Loading...
HomeMy WebLinkAbout0070 MAIN STREET (HYANNIS) UNIT BLDG C UNIT 12 - Health 70 Main Street Hyannis :, A=_342 -023 - OOL m I I 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.) 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, 1st'Fl., 367 Main'St., Hyannis, MA 02601 (Town Hall) and get the Business Certificate that is. regUired by law. DATE: �'� Fill in please: APPLICANT'S YOUR NAME/S: ShzuoA ; BUSINESS YOUR HOME ADD SS: i r� (— R S M TELEPHONE # Home Telephone Number NAME OF CORPORATION: tom" NAME NEW BU INESS a TYPE OF BUSINESS "� IS THIS. HOME OCCUPATION YES NO ADDRESS OF BUSINESS ' 0 6 l ( �I j MAP/PARCEL NUMBER Z ',® ��� (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. 1.. �B.UILDING COMMISSIONER'S OFFICE This individual has been informed of any.permit requirements'that pertain to this type of business. Authorized Signature** COMMENTS: 2. BOARD OF HEALTH This individual . s be rammed of per rements that pertain to this type of business. MUST COMPLY WITH ALL Authorized Signature** HAZARDOUS MATERIALS REGULATIONIS COMMENTS: 3. CONSUMERAFFAIRS (LICENSING AUTHORITY) This individual has been informed of the licensing requirements that pertain to this type of business. Authorized Signature** COMMENTS: cy ,I'Raz rdous Materials Inventory Sheet Checklist 7/ Date V Physical Street Address-Check database to ensure it exists ✓/ Working Phone Number Actual Amounts -( ie. gas being used to fuel machines, thinner to clean brushes all count as hazardous materials-no blanks) Storage Information location of storage, how long is storage for? If none, note that. Disposal Information :where and.who? If none, note that. Applicant Signature - understand what is listed and noted Staff.Initial -any questions, know who to ask Vehicle Washing/Rinsing? -give a vehicle washing policy and ' explain it __TAttach the Business Certificate with your sign off and comments "The inventory form should explain what the business consists of and the procedures they are doing. Notes need to be left to explain what you.discussed with them. :Y LN-t"ri 60 GI���1�� lA-E�ria IS Date: TOWN OF BARNSTABLE TOXIC AND HAZARDOUS MATERIALS ON-SITE INVENTORY NAME OF BUSINESS: ( -Aj&pllk� BUSINESS LOCATION: S INVENTORY MAILING ADDRESS: 3 a-� T-l'-AI`i1 0- V-­&4V TOTAL AMOUNT: TELEPHONE NUMBER: CONTACT PERSON. AAV k` r6y\`- � �r EMERGENCY CONTACTTE EPHONE NUMBER: 7LLY— 7 I 1 MSDS ON SITE? TYPE OF BUSINESS: a-r�` -Pv-A 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 materials 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) _ Misc. 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 Misc. 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 Misc. 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 (inc. carbon tetrachloride) NEW USED Any other products with "poison" labels Paint &varnish removers, deglossers (including chloroform, formaldehyde,, Misc. Flammables hydrochloric acid, other acids) Floor &furniture strippers Other products not listed which you feel Metal polishes may be toxic or hazardous (please list): Laundry soil & stain removers VQ,+ Il vlj ouL 2 c-Aea -,\G 1 a,)Ian (including bleach) Spot removers &cleaning fluids (dry cleaners) Other cleaning solvents Bug and tar removers Windshield wash WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS ��• -.. _ ... ti..h.y , .�..a r.:,s>, r✓+i'fa:..r xY.�,,. +'. J.,,-'a5++ 'r :.#+...,.�"5;.. ,•?`r..T..• ,ti •'w1`S#w _ w r ' yk"!' tr� �,y �'4.• +��. f Date: F.. .