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TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION
Map Parcel t✓ Application# _" L
Health Division
Conservation Division Permit#
Tax Collector Date Issued (e) 0_1
Treasurer Application Fee
Planning Dept. Permit Fee
Date Definitive Plan Approved by Planning Board
Historic-OKH Preservation/Hyannis
�P-roject Street A_ddre_ss ' 4,z
<=yiilage� . V Gc T4
,Owner--=-0,A U 1j �J° /�rRG��A CAddres�4a 3 Ots hops
,,�,—Telephon—FW O" ✓ 40 5
,_._.Permit-Request--- aaA
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Square feet: 1 st floor:existing proposed 2nd floor:existing proposed Total new
Zoning District Flood Plain Groundwater Overlay
Project=Valuafion"���D Construction Type
Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation.
Dwelling Type: Single Family Two Family ❑ Multi-Family(#units)
Age of Existing Structure Historic House: ❑Yes ❑No On Old King's Highway: ❑Yes ❑No
—�/� n
Basement Type: it lull ❑Crawl ❑Walkout ❑Other a
Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft
Number of Baths: �Full:existing new Half:existing r ew
CIO
Number of Bedrooms: existing_ new
o �•
77 to
Total Room Count(not including baths):existing new First Floor Room ount -=i
r
w
Heat Type and Fuel: Gas ❑Oil ❑Electric ❑Other rn
Central Air: ❑Yes U.P 'o� Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑No
Detached garage:❑existing ❑new size Pool:❑existing ❑new size Barn:❑existing ❑new size
Attached garage:ld—existing ❑new size Shed:❑existing ❑new size Other:
Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑
Commercial 0 Yes 0 No If yes, site plan review#
Current Use Proposed Use
BUILDER INFORMATION
Name YYVe—c� W Telephone Number
Address License#
Home Improvement Contractor#
Worker's Compensation#
ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO
Sf IGNATU.RE —ems �9 DATE
Y
.y
n
FOR OFFICIAL USE ONLY
PERMIT NO.
DATE ISSUED
MAP/PARCEL NO.
r ,
ADDRESS VILLAGE
OWNER
s
DATE OF INSPECTION:
I
2 FOUNDATION
s
FRAME
INSULATION
FIREPLACE
f
ELECTRICAL: ROUGH FINAL
k
PLUMBING: ROUGH FINAL
4
GAS: ROUGH FINAL
t FINAL BUILDING
s
DATE CLOSED OUT
'f ASSOCIATION PLAN NO.
t
The Commonwealth of Massachusetts
Department of Industrial Accidents
" Office of Investigations
a 600 Washington Street _
Boston,MA 02111
www.mass.gov/dia
Workers' Compensation Insurance Affidavit:.Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
Na—me-(Business/Or-gauizationandividual): . OD4111' 64415024 s.T AjQf(//D(,4t.
Are you an employer?Check the appropriate box: Type of project(required):.
1.❑ I am a employer with 4. I am a general contractor and I
employees (full and/or part-time).* have hired the sub-contractors 6. New construction .
2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling
ship and have no employees These sub-contractors have g• Demolition
working for me in any capacity. employees and have workers'
9. ❑Building addition
o workers' comp.insurance comp.insurance.$
/required.] 5. We are a corporation and its 10.❑Electrical repairs or additions
3.' m a'homeowner doing all work officers have exercised their 1L�Plumbing repairs or additions
myself. [No workers' comp. right of exemption per MGL 12,❑Roof repairs
insurance,required.]t c. 152, §1(4),and we have no
employees. [No workers' 13.7 Other
comp.insurance required.] .
*Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information.
t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such.
$Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have
employees. If the sub-contractors have employees,they must provide their workers'comp.policy number.
I am an employer that isproviding workers'compensation insurance for my employees..Below is.1he policy and job site
information.
Insurance Company Name:
Policy#or Self-ins.Lic.#: Expiration Date:
Job Site Address: City/State/Zip:
Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date).
Failure.to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a
fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine
of up to$250.00 a day against the violator. Be advised that a copy of this statement maybe forwarded to the Office of
Investigations of the DIA for insurance coverage verification.
I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct:
Signature: Date: 0,61 0��./0
Phone#: .
Official use onlv. Do not write in this area,to be completed by city or town offcciaL
City or Town: Permit/License#
Issuing Authority(circle one):
1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector
6.Other
Contact Person: Phone#:
Information and Instructions
Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees.
Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire,
express or implied, oral or written."
An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two.or more
of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the
receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the
owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the
dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house
or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." ,
. r
MGL chapter 152) §25C(6)also states that"every state or local-licensing agency shall withhold the issuance or
renewal of a license or permit to'operate a business or to construct buildings in the commonwealth for any
applicant who has not produced�acceptable evidence of compliance with the insurance coverage required."
Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall
enter into any contract for.the performance of public work until acceptable evidence of compliance with the insurance
requirements of this chapter have been presented to the contracting authority."
Applicants
Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and,if
necessary,supply sub-conti•actor(s)name(s),address(es)and phone number(s) along with their certificate(s) of
insurance. Limited Liability Compames(LLC)or Limited Liability Partnerships(LLP)with no employees p yees other than the
members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have
employees, a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial
confirmation of insurance coverage. Also be sure to sign date the affidavit. The affidavit should
Accidents for g gn and
be returned to the city or town that the application for the permit or license is being requested,not the Department of
Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers'
compensation policy,please call the Department at the number listed below. Self-insured companies should enter then
Self-insurance license number on the appropriate line.
