Loading...
HomeMy WebLinkAbout0141 STEVENS STREET - HAZMAT i Number Fee 1124 THE COMMONWEALTH OF MASSACHUSETTS $150.00 Town of Barnstable Board of Health This is to Certify that PREMIER MAZDA OF CAPE COD 141 STEVENS STREET, HYANNIS, MA Is Hereby Granted a License For: Storing or Handling 500 gallons or more 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 Town of Barnstable Inspectional Services BAB TABLE • MRNS Public Health Division �1F. TIS 41LLs•a5rrFaue•5-=i'f 9fc4ST+.6:E 1639-2014 yKASS. '� Thomas McKean, Director ' o aim 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 BARNS-TABLE 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 El CATEGORY 2 PERMIT 111 —.499 Gallons: $125.00 ❑. CATEGORY 3 PERMIT 500 or more Gallons: $150.00 19 VS_/ *A late charge of$10.00 will be assessed if payment is not received by July 1st p- Q D 1. ASSESSOR'S MAP AND PARCEL NO. U 2. IS THIS A PERMIT RENEWAL? J 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: ' ft M— 5. NAME OF ESTABLISHMENT: ` ' S S v W A 6. ADDRESS OF ESTABLISHMENT: jG�A _ Q- 7. MAILING ADDRESS (IF DIFFERENT FROM ABOVE: 5b0 u Q,11 (,IJ� }�,%n , �-p2kbi 8. TELEPHONE NUMBER OF ESTABLISHMENT: 5 b I��`•`5�b® �� 9. EMAIL ADDRESS: 10. SOLEOWNER: V YES NO IF NO,NAME OF PARTNER: 11. FULL NAME,HOME ADDRESS,AND TELEPHO #OF: CORPORATION NAME ,, PRESIDENT J)li TREASURER g CLERK 12. IF PREPARED BY OUTSIDE PARTY: NAME: �' TELEPHONE#: • COMPANY ADDRESS ! EMAIL: SIGNATURE OF APPLICANT DATE Q\Applicafion Forms\Haz Mat App Revised 09-10-18id'"x Ci' Number Fee 1124 THE COMMONWEALTH OF MASSACHUSETTS $150.00 Town of Barnstable Board of Health This is to Certify that PREMIER MAZDA OF CAPE COD 141 STEVENS STREET, HYANNIS, MA Is Hereby Granted a License For: Storing or Handling 500 gallons or more 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 THOMAS A.MCKEAN, R.S.,CHO Director of Public Health Town of Barnstable Inspectional Services • OF t o� BARNSTABLE qsPublic Health Division 699-204 LE, Thomas McKean, Director MASS,OrEv a`0� 200 Main Street, Hyannis,MA 02601 �z Office: 508-862-4644 Fax: 508-790-6304 -` APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE t" 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 1 st—JUNE 3 0th). 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 '2 *A late charge of$10.00 will be assessed if payment is not received by July 1st. 1. ASSESSOR'S MAP AND PARCEL NO. C309-r:3� 2. IS THIS A PERMIT RENEWAL? J 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: Joe Ui,_ , m_ 5. NAME OF ESTABLISHMENT: `q I Siaws St w U& pmfly y Ka", 6. ADDRESS OF ESTABLISHMENT: 7. MAILING ADDRESS (IF DIFFERENT FROM ABOVE: 5 � I J lhziQDi 8. TELEPHONE NUMBER OF ESTABLISHMENT: 5�� • 0 S 59 60 9. EMAIL ADDRESS: 1 �DI(P d,QX,rat 10. SOLEOWNER: V YES NO IF NO,NAME OF PARTNER: 11. FULL NAME,HOME ADDRESS,AND TELEPHON #Of. CORPORATION NAME141 PRESIDENT T Ad TREASURER CLERK 12. W PREPARED BY OUTSIDE PARTY: NAME: TELEPHONE#: • COMPANY ADDRESS EMAIL: SIGNATURE OF APPLICANT / i DATE Q:\Application Forms\Haz Mat App Revised 09-10; x Number Fee 1124 THE COMMONWEALTH OF MASSACHUSETTS $150.00 Town of Barnstable Board of Health This is to Certify that PREMIER MAZDA OF CAPE COD 141 STEVENS STREET, HYANNIS, MA Is Hereby Granted a License For: Storing or Handling 500 gallons or more 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 pa Vowl of Unstable S-/ eg atory ervices Richard V. Scah,Director THE T Public Health Divisi on BARNSTABLE . N r 6ARNSihBIE.CliREPY11lE.Wi N STM BARNSPABLE. • nwu�ons w�u•639-201 arm eannsl4e�e Thomas McKean,Director 1639-2014 iOrE1 639. 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 ❑ CATEGORY 3 PERMIT 500 or more Gallons: $150.00 .4 V.S *A late charge of$10.00 will be assessed if payment is not received by July 1st. 1. ASSESSOR'S MAP AND PARCEL NO.J 2. IS THIS A PERMIT RENEWAL? 