Press Alt + R to read the document text or Alt + P to download or print.

No preview available

The URL can be used to link to this page

Home My WebLink AboutApplications, WC and Licenses Prior to 2010 , : Wz��l �%a� ou TOWN OF YARMOUTH BOARD OF HE �`� APPLICATIONFORLICENSE/PE �-,20 9 `-�� t� � 6 2008 �� DEPT. * Please complete form and attach all necessary doc.bil�tent��fy Decemh Failure to do so will result in the retum of yb�u applicatton pac cet. NAME OF ESTABLISHMENT: J�}'�I�NLS fCI'F C2�AM TEL. # 5��'-776-aA�� LOCATIONADDRESS: f3f}55 F��E�+- �ACI� c��✓c,Ess�d'✓ MAILING ADDRESS: ,P o �x ( S . D�NN/S /�fJ o� b OWNER NAME: HYA�^'/S (C�E c'�t,Eiir� �ortP, TAX ID (FEIN or N)_� - � CORFORATION NAME (IF APPLICABLE): MANAGER'S NAME:�1C c ,C 66Ce2 TEL. #S�'-7JG-��o MAILING ADDRESS: 5g M iL POOL CERTIFICATIONS: The pool supervisor must be certified as a Pool Operator,as required by State law. Please list the designated Pool Operator(s) and attach a copy of the certification to this form. 1. 2, Pool operators must list a minimum of two employees currently certified in basic water safety, standard Fiist Aid and Community Cardiopulmonary Resuscitation(CPR). Please list these employees below and attach copies of employee certificarians 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 tiusiness. l. 2, 3. 4. FOOD PROTECTION MANAGERS - CERTIFICATIONS: All food service establishments are required to have at least one fu91-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 Cle at your establishment. 1. I3rtt �3u/tit/ 2 PERSON IN CHARGE: Each food establishment must have at least one Person In Charge (PIC) on site during hours of operation. I. 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-cholang procedures below and attach copies of employee certifications to this form. The Health Department will uot 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 # IOFFICE USE ONLY I LODGItiG: LICENSE REQUIRED FEE PERNIIT# LICENSE REQI7IItED FEE PERMIT# LICENSE REQiIIItED FEE PERMIT# _B� S55 _CABIN $55 _MOIEL 555 . _INN S55 _CAMP S55 _SWIIvIIvIIAIGPOOL S80ea. _LODGE S55 _'IRAII,ERPARK 5105 _WIIIRLpOOL $80ea FOOD5ERVICE:� � � " -�" � �� - - . . - -� --- .. __. . _ LICENSE REQT.JIRED FEE PERMTI# LICENSE REQUIltED FEE PERMiT# LICENSE REQUIREb FEE PERMII'# �0.100 SEATS SSS #'a 9-/ZI _CON�I'INENiAL $35 _NON-PROFiT S30 _>100 SEATS 5160 � _COMMON ViC. �60 _WHOLESALE S80 RETAIL SERVICE: —RESID.ICIl'CHEN S80 � LICENSE REQiJIItED FEE PE&bliT# LICENSE REQUIRED FEE PERMIT# LICENSE REQUIRED FEE PERMIT# _<i0sq.8. $50 _>25,OOOsq.ft. 5225 _VENDID7G-FOOD 525 _<25,OOOsq.ft. S80 _FROZENDESSER'I S40 _TOBACCO 555 �n��c�nvcE: s�o AMOUNT DUE _ $ 85.00 •"*•"pLEASE TURN OVER A1VD COMPLETE OTHER SIDE OF FORM**•`* � �, ,. '� l ADMINI5TRATION 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 AFFIDAVTT MUST BE COMPLETED AND SIGNED,OR j CERT. OF INSURANCE ATTACHED ' OR WORKER'S COMI'. AFFIDAVIT SIGNED AND ATTACHED Town of Yazmouth taxes and liens must be paid prior to renewal or issuance of your pemuts. PLEASE CHECK APPROPRIATELY IF PAID: YES NO M01'ELS AND OTHER LODGING ESTABLISffiVIENTS ' TRANSIENT OCCUPANCY: For purposes of the limitarions 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. Transiem occupatrts must ha�e and be able to demonstrate that they maintain a principal place ofresidence 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 uansient. 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 i by the Health Department prior to opemng. Contact the Health Department to schedule the inspection five(�days pnor to opening.PLEASE NOTE:People are NOT allowed to sit m the pool area urnil 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, 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 Yazmouth must notify the Yarmouth Health Departmentby filingthe required Temporary Food Service Application form 72 hours prior to the catered event. These forms can be obtauied at the Health Departmem. FROZEN DESSERTS: Frozen desserts must be tested on a monthly basis by a State certified lab. Test results must be sent to the Health Departmem. Failure to do so will result in the suspension or revocation of your Frozen Dessert Permit until the above terms haue been met. OUTSIDE CAFES: Outside cafes(i.e.,outdoor seating with waiter/waitress service),must have prior approval from the Board of Health. OUTDOOR COOKING: Outdoor cooking,preparation,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 RESPONSIBILIT'Y TO RETLJRN THE CO1��IPLETED RENEWAL APPLICATION(S)AND REQUIRED FEE(S)BY DECEMBER 15, 2008. � ALL RENOVAT'IONS TO ANY FOOD ESTABLISHMENT, MOTEL OR POOL (i.e., PAINTING, NEW EQUIPMENI', ETC.),MUST BE REPORTED TO AND APPROVED BY THE BOARD OF HEALTH PRIOR TO CONIMENCEMENT. RENOVATIONS MAY REQUIRE A SITE PL N. � ; . DATE: !d' � 0� _ SIGNATURE: G✓ PRINT NAME&TITLE: l•�r�c i f!^'' ,��s v,��✓ ,�n�5. ionvos i . , - � The Com�nonwealth ofMassachusetts i Department of Lndushral Accidents NIwaN� 600 fPashington St�eet, 7`"F[oor Bostox,Mass. 0211I Worlcers'Compeia+satio�im�a�ec A�davih Baildiog/Plambieg/Ekc[rical Costraetors l�se PRi1�1'le�blv �: F/YAr✓.�r s lG� c?E,9M coaLc� � �: 1°o g aX �I siN.S�.. ��M/✓� 5 . . � te• /✓«� � zin� Ool6�� ohme# �7��-7��i 'O�c'7023 vvark siM lacatim lfiill addressl: `. � � . . ❑ I mm a homeowner perfoxmi�g all wak myself. Project Type: ❑New Consuvcti�❑R�adel ❑ I am a sole�{ao�sietor and Lave no me wo�king in aey�capxity. ❑Build'mg Addition ��PbY��viding wa�kecs'comQensation for my empbyees wodcing on thia job. � �o�o��: l�4-A�vN!s i c�E C�cE,e M co/eP, �a�..: �� ax S.�' / en.: S_ 17,�Ni✓l 5 M/� o�G� o �r• S�F'- 77�- ��OO f}5$ocl9��Pco 2�� vS�29NC � PA p t✓LC GYJ O (�'DO � ❑ I am a sole propriefnr,geaeral eoetraetor,or Yomaww�(cirde oue)and have hired the contrxtois listed below�ve the following waicers'comPensa[ion Polices: � �tv�mt• � � � � � . . an . addrm•.. . � � � . . . . . �• . . , . . . � nia�s IF � � . . .. . . . � . . in�ia�oeee. , . ,. ��p . . :. .._. , . -, ,<r;; ��.. ,_ „�+� ..c,.,; aosoav�me• �• titv:- � . . . . . . ��. . . � � . ��}�t .. . �. oalievY ��1E�YaiYW�; , . ., .. :,�e .,. . ,. t, . ..�,-..�,, , �:� � FNs�e O seeve wma�e n�eqe6ed odv Seclfaa 2Tv►a[MGL 152 u�Iwd b He�W�CaMW psWe da fae q�M S1.SN.M aW�r'.: . ae�ern'�set a wN n eM pmdin d tie fKs Ka STOr WOAC ORDSR aed�Bu iS1M.M a Ary apMt�e.1 od�wW HN a wpg�[1Y4�haamt�ry6efarwudMe�NeOmeedl��tl��DiARrcwp�evs�ntl�a, � . � � � . !da hereby��i�6`��P�/y''t6et Me injon'adaw provided above b�e a�d oemct — .. �'� T �ax /Z /S O� Ptintname i�/�c t i 9m �/,3uR/✓ � Plwm#_��t5`'�7G � �ODO� .