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Home My WebLink About0085 WOODLAND AVENUE ss ��la� bnd fluz. -- — ray Town of BarnstablBuilding e 0.7 a i,, _ PostThis GardtSo That it Is Visible From the Streeter,-Approved Plans Must be Retained on-Job and this Card Must be Kept ,.unANtetx�e 63� ,0$1� Posted Until Final Inspection Has Been Made. ;., < in hall:Not be Occu ied until a Final.lns ect WhPermit ere a Certificate,of,Occupanpy ts.Req,uired,such,,Butld, g s p p ion has been made. :. :. Permit NO. B-17-3524 Applicant Name: todd leduc Approvals Date Issued: 10/19/2017 Current Use: Structure t Foundation: Permit.Type: Building Insulation-Residential - Expiration.Date: 04/19/2018 Location: 85 UNIT 1 WOODLAND AVENUE, HYANNIS Map/Lot: 269-06140A Zoning District: RB Sheathing: Owner on Record: Helen Raftery Contractor Name: TODD LEDUC Framing: . 1 Address: 85 WOODLAND AVE Contractor License: CSSL-106019 2 HYANNIS, MA 02601 ` Est. Project Cost: $5,000.00 Chimney: Description: Air sealing and insulation of attic flat,"kneewalis, kneewall floor and Permit Fee: $85.00, basement ceiling. Insulation: Fee Paid: $85.00 Project Review Req: Dater .10/19/2017 Final: Plumbing/Gas Rough Plumbing: Building Official Final Plumbing: This permit shall be deemed abandoned and invalid unless the work authorized by this permit is commenced within six months after issuance. All work authorized by this permit shall conform to the approved application and the approved construction documents for which this permit has been granted. Rough Gas: All construction,alterations and changes of use of any building and structures shall be in compliance with the local zoning by-laws and codes. This permit shall be displayed in a location clearly visible from access street or road and shall be maintained open for public inspection for the entire duration of the Final Gas: work until the completion of the same. Electrical The Certificate of Occupancy will not be issued until all applicable signatures by the Building and Fire Officials are provided on this,permit. Minimum of Five Call Inspections Required for All Construction Work:- Service: 1.foundation or Footing 2.Sheathing Inspection Rough: 3.All Fireplaces must be inspected at the throat level before firest flue lining is installed 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection Final: . 5.Prior to Covering Structural Members(Frame Inspection) Low Voltage Rough: 6.Insulation 7.Final Inspection before Occupancy Low Voltage Final: Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Health Work shall not proceed until the Inspector has approved the various.stages of construction. Final- "Persons contractrng..with.Unregisteredac _ntrac�tors.do.not have access to the guaranty fund":(:as-setforth�in MGL c:142A). i Fire Department_'. . -- , b Building plans are to be available on site - Final: '_.All Permit Cards are the property of the APPLICANT-ISSUED.RECIPIENT CONSTRUCTION CO_ Lc 546A Higgins Crowell Rd,WEST YARMOUTH,MA(12673 PHONE: 508-778-0111 FAX: 508-778-5010 %PhMN.TUPPERCO.COM Date: r -m) 03 Town of Barnstable Thomas Perry CBO tz 200 Main Street ' Hyannis, Ma 02601 (508) 790-6230 fax Re: Insulation Permits Dear Mr. Perry This affidavit is to certify that all work completed for permit application Issued on j r7 �, has been inspected by a certified Building Performance Institute (BPI) inspector. All work performed meets or exceeds Federal and State requirements. Sincerely, Permit#: ; ( G � �� ,= J I Address: Ave-_ Richard Tupper License # CS-69058 1 _ TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map.. Parcel Application # Health Division Date Issued 1 Z—� —� P�—' Conservation Division Application Fee Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/ Hyannis Project Street Address Q2a In taj Ale, Village t r D2-� Gj OwnerBJ., Address V (�l �. ►vl