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HomeMy WebLinkAboutApp-License-Certifications The Commonwealth of Massachusetts Fee Town of Yarmouth $110.00 Lodging License Number: BOHL-15-6165-06 Issue Date: 1/1/2022 Mailing Address: Location Address: RIVERVIEW RESORT HOMEOWNERS ASSOCIATION 37 NEPTUNE LN RIVERVIEW RESORT CONDOMINIUM TRUST SOUTH YARMOUTH, MA 02664 37 NEPTUNE LANE SOUTH YARMOUTH, MA 02664 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 MOTEL UNITS- 44 (PER BOARD OF APPEALS#4056); BEDROOMS- 54 Board Hillard Boskey, M.D., Chairman Mary Craig, Vice Chairman of Charles T. Holway, Clerk Debra Bruinooge Health Eric Weston Bruc- G. Murph. MPH, ;.., CHO Heals Director The Commonwealth of Massachusetts Fee /.. Town of Yarmouth $25.00 Food Establishment License Number: BOHF-15-6173-06 Issue Date: 1/1/2022 Mailing Address: Location Address: RIVERVIEW RESORT HOMEOWNERS ASSOCIATION 37 NEPTUNE LN RIVERVIEW RESORT CONDOMINIUM TRUST SOUTH YARMOUTH, MA 02664 37 NEPTUNE LANE SOUTH YARMOUTH, MA 02664 IS HEREBY GRANTED A 2022 LICENSE TO OPERATE: Vending Food; 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. Board Hillard Boskey, M.D.,Chairman Mary Craig, Vice Chairman of Charles T. Holway, Clerk Debra Bruinooge Health Eric Weston110 A / • _•‘ .) Bruce G. Murphy, PH, . ., CHO Health Director The Commonwealth of Massachusetts Fee Town of Yarmouth $110.00 Swimming Pool Operations License Number: BOHSP-15-6171-06 Issue Date: 1/1/2022 Mailing Address: Location Address: RIVERVIEW RESORT HOMEOWNERS ASSOCIATION 37 NEPTUNE LN RIVERVIEW RESORT CONDOMINIUM TRUST SOUTH YARMOUTH, MA 02664 37 NEPTUNE LANE SOUTH YARMOUTH, MA 02664 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 4119 OP Bruce G. Murphy, M y ,R. , HO Health Director The Commonwealth of Massachusetts Fee Town of Yarmouth $110.00 Swimming Pool Operations License Number: BOHSP-15-6169-06 Issue Date: 1/1/2022 Mailing Address: Location Address: RIVERVIEW RESORT HOMEOWNERS ASSOCIATION 37 NEPTUNE LN RIVERVIEW RESORT CONDOMINIUM TRUST SOUTH YARMOUTH, MA 02664 37 NEPTUNE LANE SOUTH YARMOUTH, MA 02664 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. Murphy, MPH '.`., 0 Health Director The Commonwealth of Massachusetts Department of Industrial Accidents • Office of Investigations 'FE ( -4444 7."---77,461=71.. . 1 Congress Street, Suite 100 pT. '11' Boston, MA 02114-2017 www.mass.gov/dia • Workers' Compensation Insurance Affidavit: General Businesses Applicant Information Please Print Legibly Business/Organization Name: CL./ �c,2 T_ Cc.tio oi\-. t,.•i L,A 1 t'zLii Address: .y AE-p.1 „,/ City/State/Zip: 50,-; y c,�,,,.,,— ��� Phone #: -3 (-2 c7 _ 9. I Are you an employer? Check the appropriate box: Business Type(required): l. I am a employer with employees(full and/ 5• 0 Retail or part-tiff c).*' 6. ❑ kestaurant'Bar/Eating Establishment 2.❑ I am a sole proprietor or partnership and have no 0 Office and/or Sales(incl. real estate, auto,etc.) employees working for me in any capacity. [No workers' comp. insurance required] 8. ❑ Non-profit 3.❑ We are a corporation and its officers have exercised 9. 0 Entertainment their right of exemption per c. 152, §1(4), and we have 10.0 Manufacturing no employees. [No workers' comp. insurance required]' 4.