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Home My WebLink AboutApplication and WC . ; �, �°��`�� TOWN OF YARMOUTH Ha�f t' - �,o �{�-- � "y ll 46 ROUTE 28, SOUTH YARMOUTH, MASSACHLJSETTS 02664-24451 - `• ;�T E9b '� Telephone(508)398-2231, ext. 1241 Heaith '"`"f Fax(508)760-3472 Division To: Yannouth Business Establishments GRS� O�u�ti MoTEL a�c�oe�� From: Bruce G. Murphy, Director �t(: ') 1 11111 Yazrnouth Health Deparhnent HEALTH DEPT. Date: November 7,2014 Subject: Increase in License/Permit Fees _ -- - _ _ Please be awaze that the Yannouth Boazd of Health, under the direction of the Yannouth Board 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 Yarmouth Health Department with all required certifications and worker's compensarion coverage information (certificate of insurance OR completed �davit) 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 WhirlpooUVapor Baths $ 80.00 Tobacco Sales $ 95.00 Motels $ 55.00 5 60 Restaurants 0-100 Seats $ 85.00 R�taurantsQverlOQSeats ----- $��0,�1)__ _- - - _ _---- __ _ Retail Food Service CL5,000 sq. ft. $ 80.00 ' Retail Food Service>25,000 sq. ft. $225.00 Other fees owed but not listed above: $3S.oo c�N�n+ Oa�AkcAs-r Total fees owed for your establishment: ��o.o0 NOTE: To be entitled to pay the current 2014 rates listed above, your business application, food andJor pool certifications, along wit6 worker's compensation information must be received, or mailed (postmarked) on or prior to December 31, 2014. [Those establishments which open in the spring will be allowed to provide food andlor pool certifications prior to opening, however, you must note "Will provfde in the springprior to opening" on the application.J BGM/maf a TOWN OF YARMOUTH BOARD OF HEALTH r-�s ��d�D �� APPLICATIONFORLICENSE/FL'�II�'-`2015�: ' ' UtC i7 'LU14 " * Please complete form and attach all necessary docwnents by'IJ�ece ber 15 2014. Failure to do so will result in the return of your application p ckeHEALTH DEPT. ESTABLISHMENT NAME: ��C. TAX ID: - LOCATION ADDRESS:�6' ��$' W- +�s„neu4�- l�In� TEL.#: '1�I - �/2A `f MAILING ADDRESS: t r E-MAIL ADDRESS: Cp.4l-l� 7 �nn/�E' ��u;.�o ` ( Crw� OWNER NAME: CORPORATION NAME (IF APPLICABLE): S'?a `Zv�,uy� L1.�. MANAGER'S NAME: N� lc �a.F�-� TEL.#: � C MAILING ADDRESS: 22C �..kC. �-�' IN 4n a..,n.,/1_ r� 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 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 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 file at your place of business. 1. 2• 3. 4. FOOD PROTECTION MANAGERS - CERTIFICATIONS: All food service establishments are 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. Z• PERSON IN CIIARGE: 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 establishments aze 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 applicaUon. The Health Department wilt not use past years' records. You must provide new copies and maintain a Sle at your establishment. 1. 2• HEIMLICH CERTLFICATIONS: 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: LICENSE REQUIRED FEE PERMIT# LICENSE REQUIRED FEE PERMIT# LICENSE REQUIRED FEE P�IO�� B&B $55 CABIN $55 �MOTEL $110 INN $55 CAMP $55 SWIMMINGPOOL$IlOea. LODGE $55 TRAILERPARK $105 WH[RLPOOL $IlOea FOOD SERVICE: LICENSE REQUIRED FEE PERMIT# LJCENSE REQUIRED FEE PERMTT# LICENSE REQUIRED FEE PERMIT# 0-100SEATS $125 1�.CONTINENTAL $35 f5—�3S NON-PROFIT $30 —>100 SEATS $200 COMMON VIC. $60 WHOLESALE $80 —RESID.KITCHEN $80 RETAIL SERVICE: LICENSE