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HomeMy WebLinkAbout2023 Licensing The Commonwealth of Massachusetts Fee Town of Yarmouth s125.00 Food Establishment License Number: BOHF-22-4106-01 Issue Date: 1/1/2023 Mailing Address: Location Address: BRAMBLE COTTAGE KITCHEN LLC 1338 ROUTE 28 1338 ROUTE 28 SOUTH YARMOUTH. MA 02664 SOUTH YARMOUTH, MA 02664 IS HEREBY GRANTED A LICENSE TO OPERATE: Food Service This license is granted in conformity with the statutes and ordinances relating thereto, and expires December 31, 2023 unless sooner suspended or revoked and is not transferable. Conditions: Baked Goods Only Board Hillard Boskey, M.D.,Chairman Mary Craig, Vice Chairman of Charles T. Holway, Clerk Eric Weston Health es G. Gardiner Health Director TOWN OF YARMOUTH BOARD OF HEALTH 9APPLICATION 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 yo ur application packet. -1 ���(] ESTABLISHMENT NAME:)ravel.bl 5 (10 i4 R i TAX ID: — !-i Lj 9 LOCATION ADDRESS: 3 �f ...M A' as tel v ) f-11 �Q�O MAILING ADDRESS: G N"1 L.) ` a JZ M !°�- Q,�(p 3"y E-MAIL ADDRESS: ,fit a• nv5V‘f_triTt r� yy • C' (ring OWNER NAME:tt I : SE CORPORATION NAME(IF APPLICABLE): 8lr evw('O'e Co e.I--C. MANAGER'S NAME: TEL.#: oS 33._ZQ & MAILING ADDRESS: a 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. 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. 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 599,009, Please attach copies of certification to this application. The Health Department will not use past years'hdiikEiNgP You m st provide new copies and maintain a le at your establishment. zr 1. X et k x Sc 1n a c e\ 2. PR 2 4 2023 PERSON IN CHARGE: HEALTH DEPT. Each food establishment m t ha at le o Q Perrn I Charge(PIC)on site during hours of operation. 1. \4 \ X `y ��Jt `-' <tt 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 D artment will not use past years'records. You must providezev cogie` m 'nd t feat rev tabl hment. 1. 1 k C! 1� 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. T Health Department will not use past years'records. You must provide+Iew co ies and mai tain a file at ur place of business... 11eU ' 4. RESTAURANT SEATING: TOTAL# OFFICE USE ONLY LODGING: LICENSE REQUIRED FEE PERMIT# LICENSE REQUIRED FEE PERMIT# LICENSE REQUIRED FEE PERMIT# B&B $55 CABIN $55 MOTEL $110 INN $55 CAMP $55 _SWIMMING POOL$1 l0ea. 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 =<25,000sq.ft. $150 —FROZEN DESSERT $40 TOBACCO $110 NAME CHANGE: $15 AMOUNT DUE = $ /2. �� *****PLEASE TURN OVER AND COMPLETE OTHER SIDE OF FORM***** Or-iv -•! • C. t • — 8 r f‘,) Al rise ty pr,e- , . • i1• 1.7%-N4 ▪ r---t eo, t ,• " • / • *".1-1•1 1 / elg ' 4 ..4) p • 1 • . Ii I • f • r '` - , , • • ' ft \ • r e I ) :" ..J• 3 • 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 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 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 A APPROVED BY THE BOARD OF HEALT 0 TO COMMENCEMENT. RENOVATIONS MAY Q A S TE P . � DATE: T/( l/a3 SIGNATURE: • PRINT NAME&TITLE: �, t ytC Rev.10/15/19 ••••••••,..- 1 '. . . . ! • ‘..11 ,- ‘ *. • ,-• ...'} -..... ... \ -.') N 4 ) .1 . •..." -• I • 1- f) ri- ,...,.. • r ••• t. _ r't r. 1 Irt•I'NI` )c-_ se safe. CERTIFICATION KELLI SCHOFIELD for successfully completing the standards set forth for the ServSafe®Food Protection Manager Certification Examination, which is accredited by the American National Standards Institute(ANSI)--Conference for Food Protection (CFP). 20790381 10752 CERTIFICATE NUMBER EXAM FORM NUMBER 7/15/2021 7/15/2026 DATE OF EXAMINATION DATE OF EXPIRATION Local laws apply.Check with your local regulatory agency for recertification requirements. Sherman Brown Executive Vice President, National Restaurant Association Solutions In accordance with Maritime Labour Convention 2006,Resolution ADM N 068-2013(Regulation 3.2,Standard A3.2). ©2017 National Restaurant Association Educational Foundation(NRAEF).All rights reserved.ServSafe®and the ServSafe logo are trademarks of the NRAEF.National Restaurant Association®and the arc design are trademarks of the National Restaurant Association. This document cannot be reproduced or altered. 17110811 v.171 1 Contact us with questions at 233 S.Wacker Drive,Suite 3600,Chicago,IL.60606-6383 or ServSafe@restaurant.org. ► aAkt + a CS1�j r a e L fJ. 021 CERTIFICATE OF 6re; #2. ALLERGEN AWARENESS TRAINING .- . n . Name of Recipient:KELLI SCHOFIELO •11c;,7 i Certificate Number: 5201302 �' 'n. Date of Completion: 8t22/2021 Date of Expiration: 8122r21326 fCN CI • . ,, vt'ti tla•.7 �- 0. r St > C O m Issued By:S „0 0 The above-named person if hereby issued this certificate ‘— • for completing an allergen awareness training pogrom [1111 iR 'A J4 2 • recognized by the Massachusetts Department of Public Health '�'• �ATION` ;_ in accordance with 105 CMR 590.009(C)(3)(a). Massachusetts Restaurant Association S00.765.2122 •� 333 Turnpike Road,Suite 102 www.restaurant.org .C+ • mil certificate will he valid for five(S 1'ears from date al-completion Southborough,MA 01772 SOS-303-9905 3� www.rnarestaurantaserx.org ttti(, WCCCJ'el J Ski ;r ^ n�` asV „^ ^ r 1 )Z