HomeMy WebLinkAbout0021 QUAKER ROAD - Health (2) [b QUAKER ROAD
Hyannis
- - - -------- - A = 310 - 304
YOU WISH TO PEN A BUSINESS? .
For,Your Information: Business certificates (cost$.4.Q 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 compleled 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 la w.
DATE: C 1 Fill in please:
APPLICANT'S YOUR NAME/S: nip,�j��`7-c 3,ltil �,
7 x BUS1NESS � YOUR HOME ADDRESS: U.4 � (� W y,41LIA1'(C
73
TELEPHONE # Home Telephone Number
NAME OF CORPORATION: rA o aA cS S ;
NAME OF NEW BUSINESS TYPE OF BUSINESS L A e,-/cel S C!u,�IQ�_
IS THIS A HOME OCCUPATION? YES NO
ADDRESS OF BUSINESS ` MAP/PARCEL NUMBER C)���` I (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 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 MUST"OMpLlf ihllTN ALL
This individual has be n infr�,e�I f the permit requirements that pertain to this type of business. „ pT,nN,q
I�GIY 1Pl�I RAZARDOUS M:ATFRIALS Rt_C(_ ..
Authorized Signature*
COMMENTS: SEPT �(, �Z F3/Z- d/5 A �D�t-S S - it/0 eA/E ' OA E. A19 L'Y166 J6E yF /�A AIA S�Rq GC ia�
9c6-0 >46 4YL k.5 4eSeb TD t
3. CONSUMER AFFAIRS(LICENSING AUTHORITY)
This individual has been informed of the licensing requirements that pertain to this type of business.
Authorized Signature**
COMMENTS:
d
7 TOWN OF BARNSTABLE �
LOCATI a SEWAGE# a 0 D -q lj
VILLAGE �h in ASSESSOR'S MAP&PARCEL .,3 l l) - 5
INSTALLER'S NAME&PHONE NO. �,
SEPTIC TANK CAPACITY CO) ( 00o .ate l ad o
LEACHING FACILITY:(type) J►j l &,3(0� �2 (size) 3 X Y0
NO.OF BEDROOMS q
OWNER C �q c.l&A;LZ .!Life
PERMIT DATE: COMPLIANCE DATE: 12 - y/0
Separation Distance Between the:
Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility o to Feet
Private Water Supply Well and Leaching Facility(If.;ahy wells exist on
site or within 200 feet of leachingfacility) k'"" Feet
tY) �:��='�'
Edge of Wetland and Leaching Facility(If any wetlands exist within
300 feet of leaching facility) Feet
FURNISHED BY
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and wDVII
Sheet Checklist
MRIM�ateenals 1nvento ry
� 1 Physical Street Address-Check database to ensure it exists k
V/ Working Phone Number
Actual Amounts x-( 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? i
If none, note that.
Disposal Information -where and who? If none, note that.
V 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 .
Attach.the Business Certificate with your.sign off and comments
**Th 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.
.r
TOWN OF BARNSTASLE Date: r�12q
(3 On
P
TOXIC AND HAZARDOUS MATERIALS ON-SITE
NAME OF BUSINESS: M AG- . A L\/cls c�n,
BUSINESS LOCATION: � ,� , ��� INVENTORY
MAILING ADDRESS: «v 1r g_�3DA/lga (.,Lr, 1 TOTAL AMOUNT:
TELEPHONE NUMBER: 09 -7U369
CONTACT PERSON:
EMERGENCY CONTACT TELEPHONE NUMBER: ';OR 36, a MSDS ON SITE?
TYPE OF BUSINESS: 1, ,Q4161 S_,c I)Qp-_
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 _0_USED_ _ (�nclud(including products with
formaldehyde,
labels
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 r�/ry NP `�'� P,� ��
(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 Initial