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Town of Barnstable
Regulatory Services
f'=i L}} Richard V.ScHli,Director
• BAaNBTABLE,
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Licensing Authority
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`:Fa 200 Main Street
Hyannis,MA 02601
www.town.barastable.ina.us
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Off cc: 508-852.4674 Fax: 15087778.2412
Licensed Premises Zoning Approval
To All Applicants:Zoning approval MUST be obtained 8FFORE an application:can be.a.ccepted'by this office. Fully dimensional
floor plans,with regresses, fixtures and furniture marked; must be submitted to the Building Corrimissioner's Office; along with a
fully dimensional parking plan, .prior to, or along with, this document. Plans must be initiated by the:Building Department and
submitted along with this form, completed and signed by the Building Commissioner or his representative, wfh;a completed
Licensing Application. No applications for a license or hearings on a license application will be accepted or scheduled until the
above requirements are met.
To Be Filled Out By Applicant-
Uses/License'Applied For.._:UA-Pt>4.Y r ? , 1v .. _�. 1� .._._.�. :c?c ca G��42 G Gsdt j.
Location..
Business Narrle .._
Business Owner
Address
Property Owner_. 13fZ1 t,.". IAAh U�.
Town of Barnstable Map(s)and Parcel(s)No(s)
List All Uses Of: A � )
Basement (Area)-_...... First'Flr.
Second_....__. . . (Area)
. _... . .___.: .... : ..... _ Third :_..___...�.......,..,.:W�. . ,.. ._.,
Fourth _.. (Area).. Roof - ._ ... :.. (Area) ..,_ .. ..____.......: ._
Decks, Patios,'etc, _v_R._ _ (Area) _ -
Date 411,412/-. Signature of Applicant.....-._
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To be completed by Building Commissioner's Office:Zoning Districts
is Site Plan Review Necessary?........ ........YES= NO
Are the above uses permitted? YES Q NO
Legal Nonconforming Use YES _ NO,F7
Variance Granted YES 17--T_ NO
Special Permit Granted YES NO
Total number of occupants permitted =, Total number of a—rk—ln�-ssj aces exclusively dedicated to the proposed
business use and available at all times en business is to be operatedrp
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Signature of Building Official Date_ -M 2f12 I
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The Town of Barnstable
;�• � Office of Town Manager
,•lanxNsresr.s, •'�
/�/ 367 Main Street, Hyannis Mf102601
www.town.barnstablg,maus
Office: 508-862-4610 Mark S Ells,Town Manager
Fax: 508-790-6226
Email: mark,ells_;town,bamale.ma,us
TO Applicant for flammable or Explosive Materials Storage License
FROM Richard V. Seali, Director of Regulatory Services
SUBJECT; Pre-application Procedure
Prior to filing an application for a license to authorize the use of a specific parcel of land
for the storage of flammables or explosives stored in a building(s) or structure(s)
applicants are required to review the proposal with officials of the Health Department,
Conservation Department and Building Department(Zoning).
This review is to assist the applicant in understanding any requirements of the Zoning,
Health, or Conservation Departments which may apply to the proposed project. A few
minutes spent early in the process in this area should prevent surprise or complications in
the later stages of the process.
The applicant is required to complete a Licensed Premises Zoning Approval form and.
have the form reviewed and signed by an official of the Building Department. The signed
form is to be submitted with the application submitted to the Town Manager's Office.
In addition, the applicant is required to have this form signed by officials of the Health
Department and the Conservation Department and include this completed form with the
application submitted to the Town Manager's Office.
The signatures of the Health Department and Conservation Department officials on this
form is not intended to indicate approval or authorization, and is intended only to indicate
that the applicant has discussed the project with officials of the Health and Conservation
Department and been advised of requirements of the respective departments.
1
Health Department Official Date l
l
Conservation Department Official Dater
Completed application for license attached? a Yes No
Completed Licensed Premises Zoning Approval Form attached? Yes _ No
Application Fee$100.00 paid? Yes 7— No
Name/Location of applicant:
Q:1WPFILBS\LICENSrNG\FORMSV'lommablc&Explosives SloreagePraapplic.doc
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_.� Town of Barnstable
Regulatory Services
Richard V.Sculi,Director
• 8A tN8rABLE,/
/ Licensing Authority
200 Main Street
Hyannis,MA 02601
www.town.barnstable.ma..us
Office: 508-862-4674 Fax: 508-778-2412
Licensed Premises'Zoning Approval
To All Applicants:Zoning approval MUST be obtained BE an application can be accepted by this office. Fully dimensional
floor plans,with egresses, fixtures and furniture marked, must be submitted to the Building Commissioner's Office; along with a
fully dimensional parking plan, prior to, or along with, this document. Plans must be initialed by the Building Department and
submitted along with this form, completed and signed by the Building Commissioner or his representative, with-a completed
Licensing Application. No applications for a license or hearings on a license application will be accepted or scheduled until the
above requirements are met.
To Be Filled Out By Applicant:
Uses/License Applied For (JA.jbEYZ6'Rd0��__..t �....._�_ l�f''A _ �rac��s ��}L,"Aj j
Location D r�
Business Name -
Business Owner
�cr� /� �, ___ __..._....
Address 1 rev �11�t ±= ' . _ 1 Telephone: �5CII 7 ! _��`7,c�'....._..,..
Property Owner_...t.7._l21 t'qQ N-^& L)
............ ._....... _
Town of Barnstable Map(s)and Parcel(s)No(s) � _ T _ L vp R rSa. ••=. .
List All Uses Of: , !�
Basement (Area)......_..............-., First Fir.
Second---._.._-... ... -------- (Area) __-__---- Third
_(Area)---------...
Fourth
-..........._.__..._ —_.._.__..._......_..._.-_.. (Area).- Roof ..._ (Area).:.._....... ___,.___........_
Decks, Patios, etc. (Area)
Date �1/� ?/.. Signature of Applicant
To be completed by Building Commissioner's Office:Zoning District:
Is Site Plan Review Necessary?................YES N00
Are the above uses permitted? YES Q NO }
Legal Nonconforming Use YES r-1� NO 71
Variance Granted YES II_ NO 0
Special Permit Granted YES �_ NO, 0_^
i
Total number of occupants permitted =.. Total number of parkqjg spaces exclusively dedicated to the proposed
business use and available at all times when business is to be operated .
Signature of Building Official Date
Q:\WPFILES\LICENSLNG\FORMS\ZONMAPPRVLFORM.DOC
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Certificate of Registration
FP-005 - -
(Rev.1.1.2015) Massachusetts General Law, Chapter 148 §13 t.,cense Number
In accordance with the provisions of Massachusetts General Law,Chapter 148 §13,the undersigned hereby certifles that;
Person,partnership, corporation or other entity:
Name o!Licence Holder ."'"'...............
_......._ -- Business Addric i of License HoideF_._...,...,.._.._....._...... A
_._..:.._.............
Is the holder of a license granted on ,and subsequently amended on
For the lawful use of buildings and structures located or to be located at:
Nu nber,5tMe,an.: sses r`s'.tap an.P=ei It) __. _...__-.____._...... .... _.-..
As relates to the keeping,storage,manufacture,or sale of flammables,combustibles, or explosives.
S;gnaini•c o`Gccnac N del or Agem ! rJatM/ � Trtnlei tiame
Ali mdtetia.fs must be stored in accordance with the l�rovisions_ofMassachusetts General I,aw,Chapter 14$.
the Mas�achust t1s!{ire Cgde i 527,CMR and all other applicable laws.and rein lations including the terms and
___..
ccon-cirtions of the subiect license .cnuantitigs,.�tored mad not exceed the maxtmum,quanttt�sr�ecifed by the licence,
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GISTRATION
This is to certify that the within named license holder has in accordance with the provisions of Massachusetts 1
General Law,Chapter 148 §13 filed with me,a certificate of registration setting forth that the above named
entity is the holder of license as relates to the keeping, storage, manufacture,or sale of flammables,
combustibles, or explosives at the above described location.
