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Home My WebLink AboutApplication and WC OF'Y'�R �� -�` , �`�� TOWN OF YARMOUTH Ha�f fl -, � � `3 1146 ROUTE 28, SOUTH YARMOUTH,MASSACHUSETTS 02664-24451 " Y 4��tACXE�04 � Telephone(508)398-2231,e�ct. 1241 Di�n Fax(508) 760-3472 ' To: YarmouthBusinessEstablishmenu R��2�tEtu �ESoRT CaNDoMiNiUr-�TR�ST From: Bruce G. Murphy, Director � �� Yazmouth Health Department� Date: November 7, 2014 DkC 0 2 p014 HEALTH DEPT. Subject: Increase in License/Permit Fees - -- -- — - _ _�- �__-� _._--- s�-��—,�_�_ Please be aware that the Yazmouth Boazd of Health, under the direction of the Yannouth Boazd I of Selectmen, has raised a number of license and permit fees issued through the Yarmouth ' Health Department, effective January l, 2015. I 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 applicarion, and submit it to the Yatmouth Health Depaztment with all 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 �$0.00 Public WhirlpooUVapor Baths $ 80.00 � 80.06 Tobacco Sales $ 95.00 Motels $ 55.00 S •00 Food Service 0-100 Seats $ 85.00 _:Faod�enic�6v�r 1i38 Scai� _.- - --�}£8.0�`.-_---= - -— -- _„ -_- - __ -,_ Retail Foo�Service <25,000 sq. ft. $ 80.00 Retail Food Service>25,000 sq. ft. $225.00 Other fees owed but not listed above: � �o,o� coa��N.era�r-r,�sr� vaJoi N(r•Foop Total fees owed for your establishment: $27S•00 NOTE: To be entitled to pay the current 2014 rates listed above, your business application, food and/or pool certitications, along with worker's compensation information must be received, or mailed (postmarked) on or prior to December 31, 2014. [Those estabdishments which open in the spring widl be allowed to provide food and/or pool certif:cations prior to opening, however, you must note "Will provzde in the spring prior to opening" on the application.J BGM/maf � TOWN OF YARMOUTH BOARD OF HEALTH ��6��d��° � � APPLICATION FOR LICENS ��EC 0 2 2014 � , - -�� * Please complete form and attach a11 neces� . n �}�Dec ►tber IS 2014. Failure to do so will result in the return of ' � pp�c�rio� ck�tlEALTH DEPT. ESTABLISHMENT NAME: P.�vE2v�Ew 2�s�rz.� C Nn� TeusrTAX ID• LOCATIONADDRESS: 3 � NEPTv.�� LAN�� 5. Y,aa,., ry_,, tiw TEL.#: 5a8�-39y-9b'ol MAILINGADDRES$: 3 � NE�rv.�F 4.a�.rE' Ts. Ya,cn.,�..rH .wa o 2e6�1 E-MAII,ADDRESS: �t,_tl•T s � fL, rive �' i �res �� con., OWNERNAME: 2��ta��Ew 2Csoz-r µ .�..—o cz3 A SSOC ATI oN CORPORATION NAME (IF APPLICABLE): MANAGER'SNAME:��.--� PH��uPS TEL.#: _3'08-35�f- 98o ) MAILINGADDRESS: 3'1, NEOTvNE LqNt S_ �/q(LN.u .�TL{ M/! OZ6G,� 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. .4a n Poo� Co, MArryEw wes�FR 2. Pool operators must list a minimum of two employees currently certified in basic water safety, standard First Aid and Community Cardiopulmonary Resuscitation (CPR), having one certified employee on premises at a11 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 file at your place of business. 1. ��FF Pui��iPS 2, Lvc.as DEvr.av 3. �IMITlL-A oTTo 4. �AJ1D '`SoTT 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 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. N�/-} 2• PERSON IN CIIARGE: Each food establishment must have at least one Person In Chazge(PIC) on site during hours of operation. _ _l. N/�i� _ Z• __ _ _ _ _ _ ALLERGEN CERTIFICATIONS: All food service establishxnents 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. Nf,t� 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 Deparhnent will not use past years' records. You must provide new copies and maintain a file at your place of business. 