�aid ex oe�y a..af.rtke r m.,.r�a oe nmMefep pr cKr.r ewr.�a�t61 . � e�yarteira: � . p�p�s �x.rnti..pip�a t ❑cYaic Hf�se�t�apaeac b td��oited � � . �� ta �y�� ceWe/�e�eea: ��, �� lmso!sW.m¢f! TOWN OF YARMOUTH BOARD OF HEALTH PERMIT TO OPERATE A FOOD ESTABLISHMENT PERMIT NUMBER: #09-121 FEE: 585.00 In accordance with regulations promulgated under authority of Chapter 94,Section 305A and Chapter I 11, Section 5 of ihe General Laws,a permit is hereby granted to: Hyannis Ice Cream Corp., South Shore Drive, South Yarmouth Whose place of business is: Bass River Beach Concession Stand Type of business: Food Service To operate a food establishment in: Town of Yarmouth Pernut expires: December 31 2009 BOARD OF HEALTH: ,�feQ¢rt SRtaI£, `JZ..N., C'&ai�tnta�t C'l�axleo ,�E. 9felCiRex��tce 'C.li�ixattata 'RESiRICT[ON: No seating. �PXt S.✓�Mb(!lft� ��..Ar. January 8.2009 Bruce Cr.Murphy ,R.S., CHO Director of Heal r � ^ ..:Jt._yqk .,.. :`3�0�� - , .,� TOWN OF YARMOUTH BOARD OF HEALTH s �'�=� APPLICATIONEORLICENSE/PERMIT- ��. �� 's �l �'' �� DD � , - ,`,r ' Please complete form and attach all necessary doc y 'T` ber 1, 200'�. � �� L0�8 Failure to do so will result in the retum ofyour "' ica �on packet. Htf?�rF1 J�(�I. NAME OF ESTABLISHMENT: �n,pn o�s,�,p„ TEL. #�SD�S-77.F�'o�C� LOCATION ADDRESS: J,� tas.t (�2�i)Pr Y��Ac.l. ��uc.vssrotit S�- 17 MAILING ADDRESS: SS vU i� �'�7 OWNER NAME:��j„s Co CYPK�rr, <'dY� TAX ID(F�iN or S Nl� CORPORATION N E (ff APPLICABLE): ►r, MANAGER'S NAME: (� j �)j l�m r�'[�t ll rQ lU TEL. #SO - 77 6'aDQ(� MAILING ADDRESS: h� n �"S f C. Den1Y�V c Y71�- 0��,(�� POOL CERTIFICATIONS: , - The pool supervisor must be certitied as a Pool Operator,as required by State law. Piease list the desi¢nated Pool Operator(s) and attach a copy of the certification to this form. 1. 2, Pool operators must list a minimum of two employees currently certified in basic water safety, standard First Aid and Community Cardiopulmonary Resuscitation(CPR). Please list these employees below and attach copies of employee eertifications to this form. The Healt6 Department will not use past years' records. You must previde nen� copies and maintain a file at your place of business. 1. 2. 3. 4. FOOD PROTECTION MANAGERS - CERTIFICATIONS: All food service establislunents are required to have at least one full-tune employee who is cenified as a Food Protection Manager, as deSned in the State Sanitary Code for Food Service Estabiishments, 105 CMR 590.000. Flease attach copies of certiScationto this applieation. The Health Department�viN not nse past years'records. You must provide new copies and maintain a fde at,your estabGshment. 1. (.t) 1 �� i R m r�'t�(1�0 �'l� 2. �.1� a)»�} ('�'//1/J�y� P��;�9N IN�HARGE: Each food establishment must have at least one Person In Chazge (PIC) on site during hours of operarion. 1. (A) � � � � prY. c� L� UR►t� 2. HEIMLICH CERTIFICATIONS: All food service establislunents 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'rewrds. You must provide new copies $nd maintain a file at your place of business. 1. /U��►- 2, I 3. 4_ RESTAURANT SEATING: TOTAL # OFFICE USE ONLY LODGING: LICENSE REQUIRF,D FEE PER`bflT* LICENSE REQUIRED FEE PERYSIT?� LICEA'SE REQL'IItED FEE PERWIT= _B&B S50 _CABIN S50 _M07EL . S50 _INN S50 _CA:'NP Si0 _SW'1'�i.\4INGPOOLS')Sea. _LODGE S50 _TRATLERPARK S100 R7-IIRLPOOL S75ea. FOOD SERVICE: LICENSE REQ[JIRED FEE PERMIT# LICENSE REQL7RED FEE PER'�iIT= LICENSE REQ�IRED FEE PER�fIT= � �0.100SEA'tS 575 $—/S�� _CONTINENiAL S30 _NON-PROFI7 S25 >IOOSEA'IS SI50 _CO:bLbIONVIC S50 R1-IOLESALE S75 RE'IAIL SERVICE: —RESID.KIICHEN S7� LICENSE REQUIItED FEE PERMIi= LICENSE REQUIRED FEE PERbI1T= LICENSE REQLTRED FEE PER�IIT r _a50 sq.A. S45 _>25,000 sq.ft. 5200 VENDING-FOOD S20 _<25,000 sq.tt. S75 _FROZEN DESSERT S35 _TOBACCO S50 VA:�CReLYGE: 510 AMOUrTDUE _ $ 75,,aZ *•""•PLEASE 7'L'R\O�'ER�\'p COV[PLE'IE OTHER SIDE OF FOR�i*"*'* � . �, , ADMINISTRATION Under Chapter 152, Section 25C, Subseclion 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 CeRificate of Worker's � Compensation Insurance. THE ATTACHED STATE WORKER'S COMPENSATION INSURANCE AFFIDAVII'MUST BE COMPLETED AND SIGNED,OR CERT. OF INSURANCE ATTACHED / OR WORKER'S COMP. AFFIDAVIT SIGNED AND ATTACHED Town of Yarmouth tazces and liens must be paid prior to renewal or issuance of your pemoits. PLEASE CHECK APPROPRIATELY IF PAID: / YES / NO MOTELS AND OTHER LODGING ESTABLISHMENTS TRANSIENT OCCUPANCY: For purposes of the limitations ofMotel or Hotel use,TransieM 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 principat place ofreside,nce elsewhere. Transie� oc;cupancy shatl 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 deSned in M.G.L. a 64G or 830 CMR 64G, as amended, shall generally be considered Transient. * NOTE: Encios�Motel Census must be completed and returned w�th tnis appticat�on. rooLs POOL OPENING:All swimming,wading and whirlpools which have been closed for the seagon must be' by the Heakh Department prior to opemng. Contact the Aealth Depaztment to schedule the inspection five( days prior to opening. ' i 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 CATERING POLICY: Anyone who caters within the Town of Yazmouth must notify the Yarmouth 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 Departmeni. FROZEN DESSERTS: Frozen desseRs 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 suspens�on or revocation of your Frozen Dessert Peimit until the above terms have been met. OUTSIDE CAFES: Outside cafes(i.e.,outdoor seating with waitedwaitress service),must have prior approval fromthe Board ofHealth. 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 January 1 to December 3 I. Tl'IS YOUR RESPONSIBII.ITY TO RET(JRN � Tf� COMPLETED APPLICATION(S)AND REQUIItED FEE(S)BY DECEMBER 31, 2007. ALL RENOVATIONS TO ANY FOOD ESTABLISF�vvIEE1VT, MOTEL OR POOL (i.e., PAINTING, NEW EQUII'MENT, ETC.),MUST BE REPORTED TO AND APPROVED BY TI-IE BOARD OF HEALTH PRIOR TO COMMENCEMEVT. REVOVATIO�TS MAY REQUIRE A SITE PLAN. ! DATE: S'-a3-0� SIGNATURE: ,,,,,�� .0+. .,,r... PRINT NAME&TITLE: '�D!�esn pn �o?u o� �� ,�y�, � TSe Comnronwealth ojMassachusetts Departmext ofladuslrialAccidents � �'a� ,1 60o w�k�Rgm��, �'"�Fr�. Boston,Mass 0211I Workers'Comp�saHoa Itsuraaee A�davk:Baildiag/Pirmbieg/Electrieal Coetractors �lkle3ittLYfeetnliiar: _ PleaePttiN1`le�l�a ��-}�I�)� S .�GP \ hP�-1 Yv� �3: y�� o�� cti�-�a,�,� ��o �Q' ♦> �IJ YV � C� slate YY)� �zio �b b V ohme# � . work site tocatim ffiill addressY.. . . - . ❑ I am a homoowna pedoiming al�waxlc myself. Project Type: ❑New Co�uctiao❑R�odel � ❑ I am a sole propiie,W�r amt�ve m�e wodcing in�y cap�ity. . ❑Btiilding Addition �am an emptoye[proviaing w�s'comve�matiam ras mr�nlorees wo�lcins o�n ihis jon. � . . eeqaav me: ��K11J n��S �o.