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HomeMy WebLinkAboutSHAW'S - FOOD l Shawls 1070 - pnnoft 24 o-Aq- x--a ; --o Town of Barnstable BOARD OF HEALTH John T.Norman Board of Health Donald A.Gaudagnoli,M.D. Paul J.Canniff,D.M.D. MA F.P. Thomas Lee Alternate ;;( � 200 Main Street, Hyannis, MA 02601 Phone: (508) 862-4644 Fax: (508)790-6304 www.townofbarnstable.us Permit to Operate a Food Establishment In accordance with regulations promulgated under authority of 105 CMR 590.000 M.G.L. Chapter 94 Sections 305A, 305B, 146, 189 and 189A; Chapter 111,Sections 5 and 127A, a permit is hereby granted to: Permit No: 748 Issue Date: 01/01/2021 DBA: SHAW'S SUPERMARKET INC.#1598 OWNER: ALBERTSONS Location of Establishment: 1070 IYANNOUGH ROAD HYANNIS„ MA 02601 Type of Business Permit: SUPERMARKET Annual: YES Seasonal: IndoorSeating: 0 OutdoorSeating: 0 Total Seating: 0 FEES FOOD SERVICE ESTABLISHMENT: $250.00 YEAR. 2021 RETAIL FOOD: $285.00 COTTAGE FOOD OPERATION: Permit Expires: 12/31/2021 B&B-FULL BREAKFAST: CONTINENTAL BREAKFAST: MOMLE-FOOD: MOBILE-ICE CREAM: FROZEN DESSERT: Thomas A. McKean, RS, CHO, Health Agent FOR ESTABLISHMENTS WITH SEATING: PERMIT IS NOT VALID UNLESS ISSUED IN CONJUNCTION WITH A COMMON VICTUALER LICENSE Restrictions: In For Office.Us- Only- Initials: Town of Barnstable( Date Paid (p Amt Pd$�--•• BAMSTABLE. ; Inspectional Services v Check# CaWer Public Health Division j°rEn Ntp+a Thomas McKean, Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT DATE NEW OWNERSHIP RENEWAL NAME OF FOOD ESTABLISHMENT: c)Y) W S (� ADDRESS OF FOOD ESTABLISHMENT: O 7 D s, rtA 0 a(0O MAILING ADDRESS(IF DIFFERENT FROM ABOVE):�O O)C gt b I�� t l S_CPS31 E-MAIL ADDRESS: � J�• a P,((�TQ,1�1l��d4 ' '64' �Z ��03£�-�Oy� TELEPHONE NUMBER OF FOOD ESTABLISHMENT: &L L 7 - IDI I TOTAL NUMBER OF BATHROOMS: 0 WELL WATER:YES NO ... (ANNUAL WATER ANALYSIS REQUIRED) ANNUAL: /` SEASONAL: DATES OF OPERATION: / /_ TO 1 /_ NUMBER OF SEATS: INSIDE: _ OUTSIDE: TOTAL: O SEATING: MUST OBTAIN A COMMON VICTUALLER'S LICENSE FROM LICENSING DIV. ***OUTSIDE DINING REMINDER*** OUTSIDE DINING,MUST BE APPROVED BY THE HEALTH DIV.AND LICENSING,AND MEET OUTSIDE DINING REQUIREMENTS. IS WAIT STAFF PROVIDED FOR OUTSIDE DINING? IS AN AIR CURTAIN PROVIDED AT WAITSTAFF SERVICE DOOR(S). TYPE OF ESTABLISHMENT: (PLEASE CHECK ALL THAT APPLY BELOW) FOOD SERVICE RETAIL FOOD-ONLY required for TCS foods(foods requiring refrigeration/freezer) BED&BREAKFAST CONTINENTAL BREAKFAST COTTAGE FOOD INDUSTRY(formerly residential kitchen) MOBILE FOOD FROZEN DAIRY DESSERT'MACHINES ... (MONTHLY LAB ANALYSIS REQUIRED) CATERING ... (CATERING NOTICE REQUIRED BEFORE EVENT(SEE PAGE#2) fl *** SEASONAL,MOBILE & NEW FOOD ONLY*** REQUIRED TO CALL HEALTH DIV.FOR INSPECTION PRIOR TO PERMIT BEING ISSUED PLEASE CALL 508-862-4644 Q:\Applicaticn FormsTOODAPP 2020.doc OWNER INFORMATION: _ -— - - ------ FULL NAME OF APPLICANT r�� (��LCA , j�r . OWNER PHONE# ADDRESS CORPORATE OWNER: rk—e C CORPORATE NADDRESS0C1 & J' (OS 0" 1 P� Z $S76 g —`?Oct Co PERSON IN CHARGE OF DAILY OPERATIONS: CtA List (2) Certified Food Protection Managers AND at least(1)Allergen Awareness Certified Staff All FOOD ESTABLISHMENTS must have 1 Certified Food Protection Manager PER SHIFT. **ATTACH COPIES OF CERTIFICATES** The Health Div. will NOT use past years' records. You must provide new copies and POST THE CERTIFICATES at your food establishment. Certified Food Managers Expiration Date Allergen Awareness Expiration Date 1� �►WO 1. lftylb4mm, s a /Z �aa 2� --eVl?e ircQ la / a �� 4^k/ to/� SIGNATUR F APPLICANT DATE ***FOOD POLICY INFORMATION"* * SEASONAL FOOD SERVICE: All seasonal food establishments,including mobile trucks must be inspected by the Health Div. prior to opening!! Please call Health Div.at 508-862-4644 to schedule your inspection. Please call at least(7)days in advance. FROZEN DAIRY DESSERTS: Frozen desserts must be tested by a State Certified lab prior to opening and monthly thereafter, with sample results submitted to the Health Div. Failure to do so will result in the suspension or revocation of your Frozen Dessert Permit until the above terms are met. CATERING POLICY: Anyone who caters within the Town of Barnstable must notify theTown by fax or mail prior to catering event. You must complete a catering notice found at httu://www.townofbarnstable.us/healthdivision/applications.asp. OUTDOOR COOKING: Outdoor cooking,preparation,or display of any food product by a food establishment is prohibited. NOTICE: Permits run annually from January 1 st to Dec.3155 each calendar year. IT IS YOUR RESPONSIBILITY TO RETURN THE COMPLETED APPLICATION(S)AND REQUIRED FEES BY DEC 1st. Q:\Application FormsTOODAPP REV3-201S.doc I ►+ BOARD OF HEALTH Town of Barnstable John T.Norman Board of Health Donald A.Guadagnoli,M.D. IdA1L«1'A0 F.P.(Thomas)Lee Daniel Luczkow,Alternate 200 Main Street, Hyannis, MA 02601 Phone: 508 862-4644 Fax: 508 790-6304 www.townofbarnstable.us Permit to Sell Tobacco In accordance with regulations promulgated under authority granted by Sections 5,31 and 127A of the General Laws of the Commonwealth of Massachusetts and Chapter 371 of the Town of Barnstable Code, a permit is hereby granted to: Permit No: 748 Issue Date: 1/1/2021 DBA: SHAW'S SUPERMARKET INC.#1598 OWNER: ALBERTSONS Location of Establishment: 1070 IYANNOUGH ROAD HYANNIS, MA 02601 Type of Business Permit: Non-Flavored Annual Seasonal FEES YEAR: 2021 TOBACCO SALES: $85.00 Permit Expires: 12/31/2021 Thomas A. McKean, RS, CHO, Health Agent Restrictions: PLEASE POST CONSPICUOUSLY i Fnr Office U 'hi tla9 ffi Town of, Barnstable; =� d Hate Pgul' Amt.Ed$ - inspect Onal Service public,Health Division cheek#5!S-m1S� t' /_ a =Thomas Mc&ean,.Director. 200:Mani Street,I Iyanrus MA 0260 : 6f&6- 508=8024644. Fax:; 50$?90 6364 r TOBACCO:.,.ELTAIILISHMENT.:..PERMIT APPLICATION{Non-Flavored). `DATE_11/12/20 NEW BUSINESS. OWNERSHIP RENEWAL x . k Shaw's#1598 NAME OFTOBACCO'ESTABLISHMENT: ... ADDRESS OF TOBACCO ESTABLISHMENT;, 1070 lyannough Rd Hyannis MA 02601., MAILING ADDRESS(IF'DIFFERENT`FROM t1BOdEj PO Box 29096, MS-6531 Phoenix,AZ 85038 9096 E-MAIL ADDRESS NASC.Tax@safeway.com 508 775 ,7611 TELEPHONE NUMBShaw s SB Supermarkets,TABLISII ENT: (�>> p. .rkets, Inc. O NER's PH#.�;j;869 4326 UvuNE1t'S ADDRESS: .>.,,250 Parkcenter Blvd Boise, ID 83706 CORP,QRATE NAME.. Sha w's Supermarkets, Inc.� � ' CORPORATE"ADDRESS same as above CORPORATE`FID# ANNUAL: X! SEASONAL, _4 DATES:OF OPERA`fION DAYS CIOSED;EXCLUDING`HOL,IDAYS(EX;MONDAYS„„), n/a TOWN:OF BARNS,TABL=E':C4DE(MA:GENERAL_.LAV4'I 'TERNET, LINKSi - TOWN;OF BA'RNSTABLE TOBACCO:COD,ELINK:FOR CHAPTV,R-371 'lions //wwwecode3b0 com133996392: 1VIA GENERAL'LAW CHAPTER 276/SECTION 6 http�/Imale islature gov/Laws/Oerieral Aws/P Aft IV/Titlel/cliapter270/Section6 * xNEW BUSINESSESAND NEW OWNERS ONLY*#� 'REQUIRED TO CALL HEALTH DIVISION AGENT FOR AN INSPECTION PRIOR TO:PERMIT BEIlYGj ISSUED. TLEASE'GALL 50&375=6621 rt L'L APPLICANTS ARE REQUIRED,TO SIJBMTT THE FOLLOWING REQUIR);D D�?CUMENTS A F �; 1)F'r MA State Incenseto Sell C�gareftes 3) Ilt5 Federal Tax I©#I3ocument ' Z) MA State License to Sell Cigars and'SmokIng T,.obacco 4) Payment of Fees) see page,4< f _ SIGNATURE ......,_ _ _ [ !`^:.... a.:. .. ... PRINTED NAiYIE .. 1-tiffa n Carco. nDATE:` \/ .•9/.:��Q Q,1A*p atign f M'0TOBACCO APP N644i6t I2 5z e ry I S O r Tax s i ESTABLISHMENT'S NAME TOBACCO SALES' Employee Signature Form This form is for official use to indicate that the employee(s)of this establishment received and understood Chapter 37.1 of the Town of Barnstable Code and Chapter 270 Section 6 of the Massachusetts General Laws which describes the penalties for selling and/or giving tobacco products to any person under the age of twenty-one (21). Below is Section 371-9, of the Town of Barnstable Board of Health Regulation: Sales to Minors—C.371-9.Sale and Distribution of Tobacco Products. 1. No person shall sell or provide a tobacco product,as defined herein;to a person under The minimum legal sales age. The minimum legal sales age in the Town of Barnstable is 21 years of age. 2. Identification: Each person selling or distributing tobacco products,as defined herein, shall verify the age of the purchaser by means of a valid,government-issued photographic identification containing the bearer's date of birth that the purchaser is 2.1.years.old or older. Verification is required for any person under the age of 27. The employee(s)below received and understood Section 371-9 of the Town of Barnstable Board of Health Prohibition of Smoking Regulation and Chapter 270 Section 6 of the Massachusetts General Laws: o II 117121 Signature Printed Name Date ?igna�ture! Printed Name Date ({i iR (a DC'ItSCtV+� 6 t 6 1 Z .G ignat/i7e' Printed Name Date 71 Sign u e Printed Name Date „ 1Z Signs re Printed Na a Date Ngnature Printed Name Date �Ci rcm�c rh/_ N o rt,, a v I I 112 l Signattwdj Printed Name Date Q IApp)i.cationForms\TOBACCO APP-NooFavor 11-21-19.doe ESTABLISHMENT'S NAME TOBACCO SALES Employee.Signature Form. This form is for official use to indicate that the employee(s)of this establishment received and understood Chapter 371 .of the Town of Barnstable Code and Chapter 270 Section 6 of the Massachusetts General.Laws which describes the penalties for selling and/or giving tobacco products to any person under the age of twenty-one (21). Below is Section 371-9.of the Town of Barnstable Board of Health Regulation: Sales to Minors—.§371-9.Sale and.Distribution of Tobacco Products. 1. No person shall sell or provide a tobacco product; as defined herein,to a person under The minimum legal sales.age. The minimum legal sales age in the Town of Barnstable is 21 years of age. 2. Identification: Each person selling or distributing tobacco products,as defined herein, shall verify the age of the purchaser by means of a valid government-issued photographic identification containing the bearer's date of birth that the purchaser is 21 years old or older. Verification is required for any person under the age of 27. The employee(s)below received and understood Section 311-9 of the Town of Barnstable Board of .Health.prohibition of Smoking Regulation and Chapter 270;Section 6 of the Massachusetts General.Laws: `SignatufZ Printed Na Date f Signature Printed Name Date u 117Lal Signature Printed Name Date Signature Printed Name Date. Si e Date.(_rf'�2('M Signature Printed Name Date - Signature Printed Name Da e Q:\Applic don PormsMBACCO APP-NonFavor 112:1-1.9.doc FST.ABLISHMENT' NAME TOBACCOSALES Employee.'Signature Form This form is for official use to indicate.that the employee(s)of this establishment received.and understood.Chapter 371 of the Town of Barnstable Code and Chapter 270 Section 6 of the Massachusetts General Laws which describes the penalties for selling and/or giving tobacco products to any person under the age of twenty-one (21). Below is Section 371-9, of the Town of Barnstable Board of Health Regulation: Sales to Minors—4:371-9.Sale andDistribution of Tobacco Products. I. No person shall sell or provide a tobacco product,as defined herein,to a person under The minimum legal sales age. The minimum legal sales age in the Town of.Barnstable is 21 years of age. 2. Identification: Each person selling or distributing tobacco products,as defined herein, shall verify the age of the purchaser by means of a valid government-issued photographic identification containing the bearer's date of birth.that the.purchaser is 21 years old or older. Verification is required for any person under the age of 27. The.employee(s)below received and understood Section 371-9 of the Town of Barnstable Board of Health Prohibition of Smoking Regulation and Chapter 270 Section 6 of the Massachusetts General Laws: Signature Printed Name Date gnature Printed Name date ��1W/ w i m���atut S -fit Signature/ :Printed Name Date AdPcoITQLA . S nature PrintedNakne Date AO Si ,e — Printed Name D e-K., / 1 � l Si"nure Printed Nano Date r Signature Printed Name Date Q\Application Forms\TOBACCO APP-NonFavor 1-1-21-19,doc i ............................................. ....................................... ....................... .. . ....... dFSTABBLUOHMENT'S NAME TOBACCO SALES Employee Signature Form This form is for official use to indicate that the employee(s)of this establishment received and understood Chapter 371 of the Town of Barnstable Code and Chapter 270 Section 6 of the Massachusetts General Laws which describes the penalties for selling and/or giving tobacco products to any person under the age of twenty-one (21). Below is Section 37.1-9. of the Town of.Barnstable Board of Health Regulation: Sales to Minors— 371 9.Sale and Distribution of:Tobacco Products. 1. No person shall sell or provide a tobacco product, as defined herein,to a person under i The minimum Iegal sales age. The minimum legal sales age in the Town of.Barnstable. is 21 years of age. 2. Identification: Each person selling or distributing tobacco products,as defined herein,. shall verify the age of the purchaser by means of a valid government-issued photographic identification containing the bearer's date:of birth that the purchaser is 21 years old or older. Verification is required.for anyperson under the;age of 27. The employee(s)below received and understood Section 371-9 of the Town of Barnstable Board of Health Prohibition of Smoking Regulation and Chapter 270:Section 6 of the Massachusetts General.Laws: --M VW P'll 0 Had os- J0 V) f),56tO Signature Printed.Name Date he /2 Signature Printed Name Date Sign ture , Printed Name Date r y., foci 6 n ct f F t'ci rVt t al 1,5-(z Signatt>fe Printed Name Date t jmna. I IZ I Si ature Printed Name Da t A. 40le d) Si attire Printed Name U Date Signature Printed Name Date Q;\Application,Fonns\TOBACCO APP-NonFavor 11-21-19.doc r Commonwealth of Massachusetts Letter ID:L1556808000 o Department of Revenue Notice Date:November 5,2020 Geoffrey E.Snyder,Commissioner Account ID:CGL-11258835-090 co mass.gov/dor RETAILER LICENSE FOR SALE OF CIGARETTES I�II�III�IIII'��'�111,II�I(III'�11�11'�Irlllt'lll�i111y'll'�I'� STAR/SHAW S LICENSING STAR MARKETS COMPANY INC STAR#426 PO BOX 29096 MS#6531 PHOENIX AZ 85038-9096 Attached below is your Retailer License for Sale of Cigarettes(Form CT-3). Cut along the dotted line and display at your business location.At any time,you can log into your MassTaxConnect account at mass.gov/masstaxconnect to view and re-print a copy of this license. If you have any questions about your license,call us at(617)887-6367 or toll-free in Massachusetts at (800)392-6089,Monday through Friday,8:30 a.m.to 4:30 p.m. DETACH HERE -------------------------------------------------------------------------------------------------------------------------------------------------- vsF�, MASSACHUSETTS DEPARTMENT OF REVENUE Form CT-3 Retailer License for Sale of Cigarettes This license must be posted and visible at all times.The sale of tobacco products to anyone under 18 years of age is prohibited. STAR MARKETS COMPANY INC Account ID: CGL-11258835-090 SHAW'S#1598 Location ID: 11258835-0201 1070 IYANNOUGH RD License Number: 939759616 HYANNIS MA 02601-1871 This certifies that the taxpayer named above is licensed under Chapter 64C of the Massachusetts General Laws to sell at retail at the address shown above.This license is non-transferable and may be suspended or revoked for failure to comply with state laws and regulations. Effective Date: November 5,2020 Expiration Date: September 30,2022 • a . �cF1(41 Commonwealth of Massachusetts Letter ID:L0865085184 3 �• Department of Revenue Notice Date:February 2,2018 • r� A Christopher C.Harding,Commissioner Account ID:SLS-1 1 2 5 8 83 5-045 h A sYE_t df mass.gov/dor SALES AND USE TAX REGISTRATION CERTIFICATE III11`���lllll`�Ill�nl�'�'111'11111'dlnil�llll�'Ih�`I�I�Illlu STAR/SHAW S LICENSING STAR MARKETS COMPANY INC STAR MARKETS COMPANY INC PO BOX 29096 MS#6531 PHOENIX AZ 85038-9096 Attached below is your Sales and Use Tax Registration Certificate(Form ST-1).Cut along the dotted line and display at your place of business.You must report any change of name or address to us so that a revised ST-1 can be issued. At any time,you can log into your MassTaxConnect account at mass.gov/masstaxconnect to view and re-print a copy of this certificate. DETACH HERE MASSACHUSETTS DEPARTMENT OF REVENUE Form ST-1 ' Sales and Use Tax Registration Certificate 9�t �4 This registration must be posted and visible at all ��:YT ilk times. STAR MARKETS COMPANY INC Account 1D: SLS-11258835-045 SHAW S#1598 Location ID: 11258835-0199 1070 IYANNOUGH RD Certificate Number: 453318656 HYANNIS MA 02601-1871 This certifies that the taxpayer named above is registered under Chapters 62C, 64H and 64I of the Massachusetts General Laws to sell tangible personal property at retail or for resale at the address shown above.This registration is non-transferable and may be suspended or revoked for failure to comply with state laws and regulations. Effective Date: September 8, 1994 0 Town of Barnstable BOARD OF HEALTH John T.Norman Board of Health Donald A.Gaudagnoli,M.D. easris AOM Paul J.Canniff,D.M.D. a 1 200 Main Street, Hyannis, MA 02601 F.P. Thomas Lee Alternate Phone: (508) 862-4644 Fax: (508)790-6304 www.townofbarnstable.us Permit to Operate a Food Establishment In accordance with regulations promulgated under authority of 105 CMR 590.000 M.G.L. Chapter 94 Sections 305A, 305B, 146, 189 and 189A; Chapter 111,Sections 5 and 127A, a permit is hereby granted to: Permit No: 748 Issue Date: 12/10/2019 DBA: SHAW'S SUPERMARKET INC.#1598 OWNER: ALBERTSONS Location of Establishment: 1070 IYANNOUGH ROAD HYANNIS, MA 02601 Type of Business Permit: SUPERMARKET Annual: YES Seasonal: IndoorSeating: 0 Outdoor5eating: 0 Total Seating: 0 FEES FOOD SERVICE ESTABLISHMENT: $250.00 YEAR. 2020 RETAIL FOOD: $285.00 COTTAGE FOOD OPERATION: Permit Expires: 12/31/2020 B&B-FULL BREAKFAST: CONTINENTAL BREAKFAST: MOBILE-FOOD: MOBILE-ICE CREAM: Q� FROZEN DESSERT: _ Thomas A. McKean, RS, CHO, Health Agent TOBACCO SALES: FOR ESTABLISHMENTS WITH SEATING: PERMIT IS NOT VALID UNLESS ISSUED IN CONJUNCTION WITH A COMMON VICTUALER LICENSE Restrictions: �o oD I SGI 8 -`-� �•�"'E'�I.� Town of Barnstable For Office Use Only* Initials: Date Paid 1 Amp!]$�ov BAMSTMM Inspectional ServicesKAM Check S18-o0l 200 7 4 tl Public Health Division Thomas McKean,Director ` 200 Main Street, Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT DATE NEW OWNERSHIP RENEWAL NAME OF FOOD ESTABLISHMENT:`: -fnjC HCLr_ke-Is a mr_)an s , lnC • D/e,/A Saws `i59g ADDRESS OF FOOD ESTABLISHMENT:1070 1N&V1 70LkQk & �Ioiflis MA 02(co l MAILING ADDRESS(IF DIFFERENT FROM ABOVE): PO Box 29096,MS-6531 Phoenix,AZ 85038-9096 E-MAIL ADDRESS: NASC.Tax@safeway.com TELEPHONE NUMBER OF FOOD ESTABLISHMENT: &g -7 7$ - 7 0 f TOTAL NUMBER OF BATHROOMS: Q WELL WATER:YES NO X ...(ANNUAL WATER ANALYSIS REQUIRED) ANNUAL:- X SEASONAL: DATES OF OPERATION: / / TO / 1 NUMBER OF SEATS: INSIDE: 0 OUTSIDE: 0 TOTAL: 0 SEATING: MUST OBTAIN A COMMON VICTUALLER'S LICENSE FROM LICENSING DIV. ***OUTSIDE DINING REMINDER*** OUTSIDE DINING,MUST BE APPROVED BY THE HEALTH DIV.AND LICENSING,AND MEET OUTSIDE DINING REQUIREMENTS. IS WAIT STAFF PROVIDED FOR OUTSIDE DINING? N/A IS AN AIR CURTAIN PROVIDED AT WAITSTAFF SERVICE DOOR(S)? N/A TYPE OF ESTABLISHMENT: (PLEASE CHECK ALL THAT APPLY BELOW) FOOD SERVICE X RETAIL FOOD-ONLY required for TCS foods(foods requiring refrigeration/freezer) BED&BREAKFAST CONTINENTAL BREAKFAST COTTAGE FOOD INDUSTRY(formerly residential Idtchen) MOBILE FOOD FROZEN DAIRY DESSERT MACHINES ...(MONTHLY LAB ANALYSIS REQUIRED) CATERING... (CATERING NOTICE REQUIRED BEFORE EVENT(SEE PAGE#2) *** SEASONAL,MOBILE &NEW FOOD ONLY*** REQUIRED TO CALL HEALTH DIV.FOR INSPECTION PRIOR TO PERMIT BEING ISSUED PLEASE CALL 508-8624644 Q:\Apphcation FormsTOODAPP REV3-2019.doc w (yVVNER INFORMATION: FULL NAME OF APPLICANT Shaw's Supermarkets,Inc. SOLE OWNER: YES/NO OWNER PHONE# 623-869-4326 ADDRESS PO Box 29096,MS-6531 Phoenix,AZ 85038-9096 CORPORATE OWNER:Shaw's Supermarkets,Inc. CORPORATE ADDRESS: 250 Parkcenter Blvd Boise,ID 83706 PERSON IN CHARGE OF DAILY OPERATIONS: OM List(2) Certified Food Protection Managers AND at least(1)Allergen Awareness Certified Staff All FOOD ESTABLISHMENTS must have 1 Certified Food Protection Manager PER SHIFT. **ATTACH COPIES OF CERTIFICATES** The Health Div.will NOT use past years' records. You must provide new copies and POST THE CERTIFICATES at your food establishment. Certified Food Managers Expiration Date Allergen Awareness Expiration Date n a c� as 1. low�.l,�1mi✓1.G S � � a�(v � o?o� 1. � on' 2--Ka rw Pei(•cc. l a / l o i 9,3 11 ', Llvtl SIGNAT O APPLICANT DATE ***FOOD POLICY INFORMATION*** SEASONAL FOOD SERVICE:All seasonal food establishments,including mobile trucks must be inspected by the Health Div. prior to openine!! Please call Health Div.at 508-8624644 to schedule your inspection. Please call at least(7)days in advance. FROZEN DAIRY DESSERTS: Frozen desserts must be tested by a State Certified lab prior to opening and monthly thereafter, with sample results submitted to the Health Div. Failure to do so will result in the suspension or revocation of your Frozen Dessert Permit until the above terms are met. CATERING POLICY: Anyone who caters within the Town of Barnstable must notify theTown by fax or mail prior to catering event. You must complete a catering notice found at http://www.townofbarnstable.us/bealthdivision/applications.asi). OUTDOOR COOKING: Outdoor cooking,preparation,or display of any food product by a food establishment is prohibited. NOTICE: Permits run annually from January 1 st to Dec.31't each calendar year. IT IS YOUR RESPONSIBILITY TO RETURN THE COMPLETED APPLICATIONS)AND REQUIRED FEES BY DEC 1st. :1A lication FormsTOODAPP REV3-2019.doc Q PP Eor Office IT Only: Initials '"�"'' Town of Barnstable I i Date Paid; Amt_pd S... ... . U` Inspectional Services g- t r�-1A ,,motif Public Health Division Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 `, Office: 508-862-4644 Fax, 508-790-6304 4 T_OB�CCO._.ESTABLISHM EN:T_._PERMIT-APPLICATION..'°fhf on-Flavored), DATE 11/22/19., NEW BUSINESS OWNERSHIP RENEWAL X NAME OF TOBACCO ESTABLISHMENT:. Star Markets Company,Inc,DB1A Star#1598 ADDRESS OF TOBACCO ESTABLISHMENT:. 1070 Iyannough Rd Hyannis,;.MAw02.501 MAILING ADDRESS(IF DIFFERENT FROM ABOVE):, PO Box 29096,MS-6531.Phoenix,AZ 85038-9096 ........ NASC.Tax@safeway.com E E-MAIL ADDRESS:.. _...__ TELEPHONE NUMBER OF TOBACCO ESTABLISHMENT: 5( 08 ) 775 _ 7611 3 3` ?. t OWNER'S NAM: .Star Markets Company,Inc_ _. . OWNER'S PH#(623)869 4326 OWNER'S ADDRESS: 750 W Center St. West Bridgewater,MA 02379 ..... ? _ . _ ......._ .....—.. CORPORATE ADDRESS:; 250 Parkcenter Blvd. Boise,ID 83706 CORPORATE i , ANNUAL:,.,_...X_,..:... SEASONAL: DATES OF OPERATION: / / TO r. DAYS CLOSED EXCLUDING HOLIDAYS(EX.MONDAYS)_- T-OWN�OF-BARNSTABLE..CODE/MA_GENERAL LAW EMRNET.LINKS TOWN OF BARNSTABLE TOBACCO CODE LINK FOR CHAPTER 371-9. hMs,:I/.w-w-w,.eco.de3-6O.com/3.39963.92,.,. MA GENERAL LAW CHAPTER 270/SECTION 6: httus•//mggg slature gov/Laws/GenemiLaws/PartN/TitleI/Chwer270/Section6. ***NEW BUSINESSES AND NEW OWNERS ONLY REQUIRED TO CALL HEALTH DIVISION AGENT FOR AN INSPECTION PRIOR TO PERMIT BEING ISSUED. PLEASEiCALL�508-�75-6621_ z ALL APPLICANTS WING REQUIRED DOCUMENTS. 1) MA State License to Sell Cigarettes 3) IRS Federal Tax III#Document 2) MA State License to Sell Cigars and Smoking Tobacco 4) Payment of Fee(s) -see page 4 SIGNATURE: _.. _. �- ..:. . ... . . ... . ,,,., "__& PRINTED NAME: L�..... DATE., Q:1Application Focros\TOBACCO APP-NonFavor 11-21-19.doc Town of Barnstable For Office Use Only: Initials: Inspectional Services Check#d � snRrrsrnB�, $ Mnss. i659, ON, Public Health Division 200 Main Street,Hyannis MA 02601 Office: 508-7904644 Thomas A.McKean,RS,CHO FAX: 508-790-6304 Director of Public Health Fee: $85.00 MAIL TO:TOWN OF BARNSTABLE PUBLIC HEALTH DIVISION 200 Main Street HYANNIS,MA 02601 FAX 508 790-6304 PLEASE INCLUDE THE REQUIRED FEE OF$85.00 APPLICATION FOR A TOBACCO SALES PERMIT Shawl -*(5(7F ESTABLISHMENT NAME (DB/A) 1030 1 k1r10- I1 rlA 03-(00 ADDRESS OF BUSINESS PO Box 29096,MS-6531 Phoenix,AZ 85038-9096 MAILING ADDRESS (IF DIFFERENT FROM ABOVE) Shaw's Supermarkets,Inc. NASC.Taxna,safeway.com 623-869-4326 Do you currently possess a state license to sell tobacco products? Yes X No Each employee who sells tobacco products must receive and understand Chapter 371 of the Town of Barnstable Code (copy provided herein) and the Massachusetts General Law Chapter 270, Section 6.00 (a copy is provided on the next page). Each employee who sells tobacco products must sign the Employee Signature Form (provided herein). Signature Date jjjq 11 ' d- C:\Users\decollik\AppData\Local\Microsoft\Windows\lNetCache\Content.Outlook\YZOF4J38\TOBACCO APP2019 dob.docx I , Rtse Commonwealth of Massachusetts pip -�* Department ofRevenue Later ID:L1271165568 5N�; Notice Date:September 17,2018 �'m + Christopher C.Harding,Commissioner Recount ID:CGL-11253835-090 ,I,N� � ore mass.gov/dor RETAILER LICENSE FOR SALE OF CIGARETTES ulllilitintl Iiluhhdi. uWr�Illlli� Plll�hdntr STAR/SHAW'S LICENSING STAR MARKETS COMPANY INC STAR MARKET#136-7426 PO BOX 29096 MS#6531 PHOENIX AZ 85038-9096 Attached below is your Retailer License for Sale of Cigarettes(Form CT-3T). Cut along the dotted line and display at your business location. At any time,you can log into your MassTaxConnect account at mass.gov/masstaxconnect to view and re-print a copy of this license. If you have any questions about your license,call us at(617) 887-6367 or toll-free in Massachusetts at (800)392-6089, Monday through Friday, 8:30 a.m. to 4:30 p.m. DETACH HERE MASSACHUSETTS DEPARTMENT OF REVENUE Form CT-3T Retailer License for Sale of Cigarettes M. ;! 7 This license must be posted and visible at all times.The sale of tobacco products to anyone under 18 years of age is prohibited. STAR MARKETS COMPANY INC Account ID: CGL-11258835-090 SHAW'S#1598 Location ID: 11258835-0201 1070 IYANNOUGH RD License Number: 1057753088 HYANNIS MA 02601-1871 This certifies that the taxpayer named above is licensed under Chapter 64C of the Massachusetts General Laws to sell at retail at the address shown above.This license is non-transferable and may be suspended or revoked for failure to comply with state laws and regulations. Effective Date: October 1,2018 Expiration Date: September 30,2020 .S. �t�s ��y�Aviv►s �1 ESTABLISIINIENT'S NAME TOBACCO SALES ~? Employee Signature Form This form is for official use to indicate that the employee(s) of this establishment received and understood Chapter 371 of the Town of Barnstable Code and Chapter 270 Section 6 of the Massachusetts General Laws which describes the penalties for selling and/or giving tobacco products to any person under the age of twenty-one (21.), Below is Section 371-9. of the Town of Barnstable Board of Health Regulation: Sales to Minors— Sale and Distribution of Tobacco Products 1. No person shall sell or provide a tobacco product, as defined herein,to a person under The minimum legal sales age. The minimum legal sales age in the Town of Barnstable f I is 21 years of age. 2. Identification: Each person selling or distributing tobacco products,as defined herein, I shall verify the age of the purchaser by means of a valid government-issued photographic identification containing the bearer's date of birth that the purchaser is 21 years old or older. Verification is required for any person under the age of 27. , The employees) below received and understood Section 371-9 of the Town of Barnstable Board of Eealth Prohibition of Smoking Regulation and Chapter 270 Section 6 of the Massachusetts General Laws: 1�I�l�Di✓i-� Nc�i`�lo i I �� 206 Printed hJ�(ame Date - Si natur Printed Name -- — ---_----.----_.___._ Date: Signature Printed Name Date Signature Printed Name Date axA�__ -.-.__ J _ _(Lk? _ Sipatv e P.rinted 1 me Date Aj Sl. iature Printed Name Date Si nature Print Name D to Q\Application Ftrms,TOBACCO APP-NonFavor 1 1-21-14.doc I 4_ y ,S N_�i�s _�I Yr9 'tiJ�s rs ESTAR.L:I.SHMENrS NAME ury TOBACCO SAILES i- Employee Signature Form ' This form is for official use to indicate that the employee(s)of this establishment received and understood Chapter 371 of the Town of Barnstable Code and Chapter 270 Section 6 of the Massachusetts General Laws which describes the pena.V,ies for selling and/or giving tobacco products to any person under the age of twenty-one (21). Below is Section 371-9. of the Town of Barnstable Board of Health Regulation: Sales to Minors—k 372-9.Sale and Distribution of Tobacco Products, I. No person shall sell or provide a tobacco product, as defined herein,to a person under The minimum legal sales age. The minimum legal sales age in the Town of Barnstable. i is 21 yearn of age. ' 2. identification: Each person selling or distributing tobacco products,as defined herein, shall verify the age of the purchaser by means of a valid govemment-issued photographic identification containing the bearer's date of birth that the purchaser is 21 years old or older. Verification is required for any person under the age of.27. � The employee(s)below received and understood Section 371-9 of the Town of Barnstable Board of Health Prohibition of Smoking Regulation and Chapter 270 Section 6 of the Massachusetts General La-,vs: u inn Stgnatarc Printed Nate I? to Signature Printed Name I Date Sign true Printed Name Date u7t�o �Jxl kw4p s Sign re UPrinted Name Date _._... t Printed Nam Da / �7 i ature Printed Name Dat Ignatu.re Printed Name Date QAAppl ication Forms1TOBACCO APP-Noi*avor I 1-21-19.doc + _AWs j�y�u�uiS_ VFSTAIiLIStIMF;NT'S hAl<IE; r TOBACCO SALES Employee Signature Form This farm is for official use to indicate that the employee(s) of this establishment received and understood Chapter 371 of the Town of Barnstable Code and Chapter 270 Section 6 of the Massachusetts General. Laws which describes the penalties for selling and/or giving tobacco products to any person under the age of twenty-one (?1). Below is Section 371-9, of the Town of Barnstable Board of Health Regulation: Sales to Minors—§37.1-9. Sale and Distribution of Tobacco Products � 1. No person shall sell or provide a tobacco product, as defined herein,to a person under The minimum legal sales age. The minimum legal sales age in the Town of Barnstable ' 1 is 21 years of age. I 2. Identification: Each person selling or distributing tobacco products,as defined herein, shall verify the age of the purchaser by means of a valid government-issued photographic identification containing the bearer's date of birth that the purchaser is 21 years old or older. Verification is required for any person under the age of 27. The employee(s)below received and understood Section 371-9 of the Town of Barnstable Board of Health Prohibition of Smoking Regulation and Chapter 270 Section 6 of the Massachusetts General Latin=s: Signature Printed Name Date Nwu JL-ewl� 30 /0 Signa" rinted Name Date Sig t Vri ted amc Date /1,,, //7 iv 4�i / ho YSign tare Printed Namc Date 4 . __�_ L�cj cL� JcwytS G Signat Printed Name -Date Signature Printed Name DD t� rIA 4 -,M A A-/\- M,Q MeLMUCA- ti �aiatlq Signat Panted Nam Date QAApplication Porms\FOBACCO APP-NonFavor 1 1-21-19.doc 1-T� ESTABLISHMENT'S NAME TOBACCO SALES Employee Signature Form r 4, This form is for official use to indicate that the employee(s) of this establishment received and understood Chapter.371 of the Town of Barnstable Code and Chapter 270 Section 6 of the Massachusetts General Laces which describes the penalties for selling and/or giving tobacco products to any person under the age of twenty-one (211). Below is Section 371-9. of the Town of Barnstable Board of Health Regulation; Sales to Minors— 37.1-9. Sale and Distribution of Tobacco Products. 