HomeMy WebLinkAbout0126 FREEZER ROAD - HAZMATr� �� .
��e mz�
Number Fee
1357 THE COMMONWEALTH OF MASSACHUSETTS $125.00
Town of Barnstable
Board of Health
This is to Certify that Brians Outboards, Inc.
............................. -------------------------------------------------------------------------------------------------•.
92 Freezer Road, Barnstable, MA OV-"3 6
.................................................. ---------------------------------------------------------------------------------------------------------------------
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
tr
•
&4�
Town of Barnstable
Inspectional Services
oFt�.� BARNSTABLE
Public Health Division
76 .7C1I '
+ swxMAABLE, = Thomas McKean Director 41 t
MASS.1639.
$ � 3 ,
ATEO MPS 200 Main Street, Hyannis, MA 02601 a
t.f
Office: 508-862-4644 Fax: 508-7906304
APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE
HAZARDOUS MATERIALS U.
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 J
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.
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'TORAGE/USE OF
GREATER THAN HOUSEHOLD QUANTITIES (25 GALLONS)? %/ YES NO.
4. FULL NAME OF APPLICANT: 991AN If IJ �P�e3�121�� . //•/�
5. NAME OF ESTABLISHMENT: &1,4145 //Vc-o
6. ADDRESS OF ESTABLISHMENT: 9.7- fRCEZER RA ,(349Ai�r�14131-� , n1A
7. MAILING ADDRESS (IF DIFFERENT FROM ABOVE: 1,0e 6O 3i7
8. TELEPHONE NUMBER OF ESTABLISHMENT: S`'O Lei 9 f,Z 7 Cr-9"4
9. EMAIL ADDRESS: bra«n�rcu- oQarcll a VX0+Mak1 ' -cowl
10. SOLEOWNER: YES NO IF NO,NAME OF PARTNER:
11. FULL NAME,HOME ADDRESS,AND TELEPHONE# OF:
CORPORATION NAME 69144 S• alrjfOS4RQ-5 /N[
PRESIDENT MALT Ar'i4,Cl
TREASURER
CLERK0
12. IF PREPARED BY OUTSIDE PARTY:
NAME: TELEPHONE#:
COMPANY ADDRESS EMAIL:
*SIGNATURE OF APPLICA DATE 711�2p2_
Q:\Application Forms\Haz Mat App Revised 09-10-18.docx