❑ We are a non-profit organization,staffed by volunteers, 11.0 Health Care with no employees. [No workers' comp. insurance req.] 12.64 Other T I>'E *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. **If the corporate officers have exempted themselves,but the corporation has other employees,a workers'compensation policy is required and such an organization should check box#1. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy information. Insurance Company Name: .T Kf C lc CAS ,v S v tz-A � LL C Insurer's Address: 71-4-7 Atm s rt, L;,, ,�aN y I r�S„rt4,,,c.`: - Z C C Sid yp4- t nic_ s r c- 9yt, City/State/Zip: J`v2 /� , C t C A- - 7-. 1 Policy#or Self-ins. Lic. # X WL S 7 y j Z FL / Expiration Date: y�l� Z ly Z Z_ Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage sc required. under Sec cn 25 A of MCir .. '.52 car. 1. _� t the •. "-"•'-' ' �• �.�.-�u�: !ca,-; �v t1TlpUJitlll[t oi'Cfiminal penalties Ot a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify,under the '' ndpenalties ofperjury that the information provided above is true and correct. • Si nature: • Date: /Z-7// o z 1 Phone#; -5-C" g - 3 _ 9' t I Official use only. Do not write in this area,to be completed by city or town official. City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2. Building Department 3. City/Town Clerk 4. Licensing Board 5. Selectmen's Office 6.Other Contact Person: Phone#: www.mass.gov/dia Workers Compensation And Employers Liability Insurance Policy WC 00 00 01 A Coverage Is Provided In: ��` ' LibertyPolicy Number: The Ohio Casualty Insurance Company IXWO (22)57 95 28 84 r• Mutual Prior Policy Number: INSURANCE IXWO(21)57 95 28 84 NCCI Co. No. 111363 Workers Compensation and Employers Liability Insurance Policy FEB 1 0 2022 Information Page HEALTH DEPT. ITEM 1:The Insured &Mailing Address Agent Mailing Address&Phone No. gmeame RIVERVIEW RESORT CONDOMINIUM (310) 530-0099 TRUST RIVERVIEW RESORT THE ARMSTRONG COMPANY INSURANCE ___ 37 NEPTUNE LN CONSULTANTS SOUTH YARMOUTH, MA 02664 2780 SKYPARK DR STE 440 TORRANCE, CA 90505-7518 Individual Partnership = X Corporation or Trust FEIN:202806437 NAICS.721110 Other workplaces not shown above: a ITEM 2 The policy period is from 04/01/2021 to 04/01/2022 12:01 am StandardTimeat the insured'smailingaddress. ITEM 3 A.Workers Compensation Insurance: Part One of the policy applies to the Workers Compensation Law of the states listed here: MA B.Employers Liability Insurance: Part Two of the policy applies to work in each state listed in Item 3.A. The limits of our liability under Part Two are: Bodily Injury by Acadent $1,000,000 each accident Bodily Injury by Disease $1,000,000 policy limit Bodily Injury by Disease $1,000,000 each employee C.Other States Insurance: Part Three of the policy applies to the states, if any, listed here: See Extension of Information Page 0.This policy includes these endorsements and schedules: See Policy Forms and Endorsements Summary ITEM 4 The premium for this policy will be determined by our Manuals of Rules, Classifications, Rates and Rating Plans. All information required below is subject to verification and change by audit. Classifications Code Premium Basis-Total Rate per Estimated Na. Estimated Annual $100 of Annual Remuneration Remuneration Premium See Extension of Information Page(s) Total Estimated Annual Premium $4,581.00 Total Surcharges and Assessments $143.00 Minimum Premium $301.00 MA Total Estimated Cost $4,724.00 If indicated below, interim adjustments of premiums shall be made. Deposit Premium $4,724.00 Countersigned by: Issue Date 01/31/21 To report a