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HomeMy WebLinkAbout0255 BREED'S HILL ROAD - HAZMAT - � � l �l - a 2 00 � ����...�°'s�,�y�'"ti�'-".._�+`..'_^-�re._"'��'s..+ Y�.+�J„ .._,: .�. �.-"+-Y'--9F'_r._,.^'�'_°�-.«..ice• _.. � _ _ -++r-.l_ _. -- TOWN OF BARNSTABLE BAR _W �D1� Ordinance or Regulation WARNING NOTICE Name of Offender/Manager y Address.of Offender MV/MB Reg. # Village/State/Zip . :� .2 ° J Business Name ;n �.� vt r,Cr.�yt« G�' Vie-- ,�vt c- f,t� gain/pm.; on '7/�.``�' 20 1�' Business Address UCLr� t-;� I I' Or`x 1-771� }I Signaturet`of�Enforcing Officer Village/State/Zip f'1�/h0V1 + � , V�1 l4 O-Z-6a I Location of Offense '�_ +n r - vt-li-A-vtc t x Enforcing Dept/Division Offense /4 �)A Zr' 40L-�-' M(4+;er' ct t + f P vt�at . �l 1 rA6 vL Facts Vow 11 t e Wx vt� a" •> r �> �f s, P This will serve only as a warning. At this time no legal action has been taken. It is the goal of Town agencies to achieve voluntary compliance of Town Ordinances, Rules and Regulations. Education efforts and warning notices are attempts to gain voluntary compliance. Subsequent violations will result in appropriate legal action by the Town. WHITE-OFFENDER CANARY-ORD./REG.-PROG. PINK-ENFORCING OFFER GOLD- ENFORCING DEPT. TOWN OF BARNSTABLE �0 Ordinance or Regulation BAR -W WARNING NOTICE Name of Offender/Manager 4 eau V.) r � Address of Offender MV/MB.Reg._# Village/State/Zip i . Business Name E,� r - , r �1 am/pm; on 717,4 20 1 , Business Address Signature!,ofyEnforcing Officer Village/State/Zip- v11 t f?`- ~ ► Location of Offense --r' �; \,L x: - t ��c 1C n r fVA Pt+ 1 Enforcing Dept/Division Offense ik ti• .• � F{t `t {� Dyr� 4`�`t rc ��f � t ( r y�f£ir la#'c � s•K r ioi,1."l— C': k t Facts kAv>' This will serve only-as a warning. At this time no legal action has been taken. It is the goal of Town agencies to achieve . voluntary compliance of Town Ordinances, Rules and Regulations. Education efforts.and warning notices are attempts to gain voluntary compliance. Subsequent violations will result in appropriate legal-action by the Town. WHITE-OFFENDER CANARY-ORD./REG.-PROG. PINK- ENFORCING OFFER GOLD-ENFORCING DEPT. Number Fee 1241 THE COMMONWEALTH OF MASSACHUSETTS $125.00 Town of Barnstable Board of Health This is to Certify that Independence Park, Inc. 255 Breeds Hill Road, Hyannis, MA -----------------------------------------•-----......------------------------...------------....------------......------......--.........------------...........-------- Is Hereby Granted a License For: Storing or Handling 111 - 499 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 ,,ram r^> • Y Town of Barnstable MA I_A_IMA Inspectional Services BARNSTABLE MIM�TMe n:,va:ura.c•cxrznKut•mturt•rrnnws Public Health Division "a�•6�-�`.