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Home My WebLink About0555 MAIN STREET (COTUIT) - Health!' 555 Mein Street Cotuit 1 I i i ,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: -7 ;Z-°15 Fill in please: APPLICANT'S YOUR NAME/S: M i G I I LLIr GUMN eP'4 `` #R. -k � BUSINESS YOUR HOME ADDRESS: 6.5 5 M A w S Z-r��T Ga;vii-, MASS 004�35 Ktr. TELEPHONE # Home Telephone Number 5 o 8 - 6 ,1 zS !2e al f.3UZF k NAME OF,CORPORATION F NAME OF NEW BUSINESS 1 G t4-e elf✓ N& �` TYPE OF BUSINESS C'7»RDEN IS,THIS A HOME OCCUPATIONS 3 YES ` NO ADDRESS OF„B.USINESS' : .S .Nf' �n:': T D C�%'U 7-., MAP'PARCEL,NUMBER " a) :'(Assessing] ,fill 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 OFFI E MUST COMPLY WITH HOME OCCUPATION This individual his be inform d 6an,, er i requirements that pertain to this type of business. RULES AND REGULATIONS. FAILURE TO J . Au horiz S' not C -- COMPLY MAY RESULT IN FINES, COM ENT Uj 2. BOARD OF HEALTH This individual ha info)4 he r itcreq ' ments that pertain to this type of.business. Authorized SWature** MUST COMMY WITH ALL COMMENTS: 1S MATERIALS RF-GMTIM 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�.' / '1�a15 TOWN OF BARNSTABLE TOXIC AND HAZARDOUS MATERIALS NAME OF BUSINESS: 41 G1kt Zj-,P G U/U1116 - l P—" 6-1-s-r�7T60 BUSINESS LOCATION: ,55.< IL44 1AJ Y 7— LOIT 17' A+A, 0-26 ENTORY MAILING ADDRESS: dO. 0. 430,Y /U l 0%U 3,5'TOTAL AMOUNT- TELEPHONE NUMBER: 1,41 CONTACT PERSON: 1W I (-1 H CU-457 GoluN-Er—�z EMERGENCY CONTACT TELEPHONE NUMBER: v cr,6 Y S SDS ON SITE? TYPE OF BUSINESS: {9Oe-6 LAI; 149 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 O served / 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) z __.❑_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 Signature Staff's Initials aza n ory Sneet Criecklist ,1, Date ,.--P-hysical Street Address-Check database to ensure it exists ---"Working Phone Number -Actual Amounts -( ie. gas being used to fuel machines, thinner to clean brushes all count as hazardous materials-no blanks) 4---- Storage Information -location of storage, how long is storage for? If none, note that. A- Disposal Information -where and who? If none, note that. _41t� Applicant Signature -understand what is listed and noted Staff Initial -any questions, know who to ask ehicle Washing/Rinsing? -give a vehicle washing policy and ain it 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. L'O- CATION SEWAGE PERMIT NO\ 5-S75- A i(A �gS VILLAGE I N S T A LLER'S NAME i ,, A DRESS 8 U I L D E R OR OWNER DATE PERMIT ISSUED DATE COMPLIANCE ISSUED ,, �- � .� � r r� d� -.- �-yi Y' �� r � �� r � �` -- lei �.. ,�, t w _ } .:I No..... c Fss.. .. THE COMMONWEALTH.OF MASSACHUSETTS 110" BOAR® OF HEALTH ..V...OF...... .... Appl ration for Uhipoii al Works, Tomitratrtiun Prrutit Application is hereby made for a Permit to Construct ( ) or Repair (,—)-"an Individual Sewage Disposal System at: W. Location.Address or Lot No. .......... ...........—.......�.......-.-. .-----------------------.-.---------- ...---•--........................._.._..... -•----••........................... .. -ne� �� Address ......ifs s4.............. ....................................... ........... ............................................. ................................................... Installer Address Type of Building Size Lot............................S.. q. feet Dwelling No. of Bedrooms................ ..........................Expansion Attic ( ) Garbage Grinder ( ) Other—T e of Building ....... No, of persons............................ Showers a YP g ••--•---------------- P ( )..— Cafeteria-(----.)•. Otherfixtures ------------------------------------•-•-•--•----------•-•••-------•..... WDesign Flow............................................gallons per person per day. Total daily flow..............................._............gallons. WSeptic Tank—Liquid capacity............gallons Length................ Width................ Diameter.....--..---.... Depth................ x Disposal Trench—No..................... Width.................... Total Length.....................Total leaching area....................sq. ft. Seepage Pit No..................... Diameter.............--..... Depth below inlet.................... Total leaching area..................sq. ft. z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date-..........,............................ Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........-----,--........ Lt, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ -----------------y O Description of Soil-------- .. ...............• U -----------------------•--------•-----------•--....------...••-------------------------------------•------------------------------------------••.....-•--------......•---•--•------.......---------••-•. W ----------•---------------------------•--•----•----•----•---------•---•--•-•••-------------......-•----------•-- . ......................... -------- U Nature of Repairs or Alterations—Answer when applicable..----.�:.- ...-:-...z �.-...... ' ...........................� ._._......:____.. --------•--•--•-------------•----.....-•--------....----•--•---.....-----------•--•---;....--.--.-•-----------------------------------•-----------------•---•-•-----•---••----••--.......