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HomeMy WebLinkAboutApp-License-Certifications The Commonwealth of Massachusetts Fee Town of Yarmouth $110.00 Motel License Number: BOHL-21-1553 Issue Date: 1/1/2022 Mailing Address: Location Address: RED JACKET BEACH 28 SOUTH SHORE DR RJ RESORTS BEACH RESORT OWNER LLC SOUTH YARMOUTH, MA 02664 65 E 55TH STREET, FLOOR 33 NEW YORK, NY 10022 IS HEREBY GRANTED A 2022LICENSE 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 150 UNITS, 150 BEDROOMS Board Hillard Boskey, M.D.,Chairman Mary Craig, Vice Chairman of Charles T. Holway, Clerk Debra Bruinooge Health Eric Weston 6S271"-7 / Bruce G. Mtti►-phy, MPH, R.S., CHO Health Director The Commonwealth of Massachusetts Fee Town of Yarmouth $260.00 Food Establishment License Number: BOHF-21-1552 Issue Date: 1/1/2022 Mailing Address: Location Address: RJ RESORTS BEACH RESORT OWNER LLC 28 SOUTH SHORE DR RED JACKET BEACH 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: 102 RESTRICTIONS FOR OUTDOOR COOKING FACILITY: 1. Hours of operation will be from 11:00 a.m. to 5:00 p.m. from Memorial Day through Columbus Day. 2. Food(hamburgers and hot dogs) will be cooked to order. 3. The area must be on a concrete slab and a canopy must be over the food prep area. 4. Variances will expire after Columbus Day weekend. 5. Variances will be granted on a yearly basis and must be applied for in writing each December. The variances will be reviewed by the Board to determine if they should be revoked, modified or renewed. 6. The kitchen chef who holds a certified food handler certificate must oversee the operation. Board Hillard Boskey, M.D.,Chairman Mary Craig, Vice Chairman of Charles T. Holway,Clerk Debra Bruinooge Health Eric Weston Bruce G. irphy, MPH, R.S., CHO Health Director The Commonwealth of Massachusetts Fee Town of Yarmouth $220.00 Swimming Pool Operations License Number: BOHSP-21-1554 Issue Date: 1/1/2022 Mailing Address: Location Address: RJ RESORTS BEACH RESOR OWNER LLC 28 SOUTH SHORE DR RED JACKET BEACH 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. M shy, MPH, R.S., CHO Health Director The Commonwealth of Massachusetts Fee Town of Yarmouth $220.00 Swimming Pool Operations License Number: BOHSP-21-1554 Issue Date: 1/1/2022 Mailing Address: Location Address: RJ RESORTS BEACH RESOR OWNER LLC 28 SOUTH SHORE DR RED JACKET BEACH 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 41, Bruce G. Mu r y, MPH, R.S., CHO Health Director The Commonwealth of Massachusetts Fee (.6°' Town of Yarmouth $110.00 Swimming Pool Operations License Number: BOHSP-21-1555 Issue Date: 1/1/2022 Mailing Address: Location Address: RJ RESORTS BEACH RESORT OWNER LLC 28 SOUTH SHORE DR RED JACKET BEACH 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 Board Hillard Boskey, M.D., Chairman Mary Craig, Vice Chairman Of Charles T. Holway, Clerk Debra Bruinooge Health Eric Weston Bruce G. MurpF,F, MPH, R.S., CHO Health Director d. TOWN OF YARMOUTH BOARD OF HEALTH If \ 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: !"l'F CIS :)a CVN telC TAX 1D 87-2915671 LOCATION ADDRESS: 1 S Shore Drive,S Yarmouth,MA 026 TEL.#: (508)398-6941 MAILING ADDRESS: 65 E 55th Street,Floor 33 New York,NY 10022 E-MAIL ADDRESS: jwang@eosinvestors.com OWNER NAME: Jonathan Wang __ CORPORATION NAME(IF APPLICABLE): RJ Resorts Beach Resort Owner LLC MANAGER'S NAME:...-., EOS Hosptiality 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 Operators)and attach a copy of the certification to this form. I Joseph Souza ,, 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. Joseph Souza _w.__..__.. . �_....... 2._ Adam Ashland LI an71-1D DEC 1 s 2021 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. HEALTH DEPT 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 John Payne Edward Chaput PERSON IN CHARGE: Each food establishment must have at least one Person In Charge(PIC)on site during hours of operation. I.John Payne2 Edward Chaput 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)(al. 