� l .:Yw�1.-, - . ��-. �(3 �S( �- S� C��eror�l � m�3 �e- �75� • '�'7-��00-� � . O a 8' 301 � .� _:.:, ... ... :�. i'. .. ._ ..: _ ._: �t.,i.. :4%"�M 3,A'H''..t* .-.. 4 ,fd:.�� ❑ I am a sole proprietor,g�ral ca�tracMr,or iomaw�er(drefe osej and liave Liad�9�e co�act«s listod below wlw Imve. . tLe followinS wakas'comp�sation Pulioes: - . a�nmvime• . . . . . . . . add'e!s• eitv' � � . . � oYo�eO• � � . iuvaaaeea � � � . d4.v# . . , � .. , . _. . . ... __ . .. . . .. . . . , �,ri� s �... ��: �ld�er db: �p� ��% �� p�9* � ;t s a , ,:: :,k`. Faiee Y aeese amqe arqel'ed odQ Sedfu 2SA�MGL J52 us kW M Hs�W�[ertW�a1 pmdNe da de�p b tl SN.M aY/ar �R�+'�t n wH n eM pmltln is tYe tws 1a S1�Dr WORK OBDBR a��e Kf1N.N a 6ay a�tee.I odmOW tM a capy�tt�G�ry he�b Ne Omte.stl�ef 14e DIA teamrge t�nWa. � !1o�Aoeby rndn NYe peins onApenaltles ojperjrry Mat Me iwfer�eNon prevldel ebovie is trre aA aarr+uct ' � �_�,� ��.u,�,.. ��c /2 - al-0 7 r,;m��,iiJnia �'aul�hJ rn�� So� - 77-6 -�0� �eWafee.ly Meatwtkel�fllsareab6eaooPktedby.dl3'�Wrre�dal . .. � dryertown: - � � � PernitlittaeS �Dcparhmmt ❑�eek K�6e�cepeex h�'W�ed �Sde�ea's O�oe �� nWaRpeasea' phos#, I� . (n:M4MmWl . � � . �f= d I Client#: 17353 2HYIG ,4CORDn CERTlFICATE OF LIABiLITY INSURANCE +__ o�;�,o�YY� rreooucert THIS CERTfftCATE L813SUEC AS A MAtTER OF INFORMATION � Dowlin�&O'Neil Insurance ONLY AND CONFERS NO R16HT8 UPON THE CERTIFICi4TE � A9@��Y . . A�T RTME COVEitAGE A FORDEDNB�Y'tHEgPOUCEfE8 8E LOW 873 iyanough Rd., PO Box l980 Hyannis>NIA 02801 INSURER$AFfORDIN6 COVERAGE MAIC t �nsuReo �nisursr�xa Zurich inauranu Com n U88 Hyannis Ice Cream Corporetion ,r,suneas: Associeted Em ers Insurance Compa PO BOX SSI INSURER C: P�I rim Insurenca Compan� $OUt�i�81111i9�MA OZSBD INSURERD' INBURER E: coveRncea THE POLIGE6 OF INSURANCE LISTED BEIOW MAVE BEEN ISSUEO TO THE INSURED NAMED ABOVE FOR TME POUCY PERtOD INDICATEO.NOTW�THSTAHOING � ANV REOl11REMENT,TERM OR CONDITION OF ANY CONritACT OR OTHcR DOCUMENT N7TH ftESPECT TO WNICFI THIS CERTIFIGATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFpRDED BY THE POLICIES DESCRIBE�HEREfN I$SUBJECT 70 ALL THE TERMS,EXCLV910N3 NID CONDITIONS OF SI.iCH POIJCI�S.R6f3Rf.GATE I.1MR9 SHOVdN P.�IAY�HAVE BfEN REO'JCEC SV PAiO CLA:ttti. � Tp TYPEOF INSUftANCE POLICY NUMBER TqN � UYRB A m+eru��weiurv PA342223504 05/18107 OSH8/09 �+G+occuw�nce s1000 COMMERCIALOENERALLU0ILITV � 4� O CWNSMqDE �OCCVR ' � MFDEXPI � �o^) f � � VENSONN.LADVfNJURY ;� O O OOO � OENENALA60REGATE f'1 OOO OOU i GEN'L AGGREGltTE IIMIT APPLIEB PER: PRODUCTS•COMPXIP A08 i2 O OOO PbIICY PR6 LOC ' C wrowo��u�m Pt3C70009627882 07/30/07 07/90/06 �M��NfiLELIMIT st.aoo.000. �. `:. .ANYAUTO .. ..._. . . . . .. _ _ . . . . . .. . . . .:: . - ALL OP}NED AUTOS . BODILV INJURV .. . . . . � BCNEWCEDAUTOS.'..� .. . (Parpreon} ... _ . HIRED'AUTOS . � . gOp1�V INJ�IRY� E I NON•OWNEDAUTOS . . .. � . . . - � (Paruddx�t) � � (Wr�aodaiM��E s . 6MAOEWI&LffY AUTOOMLY•EAAGCIDENT E -ANY AUTO OiMER TH/W ��C 5 . . AUTOONLY: AOfi S FXC6fafUMBRELLA L4t&LITY . ' EACN oCCURRENCE d OCWR �CWMSMPDE KW(iEGOTE S . . .. . .. . . . . S �EDUCTiBLE . . . . . � � . : . RE7EN710N E s B won�asoaw�siiTanu+o WCC5002683012007 05l27/07 OB/Z7108 X. . "�srnru- oni. EMP�OYCRB'W8�lT' � - 4.t.EACNPtCIDENT....... , S�O�-OO�.. . . qNyppppplETdRrPPRTi'oWE%EGUTIVE NO: � � E:C:D'18EABE=FAEMPLOYEE f�4O000 OFFICEH7MEMBER£%CLWED? - H de�irbs`untltli �'�'"-". . � E4DIBEASE=POLICYUMff� 5��0�� ig � .� Oebw . .. � I OTXER �- � . i i I OE8CRIPTION OF OYERA710N6/LOCAT�ON8!VBMCLC9�PICLY610N8�DDEO BY ENDOItBFJYEMT 18►fiCUL PROYI�IOM3 RE: Parker Rivar Beach,Seagull Baach,and Bass River Beaeh j Town of Yarmouth ls named addkianal insursd for genaral liabilky. pperaypna parFprmod by the named insund wbjoet to poliey tonditions and exclusions: ' ' ' � - (Sae Attach�d Ueseriptions) CERTIFICATE MOLDER � CANC@lLAT10 � yNpU1.0 ANY OF THE ABOVE DElCRISlD POUGEB BE CANCELLED BEFORE TNE EXPIRATIf - OATETXEREOF,TNEISWIPi0�N3URERN7lLENPEAVORTONAi4 �'LL� �YSWRRTEF TOWII Of Y9�f�10litI1 � NOfICB i0 AIE CHR7�FILA'�E MOI.GER NAM60 TO THE LEFT�!UT FAIWRE TO 00 SO SMALL 74 ToWn BroOk Roed ��E No os�wAnoN oa�u�w.�rv or N+'t+cu��uvo�T'�'"°�REp'^6 woexrs oa West Yarmoutb��A ��B73 REPfiESEMAlfVEB. p�7Hpp�p�GREBENiATNE � �' "'7`��+ �� Q��'ORPORATlON'I' I . • TOWN OF YARMOUTH BOARD OF HEALTH PERMIT TO OPERATE A FOOD ESTABLLSfIMENT PERMIT NUMBER: #08-183 FEE: $75.00 In accordance with re ations promulgated under authority of Chapter 94,Section 305A and Chapter I 1 I,Section 5 of the�eneral Laws,a permit is hereby graated to: Hyannis Ice Cream Coip., South Shore Drive, South Yarmouth Whose place of business is: Bass River Beach Concession Stand Type of business: Food Service To operate a food establishment in: Town of Yarmouth Permit expires: December 31 2008 BOARD OF HEALTI-I: .�fefe�t SRaB., J2rV., C'/�atb¢eeaet @R�anfes .�.Jfefeiflenc `l7iee C(faia�ntaut •RESII2ICITON: No seating. J�4�PI¢E 3.�yolltft� � . . Qlut�llQ¢�t�qu,.�!!!L=JZ'JY_ ..��.�,.. May 29.2008 nice G. hy, ,R.S.,CHO Director of Health i . . . . y tc . .. - .:. . ,:: . . . ,. ?�"��, ��€-. o A^Ry TOWN OF YARMOUTH B D TH � r N � C ri' f� � 3r = APPLICA7'ION FOR -2003 &;��s , �� 7�-t MAY 1 5 2003 * Please complete form and attach all nec ocuments by December,31,�002, ;��PT. Failure to do so will result in the return of your application packet. � . . NAMF nF F4TARi ISIiMENT S'M��'r�+G�2S' P.�c�c1t/a G7JAcK F3II�2. TEL # i.()C ATi(1N A D F. • "f U A-NA�C�� 1vt rr.rnrr, annuFcc�� D ��X 99'�,✓ �,�D�xi� ryI�Z,6o� ' /�.Sl� r TEL. �• 0•39'07 MAiiTN('. AnnRFSS• . . (J. �,/� /S�IY7H ��L�� POOL CERTIFICATIONS: The pool supervisor must be certified as a Fool Operator,as required by State law. Please list the designated Pool Operator(s)and attach a copy of the ceRification to this form. L , ,,, 2. _ , __ Pool operators must list a minimum of two employees currently certified in basic water safety, standard First Aid and Community Cazdiopulmonary Resuscitation(CFR}; PleBse list these employees below and attach copies of employee certifications to this fonn. The'Heaith Departroent wiil not use past years' records. You must provide new copies and maintain a file at your place.of business. L 2. 3 : � _., FOOD PROTECTION ANAGERS - CERTIFICATIONS: All food service establishments are required to liave af least one full-time employee who is certified as a Food Protection Manager, as defined in the State Sanifary Cade for Food Service Establishments, 105 CMR 590.000. Please attach copies of certification to this applicarion. The Health Deparhneot will not use past years' records. You must provide uew copies and maintain a file at your establishment. 