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Home My WebLink AboutApplication and WC Florio, Mary Alice From: Florio, MaryAlice Sent: Tuesday,lune 09, 2015 1:08 PM Ta: 'lara@somethingsweetcapecod.com' Subject: Something Sweet Cape Cod Dear Ms.Thonus, Thank you for submitting the renewal application for the Something Sweet Cape Cod food service permit issued through the Health Department. However, we are unable to process the application at this time because there was only a partial payment enclosed. Effective lanuary 1, 2015, the food service license fee was increased to $125.00. If you had paid PRIOR to lanuary 1" you were allowed to pay the previous rate of$85.00. Since you submitted your renewal application in June, the higher fee is now in effect. Please remit the balance owed of$40.00, check payable to the Town of Yarmouth, to the Health Department at your earliest convenience. If you have any questions on the above, please feel free to contact the Health Department at (508)398-2231, ext. 241. Thank you for your anticipated cooperetion. MaryAlice Florio, Principal Office Asst. Yarmouth Health Department 1146 Route 28 South Yarmouth, MA 02664 508-398-2231,ext. 1241 1 , � ��°f�\`�o TOWN OF YARMOUTH He�f 0 :.. ` � `j 1146 ROUTE 28, SOUTH YARMOUTH, MASSACHiJSETTS 02664-24451 - °`�. H �,�r^eNf�.i"•r Telephone(508)398-2231, ext. 1241 Div si n '*�� Fas(508)760-3472 To: Yarmouth Business Establishments SoME-rH iNG- SuJC-ET Cr}PF CoD From: Bruce G. Miuphy, Director � ,[��,y�5�r�s�G�� Yarmouth Health Departsnent� JJf� C� p��i5 Date: November 7, 2014 HEALTH DEPT Subject: Increase in License/Permit Fees - Please be awaze that the Yannouth Boazd of Health, under the direction of the Yarmouth Boazd of Selectmen, has raised a number of license and permit fees issued through the Yarmouth 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 a11 required certifications and worker's compensation coverage information (certificate of insurance OR completed �davit) nrior to December 31. 2014, you will be allowed to pay the 2014 rates for the following licenses: ' Current 2014 Fee Public Swinuning Pools $ 80.00 Public WhirlpooUVapor Baths $ 80.00 Tobacco Sales $ 95.00 Motels $ 55.00 Food Service 0-100 Seats $ 85.00 $ 35•00 -- - Fae�Ser:�ise�ver i00-Sea{s �164:!1C1 Retail Food Service Q5,000 sq. ft. $ 80.00 Retail Food Service >25,000 sq. ft. $225.00 Other fees owed but not listed above: Total fees owed for your establishment: �85.cX� NOTE: To be enfitled to pay the current 2014 rates listed above, your business application, food and/or pool certifications, along with worker's compensation information must be received, or mailed (postmarked) on or prior to December 31, 2014. [Those establishments which open in the spring will be allowed to provide food and/or pool certif:cations prior to opening, however, you must note "Will provide in the spring prior to opening" on the application.J BGM/maf o1+6T4 WG$�WEET C,f. ' d TOWN OF YARMOUTH BOARD OF HEALTH �5 G3��J�DD �� APPLICATION FOR LICENSE/PERI4IIT-�0� �. ;, � ��. JJPJ 0� 2015 * Please complete form and attach all neces�y d�t�nt� e ber 1 S 20 4. Failure to do so will result in the return of your applicahon p ket}�EALTH DEPT. ESTABLISIIIVIENT NAME: So.µe. � TAX ID: LOCATION ADDRESS: 0"2 1 c.� �. � TEL.#: 7 `� 2-Y O MAILING ADDRESS: S 9� .� d E-MAIL ADDRESS: l ra. �.,� . OWNER NAME: CORPORATION NAME (IF APPLICABLE): MANAGER'SNAME: � rn �(�.orus5 / /Vl�� 'TL.r�n,�5 TEL.