•..n� s &` :63fy{{955-772[[U��1�: • a JU.J AMUMB Y Thomas McKean, Director 200 Main Street H ni MA 02601 RFD Mld A ' ans y ' C> Office: 508-862-4644 Fax: S68-790-6304 APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE 6 HAZARDOUS MATERIALS �',L 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. j 1. ASSESSOR'S MAP AND PARCEL NO. IL+ oZc= 2. IS THIS A PERMIT RENEWAL? X 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: t>&N de p4VL�M- 5. NAME OF ESTABLISHMENT: C AIDS M• SA'F3A't''C 6. ADDRESS OF ESTABLISHMENT: 7. MAILING ADDRESS(IF DIFFERENT FROM ABOVE: rPQ-SO)< \,1(40� +-*/AWt4 8. TELEPHONE NUMBER OF ESTABLISHMENT: `.J V� •�`� ' S o s o 9. EMAIL ADDRESS: . GM5 " S A�A T'� w • �'®Ir°l 10. SOLEOWNER: YES NO IF NO,NAME OF PARTNER: 11. FULL NAME,HOME ADDRESS,AND TELEPHONE#OF: CORPORATION NAME PRESIDENT mil, 54SAT-r TREASURER G,I*e1L Lf & h SASH-C-'r CLERK 12. IF PREPARED BY-OUTSIDE PARTY: .4 NAME: TELEPHONE#: COMPANY ADDRESS EMAIL: SIGNATURE OF APPLICAN DATE Q:\Application Forms\Haz Mat Appli Draft Jan20l9.docx iJ Fee Number 1241 THE COMMONWEALTH OF MASSACHUSETTS $125.00 Town of Barnstable Board of Health This is to Certify that Independence Park, Inc. 255 Breeds Hill Road, Hyannis,MA Is Hereby Granted a License For: Storing or Handling 111 -499 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 THOMAS A.MCKEAN, R.S.,CHO Director of Public Health Town of Barnstable t+l (inspectional Services BARMSTABL • �.�.t�,� M SICTSPIN.LS<3ix�l�ILL�.`ASI B:f K'.'3.E -i..� Public Health Division NG lu]9-7014 Thomas McKean, Director '°Tpp A�0 200 Main Street,Hyannis,MA 02601 : Office: 508-862-4644 Fax 508-790-6304 APPLICATION-FOR PERMIT TO STORE AND/OR UTILIZE PZ 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 MY 1 st—JUNE 30th). APPLICATION FEES CATEGORY 1 PERMIT 26- 110 Gallons: $ 50.00 ❑ GA_T_EGORY_2=P-ERiVIIT=11:1=4.99,Gailons: $=12500— �,. ILa'j 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? X 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: eew& . 5. NAME OF ESTABLISHMENT: -TNOt`►-N • '�p►'iZIL� 04 6. ADDRESS OF ESTABLISHMENT: 26S '3Ttm�s Aw. F-a A0b 7. MAILING ADDRESS (IF DIFFERENT FROM ABOVE: COX 1`n(o NYDNN I 0240a 1 8. TELEPHONE NUMBER OF ESTABLISHMENT: 9. EMAIL ADDRESS: G M 5 S�T3Az'TIAw tit 10. SOLEOWNER: YES '*A-NO IF NO,NAME OF PARTNER: 11. FULL NAME,HOME ADDRESS,AND TELEPHONE#OF: CORPORATION NAME kNG. PRESIDENT '5ds,,e Awm TREASURER 4"A-erK;S M . Sale&-r-r CLERK i 12. IF PREPARED BY OUTSIDE PARTY: NAME: TELEPHONE#: COMPANY ADDRESS EMAIL: • SIGNATURE OF APPLICANT DATE 15•'Z% 7s2,%g Q:1Application Forms\Haz Mat App Revised 09-10-1 .docx i Charles M. Sabatt PC =- • Attorney At Law 540 Main Street — Suite 8 Telephone Hyannis, MA 026o1 Facsimile 5o8-775-5050 5o8-778-460o p dWl May 21, 2019 Town of Barnstable Public Health Division 200 Main Street Hyannis, MA 026o1 