1. No person shall sell or provide a tobacco product, as defined herein,to a person under I The minimum legal sales age. The minimum legal sales age in the'Town of Barnstable { is 21 years of age. f 2. Identification: Each person selling or distributing tobacco products,as defined herein, i shall verify the age of the purchaser by means of a valid government-issued photographic identification containing the bearer's date of birth that the purchaser is 21 years old or older. Verification is required for any person under the age of 27, The employee(s)below received and understood Section 371-9 of the Town of Barnstable Board of Health Prohibition of Smoking Regulation and Chapter 270 Section 6 of the Massachusetts General Laws: J , V66 Signature Printed Name Date ck� - T� X M�n Spy Signature Printed.Name Date -� Signature Printed.Name Date Signature Printed Name Date Signature Printed.Name Date Signature i -- Printed Name Date Signature Printed Name Date Q\Application PonnffOBACCO APP-NonFavor 1 1-21-19.doc Town of Barnstable BOARD OF HEALTH John T.Norman Board of Health Donald A.Guadagnoli,M.D. t: UARNSUD.Le, : Paul J.Canniff,D.M.D. t MA F.P. Thomas Lee Alternate 200 Main Street, Hyannis, MA 02601 Phone: (508) 862-4644 Fax: (508)790-6304 www.townofbarnstable.us Permit to Sell Tobacco In accordance with regulations promulgated under authority granted by Sections 5,31 and 127A of the General Laws of the Commonwealth of Massachusetts and Chapter 371 of the Town of Barnstable Code, a permit is hereby granted to: Permit No: 748 Issue Date: 1/1/2020 DBA: SHAW'S SUPERMARKET INC.#1598 OWNER: ALBERTSONS Location of Establishment: 1070 IYANNOUGH ROAD HYANNIS, MA 02601 Type of Business Permit: Non-Flavored Annual _ / Seasonal FEES YEAR: 2020 TOBACCO SALES: $85.00 Permit Expires: 12/31/2020 Thomas A. McKean, IRS, CHO, Health Agent Restrictions: PLEASE POST CONSPICUOUSLY 1 �1KIF Town of Barnstable BOARD OF HEALTH Paul 1 Canniff,D.M.D. Board of Health Donald A.Gaudagnoli,M.D. RAIMSrA LL John T. Norman MAS& F.P. Thomas Lee Alternate �q. 200 Main Street, Hyannis, MA 02601 r4 �� Phone: (508) 862-4644 Fax: (508)790-6304 www.townofbarnstable.us Permit to Operate a Food Establishment In accordance with regulations promulgated under authority of 105 CMR 590.000 M.G.L. Chapter 94 Sections 305A, 305B, 146, 189 and 189A; Chapter 111, Sections 5 and 127A, a permit is hereby granted to: Permit No: 748 Issue Date: 01/03/2019 DBA: SHAW'S SUPERMARKET INC.#1598 OWNER: SHAWS/ALBERTSON'S Location of Establishment: 1070 IYANNOUGH ROAD HYANNIS MA 02601 Type of Business Permit: SUPERMARKET Annual: YES Seasonal: IndoorSeating: 0 OutdoorSeating: 0 Total Seating: 0 ' FEES - - -- - - - -- - FOOD SERVICE ESTABLISHMENT: $250.00 YEAR: 2019 RETAIL FOOD: $285.00 COTTAGE FOOD OPERATION: Permit Expires: 12/31/2019 B&B-FULL BREAKFAST: CONTINENTAL BREAKFAST: - _-- MOBILE-FOOD: MOBILE-ICE CREAM: Q� FROZEN DESSERT: Thomas A. McKean, RS, CHO, Health Agent TOBACCO SALES: $85.00 FOR ESTABLISHMENTS WITH SEATING: PERMIT IS NOT VALID UNLESS ISSUED IN CONJUNCTION WITH A COMMON VICTUALER LICENSE Restrictions: ,,,E Town of Barnstable For Office UsYWfInitials: Date aid Amt Pd$ ' ^� PInspectional Services ° 16 My Public Health Division '` � Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 I l� Office: 508-862-4644 Fax: 508-790-6304 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISBT-RENT DATE 0/vi i e NEW OWNERSHIP RENEWAL NAME OF FOOD ESTABLISHMENT: .S / 1,-r.k.&-47 Co•+�a+ nor , .rift, p�1i�i¢ S a w's # l S 9 8 ADDRESS OF FOOD ESTABLISHMENT: 16 70 n rI o STAR MARKETS COMPANY,-INC. MAILING ADDRESS(IF DIFFERENT FROM ABOVE): P.O.Box 29096 MS#fsS ' ,'�, - - - -Phoenix,AZ 85038-50W E-MAIL ADDRESS: Nasc.tax@safeway.com TELEPHONE NUMBER OF FOOD ESTABLISHMENT: ���-- 7G// TOTAL NUMBER OF BATHROOMS: V WELL WATER:YES NO (ANNUAL WATER ANALYSIS REQUIRED) ANNUAL: SEASONAL: DATES OF OPERATION: / / TO NUMBER OF SEATS: INSIDE: OUTSIDE: TOTAL: .6f SEATING: MUST OBTAIN A COMMON VICTUALLER'S LICENSE FROM LICENSING DIV. ***OUTSIDE DINING REMINDER*** OUTSIDE DINING,MUST BE APPROVED BY THE HEALTH DIV.AND LICENSING AND MEET OUTSIDE DINING REQUIREMENTS. IS WAIT STAFF PROVIDED FOR OUTSIDE DINING?_ A/ IS AN AIR CURTAIN PROVIDED AT WAITSTAFF SERVICE DOOR(S)? Al- TYPE OF ESTABLISHMENT: (PLEASE CHECK ALL THAT APPLY BELOW) iOOD SERVICE RETAIL FOOD-ONLY required for TCS foods(foods requiring refrigeration/freezer) BED&BREAKFAST CONTINENTAL BREAKFAST COTTAGE FOOD INDUSTRY(formerly residential kitchen) MOBILE FOOD FROZEN DAIRY DESSERT MACHINES ... (MONTHLY LAB ANALYSIS REQUIRED) CATERING... (CATERING NOTICE REQUIRED BEFORE EVENT(SEE PAGE#2) 7TOBACC0 SALES ... (ANNUAL TOBACCO SALES APPLICATION REQUIRED) *** SEASONAL,MOBILE &NEW FOOD ONLY*** REQUIRED TO CALL HEALTH DIV.FOR INSPECTION PRIOR TO PERMIT BEING ISSUED Q:1Application FornsTOODAPPREV2018.doc PLEASE CALL 508-862-4644 OWNER INFORMATION: FULL NAME OF APPLICANT .S 4,1k /tea /ce�s �or�fJ a may, Tn c. SOLE OWNER: ' /NO OWNER PHONE# ADDRESS Z.s6 Pam t_c c n - 1 ar�, /30;.s e, ( D e?-2�76 CORPORATE OWNER: C �p o�..v . 2`nc. FEDERAL ID NO. : CORPORATE ADDRESS: Z r-y PERSON IN CHARGE OF DAILY OPERATIONS: List (2) Certified Food Protection Managers AND at least(1)Allergen Awareness Certified Staff All FOOD ESTABLISHMENTS must have 1 Certified Food Protection Manager PER SHIFT. **ATTACH COPIES OF CERTIFICATES** The Health Div.will NOT use past years' records.You must provide new copies and POST THE CERTIFICATES at your food establishment. Certified Food Managers Expiration Date ---Allergen Awareness Expiration Date 2. NAIL,- 0-/ ►Z / 14 ( 16 SIGNA OF APPLICANT DATE ***FOOD POLICY INFORMATION*** SEASONAL FOOD SERVICE:All seasonal food establishments,including mobile trucks must be inspected by the Health Div. prior to openin 11 Please call Health Div.at 508-862-4644 to schedule your inspection. Please call at least(7)days in advance. FROZEN DAIRY DESSERTS: Frozen desserts must be tested by a State Certified lab prior to opening and monthly thereafter, with sample results submitted to the Health Div. Failure to do so will result in the suspension or revocation of your Frozen Dessert Permit until the above terms are met. CATERING POLICY: Anyone who caters within the Town of Barnstable must notify theTown by fax or mail prior to catering event. You must complete a catering notice found at http://www.townofbarnstable.us/bealthdivision/applications asp. OUTDOOR COOKING: Outdoor cooking,preparation,or display of any food product by a food establishment is prohibited. TOBACCO ESTABLISHMENTS: All tobacco establishments must complete an Application for Tobacco Sales Permit and Employee Signature Form. NOTICE: Permits run annually from January 1 st to Dec.3 1"each calendar year. IT IS YOUR RESPONSIBILITY TO RETURN THE COMPLETED APPLICATION(S)AND REQUIRED FEES BY DEC 1st. Q\Application FomisT00DAPPREV2018.doc r .�TME ,os Town of Barnstable • snRr►sr,,s�, Regulatory Services Department Public Health Division F411' 200 Main Street, Hyannis MA 02601 Office: 508-790-4644 Thomas A McKcan,RS,CHO FAX: 508-790-6304 Director of Public Health Fee: $85.00 MAIL TO:TOWN OF BARNSTABLE PUBLIC HEALTH DIVISION 200 Main Street HYANNIS,MA 02601 FAX 508 790-6304 PLEASE INCLUDE THE REQUIRED FEE OF$85.00 APPLICATION FOR A TOBACCO SALES PERMIT LAST NAME OF APPLICANT FIRST NAME MIDDLE INITIAL DB/A / 070 -� Qny]o �9�i � .� rY4nn11, ,14,4 02-CO / STREET ADDRESS TELEPHONE# FID# Do you currently possess a state license to sell tobacco products? Yes ✓ No Each employee who sells tobacco products must receive and understand the Sections VII b. and VII c. of the Board of Health Prohibition of Smoking Regulation, (copy provided herein) and the Massachusetts General Law Chapter 270, Section 6.00 (a copy is provided-on the next page). Each employee who sells tobacco products must sign the ployee Signature Form (provided herein). Signatul*) Date Q:Wpplication Forms\TOBACCO APP2018 dob.docx I �s� �►s�o Commonwealth of Massachusetts Q � G Letter ID:L1271165568 aN Department of Revenue Notice Date:September 17,2018 90 m Christopher C.Harding,Commissioner Account ID:CGL-11258835-090 y "rk NTo1C& mass.gov/dor RETAILER LICENSE FOR SALE OF CIGARETTES nll �l��l� l�� lli�nh4il � nl�i �llli �ill�lll�lulnr STAR/SHAW'S LICENSING STAR MARKETS COMPANY INC STAR MARKET#136-7426 PO SOX 29096 MS#6531 PHOENIX AZ 85038-9096 Attached below is your Retailer License for Sale of Cigarettes(Form CT-3T). Cut along the dotted line and display at your business location. At any time,you can log into your MassTaxConnect account at mass.gov/masstaxconnect to view and re-print a copy of this license. If you have any questions about your license,call us at(617) 887-6367 or toll-free in Massachusetts at (800)392-6089, Monday through Friday, 8:30 a.m. to 4:30 p.m. I DETACH HERE •-------------------------------------------------------------------------------------------------------------------------------------------- r� �A °sF�r MASSACHUSETTS DEPARTMENT OF REVENUE Form CT-3T 7 Retailer License for Sale of Cigarettes Y � yFt�T& This license must be posted and visible at all times.The sale of tobacco products to anyone under 18 years of age is prohibited. STAR MARKETS COMPANY INC Account ID: CGL-11258835-090 SHAW'S#1598 Location ID: 11258835-0201 1070 IYANNOUGH RD License Number: 1057753088 HYANNIS MA 02601-1871 This certifies that the taxpayer named above is licensed under Chapter 64C of the Massachusetts General Laws to sell at retail at the address shown above. This license is non-transferable and may be suspended or revoked for failure to comply with state laws and regulations. Effective Date: October 1,20I8 Expiration Date: September 30,2020 r— ESTABLISHIVIENT'S NA'AC TOBACCO SALES Employee Signature Form This form is for official use to indicate that the employee(s) of this establishment received and understood.Chapter 371 of the Town of:Barnstable Code and Chapter 270 Section 6 of the Massachusetts General Laws which describes :the penalties for selling ;and/or giving tobacco: products to any person under the age of twenty-one(2I). Below is Section.3.71-0.of the Town.of Barnstable Board of Health Regulation: Sales to Minors—§371-9.Sale and Distribution of Tobacco'Products I. No person shall sell or provide a tobacco product;as defined herein,to a person:under The minimum legal sales age. The minimum legal sales age in the Town.of Barnstable is Zl years of age. 2. Identification: Each person selling or distributing tobacco products;as defined herein, shall verify the age of the purchaser by means of a valid government-issued photographic identification containing the bearer's date of birth that the purchaser is:21 years old or older. Verification is required for any person under the age of 27. The following employee(s) received and understood Section 371-9 of the Town of Barnstable Board of Health Prohibition of Smoking Regulation and Chapter 270 Section 6 of the Massachusetts General.Laws: �' GSiC� 12 gna e \ Printed Name Date a, 111117dvfi ure Printed me Date Signature Printed Name Date Signature Printed Name Date Signature Printed.Name Date. l Si gna� � � P ' led e / :Date . a e Prime Name Date QAApp�tion F-cypsNTOBACCOA.PP2019&b.docx `pp VIE r, TOWN OF BARNSTABLE HEALTH wsPECTOR's Establishment Name: Date: Page: of ti OFFICE HOURS eARNSTAs�e.oi PUBLIC 0 N STREALTH ET RETSION 8:00-9:30 A.M. 3:30-4:30 P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified A : �•� HYANNIS, MA 02601 MON.-FRI. No Reference R-Red Item PLEASE PRINT CLEARLY �ptFO M0 e � 508-862-4644 FOOD ESTABLISHMENT INSPECTION REPORT Name � � Date �j Type of Ins ec io i O ation s Routin Address ��� Risk oo Re-inspection v Level a ai Previous Inspection C cb Telephone, Residential Kitchen Date: Mobile Pre-operation Owner HACCP Y/N Temporary Suspect Illness ° )o Caterer General Complaint Person in Charge(PIC) Time Bed&Breakfast HACCP In: Other Inspector Out: Each violation checked requires an explanation on the narrative page(s)and a citation of specific provision(s)violated. Violations Related to Foodborne Illness Interventions and Risk Factors(Red Items) Anti-Choking 590.009(E) ❑ Violations marked may pose an imminent health hazard and require immediate corrective Tobacco 590.009(F) ❑ A' Action as determined by the Board of Health. Allergen Awareness 590.009(G) ❑ FOOD PROTECTION MANAGEMENT ❑ 12.Prevention of Contamination from Hands 5-9 ❑ 1.PIC Assigned/Knowledgeable/Duties ❑ 13.Handwash Facilities EMPLOYEE HEALTH PROTECTION FROM CHEMICALS ❑2.Reporting of Diseases by Food Employees and PIC ❑ 14.Approved Food or Color Additives ❑ 3.Personnel with Infectious Restricted/Excluded ❑ 15. Toxic Chemicals FOOD FROM APPROVED SOURCE TIME/TEMPERATURE CONTROLS(Potentially Hazardous Foods) ❑4.Food and Water from Approved Source ❑ 16.Cooking Temperatures ❑5.Receiving/Condition ❑ 17.Reheating ❑6.Tags/Records/Accuracy of Ingredient Statements ❑ 18.Cooling ❑ 7.Conformance with Approved Procedures/HACCP Plans ❑ 19.Hot and Cold Holding PROTECTION FROM CONTAMINATION ❑ 20.Time Asa Public Health Control ❑ 8.Separation/Segregation/Protection REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) ❑ 9.Food Contact Surfaces Cleaning and Sanitizing ❑21.Food and Food Preparation for HSP ^ ❑ 10.Proper Adequate Handwashing CONSUMER ADVISORY ❑ 11.Good Hygienic Practices ❑22.Posting of Consumer Advisories Violations Related to Good Retail Practices(Blue Items) Total Number of Critical Violations (� ,� C Critical(C)violations marked must be corrected immediately. (blue&red items) (;J�11(� Corrective Action Required: ❑ No Yes Non-critical(N)violations must be corrected immediately or Overall Rating within 90 days as determined by the Board of Health. ❑ Voluntary Compliance ❑ Employee Restriction/Exclusion ❑ Re-inspection Scheduled ❑ Emergency Suspension C N Official Order for Correction: Based on an inspection today,the items ❑ Embargo ❑ Emergency Closure ❑ Voluntary Disposal ❑ Other: checked indicate violations of 105 CMR 590.000/Federal Food Code. 23.Management and Personnel (FC-2)(590.003) This report,when signed below by a Board of Health member or its agent A=Zero critical violations and no more.than 3 non-critical violations. F=3 or more critical violations.9 or more non-critical violations, 24.Food and Food Preparation (FC-3)(590.004) constitutes an order of the Board of Health. Failure to correct violations regardless of the number of critical,results in an F. 25.Equipment and Utensils (FC-4)(590.005) cited in this report may result in suspension or revocation of the food 6=One critical violation and less than non-critical violations if no critical violations observed,4 too 6 von-critical violations=B. Seriously Critical Violation=F is scored automatically if: no hot 26.Water,Plumbing and Waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If 27.Physical Facility (FC-6)(590.007) aggrieved by this order,you have a right to a hearing. Your request must C=2 critical violations and less than i non-critical. if no critical water,sewage back-up, infestation of rodents or insects,or lack of be in writing and submitted to the Board of Health at the above address violations observed,7 to anon-critical violations. If 1 critical refrigeration. 28.Poisonous or Toxic Materials (FC-7)(590.008) 9 violation,4 to anon-critical violations=C. 29.Special Requirements (590.009) within 10 days of receipt of this order. _ re Print:a 3 .D DATE OF RE-INSPECTION: Ins p 31um.Dumpster screened from public view IK�1,X1 Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y N #Seats Observed Frozen Dessert Machines: Outside Dining Y N PIC's Signature Print: Self Service Wait Service Provided Grease Trap Size Variance Letter Posted Y N I X Dumpster Screen? Y N t t ., . ..:.�.��_ ,...M,,. �.r_ ,��-„�.r.,., -` - - ....�.. -._-:�..w---.� r,.., -- � vim„-..w �J-- � �-,_..�w � _ +-. -. .. �- 3 _. _- .- � - _• __ -^,--_.- .-- .. : � .. - �,.-..�.-.< -•'�--- -,.. _� Violations related to Foodborne Illness Violations Related to Foodborne Illness Interventions Interventions and Risk Factors(Red Items 1-22) and Risk Factors(Red Items 1-22) (Cont.) FOOD PROTECTION MANAGEMENT PROTECTION FROM CONTAMINATION PROTECTION FROM CHEMICALS 3-501.14(C) PHFs Received at Temperatures According to 1 590.003(A) Assignment of Responsibility* 8 Cross-contamination 1 q Food or Color Additives Law Cooled to 41°F/45°F Within 4 Hours* * * 3-501.15 Cooling Methods for PHFs 590.003(B) Demonstration of Knowledge 3-302.11(A)(1) Raw Animal Foods Separated from 3-202.12 Additives Cooked and RTE Foods.* * 19 PHF Hot and Cold Holding 2-103.11 Person-in-Charge Duties 3-302.14 Protection from Unapproved Additives ' Contamination from Raw Ingredients 15 Poisonous or Toxic Substances 3-501.16(B) Cold PHFs Maintained At or Below 41°F/45°F EMPLOYEE HEALTH 3-302.11(A)(2) Raw Animal Foods Separated from Each 7-101.11 Ident ifying Information-Original Containers*7-102.11 Common Name-Working Containers 590.004(F) 2 590.003(C) Responsibility of the Person-in-Charge to Other* * 3-501.16(A) Hot PHFs Maintained At or Above 140°F* _ Require Reporting by Food Employees and Contamination from the Environment 3-501.16(A) Roasts Held At or Above 130°F* 7-201.1 l Separation-Storage* Applicants* 3-302.11(A) Food Protection* P g 20 Time as a Public Health Control 7-202.11 Restriction-Presence and Use* 590.003(F) Responsibility of A Food Employee or An 3-302.15 Washing Fruits and Vegetables 3-50].19 Time as a Public Health Control* Applicant To Report To The Person In Charge* * 7.202.12 Conditions of Use* 590.004 11 Variance Re uirements 590.003(G) Reporting by Person in Charge * 3-304.11 Food Contact with Equipment and Utensils 7-203.11 Toxic Containers-Prohibitions* ( ) q Contamination from the Consumer 3 590.003(D) Exclusions and Restrictions* 7-204.11 Sanitizers,Criteria-Chemicals* REQUIREMENTS FOR 3-306.14(A)(B)Returned Food and Reservice of Food* 7-204.12 Chemicals for Washing Produce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP 590.003(E) Removal of Exclusions and Restrictions Disposition of Adulterated or Contaminated g ) Food 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,lubricants* Beverages with Warning Labels* q Food and Water From Regulated Sources g Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs* 590.004(A-B) Compliance with Food Law* 4-501.111 Manual Warewashing-Hot Water 7.206.12 Rodent Bait Stations* 3-801.11(D) Raw or Partially Cooked Animal Food and 3-201.12 Food in a HermeticallySealed Container* Sanitization Temperatures* Raw Seed Sprouts Not Served* P 7-206.13 Tracking Powders,Pest Control and 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-Hot Water Monitoring* 3-801.11(C) Unopened Food Package Not Re-Served* 3-202.13 Shell Eggs* Sanitization Temperatures* TIMEITEMPERATURE CONTROLS 3-202.14 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. 16 Proper Cooking Temperatures for PHFs CONSUMER ADVISORY 3-202.16 Ice Made From Potable Drinking Water* Concentration and Hardness* 3-401.1]A(1)(2) Eggs-155°F 15 sec 22 3-603.11 Consumer Advisory Posted for Consumption of 4-601.11(A) Clean Utensils and Food Contact Surfaces of Eggs-Immediate Service 145°F 15 sec* Animal Foods That are Raw,Undercooked or Equipment 5-101.11 Drinking Water from an Approved System* * gg Not Otherwise Processed to Eliminate 590.006(A) Bottled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* Effective 11112001 4-602.11 Cleaning Frequency of Utensils and Food Animals-155°F 15 sec* 590.006(B) Water Meets Standards in 310 CMR 22.0* Contact Surfaces of Equipment* 3-302.13 Pasteurized Eggs Substitute for Raw Shell Shellfish and Fish From an Approved Source 3-401.1](B)(1)(2) Pork and Beef Roast-130°F 121 min* Eggs* 4-702.11 Frequency r f ces of qui of Utensils and Food 3-401.11(A)(2) Ratites,Injected Meats-155°F 15 sec* 3-201.14 Fish and Recreationally Caught Molluscan Contact Surfaces of Equipment* Shellfish* 4-703.11 Methods of Sanitization-Hot Water and 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS Stuffing Containing Fish,Meat,Poultry or 590.009(A)-(D) Violations of Section 590.009(A)-(D)in cater- 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* Ratites-165°F 15 sec* Sources* 10 Proper,Adequate Handwashing ing,mobile food,temporary and residential Game and Wild Mushrooms Approved By 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 145°F* kitchen operations should be debited under Regulatory Authority 2-301.11 Clean Condition-Hands and Arms* 3-401.12 Raw Animal Foods Cooked in a Microwave the appropriate sections above if related to 3-202.18 Shellstock Identification Present* 2-301.12 Cleaning Procedure* 165°F* foodborne illness interventions and risk factors. * 2-301.14 When to Wash* 3-401.11 A 1 b All Other PHFs-145°F 15 sec* Other 590.009 violations relating to good retail 590.004(C) Wild Mushrooms ( )( )( ) 3-201.17 Game Animals* 11 Good Hygienic Practices 17 Reheating for Hot Holding practices should be debited under#29-Special Requirements. 5 Receiving/Condition 2-401.11 Eating,Drinking or Using Tobacco* 3-403.11(A)&(D) PHFs 165'17 15 sec* 3-202.11 PHF's Received at Proper Temperatures* 2-401.12 Discharges From the Eyes,Nose and Mouth* 3-403.11(B) Microwave-165°F 2 Minute Standing Time* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES * 3-301.12 Preventing Contamination When Tasting* 3-403.11 C CommerciallyProcessed RTE Food-140°F* (Blue Items 23-30) 3-202.11 Package Integrity ( ) Critical and non-critical violations,which do not relate to the foodborne 3-101.11 Food Safe and Unadulterated* 12 Prevention of Contamination from Hands 3 403.11(E) Remaining Unsliced Portions of Beef Roasts* illness interventions and risk factors listed above,can be found in the 6 Tags/Records:Shellstock 590.004(E) Preventing Contamination from Employees* 18 Proper Cooling of PHFs following sections of the Food Code and 105 CMR 590.000 3-202.18 Shellstock Identification* 13 Handwashing Facilities 3-501.14(A) Cooling Cooked PHFs from 140°F to 70°F 3-203.12 Shellstock Identification Maintained* Conveniently Located and Accessible Within 2 Hours and From 70°F to 41°F/45°F Item Good Retail Practices FC 1590.000 Tags/Records:Fish Products 5-203.11 Numbers and Capacities* Within 4 Hours* 23. Management and Personnel FC-2 .003 * 5-204.11 Location and Placement* 3-501.14(B) Cooling PHFs Made from Ambient 24. Food and Food Protection FC-3 .004 3-402.11 Parasite Destruction Temperature Ingredients to 41°F/45°F 25. Equipment and Utensils FC-4 .005 3-402.12 Records,Creation and Retention* 5-205.11 Accessibility,Operation and Maintenance Within 4 Hours* 26. Water,Plumbing and Waste FC-5 .006 590.004(J) labeling of Ingredients* Supplied with Soap and hand Drying Devices 27. Physical Facility FC-6 .007 7 Conformance with Approved Procedures/ 6-301.11 Handwashing Cleanser,Availability 28. Poisonous or Toxic Materials FC-7 .008 HACCP Plans 6-301.12 Hand Drying Provision 29. Special Requirements 1.009 3-502.11 Specialized Processing Methods* 130. 1 Other 3-502.12 Reduced-Oxygen Packaging Criteria* r 8-103.12 Conformance with Approved Procedures* S:590Formback6-2doc *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. �F THE r TOWN OF BARNSTABLE HEALTH INSPECTOR'S Establishment Name: Date:'/0 �'a 1` Page:, of - 1 OFFICE HOURS PUBLIC HEALTH DIVISION 8:00-9:30 A.M. BARNSTABLE. : 200 MAIN STREET 3:30-4:30 P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified HYANNIS,MA 02601 soe-62 FRI. No Reference R-Red Item PLEASE PRINT CLEARLY p'FD""pye FOOD ESTABLISHMENT INSPECTION REPORT Name Date fA/ �I Tvoe of Ins ec ion v O er outi Address Risk o Re-inspection ��® ^ Level Previous Inspection Telephone Residential Kitchen Date: 4 �� J Mobile Pre-operation Owner HACCP Y/N Temporary Suspect Illness Caterer General Complaint Person in Charge(PIC) Time Bed&Breakfast HACCP In- Other Inspector S Out: � K, Each violation checked requires an explanation on the narrative page(s)and a citation of specific provision(s)violated. Violations Related to Foodborne Illness Interventions and Risk Factors Red Items ( ) Anti-Choking 590.009(E) ❑ Violations marked may pose an imminent health hazard and require immediate corrective Tobacco 590.009(F) ❑ Action as determined by the Board of Health. Allergen Awareness 590.009(G) ❑ vo FOOD PROTECTION MANAGEMENT ❑ 12.Prevention of Contamination from Hands ,^ c (� ❑ 1.PIC Assigned/Knowledgeable/Duties ❑ 13.Handwash Facilities �G �c EMPLOYEE HEALTH PROTECTION FROM CHEMICALS - ) Q ❑ 2.Reporting of Diseases by Food Employees and PIC ❑ 14.Approved Food or Color Additives ❑ 3.Personnel with Infectious Restricted/Excluded ❑ 15. Toxic Chemicals FOOD FROM APPROVED SOURCE TIME/TEMPERATURE CONTROLS(Potentially Hazardous Foods) ❑4.Food and Water from Approved Source ❑ 16.Cooking Temperatures ❑ 5.Receiving/Condition ❑ 17.Reheating tC-� CM ❑ 6.Tags/Records/Accuracy of Ingredient Statements ❑ 18.Cooling C ���� t e" ❑ 7.Conformance with Approved Procedures/HACCP Plans ❑ 19.Hot and Cold Holding \ PROTECTION FROM CONTAMINATION ❑20.Time As a Public Health Control ❑ 8.Separation/Segregation/Protection REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) ❑ 9._Food Contact Surfaces Cleaning and Sanitizing ❑21.Food and Food Preparation for HSP ❑ 10.Proper Adequate Handwashing CONSUMER ADVISORY ❑ 11.Good Hygienic Practices ❑ 22.Posting of Consumer Advisories Violations Related to Good Retail Practices(Blue Itemsj Total Number of Critical Violations Critical(C)violations marked must be corrected immediately. (blue&red items) I Corrective Action Required: ❑ No ❑ Yes Non-critical(N)violations must be corrected immediately or Overall Rating within 90 days as determined by the Board of Health. ❑ Voluntary Compliance ❑ Employee Restriction/Exclusion ❑ Re-inspection Scheduled ❑ Emergency Suspension C N Official Order for Correction:Based on an inspection to , he items ❑ Embargo ❑ Emergency Closure Voluntary Disposal Other: checked indicate violations of 105 CMR 590.000/Federal Food Code. 23.Management and Personnel (FC-2)(590.003) This report,when signed below by a Board of Health member or its agent A=Zero critical violations and no more than 3 non-critical violations. F=3 or more critical violations.'9 or more non-critical violations, 4.Food and Food Preparation (FC-3)(590.004) constitutes an order of the Board of Health. Failure to correct violations regardless of the number of critical,results in an F. 6=One critical violation grid less than 4non-critical violations 9 25.Equipment and Utensils (FC-4)(590.005) cited in this report may result in suspension or revocation of the food if no critical violations observed,4 to 6von-critical violations=B. y y 26.Water,Plumbing and Waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If I Serious) Critical Violation=F is scored automatically If: no hot C=2 critical violations and less.than 9 non-critical. If no critical water,sewage back-up,infestation of rodents or insects,or lack of 27.Physical Facility (FC-6)(590.007) aggrieved by this order,you have a right to a hearing. Your request must 28.Poisonous or Toxic Materials (FC-7)(590:008) be in writing and submitted to the Board of Health at the above address violations observed,,?to anon-critical violations. If 1 critical refrigeration. violation,4 to Snon-critical violations C. 29.Special Requirements (590.009) within 10 days of receipt of this order. = 3 .Other PATE OF RE-INSPECTION: Inspe ) to 31.Dumpster screened from public view Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y N ✓�' #Seats Observed Frozen Dessert Machines: Outside Dining Y N PIC's Sign atu Print: / Self Service Wait Service Provided Grease Trap Size Variance Letter Posted Y N Dumpster Screen? Y N I Violations related to Foodborne Illness Violations Related to Foodborne Illness Interventions Interventions and Risk Factors(Red Items 1-22) and Risk Factors(Red Items 1-22) (Cont.) FOOD PROTECTION MANAGEMENT PROTECTION FROM CONTAMINATION PROTECTION FROM CHEMICALS 3-501.14(C) PHFs Received at Temperatures According to 1 590.003(A) Assignment of Responsibility* 8 Cross-contamination 1 q Food or Color Additives Law Cooled to 41°F/45°F Within 4 Hours* 590.003(B) Demonstration of Knowledge* 3-302.1'1'(A)(1) Raw Animal Foods Separated from 3-202.12 Additives* 3-501.15 Cooling Methods for PHFs Cooked and RTE Foods.* Additives* 19 PHF Hot and Cold Holding 2-103.11 Person-in-Charge Duties 3-302.14 Protection from Unapproved Contamination from Raw Ingredients 15 Poisonous or Toxic Substances 3-501.16(B) Cold PHFs Maintained At or Below 41°F/45°F EMPLOYEE HEALTH 3-302.11(A)(2) Raw Animal Foods Separated from Each * 590.004(F) 7-101.11 Identifying Information-Original Containers 2 590.003(C) Responsibility of the Person-in-Charge to Other* * 3-501.16(A) Hot PHFs Maintained At or Above 140°F* 7-102.11 Common Name-Working Containers Require Reporting by Food Employees and Contamination from the Environment 3-501.16(A) Roasts Held At or Above 130°F* * 7-201.11 Separation-Storage* Applicants 3-302.11(A) Food Protection* 20 Time as a Public Health Control 590.003(F) Responsibility of A Food Employee or An 3-302.15 Washing Fruits and Vegetables 7-202.11 Restriction-Presence and Use** 3-501.19 Time as a Public Health Control* - Applicant To Report To The Person In Charge* 7.202.12 Conditions of Use 3-304.11 Food Contact with Equipment and Utensils* 590.004(11) Variance Requirements 590.003(G) Reporting by Person in Charge* 7-203.11 Toxic Containers-Prohibitions* Contamination from the Consumer - 3 590.003(D) Exclusions and Restrictions* 7-204.11 Sanitizers,Criteria-Chemicals* REQUIREMENTS FOR 3-306.14(A)(B)Returned Food and AdulteReserrated or of Food* 7-204.12 Chemicals for WashingProduce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP 590.003(E) Removal of Exclusions and Restrictions Disposition ofAdulterated or Contaminated � ) Food 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels* q Food and Water From Regulated Sources 9 Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(13) Use of Pasteurized Eggs* 590.004(A-B) Compliance with Food Law* 4-501.111 Manual Warewashing-Hot Water 7.206.12 Rodent Bait Stations* 3-801.11(D) Raw or Partially Cooked Animal Food and 3-201.12 Food in a Hermetical) Sealed Container* Sanitization Temperatures* Raw Seed Sprouts Not Served* Y P 7-206.13 Tracking Powders,Pest Control and 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-Hot Water Monitoring* 3-801.11(C) Unopened Food Package Not Re-Served* 3-202.13 Shell Eggs* Sanitization Temperatures* TIME/TEMPERATURE CONTROLS 3-202.14 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. 16 Proper Cooking Temperatures for PHFs - CONSUMER ADVISORY 3-202.16 Ice Made From Potable Drinking Water* Concentration and Hardness* 3-401.11A(1)(2) Eggs-155°F 15 sec 22 3-603.11 Consumer Advisory Posted for Consumption of 5-101.11 Drinking Water from an Approved System* 4-601.11(A) Clean Eggs Utensils and Food Contact Surfaces of E s-Immediate Service 145°F 15 sec* Animal Foods That are Raw,Undercooked or Equipment* Not Otherwise Processed to Eliminate 590.006(A) Bottled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* Eg°"°°11112001 4-602.11 Cleaning Frequency of Utensils and Food Animals-155°F 15 sec* 590.006(B) Water Meets Standards in 310 CMR 22.0* Contact Surfaces of Equipment* 3-302.13 Pasteurized Eggs Substitute for Raw Shell Shellfish and Fish From an Approved Source 3-401.11(B)(1)(2) Pork and Beef Roast-130°F 121 min* Eggs* 3-201.14 Fish and Recreationally Caught Molluscan Contact Surf 4-702.11 Frequency Sanitization of Utensils and Food 3-401.11(A)(2) Ratites,Injected Meats-155°F 15 sec* aces of Equipment* Shellfish* 4-703.11 Methods of Sanitization-Hot Water and 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS Stuffing Containing Fish,Meat,Poultry or 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* g g � 590.009(A)-(D) Violations of Section 590.009(A)-(D)in cater- Sources* Ratites-165°F 15 sec* ing,mobile food,temporary and residential 10 Proper,Adequate Handwashing 3-401.11 C Game and Wild Mushrooms Approved By 2-301.11 Clean Condition-Hands and Arms* ( )(3) Whole-muscle,Intact Beef Steaks 145°F* kitchen operations should be debited under Regulatory Authority 3-401.12 Raw Animal Foods Cooked in a Microwave the appropriate sections above if related to 3-202.18 Shellstock Identification Present* 2-301.12 Cleaning Procedure* 165°F* foodborne illness interventions and risk factors. 590.004(C) Wild Mushrooms* 2-301.14 When to Wash* 3-401.11(A)(1)(b) All.Other PHFs-145°F 15 sec* Other 590.009 violations relating to good retail 3-201.17 Game Animals* 11 Good Hygienic Practices 17 Reheating for Hot Holding practices should be debited under#29-Special Requirements. 