The URL can be used to link to this page

Home My WebLink AboutPALIO PIZZERIA - FOOD (2) PALIO PIZZERIAro$ 435 Main Street,Hyannis r IKE Town of Barnstable BOARD OF HEALTH 1Q John T.Norman Board of Health Donald A.Gaudagnoli,M.D. nAWNSTAat.L F.P.(Thomas)Lee non . Daniel Luczkow,M.D.,Alt. 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: 834 Issue Date: 04/06/2022 DBA: PALIO PIZZERIA OWNER: PALIO P INC Location of Establishment: 435 MAIN STREET HYANNIS MA 02601 Type of Business Permit: FOOD SERVICE Annual: YES Seasonal: IndoorSeating: 50 OutdoorSeating: 16 Total Seating: 66 FEES FOOD SERVICE ESTABLISHMENT: $300.00 YEAR. 2022 RETAIL FOOD: COTTAGE FOOD OPERATION: Permit Expires: 12/31/2022 B&B- FULL BREAKFAST: CONTINENTAL BREAKFAST: MOBILE-FOOD: MOBILE-ICE CREAM: Q✓� FROZEN DESSERT: Thomas A. McKean, RS, CHO, Health Agent FOR ESTABLISHMENTS WITH SEATING: PERMIT IS NOT VALID UNLESS ISSUED IN CONJUNCTION WITH A COMMON VICTUALER LICENSE Restrictions: TM-Approved for TCS Food -Pizza may be left out at room temperature for a maximum of 2 hours. UPE� P,4LI PIZZERIA 1n Am 4 PALIO PIZZU11 s t h 1� OF + ot ;►,� ~- MOWaFPO te, n7� � ✓r �I c �ve��e A11111IIiU 7 vu e$^ YAK nexx c UPE\ PA �PIZ7.CItIA AM tff NO wt ON if WIR Y Ii1Lf0 P1ZLHRL1 _ MEN o- view �u IVA M PALIO PIZZERIA BRICK OVEN PIZZA 435 Main Street,.Hyannis 508 771 7004 APPETIZERS Antipasto: Sliced tomatoes,pitted Kalamata olives,mozzarella,cucumbers,roasted red peppers, Italian meats, provolone and extra virgin olive oil. 7 I� Breadsticks: The house made breadsticks brushed with olive oil and garlic,then topped with mozzarella. 3.5 HOUSEMADE SOUPS Italian Wedding Soup: Chicken broth based soup with fresh green vegetables and mini homemade meatballs. 4 Minestrone Soup: Seasonal fresh green vegetable soup with Ditalini pasta. 4 Pasta a Fagioli Soup: Tomato based soup with Ditalini pasta and beans from Northern Italy. 4 i SALADS Arugula Insalata: Baby arugula,tomatoes,shaved Parmigiano-Reggiano and balsamic vinaigrette. 7 Caesar: Crisp romaine,garlic croutons, Parmesan and Caesar dressing. 6 Greek: Crisp romaine,tomatoes,red onions,cucumbers,pepperoncini,feta cheese, Kalamata olives, parsley and Greek dressing. 7 House Garden: Crisp romaine,tomatoes,cucumbers,green peppers, red onions and Italian dressing. 6 Tomato & Homemade Mozzarella: Sliced tomatoes,mozzarella,extra virgin olive oil and basil. 7 BRICK OVEN GRINDERS Served with provolone cheese, lettuce,tomato,onion,pickles and potato chips. 7.5 Italian Grinder Imported Ham BLT Grinder Roasted Turkey Roast Beef Veggie Grinder Served with potato chips.7.5 Homemade Meatball Chicken Parmigiana Meatball & Sausage PANINI All made on rosemary foccacia bread and served with potato chips. 7 Chicken Pesto: Homemade pesto,grilled chicken and fresh mozzarella cheese Italian: Italian cold cuts,extra virgin olive oil, roasted red peppers,fresh mozzarella and provolone cheese Pesto and Portabella: Homemade pesto,roasted portabella mushrooms,roasted red peppers and provolone cheese Grilled Chicken: Grilled chicken,mayo,roasted mushrooms,sliced tomatoes,basil and provolone cheese Roasted Eggplant: Extra virgin olive oil,roasted eggplant,red onions,roasted red peppers and provolone cheese SPECIALTY PIZZA AND CALZON ES 14"Regular: 15 18"Family: 20 Broccoli Rabe: Fresh minced garlic,mozzarella cheese,broccoli rabe and fennel sausage Margherita: Fresh mozzarella cheese,garlic,fresh basil and sliced tomatoes White Veggie: Caramelized onions,roasted red peppers and artichoke hearts BBQ Chicken: Chicken, BBQ sauce and caramelized onions Cape Codder: Mozzarella cheese,shrimp,clams,fresh garlic and lemon Buffalo Chicken: Grilled chicken marinated in Palio's hot sauce with blue cheese dressing on the side Quattro Funghi: Mozzarella cheese topped with oyster,shitake,portabella and crimini mushrooms Polio Pepper: Italian chicken,ricotta cheese and roasted red peppers Arugula:Fresh minced garlic and mozzarella cheese,baked,topped with baby arugula insalata Polio Pesto: Pesto,chicken,fresh garlic and caramelized onions CREATE YOUR OWN 14"Regular: 10 Each Additional Topping: 2 18"Family: 14.5 Each Additional Topping: 2.5 Cheese Protein Veggies Fresh Mozzarella Anchovies Artichoke Hearts Ricotta Bacon Caramelized Onions Feta Canadian Bacon Fresh Basil Ham Black Olives Italian Chicken Green Peppers Other Linguica Jalapenos Homemade Meatball Mushrooms Crushed Garlic Pepperoni Onions Pineapple Prosciutto Roasted Broccoli Homemade Sausage Roasted Eggplant Roasted Red Peppers Spinach Tomatoes PIZZA BY THE SLICE Cheese 3.04 Pepperoni 3.27 Slice of the Day 3.27 ITALIAN PASTA Meatballs': Homemade meatballs and sauce,with linguini or ziti,topped with Parmigiano-Reggiano.7 Pesto: Homemade pesto sauce with your choice of linguini or ziti,topped with Parmigiano-Reggiano.7 Lasagna: Housemade lasagna with Ricotta,parmesan and mozzarella cheese and a tomato meat sauce.7 DRINKS Fountain Soda: Pepsi,Diet Pepsi,Mountain Dew,Sierra Mist, Root Beer,Pink Lemonade. 2 Bottled Drinks: San Pellegrino, Poland Springs Water,Mott's Apple Juice,Orange Juice,Pepsi Products.2.15 Bottled Beer: Domestic 3.5 Import/Craft 4.5 Draft Beer Pints: Budweiser 4 Specialty 4.5 Pitcher of Beer: Budweiser 12 Specialty 13.5 Italian Wines: Our wine selections change seasonally. 435 Main Street, Hyannis Ask To See Our Dessert Menu 508.771.7004 www.paliopizzeria.com Before placing your order,please inform your server if anyone in your parry has any food allergy. I `--_ -- — — - - . . a __, c � �� '� ��✓ ;y i� I t _ _ Town of Barnstable Inspectional Services —Health Division �IREILt 200 Main Street,Hyannis MA 02601 ''(B1tN8TAB1T" ` APPLICATION FOR OUTSIDE DINING/SIDEWALK CAFE awes. Arfpp LOCATION Name of Establishment: Patio Pizzeria Establishment Address: 435 Main St,Hyannis,MA 02601 APPLICANTS NAME: Paulo Paraguay Phone# 508-771-7004 SEATING FACILITIES/EQUIPMENT Total#of Seats Existing 50 #of Restrooms Provided 2 Size of Grease Trap 1000 gal Total#of Seats Proposed 66 Air Curtains(Yes or No) N (Total means overall number of seats indoors plus outdoors) Hose Bib (Yes or No) N Screens (Yes or No) Y Brief Description of Seating Arrangement,Type of Furniture Proposed,Hours of Operation,Projected Opening and Closing Dates Fnnr cetc of hlack-,tee] Datin tahlec with fairs chairs,lined up in the front section of the restaurant,protected a barrier of black flower planters. Hours of operation from 11 am to 11 pm daily—from May 1 s . to Uct I D s . Uwe the undersigned certify that the above information which I/we provided is correct. I/we have read and fully understand the Town of Barnstable Code Chapter 322 and further understand that failure to comply with said procedures may result in the immed' r cation of this permit. Signature of Applicant(s): , Date: ii 11747,1 Date: IMPORTANT-PLEASE REMEMBER TO INCLUDE: 3 Copies of the Neatly Drawn Sketch Plan of the Outside Dining Area Showing Separation Distances to Curbing,Trees,Rubbish Containers and any other Obstacles in Pedestrian Walkway 3 Copies of Pictures of the Proposed Outside Dining Location(Front and Side Views) 1 Copy of the Menu FOR OFFICIAL USE ONLY Town Manager Approval: Public Health Division: Licensing Board Approval: Certificate of Insurance: License Agreement: Comments: --OVER-- I /Users/paulo/Dropbox/My Mac(Paulos-MacBook-Pro.local)/Downloads/OUTSIDE DINING APPL Sep2019.docx 4 i McKenzie, Marybeth From: McKean, Thomas Sent: Thursday, March 17, 2022 4:55 PM To: Bellaire, Dianna; Crocker, Sharon; McKenzie, Marybeth Cc: Coyle, Brenda; Logan, Erin Subject: RE: Palio Permanent Food Permit Yes,the total is limited to 66 (combined indoors and outdoors). Also- we did not approved six seats at the bar. From: Bellaire, Dianna Sent: Thursday, March 17, 2022 11:38 AM To: Crocker, Sharon; McKenzie, Marybeth; McKean, Thomas Cc: Bellaire, Dianna; Coyle, Brenda; Logan, Erin Subject: FW: Palio Permanent Food Permit He submitted the seats but, it has a total of 72 seats, aren't we counting the outside seats in the 66? 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 dsclosure.It is for the addressee only.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 Attorney'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: Paulo Paraguay [mailto:admin@paliopizzeria.com] Sent: Thursday, March 17, 2022 11:18 AM To: Bellaire, Dianna Cc: paulo@kandykorner.com; Coyle, Brenda; Logan, Erin Subject: Re: Palio Permanent Food Permit Hi, Thank you for the updated information. I i I am attaching the Palio floor plan. We have 56 inside seats; from this count, 6 are take-out waiting seats and 16 seats outside. The total number of seats is 72, and the total number of customer dining seats is 66. I will submit the outdoor dining application to Marybeth today. Please let me know if you have any questions or concerns. Regards, Paulo Paraguay Palio Pizzeria 435 Main St Hyannis, MA 02601 PalioPizzeria.com On Wed, Mar 16, 2022 at 4:31 PM Bellaire, Dianna<Dianna.Bellairegtown.bamstable.ma.us>wrote: Paulo, I have spoken with Tom McKean and Licensing/Building Depts. The Licensing Dept. has the 66 seats and Food has 56 seats and those seats are indoors. The Building Dept. has 56 inside seats with 5 employee seats and 32 seats outside. We need a confirmed/floor plan. We need to have the seats shown that will be indoors and if you are going to have outdoor seats. Marybeth McKenzie, Health inspector stated you have not applied for the outdoor dining. The total seats can't be more than 66 total seats, whether indoor or outdoor. Marybeth had stated in last indoor inspection, you had 56 seats inside. Please send us a new seating floor plan with designated seats. Please apply for outdoor dining, if needed. I've attached the form if you so choose. The floor plan will need to be approved by Building Dept, Health and Licensing. Once everything is set, I can issue a new food permit, please be aware you are on a temporary food permit until 04/30/2022. We must resolve the seat issue to issue a permanent food permit. Brenda and Erin can direct you on what is required from their departments, if anything. Thank you. Dianna Bellaire Permit Technician Town of Barnstable Health Division i 200 Main Street Hyannis, MA 02601 2 P:508-862-4643 Fax:508-790-6304 Email:Dianna.Bellaireptown.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 only.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 Attorney'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. CAUTION:This email originated from outside of the Town of Barnstable! Do not click links, open attachments or reply, unless you recognize the sender's email address and know the content is safe! 3 � G�rbbrti'►d Palio Pizzeria-435 Main St,Hyannis MA 026001 25 FT 4 4 10 31 FT DOOR 4 4 4 E] LL tD N 2 2 2 2 4 LL 4 4 r4 N 6 4 PALIO PIZZERIA SEATING PROPOSAL 32 INDOOR SEAT(BOOTHS) SODA FOUNTAIN STATION 18 INDOOR SEATS(CHAIRS) 16 OUTDOOR SEATS 4IN000R STOOL(TO GO-NO FOOD CONSUMPTION) 14 Ft 72 SEATS TOTAL MEN'S BATHROOM DOOR 66 SEATS FOR PATRONS WHO ARE EATING/DRINKING TO GO COUNTER BARSTOOLS-WAITING AREA 14 Ft yn(� COUNTER PIZZA TABLE PIZZA UNIT REG 2 BEER TAP REG 1 MOP/CHEMICAL STORAGE ROOM DOUGH TABLE LADIES BATHROOM z 0 5 a m a HAND -W' SINK OVENS OVENS Hot Plate OD COKE FURNACE/Office Personal Storage N WALL WALL HANDSINK Grease Trap DISH ICE 3 BAY SINK WASHER Machine � I a O F CAN CART � DOOR WALK-IN REFRIGERATOR FREEZER TABLE MIXER STORAGE RACK I GV YkI01-Y CIA Palio Pizzeria-435 Main St,Hyannis MA 026001 25 FT 4 4 4 4 F4 31 FT DOOR 4 4 4 4 LL LO N F2 2 1 2 2 F 2 4 L~L 4 -1 4 N 6 4 PALIO PIZZERIA SEATING PROPOSAL 32 INDOOR SEAT(BOOTHS) SODA FOUNTAIN STATION 18 INDOOR SEATS(CHAIRS) 16 OUTDOOR SEATS �j INDOOR STOOL(TO GO-NO FOOD CONSUMPTION) 14 Ft 72 SEATS TOTAL MEN'S BATHROOM DOOR 66 SEATS FOR PATRONS WHO ARE EATING/DRINKING TO GO COUNTER BARSTOOLS -WAITING AREA 14 Ft 6 COUNTER PIZZA TABLE PIZZA UNIT REG 2 BEER TAP REG 1 MOP/CHEMICAL STORAGE ROOM DOUGH TABLE z LADIES BATHROOM 0 5 a m a —THAN m OVENS OVENS Hot Plate 00 COKE FURNACE/Office Personal Storage N WALL WALL HANDSINK Grease Trap DISH ICE 3 BAY SINK WASHER Machine i7 s O CAN CART DOOR WALK-IN REFRIGERATOR FREEZER TABLE MIXER STORAGE RACK Bellaire, Dianna From: Crocker, Sharon Sent: Thursday, March 17, 2022 11:46 AM To: McKean, Thomas; McKenzie, Marybeth; Bellaire, Dianna Cc: Crocker, Sharon Subject: CFW: FW: BOH 1/25/22 Palio-Pizzeria - 435 Main St Hy Grease Tank Var 1 Attachments: Variance - Palio Pizzaria .pdf FYI, Paulo Pizzeria is reapplying to go in front of BOH for 4/26/22. He is hoping once Griffin sees their"low, low" water usage, he may be willing to support the approval of 22 additional seats. He is also bringing in an