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Home My WebLink AboutApplications, WC and Licenses� 1 ` ~ _ .: ;, ; z ' �}�� TOWN OF YARMOUTH BOARD OF HEA�.'��'�,� 2 �� ,�I � APPLICATIUN FOR LICEN�I��MIT�20p9� �� Q� 2008 �e � � :. �. ;� �,� * Please complete form and attach a11 necessary dr�cu�en`�s'�tiy Dece . ��-. � Failure to do so will result in the return of your application pa . I NAME OF ESTABLISHMENT: i4 � TEL. # fI�- 3'9 F ZZ f� LOCATION ADDRESS: 2. o • .v7�. MAILING ADDRESS: OWNER NAME: ttA�L 7Zi v.1' TAX ID FE1N or S N : CORFORATION NAME (IF A IC B E : . MANAGER'S NAME: �t � (/�� t E TEL. # 3e �=�?7-12LL � MAILING ADDRESS: 2 R- � z POOL CERTIFICATIONS: The pool supervisor must be certified as a Pool Operator,as required by State law. Please list the designated Pool Operator(s) and attach a copy of the cei-tification to this form. 1. �c� �H o�r �-- �-' ,�,.r,at.�._ ��l.r _ _ 2. ��W� ��-�►,�r � ��.,�.u..2� �� , Cc�c� Pool operators must list a minimum of two employees cun-ently certified in basic water safety,standard First Aid and Community Cardiopulmonary Resuscitation(CPR). Please list these employees below and attach capies of employee certifications to this form. The Health Department will nat use past years' records. You must provide new copies and maintain a file at our place of business. 1. t ch R�td i�� 2. V/�ND�2A- ��1E's 3. 4. � FOOD PROTECTION MANAGERS - CERTIFICATIONS: � All food service establislunents are requued to have at least one fiill-time employee who is certified as a Food � Protection Manager, as defined in the State Sanitary Code for Food Service Establishments, 105 CMR 590.000. Please attach copies of certification to this application. The Health Department will not use past years' records. You must provide new copies and maintain a �le at your establishment. 1. �A-nl.�2A �y� 2. �� /ho H AS ' PERSON IN CHARGE: __ _ ____ - - __ __ Each food establishment must have at least one Person In Charge (PIC) on site during hours of operation. 1. d � �M/K 2. ��i9-I�l�/1.A- f�4 E i HEIMLICH CERTIFICATIONS: All food service establislunents with 25 seats or more must have at least one employee trained in the Heunlich Maneuver on the premises at all times. Please list your employees trained in anti-choking procedures below a.nd : attach copies of employee certifications to this form. The Health Department will not use past years' records. You must provide new copies and maintaisi a �le at your place af business. ; 1. �c� �l ` 2. RA- � 3. 4. ! � � RESTAURANT SEATING: TOTAL # ZOS � ' OFFICE USE ONLY LODGING: � ' _. LICENSE REQUIRED FEE PERMIT# LICENSE REQUIRED FEE PERMIT# LICENSE REQUIRED FEB PERMIT# B&B S55 CABIN $55 I MOTEL �5� _ 1 � � Vo�� GANIY �55 ZSWIMMING POOL �80ea. #�� ' LODGE S55 TRAILERPARK $1Q5 � WHIRLPOOL �80ea. �O`1-O�L FOOD SERVICE: 1 LICENSE REQUIRED FEE PERMIT# LIGENSE REQUIItED FEE PERMIT# LICENSE REQUIRED FEE PERMIT# i ' 0-100 SEATS S8� _CONTINENTAL �35 NON-PROFTI �30 �>100 SEATS �160 �O�j-Qsr / COMMON VIC. �60 �01�-(�� _WHOLESALE �80 ; ; RETAIL SERVICE: —RESID.KITCHEN �80 ' LICENSE REQLTIRED FEE PERI�IIT# LICENSE RF�QUIRED FEE PERMIT# LICENSE REQUIRED FEE PERMIT#, � . ; <�0 sq.ft. �50 _>23,�►8Q�ft. 5225 VENDING-FOOI7� �25 � <25,000 sc�.ft. � . �$d . � � ._FROZ��I.��SSERT S40 _TOBACCO 5�5 — � . ,.� --� . NAME(:HANGE: sio ' AMOUNT DUE = S 5 l 5.00 "'*�'**PLEASE TLTRY OVER A�GO'VIPLETE OTHER SIDE OF FORNI***** r . � t �, , � � �,.. ADMINI5TRATION Under Chapter 152, Section 25C, Subsection 6,the Town of Yarmouth is now required to hold issuance or renewal of any license or permit to operate a business if a person or company does not have a Certificate of Worker's � . , Cort�p,�satiqn..aInsurance. THE A��HEDy 5TAT�. W�1t�ER'S COMPENSATION INSURANCE _ . A�'Fi��A�I�i"11(tUST$E COMP�.,�} �AN''IY S�GN��,,+d�2� ` =�` � � - ��-�� s�. .+�� :�, ,_ � `:f' . _ �- �: . r: . '� �,�'`_. z � CERT. OF INSLIRANCE A TA��IED�_ � �� •�''$, . . �. . , � �R� � � '.� ,�, ,�, , WORKER'S COMP. AFFIDAVIT SIGNED �1ND ATTACHED � . .. �� . . . . . "F . . � Town of Yarmouth tax�s and liens m�tst t�e paid prior to renewal or issuance of your permits. PLEASE CHECK APPROPRIATELY IF PAID: / YES �/ NO l�O�F�Y.S AND',E1T�ER LO�GING�STABLiSHMENTS � , � . � ��►-y� ` .:',y � .. � , " - . . . � � ., .. . . '.- R `� . TRANSIENT OCCUPANCY: For purposes of the limitations of Motel or Hotel use,Transient occupancy shall be limited to the temporary and short term occupancy, ordinarily and customarily associated with motel and hotel use. Transient occupants must have and be able to demonstrate that they maintain a principal place of residence elsewhere. Transient occupancy shall generally refer to continuous occupancy of not more than thirty (30) days, and an aggregate of not mor.e`than��nety,(9Q) days within any six(6)month period. Use of a gues�,unit�.s!a residence or dwelling unit sha11 not be considered transient. Occupancy that i� s�bject to the coll�tion of Room Occupancy Excise, as defined in M.G.L. c. 64G or 830 CMR 64G, as amended, shall generally be consxdered Transient. POOLS POOL OPENING:All swimming,wading and whirlpools which have been closed for the season must be ins ected by the Health Department prior to opening. Contact the Health De�artment to schedule the inspection five(5�days pnor to opening.PLEASE NOTE:People are NOT allowed to srt m the pool area.until the pool has been inspected and opened. POOL WATER 1'ESTING: The water must be tested for pseudomonas,total coliform and standard plate count by a State certified lab, prior to opening, and quarterly thereafter. POOL CLOSING:Every outdoor in ground swimming pool must be drained or covered within seven(7) days of ' closing. . - FOOD SERVICE . CATERING POLICY: - ' Anyone who caters within the Town of Yarmouth must notify the Yarmouth Health Department by filing the required '' Temporary Food Service Application form 72 hours prior to the catered event. These forms can be obtazned at the ' Health Department. ' � FROZEN DESSERTS: � � Frozen desserts must be tested on a monthly basis by a State certified lab. Test results must be sent to the Health Department. Failure to do so will result in the suspension or revocation of your Frozen Dessert Permit until the above terms have been met. OUTSIDE CAFES: Outside cafes(i.e., outdoor seating with waiter/waitress service),must have prior approval from the Board ofHealth. OUTDOOR COOKING: ' _.. putdoor cookin�,_�reparation,or display_of any food product by a retail or food service establishment is prohibited. ' NOTICE:Permits run annually from January 1 to December 31. IT IS YOUR RESPONSIBILITY TO RETURN THE COMPLETED RENEWAL APPLICATION(S)AND REQUIRED FEE(S)BY DECEMBER 15, 2008. ALL RENOVATIONS TO ANY FOOD ESTABLIS�-IlVIENT, MOTEL OR POOL (i.e., PAINTING, NEW ' EQUIl'MENT, ETC.),MtTST BE REPORTED TO A1VD APPROVED BY TI-�BOARD OF HEALTH PRIOR TO COMMENCEMENT. RENOVATIONS MAY REQUIRE A SITE PLAN. � DATE: /�ol/. 12� Zo o� SIGNATURE: ��,�,,� ' PRINT NAME&TITLE: l c. Ar2.�. � � (�-E�t 10121/08 � _ ,�� , 1 �\ The Commonwealth o Massachusetts f Department of Industnial Accidents � NAfe�N�llf�rs 600 Washington Stree� f"'Floor ' ' Boston,Mass. 02111 Workers'Compeas�tion Iasnraece AiSdavih BniidiHg/plambing/E►ectrical Coetractors �fas�lisr� P'lea�oe 1'RIC�1'i'ie�� _ �: E �.. Bl�� c�- adctress- Z 9( d O r� � �I U!G � citv V o• //�7�0✓//'�.- state• ��' zip• D Z�►�i'�' phone# �0/ ' �9/ —ZL� work site location ffnll addressl_ ❑ I am a homeowner perfomiing all work myself. Project Type: ❑New Construction�Remodel ❑ I am a sole proprietor and have no one working in any capacity. Q Building Addition �I am an employer viding warkers'compensation f�my employees worlcing on this job. commav�me: �t.[�f' �tt.:.�ar+l..` 'L-1— _ _ __ �aa�: o� �d� �'1�i rl Sf �n: �� ,r rrn�� ,�'tl-,� 4'��loy �a- 5��35�-�-�-1'�- - �.Zi.�--�'`c �r�z 2i-t .S �-'' # � G 03 ._<..,>. . . .._..�., r.�:.., v<. �,x � N..�#=�R.�,�:�,k�,��...:.>> ❑ I am a sole proprietor,geieral co.traetor,or�omeowner(c�rcle oAe)and have lrired the co�actors listed below who have the following workets'compec�ataon polices: �m1H�Y�!' _ �ailSS: citv- okaie#• ias co. # . , , .,��,�t�,.. ,�, k. �Y aame: �ddress• s�Y: otiooe#. _ -- — -- _ _ __ ___ - —- - -- _- -- - ----—- ----- -- —_ _� - - iis # , . .: - : . t , : . : . ''�..�� : . , ,.. ._,. �.,,;n, a., x�'�t os��3.9"+ ��{ y.w . � ��` t...:�> . Fa�m�c M see�e awera�e a�reqaired a�da Satlo�2SA�'MGL 152 ne k�d t�tlie��f cri�al pnaNia�f a�e�te S1,SM.M udlo� eoe years'laspthonmmt as wr8 as dvr pe�alties i■t6e forn o[a STOP WORK ORDER asd a 5ne otS190.Os a day against a�e. 1 asdets4ud t6at a cepy�f this staleee�t maq be forwaMed 1e the�16oe�tlave�o�of t6e DIA for eeverage vdi&atiee. I do kenby cerlify xrider t ns ad penarlties o pe r�ry t6et t6e iwfor�adon prowded aboae is dzre mrd c»rre�c� _ j _ Signahue 1 GI . Date _ ' /( O�' -- � Print name l C � t I Plwne# .S/ �' a,��l�' 2 2 f� official ese oaly de a�t write i this am to 6e mmpleted bp dty er qwn o�Cchi eity or te�va: pe�l�o�e g �s pe��gt ❑ehed[iE�a1e rdpsme is reqaQ+ed �'s�te ��t �aatact Peneo: phene#; �Of4v (!'�'��-�pp) + ' ' ' ` A�`QRo� CERTIFICATE C)F LIABILITY (NSURANCE °"'�`"�°°"'"'" ` na►v°PEN%i o2 14 os i � P�ouucc� TH13 CER'flFtCATE 181SSUED AS A IIAATTER OF�IFORMA7101�. ! ONLY AND CONFERS NO RIGHTS UPON THE CERTIFlCATE :- The Addi.s Group, Inc. HOLDER.THt$CERTfFICATE DOES NOT AMEND,EXTEND OR ; 250Q_Renaissance Blvd. � 3te 1�0 ' ALTER THE COVFI3AGE AFFORDED BY THE POLIqE3_BELOW. � iCiag of Prusaia PA 19405-2772 - . ; Phone: 610-279-8550 Eax:610-279-8543 INSURERSAFFORDiNGCOVERAGE . NAlC# � nrsuRERw �w.zsau.Sarsan sn.nr.ace r.o. � 40242 � B ua Water L8 ws�� z,�.�a�.��sn,��.ea. 16535 � � o Danenport Realty Trnst w�R�c . an Asehettiao 3outh Yarmouths b�► 02664 x�su�o: WSIktER� .C'OVER/4t`aE$ . THE POLICIEB OF INSURANCE LISTED BELOW HAVE BEEN�SUED TO 11�INSURED W WIED AB�VE FOft 7HE POUCY PERt�NIDICA'iED.N01YIRiHBTMIDWG � ANY RECMJIREWENT.TEI�1A�CONDtT10N OF ANY CONTRACT OR OTNER OOCIAI�NT W�M RESPECT TO WHICN THIS CERTIFICATE MAY BE IS�IED OR i W1Y PERTAIN.Tt�MiSUR/WCE AFFORDED BYTHE POLIC�S DESCRIBEd HEREIN�SfJBJECT TO ALL THE 7ERMS.EXCLUSIONS AND CONDrt101��SUCH i POLIC�.R.AC�3tEGATE LMfTS SHOUA�1 MHY HAVE BEEN REDUCED BY PAID CLNMS. � LTR TYPE Of INS[IRANCE P�� W► DA ��T$ 6E!lERALL1ABtLM EACHOCCURRENCE il OOO OOO a B 8 c�xcu+�c�newu.uasn.rrr GIA8196255 03JO1J08 Q3/Ol/09 ar�uses �,o�o�.r,� s 5d0 Q00 � � a�as nnaoe Q occuR �c►Exa cnnr�w�+) a 10 0 Q 0 ��so�n�aaove•uuttv s S 000 000 � c�ewu.a�cRecnre s 2 000 OOQ c�.ncc�c,�a�ix�raaaL�esr�ax: aRooucrs-co�ncc a 2 000 000 ; POLiCY � LOC j �LIABr.tTY COMBINED SINGLE UINfT � B ' a�vnuro 8AP8196256 03j01/08 03/03/09 t��, :i,000,00a � 7L a.��nuros �a�i� j a $ HlREDAUTOS ' BOD�Y INJtfftY 5 � $ i�N-0WNED AIITOS (Per aeddan� i IC ZSO COIDQ . pROPERTYDAAQl4�3E S X 'Jr�� .'0�.1. �raocid�t) i GARAGE ti�B9ISY AUTO ONIY-EA I1CClDENT E � ANYAUTO OTHERTHAN EJ►ACC $ i AUTB OI�N Y: AGt3 5 ' ; ��y EACH OCCURRENCE S 1. pGCUR �pLA@Ag MppE AGGREGATE i a n�cna�.� : s REFENitON s s i YVORKERS COi1PENSATI[NE AND 8 TORY LtliA1TS ER � �A�LOYER.R'IJAHB.11'Y A �TM �C8196036 03JO1J08 03J01/09 �.�.�►c�sncc�Ern' s l 000 000 �wr�topwerowP �curnrE o�occiu�r EL asensE-En�. s 1 O O O- Q Q O s��s� e�ois�-Poucr�rr a1 000 000 on� ; � � DESCWPTION OF OPERATIOl�1S!LOCJ1710N8!VEHICLES 1 EXCLUS10N3 ADDBD BY ENDORSEMENT J SPECtAL PROVISIONS } . . � . . . . � � . . . i Cp��^- ,^�p ^-�' M 3 i�nl��W��WGR �M{I�YGL�,WN � YA1iNiD-2 sHo�.o a►�v c�n�aeove n�scws�o PouaEs�cnxc�a s�or��e oc�a� ! DATE THEREOF,7F�ISSUMt6 W3l1RER WILL C-�EAVOR TO IIINL 3O DAY3 WRITTEN I T01�TI1 Of Y3TmOli�1 N0710E TO SHE CERTi�ICA7E HOLOER N/1NED TO THE LER7,BUS FARURE SO�IIC SHA6L 1 � AttY!: P0i7�it D�Qt INP0.RE I�OHi.[C,ATION OR LlABILlfY OF ANY KINb UPdN 7HE OdSURER,ITS AGHNTS OR � 1146 Route 28 ; j S. Yazmouth, �, d2664 �P�°'�a � AU ATN 4 � ACORD 25{2001108) �ACORD CQRPORATION 1988 i i � � � � TAE COMMONWEALTH OF MASSACHUSETTS TOWN OF YARMOUTH BOARD OF HEALTH PERMIT NLTMBER: #09-006 FEE: S80.00 j �rhis is co cenit��that Davenport Realtv Trust d/b!a Best Western Blue Water � 291 South Shore Drive, Sauth Yarmouth, MA HAS BEEN GRANTED A LICENSE TO ENGAGE IN THE BUSINESS OR PRACTICE OF - GIVING OF VAPOR BATHS � This License is issued in confonniry with the authorit�granted to the Board of Health,bv Chapter 140,Sections 51,of the General La�vs,and amendments thereto,and is subject to the provisions of the Law�s of the Common�vealth ofMassachusetts relating thereto, and upon such ternis and conditions, and to the niies and regulations in regard to the carrying on of the ioccupation so licensed as adopted b��the Board of Health,and expires December 3 l,2009 unizss sooner re��oked. � December�,2008 BOARD OF HEALTH: .`;E¢�¢tt S�IX�� ✓�.'..lV.� ��it1'Itp�t C.t�avc�e.� .� ��klif$en `Uice C!t#ai�crrur�e J2a��xE �. J3aacrsra, e� Clirur.�'xeercBEcurn, �..N. �. .�Ea� Bruce .Murphy,MPH,R O Director of Health , THE COMMONWEALTH OF MASSACHUSETTS TOW1V OF YARMOUTH � BOARD OF HEALTH PERMIT NUMBER: #09-018 FEE: 580.00 � 1 This is to Certifi�that Daven ort Realt Trust dJb/a Best Western Blue Water , 2 1 out re ve, out armout IS HEREBY GRANTED A PERMIT Ta Operate a Public, Semi-Public Swimming or Wading Pool At Best Western Blue Water - IND04R POOL 291 South Shore Drive Sout Yarmaut , MA This pernzit is granted in confonnin�ith Article VI of the Sanitan�Code of The Commamcrealth of Massachusetts>and expires December 31 2009 unless sooner suspended or re�•oked. Deceniber�,?008 BOARD OF HEALIT-I: .`�E¢�¢tt 5�� .,.lv.� ��'�ttt�[t!. ; � ��co�un��C,�cce C'��nca� Qnri C'�cwzrr�aum, ✓2-.1V- ; .�. 1 I i , P . Z`F�� ? Dir ctor of Health ' � � , • . 1 � THE COMMONWEALTH OF MASSACHUSETTS TOWN OF YARMOUTH PERMIT NUMBER: #09-035 FEE: S60.00 This is to Certify that Davenport Realtv Trust d!b/a Best Western Blue Water � 291 Sauth Shore Drive, South Yarmouth, MA � . IS HEREBY GRANTED A � COMMON VICTUALLER'S LICENSE i In said Tawn of Yarmouth and at that place only and expires December thirty-first 2009 unless sooner suspended or revoked for violation of the laws of the Common�vealth respecting the licensing of common victuallers. This license is issued in conformity with the authority granted to j the licensing authorities by General Laws, Chapter.' 