5 Receiving/Condition 2-401.11 Eating,Drinking or Using Tobacco* 3-403.11(A)&(D) PHFs 165°F 15 sec* 3-202.11 PHF's Received at Proper Temperatures* 2-401.12 Discharges From the Eyes,Nose and Mouth* _. 3-403.11(B) Microwave-165°F 2 Minute Standing Time* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3-202.15 Package Integrity* 3-301.12 Preventing Contamination When Tasting* 3-403.11(C) Commercially Processed RTE Food-140°F* (Blue Items 23.30) 12 Prevention of Contamination from Hands Critical and non-critical violations,which do not relate to the foodborne 3-101.11 Food Safe and Unadulterated* 3 403.11(E) Remaining Unsliced Portions of Beef Roasts* illness interventions and risk factors listed above,can be found in the 6 Tags/Records:Shellstock 590.004(E) Preventing Contamination from Employees* 1 g Proper Cooling of PHFs following sections of the Food Code and 105 CMR 590.000 3-202.18 Shellstock Identification* 13 Handwashing Facilities 3-501.14(A) Cooling Cooked PHFs from 140°F to 70°F 3-203.12 Shellstock Identification Maintained* Conveniently Located and Accessible Within 2 Hours and From 70°F to 41°F/45°F Item Good Retail Practices FC 590.000- Tags/Records:Fish Products 5-203.11 Numbers and Capacities* Within 4 Hours* 23.' Management and Personnel FC-2 .003 * 5-204.11 Location and Placement* 3-501.14(B) Cooling PHFs Made from Ambient 24. Food and Food Protection FC-3 .004 3-402.11 Parasite Destruction Temperature Ingredients to 41°F/45°F 25. Equipment and Utensils FC-4 .005 3-402.12 Records,Creation and Retention* 5-205.11 Accessibility,Operation and Maintenance Within 4 Hours* 26. Water,Plumbing and Waste FC-5 .006 590.004(J) Labeling of Ingredients' Supplied with Soap and hand Drying Devices 27. Physical Facility FC-6 .007 7 Conformance with Approved Procedures/ 6-301.11 Handwashing Cleanser,Availability 28. Poisonous or Toxic Materials FC-7 .008 HACCP Plans 6-301.12 Hand Drying Provision 29. Special Requirements 009 3-502.11 Specialized Processing Methods* 130. 1 Other 3-502.12 Reduced-Oxygen Packaging Criteria* 8-103.12 Conformance with Approved Procedures* S:590Fomtback6-2doc *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. . *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. `oFae r TOWN OF BARNSTABLE HEALTH INSPECTOR'S Establishment Name: 5, A Date: 'Y/r��q Page: of 1 OFFICE HOURS BARN57'A9LE O' PUBLIC 0 MAN STREEETSION 3:30-4:30 A.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION PLAN OF CORRECTION Date Verified : 0- :30 P.M. mAss. HYANNIS,MA 02601 M-8 -FRI. No Reference R-,Red Item PLEASE PRINT CLEARLY p +a3o• 508-862-4W 'FON1P'' FOOD ESTABLISHMENT INSPECTION REPORT Name Date Type o Tyne of ns c ion �� Q er ion ��� '-` Address Risk Re-inspection 14a Level Previous Inspection Telephone Residential Kitchen Date: Stfv Mobile Pre-operation Owner HACCP YIN Temporary Suspect Illness IIICaterer General Complaint Person in Charge(PI /' Time Bed&Breakfast HACCP In: Other , Inspecto Out: ` Each violation checked requires an explanation on the narrative page(s)and a citation of specific provision(s)violated.. Violations Related to Foodborne Illness Interventions and Risk Factors(Red Items) Anti-Choking 590.009(E) ❑ Violations marked may pose an imminent health hazard and require immediate corrective Tobacco 590.009(F) C Action as determined by the Board of Health. Allergen Awareness 590.009(G) ❑ . FOOD PROTECTION MANAGEMENT ❑ 12.Prevention of Contamination from Hands ❑ 1.PIC Assigned/Knowledgeable/Duties ❑ 13.Handwash Facilities EMPLOYEE HEALTH PROTECTION FROM CHEMICALS ❑ 2.Reporting of Diseases by Food Employees and PIC ❑ 14.Approved Food or Color Additives ❑ 3.Personnel with Infectious Restricted/Excluded ❑ 15. Toxic Chemicals ) 4 FOOD FROM APPROVED SOURCE TIMEITEMPERATURE CONTROLS(Potentially Hazardous Foods) i ❑4.Food and Water from Approved Source ❑ 16.Cooking Temperatures ❑ 5.Receiving/Condition ❑ 17.Reheating C Y.n\55 y C C ❑ 6.Tags/Records/Accuracy of Ingredient Statements ❑ 18.Cooling _ mom✓' ❑ 7.Conformance with Approved Procedures/HACCP Plans ❑ 19.Hot and Cold Holding \ N PROTECTION FROM CONTAMINATION ❑20.Time As a Public Health Control ❑8.Separation/Segregation[Protection REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) � ❑ 9.Food Contact Surfaces Cleaning and Sanitizing ❑ 21.Food and Food Preparation for HSP ❑ 10.Proper Adequate Handwashing CONSUMER ADVISORY 4❑ 11.Good Hygienic Practices ❑ 22.Posting of Consumer Advisories 1100 Violations Related to Good Retail Practices(Blue Items) Total Number of Critical Violations Kr V 1�e-AQ_ C<k_S�0_ Critical(ca violations marked must corrected immediately. (blue&red items) y' J�� Corrective Action Required: ❑ No Yes Non-critical(N)violations must be corrected rected immediately or within 90 days as determined b the Board of Health. Overall Rating ryCompliance ❑ Employee ❑ p ❑ 9 Y P Y Y ❑ Voluntary Restriction/Exclusion Re-inspection Scheduled Emergency Suspension C N Official Order for Correction:Based on an inspection today,the items ❑ Embargo ❑ Emergency Closure Voluntary Disposal Other: checked indicate violations of 105 CMR 590.000/Federal Food Code. 23.Management and Personnel (FC-2)(590.003) This report,when signed below by a Board of Health member or its agent A=Zero critical violations and no more than 3 non-critical violations. F=3 or more critical violations.9 or more nori-critical violations, 24.Food and Food Preparation (FC-3)(590.004) constitutes an order of the Board of Health. Failure to correct violations regardless of the number of critical,results in an F. 25.Equipment and Utensils FC-4 590:005 B=One critical violation and less than 4non-critical violations 9 ( )( ) cited in this report may result in suspension or revocation of the food if no critical violations observed,4 to 6 non-critical violations=B. Seriously Critical Violation=F is scored automatically if: no hot 26.Water,Plumbing and Waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If 27.Physical Facility (FC-6)(590.007) aggrieved by this order,you have a right to a hearing. Your request must C=2 critical violations and less than 9nori-critical. If no critical water,sewage back-up,infestation of rodents or insects,or lack of 28.Poisonous or Toxic Materials (FC-7)(590.0o8) be in writing and submitted to the Board of Health at the above address violations observed,7 to Snon-critical violations. If 1 critical refrigeration. Within 10 days of receipt of this order. violation,4 to 8 critical violations=C. 29.Special Requirements (590.009) Y P 30.Other DATE OF RE-INSPECTION: Inspecto s t e Prin 31.Dumpster screened from public view / Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y N R #Seats Observed Frozen Dessert Machines: Outside Dining Y N PIC' ign Print: D /' Self Service Wait Service Provided Grease Trap Size Variance Letter Posted Y N ( � . �icK�G Dumpster Screen? Y N Violations related to Foodborne Illness Violations Related to Foodborne Illness Interventions Interventions and Risk Factors(Red Items 1-22) and Risk Factors(Red Items 1-22) (Cont.) FOOD PROTECTION MANAGEMENT PROTECTION FROM CONTAMINATION PROTECTION FROM CHEMICALS 3-501.14(C) PHFs Received at Temperatures According to 1 590.003(A) Assignment of Responsibility* 8 Cross-contamination 14 Food or Color Additives law Cooled to 41°F/45°F Within 4 Hours* 590.003(B) Demonstration of Knowledge* 3-302.11(A)(1) Raw Animal Foods Separated from 3-202.12 Additives* 3-501.15 Cooling Methods for PHFs Cooked and RTE Foods.* 19 PHF Hot and Cold Holding 2-103.11 Person-in-Charge Duties 3-302.14 Protection from Unapproved Additives* Contamination from Raw Ingredients 15 Poisonous or Toxic Substances 3-501.16(B) Cold PHFs Maintained At or Below 41°F/45°F EMPLOYEE HEALTH 3-302.11(A)(2) Raw Animal Foods Separated from Each 7-101.11 Identifying Information-Original Containers* 590.004(F) * 7-102.11 Common Name-Working Containers* 2 590.003(C) Responsibility of the Person-in-Charge to Other* 3-501.16(A) Hot PHFs Maintained At or Above 140°F Require Reporting by Food Employees and Contamination from the Environment 3-501.16(A) Roasts Held At or Above 130°F* * 7-201.11 Separation-Storage* Applicants 3-302.11(A) Food Protection* 20 Time as a Public Health Control ' 590.003(F) Responsibility of A Food Employee or An 3-302.15 Washing Fruits and Vegetables 7-202.11 Restriction-Presence and Use** 3-501.19 Time as a Public Health Control* Applicant To Report To The Person In Charge* * 7.202.12 Conditions of Use 590.004 11 Variance Requirements 3-304.11 Food Contact with Equipment and Utensils * ( ) 9 590.003(G) Reporting by Person in Charge* 7-203.11 Toxic Containers-Prohibitions Contamination from the Consumer 3 590.003(D) Exclusions and Restrictions* 7-204.11 Sanitizers,Criteria-Chemicals* _ REQUIREMENTS FOR 3-306.14(A)(B)Returned Food and Reated or of Food* 7-204.12 Chemicals for WashingProduce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP 590.003(E) Removal of Exclusions and Restrictions Disposition of Adulterated or Contaminated � ) Food 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels* 4 Food and Water From Regulated Sources 9 Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs* 590.004(A-B) Compliance with Food Law* 4-501.111 Manual Warewashin Hot Water 7.206.12 Rodent Bait Stations* 3-801.11(D) Raw or Partially Cooked Animal Food and 3-201.12 Food in a Hermetical] Sealed Container* Sanitization Temperatures* Raw Seed Sprouts Not Served* Y Pe 7-206.13 Tracking Powders,Pest Control and 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-Hot Water Monitoring* 3-801.11(C) Unopened Food Package Not Re-Served* 3-202.13 Shell Eggs* Sanitization Temperatures* TIME/TEMPERATURE CONTROLS 3-202.14 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. 16 Proper Cooking Temperatures for PHFs CONSUMER ADVISORY 3-202.16 Ice Made From Potable Drinking Water* Concentration and Hardness* 3-401.11A(1)(2) Eggs-155'17 15 sec 22 3-603.11 Consumer Advisory Posted for Consumption of 4-601.11(A) Clean Utensils and Food Contact Surfaces of E s-Immediate Service 145°F 15 sec* Animal Foods That are Raw,Undercooked or 5-101.11 Drinking Water from an Approved System* gg Equipment* Not Otherwise Processed to Eliminate 590.006(A) Bottled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* E6 give inrzooi 4-602.11 Cleaning Frequency of Utensils and Food Animals-155°F 15 sec* 590.006(B) Water Meets Standards in 310 CMR 22.0* Contact Surfaces of Equipment* * 3-302.13 Pasteurized Eggs Substitute for Raw Shell Shellfish and Fish From an Approved Source 3-401.11(B)(1)(2) Pork and Beef Roast-130°F 121 min Eggs* 3-201.14 Fish and Recreationally Caught Molluscan Contact Surf 4-702.11 Frequency Sanitization of Utensils and Food 3-401.11(A)(2) Ratites,Injected Meats-155°F 15 sec* faces of Equipment* Shellfish* 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS 4-703.11 Methods of Sanitization-Hot Water and StuffingContaining Fish,Meat,Poultry or 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* g 590.009(A)-(D) Violations of Section temporary and - ide in cater- Sources* Ratites-165°F 15 sec* ing,mobile food,temporary and residential 10 Proper,Adequate Handwashing 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 145°F* kitchen operations should be debited under Game and Wild Mushrooms Approved By 2-301.11 Clean Condition-Hands and Arms* Regulatory Authority 3-401.12 Raw Animal Foods Cooked in a Microwave the appropriate sections above if related to 3-202.18 Shellstock Identification Present* 2-301.12 Cleaning Procedure* 165°F* foodbome illness interventions and risk factors. 590.004(C) Wild Mushrooms* 2-301.14 When to Wash* 3-401.11(A)(1)(b)All Other PHFs-145°F 15 sec* Other 590.009 violations relating to good retail 3-201.17 Game Animals* 11 Good Hygienic Practices 17 Reheating for Hot Holding practices should be debited under#29-Special 2-401.11 Eating,Drinking or Using Tobacco* * Requirements. 5 Receiving/Condition g. g g 3-003.11(A)&(D) PHFs 165°F 15 sec 3-202.11 PHF's Received at Proper Temperatures* 2-401.12 Discharges From the Eyes,Nose and Mouth* 3-403.11(B) Microwave-165°F 2 Minute Standing Time* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES * 3-301.12 Preventing Contamination When Tasting* 3-403.11 C * (Blue Items 23-30) 3-202.15 Package Integrity O Commercially Processed RTE Food-140°F 12 Prevention of Contamination from Hands Critical and non-critical violations,which do not relate to the foodbome 3-101.11 Food Safe and Unadulterated* 3-403.11(E) Remaining Unsliced Portions of Beef Roasts* illness interventions and risk factors listed above,can be found in the 6 Tags/Records:Shellstock 590.004(E) Preventing Contamination from Employees* 18 Proper Cooling of PHFs following sections of the Food Code and 105 CMR 590.000 * 13 Handwashing Facilities 3-501.14 A 3-202.18 Shellstock Identification ( ) Cooling Cooked PHFs from 140°F to 70°17 hem Good Retail Practices FC 590.000 3-203.12 Shellstock Identification Maintained* Conveniently Located and Accessible Within 2 Hours and From 70°F to 41'F/45°F Tags/Records:Fish Products 5-203.11 Numbers and Capacities* Within 4 Hours* 23. Management and Personnel FC-2 .003 * 5=204.11 Location and Placement* 3-501.14(B) Cooling PHFs Made from Ambient 24. Food and Food Protection FC-3 .004 3-402.11 Parasite Destruction Temperature Ingredients to 41°F/45°F 25. Equipment and Utensils FC-4 .005 3 402.12 Records,Creation and Retention* 5-205.11 Accessibility,Operation and Maintenance Within 4 Hours* 26. water,Plumbing and waste FC-5 .006 590.004(J) Labeling of Ingredients' Supplied with Soap and hand Drying Devices 27. Physical Facility FC-6 .007 7 Conformance with Approved Procedures/ 6-301.11 Handwashing Cleanser,Availability 28. Poisonous or Toxic Materials FC-7 .008 HACCP Plans 6-301.12 Hand Drying Provision 29. Special Requirements 009 3-502.11 Specialized Processing Methods* 130. 1 Other 3-502.12 Reduced-Oxygen Packaging Criteria* 8-103.12 1 Conformance with Approved Procedures* S.590Formback6-2doc 'Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. 'Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. '•HE�`°- TOWN OF BARNSTABLE HEALTH INSPECTOR'S Establishment Name: Date: / age: of OFFICE HOURS PUBLIC HEALTH DIVISION 8:00-9:30 A.M. BARNSTABLE 200 MAIN STREET 3:30-4:30 P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified MA53. �,. MON.-FRI. ;t6. a 0 HYANNIS,MA 02601 sob-asz 464a No Reference R-Red Item. PLEASE PRINT CLEARLY ,FDMP, FOOD ESTABLISHMENT INSPECTION REPORT Name Date yge of Type of Inspection O e S Routine ev Address�� Risk ervice Re-inspection Level Previous Inspection Telephone idential Kitchen Date: Mobile Pre-operation Owner HACCP Y/N Temporary Suspect I Caterer era)Com I Person in Charge(PIC) Time Bed&Breakfast s �In: Other _ Inspect Out: �e.12� ol Each violation checked requires an explanation on the narrative page(s)and a citation of specific provision(s)violated. Violations Related to Foodborne Illness Interventions and Risk Factors(Red Items) Anti-Choking 590.009(E) ❑ Violations marked may pose an imminent health hazard and require immediate corrective Tobacco 590.009(F) ❑ cw Action as determined by the Board of Health. Allergen Awareness 590.009(G) ❑ FOOD PROTECTION MANAGEMENT ❑ 12.Prevention of Contamination from Hands ❑ 1.PIC Assigned/Knowledgeable./Duties ❑ 13.Handwash Facilities EMPLOYEE HEALTH PROTECTION FROM CHEMICALS ❑ 2.Reporting of Diseases by Food Employees and PIC ❑ 14.Approved Food or Color Additives ❑ 3.Personnel with Infectious Restricted/Excluded ❑ 15. Toxic Chemicals FOOD FROM APPROVED SOURCE TIME/TEMPERATURE CONTROLS(Potentially Hazardous Foods) ❑4.Food and Water from Approved Source ❑ 16.Cooking Temperatures ❑ 5.Receiving/Condition ❑ 17.Reheating ❑ 6.Tags/Records/Accuracy of Ingredient Statements ❑ 18..Cooling ❑ 7.Conformance with Approved Procedures/HACCP Plans ❑ 19.Hot and Cold Holding PROTECTION FROM CONTAMINATION ❑20.Time As a Public Health Control ❑ 8.Separation/Segregation/Protection REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) ❑ 9.Food Contact Surfaces Cleaning and Sanitizing ❑21.Food and Food Preparation for HSP ❑ 10.Proper Adequate Handwashing CONSUMER ADVISORY ❑ 11.Good Hygienic Practices ❑ 22.Posting of Consumer Advisories Violations Related to Good Retail Practices(Blue Items) Total Number of Critical Violations Critical C violations marked must be corrected immediately. �� ( ) y (blue 8�red items) Corrective Action Required: ❑ No Yes Non-critical(N)violations must be corrected immediately or Overall Rating �( It I K within 90 days as determined by the Board of Health. I _1 ❑ Voluntary Compliance , ❑ Employee Restriction/Exclusion ❑ Re-inspection Scheduled ❑ Emergency Suspension C N Official Order for Correction: Based on an Inspection today,the items o Embar checked indicate violations of 105 CMR 590.000/Federal Food Code. ❑ g Emergency Closure ❑ Voluntary Disposal ❑ Other: 23.Management and Personnel (FC-2)(590.003) This report,when signed below by a Board of Health member or its agent A=Zero critical violations and no more than 3 non-critical violations. F=3 or more critical violations.9 or more non-critical violations, 24.Food and Food Preparation (FC-3)(590.004) constitutes an order of the Board of Health. Failure to correct violations regardless of the number of critical,results in an F. 25:Equipment and Utensils (FC-4 590.005 B=One critical violation and less than 4nnn-critical violations 9 )( ) cited in this report may result in suspension or revocation of the food if no critical violations,observed,4 to 6 non-critical violations=B. Seriously Critical Violation=F is scored automatically if: no hot 26.Water,Plumbing and Waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If g p,infestation of rodents or insects,or lack of 27.Physical Facility (FC-6)(590.007) aggrieved by this order,you have a right to a hearing. Your request must C=2 critical violations and less than 9 non-critical. If no critical water,sewage back-up, be in writing and submitted to the Board of Health at the above address violations observed,7-to anon-critical violations. If 1 critical refrigeration. 28.Poisonous or Toxic Materials (FC-7)(590.008) 9 violation,4 to 8non-critical violations=C. ' 29.Special Requirements (590.009) within 10 days of receipt of this order. 30.Other DATE OF RE-INSPECTION: Inspector's Signatur Print: 31.Dumpster screened from public view Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y N #Seats Observed Frozen Dessert Machines: Outside Dining Y N PI ,s gna ure Pr' it: Self Service Wait Service Provided Grease Trap Size Variance Letter,Posted Y N Q Dumpster Screen? Y N f 'k, I Violations related to Foodborne Illness Violations Related to Foodborne Illness Interventions Interventions and Risk Factors(Red Items 1-22) and Risk Factors(Red Items 1-22) (Cont.) 1 FOOD PROTECTION MANAGEMENT PROTECTION FROM CONTAMINATION PROTECTION FROM CHEMICALS 3-501.14(C) PHFs Received at Temperatures According to 1 590.003(A) Assignment of Responsibility* 8 Cross-contamination 14 Food or Color Additives Law Cooled to 41°F/45°F Within 4 Hours* 590.003(B) Demonstration of Knowledge* 3-302.11(A)(1) Raw Animal Foods Separated from 3-202.12 Additives* 3-501.15 Cooling Methods for PHFs Cooked and RTE Foods:* € 19 PHF Hot and Cold Holding 2-103.11 Person-in-Charge Duties - ` - - 3-302.14 Protection from Unapproved Additives Contamination from Raw Ingredients 15 Poisonous or Toxic Substances 3-501.16(B) Cold PHFs Maintained At or Below 41°F/45°F 590.004(F) *- EMPLOYEE HEALTH 3-302.11(A)(2) Raw Animal Foods Separated from Each 7-101.11 Identifying Information-.Original Containers* 7-102.11 Common Name-Working Containers* 590.003(C) Responsibility of the Person-in-Charge to Other* 3-501.16(A) Hot PHFs Maintained At or Above 140°F 7-201.11 Separation-Storage* 2 Require Reporting by Food Employees and Contamination from the Environment 3-501.16(A) Roasts Held At or Above 130°F* __ _ _ Applicants* 3-302.11(A) Food Protection* _ 20 Time as a Public Health Control 7-202-11 Restriction-Presence and Use* 590.003(F) Responsibility of A Food Employee or An 3-302.15 Washing Fruits and Vegetables * 3-501.19 Time as a Public Health Control* Applicant To Report To The Person In Charge* * 7.202.12 Conditions of Use 590.004 11 Variance Requirements 3-304.11 Food Contact with Equipment and Utensils ( ) 9 590.003(G) Reporting by Person in Charge* 7-203.11 Toxic Containers-Prohibitions* I Contamination from the Consumer 3 590.003(D) Exclusions and Restrictions* 7-204.11 Sanitizers,Criteria-Chemicals* REQUIREMENTS FOR 3-306.14(A)(B)Returned Food and Reated or of Food* 7-204.12 Chemicals for WashingProduce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP 590.003(E) Removal of Exclusions and Restrictions Disposition of Adulterated or Contaminated � ) ' Food 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels* 4 - Food and Water From Regulated Sources- 9 Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs* 590.004(A-B) Compliance with Food Law* * 3-801.11(D) Raw or Partially Cooked Animal Food and * 4-501.111- Manual Wazewashing-Hot Water 7.206.12 Rodent Bait Stations 3-201.12 Food in a Hermetically Sealed Container Sanitization Temperatures 7-206.13 Tracking Powders,Pest Control and Raw Seed Sprouts Not Served* 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Wazewashing-Hot Water Monitoring* 3-801.11(C) Unopened Food Package Not Re-Served* 3-202.13 Shell Eggs* Sanitization Temperatures* TIME/TEMPERATURE CONTROLS 3-202.14 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. 16 Proper Cooking Temperatures for PHFs CONSUMER ADVISORY 3-202.16 Ice Made From Potable Drinking Water* Concentration and Hardness* 3-401.11A(1)(2) Eggs-155°F 15 sec 22 3-603.11 Consumer Advisory Posted for Consumption of 4-601.11(A) Clean Utensils and Food Contact Surfaces of Eggs-Immediate Service 145°F 15 sec* Animal Foods That are Raw,Undercooked or Equipment 5-101.11 Drinking Water from an Approved System* * gg Not Otherwise Processed to Eliminate 590.006(A) Bottled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* Effective rorzoot 4-602.11 Cleaning Frequency of Utensils and Food Animals-155°F 15 sec* 590.006(B) Water Meets Standards in 310 CMR 22.0* Contact Surfaces of Equipment* 3-302.13 Pasteurized Eggs Substitute for Raw Shell Shellfish and Fish From an Approved Source 3-401.11(B)(1)(2) Pork and Beef Roast-130°F 121 min* Eggs* 3-201.14 Fish and Recreationally Caught Molluscan Contact Surf 4-702.11 Frequency Sanitization of Utensils and Food 3-401.11(A)(2) Ratites,Injected Meats-155°F 15 sec* faces of Equipment* Shellfish* 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS 4-703.11 Methods of Sanitization-Hot Water and Stuffing Containing Fish,Meat,Poultry or 590.009(A)-(D) Violations of Section 590.009(A)-(D)in cater- 3-201.15 Molluscan Shellfish from NSSP Listed _ .Chemical* Ratites-165°F 15 sec* Sources* ing,mobile food,temporary and residential CO Proper,Adequate Handwashing 3-401.11 C 3 Whole-muscle,Intact Beef Steaks 145°F* kitchen Game and Wild Mushrooms Approved By * ( )( ) operations should be debited under Regulatory Authority 2-301.11 Clean Condition-Hands and Arms 3-401.12 Raw Animal Foods Cooked in a Microwave the appropriate sections above if related to 3-202.18 Shellstock Identification Present* 2-301.12 Cleaning Procedure* 165°F* foodbome illness interventions and risk factors. 590.004(C) Wild Mushrooms* 3-401.11 2-301.14 When to Wash* A 1 b All Other PHFs-145°F 15 sec* Other 590.009 violations relating to good retail ( )( )( ) 3-201.17 Game Animals* 11 Good Hygienic Practices 17 Reheating for Hot Holding practices should be debited under#29-Special Requirements. 5 Receiving/Condition 2-401.11 Eating,Drinking or Using Tobacco* 3-403.11(A)&(D) PHFs 165°F 15 sec* 3-202.11 PHF's Received at Proper Temperatures* 2-401.12 Discharges From the Eyes,Nose and Mouth* 3-403.11(B) Microwave-165°F 2 Minute Standing Time* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3-202.15 Package Integrity* 3-301.12 Preventing Contamination When Tasting* 3-403.11(C) Commercially Processed RTE Food-140°F* Blue Items 23-30) 12 Prevention of Contamination from Hands Critical.and non-critical violations,which do not relate to the foodbome 3-101.11 Food Safe and Unadulterated* 3-403.11(E) Remaining Unsliced Portions of Beef Roasts* illness interventions and risk factors listed above,can be found in the 6 Tags/Records:Shellstock 590.004(E) Preventing Contamination from Employees* 16 Proper Cooling of PHFs following sections of the Food Code and 105 CMR 590.000 3-202.18 Shellstock Identification* 13 Handwashing Facilities 3-501.14(A) Cooling Cooked PHFs from 140°F to 70°F * Conveniently Located and Accessible Within 2 Hours and From 70°F to 41*F/45°F Item Good Retail Practices FC 590.000 3-203.12 Shellstock Identification Maintained Tags/Records:Fish Products 5-20311 Numbers and Capacities* Within 4 Hours* 23. Management and Personnel FC-2 .003 * 5-204.11 Location and Placement* 3-501.14(B) Cooling PHFs Made from Ambient 24. Food and Food Protection FC-3 .004 3-402.11 Parasite Destruction Temperature Ingredients to 41°F/45°F 25. Equipment and Utensils FC-4 .005 3-402.12 Records,Creation and Retention* 5-205.11 Accessibility,Operation and Maintenance Within 4 Hours* 26. Water,Plumbing and Waste FC-5 .006 590.004(J) Labeling of Ingredients* Supplied with Soap and hand Drying Devices 27. Physical Facility FC-6 .007 7 Conformance with Approved Procedures/ 6-301.11 Handwashing Cleanser,Availability 28. Poisonous or Toxic Materials FC-7 .008", . HACCP Plans 6-301.12 Hand Drying Provision 129. 1 Special Requirements 1.009 3-502.11 Specialized Processing Methods* 30. 1 Other 3-502.12 Reduced-Oxygen Packaging Criteria* 8-103.12 Conformance with Approved Procedures* S:590Forrnback6-2doc *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. oFIKE Tp� TOWN OF BARNUABLE HEALTH INSPECTOR'S Establishment Name: t_7 Y)Q W S Date:W Page:�_Of1_ OFFICE HOURS a PUBLIC HEALTH DIVISION 8:00-9:30 A.M. B RNSTARLE. ` 200 MAIN STREET 3:30-4:30 P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified �p 2639.a m� HYANNIS,MA 02601 soa-sz 4644 No Reference R-Red Item PLEASE PRINT CLEARLY TFD MI'� FOOD ESTABLISHMENT INSPECTION REPORT "- Name S h Dateg / !ylpe of ` " I_""Iybe of Inspection L/ S Routine e e e r Address Risk d Service r• Re;inspection o I Level Retail _Previous Inspection I `� a ( r oduc Telephone Residential Kitchen ' Date: Mobile Pre-operation e L T Owner HACCP Y/N Temporary Suspect Illness S n t- C r Caterer General Complaint - Person in Charge(PIC) Time Bed&Breakfast HACCP tc V In: Other Inspector S�fi Out: l r e n = J 0 s sl Each violation checked requires an explanation on t e rrative page(s)and a citation of specific provision(s)violated. Violations Related to Foodborne Illness Interventions and Risk Factors(Red Items) Anti-Choking 590.009(E) ❑ - t 0, ✓ V Violations marked may pose an imminent health hazard and require immediate corrective Tobacco 590.009(F) ❑ I 1 S S V t U. Action as determined by the Board of Health. Allergen Awareness 590.009(G) ❑ Scl -v I z-e- c ✓ FOOD PROTECTION MANAGEMENT ❑ 12.Prevention of Contamination from Hands -meato ✓ ❑ 1.PIC Assigned/Knowledgeable/Duties ❑ 13.Handwash Facilities EMPLOYEE HEALTH PROTECTION FROM CHEMICALS n -r v/ ❑ 2.Reporting of Diseases by Food Employees and PIC ❑ 14.Approved Food or Color Additives p L4 ❑ 3.Personnel with Infectious Restricted/Excluded ❑ 15. Toxic Chemicals FOOD FROM APPROVED SOURCE TIME/TEMPERATURE CONTROLS(Potentially Hazardous Foods) I C ❑4.Food and Water from Approved Source ❑ 16.Cooking Temperatures r ❑ 5.Receiving/Condition ❑ 17.Reheating rA ` Ir) ❑6.Tags/Records/Accuracy of Ingredient Statements ❑ 18.Cooling ❑ 7.Conformance with Approved Procedures/HACCP Plans ❑ 19.Hot and Cold Holding w 'e rJG C.t S PROTECTION FROM CONTAMINATION ❑20.Time As a Public Health Control 0_ ❑8.Separation/Segregation/Protection REQUIREMENTS FOR HIGHLY SUSCEPTIBL POPULATIONS(HSP) or. 'SCA �' ❑9.Food Contact Surfaces Cleaning and Sanitizing ❑21.Food and Food Preparation for HSP ❑ 10.Proper Adequate Handwashing CONSUMER ADVISORY f w' ❑ 11.Good Hygienic Practices ❑22.Posting of Consumer Advisories - U U +GJ v! 1� Violations Related to Good Retail Practices(Blue Items) Total Number of Critical Violations Critical(C)violations marked must be corrected immediately. (blue&red items) Q Corrective Action Required: ❑ No Yes Non-critical(N)violations must be corrected immediately or Overall Rating p)�_l within 90 days as determined by the Board of Health. IQ v ® Voluntary Compliance ❑ Employee Restriction%Exclusion ❑ Re-inspection Scheduled ❑ Emergency Suspension C N Official Order for Correction:Based on ai inspection today,the items checked indicate violations of 105 CMR 590.000/Federal Food Code. ❑ Embargo ❑ Emergency Closure ❑ Voluntary Disposal ❑ Other: 23.Management and Personnel (FC-2)(590.003) This report,when signed below by a Board of Health member or its agent A=Zero critical violations and no more than 3 non-critical violations. F=3 or more critical violations.9 or more non-critical violations, 24.Food and Food Preparation (FC-3)(590.004) constitutes an order of the Board of Health. Failure to correct violations regardless of the number of critical,results in an F. 25.Equipment and Utensils (FC-4)(590.005) cited in this report may result in suspension or revocation of the food B-One critical violation and less than non-critical violations 26.Water,Plumbing and Waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If if no critical violations observed,4 too 6 von-critical violations=B. Seriously Critical Violation=F is scored automatically if: no hot C=2 critical violations and less than 9 non-critical. If no critical ' water,sewage back-up,infestation of rodents or insects,or lack of 27.Physical Facility (FC-6)(590.007) aggrieved by this order,you have a right to a hearing. Your request must violations observed,7 to anon-critical violations. If 1 critical refrigeration. 28.Poisonous or Toxic Materials (FC-7)(590.008) be in writing and submitted to the Board of Health at the above address . violation,4 to 8non-critical violations=C. 29.Special Requirements (590.009) within 10 days of receipt of this order. 30.Other DATE OF RE-INSPECTION: Inspector's gna re _ Print:} y�31.Dumpster screened from public view r I v Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y N #Seats Observed Frozen Dessert Machines: Outside Dining Y N PIC's Signature Print: Self Service Wait Service Provided Grease Trap Size Variance Letter Posted Y N Dumpster Screen? Y IN Violations related to Foodborne lliness - - Violations Related to Foodborne Illness Interventions Interventions and Risk Factors(Red Items 1-22) and Risk Factors(Red Items 1-22) (Cont.) FOOD PROTECTION MANAGEMENT PROTECTION FROM CONTAMINATION PROTECTION FROM CHEMICALS 3-501.14(C) PHFs Received at Temperatures According to 1 590.003(A) Assignment of Responsibility* 8 Cross contamination 14 _. Food or Color Additives Law Cooled to 41'F/45°F Within 4 Hours* 590.003(B) Demonstration of Knowledge* 3-302.11(A)(1) Raw Animal Foods Separated from 3-202.12 Additives* 3-501.15 Cooling Methods for PHFs Cooked and RTE Foods.* i -*- 19 PHF Hot and Cold Holding 2-103.11 Person-in-Charge Duties 3-302.14 Protection from Unapproved Additives Contamination from Raw Ingredients 15 Poisonous or Toxic Substances 3-501.16(B) Cold PHFs Maintained At or Below 41°F/45'F 590.004(F)- EMPLOYEE HEALTH 3-302.11(A)(2) Raw Animal Foods Separated from Each 7-101.11 Identifying Information-Original Containers* 2 590.003(C) Responsibility of the Person--in-Charge to - Other* * 3-501.16(A) Hot PHFs Maintained At or Above 140°F* 7-102.11 Common Name-Working Containers Require Reporting by Food Employees and Contamination from the Environment 3-501.16(A) Roasts Held At or Above 130`F* Applicants* 3-302�.11(A) -Food Protection 7-201.11 Separation-Storage*- * P g me as a Public Health Control * 2Q Ti 590.003(F) Responsibility of A Food Employee or An 3-302.15 Washing Fruits and Vegetables 7-202.11 Restriction-Presence and Use* 3-501.19 Time as a Public Health Control* * Applicant To Report To The Person In Charge* * 7.202.12 Conditions of Use 3-304.11 Food Contact with Equipment and Utensils 590.004(11) Variance Requirements - 590.003(G) Reporting by Person in Charge* 7-203.11 Toxic Containers-Prohibitions* Contamination from the Consumer 3 590.003(D) Exclusions and Restrictions* 7-204.11 Sanitizers,Criteria-Chemicals* _ _ , < REQUIREMENTS-FOR 3-306.14(A)(B)Returned Food and Reservice of Food* 7-204.12 Chemicals for WashingProduce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP 590.003(E) Removal of Exclusions and Restrictions Disposition of Adulterated or Contaminated Food 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels* 4 Food and Water From Regulated Sources 9 Food Contact Surfaces 7-206.11 Restricted Use.Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs* 590.004(A-B) Compliance with Food Law* 4-501.111 Manual Warewashing-Hot Water 7.206.12 Rodent Bait Stations* 3-801.11(D) Raw or Partially Cooked Animal Food and 3-201.12 Food in a Hermetically Sealed Container* Sanitization Temperatures* Raw Seed Sprouts Not Served* _ 7-206.13 Tracking Powders,Pest Control and 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-Hot Water I Monitoring* 3-801.11(C) Unopened Food Package Not Re-Served* 3-202.13 Shell Eggs* Sanitization Temperatures* TIMEITEMPERATURE CONTROLS 3-202.14 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. 16 Proper Cooking Temperatures for PHFs CONSUMER ADVISORY 3-202.16 Ice Made From Potable Drinking Water* Concentration and Hardness* 3-401.11A(1)(2) Eggs-155°F 15 sec 22 3-603.11 Consumer Advisory Posted for Consumption of 4-601.11(A) Clean Utensils and Food Contact Surfaces of Eggs-Immediate Service 145°F 15 sec* Animal Foods That are Raw,Undercooked or Equipment 5-101.11 Drinking Water from an Approved System* * gg Not Otherwise Processed to Eliminate 590.006(A) Bottled Drinking Water* - 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* E�c""e rq/2001 4-602.11 Cleaning Frequency of Utensils and Food 590.006(B) Water Meets Standards in 310 CMR 22.0* Contact Surfaces of Equipment* Animals-155'17 15 see* 3-302.13 Pasteurized Eggs Substitute for Raw Shell 3-201.14 Fish and Recreationally Caught Molluscan Contact Surf Shellfish and Fish From an Approved Source 3-401.11(B)(1)(2) Pork and Beef Roast-130'F 121 min* Eggs* 4-702.11 Frequency Sanitization of Utensils and Food 3-401.11(A)(2) Ratites,Injected Meats-155°F 15 sec* faces of Equipment* Shellfish* 4-703.11 Methods of Sanitization-Hot Water and 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS Stuffing Containing Fish,Meal,Poultry or 590.009 A D Violations of Section 590.009(A)-(D)in cater- 3-20L15 Molluscan Shellfish from NSSP Listed Chemical* ( )-( ) Ratites-165°F 15 sec* Sources* 70 Proper,Adequate Handwashing ing,mobile food,temporary and residential Game and Wild Mushrooms Approved By - 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 145'F* kitchen operations should be debited under Regulatory Authority 2-301.11 Clean Condition-Hands and Arms* 3-401.12 Raw Animal Foods Cooked in a Microwave the appropriate sections above if related to 3-202.18 Shellstock Identification Present* 2-301.12 Cleaning Procedure* 165'F* foodbome illness interventions and risk factors. 590.004(C) Wild Mushrooms*- - 2-301.14 When to Wash* 3-401.11(A)(1)(b)All Other PHFs-145°F 15 sec* Other 590.009 violations relating to good retail 3-201.17 Game Animals* 11 Good Hygienic Practices 17 Reheating for Hot Holding practices should be debited under 929-Special Requirements. 5 Receiving/Condition 2-401.11 Eating,Drinking or Using Tobacco* 3-403.11(A)&(D) PHFs 165°F 15 sec* 3-202.11 PHF's Received at Proper Temperatures* 2-401.12 Discharges From the Eyes,Nose and Mouth* 3-403.11(B) Microwave-165'F 2 Minute Standing Time* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES * 3-301.12 Preventing Contamination When Tasting* 3-403.11 C Commercial] Processed RTE Food-140`F* (Blue Items 23-30) 3-202.11 Package Integrity ( ) y Critical and non-critical violations,which do not relate to the foodborne * 12 Prevention of Contamination from Hands 3 403.11 Remaining Unsliced Portions of Beef Roasts* 3-101.11 Food Safe and Unadulterated �) g illness interventions and risk factors listed above,can be found in the 6 Tags/Records:Shellstock 590.004(E) Preventing Contamination from Employees* 1 S Proper Cooling of PHFs following sections of the Food Code and 105 CMR 590.000 3-202.18 Shellstock Identification* 13 Handwashing Facilities 3-501.14(A) Cooling Cooked PHFs from 140°F to 70°F 3-203.12 Shellstock Identification Maintained* Conveniently Located and Accessible Within 2 Hours and From 70°F to 41°F/45°F Item Good Retail Practices FC 590.000 Tags/Records:Fish Products 5-203.11 Numbers and Capacities* Within 4 Hours* 23. Management and Personnel FC-2 .003 * 5-204.11 Location and Placement* 3-501.14(B) Cooling PHFs Made from Ambient 24. Food and Food Protection FC-3 .004 3-402.11 Parasite Destruction Temperature Ingredients to 41°F/45°F 25. Equipment and Utensils FC-4 .005 3-402.12 Records,Creation and Retention* 5-205.11 Accessibility,Operation and Maintenance Within 4 Hours 26. Water,Plumbing and Waste FC-5 .006 590.004(J) Labeling of Ingredients* Supplied with Soap and hand Drying Devices 27. Physical Facility FC-6 .007 7 Conformance with Approved Procedures/ 6-301.11 Handwashing Cleanser,Availability 28. Poisonous or Toxic Materials FC-7 .008 HACCP Plans 6-301.12 Hand in Provision 29. Special Requirements .009 3-502.11 Specialized Processing Methods* 30. Other 3-502.12 Reduced-Oxygen Packaging Criteria* 8-103.12 Conformance with Approved Procedures* S:590Formback6-2doc 'Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. 'Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. Ft r TOWN OF BARNSTABLE f HEALTH INSPECTOR'S Establishment Name: S V\(S Date: S l Page:� o � .o M ; -1'J: OFFICE HOURS PUBLIC HEALTH DIVISION •r e o i" r',` - 8:00-9:30 A.M. BARNSTABLE. 200 MAIN STREET 3:30-4:30 P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified HYANNIS,MA 02601 - <r '/';y:•' 508-862-4644 No Reference R-Red Item Cont.', PLEASE PRINT CLEARLY FOOD ESTABLISHMENT INSPECTION REPORT -- - - -- Name S w S Dat De of ;,-E i - jVjgjqf I s ectio CA b s Routin - 1 ""l V't C.( t 1 sz Address Risk Se Re-inspection _ 011 S 1LA CA n 01 2C4nLevel Cetai -Previous Inspection Telephone Residential Kitchen Date: t ; Mobile Pre-operation Owner HACCP Y/N Temporary Suspect Illness -pollnot cnicteen at o Caterer General Complaint Person in Charge(PIC) Time Bed&Breakfast HACCP C In: Other Inspector Out: U c e r ✓ Each violation checked requires an explanation on the narrative page(s)and a citation of specific provision(s)violated. Violations Related to Foodborne Illness Interventions and Risk Factors Red Items I d S e ( ) Anti-Choking 590.009(E) ❑ Violations marked may pose an imminent health hazard and require immediate corrective Tobacco 590.009(F) b a v ✓ Action as determined by the Board of Health. Allergen Awareness 590.009(G) ❑ AID' IlD C_ US C d df I I Vnif CAT o ✓ FOOD PROTECTION MANAGEMENT ❑ 12.Prevention of Contamination from Hands ❑ 1.PIC Assigned/Knowledgeable/Duties ❑ 13.Handwash Facilities 1 Q `'1 1 '1 s n C f EMPLOYEE HEALTH PROTECTION FROM CHEMICALS td d A ❑2.Reporting of Diseases by Food Employees and PIC ❑ 14.Approved Food or Color Additives - desiqnnierin ❑ 3.Personnel with Infectious Restricted/Excluded ❑ 15. Toxic Chemicals j e FOOD FROM APPROVED SOURCE TIME/TEMPERATURE CONTROLS(Potentially Hazardous Foods) V 1 n -f K 1 ❑4.Food and Water from Approved Source ❑ 16.Cooking Temperatures wasn r 1 In I. ✓ s a no T 1 e, ❑ 5.Receiving/Condition ❑ 17.Reheating II, 1 q ' ❑6.Tags/Records/Accuracy of Ingredient Statements ❑ 18.Cooling C ❑ 7.Conformance with Approved Procedures/HACCP Plans ❑ 19.Hot and Cold Holding PROTECTION FROM CONTAMINATION ❑20.Time As a Public Health Control ❑ 8.Separation/Segregation/Protection REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) Y �/✓ ❑ 9.Food Contact Surfaces Cleaning and Sanitizing ❑ 21.Food and Food Preparation for HSP I ' r o ❑ 10.Proper Adequate Handwashing CONSUMER ADVISORY L25 r e• ❑ 11.Good Hygienic Practices ❑22.Posting of Consumer Advisories - `:A ' Violations Related to Good Retail Practices(Blue Items) Total Number of Critical Violations -I - � t r-S ✓ V1 Ut d J I ,✓ Critical(C)violations marked must be corrected immediately. (blue&red items) -, . Corrective Action Required: ❑ No Yes Non-critical(N)violations must be corrected immediately or Overall Rating . within 90 days as determined by the Board of Health. Voluntary Compliance ❑ Employee Restriction/Exclusion ❑ Re-inspection Scheduled ❑ Emergency Suspension C N Official Order for Correction:Based on an inspection today,the items Embargo checked indicate violations of 105 CMR 590.000%Federal Food Code. ❑ Emergency Closure ❑ Voluntary Disposal ❑ Other: 23.Management and Personnel (FC-2)(590.003) This report,when signed below by a Board of Health member or its agent A=Zero critical violations and no more than 3 non-critical violations. F=3 or more critical violations._9 or more non-critical violations, 24.Food and Food Preparation (FC-3)(590.004) constitutes an order of the Board of Health. Failure to correct violations B_One critical violation and less than 4 non-critical violations regardless of the number of critical,results in an F. . 25.Equipment and Utensils (FC-4)(590.005) cited in this report may result in suspension or revocation of the food if no critical violations observed,4 to 6 non-critical violations=B. 26.Water,Plumbing and Waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If Seriously Critical Violation t F is scored automatically o la hot 27.Physical Facility (FC-6(590.007 aggrieved b this order,you have a right to a hearing. Your request must C=2 critical violations and less than i non-critical. If no critical water,sewage back-up,infestation of rodents or insects,or lack of y y ) ) 9 y g g� q violations observed,7 to 8non-critical violations. If 1 critical refrigeration. 28.Poisonous or Toxic Materials (FC-7)(590.008) be in writing and submitted to the Board of Health at the above address violation,4 to 8 non-critical violations=C. 29.Special Requirements (590.009) within 10 days of receipt of this order. 30.Other DATE OF RE-INSPECTION: Inspector's Signature Print: 31.Dumpster screened from public viewD 'J Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y N #Seats Observed Frozen Dessert Machines: Outside Dining Y N PIC's Signature V Print: Self Service Wait Service Provided Grease Trap Size Variance Letter Posted Y N 0 Jfj�/f�+e , " Dumpster Screen? Y N f Violations related to Foodborne Illness Violations Related to Foodbome Illness Interventions Interventions and Risk Factors(Red Items 1-22) and Risk Factors(Red Items 1-22) (Cont.) FOOD PROTECTION MANAGEMENT PROTECTIONiFROM CONTAMINATION PROTECTION FROM CHEMICALS 3-501.14(C) PHFs Received at Temperatures According to 1 590.003(A) Assignment of Responsibility* 8 Cross-contamination 14 - Food or Color Additives Law Cooled to 41°F/45°F Within 4 Hours* 590.003(B) Demonstration of Knowledge* 3-302.1l(A)(1) Raw Animal Foods Separated from 3-202.12 Additives* 3-501.15 Cooling Methods for PHFs Cooked and RTE Foods.* Additives*- 19 PHF Hot and Cold Holding 2-103.11 Person-in=Charge Duties - 3-302.14 Protection from Unapproved Contamination from Raw Ingredients 15 Poisonous o?Toxic Substances 3-501.16(B) Cold PHFs Maintained At or Below 41°F/45°F EMPLOYEE HEALTH 3-302.11(A)(2) Raw Animal Foods Separated from Each * 590.004(F) - * 7-101.11 Identifying Information-Ori - Original Containers 2 590.003(C) Responsibility of the Person-in-Charge to 9ther* 7-10211 Common Name-Workin Containers*g 3-501.16(A) Hot PHFs Maintained At or Above 140°F* . Require Reporting by Food Employees and Contamination from the Environment 3-501.16(A) Roasts Held At or Above 130°F* * - - 7-201..11 Separation-Storage* Applicants 3-302.11(A) Food Protection* 20 Time as a Public Health Control 7-202.11 Restriction-Presence and Use* 3-501.19 Time as a Public Health Control 590.003(F) Responsibility of A Food Employee or An 3-302.15. Washing Fruits and Vegetables Applicant To Report To The Person In Charge* 7.202.12 Conditions of Use 3-304.11 Food Contact with Equipment and Utensils* 590.004(11) Variance Requirements Contamination from the Consumer 590.003(G) Reporting by Person in Charge* 7-203.11 Toxic Containers-Prohibitions* 3 590.003(D) Exclusions and Restrictions* 7-204.11 Sanitizers,Criteria-Chemicals* _ _ REQUIREMENTS FOR 3-306.14(A)(B)Returned Food and Reservice of Food* 7-204.12 Chemicals for WashingProduce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP 590.003(E) Removal of Exclusions and Restrictions Disposition of Adulterated or Contaminated ) Food 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Waming.Labels* 4 Food and Water From Regulated Sources 9 Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs* 590.004(A-B) Compliance with Food Law* 4-501.111 Manual Warewashing-Hot Water 7.206.12 Rodent Bait Stations* 3-801.11(D) Raw or Partially Cooked Animal Food and 3-201.12 Food in a Hermetically Sealed Container* Sanitization Temperatures* Raw Seed Sprouts Not Served* 7-206.13 Tracking Powders,Pest Control and 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-Hot Water Monitoring* 3-801.11(C) Unopened Food Package Not Re-Served* 3-202.13 Shell Eggs* Sanitization Temperatures* TIME/TEMPERATURE CONTROLS 3-202.14 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. 16 Proper Cooking Temperatures for PHFs 3-202.16 Ice Made From Potable Drink ing Water* CONSUMER ADVISORY Concentration and Hardness* 22 3-603.11 Consumer Advisory Posted for Consumption of 3-401.11A(1)(2) Eggs-155°F 15 sec Animal Foods That are Raw,Undercooked or 5-101.11 Drinking Water from an Approved System* 4-601.11(A) Clean Utensils and Food Contact Surfaces of Eggs-Immediate Service 145°F 15 sec* Equipment* Not Otherwise Processed to Eliminate 590.006 A Bottled Drinking Water* - - 3-401.11(A)(2) Comminuted Fish,Meats&Game * e n u1aooi ( ) g Pathogens 9C 4-602.11 Cleaning Frequency of Utensils and Food Animals-155°F 15 sec* 590.006(B) Water Meets Standards in 310 CMR 22.0* Contact Surfaces of Equipment* 3-302,13 Pasteurized Eggs Substitute for Raw Shell Shellfish and Fish From an Approved Source _ 3-401.11(B)(1)(2) Pork and Beef Roast-130°F 121 min* Eggs* 4-702.11 Frequency of Sanitization of Utensils and Food 3-401.11(A)(2) Ratites,Injected Meats-155°F 15 sec* 3-201.14 Fish and Recreationally Caught Molluscan Contact Surfaces of Equipment* Shellfish* 4-703.11 Methods of Sanitization-Hot Water and 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS Stuffing Containing Fish,Meat,Poultry or 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* g g � 590.009(A)-(D) Violations of Section 590.009(A)-(D).in cater- Ratites-165°F 15 sec* Sources* 10 Proper,Adequate Handwashing ing,mobile food,temporary and residential Game and Wild Mushrooms Approved By 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 145°F* kitchen operations should be debited under Regulatory Authority 2-361.11 Clean Condition-Hands and Arms* 3-401.12 Raw Animal Foods Cooked in a Microwave the appropriate sections above if related to 3-202.18- Shellstock'Identification Present* 2-30.1.12 . Cleaning Procedure* 165°F* foodborne illness interventions and risk factors. i 2-301.14 When[o Wash* * Other 590.009 violations relating to good retail 590.004(C) - Wild Mushrooms* 3-401.11(A)(1)(b)All Other PHFs-145°F 15 sec 3-201.17 Game Animals* 11 Good Hygienic Practices 17 Reheating for Hot Holding practices should be debited under#29-Special 2-401.11 Eating,Drinking or Using Tobacco* * Requirements. 5 - Receiving/Condition g• g g 3-403.11(A)&(D) PHFs 165°F 15 sec 3-202.11 PHF's Received at Proper Temperatures* 2-401.12 Discharges From the Eyes,Nose and Mouth* 3-403.11(B) Microwave-165°F 2 Minute Standing Time* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3-202.15 Package Integrity* 3-301.12 Preventing Contamination When Tasting* 3-403.11(C) Commercially Processed RTE Food-140°F* (Blue Items 23-30) * 12 Prevention of Contamination from Hands 3 403.11 Remainin Unsliced Portions of Beef Roasts* Critical and non-critical violations,which do not relate to the foodborne 3-101.11 Food Safe and Unadulterated (E) g illness interventions and risk factors listed above,can be found in the 6 Tags/Records:Shellstock 590.004(E) Preventing Contamination from Employees* 18 Proper Cooling of PHFs following sections of the Food Code and 105 CA4R 590.000 3-202.18 Shellstock Identification* 13 Handwashing Facilities 3-501.14(A) Cooling Cooked PHFs from 140°F to 70°F * Conveniently Located and Accessible Within 2 Hours and From 70°F to 41°F/45°F Item Good Retail Practices FC 590.000 3-203.12 Shellstock Identification Maintained Tags/Records:Fish Products 5-203.11 Numbers and Capacities* Within 4 Hours* 23. Management and Personnel FC-2 .003 * 5-204.11 Location and Placement* 3-501.14(B) Cooling PHFs Made from Ambient . 24. Food and Food Protection FC-3 .004 3-402.11 Parasite Destruction Temperature Ingredients to 41°F/45°F 25. Equipment and Utensils FC-4 .005 3-402.12 Records,Creation and Retention* 5-205.11 Accessibility,Operation and Maintenance Within 4 Hours* 26. Water,Plumbing and Waste FC-5 .006 590.004(J) Labeling of Ingredients* Supplied with Soap and hand Drying Devices 27. Physical Facility FC-6 .007 7 Conformance with Approved Procedures/ 6-301.11 Handwashing Cleanser,Availability 28. Poisonous or Toxic Materials FC-7 .008 HACCP Plans 6-301.12 Hand Drying Provision 29. Special Requirements .009 3-502.11 Specialized Processing Methods* 30. 1 Other 3-502.12 Reduced-Oxygen Packaging Criteria* 8-103.12 Conformance with Approved Procedures* S:590Formback6-2doc *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. `pQ ZME Imo, , TOWN OF BARNSTABLE . ��. ;; 1 `t .HEALTH INSPECTOR'S Establishment Name: s � S Dater Page: _of ti OFFICE HOURS PUBLIC HEALTH DIVISION ;'% z',t »i.r. 8:00-9:30 A.M. E&RN5rABLE. • 200 MAIN STREET 3:30-4:30 P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified p Mb39,a m� HYANNIS,MA 02601 . , MON.-FRI. No Reference R-Red Item PLEASE PRINT CLEARLY It',J r) " 508-862-4644 'FDN1"` FOOD ESTABLISHMENT INSPECTION REPORT- Name S S T e o of Ins ection Operation(s) outingg ✓ Address Risk Service Re-rspection r Level R et ' Previous Inspection Z O u Telephone Residential Kitchen Date: C10 QIC6 T S Of CICLS Mobile Pre-operation Owner HACCP Y/N Temporary Suspect Illness y o ,, - 5 ev e Y 0" ( rt Vic,Ir nn O S Caterer General Complaint Person in Charge(PIC) Time Bed&Breakfast HACCPPIC e SC r1r In: Other Inspector S-t <? ' Out: G e vll O ✓ Each violation checked requires an explanation on th narrative page(s)and a citation of specific provision(s)violated. Violations Related to Foodborne Illness Interventions and Risk Factors(Red Items) Anti-Choking 590.009(E) ❑ 00 C- e C Violations marked may pose an imminent health hazard and require immediate corrective Tobacco 590.009(F) ❑ ` f-. �/ Action as determined by the Board of Health. Allergen Awareness 590.009(G) ❑ V C l 11 d ( t Cl n FOOD PROTECTION MANAGEMENT ❑ 12.Prevention of Contamination from Hands o ❑ 1.PIC Assigned/Knowledgeable/Duties ❑ 13.Handwash Facilities (r ' t� 1 EMPLOYEE HEALTH PROTECTION FROM CHEMICALS O CI U cc d sepin rcA TC V ❑2.Reporting of Diseases by Food Employees and PIC ❑ 14.Approved Food or Color Additives �-C ❑3.Personnel with Infectious Restricted/Excluded ❑ 15. Toxic Chemicals FOOD FROM APPROVED SOURCE TIME/TEMPERATURE CONTROLS(Potentially Hazardous Foods) 0 ❑4.Food and Water from Approved Source ❑ 16.Cooking Temperatures S ❑ 5.Receiving/Condition ❑ 17.Reheating r lf CA (2CA 6.Tags/Records/Accuracy of Ingredient Statements ❑ 18.Cooling ❑ 7.Conformance with Approved Procedures/HACCP Plans ❑ 19.Hot and Cold Holding PROTECTION FROM CONTAMINATION ❑20.Time As a Public Health Control f y L CInCA y P - O ❑ 8.Separation/Segregation/Protection REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) d norldwasni-joct ❑9.Food Contact Surfaces Cleaning and Sanitizing ❑ 21.Food and Food Preparation for HSP { ❑ 10.Proper Adequate Handwashing CONSUMER ADVISORY _ ✓ ❑ 11.Good Hygienic Practices ❑ 22.Posting of Consumer Advisories Ov Cyl S P Y C Violations Related to Good Retail Practices(Blue Items) Total Number of Critical Violations at 0✓e S + 10 CI I V_ n C IS fi Critical(C)violations marked must be corrected immediately. (blue&red items) Corrective Action Required: ❑ No Yes r Non-critical(N)violations must be corrected immediately or ' within 90 days as determined by the Board of Health. Overall Rating ® I)kvoluntary Compliance ❑ Employee Restriction/Exclusion ❑ Re-inspection Scheduled ❑ Emergency Suspension C N Official Order for Correction: Based on an inspection today,the items checked indicate violations of 105 CMR 590.000/Federal Food Code. tj Embargo ❑ Emergency Closure ❑ Voluntary Disposal ❑ Other: 23.Management and Personnel (FC-2)(590.003) This report,when signed below by a Board of Health member or its agent A=Zero critical violations and no more than 3 non-critical violations. F=3 or more critical violations.9 or more non-critical violations, 24.Food and Food Preparation (FC-3)(590.004) constitutes an order of the Board of Health: Failure to correct violations regardless of the number of critical,results in an F. 25.Equipment and Utensils (FC-4)(590.005) cited in this report may result in suspension or revocation of the food B=One critical violation and less than non-critical violations g if no critical violations observed,4 too 6 von-critical violations=B. Seriously Critical Violation=F is scored automatically if: no hot 26.Water,Plumbing and Waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If C=2 critical violations and less than 9 non-critical. If no critical water,sewage back-up,infestation of rodents or insects,or lack of 27.Physical Facility (FC-6)(590.007) aggrieved by this order,you have a right to a hearing. Your request must violations observed,7 to 8 non-critical violations. If 1 critical refrigeration. 28.Poisonous or Toxic Materials (FC-7)(590.008) be in writing and submitted to the Board of Health at the above address violation,4 to 8 non-critical violations=C. 29.Special Requirements (590.009) within 10 days of receipt of this order. 30.Other DATE OF RE-INSPECTION, Inspector's Signat re Print: 31.Dumpster screened from public view rif aTm E2 0 Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y N #Seats Observed Frozen Dessert Machines: Outside Dining Y N PIC's Signature Print: Self Service Wait Service Provided Grease Trap Size Variance Letter Posted Y N Y Dumpster Screen? N Violations related to Foodborne Illness Violations Related to Foodborne Illness Interventions Interventions and Risk Factors(Red Items 1-22) and Risk Factors(Red Items 1-22) (Cont) , FOOD PROTECTION MANAGEMENT PROTECTION FROM CONTAMINATION PROTECTION FROM CHEMICALS 3-501.14(C) PHFs Received at Temperatures According to 1 590.003(A) Assignment of Responsibility* 8 Cross-contamination 14 Food or Color Additives Law Cooled to 41°F/45°F Within 4 Hours* 590.003(B) Demonstration of Knowledge* 3-302.11(A)(1) Raw Animal Foods Separated from 3-202.12-- Additives* 3-501.15 Cooling Methods for PHFs Cooked and RTE Foods.* 19 PHF Hot and Cold Holding 2-103.11 Person-in-Charge Duties 3-302.14 Protection from Unapproved Additives* Contamination from Raw Ingredients 15 Poisonous or Toxic Substances 3-501.16(B) Cold PHFs Maintained At or Below 41°F/45°F - EMPLOYEE HEALTH 3-302.11(A)(2) Raw Animal Foods Separated from Each 7-101.11 Identifying Information-Original Containers* 590.004(F) - - * - - - 2 590.003(C) Responsibility of the Person-in-Charge to Other* * 3-501.16(A) Hot PHFs Maintained At or Above 140°F* 7-102.11 Common Name-Working Containers Require Reporting by Food Employees and Contamination from the Environment 3-501.16(A) Roasts Held At or Above 130°F* 7-201.11 Separation-Storage* Applicants* 3-302.11(A) Food Protection* P20 Time as a Public Health Control 590.003(F) Responsibility of A Food Employee or An .3-302.15 Washing Fruits and Vegetables 7-202.11 Restriction-Presence and Use** 3-501.19 Time as a Public Health Control* Applicant To Report To The Person In Charge* 7.202.12 Conditions of Use 3-304.11 Food Contact with Equipment and Utensils* 590.004(11) Variance Requirements 590.003(G) Reporting by Person in Charge* - 7-203.11 Toxic Containers-Prohibitions* Contamination from the Consumer 3 590.003(D) Exclusions and Restrictions* 7-204.11 Sanitizers,Criteria-Chemicals* REQUIREMENTS FOR 3-306.14(A)(B)Returned Food and Rrated or of Food* 7-204.12 Chemicals for Washing Produce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP 590.003(E) Removal of Exclusions and Restrictions g � ) Disposition of Adulterated or Contaminated Food 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and FOOD FROM APPROVED SOURCE 3=701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels* 4 Food and Water From Regulated Sources g Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs* 590.004(A-B) Compliance with Food Law* * 3.801.11(D) Raw or Partially Cooked Animal Food and ' * 4-501.111 Manual Warewashing-Hot Water 7.206.12 Rodent Bait Stations Raw Seed Sprouts Not Served* 3-201.12 Food in a Hermetically Sealed Container Sanitization Temperatures 7-206.13 Tracking Powders,Pest Control and 3-201.13 Fluid Milk and Milk Prods* 4-501.112 Mechanical Warewashing-Hot Water Monitoring* 3-801.11(C) Unopened Food Package Not Re-Served* Products* 3-202.13 Shell Eggs*. Sanitization Temperatures* TIME/TEMPERATURE CONTROLS 3-202.14 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. 16 Proper Cooking Temperatures for PHFs CONSUMER ADVISORY 3-202.16 Ice Made From Potable Drinking Water* Concentration and Hardness* 3-401.11 A(1)(2) Eggs-155°F 15 sec 22 3-603.11 Consumer Advisory Posted for Consumption of Eggs 5-101.11 Drinking Water from an Approved System* 4-601.11(A) Clean Utensils and Food Contact Surfaces of E s-Immediate Service 145°F 15 sec* Animal Foods That are Raw,Undercooked or Not Otherwise Processed to Eliminate Equipment* 590.006(A) Bottled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* Effective 1112001 590.006(B) Water Meets Standards in 310 CMR 22.0* 4-602.11 Cleaning Frequency of Utensils and Food Animals-155°F 15 sec* Contact Surfaces of Equipment* 3-302.13 Pasteurized Eggs Substitute for Raw Shell ., Shellfish and Fish From.an Approved Source 3-401.11(B)(1)(2) Pork and Beef Roast-130°F 121 min* Eggs* 4-702.11 Frequency of Sanitization of Utensils and Food 3-401.11(A)(2) Ratites,Injected Meats-155°F 15 sec* 3-201.14 Fish and Recreationally Caught Molluscan Contact Surfaces of Equipment* Shellfish*" 4-703.11 Methods of Sanitization-Hot Water and 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS Stuffing Containing Fish,Meat,Poultry or 3-201.15 Molluscan Shellfish from NSSP Listed . Chemical* g g �' S90.009(A)-(D) Violations of Section 590.009(A)-(D)in cater- Ratites-165°F 15 sec* Sources* 1 p Proper,Adequate Handwashing ing,mobile food,temporary and residential Game and Wild Mushrooms Approved By - 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 145'F* kitchen operations should be debited under Regulatory Authority 2-301.11 Clean Condition-Hands and Arms* 3-401.12 Raw Animal Foods Cooked in a Microwave the appropriate sections above if related to 3-202.18 Shellstock Identification Present* - 2-301.12 Cleaning Procedure* 165°F* foodbome illness interventions and risk factors. 2-301.14 When to Wash* * Other 590.009 violations relating to good retail 590.004(C) Wild Mushrooms* 3-401.1l(A)(1)(b) All Other PHFs-145°F 15 sec 3-201.17 Game Animals* 11 Good Hygienic Practices 17 Reheating for Hot Holding practices should be debited under#29-Special Requirements. 5 Receiving/Condition 2-401.11. Eating,Drinking or Using Tobacco* 3-403.11(A)&(D) PHFs 165°F 15 sec* 3-202.11 PHF's Received at Proper Temperatures* 2-401.12 Discharges From the Eyes,Nose and Mouth* 3-403.11(B) Microwave-165°F 2 Minute Standing Time* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES * 3-301.12 Preventing Contamination When Tasting* * (Blue Items 23-30) 3-202.15 Package Integrity g g 3-403.11(C) Commercially Processed RTE Food-140°F Critical and non-critical violations,which do not relate to the foodborne 3-101.11 Food Safe and Unadulterated* 12 Prevention of Contamination from Hands 3-403.11(E) Remaining Unsliced Portions of Beef Roasts* illness interventions and risk factors listed above,can be found in the 6 Tags/Records:Shellstock P5-204.11 Preventing Contamination from Employees* 1 S Proper Cooling of PHFs following sections of the Food Code and 105 CMR 590.000 3-202.18 Shellstock Identification* 13Handwashing Facilities 3-501.14(A) Cooling Cooked PHFs from 140°F to 70°F 3-203.12 Shellstock Identification Maintained* Conveniently Located and Accessible Within 2 Hours and From 70°F to 41°F/45°F Item Good Retail Practices FC 590.000 Tags/Records:Fish Products Numbers and Capacities* Within 4 Hours* 23. Management and Personnel FC-2 .003 * Location and Placement* 3-501.14(B) Cooling PHFs Made from Ambient 24. Food and Food Protection FC-3 .004 3 402.11 Parasite DestructionTemperature Ingredients to 41°F/45°F25. Equipment and Utensils FC-4 .005 3-402.12 Records,Creation and Retention* . Accessibility,Operation and Maintenance Within 4 Hours* 26. Water,Plumbing and Waste FC-5 .006 590.004(J) Labeling of Ingredients* Supplied with Soap and hand Drying Devices 27. Physical Facility FC-6 .007 7 Conformance with Approved Procedures/ 6-301.11 Handwashing Cleanser,Availability 28. Poisonous or Toxic Materials FC-7 .008 HACCP Plans 6-301.12 Hand Drying Provision 29. Special Requirements 009 3-502.11 Specialized Processing Methods* 30. Other 3-502.12 Reduced-Oxygen Packaging Criteria* 8-103.12 Conformance with Approved Procedures* S:590Formback6-2doc *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. TOWN OF BARNSTABLE HEALTH INSPECTOR'S Establishment Name: Date: Page:_�of OFFICE HOURS PUBLIC HEALTH DIVISION c - 8:00-9:30 A.M. BARN STABLE. ' 200 MAIN STREET 3:30-4:30 P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified �p t A3 p HYANNIS,MA 02601 ,- f 2 sos-N.-FRI' No Reference R-Red Item (V PLEASE PRINT CLEARLY rfO MPS FOOD ESTABLISHMENT INSPECTION REPORT _ - rl c Name W-S @e Type of Inspection S Yin C' s outin-j Address Risk Servic =nlpection IDI 01WQIn0Q(X�n1Z Level et Previous Inspection 5 e a rn Telephone Residential Kitchen Date: e rA a T C s n n Ct Mobile Pre-operation Owner HACCP Y/N Temporary Suspect Illness A o Caterer General Complaint Person in Charge(PIC) Time Bed 8 Breakfast HACCP oo V_ I, e`j In: Other o f ( Z G G ✓ Inspector I{ ; aQ S Out: ` Each violation checked requires an explanation on the narrative page(s)and a citation of specific provision(s)violated. N _ n ( e s Violations Related to Foodborne Illness Interventions and Risk Factors(Red Items) Anti-Choking 590.009(E) ❑ Violations marked may pose an imminent health hazard and require immediate corrective Tobacco 590.009(F) ❑ Action as determined by the Board of Health. Allergen Awareness 590.009(G) ❑ FOOD PROTECTION MANAGEMENT ❑ 12.Prevention of Contamination from Hands m , ❑ 1.PIC Assigned/Knowledgeable/Duties ❑ 13.Handwash Facilities EMPLOYEE HEALTH PROTECTION FROM CHEMICALS CIJt ❑ 2.Reporting of Diseases by Food Employees and PIC ❑ 14.Approved Food or Color Additives h U msylelvej ❑ 3.Personnel with Infectious Restricted/Excluded ❑ 15. Toxic Chemicals FOOD FROM APPROVED SOURCE TIME/TEMPERATURE CONTROLS(Potentially Hazardous Foods) (/ t ❑4.Food and Water from Approved Source ❑ 16.Cooking Temperatures ❑ 5.Receiving/Condition ❑ 17.Reheating h ❑6.Tags/Records/Accuracy of Ingredient Statements ❑ 18.Cooling S ✓ ❑ 7.Conformance with Approved Procedures/HACCP Plans ❑ 19.Hot and Cold Holding PROTECTION FROM CONTAMINATION ❑ 20.Time As a Public Health Control c r S ❑ 8.Separation/Segregation/Protection REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) c cA n io e d cA t ❑ 9.Food Contact Surfaces Cleaning and Sanitizing ❑21.Food and Food Preparation for HSP I V C V ❑ 10.Proper Adequate Handwashing CONSUMER ADVISORY ❑ 11.Good Hygienic Practices ❑ 22.Posting of Consumer Advisories r e a cl I ( f o 0d117 Violations Related to Good Retail Practices(Blue Items) Total Number of Critical Violations { Critical(C)violations marked must be corrected immediately. (blue&red items) Corrective Action Required: ❑ No Yes Non-critical(N)violations must be corrected immediately or Overall Rating within 90 days as determined by the Board of Health. Voluntary Compliance ❑ Employee Restriction/Exclusion ❑ Re-inspection Scheduled .