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TOWN OF YARMOUTH HEALTH DEPARTMENT
FOOD ESTABLISHMENT
ANNUAL LICENSE APPLICATION
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($15.00) NAME CHANGE ONLYo
PLEASE LIST STAFF MEMBERS WHO HOLD THE FOLLOWING CERTIFICATIONS AND ATTACH
COPIES OF CERTIFICATIONS TO THIS APPLICATION.
R,ESTAURA.NT SEATING TOTAL NO.:
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FOOD PROTECTION MANAGER(S)
AII food service establishments are required to have at least one (l) full-time certified FOOD PROTECTION MANAGER on stafl
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PERSON IN CHARGE
All food service establishments must have at least one (l) PERSON IN CIIARGE on site during hours ofoperation
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AILERGEN CERTIFICATIONS
All food service establishments are required to have at least one (l) full+ime ALLERGEN CERTIFIED staffmember
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HEIMLICH CERTIFICATIONS
All food service establishmenh with twenty-five (25) seats or more are required to have at least one (l ) employee trained in the
HEIMLICH MANEUVER on site during hours of operation.
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A \I'ORKER'S COMPENSATION AFFIDAVII' NTUSI' BE ATTACHED \T'ITH THIS APPLICATION
The Town of Yarmouth taxes and liens must be paid prior to renewal or the issuance ofyour licenses.
Please check if aprypriately paid:
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\OTICE:
LICENSES RUN ANNUALLY FROM JANUARY I TO DECEMBER 3I. IT IS YOUR RESPONSIBILITY TO RETURII THE
COMPLETED RENEWAL APPLICATION(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 PRIOR TO COMMENCEMENT. RENOVATIONS MAY REQUIRE MA ENGINEER SITE PLAN.
SIGNAIURE DATE l.t(!,20
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FOOD SERVICE
SEASONAL FOOD SERVICE OPENING: All food sen,ice establishments must be inspected by the Health Department
prior to opening. Please contact the Health Department to schedule the inspection thee (3) days prior to opening.
CATERING POLICY Anyone who caters within the Town of Yarmouth must notify the Yarmouth Health Departrnent 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 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.
LICENSE FEES
Food Service:
0-100 SEATS - $125.00
>100 sEATs - $200.00
Continental - 535.00
Common Vic - 560.00
Non-Profit - 330.00
Wholesale - $E0.00
Rcaldcrttal Kitchen - $80.00
R(tail Servic€:
<50 sF - $50.00
<25,000 sF - $150.00
>25.000 sF - $285.00
Frozen Dessert - $40.00
Vending Food - $25.00
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OUTDOOR COOKING: Outdoor cooking, preparation, or display of any food product by a retail or food service
establishment is prohibited.