application for outdoor seating. Currently ok for 66 seats: of those he would like 50 inside and 16 outside. He also mentioned he has always had 6 seats at front take-out counter will not food consumption—to wait for take-out orders. (I can contest,they do take a while to cook take-out). Sharon Crocker Office Manager Town of Barnstable—Health 508-862-4739 The information contained in this electronic trausniission("e-mail"),including any attachment(the"Information"),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 Information may also be deliberative and pre-decisional in nature.As such,it is for Internal use only.41.c Information may nott 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-maul 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: Paulo Paraguay [mailto:paulo@kandykorner.com] Sent: Tuesday, January 18, 2022 8:33 PM To: Crocker, Sharon Subject: Re: FW: BOH 1/25/22 Palio Pizzeria - 435 Main St Hy Grease Tank Var Best, Paulo Paraguay Kandy Korner Gifts 474 Main Street PO Box 101 Hyannis, MA 02601 P: (508) 771-5313 www.KandyKorner.com 1 I Ili t , , On Tue, Jan 18, 2022 at 8:28 PM Crocker, Sharon<sharon.crockergtown.barnstable.ma.us> wrote: Ok, I got it. i You are welcome. i E s Regards, Sharon 1 F Sharon Crocker Office Manager s Town of Barnstable—Health 508-862-4739 I The information contair-ed in this electronic transmission("e-mail"),including any attachment(the"Infori.nation"),may be confidential or F. other-A-ise exempt from disclosure.It is for the addressee only.Tlus 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 I lealth and/or the Town ltornev's Office of the.Town of Barnstable. If`-ou 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. i I From: Paulo Paraguay [mailto:paulo@kandykorner.com] Sent: Tuesday, January 18, 2022 8:26 PM To: Crocker, Sharon Subject: Re: FW: BOH 1/25/22 Palio Pizzeria - 435 Main St Hy Grease Tank Var j Sharon, i l 2 Thank you so much for your help. Please find attached. Best, Paulo Paraguay Kandy Korner Gifts 474 Main Street PO Box 101 Hyannis, MA 02601 P: (508) 771-5313 www.KandyKorner.com I On Tue, Jan 18, 2022 at 8:04 PM Crocker, Sharon <sharon.crocker(?town.bamstable.ma.us> wrote: Paulo, I put the documents together. Please see attached. You will need to get the full packet to the Town Engineering Dept, Griffin Beaudoin. 508-790-6400 x4931. tomorrow, so they can review it before the meeting. The 'fee is $95 payable to Town of Barnstable. Please drop off or mail in by tomorrow to: Public Health, Attn Sharon Crocker, 200 Main St, Hyannis. 3 it I OF 114E l DATE: g" $95.00 FEE*: BARMASS,NSTABLE ' Town of Barnstable 9c 639� � REC.BY: Board of Health SCHED.DATE: 200 Main Street, Hyannis MA 02601 Office: 508-862-4644 John T.Norman FAX: 508-790-6304 Donald A.Guadagnoli,M.D. F.P.(Thomas)Lee Daniel Luczkow,D.M.,Alternate GREASE TRAP VARIANCE REQUEST FORM LOCATION Property Address:441 Main St,Hyannis MA 02601 Assessor's Map and Parcel Number: 380/080 Business Name: Palio Pizzeria CONTACT PERSON ATTENDING MEETING: BUSINESS OWNER'S NAME If you are not the owner,did owner of business authorize you to represent him/her? Yes_X_ No Name: Paulo Paraguay Name: Address: 21 LIBERTY LANE,MARSTONS MILLS,MA 02648 Address: Phone: 774-836-6432 Phone: EMAIL: admin@PalioPizzeria.com EMAIL: VARIANCE FROM REGULATION(Incl.Reg.Code#) REASON FOR VARIANCE(May attach separate sheet if more space needed) 322-3 Grease Trap Increase seating capacity On Town Sewer X On-Side Septic System LJ Checklist (to be completed by office staff-person receiving variance request application) Please submit five packets,each containing A-D(below) A. Five(5)copies of the completed variance request form. B. Five(5)copies of labeled dimensional restaurant floor plans submitted C. Full menu—Five(5)copies of full menu submitted(for grease trap variance requests only). D. Signed letter stating that the business owner authorized you to represent the owner for this request,if applicable. IMPORTANT: If on Town Sewer,applicant MUST submit package of all documents on this list to:Griffin Beaudoin,Town Engineer,382 Falmouth Road,Hyannis,MA 02601 508-790-6400 within a day of this submittal. Fee Submitted*$95.00 for the grease trap variance. Variance request submitted at least 15 days prior to meeting date. Board of Health meets once a month. VARIANCE APPROVED John T.Norman NOT APPROVED Donald A.Guadagnoli,M.D. REASON FOR DISAPPROVAL F.P.(Thomas) Lee Daniel Luczkow,M.D.,Alternate Palio P Inc Palio Pizzeria 435 Main Street Hyannis, MA 02601 January 18, 2022 Town of Barnstable Board of Health Division, We are applying for a variance of seating increase from 56 to 88 seats, the additional seats would be located outdoors. Our 1000gl grease trap can handle 66 seats. As casual dining restaurant we use single use paper plates, cups, and utensils which allows us to conserve water. The internal grease trap in pumped once a month and the external trap is pumped ever three months. In addition to our two main restrooms, we also have access to two other public restrooms located inside the former Duckmobile for sue during summer months. Paulo Paraguay Owner Palio Pizzeria Palio P Inc Palio Pizzeria-435 Main St,Hyannis MA 026001 25 FT 14 Ft 31 FT DOOR 4 4 4 4 4 Il w N ❑ 2 2 F2 4 4 4 4 r-1 N 6 4 4.0 PALIO PIZZERIA SEATING PROPOSAL SODA FOUNTAIN STATION 32 INDOOR SEAT(BOOTHS) 32 OUTDOOR SEATS Is INDOOR SEATS(CHAIRS) 14 Ft 61NDOOR STOOL(TO GO) MEN'S BATHROOM 88 SEATS TOTAL DOOR TO GO COUNTER BARSTOOLS 14 Ft 6 COUNTER PIZZA TABLE PIZZA UNIT REG 2 BEER TAP REG 1 MOP/CHEMICAL STORAGE ROOM DOUGH 4 TABLE L: LADIES BATHROOM z 0 5 m HAND m SINK a OVENS OVENS LL Hot Plate 00 COKE FURNACE/Office Personal Storage N WALL WALL HAND SINK Grease Trap DISH ICE 38AY SINK WASHER MACHine z O r CAN CART DOOR WALK-IN REFRIGERATOR FREEZER TABLE MIXER STORAGE RACK L PIZZERIA A ra I PIZ BRIC""K OVEN PIZZA ........... ..., __ 435 Main Street, Hyannis 508 771 7004 APPETIZERS Antipasto: Sliced tomatoes, pitted Kalamata olives, mozzarella, cucumbers, roasted red peppers, Italian meats, provolone and extra virgin olive oil. 7 Breadsticks: The house mEde breadsticks brushed with olive oil and garlic,then topped with mozzarella. 3.5 HOUSEMADE SOUPS Italian Wedding Soup: Chicken broth based soup with fresh green vegetables and mini homemade meatballs. 4 Minestrone Soup: Seasonal fresh green vegetable soup with Ditalini pasta. 4 Pasta a Fagioli Soup: Tomato based soup with Ditalini pasta and beans from Northern Italy. 4 SALADS Arugula Insalata: Baby arugula,tomatoes,shaved Parmigiano-Reggiano and balsamic vinaigrette. 7 Caesar: Crisp romaine,garlic--routons, Parmesan and Caesar dressing. 6 Greek: Crisp romaine,tomatoes, red onions, cucumbers, pepperoncini,feta cheese, Kalamata olives, parsley and Greek dressing. 7 House Garden: Crisp romaine,tomatoes,cucumbers,green peppers, red onions and Italian dressing. 6 Tomato & Homemade(Mozzarella: Sliced tomatoes, mozzarella, extra virgin olive oil and basil. 7 BRICK OVEN GRINDERS Served with provolone cheese, leluce,tomato,onion, pickles and potato chips. 7.5 Italian Grinder Imported Ham BLT Grinder Roasted Turkey Roast Beef Veggie Grinder Served with potato chips. 7.5 Homemade Meatball Chicken Parmigiana Meatball & Sausage PANINI All made on rosemary foccacia bread and served with potato chips. 7 Chicken Pesto: Homemade pesto,grilled chicken and fresh mozzarella cheese Italian: Italian cold cuts,extra virgin olive oil, roasted red peppers,fresh mozzarella and provolone cheese Pesto and Portabella: Homemade pesto, roasted portabella mushrooms, roasted red peppers and provolone cheese Grilled Chicken: Grilled chicken,mayo, roasted mushrooms,sliced tomatoes, basil and provolone cheese Roasted Eggplant: Extra virgin olive oil, roasted eggplant, red onions, roasted red peppers and provolone cheese SPECIALTY PIZZA AND CALZONES 14"Regular: 15 18"Family: 20 Broccoli Rabe: Fresh minced garlic, mozzarella cheese, broccoli rabe and fennel sausage Margherita: Fresh mozzarella cheese, garlic,fresh basil and sliced tomatoes White Veggie: Caramelized onions, roasted red peppers and artichoke hearts BBQ Chicken: Chicken, BBQ sauce and caramelized onions Cape Codder: Mozzarella cheese,shrimp,clams,fresh garlic and lemon Buffalo Chicken: Grilled chicken marinated in Palio's hot sauce with blue cheese dressing on the side Quattro Funghi: Mozzarella cheese topped with oyster,shitake, portabella and crimini mushrooms Pollo Pepper: Italian chicken, ricotta cheese and roasted red peppers Arugula: Fresh minced garlic and mozzarella cheese, baked,topped with baby arugula insalata Pollo Pesto: Pesto,chicken,fresh garlic and caramelized onions CREATE YOUR OWN 14"Regular: 10 Each Additional Topping: 2 18"Family: 14.5 Each Additional Topping: 2.5 Cheese Protein Veggies Fresh Mozzarella Anchovies Artichoke Hearts Ricotta Bacon Caramelized Onions Feta Canadian Bacon Fresh Basil Ham Black Olives Italian Chicken Green Peppers Other Linguica Jalapenos Homemade Meatball Mushrooms Crushed Garlic Pepperoni Onions Pineapple Prosciutto Roasted Broccoli Homemade Sausage Roasted Eggplant Roasted Red Peppers Spinach Tomatoes PIZZA BY THE SLICE Cheese 3.04 Pepperoni 3.27 Slice of the Day 3.27 ITALIAN PASTA Meatballs: Homemade meatballs and sauce,with linguini or ziti,topped with Parmigiano-Reggiano.7 Pesto: Homemade pesto sauce with your choice of linguini or ziti,topped with Parmigiano-Reggiano. 7 Lasagna: Housemade lasagna with Ricotta, parmesan and mozzarella cheese and a tomato meat sauce.7 DRINKS Fountain Soda: Pepsi, Diet Pepsi, Mountain Dew,Sierra Mist, Root Beer, Pink Lemonade. 2 Bottled Drinks: San Pellegrino, Poland Springs Water, Mott's Apple Juice,Orange Juice, Pepsi Products.2.15 Bottled Beer: Domestic 3.5 Import/Craft 4.5 Draft Beer Pints: Budweiser 4 Specialty 4.5 Pitcher of Beer: Budweiser 12 Specialty 13.5 Italian Wines: Our wine selections change seasonally. 435 Main Street, Hyannis Ask To see Our Dessert Menu 508.771.7004 . www.paliopizzeria.com Before placing your order,please inform your server if anyone in your parry has any food allergy. �I Entered in cornputer. THE.COMMONWEALTH OF MASSACHUSETTS Yes PUBLIC HEALTH DIVISION - T,©WN dF BARNSTABLE, MASSACHUSETTS application for -igco at �&pE;tEm �Cari�truction hermit Application for a Pcsmt to Construct( )Repair{ X)Upgrade( ) Abandon( } Q CompleteSystern ❑Individual Components Location Adcjtrss or,Lot No' 7 7� 7a-iq Owner's Nune.Address and Tel.No. 7 7 4—2 3 8 0 1 3 6 l j in Street Hyannis Palio Pizzeria Assessor's;�1Dr)p3rl G U Ss'-v PO Box 1 291 , Hyannis In.Kaller's Name,Addttss,and Tel.No. 7 7 S—8 7 7.6 L'esigner's Name,Address aad Tel:No. Wm 'E Robinson..Sr 'Septic PO Box 1089, 'Centerville . Tape of Building; Dwelling No.of Bedrooms r , Lot Si.zc. - -sq, ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( } Cafeteria( } Other Fixtures Design Flow gallons.per day. Calculated daily now gallons` Ilan Date \'utnbcr.ofshects Revision Date Title Size of Septic Tank. lype of S.A.S. Description of Soil,., Natu of Repairs or Alterations(Answer when,applicabic} Install a`.grease. trap, (1 000 g-al) re connected to own sewer. i Date last tnspeced: Agreement: The undersigned igrecsjo ensuia th a eon"stru.c..uo.n.and main,.tenance6.,,a"afo_re descrbed on-site.sewage.disp osal system in accordance with the provisions of Title 5 of the Env'ronmental�Code andaot to place the system; n operation until a Certifi- rate of CompLar ce has been issued by this B d ealths Signed., Dat `Applica6on.Approved by Date Application Disapproved for the following reasons- t n h-. , Peraut No: Date,Issiiec!= -5 4 —— — . . U - Roomin 1 .r High school or)unicrhigh 4sa g boarding house 629 Gy'r. College,adult ed, `� ❑ Commercial hotel of.motel Laborato Ise science lab 7t?0 ❑ ry, ten r 459 Residential ❑ .Manufacturing plant Care,acifibj for the aged ❑ ,board and care 819 t `w 1 Haspi 21, CI DormiEorylbarraclis ❑ Livestock/poultry storage(barn) 1 519 ❑ Food and beverage sales 882 ❑ Non-residential parking garage 891 [] Ware use K Outside s` 1N ❑ Playground or park 936 ❑:` Vacant lot 981 G Crops or orchard °�� ❑ Grddedlcared for plot of land ❑ Construction site 6�5 ;'❑ Forest(timberland) .� ❑ Lake,river,stream 9� ❑ 'Industrial planfyaid ❑ Outdccrstoraee area 951 ❑ Railroad right ofway' ' l e Dump or sanitary landfill ❑ .Other street Lo k up and enter a t ❑ Open,and or field 561 ❑ Highway/divided highway Prope Use code 0111, n it r pro� Y Use `-�/ 562 ❑ 'Residential streetldrivewa au have N07check da a x� yy Y Property Use box: E ._ _ Household goti�s, sales t j2ev wed ee,2-_TM µg x Town of BarnstableBOARD OF HEALTH ref' `�` John T.Norman i f �Q"' Board of Health Donald A.Gaudagnoli,M.D. I' ') F.P.