HomeMy WebLinkAboutLicense-App-CertsDocusign Env€lopa lD: D89FA390-0C1A4EF1-8280-939474392E21
**iIUST BE POSTED ON PREiIISES**
This License afllrms that the specifled premises, structure, or portaon thereof has met the necessary
conditions including any inspections requlred at the time of issuance,
It must be framed or laminated and prominently displayed in a clearly visible location within the approved
premises.
lnterim Health Director James Ga.diner
Signature of Interim Health Director lr4 earrtwy
A The Commonwealth of llassachusetts
Town of Yarmouth
Health Department
FOOD ESTABLISHMENT LICENSE
Singing Marshes Jams & Jelly
70 Alms House Rd, Yarmouth Port, MA 02675
ISSUED TO:Certificate No.
BOHF-24-94
The purpose of 105 CMR 500.000 is to establish minimum standards for those persons engaged in the
business of preparing, processing, or distributing food for sale in Massachusetts.
105 CMR 500.000 shall be liberally construed and applied to promote the underlying purpose of protecting the
public hea lth,
License Expiration:
December 3L, 2(,26
Board of Health:
Hillard Boskey, M.D., Chairman
Mary Cra ig, Vice Chairman
Charles T. Holway, Clerk
Laurance Venezia, DVM
Eric Weston Fee: $80.OO
R€strictiors / Condltlonsi Jams & Jellles only
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TOWN OF YARMOUTH HEALTH DEPARTMENT
FOOD ESTABLISHMENT sd^ANNUAL LICENSE APPLICATION J4il .t
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NEW APPLICATIONtrnr,ncualv
($I5.OO) Nfft.E CHANCE oNLYtr
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BUSINESS NAME t-l^t'kt1 $rns f tfe1'PHoNE tot grt -b075'Ji,^i11
BUSINESS ADDRESS H.rr." e.l t/o rrnouw^'7o *1 vv15 0r k 1zb-/{
MAILINC ADDRESS if di fferent)bv*1
EMA,L ADDRESTS
ho rl.e nbu 14 C; Qrwi l, tonn TAX ID (FEIN oR ssN)
OWNER'S NAME sa/rf iiii;d PHONE #qc qtt-cb1;
MANAGER/coNro.r ra*rob^J
I * lirl.o ^brrq
PHONE #
CORPORATION NAME (rF AppLrCABr.E).J
PLEASE LIST STAFF MEMBERS WHO HOLD THE FOLLOWING CERTIFICATIONS AND ATTACH
COPIES OF CERTIFICATIONS TO THIS APPLICATION.
2
PERSON IN CHARGE
All food service establishments must have at least one (l) PERSON lN CHARGE on site during hours ofoperation
tbeoA
All food service establishments are required to have at least one (1) full-time ALLERGEN CERTIFIED staff member
ALLERGEN CERTIFICATIONS
2
seats or more are required to have at least one ( I ) employee trained in the
eration.
All food service establishments with twell
HEIMLICH MANEUVER on site durin
fi e 25
oursh Io
HEIMLICH CERTIFICATIONS
RESTAURANT SEATING ToTAL No. : dTOTAL SQ. FOOTAGE :
I
FOOD PROTECTIO\ MANACERTS) * /+
All food service establishments are required to have at least one ( 1) full-tirne certified FOOD PROTECTIoN MANAGER on staff.
1.
1.
?.
l.
1.
2.
A WORKER'S COMPENSATION AFFIDAVIT MUST BE ATTACHED WITH THIS APPLICATION
The Town of Yarmouth taxes and liens must be paid prior to renewal or the issuance ofyour licenses.
Please check if appropriately paid:
YEs gz No tr
NOTICE:
LICENSES RLIN ANNUALLY FROM JANUARY I TO DECEMBER 3I. IT IS YOUR RESPONSIBILITY TO RETURN THE
COMPLf,TED RENEWAL APPLICATION(S) AND REQUTRED FEE(S). ALL RENOVATIONS TO ANY FOOD
ESTABLISHMENT (PAINTING, NEVr' EQUIPMENT, ETC.) MUST BE REPORTED TO AND APPROVED BY THE BOARD OF
HEALIH PRIOR TO COMMENCEMENT, RENOVATIONS MAY REQUIRE MA ENGTNEER SITE PLAN.
SIGNATURE DATE I ZC
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 notifo the Yarmouth Health Depaftment 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 cefiified 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 License 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 ofany food product by a retail or food service
establishment is prohibited.
LICENSE FEES
Food S€ryice:
0-r00 sEATS - st25.00
>100 sEATs - $200.00
Continental- $35.00
Common Vic - $60.00
Non-Profit - $30.00
Wholesale - $80,00
Residential Kitch€n - $80.00
Retail Service:
<50 sF - s50.00
<25,000 sF - $150.00
>25,000 sF - $285.00
Frozen Dessert - $40.00
Vending Food - $25.00
PRINTNAME&TITLE SAITq IhcICE nLt:r(l OWNET
JJ
CTRTTFICATE oF
ATTERGEN AWERENE S S TNruN TNG
Name of Recipient: SALLY HocKENBURy
certificate Number. 6008746
Date of Completiot 11t1 2022
Date of Expir atior\' 11t17t2027
lssucd Bv,
7be abote-naned penon is hetebl iswed tbis ertfacate
for completitg an allergen auarenes haining program
recogni*d fii tbe Massacbusetts Department oJ'hitic Health
in accardanct ttitl 105 CMR 590.009(G)(3)(a).
This certifcaa zoill be ttalidforfae (5) yearsfrom daa af camplction,
fi mtfl NATIONAL ,
RESTAURANT
ASSOCIATIONo
Maseachurtts Rcstaurant Associntion
333 Tirnpikc Road, Suitc 102
Southboough, MA 01772
508-303-9905
www. milcgtaurant:tSsoc, otg
8c0,765.2122
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