HomeMy WebLinkAboutApplication and WC �� ��
� . _. _`�� TOWN OF YARMOUTH Boazdof
�� - _ ��y� Health
��-�. : `�"� 1146 ROUTE 28, SOUTH YARMOUTH,MASSACHIJSETTS 02664-24451 -
�. �'r>^LME�s'� '� Telephone(508)398-2231, ext. 1241 Div s�'on
Fax(508) 760-3472
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Ta Yazmouth Business Establishments C.hPE co�p� SER�oD MqRk�'T, �C
From: Bruce G. Murphy, Director ��'��-��--'
Yarmouth Health Department �t� �:i CU i {
Date: November 7, 2014 HEqLTH GEPT
Subject Increase in License/Permit Fees
Please be awaze that the Yannouth Boazd of Health, under the direction of the Yannouth Boazd
of Selectmen, has raised a number of license and permit fees issued through the Yannouth
Health Department, effective January 1, 2015.
Attached is the Yarmouth Business License/Permit Application for 2015. You will note that the
fees listed aze the fees effective January 1, 2015. These fees will be due if you complete and
submit the application after January 1, 2015.
However, if you fully complete the application, and submit it to the Yannouth Health
Department with a11 required certifications and worker's compensation coverage information
(certificate of insurance OR completed affidavit) prior to December 31. 2014, you will be
allowed to pay the 2014 rates for the following licenses:
Current 2014 Fee
Public Swimming Pools $ 80.00
Public Whirlpool/Vapor Baths $ 80.00
Tobacco Sales $ 95.00
Motels $ 55.00
Restaurants 0-100 Seats $ 85.00
Restaurants Over 100 Seats $160.00
Retail Food Service <25,000 sq. ft. $ 80.00 $BC;.oa
Retail Food Service>25,000 sq. ft. $225.00
Other fees owed but not listed above:
Total fees owed for your establishment: �go.CO
NOTE: To be entitled to pay the current 2014 rates listed above, your
business application, food and/or pool certi�cations, along with worker's
compensation information must be received, or mailed (postmarked) on or
prior to December 31, 2014. [Those establishments which open in the spring will be
allowed to provide food and/or pool certifzcations prior to opening, however, you must note
"Will provide in [he spring prior to opening" on the application.J
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� � TOWN OF YARMOUTH BOARD OF HEALTH G ������[�D
��� APPLICATION FOR LICENSE/PE T 15 �r��
����s �s� �, . �. . .
`" * Please complete form and attach all necessat}�documents by Decem er 1�� 20�4.' `-' `
Failure to do so will result in the retum of your"ap�li�ahon pa et�y������,fiFl .
ESTABLISHMENT NAME: /'1 .t. TAX ID: : /�
LocaTloN aDD�ss:�� /��„ Sf. s . ��,s mv�tl�'lA TEL.#: �o�� 7;U�-G��
MAILING ADDRESS: �Sa� � �`u�
E-MAIL ADDRESS: ,�''I/}//,8,�G3 C�yo.�i�a• �or''�
O WNER NAME: �
CORPORATION NAME (IF APPLICABLE):
MANAGER'S NAME:��. �n Q�tS Ki�l� TEL.#:?'J -d38'�`��
MAILING ADDRESS: O �Be�f�, S-�,.�/u�,' �/fl d,2SL-�
POOL CERTIFICATIONS:
The pool supervisor must be certified as a Pool Operator,as required by State law. Please list the designated
Pool Operator(s) and attach a copy of the certification to this form.
1. 2.
Pool operatars must list a minimum of two employees cunently certified in basic water safety, standard First Aid
and Community Cardiopulmonary Resuscitation (CPR), having one certified employee on premises at all times.
Please list the employees below and attach copies of their certifications to this form. The Health Department will
not use past years' records. You must provide new copies and maintain a £►le at your place of business.
1. 2•
3. 4.
FOOD PROTECTION MANAGERS - CERTIFICATIONS:
All food service establishments aze required to have at least one full-time employee who is certified as a Food
Protection Manager, as defined in the State Sanitary Code for Food Service Establishments, 105 CMR 590.000.
Please attach copies of cerkification to this application. The Health Department will not use past years'records.
You must provide new copies and maintain a file at your establishment.
1. 2•
PERSON IN CHARGE:
Each food establishment must have at least one Person In Charge (PIC) on site during hours of operation.
1. 2.
ALLERGEN CERTIFICATIONS:
All food service estabiishments are required to have at least one full-time employee who has Allergen certification,
as defined in the State Sanitary Code for Food Service Establishments, 105 CMR 590.009(G)(3)(a). Please attach
copies of certification to this application. The Health Department will not use past years' records. You must
provide new copies and maintain a file at your establishment.
1. 2•
HEIMLICH CERTIFICATIONS:
All food service establishments with 25 seats or more must have at least one employee trained in the Heimlich
Maneuver on the premises at all times. Please list your employees trained in anti-choking procedures below and
attach copies of employee certifications to this form. The Health Department will not use past years' records.
You must provide new copies and maintain a file at your place of business.
1. 2.
3. 4.
RESTAURANT SEATING: TOTAL #
OFFICE USE ONLY
LODGING:
LICENSEREQUIRED FEE PERMIT# LICENSEREQUIRED FEE PERMIT# LICENSEREQUIRED FEE PERMIT#
B&B $55 CABIN $55 MOTEL $110
INN $55 CAMP $55 SWIMMING POOL$110ea.
LODGE $55 TRAILER PARK $105 WHIRLPOOL $110ea.
