HomeMy WebLinkAbout0050 ROSARY LANE - HAZMAT &t LA, b-hlcytwl-S
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No.2-153LGN
UPC 12134
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Number Fee
1259 THE.COMMONWEALTH OF MASSACHUSETTS $125.00
Town of Barnstable
Board of Health
This is-to Certify that EJ Jaxtirner Builder Inc.
60 Rosary Lane, Hyannis, MA
Is Hereby Granted a License
For: Storing or Handling 111 - 499 gallons of Hazardous Materials.
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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.
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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
i
Town of Barnstable
�+ Regulatory Services
Richard V. Scali,Director
` B"R" Public Health Division BARNSTABLE
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�FD NIAy a iba9-zoin
Thow-:s_1 i ean,.Director
200 Main Street,Hyannis,MA 02601 �
Office: 508-862-4644 Fax: 508-790-631
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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 1 st-JUNE 30th).
APPLICATION FEES
CATEGORY 1 PERMIT 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$10.00 will be assessed if payment is not received by July 1st.
ASSESSORS MAP AND PARCEL NO. DATE Pn1nU S}
FULL NAME OF APPLICANT: E S Saxfi m&,(
NAME OF.ESTABLISHMENT: �a'`J� ^^'r 1 Cj4_' ) 1 riC
ADDRESS OF ESTABLISHMENT: G O 1-z 0 5 0.-ki LA A- 4�3 q,n n i s m p OZ(,01
MAILING ADDRESS(IF DIFFERENT): 0.5w 1 ", �Cynrti► 1 (nil (7Z�01
TELEPHONE NUMBER OF ESTABLISHMENT: 50$ - 11 Y ' 4q I I
EMAIL ADDRESS: C�-r`, o�ya -✓.c�wt.
SOLE OWNER: ✓ YES NO IF NO,NAME OF PARTNER:
FULL NAME,HOME ADDRESS,AND TELEPHONE#OF:
CORPORATION NAME S mac,x+m e v BV► l d-,v . I n C
PRESIDENT C a Za x t�M" , 35 o 11A Wj j 75�H tJL+, O S klV i ILA MA
TREASURER /1�c�M I rov-� 3 5 1�a,m 51'Y�.0 O r ►^1 tVvA
CLERK M(.Vy1� T. T6 X_-k-iYl � 3S0 "n, 5yca -, of L4 thA
IF PREPARED BY OUTSIDE PARTY:
SI?Ak 'PLICANT Name:
Company Address
Telephone#:
Email:
CAT.emp\HAZZAPP Rev 16.docx -Page I.of 2