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: PWIAA 6. ADDRESS OF ESTABLISHMENT: Stuws aI oau-&l 7. MAILING ADDRESS (IF DIFFERENT FROM ABOVE: Q n 8. TELEPHONE NUMBER OF ESTABLISHMENT: � �� ' Oar)—15q 0D 9. EMAIL ADDRESS: dn Vt,B,ImUA o 10. SOLEOWNER: V YES NO IF NO,NAME OF PARTNER: 11. FULL NAME,HOME ADDRESS,AND TELEPHONE#OF: CORPORATION NAME 141 al , . PRESIDENT TREASURER CLERK 12. IF PREPARED BY OUTSIDE PARTY: NAME: TELEPHONE#: • COMPANY ADDRESS / EMAIL: SIGNATURE OF APPLICAN DATE Q:\Application Forms\HAZMAT APP 2017 REVISE 6cx Number Fee 1124 THE COMMONWEALTH OF MASSACHUSETTS $150.00 Town of Barnstable Board of Health This is to Certify that PREMIER MAZDA OF CAPE COD 141 STEVENS STREET, HYANNIS, MA 1s Hereby Granted a License For: Storing or Handling 500 gallons or more 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. ---------------------------------------- PAUL J.CANNIFF,D.M.D,CHAIRMAN DONALD A.GUADAGNOLI,M.D. 0.7/01/2017 JUNICHI SAWAYANAGI THOMAS A.MCKEAN,R.S.,CHO Director of Public Health TRowr1 of B�nstable f� 40 e&(p, eg atory ervices Richard V. Scah,Director , �TWE Public Health Division BABSTABLE « wansrnntt.,:txreyQi�.coturt•xrura<- EMANF°ABL r Thomas McKean Director 1639-2014034 1 39- 6. 200 Main Street,Hyannis, MA 02601 3�g Office: 508-862-4644 �D —�D` Fax: 508-790-6304 TI 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 19,VS _ *A late charize of$10.00 will be assessed if payment is not received by July 1st. 1. ASSESSOR'S MAP AND PARCEL NO.O. 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 (25G,A;�L,LONS)? YES NO. / 4. FULL NAME OF APPLICANT: � p� �!�ly) 5. NAME OF ESTABLISHMENT: / G�- 6. ADDRESS OF ESTABLISHMENT: / I ` 1c"Ve/b wltj 7. MAILING ADDRESS (IF DIFFERENT FROM ABOVE: 8. TELEPHONE NUMBER OF ESTABLISHMENT: SOS- 9. EMAIL ADDRESS: j)C(D d ox-PT'm i el,- 00M 10. SOLEOWNER: YES NO IF NO,NAME OF PARTNER: 11. FULL NAME,HOME ADDRESS, TELEP_ONE#�OF: CORPORATION NAME IM 5 /(173 (!q- _T 1 PRESIDENT � j()`5kjQi- LGIh n TREASURER � h LE1hG9 n-� CLERK p, Yj L 6oyy M 12. IF PREPARED BY OUTSIDE PARTY: NAME: TELEPHONE#: • COMPANY ADDRESS EMAIL: SIGNATURE OF APPLICANT DATE Q:\Application Fonns\IAZMAT APP 2017 REVISED do,, Number Fee 1125 THE COMMONWEALTH OF MASSACHUSETTS $150.00 Town of Barnstable Board of Health This is to Certify that PREMIER VOLVO OF CAPE COD 2.70 NORTH STREET, HYANNIS, MA Is Hereby Granted a License For: Storing or Handling 500 gallons or more of Hazardous Materials. ------------------------------------------------------------------------------------------------------------------------------------------------------------- ---------------------------------------------- -------------------------------- ------------------------------------------------------ This license is granted in conformity with the Statutes and ordinances relating there to,and C� and expires 06/30/2018 unless sooner suspended or revoked. PAUL J.CANNIFF,D.M.D,CHAIRMAN DONALD A.GUADAGNOLI,M.D. 07/01/2017 JUNICHI SAWAYANAGI THOMAS A.MCKEAN,R.S.,CHO Director of Public Health :.c �. . - 'TRowr of Unstable eg atory e"ces Richard V. Scali,Director ft A # ..., " Public Health Division BARNS LE21 Y PnR'IStAPIF.itHiPRY10f.CONO.RyLLY.15 °tiw'. Vt0.51fY.5 F:'L'S• •%31 PL^.,NiILBt LE. = Thomas McKean,Director 1639M1:4VIllE-20141 200 Main Street, Hyannis,MA 02601 575 -ry D/3-�o1$ 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 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 X V S. *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,SKIP 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: VO � o o` OAPE CO�J 6. ADDRESS OF ESTABLISHMENT: @,76 /y 6 r8,) � l v nl J 7. MAILING ADDRESS (IF DIFFERENT FROM ABOVE: / 8. TELEPHONE NUMBER OF ESTABLISHMENT: &b-9G S 5-`I 0 9. EMAIL ADDRESS: - 10. SOLEOWNER: VYES NO IF NO,NAME OF PARTNER: 11. FULL NAME,HOME ADDRESS,AND TELEPHONE#OFi CORPORATION,NAME OL4 ej. PRESIDENT 0 TREASURER CLERK h 12. IF PREPARED BY OUTSIDE PARTY: NAME: X TELEPHONE#: COMPANY ADDRESS / EMAIL: SIGNATURE OF APPLICAN' DATE (112-7 / Q:\Application Forms\I-IAZMAT APP 2017 REVI docx ' e Number Fee 1124 THE COMMONWEALTH OF MASSACHUSETTS 1oo.00 Town of Barnstable Board of Health This is to Certify that PREMIER MAZDA OF CAPE COD 141 STEVENS STREET, HYANNIS, MA Is Hereby Granted a License FOR: STORING OR HANDLING 111 GALLONS OR MORE OF HAZARDOUS MATERIALS. -------------------------------------------------------------------------------------------------------------------------------------------------------------------- --------------------------------------------------------------------------------------------------------------------------------------------------------------- This license is granted in conformity with the Statutes and ordinances relating there to, and and expires 06/30/2016 unless sooner suspended or revoked. ---------------------------------------- WAYNE MILLER,M.D.,CHAIRMAN PAUL J.CANNIFF, D.M.D. 07/01/201 rJ JUNICHI SAWAYANAGI THOMAS