HomeMy WebLinkAbout0044 KELLEY ROAD - Health I k,]. ey Road -
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 town (which you
must do by M.G.L.-it does-not give you permission to operate.) You must•fi_rst obtain the necessary signatures on this form at 200 Main St., Hyannis.
Take the completed form to the Town Clerk's Office, 1 st FI., 367 Main St., Hyannis, MA 02601. (Town Hall) and get the Business Certificate that is
required by law. /
DATE: — •6 Fill in please:
APPLICANT'S YOUR NAME/S:
�;�L:° S N S YOUR HOME ADD ESS:
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kyplys- tier TELEPHONE # Home Tel hone umber
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�E;;;i :•r.::i ysr;Y SOC I AL SECURITY OR EIN #• — —Q E-MAIL
NAME OF CORPORATION:
NAME bF-NEW BUSINESS TYPE OF BUSINESS
IS THIS-A HOME OCCUPATION? . YES NO
ADDRESS OF BUSINESS. MAP/PARCEL NUMBER A� 05 (Assessing)
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.
MUST COMPLY.WITH HOME OCCUPATION
1. BUILDING COM 10 R'S OFFICE RULES AND REGULATIONS. FAILURE TO
This individual has n i fe e a y er t requirements hat pertain to this type of busiQOM! LY MAY RESULT IN FINES.
Auth zed Signatur
OMMENT
C 'LTH
2. BOARD OF
This individual has been info�lmed.�t5 tfi he permit requirements that pertain to this type of business.
Authorized Signature*
Mug.• OMPLYWI`FH ALL:
COMMENTS: °HAZARDOUS MATERIALS FtEGULlAT10NS
3. CONSUMER AFFAIRS (LICENSING AUTHORITY)
This individual has been informed of the licensing requirements that pertain to this type of business.
Authorized Signature**
COMMENTS:
Dater' /,�S/
TOWN OF BARNSTABLE
TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM
NAME OF BUSINESS: 99/l/ e
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BUSINESS LOCATION: , , } e U INVENTORY
MAILING ADDRESS: G l / D TOTAL AMOUNT:
TELEPHONE NUMBER: j
CONTACT PERSON: jai /
EMERGENCY CONTACT TELEPHON NUMB MSDS ON SITE?
TYPE OF BUSINESS: .5
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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)
❑ 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 Q �-
WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS Applicant's Signature �l Staff's Initials
LOC TION SEWAGE PERMIT NO.
Le ,POD
Vl ILAGE
INSTALLER'S NAME` i AODnDRESS
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R UILDER OR / /OWNER
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DATE PERMIT ISSUED
DAT E COMPLIANCE : ISSUED _
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