Telephone Permit Request ki I!?, e, ' (0- <,--taa n a 11J'AN ::t!Ab-Wrr± E�affl Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District JJ Flood Plain Groundwater Overlay Project Valuation �`r�J 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 Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existing new Half: existing _ sI new Number of Bedrooms: existing _new Total Room Count (not including.baths): existing new First Floor Pb m Count_ o } Heat Type and Fuel: , Gas ❑ Oil ❑ Electric ❑Other _* } � Central Air: ❑Yes �'No Fireplaces: Existing New Existing woo /coal st�/e: 'es O No Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ existing,❑ rMvM size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: + Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review# Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) ' Name Telephone Number Address5MHio(V):S(Y,0AJ6[19JLicense# (ic)` (JeQ Z Ynam& MA0 Home Improvement Contractor# 1 Email Worker's Compensation #(�(°,C S��r)(26 t 7A ALL CONST CT-o A lirR RESULTING FROM THIS PROJECT WILL E TAKEN TO 6�fiWA 09-05 SIGNATUR DATE Z- l I FOR OFFICIAL USE ONLY ,APPLICATION# .DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING --' DATECLOSED OUT AS;SQC1ATION PLAN NO. The ComMbfiwealth of Massachusetts Departmentf Industrial Accidents Office.of Investigations 600 Washington Street Boston, MA 02111 www.mass gov1dia Workers'Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): Tuppe.r Construction' 'Co. LLC Address: 546A Higgins Crowell Rd City/State/Zip: West Yarmouth, MA 02'673 Phone.# 508 778=0111 Are you an employer?Check-the appropriate box: Typeof project(required): L❑X I am a employer with 4. ❑ I am a general contractor and I 6.. New.construction employees(full and/or part-time).* have hired the sub-contractors 2.0-I,am a sole proprietor or partner listed:on the attached she 70 Remodeling ship and have no:employees These'sub-contractors have 8', Demolition working for in any capacity. workers' comp.insurance 9, 11 Building addition [No workers' comp.insurance 5. Q We are a corporation.and its required.] officers:.have.exercised their 10.❑Electrical repairs or additions 3.❑ I am a;homeowner doing.all:work right of exemption per MOL 11.�Plumbing repairs or additions myself [No workers' comp:.; c. 152; §1(4),and we have no 12 0 Roof.repairs_ insurance required.]t employees. [No workers' " 13.0 other Weathe6zation comp'.,insurance required.] *Any applicant that checks box#1.must also:fill out the section below showing their workers'wmpensation;policy information. t Homeowners who submit this affidavit indicating1hey are doing all work and then hire outside contractors must.submit anew affidavit'indicating such: :Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. I am an employer that is providing workers'compensation insurance for my entp loyee Below is the policy.and job site information. 1 Insurance.Company Name.-, AE.I C Policy#or Self-ins.Lic.#t WCC. 5 0.0 5 5 9 3 0`12 014A. __ Expiration Date: 10/3/15- Job Site;Address: aw� City/State/Zip: 061 Attach a copy of the workers'compensation policydeclaration page(showing the policy num er and expiration date). Fat ure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criininal 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 may be forwarded to the Office of Investigations of the;DIA for insurance coverage-verification. I do hereby certify under the parsp.enalties of perjury that the information provided above is true and correct Si ature: Date: :... Phone#:. ISO8) 778-0,111 Official.use only.. Do not.wriie ih4hrs:area,to be con pleted'by city`or town offIciaL City or Town: Permit/License# 'Issuing Authority(circle one): 1.Board of gIealth 2 Budding Department.3.City/.Town Clerk. 