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S,gnawre of dl i,cial — - - 1`itle
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At
THIS REGISTRATION AND THE LICENSE MUST BE CONSPICUOUSLY POSTED ON THE LAND }
FOR WHICH IT IS GRANTED,
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Application for Standard permit
FP-0 �►Return com feted application to: .,..,,,__..__
(Rev. 1.1.2Q15) p pP
Permit Number DIG SAFE NUMBER
City or Town:
Start Date-
Date:,. — _....._�.... _..
In accordance with the provisions of M.G.L.Chapter 148,as provided in Section 140 A__. application is hereby made
by
p (FuR Name or Pe on,Firm or Corporation) (Phone Number)
of .
(Address:Street or P.U.Box,City or Town,Zp Coda)
for permission to(state clearly purpose for which permit is requested)--t?.__ /+s !� __ r*
Name of Competent Operator(if appiicab1e),1// '!.q. ?U�Gerti.No.
Date Issued-rejected -. By ........ .
(Signature of Applicant)
Date of expiration Fee Amount Paid$
---.._-----------------------------_,,.--_..---- ———————————-
Wevd:501 K Yl
FP-006
(Rev. 1.1.2015) PERMIT
City or Town: FDIG SAFE NUMBERDate: -t-e. ------rtDate:Permit Number(if applicable): --__.._._�
In accordance with the provisions of M.G,L.Chapter'148,as provided in_..,..__.- _ this permit is granted
to
(Full Name of Person.Firm or Corporation)
for
_..........
Restrictions:
at
(Street and 1F or oeserice location for Adequate Identification)
Fee Paid$ ;.....___—�__._ This permit will expire an
Signature of Official Granting Permit: Title_
This permit must be conspicuously posted upon the premises
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€ ' LONG. .... .__
License
Massachusetts General Law, Chapter 148 §13
FP-002 License Number
(Rev. ).1.201 s) New License ❑ Amended License µ
After notice and hearing,and in accordance with Chapter.148 of the Mass.General Laws,
a license is hereby granted to use the land herein described for the purposes described.
Location of Land: Sly 1,1�1tJ
Number,Street and Assessor's Map and Parcel ID
Owner of Land: 3RIAN U L.
Address of Land Owner: tv d G1 k Aj 1614 FP DIUV4C
_Flam_mable and Combustible Lit aids.Flammable Gases and Solids
Complete this section for the storage of flammable and combustible liquids,solids,and gases..411 tanks and containers are considered
full for the purposes of'licensing and permitting. (Attach additional pages if necessary.)
PRODUCT NAME CLASS MAXIMUM UNITS CONTAINER
QUANTITY gal„Ibs, UST,AST,IBC,
cubic feet drums
LP-gas (Complete this section for the storage of LP-gas or propane)
❖ Maximum quantity(in gallons)of LP-gas to be stored in aboveground containers:
List sizes and capacities of all aboveground containers used for storage.
__...__.._.....................--........ ....... -....._...__.__
Maximum quantity(in gallons)of LP-gas to be stored in underground containers: ..
List sizes and capacities of all underground containers used for storage - 1,100- -A.L:ONTtl N A
Total aggregate quantity of all LP-gas to be stored: 40CGo 1
I
Fireworks (Complete this section for the storage offareworks) 1
Maximum amount(in pounds)of Class 1.3G:
Maximum amount(in pounds)of Class 1.4G:_.-....._._........
Maximum amount(in pounds)of Class 1.4: „_.._.........,_„ ,_..
Total aggregate quantity of all classes of fireworks to be stored:
THIS LICENSE OR A CERTIFIED COPY THEREOF MUST BE CONSPICIOUSLY
POSTED ON THE LAND FOR WHICH IT IS GRANTED.
