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Home My WebLink AboutApplications, WC and Licenses Prior to 2010 � . • Amaa�sa�on- � �^� TOWN OF YARMOUTH BOARD OF HEAL3'H`� `�� ,��s � : � C�`- C� � M !� DD APPLICATION FOR LICENSE/P 004 �,..- `�� (}��ky'�� NOV 1 2 2008 * Please complete form and attach all necessary docux�ents by Decemb r IS 2008. Failure to do so will result in the retum ofyour applicat�on pack .H DEPT. NAME OF ESTABLISHMENT: 'V1 W�� TEL. #(S�� I�}�IC� LOCATION ADDRESS: � _ MAILING ADDRESS: OWNER NAME: 'arr.t `o7J TAX ID FEIN or SSN : CORPORATION NAM IF APPLICA LE): MANAGER'S NAME: I� � TEL. # "a6 MarilrrG.��ss: -E— ,,� vve ----� � POOL CERTIFICATIONS: The pool supervisor must be certified as a Pool Operator,as required bS�State law. Please list the designated Pool Operator(s) and attach a copy of the certification to this form. �. ��v��rr p� 2. ��.n� pG�--� , Pool operators must list a minnnum of two employees cmrently certified in basic water safety,standard First Aid and Community Cardiopulmonary Resuscitation(CPR). Please list these employees below and attach copies of employee certifications to tlus form. The Health Department will not use past years' records. You must provide new copies and maintain a Gle at your place of business. i. �►v�,s+-� p�z=� 2.��-�-�r-� Q ►so n� 3. �- 4. FOOD PROTECTION MANAGERS - CERTIFICATIONS: All food service establishments aze requn•ed 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. Piease attach copies of certification to this application. The Health Department w' not use past years' records. You must provide new copies and roaintain a file at your establishment. 1. PERSON IN CHARGE: Each food establishment must have at least erson In Charge (PIC) on s' uring hours of operation. 1. Z HEIMLICH CERTff TIONS: All food service ablishments with 25 seats or re must have at least one employee trained in the Hennlich Maneuver e premises at all times. Plea st your employees a•ained in anti-chokmg procedures below and attach ies of employee certifications t s foim. The Health Department will not use past years' records. Y ust provide new copies and mtain a file at your place of business. 1. 2 3. 4. RESTAURANT SEATING: TOTAL # OFFICE USE ONLY LODGItiG: LICENSE REQi7IRED FEE PERMIT# LICENSE REQUIRED FEE PERMIT ik LICENSE REQUIItED FEE PERMIT#' _�.__ .=B&B_ S55 CABIN S55 I MOTEL $S �� ----- .. _. ._._ __ — — _.�viv an ��-00 —�A� a5� �JK'ilvlNilfYGPOVL SSOea. LODGE S55 " — _TRAILERPARK $105 �Wf;IRI,pOOL S80ea. FOOD SERVICE: � LICENSE REQiIIRED FEE PERMII# LICENSE REQIIIRED FEE PERMIT# LICENSE REQUIRED FEE PERMIT# _0-100 SEATS S85 LCONI�INENTpL S35 �,� _NON-PROFIT S30 _>100 SEATS SI60 COMMON VIC. 560 — WHOLESALE S80 RET.AIL SERVICE: —RESID.KITCHEN S80 LICENSE REQUIRED FEE PERMII'# LICENSE RbQUIItED FEE PERMI'I# LICENSE REQLTIItgD FEE PERMIT# _<50 sq.8. S50 _>25,000 sq.ft. SZ25 � VENDING-FOOD S25 _QS,OOOsq.ft. 580 _FROZENDESSERT S40 _TOBACCO gj5 tiA>1ECHArGE: 510 AMOUNTDUE _ $ 330.00 *"*'*PLEASE TUR:\OVER AND COMPLETE OTHER SIDE OF FOIL'11•**** � ADMIlVISTRATION