#: 7 '1�1 ?d2- �[?Ov MAILING ADDRESS: �c� • -Q. POOL CERTIFICATIONS: The pool supervisor must be certi�ed 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. - --- -- -- - -_- -- ----- --_ - _ 2 _ _ _ . — - 1. Pool operators must list a minimum of rivo 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 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 fixll-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. ��C��. \ V�onuS °�KP R!I or�2�I7 Z. PERSON IN CHARGE: Each food establishment must have at least one Person In Charge (PIC) on site during hours of operation. -�-at�'0. _ y-�=a-�,� - — --- -- - - -- --__- ''--__— - __ -- - �- 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 application. The Health Department will not use past years' records. You must provide new copies and maintain a file at your establishment. 1. L�G Crn ��...o h,✓5 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: LICENSE REQUIRED FEE PERMIT# LICENSE REQUIRED FEE PERMIT# LICENSE REQUIRED FEE PERMIT# B&B $55 CABIN $55 MOTEL $110 —INN $55 CAMP $55 SWIMMINGPOOL$il0ea. LODGE $55 T2AILERPARK $105 _WHIRLPOOL $t10ea. FOOD SERVICE: LICENSE REQUIRED FEE PERMI # LICENSE REQUIRED FEE PERMIT# LICENSE REQIDRED FEE PERMIT# �0-100SEATS $125 ��1 _CONTINENTAL $35 . NON-PROFIT $30 >100 SEATS $200 COMMON VIC. $60 WHOLESALE $SO — — —RESID.KTTCHEN $80 RETAIL SERVICE: LICENSE REQUIRED FEE PERMIT# L[CENSE REQUIRED FEE PERMIT# LICENSE REQUIRED FEE PERMIT# <50 sq.ft. $50 >25,000 sq.ft. $285 VENDING-FOOD $25 <25,000 sq.ft. $150 _FROZEN DESSERT $40 _TOBACCO $1 IO NAMECHANGE: $15 AMOUNTDUE _ � IZ-5 .� *'"***PLEASE TURN OVER AND COMPLETE OTHER SIDE OF FORM***** ADMINISTRATION ' Under Chapter 152,Section 25C, Subsection 6,the Town of Yarmouth is now required to hold issuance or renewal of any license or permit to operate a business if a person or company does not have a Certificate of Worker's Compensation Insurance. THE ATTACHED STATE WORKER'S COMPENSATION INSURANCE AFFIDAVIT MUST BE COMPLETED AND SIGNED, OR CERT. OF INSURANCE ATTACHED OR WORKER'S COMP. AFFIDAVIT SIGNED AND ATTACHED Town of Yannouth taxes and liens must be paid prior to renewal or issuance of your permits. PLEASE CHECK APPROPRIATELY IF PAID: YES NO MOTELS AND OTHER LODGING ESTABLISHMENTS TRAIVSIENT OCCUPANCY: For purposes of the limiYations of Motel or Hotel use,Transient occupancy shall be limited to the temporary and short term occupancy,ordinarily and customarily associated with motel and hotel use. Transient occupants must have and be able to demonstrate that they maintain a principal place of 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 period. Use of a guest unit as a residence or dwelling unit shall not be considered transient. Occupancy that is subject to the collection of Room Occupancy Excise, as defined 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 for the season must be inspected by the Health Department prior to opening. Contact the Health Department to schedule the inspection three(3) days prior to opening. PLEASE NOTE: People are NOT allowed to sit in the pool azea until the pool has been inspected and opened. POOL WATER TESTING: The water must be tested for pseudomonas,total coliform and standard plate count by a State certified lab, and submitted to the Health Department three (3) days prior to opening, and quarterly thereafter. POOL CLOSING: Every outdoor in ground swimming pool must be drained or covered within seven(7)days of closing. FOOD SERYICE SEASONAL FOOD SERVICE OPENING: All food service establishxnents must be inspected by the Health Department prior to opening. Please contact the Health Department to schedule the inspection three (3) days prior to opening. CATERING POLICY: Anyone who caters within the Town of Yarmouth must notify the Yarmouth Health Department by filing the required Temporary Food Service Application form 72 hours prior to the catered event. These forxns can be obtained at the Health Department,or from the Town's website at www.vannouth.