❑ Emergency Suspension C N Official Order for Correction: Based on an inspection today,the items checked indicate violations of 105 CMR 590.000/Federal Food Code. ❑ Embargo ❑ Emergency Closure ❑ Voluntary Disposal ❑ Other: 23.Management and Personnel (FC-2)(590.003) This report,when signed below by a Board of Health member or its agent A=Zero critical violations and no more than 3 non-critical violations. F=3 or more critical violations.9 or more non-critical violations, 24.Food and Food Preparation (FC-3)(590.004) constitutes an order of the Board of Health. Failure to correct violations regardless of the number of critical, results in an F. 25.Equipment and Utensils (FC-4 590.005 B=One critical violation and less than 4non-critical violations 9 )( ) cited in this report may result in suspension or revocation of the food if no critical violations observed,4 to 6 non-critical violations=B. Seriously Critical Violation=F is scored automatically if: no hot 26.Water,Plumbing and Waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If C=2 critical violations and less than non-critical. If no critical water,sewage back-up,infestation of rodents or insects,or lack of 27.Physical Facility (FC-6)(590.007) aggrieved by this order,you have a right to a hearing. Your request must violations observed,7 to anon-cri 28.Poisonous or Toxic Materials (FC-7)(590.008) be in writing and submitted to the Board of Health at the above address non-critical violations. If 1 critical refrigeration. s violation,4 to 8non-critical violations within 10 days of receipt of this order. =C. 29.Special Requirements (590.009) y p 30.Other DATE OF RE-INSPECTION: Inspector's Sig ture Print: 5r31.Dumpster screened from public view AJK _4�j CAPermit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y N 4q�� #Seats Observed Frozen Dessert Machines: Outside Dining Y N PIC's Si nat a Print: Self Service Wait Service Provided Grease Trap Size Variance Letter Posted Y N Dumpster Screen Y N Violations related to Foodborne Illness Violations Related to Foodborne Illness Interventions Interventions and Risk Factors(Red Items-1-22) and Risk Factors(Red Items 1-22) (Cont) ` FOOD PROTECTION MANAGEMENT PROTECTION.FROM CONTAMINATION PROTECTION FROM CHEMICALS 3-501.14(C) PHFs Received at Temperatures According to 1 590.003(A) Assignment of Responsibility* 8 Cross-contamination L 14 Food or Color Additives Law Cooled to 41°F/45°F Within 4 Hours* 590.003(B) Demonstration of Knowledge* 3-302.11(A)(1) Raw Animal Foods Separated from 3-202.12 Additives* 3-501.15 Cooling Methods for PHFs Cooked and RTE Foods.* * 19 PHF Hot and Cold Holding 2-103.11 Person-in-Charge Duties 3-302.14 Protection from Unapproved Additives Contamination from Raw Ingredients 15 Poisonous or Toxic Substances 3-501.16(B) Cold PHFs Maintained At or Below 41°F/45°F 590.004(F) * - - EMPLOYEE HEALTH 3-302.11(A)(2) Raw Animal Foods Separated from Each 7-101.11 Identifying Information-Original Containers* 2 590.003(C) Responsibility of the Person-in-Charge to Other* ty g g 7-102.11 Common Name-Working Containers* 3-501.16(A) Hot PHFs Maintained At or Above 140°F* Require Reporting by Food Employees and Contamination from the Environment 3-501.16(A) Roasts Held At or Above 130°F* 7-201.11 Se azation-Storage* Applicants* 3-302.11(A) Food Protection* P g 20 Time as a Public Health Control 7-202.11 Restriction-Presence and Use* 590.003(F) Responsibility of A Food Employee or An 3-302.15 Washing Fruits and Vegetables 3-501.19 Time as a Public Health Control* Applicant To Report To The Person In Charge* * 7.202.12 Conditions of Use* 590.004 11 Variance Re uirements 3-304.11 Food Contact with Equipment and Utensils 7-203.11 Toxic Containers-Prohibitions* ( ) q 590.003(G) Reporting by Person in Charge* Contamination from the Consumer 3 590.003(D) Exclusions and Restrictions* 7-204.11 Sanitizers,Criteria-Chemicals* REQUIREMENTS FOR 3-306.14(A)(B)Returned Food and Reservice of Food* 7.-204.12 Chemicals for WashingProduce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP 590.003(E) Removal of Exclusions and Restrictions Disposition of Adulterated or Contaminated Food 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels* 4 Food and Water From Regulated Sources 9 Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs* 590.004 A-B) Compliance with Food Law* * 3-801.11(D) Raw or Partially Cooked Animal Food and ( P 4-501.111 Manual Wazewashing-Hot Water 7.206.12 Rodent Bait Stations 3-201.12 Food in a HermeticallySealed Container* Sanitization Temperatures* Raw Seed Sprouts Not Served* P 7-206.13 Tracking Powders,Pest Control and 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-Hot Water Monitoring* 3-801.11(C) I Unopened Food Package Not Re-Served* 3-202.13 Shell Eggs* Sanitization Temperatures* TIME/TEMPERATURE CONTROLS 3-202.14 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. 16 Proper Cooking Temperatures for PHFs CONSUMER ADVISORY 3-202.16 Ice Made From Potable Drinking Water* Concentration and Hardness* 3-401.1 I A(1)(2) Eggs-155°F 15 sec 22 3-603.11 Consumer Advisory Posted for Consumption of 5-101.11 Drinking Water from an Approved System* 4-601.11(A) Clean Eggs Utensils and Food Contact Surfaces of E s-Immediate Service 145°F 15 sec* Animal Foods That are Raw,Undercooked or Equipment* _ Not Otherwise Processed to Eliminate 590.006(A) Bottled Drinking Water* 4-602.11 Cleaning Frequency of Utensils and Food cave 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* Ef 11112001 590.006(B) Water Meets Standards in 310 CMR 22.0* Contact Surfaces of Equipment* Animals-155°F IS sec* 3-302.13 Pasteurized Eggs Substitute for Raw Shell Shellfish.and Fish Froman Approved-Source 3-401.11(B)(1)(2) Pork and Beef Roast-130°F 121 min* Eggs* 4-702.11 Frequency of Sanitization of Utensils and Food 3-401.11(A)(2) Ratites,Injected Meats-155°F 15 sec* 3-201.14 Fish and Recreationally Caught Molluscan Contact Surfaces of Equipment* Shellfish* 4-703.11 Methods of Sanitization-Hot Water and 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS 3-201.15 Molluscan Stuffing Containing .Shellfish from NSSP Listed _ _ Chemical* Ratites-165'F 15 sec*Fish,Meat,Poultry or 590.009(A)-(D) Violations of Section 590.009(A)-(D)in cater- Sources* ing,mobile food,temporary and residential 10 Proper,Adequate Handwashing 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 145°F* kitchen operations should be debited under Game and Wild Mushrooms Approved By 2-301.11 Clean Condition-Hands and Arms* Regulatory Authority 3-401.12 Raw Animal Foods Cooked in a Microwave the appropriate sections above if related to 3-202.18 Shellstock Identification Present* 2-301.12 Cleaning Procedure* 165°F* foodhome illness interventions and risk factors. * 2-301.14 When to Wash* 3-401.11 A 1 * Other 590.009 violations relating to good retail 590.004(C) - Wild Mushrooms ( )( )(b) All Other PHFs-145°F 15 sec 3-201.17 Game Animals* 11 Good Hygienic Practices 17 Re eati for Hot Holding practices should be debited under#29-Special h ng 2-401.11 Eating,Drinking or Using Tobacco* * Requirements. 5 Receiving/Condition g• g g 3-403.11(A)&(D) PHFs 165°F 15 sec 3-202.1 T PHF's Received at Proper Temperatures* 2-401.12 Discharges From the Eyes,Nose and Mouth* 3 403.11(B) Microwave-165°F 2 Minute Standing Time* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES * 3-301.12 Preventing Contamination When Tasting* 3-403.11 * (Blue Items 23-30) 3-202.15 Package Integrity (C) Commercially Processed RTE Food-140°F Critical and non-critical violations,which do not relate to the foodborne 12 Prevention of Contamination from Hands 3-403.11 Remaining Unsliced Portions of Beef Roasts* 3-101.11 Food Safe and Unadulterated* �) g illness interventions and risk factors listed above,can•be found in the 6 Tags/Records:Shellstock 590.004(E) Preventing Contamination from Employees* 18 Proper Cooling of PHFs following sections of the Food Code and 105 CMR 590.000 * 13 Handwashing Facilities 3-501.14 A CoolingCooked PHFs from 140'F to 70°F 3-202.18 Shellstock Identification ( ) Item Good Retail Practices FC 590.000 3-203.12 Shellstock Identification Maintained* Conveniently Located and Accessible Within 2 Hours and From 70°F to 41°F/45°F Tags/Records:Fish Products 5-203.11 Numbers and Capacities* Within 4 Hours* 23. Management'and Personnel FC-2 .003- * 5-204.11 Location and Placement* 3-501.14(B) Cooling PHFs Made from Ambient 24. Food and Food Protection FC-3 .004 3 402.11 Parasite Destruction Temperature Ingredients to 41°F/45°F 25. Equipment and Utensils FC-4 .005 3-402.12 Records,Creation and Retention* 5-205.11 Accessibility,Operation and Maintenance Within 4 Hours* 26. Water,Plumbing and Waste FC-5 .006 590.004(J) Labeling of Ingredients* Supplied with Soap and hand Drying Devices 27. Physical Facility, FC-6 .007 7 Conformance with Approved Procedures/ 6-301.11 Handwashing Cleanser,Availability 28. Poisonous or Toxic Materials FC-7 .008 HACCP Plans 6-301.12 Hand Drying Provision 29. Special Requirements 009 3-502.11 Specialized Processing Methods* 130. 1 Other 3-502.12 1 Reduced-Oxygen Packaging Criteria* 8-103.12 Conformance with Approved Procedures* S:590Formback6-2doc *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. i DocuSign Envelope 10:FMD222-05F9 478"597-2D41A956M POWER OF ATTORNEY FOR BUSINESS LICENSE FORMS KNOW ALL MEN 13Y THESE PRESENTS THAT Albertson Companies,Inc.,a Delaware corporation with offices at 250 Parkcenter Blvd.,Boise,ID 83706,on behalf of Itself and each of its directly and indirectly owned subsidiaries(hereinafterreferred to collectively.as the"Principal"};authorizes Corporation Service Company,a Delaware corporation with offices at 251 little Falls Drive,Wilmington, DE 19808 and its designated employees(°CSC°)to act as its attomey-in-fact for the purpose of signing, stamping;and/or affixing the Pri • - .9 g nclPal's signature and filing in the Principals name any business license applications,tax documents,renewal forms,or related documents(hereinafter referred to collectively as Business License Forms")as the Principal mayrequest..Principal�specifically authorizes CSC to notarize documents on its behalf and perform other necessary acts to fulfill the services requested by Principal. This POA will,remain infull force and effect until due notice of its revocation i5 given bythe Principal to CSC. CSC IS NOT AN ATTORNEY OR LAW FIRM AND DOES NOT PROVIDE LEGAL ADVICE. PRINCIPAL AGREES THAT IT IS RESPONSIBLE FOR REVIEWING LICENSE FORMS AND.SEEKING ADVICE OF COUNSEL WHERE NECESSARY. IN WITNESS WHEREOF,the-Principal has caused this instrument to be executed by a duty authorized representative as of the date set forth below. ALBERTSONS COMPANIES,INC. Principal DocuS}gned by. By: J ' _ Nam . ?P F4 fWP' br Title: Executive VicePresident,General.Counsel&Secretary Date:. ink 1?f"9 Sworn to and subscribed before me on this day of-JuYLL 2001. YAW-95 NOTARY PUBLIC Date of Commission Expiration .•p�uu�gy de.� ►�'eep"Bee ' g. J'UBLIG^� OF y'�tirn��,•+•�' i Bellaire, Dianna From: Kegelman, Michael <Michael.Kegelman@cscglobal.com> Sent: Thursday, November 11, 2021 9:59 AM To: Bellaire, Dianna Subject: Shaw's Tobacco Permits Online Account Attachments: Store 4595 Screenshot.PNG; Store 1598 Screenshot.PNG Good Morning, I am writing in regard to the tobacco license/permits for Shaw's 1598 and 4595. Albertsons/Shaw's has partnered with CSC for their license/permit processing and renewals and we are working on the transition.To that end, could you please assist me with the online account set up?When trying to link the account the building information comes up to completely different addresses. I have attached screenshots for reference.This might be the information for the companiies that own the physical building but I just want to make sure this is the case before I move forward. If it is the case and I can just move forward please let me know. If needed I can be reached at 302-636-5400 direct extension 66262 to go over this in more detail.When I attempted to contact the number on your email all I got was a busy tone unfortunately. If you need additional information, please contact the following Albertsons email: LegalLicensing.Team@albertsons.com Thank you, Michael Begelman (He/Him) what's this? Customer Service Representative I Business License Team Phone: 302-636-5400 x 66262 Michael.Ke,.qeli?zan@csc,global.com CSC® 251 Little Falls Drive Wilmington, Delaware 19808-1674 USA cscglobal.com CIC We are the business behind business, CSC is pleased to provide evening email coverage until 11:00 p.m. ET and weekend email coverage from 9 a.m.-6 p.m. ET. To reach a customer service representative, please forward your request to evening team @cscglobaL com. CAUTION:This email originated from outside of the Town of Barnstable!.Do not clicklinks, open attachments or reply, unless you recognize the sender's email address and know the content is safe! i Bellaire, Dianna From: Kegelman, Michael <Michael.Kegelman@cscglobal.com> Sent: Friday, November 12, 2021 10:22 AM To: Bellaire, Dianna Subject: RE: Shaw's Tobacco Permits Online Account Yes that would most likely speed the process up. I did update the mailing address on the forms as well as the email on there as well.The new address should be 251 Little Falls Drive, Wilmington DE 19808, and email being legal.licensing.team@aIbertsons.com. Thank You, Michael Kegelman (He/Hire) what's this? Customer Service Representative ( Business License'Team Phone: 302-636-5400 x 66262 Michael.Kegelman@cscglobal.com CSC® 251. Little Falls Drive Wilmington, Delaware 1.9808-1.674 USA cscglobal.com CISC We are the business behind business CSC is pleased to provide evening email coverage until 11:00 p.m. ET and weekend.email coverage from 9 a.m.-6 p.m. ET. To reach a customer service representative, please forward your request to evening team@cscglobal.com. From: Bellaire, Dianna [mailto:Dianna.Bellaire@town.barnstable.ma.us] Sent: Friday, November 12, 2021 10:20 AM To: Kegelman, Michael <Michael.Kegelman@cscglobal.com> Cc: Bellaire, Dianna <Dianna.Bel laire@town.barnstable.ma.us> Subject: RE: Shaw's Tobacco Permits Online Account Yes, the POA will work. Thank you. However,will I be changing the contact info for renewals in the future? Dianna Bellaire Permit Technician Town of Barnstable Health Division 200 Main Street Hyannis, MA 02601 P:508-862-4643 Fax:508-790-6304 Email:Dianna.Bellaire@town.barnstable.ma.us The.information contained in this electronic transmission("e-mail"),including any attachment(the"Information"),may be confidential or otherwise exempt from disclosure.It is for the addressee o.n.ly.this Information may be privileged and confidential work-product or a privileged and confidential communication.The Information may also be deliberative and pre-decisional in nature.As such,it is for internal use only.The Information may not be disclosed without the prior written consent of the Director of Public Health and/or the Town_yttorne:y's Office of the Town of Barnstable.If you have.received this e-mail by mistake,please notify the sender and delete it from your system.Please do not copy or forward it.Thank you for your cooperation. From: Kegelman, Michael [mailto:Michael,Kegelman cscglobal.com] Sent: Friday, November 12, 2021 10:18 AM To: Bellaire, Dianna Subject: RE: Shaw's Tobacco Permits Online Account Good Morning, Thank you for getting this form over to me, as well as providing direction for the online process for the tobacco permits. I do have one question about the Food Permits. Since CSC has power of attorney to handle the renewals for Albertson's/Shaw's, are we able to sign on their behalf for the Owner/applicant area of the application? I have also attached our Power of Attorney for your reference if it helps. Thank You, Michael Kegelman (He/Him) what's this? Customer Service Representative ( Business License'Team Phone: 302-636-5400 x 66262 Mich ael.Kegelman@cscglobal.corn CSC® 251 Little balls Drive Wilmington, Delaware 1.9808-1.674 USA cscglobal.com CSC We are the business behind business CSC is pleased to provide evening email coverage until 11:00 p.m. ET and weekend.email coverage from 9 a..m.-6 p.m. ET. To reach a customer service representative, please forward your request to eveningteam@cscglobal.com. From: Bellaire, Dianna [mailto:Dianna.Bellaire@town.barnstable.ma.us] Sent: Friday, November 12, 20218:56 AM To: Kegelman, Michael<Michael.Ke elman csc lobal.com> Cc: Bellaire, Dianna <Dianna.Bellaire@town.barnstable.ma.us> Subject: RE: Shaw's Tobacco Permits Online Account Importance: High Good Morning, 2 4 I am working from home today, but I received email that all phones are down at the office and that is why you received the busy signal.The database uses the owner of the property that pays the tax bills and it will not show your name. You have one r add ess correct and one that needs to be different. 1070 lyannough Road is the correct address for Shaws #1598 625 West Main Street is for Star Market#4595, please choose that address and NOT the 626. Both of your establishments are non-aged restricted category. I have not received the food renewal applications in the mail for either location. I've attached the blank food application which you will need to print one for each. The fee is$535.00 for each establishment for the food. Each market needs 2 food protection managers and one of them needs the 5 year allergen certification. I have the following employees with these certifications on file for each store, if different, I need a copy of those certifications: Star Market#4595 1. Gerald Butts 2. Michael Zajko Shaws#1598 1.Karen Peirce 2.Thomas Cummings Dianna Bellaire Permit Technician Town of Barnstable Health Division 200 Main Street Hyannis, MA 02601 P:508-862-4643 Fax:508-790-6304 Email:Dianna.Bellaire@town.barnstable.ma.us The information contained in this electronic truisnussiou("e-mail"),including any attachment(the"Infornation"),may be confidential or otherwise exempt from disclosure.It is for the addressee only.This Information may be privileged and confidential work-product or a. privileged and confidential communication.The hrformation may also be deliberative and pre-decisional in nature.,As such,it is for ii.iternal use only.'1:1e Information may not be disclosed without the prior written.consent of the Director of Public health and/or the Town_Attorneys Office of the Town of Barnstable.If you have received this e-mail by nustake,please notify the sender and delete it from your system.Please do not copy or.forward.it.Thank you for your cooperation. From: Kegelman, Michael [mailto:Michael.Kegelman(abcscglobal.com] Sent: Thursday, November 11, 2021 9:59 AM To: Bellaire, Dianna Subject: Shaw's Tobacco Permits Online Account Good Morning, I am writing in regard to the tobacco license/permits for Shaw's 1598 and 4595. Albertsons/Shaw's has partnered with CSC for their license/permit processing and renewals and we are working on the transition.To that end, could you . please assist me with the online account set up?When trying to link the account the building information comes up to completely different addresses. I have attached screenshots for reference.This might be the information for the companies that own the physical building but I just want to make sure this is the case before I move forward. If it is the case and I can just move forward please let me know. If needed I can be reached at 302-636-5400 direct extension 66262 to go over this in more detail. When I attempted to contact the number on your email all I got was a busy tone unfortunately. 3 TOWN OF BARNSTABLE �FTHETO w OFFICE OF = Daaa9TeDL : BOARD OF HEALTH 7 NABS. °o i639• gee 367 MAIN STREET craY� HYANNIS, MASS.02601 July 21, 1998 Lori Stances Star market 1070 Iyanough Road Hyannis, MA 02601 Dear Ms. Stances: You are granted permission to obtain temporary food permit applications in order to prepare and serve hot dogs, popcorn, packaged ice-cream, and spun candy outdoors at 1070 Iyanough Road, Hyannis, Massachusetts on the following Wednesdays: July 15, 1998, July 22, 1998, July 29, 1998, August 5, 1998, August 12, 1998, August 19, 1998, August 26, 1998 and September 7, 1998. This permission is granted with the following conditions: (1) The applicant must obtain temporary food permits at least four(4) days prior to the event from the Public Health Division, located at the 3rd floor of the Town Hall, 367 main Street, Hyannis. The permit fee is $20.00 for food service table or booth. (2) All foods shall be maintained at proper temperatures (below 45 degrees Fahrenheit or above 140 degrees Fahrenheit). (3) An electronic refrigeration unit shall be provided at the outdoors to keep foods at the proper temperature, below 45 degrees Fahrenheit. (4) Hot and cold potable water, dispenser soap, and paper towels must be provided outdoors at the hand washing facility. (5) Foods shall not be handled with bare hands. Gloves,tongs, or other sanitary utensils shall be utilized to serve foods. Sincerely yours, O/Susan G. RaA, R.S. Chairman Board of Health Town of Barnstable stances z vmi .. y -1 0 0a_/^+- O CAS 3 �,Pr Rs S �� czio 1.. / .�.___ +7 C7 t__ NRSALE o t 1 z ra C . - 6SEEASONAL ED FRUIT c n 7102-2 o 1 NRSALE z (� cA 0 AGIN All _ AjA ZN z�. ;S6L6 40' SERVICE.DELI r. _ 0o -- -- -O'd3ii91130 BO 00 9 - —{ pb'3218 1130 BO 00'B 11 ' � /^� FI Se:ArvN'. suLT'6RN �J _ SGVI'f.12N S .lilt ltN �OUFIiFixN - -G ItiF I? � ' ff.1� /�/��.'l .. -� HC(t'.' ..0 E• b cri Fl`J DM, 1)(H!H _ O O 0 p A N 'a m -- D- T Ko /,,O O l ay yD0C_�Z '7� \ C STAINLESS £ STA NlE55 n O �S %,y-�� �f. Z i--7juj('>•`� U ® l_--1. •� !i_..1. C+ r. �. �. o / _ T V — I CALL AD j� - PIP .00 ~ O =F c> Z CA mI\� p, I EXCITIMENT C.,.� n _m. _ / J EXCITM ) a7 f ll 'L �, o fry f_ u ✓ >,,,JYc� �O ✓ �A1. - - ' a (AMC :�7 n m, D LA M r m m n �m fi. o I, x=o \ j m0M0 iC 2.50 W J.ECR GI M FZ S.OD WH FZ 2.50 H FZ M 2.50 W ,24.00 GR SPAGHETTI SAUCE/SPCL SAUCE 17.ODGRPASTA DRY - fABLE ENTREES WH FZ M FZ I H FZ B �\', �`' ` , �`. ` —� m y Ayye�gPIZZA SSRT 9 /0.55 00 n <0 11 92 93 895 694 I WITH SHELVING (84" HICH)— W W m O mO \ 8 DMRS NATURAL SPCL O mC) FROZEN (20') I Fn 1 OLD CEREAL BRKFAST BARSI rn rn ..... ...__—I SPCL - A m m N y L y WITH W n m]a D It, HOT C CEREAL rn I �rl OOL9 LL6Z 096Z LLSL LOLS ��1' y A : LZSS In n ! tl1Stld - IOdS rn o a T ro N O m O 3N30 0100 HM 00'BL /S2JtlB • m S HSId/1V3W NV0 G6dNd 210 002I, SOOOd ONdHd LID 00'9L NVO 0ydNd il0 00'8 M1Stld O31LIOdV4100*9 3N31SVd OSO 00'L [,n 2'00 NT A N a m o 3AKING {' Oo myy tOp On CI BAD SW -6UGUES4.00S WAUTH 615 0 IA BRAI CMOMRIENG M 4S00 EE 8.00GRCHINESE. DSD TW OUR TORTL ENTIO DSD OSHE . . 'A O / I S 4 LIG MILLWv ^' N) -_--___— A (66 HIGH) TEAICOFFEEICHAI SPREADS^ MFDNTS SL17 KAK G GONDOLA (84" HIGH) T _ DSSl/30Nf1.tl rSl N 3W /.. � Na'i f.1 - G ZO { WORLD AKE SOUP ILL TOS LSICONDIMENTS G N MILLWORK CANOPY — pLIGHTED LfSS £LSS O 0 md10S HM 009 x NVOi3 V Nltll OS000'BZ Ntl01X3W tl000'9 Dp vm OLD PAPRPET FO ' ODAPE19 E 16.00 OR OILS O 54985 5543 5544 1- . . .... ... .. Op ET_ a panA(66 HIGt�USEHOLD PAPER P --N - ------ EN COMPONENTS FOOD {, WITH— GONDOLA(84" HIGH) DIAPERS ` SPCL - - { �1 ^b rbwp•n:sm 9m)wvwwA sd,-zo wew - ngecc sneAen - . Lj m'�f a- �.9, a7 ��•f' ®1 �' -�� f,_�r ""� � ,il.,� � � � �� a� � i —� �» fi �I- Ea °I Ea , a' ^ ^1 E L , E �mu E ee 1p @ d'° Q .� p 0 • 8 Oa. i O O Odi 0 Q p; Qu 9 Q j' Q a =Q Q Q g e E 9 e � ° PI! g � � � s E •I- S - �I �d� •, ��' u i! E 5 dg,'6 S: ;as i @ �= ; �1 �� ® g E i I If ii,, 'sg. :@ �i -&. a ap to � �� � i ¢ � � � � ..a :E•9 dp � a � @ � � a a � k i : € Ea d• I� EQ at Iw, am^.. \ ,� n �E zamlf �, '• ` �. n a.!• i`;da 9 I i,a k _f 4 ; e S e i ; ` d 9. ` �t1- -=.. / *� fi7 '� ` � � d � E � •� —J,�,e/ •— _,..o ..� _...>.. ..,,.. A, — C � $ g � E : E3! -----.� 1'' FEM SIZE 579 (7598) HYANNIS MALL,MA 25' 25 POCKET BRAWINO OROIN CURRENT REFERENCE FILE - SCALE POINT(0,0,0) STORE MERCHANDISING PLAN - 2/22/12 -�' �fhi Rice - HACCP Plan 09/05/00 Pr+e-Pry atton Weigh 6.5 bs rimirinto the cooking pot and Inspect rice for foreign objects (i.e. pebbles and wash until vater is clear, changing water for physical hazards)and remove if present. every wash. Drain water to best extent. Weigh in 7 5 Ibs cold potable water into the washed rice In the pot and let it soak. g ----------------------------------------------------------------------------- Preparatig 1. Wipe out side of pot and place it in the rice Cooking the rice at boiling point will reduce all cooker. P ice the lid on the pot and turn the vegetative pathogens to a safe level. switch on. DO NOT LIFT OPEN THE LID, 2. When do 3 has cooked (power-switch turns Steaming lets the over boiling point steam off autorr Acally),steam rice. blend into the rice to get the proper texture. DO NOT .IFT OPEN THE LID. 3. Empty col ked rice into a shallow NSF Temperature is too high and time is too approved i ontainer. Spread rice into a flat short for any risk. even layer 4. Measure Awasezu and sprinkle it evenly If the correct amount of Awasezu vinegar(Iqt over the a itire surface of the rice. Run the vinegar to 1 pot of cooked rice)was not blended rice spate a through the rice in a cutting properly into the cooked rice,the pH may not reach motion lit, ng and turning to mix in the 4.1 or lower.In that case,blend in a small additional awasezu amount of Awasezu. The final pH of the rice must be reduced to 4.1 or lower in order to control the growth of Bacillus cereus. C.botulinum can be CCP#1 controlled with the pH below 4.6 CCP#1 The pH of each batch of rice is recorded on 5. Check th, pH of the rice. It must be at 4..1 IAA or lower. h easure and record the pH of each new batch )f rice. Label time completed. CCP#2 Throw away aII1eft over sushi rice after 6 $tom hours,Record the time Rice is Acidified and tim left over rice is finished or discarded on Logue 6. Ynegarec-conked rice may be-stared at.. room tern perature. Use within 6 hours from CCP#2 Step 5 ab)ve. Aff leftover rice must be discarded.after 6 hours from labeled time. 7. Sushi are :o be placed inside the cooled display ca ie of 41 OF or lower, as soon as they are n ade and packed. AFC Corp. 19205 S.Laurel Paris Rd. , Rancho Dominguez,CA 90220 1 SUSHI BAR OPERATION CHECKLIST CHECK 1. PH and Temperature 1)Ph must be checked every time you cook rice, and the range has to be 3.3-4.1. 2) Temperature must be checked 3 times a day. (9am, 12pm, and 3pm) 3) These log sheets have to be kept for 6 months in your file. 4)Ph and temperature log has to be in sushi bar all the time. CHECK 2. Sanitation (Cleaning sushi bar) 1) Please make sure that your sushi bar (glass, door, cooler, etc) and equipment (knife, container, etc) are CLEAN. No food particle, no food stick, and no stain. 2) Use SANITIZER to all the things you use in your sushi bar. CHECK 3. Date on sushi package 1) Date must be on all sushi related products. Sushi ldav, SMM(all kinds)-5days, Edamame(soybean)-2days Pa e k e dn< g = r 1 5 d a y s , dale d�'s vg va swab i, y5 d a y s CHECK 4. Handling fish (Preparation and malting sushi with raw fish) 1) Raw fish is very fresh. DO NOT put it outside for more than 15 minutes. 2) Before you use fish, check the smell and taste. CHECK S. Daily Production Report 1) It must be faxed to 617-738-6204 every week. CHECK 6. Food Handling Certificate 1)All sushi chefs including your helper must have this certificate. 2) If you and/or your helper don't have,it, please contact your local health department. These are minimum requirements based on AFC and state health department. If you do not follow these lists above, WARNING LETTER will be issued from an AFC representative(Ex.regional manager or supervisor). As you know, if you receive 3 warning letters.you will be terminated To contractor: Please tell all your helpers to follow this, and re-train them as needed. Contractors are all responsible for all your helpers!! If you have a question and/or a problem,please feel free to call me. Richie A)izaki: 1-888-923-9401(Pager) TOWN OF BARNSTABLE Bpi TN E TO 6Q � OFFICE OF DAH39T&n i BOARD OF HEALTH MASS. vo 039• `em 367 MAIN STREET 'FO MAy k' e 11, 1998 HYANNIS, MASS.02601 Marilyn Fox Cape Cod Bagel Co., Inc. 419 Palmer Avenue Falmouth, Ma 02540 RE: Cape Cod Bagel at Star Market Dear Ms. Fox: You are granted a variance to operate a food service establishment at 1070 Iyanough Road, Hyannis, without connecting the three compartment sink into the existing inground grease trap. This variance is granted with the following conditions: (1) No cooking is authorized at this site. Only pre-made soups may be heated and pre-made bagel sandwiches may be heated in a microwave oven only. Muffins and all bagel foods proposed on the menu shall not be cooked at this site. (2) Only sandwiches which require little or no mayonnaise may be pre are is site. No tuna fish salad sandwiches, chicken salad sandwiches,ham salad sandwiches, nor any other sandwiches requiring larger amounts of mayonnaise are authorized. (3) Only single-service plastic utensils and paper plates are authorized at this site. (4) An under-sink-grease interceptor shall be installed beneath the three compartment sink in accordance with the MA Plumbing Code. (5) This variance decision letter shall be posted on the wall adjacent to the food service permit for easy viewing by a health inspector any time an unannounced inspection is made. This variance is granted because the applicant stated a majority of the foods will be prepared at her food establishment located in Falmouth and will be transported by refrigerated truck to this site. Sincerely yours, &W w/h Susan G. Ras , R.S. 'p Chairperson ��y� Board of Health Town of Barnstable v A,,/L �/ U SGR/bcs Vn (4- CiZ4-�-1 OT* fi',9/L cc: Edward Jenkins --L__A rLe1 fox [/�/•( V j�C/�.� Q�/l../ j;� Ci��l/j/yLc'�'' /��� U �� � VC-re C--2� - i v STA,R*MARKET RISK ADMINISTRATION OFFICE -7. The documents accompanying this transmission contain confidential information belonging to the sender which is legally privileged. This information is tended for the use of the individual(s) or entity(ies) named below. If you are not the intended recipient, you are hereby notified that disclosure, copying, distribution or the taking of any action in reliance on the contents of this information is strictly prohibited. if you have received this transmission in error, please notify us by telephone to arrange for return of the original documents) to us. Risk Administration Office: (617) 528-2440 Risk Administration Fax #: (617) 528-3489 TO: ECOMPANY: y � FROM: DATE: _ FAX #: � 790 _�:d No. of Pages includin cover Message: VOL" TO'd 68b£ EScS LT9 d1SINIWGV ASI8 S1AW 8UiS ec:©© 866i-9F-Nnr Z0'dQ1d1�011 /� BA 1 STATE �3 BOMMELLEVUE STREET WEST'ROXBugY.MA 02132 PROPOSAL CONSTRUCTION Inc. (et n 325-MI (617)3Z3,3 a FAX(81 T) 325-M Proposal Number 79403 Proposal Date 25-Jun-98 Gary Collette Star Market 625 Mount Auburn Street Cambridge,MA 02238 Customer PO # 1 Payment Terms Vender # Bay State Job # Valid Through 913 121 25•JuI.98 Description Amount Grease Trap Gary , As per your request we have investigated the possibility of tying into your existing grease trap for new bagel store. Boystate feels it is impossible to tie into your trap due to the distance needed as well as the pitch required for the pipe, The following are two options you can take. Option # I : Preferred by local authorities, To install exterior 1000gallon grease trap . g 11,000.00 Option # .2: will need variance. To use a grease extraction unit. $4,900.00 Sales Tax Included Total o.00 THANK YOU FOR YOUR BUSINESS I Z0'd 68b2 28ZS LZ9 8iSINIWGU ASId SiAW dUIS 0Z:00 8661-9Z-Nnf Marathon Commercial Solutions LLC Professional Construction & Facilities Services •��I A6, A C 448 Turnpike Street,Suite 1-1 South Easton, MA 02375 r Shaw's Supermarket .t��f<7" D C�np2;j- 1070 lyannough Rd. Hyannis, MA 02601 � y -i1-5,.2OJ-1 Minor Interior Upgrade—Scope of Work Main Sales Area— Painting of all interior walls, soffits,columns etc. Repair/Replace bad ceiling tiles&floor tiles as required Remove all existing signage &graphics and replace with new Misc. shelving, millwork fixtures&displays per plan Remove &dispose of Wild Harvest Trellis& Lighting Remove &dispose of Hanging HBC Lighting Existing Pharmacy- Remove interior Pharmacy Area in its entirety Patch in acoustical ceiling&floor tile Adjust sprinkler heads for proper coverage per surrounding area Produce Area- Remove&dispose of 32ft. Upright Refrigerated Cases Remove&dispose of Prepared Foods/Vac-Pack Island Remove&dispose of Salad Bar Island Remove Free Standing Soup Kiosk Add 24 ft.Self-Contained Refrigerated Mobile Cases Add 12 ft. Multi Deck Prepared Foods Case Add Free Standing Hot/Cold Soup POD Add 12 ft. shelving on wall Meat Area - Add 12 ft. Refrigerated Tub Case in Rear Aisle Dairy Area - Remove&dispose of 16 ft. Upright Refrigerated Cases Remove Seasonal Shelving per plan Add 15 ft.shelving on wall Add additional open floor pallet positions Note: No changes to the building envelope, no changes to access or egress. No changes to HVAC or Fire Alarm Systems No exterior work. Only sprinkler work is head adjustment at area of removed Pharmacy. Prepared by: Gary J. Laboa General Manager Marathon Commercial Solutions 1 II •_ • _• • .. _ The FIX-EC is a refrigerated end cap unit that is designed to be utilized either as a standolone display or used In conjunction with Southern FIX ••• _ •• merchandisers to complete a produce island configuration. The FL EC is available in the some finishes as the FIX and is suitable for produce applications. 