(Thomas)Lee 200 Main Street Hyannis, MA 02601 Daniel Luczkow,M.D.,Alt. 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: 834 Issue Date: 01/01/2022 DBA: PALIO PIZZERIA, INC. - TEMPORARY FOOD PERMIT OWNER: PALIO P INC Location of Establishment: 435 MAIN STREET HYANNIS MA 02601 Type of Business Permit: FOOD SERVICE Annual: YES Seasonal: IndoorSeating: 56 OutdoorSeating: 0 Total Seating: 56 FEES FOOD SERVICE ESTABLISHMENT: $300.00 YEAR. 2022 RETAIL FOOD: COTTAGE FOOD OPERATION: Permit Expires: 04/30/2022 B&B-FULL BREAKFAST: CONTINENTAL BREAKFAST: MOBILE- FOOD: MOBILE- ICE CREAM: p� 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: TM-Approved for TCS Food -Pizza may be left out at room temperature for a maximum of 2 hours. I tt{E BOARD OF HEALTH ' • Town of Barnstable aJohn T. Norman Board of Health Donald A.Gaudagnoli,M.D. RAWgSTA8W_ F.P.(Thomas)Lee MAIA& Daniel Luczkow,M.D.,Alt. p4, +�s9• ,0 200 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: 834 Issue Date: 01/01/2022 DBA: PALICI PIZZERIA, INC. OWNER: PALIO P INC Location of Establishment: 435 MAIN STREET HYANNIS MA 02601 Type of Business Permit: FOOD SERVICE Annual: YES Seasonal: IndoorSeating: 56 OutdoorSeating: 0 Total Seating: 56 FEES FOOD SERVICE ESTABLISHMENT: $300.00 YEAR. 2022 RETAIL FOOD: COTTAGE FOOD OPERATION: Permit Expires: 12/31/2022 B&B-FULL BREAKFAST: CONTINENTAL BREAKFAST: MOBILE-FOOD: MOBILE-ICE CREAM: G�n FROZEN DESSERT: Thomas A. McKean, RS, CHO, Health Agent -- l FOR ESTABLISHMENTS WITH SEATING: PERMIT IS NOT VALID UNLESS ISSUED IN CONJUNCTION WITH A COMMON VICTUALER LICENSE Restrictions: TM-Approved for TCS Food -Pizza may be left out at room temperature for a maximum of 2 hours. , Ata P* For Office Usc Iv I itials: Town of Barnstable 1�>Clk. �, a i = Date Paidl Am Pd I$ l(�U BAMffr,BM : Inspectional Services k p,� Public Health Division �L1 0Z ec mp< /oo,Ob 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 12/21/21 NEW OWNERSHIP X RENEWAL NAME OF FOOD ESTABLISHMENT: Palio Pizzeria ADDRESS OF FOOD ESTABLISHMENT: 435 Main St, Hyannis MA 02601 MAILING ADDRESS(IF DIFFERENT FROM ABOVE): PO Box 201, Hyannis, MA 02601 E-MAIL ADDRESS: Paulo@kandykorner.com TELEPHONE NUMBER OF FOOD ESTABLISHMENT: 5( O8 ) 771 - 5313 TOTAL NUMBER OF BATHROOMS: 2 WELL WATER:YES NO_X ... (ANNUAL WATER ANALYSIS REQUIRED) ANNUAL: X— SEASONAL: DATES OF OPERATION:_/ / TO NUMBER OF SEATS: INSIDE: 56 OUTSIDE: 32 TOTAL: 88 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? no IS AN AIR CURTAIN PROVIDED AT WAITSTAFF SERVICE DOOR(S)? no 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 REV3-2019.doc I i i OWNER INFORMATION: FULL NAME OF APPLICANT Paulo Paraguay SOLE OWNER: YES/ O OWNER PHONE # 774-836-6432 ADDRESS_ 21 LIBERTY LANE, MARSTONS MILLS, MA 02648 CORPORATE OWNER: CORPORATE ADDRESS: PERSON IN CHARGE OF DAILY OPERATIONS: Paulo Paraguay 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 Paulo 1.P a Paraguay 3 / 1 /2026 1. Paulo Paraguay / 11 / 23 2. Jeniffer Lechenchem 12 / 19 / 2024 lZ / zl / 2J GNATURE O APPLIC T 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 htty://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 1st to Dec.31"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 4 y3'5-. 31 FT DOOR 4 4 4 4 a 2 2 4, LL 4. 4 r-I N 6 4 i PALIO PIZZERIA SEATING PROPOSAL SODA FOUNTAIN STATION 32 INDOOR SEAT(BOOTHS) 18 INDOOR SEATS(CHAIRS) 56 SEATS TOTAL MEN'S BATHROOM DOOR / TO GO COUNTER BARSTOOLS ✓ 6 COUNTER PIZZA TABLE PIZZA UNIT REG 2 BEER TAP REG 1 MOP/CHEMICAL STORAGE ROOM DOUGH TABLE LADIES BATHROOM z o Q J N m Q f w HAND m SINK Q E- OVENS OVENS � 7PIt, 00 COKE FURNACE N WALL WALL HAND SINK Grease Tra DISH ICE 3 BAY SINK WASHER MACHine W Q 0 H CAN CART DOOR WALK-IN REFRIGERATOR FREEZER TABLE MIXER STORAGE RACK � I Palio P Inc Palio Pizzeria 435 Main Street Hyannis, MA 02601 December 21, 2021 Town of Barnstable Board of Health Division, Procedure for pizza slices. • Pizza shall be kept at room temperature for slices of pizza. The time help at room temperature shall not exceed 2 hours. • Food will clearly be marked with a "discard time that is two hours past the point of removal from the pizza oven. • The food shall be cooked and served, ready-to-eat or discarded within two hours from the point time the food is removed from the temperature control. • Any food in unmarked containers or packages or marked to exceed a two hour limit shall be discarded • The TPHC variance decision statement shall not be posted immediately adjacent to and /or included onto the food establishment permit, in a location which is easily viewable by health inspector during inspections. 3 Paulo Paraguay Owner Pali P Inc o t BOARD OF HEALTH Town of Barnstable John T.Norman Board of Health Donald A.Gaudagnoli,M.D. BARNSTABLE, : F.P.(Thomas)Lee,. ,MASS Daniel Luczkow.M.D. Alt. x��9• ,� 200 Main Street, Hyannis, MA 02601 Phone: (508) 862-4644 Fax: (508)790-6304 www.townofbarnstablems 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: 834 Issue Date: 01/01/2022 DBA: PALIO PIZZERIA, INC. OWNER: PALIO PIZZERIA INC Location of Establishment: 435 MAIN STREET HYANNIS„ MA 02601 Type of Business Permit: FOOD SERVICE Annual: YES Seasonal: IndoorSeating: 56 OutdoorSeating: 32 Total Seating: 88 FEES FOOD SERVICE ESTABLISHMENT: $300.00 YEAR. 2022 RETAIL FOOD: COTTAGE FOOD OPERATION: Permit Expires: 12/31/2022 B&B-FULL BREAKFAST: CONTINENTAL BREAKFAST: MOBILE- FOOD: MOBILE- ICE CREAM: Qn FROZEN DESSERT: Thomas A. McKean, RS, CHO, Health Agent FOR ESTABLISHMENTS WITH SEATING: PERMIT IS NOT VALID UNLESS ISSUED IN CONJUNCTION WITH A COMMON VICTUALER LICENSE Restrictions: TM-Approved for TCS Food -Pizza may be left out at room temperature for a maximum of 2 hours. For Office Use Only: Initials: j ' •a Town of Barnstable Date Paid Amt I'd$ Inspectional Services 16 9. `� Public Health Division Check# Cash iOrFo�" 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#X oZI NEW OWNERSHIP RENEWAL NAME OF FOOD ESTABLISHMENT:—TCI , ADDRESS OF FOOD ESTABLISHMENT: �J 5 am Coif f115 �\,N MAILING ADDRESS(IF DIFFERENT FROM ABOVE):P •0. p 02�1 I E-MAIL ADDRESS: t�G 1 n Zz e r i C� GSM Cb.�.� • Lo W-) TELEPHONE NUMBER OF FOOD ESTABLISHMENT: (503) 9 _ 0 0 TOTAL NUMBER OF BATHROOMS: OIL WELL WATER:YES NO—X� ...(ANNUAL WATER ANALYSIS REQUIRED) ANNUAL:_ SEASONAL: DATES OF OPERATION: /_/_ TO NUMBER OF SEATS: INSIDE: OUTSIDE: TOTAL: 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) *** SEASONAL, MOBILE & NEW FOOD ONLY*** REQUIRED TO CALL HEALTH DIV.FOR INSPECTION PRIOR TO PERMIT BEING ISSUED PLEASE CALL 508-862-4644 Q:wpplication FormsT00DAPP 2020.doc r OWNER INFORMATION:FULL NAME OF APPLICANT Sam u.e, A Gcz Z!e-o CeA n 111 4- oZ 92-1 3 11 SOLE OWNER: YES NO OWNER PHONE# , 02- 9 ' 1 I ��y ADDRESS L4 3 SAr42e O C CORPORATE OWNER: CORPORATE ADDRESS: PERSON IN CHARGE OF DAILY OPERATIONS: Z'P—n 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 ni 1-�.chechem ►z/ 19 / 207 q 0 SIGNATURE OF APPLjj� NT 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 508-8624644 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/healthdivi5ion/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.3151 each calendar year. IT IS YOUR RESPONSIBILITY TO RETURN THE COMPLETED APPLICATION(S)AND REQUIRED FEES BY DEC 1st. Q:\Application FormsTOODAPP REV3-2019.doc r w Ogt1 Town of Barnstable BOARD OF HEALTH John T.Norman Board of Health Donald A.Gaudagnoli,M.D. a NSTAULF, -: Paul J.Canniff,D.M.D. 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: 834 Issue Date: 01/01/2021 DBA: PALIO PIZZERIA, INC. OWNER: SAM MAllEO Location of Establishment: 435 MAIN STREET HYANNIS„ MA 02601 Type of Business Permit: FOOD SERVICE Annual: YES Seasonal: IndoorSeating: 56 OutdoorSeating: 32 Total Seating: 88 FEES FOOD SERVICE ESTABLISHMENT: $300.00 YEAR. 2021 RETAIL FOOD: COTTAGE FOOD OPERATION: Permit Expires: 12/31/2021 B&B-FULL BREAKFAST: CONTINENTAL BREAKFAST: MOBILE-FOOD: MOBILE-ICE CREAM: G� 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: TM-Approved for TCS Food -Pizza may be left out at room temperature for a maximum of 2 hours. +v 44 DOOR ^4 • 2 6 . 2 To Go Counter Barstools 31 SPA 4 4 . 2 ? PALIO PIZZERIA SEATING PROPOSAL ( / 32 outdoor seats 32 indoor seats (booths) _ jig indoor seats (chairs) - - _- C4 DOOR ( .indoor stools (to go) 1 � $� seats total rn 82seats for patrons who are eating/drinking i t i `n F4 4 4 _ -I Town of Barnstable For Office Use Only: Initials: Date Paid !J AmLP-d$ z B,RNSTABLZ Inspectional Services • NAB& ' 9. ``� Public Health Division check# I'1 - ' QED MA'S s 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 0 I_ 1 2-2 I NEW OWNERSHIPnn ` RENEWAL K NAME OF FOOD ESTABLISHMENT: �V�l I D I Gx. ADDRESS OF FOOD ESTABLISHMENT: 1435 m a 1.►) 5-� H U a n n I S MA- d 2 C,70 1 MAILING ADDRESS(IF DIFFERENT FROM ABOVE): 1 , E-MAIL ADDRESS: 1�a l i 0 � � aCT I� l`'' U I�G� TELEPHONE NUMBER OF FOOD ESTABLISHMENT: ( jo �� - o O TOTAL NUMBER OF BATHROOMS: 02 WELL WATER: YES NO_ ... (ANNUAL WATER ANALYSIS REQUIRED) ANNUAL: X SEASONAL: DATES OF OPERATION: / / TO NUMBER OF SEATS: INSIDE: OUTSIDE: TOTAL: 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) *** 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 O 435 Main Street • P.O. Box 1291 • Hyannis, MA 02601 508/771-7004 •fax 508/771-4468 OWNER INFORMATION: , �/�f/�� )/� �l FULL NAME OF APPLICANT �JVI:Y�' I / i )a Z Ze V / SOLE OWNER: S NO OWNER PHONE# —77/— 700 ADDRESS ►/ a I r) &'t Pj(I a.o n i,S 0.2- CORPORATE OWNER: CORPORATE ADDRESS: 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 I. 2.Nance SIGN RE 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 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/applicationsasp. 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.3I't each calendar year. IT IS YOUR RESPONSIBILITY TO RETURN THE COMPLETED APPLICATION(S)AND REQUIRED FEES BY DEC 1st. Q:\Application ForrmsTOODAPP REV3-2019.doc 435 Main Street • P.O. Box 1291 • Hyannis, MA 02601 508/771-7004 •fax 508/771-4468 Y Town of Barnstable BOARD OF HEALTH John T.Norman Board of Health Donald A.Gaudagnoli,M.D. BARNsrABLY. Paul J.Canniff,D.M.D. 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: 834 Issue Date: 12/10/2019 DBA: PALIO PIZZERIA, INC. OWNER: SAM MAllEO Location of Establishment: 435 MAIN STREET HYANNIS, MA 02601 Type of Business Permit: FOOD SERVICE Annual: YES Seasonal: IndoorSeating: 56 OutdoorSeating: 32 Total Seating: 88 FEES FOOD SERVICE ESTABLISHMENT: $300.00 YEAR. 2020 RETAIL FOOD: COTTAGE FOOD OPERATION: Permit Expires: 12/31/2020 B&B-FULL BREAKFAST: CONTINENTAL BREAKFAST: MOBILE-FOOD: MOBILE-ICE CREAM: FROZEN DESSERT: Thomas A. McKean, RS, CHO, Health Agent TOBACCO SALES: FOR ESTABLISHMENTS WITH SEATING: PERMIT IS NOT VALID UNLESS ISSUED IN CONJUNCTION WITH A COMMON VICTUALER LICENSE Restrictions: TM-Approved for TCS Food -Pizza may be left out at room temperature for a maximum of 2 hours. X For Office gUse Only: Initials: � '�.� Town of Barnstable Date Paid;�L�►� � Amt Pd$ ■ARNSTABLE, . Inspectional Services 1639• , Public Health Division Check s # PEED MAC Thomas McKean, Director r` 200 Main Street,Hyannis, MA 02601 ' Office: 508-862-4644 Fax: 508-790-6304 r�5 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT DATE I0"2U_.,_o►q NEW OWNERSHIIPP RENEWAL NAME OF FOOD ESTABLISHMENT.: i O 0 �t7i7iGr�Ol. ADDRESS OF FOOD ESTABLISHMENT: 1435 Main Si H 4a no i s vf1 MAILING ADDRESS(IF DIFFERENT FROM ABOVE):—PC)C) e)C) -K /L 21 , V�Gugq(� I' ' 0240c E-MAIL ADDRESS: YQ I i o p iZ"ZGri o- 65) q Ma i I ' Co m TELEPHONE NUMBER OF FOOD ESTABLISHMENT: J( 06)-77 1 - 700`I TOTAL NUMBER OF BATHROOMS: 2. WELL WATER: YES_NO ... (ANNUAL WATER ANALYSIS REQUIRED) ANNUAL: SEASONAL: DATES OF OPERATION:_/ /_ TO 32 S2S r9 � NUMBER OF SEATS: INSIDE: V2 OUTSIDE: TOTAL: 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(sr t0 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) I 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 a OWNER INFORMATION: FULL NAME OF APPLICANT S%*P'Ma-L SOLE OWNER: 49/NO OWNER PHONE# �� 23U ' 62 -1 —I ADDRESS_ 320 TaUlgle wood 'Drive ©stervi lie , �IAss 42� 5 5 CORPORATE OWNER: CORPORATE ADDRESS: 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 1. JQVIOL t r1ol S i Iv 0 JanainQ Si Iva w/ 15 a3 2. Samuel M41-VO l �124��0 10 /2B 2.01 q SIGNATURE OF AP LICANT 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 508-862-4644 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 httt)://www.townofbarnstable.us/heaIthdivision/api)lications.asp. OUTDOOR COOKING: Outdoor cooking,preparation,or display of any food product by a food establishment is prohibited. NOTICE: Permits run annually from January 1st to Dec.31"each calendar year. IT IS YOUR RESPONSIBILITY TO RETURN THE COMPLETED APPLICATION(S)AND REQUIRED FEES BY DEC 1st. Q:Wpplication FormsVFOODAPP REV3-2019.doc T BOARD OF HEALTH �I�T Town of Barnstable Paul 1 Canniff,D.M.D. Board of Health Donald A.Gaudag noli,M.D. BARNSTAUM John T.Norman v6 K. 