1. _ 2. PERSON IN CHARGE: Each food establishment musthave at least one Aerson I�Chatge,(PIC)on site during hours of operation. 1.� / s ,�}SS/S ' 2, HFT1��I.IGH GERTIFICA'fIONS: All food service establishments with 25 seats ox more must hav8 at least one empioyee trained 'm the Heimlich Maneuver od 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. Yon mNst provide new copies and maintain a file at your place of business. L 2• 3. 4• RF TA 1RANT SEATING: TOTAL# _ OFFICE USE ONLY � D N : .. � _. . . . ... . . . . , .. .. . . . LICENSE REQUIRED FEE PERMIT N I.ICENSE REQUIRED FEE PERMIT# LICENSE REQUIRED FEE PERMIT N BBcB $50 �_CABIN �'�. .`S50 � �� .- _MOTEL S50 INN $50 _CAIv1P S56 SWIMMINGPOOLS75ea LODGE S50 ��_TRAILER PARK �� 850 � . � �_WHIRLPOOL $�Sea � � FQOD SERVIGE: .� . ; .. .. .:. . ..- ._ . . .., . . ..; � . .. I LICENSEREQUIRED FEE PERMIT# LiCENSEREQUIRED FEE PERMIT# L(CEftSER'EQUIRED FEE "PERMIT# � 10-100 SEATS S75 .�03-�� _CONTINENTAC" S30 � �. ' _NON-PROFIT S25 >il00SEATS St50 _COMMONVI(,T: S50' _WHOLESALE $75 � u(7T IA �•�ERVICF: .. ' '� . . � : . . _ . . . . ��LICENSEREQUIRED FEE PERMITq � . LICENSE�RL•QUIRED F8G �PERMIT#� � LICENSEREQUIRED FEE . PERMITH _<50 sq.ft. S45 >25,000 sq.R. 5200 VENDMG-FOOD $20 , <25,000 sq.ft. S75 `" ` _FItO�PN DESS�RT S33 ' " ,` ` _.fODACCO S25 tvnME Cxn[vcE: $io AMOUNT DUE _ $ 75 �b � ••*"*pLEASE TURN OVER AND COMPLETE OTHER SIDE OF FORM"""*" . �� . .. . . . . . . �.. � ��♦ � � ,�jr,e . I � ' AI�3�TNI� T�ON � ' -��:�r"r'e�A , 1 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 cpmpany does not have a Certificate of Worker's Compensation Insurance. THE �kTTACFIEA'ST,ATE WORKER'S CrOMPENSATION INSURANCE AFFIDAVIT MUST BE COMPLETED AND SIGNED, OR I CERT. OF INSURANCE ATTACHED � ' 2!� WORKER'S COMP. AFFIDAVTI'SIGNED AND ATTACHED ', Town of Yazmouth taxes and liens must be paid prior o renewal or issuance of your permits. PLEASE CHECK APPROPRIATELY IF PAID: � YES NO : . � NOTICE:Permits nu►annualiy from January 1 to December 31. IT IS YOUR RESPONSIBILITY TO RETURN TF�COMPLETED:APPLIGATION(S}AND�ItE�tJI3�ED FE�(S) BY DECEM$ER 31, 2002. ' . ��.�:. . � , .. . . . ". � .. . �" � i ':. �...; .. . . , SEASONAL ESTABLISHMEtVTS RRE TO COIsFTACT.'I'I-IE•HEALTH DEPART[v1ENT FOR IN3PEC"I'ION 7-10 ' DAYS PRIOR TO OPENING FRR.THE:SEASON. ..: ALL RENOVATIONS TO ANY FOOD ESTABLISHMENT, MOTEL OR POOL (i.e., PAINTING, NEW ', EQUIPMENT, ETC.), MUST BE REPORTED TO AI�D APPROVED BY THE BOARD OF HEALTH PRIOR TO COMMENCEMENT. RENOVATIONS MAY REQUIRE A SITE PLAN., ', ADDITIQNAL REGULATIONS ' ��, " • PQQLS . � ' POOL OPENING:Ali swimming,wading and whirlpools which have been closed forthe s`�ason must be inspected by the Health Department prior to openmg. . � ' POOL WATER TESTTNGi Ttie water must be tested for pseudomonas,total coliform and s:andard plate count I by a State certified lab,prior to opening,and quarterly thereafter. r \ i , ,. , � : POOL CLOSING: Every outdoor in ground swit�ming pool must be drained or covered within seve\(7)days of ' g , � FOOD SERVICE ' ' CONSUMER ADVISORY: \\� Each food establishment which serves or sells�eady-to-eat,raw or undercooked animal products are roquited fi.o post Consumer Advisories. CATERING POLICY: . _ , Anyone who caters within the Town of Yarmouth must notify the Yarmouth Health Department by �lin� the reqmred Temporaty Food Service Application form 72 hours prior to the catered event. Thses forms Gan be obtained at the Health Department: I FBOZEN DESSF,RTS: ' r , -, Fmzen desserts must be tested on a montfily basis by a State certified lab. Test resuhs must be sent to d�e Health Department. Failure to do sa will result in the suspei�sion or revocation of your Frozen Dessert Perm.it until the above terms have been met. ' r � , � OUTSIDE CAFtS: , Outside cafes(i.e.,outdoor seating with waiter/waitress seivice),�have prior approval from the Board o:�Health. OUTDOOR COOHING: �� Outdoor cooking,preparatioq or display of any food praduct bya retail or food service establishment is prohibi,,1. F DATE: 1 O� SIGNATURE• � . PRINT NAME &TITLEc (r�l�CLIS /� I�..SSI S ( _ , � 10/18/02 �. , ( ' ' � The Commonwealth ojMassachusetls � = Departmen! ojlndustria/.-lccidexts ' b 011/COOI/In?S�IYfdIIf 600 Washington Sneer ' Boston. Mass. 02171 w'orkers' Compensation Insunnce AfQdavit Aoolicant informallon• PIL�ePRiIVTTes�iida namc l9"EI��L1,5'�1 /-7 S (S ��,�„��-- srhtz�Z c��FAc�, �rv�c� r� � 2 cit� v � Y � ///�fif � 1�� A � .. � ehon # �-�� /�� 7 �� I am a ho ecwner penortning all work myself. 0 I am a solz propriemr_r..'. ha�z no one��orking in am capatiry � I am an employer pro�iding workers' compensation for my emplo}ees u�orking on this job: eomnan�� name: � � aJdress• � � � eity: eAone N• insurance co. eolicv M . � I am a sole proprietor. general eontraetor, or homeowner�cire(e onU and hace hired the contracrors listed below ��ho ha�e the follu��ing «arker, ,ompensation policas camoanv name• � addresr cin: � phone q� insurance co. oelie�•M tomoanv name: addrcss• tiri• eheee M• � insuranee eo. neflev N Failun�o s[ture coreraQe as required uoder Secnoo 25A of MGL ISt n�Ind to qe i�pailia W tri�f W peultles of��e�p ro 51300.00 a�d/or oae ye�n'{mprisonmrnt a w�ell u civil pee�idn is tAe form of a SfOP WORK ORDER�M a Ilae ofS100A0�M�Ktimt sn !��dersh�d��Yn a eopy ottAn sntement m�y be fonwrded ro the 011fee of Inratiptlom of I!e DG tor eovera�e veriBaW�. , � I do�hrreby c rti y un tAf.pai s a d pe�ahies ojptrjury�ha1 tht injornmtion provrded abovt$we and rnrrect Signatu � .Jr/1d/� 3 � Print name (rf K �L/ S� �SS � � Pfione M / ., oRciat use onl� do no��rite in thit trea to be completed by tiry or Mw�n ollltial eiry or town: YARMODTq permiUlkeox N nBuildin`Departmem � �Litee�iog Bo�rd Q eAeek if immedia�e respoase i�required 261 QSelettmen'�Ofliee (508) 398-7231 p,at. �Hea1tA Dep�nmeet , eontartperson: phoatN:_ nOther TOWN OF YARMOUTH BOARD OF HEALTH PERMIT TO OPERATE A FOOD ESTABLISHMENT PERMIT NUMBER: #03-190 FEE: $75.00 In accordance wiW re ations promulgated under audwrity of Chapter 94,Se�tion 305A and Chapter 111,Section 5 ofthe eral Lawa,a permit is hereby granted to: Juliana's Ice Cream, South Shore Drive, South Yazmouth Whose place of business is: Bass River("Sm„a r's'�Beach Snack Baz Type of business: Food Service To operate a food establishment m: Town of Yarmouth Permit expires: December 31.2003 BOARD OF HEALTH: �ia;{� Zel!l�es, � D. �dn,:. 