HomeMy WebLinkAboutApp-License-CertsDocusign Envelope lD: 3AFF5464-87D9-47DE-B5F4-E19EFFDFD7D4
'r'TMUST BE POSTED Ot{ PREI',IISES* *
This Licens€ affirms th.t the specificd pr€mises, structure, or portion thereof has met the necessary
conditions includlng any inspections required at the time of issuance.
It must be framed or laminated and prominently displayed in a clearly visible location within the approved
premises.
Interim Health Director James Gardiner
Signature of Interim Health Director ff,7im,
A The Commonwealth of l,lassachusetts
Town of Yarmouth
Health Department
FOOD ESTABLISHMENT LICENSE
Just Picked Gifts
13 Willow Street Yarmouthport Ma 02675
ISSUED TO:Certificate No.
BOHF-25-12
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 health.
License Expiration:
December 31, 2fJ26
Fee: $150.OO
Bolrd of a{Crlth:
Hillard Boskey, M.D., Chairman
Mary Craig, V:ce Chairman
charles T. Holway, Clerk
Laurance Venezia, DVM
Eric Weston
Restrictions / Condltlons: Retall Food <25,OO0 Sq. FT.
Details
lnternal Only
License Restrictions/Conditions
Retail Food <25,000 Sq. FT.
Expiration oate*
12t31t2026
Business lnformation
Business Name*
Just Picked Gifts
Business Mailing Address (if different)
425 Main Street West Dennis Ma 02670
Business E-Mail*
Ap@4-corners.com
Business Legal Entity
lndividual
Business Address in Yarmouth'
13 Willow Street Yarmouthport Ma 02675
Business Phone #-
508-375-0009
Business Type*
Retail Service
Corporation Name (if applicable)
Tax lD (FEIN or SSN)-
FEIN
Is Ihis a NAME CHANGE?
No
Owner / Manager lnformation
Owner's Name*
Greg Bilezikian
Manager/Contact Person Name*
Lisa Medlin
FE IN
*----3518
Owner's Phone Number
508-375-0009
Manager / Contact Person Phone Number'
508-364-9031
PLEASE LIST STAFF MEMBERS WHO HOLD 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
Name and Title Address
13 Willow Street Yarmouthport Ma 02670Melanie Semple store Manager
Telephone Number
508-362-0207
Establishment Type
Continental Breakfast
Emergency Telephone Number
5083649031
Please attach copies of certifications for all listed below:
List all Certified Food Protection Managers*
Lisa Medlin
List all employees with Allergen Certification-
Lisa Medlin
Establishment Operations
Length of Permit
Annual
Email
msemple@ustpickedgift s.com
Location is Permanent Structure?
Yes
Common Victualler
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Non-Profit
Residential Kitchen for Retail Sale
Frozen Desserl
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Retail Square Footage*
Less than 25,000 sq. ft.
Wholesale
Food Service
Retail Service
Vending Food
I
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Other Name Change 0nly
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Affidavit
New construction, remodel or conversion requires an Occupancy Permit from the Building
Department in order to receive a valid Food Permit.
l, the undersigned, attest to the accuracy of the informalion
provided in this application and laffirm that the food
eslablishment operation will comply with 105 CMR 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 certify
under the penalties of perjury that l, to the best of my
knowledge and belief, have filed all state tax returns and paid
taxes required under law.'
Lisa
Medlin
Jan 13,
2026
Worker's Compensation lnsurance Affidavit
Type of Business*
I am an employer with employees .
Submifted by Statf
I
Business
Retail
I do hereby certify, under the pains and penalties of perlury, that
the information provided above is true and correct.*
Lisa
Medlin
Jan 13,
2026
lnsurance Policy lnformation
Failure to secure coverage as required under Section 25A 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
lnvestigations of the DIA for insurance coverage verification.
lnsurance Company Name
Sullivan lnsurance Group
Policy # or Self-ins Lic. #
014005031589122
lnsurer's Address
72 River Park Needham MA 02494
Expiration Date
03t01t2027
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 flling 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 that I have read and understand the informalion
above.*
Notice
PERMITS RUN ANNUALLY FRO[/ JANUARY ,1 TO DECEIVBER 31. IT IS YOUR RESPONSIBILITY
TO COMPLETE THIS APPLICATION EACH YEAR.
ALL RENOVATTONS TO ANY FOOD ESTABLTSHTMENT (pAtNTtNG, NEW EQUtpMENT, ETC.) MUST
BE REPORTED TO AND APPROVED BY THE BOARD OF HEALTH PRIOR TO COMMENCEMENT.
RENOVATIONS MAY REQUIRE MA ENGINEER SITE PLAN.
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