HomeMy WebLinkAboutApp-License-Certification ,__s.= 1:V/i= .—
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.�►, TOWN OF YARMOUTH BOARD OF HEALTH
hi*- ; APPLICATION FOR LICENSE/PERMIT -2022
JUN 0 9 2022
— ` * Please complete form and attach all necessary documents by DeceMithalt DM
Failure to do so will result in the return of your application packet.
ESTABLISHMENT NAME ego cNi\l '4y. ov14,4M'(\S`s)t (.. TAX ID: (,
LOCATION ADDRESS:Cr 0 -ci 'c' o� (If ‘ (M� } STEL.#:oI el- 1 -�\) 17
ADDRESS.. :•� a ' b .; i at 1 ti V SS I I.
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MAILING E-MAIL �
ADDRESS: laC S l - •C •a - riti
OWNER NAME:
CORPORATION NAME (IF MPLICA E : _
MANAGER'S NAME:.o I\ �] TEL.#:. a - l -
MAILING ADDRESS:c 'b\X 1 o•J 'a'� tJ.1-SyoAcr, \1 r IYI,A 'tea I
POOL CERTIFICATIONS:
The pool supervisor must be certified as a Pool Operator,as required by State law. Please list the designated
Pool Operator(s)ad attach a copy of the certification to this form.
1. ?.;)..\\-C(., -10Y\ 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. (A(k 2.
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 rovide new copies and maintain a file at your establishment.
1. `\ 2.
PERSON IN CHARGE:
Each food establishment must have at least one Person In Charge (PIC) on site during hours of operation.
1. '(\'\X 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. ‘1/4\\C 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. -\(\ 2.
3. 4.
I
RESTAURANT SEATING: TOTAL#
f OFFICE USE ONLY -
LODGING:
LICENSE REQUIRED FEE PERMIT# LICENSE REQUIRED FEE PERMIT# LICENSE REQUIRED FEE PERMIT#
B&B $55 CABIN $55OTEL $110
_INN $55 CAMP $55 WIMMING 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 = \\0
*****PLEASE TURN OVER AND COMPLETE OTHER SIDE OF FORM*****
i
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
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 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 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 IS YOUR RESPONSIBILITY TO RETURN
THE COMPLETED RENEWAL APPLICATION(S) AND REQUIRED FEE(S) BY DECEMBER 18, 2024.
ALL RENOVATIONS TO ANY FOOD ESTABLISHMENT, MOTEL OR POOL (i.e., PAINTING, NEW
EQUIPMENT, ETC.), MUST BE REPORTED TO AND APPROVED BY TH BOARD OF HEALTH PRIOR
TO COMM NC MENT. RENOVATIONS MAY REQUIRE A SI P
DATE: SIGNATURE:
PRINT NAME & TITLE:(1; / j IS'au 302 / T477
Rev. 10/15/19
The Commonwealth of Massachusetts Fee
Town of Yarmouth $110.00
Swimming Pool Operations License
Number: BOHSP-15-1502-07 Issue Date: 1/1/2022
Mailing Address: Location Address:
BEACHWOOD CONDOMINIUM ASSOCIATION 638 ROUTE 28
BEACHWOOD CONDOMINIUMS WEST YARMOUTH, MA 02673
638 ROUTE 28
WEST YARMOUTH, MA 02673
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
*RESTRICTIONS: Safety report must be submitted annually with application.
Board of Health Hearing, 06/21/99-Do not need CPR, First Aid and Water Safety certifications.
Board Hillard Boskey,M.D.,Chairman
Mary Craig,Vice Chairman
Of Charles T.Holway,Clerk
Debra Bruinooge
Health Eric Weston
AldadBruce G. Murphy,'MPH,R.S.,CHI /J. G. Gardiner
Health Director/Assistant e. Director
BEACHWOOD CONDOMINIUM ASSOCIATION POOL RULES AND REGULATIONS JUN ton
HEALTH DEPT.
1. THE POOL SEASON WILL BE FROM JUNE 1, 2032,THRU SEPTEMBER 30 201
2. THE POOL HOURS OF OPERATION WILL BE FROM 10:00 A.M. TO 10:00 P.M.
3. THE AUTHORIZATION FOR USE OF THE POOL IS LIMITED TO THE POOL AND ADJACENT AREA.
4. THE AUTHORIZED USERS WILL BE OWNERS AND THEIR IMMEDIATE FAMILY AND/OR GUESTS
ACCOMPANIED BY THE OWNER.
TENANTS WILL BE ALLOWED POOL PRIVILEGES, AND WILL RECEIVE A KEY FROM THE BOARD OF
MANAGERS, WHEN THEY PROVIDE TO THE BOARD OF MANAGERS A VALID CPR CERTIFICATE, AND A
VALID TOWN OF YARMOUTH WATER SAFETY CERTIFICATE. TENANTS ELIGIBLE FOR CONSIDERATION
OF POOL PRIVILEGES ARE ONLY THOSE TENANTS LISTED ON THE LEASE PROVIDED TO THE
ASSOCIATION. IN ADDITION ONLY THOSE TENANTS LISTED ON THE LEASE MAY ACCOMPANY AN
AUTHORIZED TENANT IN THE POOL AREA. AUTHORIZED TENANTS MAY NOT INVITE TENANTS FROM
OTHER UNITS TO THE POOL AREA. OWNERS THAT DO NOT WANT THIS PRIVILEGE AFFORDED TO
THEIR TENANTS MUST PUT THIS RESSTRICTION IN THE LEASEAND NOTIFY THE BOARD OF
MANAGERS OF THIS CLAUSE.