claim, call your Agent or 1-844-325-2467 WC 00 00 01 A (WC 30 10 E) © 1987 National Council on Compensation Insurance, Inc. 01/31/21 57952684 POLSVCS 280 NCAOPPNO INSURED COPY 003323 PAGE 13 OF 46 / 1 / www.capecodsafetytrain'ing.co_^-' _ ---,pa p` s NSC CPR Course a -I Z °""`'o Adult, Child, Infant, FBAO & AED Name: Dimitra Otto - Security Control No. Address: Riverview Resort 883213 Address: 37 Neptune Lane FES 7 L iCi 1 City, State,Zip: South Yarmouth,MA 02664 HEALTH DEPT. d Course Completion Date: 02/10/2021 Training Center: Cape Cod Safety Training Expiration Date: 02/10/2023 Instructor Name: Rick Todd Instructor Number: 1040918 Dimitra Otto has successfully completed the NSC CPR Course based on the current Guidelines for CPR and ECC. The National Safety Council eliminates preventable deaths at work, in homes and communities,and on the road through leadership, research,education and advocacy. For more life-saving courses from NSC please visit nsc.org/fatraining L THIS DOCUMENT IS VOID IF REPRODUCED • D•.,* Security Control No. ,�,� rQ? Dimitra Otto 883213 o,I. ` has completed the mWe wantyour feedback! Ad �nigrfantt�►trag&AED Cape Cod Safety Training Training Center: Please visit nsc.org/firstaidevaluation to Completion Date: 02/10/2021 take a brief survey and share your opinions Expires: 02/10/2023 Instructional Hours: about the NSC course you completed. #1040918 1 ia>,9 Instructor Signature Instructor No. NSC-in it for life® nsc.org/fatraining Keep this card for your records.Void if reproduced 50M04012020 1015 900008130 02016 National Safety Council 79174-0000 ,, ' www.capecodsafetytraining.com gyp` w NSC CPR Course (O'e °°"`sAdult, Child, Infant, FBAO & AED Na00.°°"me: John Spignese 1,------- - - Security Control No. Address: Riverview Resort I = . 883212 Address: 37 Neptune Lane City, State, Zip: FEB 1 Q 2022 South Yarmouth,MA 02664 HEALTH DEPT. Course Completion Date: 02/1012021 Training Center: Cape Cod Safety Training Expiration Date: 02/10/2023 Instructor Name: Rick Todd Instructor Number: 1040918 John Spignese has successfully completed the NSC CPR Course based on the current Guidelines for CPR and ECC. The National Safety Council eliminates preventable deaths at work, in homes and communities, and on the road through leadership, research, education and advocacy. For more life-saving courses from NSC please visit nsc.org/fatraining ;��_... __ __ 2 THIS DOCUMENT IS VOID IF REPRODUCED • o„u,f Security Control No. 1-3, '''' John Spignese 883212 o.■.` has completed the We want your feedback! Aa 9hiPtn1anfa�raR&AED Cape Cod Safety Training Training Center: Please visit nsc.org/firstaidevaluation to 02/1012021 take a brief survey and share your opinions Completion or about the NSC course you completed. Expires:s: 02H012023 Instructional Hours: FALL' 1i;,s-r #1040918 Instructor Signature Instructor No. NSC-in it for life® nsc.org/fatraining Keep this card for your records.Void if reproduced. 