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Home My WebLink AboutApplications, WC and Licenses Prior to 2010� «�� TOWN OF YARMOUTH BOARD OF HEAIr'P$ ��j � '-_ �- � i� ✓J �� DD �� APPLICATIONFORLICENSE/PER1VIFf'''?.2009��,��`� NOV 1 O 2008 * Please complete form and attach all necessary dqcu�s��ts by Decemb Failure to do so will result in the return o£�ou�apphcahon pac . �E PT. NAME OF ESTABLISHMENT:�/�S �{��G� /''{✓T(� TEL. # �8 ��`�G�� LocaTiotv a��ss: �9 I ,e T: � t� ,�� s7 so � 7�-i y,�G�-,�� v�-�r`_ ��7�yA MAILING ADDRESS: r�,L' OWNER NAME: ritAc�f�Pd-A � - /�4��k ��( TAX ID (FEIN or SSNI': ° CORFORATION NAME (IF APPLICABLE): 'u/AM ti' L 1—L MANAGER'S NAME: �E3 �L,� f1�- ,�u��7 TE . #S�Y--� 9�L�t MAILING ADDRESS:sr�! � -r .z��K�666Y a-t-=��,�-•'-'�t��l ��-� �v �— ?�y—� rr POOL CERTIFICATIONS: The pool supervisor must be cerrified as a Pool Operator, as required by State law. Please list the designated Pooi Operator(s) and attach a copy of the certification to ttus form. l.� �� S 7'C V ��-st�'N 2. Pool operators must list a minimum of two employees cun•ently certified in basic water safery,standard First Aid and Community Caz•diopulmonary Resuscitation(CPR). Piease list these employees below and attach copies ofemployee 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. i. �A �-�-��'�� ,� 2�z7 z. 3. �,lr,� s Y�J(�'��_S'G'�tJ 4. FOOD PROTECTION MANAGERS - CERTIFICATIONS: All food service establishments are requu•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 Establishxnents, 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. /�� '� 2. PERSON IN CHARGE: Each £ood establishmenf must have at least one Person In Chuge (PIC) on site during how•s of operation. � 1. eL�- 2. HEIMLICH CERTIFICATIONS: Ali 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-chokmg procedures 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 �le at your place of business. 1. l�� 2. 3. 4. RESTAURANT SEATING: TOTAL # OFFICE USE ONLY LODGIVG: LICENSE REQUIRED FEE PERMIT# LICENSE REQTJIKED FEE PERMII'# LICENSE REQUIltED FEE PERMIT= _B&B S55 _CABIN S55 / MOIEL 555 6�T—OOJ` _1N1V S55 _CAMP 555 I SA�'IMMINGPOOL 580ea. �/—O(a— _LODGE S55 'I"RAILERPARK 5105 WfiIRLPOOL S80ea. FOOD SERVICE: LICENSE REQUIRED FEE PERMIl"# LICENSE REQL7RED FEE PERMI?# LICENSE REQi7IILED FEE PERMI'I# _0.100 SEA7S 585 _CONTINENl"AL 835 NON-PROFIT S30 _>100 SEATS SI60 _COMMON VIC. 560 _WHOLESALE S80 RETAIL SER�7CE: —RESID.KITCHEN S80 LICENSE REQUIRED FEE PERMIT!? LICENSfi REQUIRED FEE PERMIT# LICENSE REQU[RED FEE PERMIT# _<SOsq.ft. S�0 _>25,OOOsq.ft. 5225 VENDING-FOOD S25 _<25,000 sq.R. 580 � _FROZEN DESSERT S40 TOBACCO 555 va�7E c�n�ce: s�o AMOiJNT DUE _ $_j�35�00 •*""PLEASE TUR�OVER AND COMPLETE OTHER SIDE OF FOR'1-I**•*' �=- _ � . � ADMIlVISTRATION Under Chapter 152, Section 25C, Subsection 6,the Town of Yazmouth is now required to hold issuance or renewal of any license or pemut 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 i/ Town of Yazmouth taxes and liens must be paid prior to renewal or issuance of your permits. PL�ASE CHECK APPROFRIATELY IF PAID: YES NO �t7 i�LS A1V� OT73ER L('iDGING ESTABLISHNIENTS TRANSIENT OCCUPANCY: For purposes ofthe 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 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)momh period. Use of a guest unit as a residence or dweliing 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 De�artment to schedule the inspection five(5�days pnor to opening.PLEASE NOTE:People are NOT allowed to srt m the pool area until the pool has been inspected and opened. POOL WATER TESTING: The water must be tested fot pseudomonas,totai coliform and standazd plate count by a State certified lab, 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 SERVICE CATERING POLICY: Anyone who caters within the Town of Yarmouth must notify the Yazmouth Health Departmerrt 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 results must be sent to the Health Department. Failure to do so will result in the suspension or revocation of your Frozen Dessert Pernvt 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�ealth. OUTDOOR COOHING: Outdoor cooldng,prepazation, or display of any food product by a retail or food service establishment is prohibited. N01TCE:Pernuts run annually from January 1 to December 31. TT IS YOUR RESPONSIBILITY TO RET[.TRN THE COMPLETED RENEWAL APPLICATION(S)AND REQLTIItED FEE(S)BY DECEMBER I5, 2008. ALL RENOVATIONS TO ANY FOOD ESTABLISfIMENT, MOTEL OR POOL (i.e., PAINTING, NEW EQUIPMENT,ETC.), MUST BE REPORTED TO AND APPROVED BY TIIE BOARD OF HEALTH PRIOR TO CONIMENCEMENT. RENOVATIONS MAY REQUIRE A SITE PLAN. DATE:�� jO � SIGNATURE: ��~ � . Sa'� PRINT AtAME&TITLE: �6}'�� _ G3 Zd�T'7— ioizvos ' , �� \ The Commonwealtk of Mwssachusetts Deparlment of Irsdustrial Accidenu nr.a�r�nu�n 600 {{'ashington Street, f"'Floor Boston,Mass. 02111 wurkers•compe.sadu0[aaeanee nai�.�t:eaadiog/rlambiag/Ekrtrical cuntraerors A�t ie�aliH: Pl�e PR_�1'Ie�Wv �: n1�r-tZ�P�a � ,��,a-�� ac�t� S-C/1 i2-l- .2'�j /��G7(,) S7 SCLlJ TH ��O CL��.—/tic� �2 7�'�- zi : EJ.Z � e -y'a�i .3 q b%� Z. �0 0 . work site location fiill address: �� . ��''- � ��. ,�,T��6� I am a homeowner perfomung all work myself. � Project Type: ❑New Ca�struction QR�odel ❑ I am a sole-proprietor and have no one working in any�capacity. ❑Building Addition ❑ I am an anployer pioviding woike�s'compensation fq my employees wodcing on Uils job. � camwav une• . � � .. . � . . . . _ . _ � . . . - . . .aa�• �L� an- �#- fasma.ee ee. pelk�M ..-- , ,; . , -,, ,a: _,.w:rw�e�« ,«-..2 ❑ I am a sole proprietoy ge.eral e�McMr,or homeowwer(circle oxe)and have hired the conhac[as�lisced below who have tLe following waakeas'compensation polices: mmouv�ane• �� . . . . tl tlty: � . �g' . . . , . . i�so�axe co. . . . �g . . . . . . . . _. .. . .. . ... . , ... . . __ � ,� .��"-: aaoouv ume• . add►ess- �'� � . . � . . . � oY�e A- � . . . . ��s�wcf�erw.� , .- ; . . ,. pd�ey#.< , ----__ .. . .�., y.: : .. .�»s,. .� �.: FaiQe Y xcve m�a�e n roq�fuN odQ SeelW 2SA�f MC.L 152 m kad b He ispNtlw dai�Yal pn�Nio d��e�p b S1JM-M aiN�r �Yp�*'uP��t n weH u dH pe�Mies h tYe[xr s(a STOr WORK 08DER aW�Bu NS19i.N a dry atalmt se. I eWnah�d tY#a ropy�Nbffatrmntmy6efxw�MedbtAcOmecdineM�ofNeDlALormerageverigntlea, . . . I b benby eerdfy rnder tMe palns anApena&iu olperJ µet dis ieformmion provided abarie fs arre and cerrtct � . � . Sig°at"re '�� /L�� g� Date /1-'6�-r�!