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, 30513, 146, 189 and 189A; Chapter 111, Sections 5 and 127A, a permit is hereby granted to: Permit No: 834 Issue Date: 01/31/2019 DBA: PALIO PIZZERIA, INC. OWNER: SAM MAllEO Location of Estabkshment: 435 MAIN STREET HYANNIS MA 02601 Type of Business Permit: FOOD SERVICE Annual: YES Seasonal: IndoorSeating: 56 OutdoorSeating: 32 Total Seating: 88 FEES FOOD SERVICE ESTABLISHMENT: $250.00 YEAR: 2019 RETAIL FOOD: COTTAGE FOOD OPERATION: Permit Expires: 12/31/2019 B&B-FULL BREAKFAST: CONTINENTAL BREAKFAST: MOBILE-FOOD: MOBILE-ICE CREAM: G�� FROZEN DESSERT: Thomas A. McKean, RS, CHO, Health Agent TOBACCO SALES: I FOR ESTABLISHMENTS WITH SEATING: I PERMIT IS NOT VALID UNLESS ISSUED IN CONJUNCTION WITH A COMMON VICTUALER LICENSE Restrictions: TM-Approved for TCS Food -Pizza may be left out at room temperature for a maximum of 2 hours. f Y Board Of Health 1.Pizza shall be kept at room temperature for slices of pizzas.The time held at room temperature shall not exceed 2 hours. 2.Food will clearly be marked with a"discard time"that is two hours past the point of removal from the pizza oven. 3.The food shall be cooked and served,ready-to-eat or discarded within 2 hours from the point of time the food is removed from temperature control. 4.Any food in unmarked containers or packages or marked to exceed a 2 hour limit shall be discarded. 5.The TPHC variance decision statement shall be posted immediately adjacent to and/or included onto the food establishment permit,in a location which is easily viewable by a health inspector during inspections. Samuel Mazzeo Owner of Palio Pizzeria For Office Use Only- Initials: yf• Town of Barnstable Date Paid Amt Pd$ • 'AB�. ' Inspectional Services 1639. Public Health Division Check# Cash 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 X NAME OF FOOD ESTABLISHMENT: 'p_ ;lj ADDRESS OF FOOD ESTABLISHMENT: 43S II la"n 5fre,T MAILING ADDRESS(IF DIFFERENT FROM ABOVE): p "-02(o(3 I E-MAIL ADDRESS: 1'rj ►Z ;f�r) ,Cc TELEPHONE NUMBER OF FOOD ESTABLISHMENT: t f) - 70o y TOTAL NUMBER OF BATHROOMS: _ WELL WATER: YES NO X ... (ANNUAL WATER ANALYSIS REQUIRED) ANNUAL: x SEASONAL: DATES OF OPERATION:_/_/ TO / /^ NUMBER OF SEATS: INSIDE: s a OUTSIDE: 3,6 TOTAL: SS 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? Afl 4 IS AN AIR CURTAIN PROVIDED AT WAITSTAFF SERVICE DOOR(S)?44— 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) TOBACCO SALES ... (ANNUAL TOBACCO SALES APPLICATION REQUIRED) *** SEASONAL, MOBILE & NEW FOOD ONLY*** REQUIRED TO CALL HEALTH DIV.FOR INSPECTION PRIOR TO PERMIT BEING ISSUED Q:Wpplication Fonns1F00DAPPREV2018.doc PLEASE CALL 508-862-4644 OWNER INFORMATION: FULL NAME OF APPLICANT S G�nyQ hl jed SOLE OWNER: 'EE /NO OWNER PHONE# 7 ?q-a 3SAa h ADDRESS 3 aG I ti e CORPORATE OWNER: FEDERAL ID NO. : CORPORATE ADDRESS: l PERSON IN CHARGE OF DAILY OPERATIONS: TAA& S, IVt 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 1. J01AC, �L �� 1. �G�� (IoN 6 , 15 ia� 3 2. ��iwJp, Gzzra S /a 0f /01 SIGNATURE OF PLICANT 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 508-862A644 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.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 I st to Dec.31"each calendar year. IT IS YOUR RESPONSIBILITY TO RETURN THE COMPLETED APPLICATIONS)AND REQUIRED FEES BY DEC Ist. QAApplication FortnsXF00DAPPREV2018.doc `pFtNE►oyti TOWN OF BARNSTABLE - _ _ HEALTH IySPECTOR,s Establishment Name: Date: b age:, of y� p� OFFICE HOURS who PUBLIC HEALTH DIVISION 8:00-9:30 A.M. BARNSfABLE, ` 200 MAIN STREET 3:30-4:30 P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified �b 6s- .0� HYANNIS,MA 02601 MON.-FRI- No Reference ..R-Red Item PLEASE PRINT CLEARLY .erFD MP'�" 508-862-4644 FOOD ESTABLISHMENT INSPECTION REPORT Name Date T o Type of Insoection Address er s Routine �_,.�"`` S /X62 III Ris d Service Re-insr,P _ Telephone Level ^y f� Previous Inspection *. P _ Residential Ki„ nen r Date: 1! 1 Owner ile�� Pre-operation HACCP? 'IN Tempordry Suspect Illness Caterer General Complaint - Person in Charge(PIC) . �„-o _' Time Bed 8 Breakfast HACCP Othe KV�iTlSNati:Ii OUt: _' OF 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) ❑ 414 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 ❑ 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 lW� ❑ 3.Personnel with Infectious Restricted/Excluded ❑ 15. Toxic Chemicals FOOD FROM APPROVED SOURCE TIME/TEMPERATURE CONTROLS(Potentially Hazardou ods " ❑4.Food and Water from Approved Source ❑ 16.Cooking Temperatures ❑ 5.Receiving/Condition ❑ 17.Reheating ",Uj ❑ 6.Tags/Records/Accuracy of Ingredient Statements ❑ 18.Cooling p ❑ 7.Conformance with Approved Procedures/HACCP Plans ❑ 19.Hot and Cold Holding __41 r - 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 iolations Related to Good Retail Practices(Blue Items) Total Number of Critical Violations Critical(C)violations marked must be corrected immediately. (blue&red items) (1 Corrective Action Required: -. - Non-critical(N)violations must be corrected immediately or �J within 90 days as determined b the Board of Health. Overall Rating Y ❑ Voluntary Compliance Employee Restriction/Exclusion ❑ Re-ins ection Scheduled ❑ Emergency Susp io C N Official Order for Correction: Based on an inspection today,the items ❑ Embargo ❑ n to r I 23.Management and Personnel (FC-2)(590.003) checked indicate violations of 105 CMR 590.000/Federal Food Code. 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 cri c la' c I violation 24.Food and Food Preparation (FC-3)(590.004) constitutes an order of the Board of Health. Failure to correct violations re ardless er �(otical,r I i aF. �/�!�/'/'/� 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 Tess than 4non-critical violations 9 y') C4 if no critical violations observed,4 to 6 non-critical violations=B. Seriously Critical Violation= Is scored auto atically if: o hot 27.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 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,7 to 8 non-critical violations. If 1 critical refrigeration. 29.Spe cial within 10 days of receipt of this order. violation,4 to 8 non-critical violations=C. pquirements (590.009) Y p Print: AA-f4l-dAlff�� 30.Ot DATE OF RE-INSPECTION: Inspector's Signature 31.Duscreened from public view Permit Posted? N Grease Trap Previous Pumping Date Grease Rendered Y N #Seats Observed IC's Signatur Print: Frozen Dessert Machines: Outside Dining Y N Self Service_ YWait Service N Provided Grease Trap Size Variance Letter Posted Y N Dumpster Screen? C � l \ 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 Law Cooled to 41°F/45°F Within 4 Hours* 1 590.003(A) JAssignment of Responsibility* 8 Cross-contamination 14 Food or Color Additives 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* �,. . 1g PHF Hot and Cold Holding, 2-103.11 Person-in-Charge Duties Cooked and RTE Foods.* "�•t.3.302.14 Protection from Unapproved Additives* '" Contamination from Raw Ingredients 3-501.16(B) Cold PHFs Maintained At or Below 41°F/45°F 15 Poisonous or Toxic Substances 590.004(F) *- t EMPLOYEE HEALTH 32302.11(A)(2) Raw Animal Foods Separated from Each 7-101.11 Idem:; Information-Ori Original Containers* 2 590.0.03(C1 Responsibility of the Person-in-Charge to _ _ - _ Other* �� g * 3-501.16(A) Hot PHFs Maintained A[or Above 140°F 7-102.11 Common Name-Worxttittainers Require Reporting by Food Employees and Contamination from the Environment _ ..- ._ 3-501.16(A) Roasts Held At or Above 130°F Applicants* 7-201.11 Separation-Storage* 20 Time as a Public Health Control 3-302:11(A) Food Protection* +�„ 590.003(F) Responsibility of A Food Employee or An 3-302.15 Washing Fruits and Vegetables 7-202.11 Restriction-Presence and Use* -t_501.19 Time as a Public Health Control* Applicant To Report To The Person In Charge* 7.202.12 Conditions of Use* 3-30411 Food Contact with Equipment and Utensils* 590.004(1i f' a Variance Requirements .590.003(G) Reporting by Person in Charge*. Contamination from the Consumer 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* 590.003(E) Removal of Exclusions and Restrictions Disposition of Adulterated or Contaminated 7-204.12 Chemicals for Washing Produce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS(HSP) 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 Wazewashing-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 P 3-201.13 Fluid Milk and Milk Products* _ -' -"4-501.112 '"- Mechanical Wazewashing-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. -_ CONSUMER ADVISORY gg 16 Proper Cooking Temperatures for PHFs 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 A11-601. ean Utensils and Food C f f ontact Surfaces o * Animal Foods That are Raw,Undercooked or 5-101.11 Drinking Water from an Approved System* 4 ( ) Cl " 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 Pathogens* Ef ctiw 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* 4-702.11 Frequency of Sanitization of Utensils and Food 3-401.11(A)(2) Ratites,Injected Meats-155°F IS sec* 3-201.14 Fish and Recreationally Caught Molluscan Contact Surfaces of Equipment* - Shellfish* 4-703 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS .11 Methods of Sanitization-Hot Water and n 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* Stuffing Containing Fish,Meat,Poultry or ,590.009(A)-(D) Violations of Section 590.009(A)-(D)in cater- * - Ratites-165°F 15 sec* in mobile food,temporary and residential Sources g. P azY 10 Proper,Adequate Handwashing 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 145*P1 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 practices sho9 violations relating to good retail 3-201.17 Game Animals* 11 - Good Hygienic Practices 17 Reheating for Hot Holding Requ rem nos Id be debited under tt29-Special 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) 1=212 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/Record_si Shellstock _ 590.004(E) Preventit}g,Contamination from Employees* 18 Proper Cooling of PHFs following sections of the Food Code and 105 CMR 590.000 1=313 - Handwashing Facilities 3-202.18 Shellstock Identification* 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* * 23. Mana ement and Personnel FC-2 .003 Tags/Records:Fish Products 5-203.11 Numbers and Capacities* Within 4 Hours 9 3-402.11 Parasite Destruction* 5-204.11 Location and Placement* 3-501.14(B) Cooling PHFs Made from Ambient 24. Food and Food Protection FC-3 .004 * 5-205.11 Accessibility,Operation and Maintenance Temperature Ingredients to 41°F/45°F 25. Equipment and Utensils FC-4 .005 3-402.12 Records,Creation and Retention 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: `pptME Toti, TOWN OF BARNSTABLE HEALTH INSPECTOR'S Establishment Name: - Date: age:. of OFFICE HOURS : BARNSTARLE. PUBLIC 2 0 MAIN STREET .. 3:30-4:30A.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified 3:30-4:30 P.M. e3. `0$ HYANNIS, MA 02601 MON.-FRL No Reference R-Red Item PLEASE PRINT CLEARLY OrFO MP+° 508-862-4644 FOOD ESTABLISHMENT INSPECTION REPORT _ Name Dat Type of TXWMf Inspection OF g outin Address Risk d Se9Cice e-inspection �. Level Re ai Previous Inspection Telephone Residential Kitchen Date: f Mobile Pre-operation Owner Pak(/ k HACCP Y/N Temporary Suspect Illness Caterer General Complaint Person in Charge(PIC) jime Bed&Breakfast HACCP In: Other Inspector v, Out: cc6ew ea .i ley Each violation checked requires an explanation on 6e 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) FOOD PROTECTION MANAGEMENT ❑ 12.Prevention of Contamination from Hands ❑ 1.PIC Assigned/Knowledgeable/Duties ❑ 13.Handwash Facilities 4.4 EMPLOYEE HEALTH PROTECTION FROM CHEMICALS ❑ 2.Reporting of Diseases by Food Employees and PIC ❑ 14.Approved Food or Color AdditivesFv ',.Jr ❑ 3.Personnel with Infectious Restricted/Excluded ❑ 15. Toxic Chemicals ;J FOOD FROM APPROVED SOURCE TIMErrEMPERATURE CONTROLS(Potentially Hazardous Foods) ❑4.Food and Water from Approved Source ❑ 16.Cooking Temperatures V ❑ 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 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 within 90 days as determined b the Board of Health. Overall Rating Y y ❑ 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. ❑ 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) cited in this report may result in suspension or revocation of the food B=One critical violation and less than non-critical violations 9 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 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 8non-critical violations=C. 29.Special Requirements (590.009) within 10 days of receipt of this order. 