50M04012020 1015 900008130 ©2016 National Safety Council 79174-0000 www.capecodsafe ytr inrng ao,,. -°gyp` s9t NSC First Aid Course CE Z IC cOUNC%o OSHA includes Epi Pen Name: Dimitra Otto-0t_,, i Security Control No. Address: Riverview Resort -- 19830 6 Address: 37 Neptune Lane HEALTH DPT. City, State, zip: South Yarmouth, MA 02664 -- Course Completion Date: 0211012021 Training Center: Cape Cod Safety Training Expiration Date: ;0211012023 Instructor Name-,: Rick Todd Instruction-Number: 1�g�� Dimitri. Otto has successfully completed the NSC First Aid Course. __ _ The National Safety Council eliminates preventable deaths at work, in homes and communities, and on the road through leadership, research, education and advocacy. For more life-saving courses from NSC please visit nsc.org/fatraining I THIS DOCUMENT IS VOID IF REPRODUCED ,..0 :: Security Control No. ,oP.I.S� _C ' Dimitra Otto 19 8306 Ari Vo0110 c,as completed the NSC First Aid Course We want your feedback! Taining Center: Cape Cod Safety Training Please visit nsc org/firstaidevaluation to Completion Date: 0211812021 take a brief survey and share your opinions Expiry. 0211012023 Instructonai Hours about the NSC course you completed. � 1 tG.r' --;;;-/-/ #1040918 Instructor Signature Instructor No. NSC-in it for lifensc.org/fatraining) Keep this card for your records.Void if rept ,c hat 30M04032019 . 1015__9.00008129 e2016 National Safety Council 79173-0000 a tea. 'r+, c'_, ,:-;. „_..,.• :- 'q^ .:,,"a# ..,.E .r _ - - www.capec dsafetvaini . n,- -°gyp` 1:0NSC First Aid Course t 2 < COVNG%� ® OSHA includes Epi Pen Name: John Spignese — = Security Control No. Address: Riverview Resort - 198307 Address: 37 Neptune Lane - city, &tate zip; South Yarmouth, MA 02664 =_- , � 1 � 2022 pT Course Completion Date: 02!1012021 Training Center: Cape Cod Safety Training Expiration Date:-_02110120.23 Instructor Name Rick Todd Instructor Number: 1040918 John Spignese has successfully completed the NSC First Aid Course. The National Safety Council eliminates preventable deaths at work, in homes and communities,and on the road through leadership, research, education and advocacy. For more life-saving courses from NSC please visit nsc.org/fatraining THIS DOCUMENT IS VOID IF REPRODUCED opµ, Security Control No. aP�a =�0 198307 John Spignese t°c�,o. has compietea the NSC First Aid Course We want your feedback! Training Center: Please visit nsc.org/firstaidevaluation to j Completion nate. 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Zip: South Yarmouth, MA 02664 Course Completion Date: 0311412022 Training Center: Cape Cod Safety Training Expiration Date: 0311412024 Instructor Name: Rick Todd Instructor Number 1040918 Lucas Deveau has successfully completed the NSC First Aid Course. The National Safety Council eliminates preventable deaths at work, in homes and communities, and on the road through leadership, research, education and advocacy. For more life-saving courses from NSC please visit nsc.org/fatraining I ) J THIS DOCUMENT IS VOID IF REPRODUCED t , .I.s Security Control No. e l",';'.50,',7, y. e µ 234131 ° 01 has completed the ;1 on NSC First Aid CoursaS 10.I51 ,;-Y-''-''' We want your feedback! Training Center: Cape Cod Safety Training Please visit nsc.org/firstaidevaluation to Completion Date._ 0311412022 take a brief survey and share your opinions Expir 0311412024 - Instructional Hours. about the NSC course you completed. - #1040918 instructor Signature Instructor No. NSC-in it for life' nsc.org/fatrainin9) Keep this'card for your records.Void if reproduced. - 30M04012020.