZZ: , lr APPLICANT'S YOUR NAME: A C-" `T% L Lr U ,--y T64&iMr LLC cn,21 a",°��v�\�S
'.•' - "' �t. �x•_ BUSINESS YOUR HOME ADDRESS: t S A co2ev 0 a—
r t 05TER
r = .. , ,�:r�t` �''` �i "�f� '�9�$08► VILt. F M4 07g .5'5-
TELEPHONE # Home Telephone Number: So 9 4lg \C>2 -2-
NAME OF NEW BUSINESS ►LL D S C 4 f7-5 AiVD 'VhV C,45 TYPE OF BUP INESS a55
IS THIS A HOME OCCUPATION? YES NO L
Have you been given approval from the building division? YES NO
ADDRESS OF BUSINESS 2 D G EA 9.51: (L Q. }-VY ANN►- MAP/PARCEL NUMBER 3 1 103 9-
When starting a new business there are several things you must do in order to be in compliance with the rules and regulations of the Town of
Barnstable. This form is intended to assist you in obtaining the information you may need. You MUST GO TO 200 Main St. — (corner of
Yarmouth Rd. & Main Street) to make sure you have the appropriate permits and licenses required to legally operate your business
in this town.
1. BUILDING COMMISSIONER'S OFFICE
This individual has been informed of any permit requirements that pertain to this type of business.
Authorized Signature**
COMMENTS: -a
2. BOARD OF HEALTH
T112U[ GH Pl�'UP �1/L-7�LS
This individuals een i form d the peit r uirements that pertain to this type of business. .4 sAcu °y�� �No
ly 4,01 wr, n+e7cc 6 Nv
orized **Si nature r-ore a� v �E-�✓�ce._••�'�� may'���`�
9 �,- irAa.a-rzduus ��: r <fi? s usr
COMMENTS: 5VU�e 70 Z4 «"oNS/7 .:eAt
3. CONSUMER AFFAIRS (LICEN ING AUTHORITY)
This individual has en i ftzoft he licensing requirements that pertain to this type of business.
e
dA, =
na
COMMENTS: -1 CL�-� Z (�(�� •�J (�/
/
TOWN OF BARNSTABLE Date:�j/� y�
TOXIC AND HAZARDOUS MATERIALS ON-SITE INVENTORY
NAME OF BUSINESSIACI-F 0-1-o Enrrk9(LI5CS 44-e- J b., CA-25 ( 'f2v&y_5
BUSINESS LOCATION: 20 6 EA9SE (LD . 14YAW(Vt S INVENTORY
MAILINGADDRESS: _65- ACoa_N 02. MA 02bS1S TOTAL AMOUNT:
TELEPHONE NUMBER: 710 SD 9\
CONTACT PERSON: ZPrcq -�111_LO
EMERGENCY CONTACT TELEPHONE NUMBER: YOE 4-\ q 1022 MSDS ON SITE?
TYPE OF BUSINESS: C L/ASS ::LT= A v To OEALr� 2
INFORMATION/RECOMMENDATIONS: Fire District:
RDOUS MATERIALS REGULATtGtiI�
Waste Transportation: Last shipment of hazardous waste:
Name of Hauler: Destination: ~�
Waste Product: Licensed? Yes No
NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws of MA, hazardous material use,
storage and disposal of 111 gallons or more a month requires a license from the Public Health Division.
�. LIST OF TOXIC AND HAZARDOUS MATERIALS
The board of health and the Public Health Division have determined that the following products exhibit toxic or
hazardous characteristics and must be registered regardless of volume.