FOR ALL UNITS THE TREASURER MUST VERIFY THAT ALL MONIES OWED TO THE ASSOCIATION FOR
SAID UNIT ARE PAID IN FULL AND A CURRENT LEASE IS ON FILE WITH THE ASSOCIATION.
ONLY TWO KEYS WILL BE ISSUED PER UNIT.
IF AT ANY TIME DURING THE SEASON AN OWNER, GUESTS AND/OR TENANT SHOULD BECOME
DELINQUENT IN MAINTAINING THEIR POSITIVE STATUS WITH THE ASSOCIATION ALL PRIVILEGES,
FOR THE OWNER AND/OR TENANTS WILL BE REVOKED ONTIL SUCH TIME AS THE SPECIFIC
SHORTCOMINGS ARE RECTIFIED.
5. THE MINIUM AGE FOR ANY PERSON UNACCOMPANIED BY A RESPONSIBLE ADULT IS 18 YEARS
OF AGE.
6. THE POOL GATE WILL BE LOCKEDD AT ALL TIMES, EVEN WHEN THE POOL IS OCCUPIED BY
USERS. EACH ENTRANT AS WELL AS EACH USER DEPARTING WILL BE RESPONSIBLE TO ASSURE
THAT THE GATE IS LOCKED BEHIND THEM UNDER NO CIRCUMSTANCES IS A USER TO OPEN THE
GATE FOR ANOTHER PARTY. IT IS EACH INDIVIDUAL'S RESPONSIBILITY TO PROVIDE THEIR OWN
KEY AND TO POLICE THEMSELVES.
7. ALL USERS AND GUESTS ARE REQUIRED TO SIGN IN AND OUT OF THE POOL AREA. A LOG BOOK
WILL BE PROVIDED FOR THIS FUNCTION.
8. IF AN AUTHORIZED USER SHOULD LEAVE THE POOL AREA FOR ANY REASON (INCLUDING USING
THE LAVATORY FACILITIES)ALL PARTIES IN THE POOL AREA WITH THAT AUTHORIZED USER THEN
BECOME UNAPPROVED USERS AND MUST LEAVE WITH THEIR HOST.
9. ALTHOUGH IT IS STRONGLY RECOMMENDED THAT NO INDIVIDUAL SWIM ALONE (ALONE BEING
WITHOUT ANOTHER RESPONSIBLE ADULT ACCOMPANYING THEM) ANY PERSON POSSESSING THE THREE
REQUIRED CERTIFICATIONS WILL NOT BE HELD TO THIS REQUIREMENT. ALL NON-CERTIFIED USERS WILL
REQUIRE A RESPONSIBLE ADULT POOLSIDE AT ALL TIMES WHILE UTILIZING THE POOL FOR
RECREATIONAL PURPOSES.
10. ANY PERCEIVED VIOLATION OF THESE RULES AND REGULATIONS WILL BE SUBMITTED TO THE
BOARD OF MANAGERS BY THE PERSON INTEPRETING THE OFFENCE. THE BOARD OF MANAGERS WILL
REVIEW THE SUBMISSION WITH BOTH THE SUBMITTER OF THE COMPLAINT AND THE PARTY AGAINST
WHOM THE COMPLAINT HAS BEEN LODGED. IF THE BOARD OF MANAGERS AFTER CONFERRING WITH
BOTH PARTIES DEEM THAT A VIOLATION HAS OCCURRED ARTICLE 11 WIL BE INVOKED, THERE WILL BE
NO APPEAL PROCESS FOR THIS PROCEEDING.
11. ANY VIOLATION OF THESE RULES AND REGULATIONS WILL RESULT IN THE FOLLOWING
PENALTIES:
FIRST OFFENCE: 24 HOUR SUSPENSION FROM POOL PRIVILEGES.
JUN 0 9 2022
HEALTH DEPT
SECOND OFFENCE. 50.00 FINE*
THIRD OFFENCE: REVOCATION FROM POOL PRIVILEGES FOR THE REMAINDER OF THE SEASON &
100.00 FINE*
*MONETARY FINES WILL BE ASSESSED TO THE OWNER OF THE UNIT IN VIOLATION
JUN 0 9 2022
HEALTH DEPT.
Town of Yarmouth HEALTH DEPARTMENT
Re:BEACHWOOD CONDOMINIUM ASSOCIATION
638 Main Street Route 28
West Yarmouth,MA
06/05//2022
Attention Health Department
I Jonathan Sides President of Beachwood Condominium Association hereby agree to all the
rules and regulations for maintaining our pool according to the Commonwealth of
Massachusetts and Town of Yarmouth.
Under the supervision and direction of our Pool Technicians Pooltection who will be
continuously maintaing our pool throughout the season.The pool will be closed for the season
by September 16,2022 ,
Our President and and Pool Management Company also agree to test the pool four times daily
for the proper readings set forth by the Town of Yarmouth.To maintain all proper signage for
pool.Maintain a log for entry and exit of pool area .Only open to Pool owners. with no exceptions
.We take this very serious here at Beachwood and completely understand the importance of
the safety and compliance of our pool area.The pool area is locked at all times.I have included
a copy of the Beachwood Condominium Association Rules and Regulations.
All Safety regulations are strictly enforced.The pool will be open for its owners only between
10:00AM and 10:00 PM.