FOOD SERVICE:
LICENSE REQUIRED FEE PERMIT# LICENSE REQUIRED FEE PERMIT# LICENSE REQUIRED FEE PERMIT#
0-100 SEATS $125 _CONTINENTAL $35 NON-PROFTT � $30
>]00 SEATS $200 COMMON VIC. $60 WHOLESALE $80
—RESID.KITCHEN $80
RETAIL SERV[CE: �
LICENSE REQUIRED FEE PERMIT# UCENSE REQUIRED FEE PERMIT# LICENSE REQUIRED FEE PERMIT#
<50 sq.ft. $50 >25,000 sq ft. $285 VENDING-FOOD $25
�<25,000 sq.ft. $150 �S' =FROZEN DESSERT $40 _TOBACCO $110
NAME CHANGE: $15 AMOUNT DUE _ � I S� .CX�
*•***PLEASE TURN OVER AND COMPLETE OTHER SIDE OF FORM***** ��'�� `C ��+ �C'
C:f2-"tT (C� �S �°�G���j`1
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ADMINISTRATION
Under Chapter 152, Section 25C, Subsection 6,the Town of Yarmoufh is now required to hold issuance or renewal
of any license ar permit to aperate a business if a person ar company does not have a Certificate of Worker's
Campensation Insurance. THE ATTACHED STATE WORKER'S COMPENSATION INSURANCE
AFFIDAVIT MUST BE COMPLETED AND SIGNED, QR
CERT. OF INSURANC,E ATTACHED !/
OR
WOI2KER'S CQMP. AFFIDAVIT STGNED AND ATTACHED
Town of Yannouth taxes and liens must be paid prior to renewal or issuance of your pertnits. PLEASE CHECK
APPROPRIATELY IF PATD:
YES �^� NO
MQTEL5 AiVll dTHER LODGING FSTABLISHMENTS
TI2ANSIENT OCCUPANCY: Fnr purposes of the limitations of Motel or Hotel use,Transiettt occupancy shall be
I9mited ta the temporary and shart term occupancv,ordinarily and custoinariiy associated with motei and hotei use.
Trans9ent occupants must have and be able to den�onstrate that they maintain a principal place of residence
elsewhere,Transient occupancy shall generally re£er to continuous occupancy of not more than thirty(30}days,and
an aggregate af not more than ninety{9Q}days within any sik(6}mozzth period. Use of a guest unit as a residence or
dwelling uniY sha11 not be considered transient. Occupanoy that is subject Yo the collection of Room Occupancy
Excise, as detined in M.G.L. c. 64G or 830 CMR 64G, as amended, shall generally be considered Transient.
POOLS
POOL OPENING:All swimming,wading and whirlpools which have been closed far the season must be inspected
by the Heaith Deparnnent prior to opening. Contact the Health Department to schedule the inspection t6ree{3)
3ays prior to opening. PLEASE NOTE: People are NOT allowed to sit in the pool area until the paol laas been
inspected and opened.
I'OOL WATER TESTING: The water must be tested for pseudomonas,total coliform and standard plate count
by a State certifieti lab, and submifted 10 the Hcalth Dapartment three (3') days prior to opening, and quarferly
thereafter.
POOL CLOSING: Every outdoor in ground swirnming pool musi be drained«r covered within seven(7)days of
closing.
Ff�QD S�RVZCE
SEASONAL FOOD SERVICE OPENING:
All faod service establishments must be inspected by the Health DeparCment prior to opening. Ylease cantacl the
Health Dapartrnent to schedule the ittspection three (3) days prior to opening.
CATERING POLICY:
Anyone who caters within the Tawn of YannauTh must notify the Yarmauth Health Departrnent by filing the
required 'I'emporary Food Service Applicakion fornl 72 hours prior ko the catered event. These forms can be
obtained at the Health I}epartment,or from the To��n's website at wcvw.yannouth.ma.us under Heaith Department,
Downloadable Forms.
FR07.EN DESSERTS:
Frozen desserts must be tested by a State certified lab prior to apening and monthly thereafter,with sample results
submitted to the Health Departrnent. Failure to do so wrll resuit in the suspension or revocation of your Frozen
Dessert Permit until the abave terms have been met.
OUTSIDE CAFES:
f>utside eafes{i.e.,outdaor seating with waiterJwaitress sezviee),must have prior appraval from the Boazd of IIealth.
OUTDQC}R COOKING:
Outdaor cooking,preparation,or display of any fr>od product by a retail ar food service establishment is prohibited.
N01"ICE:Permits run annually from January 1 to December 31, IT IS YOUR ItESPONSIBII.I"CY TO RET'[JR1V
THE COMPLETED REN�WAL APPI.ICATION(S) AND RBQUIRED FEE(S) BX DECEMBER 15, 2014.
ALL RENOVATION3 TO ANY FOOD �STABLISHMENT, MOTEL Olt POOL {i.e., PAINTINCi, NEW
EQUIPMENT, ETC.), MUST F3E hEPORTED 1'O AND APPROVED BY THE BOARD OF HEALTH PRIOR
TO COMMENCEVIENT. RENdVATIONS Mt1Y REQUIRE A SITE PLAN.
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TH�S CERTIFICAYE tS ISSUED AS A MATTER OF INPORMpTION ONtY AND CONPEftB NO RtQHTS t1PON 7H8 CERTIPICATE HOLDEft, THiS
CERTIFICATE OOFS NOT AFFIRMATIVELY OR NEGA7IVELV AM@ND, EKTEND OR AL7Eft THE COVERAGE AFFOROED @Y TH� POLIqES
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tAiPDRTANT: Vf the cediGcale ho�der Ss an ADDiTlONAL IN3UftE4,the paticp(tes}must be antlorsed. IF 3U8RO�ATIQN IS WAiVE6,subject to
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