711.D.. ?/iee �. �. � �s�te�E'�1ClDo�etY �de.c Ska�E. ,�.�1. May 20 ,2003 � ruce G.Murphy, .S.,CHO Director of Health I - a. R. B�+u+ sNack � � ��"'± TOWN OF YARMOUTH BOARD OF HEALTH • Pl�' APPLICATION FOR LICENSE/PERMIT -2002 � �plete form�attach all necessary documents by December 31, 2001. Failure F s��Li��'�ult�n the return of your applica6on packet. OF E T ISIIMENT: L. # L - O ss /✓' MAILIN ADDRE • S .a � �no 02G73 C I J MANAGER'SNAME• �' L-2s-�/�' �X�j TEL #�=77�oGY�'y MAILING ADDRESS: ,�'�--P�S' �o ✓.�.— POOL CERTLFICATIONS_ The pool supervisor must be certified as a Pool Operator,as required by State law. Please list the designated �eo��p�rateF'�s}a� . . . _ -- - -- _ 1. 2. Pool operators must list a minimum of two employees currently certified in basic water safety, standard First Aid and Community Cazdiopulmonary Resuscitarion(CPR). Please list these employees below and attach copies of employee certifications to this form. The Health Deparhnent will not use past years' rernrds. You must provide new copies and maintain a file at your place of busineas. 1. 2. 3. 4. FOOD PROTECTION MANAGERS - CERTIFICATIONS: All food service establishments are required to have at least one full-time employee who is certified as a Food � Protection Manager, as defined in the State Sanitary Code for Food Service Establishments, 105 CMR 590.000. Please attach copies of certification to this application. The Health Department will not nse past years' records. �i Yon must provi e new copies and maintain a file at your establishment � I 1. 2. � Y'��303�'�1 CIIAR�E:_ - _ _ -- — _ Each food establishment must have at least one Person In Charge(PIC)on site during hours of operation. � 1.' 2. I ', 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 ail times. Piease list your employees hained in and-choking pmcedures below and attach copies of employee certifications to this form. The Health Department will not use past years' records. You must pr ide new copies and maintain a fde at your place of business. i 1. 2. 3. 4. RESTALJRANT SEATING: TOTAL# , OFFICE USE ONLY �� LODGING: LICENSE REQUIRED A�E PERMIT# LICENSE REQUIRED FEE PERMIT# LICENSE REQUIRED FEE PERMIT p � �a..;.�BBcB �--SSO ... _� _CABIN S50 _MOTEL $50 s r =1NN S50 --�� , � _CAMP $50 _SWIIv1T�[ING POOL$SOea. � LODGE S50 �� ; _TRAILERPARK $50 WHIRI,POOL E25ea — —T — ' FOOD SERVICE: i � LICENSE REQUIRED FEE PERMIT# � �-a.,LICENSE REQUIRED FEE PERMIT 1! LICENSE REQUIRED FEE PERIvfIT# ' _0.100 SEATS S75 _GpNT1NENTAL S30 �NON-PROFIT $25 �0.2-0�� >I00 SEATS SI50 � � _CON�(,ON VICT. $50 _WHOLESALE S75 RETAIL SERVICE: � � •��` LICENSE REQU[RED FEE PERMIT# LICENSE REQUI� FEE PERMIT# LICENSE REQi7IRED FEE PERMIT# �TOBACCO S20 _<Z5,000 sq.ft �75 _TOBACW S20 _<50 sq.R. S45 - _>25,000 sq.R. S2f10 FROZEN DESSERT$35 LYAME CHANGE: 510 AMOUNT DUE _ $ 'L S.O O •**'•F�A3E TURN OVER AND COMPLETE OTHER SmE OF FORM•*'*** � � , _ �� 1 ADMINISTRATION Under Chapter 152, SecUon 25C, Subsection 6,the Town of Yarmouth is now required to ho(d issuance or renewal of any license or pernut to operate a business if a person or company does not have a Certifica;e of Worker's Compensation Insurance. THE ATTACHED STATE WORKER'S COMPENSATION INSURANCE AFFIDAVIT MUST BE COMPLETED AND SIGNED,OR CERT. OF INSURANCE ATTACHED 9$ WORKER'S COMP. AFFIDAVIT SIGNED AND ATTACHED Town of Yarmouth taxes and liens must be paid pri to renewal or issuance of your permits. PLEASE CHECK APPROPRIATELY IF PAID: YES NO NOTICE:Pemuts run atumally from January 1 to December 3 L IT IS YOUR RESPONSIBIL.ITY TO RETURN THE COMPLETED APPLICATION(S) AND REQLTIRED FEE(S) BY DECEMBER 31, 2001. SEASONAL ESTABLISF�vIENTS ARE TO CONTACT Tf�HEALTH DEPARTMFNT FOR INSPECTION 7-10 DAYS PRIOR TO OPENING FOR THE SEASON. 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. ADDITIONAi REGULATIONS — - -_ _ _ _ POOLS POOL OPENIPiG:All swimming,wading and whirlpools which have been closed for the season must be inspected by the Health Deparhnent 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 �ONSUMER A�VISORY• Each food estabiishment which serves or sells ready-to-eat,raw or undercooked animal products are required to post Consumer Advisories. CATF.RiNG POL.ICY: Anyone who caters within the Town of Yazmouth must notify the Yarmouth Health Department by filing the �` required Temporary Food Service Application forrn 72 hours prior to the catered event. Thses forms can be �'' obtained at the Health Department. FR07.F1v DESSERTSc____ _ __ __ __ __ _-- - _ _ __ Fmzen 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 Permit until the , above terms have been met. OUTSIDE CAF�S: Outside cafes(i.e.,outdoor seating with waiter/waitress service),mu have prior approval from the Boazd of Health. OUTDOOR COOKING: ' Outdoor cooking,preparation,or display of any food product by a retail or food service establishment is pmhibited. , DATE: Z 7� p � SIGNATURE: � PRINT NAME & TITLE:�� S/ /�' � 05��"4� ��.�.0 09/11/Ol . �\ The Commonwealth of Massachusetts 3 : Department ajlndustrial.-1 ccidexa s ; OlBceo!/eresdOstlus 600 Washingmn S�reet Boston. Mass. 011ll "" °� '` W'orkers' Compensation Insurance Affidavit Aoolicant information: Pfea��PRi1VTTer.'hia nam� KJ G7��S��[SL.Pi��i�'/O/Jl� ��O�Y/S CC� ��2:�9�'s ///'or� �-�/ ci�� ' 6/[�Q/I�D!/r`ie /�7�'� /7 7 � / � ehoneMJd��I/�—�O(�� I am a homeoµner pzrtbrtning ail work myself. ,�I am a solz propriator_r..'. h��r no one uorkin� in am capacity _ I am an employer pro�rdin�uorkers' som�snsa[ion for my emplosees�a:uckine oa this job. ` �/Dw�' tompanv name: � •� CL�J�i adAress: �� lZ-G � /'� �' �A G . titr•: J � ��/�'IDII �Gs l��i c�GGf� phonep� .�vl �7� O 0�/9� insurnnce co. �`P�/O�/ �/�.� �LJ oolicv�t I�L��' l0 ��-7 /7-3 '� � I am a sole proprietor. _eneral contractor, or homeowner Icircle ortU and have hired the contractors listed below ��ho ha�e thz follu�cing«arker; ,ompensa[ion polices: companv name• � address• ��• � ohone N• insurancc co poliev# comoanv name• .___ _____ ..._----�—--- � - _._..-- -- -- — addrcss• citv phoee A• � insurance co eefln N • F�ilure m secure coverqe as reauired uoder Secnos 25A of MGL 152 n�ind to the i�paitlae W eri�iul pndtln of�O�e�q w SI,500.00��d/o� �one yan'imprisonment u w�dl u civil penaltla in Ihe(orm o(�SI'OT WORK ORDER aad�Mt of 5100.M�d�)q�iott mt 1 ndmta�d thH a eopy of thH sutemrn�mir be fonvvded to the Olfiee of Inve��ig�uom ofthe DIA for eoven{a verilleatfo�.� � 1 do hereby cenij}•und rhe pai and pena 'et ojprrjury tha fhe ' ornmtion provided abovt is d�t and rnr►tct. . l�/j-�� Signaturc Print name !