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HomeMy WebLinkAbout0049 BEARSE ROAD - HAZMAT j \ 3 0- oak 0 S M E A KEEPING YOU ORGANIZED No.10334 2453L MM IN USA GET ORGAN M AT SMEM-C®M Number Fee 1266 THE COMMONWEALTH OF MASSACHUSETTS $50.00 Town of Barnstable j Board of Health This is to Certify that Premier Auto Detailing 49 Bearses Way, Hyannis, MA Is Hereby Granted a License For: Storing or Handling 26 - 110 gallons of Hazardous Materials. Restrictions: This license is granted in conformity with the Statutes and ordinances relating there to, and expires 06/30/2021 unless sooner suspended or revoked. --------------------------------------- JOHN NORMAN DONALD A.GUADAGNOLI,M.D. 07/01/2020 PAUL J.CANNIFF,D.M.D. THOMAS A.MCKEAN,R.S.,CHO Director of Public Health VoewgullatoOf Brnsxary emces • oFtH Richard V. Scali,Director Public Health Division BARMTABLE wsnxNsrasLE. '` euws*"e'P• •m""r.'rcua°s „� Thomas McKean,Director �'°���;��q�UNW� 0.19. .�1% 200 Main Street, Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE HAZARDOUS MATERIALS IN ACCORDANCE WITH THE TOWN OF BARNSTABLE GENERAL ORDINANCE, CHAPTER 108, HAZARDOUS MATERIALS,ALL BUSINESSES THAT HANDLE OR STORE HAZARDOUS MATERIALS GREATER THAN HOUSEHOLD QUANTITIES ARE REQUIRED TO OBTAIN AN ANNUAL PERMIT(RUNS DULY 1st—JUNE 30th). APPLICATION FEES CATEGORY 1 PERMIT 26— 110 Gallons: $ 50.00 �� CATEGORY 2 PERMIT 111 —499 Gallons: $125.00 ❑ 3 1-f CATEGORY 3 PERMIT 500 or more Gallons. $150.00 *A late charge of$10.00 will be assessed if payment is not received by duly 1st 1. ASSESSOR'S MAP AND PARCEL,NO. bq 6 2. IS THIS A PERMIT RENEWAL?V YES_NO. IF YES,SKIP QUESTION 3. • 3. FOR ALL NEW PERMIT APPLICATIONS,INDICATE WHETHER BUSINESS HAS ZONING/BUILDING APPROVAL,FOR HAZARDOUS MATERIALS STORAGE/USE OF GREATER THAN HOUSEHOLD QUANTITIES(2i5„GALLONS)? YES NO. 4. FULL NAME OF APPLICANT: g LQ �NL 5. NAME OF ESTABLISHMENT: 6. ADDRESS®F ESTABLISHMENT: , �1 , 1A� 7. MAILING ADDRESS (IF DIFFERENT FROM ABOVE: 8. TELEPHONE NUMBER OF ESTABLISHMENT: 50S • 6U 9. EMAIL.ADDRESS: 10. SOLEOWNER: YES NO IF NO,NAME OF PARTNER: 11. FULL NAME,HOME ADDRESS,AND TELEPHONE#OF: CORPORATION N 85 p-te A W. . PRESIDENT TREASURER A CLERK 12. IF PREPARED BY OUTSIDE PARTY: NAME: TELEPHONE#: COMPANY ADDRESS EMAIL: SIGNATURE OF APPLICANT' DATE Q:1Application FonnsUiAZMAT APP 2017 REVI .docx Number Fee 1266 THE COMMONWEALTH OF MASSACHUSETTS $50.00 Town of Barnstable Board of Health This is to Certify that Premier Auto Detailing 49 Bearses Way, Hyannis, MA Is Hereby Granted a License For: Storing or Handling 26 - 110 gallons of Hazardous Materials. ---------------------------------------- ---- --- ----------------------------------- ---------------- .-------------------- This license is granted in conformity with the Statutes and ordinances relating there to,and and expires 06/30/2020 unless sooner suspended or revoked. PAUL J.CANNIFF, D.M.D,CHAIRMAN DONALD A.GUADAGNOLI, M.D. 07/01/2019 JUNICHI SAWAYANAGI �T THOMAS A. MCKEAN, R.S.,CHO Director of Public Health Town of Barnstable . Inspectional Services • - ��►�r BARNSTABLE Public Health Division ;:jzAY!•kFi Pi'i5"t5: '<16352Cta 9 MASS. Thomas McKean, Director • BARNSTABLE, • < �0rfo +A`0 1639. 