36' 2 1 �`.. 2 .. Cott. ' SECTION VIEW-FIX-EC Standard Features: Options: Architecture: •Consult factory on alternative:case controls •All welded rigid frame 9 Liquid-suction heat exchanger •CFC-free foam injected seamless basin •Specify for use with secondary coolant systems • Heavy duty casters • LED lighting-specify location(s) •Open base-exposed leg design • Interior stainless steel finish Mechanical: • Exterior stainless"steel, standard/premiuni,color,•wood or • High efficiency refrigeration system w/copper tube coils laminate finish • Energy efficient fans • Exterior down light • 1 1/2'drains w/traps • NSF leveler legs •Thermometer •Cart bumper specify size —T •Self-contained refrigeration system with: •Stainless steel,solid surface,or stone top/reorledge a w -Condensing unit •Alternative heights, lengths, &options-consult factory 4 -Electric condensate dissipator �WW -Electronic temperature and defrost controls Remote Refrigeration Options: Interior: •Thermostat w/defrost'control.&suction line'solenoid PLAN VIEW • Black interior • Liquid line hand valve: • Removable base deck with riser for 4-step display • Expansion valve-specify refrigerant Exterior: •Temperature,sensor-specify • Block color finish with wood trim •Block top/rear ledge •Insulated bock panel .F . 1„ 98 MODEL: 8' MPSS-DS BTUH/LN FT: 1100 EVAP TEMP: 20° �b0 as., �N ,� SUPER HEAT SET POINT: 7 ° "' DISCHARGE AIR: 29 ° F t� 11 _ ________________________ _______________________________ _� AVERAGE PRODUCT TEMPERATURE: 36 ° F INSIDE OF FRA E&KICKPLATE DEFROST: OFF TIME 30 MIN/6 HR Lo ELECTRICAL CASE FAIL SAFE MIN. 35 RAIN Ml(o TEMP TERMINATION 45 OF co 00 VOLTAGE: 120v-1-60 N REFRIGERATION LIGHT AMPS: NA 0 o W LINES INSIDE OF FRAME&KICKPLATE w LU a --------------------------------------------------- FAN AMPS: .3 ANTICONDENSATE HEATERS: NA m < ui a 2 zo w TOTAL AMPS: .3o� DRAIN: 1-1/2" REVISED WITH MORRILL SSC ENERGY EFFICIENT FANSPLAN VIEW a � o� Q o Nio Eg>� MPSS-DS 96" 8116 U Z N $@@ Lu LL co Q N CASE SPECS o C PARNELL ILU, FRONT VIEW SIDE VIEW Zoos-REv#IR MPSS-DS MPSS-DS 0:\ClientWbertsons\Master Case Specs 2005\Master Case Specs 2005.dwg June 08,2005-01:19pm Printed By: CPamell r Hussmwnn® 0 D5X-LEP IAW/PA�C�T TM ��� Technical Data Sheet P/N 0463869A C NSF® Certified 11� D February 2006 � o � S 1 I a F c --� We reserve the right to change or revise specifications 0 and product design in connection with any feature of our products.Such changes do not entitle the buyer to corresponding changes,improvements,additions or replacements for equipment previously sold or shipped. A Item Part# Description Wiring Item# Item Part# Description Wiring Item# FAN ASSEMBLIES AND THERMOSTATS LAMPS AND BALLASTS A. 12W Standard Fan Assembly (1) C. Ballast,Electronic (3) (SVC#M04410324) 0464251 2 lamps 0047000 Fan Motor,Evaporator 0464252 3 lamps 0461805 Fan Blade 0464253 4 lamps 12W Energy Efficient Fan Assembly (1) D. Fluorescent Lamp (4) (SVC#M04410325) Replace with like fixtures 0439053 Fan Motor,Evaporator 0461805 Fan Blade B. Optional Adjustable Refrigeration Thermostat (2) Note:Changed items have been underlined. HUSSMANN CORPORATION,Bridgeton, MO 63044-2483 U.S.A. P/N 0463869A Engineering Plan Views Dairy & Delicatessen Dimensions shown as in.and(mm). 10-2004 05X A D 3 In. B77 mm) 8(203) Required 41 1/2 43 7/s 41 1/2 41/a(115) Air Gap (1054) (1114) (1054) 41/4(108) 4 3/4(120) Electrical Refrigeration Stub Up Area Outlet 26 1/4 31 % 42 (6 2) 1 1 6 x 6 i i Z 4 3/4(120) 1 I I I (665) (804) (1064) + 1 1 (152x152) I I I I Waste Outlet 1 1 301/4 331/2 Electrical z r Outlet ' ` ;r (767) (851) Feld ,�Waste -------------------- -- Connection 26 1/2 Splashguard 12 1/8(307) (673) C NOTE:Case-to-Case Electrical Connections are made IN FRONT OF SPLASHGUARD. FRONT 4 ft 6 ft 8 ft 12 ft General (A) Case Length(without ends or partitions) 48 3/8(1229) 72 3/8(1838) 96 3/8(2448) 144 1h(3670) (Each end and insulated partition adds 1 112 in.(38 mm)to case line up.) Maximum O/S dimension of case back to front (includes bumper) 42 (1064) 42 (1064) 42 (1064) 42 (1064) Back of case to front of splashguard 33 1/2 (851) 33 1/2 (851) 33 1h (851) 33 lh (851) Back of case to O/S edge of front leg 30 1/4 (767) 30 1/4 (767) 30 1/4 (767) 30 1/4 (767) Distance between edges of external legs and center legs NA 29 1/2 (750) 41 1h (1054) 41 1h (1054) Distance between edges of center legs NA NA NA 43 7/8 (1114) Distance between front legs and splashguard 2 3/4(70) 2 3/4(70) 2 3/4(70) 2 3/4(70) Electrical Service Z (Electrical Field Wiring connection point) (B) RH End of case to center of stub up area 36 1/4 (921) 60 1/4 (1530) 84 1/4 (2140) 132 3/8 (3363) Back of case to center of stub up area 24 (612) 24 (612) 24 (612) 24 (612) Length of electrical raceway 26 1/2 (673) 26 1/2 (673) 26 1/2 (673) 26 1/2 (673) (C) RH End of case to LH end of raceway Raceway 42 1/8 (1070) 66 1/8 (1680) 901/8 (2289) 138 1/4 (3511) Waste Outlets (One each end) (D) RH End of case to the center of LH waste outlet 36 1/4 (921) 60 1/4 (1530) 84 1/4 (2140) 132 3/8 (3363) RH End of case to the center of RH waste outlet 12 1/8(307) 12 1/8(307) 121/8(307) 12 1/8(307) Back O/S of case to center of waste outlets 31 5/8 (804) 31 5/8 (804) 31 5/8 (804) 31 5/8 (804) Schedule 40 PVC drip pipe 1 1/4 ' 1 1/4 1 1/4 1 1/4 Refrigeration Outlet F-1 Back of case to center of refrigeration outlet 26 1/4 (665) 26 1/4 (665) 26 1/4 (665) 26 1/4 (665) RH end of case to center of refrigeration outlet 8 (203) 8 (203) 8 (203) 8 (203) 2 of 6 HUSSMANN CORPORATION,Bridgeton,MO 63044-2483 U.S.A. ' D5X-LEP Technical Data Sheet Multi-deck, 5 Display Levels, Low Front impact EXCe/ D5X-LEP Dairy& Delicatessen REFRIGERATION DATA Dimensions shown as in.and(mm). Note:This data is based on store temperature and humidity that does not exceed 75°F and 55% R.H. 42 3 In.(77 mm) D5X-LEP UNLrr Lrr PEG** D5X-LEP (losa) Required Discharge Air*F 32 30 30 Air Gap Evaporator°F 28 26 26 7 1/4(183) Unit Sizing°F 26 24 24 �— Btu/hr/ft* D5X-LEP UNLrr LIT PEG** Parallel 1290 1385 1445 Conventional 1365 1465 1530 *For all refrigeration equipment other than Hussmann,use conventional Btu values. 56 1/2 **Hussmann Peg Shelves(Deli only). (1335) 61 (1549) 3 DEFROST DATA 61 /a , (2077) Frequency Hrs 8 Defrost Water(lb/ft/day) 10.5 (±15%based on case configuration and product 301/4 C loading). (769) 0 OFFTIME D5X-LEP Time(minutes) 30 L 19 1/4 5 1h 5 1/2 EL.ECTRic oR Gas Not Recommended (485) (140) 31/4 FAN (138) (84) Refrigem9w 17 "et_ (I CONVENTIONAL CONTROLS 4F-1 1/2(144) Low Pressure Backup Control 171/8 Cl/CO** D5X-LEP Electdcal i (436) 19017/9017 Case to Case i 4 3/4(120) Connections Indoor Unit Only,Pressure Defrost ►-- 26 1/4(665) Termination** 48°F 30 1/4 (767) **Use a Temperature Pressure Chart to 31 %(804) determine PSIG conversions. 33 1/2(851) �— 42(1064) PHYSICAL DATA Drip Pipe(in.) 1 1/4 Liquid Line(in.) 3/8 Suction Line(in.) 7/8 Estimated Charge(lb)*** D5X-LEP NSF Certification 4 ft 1. 6 ft 2.8 These merchandisers are manufactured to meet ANSI/National 8 ft 3.7 Sanitation Foundation(NSFO)Standard#7 requirements. 12 ft 5.1 ***This is an average for all refrigerant types. Actual refrigerant charge may vary by approximately half a pound. P/N 0463869A HUSSMANN CORPORATION,Bridgeton, MO 63044-2483 U.S.A. 3 of 6 Impact Excel D5X-LEP Dairy& Delicatessen Electrical Data 4ft 6ft 8ft 12ft Number of Fans-12W 1 2 2 3 Amperes Watts 4ft 6ft 8ft 12ft 4ft 6ft 8ft 12ft Evaporator Fan 120V 60Hz Standard 0.70 1.40 1.40 2.10 55 110 110 165 120V 50Hz Standard 0.81 1.62 1.62 2.43 59 118 118 177 230V 60Hz Export .0.33 0.66 0.66 0.99 54 108 108 162 230V 50Hz Export 0.38 0.76 0.76 1.14 57 114 114 171 120V 60Hz Energy Efficient 0.38 0.76 0.76 1.14 25 50 50 75 230V 60Hz Energy Efficient 0.19 0.38 0.38 0.57 25 50 50 75 Minimum Circuit Ampacity 120V 60Hz Standard 0.90 1.60 1.60 2.30 120V 50Hz Standard 1.01 1.82 1.82 2.63 230V 60Hz Export 0.53 0.86 0.86 1.19 230V 50Hz Export 0.58 0.96 0.96 1.34 120V 60Hz Energy Efficient 0.58 0.96 0.96 1.34 230V 60Hz Energy Efficient 0.39 0.58 0.58 0.77 Maximum Over Current Protection 120V 20 20 20 20 Maximum Over Current Protection 230V 15 15 15 15 Standard Lighting 1 Row Canopy 0.26 0.51 0.51 0.77 30 59 59 85 Optional Lighting Additional 1 Row Canopy 0.26 0.51 0.51 0.77 30 59 59 85 Additional 2 Row Canopy 0.51 1.02 1.02 1.54 59 118 118 170 1 Row Rail Light 0.26 0.51 0.51 0.77 30 59 59 85 Optional Shelf Lighting 1 Row Shelf Receptacle 0.26 0.51 0.51 0.77 30 59 59 85 4 Row Shelf Receptacle 1.02 2.04 2.04 3.08 118 236 236 340 5 Row Shelf Receptacle 1.28 2.55 2.55 3.85 148 295 295 425 6 Row Shelf Receptacle 1.53 3.06 3.06 4.62 177 354 354 510 115V Lighting Circuit Total=Standard Lighting+Total Optional Lighting+Optional Shelf Lighting 230V Lighting Circuit Total=Mutiply 115V Lighting Circuit Total by 0.52 4 of 6 HUSSMANN CORPORATION,Bridgeton, MO 63044-2483 U.S.A. D5X-LEP Technical Data Sheet 1-�0 L-0 's popCl) E0004024 0i ell- (001 LawceM�eA.arAttm - ® dsum"= tawwr m s.rr ADJUSTABLE HEIGHT SNEEZE ar x 8'x are- r.mMaMoowN�'o� . GUARD GLASSENDGMELF w�wsTwaaam n.w a LID DISPENSER TAG MOLD UNTENSIL CROCK �mywNwwowr pm ON BASE uaRNsswm o.o DECK swn.wwa�w.�aRasN.00wm to t = O REFRRSERATED.CJIPACM. TOP 511ELF-70 UN(iS . BAN C E' .42 UNcrs S (c«rtA ER sae w•oa.surTAL) `� AMPLE CUP DISPENSER N CORIAN PACKAGING AND NOT SOUP LEDGES (4)T CT.SOUP WARMERS �L MID SECTION VIEW PLAN VIEW Is ROUTE ELECTRICALS ci ems, FROM TOPj�e � of ow- 0- 1., F- ar e• E • � �N Ip II REFRIGERATED SIDE VIEW LAMINATED BASE WITH (MEDIUMW) DISPLAY SHELF END VIEW SOUP SIDE VIEW VENT GRIT I PACKAGING END VIEW JJ ONES 08/20M w. mr—o=0• AIMMIL700.•n:1.n Mara 1r 0 Hussmnnno LN 11MIPAA C, 1_6erchandisers Technical Data Sheet P/N 0395733 G C NSF°Certified I't ' , A February 2007 E G C"5-0- D o , B We reserve the right to change or revise specifications and product design in connection with any feature of our products.Such changes do not entitle the buyer to 0 corresponding changes,improvements,additions or replacements for equipment previously sold or shipped. Item Part# Description Wiring Item# Item Part# Description Wiring Item# FAN ASSEMBLIES AND THERMOSTATS HEATERS A. 4W Fan Assembly (1) E. 0395709 Modular Electric 0392457 Fan Motor, Standard(MO.4410101) Defrost Heaters,208V (5) 0409511 Fan Blade,embossing toward motor (HE.4850409) (FB.0409511) F. Drip Pan Heaters,Electric 208V (6) B. Optional Adjustable Refrigeration Thermostat (2) 0392413 8 foot case(HE.0392413) 0392414 12 foot case(HE.0392414) C. 0398557 Defrost Termination Thermostat (3) Drip Pan Heaters,Koolgas 120V (7) (Electric Defrost only) 0421238 8 foot case(HE.4850496) (CT.4440611) 0421239 12 foot case(HE.4850497) D. 0425304 Heater Switch (4) Defrost only) G. Nosing Anti-sweat Heaters (8) (Koolgas D (CT.0425 efro 0401605 8 foot case(Discharge)(HE.0401605) 0401557 8 foot case(Return)(HE.4850467) 0401606 12 foot case(Discharge)(HE.4850471) 0401558 12 foot case(Return)(HE.4850468) NOTE: Revision G corrects heater data on Page 4. ©2007 HUSSMANN CORPORATION•BRIDGETON,MO 63044-2483 U.S.A. P/N 0395733_G U.S.&CANADA 1-800-922-1919 9 MEXIC01-800-522-1900•WWW.HUSSMANN.COM Engineering Plan Views Low Temperature Narrow Island Models Dimensions shown as Inches&(mm). A — C I• B i --- ---------------------- I 32 ate 33 ate LN I— ---------�; eza) (ea8) 35 7/8 39 5sne (911) 41 ste II191/8 (1a1)� — (991) lU Base Rail i 45at4 I i(486) (1161) Waste Outlet Retrig.Outlet ---- — ----- I Access Area foray/ —- —-- 1 ---------------------- r Water Seal 2 718 (See Note*) (98) '-.45 (127) 8ft 12ft General (A) Case Length(without ends or partitions) 96 1/4(2445) 144 1/2(3670) (Each end and insulated partition adds 2 in.(51 nun)to case line up.) Maximum O/S dimension of case back to front(includes bumper) 45 3/4 (1162) 45 3/4 (1162) Back of case to front of splashguard 41 5/8 (1057) 41 5/8 (1057) Back of case to O/S edge of front base rail 32 3/8 (822) 32 3/8 (822) Width of base rail 2 1/8(54) 2 1/8(54) Stub-up area(gray)between base rail and splashguard 7 5/8 (194) 7 5/8 (194) Electrical Service ® (Electrical Field Wiring connection point) RH End of case to center of nearest knockout 5(127) 5(127) Back O/S of case to center of knockout 39(991) 39(991) Waste Outlets Q (B) RH End of case to the center of waste outlet 58 1/4 (1480) 72 1/4 (1835) LH End of case to center of waste outlet 38(965) 72 1/4 (1835) Back O/S of case to center of waste outlet 35 7/8 (911) 35 7/8 (911) Water Seal 1=i Edge of water seal to center of waste outlet 11 (279) 11 (279) O/S diameter of drip pipe lines 1 1h(38) 1 1/2(38) Note*:Field installed water seal outlet,tees and connectors are shipped with case. Refrigeration Outlet RH end of case to center of RH refrigeration outlet 5 9/16(141) 5 9/16(141) (C) LH end of case to center of LH refrigeration outlet 88 3/8 (2245) 138 7/8 (3527) Back O/S of case to center of refrigeration outlet 33 3/8 (848) 33 3/8 (848) 2 of 6 HUSSMANN CORPORATION, Bridgeton, MO 63044-2483 U.S.A. LN Technical Data Sheet Single Level Narrow Island Display Impact LN Frozen Food&Ice Cream REFRIGERATION DATA Note:This data is based on store temperature and humidity that does not exceed 75°F and Dimensions shown in inches&(mm). 55%R.H. FF IC Discharge Air(°F) —12 —22 Evaporator(°F) —20 —30 Unit Sizing(°F) —23 —33 FOR] Brulhrifr FF IC Parallel 390 400 Conventional 405 415 J 14 3/4 DEFROST DATA FF IC (375) 3215116 Frequency(hr) 24 24 1/2 (862) Defrost Water(lb/ft/day)0.75 0.60 (902) (t 15%based on case configuration and product 30 — loading). ELECTRic FF IC L — J FANECO�tL Temp Term(°F) 480 48' Failsafe(minutes) 60 60 1 1 �l GAS 81/ I ® 7(17i3) Duration(minutes) 15 18 i 5 I I OFFTIME Not Recommended (1Z7) 19 1/8 (486) Standard Defrost Thermostat 32 3/ (824) Close on rise: close 48°F — open 33°F ' 8 - 33 / CONVENTIONAL CONTROLS 3 4� 8(8 8) Low Pressure Backup Control i I. 35 7/8(911) FF IC I� 39(991) Cl/CO(Temp°F)* —27/-39 —27/-39 41 5/8(1057) Indoor Unit Only,Pressure Defrost Termination(Temp°F)* 45 3/4(1161) Not Recommended *Use a Temperature Pressure Chart to determine PSIG conversions. PHYSICAL DATA Merchandiser Drip Pipe(in.) 1 1/4 Merchandiser Liquid Line(in.) 3/8 Merchandiser Suction Line(in.) 5/8 Estimated Charge(lb)** 8 ft 1.7 12 ft 2.6 **This is an average for all refrigerant types. Actual refrigerant charge may vary by approximately half a pound. NSF Certification These merchandisers are manufactured to meet ANSI/National Length Added to Lineup by: Sanitation Foundation(NSh)Standard#7 requirements. Each End/Partition(in.) 1 1/2 P/N 0395733_G HUSSMANN CORPORATION•BRIDGETON,MO 63044-2483 U.S.A.•WWW.HUSSMANN.COM 3 of 6 Impact LN Frozen Food &Ice Cream Electrical Data 8 ft 12 ft Number of Fans—4W 2 3 (Energy Efficient fan motors are not available for End or End-compartment models) Amperes Watts 8ft 12ft 8ft 12ft Evaporator Fans 120V 60Hz Standard 0.62 0.93 48 72 120V 50Hz Standard NA 230V 60Hz Export 0.30 0.45 48 72 230V 50Hz Export 0.36 0.54 54 81 120V 60Hz Energy Efficient 0.28 0.42 20 30 230V 60Hz Energy Efficient NA Nosing Anti-sweat Heaters(on fan circuit) 120V 60Hz Standard 0.94 1.40 112 168 230V 50Hz Export 0.49 0.73 112 168 Cycling Anti-sweat Heaters NA 230V 50hz Export NA Minimum Circuit Ampacity 120V 60Hz Standard 1.76 2.53 120V 50Hz Standard NA 230V 60Hz Export 0.99 1.38 230V 50Hz Export 1.05 1.47 120V 60Hz Energy Efficient 1.42 2.02 230V 60Hz Energy Efficient NA Maximum Over Current Protection 120V 20 20 Maximum Over Current Protection 230V 15 15 Electric Defrost Heaters 208V 60Hz Standard 8.0 12.0 1670 2505 230V 50Hz Export 8.9 13.3 2040 3060 Koolgas Drip Pan Heaters 120V 60Hz Standard 2.50 3.75 300 450 230V 50Hz Export NA Standard Lighting: None 4 of 6 HUSSMANN CORPORATION, Bridgeton, MO 63044-2483 U.S.A. LN Technical Data Sheet I •� 1 R - \\ m o e I n I D aI ° 0 IQ D a Io p I i � D m D -u � ;] —01 9 I m - D rE = m !_j o i I 6 I rw 1r1,l1 ;!1np coo[ z�m m r 3 Ln =I in To A I T mm § 4 mr_ fig.: 9 ;o v m � O all k� ll m i 0 m " o o -r Fn T --- � � m ' A� o N SS ` g P T� \ N 9 Dr (rwLi z mm cn II ° MT, NM II m< \ II = O H III i S4 ON ° II � smREPVJNNER MARK G. BREE 7nU 7 MMAG: ROBIN A. INITIATIVE-WORK HYANXIS=MALL NSDEDA 05-16-2016. ° 1070 IYANNOUGH RD BUBD@lDsIZE 54,879 SF r-33-:75.98: s HYANNIS,MA DRAWRlo SCALE 1/8R=T-0" DMSION I SMRE NUMBER u N � i 09E-1R DSE-12 09E pg_,'� PRE-IR �pgr�12 ��_2• ���✓ -4• SW-HIGH CAPACITY REFRIGERATED PRODUCE CHlNM UPRIGHT RERRIGERATED PRODUCE CAS 'WITH NEW CARISON RACKS AND IN of 1 REFRIGERATED PRODUCE END i I I I I I ' I a�ru•ml i I I a��d 1 ITI I c pT 1 I I I I 1(mu as Rapes I I �w I I I I I I 1 3 '.lM �A 1 1 1 I <b<Ps N o Q 8s lilt a7 0 ,� In m x� �Ae OI m y mA ` O �f I M1I P O E E z-Bar v x c _ z mF S(NK D c: 0�0� RLY � rmcPc u LEI R O 5 m -i O oil I °�'° I o PxaR+Rle ar�xoDml wRawol ti O POS C 3 w u N m o I 40�-7. (� LOTT n DECK REF.8' MULTI— M/DDAIRY 8 DOORS NATURAL SHELVING(BA'HI m n — BEVERAGE FROZEN (20') — z N — — m Pos rn I I 0 m a 26._Z. g --- ---------- f�NE •AU.GREEN ODt9'ONENfs - o Q I O m ?W P N I [HYANNIS, ^\ z m � 5 smREPIANNER MARK G. SHEETTIRE HY�ANN_I.SIMAJE� AGM ROBIN A. S R CEBAKERV zCONCEPTDAm 03-29-2016 1070 IYANNOUGH RD ENLDPII6� 54,879 SF MA _ 33-7598 DRgWD1G SCAM 1�8N-1�-0" DNISKIN/STORE NUMBER HUSSMnnno SMGT EAxcel Technical Data Sheet P/N T'Stat Bulb NSF® Certified Location C Apr. r - — ,= DOE 2012 E G •` G Energy Efficiency Compliant E H r _ — . (Optional o I' Lights) V� I B D F We reserve the right to change or revise specifications A and product design in connection with any feature of our products.Such changes do not entitle the buyer to corresponding changes,improvements,additions or replacements for equipment previously sold or shipped. Item Part# Description Wiring Item# Item Part# Description Wiring Item# FAN ASSEMBLIES AND THERMOSTATS LAMPS AND BALLASTS A. 0392457 Fan Motor,Evaporator(120V) (1) D. 0440215 2 lamps(230V 50-60 Hz) (4) 0425336 Fan Blade(120V) 0428652 3 lamps (230V 50-60 Hz) embossing toward motor 0385104 Ballast Transformer 0436517 Fan Motor,Evaporator(230V) (230V 50-60 Hz, per ballast) 0440141 Fan Blade(230V) embossing toward motor E. Fluorescent Lamp (5) B. 0522287 High Efficiency Fan Motor, (2) Replace with like fixtures Ambient(120V) 0404552 Fan Motor, LED FIXTURES AND POWER SUPPLY Ambient(230V) F. 0501213 Power Supply (6) C. 0137880 Optional Adjustable (3) G. LED Canopy Fixture (7) Refrigeration Thermostat Replace with like fixtures H. LED Shelf Fixture (8) LAMPS AND BALLASTS Replace with like fixtures D. Ballast, Electronic (4) 1 LED Rail Fixture (9) 0355716 2 lamps(120V) Replace with like fixtures 0355398 3 lamps(120V) NOTE.For LED lighting parts contact your Hussmann service representative at 1-800-922-1919. Please have your model and serial number available.Descriptions including size and color are at WWW.HUSSMANN.COM/SERVICEANDPARTS. Note: Revision B adds optional EcoShine II LED lighting,pages 1,4,8,9,& 10.Other changes marked by bar,underline or circle. ©2013 HUSSMANN CORPORATION-BRIDGETON,MO 63044-2483 U.S.A. Spanish 0538812 U.S.&CANADA 1-800-922-1919-MEXICO 1-800-890-2900-WWW.HUSSMANN.COM French 0538813 Engineering PHYSICAL DATA Merchandiser Drip Pipe(in.) 1 1/2 Plan Views Merchandiser Liquid Line(in.) 3/8 Merchandiser Suction Line(in.) 5/8 Meat & Delicatessen Flat Hinged Glass Models 05-2011 Dimensions shown as in.and(mm). A D C SMBT 43 45 3/8 43 SMGT (1092) ( (1092) 1�/8(47) B 2 3/4(70)(70) �,�,-5 1/2(140) — 7- --- —————— — Electrical - . 5 , �, , , 321/4 T T 24 /8 T 7-t 3 T T (See Note') T T 27 (819) (625) L 4 /4(120) Refrigeration Outlet �-►1(203) (686) 33 1/8 a i-wa"teiseal , I I 28 3/4 I I wate=Seal i ($41) ti LJ `" --- - — ---—— ——!- -I-- — —— .._.._ r ..; Waste Outlet L, L� ��� �� 44 7/8 Waste Outlet-� (1140) Splashguard FRONT —12 1/8(307) 4ft 6ft 8ft 12ft General (A) Case Length 48 1/4(1226) 72 1/4(1835) 96 3/8(2448) 144 1/2(3670) Maximum O/S dimension of case back to front 44 7/8(1140) 44 7/8(1140) 44 7/8(1140) 44 7/8 (1140) (Note: Includes bumper) Back of case to front of splashguard 33 1/8(841) 33 1/8(841) 33 1/s(841) 33 1/8(841) Center of rear legs to center of front legs 23 1/2(598) 23 1/2(598) 23 1/2(598) 23 1/2(598) Each End and Partition adds 1 1/2 in. (38 mm)to the length of the lineup. Electrical Service (B) RH end of case to Electrical raceway right edge 3 7/8(98) 3 7/8 (98) 3 7/8(98) 3 7/8 (98) (C) RH end of case to Electrical raceway left edge 44 1/s(1121) 40 1/2 (1029) 44 1/s(1121) 44 1/8(1121) Back of case to center of knockout 1 7/8 (47) 1 7/8(47) 1 7/8(47) 1 7/8(47) * Electrical Field Wiring Connection Point Waste Outlet (D) RH End of case to the center of LH waste outlet 36 1/4(921) 60 1/4(1530) 84 318(2143) 132 1/2(3366) RH End of case to the center of RH waste outlet 121/8(307) 12 1/8 (307) 12 1/8(307) 12 1/8(307) Back O/S of case to center of waste outlets 32 1/4(819) 32 1/4(819) 32 1/4(819) 32 1/4(819) Schedule 40 PVC drip pipe 1 1/4(32) 1 1/4(32) 1 1/4(32) 1 1/4(32) ** Field installed water seal outlets,tees,and connectors are shipped with the merchandiser. Refrigeration Outlet - Back of case to center of refrigeration outlet 27(686) 27(686) 27(686) 27(686) RH end of case to center of refrigeration outlet 8 (203) 8(203) 8 (203) 8(203) Outside diameter of the liquid line 3/8(9.5) 3/8(9.5) 3/8(9.5) 3/8(9.5) Outside diameter of the suction line 5/s(16) 5/8(16) 5/8(16) 5/8(16) 2 of 10 U.S.&CANADA 1-800-922-1919•MEXIC01-800-890-2900•WWW.HUSSMANN.COM SMGT Technical Data Sheet J Flat Hinged Glass, Gravity with Blower assist, 3 Display Level Excel SMGT DOE 2012 Hussmann refrigerated merchandisers configured for sale for use in the United States Meat/Delicatessen .Energy Efficiency Compliant meet or surpass the requirements of the DOE 2012 energy efficiency standards. REFRIGERATION DATA Note:This data is based on store temperature and humidity that does not Dimensions shown as in,and(mm). exceed 75°F and 55%R.H.Schedule defrost at night while lights are off. 10 1/2 (267) SMGT Discharge Air(°F) 24 C O I L Evaporator(°F) 18 SMGT 20 Unit Sizing(°F) 16 Btftlhrlft SMGT 24 1/4 �e) I Parallel 420 (616)j/ 10 24° Conventional 450 i �—(254)--1 52 1/2 DEFROST DATA 33 5/e C (1321) SMGT i (854) 0 i 1 Frequency(hr) 24 ---- Defrost Water(lb/ft/day) 0.17 dz_ _ 00 34 5/$ (+15%,based on case configuration and Refng. r FA N (879) product loading). 23 Outlets Elec. (584) _ - -- SMGT 19 14 3/a OFFTIME(minutes) 70 (483) 11 3/a (365) Failsafe(minutes) 90 I I (298) 1 7/8 (47) ELECTRIC OR GAS Not Recommended I= 24 5/8 (625) CONVENTIONALCONTROLS Low Pressure Backup Control 1_ 27(686)' SMGT V —32 1/4 (819) 10 Cl/CO(Temp°F)** 11°F/1°F =---33 1/8 (841) Indoor Unit Only,Pressure Defrost 44 718 (1140) BPI Termination(Temp°F)** Not Recommended NOTE: **Use a Temperature Pressure Chart to determine PSIG conversions. Lighted or unlighted shelves may be used. PHYSICAL DATA Estimated Charge(lb)** 4 ft 0.75 lb 12 oz 0.35 kg 6 ft 1.0 lb 16 oz 0.5 kg NSF Certification 8 ft 1.5 lb 24 oz 0.7 kg This merchandiser model is manufactured to meet NSF/ANSI 12 ft 2.0 lb 32 oz 0.9 kg (National Sanitation Foundation) Standard#7 requirements **This is an average for all refrigerant for construction,materials&cleanability. types.Actual refrigerant charge may vary by approximately 0.5 lb(8 oz/0.2 kg). Length Added to Lineup by: Each Plastic End w/Bumper(in.) 3 1/2 Each End/Partition(in.) 1 1/2 P,/N 0519837_B HUSSMANN CORPORATION•BRIDGETON, MO 63044-2483 U.S.A.•WWW.HUSSMANN.COM 3 of 10 t � s � � w u n i r „ a EXTERIOR COLOR ❑Painted ❑Laminated(confirm pattern/grain direction) ❑Stainless steel INTERIOR COLOR ❑Black ❑Stainless steel ❑White REAR EXTERIOR COLOR ❑White ❑Black ❑Stainless steel ` TRIM COLOR ❑Black ❑Silver END PANELS ❑None(Specify per line-up) ❑Case to case glass end ❑Cutaway with glass ❑Full with mirror FRONT GLASS ❑Curved single pane, lift-up front glass • • • on HV(L)R models and Flat angled single pane,lift-up front glass on HVK(L)R models • • : FRONT PANEL ❑ABS front panel on HV(L)R models and ❑Flat front panel •- • •. - xr Flat front panel on HVK(L)R models REAR DOORS ❑Clear glass rear sliding doors ❑Reflective glass rear sliding doors SHELVING ❑Clear glass shelves, lighted ❑Smoked glass shelves,lighted LIGHTS ❑T-8 top&shelf lights ❑LED top&shelf lights - ELECTRICAL CONNECT ❑Leads ❑6'straight blade power cord(self-cont.) REFRIGERATION ❑Remote DX refrigeration ❑BreezeTM w/EnergyWise s/c refrigeration MISCELLANEOUS ❑ 1"bumper on front&ends ❑Angled deck(n/a w/display step/riser) ❑Price tag moulding �u ' P ONE PART PASSION, TWO PARTS SCIENCE Structural :. IwMv �.� `t:�` �►ur Town of Barnstable BOARD OF HEALTH John T. Norman Board of Health Donald A.Gaudagnoli,M.D. Y QAMN9TAnLE. F.P.(Thomas)Lee,. MASS, Daniel Luczkow,M.D. Alt. wa34. . 200 Main Street, Hyannis, MA 02601 A Phone: (508) 862-4644 Fax: (508)790-6304 www.townofbarnstable.us Permit to Operate a Food Establishment In accordance with regulations promulgated under authority of 105 CMR 590.000 M.G.L. Chapter 94 Sections 305A, 305B, 146, 189 and 189A; Chapter 111, Sections S and 127A, a permit is hereby granted to: Permit No: 748 Issue Date: 01/01/2022 DBA: SHAW'S SUPERMARKET INC.#1598 OWNER: STAR MARKETS COMPANY INC Location of Establishment: 1070 IYANNOUGH ROAD HYANNIS„ MA 02601 Type of Business Permit: SUPERMARKET Annual: YES Seasonal: IncloorSeating: 0 OutdoorSeating: 0 Total Seating: 0 FEES FOOD SERVICE ESTABLISHMENT: $250.00 YEAR. 2022 RETAIL FOOD: $285.00 COTTAGE FOOD OPERATION: Permit Expires: 12/31/2022 B&B-FULL BREAKFAST: CONTINENTAL BREAKFAST: MOBILE- FOOD: MOBILE-ICE CREAM: GQ� FROZEN DESSERT: Thomas A. McKean, IRS, CHO, Health Agent FOR ESTABLISHMENTS WITH SEATING: PERMIT IS NOT VALID UNLESS ISSUED IN CONJUNCTION WITH A COMMON VICTUALER LICENSE Restrictions: ACV -" For Office Use Only: Initials: ' Town of Barnstable Date Paid (Amt Pd$ Inspectional Services Check ok 1659. Public Health Division Thomas McKean,Director alLy W 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT DATE 11/12/2021 NEW OWNERSHIP RENEWAL NAME OF FOOD ESTABLISHMENT: Shaw's#1598 ADDRESS OF FOOD ESTABLISHMENT: 1070 lyannough Rd Hyannis MA 02601 MAILING ADDRESS(IF DIFFERENT FROM ABOVE): 251 Little Falls Dr Wilmington DE 19808 E-MAIL ADDRESS: Legal.licensing.team@alvbertsons.com TELEPHONE NUMBER OF FOOD ESTABLISHMENT: 508 775 - 7611 TOTAL NUMBER OF BATHROOMS: 4 WELL WATER:YES NO vo ...(ANNUAL WATER ANALYSIS REQUIRED) ANNUAL:�� SEASONAL: DATES OF OPERATION: /_/ TO NUMBER OF SEATS: INSIDE: N/A OUTSIDE: N/A TOTAL: N/A SEATING: MUST OBTAIN A COMMON VICTUALLER'S LICENSE FROM LICENSING DIV. ***OUTSIDE DINING REMINDER*** OUTSIDE DINING,MUST BE APPROVED BY THE HEALTH DIV.AND LICENSING,AND MEET OUTSIDE DINING REQUIREMENTS. IS WAIT STAFF PROVIDED FOR OUTSIDE DINING? N/A IS AN AIR CURTAIN PROVIDED AT WAITSTAFF SERVICE DOOR(S)?N/A TYPE OF ESTABLISHMENT: (PLEASE CHECK ALL THAT APPLY BELOW) FOOD SERVICE RETAIL FOOD-ONLY required for TCS foods(foods requiring refrigeration/freezer) BED&BREAKFAST CONTINENTAL BREAKFAST COTTAGE FOOD INDUSTRY(formerly residential kitchen) MOBILE FOOD FROZEN DAIRY DESSERT MACHINES...(MONTHLY LAB ANALYSIS REQUIRED) CATERING...(CATERING NOTICE REQUIRED BEFORE EVENT(SEE PAGE#2) *** SEASONAL,MOBILE & NEW FOOD ONLY*** REQUIRED TO CALL HEALTH DIV.FOR INSPECTION PRIOR TO PERMIT BEING ISSUED PLEASE CALL 508-862-4644 Q:\Application FormsTOODAPP 2020.doc OWNER INFORMATION: FULL NAME OF APPLICANT Gary Morton SOLE OWNER: YES.V OWNER PHONE # 208-395-5394 ADDRESS 2000 Canal St, Boise ID 83705 CORPORATE OWNER: Shaw's Supermarkets,Inc. CORPORATE ADDRESS: 250 Parkcenter Blvd,Boise ID 83706 PERSON IN CHARGE OF DAILY OPERATIONS: List(2) Certified Food Protection Managers AND at least(1)Allergen Awareness Certified Staff All FOOD ESTABLISHMENTS must have I Certified Food Protection Manager PER SHIFT. **ATTACH COPIES OF CERTIFICATES** The Health Div. will NOT use past years' records. You must provide new copies and POST THE CERTIFICATES at your food establishment. Certified Food Managers Expiration Date Allergen Awareness Expiration Date —Vno'�� C,wVY�V1n �Z2 1. / / 1. �f11 12 2021 SIG ATURE OF APPLIC DATE ***FOOD POLICY INFORMATION*** SEASONAL FOOD SERVICE:All seasonal food establishments,including mobile trucks must be inspected by the Health Div. prior to opening!! Please call Health Div.at 508-862-4644 to schedule your inspection. Please call at least(7)days in advance. FROZEN DAIRY DESSERTS: Frozen desserts must be tested by a State Certified lab prior to opening and monthly thereafter, with sample results submitted to the Health Div. Failure to do so will result in the suspension or revocation of your Frozen Dessert Permit until the above terms are met. CATERING POLICY: Anyone who caters within the Town of Barnstable must notify theTown by fax or mail prior to catering event. You must complete a catering notice found at http://www.townofbarnstable.us/healthdivision/applications.asi). OUTDOOR COOKING: Outdoor cooking,preparation,or display of any food product by a food establishment is prohibited. NOTICE: Permits run annually from January 1 st to Dec.3 1"each calendar year. IT IS YOUR RESPONSIBILITY TO RETURN THE COMPLETED APPLICATION(S)AND REQUIRED FEES BY DEC 1 st. Q:\Application FormsTOODAPP REV3-2019.doc tHE DATE: 9U i s FEE: • BARNgrABLB, 0 9�p Town of Barnstable REC. BY tE0►� Board of Health 367 Main Street, Hyannis MA 02601 Office: 508-790-6265 Susan G.Rask,R.S. FAX: 508-790-6304 Sumner Kaufman,M.S.P.H. Ralph A.Murphy,M.D. VARIANCE REQUEST FORM LOCATION �n ���� a� Property Address:S 1 rT'` AA 7 to� Ty� oU 14 / lr� i n�- Assessor's Map and Parcel Number: Size of Lot: Wetlands Within 300 Ft. Yes Subdivision Name: n n No 3< Business Name: a"E �jjA 681. (`gyp. (J( r APPLICANT CONTACT PERSON Name:— {=L%/J Name: 5NV1 t q� Address: Address: Phone: — S'�(b'- d' Phone: FAX: S� ` �J 8' GI CA t2 SY' FAX: VARIANCE FROM REGULATION(List Reg.) REASON FOR VARIANCE(May attach if more space needed) 1 A0 U/UDEQ C.6UPT- owty_rbe e. 690LA f . R tea.6 t o A-pOAv 10 aD R_C--v/y2 4e_0 //N 0Ct 62> wv keJ i�+c to uj cU MID ;gAA/�t2-T_T E �12f1 �12 I,t C.K -M 5 A-7EU l"c 50 0 P-S 0► 2 E6RCPA&IZ 'N ,4jN)C Lo 77 2YU- Checklist(to be completed by office staff person receiving variance request application) Four(4)copies of plan submitted(including septic system plans and/or restaurant floor plans) Applicant understands that the abutters must be notified by certified mail at least ten days prior to meeting date at applicant's expense(for Title V and/or local sewage regulation variances only) Full menu submitted(for grease trap variances only) Variance request application fee collected(no fee for lifeguard modification renewals,grease trap variance renewals[same ownerneasee only],outside dining variance renewals[same ownedleasee only],and variances to repair failed sewage disposal systems[only if no expansion to the building proposed]) Variance request submitted at least 15 days prior to meeting date VARIANCE APPROVED Susan G.Rask,R.S.,Chairman NOT APPROVED Sumner Kaufman,M.S.P.H. REASON FOR DISAPPROVAL Ralph A.Murphy,M.D. Q:/WP/VARIREQ r- . INC TOWN OF BARNSTABLE OFFICE OF i 33esa9TSBLB, i MABB BOARD OF HEALTH .