� .. Print name�' �P-+��1�- Q!r"�� Phoce# �7J Y--, S'�P--- �T�� o9'idd eae anly do not wAfe m thb u'a b 6e r°oi�efm 6Y dlY er bwo a�fal . . . . . cily ar towo: �. ..��a �� ❑cheet if�seSt&reapeme 6 ieqd�ed . .. e �Sdalmn90�m . m.a�c �a; �Q n�w.�� i��■. THE COMMONWEALTH OF MASSACHUSETTS TOWN OF YARMOUTH BOARD OF HEALTH PERMIT NUMBER: #09-009 FEE: 555.00 This is co Cenih rha� Swaminarav�n LLC d/F/a Ba River Mot I 891 Route 28 South Yarmouth MA HAS BEEN GRANTED A LICENSE TO OPERATE MOTELS I�his License is issued in conformity with Ihe authonty granted to the Board ofHealth,bv Chapter 14Q Sections 32A,3?B, 3�C,32D and 32E as amended,and is subject to the provisions of the Laws ofthe Commomvealth ofMassachi�setts relating thereto,and upon such terms and condi[ions,and ro the rules and reeulations in regazd to said Motels so licensed as adopted by the Board of Health,and expires December 31,2009 unless sooner suspended or revoked. November?4.2008 BOARD OF HEALIII: ,�R,Q¢K $(fq/E� ,/Z„lY.� �fqtilryt(Ytt `J2a&ext s. .`�(3K�arun,, C�g�ce '(.l�cu�cman '20 Uni[s:20 Bedrooms �' QILfL ��X�R�IIl[/!t� �../V. tRCe(fI7. �u G. Murphy,MP , . .,CHO Director oF Health THE COMMONWEALTH OF MASSACHUSETTS TOWN OF YARMOUTH BOARD OF HEALTA PERMIT NUMBER: #09-012 FEE: 580.00 n�i5�s�o Cenifi �hac Swaminaravan LLC d/b/a Bass River Motel 891 Ro te 28 �outh Y�rmouth MA IS HEREBY GRANTED A PERMIT To Operate A Public, Semi-Public Swimming or Wading Pool At Bass River Motel - OUTDOOR POOL 891 Route 28 outh Yarmo �th MA This pennit is eranted in confomiiq' �rith Artick VI of tUe Sanitan Codz of Ilie Conmionwealth of Massachusetts. and expires Deceniber 31 2009 unless sooner suspended or reeoked.� � \mzmber 24.2008 BOARD OF HEALTH: ,�E¢Q¢ft ,S�taPj� �.,lv.� �l[Kft[q�� L�lv[e¢0 .`�. .`X¢e�4lG �lC¢ �!Q%1[ffeliK .`Radext s. J�3Kawn, C'de�tf# Cl�uc C�'xee�c�aum, ✓2.rV. �n . 3fa�yea ruce . Marp y, , . , Director of Health� � '�""� TOWN OF YARMOUTH BOARD OF HEALTH \�I ' � ;��-5 APPLICATION FOR LICENSE/PERMTT-200$ �+"�� 5 DEC 1 1 2007 * Please complete form and attach all necessary documents by Decem�ter � I��LTH DEPT. Failure to do so will result in the return of your application packet. NAME OF ESTABLISHMENT: %j I�SS /�[V� m�rFL sw� L,LL rTEL. # �p� 369—�,ti'-aq LOCATION ADDRESS: S{C1 I M�=N �T FLT".2 SS S' `� Mtl �f �Sr'b�3 9 F(--2t�� MAILING ADDRESS: T. r ;� . S • U OWNER NAME: � l-f,4'�'T TAX ID (F 1N or SN)� CORPORATION NAME (ff APPLICABLE): A �{ = MANAGER'S NAME: M�-t-tc�(lQp-d+ � �(.{,f7-r TEL. # o g— -- 7 '�' MAILING ADDRESS:_ _S{�� MA�tJ S7. Ei-f_ ,l�. 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. �Oy S 7L�V�} NS6k/ 2. Pool operators must list a minimum of two employees currently certified in basic water safety, standard First Aid and Community Cardiopulmonary Resuscitation(CPR). Please list these employees below and attach copies ofemployee eertifications to this form. The Health Department will not use past years' records. You must provide new� copies and maintain a Cde at your place of business. 1. ��F� CN.T��-A R-- i3NFt7� 2. GZ�y S��l�NSai✓ 3• 4. FOOD PROTECTION MANAGERS - CERTffICATIONS: All food service establishments are requ'ved 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 wiFl not nse past years'records. You must provide new copies and maintain a file at your estabGshment. i. � 2. / PERS9N IN CHAAGE: Each food establisl�ent must have at least one Person In Charge (PIC) on site duripg hours of operation. 1. / 2. / HEIMLICH CERTffICATIONS: 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-chokmg procedures below and attach copies of employee certifications to this form. The Health DeparYment will noY use past years' records. You must provide new copies and maintain a file at your place of business. 1. 2. � 3. q � � RESTAURANT SEATING: TOTAL # OFFICE USE ONLY LODGING: LICENSE REQUIltED FEE PERbfII# LICENSE REQIIIRF,D FEE PER�III * LICE?v'SE REQL'IRED FEE PER�IIT= _B&8 S50 _CABIN SSO 1M07EL S50 0$�-OZ� _tNN S50 _CAJ4P Si0 �S��7LL4IING POOL S75ea. dfv�Qj _LODGE 550 _7'RAILERPARK 5100 N`HIRLpOOL S75ea. FOOD SERVICE: -- ._-- ----. ..__. _. LICENSEREQUIItED FEE PERMIT� � LICENSEREQLIRED FEE PER�fIT¢ LICEtiSEREQtiIRED FEE PERbIII=� _0.100 SEATS S75 _CON"IINENTAL S30 NON-PROFIT S25 >I00 SEA7S S150 _C04LbION VIC. 550 ti7dOLESALE S75 REiAIL SERVICE: —RESID.KITCHEN 575 LICENSE REQUIItED FEE PERMff r LICENSE REQL7RED FEE PERWT= LICENSE REQL7RED FEE PER�iII'_ _a50sq.ft. S45 _>ZS,OOOsq.ft. S?00 �'E?�DING-FOOD S20 QS,OOOsq.tt. 575 _FROZENDESSERi S3i TOBACCO S50 vn�c�vcE: sio AMOUI�TDUE _ $ /2S. 0o ""•"'pLEASE'ILR\OVER A_\D C01iPLETE O'IHER SIDE OF FOR\f*»•�* � — ADIIIINISTRATION Under Chapter 152, Section 25C, Subsection 6,the Town of Yarmouth is now reqwred 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 COMI'. AFFIDAVIT SIGNED AND ATTACHED ✓ Town of Yarmouth 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 TRANSIENT OCCLTPANCY: For pwposes of the limitations of Motel or Hotel use,Transie►rt 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►�esidence elsewhere. Transiem 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 s'vc(6)manth 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 deSned in M.G.L. c. 64G or 830 CMR 64G, as amended, shall generally be considered Transient. * NOTE: Enotosed Motel Census must be completed and returned W;cn t�is apP��at�on. rooLs POOL OPENING: All swimming,wading and whirlpools wluch have been closed for the season must be' � by the Heakh Department prior to opening. Contact the Health Department to schedule the inspection five(�days pnor to opening. POOL WATER TES1'ING: The water must be tested for pseudomonas,total coliform and standard plate count by a State certified lab, 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 SERVICE CATERING POLICY: Anyone who caters within the Town of Yarmouth must notify the Yarmouth Health DepartmeiK by fiting 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 certi5ed lab. Test resuks must be sent to the Health Department. Failure to do so will resuit 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&om the Board ofHeahh. OUTDOOR COOKING: Outdoor cooking,preparatioq or display of any food product by a retail or food service establishment is prohibited. NOTICE:Permits run annually from 7anuary 1 to December 31. TT IS YOUR RESPONSIBILITY TO RET[JRN THE COMPLETED APPLICATION(S) AND REQUIItED FEE(S)BY DECEMBER,3-1;2007. t ALL RENOVATIONS TO ANY FOOD ESTABLISFIlvIEN'I', MOTEL OR POOL (i.e., PAINTING, NEW EQUIPMENT,ETC.), MUST BE REPORTED TO AND APPROVED BY TEIE BOARD OF HEALTH PRIOR TO COMME?iCEME?IT. REVOVATIONS MAY REQUIRE A SITE PLAN. DATE:�%— 2�I � 0 `7 SIGVATURE: �-.