4.Electrical:Inspector 5.Plumbing Inspector 6.Other Contact:Person: Phone' ) 7 9 t �co a�CERTIFICATE OF LIABILITY N U NC ioo24 z THIS CERTIFICATE IS ISSUED AS.A RATTER OF INFORMATION>ONLYAND CONFERS NO.RiGHTS UPON THE CERTIFICATE HOLDER THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND;.OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE'DOES NOT CONSTITUTE'A CONTRACT BETWEEN THE ISSUING INSURERS); AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT:..If the certificate holder is an ADDITIONAL:INSURED the policy(ies}mkt be:endorsed. If SUBROGATION IS WAIVED,subject-to the terms and conditions of the policy,certain.Wicies may require an endorsement. A statement on,this Certificate does not_eanfer rights to the certificate holder in Tieu ofsuch endorsement(s). PRODUCER N:CONTACT AME: Lora FitzGerald _. ... _ ..._.. Southeastern Insurance Agency PHONE 1810,No- �.(ioe)997-6661 Nfl 98)990-2731 439 State Rd. F-M L ' .lfitZ@southeasternins-com 44DMSS P.Q. Box 79398 - INSURER(S)AFFORDING cov9RAdE. - North Dartmouth %DIAL 02747: tNSURERa ArbellA Protection. Insurance 413150 INSURED INsuRER a Boston Insurance 'Brakera a Ind_ . Tupper Construction .Co IMC INSURER c 27 Roberta Drive INSURER D< West Yarmouth NA 02,673 , ..- INSURERFr::,. COVERAGES CERTIFICATE NUMBER:2015 REVISION NUMBER: THIS IS TO CERTIFY THAT 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 POLICIESiDESCRIBED HEREIN IS SUBJECT TO+ALL THE TERMS, EXCLUSIONS AND CONOITIONS'oF SUCH POLICIES.`LIMtTS'SHOWN MAY HAVE BEEN REDUCED ay PAID CLAIMS.. INSR - POLCY E `POLICY EACP: . tiTtt,. 'TYPE OF INSURANCE. POLCY NUMEFR . MMlOD P&NUD01 UNITS: . GENERAL UABIurr 1. 000 000 EACH S i r .. DAMAGE TO REAi D :100,000 X COMMERCIAL GENERAL LUa81U?Y ! e S A CLAIMS-MADE FX OCCUR 500008793. 1/1/2019 Ji/201$ MEDEXP Any one person) S 5,000 PERSONAL&'ADVINJURY. S' 1,000,000 GENERAL AGGREGATE S 2,000,000 - GEN'L AGGREGATE LIMIT APPLIES-PER: - PRODUCTS-COMPIOPAGG 5', 2,000,000 X1 POLICY PRO- JECTLOC S 'AUTOMOSILE LABILITY _ CON9tNED SINGLE LIMIT aaicdient .g 1. 0w-Oo0 ANY AUTO BODILY:INJURY(Per person) S p' ALL,OWNED X SCHEDULED 020009389 2/1/2013 /1/2014, OODIL V INJURY(PeraQddem)`,S AUTOS AUTOS. ..:-. X X NON-OANED PROPERTY DAMAGE S HIRED AUTOSAUTOS Paraecident -_.... _. .... Lxunsumdmnxrtstet' 'tErrlit g .250 000 X, UMBRELLA LIAR, HOCCUR EACH'OCCURRENCE S A EXCESS-LAB- CLAIMS-MADE AGGREGATE'-.. .. S._ 600058368 1/1/2014 161/2015 S. OED�- RETENTION S ...�� _._..... -: $ WORKERS.COMPENSATION X % TATU .OTC AND EMPLOYERS'LIABILITY Y,I N !Ry LI.T. ANY PROPRIETORIPARTNERIEXECUME EL.EACH ACCIDENT S 1,,_000 D00 OFFICERIMEMBER EXCLUDED? ® .N/A . (Mandatary in NH) CC50055934Z2014E 0/3/2014 O J3/2015 E:L,DISEASE-.EA-EMPLOYE S 1 000 000 It yes.describe under .DESCRIPTION OF OPERATONS below ., . . .' .. ... _... E.L DISEASE-POLICY LIMIT'-:S 1,000,006 - DESCRIPTION:OF OPERATIONS J LOCAMON S;VEHICLES(Attach:ACORD t69,AkW lonal Rernarft Schedule..If more space is repuIred)- CERTIFICATE HOLDER CANCELLATION' tioo D'ANY OF THE ABOVE DESCRIBED POLICIES BE CD.NCEI:.LED BEFORE THE, EXPIRATION DATE THEREOF; NOTICE' WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS: INFOF2 RATION pblE POSES ONLY TUPPER CONSTRUCTION' CO LLC _. .. .. 546 A"HIGGINS Ci20WEI,L ROAD- A oRIz REPRESFtIrATrvE WEST YARMOUT):1, MA 02573 Lora F ta6erald/LHL ACORD 25(2010105} 61988-2010_ACORD CORPORATION.All rights.rr?served:. 1NSO25rlf1itttL IOt:. T61 Af`nprl:eiamn ane8'3nnn sra',aatec4onael m. .4c.of ACAIRIA gr scr.o,.v r.�P++s'�s-y�.tn.xaa"�'�v +cs6s �"a�rik -r +-�.-a:-•.;� 3 c - .. r a tea, s z er 4 isxs<� rc zcettrtL 3rT rt ar r_ �YI� 7GE4i��i; l sLt� n. c ,J r- ' �+'`�-c s3.�.> L� s at4t AG :suklrrs3:"u' A. tGANST +....r.�._..:.�,..,._...T::..-,.--...e,.•-.�.,,=,.gw;.�az;wx .w..w±R�r.� _-�+e:;vF _wacsr%ua• �.:.�.�—.c an:,..._..c fin.:::_• .. .-... .... "__,..,. ri j �stsc ElWt, 6, TE1ANT/PROPERTY OWNER/AGENCY WEATHERIZATION AGREEMENT. 