A.MCKEAN,R.S.,CHO Director of Public Health C't r� M t r t Town of Barnstable Regulatory Services ° Richard V. S Director KAM Public Health Division Thomas McKean,Director ` 200 Main Street, Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Application Fee: $100.00 17 ASSESSORS MAP AND PARCEL NO. Q 9,°� DATE APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE MORE THAN Ill GALLONS OF HAZARDOUS MATERIALS FULL NAME OF APPLICANT NAME OF ESTABLISHMENT � �) • ADDRESS OF ESTABLISHMENT TELEPHONE NUMBER SOLE OWNER:_Y S NO IF APPLICANT IS A PARTNERSHIP,FULL NAME AND HOME ADDRESS OF ALL PARTNERS: IF APPLICANT IS A CORPORATION: FEDERAL IDENTIFICATION NO.1 4 STATE OF INCORPORATION FULL NAME AND HOME ADDRESS OF: PRESIDENT TREASURER CLERK • SIGNATURE OF APPLICANT RESTRICTIONS. HOME ADDRESS HOME TELEPHONE# 1- A �®ems C:=he\Temporary Internet Files\0LKD3IHAZAPP Rev2015DOC f Town of Barnstable d�TME' ,ti Regulatory Services • °'" Richard V. Scali,Director MAMBAWMABLE, ` Public Health Division Thomas McKean,Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Wayne Miller,M.D. Fax: 508-790-6304 Paul J.Canna D.M.D. Junichi Sawayan* NOTICE TO ALL BUSINESS OPERATORS WITH HAZARDOUS MATERIALS IN BARNSTABLE The Town of Barnstable Town Council adopted, Chapter 108: Hazardous • Materials, a requirement for each business operator to obtain an annual permit and to remit a fee of$100.00 if one-hundred and eleven (111) gallons or more of hazardous materials are stored, transported, utilized, and/or disposed of at a particular site. STEPS 1 —2: 1. Please complete the attached application form 2. Submit the fee of$100.00 payable to the:. Town of Barnstable. MAIL all of the above to this office on or before June 30, 2015. A late charge of$10.00 will be assessed if payment is not received by July 10, 2015. Please feel free to view the above Code, Chapter 108: Hazardous Materials on the i Town Website, www.town:barnstable.ma.us , which.is located under the E-Code section if you should have any questions or concerns. QAHazmat\I-iaz Mat Permit Letter.DOC Town of Barnstable Office: 508-862-4644 'M Fax: 508-790-6304 Regulatory Services Department BARN OM Public Health Division MASS. Thomas A.McKean,CHO ''�a n�r►� 200 Main Street, Hyannis, MA 02601 Payment Receipt jHazardous Materials Paymenfreceived: $110.00 (Check) on 7/31/2015 Permit number: 1124 )Check number: 6940 Check amount: $110.00 Name on check: Premier Companies Business: PREMIER MAZDA OF CAPE COD Owner: EDWARD E TR Address: 141 STEVENS STREET, Hyannis ,Note: $100 + $10 Late Fee C1 Number Fee 1124 THE COMMONWEALTH OF MASSACHUSETTS $1oo.00 Town of Barnstable Board of Health This is to Certify that PREMIER MAZDA OF CAPE,COD 141 STEVENS STREET, HYANNIS,MA 02601 —_ Is Hereby Granted a License FOR: STORING OR HANDLING 111 GALLONS OR MORE OF HAZARDOUS MATERIALS. ----------------------------------------------------------------------------------------------------------------------------------------------------------- -------------------------------------------------------------------------------------------------------------------------------------------------------------------- This license is granted in conformity with the Statutes and ordinances relating there to, and and expires 6/30/2014 unless sooner suspended or revoked. WAYNE MILLER,M.D.,CHAIRMAN PAUL J.CANNIFF,D.M.D. 3/10/2014 JUNICHI SAWAYANAGI THOMAS A.MCKEAN, R.S.,CHO Director of Public Health ' TOWN OF BARNSTABLE Date:Z/ 'j / Z0 TOXIC AND HAZARDOUS MATERIALS ON-SITE INVENTORY DAME OF BUSINESS: BUSINESS LOCATION: (4k S �y+�.rC s-� ��yrTti�iS , ►'�� va 6y t INVENTORY MAILING ADDRESS: t4I 2-r ,NS 02-4.0f TOTAL AMOUNT: TELEPHONE NUMBER: sos- CONTACT PERSON: ,5'' vj s EMERGENCY CONTACT TELEPHONE NUMBER.5c -1 Z- JM1 i00 286117 (MWS ON SITE? TYPE OF BUSINESS: - AuTfi INFORMATION/RECOMMENDATIONS: Fire District: Waste Trans portation:.SFI- �/ �,E6L/ Last shipment of hazardous waste:N Name of Destination: Waste Product: b- -,4,,)TT-: �O F _E rZ� i c e n s e d Yes No 1_1NOTE: 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 ONEW �Y6SED Cesspool cleaners vl' f Automatic transmission fluid Disinfectants Engine and radiator flushes Road salts (Halite) � ,.Hydraulic fluid(including brake fluid) / Refrigerants d Motor Oils Pesticides El NEW C9.l�S�® (insecticides, herbicides, rodenticides) fv MY SPILL CONTINGENCY PLAN Emergency Coordinator, Name: J a Y10-6 V A C Address: S r Ic 77 ^�. .�}� N �"�MJ� Daytime Phone: S0 S 116 Z- Y 0 Y 6 Evening Phone: S^o� - b 2-- Fire Department: ,��. Barnstable Public Health Division: 508-862-4644 DEP 24 Hour Spill Hot Line: 888-304-1133 Waste Hauler: Name: Phone: tl0 I 7S l - © �OFS Building diagram indicating hazardous material/waste storage area, location of absorbent scavenger materials, fire extinguishers, fire alarms (if present), and evacuation route (if applicable). cm P0 �••` tea Y Vim` Actions to be taken to control a spill or release, and preventing it from reaching a catch basin, sewer system or the ground. SELL k:�-r 7:5 Dti b1bWks _�Z� �vG T • UL REGENT ASSOCIATES,INC. ARCHITECTS ELEVEN NORWICH STREET WORCESTER MA MINIS TEL W&78229" FAX 888.7824St7 aL ..u.m .ammo s 6: /�A.�j(�Srl '4J Saturn of Hyannis r I— T ,�„�„,a„� Bassett Lane and J- 7-71 Stevens Street Hyannis,MA PROJECT 2004-03 DRAWN FV SCALE 1I8'at'-0' DATE 03.25.00 PROGRESS ONLY NOT FOR CONSTRUCTION �j LL Existing /.1 Existing Ground Floor Plan _ /1 Existing Mezzanine Plan Floor Plans ICI EX 1 fw Number Fee 1124 THE COMMONWEALTH OF MASSACHUSETTS 1oo.00 Town of Barnstable Board of Health This is to Certify that PREMIER MAZDA OF CAPE COD 141 STEVENS STREET, HYANNIS, MA Is Hereby Granted a License FOR: STORING OR HANDLING 111 GALLONS OR MORE OF HAZARDOUS MATERIALS. ------------------------------------------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------ This license is granted in conformity with the Statutes and ordinances relating there to, and and expires 6/15/2015 unless sooner suspended or revoked. -------------------------------------- WAYNE MILLER,M.D.,CHAIRMAN PAUL J.CANNIFF,D.M.D. 6/30/2014 JUNICHI SAWAYANAGI THOMAS A.MCKEAN, R.S.,CHO Director of Public Health - r Town of Barnstable °FZHE Tq,,, Regulatory Services ti ° Richard V. Scali, Director MAM. ` Public Health Division sbgy. ��� 'OlE639. Thomas McKean, Director 200 Main.Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Application Fee: $100.00 ASSESSORS MAP AND PARCEL NO. ' DATE APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE MORE THAN 111 GALLONS OF HAZARDOUS MATERIALS FULL NAME OF APPLICANT SS 4L 11.g q :1&X NAME OF ESTABLISHMENT ` rP�e4z � V�� c, ADDRESS OF ESTABLISHMENT TELEPHONE NUMBER S� SOLE OWNER:_O YES NO IF APPLICANT IS A PARTNERSHIP,FULL NAME AND HOME ADDRESS OF PARTNERS: _„t �?a ?''b IF APPLICANT IS A CORPORATION: FEDERAL IDENTIFICATION NO. (® STATE OF INCORPORATION /1 GLSS Ce Ls'� FULL NAME AND HOME ADDRESS OF:- PRESIDENT U TREASURER ✓ 6/ ✓ ✓ V" / CLERK ✓ ✓ �/ ✓ ✓ c/ SIGNATURE OF APPLICANT RESTRICTIONS: HOME ADDRESS HOME TELEPHONE# Q:\Application FormMAZA-DP.DOC MAIL-IN REQUESTS Please mail the completed application form to the address below. Also include a copy of your contingency plan (to handle hazardous waste spills, etc). In addition, please include the required fee of$100. Make check payable to: Town of Barnstable. Allow five to seven (7) working days for in- house processing. Our mailing address is: Town of Barnstable Public Health Division 200 Main Street Hyannis, MA 02601. FOR FAXED REQUESTS Our fax number is (508) 790-6304. Please fax a completed application form. Also, please fax us a copy of your contingency. plan (to handle hazardous waste spills, etc). In addition, please mail the required fee amount of$100.00. Please make the check payable to: Town of Barnstable. The check must be mailed to the address listed above. Allow up to four days for in-house processing. For further assistance on any item above,call (508) 862-4644 Back to Main Public Health Division Page Q\Application Forms\HAZAPP.DOC L ' M� SPILL CONTINGENCY PLAN Emergency Coordinator, Name: DV)4zT-: Address: Z S FAe-re7 o u'7-H A P. Daytime Phone: 50 • !2d Z - `f 0 Y,G Evening Phone: Z - 4/0 Fire Department: R Barnstable Public Health Division: 508-862-4644 - DEP 24 Hour Spill Hot Line: 888-304-1133 Waste Hauler: Name: L EEtJ Phone: q0 I- - 6 $0 0 Building diagram indicating hazardous material/waste storage area, location of absorbent scavenger materials, fire extinguishers, fire alarms (if present), and evacuation route (if applicable). 47T,4 C;04T7 n Actions to be taken to control a spill or release, and preventing it from reaching a catch basin, sewer system or the ground. 