RE: Application for renewal of Permit to Store Hazardous Materials Independence Park, Inc. - 255 Breed's Hill Rd, Hyannis To Whom It May Concern: • Enclosed please find our renewal for Application for Permit to Store and/or Utilize Hazardous Materials for Independence Park, Inc.. In the event that you have any questions, then please contact me. Sincerely, Charles M. Sabatt, Esq. Town of Barnstable Inspectional Services , " WA &M ' Public Health Division r Thomas McKean,Director " . 200 Main Street, Hyannis,MA 02601 i Office: 508-862-4644 Fax: 508-790-6304? May 10,2019 NOTICE HAZARDOUS MATERIALS RENEWALS All businesses that handle and/or store hazardous materials greater than household quantities are required to obtain an annual permit with the Public Health Division. Your current permit to store and/or utilize hazardous materials will expire on June 30, 2019. The fees are outlined below based on Category. A $10 late fee will be assessed if payment is received after July I". APPLICATION FEES CATEGORY 1 PERMIT 26— 110 Gallons: $50.00 7CATEGORY`2-PERIVIIr—i-i-1=49-9—Gallons'$125-00—= CATEGORY 3 PERNIIT 500 or more Gallons: $150.00 If you have any questions or concerns, please contact Public Health Division at 508-862-4644. Thank you. DATE: 5• Zl• 2��a, APF ZOVED BY: GAL —AMT: G/L # AMT.-I.AI G/L# A.W. 2 Sincerely, as cKean, R.S., CHO Agent of the Board of Health QAHazmatWotice Letter for Renewals 2019-2020.docx I I t %vl 4<vlt,S +v Se�.c.i•J a � — � Wt d� �g-e, ►ss��� I Daniel Meehan Property Manager,..tot. , Independence Park Inc. 255 Breeds Hill Road Hyannis,MA 02601 dan@independencepark.cc 774-487-8181 I r °PINE ro Town of Barnstable Office:508-862-4644 Public Health Division Fax:508-790-6304 • RnRMASS. 200 Main Street• Hyannis, MA 02601 M MP'� E0 A�0 TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT r Business Name: Date: g f 7 o Location/Mailing Address: 25S re.-e , 11 a `7-r Contact Name/Phone: & - - 1-1"71. Inventory Total Amount: A-1310 R&A SDS: - &XII A,ce--r-s5 License#. Tier II : M o Labelina: (X 1&6ct 04- k-t, Spill Plan: a Oil/WaterSeparator: Floor Drains: q Emergency Numbers: Storage Areas/Tanks: 1 a I A�< u r o a m Emergency/Containment Equipment: Waste Generator ID: XJ A Waste Product: Date&Amount of Last Shipment/ requency: Licensed Waste Hauler&Destination: Other Waste Disposal Methods: LIST OF TOXIC AND HAZARDOUS MATERIALS 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 tk oo Dry cleaning fluids T Automatic transmission fluid SJt Other cleaning solvents&spot removers Engine and radiator flushes )o D Bug and tar removers — Hydraulic fluid (including brake fluid) `k s Windshield wash Motor oils S-r 0,k1A•vU-t 3 Miscellaneous Corrosives Z �Gas�olinee jet fuel, aviation gas 2- Cesspool cleaners ieD sel fuel, kerosene, #2 heating oil Disinfectants l (v Miscellaneous petroleum products: Road salts grease, lubricants, gear oil A5-Y f Refrigerants Degreasers for engines&garages Pesticides: ;rJ 7-4 S 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 7 Lye or caustic soda 'L Lacquer thinners 1 k t k 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) n VIOLATIONS: 9X Q��(t�Q. 1 G•c vt — C(.