1.. The Parties to this Agreement are the following: 2. V. (print your tenant's name) (hereafter known as Tenant), �'YIr ` -u '�=_ (hereafter known as Property Owner) (print your name) and Housing Assistance Corporation(hereafter known as Agency). In consideration of the mutual promises hereafter stated,the Parties agree as follows: 3.* The date"of Agency's signature will*be the effective date'of this Agreement: i 4. Property Owner and Tenant consent and agree that the Agency may do the following with respect to the property located at(street,town) unit#f and-currently leased or rented to the j Tenant. a) Enter the premises for the purpose of performing a Weatherization inspection. b) Enter the premises to perform Weatherization work which the Agency determines in its discretion is necessary and appropriate as a result of the Agency's inspection of the property and in accordance with the appropriate priority list for the type of dwelling. The Agency and the Agency's contractors may also enter the appropriate common areas of the building for the purpose of accomplishing the Weatherization work. The Agency and representatives of the Commonwealth of Massachusetts, Department of Housing & Community Development (DHCD) may further enter the property to inspect any and all work hereunder. The Agency will provide reasonable notice of the timing of the Weatherization work and inspections. The Weatherization work will be performed in accordance with the Property Owner's consent as further specified below: INMAL ONLY ONE OF THE FOLLOWING I consent to performance by the Agency and its contractors of any Weatherization work determined necessary and appropriate by the Agency as a result of its inspection of the property. I understand that the Agency will provide a detailed statement of the actual work performed and the associated value at the completion of work. I will provide a separate consent to performance by the Agency and its contractors of Weatherization work following my receipt of the Agency's inspection report and a statement of the estimated work and associated value. This additional consent will be sent under separate cover as Attachment A. 1 understand that the Agency will .provide a detailed statement of the actual work performed and the S4Gi #Qcl vaGrae atth€?-cmRtet'?n:of thevtcrk, 5. The Property Owner understands and agrees that any and all work, including related repairs for which the Property may also be eligible, will be performed at the Agency's discretion. The Agency estimated completion of the Weatherization work by the end of 2014/2015. 6. If the Property Owner is required to make repairs to the property prior to the commencement of Weatherization work by the Agency,the Property Owner will be notified by the Agency and will be required to make the repairs as soon as possible. Except where the Property Owner receives a written extension from the Agency,time is of the essence in the performance of repairs by the Property Owner. 7. The Property Owner and Tenant authorize the Agency to receive a statement from the fuel supplier/utility supplier as to the quantity of fuel/utilities used at the above address in each of the past three years and the future three years. The information is to be used only to determine the cost effectiveness of the Veatherization improvements. 8. The Property Owner agrees that the rent for the dwelling unit will not be raised because of any increase in the value thereof due solely to the Weatherization work performed. 