200 Main Street, Hyannis,MA 02601 r r Office: 508-862-4644 Fax: 5,8-790-6 304 APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE " HAZARDOUS MATERIALS , .. IN ACCORDANCE WITH THE TOWN OF BARNSTABLE GENERAL ORDINANCE,CHAPTER 108, HAZARDOUS MATERIALS,.ALL BUSINESSES THAT HANDLE OR STORE HAZARDOUS MATERIALS GREATER THAN HOUSEHOLD QUANTITIES ARE REQUIRED TO OBTAIN AN ANNUAL PERMIT(RUNS JULY I st—JUNE 30th). APPLICATION FEES CATEGORY 1 PERMIT 26— 110 Gallons: $ 50.00 �oQ CATEGORY 2 PERMIT 111 —499 Gallons: $125.00 ❑ CATEGORY 3 PERMIT 500 or more Gallons: $150.00 ❑ 3� *A late charize of$10.00 will be assessed if payment is not received by July 1st. 1. ASSESSOR'S MAP AND PARCEL NO. 311 / 04 o 2. IS THIS A PERMIT RENEWAL? f YES NO. IF YES, SKIP QUESTION 3. 3. FOR ALL NEW PERMIT APPLICATIONS,INDICATE WHETHER BUSINESS HAS ZONING/BUILDING APPROVAL FOR HAZARDOUS MATERIALS STORAGE/USE OF GREATER THAN HOUSEHOLD QUANTITIES (25 GALLONS)? YES NO. • 4. FULL NAME OF APPLICANT: 5. NAME OF ESTABLISHMENT: Pyrm' t✓ hMo UQku k1 rL 6. ADDRESS OF ESTABLISHMENT: 4q U-eant � � '11►T �0 �4 U 7. MAILING ADDRESS (IF DIFFERENT FROM ABOVE: S 021D01 8. TELEPHONE NUMBER OF ESTABLISHMENT: 9. EMAIL ADDRESS: 0���'l •L�m ^i 10. SOLEOWNER: YES NO IF NO,NAME OF PARTNER: 11. FULL NAME, HOME ADDRESS,AND TELEPHONE# OF: CORPORATION NAMEc'J ftt aj Vt PRESIDENT D h. TREASURER 0 CLERK 12. IF PREPARED BY OUTSIDE PARTY: NAME: TELEPHONE#: COMPANY ADDRESS EMAIL: *SIGNATURE OF APPLICANT DATE Q:\Application Forms\Haz Mat App Revised 09X.doex Number Fee Number THE COMMONWEALTH OF MASSACHUSETTS $5o.00 1266 Town of Barnstable Board of Health This is to Certify that Premier Auto Detailing 49 Bearses Way, Hyannis, MA Is Hereby Granted a License For: Storing or Handling 26 - 110 gallons of Hazardous Materials. ------------------------------ ----------------------------- --------------------------- --------------- -- ----------------------- � This license is granted in conformity with the Statutes and ordinances relating there to, and and expires 06/30/2018 unless sooner suspended or revoked. ----------------------------------- --- 6 PAUL J.CANNIFF,D.M.D,CHAIRMAN DONALD A.GUADAGNOLI,M.D. 07/01/2017 JUNICHI SAWAYANAGI THOMAS A.MCKEAN,R.S.,CHO Director of Public Health e, ow of hmstable Regunlatorvices tHE Richard V. Scali, Director � .-�` n A Public Health Division BARNBLE ♦ BPNN5tA11Lk•FxfER'JILI.CONIi•HYa:t:15 1 M * 4FPSfF:S HWS•(51E0.YILLk•ffiSI KaXSftdE fld = 1ARN&rABLE. Thomas McKean, Director 1679-2U35 . ' 1639. a`0 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE HAZARDOUS MATERIALS IN ACCORDANCE WITH THE TOWN OF BARNSTABLE GENERAL ORDINANCE, CHAPTER 108, HAZARDOUS MATERIALS,ALL BUSINESSES THAT HANDLE OR STORE HAZARDOUS MATERIALS GREATER THAN HOUSEHOLD QUANTITIES ARE REQUIRED TO OBTAIN AN ANNUAL PERMIT(RUNS JULY lst-JUNE 30th). APPLICATION FEES CATEGORY 1 PERMIT 26- 110 Gallons: $ 50.00 ,p§V S CATEGORY 2 PERMIT 111 —499 Gallons: $125.00 ❑ CATEGORY 3 PERMIT 500 or more Gallons: $150.00 ❑ *A late charge of$10.00 will be assessed if(paayment is not received b�ylst. 1. ASSESSOR'S MAP AND PARCEL NO. 3 l//o�1 o 2. IS THIS A PERMIT RENEWAL? Y! YES_NO. IF YES, SKIP QUESTION 3. 3. FOR ALL NEW PERMIT APPLICATIONS,INDICATE WHETHER BUSINESS HAS • ZONING/BUILDING APPROVAL FOR HAZARDOUS MATERIALS STORAGE/USE OF GREATER THAN HOUSEHOLD QUANTITIES (25 GALLONS)? YES NO. 4. FULL NAME OF APPLICANT: JCS 5- oh Lahal1 5. NAME OF ESTABLISHMENT: �YI' aaki -oe/n. l/L 6. ADDRESS OF ESTABLISHMENT: 9 t,)�egglg., 7. MAILING ADDRESS (IF DIFFERENT FROM ABOVE: 8. TELEPHONE NUMBER OF ESTABLISHMENT: 9. EMAIL ADDRESS: Z U►m< P,,,em l-ff-, Coaq 10. SOLEOWNER: V YES NO IF NO,NAME OF PARTNER: 11. FULL NAME,HOME ADDRESS, ON ND TELEPHE#OF: CORPORATION NAME `�rj U(44t -I; C. PRESIDENT Jjset)h LaIj4/Y) TREASURER L�T CLERK /(ly� 12. IF PREPARED BY OUTSIDE PARTY: NAME: TELEPHONE#: COMPANY ADDRESS EMAIL: SIGNATURE OF APPLICANT DATE Q:\Application