�ARiti�-M A Q , ! C�t,��iosY�X✓)`t �1� �a.�c-k2.2 ORDERS: t- v�-1�, w AW w&e -¢- o, EA wcl. 5. 5D 4t 1 cam. INFORMATION/RECOMMENDATIONS: 0-' V\,o Rc140-VIL EL-5 Vl ti� 0 `, (� C � w AUC��D< I �JA lUAy—) k Inspector: A0�1' ���',/1, 1V��op �`J-�.�-�- Facility Representative: WHITE COPY-HEALTH DEPARTMENT/CANARY COPY- BUSINESS LL_ Charles M. Sabatt PC Attorney At Law 540 Main Street — Suite 8 ^ Telephone Hyannis, MA 026oi Facsimile �L 508-775-5050 5o8-778-4600 October 16, 2018 Town of Barnstable Timothy Lavelle - Hazardous Materials Specialist 200 Main Street Hyannis, MA 02601 RE: Independence Park, Inc., 255 Breeds Hill Road Hazardous Materials Fine &Application for Permit To Store and/or Utilize Hazardous Materials Dear Mr. Lavelle, On behalf of Independence Park, Inc. enclosed please find our Application for Permit To Store and/or Utilize Hazardous Materials and the Emergency Spill Response Plan. A request for a hearing to contest the October 10, 2018 Hazardous Materials fine at 255 Breeds Hill Road, Hyannis has been made as of this date. For further assistance, please contact Independence Park, Inc. Property Manager, Daniel Meehan at: 774-487-8181. Thank you for your cooperation and attention to this matter. Sincerely, Char es M. Sabatt, Esq. Enclosures l EMERGENCY SPILL RESPONSE PLAN Business Name: pAR.Ic- VN G. Address: 266 31 Eos H%" 'RAJ, H%?4ww%9 t-4,A 02100\ Emergency Coordinator, Name: `pqt.! Nl y4N Emergency Coordinator, Phone: --M 4. 4e-1 — 8% lb\ Fire District: 4-k`A5+JNtS Non-emergency Phone: —7-14 14W SIS t Barnstable Public Health Division: 508-862-4644 MassDEP 24 Hour Spill Hot Line: 888-304-1133 Waste Hauler: Name: 1zselj3"C- S6QVt5 Phone: 600 35"L -78016. PROCEDURES: Notify the fire department(911)if there is an immediate threat to life or property. 1) Evacuate the area if there is a risk of injury due to fire, fumes;or other factors. 2) Be sure to use any needed Personal Protection Equipment (PPE) located: 3) Extinguish any ignition sources. 4) Refer to the Safety.Data Sheet(s) (SDS) for the released material which are located: 5) Stop the leak or spill if safe to do so. 6) Contain and absorb the spill using absorbent material,i.e., "speedi'dry",pads, and/or booms that are located 7) Keep the spilled material contained on hard,non-porous surfaces and away from storm drains. 8) For spills in excess of one gallon of any toxic or hazardous material,notify the fire department and the health division using phone numbers listed above. 