HomeMy WebLinkAboutApp-CertsServSafe
National Restaurant Association
ServSofe Allero
Certificote of Cori
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pletion
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JATVIE STIELY
Provided by the Notionol Reslouront Associotion
Certifi.dte Num6". 8072600 D"t" 812612025
Exoirorion Dore 812612028
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ACCREDITED
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CENNFrcATE ISSUER
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ServSafe
National Restaurant Association
Servsqfe'
CERTIFICATION
JAIVIIE STIELY
for successfully completing the stondords set fo*h for the ServSofu@ Food Protaion uonoger Certificotion &ominotion,
which is occredited by the ANSI (Americon Notionol Stondords lnstitute) Notionol Accreditotion Boord {ANABI-
Conference for Food Protection (CFP)
ER
10926
EXAM FORM NUMBER
12t16t2030
DATE OT EXPIRATION
br receaificotion requiremenh.
12t16t202
DATE OF EX
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284
TIFICATE I
MC
MINATION
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Details
lnternal Only
License Restrictions/Conditions
Cookies
Expiration Date*
12t3112026
Business lnformation
Business Name*
The Cookie Caper
Business Mailing Address (if different)
Business E.Mail*
info@thecookiecaper.com
Business Legal Entity
Other Legal Entity
Business Address in Yarmouth *
90 Freeman Rd, Yarmouth Port
Business Phone #*
508-470-1186
Business Type.
Food Service
Other Legal Entity
LLC
Corporation Name (if applicable)
Tax lD (FEIN or SSN)-
FEIN
ls this a NAME CHANGE?
No
Owner / Manager lnformation
Owner's Name*
Jamie Stiely
Manager/Contact Person Name*
Jamie Stiely
Name and Title
Jamie Stiely, Owner
PLEASE LIST STAFF MEMBERS WHO HOLO THE FOLLOWING CERTIFICATIONS AND ATTACH
COPIES OF CERTIFICATIONS
Name of Certified Food Protection Manage(S)
All food service establishments are required to have at least one ('1) PERSON lN CHARGE on site
during hours of operation
FE IN
----*8256
Owner's Phone Number
Manager / Contact Person Phone Numbef
2158063379
Address
90 Freeman Rd, Yarmouth Port
Emergency Telephone Number
Please attach copies of certifications for all listed below:
List all Certified Food Protection Managers*
Jamie Stiely
List all employees with Allergen Certification"
Jamie Stiely
Establishment Operations
Telephone Number
2158063379
Length of Permit
Annual
Establishment Type
Continental Breakfast
Email
info@thecookiecaper.com
Location is Permanent Structure?
Yes
Common Victualler
I I
I!
Non-Profit Wholesale
Residential Kitchen for Retail Sale Food Service
I I
Frozen Dessert Mobile
Retail Service Vending Food
I
0ther Name Change Only
I
Affidavit
New construction, remodel or conversion requires an Occupancy Permit from the Building
Department in order to receive a valid Food Permit.
II
I
I
l, the undersigned, attest to the accuracy of the information
provided in this application and I affirm that the food
establishment operation will comply with 105 Ct[R 590.000 and
all other applicable law. I have been instructed by the Board of
Health on how to obtain copies of '105 CMR 590.000 and the
Federal Food Code. Pursuant to MGL Ch. 62C, Sec. 49A, I cerlify
under the penalties of perjury that l, to the best of my
knowledge and belief, have filed all state tar returns and paid
taxes required under law.*
Jamie
Stiely
Dec 26,
2025
Worker's Compensation lnsurance Affidavit
Type of Business-
I am a sole proprietor or partnership and have no
employees working for me in any capacity. [No
workers' comp. insurance requiredl
Submitted by Staff
I
Business
Retail
I do hereby certify, under the pains and penalties of perjury, that
the information provided above is true and correct.*
Jamie
Stiely
Dec 26,
2025
Food / Retail 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 seventy-two (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 server 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.
I acknowledge thal I have read and understand the information
above.*
I
Notice
PERMITS RUN ANNUALLY FROM JANUARY 1 TO DECEMBER 31. IT IS YOUR RESPONSIBILITY
TO COMPLETE THIS APPLICATION EACH YEAR.
ALL RENOVATIONS TO ANY FOOD ESTABLISHMENT (PAINTING, NEW EQUIPMENT, ETC.) MUST
BE REPORTED TO AND APPROVED BY THE BOARD OF HEALTH PRIOR TO COMMENCEMENT.
RENOVATIONS MAY REQUIRE MA ENGINEER SITE PLAN.
I acknowledge thal I have read and understand the Notice
information above*