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Home My WebLink About0004 WIANNO AVENUE - Health (2) 809 MAIN STREET Osterville r, -- —__ _ - - - --- - - -- A = 117 — 090 1 YOU WISI -T-DL.BPEN A B-US,I-NESS. AI For Your Information: Business certificates (cost$40.00 for 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: t<0 1 . Zo)3 Fill in please: ®' APPLICANT'S: YOUR NAME/S: 1 BUSINESI YOUR HOME A DRESS: R. C MA,id.l a . 5og-4Zo P�/l olul- TELEPHONE # Home Telephone Number - U � 2-_ �i � NAME OF CORPORATION: OP 6h NAME OF NEW.BUSINESS ! r TYPE OF BUSINESS a zSJ IS THIS A HOME OCCUPATI N? YES NO ADDRESS OF BUSINESS B01 (V),-0d MAP/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 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 r This individual ha .be o med of the permit requirements that pertain to this type of business. MUST,XMPLY WITH ALL .�"fYVIr ? W2ARDOU.S MATERIALS REGULATIONS Authorized Signature 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: Dater TOWN OF BARNSTABLE TOXICAND � t� fib' HAZARDOUS MATERIALS ON-SITE NAIVE OF BUSINESS: BUSINESS LOCATION: Jai ' M2 T. 1 yILC M INVENTORY MAILING ADDRESS: eo 35 TOTAL AMOUNT: TELEPHONE NUMBER: J ai 9 2 - C 230 CONTACT PERSON: u EMERGENCY CONTACT TELEPHONE NUMBER: SC � �7� `�`��3 MSDS ON SITE? TYPE OF BUSINESS: L�t� Sc. P . DFSt6 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 re wires 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) (r 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 (including bleach) Spot removers &cleaning fluids (dry cleaners) Other cleaning solvents Bug and tar removers Windshield wash �" WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS icant's Si�nature Staff's Initials�i YOU WISH TO OPEN A BUSINESS? For Your Information: Business certificates (cost$40.00 for 4 years). A business certificate ONLY REGISTERS YOUR NAME in town (which you must do by M.G.L.-it does not give you permission to operate.) You must first obtain the necessary signatures onthis form at 200 Main St., Hyannis. Take the completed form to the Town Clerk.'s Office, 1 st Fl., 367 Main St., Hyannis, MA 02601 (Town Hall) and get the Business Certificate that is required-by law. DATE:.3JL I Z-p l Fill in please �p APPLICANT'S ; , YOUR NAME/S: . BUSINESS "YOUR HOME ADDRESS: Z; 1 . h _ /��,1 � . u TELEPHONE # Home Telephone Number NAME OF CORPORATION: I[� . NAME OF NEW BUSINESS .: :SIGH TYPE OF.BUSINESS U� Ll: - G IS THIS A HOME OCCUPATION? YES NO ADDRESS BUSINESS rv,\d �� ': d --�:� MAP/PARCEL NUMBER) b� '(Assessing] When starting a new business there are several things you must do in order to be incompliance with the rules and regulations of the Town of Barnstable: This form is intended to assist you in obtaining the information you may need. You MUST GO TO 200 Main St. - (corner of Yarmouth Rd. & Main Street) to make sure you have the appropriate permits and licenses required to legally operate your business in this town. 1. BUILDING COMMISSIONER'S OFFICE This individual has been informed of any permit requirements that pertain to this type,ofbusiness. Authorized Signature* COMMENTS:. 2: BOARD OF HEALTH This 'individual has been ' mad of the r it requi a ents that pertain to this type of business. _4. MUST COMY WITH ALL . horized Signature*,( HAZARDOUS MATERIALS REGULATION$- , COMMENTS: 3. CONSUMER AFFAIRS (LICENSING AUTHORITY] ' This individual has been informed of the licensing requirements that pertain to this type of business. , Authorized Signature* ''iM COMMENTS: 1-; TOWN OF BARNSTABLE Date: )/a / ZG /4- TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM NAME OF BUSINESS: BUSINESS LOCATION: I��.�L� f}U� INVENTORY MAILING ADDRESS: TOTAL AMOUNT: TELEPHONE NUMBER: �� 3 CONTACT PERSON: Elm EMERGENCY CONTACT TELEPHONE NUMBER: b��5`j2 ej �3 MSDS ON SITE? TYPE OF BUSINESS: INFORMATION / RECOMMENDATIONS: Fire District: Lo_n N3 Ct - 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 re uires 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 0 Automatic transmission fluid Disinfectants Q Engine and radiator flushes Road salts (Halite) C7 Hydraulic fluid (including brake fluid) Refrigerants C7 Motor Oils b Pesticides ❑ NEW ❑ USED (insecticides, herbicides, rodenticides) Q Gasoline, Jet fuel,Aviation gas 0 Photochemicals (Fixers) l7 Diesel Fuel, kerosene, #2 heating oil ❑ NEW ❑ USED � Miscellaneous petroleum products: grease, Photochemicals (Developer) lubricants, gear oil ❑ NEW ❑ USED - 0 Degreasers for engines and metal Printing ink c7 Degreasers for driveways&garages O Wood preservatives(creosote) (� Caulk/Grout 0 Swimming pool chlorine Battery acid (electrolyte)/Batteries a Lye or caustic soda (� Rustproofers 0 Miscellaneous Combustible Car wash detergents b Leather dyes b Car waxes and polishes Fertilizers D Asphalt&roofing tar b PCB's 16 Paints, varnishes, stains, dyes Other chlorinated hydrocarbons, o Lacquer thinners (including carbon tetrachloride) �- d Any other products with "poison" labels ❑ NEW ❑ USED — (including chloroform;formaldehyde, O Paint&varnish removers, deglossers hydrochloric acid, other acids) O Miscellaneous. Flammables Other products not listed which you feel Q Floor&furniture strippers may be toxic or hazardous(please list): D Metal polishes Laundry soil &stain removers (including bleach) 0 Spot removers&cleaning fluids (dry cleaners) O Other cleaning solvents Bug and tar removers O Windshield wash WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS Applicant's Signature Staff's Initi