5t!rl-L 14,�TS 51rf-f (' PR- �, y R 0 w BMwS VOLYPgktAPEC0D To Whom It May Concern: Through our vendor partner, we continue weekly and monthly inspections of our Storage tank. Per the 108.3 and 108.4 requirements we have an authorized/certified hazmat Spill kit on sight and action plan for Safety Kleen and or Clean Harbor on call for emergency Services. Our plan is as in the past submissions unchanged from our last renewal. John Lendvai 1 508.962.4046 25 Falmouth Road • Hyannis, MA 02601 Office:508.815.5500 • Fax:508.771.6113 9 Premierbmwofcapecod.com TC►okti Town of Barnstable Office:508-862-4644 Public Health Division Fax:508-790-6304 BARNS TABLE. 200 Main Street• Hyannis, MA 02601 �"'EDMP�a`0 TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT Business Name: Y Ceyt1i e�r A k sA o-f CP-0-e- C&S Date: 2 1 b Location/Mailing Address: 14 1 S4eVe14 S 6+, 114 h K 1 S Contact Name/Phone: G64A- Slno , 5ryc rA& Sam-Q : oo Agle5 -tec� ��-Co.+ /�Q•�cc� Inventory Total Amount" k 1 1�0 A. MSDS: 5 License#: I�-`J Tier II : 0 5�.-�'1 Labelina: �� Spill Plan: o Oil/WaterSeparator: �S ` 9PN"Floor Drains: w 4 Emergency Numbers: �S Storage Areas/Tanks: 30 a.l AW o, Pt S"V 6-00 5 a,1 o,l P1,K -Sf r,, s v4-,J Emergency/Containment Equipment: ' 4,A PJ�- 4" \00o1,,k Waste Generator ID: fQ(Z0�0 SI o do Waste Product: 0, I,y � ���cs, pair}s �(�°`^�*,4► �r'�� Date&Amount of Last Shipment/Frequency: 61, b I 398 a II Zx oV4,- Vrs cica►u� Licensed Waste Hauler&Destination: 6-W(etvA- C1r jl, , -T7 va.t�l 2,xeS. Other Waste Disposal Methods: o t 1 S b � Avs,!,q w 1 vJ' ,�yv\e.ti S LIST OF TOXIC AND HAZARDOUS MATERIALS SPe. v\Ae s 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 requires a license from the Public Health Division. Antifreeze Dry cleaning fluids Automatic transmission fluid Other cleaning solvents&spot removers Engine and radiator flushes Bug and tar removers Hydraulic fluid (including brake fluid) �— Windshield wash Motor oils Miscellaneous Corrosives Gasoline,jet fuel, aviation gas Cesspool cleaners Diesel fuel, kerosene, #2 heating oil Disinfectants Miscellaneous petroleum products: Road salts / grease, lubricants, gear oil Refrigerants Degreasers for engines&garages Pesticides: Caulk/Grout insecticides, herbicides, rodenticides �- Battery acid (electrolyte)/batteries Photochemicals(Fixers) Rustproofers Photochemicals(Developer) Car wash detergents Printing ink Car waxes and polishes Wood preservatives(creosote) Asphalt&roofing tar Swimming pool chlorine Paints, varnishes, stains, dyes Lye or caustic soda Lacquer thinners Miscellaneous Combustible Paint&varnish removers, deglossers Leather dyes Miscellaneous Flammables Fertilizers Floor&furniture strippers PCB's Metal polishes Other chlorinated hydrocarbons Laundry soil &stain removers (including carbon tetrachloride) (including bleach) Any other products with "poison labels" (including chloroform, formaldehyde, hydrochloric acid, other acids) VIOLATIONS: 0 5AAk COA�,Wkv�Cj D\MA 0VI- 7kk-e— ORDERS: ar Ga p S ,lk o OS av- St e-• O q C� C., -ems . INFORMA N/ COMM NDATIONS: N& a. t� .< A Inspector: Facility Representative: _4, WHITE COPY- HEALTH DEPARTMENT/CANARY COPY-BUSINESS Number Fee 1124 THE COMMONWEALTH OF MASSACHUSETTS $150.00 Town of Barnstable Board of Health This is to Certify that PREMIER MAZDA OF CAPE COD 141 STEVENS STREET, HYANNIS, MA Is Hereby Granted a License For: Storing or Handling 500 gallons or more 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 �'THE ti Regulatory Services Richard V. Scali, Director Z ` $" MAS& Public Health Division ErE.. RNSTA:A1 W.i6;y. � ,1�n\ uis�"ose`/]r�.iem o F� •� 16�U 4 4 Thomas McKean,Director 200 Main Street, Hyannis,MA 02601 N� Office: 508-862-4644 /I 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 3 Oth). 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 'Pd V. • A late charge of$10.00 will be assessed if payment is not received by July 1st. ASSESSORS MAP AND PARCEL NO. DATE lY FULL NAME OF APPLICANT: /v/y G-��x l G NAME OF ESTABLISHMENT: � � ADDRESS OF ESTABLISHMENT: MAILING ADDRESS(IF DIFFERENT): nn QJ TELEPHONE NUMBER OF ESTABLISHMENT: C� EMAIL ADDRESS: C� 1/ SOLE OWNER: ✓ YES NO IF NO,NAME OF PARTNER: FULL NAME,HOME ADD S,AND TE EPHONE#0 CORPORATION NAME PRESIDENTjD I TREASURER O CLERK L, ply IF PREPARED BY OUTSIDE PARTY: S P T Name: yC? Company Address Telephone#: Email: Q\Application "SaAZZAPP Rev16.docx Page 1 of 2 Town of Barnstable Office:508-862-4644 Public Health Division Fax:508-790-6304 • BARMN,';A • 200 Main Street• Hyannis, MA 02601 _ �0'FD3i+,�+"�0� TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT Business Name: 2v►'�t� < �a�aCA a� ��e- �o�C Date: Location/Mailing Address: ►y I 5tevex� Contact Name/Phone: 5D8- 01 S-000 Qutk-�l,o,)e- , j�k",ce wt1 K Mvles yt'T-coves� 1�Ge- Inventory Total Amount: ".q0e,0 qt MSDS: le,g License#: 11 Tier II : 0 Labelina: "k Spill Plan: o Oil/WaterSeparator: Floor Drains: 7 Emergency Numbers: Storage Areas/Tanks: 1.