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HomeMy WebLinkAbout2023 Licensing The Commonwealth of Massachusetts Fee Town of Yarmouth $30.00 Food Establishment License Number: BOHF-15-2382-07 Issue Date: 1/1/2023 Mailing Address: Location Address: YARMOUTH-DENNIS RED SOX BASEBALL CLUB, INC. 210 STATION AVE Y-D RED SOX BASEBALL CONCESSION STAND SOUTH YARMOUTH. MA 02664 P.O. BOX 78 YARMOUTHPORT, MA 02675 IS HEREBY GRANTED A 2023 LICENSE TO OPERATE: Non-Profit; 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. Board Hillard Boskey, M.D.,Chairman Mary Craig, Vice Chairman of Charles T.Holway,Clerk Debra Bruinooge Health Eric Weston G ruce G. Murp , MPH, R.S., CHO/James G. Gardiner Hea thDirector/Assistant Health Director TOWN OF YARMOUTH BOARD OF HEALTH APPLICATION FOR LICENSE/PERMIT -2023 * Please complete form and attach all necessary documents by December 18, 2022. Failure to do so will result in the return of your application packet. ESTABLISHMENT NAME: ypr ptavth-perm;5 Red SoyTAX ID: 0 -L7YL677 LOCATION ADDRESS: 7 Io . -r-erfiavt Q."At � TEL.#: 7 g/-33a -Lo1�a MAILING ADDRESS: ( fox �y-Z.31 co. yq rpja d1N j 4 c 2L docf E-MAIL ADDRESS: %)in p-Kelly ( yoir S0X.E'M OWNER NAME: CORPORATION NAME (IF APPLICABLE): . MANAGER'S NAME: J6QQtta, C-(cw wri TEL.#: Sc b'-` 57-54/v8 MAILING ADDRESS:-to—/-¢434 ibliAtuo of.J A'i's Q 3� 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 bisfit 1. 2' DEC 2 0 2022 3. 4. i ICALTI I DEPT. . 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. i danna C(cut,SeA) 2. PERSON IN CHARGE: Each food establishment must have at least one Person In Charge (PIC) on site during hours of operation. 1. .)OQ`Ikq C(QuSP_fi 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. J cot Afro Cl/cizASe.r 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. 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$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 / ON-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# q >25,000 sq.ft. $285 VENDING-FOOD $25 I =<25,000 sq.ft. $150 FROZEN DESSERT $40 TOBACCO $110 NAME CHANGE: $15 Amount Due= $ \ j) *****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 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 & VIOLATION ASSESSMENT 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. Violations of 105 CMR 665.000, State minimum standards for retail sale tobacco, shall be assessed as follows: 1st Violation a fine of$1,000.00 shall be imposed,2"d Violation within 36 months of 1st violation,a fine of$2,000.00 shall be imposed and a prohibition on sale of tobacco products may be imposed for at least 1 day and up to 7 days, 3rd Violation within 36 months of 1st violation or additional violations during that time period,a fine of$5,000.00 shall be imposed, and a prohibition on the sale of tobacco products may be imposed for at least 7 consecutive business days and up to 30 consecutive business days. 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, 2022. All renovations to any food establishment,motel or pool(i.e.,painting,new equipment,ect.), Must be reported to and approved by the Board of Health to commencement. Ren vations may require a MA engineer site plan. DATE: / Z f go/Z z SIGNATURE: c__)c PRINT NAME&TITLE: J v 4 n MCC' (<C4((q �- ) � .�2 q S uAszft- Rev. 10/11/2022 The Commonwealth of Massachusetts Print Form __= Department of Industrial Accidents 7' ;' Office of Investigations 1 Congress Street, Suite 100 I fl., Boston, MA 02114-2017 yr-zr www.mass.gov/dia Workers' Compensation Insurance Affidavit: General Businesses Applicant Information Please Print Legibly Business/Organization Name: ya r rnov{ —0e�►it i 5 Sox/ Bets 4 4 (( C-1-0 b� I iG- Address: p.n . Q ox 1 cf.,23 City/State/Zip: . , , „ , u , , _ „ gPhone #: -7 g J-336 -at3(I-in Are you an employer? Check the appropriate box: Business Type(required): 1.® I am a employer with (, employees(full and/ 5. ❑ Retail or part-time).* 6. ❑ Restaurant/Bar/Eating Establishment 2.