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HomeMy WebLinkAbout2022 App-License-Certifications The Commonwealth of Massachusetts Fee Town of Yarmouth $110.00 Lodging License Number: BOHL-14-0370-08 Issue Date: 1/1/2022 Mailing Address: Location Address: RJ RESORTS RIVIERA BEACH RESORT OWNER LLC 327 SOUTH SHORE DR RIVIERA BEACH RESORT SOUTH YARMOUTH, MA 02664 65 E 55TH STREET, FL 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- 125 Board Hillard Boskey,M.D.,Chairman Mary Craig,Vice Chairman of Charles T.Holway,Clerk Debra Bruinooge Health Eric Weston 4 Bruce G. Murphy, MPH, '.S., '0/James G.Gardiner Health Director/Assistant Health Director The Commonwealth of Massachusetts Fee Town of Yarmouth $110.00 Swimming Pool Operations License Number: BOHSP-14-0388-08 Issue Date: 1/1/2022 Mailing Address: Location Address: RJ RESORTS RIVIERA BEACH RESORT OWNER LLC 327 SOUTH SHORE DR RIVIERA BEACH RESORT SOUTH YARMOUTH. MA 02664 65 E 55TH, FL 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 411 I Bruce G. Murphy, MPH, R.S., CHI /J es G. Gardiner Health Director/Assistant Health Director The Commonwealth of Massachusetts Fee Town of Yarmouth $110.00 Swimming Pool Operations License Number: BOHSP-14-0371-08 Issue Date: 1/1/2022 Mailing Address: Location Address: RJ RESORTS RIVIERA BEACH RESORT OWNER LLC 327 SOUTH SHORE DR RIVIERA BEACH RESORT SOUTH YARMOUTH. MA 02664 65 E 55m, FL 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. Murphy, MPH, R.S., 0 lames G.Gardiner Health Director/Assistant Health Director The Commonwealth of Massachusetts Fee Town of Yarmouth 8110.00 Swimming Pool Operations License Number: BOHSP-14-0372-08 Issue Date: 1/1/2022 Mailing Address: Location Address: RJ RESORTS RIVIERA BEACH RESORT OWNER LLC 327 SOUTH SHORE DR RIVIERA BEACH RESORT SOUTH YARMOUTH. MA 02664 65 E 55TH, FL 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 G. Murphy, MPH, R.S.,C t James G. Gardiner Health Director/Assistant Health Director The Commonwealth of Massachusetts Fee Town of Yarmouth $185.00 Food Establishment License Number: BOHF-14-0369-08 Issue Date: 1/1/2022 Mailing Address: Location Address: RJ RESORTS RIVIERA BEACH RESORT OWNER LLC 327 SOUTH SHORE DR RIVIERA BEACH RESORT SOUTH YARMOUTH. MA 02664 65 E 55TH STREET, FL 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: 40- Coffee Shop; 48- Upstairs Lounge. RESTRICTIONS: Motel guests only per Board of Health, 05/07/84. 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 preparation 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 7 • Debra Bruinooge cs Health Eric Weston Bruce G. Murphy, MPH, R..., O/James G. Gardiner Health Director/Assistant Health Director TOWN OF YARMOUTH BOARD OF HEALTH 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: =: _ TAX ID: LOCATION ADDRESS: 327 S Shore Drive,S Yarmouth,MA 02664 TEL.#:(508)398-2273 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 Riviera Beach 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. I Derek Vance 2. Kristin Brewer 3. 4. FOOD PROTECTION MANAGERS-CERTIFICATIONS: = u 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. "I EL 6 Z O Z1 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. Derek Vance 2 HEA LTH DEPT. .� PERSON IN CHARGE: Each food establishment must have at least one Person In Charge(PIC)on site during hours of operation. I Derek Vance 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. I Derek Vance 2 Tanner George HEIMLICH CERTIFICATIONS: Alt 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. I Derek Vance 2. 