140, and amendments thereto. In Testimony Whereof, the undersigned have hereunto affixed their official signatures. BOARD OF HEALTH: .�Eeee�t S�, J�Z..1V., C.'�t�tuut SEATnvG: 205 total (26,dining rooin l; �a�@d .� `.KE��,� ��[CC ��ltlnlft.lCtt 26,dining room?; 153,main dining room) J�`.0� `.�. ��t/lft� �;CP.J�R QH�L ��Yt.t.tt�lx[llit� �..iV. �'"'`'`'�„�• J�Eb Decenibzr 7 2008 Bru e�:M hy, , . .,CHO Director of Health � THE COMMONWEALTH OF MASSACHUSETTS I TOWN OF YARMOUTH BOARD OF HEALTH PERMIT NUMBER: #09-019 FEE: 580.00 This is to Certifv that Daven ort Realt Trust d/b/a Best Western Blue Water � 291 out ore nve. out armout . IS HEREBY GRANTED A PERMIT To Operate a Public, Semi-Public Swimming or Wading Pool At Best Western Blue Water - OUTDOOR P40L 291 South Share Drive Saut Yarmout MA This pennit is granted in conformin� wiih Article VI of the Sanitarv Code of The Commom;�ealth of Massachusetts,and expires Deceulber 31,2009 unless sooner suspended or revoked. DecemUer�.?008 BOARD OF HEALTH: ��¢tt S�.p�.� �..lY.� �.�lUnlltRtt ��g13'J�f,�¢0 .`�. `.K.¢�i�4it �ICC ��.CYIl�tlLQft �.� s. �f3�cousn, C'�enl� tlru� t�eeriG�aum, J2..�t�. E�ueE'r�n �- .�'fcuJ,eo Bce . M y, , . , Director of Health r , � THE COMMONWEALTH OF MASSACHUSETTS TOWN OF YARMOUTH BOARD OF HEALTH PERMIT NUMBER: #09-052 FEE: S55.00 � I This is to Certify that Daven�ort Real�,y Trust d/b/a Best Western Blue Water ' � 291 South Shore Drive, South Y�r_m__outh, 1�LA ' HAS BEEN GRANTED A LICENSE TO OPERATE MOTELS This License is isst►ed in confornuty��•ith the authoritv grauted to the Board of Health,by Chapter 140,Sections 32A,32B, 32C,3?D and 32E as amended,and is subject to tbe pro��isions of the Laws of the Common�vealth of Massachusetts relating , thereto,and upon such terms and conditions,and to the niles ami regulations in regard to said Motels so licensed as adopted by tl�e Board of Health,and expires December 31,2009 unless sooner suspended or re��oked. April 28,2009 BOARD OF HEALTH: .`�E¢e¢ft S�� .../V. t�lUXtttlYtt � �. J��QI�RA� �1C8 ��lltftLlXtt 2Uil'�iatn C. Srcau�d�n III, C''.eexf� L'nits—84;Bedrooms-84 J lYtil�.tl ��¢K ruce G;Murphy,M , . .,CHO Director of Health TOWN OF YARMOUTH BOARD OF HEALTH PERMIT TO OPERATE A FOOD ESTABLISHMENT PERMIT NUMBER: #09-051 FEE: S 160.00 In accordance�vith regulations promulgated under authorin�of Chapter 94,Section 30�A and Chapter 111,Section 5 of the General La«•s,a perniit is hereb��granted to: Davenport Realty Trust, 291 South Shore Drive, South Yarmouth, MA Whose place of business is: Best Western Blue Water Type of business: Food Service To operate a food establishment in: Town of Yarmouth Permit expires: December 3 l. 2009 BOARD OF HEALTH: .`�EQCtt SPtaf�, J�.JV., C�.Rtaix�natt j SEATING: 205 total (?6,dining room 1; (agliAl�Rb .`�. `.��e�1�41'G� ��tCE ��I�iftrilUt 26,dinuig rooin 2; 1�3,m�in diniug room) ��4X� �. �K4.Wft� �X,�t�t t �� ✓`�Z..1V. � , � i Deceuiber�.2008 ' Bruce G. Murphy,MP , .S.,CHO Director of Health � . , . G�srl�Jc-s T��N • �,J�.Y�� TOWN OF YARMOUTH BOARD OF HEALTH , � ; �"$��y-, APPLICATION FOR LICENSE/PERMIT-2�08 ��"� �7� $'��-!� r . �Yt�'`,��1 °. .� � , - *Please complete form and attach all necessary documents by December 31, 2007. + Failure to do so will result in the return of your application packet. � --� NAME OF ESTABLISHMENT; _BEST WESTFRIV BL F. WAT .R uFSnum TEL. # LOCATION ADDRESS: 291 SOUTH S ORF DRTVFj,, Sn TTH YARMniTTH , MAILING ADDRESS: same OWN�R NAM�:__ BLUE WATER LMTD PARTNERSH I P TAX I (F�IN or SSNI- CORPORATION NAME (IF APPLICABLE): MANAGER'S NAME: RICHARD V. RILEY TEL. #�p�_477_1 �titi MAILING ADDRESS: 24 ARNOLD ROAD, FORESTDAL.F� MA � POOL CERTIFICATIONS: The pool supervisor must be certified as a Pool Operator,as required by State law. Please list the designated Pool Operator(s) and attach a copy of the certification to this form. 1._ STEVE SIMON OCFAN TD . nn� � 2• Fnranun nn;p,Rr,��V g��„�T�•�•L1E Pool operators must list a minimum of two employees currently certified in basic water safety,standard First Aid and Community Cardiopulmonary Resuscitation(CPR). Please list these employees below and attach copies ofemployee eertificatians to this form. T�te �Iealth Dep�rtjnent will not use past yea�s' reeords. �'o� �t�s� pravide new ' copies and maintain a fde at your place of business. l. RT('_HARh RTT.Fy 2. SANDRA NYE 3. 4, � ��..�,.��,..�...�..�.R.�� ' FOOD PROTECTION MANAGERS - CERTIFICATIONS: All food service establishments are required to have at least one full-time employee who is certified as a Food ! Protection Manager, as defined in the State Sanitary Gode for Food Service Establishments, 105 CMR 590.000. Please attach copies of certifiea�ion to this application. The Health Departme�ct wiH not nse pa�t years'rPcords. You must provide new copies and maintain a file at your establishment. j 1. SANDRA NYE 2. P��9I�t�N�HA�GE_ __ __ _ _ _ — Each food establishment must have at least one Person In Charge(PIC) on site during hours of operation. } 1. ROBERT THOMAS 2._SANDRA NYE HEIMLICH CERTIFICATIONS: All faod service establishments with 25 seats or more must have at least one employee trained in the Heimlich Maneuver on the premises at all times. Please list your employees trained in anti-chokmg procedures below and attach copies of employee c�rtificarions to this form. The Health Department will noi use past years' records. You must provide new copies and maintain a file at your place of business. l. SANDRA NYE 2, RICHARD V. RILEY ' 3. 4. RESTAURANT SEATING: TOTAL # 2 0 5 ' OFFICE USE ONLY LODGING: LICENSE REQUIRED FEE PER'biIl'# LICENSE REQL?IRED FEE PER'4IlT� LICENSE REQL'IRED FEE PER'1�IIT� B&B S50 _CABIN S50 ,_MOTEL S50 ' O �INN �50 -�� _CAi�iP S�0 2--SVVI'_�LVIPVGPOOLS75ea. OR--6b� _LODGE 550 ,I'RAILERPARK S100 �V�7-IIRLPOOL S75ea. �O - / , FOOD SERVICE: LICE1�i5£REQUIR£D FEE PERMIT# LICEI�TSE REQUIRED FEE P£RA�II'* LICENSE REQL'IRED FEE PERviIT= � 0-100 SEATS S75 _CONTINENTAL S30 NON-PROFIT SZ5 I >100 SEATS SI50 ��B-OloO �C0;�410N VIC. S50 �Q$-0�'(� _V4�iOLESALE S75 � RETAIL SERVICE: —RESID.KITCHEN S75 LICENSE REQUIRED FEE PERMII'� LICENSE REQUIRED FEE PERy11T� LICENSE REQL7RED FEE PER�IIT r _<50 sq.ft. S45 T>25,000 sq.ft. 5200 _VEIv�ING-FOOD S20 _<25,000 sq.ft. 575 _FROZEN DESSERT S35 TOBACCO S50 NAl�IE CHANGE: SIO AMOUl�T DUE _ $ �75. a U � **"**PLEASE TL'R.\O�'ER��D COJTPLETE OTHER SIDE OF FOR�i*"*"�* I � AnNmvls�TTON � Under Chapter 152, Sectian 25C, Subsection 6,the Town of Yarmouth is now required to hold issuance or renewal of any license or permit to ogerate a business if a person or company does not have a Certificate of Worker's � Compensation Insurance. THE ATTACHED STATE WORKER'S COMPENSATION INSURANCE ; AFFIDAVIT MUST BE COMPLETED AND SIGNED, QR CERT. OF INSURANCE ATTACHED �/ OR WORKER'S COMP. AFFIDAVIT SIGNED AND ATTACHED Town of Yarmouth taa�es and liens must be paid p ' r to renewal or issuance of your permits. PLEASE CHECK APPROPRIATELY IF PAID: YES NO MOTELS AND OTHER LODGING ESTABLISHMENTS TRANSIENT OCCiJPANCY: For purposes of the limitations of Motel or Hotel use,Transient occupancy shall be limited to the temporary and short term occupancy,ordinarily and customarily associated with motel and hotel us�. Transient occupants must have and be able to demonstrate that they ma.intain a principal pla�ce ofresidence etsewhere. Transient occupancy sha11 generally refer to continuous occupancy of not more than thirty (30) days, and an aggregate of not more than ninety(90)days within any six(6)manth period. Use of a guest unit as a residence or ; dwelling unit sha11 not be considered transient. Occupancy thax is subject to the collection of Room Occupancy Excise, as defined in M.G.L. c. 64G or 830 CMR 64G, as amended, shall generally be considered Transient. * NOTE: Enclosed Motel Census must be completed and returned with this appiication. , POOLS , P�OL OPENIlVG: All swimming,wading and whirlpools which have been closed for the season must be ins ; ri r to o nin . Contact the Health De artment to schedule the ins ection five da b the Health De artment o e Y . P P P g F P ��1�� pnor to operunng. POOL WATER TESTING: The water must be tested for pseudomonas,total coliform and standard plate count ' by a State certified lab, prior to opening, and c�uarterly thereafter. POOL CLOSING: Every outdoor in ground swimming pool must be drained or covered within seven(7)days of � closing. ' FOOD SERVICE CATERING POLICY• Anyone who caters within the Tawn of Yarmouth must notify the Yarmouth Health Departmeirt hy filing the required � Temporary Food Service Application form 72 hours prior to the catered event. These forms can be obtaine�at the Health Uepartment. � FROZEN DESSERTS: Frozen desserts must be tested on a monthly basis by a State certified lab. Test results must be sent to the Health ' Department. Failure to do so will result in the suspension or revocation of your Frozen Dessert Permit wrtil the above terms have been met. � OUTSIDE CAFES: Outside cafes(i.e.,outdoor seating with waiter/waitress service),must have prior approval from the Board of Heatth. ' OUTDOOR COOKING: , _ ----� � ,P�l��is��Y�Y fvo��fad�e�-by a�ai�ar€�kse�ee-establ}st�rnen�isprahibited ' NOTICE:Permits run annually from January 1 to December 31. IT IS YOUR RESPONSIBILITY TO RETURN �. THE COMPLETED APPLICATION(S)AND REQUIRED FEE(S)BY DECEMBER 31, 2007. ALL RENOVATIONS TO ANY FOOD ESTABLIS�-IlVIENT, MOTEL OR POOL (i.e., PAINTING, NEW ; EQUIPMENT, ETC.),MUST BE REPORTED TO AND APPROVED BY TI�BOARD OF HEALTH PRIOR ' TO COMMENCEMENT. RENOVATIONS MAY RE UIRE A SITE PLAN. ; ; . � DATE:� 21 �o�SIGNATURE: �� Ir � � I ' PRINT NAME&TITLE: !c �tR� ll - � � I � ! ,o�o o, . � � I �� I _ . _ � ! t �, , , � l he Com�nonwealth of Massachusetts Dtpartment of Industrial Accidents �� 600 R'ashington SYree� 7`�'Floor Boston,Mass. 02111 !i Workers'Compe�sntion Iesar9aee Affidavit:Bailding/Plambieg/Ek�ctrical Coatractors • l�ue p'1�'Il�i'1'i�eelLtr j �= BEST WESTFRtv BLUE WATER RESORT � ackiress: 291 SOUTH SHORE DRIVE ci _�OUTH YARMOUTH state• MA zio 02664 ohane# 508 398 2288 ; work site locatian(full addressl•2 1 SOUTH SHORE D�,I VE� SOUTH YARMOUTH, MA ❑ I am a homeowner performuig all wark myself: Project Type: ❑New Constructi�[�Remodei � ❑ I am a sole proprietor and have no one worlcing in anY�P�itY• ❑Building Addition ; � I am an employer providing warkers'compensation f�my�ployees working on this job. � # _ _ _, - - L com e: - - _- ---____ _ i . . -- � address: � /1�� j � 10 #• (Y` �.- � �� .� ' � � 1 i - .? _ . - �., ' . ..n. , : � _€t._.^5. . F:a . . ."+�.F�a'F'�w�, `+ ❑ I am a sole Pro�ietor,Se�'a�coatraeMr,or yomeaw�er(circle o�e)and have hirad tbe co�'actors listed below who have � the following workars'c�mpensation polices: � v�ame: � addreesc jcitv: ulouc� � �, # j � � �,;� . �av�ne- ad�ne. � #; j _ _ _ _ ;, — - — - # — - -- _ _ _- ___ Fa�te b sccue�wera�e�oder Sa�isn 15�1 ef MGL 152 eaa kad b ti��(cri�ial pe�aNks�f a�e tip t.=i,sM,N„at.r ' �r�'e•n�t�wra a d��ce��.r�s�ror wox�c osnEe..a.e�orsieo.�e.a.y��. i�,�a ee.�. cspy of tl��ta�my be fonvae�ded b Ne Omee of lave�atls�st t6e DIA ter caverase v�ytlos, � I do hu+eby ' xwAer tAie d ptwaltiea ofPerjw►�'tlY�t tAie infonweHow provdded aboNe is trxe mird carnrR � gi��'�� p� � Date �� `�� i Prim name Phone# LJ— v�',o) i n - ��„�j�_ effidal ase only do not wrfte�this ana to be c°mpktcd 6Y dl�'er�w�o� city ar tewn: P�oe�e# �E p�� ❑ckeck if im�e�h�e n�pe�e is reqdned �s O�ee e�atact persea: ��Ha"lt-6 Dq�a�fi�e�t ; (r4viead St�t 2003) ��#' Waa� , r . � ACORv CERTIFICATE OF LIABILITY INSURANCE �P�� p °"�'�""°°"""'' ' DAVEN-1 02 21 07 i PRooucsR THI3 CERTIFICATE IS 1SSUED AS A MATTER OF INFORMATION ONLY AND CpNFERS NO RIGHTS UPON THE CERTIFICATE The Addis Group, Inc. HOLDER.THIS CERT(FICATE DOES NOT AMEND,EXTEND OR 2500 Renaissance Blvd. 3te 1U0 ALTERTHE COVERAGEAFFORDED BYTHE POlICIES BELOW. King o£ Prussia PA 19406-2772 � Phone: 610-27 9-8550 Fax:610-2 79-8543 INSURERS AFFORDING COVERAGB NA1C# � � � � INSURED INSURERA: nmeeican zurich Insuranc�Co. Qd142 ; f B 11A �P3t6Z' LP INSURER& Zuricd Amrriwn zrsuranca co. 16535 � c�o Davenport Realty Trust rt�suReRc: � St hen Aschettino 20�orth Main 3t. INSURERD: 1 3outh Yarsnouth, MA 02664 INSUtiER E� � j COVERAGES ' THE PaICtE3 OF INSURANCE LISTED BELOW HAVE BEEN ISSUEO TO THE IM3URED NAMED ABOVE FOR TFIE PdLICY PERI00 INOICATEQ.NOTWfTFISTAt�ING ANY REQUIREAIENT,TERAA OR COND)TION OF ANY CONTRACT OR OTHER�OCUMENT WITH RESPECT TO WHICH THIS CERTiFICATE MAY BE ISSUED OR ' AAAY PERTRIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS EXCLUSIONS AND CONDITIONS OF SUCH ' POLICIES.AGGREGA7E LONITS SHOWN MAY HAVE BEEN REDUCEO BY PAID CWMS. i ? LTR NS TYPE OF INSURANCE p��a��B� DATE DATE AAMlDD/YY LIMtTS ' G��uT�' EACH OCCURRENCE S�.�OOO�OOO ' � B 7C COMMERCIALOENERALlIABILITY GL08196255 03J01/07 �3f�1��$ PREMISES(Faaccurence SJcd� �� i CLAIMS M/1DE X❑OCCUR MED EXP(Arry w»psrson) S�.O�O O O t PERsoNa�&noV Ia�URY S 1,OOO OOO ; GENERALAGGREGATE S 2 OOO OOO ! GENLAGGREGATELIMITAPPLIES PER PRODUCTS-COMAfOPAGC, $2�QOO�OOO POtICY J Ca LOC AUTOMOBILE LIABILI7Y � B ANYAUTO BAP8196256 03/Ol/07 03/Ol/06 �a��NGIELIMIT g1,000,000 � X AU.OWNEDAUTOS BOOIIY INJURY f 'SCHEOULED AUTOS � �P"r P��) X HIRED AUTOS . ? 80DILY INJURY S E X NON-OWNEDAUTOS IP��de�? i X 2�JO COIIIp PROPEItTY QAMAGE $ ` � X 500 Coll (P��mf GARAGELU181LIiY AUTObNLY-EAACCIDENT S `• � ANY AUTO EA ACC $ OTHER 7HAN AUTO ONIY: AGG S � EXCE8SIUMBRELLA LIABILITY EACH OCCURRENCE S OCCUR �CWMS MAOE AGGREGATE $ j � S ? DEDUCTIBLE g � RETENTION $ g ��D � TORY LIMITS ER � A EMPLOYERS�une�tm y,�g196036 �3�4�.�� 03/O1/08 ELEACHACCI�ENT $�, a�� QQQ I ANY PROPRIE70RIPARTNERlEXECUTIVE ; 1 OfFICEHIMEM6ER EXCLUDED? E L DISEASE-EA EMPLO $�.