Forms\HAZMAT APP 2017 REVI `.docx dl Number Fee 1266 THE COMMONWEALTH OF MASSACHUSETTS $5o.00 Town of Barnstable Board of Health This is to Certify that Premier Auto Detailing 49 Bearses Way, Hyannis, MA Is Hereby Granted a License For: Storing or Handling 26 - 110 gallons of Hazardous Materials. --------------------------------------------------------------------------------------------------------------------------------------------------------------- This-license is granted in conformity with the Statutes and ordinances relating there to,and and expires 06/30/2019 unless sooner suspended or revoked. ---------------------------------------- PAUL J.CANNIFF,D.M.D,CHAIRMAN DONALD A.GUADAGNOLI,M.D. 07/01/2018 JUNICHI SAWAYANAGI THOMAS A.MCKEAN, R.S.,CHO Director of Public Health T wiA of B rnsxable eg atory erviceS Richard V. Scali,Director • oFt Public Health Division BARNSTABLE BA WABLE. �` nusf9xs nius•639-2 1•w'm eaasrnet mass Thomas McKean, hector 1639-2014 e1 39. a`0� 200 Main Stteet, Hyannis,MA 02601 �77� Office: 508-862-4644 Fax: 508-790-6304 APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE HAZARDOUS MATERIALS IN ACCORDANCE WITH THE TOWN OF BARNSTABLE GENERAL ORDINANCE, CHAPTER 108, HAZARDOUS MATERIALS,ALL BUSINESSES THAT HANDLE OR STORE HAZARDOUS MATERIALS GREATER THAN HOUSEHOLD QUANTITIES ARE REQUIRED TO OBTAIN AN ANNUAL PERMIT(RUNS JULY 1st—JUNE 30th). APPLICATION FEES / CATEGORY 1 PERMIT 26— 110 Gallons: $ 50.00 C� CATEGORY 2 PERMIT 111 —499 Gallons: $125.00 ❑ CATEGORY 3 PERMIT 500 or more Gallons: $150.00 . *A late charge of$10.00 will be assessed if payment is not received by July 1st. 1. ASSESSOR'S MAP AND PARCEL NO. 2. IS THIS A PERMIT RENEWAL?� YES_NO. IF YES,SHIP QUESTION 3. 3. FOR ALL NEW PERMIT APPLICATIONS,INDICATE WHETHER BUSINESS HAS ZONING/BUILDING APPROVAL FOR HAZARDOUS MATERIALS STORAGEIUSE OF GREATER THAN HOUSEHOLD QUANTITIES(25 GALLONS)? YES NO. 4. FULL NAME OF APPLICANT: 5. NAME OF ESTABLISHMENT: 6. ADDRESS OF ESTABLISHMENT: 7. MAILING ADDRESS (IF DIFFERENT FROM ABOVE: (,, 8. TELEPHONE NUMBER OF ESTABLISHMENT: 50� • �`i 5 -, t%- M 9. EMAIL ADDRESS:V- �J- 10. SOLEOWNER: YES NO IF NO,NAME OF PARTNER: 11. FULL NAME,HOME ADDRESS,AND TELEPHONE#OF: CORPORATION N 65 eke a& uv . PRESIDENT TREASURER 'L CLERK 676 12. IF PREPARED BY OUTSIDE PARTY: NAME: TELEPHONE#: COMPANY ADDRESS EMAIL: f SIGNATURE OF APPLICANT DATE Q:\Application FormsUiAZMAT APP 2017 REVI .docx Number Fee _ 1266 THE COMMONWEALTH OF MASSACHUSETTS $5o.00 s Town of Barnstable Board of Health This is to Certify that Premier Auto Detailing - -- 11 — -- — --—----— 49 Bearses Way, Hyannis, MA Is Hereby Granted all License For: Storing or Handling 26 - 100 gallons of Hazardous Materials. ------------------------------------------------------------------------------------------------------------------------------ This license is granted in conformity with the Statutes and ordinances relating there to, and and expires 06/30/2017 unless sooner suspended or revoked. ----------------------------------- WAYNE MILLER,M.D.,CHAIRMAN PAUL J.CANNIFF, D.M.D. 07/01/2016 JUNICHI SAWAYANAGI THOMAS A.MCKEAN, R.S.,CHO Director of Public Health Town of Barnstable kj� Regulatory Services Richard V. Scah,Director ` '" S& ' Public Health Division WNSTAB 1639. �0� m�•m Thomas McKean,Director `� � 200 Main Street, Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6 APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE HA ARDOUS MATERIALS IN ACCORDANCE.WITH THE TOWN OF BARNSTABLE GENERAL ORDINANCE, CHAPTER 108, HAZARDOUS MATERIALS,ALL