� �>�� •- �2 � /�—�.� /vl PRINT:VAME&TITLE: GYta t-�r=�c'D ILl� � - Q�fiA-�Z� — n.cs�va-e�c� �' ��v�`�. ��,�„- ,-- � _ � The Commonwealth of Massachusetts Departmest of Indus[rial Accidents N�rtN� 600 Washuegton Street, 7`�Floor Boston,Mass. 02II1 � Worlcers'Compe�satioo Iereaoee Ai6davih Baiidi�glPlombi�g/Electrical ContraMors� �� M�'u � ' � . �� 3 ,�< Q�Vc—� r�z�—,��aa-� ,e R�7r address� � CJ ' /V�L� IU .S�—�_`�-. �.� s ' ��/`--r'LO'✓�"��- /L(�`t-.Cj�.��ff s;w ��IL� ��o v 7�-t. �re: �r C-� �o: a� < on�# �—?r�s�3 6Y�9 vnrodc site tocation rruu adaress,: C��'u`— [�]'�I�a homeowcer perfoiming all wak myself. Project Type: ❑New Camshuction�Re,model B I am a sole pro�aietor and have no one woikiog in my capacity. ❑Building Addition ❑ I am an employer�xoviding wwkecs'compeasation fa my employees wodcing on flds job. m mr tl c : #- Mv��u eo. p�# �-,.... .. . .. .. .. .. . . . . � .... .,. . . : �...�:��...�. . .. ❑ I arn a sole proprie[or,geaeral co�tracMr,or iomeow�er(cirdt owt)and Lave hired the coatracto�s lis[ed below wLo have ihe following worke[s'compeu5ation polices: � d • N: ieseaeee co. ooliev 8 9- inva�ee ea m�icv# AfYdiWi�lY�YifetY�r!�.� .: . . . . . . .. . .. _ . . . � ,._.._�_._._. Failns Y secvs enenee as eeqi�ad odv SaetlN 2SA�f MGL 1S2 eu kW b tYe t�pdtlw daf�YY pnaMn Na me�p b S1,3MM+�N�r�. ex ye�n'�pHwant aa wd a dvY penitln la Ne hr�Ka STOT WOp1C ORD6R ud�6ee df1M.M a Ay aphet s. I mdeshW tM1■ npy Ktlb Mahant vy 6e ferwarded b tYe Omee a[Iave�ti af Ihe DIA/xarvenge verlRntl�e. /10 Mert6y tt+Bfy rnder diePolns anApendHa ojyerjary Mrt Me fonxdon provl/ed abnre b Grri m�Amrrtct Sigoato�e �� `"� �„ Date �!^ 2'-�—!�/ � ,/ Print name_��-(!L'�/��-'�f Pboce# �� 3 6 I � �� .�/ " �Y a e�CLI me oWy de aM wrlfe Ia thh arca W he m�Pkted 6Y d�Y oc Mwn�Bc61 ciy er fewn: Per�flice�e y �Boidd6 D�putmea� ❑check ffimmN6le`eepeme b req�rcd ��8 Beard ❑Sdxt�m's O�ee ��MY Dqn��ew! eeofacf persou: P��; ❑p� lns'sd Syt mW) THE COMMONWEALTH OF MASSACHUSETTS TOWN OF YARMOUTH BOARD OF HEALTH PERMIT NUMBER: #08-048 FEE: $75.00 This[s co Cenity chac Swaminarayan LLC d/b/a Bass River Motel 891 Ro te 28 South Yarmouth MA IS HEREBY GRANTED A PERMIT To Operate a PubGc, Semi-PubGc Swimming or Wading Pool At Bass River Motel - OUTDOOR POOL 891 Route 28 South Yarmouth MA This permit isgranted in conformity with Article VI of the Sanitary Code of The Commonwealth of Massachusetts,and expires December 31 2008 unless sooner s�lspended or revoked. December 11.2007 BOARD OF EIEALTH: .`�P�Gt S�L�, JZ..IY.� �IIiXIItlIII �.�QAI�2d .�. .�.f�{�?11G �lC¢�1X1ltQlt J2a6o�tt �. .,B�towiy Clead� (�t' un'c, J2..N Bce . Y, . , ' Director of Health THE COMMONWEALTH OF MASSACHUSETTS TOWN OF YARMOUTH BOARD OF HEALTH PERNIIT NUMBER: #08-026 FEE: $50.00 This is to Ce�tify that Swaminaravan LLC d/b/a Ba�s River Motel 891 Route 28. South Yarmouth MA HAS BEEN GRANTED A LICENSE TO OPERATE MOTELS This License is issued in conformity with the authority granted to the Boerd of Health,by Chepter]40,5ections 32A,32B, 32C,32D and 32E as amended,and is subject to the provisions of the Laws of the Commonwealth of Massachusetts relati�g thereto,and upon such te�ms and conditions,and to the niles and regulations in regsrd to said Motels so licensed as adopted by t6e Board of Health,and expires December 31,2W8 unless sooner suspended or revoked. June 30.2008 BOARD OF HEALTH: ,`�¢K$I�III�. �✓Z,JV.� �IXB[QIt C.IIQM�CO .�E. ��,l �II,I,CC ehQ%XNtQ/t� *20 Units:20 Bedrooms �p�q1Cl�. �AIpW11,� I:IPJ�R � Q�'�f�l�l/t��,�,M.C¢fiQ�A{,I,I�f�K��..lV. `""""Y" �' "`'"''J�" B G. M�irphy ,RS.,CHO Director of Heal � • (3pss2�vF2 Mor�.. 3�fs R+.c TOWN OF YARMOUTH BOARD OF HEALTH � APPLICATION FOR LICENSE/PERMIT-200�a� � "��= rie' �� - � : , �✓� � D . . * Please complete form and attach all necessary d y umeppTiy De,; mbe��3�1,�096. Failure to do so will resuh in the retum of our a lication ack'�€ 8 Z0�6 NAME OF ESTABLISf�IENT:�A SS /t,�V�iiQ T TEL. S� LOCATION ADDRESS: S�y'/ mA-r.z� S� T .zX � S�,u�,...0� �'1 �O;�j�- d "� `1 MAILINGADDRESS:__ SQyP . OWNER NAME: �,g,��v��A _/�_�-,�77 TAX ID (F�IN or SSNI� CORPORATION NAME(IF APPLICABLE): L[� MANAGER'S NAME: a T S L. # S'U� —57�7 MaII,II�rGannxEss: �1 �-u.n�t_ �-. .Zk. soc� r�f � ov��- 74� rvcA .vzG6�� POOL CERTIFICATIONS: The pool supervisor must be certified as a Pool Operator,as required by State Iaw. Please list the designated Pool Operator(s) and attach a copy of the certification to this form. 1. �� y <"f E L A-9V. Sa il/. 2. Pool operators must list a minimum oftwo employees currently certified in basic water safety, standard First Aid and Community Cardiopulmonary Resuscitation(CPR). Please list these employees below and attach copies of eanployee ceRifications to this form. T6e Health Department wiil not use past years' records. You must provide new copies and maintain a file at your place of business. 1. MA b1 C A/Dl.�--ni Q - (�f-f�A'T'T• 2. Ro`� S�Uff�/.Cn itJ. 3. 4. FOOD PROTECTION MANAGERS - CERTIFICATIONS: /Nd F°O'� D�- � �1`�� SP.�vZ�Q . All food service establishments are required to have at least one full-time employee who is certified as a Food Protection Mana�er, as de5ned in the State Sanitary Code for Food Service Establishments, 105 CMR 590.000. Please attach copies of certification to this application. T6e Health Department will not use past years' records. You must provide new copies and maintain a fde at your establishmen� 1. / 2. PERSON IN CHARGE: Each food establishment must have at least o�e Person In Charge(PIC) on site during hours of operation. 1. / 2. FIEIMLICH CER'I�ICATIONS: VVd �or/� !7 �-- �� ' �` � �" v�C�. 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 Heelth Department will not use past years' records. You must provide new copies and maintain a file at your place of business. 1. l 2. / 3. 