�?s�� . .�0 � one M ��l/ �^ 7��"�a��L— . olTcial use onh� do not.rite in this area ro be eompleud by eih or tmve o111tiN . ei�y or town: Y��DTQ _ � permitAiteex M nBuildioe Dep�rtmeet � � pLiceosias Bo�rd �eheck if immediite response is required 261 QSdeetmen'e ORitt �HnItE Depinmeat - conuctperson: phoneM;_ �SOB� 398�?231 eat. nOther , i � TOWN OF YARMOUTH BOARD OF HEALTH � PERMIT TO OPERATE A FOOD ESTABLISHMENT PERMIT NUMBER: #02-004 FEE: $25.00 � In accordance with regulations promulgated under authoriTy of Chapter 94,Section 305A and Chapter 11 i,Section 5 of the General Laws,a permit is hereby ganted to: Rarncfahlo-Yarmn � h T.ionc('lnb 441 R ick icl nd Ro d F4 CoLth Yarmonth Whose place of business is: Bass River Beach Sna�k Bar Type of business: Non-Profit Food Service To operate a food establishment in: Town of Yarmouth Permit expires: December 31. 2002 BOARD OF HEALTH: ;�t, zelGi�ae, ��a,c D. � D., qi�ee � �xeaevi. (�er� P tud�'� or«r tY Januarv 24 ,2002 ruce G.Mwphy, .S.,CHO Director of Health � `' ` BASS , � � � .�� TOWN OF YARMOUT � ��-I pEC 1 9 2000 APPLICATION FOR LI . 1 HEAITH OEPT. t' _ �$61� ' Please complete form and attach all necessary documents by December 1, 2000. ailure to do so will result in the return of your application packet. --------------------------------- -- ---------------------------------------------------------------------------- N 1vtROF . T R .ISHMENT• ,�A�Ss /�y„��n B,BSSaiY TFL # —. L�CATION D F.SS• �S�qc�,�1i S�T' �3.aSs �Cii �'i.� MAiT.IN D�SS• �Jy�/3.�rrk' iSLAw'� .C� i°� W .Y,�.ned ��-eLG.73 .v ov .Hr � MANAC�$R'�AME: �C�t,SL,/s S. .L'.��C TF . #��-77/�OLp MAii.IN D F S: S �9mtir �i-.� A�f_1 a ✓ � -----------_______------------------------____--------------------------------__—_—_------------------------- POO . . 'TIFI A"I'TTON : The pool supervisor must be certitied as a Pool Qperator, as reyuired by new State law. Please list the designated Pool Operator(s)and attach a copy of the certification to tlus form. L 2. Pool operators must list a minimum of two employees currenUy 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 Heatth Deparlment witl not use past yeara' records. Yoa must provide new copies and maintain a file at yonr place of bueinesa. 1. 2. 3. 4. HEIMLICH CER'TIFICATIONS: All food service establislunents with 25 seats or more must have at least one employee trained in the Heimlich Maneuver on the premises at all times. Plesse list your employees trained in anti-choking procedures below and attach copies of employee certifications to tlus form. T6e Health Department will not uae past years' recorda. You must provide new copies and maintain a fde at your place of business. 1. 2. 3. 4. RESTAURANT SEATING: TOTAL# NON-SMOKINC�SEATS: TOTAL# �______________________---______.___..________OFFICE USE ONLY �-�_�_.�.,..._.....�..�-_-_ LODGING: LICENSE REQUIRED FEE PERMIT# LICENSE REQUIItED FEE PERMIT# _B&B $50 CABIN $50 _INN $50 _CAMP $50 _LODGE $50 _TRAILER PARK $50 _MOTEL $50 _SWIMMING POOL $SOea. WHIRLPOOL $25ea. FOOD SERVICE: — NOTE:Per the new 105 CMR 590.0011 State Sanitary Code for Food Establishments,the effeMive date for food protectlon manager certification is October 1,2001. LICENSE REQUIRED FEE PERMIT# LICENSE REQUIRED FEE PERMIT# _0-100 SEATS $75 CONTINENTAI, $30 _>100 SEATS $150 I NON-PROFIT $25 __� p �(� _COMMON VICT. $50 WHOLESALE $75 RETAIL SERVICE: LICENSE REQiJIRED FEE PERMIT# LICENSE REQUIRED FEE PERMIT# _<50 sq.ft. $45 _TOBACCO $20 _<25,000 sq.R. $75 TFROZEN DESSERT $35 _>25,000 sq.ft. $200 NAME CHANGE: $10 AMOUNT DUE _ $ 25.00 •••«•pLEASE TURN OVER AND COMPLETE OTNER SIDE OF FORM**•"* ` �_y_ _ __ __..._�-- --'�------ -- _ .� r--_''-_`r �- - ., u ii j ' � ADMINISTRATION Uncie`r_CY�f�r'1�,��cff�on 25C, Subsection 6,•the Town of Yazmouth is now required to hold issuance or renewal of any license or pernvt to operate a business if a person or company dces not have a Certificate of Worker's � Compensation Insurance. THE ATTACHED STATE WORKER'5 COMPENSATION INSURANCE " AFFIDAVIT MUST BE COMPLETED AND SIGNED,OR I CERT. OF INSURANCE ATTACHED �' WORKER'S COMF'. AF'FIDAVTI'SIGNED AND ATTACH�D Town of Yarmouth t�es and liens must be paid prior to renewal or issuance of your pernuts. PLEASE CHECK APPROPRLATELY IF PAID: � YES NO .�:_._� __ _ —_ NOTICE:Permits run annually&om January 1 to December 31. IT IS YOUR RESPONSIBII.ITY TO RET[JRN � THE COMPLETED APPLICATION(S)AND REQUIRED FEE(S)BY DECEMBER 31,2000. ` f SEASONAL ESTABLISI-IMENTS ARE TO CONTACT Tf�HEALTH DEPARTMENT FOR INSPECCION 7-10 ' DAYS PRIOR TO OPENING FOR TI-IE SEASON. ALL RENOVAITONS TO ANY FOOD ESTABLISHMENT, MOTEL OR POOL (i.e., PAINTING, NEW EQUIPMENT, ETC.), MUST BE REPORTED TO AND APPROVED BY TF�BOARD OF HEALTH PRIOR TO COMMENCEMENT. RENOVATIONS MAY REQUIRE A SITE PLAN. AnniTtoNAL REGULATIONS POOLS POOL OPENING:All swimming,wading and whirlpools which have been closed for the season must be inspected j by the Health Department,and the water tested for pseudomonas,total coliform and standard plate count by a State . ___. cerhfied lab,pnor to opening, and quarterly thereafter. POOL CLOSING:Every outdoor in ground swimming pool must be drained or covered within seven('n days of ` closing. I I FOOD SERVICE � NEW STATE S�NIT�Y CODF FOR FOOD ESTABLISHMFNTS• i The effective date for food pmtection manager certificaHon is OMober 1, 2001. As stated in 105 CMR I 590.003(Ax2), food establistunents must have at least one person-in-charge who is a certified food protec6on manager. This provision is effective one year from the date of promulgation of 105 CMR 590.000. i The effective date for consumer advisory is January 1,2001. As stated in 105 CMR 590.000(K),enforcement ' of Consumer advisory,Food Code 3-603.11,will be implemented January 1,2001. Only establishments which sell or serve ready-to-eat,raw or undercooked animal products are required to have consumer advisories. CATEIZiNG POLT_CY• Anyone who caters within the Town of Yarmouth must notify the Yarmouth Health Depariment by filing the required Temporary Food Service Application form 72 hours prior to the catered event. Thses forms can be obtamed at the Health DePartment. _ _ — _ _. _ _--- _ -- ----- - -- __ _ I FRO .F,N D . •RTS: I 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 wiil result in the suspension or revocation of your Frozen Dessert Permit unril the above terms have been met. O D �. Fi'. : Outside cafes(i.e.,outdoor seating with waiter/waitress service),�S have prior approval from the Board of Health. oIT7'DOOR COOKING: Outdoor cooking,preparation,or display of any food product by a retail or food service establishment is prohibited. DATE: S� a'D SIGNATURE: � PRINT NAME& TITLE: r�J/"� l. 11/16/00 • ` �\ The Commonweolth ojMassachusetts W Department ajlndustrial,-1 ccidenu s o Y//ICOO/�YIWY1l� 600 Washington Srreet : Boston, Mass. 02111 W'orkers' Compensation Insurance Affidavit ARplicant informallon: PfeauPRIHT7e�it namc:�N��'� l' �/�/JlA�/r� �O.vS �L�A i64QSS�l/�CJiC .