City or'Town Officials
Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom
of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant.
Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant
that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current
policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or
town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the
applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each
year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture
(i.e. a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit.
The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions,
please do not hesitate to give us a call.
The Department's address,telephone-and fax number:.
The Commonwealth of Massachusetts
Department of Industrial Aceiderts
Office of Investigations
600 Washington Street
Boston,MA 02111
Tel.#617-727-4900 ext 4.06 or 1-877-MASSAFE
Fax 4 617-727-7749
Revised 11-22-06
www.mass.gov/dia
04Tl1E,° Town-of Barnstable
yP °� Regulatory Services
`* s MAn $ Thomas F.Geiler,Director
,y MA55. g .
i639• p ]wilding Division
�fD MP'� b
Tom Perry,Building Commissioner
200 Main Street, Hyaffiis,MA 02601
Office: 509-862-4038 Fax; 508-790-6230
Permit no.
Date
AFFIDAVIT
HOME IMPROVEMENT CONTRACTOR LAW
SUPPLEMENT TO PERMIT APPLICATION
MGL c.142A requires that the"reconstruction,alterations,renovation,repair,modernization,conversion,
improvement,removal, demolition,or construction of an addition to any pre-existing owner-occupied
building containing at least one but not more than four dwelling units or to structures which are adjacent to
such residence or building be done by registered contractors,with certain exceptions,along with other
requirements.
Type of Work_ =l_��l ev e(&I- Estimated Cost
Address-of Work:
Owner's-Name ` 4 i &k&u
Date=of Application: 0! _0 t/0 j
I,hereby_certify tha� t.
Registration is not required for the following reason(s):
Work excluded by law
❑Job Under$1,000
QB ding not owner-occupied
� ner.pulling own permit
Notice is hereby given that:
OWNERS FULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED
CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORD DO NOT HAVE
ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UDDER MGL c.142A.
SIGNED UNDER PENALTIES.OF PERJURY
I hereby apply for a permit as the agent of the owner:
Date Contractor Name Registration No.
�OR
DateName"
Q:f0=:h0mewfdav
11-7
tHE Town of Barnstable
CF Tp�
Regulatory Services
BARNSTABLE, � Thomas F.Geiler,Director
69. A,O� Building Division
rF0 MA't
Tom Perry,Building Commissioner
200 Main Street, Hyannis,MA 02601
www.town.barnstable.ma.us
Office: 508-862-4038 Fax: 508-790-6230
HOMEOWNER LICENSE EXEMPTION
/ 9 Please Print
DATE: /O O7
IJOB-LOC-ATION—"/'A?3 I S k01Q,S AX- YA/ /f/ - AQ,kI
numbers / street [ A ` village
tHOMEOWNER� 29'11/ 509 J`t6) J
name sL 2 home phone work phone#
(:CURRENT-MAILINGADDRESS - 7 t J /�sj 14,06 /t
ity/town state zip code
The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and
to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as
supervisor.
DEFINITION OF HOMEOWNER
Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to
be,a one or two-family dwelling,attached or detached structures accessory to such use and/or farm structures. A
person who constructs more than one home in a two-year period shall not be considered a homeowner. Such
"homeowner" shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be
responsible for all such work performed under the building permit. (Section 109.1.1)
The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other
applicable codes,bylaws,rules and regulations.
The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department
minimum inspection procedures and requirements and that he/she will comply with said procedures and
requirements.
�Signature-of Homeowner -%
Approval of Building Official
Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the
State Building Code Section 127.0 Construction Control.
HOMEOWNER'S EXEMPTION
The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions
of this section(Section 109.1.1-Licensing of construction Supervisors);provided that if the homeowner engages a person(s)for hire to do such
work,that such Homeowner shall act as supervisor."
Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor(see Appendix Q,
Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly
when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed
Supervisor. The homeowner acting as Supervisor is ultimately responsible.
To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application,
that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by
several towns. You may care t amend and adopt such a form/certification for use in your community.
Q:forms:homeexempt
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YOU WISH TO-OPEN A BUSINESS?
in n
ch
t!W
AME in town
ch
For Your Inf
ormation: Business certificates(cost$30.00 for 4 years): A business certificate ONLY REGISTERS Tn C ek s Off ce, 1 FL.t 6�7
you must do by M.G.L.-'it does not give you permission to operate.) Business Certificates are available at th
Main Street,Hyannis;MA 02601 (Town Hall)
DATE:
x Fill in please:
APPLICANT'S YOUR NAME:
AlNESS YO R HOME ADDRESS: C7o26
TELEPHONE # Home-Telephone Number ® �S
pd L TYPE QF BIJ.SIN :' > .
NAME OF NEW BUSINESS
IS TrS A:1 IpME pOGUP ►TI0111 .YES` s l�l V
�ANIE
tiu b'ea�hgveii. pprs oI��I�srNss ` �
to be in co
of.the Town of
When starting a new business there are several things you must do in order may need.. you MUST GO TO 200 Main Stns(corner of Yarmouth
Barnstable. This form is intended to assist you in obtaining the information you
Rd.&Main Street) to make sure you have the appropriate permits and licenses required to legally operate your business in this town.