�OOO�OOO j Ifyes descn'bo under �,�,DISEASE-POUCY LIMfT $1�Q QQ�Q Q Q f SPECIAL PRpVIS�ONS bafow 07HER DESCRIPTION OF OPERATIONS/LOCATIONB!VEHICLES!DCCLUSIONS ADDED HY ENDORSEMENT/SPECIAL PROVISION$ � 4 ! � i � CERTIFICATE HOLDER CANCELLATION Y�0�2 SH�ULD ANY OF THE ABOVE DESCRIBED POLICIE3 BE CANCELLED BEFORE 71iE EXPIRAiION i DATE THEAEOP,THE tBSUiNG INSURER WILL ENDEAWR TO MNL 3O pAYg WRITtEN j TOOPII Of Y3L"IR011�1 NQTICE 70 TME CERTIFICATE HOLDER NAAdED TO THH LEFT,BUT FAILURE TO DO 90 SHALL � At�T3: P@YSRit DHj�t IINppSB NO OBLGAT►ON OR UA8ILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR � iia6 Rout� as ; S, Ysrmouth, MA 02664 ��AT� ; AUTH ENTATIV 4 i ACORD 25(26Q1/08) �ACORD CORPORATION 1988 � ; � ; . � • � THE COMMONWEALTH OF MASSACHUSETTS TOWN OF YARMOUTH BOARD OF HEALTH ; PERMIT NLTMBER: #08-036 FEE: $75.00 � This i�to Ce�tify chat Blue Water Limited Parmers ' d/b/a Best Western Blue Water Resort 29 ou ore Dnve, out armout , IS HEREBY GRANTED A PERMIT ; To Operate a Public, Semi-Public Swimming or Wading Pool i At Best Western Blue Water Resort - OUTDOOR POOL i 291 Souffi Shore Dnve { ou Yarmou � This permit is granted in conformity with Article VI of the Sanitary Code of The Commonweatth of Massachusetts,and expires December 31_2008 unless sooner svspended or revoked. v��6.2oa� Bo�n oF�,�.�: .�f.eCeri Sl�aR�,✓�„N., (',�acixrnan C'�araclee 3��►fe�il�c `Uic�C'l�ai�cm,an ��3.�ra�cua, e�rk l�n '(�s6a�cun,J2..N. Director of H�ealtli ' ' THE COMMONWEALTH OF MASSACHUSETTS TOWN OF YARMOUTH BOARD OF HEALTH PERMIT NUMBER: #08-014 FEE: $75.00 ' T�is is to cemfy thac ___ Blue Water Limited Partnership d/b/a Best Western Blue Water Resort 291 South Shore Drive South Yarmouth MA HAS BEEN GRANTED A LICENSE TO ENGAGE IN THE BUSINESS OR PRACTICE OF - GIVING OF VAPOR BATHS This License is issued in conformity with the suthority granted to the Board of Health,by Chapter 140,Secrions 51,of the General Laws,and amendments ttiereto,and is subject to the provisions of the Laws of the Commonwealt�ofMassachusetts relating thereto,and upon such terms and conditions,and to the rules and regulations in regard to the carrying on of the occupation so licensed as adopted by the Board of Health,and expires December 31,2008 unless sooner revoked_ December 6.2007 BOARD OF HEALTH: .��¢ft S�� .�1�..1v.,��KQR ('�arxlea .`�.JGe�Ueli� ?Jice C'A�avr�Itnit J��.�f+r�vun, C'�exl� Qnn�;�e��r�aum, ✓2.,N. f Bruce G.Mutphy, . .,CHO Director of Health � , � . � THE COMMONWEALTH OF MASSACHUSETTS TOWN OF YARMOUTH � PERMIT NUMBER: #08-046 FEE: $50.00 � This is to Certify that Blue Water Limited Partnership d/bta Best Western Blue Water Resort � 291 South Shore Drive, South Yarcnouth, MA � —. _ IS f�REBY GRANTED A � COM1ViON VICTUALLER'S LICENSE i � In said Town of Yarmouth and at that place only and expires December thirty-first 2008 unless sooner s �pended or revoked for violahon of the laws of the Commonwealth respectmg the licensing u�common victuallers. This license is issued in conformity with the autliority granted to the hcensmg authorities by General Laws, Chapter 140, and amendments thereto. In Testimony Whereof, the undersigned have hereunto aff�ed their official signatwes. BOARD OF HEALTH: ��SRral� J�.N., C',�aixntan sEnrn��: 2os cot�t t26,a��m i; CIEa��'ee 3�.�fellihr�,c� `t��ice C',R�av�ma� 26,dining room 2; 153,main dining room) �Itt��ttW� �:(,FXR �ttlZ��tt[tflt� �..1�. December 6.2007 Bruce G.Murphy, ,RS.,CHO Director of Health THE COMMONWEALTH OF MASSACHUSETTS TOWN OF YARMOUTH BOARD OF HEALTH PERMIT NUMBER: #08-035 FEE: $75.00 � This is co cer�ify that Blue Water Limited Partnershi d/b/a Best Western Btue Water Resort ou ore e, out asmou , IS HEREBY GRANTED A PERNIIT To Operate a Pub�c, Semi-Public Swimming or Wading Pool At Best Western Blue Water Resort - INDOOR POOL 291 South Shore Drive Sout Yarmou _ This permit is�ranted in conformity with Article VI of the Sanitary Code of The Commanwealth of Massachusetts,and expires December 31.2008 unless sooner suspended or revoked. December 6 2007 BOARD OF HEALTH: .`��¢�¢It S� �(,�(�tpK �QX�d .�. ��,IG� ��l��RIXlittaf� J�PJIlE�.��IGQtUft� �:l�X�IL' Q/tft lL/K� ✓�..lV. ruce .Murp y, . ., Director of Health , . v THE COMMQNWEALTH OF MASSACHUSETTS TOWN OF YARMOUTH PERMIT AiUMBER: #08-004 FEE: $50.00 THIS IS TO CERTIFY THAT AN � INNHOLDER'S LICENSE I is hereby ganted to___ Blue Water Limited Parinershin d/b/a Best Western Blue Water Resort � at 1 �t6 Sho Drive S �th Yarm��rh b�A ; in said Town of Yarmouth And at that place only and expires December thirty-first,2ppg unless sooner Suspended � or revoked for vialation of�e laws of die Commonwealth respecting the licensing of innholders. This license is issued in conformity with tlie authority grauted to the licensing authorities by General Laws,Chapter 140,and amendments thereto and is subject to sectians twenty-two to thirty-two, inclusive, and of said chapter and sections twenty-five to twenty- seven,inclusive,of Chapter 272. � In Testimony Whereo�the undersigned have hereunto affixed their official signahu�es,this Sixth day of December A.D. 2007. � BOARD OF I�AI.TH: ��,ttl S�� .N.*E��it1!�lttQ/t � J�_� `v.�cce('.l�atix�ttcut ('.l�rl� , �nn , �..11/. � Bruce G.Muzp , H,R.S.,CHO Director of Health TOWN OF YARMOUTH BOARD OF HEALTH PERMIT TO OPERATE A FOOD ESTABLISAMENT PERMIT NUMBER: #OS-060 FEE: 150.00 In accordance with regulations promulgated under authority of Chapter 94,Secrion 305A and Chapter 111,Section 5 of the General Laws,a permit is hereby granted to: Blue Water Limited PartnerslLi�, 291 South Shore Drive, South Yarmouth, MA Whose place of business is: Best Western Blue Water Recnrr Type of business: Food Service To operate a food estabfishment in: Town of Yaimouth Pemut expires: December 31. 2008 BOARD OF HEALTH: ,,� • SEA�rtG: 205 total (26,dining room l; �� 'lItC6�IlQtl 26,dining room 2; 153,main dining room) J� e�.�� [�lC�.Jj�C,.I�PXHt4� �K ��IYIIIft� �..1{�. December 6 2007 ruce G. hy , .5.,CHO Director of Heal 1 ' � � �-[� DD � ` ��o�.'r•aR o TOWN OF YARMOUTH BOARD OF HEAI;T$ "�� APPLICATIUN FOR LICENSE/PERMIT-2007�� U E C O 7 ZOO6 �; •:�:i * � Please complete form and attach all necessary documents by Dec�mber�3_ }��b`�� DEPT. Failure to do so will result in the return of your application packef NAME OF ESTABLIS�-IlVIENT: (S �d,e� TEL. # JrG�—�9�-�� LOCATION ADDRESS: R.� ,�t v MAILING ADDRESS: OWNER NAME: Hi� /l�itliv�t,f rp Tt�X ID (FEIN or SSNI• CORPORATION NAME(IF AP IC LE): � MANAGER'S NAME: � I�- TEL. # o --� -LZ�' MAILING ADDRE S S: Z o . ,I' v POOL CERTIFICATIONS: The pool supervisor must be certified as a Pool Operator,as required by State Iaw. Please list the designated Pool Operator(s)and attach a copy of the certification to this form. � 1• �GZV'� �J�i�/i�/oN -- ��,,v�� do� 2. . � Pool operators must list a minimum of two employees currently certified in basic water safety, standard First Aid and Community Cazdiopulmonary Resuscitation(CPR). Please list these employees below and attach capies of employee certifications to this form. The Health Department will not use past years' records. You must prnvide new copies and maintain a file at your place of business. 1. � � 2. �nf�� 3. 4. � ,__,�._ FOOD PROTECTION MANAGERS - CERTIFICATIONS: All food service establishments a.re required to have at least one full-time empioyee who is certified as a Food � Protection Manager, as defined in the State Sanitary Code for Food Service Establishments, 1Q5 CMR 590.000. Please attach copies of certification to this application. The Health Department will not use past years'records. You must provide new copies and maintain a file at your establishmen� ` �J ; 1. M�i2c-. ��2u�7�6l.r,G 1 � z. ,e�r � rERsarr�c�cE: _ _ _ _ . __ _ __ _ --_ Each food establishment must have at lea.st one Person In Charge(PIC) on site during hours of operation. l. �G �o2v�.Zt�� , , 2. HEIlVILICH CER'I'IFICATIONS: � All food service establishments with 25 seats or more must have at least one employee trained in the Heimlich Maneuver on the premises at a11 times. Please list your employees trained in anti-cholang procedures below and attach copies of employee certifications to this form. The Health Department will nat use past years' records. You must provide new copies and maintain a file at your place of business. 1. �t� 2. N 3. 4. RESTAURANT SEATING: TOTAL# Z�S ! O�FICE USE ONLY LODGING: � LICENSE REQUIRED FEE PERMIT# LICENSE REQtlIItED FEE PERMIT# LIGENSE REQUII2ED FEE PERMIT# , _B&B �50 _CABIN �50 MOT'EL $50 _ — �� LINN $50 1�'b7-ODS _CAMP $50 2 SWIlVIlvIING POUL$75ea. #6�-0��✓a _LODGE $50 _TRAII,ER PARK $100 I WHIItLPOOL $75ea. �l-0� FOOD SERVICE: LICENSE REQUIRED FEE PERMIT# LICENSE REQUIRED FEE PERMIT# LICENSE REQUIRED FEE PERMIT# _0-100 SEATS $75 _CONTIlJENTAL $30 NON-PROFIT $25 J >I00 SEATS $l50 �#"Ol Oba- �COMMON VIC. $50 07"O'�2 _y�OLESALE $75 RETAIL SERVICE: —RESID.KTfCHEN $75 LICENSE REQUIRED FEE PERMIT# LICENSE REQUIRED FEE PERMTT# LICENSE REQUIRED F'EE PERNIIT# _<50 sq.ft. $45 _>25,000 sq.ft. $200 _VENDING-FOOD $20 _QS,OOOsq.R. $75 _FROZENDESSERT $35 _TOBACCO $50 NAME CHANGE: S10 AMOUNT DUE _ $ �f�u� ()Q '*"'•PLEASE TURN OVER MID COMPLETE OTHER SIDE OF FORM*•""• � 4 . { � • , I ADMINISTRATION I, Under Cha.pter 152, Section 25C, Subsection 6,the Town of Yarmouth is now required to hold issuance or renewal � of any license or pernut to aperate a business if a person or company does not have a Certificate of Worker's Compensaxion Insurance. THE ATTACHED STATE WORKER'S COMPENSATI4N INSURANCE AFFIDAVIT MUST BE COMPLETED AND SIGNED, OR � CERT. OF INSURANCE ATTACHED � OR WORKER'S COMP. AFFIDAVIT SIGNED AND ATTACHED Town of Yarmouth taxes and liens must be paid prior o renewal or issuance of your permits. PLEASE CHECK APPROPRiATELY IF PAID: YES NO _ f MOTELS AND OTHER LODGING ESTABLISHMENTS ; TRANSIENT OCCUPANCY: For purposes of the limitations of Motel or Hotel use, Transient occupancy shall be f limited to the temporary and short term occupancy, ordinarily and customarily associated with motel and hotel use. � Transient occupants must have and be able to demonstrate that they maintain a principal place of residence elsewhere. � Transient occupancy shall generally refer to continuous occupancy of not more than thirty (30) days, and an � aggregate of not more than ninety(90) days within any s�(6)month period. Use of a guest unit as a residence or j dwelling unit sha11 not be considered transient. Occupancy that is subject to the collection of Room Occupancy ` Excise, as defined in M.G.L. c. 64G or 830 CMR 64G, as amended, sha11 generally be considered Transient. � POOLS POOL OPENING:All swimming,wadin�and whirlpools which have been closed for the season must be ins ected 4 by the Health Degartment prior to opening. Contact the Health Department to schedule the inspection five(5�days � pnor to opening. � � POQL WATER TESTING: The water must be tested for pseudomonas,total coliform and standard plate count by a State certified lab, prior to opening, and quarterly therea.fter. POOL CLOSING: Every outdoor in ground swimming pool Fnust be drained or covered within seven(7}days of � closing. FOOD SERVICE � CATERING POLICY: ! Anyone who caters within the Town of Yarmouth must notify the Yarmouth Health Departmern by filing the required Temporary Food Service Application form 72 hours prior to the catered event. These forms can be obtamed at the Health Department. FROZEN DESSERTS: Frozen desserts must be tested on a monthly basis by a State certified lab. Test results must be sent to the Health Department. Failure to do so will result in the suspension or revocation of your Frozen Dessert Permit until the above terms have been met. OUTSIDE CAFES: Outside cafes(i.e.,outdoor seating with waiter/waitress service),must have prior approval from the Board ofHealth. OUTDOOR COOKING: ' (1�tdee�rr�k�g,p�eparation,or display�f a�y food-product by a�etail or food-senti�e establishment_is�hibited. � NOTTCE:Permits run annually from January 1 to December 31. IT IS YOUR RESPONSIBILTTY TO RETCTRN � TI�COMPLETED APPLICATION(S) AND REQUIRED FEE(S)BY DECEMBER 31, 2006. { ; ALL RENOVATIONS TO ANY FOOD ESTABLIS�-IlViENT, MOTEL OR POOL (i.e., PAINTING, NEW EQUIPMENT,ETC.), MUST BE REPORTED TO AND APPROVED BY THE BOARD OF HEALTH PRIOR TO CONIlV�NCEMENT. RENOVATI�NS MAY REQUIRE A SITE PLAN. DATE: /�cOV. l� . Z� SIGNATURE: � ` � PRINT NAME&TITLE: � c q� V• �LF � I � 10/17/06 - I � __ � � , , . � , � Tbe e'ornmomveahh of Massochusetts ; ' Departnent of Industrial Accidents � �> I�rNrw�� 60@ Washixgto�Stree� 7`�`Floo� Boston,Mass. �2111 i -- worl��rs'Com��eaaahoa I�vaaee A�davit:B�di�/Plirmbiog/EkchHc —- al Co'tnetors ; a w � ��:�.�- �,.,�,��.� m�a�,�..,��.-�.,.t .�--.- -,�. ..�..._�_��e.��._w._v..__.. ..�..�__ �: � W 7��.. L E � address: Z I( V d • 'V o A6 �,iQ I V 6 s�v cl a• T R�th4 v�. �t�- MA- rio• 0�G� r�# �o�- 3 9�'� u�� work site locari�(fnll addressl: cr�4M L� o I�a��„�,��W�m,�� Project Type: ❑New Ca�ructi�o�� I am a sole 'etor and have no a�e w in an ca Buil ' Addition (� I am an e�ployer pmviding workeis'compensatia�f�my employ�s warking on this job. ce�av moe: �� l,l� \: 1��1•�" �,� _ -._ . C) I'� i S • . , r ��r�d�ti �� - __ . Z�� -3 ��-�--� 2-�V'i C � �VY��f r i c C1,f 1 � (�l;?r ❑ I am a sole proprietor,geseral ea�tracbsr,or komeow�r(drde o�t)and have hinad the co�ract�s listed belovr who have the following worke,�s'�ation polices: a�� ._...,�� _....` t�tv'= uf�s�t�-a,,., 11� 4�T L�� +' �+�....�� +„r �"�' I S�!: .�.�� ..��.� Fai�te i�aceue sr�a�e a�req�ed arder 3ecl�a 2SA�f MGL 152 en lead b tMe L��tct�inl pesfNia�f a�oe�p b t1,3M.N aid/�r eoe yan'lesprbbaeet as weY as cM p�h tYc fira eta 31�D1'WORK OBDSR aed a Sne dS1i�N a d�y��e. I adeas�d tiat a dpy�fLie�a1e�my 6e firward�M Ne Olpce a[Isra�at tke D1A fir cwrra�e veeiAadei. !ro 1Yd+tby cer�Fj'y x� tAis �ns m��f njPt�iirr�'tNat tNe�forNr�lon provided eboNe is drre mid oomcx �� n « l«l6� P�� ,�,� v �c P��# so �- �9 �- u�� ..�� '°�� ria�n�nt p��c�.k��y.