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Home My WebLink About0176 SUDBURY LANE - Health d76 Sudbury Lane a'/Parcel270-305 P o a 'q i a tl i YOU WISH TO OPEN A BUSINESS? For Your Information: Business certificates (cost$40.00 for 4 years). A business certificate ONLY REGISTERS YOUR NAME in town (which you must do by.M.G.L.-it does not give you permission to operate.) You m ir-_e"btain the necessary Signatures on this form at 200 Main St., Hyannis. Take the completed form to the Town Clerk's Office, 1st. FI., 367 Main St., Hyannis, MA 02601 (Town Hall) and get the Business Certificate that is required by law. DATE: V��J� �� Fill in please: =ix APPLICANT'S YOUR NAME/S: BUSINESS YOUR HOME ADDRESS: task TELEPHONE # Home Telephone Number z § r ate,,Fata is: R NAME OFCORPDRATION,' NAME OF NEW BUSINESS ;: Tlf E OF BUSINESS IS THIS A HOME OCCUPATIONS YES NO ADDRESS OF BUSINESS �1N MAP/PARCEL NUMBER (Assessing] When starting a new business there are several things you must do in order to be in compliance with the rules and regulations of the Town of Barnstable. This form is intended to assist you in obtaining the information you may need. You MUST GO TO 200 Main St. - (corner of Yarmouth Rd. & Main Street) to make sure you have the appropriate permits and licenses required to legally operate • ss in this town. MUST COMPLY WITH HOME OCCUPATION " 1. BUILDING COM ISSION R'S OF nd RULES AND REGULATIONS. FAILURE TO ' This individu I n info aay er r quirem nts that pertain to this type of busineseQMPLY MAY RESULT IN FINES. -A riz Si nature-" MME TS C) " / 2. BOARD OF HE LTH `G LP This individual ha$ been e permit requirements that i o Qf pertain to this type of business. MUST ,OMPLY WITH ALL Authorized Signature** ;�iti7Ar^,1✓UiJS MAT(=.F,p,t S Pr,^i,+! 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: v♦ I TOWN OF BARNSTABLE Date: 1 l,?0 TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM NAME OF BUSINESS: r � � BUSINESS LOCATION: 026-0 INVENTORY MAILING ADDRESS: TOTAL AMOUNT- TELEPHONE NUMBER: CONTACT PERSON: EMERGENCY CONTACT LEPHONE NUMBER: 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 0 Antifreeze (for gasoline or coolant systems) 0 Miscellaneous Corrosive ❑ NEW ❑ USED 112 Cesspool cleaners to Automatic transmission fluid O Disinfectants p Engine and radiator flushes 0 Road salts (Halite) p Hydraulic fluid (including brake fluid) 0 Refrigerants 0 Motor Oils Q Pesticides 0 ❑ NEW ❑ USED (insecticides, herbicides, rodenticides) 0 Gasoline, Jet fuel,Aviation gas 0 Photochemicals (Fixers) p Diesel Fuel, kerosene, #2 heating oil O ❑ NEW ❑ USED Miscellaneous petroleum products: grease, O Photochemicals(Developer) �p lubricants, gear oil o ❑ NEW ❑ USED Degreasers for engines and metal d Printing ink o Degreasers for driveways&garages <p Wood preservatives (creosote) O Caulk/Grout a Swimming pool chlorine 0 Battery acid (electrolyte)/Batteries Lye or caustic soda �D Rustproofers p Miscellaneous Combustible b Car wash detergents 0 Leather dyes 0 Car waxes and polishes O Fertilizers 0 Asphalt& roofing tar 0 PCB's 0 Paints, varnishes, stains, dyes Other chlorinated hydrocarbons, Lacquer thinners <D (including carbon tetrachloride) Any other products with "poison" labels �, ❑ NEW ❑ USED (including chloroform, formaldehyde, O Paint&varnish removers, deglossers O hydrochloric acid, other acids) o Miscellaneous. Flammables Other products not listed which you feel p Floor&furniture strippers may be toxic or hazardous (please list): Metal polishes Laundry soil &stain removers O (including bleach) Spot removers&cleaning fluids O (dry cleaners) 0 Other cleaning solvents 0 Bug and tar removers Windshield wash WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS Applicant's Signature Staff's Initials Hazardous Materials Inventory Sheet Checklist l�� I Date Physical Street Address-Check database to ensure it exists orking Phone Number ctual Amounts -( ie. gas being used to fuel machines, thinner to . lean brushes all count as hazardous materials) 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? -provide a vehicle washing policy and /_!__ explain it -note that it.was given VV Attach 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. YOU WISH TO OPEN A BUSINESS? For Your Information, Business certificates (cost$'.,. .DO 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 Yb 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:O6 a- �� ry�) Fill in please F APPLICANT'S YOUR NAME/S: BUSINESS YOUR HOM ADDRESS: - it r , -57�0� d'tF:� — { "3 260 TELEPHONE # Home Telephone Number S _ - �su� 0 .NAME OF CORPORATION: NAME OF NEW BUSINESS 1 ` TYPE OF BUSINESS � I -IS THIS A HOME OCCUPATION? YES NO MAP PARCEL NUMBER � �� S Assessiri I' ADDRESS OF BUSINESS ' ��' �A �C^ - / ( . 9) . 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 C MISSI NER'S O FIC . This indiv ual ' era-inf r of ny ermit requirements that pertain to this type of bu�flhlsT'COMPLY WITH HOME OCCUPATION RULES AND REGULATIONS. FAILURE TO A th ized Si re** COMPLY MAY RESULT IN FINES. MENT ` �rL2 ' 2: BOARD OF HEQ.TH This individual has been irtf(K me,d�f the permit requirements that pertain to this type of business. MUST COMPLY WITH ALL Authorized Signature** HAZARDOUS MATERIALS REGULATIONS 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: TOXIC AND HAZARDOUS MATERIALS ON-SITE INVENTORY NAME OF BUSINESS: - ' 6- BUSINESS LOCATION: W INVENTORY MAILING ADDRESS: TOTAL AMOUNT- TELEPHONE NUMBER: S - S S efL -�83 CONTACT PERSON: O-t� �jo EMERGENCY CONTACT TELEPHONE NUMBER: SC7� D� �025 3 MSDS ON SITE? TYPE OF BUSINESS: 4 i ° jTi lj(!,— 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 WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS Applicant's SignatL a Staff's Initials