%O ar,\ UW o.A A5C - SoD*\ u 2,k44-0.1 AqC,K wp atoca�,t -It Emer enc /Containment E ui ment: _5,b% 1 �,[.4 w� booty. oK sake. �44 S �co� Jft-ll sp'lls Waste Generator ID: D0� T- Waste Product: d, , I+crs -CvL,� e— Date&Amount of Last Shipment/Freq_uency: NO ° �M D, CV 6c t IN.co1Qrtan` S Licensed Waste Hauler&Destination: V1Cwc-i' �J, t� Other Waste Disposal thods: %\k�<s •r aw- �S �cr,1. v\ r v � o< F¢G cI� b ��c�y� LIST OF TOXIC AND HAZARDOUS MATERIALS Ovkly +^�)-e' d"Y,�- ro g NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws of MA, hazardous material use, jS6 41 JF ST- storage and disposal of 111 gallons or more requires a license from the Public Health Division. Antifreeze Dry cleaning fluids Automatic transmission fluid Other cleaning solvents&spot removers Engine and radiator flushes Bug and tar removers Hydraulic fluid (including brake>luid) Windshield wash ,Aev,.i A5- — motor oils-t�-d-r-j 0 11 A I9 Miscellaneous Corrosives Gasoline,jet fuel, aviation gas Cesspool cleaners Diesel fuel, kerosene, #2 heating oil Disinfectants Miscellaneous petroleum products: Road salts grease, lubricants, gear oil Refrigerants Degreasers for engines&garages Pesticides: Caulk/Grout insecticides, herbicides, rodenticides Battery acid (electrolyte)/batteries Photochemicals(Fixers) Rustproofers Photochemicals(Developer) Car wash detergents Printing ink Car waxes and polishes Wood preservatives(creosote) Asphalt&roofing tar Swimming pool chlorine Paints, varnishes, stains, dyes Lye or caustic soda Lacquer thinners Miscellaneous Combustible Paint&varnish removers, deglossers Leather dyes Miscellaneous Flammables Fertilizers Floor&furniture strippers PCB's Metal polishes Other chlorinated hydrocarbons Laundry soil &stain removers (including carbon tetrachloride) (including bleach) Any other products with "poison labels" (including chloroform, formaldehyde, hydrochloric acid, other acids) VIOLATIONS: ORDERS: INFORMATION/ ECOMMENDATIONS: 0� C v i K av(, Jr 405+ OK5 . `qr , I I Inspector: Facility Representative: WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS TOWN OF BARNSTABLE Date: 5/ I 1 / I�f � TOXIC AND HAZARDOUS MATERIALS FORM NAME OF BUSINESS: BUSINESS LOCATION: I`�15-E� „�g �-d- , -I�a►n�i S INVENTORY MAILING ADDRESS: TOTAL AMOUNT: TELEPHONE NUMBER: _510'?> - A, CONTACT PERSON: EMERGENCY CONTACT TELEPHON NUMBER: MSDS ON SITE? TYPE OF BUSINESS: INFORMATION / RECOMMENDATIO S: too{ Fi a District: o o( -i- , \Akk aHV— Jeri, �A>,4A TO �n v ,� ,1� �Ikhh15 Waste T < J AKQ005�0500 Last shipment of hazardous waste: Name of Hauler: Co�kraGkLr� ,,��50.���.� P�V�Destination: Waste Product: Ho 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 a A ifreeze (for gasoline or coolant systems) Miscellaneous Corrosive NEW'0 ❑ USED Cesspool cleaners Automatic transmission fluid 11- t2x Disinfectants Engine and radiator flushes Road salts (Halite) Hydraulic fluid (including brake fluid) I �55 Refrigerants $3 Motor Oils TS -k,* '�� Pesticides U NEW BUSED5 k (insecticides, herbicides, rodenticides) Gasoline, J ,Aviation gas ea ,A Photochemicals (Fixers) fuel Diesel Fuel, kerosene,#2 heating oil ❑ NEW ❑ USED Miscellaneous petroleum products: grease, Photochemicals (Developer) 3 lubricants, gear oil 1 ❑ NEW ❑ USED Degreasers for engines and metal S 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 b WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS Applicant's Signature Staff's Initials MASSACHUSETTS FIRE INCIDENT REPORT ® 10 FD I D# DEPARTMENT Revised !