4. RESTALIRANT SEATING: TOTAL# OF'FICE USE ONLY LODGING: LICENSE REQUIItED FEE PERMiT# LICENSE REQiJII2ED FEE PERMIT# LICENSE REQUIItED FEE PERMIT t� _&&B S50 _CABIN $50 I MOTEL S50 �=� INN $50 _ _CAMP $50 / SWA�IIv1INGPOOL$75ea. �p7-06� _LODGE $50 TRAQ,ERPARK $100 WfIIRI.POOL $75ea. FOOD SERVICE: � LICINSE REQiIIltID FEE PERMIT# LTCENSE REQUII2ED FEE PF,RMII'# LICENSE REQtARED FEE PERMIT# _0-100 SEATS S75 _CON1'INENTAL $30 NON-PROFCf S25 _>]00SEATS 5150 COMMONVIC. S50 WHOLESALE S75 RETAII.SERVICE: —RESID.KTTCI�N $75 LICINSE REQIJIRID FEE PF,RM[T# LICENSE REQLJIItF,D FEE PERNIIT# LICENSE REQUIItED FEE PERMIT# _<50 sq.ft. S45 _>25,000 sq.ft. $200 _VENDING-FOOD $20 _Q5,000 sq.ft. S75 _FROZIN DESSIIiT S35 TOBACCO $50 NAME CfIANGE: S10 AMOUNT DUE _ $_ f Z,S•�O •'•••PLEASE TURN OVER AND COMPLETE OTHER SIDE OF FORM""••• ADMINISTRATION Under Chapter 152, Section 25C, Subsection 6,the Town of Yazrnouth 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 Yazmouth taaces and liens must be paid prior to renewal or issuance of your permits. PLEASE CHECK APPROPRIATELY IF PAID: YES�� NO — - M�TEL3 AftD 61'HER LODGING ESTABLISHMENTS TRANSIENT OCCUPANCI': 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. Trdnsient occupants must have and be abie to demonstrate that they maintain a principai place ofresidence elsewhere. Transient occupancy shall generally refer to continuous occupancy of not more than thirty (30) days, and an aggegate 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 coasidered Transient. POOLS POOL OPENING: All swimming,wading and whirlpools which have been closed for the season must be i�s ected by the Health Department prior to ope�ing. Contact the Heaith Department to schedule the inspection five(5�days pnor to opening. POOL WATER TESTING: The water must be tested for pseudomonas,total coliform and standard piate count by a State certified lab, prior to opening, and quarterly thereafker. POOL CLOSING: Every outdoor in ground swimming pool fnust be drained or covered within seven(7)days of closing. _ _ __ FOOD SERVICE CATERING POLICY: Anyone who caters within the Town of Yarmouth must notify the Yazmouth Health Departmem by filing the wred 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 results must be sent to the Heaith 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 waiterlwaitress service),must have prior approval from the Board ofHealth. OUTDOOR COOKING: Outdoor woking,prepazation,or display of any food product by a retail or food service establishment is prohibited. NOTICE:Pemuts run annually from January 1 to December 31. TT IS YOUR RESPONSIBILITY TO RETURN TF�COMPLETED APPLICATION(S) AND REQUIRED FEE(S)BY DECEMBER 31, 2006. ALL RENOVATIONS TO ANY k'OOD ESTABLISFIMENT, MOTEL OR POOL (i.e., PAINTING, NEW EQUIPMENT,ETC.), MUST BE REPORTED TO AND APPROVED BY Tf�BOARD OF HEALTH PRIOR TO COMII�NCEMENT. RENOVATIONS MAY REQUIRE A STI'E PLAN. DA'rE: l�zG�-OS SIGNATURE: 'y�,r/f�-�o�-� �_ �jG,� PRINT NAME&TTIZE: (�1��1�1� K-_ R-tF�}"7'T . �omio6 / ' . . � r . � The Commonweatth of Massachusettc Departw�ent ofixdasTrial AccidenLv . N�tN�M�i 600 Washington Streey f"'Floor Boston,Mass. 02111 --- Wor�as Compnaadoe Lsm�ee A�davk: ' 6i�g/Eketr�cal Co�tractors . .M- ., ...,._ � . „..> -<. w�s.,:=;s- e.��s.. - .. . W: �,:e � �: /�LF�FXl1��R�g�--�-r �: Ffql /n€��v Sz 2�: �4f �c�S��rN y�a v�,� _ �: ,,,�r�- _ rin:o�c�e�Satr-3G�-- �rG� ��«��«�,: ❑ I am a�omeownet peri'omting all waa3c myseif. Projed Type: ❑New Caost�uctiao�Remade! � I mm a sole and have�me w in� ❑B�ril ' Addition ❑ I am an�ployer poviding warkeis'compeagati�fa my empbyees wodcing on tLis job. G� � rnmrv�- aiiras• d�r' � et�e Y: . . ❑ I am a le propmdor ewtrxter,or romcowoer(dre(e ane)and have hired the conGact«s listed below wlw have the following wotkas'compensation polices: 6 i�nr�aa ta. oelier M � aasarv r�e: �; sltf: Nr�t: FaYue is seCQt orre�e a�eqWed odv SaW�2SA dMGL 132 n�Ind b He I�pdtlH da1�IW pmMs d�ile�p bA3M.M aWg ..�n«+'�.nr�.�...oa..aw��.u�b...r,srorwowcoansam.e.�.rsiaue.a.y,�.�. ��wwun. a�q�1i6 Maee�eW my 6e fiewaMN is 10e Omee of I�eMipWn KHe D1A far m�e sgMntl�e. //n 6ereby cerdfy rnler tMeD��B�P��o./P��Y Md Ms ufonwedoe preoilel ebove h bre twJ cenect �� A'�~'"""""' �Q� E��.S� t�h �"�6�� Prim nanx ��fs-�,�-�y� �E�—R-_ d1 Ii�7j Phone# � �`"".Sb 7�4 �/ o�rL�oaesWy dae�tw�ifeYWbunaheoa�Pk+mb9dl9erawaa�dal dq'K�Mn. perklicc�eee8 ^' -" Dipa�mt ❑eYcek Niwse�4 rapea�e h rMM�� ❑SdMra's Omce �Itl�ll�atdn� awhc[Paxa: PAoxB; f101� lm�ee s�mm) THE COMMONWEAL'I`H OF MASSACHUSETTS TOWN OF YARMOUTH BOARD OF HEALTH PERMI"T NUMBER: #07-037 � F'EE: $SO.QO This is to Ce�tify that Swaminaravan LLC d/b/a Bass River Motel 891 Route 28_ South Yarmouth MA HAS BEEN GRANTED A LICENSE TO OPERATE MOTELS This Licen.se is issued in confoimity with the authority ganted to the Board ofAealth,by Chapter 140,Sections 32A,32B, 32C,32D and 32E as amended,and is subject to the provisions ofthe Laws ofthe Commonwealth ofMassachusethsielatmg thereto,andupon such terms and conditians,and to the rules and regulations in�gard to said Motels so licensed as adopted by the Boazd of Health,and e7cpims December 31,2007 imless sooner suspended or revoked March 28_2007 BOARD OF HEALTH: B �5. /�'/�5., . d�fee�8/�c�r� �., Zi��s�i�xa�C u�r�: zo Ro6�tt�i. B�, G1P,aAa p�M�� R.�.��j� R.N ruce G.Murphy RS.,CHO Director of Health THE COMbIONWEALTH OF MASSACHUSETTS TOWN OF YARMOUTH BOARD OF HEALTH PERMIT NUMBER: #07-061 FEE: $75.00 This is to Certify chat Swaminarayan LLC d/b/a Bass River Motel 891 Route 28 South Yazmouth � IS HEREBY GRANTED A PERMIT To Operate a Public, Semi-PubGc Swimming or Wading Pool At Bass River Motel - OUTDOOR POOL 891 Route 28 So th Yazrno ih iblA This�mit isgr�anted in confrnmily with Ar[icle VI of the Sanitery Code of The Commonwealth of Messachusetts,and eacpires December 31.2007 unless sooner suspended or revoked �2g zoo� Bo.axD oF�ni.�: 6 ��5. �11.95., G'� �`.� s� �., v�er,� a�,s� a� e� A�M��tt A�us a arx> R.N. Bruce . MurP Y,MP •> Director of Hea(ih , � ��'�r3.R. MaTa�. o`r R.y TOWN OF YARMOUTH BOAT2D OF ?l` 2 0 ��= APPLICATION FOR LICENSE/PE��*,2 , � NOV 1 4 Z005 �`� * Please com plete form and attach aIl neces � d�u�e r ifs b y Dece mb e r 31, 2005. Faiiure to do so wili result in the ret�our applicarion paCket NAME OF ESTABLISffivIENT: R S 5 TEL.