The URL can be used to link to this page

Home My WebLink About0342 MAIN STREET (HYANNIS) - Health 42 MAIN STREq-tIpA= szWER ,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, 1st FI., 367 Main St., Hyannis, MA 02601 (Town Hall) and get the Business Certificate that is required by law. -- — DATE: Fill in please: APPLICANT'S YOUR NAME/S: IV i A4 O� U B SIwE YOU HOME ADDRESS: -� k P 4 .z . . �,t TELEPHONE # Home thlephone Number NAME OF CORPORATION: S2r NAME OF NEW BUSINESS ITYPE OF BUSINESS O(� IS THIS A HOME OCCUPATION? YES NO �e lZ CO ADDRESS OF BUSINESS ' r' AP/PARCEL NUMBER (Assessing) When starting a new business there are several things you must do in order to be in compliance with the rules and regulations of the Town of Barnstable. This form is intended to assist you in obtaining the information you may need. You MUST GO TO 200 Main St. — (corner of Yarmouth Rd. & Main Street) to make sure you have the appropriate permits and licenses required to legally operate your business in this town. 1. BUILDING COMMISSIONE OFFICE This individual has been for of any p i r�c iirements that pertain to this type of business. Autho e S' at re** COMME TS; 2. BOARD OF HEALTH This individual ha rinfor it requirements that pertain to this type of business. A thorized 5igna ure** MILI POMPLY IIVITH ALL. COMMENTS: FAA ARDOUR iVIATERIALS REhUUkTf�7NS 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:)"' 'I TOWN OF BARNSTABLE TOXIC AND HAZARDOUS MATERIALST8GAQT\1 EGISTRATION FORM NAME OF BUSINESS: - -�I�— .V y �'- 5 p A 1 Ivy,m l; BUSINESS LOCATION: j.0 to 6t, jLti ye.L 0 1 IU STR,6GT_ H Yftild S i INVENTORY MAILING ADDRESS: TOTAL AMOUNT: TELEPHONE NUMBER: 11 k y 6 q 15 d CONTACT PERSON: S 0 oZ g D 3 off- 1 +'L1 EMERGENCY CONTACT TELEPHONE NUMBER: MSDS ON SITE? PE OF BUSINESS: S-FA INFORMATION / RECOMMENDATIONS: Fire District: Waste Transportation: Last shipment of hazardous waste: Name of Hauler: Destination: Waste Product- Licensed? Yes No NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws of MA, hazardous material use, storage and disposal of 111 gallons or more a month requires a license from the Public Health Division. LIST OF TOXIC AND HAZARDOUS MATERIALS The Board of Health and the Public Health Division have determined that the following products exhibit toxic or hazardous characteristics and must be registered regardless of volume. Observed / Maximum Observed / Maximum Antifreeze (for gasoline or coolant systems) Miscellaneous Corrosive ❑ NEW ❑ USED Cesspool cleaners Automatic transmission fluid Disinfectants Engine and radiator flushes Road salts (Halite) Hydraulic fluid (including brake fluid) Refrigerants Motor Oils Pesticides ❑ NEW ❑ USED (insecticides, herbicides, rodenticides) Gasoline, Jet fuel,Aviation gas Photochemicals (Fixers) Diesel Fuel, kerosene,#2 heating oil ❑ NEW ❑ USED Miscellaneous petroleum products: grease, Photochemicals (Developer) lubricants, gear oil ❑ NEW ❑ USED - Degreasers for engines and metal Printing ink Degreasers for driveways&garages Wood preservatives (creosote) Caulk/Grout Swimming pool chlorine Battery acid (electrolyte)/Batteries Lye or caustic soda Rustproofers Miscellaneous Combustible Car wash detergents Leather dyes Car waxes and polishes Fertilizers Asphalt& roofing tar PCB's Paints, varnishes, stains, dyes Other chlorinated hydrocarbons, Lacquer thinners (including carbon tetrachloride) ❑ NEW ❑ USED Any other products with "poison" labels (including chloroform,formaldehyde, Paint&varnish removers, deglossers hydrochloric acid, other acids) Miscellaneous. Flammables Other products not listed which you feel Floor&furniture strippers may be toxic or hazardous (please list): Metal polishes Laundry soil &stain removers jorj(including bleach) Spot removers&cleaning fluids (dry cleaners) a1. Other cleaning solvents Bug and tar removers nc �lh&nAy- Windshield wash ` WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS an s Signature Staff nitials _ Name: For your convenience, this date has been reserved for your dental treatment on: ❑Mon. ❑ Tues. ❑ Wed. ❑ Thur. ❑ Fri. ❑ Sat. Date: at A.M./P.M. If