30.Other DATA OF RE-INSPECTION: Inspector's Signature Print: 31.Dumps r screened from public view Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y N WL, V #Seats Observed Frozen Dessert Machines: Outside Dining Y N PIC's Si nature Print: Self Service Wait Service Provided Grease Trap Size Variance Letter Posted. Y N Dumpster Screen-1 Y N % ',�.y.*._.,3,....._�.,,.....-r.,..r+a..w_'`-. '9 w_ -,.-. w �.... ,..-. . :.^.r -.` .-d.s�.--}...^; .rr.. ..+.,w..-+.. -+°.-� r.��-. v= .-.�--..-r-. � .� L.�ry-.�,^--rl�.. ..�+w..+.e•.�v.�_-+'�.-w.-.w �. - +.^Kr. - .. - - 1 .-J... � � �'\...- � .. -r r �- � � i SwF:.___ �_� _ 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) jAssignment of Responsibility* S Cross-contamination 14 Food or Color Additives ' t• 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 Identifying Information-Original Containers* 2 590.003(C) Responsibility of the Person-in-Charge Other* 3-501.16(A) Hot PHFs Maintained At or Above 140°F .to � _ _ 7-10211 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 7-202.11 Restriction-Presence and Use* 590.003(F) Responsibility of A Food Employee or An 3-302.15 __ WashingFruits and Vegetables 3-501.19 Time as a Public Health Control* J Aliplicant To Report To The Person In Charge* g * 7.202.12 Conditions of Use* 590.004 11 Variance Requirements * 3-304.11 Food Contact with Equipment and Utensils ( ) q 590.003(G) Reporting by Person in Charge Contamination from the Consumer 7-203.11 Toxic Containers-Prohibitions* 3 590.003(D) Exclusions and Restrictions* 3-306.14(A)(B�Returned Food and R590.003(E) -Remo-val of Exclusions and Restrictions Disposition of Adulterated 7-204.11 Sanitizers,Criteria-Chemicals* v REQUIREMENTS FOR - _ ated or of Food*Contaminated 7-204.12 Chemicals for Washing (Produce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP ated or ) 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* ) 4501.111 Manual Wazewashin Hot Water 7.206.12 Rodent Bait Stations*590.004 A-B� Compliance with Food Law* tions* 3-801.11(D) Raw or Partially Cooked Animal Food and ( P 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 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.,pI3. 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 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 Equipment* Not Otherwise Processed to Eliminate 590.006(A) Bottled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* Ef-i-1112001 _ 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 Surfaces 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,Poul or 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* 8 590.009(A)-(D) Violations of Section 590.009(A)-(D)in cater- * - - - Ratites-165°F 15 sec* in mobile food,temporary and residential Sources g. P arY 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. Other 590. violations relating to good retail 590.004(C) Wild Mushrooms* 2-301.14 When to Wash* 3-401.11(A)(1)(b) All Other PHFs-145°F 15 sec*ng should 11 Good Hygienic Practices 17 Reheating for Hot Holding practices shhould be debited under#29-Special 3-201.17 Game Animals* 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) Commercially Processed RTE Food-140°F* Blue Items 23-30) 3-202.15 Package Integrity Critical and non-critical violations,which do not relate to the foodbome 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* 1 g Proper Cooling of PHFs following sections of the Food Code and 105 CMR 590.000 * 13 Handwashing Facilities 3-501.14(A) Cooling Cooked PHFs from 140°F to 70°F 3-202.18 Shellstock Identification 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 1.008 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. `Qp THE rqr TOWN OF BARNSTABLE HEALTH INSPECTOR'S Establishment Name: Date: Page: of q OFFICE HOURS B AR EO: PUBLIC 2 0 MAN STREET 3:30-4:30 P.M.DIVISION : 0- :30A.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified �A ,639.a.� HYANNIS,MA 02601 5M08-8 62 4-FRI. No Reference R-Red Item PLEASE PRINT CLEARLY 6" FOOD ESTABLISHMENT INSPECTION REPORT r Name s Dat I Tyoe of Type ofiapoection 2..!d�S2.mc R Ine Address Risk Level Previous Inspection If Ax P2 Telephone Residential Kitchen Date: Mobile Pre-operation Owner HACCP YIN Temporary Suspect Illness '000- Caterer General Complaint Person in Charge(PIC) _ d Time Bed&Breakfast HACCP In: Other Inspector Out: 0 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) C Y FOOD PROTECTION MANAGEMENT ❑ 12.Prevention of Contamination from Hands ❑ 1.PIC Assigned/Knowledgeable/Duties ❑ 13.Handwash Facilities Y001- EMPLOYEE HEALTH PROTECTION FROM CHEMICALS kin ❑2.Reporting of Diseases by Food Employees and PIC ❑ 14.Approved Food or ColorAdditives ❑ 3.Personnel with Infectious Restricted/Excluded ❑ 15. Toxic Chemicals / FOOD FROM APPROVED SOURCE TIME/TEMPERATURE CONTROLS(Potentially Hazardous Foods) E `. ❑4.Food and Water from Approved Source ❑ 16.Cooking Temperatures. ❑ 5.Receiving/Condition ❑ 17.Reheating 76 ❑6.Tags/Records/Accuracy of Ingredient Statements ❑ 18.Cooling k ` ❑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 ❑ ❑ 1 2 �n, 11.Good Hygienic Practices 22.Posting of Consumer Advisories (�Jf J NL 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 ❑ 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 6=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 b this order,you have a right to.a hearing. Your request must C=2 critical violations and o 8 than i non-critical. If no critical water,sewage back-up,infestation of rodents or insects,or lack of y y ) 99 y y 9 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 590.009 within 10 days of receipt of this order. violation,4 to 8rion-critical violations=C. 29.Vhe equirements (590.009) Inspector's Signature Print: 30. DATE OF RE-INSPECTION: 31. screened from public viewPermit Posted? N Grease Trap Previous Pumping Date Grease Rendered Y N #Seats Observed Frozen Dessert Machines: Outside Dining Y N PIC's Siganature �fAl Print:Self Service Wait Service Provided Grease Trap Size Variance Letter Posted Y N �. rDumpster Screen? YNL/ (! 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) [Demonstration gnment of Responsibility* 8 Cross-contamination L 4 Food or Color Additives Law Cooled to 41°F/45°F Within 4 Hours* * 3-501.15 Cooling Methods for PHFs 590.003(B) 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 5 590.004(F) 590.003(C) Responsibility of the Person-in-Charge to 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* Other* 3-501.16(A) Hot PHFs Maintained At or Above 140°F* 2 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* Storage* - Applicants* 3-302.11(A) Food Protection* 7-201.11 Separation g 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 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 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 � ) i 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* 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* TIMEITEMPERATURE CONTROLS 3-202.14 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. L16 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 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* En cfi-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* 4-702.11 Frequency of Sanitization of Utensils and Food 3-401.11(A)(2) I 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 Shellfish from NSSP Listed Chemical* Stuffing Containing Fish,Meat,Poultry or 590.009(A)-(D) Violations of Section 590.009(A)-(D)in cater- Ratites-165°F 15 sec* in mobile food,temporary and residential Sources* 10 Proper,Adequate Handwashing g' P 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 ro riate 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* �� 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 * 3-301.12 Preventing Contamination When Tasting* 3-403.11 C Commercial] Processed RTE Food-140°F* (Blue Items 23.30) 3-202.15 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 8 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[0 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[0 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. 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. of vNEIo TOWN OF BARNSTABLE _ ,. .HEALTH wsPECTOR,s Establishment Name: >wl /i o '7 PG Date: 2 / Page: of OFFICE HOURS / BARNS-FABLE. ` PUB2 0 MA N 8T DIVISION 3:30-4:30A.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified 3:30-4:30 P.M. MASS. �. MON.-FRI. Ifc 59. m HYANNIS,MA 02601 saa-862-4644 No Reference R-Red Item PLEASE PRINT CLEARLY FOOD ESTABLISHMENT INSPECTION REPORT NameZ Date, /it Type T - f Inspection ! G Z tLQDJs outipAddress Risk Foo Servic I A" Level Previous If�spection -14 " a . Telephone Residential Kitchen Date:s Y�t L , yj d"re j Mobile Pre-oper lion 0 Owner HACCP Y/N Temporary Suspect Illness 00rdleolbt, U d 4 Caterer General Complaint Person in Charge(PIC) Time l s Bed&Breakfast O AC + t/ Inspector ✓ ^ r Out: u -�� 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) ❑ 99 ,�, Violations marked may pose an imminent health hazard and require immediate corrective Tobacco 590.009(F) f-� 0 o- -f C 6d Action as determined by the Board of Health. Allergen Awareness 590.009(G) Afl) I 6 FOOD PROTECTION MANAGEMENT ❑ 12.Prevention of Contamination from Hands ❑ 1.PIC Assigned/Knowledgeable/Duties ❑ 13.Handwash Facilities f 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 TIMEITEMPERATURE CONTROLS(Potentially Hazardous Foods) ❑4.Food and Water from Approved Source ❑ 16.Cooking Temperatures ��[ V vf_ Wr/ 4en t9ruct4rpiuj k.C, ❑ 5.Receiving/Condition ❑ 17.Reheating V V ❑ 6.Tags/Records/Accuracy of Ingredient Statements ❑ 18.Cooling T r L j r ct d ure C ❑ 7.Conformance with Approved Procedures/HACCP Plans ❑ 19.Hot and Cold Holding �( PROTECTION FROM CONTAMINATION ❑20.Time As a Public Health Control fJ� A au , o ❑8.Separation/Segregation/Protection REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) ❑ 9.Food Contact Surfaces Cleaning and Sanitizing ❑ 21.Food and Food Preparation for HSP I JL (_ s ❑ 10.Proper Adequate Handwashing CONSUMER ADVISORY v�/�( hl ❑ 11.Good Hygienic Practices ❑22.Posting of Consumer Advisories �.J Violations Related to Good Retail Practices(Blue Items) Total Number of Critical Violations I � ' Critical(C)violations marked must be corrected immediately. (blue&red items) I ® Corrective Action Required: ❑ No es 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,th 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 4 non-critical violations g if no critical violations observed,4 to 6von-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 27.Physical Facility (FC-6)(590.007) aggrieved by this order,you have a right to a hearing. Your request must 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 t non-critical violations=C. 29.Special Requirements (590.009) within 10 days of receipt of this order. RE-INSPECTION In ector's ' In ure Pri F 30.Other DATE O RE-INSPECTION: - 31.Dumpster screened from public view 11�4 RSPermit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y N (/y �/V b r y) #Seats Observed Frozen Dessert Machines: Outside Dining Y N PIC's n Self Service xture` ' Prin Wait Service Provided Grease Trap Size Variance Letter Posted Y N V 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) [Demonstration gnment of Responsibility* 8 Cross-contamination 14 Food or Color Additives Law Cooled to 41°F/45°F Within 4 Hours* 590.003(B) of Knowledge* 3-302.11(A)(1) Raw Animal Foods Separated from 3-202.12 Additives* 3-501.15 Cooling Methods for PHFs 2-103.11 Person-in-Charge Duties Cooked and RTE Foods.* _ g 3-302.14 Protection from Unapproved Additives* 19 PHF Hot and Cold Holding 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* 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 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 590.003(G) Reporting by Person in Charge* Contamination from the Consumer 7-203.11 Toxic Containers-Prohibitions* 3 590.003 D Exclusions and Restrictions* 7-204.11 Sanitizers,Criteria-Chemicals* ( ) 3-306.14(A)(B)Returned Food and Reservice of Food* REQUIREMENTS FOR - 590.003(E) I Removal of Exclusions and Restrictions Disposition of Adulterated or Contaminated 7-204.12 Chemicals for Washing Produce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS(HSP) 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 Wazewashing-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 Wazewashing-Hot Water 1 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. 