REQUIRED FEE PERMIT# LICENSE REQUIRED FEE PERMIT# LICENSE REQUIRED FEE PERMIT# <50 sq ft. $50 >25,000 sq.ft. $285 V ENDING-FOOD $25 <25,OOOsq.ft. $I50 _FROZENDESSERT $40 _TOBACCO $110 NAME CHANGE: $15 AMOUNT DUE _ $ l�S•�O *****PLEASE TURN OVER AND COMPLETE OTHER SIDE OF FORM***** �"�� ,� O� cOtJ��23 `�I7�y ADMINISTRATION Under Chapter 152,Seation 25C,Subsection 6,the Town af Yarmouth is now required to hold issuance or renewal a£any license or permit to operate a business if a person or company does nat have a Certificate of Worker's Compensation Insuranee. THE ATTACHEI) STATE WQI2KER'S CtlMPEPISATI4N INSUItANCE AFFXDAVIT MUST BE COMPLETED AND SIGNEll, OR CBRT. OF INSURANCE A"ITACHED i/ OR WORKER'S COMP. AFFIT3AVIT SIGNED AND ATTACHED Town of Yarmouth taates and liens rnust be paid prior to renewal ar issuance of your perrnits. PLEASE CHECK APPROPRIATELY IF PAID: 1rES NO MOTELS AND OTHF,R LODGING ESTABLISHMENTS TRANSIENT OCCUPANCY: For purposes ol'the limitatiotxs of Motel ar Hotel use,Transient occupancy shall be limited to the temporary and short term occupancy,ordinarily and customarily associated with motel and hotel use. Trans9ent occupants must have and be able to demanstrate that they maintain a principal place af residence elsewhere.Transient occupancy shall generally refer to continuous occupancy of not more than thirty(30)days,and an aggregate of not more than ninety(90)days within any six(6)month periad. Use af a guest unit as a residenoe or dwelling unit shall not be conszdered transient. Occupancy that is subject to the coltection of Room Qecupancy Excise,as defined in M.G.I.. c. 64G or 830 CMR 54G,as amended, shall generally be cansidered Transient raaz�s P40L OFENING:Atl swirnming,wading and whirlpools which have been closed for the seasan must be inspected by tha Health llepartment prior to opening. Contact the Health Departrneiat to schedule the inspection three(3) days priar to opening. PLBASE R10TT: Peopie are NOT allawed to sit in the pool area until the poal has been inspected and opened. PQOL WATER'1'ESTING: The water must be tested for pseudomonas,total coli£onn and standard plate caunt by a State certified Iab, and submitted to the Health Department three (3} days prior to opening, and quarterly thareafter. POOL CLOSING: Every autdoar in ground scvimming pool must be drained or cavered within seven{7}days of closing. FOOD SERVICE SEASONAL FOOD SERVICE OPENING: All food service establishments must be inspected by the Heatth Departrnent prior to opening. Please contact the Iiealth Departrnent to schedule the inspcction three (3)days pcior to opening. CATERING P4LICY: Anyone who caters within the Town of Yarmouth must notify the Yarmouth Health Department by filing the reqwred Temporary Faod Service Applicatian farm 7? haurs prior ta the catered event. These forms can be obtained at the Health Department,ar fmrn the Tawn's website at www.yarmouth.ma.us under Health Deparhnent, Downloadable Forms. FiZOZEN DESSE1tTS: Frozen desserts must be tested by a State certified lab prior to apening 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 abave tercns have been met. OUTSIDE CA.FES: Outside cafes(i.e.,outdoor seating with waiter/waitress service),must have prior approval from the Board of Health. OUTDOOR COOKING: Outdoor cooking,prepazafron,�r display of any food product by a retail or faod service establishment is prohibited. NOTICE:Permits run annually from January I to December 31. IT IS YOLTR RESPONSIBILITY`I"O RE'I't.IRN "I'HE COMPLETEI3 RENEWAL APPLTCATIflN(S}AND REQLJIREI}FEE{S}BY DEC�MBER 15,2014, ALL RENOVATIONS TQ ANY POOD ESTABLISHMENT, MOTEL OR POOL (i.e., PAINTING, NEW �QUIPMEN"I',ETC.