- 1015_900008129©2016 National Safety Council 79173-0000 I __, „_ __ _ ?, : : nsc NSC CPR Course National Safety Council Nyvvw i Adult, Child, Infant, FBA } & AED Name: Lucas-Deveau Security Control No. n Address: Riverview Resort - �l O 4 °° 5 �y r Address: 37 Neptune Lane �1 City, State,Zip: South Yarmouth,MA 02664 Course Completion Date: 0311412022 Training Center: Cape Cod Safety Training Expiration Date: 03114/2024 Instructor Name: Rick Todd Instructor Number: 1040918 Deve u Lucas a - 1 i has successfully completed the NSC CPR Course based on the current Guidelines for CPR and ECC. j 1 jr � 4 The National Safety Council is America's leading nonprofit safety advocate.We focus on eliminating the leading causes of I; preventable injuries and deaths so people can live their fullest lives.We create a culture of safety to not only make people safer at I work but also to make people safer beyond the workplace.For more life-saving courses from NSC please visit nsc.org/fatraining ii 1, %t--T THIS DOCUMENT IS VOID IF REPRODUCED rAi ) ■:nsc Security Control No. N.....Safety Cetl . . n$C: :1 Wt^Lucas Deveau 9 3 7 50 National Safety Council _ _ has completed the We want your feedback! NSC CPR Course Adult,Child,Infant FBAO&AED Training Center: Cape Cod Safety Training .. Please visit nsc.org/firstaidevaluation to Completion Date: o3ii412022 take a brief survey and share your opinions Expires 03n-4/20Instructional Hours: about the NSC course you completed. ?. ._, #1040918 Instructor Signature Instructor No. Keep this card for your records.Void if reproduced a3 \....... ___J 50M11092021 02020 National Safety Council 79174-0000 • W _a t ecodsafetytraining.co m 0 16 NSC First Aid Course z,. ou"0` OSHA 1910.151 Name: Jeffrey rey PhitIt _ _ _ Security Control No. Address: Riverview Resort = = = 234130 Address: 37 Neptune Lane City, State, Zip: South Yarmouth,MA 02664 Course Completion Date: 03114/2022 Training Center: Cape Cod Safety Training Expiration Date: 0311412024 Instructor Name: Rick Todd Instructor Number: 1040918 - Jeffrey Phillips has successfully completed the NSC First Aid Course. The National Safety Council eliminates preventable deaths at work, in homes and communities,and on the road through leadership, research, education and advocacy. For more life-saving courses from NSC please visit nsc.org/fatraining THIS DOCUMENT IS VOID IF REPRODUCED `t. °,..s a Security Control No. Jeffrey P Philli s 234130 °° � has completed the NSC First Aid CoursOSHA 1910.151 e. We want your feedback! Please visit nsc.org/firstaidevaluation to Training Center: Cape Cod Safety Training Completion Date: 0311412022 take a brief survey and share your opinions Expires. 03/14/2024 = - instructional Hours: about the NSC Course you completed. .yam #1040918 Instructor Signature Instructor No. KNSC-in it for life nsc.org/fatraining J Keep this card for your records.Void if reproduced. 30M04012020,, 1015 900008129 ©2016 National Safety Council 79173-0000 -nnat,rseni•mafaler—lamaa - I i I, www.capecodsafetytramin .com • : • nsc NSC CPR Course National Safety Council Adult, Child, Infant, FBAO & AED Name: Jeffrey Phillips Security Control No. I- Address: Riverview Resort - -- 9 3 6 7 6 4 Address: 37 Neptune Lane City, State, Zip: South Yarmouth,MA 02664 Course Completion Date: 0311412022 Training Center: Cape Cod Safety Training Expiration Date. 03/1412024 Instructor Name:-- Rick Todd Instructor Number: 1040918 i 11 Jeffrey Phillips r, has successfully completed the NSC CPR Course based on the current Guidelines for CPR and ECC. 1 . 