� :..0..1,.9,2.2..,,... Hyannis Fire Department Report Form If Date Alarm ArrivalIn Service 0�•��•..201 Fire 0011 /22/95 Day lWednesdayEl 116:10 116:14 16:40 IST =FACTION TARN ::;::;: MUTUAL AID w/ No Ign »4 1 Remove Hazard FIXED PROPERTY USE (OCCUPANCY) _ `><# IGNITION FACTOR C Uncovered Parkin Area 9 6 5 ': NOT A FIRE »0 0 OCORRECT ADDRESS ZIP CODE CENSUS TRACT D STEVENS ST. 1 02601 000040 O 11 OCCUPANT NAME (LAST, FIRST, MI) TELEPHONE ROOM or APT. CHART HOUSE VILLAGE 508 778-1533 PARK 012OWNER NAME (LAST, FIRST, MI) ADDRESS TELEPHONE STUART BORNSTEIN MASHPEE MA. G 13 METHOD OF ALARM CO. DIST. PERSONNEL ENG RESP. ........... AERIALS RESP. 3 © RESP. 0 SHIFT HAZ MAT PRESENT? TANK. RESP. 0 OTHER RESP. — Telephone (Tie-line) NO. LAB SUBSTANCE 0 0 1 SPEC. EQUIP. USED> O2 SERVICE 0 >> 0«« OTHER 0 0 0 O MOBILE PROPERTY TYPE VEHICLE STOLEN. ESTIMATED TOTAL INSURANCE CO. DOLLAR LOSS } yi TOTAL INS. CLAIM PD 30 YEAR MAKE MODEL COLOR LICENSE NO. VIN# 40 IF EQUIP INVOL. YEAR MAKE MODEL SERIAL NO. IN IGNITION O COMPLEX AREA OF :;:EQUIP INVOLVED IN IGN. ORIGIN FORM OF HEAT IGNITION M MATERIAL FORM ..."' TYPE IGNITED METHOD OF LEVEL OF ORIGIN Number of Stories CONSTRUCTION TYPE O EXTINGUISHMELA NT EXTENT OF DAMAGE Flame r77M Smoke r77M DETECTOR PERFORMANCE SPRINKLER PERFORMANCE N COop E Material generating FORM TYP ® most smoke AVENUE OF SMOKE TRAVEL R WEATHER CONDITIONS Officer in Charge: Date JOSEPH P.CABRAL JR. CAPTAIN 1 1 /2 2/9 5 •, Comments for this incident have been printed on an additional comments page. r Comments for Incident: 95 001'201 Exposure: 00 Date: 11/22/95 RECEN D A CALL FROM THE POLICE REPORTING A SPILL IN THE PARKING LOT OF THE CHART HOUSE VILLAGE STEVENS ,.,%AND NORTH STS.RESPONCE ENGINE 826 WITH FIREFIGHTERS WASIERSKI AND GRANDAW. UPON ARRIVAL MET THE CHART HOUSE VILLAGE MAINTENANCE MAN ROBERT BOCCUZZI IN THE PARKING LOT ON THE STEVENS ST.SIDE NEXT TO A DUMPSTER.THERE WAS A 55 GALLON DRUM OF USED COOKING GREASE THAT HADBEEN KNOCKED OVER BY 2 YOUTHS,THAT HAD LEFT THE AREA PRYOR TO OUR ARRIVAL. THE DRUM WAS NOT FULL WE WERE ABLE TO UPRIGHT THE DRUM AND BUILD A CONTAINMENT DIKE WITH STARBRIGHT, WE ALSO PLACED SOME ABSORBANT PADS UNDER THE DRUM. THE BOARD OF HEALTH WAS NOTIFIED AND DONNA MIORANDI RESPONDED TO OUR LOCATION.THE RESPONSIBLE PARTY FOR THE CLEAN UP OF THE SPILL IS CARLOS BARBOSA OF THE COPA-CABANA REST. (508) 790-8227. THE PLAN OF ACTION IS THEY ARE GOING TO DO A TEMPOARY CLEAN UP AND PLACE IT IN BARRELS AND PROPER DISPOSAL AND FOLLOW UP WILL BE DONE AFTER THE HOLIDAY. DONNA MIORANDI WILL FOLLOW UP ON THIS FOR THE BOARD OF HEALTH. NOTE:FIREFIGHTER SYLVESTER DID RESPOND WITH TRUCK 800 WILL EXTRA SUPPLIES FOR THE CONTAINMENT. ENGINE 826 CLEARED THE CALL AND RETURNED TO OTRS.AT 1640 HRS. CAPTAIN JOSEPH P.CABRAL JR. 11/22/95. t l } ti, _.� ,:.v:_.ri..� . -Ixfi7r'rTy. •-Xi'�...,v ... �.. , ,..-''......r}3' .'•�A,.,-.try.{'N srrj.,. nr`Yry_.,E' ,_,3..,:=y ,'�, .. .-w. ...:'}... ...t }.r, �,.-...�. ..r. .., r r / 501- � 3"l oFtM TOWN OF BARNSTABLE Date: ......_ �2**... .?-�...... ❑ New Application BARNSPABLE ; LICENSE APPLICATION ;W'Renewal 9� 63S. ,�g 200 Main Street Transfer p 10tfp�.�a Hyannis,MA 02601 ❑ Other i co 508-862-4674 ♦ NO BUSINESS MAY OPERATE WITHOUT A VALID LICENSE ON THE PREMISES ♦ N Name of applicanVeorporation: t , ._A'"U..r.....- ......_[ ...._....�!I... Ad.a.S..........1. G.-'-.-'-'--._. _.... _._._..._. Home phone#: Address of applicant/corporation:......� ��....-.- ..SSr�-d .......Lrf..` /S '� ;�/i5Business phone ----'---.........._........................... ......_.......rn. ..A..._........._._!_3..Z_ro o._..............._._........._....................._._ ..... ._............._._................. D/B/A _.. ,'_'�'_._....---._._..__..._....._...----._...------'---._._........__ ._._ _-'-' -_-__._ _-' _-._._-__-'-'-'-'-'-.-.-- Business phone#: Business location: `50 t Y)(f Businessmailing address: ...`-o_ VVIe'" - '-.._.---' .....-..._.._........_......................_...........-......_._................_....__..._......_.......----'---'-..__._..._...._..:._.:_.-................._.................--.... _..._...------ _...----...----'--' Local business address: _..._ .............P....._..._....._..._.........:_._ .. ........................_........................_............._..............._._...._._............................_......._._.................._........................................................._..._.........._...........................__..........................__....._..........._...................... - Localmailing address: _--------_--- _n _'-._.....___....._...._................_.............................._......................................._.................... ................... .... ... .. .. .. .. .. .. . .. . 0 LICENSE TYPE: A LA-k b.rr1._ph,1.l :.....:......:.....0..'.q..