9) Notify MassDEP at the hotline listed above for any spills that exceed 10 gallons r that enter an aterbod or storm drain. o yw y °FIHME Tok� Town of Barnstable Office:508-862-4644 Public Health Division Fax:508-790-6304 • BARMAR,R- 200 Main Street• Hyannis, MA 02601 i639 M TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT rED P'� Business Name: 0 e- • Date: Location/Mailing Address: S f S , D p 1'►7 Contact Name/Phone: av o So►.c_ SOB - 77 - 1774, o Inventory Total Amount. < < MSDS: Mal,u.4,VILJ4, 4-1 License#: QIA Tier II : ot, Labelina: 0K. Spill Plan: WA Oil/WaterSeparator: Floor Drains: Emergency Numbers: I Storage Areas/Tanks: o� 01k, cortct Emergency/Containment E ui nt: Waste Generator ID: -1 c SXA•( wA�- ,Q ag VgQC�Waste Product: 1D% Woe Date&Amount of Last Shi ment/ a uenc : Licensed Waste Hauler&Destination: laW� C< 0C--5+e „- v-,4k � 4�wqek 4<4 Other Waste Disposal Methods: cooAk A-qA< 5 LIST OF TOXIC AND HAZARDOUS MATERIALS 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' , 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/RECOMMENDATIONS 044-- . qi a osC,L-P- \VL-'J.0 &"- GvCV 1 Q 'S S �SS�tp 6)T-A<- ASDS LA 1 'a �G �rr:'45 Inspect ei 72,k,¢�( Gls Facility Representat e: WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS b Number Fee 1241 THE COMMONWEALTH OF MASSACHUSETTS $125.00 Town of Barnstable Board of Health This is to Certify that Independence Park, Inc. 255 Breeds Hill Road, Hyannis, MA Is Hereby Granted a License For: Storing or Handling 111 - 499 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 • f Jf ow of Unstable, legaatoeYv ces Richard V. Scali,Director!Ot • oFt� Public Health Division BARNS'I'ABI; . 3iCV3`M4L•iYefY 1 .:1 fi � IIAA.'4STADLE,p= Thomas McKean,.Director 9 MAS9. Bo M9. 6. 200 i\T ii i Sucec, I-yarinis,\4A 02601 37 Office: 508-862-4644 Fax: 508-790-61- APPLICATION FOR.PERMIT TO STORE AND/OR UTILIZE HAZARDOUS MATERIALS IN ACCORDANCE WITH C THE TOWN OIL BARNSTABLE GENERAL ORDINANCE,CHAPTER 108, HAZARDOUS MATERIALS, ALL BUSINESSES THAT EANDLE OR STORE HAZARDOUS MATERIALS GREATER THAN HOUSEHOLD .QUANTITIES ARE REQUIRED TO OBTAIN AN ANNUAL PER-MIT(RUNS JULY Ist'-JUNE 30th). APPLICATION FEES CATEGORY I PERMIT 26— 1.1.0 Gallons: $ 50.00 ❑ CATEGORY 2 PERMIT 111 —499 Gallons: $125.00 fdf,.I, CATEG , 3 P RMIT 500 or more.Gallons: $150.W El *A late char c P: 1Q.Q ill be assessed if` 'a naeilt is not,received:by;Tuty 1st. 1. ASSESSOR'S MAP AND PARCEL NO.. .%'4 02C-e> C=4-�Lk 2.. IS THIS A PERMIT RENEWAL? Y YES—NO. IF YES,SKIP QUESTION 3. 3. FOR ALL NEW PERMIT APPLICATIONS,INDICATE WHETHER BUSINESS HAS ZONING/.BUILDING APPROVAL FOR HAZARDOUS MATERIALS STORAGE/USE OF GREATER THAN HOUSEHOLD QUANTI.TI:ES (25.GALLONS)? YES NO. 4. FULL.NAME OF APPLICANT: ► � � � 5. NAME OF ESTABLISHMENT: 6. ADDRESS OF ES.TABLISI-IMENT: '255 T3' 5 N`tv�. 2aAt5 {.-lYeSrv►v�5 7. MAILING ADDRESS(IF DIFFERENT FROM ABOVE: 2-� �� 1 � � NYAN N 15 8. TELEPHONE NUMBER OF ESTABLISHMENT: ' U ` 7-1'5 Q0 9. EMAIL ADDRESS: 'T�f]iN��Nb�(ytv' NC -• CC 10. SOLEOWNER:. YES . NO IF NO,NAME.OF PARTNEIDATE: APPROVED I L FULL NAME,HOME ADDRESS,AND TELEPHONE#OF: C(ORI'ORATIO NAME PRESIDENT � TREASURER ' CLERK 12. ,IF PREPARED BY OUTSIDE PARTY: NAME: R�sJ Cam, tr1. SAB4"r-r TELE PHONE#;.-50$ -rl 5 `j050 COMPANY.ADDRE S ' 4D V-WsJ s-t, EMAIL: {.r(At-st�j15% NSA 02{o 01 • SIGNATURE OF APPLICANT DATE 1 b +S• Z 01 a Q:\Application Forms\HAZMAT API'.2_0,1 CVISED dncx . owi of Barnstable egu atory ervices OFINE T Richard V. Scali, Director Public Health Division BARN TABLE o� � • &1RN5'AELE•LHR[RVILLE•COTIIIT•:t:4:ti15 •A MASS. Thomas McKean, Director 16 'Z 4•`5,• „s.nEF T MASS. $. 4'- 1639. 39. A 200 Main Street, Hyannis, M 02601 5Y5 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 1 st-JUNE 30th). APPLICATION FEES CATEGORY 1 PERMIT 26- 110 Gallons: $ 50.00 ❑ CATEGORY 2 PERMIT 111 -499 Gallons: $125.00 V'r.1-' CATEGQRN,3 RMIT 500 or more Gallons: $150.00 ❑ *A late char e f S10.00 ill be assessed if payment is not received by July 1st. 1. ASSESSOR'S MAP AND PARCEL NO. 3 0-4 ©2G P CX�LE 2. IS THIS A PERMIT RENEWAL? Y YES_NO. IF YES, SKIP QUESTION 3. 3. FOR ALL NEW PERMIT APPLICATIONS,INDICATE WHETHER BUSINESS HAS ZONINGBUILDING APPROVAL FOR HAZARDOUS MATERIALS STORAGE/USE OF • GREATER THAN HOUSEHOLD QUANTITIES (25 GALLONS)? YES NO. 4. FULL NAME OF APPLICANT: N � �a►SLI� 5. NAME OF ESTABLISHMENT: 6. ADDRESS OF ESTABLISHMENT: 255 •r3'� �5 Wtu` 2aA� 1-lYp�►N�5 7. MAILING ADDRESS (IF DIFFERENT FROM ABOVE: ?• • 'S01X 1^1� (.o 1 k4yAN N 15 8. TELEPHONE NUMBER OF ESTABLISHMENT: -7-1'5 \"-n Qp t '�� ' Nb1 'at s 1 9. EMAIL ADDRESS: &'\Nor. CC 10. SOLEOWNER: YES NO IF NO,NAME OF PARTNER: 11. FULL NAME,HOME ADDRESS,AND TELEPHONE#OF: CORPORATIQD4NAME 1:6 C� ^-rA21¢ INS• PRESIDENT TREASURER - - CLERK 12. IF PREPARED BY OUTSIDE PARTY: NAME: 0JA414S M. S A154-r r TELEPHONE#:jOg -T1 'S 5 050 • COMPANY ADDRESS IS140 M41o.1 ST EMAIL: }A+At j%g• J AA MCoo 1 SIGNATURE OF APPLICA Q: NT DATE 10 •l S • Z.0 1 e5 �Application Forms�IIAZMAT AP�20 EVISED docx n Q✓t w/. ,J L L, Number Fee 1241 THE COMMONWEALTH OF MASSACHUSETTS . $so.00 Town of Barnstable Board of Health This is to Certify that Indpendence Park, Inc. 255 Breeds Hill Road,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. ---------------------------------------- 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 q'TOHd LT OZ 170 D U " r»lof B nstable iw egu atory e'mces Richard V. Scali,Director • "�, Public Health Division BARNSTABLE tARNBTABIS.-' .�.Ms„�.mrtmuu.00rt...mw.m Thomas McKean,Director ; ';;°" "` �(D 59. 