Observed / Maximum Observed / Maximum
Antifreeze (for gasoline or coolant systems) Miscellaneous Corrosive
❑ NEW ❑ USED Cesspool cleaners
Automatic transmission fluid Disinfectants
Engine and radiator flushes Road salts (Halite)
Hydraulic fluid (including brake fluid) Refrigerants
Motor Oils Pesticides
❑ NEW ❑ USED (insecticides, herbicides, rodenticides)
Gasoline, Jet fuel,Aviation gas Photochemicals (Fixers)
Diesel Fuel, kerosene, #2 heating oil ❑ NEW ❑ USED
Miscellaneous petroleum products: grease, Photochemicals (Developer)
lubricants, gear oil ❑ NEW ❑ USED
Degreasers for engines and metal Printing ink
Degreasers for driveways &garages Wood preservatives (creosote)
i
Caulk/Grout Swimming pool chlorine
Battery acid (electrolyte)/Batteries Lye or caustic soda
Rustproofers Miscellaneous Combustible
Car wash detergents Leather dyes
Car waxes and polishes Fertilizers
Asphalt& roofing tar PCB's
Paints, varnishes, stains, dyes Other chlorinated hydrocarbons,
Lacquer thinners
(including carbon tetrachloride)
❑ NEW ❑ USED Any other products with "poison" labels
_ _ -(including chloroform formaldehyde;
Paint&varnish removers, deglossers hydrochloric acid, other acids)
Miscellaneous. Flammables Other products not listed which you feel
Floor&furniture strippers may be toxic or hazardous (please list):
Metal polishes
Laundry soil &stain removers
(including bleach)
Spot removers&cleaning fluids
(dry cleaners)
Other cleaning solvents
Bug and tar removers
Windshield wash
WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS Ap cant's Signature Staff's Initial
Date:
TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM
NAMEOFBUSINESS: LG
BUSINESS LOCATION: P
MAILINGADDRESS: 2 60e /Z (r Mail To:
Board of Health
TELEPHONE NUMBER: S —
Town of Barnstable
CONTACT PERSON: P.O. Box 534
EMERGENCY CONTACT TELEPHONE NUMBER: ��l b/era_rl Hyannis, MA 02601
TYPEOFBUSINESS: 46z,�_O_ Sip s
Does your firm store any of the toxic or hazardous materials listed below, either for sale or for you own
use? YES NO ---X—
This form must be returned to the Board of Health regardless of a yes or no answer. Use the enclosed
envelope for your convenience.
If you answered YES above, please indicate if the materials are stored at a site other than your mailing
address:
ADDRESS:
TELEPHONE:
LIST OF TOXIC AND HAZARDOUS MATERIALS
The Board of Health has determined that the following products exhibit toxic or hazardous character-
istics and must be registered regardless of volume. Please estimate the quantity beside the product that
you store. NOTE: LIST IN TOTAL LIQUID VOLUME OR POUNDS.
Quantity Quantity
Antifreeze(for gasoline or coolant systems) Drain cleaners
NEW USED Cesspool cleaners
Automatic transmission fluid Disinfectants
Engine and radiator flushes Road Salt (Halite)
Hydraulic fluid (including brake fluid) Refrigerants
Motor oils Pesticides
NEW USED (insecticides, herbicides, rodenticides)
Gasoline, Jet Fuel Photochemicals (Fixers)
Diesel fuel, kerosene, #2 heating oil NEW USED
Other petroleum products: grease, Photochemicals (Developer)
lubricants, gear oil - NEW USED
Degreasers for engines and metal Printing ink
Degreasers for driveways & garages Wood preservatives (creosote)
Battery acid (electrolyte) Swimming pool chlorine
Rustproofers Lye or caustic soda
Car wash detergents Jewelry cleaners
Car waxes and polishes Leather dyes
Asphalt & roofing tar Fertilizers
Paints, varnishes, stains, dyes PCB's
Lacquer thinners
q Other chlorinated hydrocarbons,
NEW USED (inc. carbon tetrachloride)
Paint & varnish removers, deglossers Any other products with "poison" labels
Paint brush cleaners (including chloroform, formaldehyde,
Floor & furniture strippers
hydrochloric acid, other acids)
Metal polishes
Laundry soil & stain removers Other products not listed which you feel
(including bleach) may be toxic or hazardous (please list):
Spot removers & cleaning fluids &. ��
(dry cleaners) /P a, �G)r /Br�nle
Other cleaning solvents `10
Bug and tar removers
WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS
TOWN OF BARNSTABLE COMPLIANCE: CLASS: 1. Marine,Gas Stations,Repair
BOARD OF HEALTH O satisfactory 3. Printers to Body Shops
O unsatisfactory- 4.Manufacturers
COMPANY v- �-S (see"Orders") 5. Retail Stores
6.Fuel Suppliers
ADDRESS &WSES Q• Class: 7. Miscellaneous
QUANTITIES AND STORAGE (IN= indoors; OUT=outdoors)
MAJOR MATERIALS Case lots Drums Above Tanks Underground Tanks i
IN OUT IN OUT IN OUT #&gallons Age Test
Fuels:
Gasoline Jet Fuel (A)
Diesel, Kerosene, #2 (B)
Heavy Oils:
waste motor oil (C)
new motor oil(C)
f
transmission/hydraulic K0
Synthetic Organics:
degreasers
Miscellaneous:
DISPOSAL/RECLAMATION REMARKS:
1. Sanitary Sewage 2.Water Supply k,0A ME- �s C
O Town Sewer OPublic T
O On-site OPrivate
3. Indoor Floor Drains YES NO
O Holding tank:MDC
O Catch basin/Dry well
O On-site system
4. Outdoor Surface drains:YES NO ORDERS:
O Holding tank:MDC
O Catch basin/Dry well
O On-site system
5.Waste Transporter
Name of Hauler Destination Waste Product •d
YES NO
1.