9• In consideration of the Weatherization work hereunder, the Property Owner further agrees that upon the effective date of this Agreement and during a period extending through 2014/2015, approximately one year from the time the work is completed, a) The present rent$JOCa CQ per month will not be raised for an . filled in). Heat included in rent?Yes_ No y reason (The rent amount must be However,this Paragraph (8a)will be waived by the Agency in writing if, and only if,the premises are leased under a state or federal rent subsidy program, in which case the actual rent charged by the Owner shall conform to the standards of the rent subsidy program. Please state which Housing Subsidy program your tenant is on and through which Agency: i b) The Property Owner will not institute an summaryp p non-payment of rent or other good cause related t the Tenant(or any successors Tenant). in the case of c) in the event the Property Owner decides to sell the premises, Property Owner shall comply with one of I the two requirements below: --The Property Owner shall not sell the premises unless the buyer agrees(with a copy forwarded to the Agency) in writing prior to sale to assume all obligations of the Property Owner set out in this Agreement;or --The Property Owner shall pay the Agency an amount equal to the cost, as certified by the Agency, of the Weatherization materials installed and labor performed in the premises as of the date of sale. Said amount shall be paid to.the Agency immediately upon sale. 4 10. (Applicable only if Tenant's heat is included in rental payment and blanks are filled in) At the end of the period set forth in Paragraph 8 above, the rent shall not be raised more than °kue in effect for such period. per for an additional period of one year, and the provisions of 8b and 8c above shall continu However, the rent provisions of this Paragraph 9 may be waived by the Agency writing if,.and only if, the premises are leased under a state or federal rent subsidy program, in which case the actual rent charged by the Owner shall conform to the standards of the rent subsidy program. • i 11. The Parties agree that the terms of this Agreement are incorporated into any other lease or agreement between the Property Owner and the Tenant, and between the Property Owner and any successor Tenant, and if there any conflict between the provisions of this Agreement and the provisions of such other lease or agreement, theis provisions of this Agreement shall govern. However, if.such other lease or agreement, including without limitation a lease oF;Ggrss^ nt:snd��.s; ta feri rat rerrt_ ubvidY,pregCalx; gc�niai,'1S Str. .oto.t;g fi •:tl'is"Tor,Art, such stronger protections shall apply. 12. For.breach of this Agreement by the Property Owner, the Property Owner shall reimburse the Agency in an amount equal to the cost, as certified by the Agency, of the Weatherization materials installed and labor performed on the premises, as well as attorneys fee and court costs. The Property Owner may also be liable for damages to the Tenant in accordance with applicable law; in such instance, the Property Owner shall reimburse the Tenant for attorneys fees and court costs. Without limiting the foregoing, the Agency may at its option terminate this Agreement,by providing written notice to the Property Owner and Tenant, in the event of breach by the Property Owner or Tenant. IS. Performance of the Weatherization work,hereunder by the Agency is contingent upon the availability of funds to the Agency from the commonwealth of Massachusetts and the federal government, as well as the eligibility of the Tenant under WAP program requirements. The Agency may terminate this Agreement, by providing written notice to the Property Owner and Tenant, if the Agency determines that the unavailability of funds or ineligibility of the Tenant warrants termination. r 1`4. The Parties acknowledge that this Agreement is under seal. It is intended by the Parties that the Tenant or any successor Tenant is the inten a beneficiary of the Agreement and shall have a right of enforcement. Property Owner's Signature: DatQ Phone: L 7 W17 Address: Tenant Signature Date Agency Approved Weatherizabon Company Adam T. Incorporated/ All Cape Energy / Alternative Weatherization / Building Science, Construction Cape Cod Insulation ! Cape Save / Frontier Energy Solutions / Lohr Home Improvement Resolution Energy / Tupper Construction Agency Signature Date IKE Regulatory Services Thomas F. Geiiler,Director Building Division • =ABNSPAffi.