�a p��o� �o�ut penon: �� '�'e�t lTM��a s,�r.z000� � Feb, 24, 2006 4:05PM No. 8554 P. 4 ; � ACORD CERTlFICATE QF LIAB1LlTY 1NSUFZ,ANCE �A°v�r°x �02 z�o � pRonuceR , TH15 CER7IFICATE IS ISSUED AS A NfA7TEk OF INFGRMATIQN � aNLY AND CONFERS NO RIGH7S UPON TH�CERTIFICATE The Addi� Group, =xsc. HOLDER.TNIs CER'nFICATE DOE3 NOT AMEND,EXT�ND OR 2500 Reaaissance Sivd. Ste 100 ALTER THE COVERAGE AFFORDED BY THE POLICIES HE�QW. � liing af Prussia PA 19406-2772 � Phone: 6I0-279-855Q Fax:610-279-8543 INSURERSAFFORDINGCOVERAGE NAIG# ' �NsuREo �NSGfftEFta �r;,�sar��n znsu�aa�.co. 40142 8 ue 9P�'�er LP iNsur�a a a�fen n�ez�caa s,+�� oo. 16535 c o a.venport Realty Trust n� ' S�e�ea i�schat�ino . wsur�R c: { 20 Rarth Main s�. INSURERD: Scuth Yaxmouth, MA 02664 INSURER E: CCV�RACsES , TNE POLICIES OF INSUR�wCE u3TED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR 1HE POUGY PEwoo INDICA7ED.N07WIiHSTANDING ANY REDUIREM�E�>T�x�a oR CONDmON OF ANY CONTRACT OR Q'�'FIER DOCtIMENT w17H RESPECT TO WHICy THiS C�R7'�FICATE MAY 8E ISSUEO OR MqY PERTAIN,THE INSURANCE AFFORDED BY TNS PQUCIES�ESCRteED H�REiW 16&UBJECT TO All'�E TERMs.EXCLUSIONS AND CflND1T10NS OF St1CM POLiCIE3 AC?OREGATE LIMRS SHOWN bN►Y HAYE BEEN REDUCED BY PAID CLAIMS� LTR NSR TYPe OF 1NSuw►NCE ��'�►�� GATE MAUG I�oaTE nMID uM� �n+�,u ws�urr FacHoccu�cE s 1,OAO 000 i $ �C COMA�ERCL4LGENERALLIABiLt1`� GL0819625504 03/01/06 03/01/07 PREMISE3 Ee000w'6�4i) s500 p00 CLAIMS MAPE �occuR �neo ow�nry one vwsa�? s 10,0 0 0 PERsowa��aovi�uV�r S 1,000,OOO GENa�,ntAc�E�a� S 2 OOO OOO GEN'LAOGREGATELIMRAPP4IESPER: aRODUC73-COMP/OPAGG S2 OOO�COO POlIC1' �E� LOG AUT6M�81LE IIAB��ITY COMBIAIED SINGLE LIMR ;1�000�OOO B nNY/+uTo P�AP819625604 Q3/Ol/O6 03/01/07 (Ea�m� X ALL OWNE�AIJTp3 HODILY WJURY SCMEDUtED AuiO3 tp�pp�� S X HIRED AlSTO& 80DILY INJURY i X NON-OWNEp�OS (�°�tl°� $ � g a s o co� PROPEk7Y DAMAGE ! X 500 Coll � �P�""°a"� GARAG��-ri1' RUTOONLY-FAAGCIDENT �i ' ANY AlJTO . . OTHE12 THAN EA ACC S � AU'�0 ONLY: —� ; AfiG S ' �CC�SFJUTABREUA uA81uTY EACH OCCURRENCE S ; �PCG�sR �CLAIM9 MADE AGGREGAT� S � . � DEDUC'f�stE 5 � RETENTIDN $ $ i waRKER9 COIHPENSATION ANo R TORY I,�AISS ER A E��'�`�� wC819603�09 03/03./06 03/01/07 E.LEACHACCIDENT s1,Q00,000 ANY PR�PR�ETORlPAKiNER1FXECUTlVE OPFICERIMEMBERFXGWDED9 E.LDISEASE•�nQnP�ore s 1 000 000 � s�EC�VI.SI�OPlBbelow �4o�sEASE-POLICYLIMIT i1 Q00,000 � pTNER dESCR1PT10N QF OPERA710N3/LOCATIONSlVEFIICLES/ExCLUSIONS ADDED BY ENDORSEMENT!SPECIAL PROV1310NS CERTlFiCATE HOLDER CANCELLATI4N q�_2 SHOUl.D MI1r PF 71iE A�VE DE9CRIBED POUCIES BE CANCELLED BEFORE THE EXPIRATION DATE TFfEREOF,THE I$$tlING{NSURBR WILL ENDEAYOF!TO YIAR 3O ppy$WRITTEp NDTICE 70 THE GEEt71FICATE NW.DER w1M�o 70 THE LEFT,BU7'FAIW Re To�SO 3MALL Towil of Ya.xmouth Routo Z$ IMPOSE NO 0ai-IGA71oN OR uAB1U'IY OF MIY KINQ UPON TEIE INSURER,RS AOEN7S OR s. Yasmouth, MA 02 664 ��E"TaTn�s. ALR}JEJRlZQRREPR NTATN K�.� ACpRD 25(2D01l08) �ACORD CORPORATION 19$$ i THE COMMONWEALTH OF MASSACHUSETTS � TOWN OF YARMOUTH i PERMIT NUMBER: #07-005 FEE: $50.00 � THIS IS TO CERTIFY THAT AN � INNHOLDER'S LICENSE is hereby granted to Blue Water Limited Parinershin d/b/a Best Western Blue Water Resort ! at 29l u h hore Drive � Lth Y **�o h MA in said Town of Yannouth And at that place only and expires December thirty-first,2�7 unless sooner suspended or revoked for violation of the laws of the Commonwealth respecting the licensing of innholders. This license is issued in confomuty with the authority granted to the licensing authorities by General Laws,Chapter 140,and amendments thereto and is subject to sections twenty-two to thiity-two, inclusive, and of said chapter and s�tions twenty-five to twenty- seven,inclusive,of Chapter 272. In Testimony Whereof,the undersigned ha�e heretmto aff�ed their official signatures,this Thirtieth day of January A.D. 2007. BOARD OF HEALTH: S �S. , !I��., . ��s�, .�v., v�e�� a�t� a�, �!�,� Aat,r�io��tfa`��ott �I��, R,/I! J Bruce G. Murphy, H,RS.,CHO Director of Health I : � � � i � TOWN OF YARMOUTH BOARD OF HEALTH PERNIIT TO OPERATE A FOOD ESTABLISHMENT PERMIT NUMBER: #07-062 FEE: 150.00 In accordance with regulations promulgated under authority of Chapter 94,Section 305A and Chxpter 111,Section 5 of the General Laws,a permit is hereby granted to: __ Blue Water Limited Partnership, 291 South Shore Drive, South Yarmouth, MA Whose place of business is: Best Western Blue Water Resort Type of business: Food Service To operate a food establishment in: Town of Yarmouth Pernut e�ires: December 31 2007 BOARD oF HEALTH: B $. ,A+J.,�y., ' SEATING_ 2OS tOtal (26,dining room 1; �{e��,�S�i, �tu;e e�t�i�x�t 26,dining room 2; 153,main dining room) /��6� B�y �� /��iu'c�/�a�e�o�` �l�us(j'�e.r�sr�, RJY. __January 31.2Q07 ruce G.Murphy, ,R S.,CHO Director of Health � THE COMMONWEALTH OF MASSACHUSETTS TOWN OF YARMOUTH i ; PERMIT NUMBER: #07-042 FEE: $50.00 This is to Certify that Blue Water Limited Partnership d/bla Best Western Blue Water Resort ; 291 South Shore Drive, South Yarmouth, MA � IS HEREBY GRANI'ED A COMMON VICTUALLER'S LICENSE In said Town of Yarmouth and at that place only and expires December thirty-first 2007 unless sooner suspended or revoked for violation of the laws of the Commonvvealth respecting the licensing of common victuallers_ This license is issued in canformity with the authority granted to the licensing authorities by General Laws, Chapter 140, and amendments thereto. In Testimony Whereof, the undersigned have hereunto aff�eti their official signatures. BOARD OF HEALTH: B �} `7�. �a�.o�, /6v�5., ' SEATING: 2Q5 total (26,dining room 1; d�e6�,(��e��t, ./V, �/u;e�s�t 26,dining room 2; 153,main dining room) Qo1�eJ��BdQu�vt, � ��isa�a/�c�� !��, R.N. January 31,2007 � � _ Bruce G. M hy, ,RS.,CHO Director of Hea1 THE COMMONWEALTH OF MASSACHUSETTS TOWN OF YARMOUTH BOARD OF HEALTH PERMIT NUMBER: #07-032 FEE: $75.Q0 Tlus is to Certify that Blue Water Limited Partnershi d/bJa Best Western Blue Water Resort 291 Sout S ore Dnve_ Sout Yazrnout MA IS HEREBY GRANTED A PERMIT To Operate a Public, Semi-Public Swimming or Wading Poal At Best Western Blue Water Resort - OUTDOOR POOL 291 South Shore Drive South Yarmouth,MA This permit is granted in conformity with Article VI of the Sanitary Code of The Commonwealth of Massachusetts,and expires December 31.2007 unless sooner suspended or revoked. January 31.2007 BOARD OF HEALTH: Q �. ,/��., . dfe��e��i�i, �sce�i�ihix� � Rodeht�B�ix.Rsc, Gle� I��ic�(a A�lc.`$�� 4.�C�' , R.1V. ruce .Murphy, -, H Director of Health j THE COMMONWEALTH OF MASSACHUSETTS � � TOWN OF YARMOUTH BOARD OF HEALTH � PERMIT NUMBER: #07-031 FEE: $75.Q0 � ' This is to Certify that Blue Water Limited Partnershi d/b/a Best Western Blue Water Resort 291 Sout S ore Dnve South Yarmouth MA : � IS HEREBY GRANTED A PERMIT I To Qperate a Pubtic, Semi-Public Swimming ar Wading Pool � At Best Western Blue Water Resort - INDOOR POOL 291 South Shore Drive ` South Yarmouth, MA This permit is granted in conformity with Article VI of the Sanitary Code of The Commonwealth of Massachusetts,and expires Deceinber 31_2007 unless sooner suspended or revoked. January 31.2007 BOARD OF HEALTH: B �tut�. ,/��., ' ��r�, ��v.'�`, v�� R�t� B�, e� P�til�� 4�f�'��, R.N ruce G.Miuphy, R ., Director of Health THE COMMONWEALTH OF MASSACHUSETTS TOWN QF YARMOUTH BOARD OF HEALTH PERMIT NUMBER: #07-013 FEE: $75.00 This is to Ce�tify that Blue VVater Limited Partnership d/b/a Best Western Blue Water Resort � _ 291 South Shore Drive South Yarmout MA ; HAS BEEN GRANTED A LICENSE TO ENGAGE IN TI�BUSINESS OR PRACTICE OF � -GIVING OF VAPOR BATHS iThis License is issued in confomuty with the authority granted to the Board of Health,by Chapter 140,Sections 51,of the General Laws,and amendments thereto,and is subject to the pmvisions of the Laws of the Commonwealth ofMassachusetts relating thereto,and upon such terms and conditions,and to the rules and regulations in regazd to the cazrying on of the occupation so licensed as adopted by the Board of Health,and e�ires December 31,2007 unless sooner revoked. January 31.2007 BOARD OF HEALTH: B �. ,/f',�,� ' dfe&�e��ilr�li, �u�G�lu�ih� R�`�B�ry � P�k�la�s��t �� R.N. - , ruce G. uiPhY , S.,CHO Director of Hea1 � r _� -r v IrJAT�1e. z ��i R.y TOWN OF YARMOUTH BOARD OF HEALTH � � C� � �J `� � �rJ -'� APPLICATION FOR LICE��tIYIIT-2006�'� 2 O 200�3 °; ;�� k � DEC * Please complete form and attach all necessary dacuments by 3.�1.H2$ �T Failure to do so wi�l result in the return of your applicatio NAME OF ESTABLIS�IlVIENT: T T �I v T�� E1'oR TEL. # Si F-� .�y�- Z2 F� LOCATION ADDRESS: .�' 7'�. •v iv7� o [ I MAILING ADDRESS: s { OWNER NAME: ,1" RRT�+rc�c.. TAX ID IFEIN or SSN1: � I CORPORATION NAN� �PLICABLE • MANAGER'S NAME: � A-it.d V• I TEL. # - Z—/uL MAILING ADDRESS: �. 2G POOL CERTIFICATIONS: The pool supervisor must be certified as a Pool Operator,as required by State law. Please list th�designated � Pool Operator(s) and attach a cQpy af the certificaxion to-this form. I . � L o 2. o A�1 ' GfAK•�'/DE •• Pool operators mu 'st a minimum of tw employees currently certified in bas'c wa� ety,stan d First Aid and Community Cardiopulmonary Resuscitation(CPR). Please list these employees below and attach copies of employee certifications to this form. The Health Department wilt not use past years' records. You must provide new copies and maintain a file at yqur place of business. 1. iGh�4/1 l � • 2.�i2Ll7"ln�� ./�.v, bn! �i.BW E� 3. 4. i FOOD PROTECTION MANAGERS - CERTIFICATIONS: All food service establishments are required to have at least one full-time employee who is certified as a Food Protection Manager, as defined in the State Sanitary Code for Food Service Establishments, 105 CMR 590.000. Please attach copies of certification to this application. The Health Department will not use past years' records. You must provide new copies and maintain a fde at your establishment. ; i. /�l9Rc G'Rud�Z��LJI�� 2. fN�� ; � PERS011T IN CHARGE: . _ � Each food establishment must have at least one Person In Charge(PIC) on site during hours of operation. � ; 1. I�i4Rc ��2v� Z��LS� 2. �I f}a��eA 1�yE � HEIlb��CH CERTIFICATIONS: All food service establishments with 25 seats or more must have at least one employee trained in the Heimlich Maneuver on the premises at all times. Please list your employees trained in anti-choking procedures below and at�ae�i copies of employee certifications to this form. The Health Department will not use past years' records. ; You must provide new co ies and maintain a file at your place of business. i . � I 1. !Lh.R/t 2. ��-/1.�� ltJ� ��o r1 �� 3. 4. � RESTAURANT SEATING: TOTAL# L0� � OFFICE USE ONLY LODGING: i ' LICENSE REQUIRED FEE PERMIT# LICENSE REQUIItED FEE PERMIT# LICEN5E REQUIIZED FEE PERMIT# B&B $50 CABIN $50 MOTEL $50 � �INN $50 �QO�o _CAMP $50 2.SWIIvI1VIING POOL$75ea. �� TLODGE $50 _'IRAILER PARK $50 I WHIRLPOOL $75ea. -��-Q(�' � FOOD SERVICE: I LICENSE REQUII2ED FE$ PERMIT# LICENSE REQUIRED FEE PERMIT# LICENSE REQUIRED FEE PERNIlT# 0-100 SEATS $75 CONTINENTAL $30 NON-PROFIT $25 I >100 SEATS $150 ��O�O? �COMMON VIC. $50 '�dC�� WHOLESALE $75 � RETAIL SERVICE: I LICENSE REQUIItED FEE PERMI"P# LICENSE REQIJIRED FEE PERMIT# LICENSE REQtIIl2ED FEE PERMIT# � _<50 sq.ft. $45 >25,000 sq.ft. $200 _VENDING-�OOD $20 � _Q5,00�sq.ft. $75 _FROZENDESSERT $35 _TOBACCO $25 � 4; � NAME CHANGE: $10 AMOUNT DUE _ $ ��]�j.O Q � "•"""PLEASE TURN OVER AND COMPLETE OTHER SIDE OF FORM*"•"" � � _ } f w � ;-� k ADMINISTRATION � Under Chapter 152, Section 25C, Subsection 6,the Town of Yarmouth is now required to hold issuance or renewal of any license or permit to operate a business if a person or company does not have a Certificate of Worker's � Compensation Insurance. THE ATTACHED STATE WORKER'S COMPENSATION INSURANCE AFFIDAVIT MUST BE COMPLETED AND SIGNED, OR i � . . ( CERT. OF INSURANCE ATTACHED � � OR : . WORKER'S COMP. AFFIDAVIT SIGNED AND ATTACHED � Town of Yarmouth taxes and liens must be paid prior to renewal or issuance of your permits. PLEASE CHECK APPROPRIATELY IF PAID: / YES �/ NO NOTICE:Permits run annually from January 1 to December 31. IT IS YOUR RESPONSIBILITY TO RETLJRN TI�COMPLETED APPLICATION(S)AND REQUIRED FEE(S)BY DECEMBER 31, 2005: SEASONAL ESTABLIS��VIENTS ARE TO CONTACT THE HEALTH DEPARTMENT FOR INSPECTION 7- 10 DAYS PRIOR TO OPENING FOR THE SEASON. ; i ALL RENOVATIONS TO ANY FOOD ESTABLISHIVIENT, MOTEL OR POOL (i.e., PAINTING, NEW E EQUIl'MEN'I',ETC.),MUST BE REPORTED TO AND APPROVED BY TI�BOARD OF HEALTH PRIOR TO ! COl��Il1�NCEMENT. RENOVATIONS MAY REQUIRE A SITE PLAN. i i � i ADDITIONAL REGULATIONS ; POOLS POOL OPENING:All swimming,wading and whirlpools which have been closed for the season must be inspected by the Health Department prior to opening. POOL WATER TESTING: The water must be tested for pseudomonas,total coliform and standard plate count by a State certified lab, prior to opening, and quarterly thereafter. POOL CLOSING: Every outdoor in ground swimming pool must be drained or cavered within seven(7)days of closing. FOOD SERVICE CONSUMER ADVISORY: Each food establishment which serves or sells ready-to-eat,raw or undercooked animal products aze required to post Consumer Advisories. CATERING POLICY• Anyone who caters within the Town of Yarmouth must notify the Yarmouth Health Department by filing the required Temporary Food Service Application form 72 hours prior to the catered event. These forms can be obtained at the Health Department. � t FROZEN DESSERTS: ' _ . Fra�en desserts-mrrst-be-testet�an a-monthiy basisbya�tate certifiert�ab. '�est�-e�b�sentt�th��i�a�tlr __ ` Department. Failure ta do so will result in the suspension or revocation of your Frozen Dessert Permit until the above terms have been met. OUTSIDE CAFES: Outside cafes(i.e.,outdoor seating with waiter/waitress service),must have prior approval from the Boazd of Health. OUTDOOR COOKING: ' Outdoor cooking,preparation,or display of any food product by a retail or food service establishmern is prohibited. DATE: N. Zl. ZoDs SIGNATL7RE: I G�K. V- ' PRINT NAME&TITLE: A I GE . � ' 09/28/OS E , F . �� '''+%�� - T1.--- r � ' �i.r4.1�e3„ F„9�f� N ��lF:.�� aJI� ��st-4�8�� 1 Y IlV��li'p1�1�� OPID C1 OAYE(MAIID�/YYYY1 DAVEN-1 02/2�1/05 Pr�onucE� THIS CERTIFfCATE IS ISSUED AS A MATTER OF INFORMATION ONLY ANb CONFERS NO RIGHTS UPON THE CER7IFICATE The Addis Group, Inc. FIOLDER.7HI5 CER7I�ICATE DOES NOT AIVIEND,EX7ENb OR � 2500 Renaissance Blvd. Ste 100 AL7'ER 7HE COVERAGE AFFORDEd BYThIE POLICIES BELOW, King of Prussia PA 19406-2772 t�hone: 610-279—II550 Fax:n1.6-279-85h3 IhiSUHE�{SAF�'O}�t]Ii�GCOVERAt'.,E NAIC# _---_. -------- -----.. :--_ ___.. .--- -- ----- --.. � � INSl1RED � � � INSURFRA: Amarican Zuricl� xns�rance co.' ��147 � � Blue [9ater LP irisuflEa B: Z„r��h amez��an x�s�ra��a co. 16535 i c o Davenport Itealty Trust �-----�------�----�--'—----�--- ------------- S ephen 1�schetti.no INSUflER C: � 20 North Main St. iNsuReR n: South Yarmouth, MA 02664 • � INSURER[: � COVERAGES TFIE POLICIES Of INSURANCE LISTED BEIOW FI�VE BEEN ISSUEp TO TFIE INSURED NAMED ABOVE FOR THE POLICY.PERIOD INDICATED.NOTW17t�STANDING ANY flEQUIREMENT,TENM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT W ITH NESPECI"f0 WHICH TFIIS CERTIFICAI'E MAY BE ISSUEO OR � � � A4AY PER7AIN,TFiE INSURA.NCE AFFORDE4 BY THE PO�ICIES DFSCRBFD I�IEREIN IS SUBJFC.T TO ALI_THE TERMS,FXCLUSIONS AND CONDITIONS OF SUCH . . POLICIES.AGGREGATE UMITS SFIOVJN MAY HAVE BEEN REDl10ED BY PAID CI.AIMS. �� 1N5q'yCDLP — � �� POTrP��F C POGC��k�IF�A O ' � � � . L7R APISR TYPE OF INSURANCE POLICY NUMBER pATE(MMIDUIYY) [7A7E(MM/DD/YY) LIMITS � � GENERALLIA8ILITY EACHOCCURRENCE 5�.�OOO�OOO 675AAAGFf6FfENTEO � . $ }C COMMERCIALGENEpALLIABILI"fY GLGII19625503 03/01/05 03/O1/06 PREMIS[S(Eacecurence) b 5�4 0�� f I CLAIMS MADE �J OCCUR MED EXP(Any one parson) S 1 Q�O O O PERSONAlBADVINJURY 5 1�OOO�OOO GENERALAGGFlEGATE 5 2�OOO�OO.O GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $Z�OOO�O OO . � POUCY PRO• LOC � � � JEC7 AUTOMOBILE LIABILITY COMBINED SINGLE LIMI7' � ANvnuro BAP819625603 03/O1/05 03/01/06 (Eaaccident) S 1�000�000 X ALL OWNED AUTOS @pDILY INJURY SCFIEDULED AUTOS � � � . � � (Per person) � � X FIIRED AUTOS . � � BODILY INJURY X NON-OWNED AUTOS ' (Per accident) s X Z rJ O COttl� PROPERTY DAMAGE X 500 Coll (Peraccident) � � �GARAGEUABIUTY � �� AUTOONLY-EAACCtDENT . S ANY AUTO OTFIER 7H,4N _EA ACC $ __ -- AUTU ONLY: qGG $ EXCESSNMBRELLA LIABILITY � � EACH OCCURRENCE $ . � � OCCUR �CLAIMS MADE . AGGREGATE b _ S DEDUCTIBLE � - S RETENTION $ � � S WORKERS COMPENSATION AND � X TORY UMI7S ER � EMPLOYERS'LIABILITY A WC819603608 03/OT/05 03�OI�06 E.L.EAChIACL'IDENT E 1�000�_D00 � ANY PROPRIETOR/PARTNER/EXECUTIVE . . - — — OFFICER/MEMBEREXCLUbED? � E.L.DISEASE-EAEMPLOYCE $ j�OOO�OOO If-yes,descri6e under � � ---�—'�— ' � SPECIAL PROVISIONS below E.L.DISEASE-POLICY UMIT •$ ;��OO O�O OO OTHER : .-.DESCRIP710N-DF-OPERATIONS�lLOCATIONSlVEHICLESlEXCLUSIONS.A�DEDBYENDORSEMENTISPECIAI_PROVlSI(?NS.., .....:. . . ...... ..._, � ........ . _.. ..... .. �.:. CERTIFICATE HOLDER � CANCELLATION � . YA�Q_�i SHOULD ANY OF THE ABOVE�ESCRIBED POLICIES BE CANCELLEp BEFORE?HE EXPIRATION DATE TNEREOF,THE ISSOIMG INSUflER WILL ENDEAVOR TO MAIL 3 O DAYS WRlTTEN � . NOTICE TO 7HE CERTIFICATE HOLDER NAME�TO THE LEFT,6UT FAiWRE TO DO SO SHQLL Tocm Of Y3LIl1011t.�1 {MpOSE NO OBLIGATION OR LIABIUTY OF ANY KINO UPOhI THE INSUAER,ITS AGEN7S OFl 1146 Route 28 S. Yarmouth, M21. O2FiS4 flEPRESENTATI4ES. � � AU7H SEN7ATIVF � �� ACOR[3 25(2001/08) OO ACORD CORPORATION 7988 � � � 1 t � �� ! - 1 • i � • THE COMMONWEALTH OF MASSACHUSETTS TOWN OF YARMOUTH { PERMIT NUMBER: #06-006 FEE: $50.00 � TffiS IS TO CERTII�'Y THAT AN INNHOLDER'S LICENSE � is hereby granted to Blue Water Limited Partnership cUb/a Best Western Blue Water Resort at 291 0�h�hore I)riv. �ou h Y rmo rth MA in said To�of Yamiouth And at that place only and e�ires December thirty-first,2006 unless sooner suspended or revoked for violation of the laws of the Commonwealth resp�cting the licensing of innholders. This license is issued in confornuty with the authority gr�ted to the licensing suthorities by General Laws,Chapter 140,and amendments thereto and is subject to sections twenty-two to thirty-two, inclusive, and of said chapter and sections twenty-five to twenty- seven,inclusive,of Chapter 272. In Testimony Whereof,the undersigned have hereunto affixed fheir official signat�ues,this Tenth day of January A.D. 2006. BOARD OF HEALTH: B '�f��ti�t�S. �j�� ,/��., . a��sLen�>'��i, FCJY., (/�ce�s�vii�s��rs llo�ict�. B�to[u�st, C� P��t9��att � �4.��j��, R.N. Bruce G. Murphy, ,R S.,CHO Director of Health _ _ ___ ___ __ _ . . _ TOWN OF YARMOUTH BOARD OF HEALTH PERMIT TO OPERATE A FOOD ESTABLISffil�NT PERMIT NUMBER: #06-057 FEE: $150.00 In accordance with re�ulations Promulgated under authority of Chapter 94,Section 305A and Chapter 111,Section 5 of the General Laws,a permit is hereby granted to: _ Blue Water Limited Partnership, 291 South Shore Drive, South Yarmouth, MA Whose place of business is: Best Western Blu�Water Recnrt Type of business: Food Service ; To operate a food establishment in: Town of Yarmouth Pernut e�ires:_December 31, 2006 BOARD oF HEALTH: L� `.�. �if,$,� • SEATING: 205 tOtSI (2G,�g�m�; ��r� ��e�� 26,dining room 2; 153,main dining room) R�6� � . A�k�t�s� �I.��, R.N. J��y io.�006 Bru .Murph , H,R S.,CHO Director of Heal , � f THE CQMMONWEALTH OF MASSACHUSETTS � TOWN OF YARMOIJTH � t pERMIT NUMBER: #06-OQ6 FEE: $50.00 ; THIS IS TO CERTg'Y THAT AN � INNHOLDER'S LICENSE is hereby granted to Blue Water Limited Partnership,d/bla Best Western Blue Water Resort at 291 �oLth�hore T_�ive,�uth Yatmouth lv(A ` in said Tovvn of Yarmouth And at that place only and e�ires December thirty-first,2Q06 unless sooner suspended or revoked for violation of the laws of the Commonwealth resp�cting the licensing of innholders. This license is issued in conformity with the authority granted to the licensing authorities by General Laws,Chapter 140,and amendments thereto and is subject to sections twenty-two to thirty-two, inclusive, and of said chapter and sections twenty-five to twenty- seven,inclusive,of Chapter�72. In Testimony Wher�f,the undersigned have hereunto affixed their official signatures,tbis Tenth day of Janu,�ry A.D. 200b. BOARD OF HEALTH: Q �t�S. ,/��5., ' ��`�s�, �v., v�e�� R�t�. a� � A�� 4��, R.N. � Bruce G.Murphy, ,RS.,CHO Director of Health _ _ . _ _ _ _ _ _ TOWN OF YARMOUTH BOARD OF HEALTH PERMIT TO OPERATE A FOOD ESTABLISffiV�NT, PERMIT NUMBER: #06-057 FEE: 150.00 In accordance with regulations promulgated under authority of Chapter 94,Section 305A and Chapter 111,Section 5 of the General Laws,a pemut is hereby granted ta Blue Water Limited Partnership, 291 South Shore Drive, South Yarmouth,MA Whose place of business is: Best Western Blue Water Resort Type of business: Food Service To operate a food establishment in: Town of Yarmouth Permit e�ires: December 3 l, 2006 Bo�oF HEAI.'rx: Ba��rsrs`?5. �o�,�`n., ' ' sEa'rnvG: 205 total (26,dining room 1; .sa cs'�tr.�i, ./�, �/u:e�i�ihsws i 26,dining room 2; 153,main dining room) Qo��. B�u�t� �el� j � n�� 4.�,��.�G� R.N. , I I , JanuarX 10.2006 Bru .Murph , H,RS_,CHO j Director of Heal i 1 . , ` THE COMIMONWEALTH OF MASSACHUSETTS + TOWN QF YARMOUTH � PERMIT NUMBER: #06-051 FEE: $50.00 { This is to Certify that Blue Water Limited Partnership d/b!a Best Western Blue Water Resort 291 South Shore Drive, South Yarmouth, MA � IS HEREBY GRANTED A COMMON VICTUALLER'S LICENSE In said Town of Yarmouth and at tha.t place only and e�ires December thirty-first 2006 unless sooner suspended or revoked for violation of the laws of the Commonwealth respecting the licensing of common victuallers. This license is issued in conformity with the authority granted to the hcensmg authorities by General Laws, Chapter 140, and amendments thereto. In Testimony Whereof, the undersigned ha.ve hereunto a.ff�ed their official signatures. BOARD OF HEALTH: B `?S. �ond�xs,/l�l.`h., . SEAITIJG: 205 total (26,dining room 1; d�¢��,��$�y, ./V, 7/lee e�t�t 26,dining room 2; 153,main dining room) /lo��}Bhou�, (?f,eh� P��Lf��t �4.�fj' , R.N. January 10.2�6 Bruce G.1Vlurphy, S.,CHO Director of Health THE COMMONWEALTH OF MASSACHUSETTS TOWN OF YARMOUTH BOARD OF HEALTH PERMIT NIJMBER: #06-030 FEE: $75.00 This is to Certify that Blue Water Limited Partnershi d/bIa Best Western Blue Water Resort 291 out ore Dnve out Yarmout MA IS HEREBY GRANTED A PERMIT To Operate a Public, Semi-Public Swimming or Wading Pool At Best Western Blue Water Resort -INDC)OR POOL 291 South Shore Drive South Yarmouth MA This permit isgranted in conformity with Article VI of the Sanitary Code of The Cammonwealth of Massachusetts,and e�ires Deceinber 31_2006 unless sooner suspended or revoked. January 10_2006 B011RD OF HEALTH: �es ' �. ,�f,�., • . ��s�, ��e�� a�t�B�, et� �� , R.lv. ��G- um y,� ., �, Director of Health � s � THE COMMONWEALTH OF MASSACHUSETTS TOWN OF YARMQUTH BOARD OF HEALTH PERMIT NUMBER: #06-031 FEE: $75.Q0 This is to certify tt�aat Blue Water Limited Partnershi d/b/a Best Western Blue Water Resort 291 Sout ore Dnve Sout Yarmout MA IS HEREBY GRAN'PED A PERMIT ' To Operate a Public, Semi-Pu61ic Swimming or Wading Pool ; ' At Best Western Blue Water Resort OUTDUOR PO�L ' 291 South Shore Dnve ' Sout Yarmout MA 1 — � �11S efi111t 1S p granted in conformity with Article VI of the Sanitary Code of The Commonwealth of Massachusetts,and �pires December 31.2006 unless sooner suspended or revoked. January 10 2006 BOARD OF HEALTH: Be �, �/�f,�,� • � d�e •��Sluli, �ice G�luvi�� /�c$�uir�` � �0su� , R./V. � �u� .M� Y,��, Director of Health � , THE COMMONWEALTH OF MASSACHUSET"TS TOWN OF YARMOUTH BOARD OF HEALTH PERMIT NUMBER: #06-012 FEE: $75.00 This is to certify that Blue Water Limited Partnership d/b/a Best Western Blue Water Resort 291 South Shore Dnve South Yarmouth MA HAS BEEN GRANTED A LICENSE TO ENGAGE IN THE BUSINESS OR PRACTI,CE OF -GNING OF VAPOR BATHS This License is issued in conformity with the authority granted to the Board of Health,by Chapter 140,S�tions 51,of the General Laws,and amendments thereto,and is subject to the provisions of the Laws of the Commonwealth ofMassachusetts relating thereto,and upon such terms and conditions,and to the rules and regulations in regazd to the canying on of the occupation so licensed as adopted by the Board of Health,and expires Deceinber 31,2Q06 unless sooner revoked. -- January 10 2006 BOARD OF HEALTH: L� �. /��., . - ��s�, ��e�� R�t� B�, et�k ��Lla�� , ruce G.Murphy, .5.,CHO Director of Health � l��dw��.t� , ; � o�'Y.�� r ��: �: . � TOWN OF YARMOUTH 0 � '� 1146 ROUTE 28 SOUTH YARMOUTH MASSACHUSETTS 026644451 ��MATTACHE 95� � Telephone (508) 398-2231,Ext. 241 — Fax (508) 760-3472 � ��AVORl�IF0�6� � �U B O A R D O F H E A L T H � � (� ,: _ � �� ,c � � To: Yarmouth Board of Health Permit Holders q N� j � 2005 � From: David D. Fi Jr., RS. � � ��,. 1 Heahh In � �-�r H�� u�t'T. � � Town of Yarmouth i ' Re: Federal Taar ID Number Date: 11�aa�ch 22, 2�D5 - i ` T'he lViassachusetts Department of Revenue is�w requiring that we furnish detailed information ' to them regazding all permits and licenses that we issue. One of the details that they require we � send to them is every establishment's Federal Employer ldentification Number(FEII�otherwise � known as your"Ta�c ID Number". This is purely for administrative purposes only. � I ' Some businesses use the owner's Social Security Number (SSN} for this purpose. If this is the case for your establishment, be assured that we will not allow this information to be public record ; � Please fill out the fields below and return this letter to i Yarmouth Heatth Department � 1146 Route 28 � " South Yarmouth,MA 02664 � Thank you for your anticipated compliance. If you have any questians regarding this matter, please do not hesitate to call. The office hours are Monday to Frida.y, 8:30 a.m to 430 p.m The telephone number is(S08) 398-2231,ext.24L � � Establishment: B/(,� �lU6 �� l. -T• FEIN or SSN: , �,/ /� �Q - Location Address: Z� �v/!..- �-r,�,, � , d�• /A�t..M.d� Signature: � � �� • � Print: �t c�,��t,,�, V� [ � Ti 1 t e: �� ; . � ; � Printed on i �c`( Recycle � �13 Paper , . ; . �'AOt�G� �ZD 8c,�GJA'l�. f�cRT � •O`.:R�s TOWN OF YARMOUTH BOARD OF HEAL � �: ,� APPLICATION FOR LICENSE/P ;2 5 ��5 �; r� � � `� � � �..�:�: * Please complete form and attach all necess�y d y ` by December 1, �4.� 9 2004 Failure to do so will result in the return o�"yo applica.t�on packet e,. ; i NAME OF ESTABLIS�IlVIENT: R F�!' TEL. # -ZZ LOCATION ADDRESS: Z E o . �t. u z MAILING ADDRESS: J � OWNER/CORPORATION N R.c � MANA ER'S NAME: ` TEL. # •f0� �'77� /26G MAILING ADDRESS: 2 e o E POOL CERTIFICATIONS: The pool supervisor must be certified as a Pool Operator,as required by State law. Please list the designated Pool Operator(s) and attach a copy of the certification to this form. 1. U� cJ l Nl o'N� 2. Pool operators�st is�Tt a miiumum of o emplo ees currently,certified in ��c wa er sa ety, sta�n�ar irst Aid and Community Cardiopulmonary Resuscitation (yCPR). Please list these employees below and attach copies of employee certifications to this form. The Heatth Department will not use past years' records. You must provide new copies and maintain a file at your place of business. ; , r �. L 2. k� - �ln�� Q2,�� 3. 4. i I � FOOD PROTECTION MANAGERS -CERTIFICATIONS: All food service establishments are required to have at least one full-tirne employee who is certified as a Food Protection Manager, as defined in the State Sanitary Code for Food Service Establishments, 105 CMR 590.000. Please attach copies o�certification to this application. The Health Department will not use past years'records. '. Yon must provide new copies and maintain a file at your establishment. ' l. l�/4RC. �IQ.U�Z1e�J�.� 2. �IAKTR.R �y�5 � —T_ PERSQN 1N CI-�ARGE: _ _ ___ _ Each food establishment must have at least one Person In Charge(PIC) on site during hours of operation. � �._�AQc G'k�dL2,�L.�c� z. �.�'A,�aQa rlv� � HEIlVILICH CERTIFICATIONS: All food service establishments with 25 seats or more must have at least one employe� e trained in the Heimlich Maneuver on the premises at a�,l times. Please list your employees trained in anti-choking procedures below and attach copies of employee certifications to this form. The Health Department will not use past years' records. ' You must ovide new copies and maintain a file at your place of business. � ; 1. c. L 2._�'ly�E - R�.l� ��c 3. 