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 Hollie Handrahan 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. Adam Ashland -, Jill-Anne Nawoichik 1. — Tell Streeter _..._ ... _.__._-.__ ,.Karen Rood__. _ _. a.7 RESTAURANT SEATING: TOTAL# 102 OFFICE USE ONLY LODGING; LICENSE REQUIRED I,EE PERMIT a LICENSE REQUIRED FEE IERMIT:f LICENSE REQUIRED FEE PERMITS B&D $55 CABIN $55 MOTEL SI It --INN $55 CAMP $55 SWIMMING POO1.SI Illea. —LODGE $55 TRAILER PARK 5105 \VHIRLPOOL $I l(ka. _ FOOD SERVICE: LICENSE REQUIRED IEE PtR\11Th 1 IGEN'l REQUIRED FEE FERMI Ik LICENSE REQUIRED FEE PERMITS 0-1)51 SEATS SI25ONTINEN(AAI. $35 NON-PROFIT $30 7>100 SEATS $200 `C'OMMON VIC. $60 WHOLESALE $80 RESID.ATICIIEN 500 RETAIL SERVICE: LICENSE REQUIRED FEE PERMITS LICENSE REQUIRED LEE PERMIT# LICENSE REQUIRED FEE PERMIT* <50 sq.ft. $511 >25.000 sq.11. $285 _ VENDING-FOOD$25 _<25.U0h) i.11. $150 _ =FROZENDESSERT S10 -TOBACC(I SI 10 NA\IECHANCE: $15 AMOUNT DUE = $ ;7( °::J.. .„_. •••••PLEASE TURN 05 F.R ANI)COMPLETE:OTHER SIDE.OF FORI11••••• 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 be paid prior to renewal or issuance of your permits. PLEASE CI IECK 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 the)maintain a principal place of residence elsewhere.Transient occupancy shall generally refer to continuous occupancy of not more than thirty(301 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 shad 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,shall generally be 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 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 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 he drained or covered within seven(7)days of closing. FOOD SERVICE SEASONAL FOOD SERVICE OPENING: All food service establishments must he inspected by the Health Department prior to opening. Please contact the Health Department to schedule the inspection three(31 days prior to opening. CATERING POLICY: Anyone who caters within the Town of Yarmouth must notify the Yarmouth I lealth Department by filing the required Temporary Food Service Application form 72 hours prior to the catered event. These form>can be obtained at the Health Department,or from the"T'own's website at www.%armouth,maus 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 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 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 I to December 31.IT IS YOUR RESPONSIBILITY TO RETI.IRN THE COMPLETED RENEWAL APPLICATION(S)AND REQUIRED FEES)BY DECEMBER 18.2020. ALL RENOVATIONS TO ANY FOOD ESTABLISHMENT. MOTEL OR POOL (i.e., PAINTING. NEW EQUIPMENT.ETC.).MUST BE REPORTED T AND APPROVED BY THE..BOARD OF HEALTH PRIOR TO COMMENCEMENT. RENOVATIONS MAN E RE A SITE PLAN. DATE:1111gia.oa® _— SIGNATURE: _ PRINT NAME&TITLE: than Wang-President Re' 1V!1»I7 , � ACORO CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DDIYYYY) 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 (480)951-4177 FAX No (480)951-4266 do Artex Risk Solutions, Inc. (.MAIL Ext). ): P.O. Box 13838 E-MAIL 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:21FL1751086836 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 1 EACH OCCURRENCE $ CLAIMS-MADE OCCUR PRSlO RENTED PREMISES(Ea occurrence) $ MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ _ POLICY PRO- 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 PER NH- AND I ! EMPLOYERS'LIABILITY Y/N STA /•& OF ICER/MEMB REXCLUDED?ECUTIVE N N/A WC 16-85-800-00 10/01/2021 06/01/2022 E.LEACH ACCIDENT $ 2,000,000 (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# 23979-1 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Coverage is provided for EOS HOSPITALITY LLC only those co-employees 1 S SHORE DR 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 1 S SHORE DR THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN SOUTH YARMOUTH,MA 02664 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE e ;i;4--'40,111011/1401441.1"....' ©1988-2015 ACORD CORPORATION. All rights reserved. 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