2.
erson(s) I rviewed Inspector Date
U,000/
TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM
NAME OF BUSINESS: 4y37�' Mail To:
BUSINESS LOCATION: 2a D Board of Health
s.9'�� Town of Barnstable
MAILING ADDRESS:
P.O. Box 534
TELEPHONE NUMBER: NO .ZYVo Hyannis, MA 02601
CONTACT PERSON: Da/
EMERGENCY CONTACT TELEPHONE NUMBER:
Does your firm store any of the toxic or hazardous materials listed below, either for sale or for
your own use, in quantities totalling,at any time, more than 50 gallons liquid volume or 25 pounds dry
weight? YES NO
This form must be returned to the Board of Health regardless of a yes or no answer. Use the
enclosed envelope for your convenience.
If you answered YES above, please indicate if the materials are stored at a site other than your
mailing address:
ADDRESS: i
TELEPHONE:
LIST OF TOXIC AND HAZARDOUS MATERIALS
The Board of Health has determined that the following products exhibit toxic or hazardous character-
istics and must be registered regardless of volume. Please estimate the quantity beside the product that
you store:
Quantity/Case Quantity/Case
l64/ Antifreeze (for gasoline or coolant systems) Drain cleaners
Automatic transmission fluid Toilet cleaners
Engine and radiator flushes Cesspool cleaners
Hydraulic fluid (including brake fluid) Disinfectants
1645f Motor oils/waste oils ,O,#G Road Salt (Halite)
Gasoline, Jet fuel Refrigerants
Diesel fuel, kerosene, #2 heating oil Pesticides (insecticides, herbicides,
Other petroleum products: grease, lubricants rodenticides)
Degreasers for engines and metal Photochemicals (fixers and developers)
Degreasers for driveways & garages Printing ink
Battery acid (electrolyte) Wood preservatives (creosote)
C��✓ Rustproofers Swimming pool chlorine
Car wash detergents Lye or caustic soda
Z c47115 Car waxes and polishes Jewelry cleaners
Asphalt & roofing tar Leather dyes
Paints, varnishes, stains, dyes Fertilizers (if stored outdoors)
Paint & lacquer thinners PCB's
Paint & varnish removers, deglossers Other chlorinated hydrocarbons,
Paint brush cleaners (inc. carbon tetrachloride)
Floor & furniture strippers Any other products with "Poison" labels
Metal polishes (including chloroform, formaldehyde,
Laundry soil & stain removers hydrochloric acid, other acids)
(including bleach) Other products not listed which you feel may
Spot removers & cleaning fluids be toxic or hazardous (please list): t
(dry cleaners)
Other cleaning solvents
Bug and tar removers
Household cleansers, oven cleaners
White Copy- Health Department/ Canary Copy-Business
TOWN OF BARNSTABLE PI,�ANCE: CLASS: 1.Marine,Gas Stations,Repair
satisfactory 2.Printers
BOARD OF HEALTH 3.Auto Body Shops
unsatisfactory- 4.Manufa'cturers
` ► COMP O (see"Orders") 5.Retail Stores
G.Fuel Suppliers
ADDRESS ., �Q /1��� , Class: 7.Miscellaneous
� �ITIES AND STORAGE (IN=indoors;OUT=outdoors)
MAJOR MAT�IALS _
IN OUT IN OUT . IN OUT IA&gallons Age ITest
Fuels:
Gasoline,Jet Fuel (A) s
Diesel, Kerosene, #2 (B)
Heavy Oils:
waste motor oil (C)
new motor oil(C)
transmission/hydraulic .
Synthetic Organics:
degreasers
i
Miscellaneous:
r
I
DISPOSAL/RECLAMATION REMARKS:
1. Sanitary Sewage 2. Water Supply
(Mown Sewer `Public =-�
O On-site OPrivate
3. Indoor Floor Drains YES NO '
O Holding tank:MDC _
O Catch.basin/Dry well
O On=site system
4. Outdoor Surface drains:YES NO ORDERS:
O Holding tank:MDC
O Catch basin/Dry well
O On-site system
5.Waste Transporter :a
Name of Hauler Destination Waste Product
YES NO
f
2.
Slaifs �p E
Person(s) Interviewed Inspector Date
,C7e7pl,9
�� Q .