Under Chapter 152, Section 25C, Subsection 6,the Town ofYarmouth is now required to hold issuance or renewal of any license or permit to operate a business if a person or company does not haue a Certificate of Worker's Compensation Insurance. THE ATTACHED STATE WORKER'S COMPENSATION INSURANCE AFFIDAVTl'MUST BE COMPLETED AND SIGNED, OR CERT. OF INSURANCE ATTACHED OR WORKER'S COMI'. AFFIDAVIT SIGNED AND ATTACHED Town of Yarmouth taz�es and liens must be paid pnor to enewal or issuance of your pemuts. PLEASE CHECK APPROPRIATELY IF PAID: YES� NO MOTELS AND OTHER LODGING ESTABLISffi�IENTS TRANSIENT OCCUPANCY: For purposes of the limitations 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 sha11 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 residerice 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 ins ected by the Health Department prior to opening. Contact the Health Department to schedule the inspection five(5�days prior to opening. PLEASE NOTE: People are NOT aliowed to sit m the pool azea until the pool has been inspected and opened. POOL WATER TESTING: The water must be tested for pseudomonas total c_olif9rm and standard}�late couut -- by a State ee:tified iab,�rior tu uge�sing; an�quartetly therealter. POOL CLOSING: Every outdoor in ground swimming pool must be drained or covered within seven(7) days of closing. FOOD SERVICE CATERING POLICY: Anyone who caters within the Town of Yarmouth must norify the Yatmouth Health Department by filing the required Temporary Food Service Application form 72 hours prior to the catered event. These forms can be obtained at the Health Department. FROZEN DESSERTS: Frozen desserts must be tested on a monthly basis by a State certified lab. Test resuks must be sent to the Health Depar[mem. 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 ofHealth. OUTDOOR COOHING: Outdoor cooldng,prepazation,or dis la of an food r NOTICE:Permits run annually from 7anuary 1 to December 31. TT IS YOUR RESPONSIBILTTY TO RETURN TI�COMPLETED RENEWAL APPLICATION(S)AND REQUIItBD FEE(S)BY DECEMBER 15, 2008. ALL RENOVATIONS TO ANY FOOD ESTABLISHMENT, MOTEL OR POOL (i.e., PAINTING, NEW EQUIpMENT,ETC.),MUST BE REPORTED TO AND APPROVED BY TI�BOARD OF HEALTH PRIOR TO COMMENCEMENT. RENOVATIONS MAY REQUIRE A SI �PLAN. DATE: II ��/�� SIGNATURE: ' g �e�-�"'`�' pRINT NAME&TITLE: `-� tmzi�oa N �\ The Commonwealth ofMassachusetts Department of Indus[rial Accidents M�N� 600 Washington Street, f"Floor , Boston,Mass. 02111 Workers'Compesaation Iesaraace Affidavit:Boitding/piembiog/Electrieyl Cootnctors �: �rAo�� u✓ N ��el� �. (�I �-rT�t ' 2g ��,_,iS�u�-G, �-/c<.2vw.ot,e�f� �sm�� Iv1�- �;p��61, oh�„f�r�sr)�9 4 r�� s�re i«ar;�rs,u�sr. 0 I�a homeowner performing all work myseif. Project Type: ❑New Camstcuction DRemodel ❑ I am a sole�proprietor and have no one wodcing in any ca�city. ❑Building Addition .. ❑ I am an anployer Faovidiog workexs'compensati�for my e�byees wo�ciog m this job. . wmpan6 une• . � � . . --- . .. .. ad�as: . . . . citr' � ��y . Ls�aKe ee. palbetiM ❑ I am a sole propnetor,ge��al catractor,or homeowwer(cirde one)and have hired the con�actas listed bel ��.