�f� location: �x � ��' y � . �� J'!Q�{rJ'j��Ll . 1�� iLGY phoneN�d� '/��7�/�7 � 1 am a homeowner pzrtormin�work myself. , � I am a sole propnetor�-d hace no one��orking in an} capacih� I am an emp{oyer pro�iding workers' compensation for my emplovees workine on thislob.__ /` - - -- —__ compam� name• /3/9-81' �1�� /�-�^J - ��- I,ira55' i/� �2.�5�� .. �- �/f2�U� '�,/L Y �L�-� �phone H: .5��7��Y insur�nce co �,6-/'.-1d/V Jv✓�' ��7 policv 1+ �i�/ �C2�a / 2.3� � I am a sole proprietor. general contractor,or homeowner(cirde onel and hace hired the contractors listed below �cho ha�e thz follo�cin�«orker' �ompensation polices: comFsnv n+m • addre s• ��• phone p• . in s u ra n ce co pelicr•# tom�v name• -_. -- - --- -- --- -_.__ _ _ - - ada �y- phoee N• — inu�ronrw wn �p�(N x Failure to secure covenge aa required under Seetloo 25A of MGL IS2 n�lad to lie i�paitloe Merisiol pndtla of�e�e ap to 51,500.00 a�d/or ooe ynn•imprisonmrnt.0 w�dl as eivil peo�ltla io the torm of�STOP WORK ORDER�b�Ru of 5100.00�d�y qaiast ma I a�dmu�d H�t• eopy ot thh shlemrnt may br lonv�rded ro the ORce of Invatigatlooe of the DU for eovengt veri6aAw. /do hrreby cenij�•under rhe ains and penoitia ojpery'ury that�he injormatinn provided abuve is but aad cor►ect Signamrc � �1//S�� n . 9 Print name �rcS/.�/� �, 9'�Y� _ Phone M /��d'�'6/ , oRci�l use only do not write in ihi�ara to bt eompleted by cih w towo ollltial - ciry or rown: Y��DTQ _ permiNieeox M nBuildiog Department - ❑Liceosing Bo�rd ❑theck if immediarc response ie required � � 261 �SAcctmenb Offiee (508) 398-?231 pgt_ �HraltEDepartmeot connct person: pAone N:_ _ nOtAer Vn�neOlAS P1M _ _ . . . ,. . . .. .. >__ ._ TOWN OF YARMOUTH BOARD OF HEALTH PERMIT TO OPERATE A FOOD ESTABLISHMENT PERMIT NUMBER: #01-046 FEE: $25.00 In accordance with regulations promulgated wder authority of Chapter 94,Secrion 305A and Chapter 111,Section 5 of the General Laws,a pecmit is hereby granted to: Rarnctahle-Yarmnuth T.ions ( lnh 441 Ruck icland Roazi_ F4, South Yarm�nth Whose place of business is: Bass River Beach Snack Baz Type of business: Non-Profit Food Service To operate a food establishment in: Town of Yarmouth Permit expires: December 31_ 2001 BOARD OF HEALTH: �a�11. etled, �maac G�� z�. v� �� s�. �, � �liekad d :L'oa �f1a 'w�uc oulo.� ?�. February 7 ,2001 cc,c_s_- � o �C_ Bruce G. Murphy, MP R. CHO , Director of Health , �SS �i��' �Y�tCdl�'CC � � a� ` � � � G�3 C� C�L� �� z TOWN OF YARMOUTH BO�RD OF HEALTH APPLICATION FOR LICENSE/P'ER{MI1�= 200 ��1�� D E C 2 3 1999 * Please complete form and attach all necessary documents by December 31, 19��ailu H ALTH D eP t� the retum of your applicaxion packet. --------------------------__--�---�t-E►...��__--��1�.W��_w�---------------_—__—__�. NAME OF EST RT T4HMFNT� /,Sgss y��{�.Q/� Ajp,q c% �/�g� 7�,'T �'o�- 77/ �(�S � LQCATION DT]RFSS� o3.¢ss s.'e v c� /z t�c�i � 1�7LINGADD FS4� �f�!/ /Suc� /S'C-9-�D �t 1� �� LU ,I�A+?rrio�li ,�4 N N cL MINAGF,R'S N : /-. � / � .S /� YD �h TFT # re9--77/- 6?� ', MAILING nD F4C� 4 .9-�n..v .�s--s i-t/�o � ' POOL ---RTIFI ATION ------��_R�__��---��_��_�----�_�-- --. TLe pool supervisor must be certified as a Pool Operator, as re�uired by new State law. Please list the designated Pool Operator(s) and attach a copy of the certification to ttus form. 1. 2. - -- _ -- - - Pool operators must list a minimum of two employees currernly 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 wiN not use past years' records. You must provide new copies and maintain a file at your place of business. 1. 2. 3• 4. I H RTIFI ATION 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 muat provide new copies and maintain a file at your place of business. 1. 2 3. 4. RESTAL7RAI�1T SEATING: TOTAI,# NON�SMOKINL'i SEATS:TOTAL# - - _- _ ___ _________W__ OFFT E SF. nrn.v ----------------------__�.___� IADGING: LICENSE REQUIItED FE$ PERMIT# LICENSE REQUIRED FEE PERMIT# iI _B&B $50 _CABIN $50 _INN $50 _CAMP $50 _LODGE $50 _TRAII.,ER PARK $50 MOTEL $50 _SWIMMINGPOOL $SOea. FOOD SERVI F• _WHIltLPOOL $25ea. LICENSE REQUIRED FEE PERMIT# LICENSE REQUIRED FEE PERMIT# _0-100 SEATS $75 �CONTINENTAL $30 • _>100 SEATS $I50 I NON-PROFIT $25 YZk-�� _COMMON VICT. $50 _WHOLESALE $75 _ __ :R�T��Dtnn� '— -- � LICENSE REQUIRED FEE PERMIT# LICENSE REQUIRED FEE PERMIT# _<50 sq.ft. $45 _TOBACCO $2p _<25,000 sq.ft. $75 _FROZEN DESSERT $35 ! _>25,000 sq.ft. $Zpp NAMF AN E• $10 � AMOt7NT DUE _ $_;Z�� ""•"pLEASE TURN OVER AND COMPLEI'B OTHER SIDE OF FORM••••• � � - _ � � �_....�... _..._ ff ADMINISTRATION ' tJNDER CHAPTER 1$2, SECTION 25C, SUBSECTION 6, Tf�TOWN OF YARMOUTH IS NOW REQUIRED TQ HQLI�,�.SSUA�iCE OR RENEWAL OF ANY LICENSE OR PERMIT TO OPERATE A BUSINESS IF A PERS014 "OR EQIvIPANY DOES NOT HAVE A CERTIFICATE OF WORKER'S COMPENSATION INSURANCE. THE ATTACHED STATE WORKER'S COMPENSATION INSURANCE AFFIDAVIT i MUST BE COMPLETED AND SIGNED, OR ', CERT. OF INSURANCE ATTACHED � � WORKER'S COMP. AFFIDAVIT SIGNED AND ATTACHED i TOWN OF YARMOUTH TAXES AND LIENS MUST BE PAID PRIOR TO RENEWAL OR ISSUANCE OF I YOUR PERMITS. PLEASE CHECK APPROPRIATELY IF PAID: ` YES NO I NOTICE: PERNIITS RUN ANIVIJALLY FROM JANUARY 1 TO DECEMBER 31. TT IS YOUR � RESPONSIBII.ITY TO RE'TURN TI� COMPLETED APPLICATION(S) AND REQUIltED FEE(S) BY I DECEMBER 31, 1998.: SEASONAL ESTABLISHMENTS ARE TO CONTACT Tf�HEALTH DEPARTMENI'FOR INSPECTION 7-10 DAYS PRIOR Tp OPEIVING FOR TFIE SEASON. ALL RENOVATIONS TO ANY FOOD ESTABLISF�vviEEN'T, MOTEL OR POOL (i.e., PAINTING, NEW EQUII'MENT,ETC.),MUST BE 1tEPORTED TO AND APPROVED BY TI�BOARD OF HEALTH PRIOR TO COMNIENCEMENT. RENOVATIONS MAY REQUIItE A SITE PLAN. I �1 DITIONAi RFC'.Ln ATIONS POOLS � POOL OPENING: ALL SWIl4INIING, WADING AND WHIItLPOOLS WHICH HAVE BEEN CLOSED FOR TI-IE SEASON MUST BE INSPECTED BY TF�HEALTH DEPARTMENT, AND THE WATER TESTED FOR PSEUDOMONAS,TOTAL COLIFORM AND STANDARD PLATE COUNT BY A STATE CERTIFIED LAB; , PRIOR TO OPENING, AND QUARTERLY TI�REAFTER. , POOL CLOSING:EVERY OUTDOOR IN GROUND SWIMN�IING POOL MUST BE DRAINED OR COVERED WITHIN SEVEN(�DAYS OF CLOSING. FOOD SERVICE CA .RING POLICY: ANYONE WHO CATERS W1THIN Tf�TOWN OF YARMOUTH MUST NOT'IFY Tf�YARMOUTH HEALTH f DEPARTMENT BY FILING TF� REQUIItED TEMPORARY FOOD SERVICE APPLICATION FORM 72 I HOURS PRIOR TO Tf� CATERED EVENT. Tf�SE FORMS CAN BE OBTAINED AT TI-IE HEALTH i DEPARTMENT. FROZEI`T DESSERTS� FROZEN DESSERTS MUST BE TESTED ON A MONTHI.Y BASIS BY A STATE CERTIFIED LAB. TEST RESULTS MUST BE SENT TO Tf�HEALTH DEPARTMENT. FAILURE TO DO SO WII,L RESULT IN Tf� ' SUSPINSIONORREVOCATIONOFYOURFROZENDESSERTPERMTPUNTII,Tf�ABOVETERMSHAVE � BEEN MET. OUTGIDE Ct��S� OtTf SIDE CAFES(i.e., OtTI'DOOR SEATING WITH WAITER/WAI'TRESS SERVICE),�.T HAVE PRI�R �I APPROVAL FKOM Tf�BOARD OF HEALTH. � OUTi�00R COOKING: , OUTDOOR COOKING,PREPARATION, OR DISPLAY OF ANY FOOD PRODUCT BY A RETAIL OR FOOD SERVICE ESTABLISHMENT IS PROHIBITED. /J i� ; DATE: � SIGNATURE: o��u I PRINT NAME& TITLE: SG/G �S-' �' ll/12/99 � I h � � The Commonwealth ojMassachusetts = = Department ojlndustria/.