�, r MASS. � 'Tom Perry,Building Commissioner s639 �� A °• 200:Main Street, Hyannis,MA 02601 www.town:barnstable.ma.us " Office: 509-862-4038 Fax: 508-790-6230 Approved: Fee: - Permit#: 9I 1296 HOME OCCUPATION REGISTRATION Date: 03 fa22 1 1 . Name: CARJ» .�1� �Ar Phone#:' 50e-J2`y iC35�� Address:�j, V'WOOZ 9LAIV-1 X4 11d/S Name of Business: :I J i AS 'T IPA ��J/V Type of Business: 64 J n •��0 Map/Lot:�(D l ' ( ." 10 II1''I'EN'I': It is the intent of this section to alloH,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,prwided that the acti-,Rty 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 vdth the Building Inspector,a customary home occupation shall be permitted as of right subject to the follovdng conditions: • The actitaty is carried.on by4ie 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 iu 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,hunudity 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.are no commercial velucles.related to the Customary Horne 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 i the Customary Home Occupation N•vho is not a permanent resident of the dwelling unit. I, the undersigned,have read and agree F the above restnctioris for my home occupation I am registering. . A-PPlicant: Date Hoineoc.doc Rel.01/3/08 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 Fl., 367 Main St., Hyannis, MA 02601 (Town Hall) and get the Business Certificate that is required by law. DATE: 0 2 h , Fill in please: fg° APPLICANT'S YOUR NAME/S: I C �� .. Y BUSINEEB YOUR HOME ADDRESS: . 5 WQW i 0 - a -P9 TELEPHONE # Home Telephone Number 50if- H NAME QF CORPORATION TY NAME OF NEW BL181NESS 1 QlJ R i11 PE OF'BUSINESS IS ISi. HOME OCCUPA fir IpN? YES. 10 ;ADDRESS OF,BUSI,IyESS r MAP/PARCEL NUMBER Z `.O�p D' Assessrn9 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 CO ISSIO RCS OFF MUST COMPLY WITH HOME OCCUPATION This individu I h1a a in ad ,f ny rmit ire ent s hat pertain to this type of businessRULES AND REGULATIONS. FAILURE TO COMPLY MAY RESULT IN PINES. :Au horized-Sign r O 14TS: r CtiY777 2. BOAR F HEALTH This individual has en i ,rp� of the permit requirements that pertain to this type of business. ' MUST c OMPLY WITH ALL Authorized Signature** HAZARDOUS MATERIALS REGULAT&111 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: Date: / ZZ/ TOWN OF BARNSTABLE TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM NAME OF BUSINESS: D t Ag BUSINESS LOCATION: '35-, W-2261Aovl AiC- PV,4rynV1 e, INVENTORY MAILING ADDRESS: e5-, t//oo„ZLAjf /z A-,)C 11 IzA rywr G TOTAL AMOUNT: TELEPHONE NUMBER:_.50$- 5.241 CONTACT PERSON: ir-)y6.w_lbts;4 E EMERGENCY CONTACT ELEPHONE NUMBER: -5 US- -5.2 4,1-6 5 19 MSDS ON SITE? TYPE OF BUSINESS: INFORMATION / RECOMMENDATIO S: 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, Section131, 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 i Motor Oils Pesticides ❑ NEW ❑ USED (insecticides, herbicides, rodenticides) j Gasoline, Jet fuel,Aviation gas Photochemicals(Fixers) Diesel Fuel, kerosene, #2 heating oil ❑ NEW ❑ USED Miscellaneous petroleum products: grease, Photochemicals (Developer) i 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 I 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) 1 ❑ 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): j _ Metal polishes Laundry soil &stain removers t j (including bleach) 0 V 70L Spot removers &cleaning fluids (dry cleaners) Other cleaning solvents Bug and tar removers Windshield wash -- ----- WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS pplicant's Signature Staff's Initia s