� ;�"':t ow who have the following wodcers'compemsa[ion polices: �swuue: � � - ad�esr . . . � � . �' . . . . . erwe8- � � . . . . . . . i�ema�ee[a . . � �ky p ' . . . . � __, . . . . .-. . . , . .. _ ,. ._ .. :a.� sanout�e' � . addrear: . . � eUY. � : . � . . � o�me N• - - . . . AMiR�}Z^.C��'�.�.��r.j- �� i H., . .t.n.9"v.y .z' �.�: Fa�ms 1�aame�e n�eqdrN uder Satlw 2SA�MGL l3t ne lead M Ik�n�Ca1�Y pewMin a[a ise q�b SI,SM.M udx... ex Ynn'laptbe■omt a�we9 n eM peealtln iv the Corm Na STOr WORK ORDEA atl�8ee dS1B0.N a day splmt se. 1 eedashed 1Yg a npy.t wememeac n.r uc 6r�...a.e r�ee omoe Klse�ptlo�s er�6e nu far e.venge veMenm.. . . . !lo Aarby nr8fy under NYe patns wd pena/�ie'ofperyrry tAiat the infmnalon prevldal above Ls ure�wd oo'recR . . � Signatum Date .. Priet name � � Phone# . . o9'icW ufe ouly do eof wMe i tWs area fo be 000Plefm 69.d1Y ar Nwn a�Li . � . dly or tewu: � . � �A 1-lBaYdiee Deputmmt ❑ehcck ifi�4`eapeme 6 re4� � �'a Omm . . . � ❑1WMhD�t ceWacl pvaou: PmaK p; ❑p� l omns�y�.mm) . �-, WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY INFORMATION PAGE Associated Industries of Niassachusetts Mutual Insurance Company ' Burlington, Massachusetts (800� 876-2765 NCCI NO 26158 POLICY NO. V WC 6008047012008 � PRIOR NO. VWC 6008047012007 � ITEM 1. The Insured Gaylri Krupa Corp dba Quality Inn 8 Suiles . Mailing Address: 1314 Route 128 South Yarmouth MA 02664 (No. Sireet Town m Ciry County SIa1e Zip Cade ❑ Individual ❑ Partnership � Corporalion ❑ Other . . FEIN Other workplaces not shown above: -� � � � � 2. Tha policy perlod is fmm03/09/2008� �0 03l09/2009 �p:01 a.m.standard time at the insured's mafling address. 3. A. Workers Compensation Insurance: Part One ot the policy applies lo lhe Workere Compensation Law of the states lisled here; MA B. Employers Liability insurance: Part Two of the poiicy applies lo work in each state listed in ilem 3.A. ThelimitsofourliabilityunderPartTwoare: BodilylnjurybyAccident $ 100,000 eachaccident BodilylnjurybyDisease $ 500,000 policylimit BodilylnjurybyDisease $ 100,000 eachemployee � C. Olher States Insurance:Coverege Replaced By Endorsement WC 20 03 06A - D. This policy includes these endorsements and schedules: SEE SCHEDULE 4. The premium for lhis policy will be determined by our Manuals of Rules,Classificatlons,Rates and Rating plans. All infortnation required below Is subject to verification and change by audit. Classiflcations Premfum Basis Rales �� Eslimaled PerE100 Estimetetl Ne TdelMrival of Annual Rem�neralion Rem�ne�etbn P�¢mi�m INTRA 240870 SEE EXT NSION OF INFOR ATION PAGE Minimum premium$ 236.00 Total Estimated Annual Premium $ 1,379.00 � As indicaled,interim adjustments of premium shall be made: Deposit Premium $ 1,373.00 � Annually ❑ SemiMnually ❑ �uartedy ❑ Monthly �� MA Assessment Chg. $975.65 x 5.5000°� $54.00 This policy,induding ali endorsements,is hereby countereigned by ��'--�� 02/12/2008 AUModzed Slpnalure Oete GOV� GOV KIND