# s`� '3 9�i 5'7?7 R R T-�L�R l�T�L d — �-�1 �5rY LOCATION ADDRESS:�� n.i A z�{ST• at• Ze� MAII.ING ADDRESS: - v OWNERNAME: MfFNt%//f�/L�r �/�A7T T� �II•rorssrr�, CORPORATION NAME(IF APPLICABLE): 4J M G� L MANAGER'SNAME: p.tfktdL=l�/D�2A �. fj�r-A-7'T TEL. # S�Sr�'" 6 — 5�9 MAILING ADDRESS: �y/ M R SN S�_ �� .L F( �j�1��..t ��1-�C,M OUTff: .t�a ♦ LLt� POOL CERTIFICATIONS: The pool supervisor roust be certified as a Pool Operator,as required by State law. Piease list the designated Pool 9peratnr(s)and-attach a copy of the certification to this form. 1. _�c�y 5—rc—v �so n/ 2. Pool operators must list a minimum of two employees currently certified in basic water safety, standard First Aid and Community Cazdiopulmonary Resuscitation(CPR). Please(ist these employees below and attach copies of employee certifications to this form. The Heatth Department will not use past years' records. You must provide new copies and maintain a file at your place of business. 1. Q u y 3 �t% v�i�/s o�t/ 2. M1�"�L=�O/L�1 fZ_ LS-f{A '77 3. 4. FOOD PROTECTION MANAGERS - CERTIFICATIONS: — N � f-�u,j> s'E�. All food service establishments are required to have at least one fiill-time employee who is ceRified 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 fde at your establishment. l. / /U i� . 2. �.:s�" PEBSON IN CHARGE:_ _ _ _ - - --_ _ Each food establishment must have at least one Person In Charge(PIC) on site during hours of operation. 1. 1v f� 2. �'� HEA+g;�CH 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-chokmg procedures below and attael4 eopies 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. N�LG 2. N�1 3. 4. RESTAURANT SEATING: TOTAL# OFT�ICE USE ONLY LODGIlNG: LICENSE REQUIItED FEE PERMIT# LICINSE REQUIl2ED FEE PERMIT# LICENSE REQUII2ED FEE PFZ2MIT# _B&B $50 _CABIN $50 �MOTEL $50 �6-OOZ _INN S50 CAMP S50 I SWIIvII��IING POOL$75ea. O(e��li LODGE $50 'I'RAII,ER pARK $50 WIIIRI,POOL $75ee. FOOD SERVICE: LICENSE REQUII2ED FEE PERMIT# LICENSE REQUQ2ED FEE PERMI1'# LICENSE REQIJIItED FEE PERMIT N 0-100 SEATS $75 CON1'INENTAL $30 NON-PROFTT $25 >100 SEATS E150 COMMON VIC. S50 WHOLESALE $75 RETAIL SERVICE: LICENSE REQiJIItED FEE PERMII'# LICENSE REQilII2ED FEE PERMI1'# LICENSE REQUII2ED FEE PF.RMI1'k _�50 sq.ft. $45 >25,000 sq.ft. $200 _VENDING-FOOD $20 _QS,OOOsq.ft. � $75 _FROZENDESSERT 535 TOBACCO E25 NAMECHANGE: S10 AMOUNTDUE _ $ 125•00 "•"""pLEASE TURN OVERAND COMPLETE OTHER SmE OF FORM"•*"" ADNIINISTRATION 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 AF'F'IDAVIT MUST BE COMPLETED AND SIGNED, OR CERT. OF INSURANCE ATTACHED OR WORKER'S COMI'. AFFIDAVIT SIGNED AND ATTACHED Town of Yazmouth ta�ces and Gens must be paid prior to renewal or issuance of your permits. PLEASE CHECK APPROPRIATELY IF PAID: YES ✓ NO NOTICE:Pernuts run annually from January 1 to December 31. TT IS YOUR RESPONSIBILdTl'TO RETURN TfIE COMPLETED APPLICATION(S)AND REQUIRED FEE(S)BY DECEMBER 31, 2005. SEASONAL ESTABLISFIMENTS ARE TO CONTACT THE HEALTH DEPARTMENT FOR INSPECTION 7- 10 DAYS PRIOR TO OPENIIVG FOR THE SEASON. ALL RENOVATIONS TO ANY FOOD ESTABLISfIlV1ENT, MOTEL OR POOL (i.e., PAINTING, NEW EQUIPMENT,ETC.),MUST BE REPORTED TO AND APPROVED BY Tf�BOARD OF HEALTH PRIOR TO COn�lENCEMENT. RENOVATIONS MAY REQUIRE A SITE PLAN. ADDTl'IONAL REGULATIONS POOLS POOL OPENING:Alt swimming,wading and whirlpools which have been closed for the season must be inspected by the Health Department prior to opening. POOL WATER TESTING: The water must be tested for pseudomonas,total coliform and standard plate count by a State certified lab, 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 SERVICE CONSUMER ADVISORY: Each food establishment which serves or sells ready-to-eat,raw or undercooked animal products aze required to post Consumer Advisories. CATERING POLICY: Anyone who caters within the Town of Yannouth must notify the Yarmouth Health Department by Sling 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 musf betested an a monthly basisi�q a State certified lab. Test resalts must be sentto the Heatth Department. Failure to do so will resuh m the suspens�on or revocation of your Frozen Dessert Permit until the above terms have been met. OUTSIDE CAFES: Outside cafes(i.e.,outdoor seati�g with waiterlwaitress service),must have prior approval from the Board ofHeahh. OUTDOOR COOKING: Outdoor cooking, prepazatioq or display of any food product by a retail or food service establishmern is prohibited. na�: �/� � o - a f s�c�rrA�:�,,�.L�,....�a /Z. 6 4� PRINTNt1ME&TITLE: ►Lt�N�//'A.aA R - ��7T,_fUW/��L� 09/28/OS -=�—= The Commomvewlth ojMassachusettc J�J:; _ DepaYwreet ojlndrts7rial Accidents p� _ __ .__ �I N� 600 Washu+gAva SMey �'Floor = Bostae,Masc 02111 ... Worlcen'Compeasahoe I�sm�ce A�d�vk:B� ' M�glEleetrlcal Coetrxtors ,-�- ._.. „< <: .. .. .., ,. _ . '4€-„ k`"'",*�z;..s..a ?�- ' M" �.. �, �d�.'�°ro".�',.�"'�". _.. �: M�k-�na.a R _ �S�-��r �� y/ wtR`s� St �� tSr si�i�lLt-�t_`�k�--r�vt>7i�. aam• �-c A- ao• o t L6T�Sv X- �� 5�7�L/ ��re i�nm�rnu�r. 0"I am a Lomeowna petfoxming all wa�c myself. Projed Type: ❑New Cmsf�ao�Remodel I am a sole and]mve no a�e w m� B ' ' Addition ❑� I am��ployer providing wadc�s'compe�satim far my employces wotking�this job. co�erv r�• ■idtas: sl�: . eYrrN: ❑ I am a sole praprietor,ge�eral ee�trxtor,or 4omeaw�(cirde owe)aed Lave lurod the conhactas lis[ed below who Lave the following wakeas'compeasation polices: �t rwe: � db: oYae N: N �r me: �• dls: ��- Fa�e i��eeae evera�e n Rq�4ad odv Seel�iSA d11lGL 1S m Ind b IYe�pa1W�f niiol pWb da he R q t1.TN.M a�dl�r •�r�*'dr��,.wa,.aw�.�,due6r.et,slorwos�coBoas..a.�ersieu�aa.y�.�. i..a�owau, eepy Ktlb Ma4sat ry be[�ewaNed!�Ne Oma dLvn�ptlw dNe DIA fir owaqe ve�nYN. /ta Menby caeFfy rnJer t6e pdna m�dK�v��O��Y t1Yd Me inforaraUan proddal a6nve b bre m�d camect �� r��4 �,..�,�.•��r��„�f � //— o �—�r Printname /�'lfl }�C�f��/Z.k . �� /{FhA-?^I Phoce# S'b S�� 3�°. ��'� �V / 0 omew we.wy ao er.via r tY.,.n b ae w�plefed Ur eih.r w�.n.mdd dl9 or bwn. p�kliee�/ pe.pat�eat ❑tYcek if f�med�!�eaqeae N rtq�M ❑��He�N �Sdeelwi O�m cs�el Pena�: P�Yxe g: � ��dn� l.se s�mm� THE COMMONWEALTH OF MASSACHUSETTS TOWN OF YARMOUTH BOARD OF HEALTH PERMIT N[JMBER: #06-002 FEE: $50.00 This is to Ce�tify U�at Swaminazavan LLC d/b/a Bass River Motel 891 Route 28, South Yarmouth. MA HAS BEEN GRANPED A LICENSE TO OPERATE MOTELS This License is issued in confornuty with the authority granted to the Boazd ofHealth,by Chapter 140,Sections 32A,32B, 32C,32D and 32E as amended,and is subject to the provisions of the Laws ofthe Comuionwealth of Massachusetts relating thereto,and upon such teims and condi[ions,and W the rules and regulations in regard to said Motels so licensed as adopted by the Board of Health,and eacpues December 31,2006 unless sooner suspended or revoked. November 23 2005 BOt1RD OF HEALTH: B¢it'�'.wtin�1. �o3�art, /��5. ' P��f�� v:� ef� u�r�: zo Ro6�,t 4. B� � � Slul� R.N. Q� 4� R.n�. Bruce G. Murphy,MP , .,CAO Director of Health THE COMMONWEALTH OF MASSACHUSETTS TOWN OF YARMOUTH BOARD OF HEALTH PERMIT NUMBER: #06-004 FEE: $75.00 T'h�s is to Ce,tify that Swaminarayan LLC d/b/a Bass River Motel 891 Route 28 South Yanno th,MA IS HEREBY GRANTED A PERMIT To Operate a Public, Semi-Public Swimming or Wading Pool At Bass River Motel - OUTDOOR POOL 891 Route 28 . outh Yarmo th MA This pe�mit is granted in confomvty with Article VI of the Sanitary Code of The Commonwealih of Msssachusetts,and expires December 31 2006 unless sooner suspended or revoked. rro��t�z3_zoos soaRn oF�a1.�: B�`15. �joad�,.�M.�. G'k� P��fa��rt, v� ef� R�,14. B� � � Sl�k, R.N. � �Iut�33¢¢� tNly R.N. ruce G. urph ,MP D'uector of Health �� _ ��S �c�l 3°e"�sc TOWN OF YARMOUTH BO ALTH � � C,5 � � n� s � o ,� APPLICATION FOR LIC R ��-2005 NO V 2 4 F��= 2004 * Please complete form and attach all necessary'' cuments by December 3 , �LTH DEPT. Failure to do so will resuit in the retum of your application packet. NAME OF ESTABLISHI�IENT: RR-�� RTV r=fi M'v7GL ��,1,�'rr^i,:�,c,t,f l, �',�# � ' `l -��4�`"s LOCATION ADDRESS ��/' '�t-FS,� _.i•t � L ��- ' �� ' '- � �� > �T � ,.;� ,s � �rv MAILING ADDRESS: sJ�i� r-ls�� N r-F �� ut e .:? (f Sn�� rf-+ �i.a�v ; r� . ,�.,n � � 1 �:yG� OWNER/CORPORATION NAME: Su%J�.r�T X��R h�i;�t-�� LJ L . MANAGER'S NAME: N-%�M� 1� "Di��i< lZ l�a l.l �t 'T TEL. # SCS�--3yb'-� 1r5�'' � MAILINGADDRESS: ��i t /�t-.V'i ,t� .c�/ . � :<� �':�r ��.,a �� rt �.L41Ly..�oar�j �-F. K� F} ,-i.� 1 l�1� T POOL CERTIFICATIONS: The pool supervisor must be certified as a Pool Operator,as required by State Iaw. Please list the designated Pool Operator(s) and attach a copy of the certification to this form. 1.�Y9 �� t -i l: i�t=�� .:(lh/ 2, Pool operators must list a minimum of two emplo ees currently 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 this form. The Health Department wilt not use past years' records. You must provide new copies and maintain a file at your place of business. l.�r} ��1G/�' �.2 �t �2 . ��i��T 2. �.�'� SYF"�C-=��5 E n�� 3. 4. FOOD PROTECTION MANAGERS -CERTIFICATIONS: �� /� All food service establishments aze required to have at least one fiill-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 t'de at your establishmen� 1. l�` R 2. PERSON IN CHARGE: �:� Each food establishment must have at least one Person In Charge(PIC) on site during hours of operation. 1. 2. HEIMLICH CERTIFICATIONS: yl/I� 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 REQUII2ED FEE PBRMIT# LICENSE REQiJIliED FEE PERMIT'N LICENSE REQUIl2ED FEE PERM[1'# _B&B $50 _CABIN S50 1MOTEL S50 QEj�l6 _u� sso _ _cn� aso I swnVu��rGrooLs�s�a. 05�0l� LODGE $50 T'RAILER PARK $50 WHQ2I.POOL $75es. FOOD SERVICE: � � LICENSE REQUIliED FEE PF.,RM[T# LICENSE REQi7IItED FEE PERMI1'# LICENSE REQUIIZED FEE PF.,RMIT k _0-100 SEATS S75 _CONT"INENTAL $30 NON-PROFIT $25 _>100 SEATS $150 COMMON VICT. S50 WHOLESALE $75 RETAII.SERVICE: LICENSE REQUIl2ID FEE PF.RMI'I'# LICENSE REQiJIItED FEE PERMI1'# LICENSE REQUIItED FEE PERMIT# <SOsq.ft. S4S _>25,OOOsq.ft. 5200 _VENDING-FOOD S20 _QS,OOOsq.ft. S75 _FROZENDESSERT $35 _TOBACCO $25 NAM&CHANGE: $]0 AMOUNT DUE _ $ �o�S.00 •••"•PLEASE TURN OVER APID 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 Yarmouth ta�ces and liens must be paid prior to renewal or issuance of your permits. PLEASE CHECK APPROPRIATELY IF PAID: YES �� NO NOTICE:Pemuts run annually from January 1 to December 31. IT IS YOUR RESPONSIBILITY TO RETURN THE COMPLETED APPLICATION(S) AND REQUIRED FEE(S)BY DECEMBER 31, 2004. SEASONALESTABLISFIMENTS ARE TO CONTACT THE HEALTHDEPARTMENTFORINSPECTION7-10 DAYS PRIOR TO OPENING FOR THE SEASON. ALL RENOVATIONS TO ANY FOOD ESTABLISH1�lENT, MOTEL OR POOL (i.e., PAINTING, NEW EQUIPMENT, ETC.), MUST BE REPORTED TO AND APPROVED BY THE BOARD OF HEALTH PRIOR TO COMIvvffiNCEMENT. RENOVATIONS MAY REQlIIRE A SITE PLAN. ADDITIONAL REGULATIONS 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. POOL WATER TESTING: The water must be tested for pseudomonas,total coliform and standazd plate count by a State certified lab, prior to opening, and quarterly thereafter. POOL CLOSING: Every outdoor in gound swimming pool must be drained or covered within seven(7)days of closing. FOOD SERVICE CONSUMER ADVISORY: Each food establishment which serves or sells ready-to-eat,raw or undercooked animal products are required to post Consumer Advisories. CATERING POLICY: Anyone who caters within the Town of Yarmouth must notify the Yarmouth Health Department by filing the required Temporary Food Service AppGcation form 72 hours prior to the catered event. Thses forms can be obtained at the Health Department. FI20T.EN.DESSERTS:-- - - -- Frozen esserts must be tested on a monthly basis by a State certified lab. Test results must be sent to the Health Department. Failure to do so will result in the suspension or revocation of your Frozen Dessert Pemrit 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 cooking,prepazation,or display of any food product by a retail or food service establishment is pro6ibited. DATE: �_ 1��1 SIGNAT[JRE: )�1li ��tG�ti� � i� ��"� PRINT NAME& TITLE: K1�A ll�-I��,r�i � - ft� �f/1`( I F � M��a�� _ 10/22/04 ``�� The Cominonweahh of Massackusdts ��--=� _ _ Departineat ojlndwsYrial AccidenLc - THE COMMONWEALTH OF MASSACHUSETTS TOWN OF YARMOUTH BOARD OF HEALTH PERMIT NLJMBER: #OS-010 FEE: $50.00 This is to Certify that Swaminaravan LC d/b/a Ba Riv Mot 1 891 Route 28 South Yazmou MA HAS BEEN GRANTED A LICENSE TO OPERATE MOTELS This License is issued in confoimity with ihe authorily granted to the Board ofHealtL,by Chapter 140,Sections 32A,32B, 32C,32D and 32E as amended,and is subject to the provisions of the Laws of the Commanwealth ofMassaclmsettsielating thereto,and upon such teims and conditions,and to the rules and regulations in regard to said Motels so licensed as�Opted by the Board of Heatth,and expires December 31,2005 unless sooner suspended or revoked January 6.2005 BOt1RD OF I�ALTH: Bsn�yi�y$. (�'o+lc�ow�/�$, • u�c�: zo P�M� v�e� Ro6w,�t�.B�, � � $� R R.N. ce G.Murphy, H, .5.,CHO Director of Health THE COMMONWEALTH OF MASSACHUSETTS TOR'N OF YARMOUTH BOARD OF HEALTH PERMIT NUMBER: #OS-015 FEE: $75.00 Th;�;s m C�tiTy rhat Swaminaravan LLC d/b/a Bass River Motel 891 Ro 28 South Yazmouth, MA IS HEREBY GRANTED A PERNIIT To Operate a Public, Semi-Pub6c Swimroing or Wading Pool At Bass River Motel - OUTDOOR POOL 891 Route 28 So �+h Y� outh, MA 17us permit is granted in conformiry with Article VI of the Sanitary Code of The Commonwealth of MessachusetYs,and eapires December 3].2005 unless sooner suspended or revoked. Januarv 6.2005 BOARD OF IIEALTH: Be�amsry�, (�p+t�pig/yJ�'j, e�t�w3�r�y P�.y� v�ef�.� a�� a.�, er� � � R.N. � r� �� a.n�. � B ce . 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Mass. 02111 ` '� • W'orkers' Campensation Insunnce Affidavit /�LFY4f'C 1�11� . J iSZfk nam�. ��nn�-��r-nJ �C. . D R f� — R /-Ks �g–�Ii�-r-rL �c-r o zr-�-4 ��,t,�� y��--�-r�-7.,,� S� Q.� � � cit� �1)If 7H ��-N�UI � �u ehone p �.�� y-�� [�I am a homecwner pzrtorming all work myselE S—v 5--6'�r �(� �/1 am a solz proprie[or �r.,', ha�z no one ��orkina in an} capacin� � I am an employer pro�iding workers' compensa�ion for my emplo}ees workine on this job. comnan� name: Sti 1 iuT �v s�—iP�P�Y�}�lf L �iC . ��14 �� 1��71� �dAresr. I . M �4'�1(� C7 ,�'�— . �� titv: . C U �) 7�� . phene p� C'�t�� _} �O � '2'Z v 0 insurance co.�'I R IZ LE�I SV 'ZLL� 1.UdRC�'7-�,s�}}� policv a �l w.��,s_ .:J.�.: ,or°r---�R/JU�t�� I am a sole proprietor. _eneral con[ractor. or omeowner(circle onU and hace hired the contractors listed below ��ho ha�e tht follu��in2 �carkrr> ;ompensation polices vn p• i rnn c . i •p tomoanv name: �y: phoee M: insuranee eo. eeRer N • F�ilure m smure covenLe�s required uader Secnoe 25A o(MGL 153 n�ind to tYe i�paido�of eri�i�1 pndtln of�O�e op ro SI,500.00 a�d/or one yean' imprisonmrnt��w�d1 u tiril peealtla io Me form o(�STOP WORK ORDER�ad a flee of SI00.00�dar K�imt me. [��denh�d�h�t a eopy ot thh sntemm�miy br fonr�rded to the 011fee ot IarefNg�Uom of Me DIA fa eovera�e veri8ptiw, � l do�hrreby ctrtijp under the pains and perta!(ies ojpery'ury�hat tht injo►nmtion provided above is nue and cnrrcet Signazurc �n a f.. ��`��e,�._. Dafe l2� f/� Print name µ,a i�t- r—�—�.J1vL� ��_,Q (�7�� pne k ,f7J� d '�� ., aRci�l use onl�� do not rrite in this�rea to be eomple�ed by eity w tow�n ollleial city or town: Y�M�� _ permiNieeeu a nBuiidinL Dep�rtmeot � pLieensios Bovd �check if imm�diate respon�t i�required 261 �Selectmen'e Ofifee (508) 398--?231 eat. �OtAere Departmmt . tonuct person: � phont It:_ _ _ THE COMMONWEALTH OF MASSACHUSETTS TOWN OF YARMOUTH BOARD OF HEALTH PERMIT NUMBER: #04-028 FEE: $50.00 This is to certify wat Swa**�inaravan LLC d/b/a Bass River Motel 891 Route 28. South Yarmouth, MA HAS BEEN GRANTED A LICENSE TO OPERATE MOTELS This License is issued in conformity with the authority granted to the Board ofHealth,by Chapter 140,Sections 32A,32B, 32C,32D md 32E as amended,and is subject to the pruvisions of the Laws ofthe Commonwealih of Massacha�ztt.s relating thereto,and upon such terms and conditions,and ro the rules and regulations in regard to said Motels so licensed as adcpted by the Board of Health,and expires December 31,2004 tmless sooner suspended or revoked. Januarv 29,2�4 BOARD OF HEALTH: Be�alrts�s �1. y'a+�,wc, /��. ' A��a�� v:� ef.�.� ��ao`R`".N� ,---- ruce G. Murp ry,MB S.,CHO Director of Health � THE COMMONWEALTH OF MASSACHUSETTS TOWN OF YARMOUTH BOARD OF HEALTH PERMIT NiJMBER: #04-050 FEE: $75.00 This is co ce�tiry rhac Swaminarayan LLC d/b/a Bass River Motel 891 Route 28 South Yarmouth MA IS HEREBY GRANTED A PERMIT To Operate a Public, Semi-Public Swimming or Wading Pool At Bass River Motel - OUTDOOR POOL 891 Route 28 South Yarmouth, MA This peanit isgranted in conformity with Article VI of the Sani[sry Code of The Conunonwealth of Massachusens,and expires December 31_2004 unless sooner suspended or revoked. Jan„azv z9.zooa aonttv oF HEa.t,TH: Be�a«u.�$. �a3�iwC, M.�i. G'l.c�b:«,c.i P�M� v:�e�K Rodm,t�. B�, G/�,6 � Sl�., R.N. � Bruce . MwP�3',MP , , Director of Health CFoanau.Y B.e.t�-t, . ` 3 a Ryc TOWN OF YARMOUTH BOARD OF HE , r � � � � �� J� � � . ��= APPLICATION FOR LICENSE/PERMI�'3 , - �� „ �,; � � ' 4y J U N U � 2003 * Please comple[e form and attach all necessary d Gnts�y D cember 31, 2002. Failure to do so will result in the return�appli6ation packe . HEALTN DEPT. I�IAME OF ESTABLISHMENT: cx�SS �ve�[ � TE .. # ��$•'�QSC-2 8'� LOCATIONADDRESS: u�h � �o UvmA� Sa 4WNER/CORPORATION NAME:- Mcx�2n ra 13h� • - ��✓A Iw i��ct��y� l—�— � MANAGER'S NAME: TEL. # M�ILIIyG ADDRESS: SCI� POOL.CERTIFICATIONSc The pool supervisor must be ceMified 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. (,Y1� (�K 2. Pool operators must list a minimum of two employees currently certified in basic water safery, standazd First Aid and Community Cardiopulmonary Resuscitation (CPR). Please list these employees 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 maints►in a file at your place of business. i. m�t i� ��v�2�t �1�!�� a. Q o 4 s ;�J v�t--�►'/SQ N 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 Managet, 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. 2. PERSON IN CHARGE: � / � Each food establishment must have at least one Person In Charge(PIC) on site during hours of operation. 1. 2. HEIMLICH CERTIFICATIONS: �N l� 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 dmes. Please list your employees trained in anti-choking procedures below and attach copies of employee certifications to this form. The Health Deparltnent will not use past years' records. You musf provide new copies and maintain a fiIe at your place of business. L 2. 3. 4. RF TA IR_A1.11' EATIN : TOTAL# OFFICE USE ONLY LODGING: � �� LICENSE REQUIRED FEE PERMIT# �- �LICENSE RBQUIRED F@G PF.RMIT�l WCENSB REQUIRED FEE PERMIT tt _B&B S50 _CABIN S50 �MOTEL $50 �3-660 _INN S50 _CAMP S50 I SWIMMING POOL$75ee.�� _CODGE S50 _TRAILER PARK S50 _WHIRLPOOL $75ea. FOOD SERVICE: � - � ��-� �� -�- � � � � - LiGENSE REQUIRED FEE PERMIT# UCENSE REQUIRED FEE PERMIT H LICENSE REQUIRED FEE PERM(T# • �Od00 SEATS S75 , �' � _CONTINENTAL S30 _NON-PROFIT S25 >IOOSEA'LS SI50 COMMONVICT. E50 WHOLESALE $75 �� RETAIL SERVICE: � LICENSE REQUIRED FEE PERMIT# UCENSE RCQUIRF.D �BE PERMIT N LICENSB RGQUfRED FEE PERMIT# . _<50 sq.ft. S45 _>25.000 sq.R. 5200 _ _VENDING-FOOD $20 _Q5,000 sq.ft. S75 _PRO'LfN DESSERT S35 _TOI3ACC0 S25 NnMecxnnce: sto AMOUNTDUE _ $ 125.�6 � � "**""pLEASE TURIV OVER AND COMPLETE OTHER SIDE OF FORM"'*"" � ; , ADMINISTRATION Under Chapter 152, Section?SC, Subsection b,the Town of Yarmouth is now required to hold issuance or renewal of any license or permit to opecate 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 � WORKER'S COMP. AFFIDAVIT SIGNED AND ATTACHED Town of Yazmouth taxes and liens must be paid prior to renewal or issuance of your permits. PLEAS� CHECK APPROPRIATELY IF PAID: YES ✓ NO NOTICE:Permits run annually from January 1 to December 31. IT IS YOUR RESPONSIBILITY TO RETURN THE COMPLETED APPLICATION(S) AND REQUIRED FEE(S)BY DECEMBER 31, 2002. SEASONAL ESTABLISHMENTS ARE TO CONTACT TI-IE HEALTH DEPAR'TMENT FOR INSPECTION 7-10 DAYS PRIOR TO OPENIAIG FOR THE SEASON. ALL RENOVATIONS TO ANY FOOD ESTABLISHMENT, MOTEL OR POOL (i.e., PAINTING, NEW EQUII'MENT, ETC.), MUST BE REPORTED TO AND APPROVED BY THE BOARD OF HEALTH PRIOR TO CbMMENCEMENT. RENOVATIONS MAY REQUIRE A SITE PLAN. ADDITIONAL REGULATIONS POOLS POOL OPEI�TING:All swimming,wading and whirlpools which have been closed for the season must be inspected by the Health Department prior to opening. POOL WATER TE5TING: The water must be tested for�seudomonas, total co(iform and standazd plate count by a State certified lab, priot to opening, and quarterly thereafter. P�OL CLOSING: Every outdoor in ground swimming pool must be drained or covered within seven (7)days of closing. . FOOD SERVICE CONSUMER AI�VISORY: Each food establishment which serves or sells ready-to-eat,raw or undercooked animal products are required to post Consumer Advisories. _ CATERING POLICY: Anyone who caters within the Town of Yarmouth must notify the Yarmouth Health Department by filin� the requtred Temporary Food Service Application form 72 hours prior to the catered event. Thses forms can be obtained at the Health Department. FROZF.N DESSERTS: Frozen desserts must be tested on a monthly basis by a State certified lab. Test results must be sent to the Health Department. Faiture to do so will result in the suspension or revocation of your Frozen Dessert Permit until the above terms have been met. ___ . f)ti7�'SIBE GAFES: —.— -_ . __ _ : ___ — -- __ _ _ _ _ _ Outside cafes(i.e.,auEdoor�ating with waiter/waitress service),must have prior approval from the Board of Health. OT�TDOOR COOHINGe Outdoor cooking,prepazation,or display of any food product by a retail or food service establishment is prohibited. DATE: b�� l�� SIGNATURE: %�'i a�w�_�.-� ,�� PRINT NAME & TITLE: m I� N��" `l�'- _ ,21-i�!1 10/18/02 -'f; .< _,a I , ' � � �° r�" , ;;,j7 The Commonwea/!h ojMassachresetts : Department ojlndustrial.-iccidents JUN 0 2 Z00� ; OIl/ceol/mstlysdiis - 600 Washington Street '.��PT. ' Bnston. Mass. 01111 " °��'` W'orkers' Campensation Insurance Affidavit namc. C�GSS a�ve,r M��Q.�� / QV�Pi'1� � I�G�I��I Lac�tion /�� "'U1� �I� ` JO:A�yUVVhPJ�;7 � I`�`�� - , �508-� 39�24fi�� I am a homecwner pznbrming all work myself. � 1 am a solz proprieror ac.'. ha�z no one uorkin� in any capacin• � I am an employer pro�iding workers' compensation for my employees uarkine on this job. comnam� name: S!'�M 1�- aJdress: cit��: ehone N• insurance co. yolicv a � I am a sole proprietor. _eneral contractor homeowner circle anel and ha�e hired the conttactors lis[ed below «ho ha�e the Folluu in_ ��arkzr .ompensation polices: sompanv n+me• - addr�• cin�: phone k• insurancc co oolicr N eomoanv name• � addrcsr eitv• p6oee M• � inaurnn�w rn � ApR�y K . . "' ' " "; F�ilun�o secure coveraec as required under Seenoo SSA of MGL ISI u�kad M Nt ioporidw o(eri�iW pndtla M�O�e�p ro Sl¢00.00�W/or oae yar�'imprisonment u w�ell�t eivil prndHa io the form of a STOP WORK ORDER��d a 11�e of SIOO.OS t d�y q�iott m� 1 ndmh�d H�t■ topy of tAy shtemcn�may be for.r�rded to the ORet of IovefHe�tlom of tht DIA tor tovera�e verillu�w. � � � /do hrreby ctrtijp under rhe pains and pertalties ojpery'ury thal�he injonnatfan provid�d abave u nve and crorrtet Signaturc x `}n a/�l�,�,d�o A2_� Date ��0 � Print name I iU�'�''1(�y;A IJVlFI Il - PhoneM .50Sr . 3q R"-24 �r� • .. olTcial use onl� do no�•rite in this area to bt eompleted by eiry ortmvo ollleial city or rown• Y�H�DT$ _ permiNieenx a n8uilding Dep�rtmcot . pLicensioe Bovd �check if immediate response ie required 261 ❑Selettmen'�OlTiee �Hedt6 Depanment � con�act person: Dnone M;_ �SOB� 398�2231 eat. nOther THE COMMONWEALTH OF MASSACHUSETTS TOWN OF YARMOUTH BOARD OF HEALTH PERMIT NUMBER: #03-060 FEE: $50.00 This is�o Certify that Mahendra Bhatt/Swaminarayan LLC d/b/a Bass River Motel LLC 891 Route 28 South Yarmouth MA HAS BEEN GRANTED A LICENSE TO OPERATE MOTELS This Licetise is issued in confomtity with the authority ganted to the Board of Health,by Chapter]40,Sections 32A,32B, 32C,32D and 32E as amended,and is subjed to the provisions of the Laws ofthe Commonwealih of Massachuselts relating , thereto,and upon such terms and condirions,and to the rules�d regulations in regard to said Cabins so licensed as adopted by the Boazd of Healffi,and expires December 31,2003 unless sooner suspended or revoked. June 6.2003 BOARD OF HEt1LTH: �ed�. zef/i�t. �a�una�c $eapanrt�c?D, Cjazdoec. 'ill.D.. `Utee ��. ��, e� �a�ttG��ornwt$ . . � . �C�CK $'�c. �,L. . r_' �, :�� (/ ruce G.Mwphy, . ,CHO Director of Health THE COMMONWEALTH OF MASSACHUSETTS TOWN OF YARMOUTT3 BOARD OF AEALTH PERNIIT NLJMBER: #03-098 FEE: $75.00 Tl,ss is co certify that Mahendra Bhatt/Swanvnarayan LLC d/b/a Bass River Motel 891 Route 28 South Yarmouth. MA IS HEREBY GRANTED A PERMIT To Operate a Public, Semi-Pub6c Swimming or Wading Pool At Bass River Motel - OUTDOOR POOL 891 Route 28 South Yarmouth. MA This permit is granted in conformity with Article VI of the Sanitary Code of The Commonwealth of Massachusetts, and exp'ves December 31.2003 unless sooner suspended or revoked. lune 6.2003 BOARD OF HEALTH: ��ra�rlea'r�, i�e�(�:�at, �iaisrwa.e $'ew1u�r+r D. �'jauiok, '!K.D., ?/iee �ax �o�d�, b'ae�. �.� Pa�ek�D�tt '�e(e�c Skak. ,��Z. �' �� B ce G.Murp y,MPH, . CHO Director of Health