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 Permit until the above terms have been met. OUTSIDE CAFES: Outside cafes(i.e.,outdoor seating with waiter/waitress service),must have prior approval from the Boazd of Health. OUTDOOR COOHING: Outdoor cooking,preparation,or display of any food product by a retail or food service estabiishment is prohibited. NOTICE:Permits run annually from January 1 to December 31. IT IS YOUR RESPONSIBILITY TO RE1'iJIZN THE COMPLETED RENEWAL APPLICATION(S) AND REQUIRED FEE(S) BY DECEMBER 15, 2014. ALL RENOVATIONS TO ANY FOOD ESTABLISHMENT, MOTEL OR POOL (i.e., PAINTING, NEW EQUIPMENT, ETC.), MUST BE REPORTED TO AND APPROVED BY THE BOARD OF HEALTH PRIOR TO COMMENCEMENT. RENOVATIONS MAY REQUIRE A SITE PLAN. DATE: l�J �� SIGNATURE: )�alti�il,f�7ti"� PRINT NAME & TITLE: I1'rr. �`..t�v� J S ��-e--� Rev. 11/03/14 � . :� The Commnmvealth of l�fassachusetJs Departneent oflndustrial Acciden�s O�ce oflnvestigations 1 Congress Streeti Suite I00 Boston,MMA 0211a-2017 �s ,ex•in.srass.gov/dia Workeis' Compensation Insuiance Affida�it: General Businesses Aoalicant Informarion Please Print Leeiblv Business/Organization IrTame: `9.d� C7i' I/� i �.c.GfC,�L/ aaa��s: �s �—�9 - ' _ � � City/State/Zip:L�� Phone k: [�� y�� Areyoa aa employer?Check the appropriete box: Business Zype(requlred): 1.❑ I azn a employer with anployees(full and! 5. ❑Retaii or part-time).> 6., Restaurant/Bar�'Eating Establishment 2„�l.am a wle proprietor orpartneiship mmd have no 7, �Office and/or Sales(incL real esta[e,auto,etc.) employees workmg for me in any capacity. (No workers'comp.insurance required] 8• ❑`��-Profit 3.❑ We aze a cotporation and its officeis ha�•e exerciszd 9. ❑Entertainment their right of exemption per c. 152, §1(4),and�ce have 10.0 Manufaclurins no employees. �Io workers'comg.msurance required]• 11.�Health Care 4.❑ We aze a non-profrt organization,staffzd by votunteers. ��/�_/� �` ,./ with no employees. (No workets'comp.insurance req.] 12.�Other /� C./J/ �� 'Aay appiicmt�haz c6edcs boa 21 mnst also fill out the secuon bdo�c shouing theii wmkci comprnsation policg iafmmetioa. ••If the corpmate d'ficers have exempted themselvez,but t6t corywmm has otha emplq�eez,a waisn'compmsmion palicy is required md suth m orgmizazion shanld c6eck box=1. I am an enrplaver lhnt ic provldtng Kwrkers'cnmpexsation insurance for»m emplq�ees. BeJnw Zs the pn/!cy infnrmation. Inwrance Company Name: lnsurer's Add:ess: City/StatelZip: Palicy k or Self-ina Lic.# Expiration Date: Attach a copy of the workers'compeosstlon po6cy dedaratioo page(s6owing the policr eamber and epirarion dste). Failure to sewre covenge as required under Section 25A of MGL c. 15?can lead to the imposition of criminal penalties of a fine up to SI,500.00 and/or one-year imprisoumznt as well as civil penalties in the foim of a STOP WORK ORDER and a Sne of up to SZ50.00 a day against ffie violator. Be advised that a copy of this statement may be forwarded to the Office of Investiga[ions of the DIA for insutance coverage cerification. I do hereby eer8,fG,rui tkepa7ns an pexa/aes ofperJurt�Wat4he iqforma@on prarided abone Ls bae and correct S ienaNie: � Dazz_ �/� f/s Phone#: v �� /z� � Y O„Q4cta1 use on{v. Do not iwhe tn thS area,fo be coinplrted bv ci{v or town oj/'�c1aL Cih•or I'otau• PermtULicense# Issuiag Aathorlry(circle one): 1.Board otHealth 2.BaUding Depar�eot 3.City/Iow�a Clerk 4.Licensing Board 5.Selecm�eo's OISce 6.O[her Contact Perwp: P6one#: wicw.mus.gm=dia