� TOWN OF ,BARNSTABLE f TONIC AND HAZARDOUS MATERIALS. ON-SITE INVENTORY NAME OF BUSINESS: BUSINESS LOCATION: z n .S INVENTORY MAILING ADDRESS: Q' . I4- 1�ai 7D. A1`'S Mom- Q''L,� TOTAL AMOUNT: TELEPHONE NUMBER:' CQNTACT PERSON: 5ka EMERGENCYCONTACTT EPHONE NUMBER: ' _3 MSDS ON SITE? TYPE OF BUSINESS: INFORMATION/RECOMMENDATIONS: Fire District: Waste Transportation: Last.shiprnent 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 materials use, '. storage and disposal of 111 gallons or more.a month requires a license from the Public Health Division. , f , 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) Misc. Corrosive NEW USED 4 Cesspool cleaners ti 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) "fi, Gasoline, Jet fuel, Aviation gas Photochemicals (Fixers) } Diesel Fuel, kerosene, #2 heating oil NEW USED Misc. petroleum products: grease, Photochemicals (Developer) %lubricants, gear oil NEW USED Degreasers for engines and metal Printing ink Degreasers for driveways & garages Wood preservatives (creosote) it F Caulk/Grout Swimming pool chlorine t Battery acid (electfolyte)/Batteries Lye or caustic soda Rustproofers Misc. 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 (inc. carbon tetrachloride) NEW USED Any other products wlth_'poison" labels„ Paint &varnish removers, deglossers (including chloroform, formaldehyde, Misc. Flammables hydrochloric acid, other acids) Floor&furniture strippers Other products not listed which you feel Metal polishes may be toxic or hazardous (please list): Laundry soil & stain removers (including bleach) 1i�," 1'; M:''(4s�,�-F.n ► -- �?'ri'vl�� Spot removers &cleaning fluids li (dry cleaners) Other cleaning solvents ' n Bug and tar removers ~ ' Windshield wash WHITE COPY-HEALTH DEPARTMENT i CANARY COPY-BUSINESS 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.) Business Certificates are available at the Town Clerk's Office, 1 FL., 367 Main Street, Hyannis, MA 02601 (Town Hall) DATE: I I - 1 Ye I Fill in please: APPLICANT'S YOUR NAMES: -i �. V A ' aRy'€u '!iS>M''iw7h� Q 1�" !`�,' BUSINESS YOUR HOME ADDRESS'' �o ,inn �"(_ Af -1 �1��+ixy%i� N A c� 2Crn 1 �eri ��,.... ifz,I.F t ,e•w.6�{r(�i�''.'t���1!`JII�'fP4 �}1!��ie J7 /� �". G _ T tELEPHONE # Home Telephone Number Ili 2o�. 15 o NAME OF CORPORATION: NAME OF NEW BUSINESS v A Gt'V TYPE OF BUSINESS t,©t� r IS THIS A HOME OCCUPATION? YES _(NO L��ZJ 15� 2_ �O� ADDRESS OF BUSINESS O IM -f ��" 02 MAP/PARCEL NUMBER V J [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. 1. BUILDING GO ISSI ER'S OF CE This individ I e n in e a per it requir ment that pertain to this type of business.MUST COMPLY WITH HOME OCCUPATION RULES AND REGULATIONS. FAILURE TO A hori Si n ** "'OMPL.Y MAY RESULT IN FINES. MMENT Ion — �- 2. BOARD O HEA H This individual has been informed of h Par it re it ent that pertain to this type of business. MUST COMPLY WITH ALL HAZARDOUS MATERIALS REGULATIONS Authorized Signatu 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: Date: b 1 I o TOWN OF BARNSTABLE TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM NAME OF BUSINESS: , it lU BUSINESS LOCATION: INVENTORY MAILING ADDRESS: 6�I/�� L� _ ��� I ��y ti�N,�' 0:G60i TOTAL AMOUNT- TELEPHONE NUMBER: so V CONTACT PERSON: EMERGENCY CONTACT TELEPHONE NUMBER: MSDS ON SITE? TYPE OF BUSINESS: CMM 1-6jVj k-n 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) i 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 K7-�J 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 Signature Staff's Initials 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 first obtain the necessary signatures on this form at-MO 