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HomeMy WebLinkAboutApp, WC, Lic & Certis The Commonwealth of Massachusetts Fee Town of Yarmouth $110.00 Lodging License Number: BOHL-15-1937-06 Issue Date: 1/1/2021 Mailing Address: Location Address: OCEAN MIST, LLC 97 SOUTH SHORE DR OCEAN MIST BEACH HOTEL & SUITES SOUTH YARMOUTH, MA 02664 28 JACOME WAY MIDDLETOWN, RI 02842 IS HEREBY GRANTED A 2021 LICENSE TO OPERATE: Motel This license is granted in conformity with the statutes and ordinances relating thereto, and expires December 31, 2021 unless sooner suspended or revoked and is not transferable. Conditions *UNITS- 63; BEDROOMS- 63; PLUS 1 MANAGER UNIT. Board Hillard Boskey, M.D., Chairman Mary Craig, Vice Chairman of Charles T. Holway, Clerk Debra Bruinooge Health Eric Weston Bruce G. Mu shy, MPH, ' .S., O/Mallory R. Langler, R.S. Health Director/Assistant Health Director The Commonwealth of Massachusetts Fee Town of Yarmouth $110.00 Swimming Pool Operations License Number: BOHSP-15-1940-06 Issue Date: 1/1/2021 Mailing Address: Location Address: OCEAN MIST, LLC 97 SOUTH SHORE DR OCEAN MIST BEACH HOTEL & SUITES SOUTH YARMOUTH, MA 02664 28 JACOME WAY MIDDLETOWN, RI 02842 IS HEREBY GRANTED A 2021 LICENSE This license is granted in conformity with the statutes and ordinances relating thereto, and expires December 31, 2021 unless sooner suspended or revoked and is not transferable. Conditions OUTDOOR SWIMMING POOL Board Hillard Boskey, M.D.,Chairman Mary Craig, Vice Chairman Of Charles T. Holway,Clerk Debra Bruinooge Health Eric WestonIP heop- — Bruce G. Murphy, MPH, R.S., ' HO/Mallory R. Langler, R.S. Health Director/Assistant Health Director The Commonwealth of Massachusetts Fee Town of Yarmouth $110.00 Swimming Pool Operations License Number: BOHSP-15-1939-06 Issue Date: 1/1/2021 Mailing Address: Location Address: OCEAN MIST, LLC 97 SOUTH SHORE DR OCEAN MIST BEACH HOTEL & SUITES SOUTH YARMOUTH, MA 02664 28 JACOME WAY MIDDLETOWN. RI 02842 IS HEREBY GRANTED A 2021 LICENSE This license is granted in conformity with the statutes and ordinances relating thereto, and expires December 31, 2021 unless sooner suspended or revoked and is not transferable. Conditions INDOOR SWIMMING POOL Board Hillard Boskey, M.D., Chairman Mary Craig, Vice Chairman of Charles T. Holway, Clerk Debra Bruinooge Health Eric Weston IP Bruce G. Murphy, MPH, R.S., C 1 / . Tory R. Langler, R.S. Health Director/Assistant Health Director The Commonwealth of Massachusetts Fee Town of Yarmouth $110.00 Swimming Pool Operations License Number: BOHSP-15-1941-06 Issue Date: 1/1/2021 Mailing Address: Location Address: OCEAN MIST, LLC 97 SOUTH SHORE DR OCEAN MIST BEACH HOTEL & SUITES SOUTH YARMOUTH, MA 02664 28 JACOME WAY MIDDLETOWN, RI 02842 IS HEREBY GRANTED A 2021 LICENSE This license is granted in conformity with the statutes and ordinances relating thereto, and expires December 31, 2021 unless sooner suspended or revoked and is not transferable. Conditions WHIRLPOOUVAPOR BATH Board Hillard Boskey, M.D., Chairman Mary Craig, Vice Chairman Of Charles T. Holway, Clerk Debra Bruinooge Health Eric WestonIP Bruce G. Murphy,MPH, R.S. CHO/Mallory R. Langler, R.S. Health Director/Assistant Health Director Oceer 'Li/ l \ TOWN OF YARMOUTH BOARD OF HEALTH r APPLICATION FOR LICENSE/PERMIT-2021 - ' Please complete torn)and attach all necessary documents by December 18,2020. Failure to do so will result in the return of your application packet. ESTABLISHMENT NAME: Ocean Mist Hotel&Suites TAX ID: 45-2525660 LOCATION ADDRESS: 97 South Shore Srive TEL.a: 508-398-2833 MAILING ADDRESS: 28 Jacome Drive Middletown, RI 02842 ———— MAIL ADDRESS: susanpl(lQnewporthoteleroA _com OWNER NAME: Ocean Mist LLC CORPORATION NAME(IF