you are unable to keep your appointment, Please give us 24-hour notice. GATEWAY DENTAL CARE GENERAL AND COSMETIC DENTISTRY DR. RANA MOSHAKE D.M.D. 344 Main Street (508) 771-1751 N Hyannis,MA 02601 fax (508)771-1753 TOWN OF BARNSTABLE COMPLIANCE: CLASS: 1. Marine,Gas Stations,Repair satisfactory 2. Printers BOARD OF HEALTH 0 ry 3.Auto Body Shops unsatisfactory- 4. Manufacturers COMPANY�� t � (see"Orders") 5. Retail Stores S. Fuel Suppliers ADDRESS S* tAW77 %k- Class: _ =�qgt 7. Miscellaneous �lY1tS, Vc.r-i- QUANTITIES AND STORAGE (IN= indoors; OUT=outdoors) MAJOR MATERIALS Case lots Drums Above Tanks Underground IN OUT IN OUT IN OUT #&gallons Age Test Fuels: Gasoline,Jet Fuel (A) Diesel, Kerosene, #2 (B) Heavy Oils: waste motor oil (C) new motor oil(C) transmission/hydraulic Synthetic Organics: degreasers d'ko c Miscellaneous: DISPOSALIRECLAMATION REMARKS: 1. Sanitary Sewage 2.Water Supply OH p _ Town Sewer Public O On-site OPrivate /Q l 3.Indoor Floor Drains YE NO)L �_3' CC) O Holding tank:MDC O Catch basin/Dry well Conif O On-site system l �, 4. Outdoor Surface drains:YES NO ORDERS- 0 Holding tank:MDC O Catch basin/Dry well _ t O On-site system � `L- �t ` l7ILL a. 5.Waste Transporter 0 Narne of Hauler Destina t ion Waste Product •d 1. � �� (S�Vb � O 0� k5^Lk.�5 71 NO 2. 1�, OP R/Q, 41L Person s) Interviewed Inspector Date t Date: TOXIC AND HAZARDOUS MATE ALS REGISTRATION FORM NAMEOFBUSINESS: tea, I CAS` BUSINESS LOCATION: 3H 2 M cc;n St 1:4 j S M A MAILINGADDRESS: I a ' o 5 Mail To: TELEPHONE NUMBER: 5o Board of Health Town of Barnstable CONTACT PERSON: RVA nCL- M cr�b.a 1/p .uu . P.O. Box 534 EMERGENCY CONTACT TELEPHONE NUMBER: (5o2) 4 Zo_ -19 6Z Hyannis, MA 02601 TYPEOFBUSINESS: men+rJ "H;Ce %Does your firm store any of the toxic or hazardous materials listed below, either for sale or for you own use? YES NO This form must be returned to t e Board of Health regardless of a yes or no answer. Use the enclosed envelope for your convenience. If you answered YES above, please indicate if the materials are stored at a site other than your mailing address: ADDRESS: TELEPHONE LIST OF TOXIC AND HAZARDOUS MATERIALS The Board of Health has determined that the following products exhibit toxic or hazardous character- istics and must be registered regardless of volume. Please estimate the quantity beside the product that you store. NOTE: LIST IN TOTAL LIQUID VOLUME OR POUNDS. Quantity Quantity Antifreeze(forgasoline orcoolant systems) Drain cleaners NEW USED Cesspool cleaners Automatic transmission fluid Disinfectants Engine and radiator flushes Road Salt (Halite) Hydraulic fluid (including brake fluid) Refrigerants Motor oils Pesticides NEW USED (insecticides, herbicides, rodenticides) Gasoline, Jet Fuel Photochemicals (Fixers) Diesel fuel, kerosene, #2 heating oil NEW USED Other petroleum products: grease, Photochemicals (Developer) lubricants, gear oil NEW USED Degreasers for engines and metal Printing ink Degreasers for driveways & garages Wood preservatives (creosote) Battery acid (electrolyte) Swimming pool chlorine Rustproofers Lye or caustic soda Car wash detergents Jewelry cleaners Car waxes and polishes Leather dyes Asphalt & roofing tar Fertilizers Paints, varnishes, stains, dyes PCB's Lacquer thinners Other chlorinated hydrocarbons, NEW USED (inc. carbon tetrachloride) Paint & varnish removers, deglossers Any other products with "poison" labels Paint brush cleaners (including chloroform, formaldehyde, Floor & furniture strippers hydrochloric acid, other acids) Metal polishes Laundry soil & stain removers Other products not listed which you feel (including bleach) may be toxic or hazardous (please list): Spot removers & cleaning fluids (dry cleaners) Other cleaning solvents Bug and tar removers WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS Date: .. - TOXIC AND HAZARDOUS MATERIALS REGISTRATION FOR NAMEOFBUSINESS: ? , BUSINESS LOCATION: MAILINGADDRESS: Mail To: TELEPHONE NUMBER: '771- 464-6 Board of Health Town of Barnstable CONTACT PERSON: D - P.O. Box 534 EMERGENCY CONTACT TELEPHONE NUMBER: Hyannis, MA 02601 TYPEOFBUSINESS: Does your firm store any of the toxic or hazardous materials listed below, either for sale or for you own use? YES t-`_ NO This form must be returned to the Board of Health regardless of ayes or no answer. Use the enclosed envelope for your convenience. If you answered YES above, please indicate if the materials are stored at a site otherthan your mailing address: ADDRESS: ��,Z ld//1 (�T�T��, lZ66)l TELEPHONE: ;ZZT 4gQda LIST OF TOXIC AND HAZARDOUS MATERIALS The Board of Health has determined that the following products exhibit toxic or hazardous character- istics and must be registered regardless of volume. Please estimate the quantity beside the product that you store. NOTE: LIST IN TOTAL LIQUID VOLUME OR POUNDS. Quantity Quantity Antifreeze(for gasoline or coolant systems) Drain cleaners NEW USED Cesspool cleaners Automatic transmission fluid f Disinfectants_ Engine and radiator flushes Road Salt (Halite) Hydraulic fluid (including brake fluid) Refrigerants Motor oils Pesticides NEW USED (insecticides, herbicides, rodenticides) Gasoline, Jet Fuel Photochemicals (Fixers) Diesel fuel, kerosene, #2 heating oil NEW USED Other petroleum products: grease, Photochemicals (Developer) lubricants, gear oil NEW USED Degreasers for engines and metal Printing ink Degreasers for driveways & garages Wood preservatives (creosote) Battery acid (electrolyte) Swimming pool chlorine Rustproofers Lye or caustic soda Car wash detergents Jewelry cleaners Car waxes and polishes Leather dyes Asphalt & roofing tar Fertilizers Paints, varnishes, stains, dyes PCB's Lacquer thinners Other chlorinated hydrocarbons, NEW USED (inc. carbon tetrachloride) Paint & varnish removers, deglossers Any other products with "poison" labels Paint brush cleaners (including chloroform, formaldehyde, Floor& furniture strippers hydrochloric acid, other acids) Metal polishes Laundry soil & stain removers Other products not listed which you feel (including bleach) may be toxic or hazardous (please list): Spot removers & cleaning fluids (dry cleaners) Other cleaning solvents zhmmmner Bug and tar removers WHITE COPY-HEALTH DEPARTMENT/CAN AY COPY BUSINESS 1 Date: 7 TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM NAMEOFBUSINESS: L& lz �mnz zcc m BUSINESS LOCATION: 00 1*91N S—IM MAILINGADDRESS: 3�)q //U alz&1_1� Mail To: TELEPHONE NUMBER: 599 925-Z/&VD Board of Health Town of Barnstable CONTACTPERSON:1.�} 19 T/U00-%7 P.O. Box 534 EMERGENCY CONTACT TELEPHONE NUMBER: Hyannis, MA 02601 TYPEOFBUSINESS: ' rfiV7-/ 59ZON Does your firm store any of the toxic or hazardous materials listed below, either for sale or for you own use? YES NO This form must be returned to the Board of Health regardless of a yes or no answer. Use the enclosed envelope for your convenience. If you answered YES above, please indicate if the materials are stored at a site other than your mailing address: ADDRESS: TELEPHONE: LIST OF TOXIC AND HAZARDOUS MATERIALS The Board of Health has determined that the following products exhibit toxic or hazardous character- istics and must be registered regardless of volume. Please estimate the quantity beside the product that you store. NOTE: LIST IN TOTAL LIQUID VOLUME OR POUNDS. Quantity Quantity Antifreeze(for gasoline or coolant systems) Drain cleaners NEW USED Cesspool cleaners Automatic transmission fluid Disinfectants Engine and radiator flushes Road Salt (Halite) Hydraulic fluid (including brake fluid) Refrigerants Motor oils Pesticides NEW USED (insecticides, herbicides, rodenticides) Gasoline, Jet Fuel Photochemicals (Fixers) Diesel fuel, kerosene, #2 heating oil NEW USED Other petroleum products: grease, Photochemicals (Developer) lubricants, gear oil NEW USED Degreasers for engines and metal Printing ink Degreasers for driveways & garages Wood preservatives (creosote) Battery acid (electrolyte) Swimming pool chlorine Rustproofers Lye or caustic soda Car wash detergents Jewelry cleaners Car waxes and polishes Leather dyes Asphalt & roofing tar Fertilizers Paints, varnishes, stains, dyes PCB"s Lacquer thinners Other chlorinated hydrocarbons, NEW USED (inc. carbon