1. N/�R 2. 3. 4. RESTALJRANT SEATING: TOTAL# OFFICE USE ONLY LODGWG: LICENSE REQUIRED FEE PERMIT# LICENSE REQUIRED FEE PERMIT# L[CENSE REQUIRED FEE PERMIT# B&B $55 CABIN $55 �SWIMMINGPOOL$IlOea� _ OL DGE , $55 _TRAILERPARK $105 �WHIRLPOOL $IlOea� FOOD SERVICE: L[CENSE REQUIRED FEE PERMIT# LICENSE REQUIRED FEE P RMI # LICENSE REQUIRED FEE PERMIT# 0-100 SEATS $125 �CONTINENTAL $35 l'S�Ly NON-PROFIT $30 >100 SEATS $200 COMMON VIC. $60 WHOLESALE $80 —RESID.KITCHEN $80 RETAIL SERVICE: � L[CENSE REQUIRED FEE PERMIT# LICENSE REQUIRED FEE PERMiT# LICENSE REQUIRED FEE P "�q[T# <50 sq ft. $50 � >25,000 sq.ft. $285 � I VENDING-FOOD $25 ��E-- <25,000 sq.ft. $I50 _FROZEN DESSERT $40 _TOBACCO $110 NAME CHANGE: $15 AMOUNT DUE _ $ O.00 •****PLEASE TURN OVER AND COMPLETE OTHER SIDE OF FORM***** �G`� Z�S�Q� � C�(�O�J� �� i - ' � ! j ADMIPiISTRATICiiV Under Chapter 152,3eciion 25C,Subsection 6,the Town of Yarmauth is now required to hold issuance or renewal af any ti�eiise:or.pernu't to operate a business if a person or cornpany does not haue a Certificate of Worker's Compensarion Insurance. T� ATTACHEll STATE WQ12I{�R'S COMPENSATION INSURANCE AFFIDAVIT Mi7ST BE COMPLETED AND SIGNED, OR C�RT. OF INSURANCE ATTACHED� OR WORKER'S CQMP. AFFIDAVIT SIGNEI7 AND ATTACHED Town of Yannouth ta:ces and liens must be paid prior to renewal ar issuance of your permits. PLEASE CHECK APPROPRIATELY IF PAID: YES � NO _ MOTELS ANA OTHER LODGING ESTABLISHMENTS : pucpesesof�e-linrit��ic��l�r�Iot4,1 use,Transient occunan�shall be_ limited ta Yhe temporary and short term occupancy,ordinarily and customarily�ssociated with motet and laqtel use. Txansient occnpants must have and be abie to demonstrate that they maintain a principal place af residence elsewhere.Transient occupancy shall generally refer to continuous occupancy ofnot more than thirry(30)days,and an aggregate o£not moxe than ninety(90)days within any six(6)month period. Use af a guest unit as a residence or dwelling unit shall not be considered transient. Occupancy thaE is subject ta the collection of Roam Occupancy Excise,as defined in M.G.L. c. 64G or 830 CMR 64G, as amended,sha11 generally be considered Transient. PQdLS POOL OPENIIYG:A,li swimming,wading and whirlpooJs which have been closed far the seasan must be inspected by the Health Deparhnent prior to opening. Coniact the Healkh Department to schedule the inspection three(3) days prior to opening. PLEASE NOTF,: People are NOT allowed to sit in the poo] area until the poal has been inspected and opened. PQOL WATER TESTING: The water must be tested i"or pseudomonas,total coliform and standard plate count by a State certified lab, and submitted to the Health Departrnent three (3) days prior to opening, and quarterly thereafter. P40L CLOSING: Every outdaor in ground swimming paol mnst be drained or cavered within seven{7)days of olosing. - -- -- FOOD SERVICE -- - -- - _._ �._ _ SEASONAL FOOD SERVICE OPE1vING: t111 food service establishments mast be inspected by the Health Departmeni prior ta opening. Ptease contact the F3ealih Departcnent to schedule the inspectian three(3)days prior to opening. CATERING POLICY: Anyone who caters within the Town af Yannouth must notify the Xazmouth Health Department by filing the required Temparary Faod Service Applicatian