1 The National Safety Council is America's leading nonprofit safety advocate.We focus on eliminating the leading causes of preventable injuries and deaths so people can live their fullest lives.We create a culture of safety to not only make people safer at ' work but also to make people safer beyond the workplace.For more life-saving courses from NSC please visit nsc.org/fatraining I l''•, ) THIS DOCUMENT IS VOID IF REPRODUCED 7 ::nsc Security Control No. tistionsi Safety Council C III IP• nsc. Jeffrey Phillips 9 3 6 7 6 4 National Safety Council has completed the NSC CPR course Adult,Child,Infant FBAO&AED We want your feedback! Training Center: Cape Cod Safety Training Please visit nsc.orgifirstaidevaluation to Completion Date: 03114/2022 E : take a brief survey and share your opinions xpihres03414/2024 Instructional Hours' about the NSC course you completed. ••••••- Id.-iv/ #1040918 Instructor Signature Instructor No. Keep this card for your records.Void if reprodiitgib',': 50M11092021 ©2020 National Safety Council 79174-0000 0TOWN.._..� OF YARMOUTH BOARD OF HEALTH fi ►'\ ` 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: give-nweN iteio27— Cd,./no.,,1Av,v.,. Ttvs:r-TAX ID: LOCATION ADDRESS: 37 /Uefrv,.,C !-A.,'E C. Y4c4- ,ri. TEL.#: sD' -35i-1-9-trv1 MAILING ADDRESS: —Ss-/`-‘E - E-MAIL ADDRESS: 3 Qt,;II.,e3 0 Q r:ver'v e�./ re3 or+. c e•,-. OWNER NAME: (4kue-rtviEw 2ESv2.c ilioA.,coi-me- .) A-Sit)c aA-f l0A/ CORPORATION NAME (IF APPLICABLE): MANAGER'S NAME: VR1 AivNe-rt1 c,AS TEL.#: 51)r—7-7 / —33 99 MAILING ADDRESS: Po Sox 311 , 8yA,,,,,,,j , 0-c‘,0% 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. 0µ,u 3P) 6..Je--Jt 22. 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. b ►^^1T2,4 orTb 2. c\ h-..-) S P I GNEl6 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. KiAv 2. PERSON IN CHARGE: Each food establishment must have at least one Person In Charge (PIC) on site during hours of operation. 1. /WA- 2. 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. A-4- 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. 1. NA- 2. 3. 4. RESTAURANT SEATING: TOTAL# OFFICE USE ONLY LODGING: LICENSE REQUIRED FEE PERMIT# LICENSE REQUIRED FEE PERMIT# LICENSE REQUIRED FEE PERMIT# B&B $55 _CABIN $55MOTEL $110 —_INN $55 CAMP $55 SWIMMING POOL$110ea. LODGE $55 TRAILER PARK $105 /WHIRLPOOL $110ea. 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 VIC. $60 WHOLESALE $80 —RESID.KITCHEN $80 RETAIL SERVICE: LICENSE REQUIRED FEE PERMIT# LICENSE REQUIRED FEE PERMIT# LICENSE REQUIRED FEE PERMIT# <50 sq.ft. $50 >25,000 sq.ft. $285 /VENDING-FOOD $25 =<25,000 sq.ft. $150 _FROZEN DESSERT $40 TOBACCO $110 NAME CHANGE: $15 AMOUNT DUE = $ 355 *****PLEASE TURN OVER AND COMPLETE OTHER SIDE OF FORM***** Q (. alt s F 141'073 I ' Lpn t15 /e) (p rr 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 / 10 ZOZZ OR FEB WORKER'S COMP. AFFIDAVIT SIGNED AND ATTACHED HEALTH DEPT. 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 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, 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 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 www.yarmouth.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 your Frozen Dessert Permit until the above terms have been met. OUTSIDE CAFÉS: 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 t obacce 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 IS YOUR RESPONSIBILITY TO RETURN THE COMPLETED RENEWAL APPLICATION(S) AND REQUIRED FEE(S) BY DECEMBER 18, 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: ) /Coz l SIGNATURE: PRINT NAME& TITLE: J EFF r - G E...,Err4 Rev. 10/15/19