1- BUILDING COM ER'S OF IC
This individu I h s n info d y permit requirements that pertain to this type of business.
MUST COMPLY WITH HOME OCCUPATION
u horize RULES AND REGULATIONS. FAILURE TO
TIN
COMMENTS t COMPLY MAY RESU
Oil
2. BOARD OF HEALTH.
This individual has been informed of the permit requirements that pertain to this type of business.
Authorized Signature"
COMMENTS:
3. CONSUMER-AFFAIRS (LICENSING,AUTHORITY)
This individual has been informed of the licensing requirements that pertain to this type of business.
rized Signature**.
Autho g .
COMMENTS:
BR.USA. Mobile car wash & power wash
Places where business will be taking act (will be working):
Will serve all over cape area where work is allowed to be performed such,
as, residences, commercial plazas and office buildings' parking lots.
List of chemicals used and respective quantities:
Car Wash Express Detergent/Shampoo (SOAP) - 3 gal./month.
• Glass Cleaner by Johnson Wax Professional (WINDEX) - 2 gal./month.
• Leather conditioner by Prochem - (Leather cleaner and conditioner) - 1
gal./month.
Polishing Wax Compound Rapid Wax by ARDEX- 2 gal./month.
• Odor Neutralizer by Prochem (Car Fragrance) -2 gal./month.
General Purpose Cleaner by Johnson Wax Professional -for Upholstery,
Vinyl and wheels - 3 gal./month.
Start to finish car washing procedure:
• Set up the containment mat on the ground;
Pull vehicle over the mat;
Wet the vehicle's surfaces;
• Hand wash vehicle with detergent; , tw
• Clean wheels with General Purpose Cleaner;
Rinse the vehicle;
Dry it out;
Vacuum inside - carpet and seats (including floor mats);
Wipe dashboard;
Clean windows using Windex;
• Spread wax on;
Wipe wax off;
Ii Spray car fragrance inside;
• Pull vehicle off the mat;
• Suck the water on the mat with an appropriate Wet-Dry vacuum;
Fold mat and put away in the trailler;
Dump dirty water in the dirty water container; dispose of dirty water at the
Town of Barnstable Water Pollution Control -whenever container gets
fully loaded.
Town of Barnstable
Regulatory Services
Thomas F.Geiler,Director
Building Division
sntWsrAsi.E. � .._ .. _
v MASS �$ Tom Perry,Building Commissioner
200 Main.Street, Hyannis,MA 02601
www.town.barnstable.ma.us
Office: 508-862-403 8 Fax: 508-790-6230
Approved:
Fee:
Permit#:
CJ "
HOME OCCUPATION REGISTRATI N
Date: t///0
Name ^` GL b / Phone#. D o
Address: 45 village;
Name of Business: S
U�l/ i GG�
Type of Business Map/Lot:
INTENT: It is the intent of this section to allow the residents of the Town of Barnstable to operate a home occupation
within single family dwellings,subject to the provisions of Section 4-1.4.of the Zoning ordinance,provided that the activity
shall not be discernible from outside the dwelling: there shall be no increase in noise or odor;no visual alteration to the-
premises which would suggest anything other than a residential use;no increase in traffic above normal residential volumes;
and no increase in air or groundwater pollution.
After registration with the Building Inspector,a customary home occupation shall be permitted as of right subject to the
following conditions:
The activity is carried on by the permanent resident of a single family residential dwelling unit,located within
that dwelling unit.
�.-Such-use occupies no,more-than-400-square feet of space.
There are no external alterations to the dwelling which are not customary in residential buildings,and there is
/ no outside evidence of such use..
b No traffic will be generated in excess of normal residential volumes.
The use does not involve the production of offensive noise,vibration,smoke,dust or other particular matter,
odors,electrical disturbance,heat,glare,humidity or other objectionable effects.
odors,
is no storage or use of toxic or hazardous materials,or flammable or explosive materials,in excess of
/normal household quantities.
,/ Any need for parking generated by.such use shall be met on the same lot containing the Customary Home-
/occupation,and not within the required front yard.
,!/here is no exterior storage or display of materials or equipment.
d 'There is no commercial vehicles related to the Customary Home Occupation,other than one van or one
pick-up truck not to exceed one ton capacity,and one trailer not to exceed 20 feet in length and not to
exceed 4 tires,parked on the same lot containing the Customary Home Occupation.
No sign shall be displayed indicating the Customary Home Occupation.
�the Customary Home Occupation is listed or advertised as a business,the street address shall not be
cluded.
No person shall be employed in the Customary Home Occupation who is not a permanent resident of the
dwelling lj
I,the undersigned,hav r and agr- 7
e above restrictions for my home occupation I am registering.
Applicant Date: �.
Homeoc.doc Rev.5/30/03
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I
Town of Barnstable Water Pollution Conrol Division
617 Bearse's Way Hyannis, MA 02601
Date: April 1, 2007
Number of pages including cover sheet:
1
To: From:
Alicia Parker Ann Mastroianni
Growth Management Barnstable WPCD Lab
617 Bearse's Way
Hyannis, MA 02601
Phone: Phone: (508) 790-6336
Fax. 508-790-6304 Fax: (508) 790-6325
--jREMARKS: _ Urgent _For your review _Reply ASAP _Please comment
Hi Alicia,
Thyago Silva, BR.USA Mobile Carwash, asked me to contact you with the results
of the washwater from his vehicle. It exhibits no harmful effects to our process here
at the wastewater plant. He included the MSDS's of the products he uses, they are
"environmentally friendly" products. We give him permission to dump his used
washwater into our system.