18 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 dness* 22 3-603.11 Consumer Advisory Posted for Consumption of Animal Foods That are Raw,Undercooked or * 4-601.11(A) Clean Utensils and Food Contact Surfaces of Eggs-Immediate Service 145°F 15 sec* 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* Ef ctsw 1/1r2001 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 l(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 Poultry or Meat, 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* Stuffing Containing Fish, 590.009(A)-(D) Violations of Section 590.009(A)-(D)in cater- Sources* 10 Ratites-165°F 15 sec*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. 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 11 Good Hygienic Practices practices should be debited under#29-Special 3-201.17 Game Animals* 17 Reheating for Hot Holding 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(13) 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* 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 1.003 * 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 I 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 596.000. Op,ME row TOWN OF BARNSTABLE _ HEALTH INSPECTOR•s Establishment Name: A, 1 /' ' 7 7e, Date: Page: of ti OFFICE HOURS PUBLIC HEALTH DIVISION 8:00-9:30 A.M. BARNSrABLE. • 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 MON.-FRI. No Reference R-Red Item PLEASE PRINT CLEARLY 508-862-4644 FOOD ESTABLISHMENT INSPECTION REPORT Name 716, Date Type of T Qf Inspection Ip outin�g ✓' Address Risk 1,Food Service �pection i �� Level Previous Inspection P O Telephone Residential Kitchen Date: f T Ae Mobile Pre-operation Owner HACCP Y/N Temporary Suspect Illness Mf Caterer General Complaint e f Od`! v-e_r Person in Charge(PIC) Time Bed&Breakfast HACCP t Q_ b 1 i C In: Other \ v e ° - OU✓7 Ll Inspector ^ Out: / 1 . 5�6Each 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) ❑ d�10 �. a Gv 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 t ❑ 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 4 Mh ' .& ❑ 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 V�Q GI lw Gr r ❑8.Separation/Segregation/Protection REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) 2. ZCn 0 (-r, r ❑ 9.Food Contact Surfaces Cleaning and Sanitizing ❑21.Food and Food Preparation for HSP rQ ` El 10.Proper Adequate Handwashing CONSUMER ADVISORY ❑ 11.Good Hygienic Practices ❑ 22.Posting of Consumer Advisories G C.", 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 es 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 i ems Embar o checked indicate violations of 105 CMR 590.000/Federal Food Code. ❑ 9 ❑ 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 4non-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 to 6 non-critical violations=B. Seriously Critical Violation=F is scored automatically if: no hot 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,infestation of rodents or insects,or lack of 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,7 to 8non-critical violations. If 1 critical refrigeration. 29.Special Requirements (590.009) within 10 days of receipt of this order. violation,JAO 8 non-critical violations=C. 30.Other DATE OF RE-INSPECTION: Insp for 4ig ature Print 31.Dumpster screened from public view. to V/) Permit P osted? Y N Grease Trap Previous Pumping Date Grease Rendered Y N #Seats Observed Frozen Dessert Machines: Outside Dining Y N PIC' I nature Print: Self Service Wait Service Provided Grease Trap Size Variance Letter Posted Y N Dumpster Screen o 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* F 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* 2 590.003(C) Responsibility of the Person-in-Charge to Other* __ - g3-501.16(A) Hot PHFs Maintained At or Above 140°F* Require Reporting by Food Employees and Contamination from the Environment 7-102.11 Common Name-Working Containers* 3-501.16(A) Roasts Held At or Above 130°F* 7-201.11 Separation-Storage* Applicants* 3-302.11(A) Food Protection* P211 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 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 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 Warewashing-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) Unopened Food Package Not Re-Served* 3-202.13 Shell Eggs* Sanitization Temperatures* TIME/TEMPERATURE CONTROLS 3-202.14 1 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* i - 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 5-101.11 Drinking Water from an Approved System* _. _ * gg Not Otherwise Processed to Eliminate Equipment 590.006(A) Bottled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meals&Game Pathogens* sg cnve 11112001 4-602.11_ Cleaning Frequency of Utensils and Food Animals-155°F 15 sec* 590.006(B) Water Meets Standards in R'310 CM 22A* 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 1' 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 3-201.15 Molluscan Shellfish from NSSP Listed_ Chemical* Ratites-165°F 15 sec*Stuffing Containing Fish,Meat,Poultry or 590.009(A)-(D) Violations of Section 590.009(A)-(D)in cater- _ y Sources* 1p Proper,Adequate Handwashing ing,mobile food,temporary and residential Game andId 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#29-Special 2-401.11 Eating,Drinking or Using Tobacco* * Requirements. $ 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 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 8 Tags/Records:Shellstock 590.004(E) Preventing Contamination from Employees* 1g 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°17 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 * 5-205.11 Accessibility,Operation and Maintenance � * 3-402.12 Records,Creation and Retention 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 6-391.12 Hand Drying Provision 29. Special Requirements 1.009 3-502.11 Specialized Processing Methods* 30. Other 3-502.12 Reduced-Oxygen Packaging Criteria* _ 8-103.12 Conformance with Approved Procedures* t S:.590Formback6-2doc 'Denotes critical item in the federal 1999 Food Code or 105 CMR 590.00+0. 'Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. Y r; Board Of Health, 1. Pizza shall be kept at room temperature for slices of pizzas.The time held ata room temperature shall not exceed 2 hours. ram, 2. Food will clearly be marked with a "discard time"that is two hours past the point of removal from the pizza oven. 3. The food shall be cooked and served, ready-to-eat or discarded within 2 hours from the point of time the food is removed from temperature control. 4. Any food in unmarked.containers or packages or marked to exceed a 2 hour limit shall be discarded. S. The TPHC variance decision statement shall be posted immediately adjacent to and/or included onto the food establishment permit,in a location which is easily viewable by a health inspector during inspections. a��f Samuel Mazzeo Owner of Palio Pizzeria 20MI r 'e- , § 322-5,, Outdoor dining. i A.-No person, corporation, or firm shall provide outdoor dining or an outdoor cafe at a food establishment until after all of the following requirements are met: (1) The applicant shall file a written request for outside dining or for an outside cafe on a form prescribed by the Town and shall submit plans of the proposed dining area.The seating capacity shall be determined by the Board of Health after a determination is made whether requirements of Subsection A(2)through (14)below will be met and after a visual inspection is conducted,by an agent of the Board of Health.A replacement food establishment permit shall be issued by the Board of Health indicating outside dining is permitted and listing the overall seating capacity, only after it is determined by an agent of the Board of Health that all of the requirements Subsection A(2)through (14)of this section are met. (2) A menu shall be submitted to the Board at the time of application. (3) The dining area must be appurtenant and contiguous to the restaurant property. The dining area must be mentioned on the described premises as in the case of a common victualler's license. (4) Sufficient restrooms, both for customers and employees, must be furnished counting.the additional outside seating as required by the State Plumbing Code and Town of Barnstable Health regulations. (5) A grease trap shall be of sufficient capacity, based upon 15 gallons per seat;as required by the State Environmental Code, Title V, and Town of Barnstable Health regulations.A grease recovery device may be installed to supplement an existing in-ground grease trap, after receiving the approval of the Board of Health. <(6)', All entrance and exit doors used by food service personnel and customers must be screened and provided with air curtains meeting National Sanitation Foundation standards. All windows or openings used for the transfer of food will be screened and provided with air curtains. Food cannot be stored or kept outside. All food must be prepared inside the facility's kitchen and kept inside until served. (7) A drainage system designed to eliminate odors will be required for all outdoor dining areas. Hose bibs with vacuum breakers must be available for washing down the dining area. (8) Trash dumpsters shall be situated no closer than 50 feet from an outdoor dining area. If such a dumpster is in the line of sight from the dining area, it must be hidden from view. The area around the dumpster and stockade must be kept clean and free of litter. Dumpsters must be closed with adequate covers designed to prevent entrance of rodents and birds and sealed to control odors. (9) The patio or other ground surface must be of constructed of material readily cleanable and not susceptible to dust, mud, or debris. (Brick, tile, and concrete are examples of acceptable materials.) (10) Table tops must be smooth, nonporous, easily cleanable and durable, and readily maintained in a clean and sanitary condition. (11) Food-service personnel must constantly police the dining area for wastepaper, garbage and other trash. Placement clips, cup holders and other such devices must be utilized to prevent blowing paper. Covered trash receptacles must be provided in close proximity to the dining area and must be emptied as needed to prevent overflowing. (12) Strict cleanup practices must be adhered to.Waitstaff and buspersons must,clean up after each patron as in indoor dining. Each establishment must abide by all regulations contained in Article`X, Minimum Sanitation Standards for Food Service Establishments, of the Commonwealth of Massachusetts, Department of Health Sanitary Code. (13) Outside food handlers must have easy access to handwash sinks and cleaning cloths. Facilities for preparation and disposal of sanitizing solutions must be accessible. (14) Hair nets or other effective hair restraints, such as hats covering exposed hair, shallbe worn by all outside food or drink handlers. Beards and mustaches must be neatly trimmed. B. Exemption from doorway air curtain requirement in Subsection A(6)above: The Board of Health may waive the requirement to provide air curtains at the doorways only if no waitstaff services will be provided to the outside dining area (self-service only). 0 83 � Yh h: '�`C��N OF BARP�SI'ABLE Pizza by the Slice 2005 MAY 12 PM 1: 5 7 Cheese — 2.25 Pepperoni — 2.75 Special of the day - 2.75 01Vis—IO Bread Sticks 4 for 2.95 Add Cheese - 1.00 extra Create Your Own Pizza Small: 14"- 8.50 Large: 18"- 12.50 Toppings 1.00 each Toppings 1.50 each Pizza Toppings and Calzone Fillings Pepperoni Onions Jalapenos Fresh basil Sausage Peppers Roasted red peppers Fresh garlic Canadian bacon Mushrooms Caramelized onions Pineapple Italian chicken * Broccoli Raasted eggplant Artichokes Meatball Black olives Spinach Feta cheese " 2.00 small 3.00 large Specialty Pizzas Small Large 14" 18" Pollo Pesto 12.50 18.50 pesto, chicken, fresh garlic, caramelized onions Margherita 12.50 18.50 fresh mozzarella, fresh garlic, fresh basil, sliced tomato White Veggie 11.50 17.00 carmelized onions, roasted red peppers, artichokes Cape Coddler 12.50 19.00 mozzarella cheese, clams, fresh garlic, lemon House Special 11.50 17.00 pepperoni, peppers,jalapenos Calzones Cheese calzone (one size) - 8.50 (mozzarella cheese & spices) Additional fillings - 1.00 each Italian chicken - 2.00 Hot Subs 9" subs - 5.50 Meatball Chicken Parmesan Sausage, Pepper & Onion Salads House Garden Salad - 5.50 Mixed greens, tomatoes, cucumbers, and Palio's own dressing Caesar Salad - 5.50 Traditional salad with crisp romaine lettuce, garlic flavored croutons, parmagian cheese and Palio's own Caesar dressing. Greek Salad — 5.50 Romain lettuce, greens, tomatoes, red onions, cucumbers, pepperoncini, feta cheese, Kalamata olives, parsley and Palio's own dressing Add Italian chicken or tuna to any salad — 2.50 Fresh Fruit Fresh Fruit Cup (priced per season) Beverages Soda Fountain Small - 1.25 Medium - 1.50 Large - 1.75 Y Juice 1.95 Water 1.50 r Beer Bottled 3.00 Draft Frosted Mug 2.50 Italian Wines 5.00 - Glass 11.00 - 1/2 Carafe 20.00 - Bottle Red or White from Sicily Chianti from Tuscany Open Everyday 11:00 am to 9:00 pm DOOR 4 4 4 14 2 � 4 Fe� 'r 4 • 2 6 . 