❑ I am a sole proprietor us partnership and have no 7. ❑ 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. ® Entertainment their right of exemption per c. 152, §1(4),and we have 10.❑ Manufacturing no employees. [No workers' comp. insurance required]* 4.❑ We are a non-profit organization, staffed by volunteers, 11.111 Health Care with no employees. [No workers' comp. insurance req.] 12.0 Other *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: 7"4 e hi-et r-1-6n rci Insurer's Address: 3000 te i_S eiocc n e4vcd City/State/Zip: ,5- 60^ O PA:f?rylc 0 ( 7 F2-31 Policy#or Self-ins. Lic.# O$ GUEC ,4g4.1 Ml Expiration Date: 6/i!/23 Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section SSA of MGL c. 152 can lead to the imposition of criminal penalties of 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, u der the pains and penaltiesl of perjury that the information provided above is true and correct Signature: (> �-�L'e'"` Date: /Z4 2/7 Z Phone#: ? -330 -ZD'f 6 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 Report-Town of Yarmouth Yarmouth Board28 of Health Food Establishment Inspection P 1146 Route.28,South Yarmouth,MA 02664 Establishment:Yarmouth Dennis Red Sox Date:June 1,2023 Address:210 Station Ave Time in:2:20 Time out:3:00 Telephone:617-306-5936 (Permit No.: Number of Violated Provisions Related to Foodborne Illness Risk • Owner: Factors and Interventions(Items 1 through 29): Person-in-charge:Paul Izzo Number of Repeat Violations Related to Foodborne Illness Risk Inspector:Philip Renaud Factors and Interventions(Items 1 through 29): Type of Operation(s): Type of Inspection: Other Information: IS Food Service Establishment Routine ❑Retail Food Store ❑Residential;Cottage Foods El Bed&Breakfast ❑Mobile/Pushcart ❑Temporary Food Estab. ❑Other FOODBORNE ILLNESS FACTORS AND PUBLIC HEALTH INTERVENTIONS IN=in compliance OUT=not in compliance N/O=not observed N/A=not applicable COS=corrected on-site during inspection R=repeat violation Compliance Status I IN/OUT I COS/R Compliance Status I IN/OUT I COS/R Supervision Protection from Contamination 1 Person-in-charge present,demonstrates knowledge and IN 15 Food separated and protected IN performs duties. 16 Food-conflict surfaces:cleaned&sanitized IN 2 Certified Food Protection Manager IN 17 Proper disposition of returned,previously served, IN Employee Health reconditioned,and unsafe food 3 Management,food employee,and conditional employee: IN Time/Temperature Control for Safety knowledge,responsibilities,and reporting 18 Proper cooking time and temperatures IN 4 Proper use of restriction and exclusion IN 19 Proper reheating procedures for hot holding IN 5 Written procedure for responding to vomiting and diarrhea) IN 20 Proper cooling time and temperatures ▪ IN events 21 Proper hot holding temperatures IN Good Hygiene Practices 22 Proper cold holding temperatures ▪ IN 6 Proper eating,tasting,drinking,and tobacco use IN 23 Proper date marking and disposition IN 7 No discharge from eyes,nose,and mouth IN 24 Time as a public health control:procedures and records ▪ IN Preventing Contamination by Hands Consumer Advisory 8 Hands clean and properly washed IN 25(Consumer advisory provided:raw/undercooked food I IN 9 No bare hand contact with RTE food or a pre-approved IN Highly Susceptible Population alternative procedure properly followed 10 Adequate handwashing sinks,properly supplied/accessible IN 26 Pasteurized food used;prohibited foods not offered I N/A Approved Source Food/Color Additives and Toxic Substances 11 Food obtained from approved source N 27 Food additives:approved and properly used N/A 12 Food received at proper temperature IN 28 Toxic substances properly identified,stored&used IN 13 Food in good condition,safe,and unadulterated IN Conformance with Approved Procedures 14 Required records available:shellstock tags,parasite destruction N/A 29 Compliance with variance/specialized process/ROP N/A criteria/HACCP Plan GOOD RETAIL PRACTICES