3. 4. RESTAURANT SEATING: TOTAL# 125 OFFICE USE ONLY LODGING: LICENSE REQUIRED FEE FERMI I k LICENSE REQUIRED FEE PERMIT# LICENSE REQUIRED FEE PERMITS B&B S55 CABIN S55 MOTEL 4I10 —`INN $55 CAMP S55 SWIMMING POOL Sl10ea. =LODGE S55 111 —TRAILER PARK $105 =WHIRLPOOL Sl10es. FOOD SERVICE: LICENSE REQUIRED FEE PERMIT# LICENSE REQUIRED FEE PERMITS LICENSE REQUIRED FEE PERMIT* 0.100 SEATS $125 CONTINENTAL $35 _NON-PROFIT S30 —>l00 SEATS $200 ,.'COMMON VIC. S60 WHOLESALE S80 —RESID.KITCHEN S80 RETAIL SERVICE: LICENSE REQUIRED FEE PERMIT$ LICENSE REQUIRED FEE PERMIT LICENSE REQUIRED FEE PERMITS <50 sqq.ft. S50 >25.000 WI. 5285VENDING-FOOD S25 i<25.000 sq.ft. $150 =FROZEN DESSERT S40 =TOBACCO Sl to NAME CHANGE: SIS AMOUNT DUE = S . 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 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 I Iealth Department three(,)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‘N ww.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.'.yith 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 1 to December 3L 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 T ND PROVED BY TI1E BOARD OF HEALTH PRIOR TO COMMENCEMENT. RENOVATIONS MAN ( RE A SITE PLAN. DATE: 1'),l1'f/2,f1-1 SIGNATURE: PRINT NAME&TITLE: Jon Wang-President Re' t(U15iI) ACRD CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY) 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 95'1-4'177 FAX 480 951-4266 do Artex Risk Solutions,Inc. iac No tk ( ) (Alc,_N0). (__) E-MAIL SDL.BSD.Certificates@artexrisk.com P.O.Box 13838 ADDRE ss; Scottsdale,AZ 85267 INSURER(S)AFFORDING COVERAGENAIC# INSURER A. American Zurich Insurance Company 40142 INSURED INSURER B: Oasis,a Paychex Company 2054 Vista Parkway Suite 300 INSURER C 1 West Palm Beach,FL 33411 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:21FL1751086837 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. TYPE OF INSURANCE. "........__A , INSR �������� ADDL SUBR, POLICY EFF POLICY EXP LTR INSD WVDi POLICY NUMBER 'IMM/DD/YYYYI IMM/DD/YYYYI LIMITS COMMERCIAL GENERAL LIABILITY ' EACH OCCURRENCE I $ ' I DAMAGE TO RENTED CLAIMS-MADE OCCUR PREMISES_LEaoccurrence) '_$__ MED EXP(Any one person) ,. $ PERSONAL 8 ADV INJURY i$ GEN'L AGGREGATE LIMIT APPLIES PER. GENERAL AGGREGATE $ POLICY PRO JECT LOC PRODUCTS-COMP/OP AGG $ OTHER: L. $ _---- ~ COMBINED SINGLE LIMIT AUTOMOBILE LIABILITY $ (Ea accident) ANY AUTO I BODILY INJURY(Per person) $ OWNED --,. SCHEDULED ...— --- AUTOS ONLY AUTOS BODILY INJURY(Per accident)'.$HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY -_- AUTOS ONLY , (Per accident) � I$ UMBRELLA LIAB I ! OCCUR EACH OCCURRENCE ' $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ i---i $ WORKERS COMPENSATION 'x I PER 'OTH AND EMPLOYERS'LIABILITY STATUTE 1 ER ANYPROPRIETOR/PARTNER/EXECUTIVE YIN E L EACH ACCIDENT $ 2,000,000 A 'OFFICER/MEMBEREXCLUDED? N NIA! 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 below1---, E.L.DISEASE POLICY LIMIT $ 2,000,000 Location Coverage Period: 11/01/2021 06/01/2022', Client# 23984-1 DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) EOS HOSPITALITY LLC Coverage is provided for 327 S SORE 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 327 S SORE DR THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN SOUTH YARMOUTH,MA 02664 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE 4: ;;W°.-40,1111111/21:044111 ©1988-2015 ACORD CORPORATION. All rights reserved. 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