�.er....... .. ..._GtS.S..d--„. Annual Seasonal it hHOURS OF OPERATION: " ..e:.. 2_R...._~_._.____9._.r'3vt°....__:._. FID#: d�/_'3.. /.ot_T..8..7/ ....... I'. Name of manager: 1._ ............._..._...................--............._...._..._..........._...._............ Local mailing address: ..!.....:.. 'Y1. .. ).........s' .................�?. v�,, rv, / ........o...:. .....-6: ..G..3 ..................................................... Manager's Permanent mailing address: Manager's home phone#: .O.5.-72, ._.:0"7 00 Business phone#: ,, s_._::'7 , -_q.QQ_0.._... / Name of property owner: ._.__jW.Ct-_r�c-........._....._.__ Gs... .....:> ........................_................................_......... ASSESSOR'S MAP/PARCEL#: MAP..............3 D9.„..„..„.,:„... PARCEL 23..?....:...:..:............ List any flammable substance or hazardous waste used in business(specify): Applicants must contact the Building Commissioners office, (508) 862-4038, the Board of Health office, (508) 862-4644, and the appropriate Fire District office to schedule inspec=t,ion`sa:' Signature of applicant a( l fil� .Jft. Far Town use onl REAL ESTATE TAXES PAID IN FULL ( � PAYMENT AGREEMENT 1N EFFECT ON IS THIS USE PERMITTED WITHIN THIS ZONING DISTRICT? YES ❑ NO ❑ INSPECTORS APPROVAL Capacity set by Building Division...................................._..._. Building/Zoning......_..._...................................................................................__... Date ................................................._:........................... Board of Health............................................_..............................................._............... Date ....._................................_....._............_................- Wire .................. Date .............................................................._............. Plumbing .............................................................................................Date ................................................................................ Gas ......__..._.................._........:............................._.... Date Fire District Date _...._..............._........._..._.._...._...__..__...._ ........_...........__..........._......_.._._........_:_......_....._......................................_............................._........................_._._......_..............................._....................._...._...._..................................................................._........................._..._....._-.......__..._................................ __..__...-'- White-Licensing Authority Canary-Health Division Gold Building Commissioner Pink-Fire Department • Number Fee 189 THE COMMONWEALTH OF MASSACHUSETTS '$100.00 Town of Barnstable Board of Health This is to Certify that Saturn Of Hyannis 115 Bassett Lane, Hyannis,MA 02601 i Is Hereby Granted a License FOR: STORING OR HANDLING 111 GALLONS OR MORE OF HAZARDOUS MATERIALS. - -----..- -- .. --- ----------- ------------------------------------------------------------------------------------------------------------------------------------------------------ This license is granted in conformity with the Statutes and ordinances relating there to, and and expires 6/30/2010 unless sooner suspended or revoked. -------------------------------- WAYNE MILLER,M.D.,CHAIRMAN PAUL J. CANNIFF,D.M.D. 6/30/2009 JUNICHI SAWAYANAGI THOMAS A.MCKEAN, R.S.,CHO Director of Public Health .+ r Town of Barnstable t; Barnstable Regulatory Services Department Public Health Division try 9A 1639, 200.Main Street,Hyannis MA 02601 m 2007 Office: 508-862-4644 FAX: 508-790-6304 Thomas F.Geiler,Director Thomas A.McKean,CHO Application Fee:$100.00 ASSESSORS MAP AND PARCEL NO. DATE APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE MORE THAN I II GALLONS OF HAZARDOUS MATERIALS FULL NAME OF APPLICANT SQ fUr• i eF .AIV4 iS NAME OF ESTABLISHMENT • ADDRESS OF ESTABLISHIVIENT // S 60 s Se-* [,owe TELEPHONE NUMBER Csos�) -�77S- 9000 SOLE OWNER: YES NO IF APPLICANT IS A PARTNERSHIP,FULL NAME AND HOME ADDRESS OF ALL PARTNERS: IF APPLICANT IS A CORPORATION: FEDERAL IDENTIFICATION NO. (DL4 3 STATE OF INCORPORATION VA a S 5 FULL NAME AND HOME ADDRESS OF: PRESIDENT a Word Lec l a ZZ(c main If- C'e^,kra/'c TREASURER CLERK • elAT-URE OF PPLICANT RESTRICTIONS: HOME ADDRESS HOME TELEPHONE # Q:\FlazmathHaz Mat Application20D&DOC