2 . To Go Counter Barstools 31 �PJ 4 2 ? PALIO PIZZERIA SEATING PROPOSAL 32 outdoor seats f y �� 32 indoor seats (booths) 1g indoor seats (chairs) 'b.indoor stools (to go) DOOR 'y-J $� seats total ' o 8.2.seats for patrons who are eating/drinking Town of Barnstable of t►+e r Regulatory Services Barnstable Thomas F. Geiler, Director A*AmericaCity Public Health Division ( � snxxsrnsLE, Mass. Thomas Thomas McKean, Director zoos ie39• a`` 200 Main Street ED MA'S Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Palio Pizzeria 435 Main Street Hyannis,MA 02601 Dear Mr. Mazzeo, The Massachusetts Department of Public Health has informed the Barnstable Health Department, on 8-2-11, that your restaurant was named in a food borne illness case on 7/7/11. The person reports to have eaten the seafood pizza on 7-7-11 and proceeded to become ill requiring them to seek medical attention. A stool sample was taken and Vibrio Parahaemolyticus was confirmed. The MADPH requested that the Barnstable health department obtain invoices or tags from Palio's that coincide with onset of the illness date so that the source of the clams could be traced back to origin. The product used on this type of pizza was Snow's canned clams. An inspection was done by Marybeth McKenzie R.S., Health Inspector for the Board of Health, on 8-3-11 at Palio's Pizzeria. On inspection, pizza was being cooked and held at room temperature on a tiered type metal holder, and then reheated upon request. Per MA Food Code 3-501.19 Time as a Public Health Control; in addition to requirements set forth in FC3- 501.19, a variance must be obtained from the board of health. Until a variance is obtained all heated product must be either cooled and held at 41 degrees or below or held at 140 degrees or above. It was also noted during the inspection that seating has been increased to 58 inside and 32 outside, totaling 90 seats. You are permitted .for 47, because of restroom constraints. Barnstable Town code § 322-4 states that each food-service establishment with a seating or standing capacity of over 50 patrons shall provide toilet facilities for employees that are separate from the toilet facilities provided for patrons. Separate facilities must be provided for male and female employees and male and female patrons. Until a variance is obtained the seating must be returned to the original permitted amount. Please contact the Barnstable Health Department if you have any question or need assistance in obtaining the variances. Per Order of the Board of Health Thomas McKean R.S., CHO Director of Public Health I'� ....-._--_w. .�.r......,......".ri.'..11r... -•-.,+.n, .. �.y..�-N. ..... .-.r ..n...qs� 'rinq,�' Fr. O.;C'. '•�-f.�.Y 1;.-. If.'... ... ....f. :mom .. a ,•:;... .,_,,., � .,.. .� a..,n,e..r+ - TOWN OF BARNSTABLE BAR-W Ordinance or Regulation WARNING °NOTICE Name of O.ffender/Manager /i: _ �_-� .t-., Address of Offender k''I j ( ,f1 MV/MB Reg.# Village/State./Zip Iti /rin t Business Name 1. A t t 1l � ��c �_ '�./'1A! c /A 1 4;Q/pm. on-,qs 1 { 20 f ! Business Address � � r1'''7 /k �`V\ iltri;� �E' A, 7 gg '" Signature of`tnforc hg `Of•ficer Village/State/Zip �''t ,4 e y f r t� Location of Offense Enforcing Dept/Division Offense "' 0 k ' � r�.tat..�� ..: "Ap V A( -/ . , .-+ '� Facts k7, `"l �...P ►t�+ �� '' �/ l��'1r� v,A.:,.� W �� >l, t� ^. " This will serve only as a warning. At this time no legal action has been taken. It is the goal of Town agencies to achieve voluntary compliance of Town Ordinances, Rules and Regulations. Education efforts and warning notices are. -attempts to gain voluntary compliance. Subsequent violations will result in appropriate legal action by the Town. WHITE-OFFENDER CANARY-ORD./REG.-PROG. PINK.ENFORCING OFFICER GOLD-ENFORCING DEPT. TOWN' OF BARNSTABLE BAR-W n Ordinance or Regulation o,� • � WARNING NOTICE Name of Offender/Manager /t.•ffi.l. A -1 t y1`2 Address of Offender. =J v Al .A �K� MV/MB Reg.# .Village/State/Zip k1l ri to � ; r" t,:- 1" Business Name 1 A 14 �f�; 1 41 --1 am°,°,/pm, on, i 1 201 1 Business Address Signature of Enforcing Officer Village/State/Zip y , sue" +w:-i L, Location of Offense Enforcing Dept/Division Offense '' } �' � ' .},� � x .t , � �. . ,.. f I Facts c1• ` •�r .,.� � t yt .. ;'y1 ' 54 •t+�L +,, i `� � '� )` y C This will serve only as a warning. At this time no legal action has been taken. It is the , goal of Town agencies to achieve ,voluntary compliance of Town Q,rdinances, Rules and Regulations. Education efforts and warning notices are attempts to gain voluntary compliance. Subsequent violations will result in appropriate legal action by the Town. • WHITE-OFFENDER CANARY-ORD./REG.-PROG. PINK-ENFORCING OFFICER GOLD-ENFORCING DEPT. U S. Postal Servicerh .ICERTIF.ED UAILT,;RECEIPT'. '(Domestic Mail Only No;Insurance Coverage;Prov�ded) __ .'For,delivery;informahoriµvisiYour,wetistte'at www.u _.,sps:com��,, OFFICIAL. U-S-1E i S, PS,Form..a00.August i2006 .�,r ,,.; See,,Reverse for Instructons,: Certified Mail Provides: f ■ A mailing receipt IN A unique identifier for your mailpiece IN A record of delivery kept by the Postal Service for two years Important Reminders:. ■ Certified Mail may ONLY be combined with First-Class Mail®or Priority Maile. in Certified Mail is not available for any class of international mail. z in NO INSURANCE COVERAGE IS PROVIDED with Certified Mail. For valuables,please consider Insured or Registered Mail. s For an additional fee;a Return Receipt may be requested to provide proof of delivery.To obtain Return Receipt service,please complete and attach a Return Receipt(PS Form 3811�to the article and add applicable postage to cover the fee.Endorse mailpiece Return Receipt Requested".To receive a fee waiver for a duplicate return receipt,a USPS®postmark on your Certified Mail receipt is, required. o For an additional fee, delivery may be restricted to the addressee or addressee's authorized agent.Advise the clerk or mark the mailpiece with the endorsement"Restricted Delivery".. ■ If a postmark on the Certified Mail receipt is desired,please present the arti- cle at the post office for postmarking. If a postmark on the Certified Mail receipt is not needed,detach and affix label with postage and mail.- , IMPORTANT-Save this receipt and present it when making an inquiry. PS Form 3800,August 2006(Reverse)PSN 7530-02-000-9047, SENDER: COIWPL�TE THISj SECTION COMPLETE THIS SECTION ON DELIVERY ■ Complete items 1,2,and 3.Also complete A. Signature ` item 4 if Restricted Delivery is desired. X �� e \ ■ Print your name.and address on the reverse r i�9 essee so that we can return the card to you. B. Received by(Printed Name) 'C. Date o Del ery ■ Attach this card to the back of the mailpiece, r. 11 or on the front if space permits. o b' . D. Is delivery add diffe item 1? s 1 1. Article Addressed to: If YES,ente deli.,, a Q��•o � 3. S ice Type,f NIAQGJ tAAAt 5 Y►"� V Certified Mail.._ ]-Express ail �CJ ❑Registered ❑Return Receipt•Fer-M rchandise ❑ Insured Mail ❑C.O.D. ��. 4. Restricted Delivery?(Extra Fee) ❑Yes I 2. Article Number M (transfer from service label) 7 011 0 4 7 0 0001 4525 5631 PS Form 3811,February 2004 Domestic Return Receipt 102595-02-M-1540 UNITED STATES POSTAL SERVICE wa Fifst-tlass.Ma_il " PostaE[e&Fees Paid USPS--o Permit-�No.eG-10 • Sender: Please print your name, address, and ZIP+4 ira�this b0 • I Aj0 om,4- i i i J j Palio Pizzeria 435 Main Street Keith Schachter 508-776-4606 P.O. Box 1291 Paul Mazzeo 508-771-5313 Hyannis, MA 02601 774-238-0136 508-771-7004 508-771-8435 FAX (2) Sandwich unit 6 booths 6 tables 6-burner gas cook top Commercial VCI the Dish washer under counter hi temp Grease trap 1000 gallon Hand sinks at least 2 Hood Ice machine Low voltage lighting seated area Mixer/shredder attachment Microwave Shelving chrome/ gold bond Shielded lighting kitchen Slicer Small ware Triple sink Walk-in cooler 8x10 Wood burning oven Worktables i ,� I _r n � � I � " ifs zzrS a {JIl 'S� w W S r ----\4- w J 17o�{ s7 atn `'x^1 I _ i 7' 5 . 1 d z O - - - 7� - 00 - - - -- -- G _I . ... { W N-- INCH � _E _- 'B L C K cA NV. • jl - 13 ►- v E S iD IN TRV�, Pr N E- r- URCIC Ct\N V M �� ET UM ( L U • 14;�ti { �� vF may" '•'`' �� T � � r � �� .i'� ,' ';� �M *�' �' 1� s ter.�'fid .�� r. f v' '�bH]£iAd �• � ',...I 1�.,,� .. �� : ��. �«:��'.-;.� �5�r r � 3S kcr-c I Town of Barnstable $ Regulatory Services Department NAM a 200 Main Street,Hyannis MA 02601 � Mld APPLICATION FOR OUTSIDE DINING/SIDEWALK CAFE LOCATION Property Address: 435 Main Street, Hyannis, MA 02601 Name of Establishment:_PALI QPIZZERIA,,I NC.___— APPLICANTS NAME: Paul A. Mazzeo, President Phone# 508-771-7004 SEATING / � 1�J% FACILITIES/EOUIPMENT Total#of Seats Existing new establis #ofRestrooms Provided 2 Size of Grease Trap 1000 gallons Total#of Seats Proposed Air Curtains(Yes or No) No (Total means overall number o ' oo an outdoors) Hose Bib (Yes or No) No Screens (Yes or No) No Brief Description of Seating Arrangement,Type of Furniture Proposed,Hours of Operation,Projected Opening and Closing Dates Wood and brick frame building with 2 entrances and exits front entrance located on Main Street as well as rear access. The building is approximately 2,800 square feet with inside seati dining area for �� 5 31 nd an outside seating area of 9'10"x 48'with seating fo 16,2 restrooms kitchen and small office area. Annual operation from 11:30am to lam daily. Outside-dining tables and chairs to be of metal construction. I/we the undersigned certify that the above information which I/we provided is correct. I/we have read and fully understand the procedures as established by the Town of Barnstable in accordance with Chapter II, Article 8,Section 2 of the General Bylaws and the Board of Health Regulation#14,and further understand that failure to comply with said procedures may result in the immediate revocation of this permit. Signature of Applicant(s): Q . Date: 3+I JOS VV Paul A. Mazzeo, President Date:March 10,2005 IMPORTANT-PLEASE REMEMBER TO INCLUDE: X 3 Copies of the Neatly Drawn Sketch Plan of the Outside Dining Area Showing Separation Distances to Curbing,Trees,Rubbish Containers and any other Obstacles in Pedestrian Walkway X 3 Copies of Pictures of the Proposed Outside Dining Location(Front and Side Views) 2L— 1 Copy of the Menu THIS SEMON BELOW IS FOR OFFO&USE ONLY �� Town Manager Approval: Public Health Division: �i/=i-p�•� " s Licensing Board Approval: Certificate of Insurance: I I License Agreement: Comment �� l q 7 to� .,� -a BOARD OF HEALTH REGULATION,PART II,SECTION 1.00,#14,Requirements a through n (a) The applicant shall file a written request for outside dining or for an outside cafe on a form prescribed by the Town and shall submit plans of the proposed dining area. The seating capacity shall be determined by the Board of Health after a determination is made whether requirements"b"through"n" below will be met and after a visual inspection is conducted by an agent of the Board of Health. A replacement food establishment permit shall be issued by the Board of Health indicating`outside dining"is pe tted and listing the overall seating capacity,only after it is determined by an agent of the Board of H th that all of the requirements"a"through"n"of this Regulation#14 are met. (b) A menu shall be submitted to the Board at the time of application. (c) The dining area must be appurtenant and contiguous to the restaurant property. The dining area m be mentioned on the described premises as in the case of a Common Victualler's License. (d) Sufficient estrooms,both for customers and employees,must be furnished counting the additional outsid seating as required by the State Plumbing Code and Town of Barnstable Health regulations. (e) A grease trap shall be of sufficient capacity,based upon 15 gallons per seat,as required by the State Environmental Code,Title V,and Town of Barnstable Health Regulations. A grease recovery devi may be installed to supplement an existing inground grease trap,after receiving the approval of the BoaAd of Health. (f) All entrance and exit doors used b f :se"rvijcepsonnel and customers must be