� OD 163i 367 MAIN STREET E0 IAAY�. iiiio►NNIS, MASS. 02801 April 24, 1989 Mr. Bryan Koop, Partner CMANE Limited Partnership Boston #1 Retail Development Corporation c/o Trammell Crow Company 1 Main Street Cambridge, MA 02142 Dear Mr. Koop: You are granted conditional variances from the Board of Health Regulation requiring all commercial buildings to connect to Town sewer within 3,000 feet of sewer lines and from the Board of Health Interim Regulation limiting sewage flows to 330 gallons, per acre, per day, in designated zones of contribution to public water supply wells. These variances will- allow you to install an onsite sewage disposal system at Route 132, Hyannis, listed as parcels 1Hy3 - 1Hy5, 1HOI and 3-158 on Assessor's map 294 and lots 19HOI, 19HO2, 19HB, and 1BO1 on Assessor's map 295 with the following conditions: (1) The septic'system must be installed in strict accordance to the submitted plan. (2) The subsurface drainage system shall be redesigned to incorporate natural swales where possible. (3) The designing engineer must be onsite and supervise construction of the onsite sewage disposal system and must certify in writing to the Board of Health that his design has been strictly adhered to prior to the issuance of a Certificate of Compliance. (4) The building must be connected to public water. (5) No high volume water users will be allowed. This includes laundromats, dentists offices, beauty parlors, fitness centers, gymnasiums, restaurants, snack bars, and other such usages as determined by the Board. (6) Offices will not be allowed. Only retail stores and dry goods stores are authorized. (7) The following activities are not authorized at the property: A) Airplane, boat, and motor vehicle storage, service washing, and repair. '13) Chemical and bacteriological laboratory..ope.ration C) Cabinet making D) Dry cleaning E) Electronic circuit assembly F) Metal plating, finishing, and polishing G) Motor and machinery service and assembly H)---Painting, wood.preserving, and _furniture stripping•. Mr. Bryan Koop, Partner CMANE Limited Partnership Re: Retail Mall - Route 132 (Hyannis Former Drive-In Theatre) April 24, 1989 I) Pesticide and herbicide application and storage J) Photographic processing K) Printing L) Jewelry cleaning M) Any activity involving the use of radioactive materials (8) The grease interceptor shall be pumped at least every three (3) months by a licensed septage hauler. (9) The septic tanks shall be pumped at least every two (2) years by a licensed septage hauler and the receipts shall be submitted to the Board. (10) The building must be connected to Town sewer when the Board determines its availability. (11) This conditional variance expires May 1, 1990. This conditional variance is granted because the Department of Public Works will not allow new buildings to connect into the Town sewer in accordance with the Department's Interim Sewer Connection Policy. Also, the calculated total sewage flow will be no more than 374.8 gallons per acre per day on this 27.16 acre parcel. It is the opinion of the Board that the installation of the onsite sewage disposal system that complies with Title 5 and all other Town of Barnstable Health Regulations, will not significantly alter the quality of the groundwater in the area. Since el yours, Grover C. M. Farrish, ., Chairman Board of Health Town of Barnstable GF/bs copy: Attorney Larry Murphy Arlene Wilson . - r I INC. *TOWN OF BARNSTABLE ��PyOf o�♦� . OFFICE OF DAHa9T,BLE NAM BOARD OF HEALTH i6J9` 367 MAIN STREET HYANNIS, MASS. 02601 August 25, 1989 Mr. Bryan Koop CMANE Limited Partnership Boston #1 Retail Development Corporation c/o Trammell Crow Company 1 Main Street Cambridge, MA 02142 Dear Mr. Koop: You are granted permission to install the onsite sewage disposal system as designed on the revised site and sewage disposal system plans dated June 29, 1989 stamped by Robert Daylor, professional engineer, as a modification to condition number one (1) of the variance letter addressed to you dated April 24, 1989. The plans were revised to not include a pump chamber as originally designed. Also the leaching facility was lowered to accept effluent via gravity flow. In addition, the septic tank capacity was increased by 2000 gallons. You are reminded that all other conditions listed in the variance letter addressed to you dated April 24, 1989 still apply. Very truly yours, rover C. M. Farrish, M.D. Chairman BOARD OF HEALTH TOWN OF BARNSTABLE GF/bs I I � ti 7�V kel- . 1 I 2 See P/ol s in t-E HAZARD ANALYSIS CRITICAL:. CONTROL POINTS FOR THE STORAGE, PREPARATION & DISPLAY OF PRODUCTS IN THE BIZERBA DELI FACTORY FLOW PROCESS HAZARD DEGREE OF CRITERIA FOR CONTROL MONITOR & VERIFY ACTION TO TAKE IF CONCERN i{ CRITERIA NOT MET DELIVERY Temperature control of ccp maintain products under 45F observe product as received reject if too warm products arriving i i STORAGE Temperature control of ccp same',as above measure temperature of lower thermostat setting products in storage product in storage i CHOOSING -using of products not ccp -check safe product list -check with MGR. -Do not use this product PRODUCTS considered safe supplied by BIZBERA -keep track of the time -return product to cooler -products getting warmer -only remove products that can of process for consistency than 45F be done in 30 minutes PREPARE PRODUCTS product contamination ccp clean& sanitize all items often observe handling & adjust practices to avoid FOR SLICING from hands, utensils & wash hands&wear sanitary sanitation practices contamination cutting board gloves E SLICING OF -contamination same as ccp -clean & sanitize slicer same as above if in doubt then clean & PRODUCTS above every 4 hours of operation sanitize -cross contamination -slice cheese last or clean & sane'ze after doing cheese PLACE IN POUCH contamination from ccp use paddles supplied by same as above same as above handling product BIZIRBA &wcar sanitary gloves A PLACE IN VACUUM contamination by not use FDA approved food grade check with gas supplier change gas supplier MACHINE & VACUUM using food grade gas gases (GAS &FLUSH) I Ey WEIGH&LABEL improper labeling label should have proper shelf check label of each item in change label or adjust scale life,ingredients&refrigeration scale for the proper program to conform warning information temperature control maintain displays under 45F check temperature in case lower PLACE IN STORAGE P ccpp thermostat setting OR DISPLAY CASE : two.. ���`!� -�� No.-- --- - --- ------ 4 Fee--------------------- BOARD OF HEALTH TOWN OF BARNSTABLE Applitation-*rVerl Cmtructiouperurit A pli�cj'tjon is hereby made for a permit t Construct 0(), Alter ( ), or Repair ( )an individual Well at: ------------------------------------------------- ----------------— - —-- -------------- ----- - - - - -------------------------- --------------- Location — Address c Assessors Map and Parcel ------------------------ --- ---- �i ---- --- -� -� Owner Address --_-- Installer —_-Driller-_---_—_—_-- Address_--_--_�------�__-�--_-_-_- Type of Building Dwelling - — -- ---------------------------------------- Other - Type of Building------------------------------------ No. of Persons------------------------------------------------------- Type of Well_��_�e__ Ly __GrJGL�__-----____-- Capacity---------------------------------—------------------------- Purpose of Well----��A�P d'- -- — -- Agreement: The undersigned agrees to install the aforedescribed individual well in accordance with the provisions of The Town of Barnstable Board of Health Private Well Protection Regulation — The undersigned further agrees not to place the well in operation u til a Certificak of Co liance has been issued by the Board of Health. Signed - ---- /d, � Application Approved By- date Application Disapproved for the following reasons:--------__________________________----------------_______---_____—__________�—_____ - -- __-_—-------— ----- — ------------------------- date Permit No.- `-' ~ - - Issued - - - �- date BOARD OF HEALTH TOWN OF BARNSTABLE Application-*rVell Con5tructioniermft Application is hereby made for a permit to Construct (x), Alter ( ), or Repair ( )an individual Well at: E14 41 --1---f--Lo'ca/tio`n�— Address �^/ ��— -_-_--- —_-------------- �--_—Assessors Map and Parcel ----_---_--^_- i C4Da" co-------------------------------------------------------------------------- -� / Owner Address Installer — Driller Address _ Type of Building Dwelling -- - — - - - - --------------------- Other - Type of Building --- No. of Persons---------------- ---------------- T e of Well-- yp - Capacity-----________—____ Purpose of Well-- � Q �'=�-------------- Agreement: The undersigned agrees to install the aforedescribed individual well in accordance with the provisions of The Town of Barnstable Board of Health Private Well Protection Regulation — The undersigned further agrees not to place the well in operation until a Certificate of Co pliance has been issued by the Board-of Health. a, ed Signed V----- ---- ---- Ape-- / date ✓APPlication Approved BY --.-7/— date -- —v Application Disapproved for the following reasons:------_—_--------—_____!----------------- ----------_____ date Permit No.---- _`.' �` --------- - Issued--------- -- --��—I `~,�---- -- date BOARD OF HEALTH TOWN OF BARNSTABLE Certifirate Of Compliance THIS IS TO CERTIFY, That the Individual Well Constructed ( ), Altered ( ), or Repaired ( ) by - r • - l O":rV-- --''11� � ----------------—- ----—-- —------ - /' Installer a t- `7'" =?� `�w/f�''_d�7j_-1 .�/�1�/ _7__ � `_7 _ -' /+��/l/l ss - __------------- has been installed in accordance with the provisions of the Town of Barnstable Board of Health Private Well Protection Regulation as described in the application for Well Construction Permit No. Dated Dated --•�`-(rD f THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORY. O � ___—----- -- Inspector___ �� s�' DATE- -- -------- ---- G BOARD OF HEALTH TOWN OF BARNSTABLE V ell 6ngtrurtion 3permit No.--------------------- ,r -• Fee----------------- Permission is hereby granted----44,l �_ -''�' f`` � '' '----------------------------- -- to Construct ( ), Alter ( ), or Repair ( ) an Individual Well at: No. --------% ''�`�/_f r/,'' ' - _ ��a'��-'�'lv<' :' ���-- ~'�''• + ✓!7— Street as shown on the application for a Well Construction Permit NO. t -- Dated--; '"- . l -------- Q -= Board of Health DATE------�-----=-�.r ------------ / IV) / SCB 7 LIMIT OF WORK FOR F9G=65.7 ROUTE .132 IMPROVEMENTS INV=62.0 � sce 6� / SC82 © w -1. F 8 G=65.5 / F&G=63.4 INV.=61.8 <a INV.=60.4- /; TAPPING / IRRIGATION SLEEVING(TYP•) SLEEVE fi VALVE W CL ..r r'-% • ss tys1�, i .. � t' C9002 a 3�., - 3 , -•�'A ,.,g.;� � 'yt. f s. I - ,� •L 'r• • R C / W _ W W 4 / .� I R -.. .. - . $, :° C.r i• .INV 56.6 ` SC v> rfg ,, r .� CAP Ff 5.7 WEL I N V. 9 -' r ' O C, ice,, *: t t„ ••� ' '�r CB -^ 3A ^. V" v F 9 G=60.5 v > - I -56.N c,- a oy� SCB. I V O . _ { / F a G=63.2 W/BEEHIVE FaG i15� INV.=60.2 /\. ---- F.E. INV.=60.5 F.E.0 _ INV.=60.0 — — — INV. 55.9 -- INV.55.9 F d GCB B60.5 OHW— —.—.—._ INV.=56.0 t W/BEEHIVE FaG i � O OUTLET EROSION PROTECTION -- OQ TYP.. SEE DETAIL t USE i /�w t VALVE O - IN FIE J �• - FOR RETAI = NOTE: UNLESS OTHERWISE. SE NOTE 'LEGEND ALL DR_.A....I. NAG_E. PIPE " .TO CONNEC CATCH_ BASIN AND LEACHING FACI cc CONCRETE CURB SHALL BED`12" PVC (SDR 35). BCB BITUMINOUS CONCRETE BERM � � � �� . [� � � � � � � �� . �� .� �° . . � : - ! � . �� . vz . . �� � � I : ;� � . t . � � : � I� ! . . � � ! � �� . �� � ° DRAINAGE CALCULATIONS FOR FESTIVAL AT HYANNIS Prepared for: Trammell Crow Company One Main Street Cambridge, MA 02142 j Prepared by: Daylor Consulting Group F Suite 216 World Trade Center Boston,MA L 02210_ June 23, 1989 Revised December 20, 1989 P�jl1 OF RO@ERT SN F. DAYLOR w Na 2374-1 AL ENNil L,. FESTIVAL AT HYANNIS Hydrologic and Hydraulic Cal culations: The objective of the storm water management system is to utilize leaching pits and ' trenches to collect runoff generated from the proposed improvements and infiltrate the storm water into the underlying soils. The roof drains and catch basins distribute storm water into properly designed leaching pits and trenches. These leaching facilities have been designed to accommodate the 25 year storm event. By providing an adequate number of leaching pits and trenches the storm water overland runoff will not increase under the post-development conditions. ' This traditional design has been enhanced by the use of vegetated swales which _ facilitates pollutant uptake prior to discharge to the underlying soils. At the loading dock areas and paved areas in the vicinity of the entrance drive, the first one-tenth of an inch will be retained within vegetated swales. The on-tenth of an inch is the design standard from 40 CFR,Part 122 which has been previously accepted in recent discussions with the Town. ' utilizingstandard engineering The storm water management system was analyzed practices based on the National Engineering Handbook, Section 4, Hydrology H-4 i n 1 Q=ciA) and the Barnstable Method' of leaching ' (NE ), the Rat o a Method ( facility design. Drainage area boundaries were developed using various available topographic maps. Drainage areas were derived from a 1 inch = 40 foot contour interval plans prepared ' ma by A.M. Wilson Associates and U.S.G.S. Quadrangle s, scale approximately 1 P inch = 2083 feet at a ten foot contour interval. Soils information, groundwater elevation and cover descriptions were taken from on-site test pits, and field' obser- vations of site conditions. The following calculations which coincide with the Site Plans dated June 23, 1989, last revised December 20, 1989 have been prepared to demonstrate the previously mentioned design objectives. ;' II Please note revisions to the previous calculations are followed by an asterisk (*). JOB F155TIVA L All- t-L jmI w-�' ' DAYLOR CONSULTING GROUP, INC. SHEET NO. 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AG. .... ... ..... .... ..... ....... ...................... .......... ..... .... .... .... .... .... .... .... ................................................................. .... .... ... . ... ..... ..... .... .... ..................................................... ..... .... .... .... ..... ..... ... ... ... .... ..... .... ..... .... PRODUCT Groton Man 01471. PHONE rou To T 0 E TOLL FREE 1 A04775-6.180 �... .�,;. .,,•� �_�o �tee► � _- -¢.�- � �. ,: E i +� � ti N "� '�, N .SOP ` ' III �� �� y`1 'I �,� yh it I`I �+ i I� t 1� v '� �� --, �j � V� d 14 J �� o —� � p� I � � °� � o _.,...! ANP co c S X49f/ . t)-c No. ��- 1 spy �p �l1 d�p8IV F�$... 0�'U�...... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE , pphrativit for DinVoBal Works Tomitrnrtiun ran i# Application is hereby made for a Permit to Construct OC) or Repair ( ) an Individual Sewage Disposal System at: Qe4ic w �.Locati o6ddtr ......................_�U� - - ue�s --------.!o. � . Ye `....... ---Lot or. z..._. r Addres �/// ...... o)- ,� Installer Addres UType of Building S1ACuRPn r Size Lot............................Sq. feet Dwelling—No. of Bedrooms--------------------------------------------Expansion Attic ( ) Garbage Grinder ( ) a` Other—T 4 ype of Buildiu g ......................_.___ No. of persons.______.._._........._______ Showers ( ) — Cafeteria ( ) dOther fixtures ------------------------------------------------------....------------------.....------. ---•------•------•---•-•--•---...--•-----------•-...--------- W Design Flow............................................gallons per person per day. Total daffy flow---._....._._______ ..__..._.._.__.____.gallons.�� W -0 Septic Tank—Liquid capacity.7'290-gallons Length---PT_...... Width..��_.---_--_ Diameter-----__........ Depth...�.__..1.�. x Disposal Trench—No. .................... Width-------------------- Total Length--------_--------- Total leaching area....................sq. ft. Seepage Pit No..---.-_............. Diameter_ ..........._-__--. Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) ~" Percolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water..................... GTq Test Pit No. 2................minutes per inch Depth of Test Pit-------------------- Depth to ground water........................ c464401- _aovo --------------------------------------------------------------------------------=---•-••-•------------------•----•----------•---------....------...-----•---- ODescription of Soil..............................................................................................................................................................--------- x U w -----• .......................................................... U Nature of Repa' s or Alterations—Answer when applicable------:nI.S _..._.?o-UCt--- a .//&a------------------- � 2, n---••-------------------------------------------------------------------- ---------------------•----------------------•-•-------- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code —The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. Signed - Zis ::.-..._ .................--------- -------------------------------- ----- - � Application Approved BY S- -----------------------------_-----------..._---------------- ..... 6i Application.Disapproved for the following reasons- --------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------- --------- -------------------------------------------------------------- ------------------------------------ ------------------------------------ Dace PermitNo. ........................... .... ........ ... ......... Issued ----------------------------------------------------------------- . Dare F E:s.....................11 y THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH 1 TOWN OF BARNSTABLE Appliratinn for Diti-Vuuttl 'Unr1w Towitrurtiun Prrutit Application is hereby made for a Permit to Construct ( k) or Repair ( ) an Individual Sewage Disposal" System at: Qe0jr_ -7-1 0 p _ ' <..�...%..e...�.�.....,.....l..._.7 .1....5. � �Ur���L�aatn�\dd N°............. .._... ...... lio/ � �1-----: �2,v - Oancr 53 cf ` (! Address/ ( s 1 a ....... •-� ?-f n � � 2!�' ? �rl_.i.i�<?r2...........................C3CJ S '_. A/2 /C>ta.? - Installer Addressu U Type of Building s a 9/4 s i r Size Lot............................Sq. feet �-. Dwelling—No. of Bedrooms--------------------------------------------Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ---------------------------- No. of persons.------------.---.---------- Showers ( ) — Cafeteria ( ) d Other fixtures .---_-------------------- Design Flow............................................gallons per person per day. Total daily flow.....-.-..-.-..-.-._-----------------,.--•..gallons.�t W ip Septic Tank—Liquid capacity-7.0qQ.gallons Length-../_17- Width..- -------- Diameter-..-.- ------ Depth.... ....1/ x Disposal Trench—No. .......:............ Width.................... Total Length_..--.-----__---- Total leaching area....................sq. ft. 3 Seepage Pit No..................... Diameter...............----- Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box (. ) Dosing tank ( ) aPercolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. I................minutes per inch Depth of Test Pit......-------------- Depth to ground water..--........---......... 04 Test Pit No. 2................minutes per inch Depth of Test Pit.------.-.-..-.----. Depth to ground water...-.-.-.---_--.._.---- x 6ReQsc - qP DDescription of Soil................................................................................................................................... U --••--•--•-••------•---------------•---------•---•-........•--•-•-••-••......----•-----•-••--- --------•-------....--------•--•---•------•------••---•--•----......------•-•-••-•---•-•----••---•--••-• --- ------------------------------------------------------------------- ------------------------------------------------------------------- U Nature of Repai*-s or Alterations Answer when applicable._- rJ -flail<_t . '.. UCI��... /�iy),,,,,,,,,,,,,,,,,, �7 rc' ............. The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. Signed --- ---- ��....... = ......... ........................ .........._..... .................. Dace Appl_cation.Approved BY ----------------------------------- ------------------------------ .....'� tt r... ce Application.Disapproved for the following reasons- ---------------------............------------------------------------ ----------------------------------_ ...... -------------------------------------------------------------------------.....__----------------------------------........----------------...------------------------------------.._...-------- ---------------------------------------- Date PermitNo. ------------------------------......---------------------------- Issued --------------------------------------------------- Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE C�Ez of rate of (ILlornlaIian,ce THIS-IS TO C RTIFY,)hat the Individual Sewage Disposal System c6..nstructed ( ) or Repaired ( ) by -------- ----- Installer , at 44 Q..... .► t)..._.. __ ��. hn . `'�`� ----------------------....................... ....... ......_............ ............. has been installed in accord-=Ice with the provisions 4—TITLE 5 of The State Environmental Code a5,described in the application for Disposal Works Construction Permit No. ..--��-�-...-:.f'S-v�f.--..--__- dated --..._-ly/t/- ..._.... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE......---�� "- '"'" L� Inspect r :...�s� �. ,,._,_;_,_—_..--__--.—__.__„----_.:_.y__—_.---_._,_,__,—___zz ----—_---.--__--__(/ —— THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH _ � TOWN OF BARNSTABLE No... ..... ......••-• FEs.....f••D 0...... �t��r.a�ttl nr�� �Anutr�rtirin 0"rrutit Permission is hereby granted.-.---_-.� - ... ----?--f----------------------------------------------------------- _ to Construct ( ) or Re air ( ) an Ir�d7vrd�ral—Sc�v�rag�Dasposal_S,yslem � `� reG� �) —t at No....�. 7 ^`�'�`^�•• `='------ o►✓rn��---- -- --------------------------------------------------------------------------•--_-_- �._.-. � .._.... . � ......_.. Street as shown on the application for Disposal Works Construction Permit No.__I�7M1 Dated.....gJ.1dr4. .................... Cz' DATE L r j Board of Health ..... I -9-- ------------------------------------------------- �� FORM 36508 HOBBS&WARREN,INC..PUBLISHERS ��Sjlvoq( 4�r r DL70 --/ovD a[lon Cps wi✓ COMPARATIVE ANALYSIS STORE#o7s98 Hyannis,MA EXISTING PROPOSED VARIATION � H } C4} GENERAL BUILDINGFOOTRiINT SF 54,879 54,879 0 SALES AREA SF ,338 0 SALES AREA TO BUILDING 71 68 G FOOT PRINT SF 71.60% 71.68% 0.00% MEZZANINE SF 0 0 0 II I I BASEMEN SF 0 0 0 CHECKTANDS EA 13 t3 0 / \ I I ------ PRODUCE(5-DECK) _—_—_—_—.i—_—_—_—_—._.—_—_—_—_—._.—_—_—_—___ t_—_—_—_—_—._—_ LOWPROFLEPR(XULICE(LE MB.ON,DUCE BAFZ) LF 0 0 0 ` ) REFRIGERATED TABLES LF 64 64 0 DRY TABLES LF 92 92 0 1 I I I I I I I ( TOTAL PRODUCE LINEAL FOOTAGE OF 292 272 (20) SALAD BAR LF 16 16 0 j I I I SHELVING(DRIED FRUIT,NUTS,ETC.) LF 11 11 0 i I FLORAL REACH-IN DOORS LF 0 0 0 REFRIGERATED FLORAL LF 11 11 0 DRY DISPLAY LF 44 44 0 I I I I I TOTAL FLORAL LINEAL FOOTAGE LF 55 55 0 I I DELI SERVICE CASE DELI LF 36 36 0 PREPAR GROCERY RECEIVING HOTFO FOODS CEI(SE SELF SERV Q KQ LF 8 6 0 HOT FOODS(SERVICE/SELF SFRVICq LF 0 0 0 SELFSERVICECHCKEN LF 5 5 0 I PIZZA(SERVICE/SELF SERVICE) LF 0 0 0 SOUP BAR LF 5 14 9 I I I I I I I VAC-PACK DELI(BLAND CASE) LF 28 0 (28) PREPARED FOOD(GLAND CASE) LF 0 32 32 II I I I CHEESE(ISLAND CASE) LF 32 32 0 TOTAL DELI LINEAL FOOTAGE LF 112 125 13 I I I I I I I BAKERY SERVICE REFRIGERATED LF 0 0 0 SELF SERVE REFRIGERATED LF 9 9 0 REACH-IN M1Lh DECK FR(REN(DOORS) LF 4 4 0 , , L ____ = --------------------- -- --- --- — --- -------- - ----- --- —11 ( _ 6 LOW PROFILE FROZEN WALL LF 0 0 0 C - \ / BAGELS 8 ROLLS 8 BREAD LF 32 32 0 3 \./\.�- \ J\.— I .^d PASTRIES LF 14 14 0 E , T. OTAL BL. LF 09 9 0 LINEAL IEEE[ EE . EE . . FOOTAGE 1 SEAFOOD SERVICE SEAFOOD OF 12 12 0 "I DECK SEA FOOD 2 3 OR 5 DECK) LF 4 4 0 /.j� 21z .\./. :IV,�; —, ; �� ��_;_ GROCERY FREEZER COFFIN OU4L TEND ISLAND LF 12 12 0 PRODUCE PREP i I I i BUSH OF 4 4 0 LOBSTffi LF 4 4 0 TOTAL SEAFOOD LINEAL FOOTAGE LF 38 36 0 MEAT SERVICE BUTCHER BLOCK LF 0 0 0 OBILE BI - MULTI DECK(OR 9 DECK) LF 18 16 0 III FISH COOLERI ICE FIAKER FISH PREP DELI COOL SECURITY MEAT COOLER I QI COFFINDIAL TEMPI FROZEN ISLAND LF a 12 12 ROOM BAKERYi I I TOTAL MEAT LINEAL FOOTAGE LF SS 100 12 PRODUCE COOLER I _ I FREEZER Lug MEAT PREP �� DAIRY/ MULTI-DECK DCARYARY(DOORS) LF o 0 0 / DELI MULTI DECK D4RY-DELI(5-DECK) LF 212 212 0 L --- - — - - - - --- - — — — _ ____ LOW PROFILE/COFFIN LF 0 0 0 3/ T O I u- TOTAL DAIRY LINEAL FOOTAGE LF 212 212 0 4'- O4RY PROMOTIONAL LF 10 10 0 LOBSTER I DAIRY COOLER FROZEN MULTVDECK FROZEN FOOD(DOORS) DR 90 90 0 SALAD PREP AREA I I I i FOOD MILTFDKK FROZEN SEAFOOD(DOORS) DR 3 3 0 BAKERY �11 ? MAT-DECK FROZEN MEAT(DOORS) DR 4 4 0 aIM1 m I STORAGE MECH. CLOSET i MLULTI-DECK FROZEN(OPEN) DR o 0 0 Ix o PN Iz ' M v sMl-� oss- NVSeIIAN RVEST FROZEN DRI I _0 n s-ave. VAC PACK LNCHBL 8.00 DL H GNG MEAT I#00 DL DOGS/SA SA.�F 0.00 OL BACDN 750 FISH FZ FISH ( ---. �D 'x: r r r r _ _ __ _ _. —_ _-_ _ _ _ _ �•_ _ __.-__ _—._._-_-____ \} TOTAL FROZENFOOD NO.OF DOORSdoors) DR 105 105 0 , v I �r TM I-�� I / ) _—._---_ _--_ _ _—_—_—._.—_ _Aoy .— _ �._ - ._ _ .. _ _. - - — -_ -_ - / FROZEN PROMOTKNI4L DR 6 6 0 a 4 24 AN russmANAN NIIWMI MIaMAN II ,mea T race Mu nra¢Nx cer°x Mu nlcozhx nw/wAmrtN 7wAmICN /WAIMR4 / ` e-u u 1: 0>•[-e tlll-s 7 r- '-'� .ss'r[D Cv2-e OI+I-3 3`'.56[ 2,50 FZ �N Vie` +t 2.50 0 z�' "z T.A.B. MULhOECK BEER edft for cooler-Im.ft.of Crs LF 0 0 0 \ S 36'MULTI-DECK DELI \-_ / 5.00 f�R'� Y FLAB ( ) p S PREP/ 4 C) 4-0" 4 0" ( 12.00 FM PR D ITS 10,00 FZ CHICKEN 1750 FM FZ MEAi SAS FZ' KOSN I5.00 DY MILN ORED 7.00 DY CREAMERS CASE SERVICE SERVICE SERVICE FROZEN FISH ICI �_ _ __ I - GDVY'A ER MILK --1 M1Lh0ECK VVFJE LF 0 0 0 R S 4- 12'PR� ICE CASE ICE CASE ICE C4BE q_tloor 36 MULTI-DECK FRESH MEAT 16'2-DKK MEAT -1 SPIRITS CABINET(LOCKABLE) OF 0 0 0 x SSP 2'-0 2 0' 36'MULTI-DECK FRESH MEAT 4- 8-6 20'-(li)-DOORS OZEN 7 BAYS ROLL-IN DAIRY 24' 2R'u I DUAL-TE P FlSH DOORS I� I ( ) SFI.LVC BEER8W9'E SIIELV9JG LF 0 0 0 CASE SEAFOOD SEAF000 SEAFOOD EME G. BEER& RIE SHEL LF 0 0 0 FROZEN MEAT EMIT 24'• TOTAL BEER B WINE LINEAL FOOTAGE LF 0 0 0 / MkuNnm I I I I � SHELVING GROCERY LF 2,136 2208, 152 . � Anr � I W1NE5 SRRITS(NOTED ABOVE) LF 0 0 0 /- WILD H4RJEST(NOT®ABOVE) LF 178 178 0 I w�ssM I I -REMOVE I 2ED000ACH IN yp8s GtCHANDSE/H.HB. LF 0 0 0 0, I 4'M/D FISH ul•Ix �.. I HBC LIGHTING I END DAIRY �FffOOZOEDN SggGMB 500 DDA{RYY SrEABONAL OFFERINGS(DRY) LF 133 148 15 NDIT-N g .yE -C, y, I END TOTAL SHELVING LF 2,447 2,614 167 SEAFOOD 15'-9" _ 12'-6'_ ENO Tn � STORE VISIT AND SCOPE DEVELOPMENT JD,JA BARRY^ �N GMB cm eREVLEWS 1�pqvvv DAL TEMP SINGLE GNB END 4� ( I 1/7/2011 DATE •'S ��0 ~61p' IATJ I W $w+ - NCN CASE(5-47423) i i :3 DATE DATE 4 4 4 I VENDOR END' SHELVING SHELVING 4' i ' i DATE SHELVING SHELVING SHELVING :SHELVING 400 SALTY 3.00 3.00 4' lY FaDD aRY FDOD d3Y F000 j HHB p2 v N J HACKS pt HHB p RY NON F SHELVING a { qy 4} O >g 4 4 ERY Nf2J F $ � °Op Sy I •' T-- SHE VING SHELVING SHELVING ' apI �-EEO �' 9 � �S, ER'�FD00 ER"FODD ERY F000 lN2ZRz s� ti I zc I 4 p5 p I c- $ $4' '^ 6'-10" 1" 1a-10" 5'-Il" 4' T-5" 4' •� 5'-11" _4' 6'7" g4' 6'-4" 4' '� 6'•6" 3' " 6'-1" T_31• 5'<. T-3" �P •< 6'-8" T-1' 6'•3' -S"'4' / \ to p I DELI 9✓ Acy I A _ - --- - - - ------- --'-- - -- -—- ---- ---- - -- COOLER .r ---- „r8 � _ --- - - - ---- - - --- - -- - - --'-' - - -- _- ¢h -- - ---- ---- -- - ------ -- ---- - ------ _---- } \ - DELI A Ng PREP I o Is I B I I d n HO COLD SOUP POD (S-N7494) ftwi ° aox4o I r O z "� � km~ REVISIONS HAND xx" WBMA#C� g 4 I i$J L S o ,- as TA812 - I a� B'3., �1 = j g I A I 9 I N S.C.MOBILE p P ODUCE DISPLAY I Wr slgt� _ F D0o8 �- I '-^ O = ABLE(S 47423 f v g N $ x •' _ 1 MILLWORK O 'Q �$ x I I - m MILLWORK- owl BOX FILLER a 3F' N A (N) (m nrua]Ms1 BO a i .. ro H o GH/CD _ c Hg,1 NYkMirof - Ux Ieerr ca,amzeoy q ,. .. BAKERY K�. uO s"• 8 I SHELVING I FS �o� r RETARDER a $ N A VECTOR a 8'-3" FLY TRAP b 3' 5.0 MOBILE 42x20x30H - SHELVING $ I V EFRIG.PRODUCE pp U�E g��5 �OTI;i.. " DISPLAY TABLE (TV�.WR2) 6'- I \Ili L7� > 08 _ `� IHHB p4 (S#7423) '(N) FRIED u r e CHICKEN a PREP. I _S� x G 8 I _. T !L FRYER SINKEll U' Ebb PD, =D FpUIT .- - x x x _ 6 n iy J N E,�t m UUU i ROTISS. a °Da' I zA _ w _ I $ x I x O w E$NV n z3,Pt PD L`:P FRL11T CHICKEN ,7 r HOOD H za ` N Ev N m n n , m O, J ~� j Y@ s�N�c `I I� - I zTz t- . $ m ; - N , g a m Pomx ;o 12'-9" Z > J M MILLWORK DRIED FRUIT FRUIT(M DISPLAYmj Z e I I �C l7 _ Im y. FILLER myW1 Ip 1d-' SB•JI( H� S }- - -- — _ - - - - -"— -- - XJ --x SHELVING — — 4 - - - 4 - - - - > -- - - -- — — — - - — — - ----- G - - - - - - - --- / \ � " ',.,. ; .... F i SF$.VIRii SHELVING' SHELVING - I _ - - 1 yn �: 'I RACK OVEN [n Y I Sj �• WATER 'REMOVE 1 Nay p6 p)p ,t'�{` HEATER WILD HARVEST Y`W 4n. P, L• b• I TRELLIS Y VFW p� I O 3. 3. 3' I I g _ x '1'1y S BAKERY PREP 4. �_� j SHELVING SHELVING SHELVING g o I _ - - I v y ry of C i �° Z § Ln (6 PRODUCE SLANT 73O Sf SHELVING ry u¢ M4 5 6 ly �ABLES W/ENDS B Bi zI ri Z - l7 (z)-S.C REFRIG.PRODUCE 3 TABLES <_ N sw1NLeN sauna:*N OgS�K. 70, .,y',4.' aoN.i nx-° r - w e r 0 A q M>a L_ Lu F. �A 8 oo Cj G1/ Ga>)'FA $w 00 N 2 R N N S N 2 2 �I m sq 9• " M1kR 03 I N E H [n L 9 I (4)PRODUCE SLANT B F ` 8 TABLES W/ENDS I - ,14i0\Rln C/'S °Gy is 5 I. - s• 2 3 4 5 - 7 O 10 11 12 13 ) 14 �5) D16 a 17 u 18 �r \ Quo°j r a _ = i W �'� swxExN saurNERH zz i zz 22 zz ;224z P82 zz M) (s (s) 22 �' E Y = nx-e zix-e uo c w E CRACKE E'CRACKE j ' 300 +'�. - 25 22 I 22 25 n (n °3 9e �J 2 DOORS FROZEN n R pl R p2 MF R I 'N} _ 3HB k1 4.00$ALiY N )^ �'w J ce sauTME¢N souTMrnN sourNERN J 1 6 ]� Tii 16 4' 4' SHELVING q SHELVING. ERY NON F SNACK$k0 K \ r+ a oov _ § / w a 000 N3 D GIFT ��ugrtrtl rAx-e � CAKES & x �' ° 5 FLYING Ik SHELVING SHELVING PALLET PALLET SHELVING (S) .(5) N N N H O ( �___. _ —_—._--_—._. _— _—._—_MILLWORK . W_ _ _. _—_—_ ._. _—._—_ 3— _—._.—_— —._ T—_—_ _ _ _—_.—_ CARD MALL _—_.—_—_—_ ¢—_.—_—._—_—_—._—_—._.—_—_—_—_—._.—_ ....,,� —_— __._—_—_ SHELVING _.—_— SHELVING _— _ _ _— �_—._.—_ —_ _—_—_ _ `� � } )( WLU 2 Y Y w�zavlLL. `d eJ (8)-S.C.REFRIG.PRODUCE m I Ld SHELVING SHELVING SHELVING O TABLES W/ENDS 5 w Jd'Q 'NEW AISLE MARKERS I 11sir• w� O AND WAY-FINDING o ='1� v g I �"a =Y� SIGNS AS NEEDED I I .... ... �.. .. 19 WILD HARVEST I 5PP F7 COFFEE i CODmxt o c, Nw$T'ro ar :N I i FROZEN GMB sae' GMB SODA AA? ,, M rir 8 #U I I 5.00 BK ' WOO CRATES STACKED(2)H. " 'emu � $Y I ENTENMANN'S I 6.00 BK HUB 2DOORS 3'xT BIN 3 xT BINS 3'x3'BINS 3'z3'BINS 3'x3'BINS YxT BINS TABLE F ODS REACH IN �= 'END DISPLAY I"H (N) (N) (N) (N) I (N) (N) I I I p REACCH-N FROZEN 6'-0"dry y W/INSERT CANOPY I I FOOD)(5) FOOD($') EXIST. tlISPi¢Y¢Otl ?Cr 7)-FLAT MOVHELVES e I ❑ I I I RHO:JE TAG MOVLOINGS. Y / (1-PRODUCE I i ,- x (3)TIER PROMOTIONAL / ND TABLE SEASONAL DISPLAY AREA w DISPLAY &15KETS (Il)-SLANT CE I. ...- .. ,(A p:25G 3- i' RFA S F.E.mobB� MASS L�jTYP 01 (TYP)...�� .. US RC pNGLodhlm I POLA GO DISPLAY AREA PALLETS fNJ K i (4)-PALLETS ,�� PAL 2: ® I i(13)-CHECKOUTS VW/(2)-EXPRESS & (3)-SELF SCA�J CUSTOMER C NTER ❑ ❑ ❑ ❑ ❑ Ili i I1 F� t: .j` - "e .`D-' 9 vxi till k1 I 2.16 G LLtJ �U LLU wU �'U wu pax DRY 01�11.11 1 VI I 0 rpA I DASANI AQUFlNA I CUSTOMER SERVICE ,� � - _ :-- -- coKE PEPSI Lass -- � ----a -- Z - ------- �-I - -------------- / 12'CIGARETTESI. li _--,�_—. o- z N _ \°5.; A �L DROSS ME R�ISE ® cmToNs cwttaa $ ❑ I �s camen^'ucrwr n '� Ij I WOMEN J I W� _ " NussNANN swArm IM 4 O �RU I iI I ..• i .r--�.aSii' -� osa-s 7. � O 16.00 PO OUT FlfiRfTJhICE ( MI70011 v I I osM I °-° m I _? Y Art ~�i O MOB F '-uu � > {� SAFE ROOM Zo II - O S 8'SHELVING I 0 I LM I - O OO U I ij I I MEN I I ^_�.. ? F—'1 EXIT e VESTIBULE I I P°r On z FLORAL i EF SE SEASON RETURN I SHELVING n ZQ COOLER BOTTLE RETURN 4d-a' d i 5FA5onALSHELVING p6"HIGH) SEASON LSHELVING k�o Q 3,00 OR '_1 �Q� ❑ `oM e d 48.00 GM EASONAL L /-\ -.- 4,00 GM 4f'-N 36. GM SEASO AL 1� 0 VEN ATM star 1 00 ICE ( —_—._—_—_ --_—_—_—_—_ _—_—_—_— _ __- _—_—_—_—_—_—_—_—_— _.— CANNING m-sA: INSECT __-_- _ __—_—_—_—_—_—_—_ _—_—_—_— — —_—_—_—_—_—_—_ _ _ _—_ _—_— _—_—_—_—_—_—_—_—_ _ _ _—_ _—_ _ _—_—_— __ __—_—_—_—_ Q O STORE NUMBER 07598 i I i i Ii i i I I I i i I PROJECT NUMBER I . I �LIFZ OF CANOPY ABOVE I i I I I SHEET TITLE FINAL 90E11'AU( I i /J, /J /j\ /J� /� /J� — /�\ /J� /�\ FIXTURE 3') j '} g'} 21 PLAN STORE PLANNER: DATE:ISSUED C. Swain 03-31-2011 MERCHANDISER DATE: R. FRENETTE 03-31-2011 SHEET NUMBER MANAGER: SO.FT. . J. ANDREWS 54,87E SCALE: CLUSTER: F 1 1/81, = 11-01, VINCENT 1 r l ( 1 1 ( l f 1 (/_ `1 / 1 COMPARATIVE ANALYSIS NI,/�� /-�, QR�" /-�1 STORES 07598 Hyannis,MA ,, ; `�,�; 1��/ 1� � ; �D/I C ; \B. �/ `.V; q GENERAL BUILDING FOOT PRINT SF 54.879 Sa,879 0 `\ EXISTING PROPOSED VARIATION / SALESAREA SF 39,338 39.338 0 SALES AREA TO BUILDING FOOT PRINT SF 71.68% 71.68% 0.00% MEZZANINE SF 0 0 0 I I i I BASEMENT SF 0 0 0 CHECKSTA EA 13 0 (13) / l�- —_—_—_ I _— —_—_ _—_—_—_—_I _—_—_—_ I _—_—_—_—_—_—_—_—_—_—_— _ I_—_—_—_—___—_—_—_ _ _ _ _—_—_---_ COMPACTOR I I I I /-~ PROEUCE MULTFDECK PRODUCE(5-DECK) LF 56 0 (56) MULTI-DECK PRODUCE or 3 OEY2() LF 80 0 -[a>r,4 1>i- \w-il�\aYIIi- \ —TA'� [. \ _ i I / LOWPR FILEDPRODUCE(4E MELON,JUICE BAR) LF 84 0 (64) —_—_—___—_—_—_—_—_—_—_—_—_—_—_—_ (80) TABLES x ORY TABLES LF 92 0 (92) xaa I I TOTAL PRODUCELINEAL FOOTAGE LF 292 0 (292) / AG i i I SALADBAR LF 18 0 (16) I I I I I I SHELVING(DRIED FRUIT,NUTS,ETC.) LF 11 0 (11) � Ir I I I FLORAL REACF4IJ DOORS LF 0 0 0 REFRIGERATED FLORAL LF 11 0 (11) i DRV DRiRAV LF 44 0 (44) I I I I I I I TOTAL FLORAL LINEAL FOOTAGE LF 55 0 (55) DELI SBTVICECASEDELI LF 36 0 (36) I I I I I I I i PREPAREDFOODS(SERVICE/SELF SERVICE) LF 6 0 (6) I I I I I I GROCERY RECEIVING I HDTFooDs(sERvrE/sELFSERVlI LF 0 0 0 SELF SERVICE CHICKEN LF 5 0 (5) PIZZA(SERVICE/SELF SERVICE) LF 0 0 0 SOUPBAR LF 5 0 (5) I I I I I VAC-PACK DELI(ISLANDCASE) LF 28 0 28) PREPAREDFOOD(ISLANDCASQ LF 0 0 0 CHEESE ISLANID CASE) LF 32 0 (32) TOTAL DELI LINEAL FOOTAGE LF 112 0 (112) BAKERY SERVICE REFRIGERATED LF 0 0 0 / \ SELF SERVE REFRIGERATED LF 9 p (9) \'^ / _ _ _—_—_—_ — _ ___—_—_—_—_ ___—_—_ ___—_ _—_._ ___—_� 1 REACH-IN MULTI-DECK FROZEN(DOORS) LF 4 p (q) U ; LOW PROFILE FROZEN WALL LF 0 0 0 BAGELS 8 ROLLS BBREAD LF 32 0 (32) i I PASTRIES LF 14 0 (14) DRY TABLES LFTOTAL BAKERY 50 0 \�jSEAFOOD SERVICESEAFOO LINEAL FOOTAGE LF '12 0 ((12) / \ MULTI DECK SEAFOOD(2,3 ORB DECK) LF 4 0 (4) / GROCERY FREEZER COFFIN OML TEMP BLAND Lp 12 0 (12) O LF 4 0 (4) PRODUCE PREP I � TOTASUSHL SEAFOOD LINEAL FOOTAGE LF 36 p (06) u,11 d �II� 1j, I MEAT SERVICE BIfTCHER BLOCK LF p 0 0 " • MULTI DECK MEAT S DECK) LF 72 0 (72) O IIII FISH COOLERI FISH PREP DELI COOLER SE ROOMY BAKERY (18) COFFIN DUAL TEMP/FROZEN ISLAND LF 0 0 0 I MEAT COOLER � I MULTI DECK(z OR DECK) LF 16 0 FREEZER TOTAL MEAT LINEAL FOOTAGE LF Be 0 (Bg) PRODUCE COOLER � � I { � I DAIRY/ M1JLTlDECK DAIRY - —-—-—-—-—-—-—-—-—- --- _-- --- - --=� - - - - - - I MEAT PREP ^� DELI MULTI DECK MIRY-DELI(6SDECK) LF 212 0 (212) LOW PROFILE/COFFIN LF 0 0 0 (212) — �---- MIRY PROMOTIONAL LF 10 0 (10) - LOBSTER I � I I TOTAL MIRY LINEAL FOOTAGE LF 212 0 \ _ DAIRY COOLER SALAD PREP AREA I - FROZEN MULTI-DECK FROZEN FOOD(DOORS) DR W 0 (PI FOOD MULTI-DECK FROZEN SEAFOOD(DOORS) DR 3 0 / BAKERY f MULTFDED(FROZEN MEAT(DOORS) DR 4 0 (a) STORAGE tNECH. CLOSET MJLTFDECK FROZEN(OPEN OR 0 p (B) / / ` COFFIN FROZEN FOOD(cony.U to doors) OR 0 0 0 o ils ° ' s "P A1r-"r .r'""�"'s-...r ItAT am !� WED HA RV EST FROZEN Ni 8 0 Ift 36'MULTI-DECK DELI 4' -24 ° --- - MuaayAN µ -Nuas14M -- rya -- —. _ - ___—_—_—___—__ — 1 TOTAL FROZEN FOOD NO.OF DOORS DR 105 0 (105) SUSHI v 1,Ia-1s W-1t mi-s caz-s -13 ' * ii ,w Isu Maass Mu nKw. Iwu vnaOsz - lr� PREP/ a'-0" 4 0' 4'-O^ la_4 az-a az-s �`rsa�-i """m "-iw.nnrN - J FROZEN PROMOTIONAL DR 8 0 (6) O —{— DU I !� ___f _. o�y DISPL. SERVICE 2'.p SERVICE 2 fp.SERVICE B, _ / T.A.B. MULTNDECK BEER(etl11 for cooer-In.It.of drs) LF 0 0 0 CASE SEAFOOD SEAFOOD SEAFOOD FROZEN FISH 12'PR 0 ICE CASE ICE CASE ICE CASE FROZEN I MULTI-DECK WINE LF 0 0 0 / �fq y t•(V FISH 36'MULTI-DECK FRESH MEAT 16'2-DECK MEAT 36'MULTI-DECK FRESH MEAT 4-DOORS 8-8 20'-(II)-DOORS�ROZEN 24" 3r SPIRITS CABINET(LOCKABLE) LF 0 0 0 yy/ FROZEN MEAT EVER(' BEER B VANE SHELVING LF 0 0 0 7 BAYS ROLL IN DAIRY(2a) SHELVG yti � I 24"" EY 1 LIQUOR SHELVING LF 0 0 0 I� Is v i TOTAL BEER S MANE LINEAL FOOTAGE LF 0 0 0 i SHELVING GROCERY LF 2,130 0 (2,130 WINE85MRfTS(NOTED ABOVE) LF 0 0 0 2 DOORS WILD HARVEST(NOTEDABOVE) tLF178 0 (178) VVV 4'MID FISH REACHRS GENERARVERTINOTE ASCIVE. 01 0. SEASONAL OFFERINIGs 9'-DELI - END DAIRY FROZEN DAIRYCONDIMENTS mq.-4 FWD END (�Y) 133 0 (133) t �M_a b oxEai"nc icw a TOTAL SFBLIVING LF 2,447 0 (2,447) REVIEWS V V v 6T ti DATE o Ay� W/sCAu I i DATE DATE DATE a 4 4 VENDOR END 3 3 i MTE 3 I SHELVING SHELVING 4' SHELVING SHELVING SHELVING vv SHELVING 4 NAND PALLET SHELVING p� I 4, W 6 o a ; AQ AO� `ry�y j I SHELVING SHELVING SHELVING � �'' ' O 33 � C ti K - ZC,S, 4' T SO'-10"PP 6'-I1" 4' T-5" 4' 6'-11" 4' 6'-7" 4' 6'J" 4' 6'-6" 3' 1" S•10" 3' 8'-6" 3' Iv T-5" 4' 6'-8" T•1"DELI -- ---------- - 5 - - -- OOLER ---- -- ---- --- - - -- ---- - --- s u $ ------------------ —i PREIP E a " £$ I \,4 s� I = I w REVISIONS 0 y rARn1aN :M i HWAND L fv O �J $ fll o >n... SANK I W I I $q 4 I s.TAM[ f F K Z ( 1C acuE k� aD.ss TAn[ I a 3 441 z 1 7 BAKERY I 3' 3' I K H V N S EL I G I SHELVING RETARDER I ¢� I � FLY TRAP 3' B " I ROTS. s I SHELVING 6'- a I. FAZED CHICKEN PREP.�I ��1I FRYER SINK ` � 3 I a 37sa CHICKEN H/W OOav N O C v ®� — _ = I _ k K i d Hoop sMK y ( w I� QQx ° `I I� 22 22 22 22 0 `i n = (o e ^ a 2) I Od I 3: O MILLWORK (4� H/yy mY 22 22 p L) Q ,Z = n Z I ®I� g gQ qa DI FILLERY gi 'LJNo NAB uP � � � CONSULTING � g££ I "¢p P o�o I I `-------- - - - -- - ------------------- - "---- pxv --19 SHdVINC --- - �[I. 4' ---- - 7- ---7 - -—-—- ---- - 8 /- 1[ q1- - '+--SHELVIR aZr SHELVING_—_—_—_SHELVING ___ 3 96 gi ri I I RACK OVEN yy yv r `p pp riw SIRKE HEATER I c� 5 A r t ( _ a F $ BAKERY PREP SHELVING SHELVING SHELVING (6)-PRDOUCE SLANT I w 'g g TABLES W/ENDS I r73D sf SHELVING $ I I n a1 w R _ _ 2 S.C.REFRIG.PRODUCE () In b h TABLES ��C�`RV '�4 �•1'pe P2ROOFERS I O FFFP 8 saulFs>1M [aunl[s1 qsF �Q. vy r, • QN b b b I 6 PHARMACY 3I � g z d ! A rLx[ Rx[ w - �jjj �� I o � 7 Y sr N EFFE- " W b b B 00 S LL bZ b b , l=R'1Z > Y ( I IA— 0D (a)-PRODUCE SLANT \ �` "' $ 8 9 F m tTABLES W/ENDS 4;, zu 26 me 24" b 1�a yy wmam sounarl somnesN V ¢ I _ I 0 b b b_ 2 22 22�ZZJ22 22 22 22 22 22 22 22 ' - WI I Y = zDoZE oas $� rooms a a 3' _ 0 I�-�p m W /-1 n eRtM ;aN sgrnaH j. C Ce AKE$ 3S W S ELVING G�/ I 0 O — CLOSET b v� Gy F W J P hr'"' SHELVING SHELVING SHELVING \ yl Y 3 .NHL 1'1 CARD MALL PALLET PALLET '� '� 4, 4' o I)r / >3 Lu u_ 2 / rJ (8)-5.C.REFRIG.PRODUCE I W W 3 3 3 I - b SHELVING SHELVING z I x O W W TABLES W/ENDS FWU' SHELVING SHELVING SHELVING yu,.s.r :0 gQ g �Oym �YW ~� E$ 3 \•-�/ W z (n LL. b +5 w'wj WILD HARVEST I wITHENDRETUR0 W f z DCtn LL COFFEE OO COm Ll I Ll LI DCANOFY �+Q I I i�sA u r_ Dsc�s w WOOD CRATES STACKED(2)H. 0 �« ❑� cObk7E/r— I I F.Lfriab e I I REAOC N 6'-0'tlry W/INSERTPCANOPYLAY H P�b+m I I I I 2 DOORS FOOD(EEND ) tlisplaY end �, ' T)-FIAT 6HELVES s I I I I I I I FOOD S') EXIST. (11-PRODUCE 6 TAG MDULDINGS. FROZEN T ,TIER PROMOTIONAL EEND TABLE R tr I I D I I i i '� ID SPLAY BASKETS (1)-PRODUCE P t'd' POLAND MASS SEASONAL DISPLAY AREA N LLL---LLLTTTYYYPPP $ANT G DISPLAY AREA II (4)-PALLETS SNELVINQ SHELVING y ®� I i(13)—CHECKOUTS W/(2)—EXPRESS & (3)—SELF SCA� I � C1UnSTOMER C INTER zn -v4 m DROPO n O ; kg DASANI AQUFINA ®®® CUSTOMER JSE VI — I O I COKE PEPS. I Q / w -- --- �, - - - -- - --- -- ----- ------- - - --------- - -- - --------- 12'CIGARETTES •- J �[. X �j z Z �15 NIERCHNDISE _�sorsouv" 4 Q TABLE. �ox�mN ir[p CM10N[ CMidq S Z u TwR d I I WOMEN I ¢ I!!! tu[11IAINIWN ❑ - [Aar Q 8'SHELVING SAFE ROOM ZOMONEY zO I I a I I SHELVING' SHELVING T 0 I I — MEN EXIT I I 5 f"rf e VESTIBULE r z J Q FLORAL SELF—SERVIC� I Imo' I� 48•-2• �%� � Z � zzN 4Q`-0" lima Y , SE45ONAL SHELVING(78"HIGH) Q LSHELVING O CIOtk (n COOLER � BOTTLE RETU �p LEI' 0 aonn VEIN ATM — — ------------ — — — — — — — — -- — — — — — — — — — — — -------I— —-— ----- I —-—-— — — — — — — — — — — — — — --------------( � 0 Z STORE NUMBER i I 07598 , I PROJECT NUMBER LIE OF CANOPY ABOVE ® _-. --_ I I I I I SHEET TITLE L_—_ --_— /J� EXISTING H .l .l FIXTURE ✓� —% \� % (�� j \D� �C.3� \C � .�j .�� f B 1 4`) 1 A } PLAN STORE PLANNER: DATE:ISSUED C. SWAIN 02-08-2011 MERCHANDISER DATE: R. FRENETTE XXX SHEET NUMBER MANAGER: SO.FT. . ). ANDREWS 54,879 I SCALE: CLUSTER: F 1 1/8" = 1'-0" VINCENT E 0 0 D S E R V II C E E Q U I P M E N T S C H E D U L E MK. QTY DESCRIPTION ELECTRICAL WATER WASTE GAS REMARKS 0- N w Ld = JaWc� o w �_ w F_ < Q 0_ :D4r 0 IV Q LJi `1 = Q �2 Z (n N 1 1 WALK-IN COOLER 2 1 WALL MTD HAND SINK 3 2 WORKTABLE 4 1 WORK TABLE 5 1 3 COMP SINK N.I.C. 6 1 REACH-IN FREEZER 7 1 RACK OVEN 8 7 WALK-IN STORAGE SHELVING 9 2 MICROWAVE OVEN 10 2 CONVEYOR TOASTER 11 1 BACK COUNTER 12 1 DISPLAY CASE 13 1 IBACK COUNTER 14 1 REACH-IN DISPLAY COOLER 15 1 BACK COUNTER 16 1 BLENDER 17 1 COFFEE GRINDER 18 1 1 COFFEE BREWER 19 - -SPARE NUMBER- 20 1 CREAMER 21 2 CASH REGISTER 22 1 DELI DISPLAY CASE 23 1 SANDWICH UNIT 24 1 DROP-IN HOT FOOD WELL 25 1 FRONT SERVICE COUNTER —_ 26 1 SNEEZE GAURD 27 1 DISPLAY CASE N.I.C. 28 1 SIT DOWN COUNTER 29 4 TABLES 30 14 CHAIRS 31 1 GATE 32 2 MICORWAVE SHELF 33 2 AIR POTS 34 3 STOOLS 50'-0" 35 2 WALL MTD SHELF 36 2 WALL MTD SHELF 37 1 U C REFRIG. 38 1 SLICER 39 - RANGE OVEN _ 40 - -SPARE NUMBER- 0 O ?460 ®�4 ® 24sD O O O ® 5 38 4 � TT- 16 2 18 — ---- 15 I 9 32 10 I I 14 / 13 12 10 11 9 32 20 33 26'-6" 21 22 \\// 23 �/� i 24 21 i 0 Tio rT'1 rTlf'T'-1 h lrT1 34 ♦•-f--i h-#--I F+ -�-I � LJ_JL 1 JL 1JL1J 27 0 31 30 29 0 21'-6" PROJECT EQUPMENT PLAN- FOOD SERVICE EQUIPMENT PLAN 1 /4" = 1 ' - 0" CAPE COD BAGELS 1 5/5/98 REVISE LB.C. y Ls, REVISIONS BY f DATE DWG N0. /30/98 PLAN / I I �A� PROJECT CODE p NT /4"=1'-0" PARAMOUNT RESTAURANT SUPPLY CORP. 5153 DRAWN BY 333 Harborside Boulevard P.O. 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CJRB DOGRr" r ) 1 I 1 I I I I ��-�-� _� t WIRE SIC CAS tZ' DAM RACK 11 I / - . 1 • 1 to W o I : DESK ) 2•-6", ,_ 111111 TT • 1 WALK-INS FREEZER < FLOOR PLAN 1. �' Q ' u._0. • IB'-0' ' 37(4 E 2 TIER GRAVITY CONVEYOR 2 5 W : SHELVING 12' , r N ____-- , I v . t%i LINE OF ; 36 X17 j w s - n Lv to C] o A11T0 1 , X MEZZANINE 2 C �, come. , O MEZZ �, 5 `a 1° -----' 12'-0' BL/STtV 16 -O /' 1 N 5. _ 5`T�-• 10 XI I SECUR ITY CURES GENERAL F'I� WRAP � L WIRE A 2z' SHELVING t d. I -- -• ,.t- . , I , AIR N+ _ ' w W Y Sc Xi0 OVERFIEAD (A Ha L �`" . MEAT COOLER ; c IN `-" `° r LATFOVE FOR ROOM MERCHANDISE I_ 5 6 1 o r` i I- F[SH > PREP R00 1 >_ c- 30 X24 � 35' SHELVING 1 / w tSHt RESV. TANK .J HOOOd M DELI COOLER i- « STORE ROOM z jn I I - W r- m __-- w COOLER W Aa i57 t 7 ° 1 10 X 16 9 6 �< 1 I --- ----- DE I PRODUCE L t IGE ----------I- 10'X12' En I �•- `'� 1 COOLER �, t8 M''.� 4 = 30•-o- 3Z' 8'-8" 1_ 0" m 42'-6' / , , 1 > . ,t5'TBL. 3Z w I S LVE SFIELVES on goQQ 1 ` :_ 1 < -, 1 I_. m O 1 1 I ,t Iw• I ., , , I 4 co O IA Z I A>F.F s 181 PALLET OSIT10N5 1.I CD -�' &- Q ' ' ' __1_ __ 4 , o - ' I(61 PALLET POSITIONS - ' 25'781. {'�'TBI.> 3'T$L. 1+ Y'1 K 5'TBL. 5`Ts3L. c� ICER - j5' TBL. OT;� m �2w A.F.F. m _ N DAIRY ER 1 ... I 5' s 4 - I� -o ,� ' W I 1 1 _ _ i d ; ' ('. : I36 XOOL , I 1 . ; �y,��._ ' - _.J 32:' E a1 F 5'-0 �0$I 5'-0 ;Q< '-0" 1 1 1 3 W j , , . r , I 1 _ _ t%_ --_ - ------�---- - ---- RO-2-63 J�mr 1 I 1 = I I--d_-! - - ---I---, I I I i I I I TT - , to m �, , ( - !- 11 I T A.F.F.A.F.F, n SELF TC-ftlSCALES E- -t- FLOOR AIL1 1 N = ; 2 , , , 1 � Y �O"X( )0 _.,t-• 5 - - M G 0 ' two; _,_ __-'-_- -- -- --'-1-----� % N : ' 'F .. UQ.�L� 1---�---1---, 36'-O" v I +S�_# f- ,1 x ! E +"( CUTT[N R OM - YliRt W G W BAKERY F- •r I I ' - .f I / L 11 1'� ! x6 __ I 1 2C' PLATTER RACKS . ` -s--- - --- -' GSSI E - -I-- ---- -- -- --- 7` °C 42'-6-X24'-O" g ------' 19' FRESH FISH CASES TANK 12, SINGLE DECK AR ME t c SEP.YICE DELI CASE BLASS�ARTTtION SCALE LATT I -----,-----------�- ' I PKG. DELI CASES �' w , : , � 1 � � ILL 44" A.F.F. '_7. _ _ _ _ i i i X STORAGE z� POT SINK` �� _ i i � •� (k. I L L 5- THL. 5' SPE a•_0" DEEP SHELF 7�s" A.F.F. 1 i i J ¢ - I-- I --' • dt Ir 51li 1 f I ; r" I- �, _ =.�u STORE SUMMARY �'�r` J F_!'� --- ----CLIP QIi T �(!( t----- _ CU7 .8 $ � ., • 4' SLIDINA� 28' SELF-SERVICE DELI C S . IN DAIRY I TOTAL SITE SF ACRES pi I 48 ' THREE DECK ESH MEAT CASES 52' St f�LE DECK MEAT CASE 8LA5S 24' REAR R LL- �``�� oti t 9' STORE SF I • • �P Cj to o s 1 54 , 65 �v Ins s 3'-O 48'-G- 6'-4' , 53--0" 4'--- SF N 23'-6• 2•-6" i5'-0" 7'-8' o 52'-6' aw 40 SALES . 22'-0" N N N I 6 6 1 w H O I -- _ STORAGE SF m X W 13 .9995 N m � ¢ '� W IlI Ln * /ice DRY t I BSMT SF MEZZ SF m W J < D p U IREF _ h_ 1.' I < O FROZEN EN I - O < Ln ill � � END- �I �E I - P/57A FRU T i � r 24' OW TEM? EAT CASES W �I I I -� FF END CAP 6' A 1 1 I PARKING MAIN = z o W ¢ ~' I I Ems= - I s ; SALAD a I I DAIRY END ROOF p z ¢ w 1-I 10 < (HII& W TEMPI (LOW TEMP) I CASE 6' IrTI TOTAL -• W I¢U; I I I 10'.0= -o p 10'-0' i < a !p w > o p -- 1~:, I 1 -1 - i I CASE 6' m ROOF U o J a¢ ra 1-i w ' �w L ���-� 3 �; =W ow to � I ( MEAT DEPARTMENT 0 p ` �; W 0 ¢ �� CHEESE ¢n ^'i � I II I I ._ I (I , I i 1 o ¢ I cwi ?x w In m KIOSK. U_w I FRESH MEAT SINGLE BECK 52 SELF SERV. < Q z 1 K w o 'o " I THREE DECK NB DELI 50K. 28' c� < -a t. " ac'n 19,.10!+ X m N 81,10w Z 7 2 , t- p Q ¢ p r ►z 10 t•-' � I' I so t FROZEN MEAT 0 Ln < a d t < LOW TEMP (COFFIN) 60 fV I p fV o 0 0 o Q 0 �W " SINK `D w 1i = : N N HEAT PREP HEAT COOLER z w z > z z -' l- N ® (n II r - m I 'n O 3 W W W W Z O ? N 42'-6 X2N' j0'X24' ! 4! 101 TABLE t �I , J < MEAT FREEZER POULTRY COOLER o o o g 12'_REFR[GER.ATEO Y N 6' II rJ ¢ x ¢ ¢ o w � � W W O O O W W w w W 1. N , DR O CHEESE CASE ENDL!!"� - " m m m m W o PRODUCE DEPARTMENT ¢ ¢ ¢ . I Z ¢ II O o PRODUCE CASES SINGLE DECK 12e' ¢ T1(0 DECK In 0) m LLJ PRODUCE DISPLAY HARMONYdo T T 0 44'-O" I1.i ii � Z FLORAL WALL 22 m 4m CD m n N o Q I I , •-10" I 1� RO(_LOYERS 120 DRIED FRUIT 26' BULK BINS SPECIALITY SHELY. 32' w v V, r m (�•� -11 ) II d Ej POTATO IS' CANDY B• COOKIE 8' DRY PROD Z' J - _j �I 1. ! I J SALAD BAR S'XIS' ;UICE DISPLAY NO x ,; x -J Y Y x >- J �. 11_0. m I PRODUCE PREP PRODUCE COOLER 1s -0' SALAD BAR c - o' 1 I 5'X16• I _ o � I6 x21 39�-6"X22'-0" I RR n c0 In c � n, - O i 2 3 I `+ � `_1 � 9 IO II � �� 14 I� ' 16 I - 18 14 0 7•-s" s•-°_ � � t I DAIRY DEPARTMENT on N% �o. I I ¢ DAIRY CASES R. FEED , s s ph 1 Q m F.YFEEDCK END 6' 24 o I (^ � O = or<o I h I Q W DALRY COOLER 36'x17' o I o t' I > APPETIZER DEPARTMENT . Cv I p o c N o _ ? I 2 III- I t oN 5' FLORAL STEP yr <v/-4 I !I I I I! ( . . a _ �- - - - - ---- - -- 9 t 1 O, i .GIs+ r•r-• 14, Q -< DISPLAY ,� 14 r ( - I _ . t, BUL , Fnr 1 aY ►(�0• ; 1 II 11 I I I I j ', I 11 .� Lie' I F FtoZtN F I�I' _I �= I � �, I I I I ! - _ I -- ---J I ' I �: 1 ( ! 11 I 4 It I I I I = ,I I " II I i 1 e FA'-' SERaiICE �P' , 1 �N tS ��,:,�. 5DK. 11 - cc cc dY mm Oti_ 1 c� KIOSK FRESH F[SN 3 SERV.19' I Li I APPY PREP (FISH-DEL D COOLER 1 0' X 1 6' ' o 2L) ,- I ¢ 10'XI6' FISH COOLER 10'X12 . aoJ < . t Q� ! I m¢ OJ XB IN . 4 I 1 6' � O' WHEE #4 ��� I FROZEN FOOD DEPA TMENT I L2 . I I I ^' m -I REACH-IN 62 DRS Y Y w c i m m ^ I N FROZEN FOOD CASES ISLAND 72'+4 ENDS m< N p F . < 3'-5- 2'-4- REACH-IN I— O w i FZX�:R a¢ z . il I 2'-4" 3'-5" � m m I'-11" " ICE CREAM CASES ISLAND 112'-EN0 ,-I 3' " 6'-7' 3'I " G'-7' 3' 6'-7• 3• " 6'-7' 3' " G'-7' 3' 6'-7" J2' 6'-11 4. 2' 6'-It" 4• 7--I" 4' " 7'-2" 4' 2" I 7� 2 4' 2" 7/-2" 4• " 7'-2" 4' 2" 7'-2" 4' 2" 7'-2" 8'-6" � 6'-6 8'-6' 10'-0' 4'-0 I'-0" FIVE OK sm 1 ]I 15' P�iTATO w FROZEN FOOD FREEZER ICE CREAn FREEZER f 1 In O 361X17' - IS' ROLLOVER 13'-OR I W N I I I < s .: , GROCERY DEPARTMENT - o M 2'-6"X6'-O' I p = . - o TABLES I - 38' 4" El z o w GROCERY SHELV• SEE BELBW J t w I = Q w w " NO-FRILLS SHELV. BAKERY SHELY. m o r ¢> I_ - I 11 N ut { ¢ �' �w t SUPERSTRUCTURE BEER CASES I PINEAPPLE CORER - 2 X 5-6o CO LE TE2 < . tL o YES I ¢Q L I 1 - H m Hw �' NON- FOOD DEPARTMENT OI I II ------------- u I - _ ¢¢ .% m 14-0 2 U w0 : < a(_ `�' 9' OLLQVEP, 0 _ m m I NON-FOOD SHELV. SEE BEL0I1 1 3'-0"X5'-6" TABLE t - t (ICEI W f ° i RX YES SERVICE CTR. YES ------------- < 1 __ . JUICE MACH_ I YES C4ECKOUTS E6 o w '' BAKERY ¢ ' 1 4 -C" GLASS 2'-O" C. CASE 1 Z TOTAL SHELVING= 3248 L/F 24' VIDEO RACK O - ro 11'-'I" ' 41111111111111 • I1n I - It 92 ( s i " -0" COMMUNICATION SYMBOLS ------------------- - _, ' UI I RESTRICTED ( 10) BUTTON MALL PHONE co ____ 3• 0"XS•_6" / If, UNLESS OTHERW15E NOTED 1i1 I?' ROLLOVER TABLE 92' _ �, ' I".: m i 0) UNLESSROTHERkISE,NOTE,TjON MALL PHONE 1 5: 4 N 0 U1 11"E' (" ; I I I �. FF ENO � ICE CREAM FF END �_- PAY PHONE g o V00r- I _- ., W (n dp ' I L L-------- -- ----------- I CASE 6' r or< I STORAG�O I II { I !) I m I I t II END CAP 6 CASE C' ( c JpW o I II i- ( �V�7 INTERCOM J�^m I 1 , I I I 11 I I I 1 1 �y :BH LINES - RJ'i I JACK - (2) LINES Q _ I o �/O IN I � U(n ; I ; I I OS t CKT ------------------------------- O m~ I SERVICE w I t I U t, CENTER � I 1 I I I I I I ORDER --------------------------- 2 U W o < r N I 3 DUE DATE ------------------------------- ��- w I _ 3' i 3- 43- 3• 3 2' 7 87 E' 7 f01 , 101 01 101 101 < _ Q �- FOOD Q FURNITURE FIRE EXIT LEASE LINE ILpCiTEO IN COMRITER ROOM Er SERIES I -ILIREI m_ a I - _ _ Q C DISPLAYS - CK1 A ---------------- -- -------- a �� I J f *^] /C OR�CR N - A. O .T I.-O. 3 - W TABLE TABLE L I - Lj I I I LA I I I t DUE DATE ------------------------------- � i � (u4 3'X 6' 3'X 6' �' BULK ROLLS w -- -- �Ll d BAGELS w T TREND ENERGY-LINES --- -- ------ --- (y U 2 cr 17' ROLL OVER -3 . � ORDER M M Q O DUE DATE ------------------------------ I •- Q . r 3'-O-X5'-6" s t I V TABLE (ICEI ---------------------- t _ , -- 1 I' `1 4" 4' NI-46 4 63'-0' ro1 *_ J . 26'-O" 6" 151-6' 6'-8" ----- --- 12'? _ 12'-0' i5'-8" RAIL ct�- - MEZZ• 4'-II" DONUT BULK '✓APO c T , f� cr r COL. , ER 4'REF (£' REFRtG SHO' ?REPACKED ROLLS I of t 1 i -..-. _ _ 1 _- 17•-5"�_ tnoPPARTtTIOM E �r�EE�\1 DCIUGH ,rtec CASE CAKE'rt 4._,1 .' f SHOYIC. 12. TAL-IA+1 IGLASS + BONY, yp ` " o: 1 I '~I Ivo�4K: VoJK -- -- I FULL HEIGHT BAK>=RY WRAP COL VIEW T I�tIX4 1 41XyI - I i`-u - I}- - - I In . TII a I 2'-6"X3' FRONT 8 t N 81 >� 5 I u E I 1 COURTESY 6•-0" i '�- % OVEN NO 1 ES% 1 FUT R -0 so ♦ PARTITION ::�;[ SEE DETAIL AA-5 1 I . i - 0 c acK�u IgRE� I ,5' DIA STORAGE BREAD �� 1"X5• 1 I . DIMENSIONS ARE FROM RCUGH STUD OR MASONRY HO SPOT ? I I TI ENTRAL T 6"x5'-0 6"T TE 1 --' I TABLE ONUT TBL SLICER o -� TO ROUGH STUD OR MASONRY. �� ;` - RED LAD S - ; 54't87" I, „ _ F I N �_ _- 1_ �, 2I:'wR 2. ALL AISLE GONDOLAS TO BE 84 r1IUl1. �� r (�� �I TATION 1 I f r1 I 5- FtN �.�--yf " -y I, g L c ec UT 2• _ _� t , ' �- DO-NUT AZ N Pk'OF 3 . ALL NON-FOOD ENDS TO BE MOVABLE . Uj ` l - ! T I _ --f ! I zw > ; FRYER L f I TR < TABLE c ;'c CART 1 _ I 13 14 15 16 Q - > w RA L 1 - - 1 1 u 4/-0" MEN ', C > = BAKER --- -__ I - ___.. ' DIA > w N FREEZE --` HOOD LINE S TABLES SEL , `C -CJ `C� --- -- ' ,BAKER = I I I R I I ( 11 I t I ( ll_1 1 I p ' S•-0" w_ OGLE 'n 16'-0' i MEZZ •• LINE o Z •_g; •_ !8}�5. 2 E. I --8' 1_ ?•-P7 4 -2'- •-E- 2 SI.4-0 2-8 y 0 2 0 4-a 2 8 �I o ' N MIXER �/__L INE COOK If I t.s MONEY ROOM , MACE • sS 1ATER L;S a ER ) I / SECURITY f�00M - - 8'X26' ONE WAY CH L ER WI_. SANI(T[ZEr( 2-D- MAPL r - {.kr'T m L. l GLASS : 'A R•=� ROOF BOX TOP TAB V ( [EE I ,-__ _.. -_ ,. �. -------� --- -- ---- -.._- -- _�-_ -�._ _ ---------------- - -.. .-- - _- -"� _ e� - - - ---- - - - -- - - t - - - -- Ofi , CONC. �'� ^ . CURB ._ " 47'-6" CL CONC. J _ - L - CURB 33' 2. 39'-z' - 'U- --- =�- -- ---- ---- -- - --- -- - ____.._ _- e.T•. 33' 5" 34 0" ;--_ I La = , R 268. 0" _ -- r - -------- _ --'----- _-'--- ,.. -- --- --_ - -- __- - __-- -___ -_ - - -- - - -._-. -...._- ,_. .._�_ L 1 _1. 1 .2 a 12''0' 7'-5" --0' 8'-6" '-0" 8--6" '-O' 31'-0' '-0 .:Fl-IN - ?z .. 15 ;• t� . •� t lb A HD/W LEDvE �` - K ST. MANAGERS P/C d COMPU ER s_ 39-AFF LA•DI -S I �L OFF ICE Ft00W _ I I - 5 O 12'-0" Ig 6" " 16 G" " c " 5" 5' ._ m 5 ._ li 5 12'-0' ,- I I11 .-0. ~ i! 15'-3" 14'-6 I :1r. 0 o 0) 3'-° y . I Lan . • N `o MANAGERS OFF ICE _ TRAINING R''.f ° 1 I � v co o . � t II r - � IiI1I t 5' ® t . . I'_?I 'Ii 1 OI 14'-9' E?' �' 3• (� r r� ! LUNCH k00M ^' I `V �" I r a i �I•oRE IdO: .-� t I t t n MENS r; I4, 1 ? . F� - . �` rt 1P o . I .. ---� 7 - - - st I -----+" t t y-` �Ci1CT CMA;E FROM I I' III-' 1 O J DON"T FRYER �6AiERYi ` , , Ii7cIG' .NTxE-I-7(Is Ex". U i f ', tt/i- iAAfLAT1011 - _ . ceI i i � �� -.I . _ - --- --j '. - I _-J _ _-__- __ _ _ - _ __ _ _ _ I - - .. - I 92 -8" s _, . FL.Or R P-AID - ...- r .sik�rca.3--..< h. as .sen s. _ss-..- ,z:..•-.--r.rc ,-sw,.:'^ems+-+,-.�'.:-_"fsiw+-accow+e�7meaeaa i,:.sw�.,w.wc ias�mcr�r-•7acs. s+wsza�awe .. _ ."„ +.� �Hryr>toar 2 ri_ PS HYANNIS MASS PLOT brlZ- DRAWIN 01 ;•4 . - - -_1 i 1 F 0 0 D S E R V I C E E GENERAL NOTES U I P I M 0 E N T S C H E D U L E t ALL FOOD SERVICE AREAS FLOORS, WALLS & CEILING MK. OTY DESCRIPTION ELECTRICAL WATER WASTE GAS REMARKS SURFACES SHALL BE OF SMOOTH NON-ABSORBENT MATERIALS AND SO CONSTRUCTED AS TO BE EASILY cn CLEANABLE. IT IS THE RESPONSIBILITY OF THE OWNER OR Q J a w J p 3 0 = � J 0 p D_ fV m HIS REPRESENTATIVE SUCH AS ARCHITECT OR GENERAL ,l Y > a o a _ o z CONTRACTOR TO SUBMIT THESE PLANS TO ALL LOCAL & { COUNTY HEALTH & BUILDING INSPECTION DEPARTMENTS 1 1 WALK-IN COOLER LIGHTS 2.5 120 1 X FOR THIER WRITTEN APPROVAL. to 1 WALK-IN CONDENSER 9.9 2 208 230 1 X 18 1 WALK-IN EVAPORATOR 4.2 _ 120 1 X 1/2 WHEN SPECIFIED ALL FABRICATED EQUIPMENT (ITEMS BUILT 2 1 WALL MTD HAND SINK 1 2' 1 2' 1 1 2' TO SPECIFIED REQUIREMENTS PERTAINING TO THIS JOB) WILL 3 2 WORK TABLE ALL BE BUILT IN ACCORDANCE WITH NATIONAL SANITATION 4 1 WORK TABLE 5 1 3 COMP SINK 211 2 2 1 2" 3 1 1 2 N.I.C. VERIFY FOUNDATION SPECIFCATIONS. _� E ALL EQUIPMENT FURNISHED BY F.S.E.C.(FOOD SERVICE 6 1 REACH-IN FREEZER 12.5 3 4 120 1 X EQUIPMENT CONTRACTOR) SHALL BE DELIVERED TO JOB - 8 7 WALK-IN STORAGE ESHELVING /2' 1/2" 1" 270.01 7 1 RACK OVEN 17.0 6.0 208 3 X 1 UNCRATED, ERECTED, SET IN PLACE (IF CONTRACTED BY 9 2 MICROWAVE OVEN 20.0 2.25 120 1 X EACH OWNER) & LEVELED READY TO RECEIVE ALL ELECTRICAL & 10 2 CONVEYOR TOASTER'. 14.0 2.80 208 1 X EACH f MECHANICAL CONNECTIONS BY OTHER CONTRACTORS. 11 1 BACK COUNTER IF ANY "HOLD TO" DIMENSIONS CAN'T BE 12 1 DISPLAY CASE HELD \ G.C. OR OWNER TO NOTIFY FOODSERVICE 13 1 BACK COUNTER EQUIPMENT SUPPLIER 14 1 REACH-IN DISPLAY (COOLER 5.5 1 5 120 1 X 15 1 BACK COUNTER ALL DOORS & DOORWAYS SHOULD HAVE A 3'-0" - 16 1 BLENDER 15.0 120 1 X WIDE MINIMUN CLEARANCE TO ALLOW FOR ACCESS 17 1 COFFEE GRINDER 4.5 120 1 X N.I.C. VERIFY OF EQUIPMENT DURING DELIVERY & INSTALLATION. 18 1 COFFEE BREWER 15.0 120 1 X 1 2 N.I.C. VERIFY IF YOU DO NOT HAVE A 36" CLEARANCE G.C. OR OWNER � ' 19 - -SPARE NUMBER- MUST NOTIFY FOODSERVICE EQUIPMENT SUPPLIER. 20 1 CREAMER ABBREVIATIONS FOR REMARKS COLUMN 21 2 CASH REGISTER 15.0 120 1 X EACH N.I.C. VERIFY 22 1 DELI DISPLAY CASE 16.0 3 4 120 1 X SEPARATE 115/60/1 15AMP FOR COND.EVAPORATOR N.I.C.- NOT IN CONTRACT 23 1 SANDWICH UNIT 7.0 1 4 '120 1 X T.B.F.- TO BE FABRICATED Oj 24 1 DROP-IN HOT FOOD WELL 4.3 9.00 208 1 X 1 2" 25 1 FRONT SERVICE COUNTER 26 1 SNEEZE GAURD 27 1 DISPLAY CASE 5.0 120 1 X N.LC. VERIFY (FOR LIGHT) 1A 28 1 SIT DOWN COUNTER � 29 4 TABLES !I 30 14 CHAIRS 31 1 GATE 32 2 MICORWAVE SHELF 33 2 AIR POTS 34 3 STOOLS l M� 35 2 WALL MTD SHELF _. 1 36 2 WALL MTD SHELF 37 1 U C REFRIG. 4.0 1 4 120 1 X 38 1 SLICER 7.0 1 1 --- 1 3 20 X ?+so ?,� zso L@j 0 0 ` 39 1 RANGE OVEN 61.0 6.7 208 3 X �') 1 40 1 DROP-IN HAND SINK 1 2' 1 2' 1 1 2" s 0 m it ^ �.. 39 ® ® s ® `� — - •� \ II - 17 j II 1 �n 15 16 9 32 10 I I 14 / 13 11 10 11 9 32 20 33 F"yl 26'-6 21 22 �� 23 � ( 24 21 1 T40 / IrT J1Jf'Tl TJI fLTI 34 - 1 \ - - - LJ_JL J_ 1J11J 27 31 26 25 •/� .. V/30 21'-6" PROJECT .E QUIPMENT PLAN- FOOD SERVICE. EQUIPMENT PLAN 1 4'' 7 Q„ 5/6/98 PLUMBING & ELECTRICAL LB.C. CAPE COD BAGELS t 1 5/5/98 REVISE LB.C. DATE REVISIONS BY DATE DWG N0. /30/98 PLAN SCALE PROJECT CODE "=V U T /4 =1 —o" 5153 PARAMOUNT RESTAURANT SUPPLY CORP. DRAW*, BY 333 Harborside Boulevard P.O. Box 6768 SHEET No. Providence, Rhode Island 02940-6768 ISHT OF L.B.C. Ph. (401 ) 461 -3000 Fax (401 ) 461 -2510 FILE NO. i i LEGEND PLUMBING CONNECTI ONS Pl- UMBING ROUGH IN SCf -HE: DUL_ E 0 HW-HOT WATER, OR CW-COLD WATER P1 WALK-IN COOLER 1/2" I.W. B.T.F.D. o GAS 1/2" C.W. © 1 '-10 A:F.F & B.T.C. NOTED P A I • WASTE, DIRECT CONNECTED UNLESS 2 HAND K S N 1 1 /2 W. ® 1 - 6 A.F.F & B.T.C. "OPEN HUB" 1/2" H.W. © 1 '-10" A.F.F & B.T.C. INDIRECT WASTE vq+ FLOOR DRAIN 2 1 /2" C.W. @ 1 '-6" A.F.F & B.T.C. P5 3 COMP SINK 3�1 1 /2" W. B.T. GREASE TRAP D-q FLOOR DRAIN W/ATTACHED FUNNEL (F.T.F.D.) - NOTE: GREASE TRAP TO BE SUPPIED, r SIZED, AND LOCATED BY PLUMBER FLOOR SINK WITH HALF GRATE UNLESS 2)1 /2" H.W. @ 1 '-6" A.F.F & B.T.C. NOTED OTHERWISE 1/2„ H.W. @ 7,--6" A.F.F & B.T.C. - - - - P7 RACK OVEN 1/2 I.W. B.T.F.D. FIELD CONNECTIONS 1 ' GAS @ 8'-0" A.F.F & B.T.C. B.T.C. BRANCH TO CONNECTION 270,000 BTU's P18 COFFEE BREWER (N.I.C. VERIFY) 1/2 C.W. © 1 '-6" A.F.F & B.T.C. D.F.A. DROP FROM ABOVE G.T. GREASE TRAP (as per code by plumber) P24 DROP-IN HOT FOOD WELL 1/2" I.W. B.T.F.D. 1/2" C.W. @ 1'-10" A.F.F & B.T.C. P40 HAND SINK 1 1 /2" W. @ 1'-6" A.F.F & B.T.C. 1/2" H.W. @ 1 '-10 A.F.F & B.T.C. MECHANICAL NOTES - 1 UNLESS OTHERWISE SPECIFIED,SERVICES SHOWN ON THIS PLAN ARE FOR FIXTURES BEING SUPPLIED BY P.R.S.C. ONLY. MECHANICAL CONTRACTOR MUST CHECK OWNERS PRESENT EQUIPTMENT BEING RE-USED OR THAT EQUIPTMENT MARKED P5 P5 P7 P7 -3 N.I.C. (NOT IN CONTRACT) WHICH IS BEING SUPPLIED BY 16-3 8" 2-3 " 12-6` 3-6 2 OTHERS SO THAT THE SERVICE REQUIREMENTS ARE CORRECTLY TYPED, ADEQUATELY SIZED, & ROUGHED-IN ! PROPERLY (LOCATION & HEIGHT) SO AS TO MINIMIZE THE AMOUNT OF MATERIALS & FITTINGS NEEDED FOR FINAL w HOOK-UP RESULTING IN A NEAT & ORDERLY LOOKING JOB. j 1' + �.Al:I SERVICES SHOWN WITH SYMBOLS CENTERED ON FACE L_ OF WALL SHOULD BE EROL''; i_ TO TFAT TP_"";T CONCEALED _IN `o;^wL !�!!D ST�I[iaED D:!T 0 WALL ENTERED Ai F't< 0.1 - r s�Awo�oc0 BE BY PU eEx SHOWN. DO NOT STUB OUT OF FLOOR AND RUN EXPOSED _ p, I UP FACE OF WALLI L J3 ALL SERVICES SHOWN WITH SYMBOLS AWAY FROM ANY WALL OR COLUMN SHOULD BE STUBBED OUT OF FLOOR TO A � I MAXIMUM OVERALL HEIGHT AS SHOWN. - "P2 4 ALL LABOR, VALVES, TRAPS, TAILPIECES, STRAINERS, PRESSURE REDUCING VALVES & FITTINGS REQUIRED FOR 1'-0 4-9. FINAL CONNECTION OF EQUIPTMENT AS NECESSARY TO 9' F Lj COMPLY WITH ALL CODES, INCLUDING ALL INTER- P18 3'- 4 P] I I CONNECTIONS TO BE FURNISHED BY MECHANICAL I CONTRACTOR UNLESS STATED OTHERWISE IN F.S.E.C. 40 7'-3" GENERAL SPECS. 5 MECHANICAL CONTRACTOR TO PROVIDE SEPERATE SHUT- 0 t0 0 OFF VALVES AT EACH CONNECTION EVEN WHEN ALL HAVE ONE COMMON SUPPLY LINE. o 6 MECHANICAL CONTRACTOR TO PROVIDE REMOVEABLE 12` SECTION OF PIPE IN MAIN GAS SUPPLY LINE IN AN ACCESSIBLE AREA FOR INSTALLATION OF. EITHER MECH. OR 18'-9" ELEC. CONTROLLED GAS SHUTOFF VALVE, FURNISHED & 224 INSTALLED AS PART OF FIRE PROTECTION SYSTEM. 12" ffPLUMBING ROUGH - IN PLAN PLUMBING PLAN- CAPE COD BAGELS 1 /4 11 0)) 5/6 98 PLUMBING & ELECTRICAL LB.C. 5/5/98 REVISE LB.C. DATE REVISIONS BY PSCALE DWG NO. /98PLAN PAM`A��� U N T PROJECT CODE /4"-1'-O" PARAMOUNT' RESTAURANT SUPPLY CORP. 5153 DRAWN BY 333 Harborside Boulevard P.O. Box 6768 SHEET NO. Providence, Rhode Island 02940-6768 SHT OF L.B.C. FILE N0. Ph. (401 ) 461 -3000 Fax (401 ) 461 -2510 —,-- - -- 'I FR O U C I s EI- ECTR I CAS H N NCH ED U l— E LEGEND - ELECTRICAL CONNECTIONS E1 WALK—IN COOLER (LIGHTS) EC 120V 1PH 2.5A 9'-0" A.F.F. & Q.T.C. (� DUPLEX RECEPT., 20—AMP, 120—VOLT, E1 A WALK—IN COMPRESSO►R(T BE LOCATED) EC 208/230V 2HP 1PH 12.4A @ 9'-0 A.F.F. & B.T.C. GROUND TYPE, HORIZONTAL MOUNT E1 B WALK—IN BLOWER EC 120V 3/4HP 1PH 4.2A © 7'-0" A.F.F. & B.T.C. c SIMPLEX RECEPT., 20—AMP, , E6 REACH—IN FREEZER DR 120V 3/4HP 1PH 12.5A @ 7'-0" A.F.F. 120—VOLT GROUND TYPE, HORIZONTAL MOUNT RACK OVEN EC 208V 6.OKW 3PH 17.OA 5'-4" A.F.F. & B.T.C. E7 SPECIAL PURPOSE OUTLET, 120—VOLT, E9 MICROWAVE OVEN 2)DR 120V 2.25KW 1PH 2O.OA @ 5'-6" A.F.F. i GROUND TYPE, HORIZONTAL MOUNT E10 CONVEYOR TOASTER 2)SR 208V 2.8KW 1PH 14.OA © 4'-0" A.F.F. SPECIAL PURPOSE OUTLET, 208/240—VOLT ® AS INDICATED, GROUND TYPE, E14 REACH—IN DISPLAY COOLER EC 120V 1 /5HP 1PH 5.5A @ 1 '-6" A.F.F. & B.T.C. � HORIZONTAL MOUNT E16 BLENDER DR 120V 1PH 15.OA © 4'-0" A.F.F. I, — L O JUNCTION BOX E17 COFFEE GRINDER (NIC VERIFY) DR 120V 1 PH 4.5A © 4'-0" A.F.F. ELECTRICAL CONDUIT, STUB AS INDICATED E18 COFFEE BREWER (NIC. VERIFY) DR 120V 1PH 15.OA © 4'-0" A.F.F. o FOR DIRECT CONNECTION E21 CASH REGISTER (NIC VERIFY) DR 120V 1PH 15.OA ® 4 STUB A.F.F. NOTE: ELECTRICIAN TO PROVIDE DUPLEX RECEPT FLOOR/CEILING RECEPTACLE AS INDICATED AFTER UNIT HAS BEEN .SET IN PLACE. FIELD WIRING, EXPOSED RIGID E21 A CASH REGISTER (NIC VERIFY) DR 120V 1PH 15.OA © 1 '-6" A.F.F. WATERTIGHT CONDUIT E22 DELI DISPLAY CASE EC 120V 3/4HP 1PH 16.OA @ 4" A.F.F. & B.T.C. - - - FIELD WIRING, CONCEALED IN WALL, NOTE: SEPARATE 115/60/1 15AMP FOR FLOOR, OR CEILING N A VA A TOR RANCH TO CONNECTION EtA E23 SANDWICH UNIT DR 120V 1 /4HP 1PH 7.OA @ 4" STUB A.F.F. B.T.C. B NOTE: ELECTRICIAN TO PROVIDE DUPLEX RECEPT D.F.A. DR OP FROM ABOVE AFTER UNIT HAS BEEN SET IN PLACE. E24 DROP—IN HOT FOOD WELL EC 208V 9.OKW 1PH 4.3A @ 4 A.F.F. & B.T.C. E27 DISPLAY CASE (NIC VERIFY) EC 120V 1PH 5.OA © 4 A.F.F. & B.T.C. (FOR LIGHTS) VERIFY LOCATION OF REMOTE CONDENSOR E38 T E7 E6 2'_6" 3'-s. s'-3" 2'-3" E37 U/C REFRIG. DR 120V 1 /4HP 1PH 4.OA © 1 —6 A.F.F. E38 SLICER DR 120V 1 /3HP 1 PH 7.OA © 4'-0„ A.F.F. ELECTRICAL NOTES E39 RANGE % OVEN EC 208V 6.7KW 3PH 61 .OA @ 1 '-6" A.F.F. & B.T.C. i 1 UNLESS OTHERWISE SPECIFIED,SERVICES SHOWN ON THIS E CONVENIENCE OUTLET DR 120V 1 PH 15.OA © 1 '-6" A.F.F. � j I PLAN ARE FOR FtrOURES on"`"G SUPPLIED BY P.R.S.C. ONLY. r R MUST OWNERS PRE_-' .. MECHANICAL CONTRACTOR -1 EQUIPTMENT BEING RE-USED OR THAT EQUIPTMENT MARKED E y N.I.C. (NOT IN CONTRACT) WHICH IS BEING SUPPLIED B L J OTHERS SO THAT THE SERVICE REQUIREMENTS ARE 11 6" CORRECTLY TYPED, ADEQUATELY SIZED, & ROUGHED-IN \ PROPERLY (LOCATION & HEIGHT) SO AS TO MINIMIZE THE AMOUNT OF MATERIALS & FITTINGS NEEDED FOR FINAL E&8") E®48 HOOK-UP RESULTING IN A NEAT & ORDERLY LOOKING JOB. E17 2 ALL SERVICES SHOWN WITH SYMBOLS CENTERED ON FACE 11- OF WALL SHOULD BE BROUGHT TO THAT POINT CONCEALED E18 IN WALL AND STUBBED OUT OF WALL<NTERED AT HEIGHT 2'- " 2'-0" '-3' '-0 2'-9" E9 SHOWN. DO NOT STUB OUT OF FLOOR AND RUN EXPOSED E9 E14 jg UP FACE OF WALL. E21A f16 E37 E10i F — 3 ALL SERVICES SHOWN WITH SYMBOLS AWAY FROM ANY4' 22'-0- WALLO0 O OR COLUMN SHOULD BE STUBBED OUT OF FLOOR TO A MAXIMUM OVERALL HEIGHT AS SHOWN. o 4 ALL LABOR, SWITCHES, DISCONNECTS AND FITTINGS l'I REQUIRED FOR FINAL CONNECTION OF EQUIPTMENT AS NECESSARY TO COMPLY WITH ALL CODES, INCLUDING ALL 8" 4'-9" 4'-6" 3'-0 3'-9" INTERWIRING TO BE FURNISHED BY ELECTRICAL CONTRACTOR UNLESS STATED OTHERWISE IN E22 E23 E24 iD FOOD SERVICE EQUIPTMENT COMPANY SPECS. I I PROJECT ELECTRICAL ROUGH - IN PLAN RI CAS PLAN CAPECOD BAGELS ECT5 6 98I PLUMBING & ELECTRICAL LB.C. �� 5/5/98 REVISE LB.C. �I 1 /4 = 0 DATE REVISIONS 8Y i 4 DATE DWG NO. /30/98 PLAN SCALEP 7 UNT PROJECT CODE 5153 /4"=1'-0" PARAMOUNT RESTAURANT SUPPLY CORP. DRAWN BY 333 Harborside Boulevard P.O. Box 6768 ISHTsHEET OF Providence, Rhode Island 02940-6768 L.B.C. Ph. (401 ) 461 -3000 Fax (401 ) 461 -2510 FlLE NO.