-Iccidents _ a Omcea//s►sesa►yst/iis 600 Washington Slreet ' Boston. Mass. 02111 W'orkers' Compensation Insurance Affidavit Analicant informallon: P► n�epR -sa� aamc �n/ST /3L-��/J�i.1/`J L/Bil/S �L r/� loc�tion �/�S� �/l/�/l �--2 �C� c�c, s _ � �✓JZo�J"/� h'//�- o7—l�GY �noo a 77/�6�' � I am a homeoµner penurming all work myself. � I am a solz proprieror_r.,', h��e no one ��orkine in am capaein• �am an emplo�er pro�iding workers' compensation for my emptoyees workine on this job. �omnanv name: �f�/'S M/ST.q+SEC"�J'/.�41r�'/oonj L! Q'''�.� C L i1l� _ —_/_ — �Jdrecs• � �T��Jl�C�(`� ��`9nd��J� /"�y �N /�/(Ob�'.� � � cltY: nhen M• / ��v�� / insur.�,n«co. ,--�/�t/aw> >w c �p . �oi��y a GlC'3 �J�3 7 � I am a sole proprietor. general contractor, or homeowner(circle ond and hace hired the contractors listed below �.ho ha�e the follo��in; ��orkzr ;ompensation polices: snmpanv name: - address: cin: nhon �• ins�rancc to nelie�•# I ._. ..__ comoanvname: . . . . . . . . . .. . . . ----- - - - - . . .., . ._ --- --_.. _ __ __--- . . . _._ . iaddrese• _ � � --� � -- - - -- [i6': - �hQnelh ----- --- - _ � insutance co. poflev M • Faiiure to ateure coverqe u requfred uoder Seeaoo 8A o(MGL I52 n�iad to IYe i�paitlw o(eri�hd pndtles o(a O�e ap w SI¢00.00��d/or ooe ynn'imprisonmrnt u w�ell��eivil pendHea io Ihe form ot�STOP WORK ORDER��d t 6�t of SI00.00 a d�y qaiott m� 1��dmu�d tLat a eopy of thu shtement may be lorw��rded to t6e 011iee of Invatia�uom ott6e DIA tar eovera�e veriliatlo�. 1 do hrreby certijp un r�he ains an perta(ia ojp 'kry tha�!ht injormalion providtd abovt is bue and cor►ed Signaturc �/�23// /, �— �j�4 Print name �-L�.SL� -�, �� p�K 5 0� 7�� `"'�/ . oRcial use onl.� do no�wNte in this arn ro be completed by eity or�owo oflkial eiry or rowe: YA��Ta _ permiUlieenx M nBuildio`Dep�rtmeu[ �Lieeosio`Bo�rd �check if immediate response i�required 261 �Stlettmen'f 011iee (508) 398-7231 eat. �He��te Dep�rtmeat conuc�person: phone M:_ _ _ nOther TOWN OF YARMOUTH BOARD OF HEALTH PERMIT TO OPERATE A FOOD ESTABLISHMENT PERMIT NUMBER: Y2K-106 FEE: $25.00 In accordance with regulations promulgated under authoriry of Chaptcr 94,Section 305A and Chapter 11 I, Section 5 of the Genernl Laws,a permit is hereby ganted to: T ionc hih nf Ramctahle Rc Yarmouth 441 R �rk icland Rd- � Snuth Y rmo rth Whose place of business is: Bass 'ver Beach Snack Ba_* Type of business: Non-Pmfit Food S rvice To operate a food establishment in: Town of Y rmouth Pemut expires: December 31_ 2000 BOARD OF HEALTH:��n/. �et�g/.+, C'1�y��.�q�n n �oan Gc.7S'/u�[CGran�nIC.///•, �ice l.�iaa.,na �o�rt J. /�rown� l.�rk �a6,�l��a��yJd� � ✓l;��l � �9��,. Januarv 13 ,2000 _ _ —_ _ — Bmce G.Murphy,MP R.S HO Director of Health thr tore�_oin_ enga__ed in ajoint enterprise, and including the le¢al representativa of a deceased employer, or the recei�zr or trustee of an indi�idual . partnership. associacion or other legal entiry, employin¢empiocees. Ho«ever the u��ner of a d«elling liouse ha�ing not more than three apartments and who resides therein, or the occupant of the d��ellin� house �f another��ho emplo}s persons to do maintenance, construetion or rcpair work on such dwellin¢ house or un �ha _rounJs or buildins appurtenant thereto shall nut because uf such emplo�ment be deemed to be an emplo}er. �IGI_ �hapter I='_ ;ection _: als.� states tha[ ecen state or loc�l licensing agency shall withhold the issuance or rcnc��al of a license or permit to operate a business or to construct buildings in the commonw•ealth for an}• :�ppiicant �cho has not produced acceptabie ecidence of compliance with the insurance coverrge required. Additiunalh. neither the �ommrm�ealth nor am of its policical subdivisions shall emer into am�contract for the performance of public ��ork witil acceptable evidence of compliance with the insurance requirements of this chapter ha�e j be�n presented to the contr�cting authurin. i Apph..:nts Please till in the .vorkers' compensation affida�•it completely, by checking the box that applies to}•our situation and suppl�in_t cnmpam names. �ddress and phone numbers u all affidavits ma�- be submitted to the Department of Industriai Accidents for contirmation of insurance covera¢e. Also be sure to sign and date t6e atfidaci� The affida�it �hould be returned �o che cit} or to�rn that the application for the permit or license is being rcquested. ' not the Department of lndustrial .�ccidents. Should }ou ha��e any questions rcgardin¢the"1aw"or if you are required to obtain a ��orkers' compensation polic�. please call the Department at the number listed below. City or Towos Please be sure that the affidavi[ is comnkte and �rinted leaihlv. The I'fenam„rr,r ha� �r�,o�de�i a c„a�e ar rh� Mn��., �v . � �� c��,yf� , _ �� , � �� i DENTtIS-YARM ONAL HIGH SCH L - 1599 VARSITY I'OOTBALL SCI-II:,DUL�- � DATE OPPONENT 'E II�v Sat.., Sept. 18 Hingham Away 1:30 ' Fri., Sept. 24 Middleboro Home 7:00 '' Fri., Oct. 1 Plymouth-South Home 7:00 Fri., Oct. 8 Marshfield* Away 7:00 Fri., Oct 15 Whitman-Hanson* Home 7:00 Sat., Oct. 23 A.B. Williams Away 10:30 a.m. Fri., Oct. 29 Duxbury* Away 7:00 Fri.,Nov. 5 Sandwich* Home 7:00 Fri.,Nov. 13 Piymouth-North" Away 7:00 Thurs.,Nov. 25 Nauset* Home 10:00 am. *league game �Uc.c �-C/Z. — �ro�,� — i'�� 1��.s -� ��.�-Cr< _ �� ; � � , ,,�, .�.. " ,-�., t�•. �� .n �IZ )�� . (��nNSi 4�- �� ia #� t�,S�L+ao'�' \� � r�a �' / " �� . ��Z� f'✓L/"`� V l �„��=/v w��,y.� a� �`� nrst � ��,t1 � �y,�,,�e� _ Cow�� r4�-e� �G,� ��l� -�� u�.Q, 3�g_ ys8o �,�G� �.µ�'� 3qy g3g� h ,�- �� (� i v�� s 1 . � i _ � � � � j E � I � ^ c� 1 � �� . � � �� N y � a ' � � � v � � �, � a Z � � � ti G 4 �� e c h � m � r � o U j' `i. Tl " ti � � � r t /' .aj (' 7 � � � r L � 0 � � ` '' ' �? S' a � � � � � n > � rJ � \\ e � 6 � � � \'�� Q ,.a 1� r 4• �