tetrachloride) Paint & varnish removers, deglossers Paint brush cleaners Any other products with "poison" labels (including chloroform, formaldehyde, Floor & furniture strippers hydrochloric acid, other acids) Metal polishes Laundry soil & stain removers Other products not listed which you feel (including bleach) may be toxic or hazardous (please list): Spot removers & cleaning fluids //O OA117OF Ca6p,,iQ ,Sv(,om1,9x) (dry cleaners) 4f- koh ol— Other cleaning solvents j lidAeLl-/L iFIcwL Bug and tar removers ), — WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS TOWN OF BARNSTABLE COMPLIANCE: CLASS: 1.Marine,Gas Stations,Repair BOARD OF HEALTH ,satisfactory 2.Printers 3.Auto Body Shops &:_tSAC unsatisfactory- 4.Manufacturers COMPANY L 2Ay (see"Orders") 5.Retail Stores 6.Fuel Suppliers ADDRESS -2 ass: 7.Miscellaneous QUANTITIES AND STORAGE (IN= indoors;OUT=outdoors) MAJOR MATERIALS Case lots / Underground IN OUT IN OUT IN OUT #&gallons Age Test Fuels: Gasoline,Jet Fuel (A) Diesel, Kerosene, #2 (B) Heavy Oils: waste motor oil (C) new motor oil (C) transmission/hydraulic Synthetic Organics: degreasers Miscellaneous: , //D 1C 0 t-7 ,d 1 S6 0 DISPOSAIJRECLAMATION REMARKS: 1. Sanitary Sewage . 2.Water Supply own Sewer Oublic O On-site OPrivate 3. Indoor Floor Drains YES .N0'1V_ O Holding tank:MDC O Catch basin/Dry well O On-site system 4. Outdoor Surface drains:YES _NO ORDERS: O Holding tank:MDC 'Latch basin/Dry well O On-site system 5.WqAte Transporter Name of Hauler Destination Waste Product YES I NO 1. 2. Person (s) Interviewed Inspector Date TOXIC AND HAZARDOUS MATERIALS EGISTRATION FORM NAME OF BUSINESS: 61 kU oter Mail To: BUSINESS LOCATION, _ MA- O1 L 4PJIV S d E!:�-4—, qownoard of Health MAILING ADDRESS: �� of Barnstable P.O. Box 534 TELEPHONE NUMBER: Hyannis, MA 02601 CONTACT PERSON: UZI fv,iC_ C q EMERGENCY CONTACT TELEPHONE NUMBER: d Does your firm store any of the toxic or hazardous materials listed below, either for sale or for your own use, in quantities total ing, at any time, more than 50 gallons liquid volume or 25 pounds dry weight? YES NO This form must be returned to the Board of Health regardless of a yes or no answer. Use the enclosed envelope for your convenience. If you answered YES above, please indicate if the materials are stored at a site other than your mailing address: ADDRESS: TELEPHONE: LIST OF TOXIC AND HAZARDOUS MATERIALS The Board of Health has determined that the following products exhibit toxic or hazardous character- istics and must be registered regardless of volume. Please estimate the quantity beside the product that you store: Quantity/Case !2nin se Antifreeze (for gasoline or coolant systems) cleaners Automatic transmission fluid Toilet cleaners Engine and radiator flushes Cesspool cleaners Hydraulic fluid (including brake fluid) Disinfectants Motor oils/waste oils Road Salt (Halite) Gasoline, Jet fuel Refrigerants Diesel fuel, kerosene, #2 heating oil Pesticides (insecticides, herbicides, Other petroleum products: grease, lubricants rodenticides P p 9 ) Degreasers for engines and metal Photochemicals (fixers and developers) Degreasers for driveways & garages Printing ink Battery acid (electrolyte) Wood preservatives (creosote) Rustproofers Swimming pool chlorine Car wash detergents Lye or caustic soda Car waxes and polishes Jewelry cleaners Asphalt & roofing tar Leather dyes Paints, varnishes, stains, dyes Fertilizers (if stored outdoors) Paint & lacquer thinners PCB's Paint & varnish removers, deglossers Other chlorinated hydrocarbons, Paint brush cleaners (inc. carbon tetrachloride) Floor & furniture strippers Any other products with "Poison" labels Metal polishes (including chloroform, formaldehyde, Laundry soil & stain removers hydrochloric acid, other acids) (including bleach) Other products not listed which you feel may Spot removers & cleaning fluids be toxic or hazardous (please list): (dry cleaners) �Sah i ,-h Zp r 14 to S Other cleaning solvents I t,ck-A Bug and tar removers -esc Household cleansers, oven cleaners _lam d 1 White Copy- Health Department/ Canary Copy-Business ('"VVS C)C,