form 72 hours priar to the catered event. These forms oan be obtained aY the Health Department,ar from the Tawn's website at www.yarrnouthma.us undar Health Deparhnent, Dowtiloadable Farms. FROZEN DESSERTS: � Frozen desserts must be tested by a State certified lab prior to opening and mon#hly thereafter,with sample results submitted to the HeaIth Department. Failure to do so wilt result in the snspension or revooafian of your Frozen Dessert Perm"st until the above terms have been met. OUTSIDE CAF�S: Outside cafes(i.e.,outdoor seating with waiter/waitress service),must have prior approval from the Board of Health. CIUTDOOR COflHING: Outdoor cooking,preparation,ar dispIay of any food product by a retail or food service establishment is praLibited. NOTICE:Permits run annually from January 1 to December 31. IT IS YOITR FtESPONS�ILITY TO RE"I't.TRN THE COMPLETED RENEWAL APPLICATIOI�I{S)AND REQI3IREI}FEE(S}BY DECEMBER 15, 2014. ALL RENOVATIONS TO ANY FOQD ESTABLISHMENT, MOTEL OR PQdL (i.e., PAIN"I'ING, NEW BQUIPMENT,ETC.},MUST BE I2EPt7RT�D'T4 AND APPROVED BY THE BtJAI2D C?F FiEALTH PRTQR TO COMMENCEMENT. RENOVATIONS MAY ItEQUIRE A SI7'E PLAN. DATE:_� ! S ! �_STGNATURE: �~ ��, . PRINT NAME& TITLE:_ `� �1�� PN�tLLtP� Cr�..�e�t_ �4��-c��. Rev.i tt93t14 t 1 ' _r . �� _ , r �.__ �_��, �.v�_� � � x��'c �'d '�� wu t:��,� ��1110 Date: March 14,2014 To: Riverview Resort -Board of Directors From: Lks Armstrong � � Re: Insur.�nce Renewai __ _ � The followsng is the insuranc;e comgarison for your April 1,2U 14--April 1, 2015 premiums: Poliev I,sst Y ear This Year Difference � Packag� $44.386.00 $43,"789.00 ($597.p0} �! �uto $ 2,Q53.04 $ 3,087A0 $134.f}G Workers' Camp $ 4,233.p0 $ 4,838.00 $605.00 Directors & Offrcers $ 1,SI=3.00 � 1,52b.�d $I2.00 L3mbrella $ 4,i49.Q4 5 4,149.OQ {$0.�0) � Increase in premiums of$i�4.00. If you haee any questions,please feel f'ree to contact us direcily. Desmond rinnstrong � (31Q} 53Q-{}499,e_a2ension#207 5�_�-�- � ��. :� c„ , - - - -- Diane Cannain ' (310)530-0099 aa�tension�r204 � --�-� _.,_ -- i � 378�Sl.rypark Drive,Sulte 440;Tosance,Califomia 9t7505 � Phone(310;i 530-OU99-(866}990-9286 -Fah(310;530.(7098 I Riverview Resort Schedule of Insurance 0 3/1 47201 4 The Armstrong Company �ye 5 Policy Information ; Armstrong Company License#0440075 278Q Skypark Or. Suite 444 Torrance, CA 90505 ! Policy#07WC06265690 Effective Expiratian � Amarican States Insurance Company 0410�t2t)�4 04101120?b A Safeco Insurance Company f2ated A XV by AM Best .. _ .... . . . _ _ Line of 8usirres,s/Premium: .._ . � � Wo�kers Compensation $4,838.00 � 1"�Iamed Insureds Named Insured Entlty Type ll Riverview Resort Unit Owners Association Association I FYorkers ComQensation Coverage : i Part 1 -Workers Compensation (States) MA � PaR 2 -Employ,er's Liability $1,Od0,00� Each Accident ; $3,OOQ040 Qisease-Policy Limit E� $'I,Op0,000 Diseese-Each Empioyee I Workers Campensation Locatinns ; __ _— _zoc�___��ress- __ — - _ _ _ —�— —__ .__ __s�o�,nty_ -- - s_tare zi � Op001 37 Neptune Lane South Yarmouth Bamstable MA 0 664 Workers Compensation Rating Information � i Sfiate Lac Class Categories, Duties, Ciassi£cations EstAn�uai � Code Remuneration MA � 9052 Hotel: All dther Employees $268,000 ; 1 � These scheduies are provided as a bnef outline of your poiFcy. Yau must referto the provisions found in your poiicy for Yhe detaiis of � your coverages,terms,canditions and exclusions that apply. �