APPLICABLE): APR 1 6 2021 N ANAGER'S NAME: Scott Alemany,Director of Operations TEL.M: 401-258-3089 N AILING ADDRESS: 28 Jacome Way Middletown,RI 02842 HEALTH DEPT, PMOL 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. I Randy Russell Pool operators must list a minimum of two employees currently certified in standard First Aid and Community Cardiopulmonary Resuscitation(CPR),having one certified employee on premises at all times. Please list the employees below and attach copies of their certifications to this form.The ealth Department will not use past years'records. You must provide new copies and maintain a file at your place of business. ), Randy Russell 2. Velma Francis Miller 3. 4. FOOD I'ROTECTION MANAGERS•CERTIFICATIONS: All food service establishments arc 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 file at your establishment. I. 2. PERSON IN CHARGE: Each folxl establishment must have at least one Person In Charge(PIC)on site during hours of-operation. ALLERGEN CERTIFICATIONS: All food service establishments arc required to have at least one full-time employee who has Allergen certification. as defined in the State Sanitary Code for Food Service Establishments,105 CMR 590.009(G)(3)(a). 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 establishment. I. 2. HEIMLICH CERTIFICATIONS: All food service establishments with 25 seats or inure must Iwve: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 t nu. The Health Department will not use past years'records. You must provide new copies and maintain a file at your place of business. I. 2 3. 4. RESTAURANT SEATING: TOTAL a OFFICE LSE ONLY LODGING: UCENSE REQUIRED FEE PERMIT LICENSE REQUIRED FEE PERMIT,, LICENSE REQUIRED FEE PERMIT _ran $55 CABIN $55 MOTEL Si lu INN $SS —CAMP __SWIMMING POOL Sl _,LOIXiE S55 TRAILER PARK SIDS _j_WIiIRLPOOI. Sl . 11ka. FOOD SERVICE: LICENSE REQUIRED FEF. PERMIT a LICENSE REQUIRED FEE PERMIT r LICENSE REQUIRED FEE PERMIT a _11.11111 SEATS SOS _CONTINENTAL 535 NON-PROFIT S? II IO SEATS $2151 COMMON VIC Srds —' "--WIIOLF.SALE Sail - RETAII,SERVICE: —RC11D KITC iIEN tau - LICENSE REQUIRED FEE PERMIT a LICENSE REQUIRED FEE FERMI r a LICENSE REQIIIKED FEF. PERMIT r <511..y ft $511 -253551 sal It S2S5 -- VENDING•FIX/0 S25 _ _ —<25,IMlll.y-tl 5150 _FROZEN DESSERT Sin TOBACCO SI III NAME CHANCE: sly AMOUNT DUE •`� PLEASE TWIN OVER AND COMPLETE OTHER SIDE OF FORM ie('x'a1* VFX i� " �9 �� �ayi ) C°, (() L ?�I s4 �� 15 19 -10 S4 . 15 . 659 • ADMINISTRATION tinder 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 ✓ 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 _ - - MOTELS AND OTHER'LODGING ESTABLISHMENTS - 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 more than ninety(90)days within any six (6)month period. Use of a guest unit as a residence or dwelling unit shall not he 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,shallgenerally he considered Transient. POOLS POOL OPENING:Ali swimming,wading and whirlpools which have been closed for the season must be inspected by the Health Department prior to opening. Contact the health Department to schedule the inspection three(3)days prior to opening.PLEASE NOTE:People are NOT allowed to sit in the pool area until the pool has been inspected and opened. POOL WATER TESTING: The water must be tested ter pseudomonas,total coliform and standard plate count by a State certified lab,and submitted to the Health Department'three(3)days 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 --SEASONAI.man 4t+Itltic-9PCsNiNG: • --- All food service establishments must be inspected by the I lealth Department prior to opening Please contact the Health Department to schedule the inspection three(3)days prior to opening. • 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,or from the t'own's website at www.yarmouth.tna.us under Health Department,Downloadable Forms. FROZEN DESSERTS: Frozen desserts must be tested by a State certified lab prior to opening and monthly thereafter,with sample results submitted to the I lealth Department. Failure to do so will result in the suspension or revocation of your Frozen Dessert Permit until the above terms have been net. OUTSIDE CAFES: Outside cafes(i.e..outdoor seating with waiter/waitress service),must have prior approval from the Board of I lealth. OUTDOOR COOKING: Outdoor cooking,preparation,or display of any food product by a retail or food service establishment is prohibited. TOBACCO PRODUCT PERMIT CAP A tobacco permit holder who has failed to renew his or her permit within thirty(30)days of the previous year's permit expiration date is considered an expired license,and the tobacco license cap is reduced. NOTICE:Permits run annually from January Ito December 3 I. IT IS YOUR RESPONSIBILITY TO RETURN THE COMPLETED RENEWAL APPLICATION(S)AND REQUIRED FEE(S)BY DECEMBER IS.2020. 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. DATE: SIGNATURE: ,,,., PRINT NAME&TITLE:..Ker-r-� Q.0 inli Y a n K., , - Operations Manager From:Kelley Sullivan FaxID: Page 1 of 1 Date:4/9/2021 03:00 PM Page:1 of 1 ___........14, SEADO-1 OP ID: KS ,44C'o1?L7" CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDlYYYY) likii....------- 04/0912021 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu nt_suCh_endnrserrtr t(s).__.- PRODUCER 508=398-6060 -- ' mom-$ryderr&Sui1Tv-aiT insurance - Bryden&Sullivan Ins Agency PHONE 508-398-6060 I FAX 508-394 2267 of Dennis Inc. (AIC,No,Ext): (AIC,No): 485 Route 134, PO Box 1497 ADDRESS: So. Dennis,MA 02660 Bryden&Sullivaniiisuraiice INSURER(S)AFFORDING COVERAGE: - ,, INSURER A:SCOTTSDALE INSURANCE COMPANY 41297J INSURED INSURER B: Sea Dog Brew Pub Cape Cod LLC 23 White's Path INSURER C: South Yarmouth,MA 02664 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT 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.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL SUER POLICY NUMBER POLICY EFF POLICY EXP LIMITS LTR INSD 1A/VD (MMIDDIYYYY) (MMIDDIYYYY) A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE X OCCUR CPS7103950 05/02/2020 05/02/2021 DAMAGETORENTED 100,000 PREMISESIEaoccurrencel $ MED EXP(Any one person) $ 5,000 X Liquor$1m1$2m PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY PRO- JECT LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: $ AUTOMOBILECOMBINED SINGLE LIMIT LIABILITY (Ea accident) $ ANY AUTO OWNED SCHEDULED BODILY INJURY(Per person) $ AUTOS ONLY ri AUTOS BODILY INJURY(Per accident) $ _ DOrPFPTV naMAf_F uin�n _ - -01 ni.: :rr. r AUTOS ONLY AUTOS ONLY - I (Per accident) I$ I I _.-. _.. I I - )- I I$ ---' . �r=Hi,n Ui,i,Urcnr=rvL,t a - EXCESS LIAB CLAIMS-MADE AGGREGATE $ -I,2.77S: iSr=q_--__.�_1'l-Z�NT�ONT _i i_ -- - _. i c WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY Y 1 N .STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ OFFICERJM9MBER EXCLUDED? N 1 A l(MMandatory in NJFF11) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ - .._::.. .:.., :.:.. lUT,---=- :- '_ --- -�z -__ __-_ — - n.. .. .. � .:a-.t. ., - ....,. - contract. Liquor Liability coverage restricted to Designated°Premises II including 40 outdoor dining seats. CERTIFICATE HOLDER CANCELLATION TOWN-02 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN TOWN OF YARMOUTH ACCORDANCE WITH THE POLICY PROVISIONS. 1146 ROUTE 28 S. YARMOUTH, MA 02664 AUTHORIZED REPRESENTATIVE \_1 G ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. 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