Ann Mastroianni
Barnstable WPCD Lab
K4
s�lli��:T,;'I:' li is i•
Ann's Fax Form.xls
e
Wimp
BRAWN ?
Section 1-Manufacturer's Information
Manufacturer's Name C.A.R. Products, Inc.
Manufacturer's Address 630 Beaulieu St. Holyoke, MA 01040
Manufacturer's Phone Number Local 413-536-9900 Toll Free 800-537-7797
Emergency Phone Number Chemtrec 800-424-9300
Product Information C.A.R. Products 800-537-7797
Effective Date 2/19/04
Chemical Name Car Wash Express Detergent
DOT Shipping Description Compounds, Cleaning Liquid (Sodium Hydroxide)
8,NA1760, PGII Emergency Response Guide 4154
Chemical Family Strong Alkaline Detergent
Chemical Comment Hazardous ingredients in section II are subject to the
reporting requirements of Section 313 of the
Emergency Planning and Community Right to Know
Act of 1986 (40CFR372),
Chemical Formula Mixture of alkalies and wetting agents.
Hazardous Materials Identification System(HMIS)
FLAMMABILITY
HAZARD RATING
O 4=EXTREME
3=HIGH
HEALTH 2 0 REACTIVITY 2=MODERATE
1= SLIGHT
0=INSIGNIFICANT
PERSONAL PROTECTION B
N/E= Not Established or Unknown
N/A= Not Applicable
I
Date Printed:03/30/07 Car Wash Express Detergent Page 1 of 4
Section II- Hazardous Ingredient
Hazardous Com op nent CAS Number Hazardous % TLV (Units)
Sodium Hydroxide 1310-73-02 < 10 2mg/m3 Ceiling
Non-Hazardous Ingredients > 90
Section III-Physical & Chemical Data
Boiling Point ff) >212 OF
Volatility/VOL (%) > 75 %
Melting Point(OF) N/A
Vapor Pressure (mm Hg) N/E
Vapor Density(Air= 1) N/E
Solubility In H2O Complete
Appearance/Odor Yellow liquid, bland fragrance
Specific Gravity(H2O = 1) 1.18
Evaporation Rate Like water
pH 11.70
Section IV- Fire & Explosion Hazard Data
Flash Point(°F) None
Lower Flame Limit N/A
Higher Flame Limit N/A
Extinguish Media As needed for surrounding fire
Special Fire Fighting Procedures . None
Unusual Fire Hazard May produce flammable hydrogen gas upon
contact with reactive metals
Section V-Health Hazard Data
Routes of Entry Inhalation(mists), skin, ingestion
Health Hazards Irritation or burns
NTP No
IARC Monographs No
OSHA Regulated No
Threshold Limit Value N/E , blended product. See section II for
information on listed ingredients.
Date Printed: 03/30/07 Car Wash Express Detergent Page 2 of 4
Section V-Health Hazard Data continued
Over Exposure Effects
Skin Contact: Irritation or burns.
Eye Contact: Burns.
Inhalation: Inhalation of concentrated mists-irritation of upper respiratory tract:
possible burns, chemical pneumonia, and lung damage.
Ingestion: Burns of mouth, throat and stomach: pain, nausea, vomiting, shock
symptoms.
First Aid
Skin Contact: Immediately flush with cool running water for 15 minutes. Remove
contaminated clothing and wash before reuse. If irritation or burn develops
and persists, get medical advice or assistance.
Eye Contact: Immediately flush with cool running water holding eye lids apart. Remove
contact lenses if present, and continue flushing for 15 minutes. Get medical
assistance.
Inhalation: Remove to fresh air. Immediately call for medical advice or assistance if
breathing difficulty or irritation is severe or continues.
Ingestion: Rinse mouth with large amounts of water. Drink water, milk or other fluids
to dilute. Do not induce vomiting unless directed by medical personnel.
Immediately call for medical advice or assistance.
Section VI-Stability & Reactivity Data
Chemical Stability Stable
Conditions To Avoid Contact with Incompatible materials
Incompatible Materials Avoid contact with strong acids, reactive metals,
strong oxidizers, most organic material such as
leather, paper, wool.
Decomposition Products Oxides of carbon
Hazardous Polymerization Will not occur
Polymerization Avoid N/A
Section VII- Spill or Leak Procedure
For Spill Small spills, less than 1 gallon: Flush to drain with
excess water.
Large spills: Only knowledgeable and properly
protected people should work with a large spill.
Get professional assistance if necessary. Stop
source of discharge if safe to do so. Evacuate
unprotected personnel. Contain spilled material,
and keep from discharging to surface waters.
Recover to drum for later use,
Date Printed: 03/30/07 Car Wash Express Detergent Page 3 of 4
r
Section VII-Spill or Leak Procedure continued
treatment, or disposal. Recover using alkali
resistant pump, scoops, absorbent material, or other
process as appropriate. Rinse contaminated area
well.Notify local, state, or national authorities if
required.