},MUST BE REPORTED TO AND APPROVED BX THE BOARI}C}F HEALTH FRTOR TQ COMMENCEMENT. RENOVATIONS MAY RE UIRE A SITE PLAN. llATE: }'Z r i�� SIGNATURE: PRINT NAME& TI'1"LE: �� Rev. SIt03174 � �. ��••, . SIADE-t OP ID:J1 '`��a CERTIFICATE t?F �IABlUTY INSURANCE ��MMIDD/YY'P/) 12t16J2Q14 THIS CERTFICATE IS ISSUEU AS A MATTER OF INFORMATION ONLV AND CONPERS NO RIGHTS UPON THE CERTIFICATE HOLdER.THIS GERTIFICATE DOES N6T AFFIRMATNELY OR N�GATIYEIY AMEtiD, EXTEN6 OR Al1ER 7HE COVERAGE AFFORDEti 8Y THE P6lIC�S BEL4W. THIS CER7IFICATE OF INSURANCE pqES NOT CON$TITUTE A CONTRACT BETWEEN THE ISSUII� INSURER(8), AUTHORIZED REPR@SENTA7IYE Ofk PRODUCER,AND 7't�CEftTifFCATE NQLDER. IMPORTANT: If Me certiflr.ate holder is an ADDITIONAI. INSURED,the poliey(ies) must be endoraW. M$UBRCIGATION 18 WANED,subject to the te'ms and carWitions of the pniicy,certain policias rrw7t requlre an endarsement A atatement on this cprtHicate tloes not eanfer riphffi tp the certiflcate holder in lieu of auch sndoraement s. p�� CANTACT �: MScheile Lillard oranite i�urenca 8 E�OMP rHa+E �� N,�:gZ5�62-8888 �L E„„'925-462-8400 F� 6600 Koll Center Parkway#100 ��- Pbasanton,GA 4d568 ,��g$: P8Yd8y�IfIC. WSURE SAFRORDINOCOVBRAGB NAICY ixsuaea.:NorGuard Insuranca Campany iNsuneo Sia Devang LLC iesuaena: ... 226 Main Street,Route 28 iNsuneac: West Varmouth,MA 02673 INSURERD: __., . _ INSIIRER E: ..WSURERF: —` COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POI.ICIES OF INSUi?ANGE IISTE6 BEL�IM HAVE BEEN ISSUED TO THE INSt7RED NAMED ABOVE FOR TF�POIIGY PER�D INDICATED. NOTNITHSTANDING ANY REqUIREMENT, TERM OR CONDITION pF ANY CONTRAGT OR OTHER DOCUMENT WfTH RESPECT TO WHICH THIS CERTIFICATE MAY 6E ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY 7HE POLICIES DESCRIBED HEREIN IS SUBJECT TO A1L THE TERMS, EXCLUSI6NS AND CONDITI6NS OF SUCH POLtCtES liMfTS SHdVJN MAV NAVE BEEN REDUCED BV PAID CLAIMS. POL V �LT R TYPB OF INSII/UNCB POLICY NUMOER W� COMMCRCUIL GENERAL L1�9ILITY EACH OCCURRENCE E ,,,,, ]CIAMtsAqppE ❑OGCUft 13ESStEe i ....., MED E%P(MYane peraon� $ _ � PERSONAt.&ADVIFWRY S GEN'L AG�REGATE LIMIi AP��PLIE"j&PER: GENERAI.AGGREGATE E FaICY❑JPEC u�� PftGDUCTS-CPMP/OPAOG $ $ orH R: ED 59KiL ld«AT S nvroMoen.E iuenrtv eauam ANY AUT� BODILY INJURY(Por pareon} $ u AUTO$�D AIITpEdC1LEQ BWILVIWURV(ParaMtivit) S .__. NON�OWNEO PRQPERf�FM.4GE �^ HIRED AUTOS AtJTpS � �— E U116RELLA t4t6 tX'.CUR EACH OCCURRENCE S E%CE$8 UAB CLAIMwMADE AOOREGATE 5_ OED RETEN x WORKERSCOYPENSATION 3TATUTE ERµ .. AND ElWLOYERS'I.IABfttiY 100�00 A ANVPROPRIETORIPARINERIEXECUTNE YtN SIVI(C59II123 OWZO�Y07A OW70YLO�S E.L.EACHACCIDENT $ OFFIGEWMEMBEftEXCW0ED4 � N�A �� {MaMsmeYlnNX) E.I.DiSEASE_=EAFA1P1.0 $ ifym,dasaibe�nEer E.4.DISEASE-PGLICVLIMfT $ 5��0� DE CRIPTI6NOFORERATONSbaWw DESCPoPTION OF UPERATIONS/LOCATWNS/VEHIGI.ES (AGQRU 701,AEtllqenal Remarks Schetlule,mry be anaNwd k mo�e speca la ipWrM) CERTIFICATE HOLDER CANCELLATION SNOULD ANV OF THE ABOVE UESCR�Eb POLICIES 9E CANCELLED BEFORE THE EXPIRATiOtt DATE TI�REOF, t�TiCE WtlA. BE OEINERED IN Proof Of�nsurance ACGORDANCE WRH THE P041CV PROVISIONS. AUTNQRIZEO REPRE$ENTATNE ��r�� iS86-2014 ACORD CORPORATIdN. AII rfgh#s resenred. ACORD 25(2014/01) The ACORD name and logo are registered marks oi ACORD