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HomeMy WebLinkAbout0017 SCHOOL STREET - Health 17 School Street, Hy DR. PAUL NEAR t� M a h i 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 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: 3 l I F'I in please: e�atapo I APPLICANT'S YOUR NAME/S: ` �. BUSINESS YOUR HP.AE ADDRESS: f ��r TELEPHONE # Home Telephone Num er NAME OF CORPORATION: l NAME OF NEW BUSINESS TYPE OF BUSINESS IS THIS A HOME OCCUPATI N? YE I,, nn ADDRESS OF BUSINESS PA040/MAP/PARCEL NUMBER (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.&MainJCOMISSID sure you have the appropriate permits and licenses required to legally operate your business in this town. 1. BUILDIqR' FICThi of a per i re ire nt th t p rtai o this type of business. *COMMEN atu r Q ) - U C ( _ 2. BOARD OF HEALTH This individual has bee d rmit requirements that pertain to this type of business. Auth a Si at COMMENTS: 3. CONSUMER AFFAIRS(LICENSING AUTHORITY) This individual has been informed of the licensing requirements that pertain to this type of business. If Authorized Signature** COMMENTS: TOXIC AND �(ZARDOUS MATERIALS REGISTRATION FORM NAME OF BUSINESS: 'DR. PA.t91 B NEARY Mail To: 17 SCHOOL STREE BUSINESS LOCATION: Board of Health Town of Barnstable MAILING ADDRESS: ji >�11y MA 026+D1 P.O. Box 534 TELEPHONE NUMBER: Hyannis, MA 02601 CONTACT PERSON: 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: 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 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 Motor oils/waste oils 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) Rustproofers Swimming pool chlorine Car wash detergents Lye or caustic soda 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, f S Laundry soil & stain removers hydrochloric acid, other acids) 1 fAJ (including bleach) Other products not listed which you feel may Spot removers & cleaning fluids be toxic or hazardous (please list): (dry cleaners) Other cleaning solvents Bug and tar removers Household cleansers, oven cleaners White Copy- Health Department/ 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 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, 1st Fl., 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 BUSINESS YOUR OM VDDRESS- ' 1 C 4qlNO TEL PHONE # Home Telephone Vumber NAME OF NEW BUSINESS 60 EIN: Have you been given approval f om. e buildin divi ion? Y S NO ADDRESS OF BUSINESS 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 Yarmouth Rd. & Main Street) to make sure you have the appropriate permits and licenses required to legally operate your business in this town. n 1. BUILDING COM SSI4thed 'S O FICE Q(. � This individu I hainf a ny permit requirements that pertain to this type of business. GYM A' Sign re" COMMENTS. - ; - 2. BOARD OF HEALTH This individual has b en o med oft a perm't equire ent that pertain to this type of business. AAJ. t Au orized Signature"" COMMENTS:©n sw�, Sa�►e_ a.,c romo 1'9. �M� JAM Seeur r 3. CONSUMER AFFAIRS(LI ENSI &ATHORITY) This individual has n inf eicensing requirements that pertain to this type of business. °" 011 Authorized Signature" COMMENT; t C"I SolmeteX—Hg5 Amalgam Separator Installation and Manual with recycling Page 1 of 1 dD SoimeteX) , The Power ofAWledScience A Layne Christensen Company �une Hg5 Amalgam Separator Hg5 Amalgam Separator 0 Accommodates up to 10 operatories. 0 Dimensions 291/2"h x 10"w x 8"d. 13 1 1/2"inlet and outlet piping. B Femco couplers for easy install 17 Floor/wall mount brackets provided. Part Number and Description Support Data O Hg5-001 Hg5 Amalgam Separator ,6 Hg5®English Brochure 0 Hg5-002CR Hg5 Collection Container with Recycle Kit 0 Hg5@ Installation&Operation Manual Watch Video 10 Hg5@ Installation&Operation Manual(Canada) 10 Vacuum Line Cleaning Solution pH and Hg5@ Performance 0 Hg5 ISO 11143 B Recycle Procedural p2011 Layne Christensen Company.All rights nesewed. `®Pacebooki rn I � S�► ool http://solmetex-.com/dental/hg5/hg5.html , 7/25/20111