Waste Disposal Method: Dilute solutions are normally sewer disposable;
check local rules for any restrictions. Product is
alkaline. Dispose of according to national, state,
and local rules.
Section VIII- Special Protection
Respiratory Protection None normally required. NIOSH/MSHA approved
respirator where conditions may cause exposure
limits to be exceeded, including mists.
Ventilation General or local to avoid exposure to irritating
mists.
Protective Gloves Alkali resistant, impermeable.
Eye Protection Goggles and/or face shield.
Other Protection Alkali resistant, impermeable apron and shoes.
Section IX-Special Precautions
Keep out of reach of children. For industrial or institutional use only.
Disclaimer: This information is , to the best of our knowledge, current, accurate, and complete as
of the date of this document. However, we make no representation as to its accuracy. Such
information may not be accurate when product is used in any process or combined with other
materials. In certain circumstances additional information may be necessary. No representation(s),
guarantee(s), or warranty, either expressed or implied, or of any nature, is made with respect to the
product or data provided.
-End of document-
Date Printed: 03/30/07 Car Wash Express Detergent Page 4 of 4
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Portable Containment
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IPI "Quality Environmental Solutions"
7-844474-7294
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AC®RD CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY)
IV 107/28/2006
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
SCHLEGEL INSURANCE ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
34 MAIN ST ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
:BEST, YARk0UTH, NIP, 02673 INSURERS AFFORDING COVERAGE NAIC#
INSURED INSURER A: COLONY INSURANCE CO
Thyago Silva Oba Miracle Cleaning INSURERS:
423 Bishops Terr INSURER C:
INSURER D:
Hyannis, MA 02601 INSURERE:
COVERAGES
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING
ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR
MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH
POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
POLICY EFFECTIVE POLICY EXPIRATION
LTR tNSRD TYPE OF INSURANCE POLICY NUMBER DATE MMIDDIYY) DATE(MWOO/YY) LIMITS
GENERAL UABILm 6I.3326440 04/07/2006 04/07/2007 Egcrl occuRRENCE $1,000,000
TO
A S COMMERCIAL GENERAL LIABILITY PREMISES(Ea occurence) $1O0,OOO
CLAIMS MADE R❑OCCUR MED EXP(Any one person) $5,000
PERSONAL&ADV INJURY $1,000,000
GENERALAGGREGATE $1,000,000
GENIAGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOP AGG $1,000,000
RO-
POLICY JECT L,OC
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $
(Ea accident)
ANY AUTO
ALL OWNED AUTOS BODILY INJURY $
(Per person)
SCHEDULED AUTOS
HIRED AUTOS BODILY INJURY $
(Peraccident)
NON-0WNED AUTOS -
PROPERTY DAMAGE S
(Per eceident)
GARAGE LIABILITY - AUTO ONLY-EA ACCILZEA
$
ANY AUTO OTHER THAN CC S
AUTO ONLY: AGO S
EXCESSRIMBRELLA LIABILITY EACH OCCURRENCE $
OCCUR ❑CLAIMS MADE AGGREGATE S
$
$
DEDUCTIBLE
RETENTION $ $
WORKERS COMPENSATION AND TORY LIMITS ER
EMPLOYERS'LIABILITY E.L.EACH ACCIDENT $
ANY PROPRIETORIPARTNERMXECUTIVE
OFRCER/MEMBER EXCLUDED? EL DISEASE-EA EMPLOYEE $
If yes,describe ender EL DISEASE-POLICY LIMIT $
SPECIAL PROVISIONS below
OTHER
DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS
CERTIFICATE HOLDER CANCELLATION
7711Z
HOSPITAF, SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BE�tFORE THE EXPIRATION
STREE'� DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 2t DAYS WRITTEN
NOTICE TO THE CERTIFICATE HOLDER NAME TO THE LEFT. BUT FAILURE TO 00 SO SHALL
HyAMIs, NIA 02601
IMPOSE NO OBLIGATION OR LABILITY OF ANY THE INSURER, ITS AGENTS OR
REPRESENTATIVES.
.C/O ROBERT T. ROWAN AUTHORIZED REPRESE ATfl/E
ACORD 26(2001/08) �ACORD�COPORATION988
TOWN OF BARNSTABLE
C t r ;.
MASSACHUSETTS `
BUSINESS CERTIFICATEr', I\I"
DATE ISSUED: 02/23/2006 DATE RENEWED: 2: 33
BOOK:192 RENEWAL BOOK: RENEWAL PAGE:
AGE 06-064 DATE DISCONTINUED:
CERTIFICATE EXPIRES: 02/23/2010 DISCONTINUED BOOK: DISCONTINUED PAGE:
In conformity with the provisions of Chapter One Hundred and Ten(110), Section Five(5)of the General Laws, as amended,the
undersigned hereby declare(s)that a business is conducted under the title below; located as shown,by the following named person,persons
or corporation:
11 SCE i l=R li AF C Ei�1T H �A1Vl acRs�N R ShyMEGgm Foram
+
lGP+L �N0T .Fr' sl ss,- A,,�'�--`^$4'Fe�"•......��E AN kfS FIERY :ERSONLNQMEsS, l QOES CEOI(�;;rYTHAT=�THEtAFPL�EA TSF#aS(H �/EMET ALL L1GEi%1SE, ,
DIFF REN3ThF ( ►gyp u
i'�""i
, RMITAIaiD OTh4PRMISSI!OP1S REQUIFEQ B�(f�lET011#Cf ? BAFINSTEBICDINGy HEALTfNd CI�tSi,II�111ERAFRTRS #
fDEP,CRTMENTSFOftlE LEGALQPEIATIOaF ISBUSINESSATE STATEDOGTI®tl � �, i °;
525�'�LNLY.`�'z4alY ;. :vY..s.Y2n,..
BR. USA. MOBILE PRESSURE WASHING.
MAILING ADDRESS: 423 BISHOPS TERRACE HYANNIS, MA 02601
THYAGO.SILVA 423 BISHOPS TERRACE HYANNIS,.MA 02601
Signatures:
THE ABOVE NAMED PERSON(S)PERSONALLY APPEARED BFEQRE ME AND MADE OATH THAT THE FOREGOING
STATEMENT IS TRUE.
TITLE
Identification Presented:
DATE: February 23, 2006 .
CONDITIONS: HOME OFFICE ONLY MUST COMPLY WITH HOME OCCUPATION REGULATIONS
In accordance with the provisions of Chapter 337 of the Acts of 1985 and Chapter 110, Section 5 of the Mass General Laws,Business
Certificates shall be in effect for four years from the date of.issue and shall be renewed each four years thereafter. A statement under oath
must be filed with the city clerk upon discontinuing, retiring or withdrawing from such business or partnership.
Copies of such certificates shall be available at the address at which such.business is conducted and shall be furnished on request during
regular business hours to any person who has purchased goods or services from such business.
Violations are.subject to a fine of not more than three hundred dollars($300)for each month during which such violation continues.
-------------------------=-------=------------------------------------------------------------------------------------------------------------------------------
CERTIFICATION CLAUSE
I certify der Ithe penalties of pe ' y that I, to the best of my knowledge and belief, have filed all state tax returns and paid all state
taxes requir der law.
* Signa of Indi3kiial or Co orate Name(Mandatory) By: Corporate Officer(Mandatory.if applicable)
** or Federal ID Number
* This license will not be issued unless this certification clause is signed by the applicant.
**. Your social security number will be furnished to the Massachusetts Department of Revenue to determine whether you have met tax filing
or tax payment obligations. Licensees who fail to correct their non-filing or delinquency will be subject to license suspension or revocation.
This request is made under the authority of Mass. G.L. Cha 62C, S.49A.
Town of Barnstable
Regulatory Services
Thomas F.Geiler,Director �" BLE
r Building Division lao-Y FEg 2 P�" -
• snxxasi.E. _ J �: ��
z6gq. �0
Tom Perry,Building Commissioner
�Ep Mp1 s 200 Main Street, Hyannis,MA 02601
www.town.barnstable.ma.us pk ,� ��
Office: 508-862-4038 ax: 508-790-6230
Approve
S:-:R1.
Fee:
Permit#:
HOME OCCUPATION REGISTRATION
Date:
Name: Gv40 5-1 0� Phone#:
/�
Address: 6� !//V / y' V' e:__��
Name of Business: 3A U
Type of Business:// wi/ &5371V X�0� �a t 0 /
INTENT: It is the intent of this section to allow the residents of the Town of Barnstable to operate a home occupation
within single family dwellings,subject to the provisions of Section 4.1.4 of the Zoning ordinance,provided that the activity
shall not be discernible from outside the dwelling: there shall be no increase in noise or odor;no visual alteration to the
premises which would suggest anything other than a residential use;no increase in traffic above normal residential volumes;
and no increase in air or groundwater pollution.
After registration with the Building Inspector,a customary home occupation shall be permitted as of right subject to the
following conditions:
• The activity is carried on by the permanent resident of a single family residential dwelling unit,located within
that dwelling unit.
• Such use occupies no more than 400 square feet of space.
• There are no external alterations to the dwelling which are not customary in residential buildings,and there is
no outside evidence of such use.
• No traffic will be generated,in excess of normal residential volumes.
• The use does not involve the production of offensive noise,vibration,smoke,dust or other particular matter,
odors,electrical disturbance,heat,glare,humidity or other objectionable effects.
• There is no storage or use of toxic or hazardous materials,or flammable or explosive materials,in excess of
normal household quantities.
• An need for parking generated b such use shall be met on the same lot containing the Customary
Y P � Y g Home
Occupation,and not within the required front yard.
• There is no exterior storage or display of materials or equipment.
• There is no commercial vehicles related to the Customary Home Occupation,other than one van or one
pickup truck not to exceed one ton capacity,and one trailer not to exceed 20 feet in length and not to
exceed 4 tires,parked on the same lot containing the Customary Home Occupation.
• No sign shall be displayed indicating the Customary Home Occupation.
• If the Customary Home Occupation is listed or advertised as a business,the street address shall not be
included.
• No person shall be a ployed in the Customary Home Occupation who is not a permanent resident of the
dwelling unit.
I,the undersigned,have re a agree.- a above restrictions for my home occupation I am registering.
r
Applicant: Date:— 2 Z 2 d
Homeoc.doc Rev.5/30/03
YOU WISH TO OPEN A BUSINESS?
For Your Information: Business certificates (cost$30.00 for 4 years). A business certificate ONLY REGISTERS YOUR NAME.in town (which
you must do by M.G.L.-it does not give you permission to operate.) Business Certificates are available at the Town Clerk's Office, I"FL.,367
Main Street,Hyannis, MA.02601 (Town Hall)
DATE:
L Fill in please:
APPLICANT'S YOUR NAME: D S/ (/
B SINESS _ YO R HOME ADDRESS: 'S S
TELEPHONE # Home Telephone Number a7gKY b
NAME OF NEW BUSINESS a U TYPE OF BUSINESS C FAA11N 4/' ��faP�. P�p.sUrP_ ivcaS
IS THIS A HOME OCCUPATION?. YE NQ ? -
Have you b'eern givens Appro�ral frorn t he bui division. YES NO .
ADDRESS OF BUSINE$S /S MAP/PARCEL NUMBE 25ooN
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 COT NER'S OFFICE
This individu I h s en ' r d of any permit re irements that pertain to this type of business.
Au horse ignature
COMMENTS:
2. BOARD OF HEALTH
This individual has been informed of the permit requirements that pertain to this type of business.
Authorized Signature'
COMMENTS:
q- 3. CONSUMER AFFAIRS(LICENSING AUTHORITY)
This individual has been informed of the licensing requirements that-pertain to this type of business.
Authorized Signature*
COMMENTS:
Ak
Town of Barnstable
of Regulatory Services
c Thomas F.Geller,Director
's ue , ; Building Division
UM
XAS& e$ Tom Perry,Building Commissioner
abJ9.
'°rEp Mpt p 200 Main Street, Hyannis,MA 02601
www.town.barnstable.ma.us
ice: 508-8624038 Fax: 508-790-6230
Approved:_
Fee: 0
Permit#:
HOME OCCUPATION REGISTRATION
de: 0�
me: �C7✓ � (� l WA Phone 0:
idress ��3 81's•HOPs -
• AAA/A11'1�� Village• ow. W S
une of Business:
Me of Business:__ C'.�F—A W 1"K G Map2ot:
7
TTENT: It is the intent;rdthis section to allow the residents of the Town of Barnstable to operate a home occupation
ithin single family dwellings,subject to the provisions of Section 4-1.4 of the Zoning ordinance,provided that the
tivity$hall not be discernible from outside the dwelling: there shall be no increase in noise or odor;no visual
tration to the premises which would suggest anything other than a residential use;no increase in traffic above normal
sidential volumes;and no increase in air or groundwater pollution.
fter registration with the Building Inspector,a customary home occupation shall be permitted as of right subject to the
(lowing conditions:
• The activity is carried on by the permanent resident of a single family residential dwelling unit,located
within that dwelling unit.
• Such use occupies no more than 400 square feet of space.
• There are no external alterations to the dwelling which are not customary in residential buildings,and there
is no outside evidence of such use. •
• No traffic will be generated in excess of normal residential volumes.
• The use does not involve the production of offensive noise,vibration,smoke,dust or other particular
matter,odors,electrical disturbance,heat,glare,humidity or other objectionable effects.
• There is no storage or use of toxic or hazardous materials,or flammable Or explosive materials,in excess
of normal household quantities.
• Any need for parking generated by such use shall be met on the same lot containing the Customary Home
Occupation,and not within the required front yard.
• There is no exterior storage or display of materials or equipment
• There is no commercial vehicles related to the Customary Home Occupation,other than one van or one
pick-up truck not to exceed one ton capacity,and one trailer not to exceed 20 feet in length and not to
exceed 4 tires,parked on the same lot containing the Customary Home Occupation.
• No sign shall be displayed indicating the Customary Home Occupation.
• If the Customary Home Occupation is listed or advertised as a business,the street address shall not be
included.
• No person shall be employed in the Customary Home Occupation who is not a permanent resident of the
dwelling unit.
he undersigned,have a and agree with the a restrictions for
my home occupation I am regis Bring.
plicantb�j Date: � 9 a 5
new.doc Rev.5/30/03 •
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.) Business Certificates are available at the Town Clerk's Office, 1 FL., 367
Main Street, Hyannis, MA 02601 (Town Hall)
DATE:
Fill in please:
APPLICANT'S YOUR NAME: 1 U BUSINESS
L-
BUSINESS YOUR E[OME ADDRES —TgFZ
-
TELEPHONE # Home Tel phone Number-1 - O
NAME OF NEW BUSINESS �' —TYPE OF BUSINESS G
IS THIS A HOME OCCUPATION? YES NO
Have you been given apprn!jal from, the
e bui division- NO
YES
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.
1. BUILDING COMMISSIONER'S OFF E N
This individual has n infor a "of any permit requirementpthat pertain to this type of business.
Authorize�2natu&*
COMMENTS: — ro
.P i -
2. BOARD OF HEALTH
This individual has be informs f� h. per.. re nts that pertain to this type of business.
2�11
rized Signatur
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:
4S
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i
FaaCq Sr
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A � b .T�►rsvc. �'
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/�
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Assessor's map and lot'number ........ J
i
y
Sewage`Permit number lci/i . '� fi,a5n SEPTIC SYSTE �Q
House.number
-INSTALLED IN C ��,1 �E:
.......................... KITH TITS 9 y 039.
ENVIRONMENTAL
TORN OV �BAR.NSTAR T �J; .
BU.IL�DING `INSPECTOR
�,`�® ��-9 red® z /� •APPLICATION FOR PERMIT TO .. .................... ........ .......................................... ....1....:b!...... .�...
TYPE OF CONSTRUCTION ............................. ......= ...........................
........
TO THE INSPECTOR .OF BUILDINGS:
The undersigned hereby.applies for a permit according to the following~ information:
Location ................ .................. 64A/A//S............................................................
Proposed Use .................... �....... .... .................. :.....
Zoning District f..(... ... �....... :...... fire District (Jx1 ) ......................................
.. .. .. .... ....
o A
Name of Owner ..............�................... .�.�....�...�.............Address J e�/� S
.......... ........... .......1 .............. .. !vfs.
Name of Builder' A). / ! ei es ®e`C�
, „ . .. ........... .. .......................� ,•
Name of Architect .......................................Address
Number of Rooms (D1.�` �:�... ............... Foundation.......... t.. .... '.. . ...........:...
Exierior ............... ........6 .......L...!!1.... .��..................Roofing ................./... • '.
�e� ,
Floors .........:......... ....G? ..: ....:....:......................Interior ......................... ........... L.....
Heating ............... �` . ............... .... Plumbing ..........>� .........................................................
Fireplace ... ...................................... ...... ...................Approximate Cost ........ ......................................
Definitive Plan Approved by Planning Board _ _------_-----------19________, ' Area /
Diagram of Lot and Building with Dimensions Fee ... .. .1........ .
SUBJECT TO APPROVAL OF BOARD OF HEALTH
a '
r
OCCUPANCY PERMITS REQUIRED FOR
I hereby•agree to conform to all the Rules and Regulations of the •Town of Barnstable regarding the above
it construction.
Name ..... . ........
'DOWNS, SHELDON
a 2441.9 BUILD ITION
. ................ Permit for ................ .. .. ......Single Family Dwelling
.......................................................................
423 Bishops Terrace
Location .................................................................
Hyannis
...............................................................................
Sheldon Downs
Owner/...................................... ...........................
Frame Type of Construction ..F........................................
......................................................................
Plot ............................. Lot ................................
t
Permi�t,.Grantecl ........Sept 2.9..... .......19 82
Date of Inspectior4,-.1�1 ... . ........ ... .... .....
Date Completed .............. I 9P
Aj/ 4.1
� _ .. �. �• _ 'ems. _ _
Assessor's ma and lot number +" 9 uu
sr L 0 e— ,e,A4.
p ..�I...........
STNET��
Sewage- Permit number/,�1�a,�+.ln� .. �,. .............J ��`�' d``Q ♦�
Z SAWSTABLE i
House number ........................ ." .... ........•................................
s6
�� rae9 e�
�O M a`
TOWN iOF BARNSTABLE
BUILDING INSPECTOR
APPLICATION FOR PERMIT TO,.......
�....... ...................................................... ..............:...
TYPEOF CONSTRUCTION ................. ............. ......................................................................
d... 1941.1..
TO THE INSPECTOR OF BUILDINGS:
The undersigned hereby applies for a permit according to the following info�rrm`ation:
Location ... . � �.........,�.16.a � ...... .. � ��. '. ............( A/? . ............................................
Proposed Use ............. . . .............................................................................................................................
...........
/� / .............Fire District .................:.. '4lUJl1 )
Zoning District ............ ........ .......................:...........
Nameof Owner t .......................................................�4 `� Address ............................................................ j ..................f
Name of Builder' „I��'"',{o,�`+`r�'.�w''... �`�s�'�`�...........Address la,� ., �sfa�d�?'��a ...��.......................At
Nameof Architect ..................................................................Address ..............,.�.......�^........:................................................
Number of Rooms . t. � ..F ....�. ............... .........Foundation `....... ? ... .... c -..................
Exterior ...............��~.....................................t`ats, "e" 4.e. ..................Roofing `.. ,� „e~ .....................................
Floors' •................... ` '_� ........... Interior ........:....... ` `�,�t,9z_`°'"......................................
Heating . ....................! n,: ....................................Plumbing ....:: .. "�.....................................................
....
Fireplace ........................ :...7................................................Approximate Cost ............. .3C'�. ...........................
Definitive Plan Approved by Planning Board ---------------____-----------19_ . Area 4
vn ' .
Diagram of Lot and Building with Dimensions Fee 5.r..............................
SUBJECT TO APPROVAL OF BOARD OF HEALTH
i
a
y
OCCUPANCY PERMITS REQUIRED FOR 'EW Dal.1/<ELLI,NGS . ;
w
I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above
construction. "Awl,
Name ........ .... .. ........ .. .........
DOWNS, S8III,DON A=250-89
' '?4419 BUILD ADDITION*.No .............. Permit for ....................................
Single Family Dwelling
.....
433 Bishops Terrace
Location '
Hyannis
--`-^'-`^--^`'~^'^^^^^^'----------'-'
Sheldon Downs
Owner -.-..------..-.-----_.-.---.
^
Ipzaoae '
Type of Construction ..........................................
----~'^''-^'~^-------'-'-^^-~---`'
Plot ............................ Lot ................................ .
. �
^ �
Sept. 29, 82
Permit Granted .........................................
Dote of Inspection ------------lA _
Date Completed ...................................... '
'
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00 �*�,��. 1_ 142 .
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