4. RESTAURANT SEATING: TOTAL# OFFICE USE ONLY LODGING: � LICENSE REQUIIZED FEE PERMIT# LICENSE REQUIItED FEE PERMIT# LICENSE REQUII2ED FEE PERMIT# ! _B&B $50 CABIN $50 MOTEL $50 �INN $50 �05-� �CAMP $50 Z�WIIvtIVIIlJG POOL$75ea,. ��5��6 _LODGE $50 _TRAII,ER PARK $50 I WHIItLPOOL $75ea. �d r�6�� FOOD SERVICE: LICENSE REQUIRED FEE PERMIT# LICENSE REQUII2ED REE PERMIT# LICENSE REQUIlZED FEE PERMIT# 0-100 SEATS $75 _CONTINENTAL $30 NON-PROFIT $25 �>100 SEATS $150 ��S�Oc� � COMMON VICT. $50 �05-OJ� WHOLBSAI,E $75 RETAIL SERVICE: LICENSB REQUiRED FEE PERMIT# LICENSE REQUIRED FEE PERMIT# LICENSE REQUII2ED FEE PERMIT# <50 sq.ft. $45 _>25,000 sq.ft. $200 VENDING-FaOD $20 " _Q5,000 sq.ft. $75 FROZEN DESSERT $35 �TOBACCO $25 NAME CHANGE: �io AMOUNT DUE = S �{�S.00 "'•"PLEASE TURN OVER AND COMPLETE OTHER SIDE OF FORM"••*• ` �� a�" �'� � 1 � � - � — - �..� �� r i r a ADMINISTRATION � i Under Chapter 152, Section 25C, Subsection 6,the Town of Yarmouth is now required to hold issuance or renewal � of any license or permit to operate a business if a person or company does not have a Certificate of Worker's � Compensation Inswance. THE ATTACHED STATE WOR�R'S COMPENSATION INSITRANCE t AFFIDAVIT.MUST BE COMPLETED AND SIGNED, OR ; , ; CERT. OF INSURANCE ATTACHED I OR ' WORKER'S COMP. AFFIDAVIT SIGNED AND ATTACHED Town of Yarmouth t�es and liens must be paid p ' r to renewal or issuance of your permits. PLEASE CHECK APPROPRIATELY IF PAID: YES� NO NOTICE:Permits run annually from January 1 to December 31. IT IS YOUR RESFONSIBILITY TO RETURN THE C4MPLETED APPLICATION(S)AND REQUIRED FEE(S)BY DECEMBER 31, 2004. SEASONAL ESTABLISHMENTS ARE TO CONTACT TI-�HEALTHDEPARTMENTFORINSPECTION 7-10 E DAYS PRIOR TO OPENING FOR THE SEAS4N. j ; ALL REN4VATIONS TO ANY FOOD ESTABLISHIVIENT, MOTEL OR POOL (i.e., PAINTING, NEW � EQUIPMENT,ETC.),MUST BE REPORTED TO AND APPRCIVED BY TI-�BOARD OF HEALTH PRIOR , TO C011�IMENCEMENT. RENOVATIONS MAY REQUIRE A SITE PLAN. � ADDITIONAL REGULATIONS r POOLS POOL OPENING:All swimming,wading and whirlpools which have been closed for the season must be inspected by the Health Department prior to opening. � � POOL WATER TESTING: The water must be tested for pseudomonas,total coliform and standard plate count i by a State certified lab, prior to opening, and quarterly thereafter. POOL CLOSING: Every outdoor in ground swimming pool must be drained or covered within seven(7)days of closing. FOOD SERVICE CONSUMER A,DVIS�RY: Each food estab 'shment which serves or sells ready-to-eat,raw or undercooked animal products are required to post Consumer Advisories. CATERING POI.YCY: Anyone w o caters within the Town of Yarmouth must natify the Yarmouth Health Department by filing the . required Temporary Food Service Application form 72 hours pnor to the catered event. Thses forms can be obtained at the Health Department. I _ -��-�H��'s�E�T�: - - __ _ .___ _ _ _-- � Frozen desserts must be tested on a monthly basis by a State certified lab. Test results must be sent to the Health � Department. Failure to do so will result in the suspension or revocation of your Frozen Dessert Permit until the above terms have been met. OUTSIDE CAFES: Outside cafes(i.e.,outdoor seating with waiter/waitress service),must have prior approval from the Board ofHealth. OUTDOOR COOKING: (}utdoor cooking,preparation,or display of any food product by a retail or food service establishment is prnhibited. , I DATE: Zdo SIGNATURE: L I�. � I i PRINT NAME& TITLE: l L V. `4 € € 10/22/04 � t 1 i . �MAR. 9. 2004 �11 ; 15ANh�F��THE..ADDIS�GRO��P NQ. 410-�—P. 3/4�� — ABILITY lNSURANCL oP�a �z°ouc°: aAvsx-i o3 09 a4 THIS CEIiTIFlCATE 151SSU�D q,g A MATT�R OF INFORAARAA'fION The Add.iB Gsoup, ZaC. ��Y�p�NFEI�S NQ itiGHTS UPON 1'yE C�R'fIFlCq7'� 2500 Aeaaissance HIYd. $b� ].00 AI.TERTHE COVERAGEcqFFpRp p BYTM PNpLj��B LOW. Ri�pg o£ prassi� PA 19406-277a Phoae: 6 i0-27 9-8 55 0 1�ax:610-27 9-8 5 43 INSURER3 A�ORpING COVERAG� �NSURED �C g rNsuR�Ra: aqsrsaan sesi,oh awuranc. ro. 40142 � $lue 1p8tes Y,P �NSURERB: �s��,,,�ws f ni,D�tis � C/o Davenpor� Itea7,t�r �g� w� 26a�7 j 3Ye hea AschQtitiao wSu�tCG Sou�hrYarmot=ithg��e1 oa66g wsu�R o: INSURER E; COVERAGES 7'►�E PaLIC16S OF INBURANCE L18tEo B�I.OW HpyH BBEN ISSUED TO 7HE IW�URED NAhIm AgpvE FpR THE ppLlCy pERlOO INDICATED.N4TwRH8Tpp�p�V� ANY REpUIREMENT,TERM oR CONDfTION OF ANY CON7RAC7 OR pTHER pOCUMEN f w17M t2�SpECTTp WH1di Tt118 CER71FfGq'I'E 11qpY @E ISSUEp pR ti44Y P�RTaiN,'1}{E IN31JRqfrCE AFFORpF�BY TME pp��6g p�$^�g�N��jN�g$UBJECT Tp q�,L THH TEFRM9,pj(CLUS�ON3 AND CONDITIpNB pp gup{ POLtCI�S.AGGREGA7E LIM1Ts ShfOWN NtAY NAVE BEEN REDt1Cm 6Y PAID CWMS, �TR' TYP�OF INSURANCE PO4CY NUMBER pA� pq � vNAtTs GEN�iA�uA@ILITY A S COMM9�CW,GENERAL LIq91L17Y GL0819 62 5$0 2 �H�� 3��0 0 0`0 0 0 o3�oz�o� �3/Oi/05 pRE�„s�s �,,,� :soo,o00 CtA1MS MAOE �OCCUR MED El�(Any one ��) z z0,000 PERsow�.aanv�wurtr a 1,000,o00 c�TtFRA1.AGf`aREBATE 3'a,.000,000 GEN'L qGORECAT�1,IMITAPPi.�ES PER POLICY jEC7 LOC PRODUCTs'COMP/OP AGG S 2�G O O i 0 0 O At1TGNfOBlLE Llpa��lYY $ ANYAUiO �,�si�saseaa 03/Q�/04 os/o�./os c�m�e«�s�`EUM�r $s,000,o00 $ A�l OWNED At�TpS SCHEDULED AUT'ds BODILY 1N.IURy s $ KIRED AU'tos �� X NON-OwnrFD nUTOs eOD�.Y�wURY g X 250 Cq� (Peracddenq � 50� (�r0�.1 Pl�PERTYbAMA� 3 (Peratddenc} GARAGE t�,q6tLCtY ANY AU70 AUTo ONIY-EA ACCIbENT S • OTHER7HAN ��C S AUTO ONLY: AGta 3 � ExCESSNMBREICA LW61uTY EACH OCCURR�NCE S � OCCUFi �CL41M3 MADE A3GRECs�qTE S DEDUCTIBLE S RET6NrION s � WORP�ts CpMP�1�tSAT1oN AND S ENIPI.OYERS'L1AgfL11'11 7C 70Rv LIMRS �R i A rwvRr�oaa,�ow�n,�,,,�w�c,mv� �G8196o3607 03/oi/04 03/oz/05 �.�.�accm�r g]. 004,000 � 4FFICERIMEMBER DCG,UOEDT E.�.o�ase_En�,�,oyE S s,00 0,p 0 0 i Sd�w�PRp�VIS�p 3 Delqw E.L D18FAgE-Pp�l(`,Y LIMtT i]„Q 0 0,0�Q o71lER o6scRIPTION oF oPERr►noNs/�OCnnoers�VEFYC�s r pqCLusIONS AOD�n ev�NDORs�N�IVT I SPEclal.P�tOMsqNS CERTI�IGAi'E HOLDER CANCELLATlpN Y�iiR'SL�C-2 sMou�n arrr oF rMe aeovE oEscw�ED PouaEs ee caNC�u.m e�o�n�p�iRanoN oArE tr�EREOF,TriE�ssU1N01NsuRER Nnu EtIDEawR TO IIA� 3 0 a►YS WRI7'TeN To�ova o f Ya�uth No'�10E ro rKE C�sr�A1'E Ho�oER NaM�TO tr��T.BUT FAII.UIlE TO CO SO SNALL R011'�e a 8 IMPOSE NO OBlIGA710N OR LIABIUTY 0�ANY l4Nb UPON THE tl�suRER�ITS AGEMTS OR SouCh Xarmouth. MA 02664 rt�pRlEs[�'raTNEs. AT 4 AC�RD 25(2001/0� �AC�iD CQIZpORq7'�pN 198B � � �` THE COMMONWEALTH OF MASSACHU5ETTS TOWN OF YARMOUTH � BOARD OF HEALTH PERMIT NUMBER: #OS-037 FEE: $75.00 ; This is to certify that Blue Water Limited Partnershi dlb/a Best Western Blue Water Resort ' 291 out ore Dnve Sout Yarmout lYIA a � IS HEREBY GRANTED A PERMIT To Operate a Public, Semi-Public Swimming or Wading Poot At Best Western Blue Water Resort -OUTDOOR POOL 291 South Shore Drive South Yarmouth,MA This permit is granted in confomuty with Article VI of the Sanitary Code of The Commonwealth of Massachusetts,and expires Decsmber 31_2005 unless sooner suspended or revoked. January 26.2005 BOARD OF HEALTH: Be�t�tsu�. �j�,/�I�. ' ��s�, v�e�� R�t�e�, et� �S!� R.N , R.N. B� .M� ,� ., Director of Health THE COMMONWEALTH OF MASSACHUSETTS � TOWN OF YARMOUTH BOARD OF HEALTH PERMIT NLJMBER: #OS-016 FEE: $75.00 This is to certify that Blue�Vater Limited Partnership dJb/a Best VVestern Blue Water Resort 291 South Shore Drive, South Yarmouth, MA HAS BEEN GRANTED A LICENSE TO ENGAGE IN TI�BUSINESS OR PRACTICE OF � -GIVIl�TG OF VAPOR BATHS This License is issued in conformity with the authority granted to the Board of Health,by Chapter 140,Sections 51,of the � General Laws;and amendments thereto,and is subject to the pmvisions of the Laws of the Commonwealth ofMass�husetts I relating thereto,and upon such tern�s and conditions,and to the rules and regulations in regard to the cazrying on of the , occupation so licensed as adopted by the Board of Hea1th,and expires December 31,2004 tmless sooner revoked. January 26,2005 BOARD OF HEALTH: Berr�c-�rrtr�rs�. ��/��. ' /�c�u�/blc.b` �t, 'Uice G��x�s �s�� R.N. ruce G.M hy, , S.,CHO Director of Health { THE COMMONV�EALTH OF MASSACHUSETTS TOWN OF YARMOUTH � PERMIT NUMBER: #OS-056 FEE: $SO.QO 1 i This is to Certify that Blue Water Limited Partnership dIb/a Best Western Blue Water Resort i � ; 291 South Shore Drive, South Yannouth,MA IS HEREBY GRANTED A COMMON VICTUALLER'S LICENSE In said Town of Yarmouth and at that place only and e�ires December thirty-first 2005 unless sooner suspended or revoked for violation of the laws of the Commonwealth respecting the licensing of common victuallers. This license is issued in conformity with the authority granted to the licensing authorities by General La.ws, Chapter 140, and amendments thereto. In Testimony Whereof, the undersigned have hereunto aff�ed their official signatures. BOARD OF HEALTH: Se��`�. C'�o+�d,o�s,/l�`h�.f s�7'�rtG: 205 total (26,dining room 1; p�lic�a J��pluito�, �/fve Gfu'�ih�t��s 26,dining room 2; 153,rnain dining room) /�[t1 e!�g B�utuivt, � m�f�ler�Sl�a�s� Q./�� I+us C�'��r�c, R.N. 7anuary, 26.2005 ' Bruce G. urphy, , S.,CHO Director of Heal � � � ! � THE COMMONWEALTH OF MASSACHUSETTS � TOWN OF YARMOUTH j BOARD OF HEALTH I PERNIIT NLJMBER: #OS-038 FEE: $75_00 This is to certi�y that Blue Water Limited Partnershi d/b/a Best Western Blue Water Resort 291 Sou ore Dnve out Yarmou MA IS HEREBY GP�ANTED A PERMIT To Operate a Public, Semi-Public Swimming or Wading Pool At Best Western Blue Water Resort -INDOOR POOL 291 South Shore Drive South Yarmout ,MA This permit isgranted in conformity with Article VI of the Sanitary Code of The Commanwealth of Massachusetts,and expires December 31.2005 untess soaner suspended or revoked. ' Jan,�acy z6_Zoos BoaxD oF HEaLTH: Be�ryr�rr�a$. �o�,g 1�1..�. � i ��a�� v�e��-� R�t�a�, et� � �&� R.N. ' � , R.N. i Bruce G.M y, ., Director of Health , r a . � THE COMMONWEALTH OF MASSACHUSETTS TOWN OF YARMOUTH PERMI'T NUMBER: #OS-005 FEE: $50.00 TffiS IS TO CERTIFY THAT AN INNHOLDER'S LICENSE is hereby granted to Blue Water Limited Partnership d/bla Best Western Blue Water Resort at 29l . �th ho Dnv r,nnth Y�o�th j��rq in said Town of Yarmouth And at that place only and expires Dec,ember thit�t�,_first,2pp5 unless sooner suspended a or revoked for violation of the laws of the Commonwealth respecting the licensing of innholders. This license is issued in ; conformity with the authority granted to the licensing authorities by General Laws,Chapter 140,and amendments thereto � and is subject to sections twenty-two to thirty-two, inclusive, and of said chapter and sections twenty-five to twenty- ' seven,inclusive,of Chapter 272. i l ' In Testimony Whereo�the undersigned have hereunto a�xed their official signatures,this Twenty-sixth day ! of_ January A.D. 2005. i Bo�oF�.�: A��l$� ��ibl.h�� R�t�B��e � � ��l�k, R.N. � � � �� R.N. 1 � Bruce G.Murphy, S.,CHO Director of Health � . TOWN OF YARMpUTg BOARD OF HEALTg PERMIT TO OPERATE A FOOD ESTABLISHMENT PERMIT NUMBER: #OS-Q80 FEE: $150.00 In accordance with regulations promuigated under authority of Chapter 94,Section 305A and Chapter 111,Section 5 of the General Laws,a permit is h�eby granted to: Blue Water Limited Partnershi 291 South Shore Drive South Yannout MA Whose place of business is: B��t Western Blue W +Pr Resc�rt Type of business: Food Service To operate a food establishment in: Town of Yarmouth � Pernut e�ires: December 31 2005 BOARD oF xEAI,TH: B ,,t�. �_ SEATING: 205 tot81 (26,dining room 1; n�� „i�_� ` ��;f u�� 26,dining room 2; 153,main dining room) Q i�� ••,`'...�, ?/ice ti �i � ��. R R.N. Januarv 26 2005 Bruce G.M hY,MP , S.,CHO Director of Health e � — Gr � i �-�()D6ll��'�'��, B�r W�s�aN . � �O`:"� �. TOWN OF YARMOUTH BOARD OF H �,,'F � I�� !� �� i� �1 � [� DD ; r a �. .;y � '�` APPLICATION FOR LICENSE/PE - ��` 4 � ' - 'y NOV 2 5 2003 �: :... ....;� :;s� * Please complete form and attach all necessary d nt y Decembe 3��f��,.H DEPT. , Failure to do so will result in the return of y� `�pplication packe . N�VIE OF ESTA�iLISHM NT•- Rr rTF WATFR RFSCIRT T T # �Ag��,��288 LOCATION ADDRFSS'291 aOUTH SHORE DRIVE SOUTH YARMOUTH, MA 026 64 LIAILING ADDRF.. • am '' OWNER/CORPORATION NAMF.: Br.TTF. WATER LIMITED ,PARTNERSHIP � MANAGER'S NAMF' R T C'N A R Tl 7 R T T FY �.- TF # 50 477 1266 � MAII�ING D F S• �a A�N�1r.n_8n, FouF�mnAr F� MA n�tiaa� , POOL CERTIFI ATIONS• The pool supervisor must be certified as a Pool Operator,as required by State law. Please list the designated ;i Pao1 Operat � �h-a�opy of the certifica�ion to this t'�rm. I 1•�v� ��4e�t ec'.�n�.s 2. Pool operators must list a minimum of two employees currently certified in basic water safety, standard First Aid and Community Cardiopulmonary Resuscitation (CPR). Please list these employees below and attach copies of employee certifications to this form. The Health Department will not use past years' records. You must provide new copies and maintain a file at your place of business. � 1. RTCHARD V_ RTT.Fv 2. EILEEN COUGHLIN I 3• 4. � FOOD PROTECTION ANACTFR� CFRTIFICATION • All food service establishments are required to have at least one full-time employee who is certified as a Faod Protection Manager, as defined in the State Sanitary Code for Food Service Establishments, 105 CMR 590.000. Please attach copies of certificatian to this application. The Health Department witl not use past years' records. You must provide new copies and maintain a file at your establishment. I 1. _ TTM(�THY MCC'�RTHY 2.__ SANDRA NYE - _----_ - ----- — -— -- --- -__ _ - -- _ ____ . ��I�IN�f�A��•, . _ _ Each food establishment must have at least one Person In Charge(PIC)on site during hours of operation. ; 1, TIMOTHY McCARTHY 2, SANDRA NYE � � HEIMLICH CERT Fi(`qT(QNS• ! ' All food service establishments with 25 seats or more must have at least one employee trained in the Heimlich Maneuver on the premises at all times. Please list your employees trained in anti-choking procedures below and attach copies of employee certifications to this form. The Health Department will not use past years' records. You must provide new copies and maintain a file at your place of business. 1, RICHARD RILEY 2, EILEEN COUGHLIN 3. __CHRISTIN_F. LOWE 4, RFSTAURANT SEATING: TOTAL#��5 i ! LODGING: OFFICE USE ONLY ; � LICENSE REQUIRED FEE PERMIT# LICENSE REQUIRED FEE PERMIT# LICENSE fiEQUIRED FEE PERMIT# � I _B&B $50 _CABIN a50 _MOTEL �50 �� S50 ��"1 _CAMP $50 2-SWIMMtNG POOL$75ea. #o�b t_8 _LODGE $50 _TRA(LER PARK S50 ( WHIRLPOOL �75ea �0�{ DD�! FOOD SERVICE• LICENSE REQUIRED FEE PERMIT# LiCENSE REQUIRED FEE PERMIT# L[CENSE REQUIRED FEE PERMIT# _0-100 SEATS a75 _CONTMENTAL $30 _NON-PROFIT S25 �>IOOSEATS a150 �D� I COMMONVICT. �50 �O�f-Oaa' _WI-{OLESALE $75 RETAIL SERVIC • LICENSE REQUIRED FEE PERMIT# LICENSE REQUIRED FEE PERMIT# LICENSG REQUIRED FEE PERMIT# _<50 sq.ft. $45 _>25,000 sq.ft. 5200 _VGNDING-FOnD $20 _<25,000 sq.ft. �75 _FROZEN DESSER'(' S35 _TOBACCO a25 NAME CHANGF. $�o AMOUNT DUE _ $ �-]S.00 ' *****PLEASE TURIY OVER AND CUMPI.ETE OTHER SIDE OF FORM***"* ' r _._._ � . p � ADMINISTRATION ' Under Chapter 152, Section 25C, Subsection 6,the Town of Yarmouth is now required to hold issuance or renewal � of any license or permit to operate a business if a person or company does not have a Certificate of Worker's � Compensation Insurance. THE ATTACHED STATE WORKER'S COMPENSATI4N INSURANCE ; AFFIDAVIT MUST BE COMPLETED AND SIGNED, OR � � CERT. OF INSURANCE ATTACHED ' 4 � WORKER'S COMP. AFFIDAVIT SIGNED AND ATTACHED� Town of Yarmouth taxes and liens must be paid prior to renewal or issuance of your permits. PLEASE CHECK APPROPRIATELY IF PAID: YES�_ NO NOTICE:Permits run annually from January 1 to December 31. IT IS YOUR RESPONSIBILITY TO RETURN THE COMPLETED APPLICATION(S)AND REQUIRED FEE(S)BY DECEMBER 31, 2003. SEASONAL ESTABLISHMENTS ARE TO CONTACT T�-IE HEALTH DEPARTMENT FOR 1NSPECTION 7-10 ; DAYS PRIOR TO OPENING FOR THE SEASON. ! � � ALL RENOVATIONS TO ANY FOOD ESTABLISHMENT, MOTEL OR PQOL (i.e., PAINTING, NEW � EQUIPMENT, ETC.), MUST BE REPORTED TO AND APPROVED BY THE BOARD OF HEALTH PRIOR TO COMMENCEMENT. RENOVATIONS MAY REQUIRE A SITE PLAN. k ADDITIONAL REGULATIONS '� POOLS POOL OPE1�iING:All swimming,wading and whirlpools which have been closed for the season must be inspected by the Health Department prior to opening. POOL WATER TESTING: The water must be tested for pseudomonas,total coliform and standard plate count by a State certified lab,prior to opening, and quarterly thereafter. POOL CLOSING: Every outdoor in ground swimming pool must be drained or covered within seven(7)days of closing. � � FOOD SERVICE � CONSUMER ADVISQRY: � Each food esta.blishment which serves or sells ready-to-eat,raw or undercooked animal products are required to post Consumer Advisories. CATFIZiNG PO�,,ICY: Anyone who caters within the Town of Yarmouth must notify the Yannouth Health Department by filing the required Temporary Food Service Application form 72 hours prior to the catered event. Thses forms can be obtamed at the Health Department. . _----------- -- _--- -_ i __ _. -- __ _ _ _- -- __ _ _ _ Frozen desserts must be tested on a monthly basis by a State certified lab. Test results must be sent to the Health ' Department. Failure to do so will result in the suspension or revocation of your Frozen Dessert Permit until the above teims have been met. OUTSIDE CAF�S: Outside cafes(i.e.,outdoor seating with waiter/waitress service),must have prior approval from the Boazd of Hea(th. � OUTDOOR COOKING• � Outdoor cooking,preparation,or display of any food product by a retail or food service establishment is prohibited. '; , � i DATE: 1�1/� �i z o Q3 SIGNATUR�: 1 C � �- PRINT NAME&TITLE: � I/ I l � �c � 10/22/03 � � � ; ., r � , � The Conrnroawealth of Massachusetts � � Department ojlndustrial.-�ccidents � a Olflceoll�es�l�stli�s : 600 Washington Street ' ,= Boston,Mass. 02111 1 �'~ �� W'orkers' Compensation lnsurance Atfidavit AR�licant ieformation: P►essepR '� namr� SLUE WAT_F.R RF.SORT lucation� 291 SOUTH SHORE DRIVE ttt� SOUmH YARMOlTH� MA 02664 nhone# 508 398 2 288 � I am a homeawner perti�rmin;all work myseff. � ( am a sole propri�ror�r.� h��e no one ��orking in am�capacity � I am an em��e�ro��dino workers' compensation for my empioyees w•orkin¢onthis job. comnanv nams: �U�� ttT�� K 1 _ _ . 7dclress: � I � �.Jrl) .LJ�� 1 v` citv:��.� 1 i-t Yti� M�� hone�;,�"�(l� 7"I U ��/� iesurance co.A Jvl��C#-!IV Z I/I�IC t'1 I M � f-��Cr" oiicy# ��[-)�"1�o�—f � �� I am a sole proprietor. :enerai contractor, or homeowner(circle onel and ha�•e hired the contractors listed below ��ho ha�e the follo+�in� ��orkzr.� ,ompensation polices: s4moanv name: a�dress• ��" nhone li• insur�ncc co. policy# comoanv namr address• stt1+: ohoee i�• insu.r_�nce co. �Y� t Failure to:ecure coveraee as required uoder Secnoo 2SA of MGL 152 n�iad to t6e iepait�of crioi�!pe�dtles ot a O�e op to 51,500.00 a�d/o� one yean'imprisonment a�w•ell s�eivil peaalde�io tAe torm of a STOY WORK ORDER aad a Aae otS100.00 a day qaiost ma I a�denta�d tbat a eopy of thy statemrnt may be fonvarded to the Otlice of(nvntieuiom of t6t DIA for eovera=e veritiado�. I do hrreby cerrifj•under tbe poins and pertal�ies of pery'ury that the injormation providtd obov�e is true and coritct Signature��s�. p�r� �� U� Print name �n n //1.� //P��'/_ Phone M �D�-3�� aa �� ., olTicial use onl� do not write in this area to be completed by eity or town oAieial city or town: YA��IIT� _ permitAiceeu k nBuildiog Departmeot �Lieeasicg Boa�d �check if immediate response i�required 261 �Seleetmen'e ORice �HealtA DeQartment • cont�ct person: pbaMx;_ (SOS} 398�?231 eat. nOther ,.. ._� .< �.,. � i THE COMMONWEALTH OF MASSACHUSETTS � TOWN OF YARMOUTH PERMIT N�JMBEg: #04-004 FEE: $50.00 TffiS IS TO CERTIFY THAT AN - INNHOLDER'S LICENSE � is hereby granted to Blue Water Limited Partnershiv d/b/a Blue Water Resort at 291 �uth�hore Drive,South Yarmouth_MA in said Town of Yaimouth And at that place only and expires December thirty-first,2004 unless sooner suspended or revoked far violation of the laws of the Commonwealth respecting the licensing of innholders. Ttus license is issued in confomiity with the authority g�anted to the licensing suthorities by General Laws,Chapter 140,and amendments thereto and is subject to sections twenty-two to thirty-two, inclusive, and of said chapter and sections twenty-five to twenty- seven,inclusive,of Chapter 272. In Testimouy Whereof,the undetsigned have hereunto a�ix�their official signaUu es,this Twenty-sixth day of November A.D. 2003. BOARD OF HEALTH: Beit�a�rxstt�1. �j�,/N.�. ' ��ra��,�st, v�e�� Rod�t� B� � �� , R,N. , , ;ti I Bruce G.Murphy, ,RS.,CHO � Director of Health I ' —� � TOWN OF YARMOUTH BOARD OF HEALTH PERNIIT TO OPERATE A FOOD ESTABLISHMENT � PERMIT NUMBER: #04-032 FEE: 150.00 I In accordance with re ations promulgated under suthority of Chapter 94,Section 305A and Chapter 111,Sectian 5 of the al Laws,a permit is hereby granted ta Blue Water Limited Partnership, 291 South Shore Drive, South Yarmouth,MA Whose plaee of business is: __�lue Water Resort Type of business: Food Service To operate a food establishment in: Town of Yarmouth Pernut expires: December 31, 2004 BOARD oF HEALTH: B�ir�$. ('+onc�orry/��5. � SEA7'n�rG: 205 total (26,dining Toom 1; p�� ?/��Q�y 26,dining room 2; 153,main dinin8 room) Ro�ie�t��. B�lawwt, � o�e�e/t e�1lQ�i, JQ./V. � � November 26_2003 — ruce G. urphy, ,R S.,CHO Dir�tor of Health � i � . - ; . � ? THE COMMONWEALTH OF MASSACHUSETTS TOWN OF YARMOUTH � ; PERMIT NUMBER: #04-022 FEE: 50.00 This is to Certify that Blue Water Limited Partnership dJb/a Blue Water Resort � 291 South Shore Drive, South Yarmouth, MA IS HEREBY GRANTED A COMMON VICTUALLER'S LICENSE In said Town of Yarmouth and at that place only and �pires December thirty-first 2004 unless sooner suspended or revoked for violataon of the laws of the Commonwealth respecting the licensing of common victualler's. This license is issued in conformity with the authority granted to the licensing authorities by General Laws, Cha.pter 140, and amendments thereto. In Testimony Whereof, the undersigned have hereunto affixed their official signatures. BOARD OF HEALTH: Be�ayr�ic$. �o�ido�.,/l�/.$. SEATIlVG: 205 total (26,dining room 1; pa��/�c�s+latQ�, �/tce ��ia�h�rtars 26,dining room 2; 153,main dining room) IQ��}. B�, �e+l� �S , R.N. ,-- -� - November 26.2003 � �•��-� ruce G. Murphy, , .S.,CHO Director of Health � i THE COMMONWEALTH OF MASSACHUSETTS TOWlY OF YARMOUTH BOARD OF HEALTH , PERIVIIT NUMBER: #04-009 FEE: $75.00 � This is to ce�tify that Blue Water Limited Partnership d/bla Blue Water Resort ; 291 South Shore Drive, South Yarmouth, MA � HAS BEEN GRANTED A LICENSE TO ENGAGE IN TI�BUSINESS OR PRACTICE OF - GIVING OF VAPOR BATHS This License is issued in confonnity with the authority granted to the Board of Hea1th,by Chapter 140,Sections 51,of the General Laws,and amendments thereto,and is subject to the provisions of the Laws of the Commonwealth ofMassachusetts relating thereto, and upon svch terms and conditions,and to the rules and regulations in regard to the carrying on of the occupation so licensed as adopted by the Board of Health,and e�ires December 31,2004 unless sooner revoked. _ November 26.2003 BOARD OF HEALTH: Be�t�hrssi�. �,/�$. ' p��o�, v�e�.� ao�d�t 4. B�, �le� �� R.N. � ; � LL ��..� �'�: ruce G. Murphy,MP � HO Director of Health 1 I i i � . �: - - i THE COMMONWEALTH OF MASSACHUSETTS TOWN OF YA�RMOUT`H � BOARD OF HEALTH ! PERNIIT NLJNIBER: #04-017 FEE: $75.OU ; This is to certify that Blue Water Limited Partnershi d/b/a Blue Water Resort 291 u ore nve, out armou IS HEREBY GRANTED A PERMIT To Operate a Public, Semi-Public Swimming or Wading Pool At Blue Water Resort -INDOOR POOL 291 South Shore Drive ou Yarmout MA This permit isgranted in canf�mity with Article VI of the Sanitary Code of The Commonwealth of Massachusetts,and e�ires December 31.2004 unless sooner suspended or revoked. November 26 2003 BOARD OF HEALTH: Be�a�$. �� /��. ' p��►� v�e�� a�t�B� G� � S!�l,y R.N. ',� �� , \ :_.� � �ce � , •, Director of Health � . . � , . . THE CONiMONWEALTH OF MASSACHUSETTS ; TOWN OF YARMOUTH ' BOARD flF HEALTH PERMIT NUMBER: #04-018 FEE: $75.00 This is to certiFy that Blue Water Limited Partnershi d/b/a Blue Water Resort 91 out ore Dnve, out Yarmout M � IS HEREBY GRANTED A PERMIT � To Oper�te a Public, Semi-Public Swimming ar Wading Pool � At Blue Water Resort -OIJTDOOR POOL 291 South Shore Drive � So Yarmouth, MA � This permit is granted in canfarmiiy with Article VI of the Sanitary Code of The Commanwealth of Massachusetts,and � expires Decetnber 31_2004 unless soaner suspended or revoked. i '' November 26.2�3 BOARD OF I�ALTH: Be�c�sst�. �j�/j'��. ' � /�at.ssa�a A�Ic�m��rvlt, ?Jrce G�frr-.�,i�t�� S�R.N� i ,/;, �� f , , / '' �:�--�;' L<c Director of H�eal�th�� •, i F � ' :� ,� G (��' ' 32�`-;�R�.c TOWN OF YARMOUTH BOARD `T � [� [� (� C� � M ' DD o _, . y APPLICATION FOR LICE � I '��2003 �.��-, Y ., .s �. .,L; oota5r¢ N0� 2 �.u�2 •.. ...•> * Please complete form and attach alt necessary d'c�cument� Dece-tn� r� �?QQ2.; r Failure to do so will result in the return of'your application pack .�°..r�' ``-- " ''�°�`�P*� NAME OF EST Bt ISHM NT: �st western Blue water Resort T #508r398-2288 LOCATION AI�DRESS• ��ai 4roii-h ��.�r nY;ye,, S�.titit]��, �a �IAILING ADDRESS: P.O.Box 276, South Yarmouth, Ma o 664 (?WNER/CORPORATION N ME• B1Le wa �m�t- c7 a tnPr�h;p 1�NAGER'S NAME: Richard v. Rile_v T L # 508-477-1266 MAILING ADDRESS: 24 Arnold Road, Forestdale, Ma 02644 POOL CERTIFICATIONS: The pool supervisor must be certified as a Pool Operator,as required by State law. Please list the designated , Pool Operator(sj and attach a copy of the certification to this form. 1,Steve Simon -Oceanside Pools 2, Edward Morgan - Oceanside Pools Pool operators must list a minimum of two employees currently certified in basic water safety, standard First Aid and Community Cardiopulmonary Resuscitation (CPR). Please list these employees below and attach copies of employee certifications to this form. The Health Department will not use past years' records. You must provide new copies and maintain a file at your place of business. l. Dick Riley 2. Eileen Couqhlin 3. 4. �OOD PROTECTION MANAGERS - CERTIFICATIONS: All food service establishments are required to have at least one full-time employee who is certified as a Food Protection Manager, as defined in the State Sanitary Code for Food Service Establishments, 105 CMR 590.000. Please attach copies of certification to this application. The Health Department will not use past years' records. You must provide new copies and maintain $ file at your establishment. l, Timothy McCarthv 2, Sandra Nve ; _ '�'EF:�BI�I�-E'��A'��'iF' _ - - _ __ __- _--- ' Each food establishment must have at least one Person In Charge(PIC)on site during hours of operation. 1. Timoth� M C`ar�-�� 2, Sandra Nye FIM .ICH RTIFICATIONS• All food service establishments with 25 seats or more must have at least one employee trained in the Heimlich Maneuver on the premises at all times. Please list your employees trained in anti-choking procedures below and attach copies of employee certifications to this form. The Health Department will not use past years' records. : You must provide new copies and maintain a file at your place of business. l. Dick Rilev 2, Eileen Couqhlin 3. 4 �STAt�ANT SEATIN �: TOTAL# 2os �.oD N�. OFFICE U nNLY ' LICENSE REQUIRED FEE PERMIT# LICENSE REQUIRGD FEE PERMtT# LICENSE REQUIRED FEE PERMIT# ___B&B $50 TCABIN $50 _,MOTEL S50 � .L� SSO 3�-Ob _CAMA _ $50 �-�OS' 2 SWIMMING POOL$75ea.�� _LODGE �50 �'TRqILER PARK $50 • FOOD SE_ R, Vic'�• �WHIRLPOOL $75ea._�-0(� LICENSE REQUIRED FEE PERMIT# LICENSE REQUIRED FEE PERMIT# LICENSE REQUIRED FEE PERMIT# �� _0-100 SEATS $'7S _CONTINENTAL $30 NON-PROFIT � �>100 SEATS $150 �'Q3�p _�(O I COMMON VICT. $50 $25 � — ��— 3�0�6 WHOLESALE $75 �ETAILS�RVI F• — LICENSE REQUIRED FEE PERMIT# LICENSE REQUIRED FEE PERMIT# _<50 sq.ft. gqs L[CENSE REQUIRED FEE PERMIT# _>25,000 sq.ft. $200 VENDING-FOOD $2p _<25,000 sq.ft. $75 _FR07,EN DESSF,RT S35 TOBACCO $2g NAME GHeN r• $�p — -- AMOUNT DUE _ $ t�(7Jc.� **"**PLEASE TURN OVER AND COMPLETE OTHER SIDE OF FORM***** � _ � -; . k � ADMINISTRATION . Under Chapter 152, Section 25C, Subsection 6, the Town of Yarmouth is now required to hold issuance or renewal of any license or permit to operate a business if a person or company does not have a Certificate of Worker's Compensation Insurance. THE ATTACHED STATE WORKER'S COMPENSATION INSURANCE AFFIDAVIT MUST BE COMPLETED AND SIGNED,OR CERT. OF INSURANCE ATTACHED � WORKER'S COMP. AFFIDAVIT SIGNED AND ATTACHED i Town of Yarmouth taxes and liens must be pai prior to renewal or issuance of yow permits. PLEASE CHECK APPROPRIATELY IF PAID: ' YES NO i NOTICE:Permits run annually from January 1 to December 31. IT IS YOUR RESPONSIBILITY TO RETURN � THE COMPLETED APPLICATION(S) AND REQUIRED FEE(S) BY DECEMBER 31, 2002. � SEASONAL ESTABLISHMENTS ARE TO CONTACT THE HEALTH DEPARTMENT FOR INSPECTION 7-10 DAYS PRIOR TO OPENING FOR THE SEASON. ALL RENOVATIONS TO ANY FOOD ESTABLISHMENT, MOTEL OR POOL (i.e., PAINTING, NEW EQUIPMENT, ETC.), MUST BE REPORTED TO AND APPROVED BY THE BOARD OF HEALTH PRIOR TO COMMENCEMENT. RENOVATIONS MAY REQUIRE A SITE PLAN. i � ADDITIONAL REGULATIONS POOLS � - _ _. POOL OPENING:All swimminS,wading and whirlpools which have been closed for the season must be inspected ; by the Health Department prior to opening. POO L WATER TESTING: The water must be tested for pseudomonas,total coliform ar►d standard plate count by a State certified lab,prior to opening, and quarterly thereafter. ool must be drained or covered within seven(7) days of � POOL CLOSING: Every outdoor in ground swimming p i closing. ' FOOD SERVICE � �.��T�iTx,rru s►�ViSORY: Each food establishm ent which serves or sells ready-to-eat,raw or undercooked animal products are required to post Consumer Advisories. : r�TFRiNG POLL�L;. caters within the Town of Yarmouth must notify rhor to heucateredlevellntp Thsestfoyrms cantbe Anyone who l�cation form 72 hours p requ�red Temporary Food Service App � obtained at the Health Department. rROZF;v nF��F,RTS: --�rti�-�l�.-��-�-��t�e-t�� - � �rozen esserts m�to do so will result�in t e susp ns on�or revocation of your Frozen Dessert Permit until the , Department. Fail above terms have been met. ' waiter/waitress service),�have prior approval from the Board of Health. � n�1TCTt�F C'�FES� � Outside cafes(i.e.,outdoor seating with ',r n`rrnnnR C'OOI�N� or dis la of any food product by a retail or food service establishment is prohibited. � Outdoor cookuzg,prepazation, P Y � � � k.a�.� v� ; DATE: ��W �1, 2o�Z SIGNA"CUR�: i� ��, , Y ^' ~ �` J � pRINT NAME&TITLE: � C % � 10/18/02 ; � X DATE(MM/DD/YYYY) OP ID ACORD CERTIFICATE OF LIABILITY INSURANCE DAVEN-1 �2 26 03 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLYAND CONFERS NO RIGHTS UPON THE CERTIFICATE The Addis Group, I�c. HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR 2500 Renaissance Blvd. Ste 100 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. King of Prussia PA 19406-2772 Phone: 610-279-8550 Fax:610-279-8543 INSURERSAFFORDINGCOVERAGE NAIC# INSURED INSURERA: Amerioan zurich � cVj I��--�, ��''' 40142 B�ue Water LP INSURERB: Lmeriaaa Guaraa e c � iicY 26247 c o Davenport Realty Trust INSURERC: f ��Q 5 ephen Aschettino 20 Aorth Main St. INSURER D: - South Yarmouth MA 02664 � INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. POLICY NUMBER LI Y IV P LI PIRA I N LIMITS LTR NSR TYPE OF INSURANCE DATE MM/DD/W DATE MM/DD/YY GENERAL UABILITY EACH OCCURRENCE $ Z�O O O�O O O A X COMMERCIAL GENERAL lIABILITY GLQ 819 S�5 S O 1 0 3/Q�./0 3 �3�Q 1�� PREMISES(Ea occurence) � $O O,0 0� CLAIMS MADE X❑OCCUR MED EXP(My one person) $ ZO�O O O PERSONAL&ADV INJURY $ 1�O O O�O O O GENERAL AGGREGATE $Z�O O O�O O O GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 1�O O O�O O O POLICY PR� LOC JECT � AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1 $ ANYAUTO BAP819625601 03/O1/03 03/O1/04 (Eaaccident) $ l,000,000 X ALL OWNED AUTOS BODILY INJURY SCHEDULED AUTOS (Per person) $ X HIRED AUTOS BODILY INJURY $ NON-OWNED AUTOS (Per accideoq $ X 2 5 O COIIIp PROPERTY DAMAGE $ X 5�� CO11 (Per accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN �ACC $ AUTO ONLY: AGG $ EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR � CLAIMS MADE AGGREGATE $ $ DEDUCTIBLE $ RETENTION $ $ � WORKERS COMPENSATION AND X TORY LIMITS ER A EMPLOYERS'LIABILITY F7CS196Q3606 03/O1/03 03�O1fO� E.L.ERC4ACCIDSNT $ ].�0��04� ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? E.L.DISEASE-EA EMPLOYEE $ 1,O O O�O O O If yes,describe under E.L.DISEASE-POLICY LIMIT $ 1 0�0,0�� SPECIAL PROVISIONS below � � OTHER I DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT!SPECIAL PROVISIONS 1{I CERTIFICATE HOLDER CANCELLATION + Y��_2 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION � DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 3 O DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE IEFT,BUT FAILURE TO DO SO SHALL � TOWIS O f Yarmouth IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR +� 1146 Route 28 + $. Yarmou th� MA 0 2 6 6 4 REPRESENTATIVES. � AUTH SENTATIV 4 ACORD 25(2001/08) O ACORD CORPORATION 1988 � � . � ._ _-- --- -- �----- --- ,--- --- ._�.�-. -. -.��.__..-�.-.��.r-rrxvsN-s, os�ao�oa ' PRODUCER �""' - THIS GEFi71�iCATE IS IS�UED AS A MA'[7�R OF INFCIRMATiON �' ONI.Y AND CONFERS NO RIGHTS UPON TH�CERTIFlCATE , '3,'kie AB��.� Gro�p, Zac. HOLDER.THIS CERTIFICATE DOE9 NOT AMEMD,�ND OR � a ao a Reaaistsarsce Houlevard AL'T�R TH�COYERAQE AFFORDED BY THE POLtC1E3 BELQW_ x�,ag at prtixa,�ia PA 19406-a��a Phona t 610-�79-8550 1''217C:610-279-8543 lNSURERS AFFORDINQ COVERAGE � �� INSURERA: A�twricasi Zurids =�ss�,sr�� Co. H1ue Wa�er Lp INSURERB: o/o D�ve�SC� Realty Trust sK$ua�ac: Aa�n ile E 2 0 North �Yain �5�. tIJSURER b: sauCh Yaruwuth� DQA OZ664 IN&UR6R p; • ' t�C1VERAGES THE POLICIES OF INSURANCE LiSTED 9��OW HAVE BEEN IS3UED Tfl TFiE INSURED NAMED ABOVE FOR TNE POLtCY PEI�10��NDlCATED.NOTWRH3TANDING {wV R�qU1REMEN'f,TERM OR CONDRION OF ANY CONTRACT OR aTHER DOCUM�NT WtTH RE$PECY TO WHICii T}iI3 CERTfFICATE MAY BE ISSUED OR ' M�4Y PERTAIN,THE INSURANCE AFFORflED BY'CFFE IyOLiCIES DESCAIBED F1EfiEIN}S SUBJECT TO qL�THE 7'ERMS,EXCLUSIQNS AND CONDRIONS OF SUCH POLIC{E5.AQdAEi3ATE LIMITS SIiOWN MAY HAVE'BEEPI RE�UC�D 6Y Pqlp CLAIMS. LSR TYPE OF INSURANC� POLICY NUMBER DATE M1U GA7B M!D � GF.�1ERAl LUIBILI7Y , EACH OCL`URRENCE $ COMMERCIAL GENERAL LIABILITY F{R�DAMAQE(PJiy one firra $ CLAIMS MADE �OCCUA M�D EXP tAny one pereortj s---� PER30NRL&MVfNJURY ffi GENERALAGGREGpTE $ GEN'4 AGGREGATE UMR{1PP�lES PER: PRODUCTS-CpMP/pP AQQ $ �041C1' �E� LOC A�QMOBU.E�.IA�IILITY COMBtNEDS1t�LELIMIT a ANY AUTa �e��) ALL OWNED AU7'0.9 BOOILY tNJURY $ SCH�4ULED AUTOS (Pe�Deraonl HTRED AUTt�3 80DlLY INJURY a NON-OWNED AUTOS (Per eccitlen4) PROPERIY OAMA�GE s (Per actidaM) G/�RAGE LIABR3TY AU30 ONLY•�+4 ACCIOENT $ 1WY AUTO OTHER TWw �� $ AUTO ONLY: �� $ EXCESS 1.1A8fLITY L"-RCH OCCURRENCE S OCCUR �CUUMS MADE AGGAEGATE S $ DEbUCT18LE � RETENTION S � WORKERS COMPENSATION AND X Eb1P6bYER3'UA8�L1T1, 70RY LIMITS ER A LQC8196036D5 03/O1/02 03/01/03 E.LEACHACCIDENT s1,000,008 E.LDISEA3E-EAEMPLOYEE S 1�OOO�OOO E.L.DISEA3E-POIIC`lLIMIT S 1�QQO�OOO 4THER DESCRIPTION OF OPERATIQNSILp()A'1901y9NEHI�y,Ey/EXCLUSIONS ADDE�BY END�tSEtuIENTJ$pE(;IAI PROVISlONB CERTIFICATE NbLD�R i1i qbplTlbNAL INSURED;INSUqER LE'RER: GANCELLATION J��d—a SHflIl�D ANY OF THE A80VE OESCHIBED PpUdE9 BE GANGELI.EG BBFORE THE EXPIRp�pN DATE THEREOF�THE IS$UING IN$URER YVILL ENDEAVOR TO MAII. �Q_DAY9 WRITTEN TO�O'tl Of Y�,X7npu'CYj NOTICE TO THE CERTip¢ATE yb1,DER NAMED TO THE LEFf,8UT FAILIJRE TO DO 30 SHALL �►TZ'1J: Permit �t. IMP�SE NO OBI1GATlON OR LiABIt.►TY OF ANY KWD UPON!HE IN9URER.(TS AGENT3 OR 1146 Routq 2$ s. YB��h, �,. oassa R��8EN7ATIVE$. AIJTypR�REPRESENTATIYE r 3teveu E. COI ACORD 25-317/97) �ACbRD CbRpORAT1pN 9ggg THE COMMONWEALTH OF MASSACHUSETTS TOWN OF YARMOUTH PERMIT NUMBER: #03-003 FEE: $50.0� . THIS IS TO CERTII+'Y THAT AN � INNHOLDER'S LICENSE � is hereby granted to Blue Water Limited Partnership d/b/a Best Western Blue Water Resort at 291 South Shore Drive South Yarmouth MA in said Town of Yarmouth .And at that place oniy and expires December thirty-first,2003 unless sooner suspended or revoked for violation of the Iaw�of:the Commonwealtli respecting the licensing of innhotders.. This license is issued in conformity with the authority gra�ted to the licensing authorities by General Laws,Chapter 140,and amendments thereto --asd-i�subjest-t�sestiexi�-Lwen ,--and-ef--said-chapEer--and-sections_ - _ seven,inclusive,of Chapter 272. � In Testimony Whereo�the undersigi��d have hereunto a�ixed their o�cial signatures,tlus ' °Tweaty-'ninth � day of November A.D;-2002:' ; ,. , BOARD OF HEALTH: �lt,�`s� i��. ��tira� �c�,c�ri�c D. ��°'r, '�G.:?�.. `l/tee �'e�t 3 �, �: . �a�rtck��oo� . ' �eltwc.Skak. ,�.?Z.' ; _.. � n�ce Cr.M H,RS:,CH0 �,, : , � Director of H th + —��—,_ _ TOWN OF YARMOUTH BOARD OF HEALTH 'PERMIT TO OPERATE A FOOD ESTABLISHMENT PERMIT NUMBER: #0�-026 FEE: $150.00 � 1n accordance with regulations promulgated under authority of Chapter 94,Section 305A and Chapter 111,Section 5 ofthe General Laws,a permrt�s hereby granted to: , _ __ _ . _ _ _ _ Blue Water Limited Partnership, 291 South Shore Drive, South Yarmauth,MA Whose place of business is: Best Western Blue Water Resort Type of business: Food Service To operate a food establishment in: Town of Yarmouth Permit e�ires: December 31.2003 BOA�tn oF HE�,TH: �� xdl�ez, �«�ra.�c SEA'ruaG: 205 total (Z6,dining room 1; �. C�ioxdo�c. '��. �f//iec ��ara�r r 26,dining room 2;153,main dining room) � �, �nosrMc, �lark �a�ttc��'Xe9auMca� ?��S�. ��l. November 29 ,2002 ruce G.Murp H,RS.,CHO Director of H � THE COMMONWEALTH OF MASSACHUSETTS TOWN OF Y�4RMOUTH � PERMIT NLTMBER: #03-016 FEE: $50.00 r ! This is to Certify tha.t Blue Water Limited Partnership d/b/a Best Western Blue Water Resort � ; i 291 South Shore Drive, South Yarmouth, MA � ; IS HEREBY GRAN"IED A COMMON VICTUALLER'S LICEN5E In saici�Town of Yarmouth and at that place only and e ires December thirty-first 2003 unless r�evo�ed for-vic�la�i t�-�espectigg-zhe-- lice�sing o c��f�om�inon victualler's. This license is issued in confornuty with the authority granted to �the l�ensuig authorities by General Laws, Chapter�40,and amendments thereto. I�Testii�iony Wher�f,the undersigned have hereunto a�`ixed their official signatures. BOARD OF H�AI;TH: �anlea;�. �ell�F�. (�kav�«aa�c SEATA�iG: 205 total (2b,diliing 1'oom 1; �. �f�t. ��., v�LG 26,dining room 2; 153,main dining room) ��. $n�. (jlack �a�iek�C�ar�rat� � $' . .� November 26 ,2002 , � . y, ,; Director of Health THE COMMONWEALTH OF MASSACHUSETTS TOWN OF YARMOUTH BOARD OF HEALTH PERNIIT NUMBER #03-005 FEE: $75.00 'rhis is to certify that Blue Water Limited Partnership d/b/a Best Western Blue Water Resort _ 291 South Shore Drive, South Yarmouth,MA IS HEREBY GRANTED A PERMIT To'Operate a Public,Semi-Public Swimming or Wading Pool At Best Western Blue Water Resort - INDOOR POOL 291 South Shore Drive South Yarmouth,MA This permit is granted in conformity with Article VI of the Sanitary Code of The Commonwealth of Massachusetts,and expires December 31.2003 unless sooner suspended or revoked. November 29 ,2002 BOARD OF HEALTH: ��i�. �ellG(caa. (�aa �'uicfa�c�ic�, y,o�rdoac. ��.. 2/�ec ,�o�art� b'''aoer�c,j� �a�rEck�ar�rot� � s ��t Bruce G.M y, ., H Director of Health ! THE COMMONWEALTH OF MASSACHUSETTS TOWN OF YARMOUTH BOARD OF HEALTH ` PERMIT NUMBER: #03-006 FEE: $75.00 � This is to cernfy t1�at Blue Water Limited Partnership d/b/a Best Western Blue Water Resort � 291 South Shore Drive South Yarmouth, MA IS HEREBY GRANTED A PERMIT To Operate a Public, Semi-Public Swimming or Wading Pool At Best Western Blue`_Water Resort - OITTDOOR POOL 291 South Shore �ve _ _ South Yazmouth: This permit is granted in conformity with Article VI of the Sanitary Code of The Commonwealth of Massachusetts,and :_ . �_, , expires December 31.Z003` nnless-soonersuspended or revoked:' `° , <., , �:. .- , , , .. . . ,. November 29 ,2002 BOARD OF HEALTH: �a�rled� i��ar, (�ct�c !�'t�c�x�c�. ��°"c. ��.. �/lee �o�vrt�, b��ra�c.� . �a�tfek�C�o� ' `� S+�a� ?Z. ° ` ruce G.Murp , , , Director of Health � y THE COMMONWEALTH OF MASSACHUSETTS TOWN OF YARMOUTH BOARD OF HEALTH PERMIT NUMBER #03-002 FEE: $75A0 �'his is to Certiiy that Blue Water Limited Partnership d1b/a Best Western Blue Water Resort !� 291 South Shore Drive. South Yarmouth. MA _ � _ HAS BEEN GRANTED A LICENSE TO _ _ _ ENGAGE IN THE BUSINESS OR PRACTICE OF - GiVING OF VAPOR BATHS This License is issued in conformity with the authority granted to the Board of Health,by Chapter 140,Sections 51,of the General Laws,and amendmerns thereto,and is subject to the provisions of the Laws of the Commom�vealth of Massachusetts relating thereto,and upon such terms and conditions,and to the rules and regulations in regard to the carrying on of the occupation so ticensed as adopted by the Boazd ofHealth,and expires December 31,2003 unless sooner revoked. November 29 ,2002 BOARD OF HEALTH: �i(raaltd rZ�, i��, (�ak bu�xrt�c D. Cf�ralau. 71L.D., ?/u;e ,�o�ait� �7aao�c, L� �aatick�Do�ot� ��s�. ��t Bruce G.Murphy,MPH,RS.,CHO Director of Health „ , �' THE COMMONWEALTH OF MASSACHUSETTS TOWN OF YARMOIJTH � BOARD OF HEALTH PERNIIT NUMBER #03-002 FEE: $75.00 ? 'rhis is to Certi£y that Blue Water Limited Partnerslup d/b/a Best Westem Blue Water Resort ' 291 South Shore Drive. South Yarmouth. MA HAS BEEN GRANTED A LICENSE TO ENGAGE IN THE BUSINESS OR PRACTICE OF - GIVING OF VAPOR BATHS This License is issued in conformity with the suthority granted to the Board of Healtl�,by Chapter 140,Sections 51,of the General Laws,and amendments thereto,and is subject to the provisions of the Laws of the Commonwealtti of Massachusetts relating thereto,and upon such terms and conditions,and to the rules and regulations in regard to the carrying on of the occupation so licensed as adopted by the Board of Healtli,and e�ires December 31,2003 unless sooner revoked. November 29 ,2002 BOARD OF HEALTH: �anled �'�. i��, l�a�c _ _ _ _ _b�uirfa«��iic D. �i�ida�c. 7�D.. �lee _, _ _ ,�a�act�. �7o�c, �ik �abiick�e�cott �eee�c.SiFak. �'�l. ruce G.Murphy,MPH, S., O Director of Health