AND MASSACHUSETTS-ONLY SECTIONS IN=in compliance OUT=not in compliance N/A=not applicable N/O=not observed COS=corrected on-site during inspection R=repeat violation Compliance Status I IN/OUT I COS/R Compliance Status IN/OUT COS/R Safe Food and Water 48 Warewashing facilities:installed,maintained and used; OUT 30 Pasteurized eggs used where required N/A cleaning agents,sanitizers,and test strips 31 Water and ice from approved sources - IN 49 Non-food contact surfaces clean IN 32 Variance obtained for specialized processing methods N/A Physical Facilities Food Temperature Control 50 Hot and cold water available,adequate pressure IN 33 Proper cooling methods used:adequate equipment for IN 51 Plumbing installed;proper backflow devices IN temperature control 52 Sewage and waste water properly disposed IN 34 Plant food properly cooked for hot holding N/A 53 Toilet facilities;properly constructed,supplied,and cleaned IN 35 Approved thawing methods used IN 54 Adequate ventilation and lighting:designated areas used IN 36 Thermometers provided and accurate OUT 55 Physical facilities installed,maintained,and clean IN Food Identification 56 Adequate ventilation and lighting;designated areas used IN 37 IFood properly labeled;original container I IN I Additional Requirements listed in 105 CMR 590.011 Prevention of Food Contamination M1 Anti-choking procedures in food service establishment IN _ 38 Insects,rodents,and animals not present IN M2 Food allergy awareness IN 39 Contamination prevented during food preparation,storage& IN Review of Retail Operations listed in 105 CMR 590.010 display M3 Caterer N/A 40 Personal cleanliness IN M4 Mobile Food Operation N/A 41 Wiping cloths,properly used and stored IN M5 Temporary Food Establishment N/A 42 Washing fruits and vegetables IN M6 Public Market;Farmers Market N/A Proper Use of Utensils M7 Residential Kitchen;Bed-and-Breakfast Operation N/A 43 In-use utensils:properly stored IN M8 Residential Kitchen:Cottage Food Operation N/A 44 Utensils/equipment/linens:properly stored,dried,and handled IN M9 School Kitchen;USDA Nutrition Program N/A 45 Single-use/single-service articles:properly stored&used IN M10 Leased Commercial Kitchen N/A 46 Gloved used properly IN M11 Innovative Operation N/A Utensils and Equipment Local Requirements 47 Food and non-food contact surfaces cleanable,properly IN L1 Local law or regulation designed,constructed,and used • L2 Other Official Order for Correction:Based on an inspection today,the items marked"OUT"indicated violations of 105 CMR 590.000 and applicable sections of the 2013 FDA Food Code.This report, when signed below by a Board of Health member or its agent constitutes an order of the Board of Health.Failure to correct violations cited in this report may result in suspension or revocation of the food establishment permit and cessation of food establishment operations.If you are subject to a notice of suspension,revocation,or nonrenewal pursuant to 105 CMR 590.000 you may request a hearing before the board of health in accordance with 105 CMR 590.015(B). Date of Reinspection: (Discussion with Person-in-Charge: Signature of Person-in-Charge:Paul izzo Date Signature of Inspector:Philip Renaud Date Food Establishment Inspection Report -Town of Yarmouth Establishment: Date: Temperature Observations Item/ Location Temp (°F ) Freezer 0 Freezer 0 Refrigerator 38 Refrigerator 35 Freezer 0 Refrigerator 34 Observations and/or Corrective Actrions Violations cited in this report must be corrected within the time frames stated below or in Section 8-405.11 of the Food Code Item Number Section of Code Description of Violation Date to be Correct By Mop sink neat and clean Good 48 FC-NC Need test strips for 3 Bay Sink 06/09/2023 Kaya Cormier ServSafe 4/16/26 Good Hand wash sink soap,paper towels Good Restrooms-soap, paper towels employees must wash hands sign neat and clean Good 36 Fc NC 06/09/2023 Signature of Person-in-Charge: Date Signature of Inspector: Date