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. ° 4l4fi�� lh' Ft ;: DATE: )/ Fill in please: APPLICANT'S YOUR NAME/S: r-ew' /2r5 C,c; c>e,e e- BUSINESS YOUR HOME ADDRESS: 70 MC�.iti Sih-ter. ¢ c •,•L �- � TELEPHONE # HomeTelep hone Number JoR 771 06 e9d' � J NAME pF CORPOFATION C+";e:i' •.. / r' NAME OF NEW BUSINESS TY IS-TH15 A HOME OCCURAXI N? t�IES NO P E OF BUSINE5S I�' S MAP%PARCEL NUMBER AbPRESS 0E BUSI.IVESS ,f- '. .. - ssessing) `, 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 CO ISSIO RCS OF MUST COMPLY WITH HOME OCCUPATION This individ al h e infor edUo an er it a uire ants that pertain to this type of business. RULES AND REGULATIONS. FAILURE TO I Aut driz Si natur * C OMPL.Y MAY RESULT IN FINES. MM NT xUr 6n — 2. BOARD OF HEALTH This individual has beev,fVo�red of the permit requirements that perta in to this type of business. MUST XMPLY WITH ALL Authorized Signature** COMMENTS: HAZARDGLIS MATERIALS REGLILATInNS 3. CONSUMER AFFAIRS [LICENSING AUTHORITY] This individual has been informed of the licensing requirements that pertain to this type of business. Authorized Signature* COMMENTS: 's TOWN OF BARNSTABLE Date: e/ I q TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM NAME OF BUSINESS: O M M e r G a ��� �✓� BUSINESS LOCATION: O A " fi t' 4Pt i�;_ INVENTORY MAILING ADDRESS: 9Q M A 1 N 5 j r Pf f A P TOTAL AMOUNT- TELEPHONE NUMBER: CONTACT PERSON: EMERGENCY CONTACT TELEPHONE NUMBER- .SC��' 77/ a60d' MSDS ON SITE? TYPE OF BUSINESS: 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 f 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, g 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 iz 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 Applican s Signature Staff's Initials Date: TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM NAMEOFBUSINESS: SOCIM 340rz,-- BUSINESS LOCATION: -70_ md;iv %r /tPT � 03 - AXAA-i ; - AO MAILINGADDRESS: P 0• I_C0X_y IT Z -11y,4y��f- lk4A; Mail To: TELEPHONE NUMBER: C100 -1 -t 1 0 3. O y Board of Health CONTACTPERSON: j026"C ©liv-CMA Town of Barnstable P.O. Box 534 EMERGENCY CONTACT TELEPHONE NUMBER: (IfQ)-7 10 -6 S Hyannis, MA 02601 TYPEOFBUSINESS: Ski' ' j"^ ^ �C�d�^-►A'G 'Does your firm store any of the toxic or hazardous materials listed below, either for sale or for you own use? 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: mA;ry rr - HN/4&/V:f_ A/+ 0?,6o) TELEPHONE: (104) ­71 l 070y 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 NO Antifreeze(for gasoline or coolant systems) /6 o z Drain cleaners NEW USED Cesspool cleaners Automatic transmission fluid 16 Disinfectants Engine and radiator flushes Road Salt (Halite) Hydraulic fluid (including brake fluid) Refrigerants /V 0 Motor oils Pesticides NEW USED (insecticides, herbicides, rodenticides) Gasoline, Jet Fuel Photochemicals (Fixers) Diesel fuel, kerosene, #2 heating oil NEW USED IV° 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) /vo Battery acid (electrolyte) Swimming pool chlorine /-o Rustproofers Lye or caustic soda "'"' Car wash detergents Jewelry cleaners N-g Car waxes and polishes Leather dyes Asphalt & roofing tar Fertilizers Paints, varnishes, stains, dyes PCB's Lacquer thinners Other chlorinated hydrocarbons, NEW USED (inc. carbon tetrachloride) Paint & varnish removers, deglossers Any other products with "poison" labels o Paint brush cleaners (including chloroform, formaldehyde, ! 12 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) 3 G i�S Other cleaning solvents an Bug and tar removers WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS