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YOU WISH TO OPEN A BUSINESS?
Fr Your Information: Business certificates (cost $3D.OD for 4 years). A business u must do by M.G.L.- it does not give you permission to operate.) Business Certificatess certificate ONLY REGISTERS YOUR NAME in town (which
ain Street, Hyannis, MA 02601 (Town.Hall) are available at the Town Clerk's Office, I367
,ors . ,a,�a
mitt.W.W17 r DATE. �/ a7
:.9 . d
AkyGyd`�7 r f , ' APPLICANT'S
��r x YOUR NAME S: s Fill in please:
iM"' - '�°n dt�lz BUSINESS / hn. fL/�1k
YOUR HOME ADDRESS:
t1 �I7aa _ TELEPHONE #
Home Telephone Number t--�,� -�
?�3_cDL&
NAME:`OF CORPORATION:
NAME OF NE.W BUSINESS
LS THIS'A HOME OCCUPAI'ION�: YES
TYPE OF.BUSINESS �
ADDRE$S:.OF BUSINESS
H /'l
MAP/PARCELNUMB.ER �-���
When starting a new business there are several things you must do in order, to 6e in compliance (Assessing)
Barnstable. This form is intended to assist you in obtaining the information you may.need.
Rd. & Main Street), to make sure you have the appropriate permits and licensesponce with the rules and regulations of the Town of
Y. You MUST GO TO 200 Main St. - (corner.of Yarmouth
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 Y type of business.
COMMENTS: Authorized Signature
.,
2. BOARD OF HEALTH
This-individual has beennimed o�e t requirements that pertain to this e
C'r ire type of.busmess.
Authorized Signature** MUST COMPLY WfT'-'
COMMENTS: HAZARDOUS M
3, CONSUMER AFFAIRS (LICENSING AUTHORITY)
This individual has been informed of the licensing requirements that pertain to this e of
type business.
COMMENTS:
Authorized Signature*
a
Date:
TOWN OF BARNSTABLE
-TOXIC AND HAZARDOUS MATERIALS ON-SITE INVENTORY
NAME OF BUSINESS: Aj,44 t/I ?SoL _
BUSINESS LOCATION: IfY (!PWel'' 155/1 o INVENTORY
MAILING ADDRESS: TOTAL AMOUNT:
TELEPHONE NUMBER: S-ot` _ _7S__ 3Oed
CONTACT PERSON:
EMERGENCY CONTACT TELEPHONE NUMBER: —O8 - &Ft - 6T/t/. 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 materials 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 t
Antifreeze (for gasoline or coolant systems) Misc. Corrosive
NEW USED Cesspool cleaners
TI�tomatic transmission fluid C) Disinfectants
O Engine and radiator flushes Road.Salts (Halite)
Hydraulic fluid (including brake fluid) Refrigerants
Motor Oils Pesticides
IC NEW USED (insecticides; herbicides, rodenticides)
Gasoline, Jet fuel, Aviation gas Photochemicals (Fixers)
Diesel Fuel, kerosene; #2 heating oil NEW USED
Misc. petroleum products: grease, Photochemicals (Developer)
lubricants, gear oil, NEW USED
4 Degreasers for engines and metal d Printing ink
Degreasers for driveways &garages Wood preservatives (creosote)
Caulk/Grout ry Swimming pool chlorine -
Battery acid (electrolyte)/Batteries Lye or.caustic soda
2 Rustproofers Misc.. Combustible
Car wash detergents Leather dyes
Car waxes and polishes Fertilizers
Asphalt & roofing tar PCB's
OPaints, varnishes, stains; dyes Other chlorinated hydrocarbons,
Lacquer fhinners= -=---_-- - _ (inc_carbon tetrachloride) -
NEW USED F Any other products with "poison'labels
Paint &varnish removers, deglossers (including,chloroform, formaldehyde,
0 Misc. Flammables hydrochloric acid, other acids)
Floor &furniture strippers Other products not listed which you feel
Metal polishes may be toxic or hazard.ous,(please list):
Laundry soil & stain removers
(including bleach)
Spot removers &cleaning fluids
-L (dry cleaners)
oOther cleaning solvents
Bug and tar removers
Windshield wash
WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS