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HomeMy WebLinkAboutApp-License-Certifications The Commonwealth of Massachusetts Fee Town of Yarmouth $110.00 Swimming Pool Operations License Number: BOHSP-15-5650-07 Issue Date: 1/1/2022 Mailing Address: Location Address: RJ RESORTS BLUE WATER RESORT OWNER LLC 291 SOUTH SHORE DR BLUE WATER RESORT SOUTH YARMOUTH, MA 02664 65 E. 55TH STREET, FLOOR 33 NEW YORK,NY 10022 IS HEREBY GRANTED A 2022 LICENSE This license is granted in conformity with the statutes and ordinances relating thereto, and expires December 31, 2022 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 Bruce G. Muthy, PH, R.S., CHO Health Director The Commonwealth of Massachusetts Fee Town of Yarmouth $110.00 Swimming Pool Operations License Number: BOHSP-15-5652-07 Issue Date: 1/1/2022 Mailing Address: Location Address: RJ RESORTS BLUE WATER RESORT OWNER LLC 291 SOUTH SHORE DR BLUE WATER RESORT SOUTH YARMOUTH, MA 02664 65 E. 55TH STREET, FLOOR 33 NEW YORK,NY 10022 IS HEREBY GRANTED A 2022 LICENSE This license is granted in conformity with the statutes and ordinances relating thereto, and expires December 31, 2022 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 Weston Bruce ... Murp , MPH, R.S., CHO Health Director The Commonwealth of Massachusetts Fee (-6°' Town of Yarmouth $110.00 Swimming Pool Operations License Number: BOHSP-15-5654-07 Issue Date: 1/1/2022 Mailing Address: Location Address: RJ RESORTS BLUE WATER RESORT OWNER LLC 291 SOUTH SHORE DR BLUE WATER RESORT SOUTH YARMOUTH, MA 02664 65 E. 55TH STREET, FLOOR 33 NEW YORK,NY 10022 IS HEREBY GRANTED A 2022 LICENSE This license is granted in conformity with the statutes and ordinances relating thereto, and expires December 31, 2022 unless sooner suspended or revoked and is not transferable. Conditions WHIRLPOOL/VAPOR BATH Board Hillard Boskey, M.D.,Chairman Mary Craig, Vice Chairman Of Charles T.Holway, Clerk Debra Bruinooge Health Eric Weston 111 Bruce G. M shy,MPH, R.S., CHO Health Director The Commonwealth of Massachusetts Fee Town of Yarmouth $260.00 Food Establishment License Number: BOHF-15-5656-07 Issue Date: 1/1/2022 Mailing Address: Location Address: RJ RESORTS BLUE WATER RESORT OWNER LLC 291 SOUTH SHORE DR BLUE WATER RESORT SOUTH YARMOUTH, MA 02664 65 E. 55TH STREET, FLOOR 33 NEW YORK,NY 10022 IS HEREBY GRANTED A 2022 LICENSE TO OPERATE: Food Service; Common Victualler This license is granted in conformity with the statutes and ordinances relating thereto, and expires December 31, 2022 unless sooner suspended or revoked and is not transferable. Conditions SEATING: 205 Total(26-Dining Room 1; 26-Dining Room 2; 153- Main Dining Room) Board Hillard Boskey, M.D., Chairman Mary Craig, Vice Chairman Of Charles T.Holway, Clerk Debra Bruinooge Health Eric Weston ii---- 1 Bruce G. Murphy, M r H, ' ., CHO Health Director The Commonwealth of Massachusetts Fee Town of Yarmouth $110.00 Lodging License Number: BOHL-15-5646-07 Issue Date: 1/1/2022 Mailing Address: Location Address: RJ RESORTS BLUE WATER RESORT OWNER LLC 291 SOUTH SHORE DR BLUE WATER RESORT SOUTH YARMOUTH, MA 02664 65 E. 55'H STREET, FLOOR 33 NEW YORK,NY 10022 IS HEREBY GRANTED A 2022 LICENSE TO OPERATE: Motel This license is granted in conformity with the statutes and ordinances relating thereto, and expires December 31, 2022 unless sooner suspended or revoked and is not transferable. Conditions Units- 84; Bedrooms- 84 Board Hillard Boskey, M.D., Chairman Mary Craig, Vice Chairman of Charles T. Holway, Clerk Debra Bruinooge Health Eric Weston J 4 ,/ Bruce G. Murphy, PH, ' .S., CHO Health I irector TOWN OF YARMOUTH BOARD OF HEALTH E APPLICATION FOR LICENSE/PERMIT-2022 \ *Please complete form and attach all necessary documents by December 18,2021. Failure to do so will result in the return of your application packet. ESTABLISHMENT NAME: 1.thke 4 - '' ` TAX ID: 87-2915917 LOCATION ADDRESS: 291 S Shore Dr,S Yarmouth,MA 02664 TEL.#; (508)398-2288 MAILING ADDRESS: 65 E 55th Street,Floor 33 New York,NY 10022 E-MAIL ADDRESS: Twang@eosinvestors.com OWNER NAME: Jonathan Wang CORPORATION NAME(IF APPLICABLE): RJ Resorts Blue Water Resort Owner LLC MANAGER'S NAME: EOS Hospitality LLC TEL.#: (212)630-5028 MAILING ADDRESS: 65 E 55th Street,Floor 33 New York,NY 10022 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 Joseph Souza 2. 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 Health Department will not use past years'records. You must provide new copies and maintain a file at your place of business. 1 Kristin Brewer 2 Derek Vance 3. 4. 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 file at your establishment. 1. Kristin Brewer 2 ... .4V L..),--i - L= PERSON IN CHARGE: Ike I 6 2021 Each food establishment must have at least one Person In Charge(PIC)on site during hours of operation. 1 Kristin Brewer 2. HEALTH DEPT ALLERGEN CERTIFICATIONS: All food service establishments are 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. 1. Kristin Brewer 2. HEIMLICH 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 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 Kristin Brewer 2. 3. 4. RESTAURANT SEATING: TOTAL# 205 OFFICE USE ONLY LODGING: LICENSE REQUIRED FEE PERMIT# LICENSE REQUIRED FEE PERMIT LICENSE REQUIRED FEE PERMITS B&B $55 CABIN $55 MOTEL $110 INN $55 CAMP $55id SWIMMING POOL SII0es. LODGE $55 _TRAILER PARK $105 WHIRLPOOL 5110es. FOOD SERVICE: LICENSE REQUIRED FEE PERMIT# LICENSE REQUIRED FEE PERMIT# LICENSE REQUIRED FEE PERMIT# 0-100 SEATS $125 CONTINENTAL $35 NON-PROFIT $30 ,,>100 SEATS $200 . COMMON V1C. $60 LESALE 580 _REBID.KITCHEN 580 RETAIL SERVICE: LICENSE REQUIRED FEE PERMIT# LICENSE REQUIRED FEE PERMIT# LICENSE REQUIRED FEE PERMITS <50 sq.ft. $50 >25.000 501. $285 _VENDING-FOOD $25 --<25.I100 sq.fi. $150 _FROZEN DESSERT$40 _TOBACCO SI 10 NAME CHANGE: $15 AMOUNT DUE = $ `' ,... 4**'•PLEASE TURN OVER AND COMPLETE OTHER SIDE OF FORM***** 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 X OR WORKER'S COMP.AFFIDAVIT SIGNED AND ATTACHED Town of Yarmouth taxes and liens must he 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 he 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 1301 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 be considered transient. Occupancy that is subject to the collection of Room Occupancy Excise,as defined in M.G L.c.MG or 830 CMR 64G.as amended.shall generally he considered Transient. 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. Contact the Health Department to schedule the inspection three(3)days prior to opening.PLEASE.MOTE: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 for 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 SEASONAL FOOD SERVICE OPENING: All food service establishments must be inspected by the Health 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 Town's website at yww.varmouth.ma.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 Health Department. Failure to do so will result in the suspension or revocation of you:Frozen Dessert Permit until the above terms have hcen met. OUTSIDE CAFES: Outside cafes(i.e.,outdoor seating with waiter/waitress service).must have prior approval from the Board of Health. 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 1 to December 31. IT 1S YOUR RESPONSIBILITY TO RETURN THE COMPLETED RENEWAL APPLICATION(S)AND REQUIRED FEE(S)B Y DECEMBER 18,2020. ALL RENOVATIONS TO ANY FOOD ESTAB1 SHMENT. MOTEL OR POOL (i.e.. PAINTING, NEW EQUIPMENT,ETC.),MUST BE REPORTED TO A )APPROVED BY THE BOARD OF HEALTH PRIOR TO COMMENCEMENT. RENOVATIONS MAY R. lI SITE PLAN. DATE:AIN f O J SIGNATURE: PRINT NAME R TITLE, gonad*Wang-President Ito-.10/15/0 ® A�RCP CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 12/10/2021 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 of such endorsement(s). PRODUCER CONTACT NAME: Doug Jones PHONE FAX c/o Artex Risk Solutions,Inc. INC.No.Ext)* (480)951-4177 (ac,No): (480)951-4266 P.O.Box 13838 E-MAILDDSS: SDL.BSD.Certificates@artexrisk.com Scottsdale,AZ 85267 INSURER(S)AFFORDING COVERAGE NAIC# INSURERA: American Zurich Insurance Company 40142 INSURED INSURER B: Oasis,a Paychex Company 2054 Vista Parkway Suite 300 INSURER C: West Palm Beach,FL 33411 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:21FL1751086834 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 SUBR POLICY EFF POLICY EXP LIMITS LTR INSD WVD POLICY NUMBER ,(MM/DDIYYYY) (MMIDDIYYYY) COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE _ $ DAMAGE TO RENTED CLAIMS-MADE OCCUR PREMISES(Ea occurrence) $ MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY PRO J JECT LOC PRODUCTS-COMP/OP AGG $ OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea accident) _ ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY _ AUTOS ONLY (Per accident) UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION X MUTE EMPLOYERS'LIABILITY STATUTE ER ANYPROPRIETOR/PARTNER/EXECUTIVE YIN • E.L.EACH ACCIDENT $ 2,000,000 A OFFICER/MEMBER EXCLUDED? N N/A WC 16-85-800-00 10/01/2021 06/01/2022 (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 2,000,000 If yes,describe under , DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 2,000,000 Location Coverage Period: 11/01/2021 06/01/2022 Client# 23972-1 DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) EOS HOSPITALITY LLC Coverage is provided for 291 S SHORE DR only those co-employees of,but not subcontractors SOUTH YARMOUTH,MA 02664 to: CERTIFICATE HOLDER CANCELLATION EOS HOSPITALITY LLC SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE S SHORE DR THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 291 291 S SOHRE DRTH,MA 02664 ACCORDANCE WITH THE POLICY PROVISIONS. SOAUTHORIZED REPRESENTATIVE ©1988-2015 ACORD CORPORATION. All rights reserved. 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'�� � �� ii� I Kristin Brewer From: ctkirkwood79@gmail.com Sent: Thursday, April 21, 2022 9:03 AM To: Kristin Brewer Subject: Fwd: CPO Letter Sent from my iPhone Begin forwarded message: From: Rob Freligh<nac4h2o@aol.com> Date:April 13, 2022 at 5:51:14 PM EDT To: ctkirkwood79@gmail.com Subject:CPO Letter Reply-To: Rob Freligh <nac4h2o@aol.com> 4-13-22 Christopher Kirkwood Blue Water 38 Swan Lake W. yarmouth, MA :02673 Dear Christopher, Congratulations on your successful completion of the CERTIFIED POOL/SPA OPERATORS course. I hope your experience was a positive one. You will be listed in the Pool and Hot Tub Alliance/National Swimming Pool Foundation's Certified Pool/Spa Operator National Registry. Within 10- 15 days, you will receive an official CPO Wall Certificate and Wallet Card by email. The email will come from the PHTA. These will contain your registration number. Please be sure to check your email, also check spam. If you have not heard from the PHTA in 2 weeks please email us at nac4h2o@aol.com. Thank you for your participation. If you have any questions, or if I or my company can be of any assistance to you now or in the future, please don't hesitate to contact me at 1- 888-833-5770. Sincerely, SCORE:96 Robert R. Freligh, CPO INSTR. Pres. NAC, Inc. I. S S X Dcm nil .. ,..,,. m n v m n m �//'''''' I• O co n "". o n n O ' Ill 1111 nZ 2,1 33y ;Cil ci. 3 alco VI nN M T 0.. S vg cp Z voa CD m C, n m ^ C1 alull< t �, O n = 0 3 n (p ; as m �D G n T as o bs 1'v Q . 9, o (el 3 ^ m ("I) o a . :�D A �. -, a .0 w C 3 >I a 3 m o • cfl O O o p N M ee-F, r� Xi7 N flat 2 1 TS Q 6 63 C ,+ " 7' V+ •♦ az,' n 'o m 3 fD (� flu � � m m Cl `G d d T ;O O 0 0 0 • • C 9 E 84 03 rr. R° 3 � a am 73 K O. cD 0 D a o v (^/�� Q nj LQ S N a. O M. e,- 0. 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