PLACING CLAIM NAME SAFETV STATE CLASS AUDIT OFFICE OFFICE CHECK GROUP � J J Gilmartin&Son Agency Inc _ MA 9052 2 604 1293 Post Road WC 00 00 01 A(11-88) Warwick,RI 02888 Irxiudea cvpynghled materiel of Ihe Natlonai Cour¢H on Canpenselbn insurance, usetl wiN Ns permhsian. THE COMMONWEALTH OF MASSACHUSETTS TOWN OF YARMOUTH BOARD OF HEALTH PERMIT NUMBER: #09-003 FEE: 555.00 Th[s is co Certifi d�ac Gaya 'kn p�Cory2oration d/b/a Ambassador Inn& Suites 1314 Route 28 South Yannouth, MA HAS BEEN GRANTED A LICENSE TO OPERATE MOTELS This License is issued in eonfomiite with the authoritv granted to the Board ofHealth,b}'Chapter I40,Sections 32A,32B, 32C,32D and 32E as amended,and is subject to the pro�isions ofthe La�cs ofthe Cmmnonwealth ofbtassachi�setts relating thereto,and upon such terms and conditions,and to the ntles and regulations in reeard to said Motels so licensed as adopted by the Board of Health,and expues Decrniber 31,2009 unless sooner suspznded or re�oked. Vo�ember 14.2008 BOARD OF HEALTH: .`�¢Q¢ft SPtA�� ..lV.� �LRIXItLQIIt ePtll/l�Rd .�. .�R.Q.e{�.PX �ICC �.�P[RIJl11111lL •C-nits—89:Bedrooms—89 � �• ��ts � Cl.uc ��6aue�., .`It.N. ce u y, , Director of Health TOWN OF YARMOUTH BOARD OF HEALTH PERMTT TO OPERATE A FOOD ESTABLISHMEl�T PERMIT NUMBER: #09-009 FEE: S35.00 In accordance�eith reaulations promulgated under authorin�of Chapter 94. Section 305A and Chapter 111, Section�ofthe Gzneral La�cs,a pennit is herebc sraiited to: Gayatrikn�pa Coiporation, 1314 Route 28, South Ya�7nouth, MA Whose place of business is: Ambassador Inn & Suites Type of business: Continental Breakfast To operate a food establishment in: To�vn of Yaimouth Permit expires: December 31. 2009 BonRD oF HEaLTi[: 3feeett SPtaPi, JZ.A�, C�ffaixmart CFiaxkeo .�. :1CeP,CiPiex `Uice (',ftai�cr►ecut :f?u6ext �. :�3sawn, C'�exPc Qnn Cjxeendaeun, J`Z.✓V_ `.P. vo�z��z� ia �oos ruce G. urp y. . .5., CHO Director of Healt THE COMMONWEALTH OF MASSACHUSETTS TOWN OF YARMOUTH BOARD OF HEALTH PERMIT NUMBER: #09-004 FEE: S80.00 Ihis is to Certift that (�a�atrikn�y ('omoration d/h/a Ambaccador Inn Rc Snites I�14 R�nte 2,$, 4nnth Yarmnuth MA iS HEREBY GRANTED A PERMIT To Operate a Public, Semi-Public Swimming or Wading Pool At Ambacsador Inn & 4uites - INDOOR POOL 1314 Route 28 South Yarmouth MA This prnnit is eranted in confonnin �sith Article VI oF tl�e Sanitan Codr of The Commomcealth of�lassachusetts, and rxpires Deceuiber 31.2009 uiiless sooner suspznded or rzcokzd.� - tio�zmber ld.2008 BOARD OF HEALTH: ,�¢e¢tt S�[AG�I� ✓2..1v.� �AIU[IftliK C�LAVle¢d .�. `.�CP�I�PJL� �JLC¢ C�.pI�LHtGIK :/Za6ext �. �ua[un, Cee�eP� Clara C�ee��rauen, J2..N. F.ieeP� ✓. f�� tfe.�s ruce . M , MPH. , � Director of Health THE COMMONWEALTH OF MASSACHUSETTS TOWN OF YAR1�10UTH BOARD OF HEALTH PERMIT NUMBER: #09-002 FEE: 580.00 Th�s is�o cenifi �het Gavatrikrupa Cornoration d/b/a Ambassador Inn& Suites 1314 Route 28, South Yarmouth_ MA HAS BEEN GRANTED A LICENSE TO ENGAGE IN THE BUSINESS OR PRACTICE OF - GNING OF VAPOR BATHS Tliis License is issued in confonnity�citU d�e authorin erautzd to tUe Board of Hzaldi,Up Cliapter 14Q Szetions�1,of diz General La�rs,and amendtnents thereto,and is subject to tUe pro�isions of the Lan s of the Commoua zalth ofMassachi�setts relating tUerzto, and upon sucU temts and conditions, and to ihe niles and reeulations in reeard to d�e cam ing on of the occupation so licznsed as adopted U��tl�e Board of Health,and espirzs DecrmUzr 31.2009 unless sooner rr��oked. \o�embzr 13.2008 BOARD OF fiEACTH: �¢e¢ft S�Al�E� ✓2.✓v.� e�CiV/itillft ePtCVIePrJ .`�. ,`X?�i�4X �lC¢ �[Ql�[/ItC1tL .`lZa�ent s. J`3Kouta, C'pen� Qeuc (jxexnbuum, J2..N. Eaeei�c J• 3Ea�e° Bruce G. Murphy, MPH, R.S..CHO Director of Health THE COMMONWEALTH OF MASSACHUSETTS TOWN OF YARMOUTH BOARD OF HEALTH PERMIT NIJMBER: #09-005 FEE: S80.00 This is to Certifi that Ga tya rikn�na ('omoration d/h/a Amhassador Inn & Suites 1�14 Rnnte 2R, Sonth Yarmnnth,MA IS HEREBY GRANTED A PERMIT To Operate a Public, Semi-Pubiic Swimming or Wading Pool At Ambassador Inn & Suites - OUTDOOR POOL 1314 Route 28 South Yarmouth MA This pennit is eranted in confonnirv«ith Article VI of tl�e Sanitarv Code of The Commonwralth of Massachusetts,and expires December 31 2009 unless sooner suspended or revoked.� No�rmber 14 2008 BOARD OF HEALTH: .`�¢Q¢tt S/f[1/E� JZ.✓V., �PtA'lXtitAt/t C'licitt[¢b .�. ,`X¢�CiReY, `UfCe C'Fiad�tntp�t :IZaBQxt .�. `�3Kau,n, Ceer� Qrue C�'xeerr�aum, J2..N. ruce y, , Director of Health LU OS Ui �3'I.LI.L�8 3t�tdi�;itaRId �3�If1iF�I�tJIS C n �3.LdQ � l,r/ I d 32I a3�t Ab'InI ShOIit+A01�32I "iI�3Y�I3JI�3I�IInIOJ O.L 2IORId H.L'IV�-I 30 Q�IVOS H' O�Id QAI�O.L Q3.LZIOd�I�g.LSf1Ni `� �.L�`.L[�I�Idifl�� M�I `JI�II.LAIIdd `"a�!) 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Project Type: ❑New Camsttuction❑Remodel ❑�/I�a sole proprietor and have no oce woilcing in any ca�city. ❑B�rildiog Addition tl� I am an employer�aoviding wakas'compeasation for my employees wodcing�tLis job. . eompaesrne: � . . � ad ��: �r• � � GI.I �� O „ a — � �� _. ,:_ �. .,. m�� .�. ,.a�. .. 2 � ��.��-�-�.; ❑ I am a sole Proptietor,ge�a�al c�haetor,rn homeewoer(arde oneJ and imve hiiod the co�acto�s listed below who have the followinB wark�s'comPensation Polices: eemouv ime• . . addrna• citY' � uhe�e p� � . . inaaa�ee�. - � �p � � � . . . . ... , . ... .. . . .. , s aonaw�v iwe• ad�ns• �' d�re k' irvuee & - -� � � . . ..... - . � r t, -. Faoeerxeceaamqeureq See1Ma� afMGLLSZcukWbNe�dvi�ialpe�MndaieRbfl3M-M�dfn�` ^K9nR' a tor�elaSTOrWORKORD6Rud�6sedfIBO.N�Aayapint�e. IndenWdtWa aPY�� v7 �LvntlpWrdHeDlAfiraweng�evermntl�e. � 1 Aa 6enby 6 M dPena!lie.*ofP�rjn+Y Miat dYe iefonwallon providel e6orr h Ave rwd cor t �� ` I�n O' �_ . � .3�M� reoce a � oB�ad.x aaly a..w.r�fe d w..rea b e�c.mW�+m nr a�r.r e.wa o�hl � . dy or bwa: ��g �� ❑eheek iftm[��6e rcepeme h req�rtd �9 O�m . ��a- plo�e#; ��r�t ._----- , WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY INFORMATION PAGE Associated Industries of Massachusetts Mutual Insurance Company ' Burlington, Massachusetts (800) 876-2765 NCcI No zsi58 POLICY NO. VWC 6008047012008 PRIOR NO. VYVC 6008047012007 ITEM 1. The Insured Gaylri Krupa Corp dba Quality inn&Suites Mailing Address: 1314 Route 128 South Yarmoufh MA 02664 (No. Sireet Town w City Counry 51aie 2�p Catle ❑ Individual ❑ Partnership � Corporalion ❑ Other FEIN Other workplaces not shown above: 2. The policy period is(rom03/09/2008 �0 03/09/2009 �p;01 a.m.standard time at the insured's mailing address. ` 3. A. Workers Compensation Insurence: Part One of the policy applies to lhe Workere Compensation Law oi the states listed here; MA B. Employers Liability Insurance: Part Two oi the policy applies to work in each state listed in item 3.A. ThelimitsotourliabilityunderPartTwoare: BodilylnjurybyAccident $ 100,000 eachaccident BodiiylnjurybyDisease $ 500,000 policylimit BodifylnjurybyDisease $ 100,000 eachemployee C. Other Stales Insurance:Coverage Replaced By Endorsement WC 20 03 06A D. This policy includes lhese endorsements and schedules: SEE SCHEDUIE 4. The premium for this policy will be detertnined by our Manuais of Rules,Classificatioos,Rates and Rating plans. All infortnation required below is subjed to verification and change by audit. Classifications Premium Basis Rates Cada Esfimaled PerE700 EsHmafetl Na TdalAnnuel a Annual Remvnemllon ftemunerallon Premi�m INTRA 240570 SEE EX7 NSION OF INFOR ATION PAGE Minimum premi�m$ 236.00 Total Esdmated Annual Premium $ 1,319.00 As indlcated,intedm adjustmants of premlum shall be made: � Deposit Premium $ 1,373.00 � Mnually ❑ Semi Annualty ❑ Quartedy ❑ Monthty , MA Assessment Chg. $975.65 x 5.5000% $54.00 This policy,induding all endorsements,is hereby countersigned by ��"—��l� OZ/12/2008 Aulhorized SignaNre Date GOV GOV KIND PLACING CIAIM NAME SAFETY STATE CLASS AUDIT OFFICE OFFICE CHECK GROUP J J Gilmartin&Son Agency Inc MA 9052 2 604 1293 Post Road WC 00 0�01 A(11-88) Warwick,RI 02888 � Indudes copyrightetl material of ihe Nalbnal CpmW on Canpe�rsaM1on Inswerice, ��e wnn tts cemmssro�. THE COMNIONWEALTH OF MASSACHUSETTS TOWN OF YARMOUTH BOARD OF I�EALTH PERMIT N[IMBER: #08-049 FEE: $50.00 I7�is is to Cenify rhac Gayatrilu•upa Corporation d/b/a Ambassador Inn & Suites _ 1314 Route 28. South Yarmouth. MA HAS BEEN GRANTED A LICENSE TO OPERATE MOTELS This License is issued in wnfornilty with the authoriry granted to the Board ofAealth,by Chapter 140,Secuons 32A,32B, 32C,32D and 32E as amended,and is subject to tlie provisions of the Laws of the Commonwealth of Massachusetts relating thereto,and upon such terms and condirions,and to the rules and reguletions in regard to said Motels so licensed as adopted by the Board of Health,and expires December 31,2008 unless sooner suspended or revoked. March 13 2008 BOARD OF I-IEALTH: ,�¢�R.IL SP[p�L� Z..l(�.� �XNtl�ft �.R'NC�¢6 .�.�E�I�P.I.�,t ��LC¢ ��.�LYlJ[IltQftL *oni�s-sv;sea�oo�-s9 �2a6e�4t 3.$4autn, lxe�[R � Qitlt�l¢P.ft�[YLlfIL� :/Z.