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Home My WebLink About0050 PINE GROVE AVENUE - Health x � 50;LPine Grove Avenue 3) EWFRT A='296�' 07&";001' a i ._s..:.;;•�.._..e.._.:.,:..::_;a.r:v..u.U:.:::.z:.,��m,m.�r:.;ee�reaa�,:n..�:a,d,ucawvv,:...._._s•,.,.w::.:m.:..,..�.;�:aave�..ns:n.a:n,¢.s.uru_vrx•.+sar....uu•:,z..ro-+•s,..er<,.�:.,.•r�-ux.:,rs.nree.e,wa„o..=....+..e..w.,.a>F.v..;..m,.wn�....,�.,w.n�.,.au>•.vsnr..,...e v.rnw�n:,,.s...,m....nl...ad...,v.<,.zv»..�u.....i....�u..,.•,,....-._._. YOU WIS14 TO OPEN A BUSINESS? For Your Information: Business certificates(cost40.00 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 FI., 367 Main St., Hyannis, MA 026.01 Clown Hall) and get the Business Certificate that is required by law. DATE: - - Fill in please: APPLICANT'S YOUR NAME/5: V' a DDRESS ` VI � V vL6U ] BUSINESS YOUR HOME A _ NAME OF CORPORATION: NAME OF NEW BUSINESS i? S - v z I 1 Y\ 1 TYPE OF BUSINE5SI h. IS THIS A HOME OCCUPAT N? YES No .(� (Assessing] ADDRESS OF BUSINESS_ t0 I ve_. v a Vl 1 MAP/PARCEL NUMBER , When starting a naw business there are several thln.gs you must do in order to be In compliance with the rules and regulations of the Town of Barnstable. This form is•intend•od 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 COMMIS510NE S E MUST COMPLY WITH 1-IOME OCCUPATION This individual has b e I any pe �iremeritsat pertain to this type of business. RULES AND REGULATIONS. FAILURE TO COW[Y MAY RFSULT�IN FINES_ uthor d i na re** OMMENT , - _ ) - �-f-� 2. BOARD OF ALTH MU COMPLY•WITH ALL This individual has been informed oft p equirements that pertain to this.type of business. HAZARDOUS MATERIALS REGULATIONS Authorized Signature** 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:-/ 9 / TOWN OF BARNSTABLE TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM NAME OF BUSINESS: i P:1 BUSINESS LOCATION: SO ► r-e Co,rov9 n V 2 tLjah\n I S INVENTORY MAILING ADDRESS: S Dm2_ TOTAL AMOUNT: TELEPHONE NUMBER: (,.:;c)gS 36 CONTACT PERSON. EMERGENCY CONTACT TELEPHONE NUMBER: (5C91 aXo- 3/6 I MSDS ON SITE? TYPE OF BUSINESS: INFORMATION / RECOMMENDAT NS: 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) 41 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 /\y 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 kplicant's nature Staff's Initials YOU WISH TO OPEN A BUSINESS? s. a 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 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. EL: DATE: �n ��4 p Fill in please: ,. APPLICANT'S YOUR NAME/S: NOIdI e T # : U I ESS YOUR HOME ADDRESS: P. TELEPHONE # Home Tel phone Number S0 _Yn3 NAME OF CORPORATION: NAME OF NEW BUSINESS 2I i 1' 4 1 rC, TYPE OF BUSINESS vi t*r� IS THIS A HOME OCCUPATION?„ t/ YES NO 1 ADDRESS OF BUSINESS 50 )OCCUPATION?,, rO v2 Ave MAP/PARCEL NUMBER OO [Assessing) _ QlWhen starting a new business there are several things you must do in order to be in compliance with the rules and regulK-2-q ns 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 COMMrai4t �A ER'S OFFICE This individualinform d of er it requirements that pertain to this type of busineM.UST COMPLY WITH HOME OCCUPATION RULES AND REGULATIONS. FAILURE TO Autlibrize t r -� COMPLY MAY F l~SULT IN FINES. OMMENTS: 2. BOARD OF HE LTH1ilUCO PL WITH ALL This individual has been informed of th, uireme that pertain to this type of business. HAZARDOUS MATERIALS REGULATIONS Authorized Signature** 11 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:03/D TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM NAME OF-BUSINESS: BUSINESS LOCATION: 1 \./e INVENTORY MAILING ADDRESS: SCR- TOTAL AMOUNT: TELEPHONE NUMBER: SO S) U -3ro CONTACT PERSON: Ad i le5 f eA/u l to EMERGENCY CONTACT TELEPHONE NUMBER: MSDS N SITE? TYPE OF BUSINESS: 1 INFORMATION / RECOMMENDATIO S: 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 n \� Laundry soil &stain removers (including