BUSINESSES THAT HANDLE OR STORE HAZARDOUS MATERIALS GREATER THAN HOUSEHOLD QUANTITIES ARE REQUIRED TO OBTAIN AN ANNUAL PERMIT(RUNS DULY 1 st—TUNE 3 Qth). APPLICATION FEES CATEGORY 1-PERNUT 26— 110 Gallons: $ 50.00 CATEGORY 2 PERMIT 111 —499 Gallons: $125.00 ❑ CATEGORY 3 PERMIT 500 or more Gallons: $150.00 ❑ A late charge of$10.00 will be assessed if payment is not received by July Ist. ASSESSORS MAP AND PARCEL NO. J12 L 0 DATE FULL NAME OF APPLICANT: S 1/2 im NAME OF ESTABLISHMENT: �2- Pre ADDRESS OF ESTABLISHMENT: % 0/ G MAILING ADDRESS(IF DIFFERENT): TELEPHONE NUMBER OF ESTABLISHMENT: ;�I�� O �✓ ,'�M (O EMAIL ADDRESS: NIJ C --- SOLE OWNER: I S NO IF NO,NAME OF PARTNER: FULL NAME,HOME ADDRESS, LEPHONE#OF: CORPORATION NAME PRESIDENT TREASURER CLERK IF PREPARED BY OUTSIDE PARTY: GNATURE OF L Name: Company Address Telephone#: Email: Q:Wpplication FonnsgiAZZAPP Revl6.docx Page 1 of IL . Page 1 of 2 Lavelle, Timothy From: McKean, Thomas Sent: Tuesday, February 09, 2016 2:32 PM To: Lavelle, Timothy Subject: FW: 49 Bearse Road, Audi detail building. Tim Wili you go out to this site and let me know if you see any violations? From: Deputy Dean Melanson [mailto:dmelanson@hyannisfire.org] Sent: Friday, February 05, 2016 2:52 PM To: Jenkins; Elizabeth Cc: Perry,Tom; McKean, Thomas; Lt. John Cosmo; William Rex; Diane LeRoux C Subject: Re: 49 Bearse Road, Audi detail building. Elizabeth, Thanks for the info. I noted that I did not include the size of the tank, it is a 500 gallon waste oil tank. Deputy Chief Dean L. Melanson rv�- Office 508-775-1300 ' Fax 508-778-6448 ° dmelansonna,hyannisfire.or a��, Q�art' e , -� $4,�b 'A� .{ k r On Feb 5, 2016, at 2:05 PM, Jenkins, Elizabeth �t� oil bV�"\p0`\Q�`�S +k04 <Elizabeth.Jenkins town.barnstable.ma.us>wrote: kZq%1.6 Thanks, Dean. lv Q%O►W ow$ I looked at this again and the ZBA did address an oil tank—in issuing Varibnce No. 2015-009, they found that the removal of a 250 gallon oil tank would bring the site into greater conformance with 00c' the GP District Regulations. Further,that relief is conditioned as follows: 1. As this property is located in a Groundwater Protection Overlay District,the generation, treatment, storage or disposal of hazardous materials or waste is prohibited, except for storage of not more than 200 gallons at any one time and/or generation in very small quantities as allowed by Section 240-35(F)(2)(p). It is my opinion, any hazardous materials on site should be accessory to the permitted auto detailing use permitted on this property, not the service use across the street. Best, Elizabeth <image002Jpg>E1izabeth S. Jenkins, AICP REGULATORY/DESIGN REVIEW PLANNER Town of Barnstable • 200 Main Street• Hyannis, MA 02601 elizabeth.jenkins@town.barnstable.ma.us 508-862-4736 2/10/2016 _ . Page 2 of 2 Town Website • Business Barnstable • HyArts• Barnstable iForum From: Deputy Dean Melanson [mailto:delanson@hyannisfire.org] Sent: Friday, February 05, 2016 11:41 AM To: Perry,Tom; McKean, Thomas; Jenkins, Elizabeth Cc: Lt. John Cosmo; William Rex; Diane LeRoux Subject: 49 Bearse Road, Audi detail building. I went out to this site and conducted an inspection pursuant to a permit application for a waste oil tank installation(details of the inspection copied below).It appears that operations in the building will not include changing of vehicle oils but, waste oil from vehicles will be transported across Hallet Road to this tank.It will then be consumed by a waste oil heater installed in the second floor.Our plans and paperwork never discussed or reflected this.I don't