✓v. �. Dl[ECtOi Of�ILIl � � TOWN OF YARMOUTH BOARD OF HEALTH PERMIT TO OPERATE A FOOD ESTABLIS�NT PERMIT NUMBER: #08-166 FEE: $30.00 In accordance with regulations promulgated under authority of Chapter 94,Section 305A and Chspter 111,Section 5 of the General Lews;a permit is hereby gtanted to: Gayatrikrupa Corporation, 1314 Route 28, South Yarmouth, MA Whose place of business is: Axnbassador Inn& Suites Type of business: Continental Breakfast � To operate a food establishment in: Town of Yarmouth Permit expires: December 31 2008 BoaRD oF HEn[.rx: .�fePe�c S�, �J2..N., C�aixrnan ' CPeauteeo .�.,7CeP,QiPceac `llice C'R�aixmart `.Ito6ext �.JZ. xowa, Cd.ex%i Qrua C�'xee�� `Jt..N. March 13.2008 ruce G.Murphy, , .5.,CHO Director of Health " THE COMMONWEALTH OF MASSACHUSETTS TOWN OF YARMOUTH BOARD OF HEALTH PERMIT NUMBER: #08-077 FEE: $75.Q0 I7ris is to Certify tUat ('■avat��a('omoratinn d/h/a Ambaccador inn Xr S �it c 1314 Rrn�tP 2R Snnth Yarmnnth MA IS HEREBY GRANTED A PERMIT To Operate a Public, Semi-Public Swimming or Wading Pool At Am accador n ,i c - INDOOR POO 1314 Route 28 South Yarmouth MA Ihis pernut isgranted in conformity with Article V[of the Sanitary Code of The Commonwealth of Massachusetts,and expires December 31.2008 unless sooner suspended or revoked. March 13 2008 BOARD OF HEALTH: .`�¢Pe�t SPtR�� ✓Z.Jv.� �ab[mllK . (.f�axP.ee .�. JfeP.�ilie�c, `Dice C�ai�cnuur. J2aBext.rt. `,�3�tow�c, C�ex/� Qruc(s'xeen�aurn, J2..N. ,�fayea Bmce .MwP Y, � , Director of Health THE COMMONWEALTH OF MASSACHUSETTS TOWN OF YARMOUTH BOARD OF HEALTFI PERMIT NUMBER: #08-031 FEE: $75.00 This is�o Cemf�that Gayatrikru�a Corporaribn d/b/a Ambassador Inn& Suites 1�14 Route 28 So tn h Ya� outh MA HAS BEEN GRANTED A LICENSE TO ENGAGE IN THE BUSINESS OR PRACTICE OF - GIVING OF VAPOR BA'I'HS This License is issued in conformiry with the authodry granted to the Board of Health,by Chapter 140,Sec[ions 51,of the General Laws,and amendments theretq and is subject to the provisions ofthe Laws of the Commonweakh ofMassachusetts relating thereto,and upon such tem�s aud conditions, and to the niles and regulations in regard to the carrying on of the occuparion so licensed as adopted by the Board of Health,and expires December 31,2008 unless sooner revoked. Mamh 13.2008 BOARD OF HEALTH: .`�¢pR.tt SP[a�� ..lv.� �.�IttlClt - � ,f .`�. .�.¢�IRRld �[C¢ �.PUYV[lftQft J2�&ext s. `u(3�eawn, C�ex� Q�uue C�'xeenBauun, J2..lV. Bruce G.M hy, ,R.S„CHO D'uector o£Healt ' ' � THE COMMONWEALTH OF MASSACHUSETTS TOWN OF YARMOUTH BOARD OF HEALTH PERMIT NUMBER: #08-078 FEE: $75.00 I'his is to Certify that ra�atriknzna Cmm�ration cUhla Amhassador inn Xc Snites 1314 Rnnte 28, Sonth Yarmrnrth MA IS HEREBY GRANTED A PERMIT To Operate a PubGc, Semi-Public Swimming or Wadiug Pool At Ambassador Inn& Suites - OIITDOOR POOL 1314 Route 28 South Yarmouth_ MA 77us pemtit isgranted in conformity with Article V[of the Sanitary Code of 17ie Commonwealth of Massachusetts,and expires December 31.2008 unless sooner suspended or revoked. March 13 2008 BOt1RD OF HEALTH: ,`�¢�Rft SPta�.� �..lv.� �ti[btlYR C'Pa�e�e.e .'�. �CeP,�i�e�e, `Uice eR�ai�rnran J2a6ext .!.fd3awruui., CEe� Qnn(�'xeen�aurn, St..A/. EueP.� 'i�a�,�ea � ce . iup M� � Director of Health / '