bleach) Spot removers &cleaning fluids (dry cleaners) Other cleaning solvents Bug and tar removers a Windshield wash 4 WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS 9plicant's Signature Staff's Initials f Town of Barnstable Health Inspector o�VE r Regulatory Services Office Hours g yery 8:30-9:30 o� Thomas F.Geiler,Director 3:30-4:30 aszAs . * Public Health Division MASS. v 039. s�0� Thomas McKean,Director �AtED MA'S 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 AMNESTY PROGRAM APPLICANT — SEPTIC QUESTIONNAIRE Date:July 21,2010 1. General Information: Size of Property: 0.31 acre Address: 50 PINE GROVE AVE HYANNIS MA 02601 Map 290 Parcel 078-001 Name: Adiles Demello Phone#: 508-360-7253 3 1-DQ YY1 S 2a. How many bedrooms exist at your property now? i mc'k n YZU�-ls� 2b. Are you planning to add any bedrooms? Q-A 0 If yes,how many? 0 ` he� Y-z)(-)1'Yl 2c. How many bedrooms total are proposed at this property(including the amnesty unit)? 2d.Please include a copy of the floor plans for the entire property. Neatly use a straight-edge. Show all existing rooms in the home and the proposed amnesty apartment. Provide width measurements of any open doorways. Please label each room clearly. 3. Is the dwelling connected to public sewer? NO If the liyellkZ is connected to public sewer,skip questions#4 through#9below. co 4. Locati@d of filling is INSIDE or OUTSIDE a Saltwater Estuary Protection Zone? Cn E 5. Locatii of welling is INSIDE or OUTSIDE a Zone of Contribution to public supply wells? 6. Is the dQ11ingppnnected to PUBLIC WATER?YES U- o 7. Is a disptgal was construction permit on file? YES or NO $ o 8. If yes,hop-maedrooms were approved according to this permit? Bedrooms. 9. Were any building permits,obtained for construction of additional bedrooms? YES or NO 10. Is there an engineered septic system plan on file at the Health Division? YES or NO 11. Has the septic system been inspected by a DEP certified inspector within the last two years? YES or NO ------------------------------------------------------------------------------------------------------------------- FOR OFFICE USE ONLY The Public Health Division has no objection to bedrooms at this property. Special Conditions: Signed: Date: /st— Q:\GMD-Housmg\Accessory Affordable Apartment Program\ADMIN\FORMS&LETTERS\Blank Forms amnestyapp I.DOC L SioP l � r _ o � I I 'O _ SSA`( � W��o� � III .' poc k aoo r a •�,�„� Pie 1��'�` � � ,, t a C� �k x Lai 40 L� 0 "YOU WISH TO OPEN A BUSINESS? For Your Information: Business certificates (cost$ [ �s;. A business certificate ONLY REGISTERS YOUR NAME in town [which you must do by M.G.L.-it does not give.you'permissibi to operate.),`,Business'Certificates are available at the Town Clerk's Office, 1"FL., 367 Main Street, Hyannis, MA..02601 (Town Hall). :G ;nwn ' DATE: Fill in please: I APPLICANT'S YOUR NAME 1 1F'S M e I/ BUSINESS YOUR HOME ADDRESS: �® i V)P Gv-o ve A ve . Y � TELEPHONE # Home Telephone Number (SOS 1 36 p i- 3 a,Is NAME OF NEW BUSINESS a. e I TYPE OF BUSINESS ° e i Yl IS THIS A HOME'OCCUPATION'?. YES NO ou bee v ."� :.NO �,�... ADDRESS OF BUSINESS_ 50 f i Yre G Pp ve i A y r? • MAP/PARCEL NUMBER 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 Yar ouch Rd. & Main Street).to make sure you have the appropriate,permits and licenses required to legally operate your business in thisy town. 1. BUILDING CON SI ER'S OFFI E This individ al h s en-inf e f any permit requTements that pertain to this type of busin"ess' Authorize nature** 3'1^C./1 e .2. BOARD OF HEALT f+. t;I' ..4 i r This individual ha n infor pe t rrsq '' nts that pertain to this type of business ;} .. „c! F` I Au horized ature* COMMENTS: G + u( i 3. CONSUMER AFFAIRS (LICENSING AUTHORITY) This individual has been informed of the licensing requirements,that pertain,to this type of;business. ' �P Authorized Signature.* Y M COMMENTS: c , I i° "