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Home My WebLink About0389 WEST MAIN STREET - HAZMATr a g 9 w�� M�, �r �nfS 7 ��` Number Fee 1130 THE COMMONWEALTH OF MASSACHUSETTS $so.00 Town of Barnstable �- Board of Health This is to Certify that CUMBERLAND FARMS#2142 389 WEST MAIN STREET, HYANNIS, MA Is Hereby Granted a 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 f lei Town of Barnstable • �IHE�,,♦ Regulatory Services Richard V. Scali DirectorMAI ` MAS& Public Health Division BARNSTABLE 1639. �0� .w�'"nrma✓��niiEfDw's-r'"'ennxnut Thomas McKean,Director 16 � 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 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 ❑ . A late charge of$10.00 will be assessed if payment is not received by July 1st. ASSESSORS MAP AND.PARCEL NO. a69 iiG -eW DATE to ` A/ FULL NAME OF APPLICANT: - f NAME OF ESTABLISHMENT:_ Cumberland Farms Store#2142 _ 389 West Main Street Hyannis,MA ADDRESS OF ESTABLISHMENT MAILING ADDRESS(IF DIFFERENT)T 7,5 Dios TELEPHONE NUMBER OF ESTABLISHMENT: EMAIL ADDRESS: L��Ll�l1C�i � �Gl•�rr��l� N /h-is , C�� SOLE OWNER: —_YiS NO IF NO,NAME OF PARTNER: FULL NAME,HOME ADDRESS,AND TELEPHONE#OF: CORPORATION NAME PRESIDENT TREASURER `S G CLERK IF PREPARED BY OUTSIDE PARTY: SIGNATU A C Name: Company Address f ichard Fournier Telephone#: Tax Manager Email: Q:\Application Forms\V AZZAP ev16.docx Page 1 of 2 ?qy,_ Town of Barnstable Office: 508-862-4644 �Y Fax: 508-790-6304 • , ' Regulatory Services Department + Public Health Division anri�rnr;� 'MAW Thomas A.McKean,CHO 200 Main Street Hyannis, MA 02601 Payment Receipt .Hazardous Materials Payment received: $50.00 (Check) on 6/14/2016. Permit number: 1130 Check number: 393380 Check amount: $400.00 Name on check: Cumberland Farms e!Business: CUMBERLAND FARMS #2142 Address: 389 West Main Street, Hyannis r • �\ Number Fee 1130 THE COMMONWEALTH OF MASSACHUSETTS 1oo.00 Town of Barnstable Board of Health This is to Certify that CUMBERLAND FARMS#2142 389 WEST MAIN 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. 07/01/2015 JUNICHI SAWAYANAGI THOMAS A.MCKEAN, R.S.,CHO Director of Public Health fF t { ...� .01 Town of Barnstable • ,a�'"E'erp� Regulatory Services Thomas F. Geiler,Director MAW Public Health Division 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. )jy DATE r ' C� ✓�-5 _ ..- APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE MORE THAN 111 GALLONS OF HAZARDOUS MATERIALS FULL NAME OF APPLICANT NAME OF ESTABLISHMENT �,� ,� ADDRESS OF ESTABLISHMENTS C �� -"/� ,,., ' TELEPHONE NUMBER SOLE OWNER:-I/Y/ES NO IF APPLICANT IS A PARTNERSHIP, FULL NAME AND HOME ADDRESS OF ALL PARTNERS: IF APPLICANT IS A CORPORATION: FEDERAL IDENTIFICATION NO.�lr. �/�T,� ' STATE OF INCORPORATION FULL NAME AND HOME ADDRESS OF: PRESIDENT TREASURER - _ CLERK - - TU APPLICANT RESTRICTIONS: HOME ADDRESS Farrr�� 111CF HOME TELEPHONE .. �,rasscngvurd Framingham, 1AA '01702 Number Fee 1130 THE COMMONWEALTH OF MASSACHUSETTS $1oo.00 Town of Barnstable Board of Health This is to Certify that CUMBERLAND FARMS #2326 389 WEST MAIN 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. 3/18/2014 JUNICHI SAWAYANAGI THOMAS A.MCKEAN,R.S.,CHO Director of Public Health t Town of Barnstable Regulatory Services Thomas F.Geiler,Director : MM 1 Public Health Division Thomas McKean,Director 200 Main Street, Hyannis,MA 02601 Office: 508-8624644 Fax: 508-790-6304 Application Fee: $100.00 ASSESSORS MAP AND PARCEL NO. �-//U �DATE APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE MORE THAN 111 GALLONS OF HAZARDOUS MATERIALS FULL NAME OF APPLICANT S -/ �� L--LAC—, d NAME OF ESTABLISHMENT ADDRESS OF ESTABLISHMENT S7 TELEPHONE NUMBER 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. STATE OF INCORPORATIONf�°>,-, -�� FULL NAME AND HOME ADDRESS OF: PRESIDENT TREASURER ' CLERK - Richard FOurnier Tax Manager SIG AT O PLICANT 07 beFlgirid Fare Im RESTRICTIONS: i�"A RESS X Department HOME TELEPHONE # VarCi Framingham, MA 01702