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TOWN OF YARMOUTH HEALTH DEPARTMENT
FOOD ESTABLISHMENT
ANNUAL LICENSE APPLICATION:zo=G
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MANAGER/CONTACTPERSON,
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FOOD PROTECTION MANAGER(S)
All food service establishments are required to have at least one (l) full-time cetified FOOD PROTECTION MANAGER on staff.
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PERSON IN CHARGE
All food service establishments must have at least one (l) PERSON lN CIIARGE on site during hours ofoperation-
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HEIMLICH CERTIFICATIONS
All food service establishments with twenty-five (25) seats or more are required to have at least one ( I ) employee trained in the
HEIMLICH MANEUVER on site during hours of operation.
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PLEASE LIST STAFF MEMBERS WHO HOLD THE FOLLOWING CERTIFICATIONS AND ATTACH
COPIES OF CERTIFICATIONS TO THIS APPLICATION.
RESTAURANT SEATING TOTAL NO. :
TOTAL SQ. FOOTAGE:
ALLERGEN CERTIFICATIONS
All food service establishments are required to have at least one (l) full-time ALLERGEN CERTIFIED staff member.
A WORKER'S COMPENSATION A[.'FIDAVIT MUST BE ATTACHED \\'ITH 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:
YEsEr'Notr
NOTICE:
LICENSES RUN ANNUAILY FROM JANUARY I TO DECEMBER 3I. IT IS YOUR RESPONSIBILTTY TO RETURN. THE
COMPLETED RENEWAL APPLICATIOT-(S) AND REQUIRED FEE(S). ALL RENOVATIONS TO ANY FOOD
ESTABLISHMENT (PAINTING, NEW EQUIPMENT, ETC.) MUST BE REPORTED TO AND APPROVED BY THE BOARD OF
HEALTH PRIO COMMENCEMENT. RENOVATIONS MAY REQUIRE MA ENGINEER SITE PLAN.
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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 pnor to openrng.
CAIEzuNC POLICY who caters within the Town of Yarmouth must notiry 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
Depafl ment. 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 License until the above terms have been met.
OUTSIDE CAFE Outside cafes (i.e., outdoor seating with server service), must have prior approval fiom the Board of
Health.
OUTDOOR COOKING: Outdoor cooki ng, preparation, or display of any food product by a retail or food service
establishment is prohibited.
LICENSE FEES:
food Service:Retail Serrice:
<50 sF - ss0.00
<25,000 sF - $150.00
>25.000 sF - $285.00
Frozen Dessert - $40.00
Vending Food - $25.00
Gl00 sEATs - 3125.00
>r00 sEATs - s200.00
Continetrtal - $35.00
-ComDon vi. - $60.0{ -
Non-Profit - 330.00
Wholesale - $80.00
Residential Kitchen - $80.00
FOOD SERVICE
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CERTIFICATION
BRANDY WALSH
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Certificote of(o'i pletion
BRANDY WALSH
Provided by the Notionol Reslrouront Associotion
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