4
=k
En)I sines (Complete this section for the storage of explosives)
•:• Maximum amount(in pounds)of Class 1.1: Number of magazines used for storage:
Maximum amount(in pounds)of Class 1.2: Number of magazines used for storage:
Maximum amount(in pounds)of Class 1.3: Number of magazines used for storage:
Maximum amount(in pounds)of Class I.4: Number of magazines used for storage;
Maximum amount(in pounds)of Class 1.5: . _ Number of magazines used for storage:
Maximum amount(in pounds)of Class 1A Number of magazines used for storage:
Licensing Authorin Use:
This license is granted upon the condition that the licensed activity will comply with all applicable laws; codes,
rules and regulations, including but not limited to Massachusetts General Law, Chapter 148,and the
Massachusetts Fire Code (527 CMR 1.00)as amended. The license holder may not store materials in an amount
exceeding the capacities herein specified unless and until any amended license has been granted.
ADDITIONAL RESTRICTIONS:
_�..__._ ._...___ w.
................. ___...__._... _.__,..... _ .._..... _
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Signature of Licensing Authority Title Date
THIS LICENSE OR A CERTIFIED COPY THEREOF MUST BE CONSPICIOUSLY
POSTED ON THE LAND FOR WHICH IT IS GRANTED.
{
FP-002 (Rev. 1,1.2015) page 2
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US` PO.SW,`ServiceTM
CERTIFIED MAILTM RECEIPT
(Domestic Mail'Only,No InsuranceCoverage Provided)
F,or,deli4eryainformationEvisit`our,website at www.usps.com® ,�;
Plostmark
Here
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PS Form 3800;August 2006 See Reverse for,lnstructions;
Certified Mail Provides:
o A mailing receipt
o A unique identifier for your mailpiece
o A record of delivery kept by the Postal Service for two years
Important Reminders:
o Certified Mail may ONLY be combined with First-Class Mail®or Priority Maile.
o Certified Mail is not available for any class of international mail.
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valuables,please consider Insured or Registered Mail.
o For an additional fee,a Return Receipt may be requested to provide proof of
delivery.To obtain Return Receipt service,please complete and attach a Return
Receipt(PS Form 3811)to the article and add applicable postage to cover the
fee.Endorse mailpiece"Return Receipt Requested".To receive a fee waiver for
a duplicate return receipt,a USPS®postmark on your Certified Mail receipt is
required. ;.
m For an additional'fee, delivery may be restricted to the addressee or
addressee's authorized agent.Advise the clerk or mark the mailpiece with the
endorsement"Restricted Delivery".
■ If a postmark on the Certified Mail receipt is desired,please present the arti-
cle at the post office for postmarkirig:*If+a postmark on the!Certified Mail
receipt is not needed,detach and affix label with postage and mail.
IMPORTANT:Save' his receipt-and present it when making an inquiry.
PS Form 3800,August 2006(Reverse)P,SN 7530-02-000-9047 ` '
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C13 Postage $
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Certified Fee
C3 Postmark
Q Return Receipt Fee Here
C3 (Endorsement Required)
C3 Restricted Delivery Fee
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(Endorsement Required) t'
OTotal Postage&Fees
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City,State,
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Certified Mail Provides:
a A mailing receipt
n A unique identifier for your mailpiece
o A record of delivery kept by the Postal Service for two years
Important Reminders:
a Certified Mail may ONLY be combined with First-Class Mails or Priority Mails.
n Certified Mail is not available for any class of international mail.
o NO INSURANCE COVERAGE IS PROVIDED with Certified Mail. For
valuables,please consider Insured or Registered Mail.
o For an additional fee,`a Return Receipt may be requested to provide proof of
delivery.To obtain Return Receipt service,please complete and attach a Return
Receipt(PS Form 3811)to the article and add applicable postage to cover the
fee.Endorse mailpiece"Return Receipt Requested".To receive a fee waiver for
a duplicate return receipt,a USPS®postmark on your Certified Mail receipt is
required.
m For an additional fee, delivery may be restricted to the addressee or
addressee's authorized agent.Advise the clerk or mark the mailpiece with the
endorsement"Restricted Delivery".
o If a postmark on the Certified Mail receipt is desired,please present the arti-
cle at the post office for postmarking.,if a.postmark-on:,the:Certified Mail
receipt is not needed,detach and affix libel"with postage and mail.
IMPORTANT:Save this receipt and present it when making an inquiry.
PS Form 3800,August 2006(Reverse)RSN 7530-02-000-9047