------•--•• Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TIT E 5 of the State Sanitary Code—The undersi ned further agrees not to place the system in operation until a Certificate.of Compliance has bee issued,by.t - bo of ealth. , Si ned f_ '.._ �......... . . ---- ----- T- Date ApplicationApproved By.............•-- •-- . --•••----•-----•---......-----.........---- ---------.1 Date Application Disapproved for the f o l wing reasons:-------•-----------------------•-------------------------.....--------------•--•-------•--•.....---------------- -----•--------•--------•---•-•---------------------•-•-•-----••-----------•••----------•--...-----...,_..........:_...----------•-----••-----•--------------•-----•-------------------•--•---•-----....--- Date PermitNO......................................................... Issued--•-------•-------•---•-•---•---•-.........------...... Date No................_....... Fps.. ................_. THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH ........ ...0 F..... .... ........................... 't Applirativit for Disposal Works Tongtrurtion Vrrmit Application is hereby m.. ade for a Permit to Construct or Repair ( an Individual Sewage Disposal System at: 1 C" i I Location-Address or Lot N � �/ o. . ... 1 wner Address a .1�... •� t 5a v................................................ --•------------------------••------------•----•-••------......_..- f Installer Address Type of Building Size Lot............................Sq. feet �. Dwelling '.' "'NO. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) a Other—Type T e of Building No. of persons............................ Showers YP g ............................ P ( ) — Cafeteria ( ) a � Other fixtures -----------------------------------------------------------------------------------------------------------------••--------------•--.._..--•--------- WDesign Flow............................................gallons per person per day. Total daily flow............................................gallons. W `.eptic Tank—Liquid capacity............gallons Length................ Width............ Diameter---------------- Depth................ x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No.__._............. Diameter............:....... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by... -------•-•--......•-•--------------------------•-----------•------ Date........................................ Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water........................ fs, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ D xDescription of Soil..........-•---= .... ..............•--------------------------------•-•---------------...---------------------._._......__....._...----• V -•..--•-----••---------••----------------•---------..----------•-----------------•----------------------•------------------- UW --••-----------------------------------------•------------•---•--•---•------------...•----------•-• ----- --------------- = Nature of Repairs or Alterations—Answer when applicable.---____1": : w._...... ...!�?�0 .................. ..--•-----------------------•-------------•-----....-----•-•---•------•-------------........----------------•-•-----------...------------------........................................................ Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Sanitary Code— The undersi ned further agrees not to place the system in operation until a.Certificate of C mpliance has bee issued by t boa d of ealth Sig ned•- •-•..... ................ 01/_ �_---- '.l�_./9ry � " Date Application Approved BY-------- --- •-••... • •--------------------••--•-------••---•-------------•--------- •taw—;1-7-z ---------- Application Disapproved for t following reasons:---•---------•--••••----•------------------------•---•-•---•------------•-----•-------••----•--•------.......••. ...................•-•--......----••----......_....---••--------•---•------•-----•.......--•-----•------•----•-=•------------------==------•----•---••------•-----•-•-••---•------ •-•---. Date PermitNo.....•••-•--••-•---•-•-•-----••--••......-•...........:.: .. Issued........................................................ Date THE COMMONWEALTH OF MASSACHUSETTS 4 BOARD OF HEALTH ................. .......0 F.........F...0 S+ r! u .: +`' r.. T&Prfif irFa#r of ToutpliFanrr T- IS CERTI Yf That the, Individual Sewa eg�,,,,D•isposal System constructed ( ) or Repaired by---•` !t .. !�c'd. :• `"r-d ----. .. 4r� � �y A.Z.+ Installer at .........--•--•------•......f ' has been installed.in accordance with the provisions of TITLE 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No......................................... dated_..................................,............. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTR E® AS A GUARANTEE THAT THE SYSTEM WILL`FUNCTION SATISFACTORY. DATE................... i Inspector.... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH I x OF...... 1 , } No......................... FEE.. `°'...::.. Disposal oos fg s#rnrua rnit --••-- ...................Permission is hereby anted.---- ..._ ----- _._.. to Construct ( ) or Re ,( jyan Individual Se T Disposal System StreaA as shown on the application for Disposal Works Construction Per Dated............................. 4 \ of• ealthod ti DATE.........l017 �S •-- •-- FORM 1255 HOBBS & WARREN, INC'., PUBLISHERS `'�`7•