recall any discussion about this at site plan review or during the initial construction discussions.The site is in a GP zone and we have no records of waste oil collection or a heater on the original site.We have issued a stop work order as it relates to this equipment until everyone can weigh in and either approve this operation in some manner or deny it.If denied we will order the equipment to be removed. please let me know. Lift Works applied for a wast oil tank install permit on.4-FEB-16 Inspection on 5-FEB-16 finds • A fully installed waste oil system designed to remove waste oil from portable containers via a compressed air vacuum pump. • Removal via a hose connection in the waste oil tank room. • A waste oil heater installed(no permit?)on the 2nd floor.Units is fully installed and vented through the roof,yet to be completed; ■ Fusible shut-off over the unit ■ Fuel line partially run dow to the Ist floor and coiled in the ceiling area of the waste oil tank room.(no pump installed yet) ■ No service/emergency shut-off at the unit ■ No emergency shut-off in area of the stairs leading to the 2nd•floor. Investigation finds no clean oil supply in the building.Explanation is that vehicle oil changing will not be done in this building.Waste oil will be transported by unknown means from the Audi garage(25 Falmouth Road)across Hallet Road and be place in this tank.It will be consumed by the waste oil heater and/or removed via removal company. STOP WORK ORDER VERBALLY ISSUED,NO PERMIT GRANTED FOR THE TANK. Deputy Chief Dean L. Melanson Office 508-775-1300 Fax 508-778-6448 dmelansonL&hyam-isfire.org <D-2015-009.pdf 2/10/2016 Date:/d/ Z / 3 TOWN OF BARNSTABLE 5 TOXIC AND HAZARDOUS MATERIALS FORM NAME OF BUSINESS: Aviqels J v.G�. BUSINESS LOCATION: �} fA-se- Q09 , Hya>7nis INVENTORY MAILING ADDRESS: Sgvw-- TOTAL AMOUNT: TELEPHONE NUMBER: -77 `f - 200 - ;L26-4 Z a//ovt CONTACT PERSON: /' OXte-/ I/ EMERGENCY CONTACT TELEPHONE NUMBER: MS PS ON SITE? TYPE OF BUSINESS: A)d �*` INFORMATION / RECOMMENDATION . 9 9 14)"b' a Je 4-1e5 ',)I+ . FiNT)11 trict: �a �s {,nn,��-eon ��0�`l-a�� S- a o►�1 s,�� �'✓Q►labl� S *4o Waste Transportation: / � Last shipment of hazardous was te- 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 dUSED (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 is Other chlorinated hydrocarbons, Lacquer thinners ,M,sc vBfoS� (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) 3 Other cleaning solvents Bug and tar removers Windshield wash WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS Applicant's Signature Staff's Initials of tN rqy TOWN OF BARNSTABLE Date: 1. ... ..1...!..n .c . LICENSE APPLICATION New Application BARNSTABLE, ® Renewal MAN. 200 Main Street 1639. ❑ Transfer Hyannis,MA 02601 508-862-4674 ❑ Other Pa I 16o" ► NO BUSINESS MAY OPERATE WITHOUT A VALID LICENSE ON THE `PREMISES f Name ofapplicant/corporation: , ,:=a.-.._-�..__ 1 � l�c Home phone#: S Sc _�') I=7 -- Address of a licant/cor oration:...............'`�......._-.`._.R`�►"" r2S�....`�Z�. ?- ......_.__.........._._._.._ pp p ----- Business phone#: e _ _......._.._._...._...._..._......-_._........._.......................... _........._._. D/B/A -- -------—----------._....._._.................._......................__..._........._......................._................................_.................--........._.......__............_............_......- Business phone#: - ---- --...- -- --------- Business location: z_............ _. __J.�' rr._._... ._..__wa._.._........ ..... .._......._._,#--k�.._ > l._1. .._�,__%--._._nZG_s>_..1..-....---....------- - -------------- Business mailing address: ....._�.4..._..�.......__...�?�� r�•A_ ............_....7 ''�..._�.._..........._........__._..� y_....... ......_.. _...... _ ..:._ ._..._T_...__....._....__._... - — - - _ .o. ..... _ . Local business address: ... .......... ...................__......_.............._.........._._.....--._-.._.-...._.._._....._..._....__........._...........__............._...._..._...._._......_._.........._............__.....---..._.........__._.........._......._._...._.__._....._...._._._...---._.._.__..._.. --._...- .._._...-- - - ..._..._...._ Local mailing address: .......... LICENSE TYPE: 1. Annual 0 Seasonal HOURS OF OPERATION: .._0............. ' __ - FID#;.._.(5.._�._-.._1.._1_-_�3.3..( Name of manager:mana g _._.._........._.._ ... -._........._._.._..._C - --._.............._.._..................-.................. _..__._._....... sc Localmailing address: ............................r ._©...... ?. ....._ ........................................1!..h /�11.t5.........vt-7- ... c-...?...........-................................. Manager's Permanent mailing address: Manager's home phone#: S2lf�..._�.�-�'....'. -� Business phone#: ....................................................................................... Name of property owner: ......--._..__....._.._ V_A-�1S......:_A"A" t2......_�6L,, 1:.._"-7►.rr....._..._.__......__.__._........._. _. ASSESSOR'S MAP/PARCEL#: MAP , 1�, PARCEL - , List any flammable substance or hazardous waste used in business (specify): Applicants must contact the Building Commissioner's office, (508) 862-4038, the Board of Health(office, (508) 862-4644, and the appropriate Fire District office to schedule inspections. Signature of applicant A vat .................................................................................................................................................................................................................................................... For Town use only REAL ESTATE TAXES PAID IN FULL PAYMENT AGREEMENT IN EFFECT ON IS THJS USE PERMITTED WITHIN THIS ZONING DISTRICT? YES Ej NO INSPECTORS APPROVAL Capacity set by Building Division................................................ Building/Zoning..............._.._....._....................................-......._..... ............... Date ................................._............................................. Board of Health................................................................................................................... Date ....................................__._......................... Wire .............................................................................. Date ................................................................._............. Plumbing ........Date ......_............._..............................._..............._...... Gas ................................................................................. Date .......................................................................... Fire District .............................................................................._... Date _---_.------..................-------------._...._-------------- Comments: .................... .......................................................................................................................................................................... White-Licensing Authority Canary-Health Division Gold-Building Commissioner Pink-Fire Department