200 Main Street,Hyannis,MA 02601 Office: 508-$62-4644 C��q—o? /" Fax: 508-790-6304 n 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. 1. ASSESSOR'S MAP AND PARCEL NO. 314 -oace-oo,4 2. IS THIS A PERMIT RENEWAL? )( YES NO. IF YES,SKIP QUESTION 3. 3. FOR ALL NEW PERMIT APPLICATIONS,INDICATE WHETHER BUSINESS HAS ZONINGBUILDING APPROVAL FOR HAZARDOUS MATERIALS STORAGE/USE OF GREATER THAN HOUSEHOLD QUANTITIES(25 GALLONS)? YES NO. 4. FULL NAME OF APPLICANT: 5. NAME OF ESTABLISHMENT: 1�ndewmdekice. ?ar- . . T )c 6. ADDRESS OF ESTABLISHMENT: �h"n►S 7. MAILING ADDRESS(IF DIFFERENT FROM ABOVE: P,()• 8oX �7710 8. TELEPHONE NUMBER OF ESTABLISHMENT: I'77& 9. EMAIL ADDRESS: fzdeptmteny-PaA,(77� 0 VVt Qn.i ld- 10. SOLEOWNER: YES NO IF NO,NAME OF PARTNER: 11. FULL NAME,HOME ADDRESS,AND TELEPHONE#OF: CORPORATION NAME Pan.IL PRESIDENT 11aY1✓I�Dngsoh, QgC1 24anhougk EA.,,4fi44 t nic-505 a30 0-76 TREASURER CLERK 12. IF PREPARED BY OUTSIDE PARTY: NAME: TELEPHONE#: COMPANY ADDRESS EMAIL: SIGNATURE OF APPLICANT V74MAfATE ?,-►-17 C:\Users\Decollik\AppData\Local\Microsoft\Window emporaI-Internet it C6ntent.Outlook\BMQD49H2\HAZMAT APP 2017 REVISED.docx Number Fee 1241 THE COMMONWEALTH OF MASSACHUSETTS $5o.00 Town of Barnstable Board of Health This is to Certify that Indfiendence Park, Inc. 255 Breeds Hill Road, 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. J 07/01/2016 JUNICHI SAWAYANAGI THOMAS A.MCKEAN,R.S.,CHO Director of Public Health Town of Barnstable �'THE Regulatory Services • °: Richard V. Scali,Director '"x"'�`"�`� ` Public Health Division BARNSTAiam t639• D ' Thomas McKean,Director 1639-201 200 Main Street,Hyannis,MA 026W a Office: 508-862-4644 Fax: 508-790-6304" " W APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE '0a HAZARDOUS MATERIALS IN ACCORDANCE WITH THE TOWN QF 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 Ej CATEGORY 2 PERMIT 111 —499 Gallons: $125.00 ❑ CATEGORY 3 PERMIT 500 or more Gallons: $150.00 ❑ ?,j&-rArc'L-�CAGLL 'CEn- A late charge of$10.00 will be assessed if payment is not received by July Ist.� Vn�css •1-12-i6 ADi�(2£-SS Gn.h•oh. • ASSESSORS MAP AND PARCEL NO. DATE 7.:%L FULL NAME OF APPLICANT: -EWibc PEODENCE ?A0.K,, =>yL NAME OF ESTABLISHMENT: ►vDEPEN�)tNCC PA(Z%:I L-s j(- ADDRESS OF ESTABLISHMENT: �3"ZEV-b5 Hit-- �-C! , W 6'2 G0 i MAILING ADDRESS(IF DIFFERENT): P.C).Y�x ►77(-, Vj!!A N,y IS TELEPHONE NUMBER OF ESTABLISHMENT: So`� —1-75- i-7 7( EMAIL ADDRESS: N� A SOLE OWNER: ✓ YES NO IF NO,NAME OF PARTNER: FULL NAME,HOME ADDRESS,AND TELEPHONE#OF: CORPORATIONNAME LN��{�E�J��NGt �'A� � �1C. A5 aroy PRESIDENT M AF-K W'Tl yoM Qsa rJ TREASURER Ck,-w-cin3 i t�n4so s� CLERK IF PREPARED BY OUTSIDE PARTY: SIGNATU OF APPLICANT Name: ��Ilea�v Company Address Telephone#: • Email: C:\Temp\HAZZAPP Rev I6.docx Page 1 of 2