HomeMy WebLinkAbout0058 WILLOW AVENUE - Health 5 8 Willow Ave
Hyannis. /,.�Q .'Wd
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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 the 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 A)
at 200 Main St., Hyannis. Take the completed form to the Town Clerk's Office, 151 FI., 367 Main St., Hyannis, MA 02601(Town Hall) and get
the Business Certificate that is required by law.
x DATE:
�r Y � Fill in please:
' APPLICANT'S YOUR NAME:
BUSINESS YOUR HOME ADDRESS:
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TELEPHONE # Home Telephone Number:
NAME OF NEW BUSINESS TYPE OF BUSINESS
IS THIS A.HOME OCCUPATION?- YES NO
Have you_,been given approv • r t ; bwldi division? YE NO .
ADDRESS OF BUSINESS _ ) P 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 OFFICE
This individual has been informed of any permit requirements that pertain to this type of business.
Authorized Signature**
COMMENTS:
2. BOARD OF HEALTH
This individual hasRb�ee�rnfo ed of the pe t re nts that pertain to this type of business. MUST COMPLY WITH ALL
HAZARDOUS MATERIALS REGULATIONS
Authorized Sign e**
COMMENTS:
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3. CONSUMER AFFAIRS (LICENSING AUTHORITY) r
This individual ha p 'n informs. " of th Iicensi g eqy!r '7g&bat pertain to this type of business.
Aut or' ed Signature**
COMMENTS: I/��. ZL C,(�Ju�c
TOWN OF BARNSTABLE Date:
TOXIC AND HAZARDOUS MATERIALS ON-SITE INVENTORY
NAME OF BUSINESS:
002 A)be?d:�&
BUSINESS LOCATION: INVENTORY
MAILING ADDRES TOTAL AMOUNT:
TELEPHONE NUMBER:
CONTACT PERSON:
EMERGENCY CONTACT TELEPHONE NUMBER. MSDS ON SITE?
TYPE OF BUSINESS: WhO 10_ .r
INFORMATION/RECOMMENDATIONS: Fire District:
Waste Transportation: Last shipment of hazardous waste:
Name of Hauler estination:
Waste Product: -d Licensed? Yes No
NOTE: Under the provisions of Ch. 11.1, 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
Q�Antifreeze (for gasoline or coolant systems) _ Misc. Corrosive
NEW USED Cesspool cleaners
Automatic transmission fluid Disinfectants
Engine and radiator flushes Road Salts (Halite)
Hydraulic fluid (including brake fluid) Refrigerants
Motor Oils 456- Pesticides
NEW USED (insecticides, herbicides, rodenticides)
Gasoline, Jet fuel, Aviation gas Photochemicals (Fixers)
Diesel Fuel, kerosene, #2 heating oil ,V NEW USED
Misc. petroleum products: grease, Photochemicals (Developer)
lubricants, gear oil NV% 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 Misc. Combustible
to Car wash detergents '�(,{/� Leather dyes
XZ -Sit Car waxes and polishes Fertilizers
Asphalt & roofing tar PCB's
Paints, varnishes, stains, dyes Other chlorinated hydrocarbons,
Lacquer thinners (inc. carbon tetrachloride)
NEW USED Any other products with "poison" labels
Paint &varnish removers, deglossers (including chloroform, formaldehyde,
Misc. Flammables hydrochloric acid, other acids)
I furniture strippers Other products not listed which you feel
Floor & u pp p
Metal polishes may be toxic or hazardous (please list):
Laundry soil & stain removers
(including bleach)
Spot removers &cleaning fluids
(dry cleaners)
Other cleaning solvents
Bug and tar removers
Windshield wash
COPY-HEALTH DEPARTMENT!CANARY COPY-BUSINESS
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24 Hour L'_ Heating Oil&- '
Service P ppane',as '
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Elm St.''-&Willow Ave:;Hyannis,~MA 02601
f ':508-771-0001 -, Fax,508-862 02.1'5 z
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TOWN OF BARNSTABLE OMPLIANCE: CLASS: 1.Marine,Gas Stations,Repair
satisfactory' 2.Printers
BOARD OF HEALTH 3.Auto Body Shops
O unsatisfactory- 4.Manufacturers
C0MPANY,1/;' �,i� (see "Orders") 5.Retail Stores
6.Fuel Suppliers
ADDRESS /��.fiil4!�"1// 1`�Class: 7.Miscellaneous
dt'iia QUANTITIES AND STORAGE (IN= indoors; OUT=outdoors)
MAJ MATERIALSUndergrouidTanks
IN OUT IN OUT IN OUT #&gallons Age Test
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,Bie��„#2 (B)
Heavy Oils:
waste or oil(C)
new or oil (C) .
transmi on/ ydraulic
Synthetic Organics:
degreasers
Miscellaneous:
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DISPOSAL/R.ECLAMATION REMARKS:
1. Sanitary Sewage 2.Water Supply �✓
011"Town Sewer OPublic
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On-site OPrivate /
3. Indoor Floor Drains YES NO --_
O Holding tank:MDC
O Catch basin/Dry well
O On-site system
4. Outdoor Surface drains:YES N0 ORDERS:
O Holding tank:MDC S
O Catch basin/Dry well
O On-site system s
5.Waste Transporter '
Name of Hauler Destination Wa ste o' d
YES NO
2.
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son(s) Interviewed fn pe�ctor Date