screenVandprovided with air curtains meeting National Sanotion standards. All windows or ope used for the transfer of food will be screened and provided with air curtains. Food cannot be store outside. All food must be prepared inside the facility's kitchen and kept inside until served (g) A drainage system designed to eliminate odors will be required for all outdoor dining areas. Hose bibs 'th vacuum breakers must be available for washing down the dining area. (h) Trash dumpsters shall be situated no closer than 50 feet from an outdoor dining area. If such a dumpster is in the line of sight from the dining area,it must be hidden from view. The area around the dumpster and stockade must be kept clean and free of litter. Dumpsters must be closed with adequate covers designed to prevent entrance of rodents and birds and sealed to control odors. (i) The patio or other ground surface must be of constructed of material readily cleanable and not sus tible to dust,mud,or debris. (Brick,tile,and concrete are examples of acceptable materials). (j) Table tops must be smooth,non-porous,easily cleanable and durable;and readily maintain a clean and sanitary condition. (k) Food service personnel must constantly police the dining area for waste paper,garbage and other trash. Placement clips,cup holders and other such devices must be utilized to prevent blowing paper. Covered trash receptacles must be provided in close proximity to the dining area and must be emptied needed to prevent overflowing. (1) Strict clean-up practices must be adhered to. Waitstaff and buspersons must clean up after each patron as in indoor dining. Each establishment must abide by all regulations contained in Article X, Minimum Sanitation Standards for Food Service Establishments,of the Commonwealth of Massach , Department of Health Sanitary Code. e�t� +r`S1rJ I Vr1reparation Outside food handlers must have easy access to handwash sinks and cleaning cloths. Facilities f and disposal of sanitizing solutions must be accessible. A (n) Hair nets or other effective hair restraints,such as hats covering exposed hair,shall be wom by all FOR MAIL-IN APPLICATIONS 1°0 '-' s outside food i f Q` t'Sl is or dank handlers. Beards and mustaches must be neatly trimmed. Please mail a completed application form to the address below. Please include: 3 Copies of the Neatly Drawn Sketch Plan of the Outside Dining Area Showing Separation Distances to Curbing,Trees,Rubbish Containers and any other Obstacles in Pedestrian Walkway 3 Copies of Pictures of the Proposed Outside Dining Location(Front and Side Views) 1 Copy of the Menu Our mailing address is: Town of Barnstable Public Health Division 200 Main Street Hyannis,MA 02601 FOR FAXED APPLICATIONS Our fax number is(508)790-6304. Please fax a completed application form. Please include: 3 Copies of the Neatly Drawn Sketch Plan of the Outside Dining Area Showing Separation Distances to Curbing,Trees,Rubbish Containers and any other Obstacles in Pedestrian Walkway 3 Copies of Pictures of the Proposed Outside Dining Location(Front and Side Views) 1 Copy of the Menu For ftuther assistance on any item above,call(508)862-4644 11— 3 1 Z 3 I .I , . I rl i 1 I - ILL pDKTICOo r i 1 �f- N - N L � --,— � i lI I �N TA s L G. �— It I Od TNI uo • I I , , I ---T- 3 w` 1 I I I I I I I � ► I I I or i j I N zQ I y I i I I 415- LYO i CIO cn T r F:- AVJN IN p _E 'B LAC 1� C T4V v 1 _ . T-. . _ M �Lr�c1c V�RoufT i rZa g i z \,B Cc- T �-E, WD C H P\t VS M F��.'�.'=X3' 'F' y` k •" 6 ,Bj "� � g 'TSB i?)�a �-Y G 7 v-t rr +� r3'�'� �� •� .. � �'� -.. • C � � t. x may: 5 F.4 i 5t x^ I:"ir - v �iL''•'a � �, 'EBB,,:. .3i`'�gy, ��1�' � � "' �x �.1 '4�h' •pt 77 I ,r F i$ 4 s i i 'ram• x':,i � ,. - - i . T I ILI I Elm 1 ml i� �.�_-. - -- _I"� •1C-�- ryas! �f 1 44fF5 1 r .�..'�!�.�Zt. q°�`.�t©r Vfx- �6 liy `:� ,•� ,� w y moo^' ��* - M nr _ 6 1 _ If r G � "!i I} t} y i y —J r :"�ar?.?�s? �W�,.J� _ -,x •£'� �;_`ix.f 'iS�a xs :� "`ti r.r."t.�.'^�„ x�' r- _ ri. a - - r i r� mmu E r �. it m L- Palio Pizzeria Menu: Pizza Salads Calzones Grinders Soft Drinks Sandwiches Beer & Wine Hour of operation 11:30AM — 1:OOAM - TA.., W;Y ONTAGtTE 01 Wemalifth B, Gas Pizza Ovens - Double Deck ;jAoNTA`. 23P-2 ,24P-2 and 25P.2 GENERAL. 23P-2 -- Double Oven,62"wide x 40-1/2"deep overall, (157.5 wide x 102.9 deep cm) overall. -Interior:8"high x 41-1/2"wide x 31"deep. (20.3 high x 105.4 wide x 78-7 deep cm), 24P-2 - Double Oven, 69"wide x 45-1/2"deep overall. (175.3 wide x 115,6 deep cm)overall, interior:8"high x 48-1/2"wide x 36"deep. (20.3 high x 123.2 wide x 91.4 deep cm) e-2 Double Oven, 81"wide x 45-1/2"deep overall. (205.7 wide x 115.6 deep cm)overall, Interior:8"high x 60-1/2"wide x 36"deep. (20.3.high x 153.7 wide x 91.4 deep cm) Two seperately controlled ovens, (stacked).Total overall height 73-3/8".(186.4 cm)Including the legs and the flue riser.Durable exterior construction - 16 gauge steel panels welded to a 1-1/4"x 1-1/4'x 1/8"(3.2 x 3.2 x.3 em)steel angle frame.Plus energy efficient and easy maintenance. Production Power with versatility.Designed for constant high volume pizza production but not limited to pizzas! Try baking casseroles,breads and other products on the optional fire brick hearths or steel deck.Maximum food 2SP-2 height: 7"(17.8 cm). Shown with standard S/S STANDARD FEATURES front and 12"(30.5 cm) legs. OVEN INTERIOR,, i Yt>72"(3.9 cm)Cordierite three-piece deck for hearth baking, SIDES, BACK AND TOP LINED WITH FIRE BRIG(for heat retention and quick recovery time, OVEN DOOR: cost.STANDARD FEATURES, -Drop-down type with aluminized steel interior door liner (cont.) Full width for easy access to entire hearth-Weight counter LEGS: balanced for a tight seal and smooth solid closing action. 12"(30.5 cm)high tubular legs with adjustable No springs to replace.Handle is one piece offset tubular- feet for leveling. type;nickel plated,cold roll. FINISH FIRE DOOR WITH CRUMB EJECTOR.- EXTERIOR: •Provides easy access to combustion chamber for manual Standard-Satin stainless steel front_ Remaining Ignition of constant burning pilot;burner adjustment and exterior black.All painted surfaces have electrolytic zinc easier cleaning. undercoating for corrosion protection and longer life. INSULATION: Optional:('extra cost): •Heat stable high temperature Fiberglas.Provides a thermal © *S/S left side ❑ •S/S right side ❑ 'S/S top blanket designed for high insulating efficiency;conserving ❑ back energy and providing a cooler atmosphere.Sides and Back, Notte:e:Ali black finish with stainless trim available. double layer,2"(5.1 cm)thick battens.Top,triple layer,2" OPTIONS,('extra cost) (5.1 cm)thick battens.Door, double layer, 1.1/2"(3.9 cm) ❑ OVEN INTERIOR battens. ❑ "Fire Brick Hearths CONTROLS: ❑ Steel Deck(for pan baking) •300°F(148"C)to 650•F(343°C)throttling type thermostat ❑ DOWN DRAFT DIVERTER, (in-lieu-of std_flue deflector). provides quick heat recovery;shuts off instantly at desired temperature;saves energy. 100%safety pilot for automatic Note;Used for direct flue connection, (in-lieu-af ventilation Ignition.Safety pilot shuts off gas flow if pilot light is hood), if local codes permit. Check codes for ventilation extinguished, requirements. 0'SIS ❑'Black BURNERS AND AIR MIXERS; ❑CUSTOM EXTERIOR DECORS. •Removable long life cast iron burners rated at 40,000 ❑.Consult factory BTU1HR each.Air mixers have adjustable air strutters with locking device. - ., .... .v :.�. ., ... Pizia 3 N �NTAGU E&N >< °�,� D Heavy Duty Pizza Ovens - Double Deck Dimensions in parenthesis are centimeters. 3/4' NPT 3-112' REAR GAS INLET Co.9) 2W-2 45-1/1 htS, �� "- ----_, O TOP VIEW z4A-2= �s-riz'crrs.61 23F-2 s.0- /z"rtOz.9J Y( e C 3-7/8 O • 0 1 C i p r 3/4 O (a•4) . 1 1 9" __ _ _ t22.9r ---------------r -� 25P-2 = 81"(205.7) 26-5/8 24F-2 = S9"t175.37 (67.6) 23p-2 s 62'(157.5) 26-1 25P-2 - 29'(73.7) C67.5) 231t58.4) --- -----, -- 65-5/B' 1 7-3/4'(r9.7) Ct66.7) -------------- ' 32 3/8 ---- , 23-7/8" -~ (82.2) o (30...) SIDE VIEW ---- -------- , Q Type Gas: Nab al Propane InLmrlor Pizza --� - dimensions capacity C99 1) per deck per de Model # Total; Total FRONT VIEW Sumers Btu/Hr Btumir H - w �2 or 18" IMPORTANT:' z3P-2 4 160.000 160,000 8"x 31"x 41-1/2" 6 ea. 2 ea Commercial Ovens must be installed in accordance with local Zap-2 s 220,090 320,000 8"x 36"x 48-1I2" 8 ea 4 ea. codes,with the National Fuel Gas Code,ANSI Z223.1,Natural 26P-2 B 30,OD 0,000• 6"x 36"x 60-112" 10 ea. 6 ee. Gas Installation Code,CAN/CQA-B149.1,or the propane GAS INLET SIZE(for all models): anceInstallwith codes is the responsibilityation Code ,of the Oappllwner a dohs ailer. One 3/4'(1.9 cm)NPT at right rear. Two 3/4"(1.9 cm)NPT gas pressure regulator is provided,Regulators must be Adequate Ventilef on System required.Refer to NFPA 06,Standard installed when appliance is connected to gas supply, for Ventilation Control and Fire Protection of Commercial Cooling Opbonal,•(e)dm cost):Operations. O Manifold assembly for single 314"(1.9 cm)NPT gas inlet. Minimum Clearances: Combustible NoncornbustibW NOTE: Specify type of gas ONaturat OPropane construction Construction Specify elevation it in6jalling above 2000 feet. Back Wait, 3" 3'' ENTRY CLEARANCE (23P-2,24P-2,25P-2) Left a Right Side: 1" o" All........27'(68.6 cm)uncrated With I legs:Sue for ku"llation on combustible floors. APPROX.CU.FT/CU.METER: SHIPPING WEIGHTS: 23P.2 Oven(2)carton: 51/1." 825 IbsJ375 kg. AGA and CGA Design Codified;In accordance with ANSI Top Fire Brick(2)carton: 510.14 130 IbsJ59 k�q. Z83.11 •CGA 1.8 Food Service Equipment-Ranges. Total: 112/3.17 1912 IbsJ867 kg. Note:These appliarices are Intended for commercial use 24P-2 Oven(2)carton: 64/1.81 1130 lbsJ513 kg. by professionally trained personnel. NOT intanded For Top Fire Brick(2)carton: 5/0,14 150 Ibs.l68 kg. Household Use Total: 138/3.91 2560 IbsJ1161 kg. 25P-2 Oven(2)carton: 82/2.32 1560 Ibs./708 kg. r Top Fire Brick(2)carton: 5/0.14 190 lbs./86 kg. Total: 174/4.93 3500 IbsJ1588 kg __., THE MONTAGUE COMPANY Montague's continuing commitment to qua/ity/product 1830 Stearman Avenue, P.O.Box 4954 Improvement can cause specification and design �tA�T�Cv Hayward,CA 94540-4964 changes without prior notice.. • Telephone: 800/346-1830 FAX:510l785.3342 Pizza 4 INA P; 0 Fj 3 _ O 1 s i Z o O O-I cl m El u b o r IN +E cou n TER ��11* JJ �y 17 ;z z `4 d, S a W 1q 1. I OF THE rp� DATE: ' + BARNSTA3LE, + FEE. V y MASS. q �A 16.39. f TFOMA,tA REC. BY Town of Barnstable SCHED. DATE: Board of Health Office: 508-*862-4644 200 Main Street, Hyannis MA 02601 FAX: 508-790-6304 Wayne A. Miller,M.D. Junichi Sawayanagi Paul J.CanniPf,D.M.D. LOCATION a�E' *ARIANCE REQUEST FORM — Property Address: Assessor's Map and Parcel Number: 30 Size — ;i Wetlands Within 300 Ft. Yes Business Name: ' P1ZL2rt No Subdivision Name: APPLICANT'S NAME 4k nn, Mcal e0 Phone rjQ W_771 _ 700 Ll Did the owner of the property authorize you to represent him or her? Yes —X_ No PROPERTY OWNER`S NAME CONTACT PERSON(� Name: I"Ol V 1 M a 7 Pn Name: Address:19 S 1' r s �} 9'1y R 0C.A, lJAr✓ilKddress: Phone:_ 7 7 1 - 7 O LI Phone: —_ VARIANCE FROM REGULATION(List R_o.) REASON FOR VARIANCE(May attach ifmore=space needed);;::: NATURE OF WORK: House Addition' ❑ House Renovation ❑ p ' Re air of Failed Sepfic System j Checklist (to be completed by office staff-person receiving variance request application) Please submit copies in 4 separate completed sets. a°� Four(4)copies of the completed variance request forth Four(4)copies of engineered plan submitted(e.g.septic system plans) Completed seven(7)page checklist confirming review of engineered septic system plan by submitting engineer or registered sanitarian Four(4)copies of labeled dimensional floor plans submitted(e.g.house plans or restaurant kitchen plans) Signed letter stating that the property owner authorized you to represent him/her for this request 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 variance requests only) Variance request application fee collected(no fee for lifeguard modification renewals,grease trap variance renewals[same owner/lessee only], outside dining variance renewals[same owner/leasee only],and variances to repair failed sewage disposal systems building proposed]) [only if no expansion to the Variance request submitted at least 15 days prior to meeting date VARIANCE APPROVED NOT APPROVED Wayne Miller,Chairman REASON FOR DISAPPROVAL Junichi Sawayanagi Paul J.Canniff,D.M.D. C:,\cache\Temporary Internet Fi1es\0LKAE\VARIREQ.D0C I THE FOLLOWING IS/ARE THE BEST IMAGES FROM POOR QUALITY ORIGINAL (S) I A , - m / LI DATA F THE r mow ; OFFICE OF THE BOARD OF HEALTH BgBA9T OF THE 9 MASM ' TOWN OF BARNSTABLE, MASS. MAY Ar• ...,,,, — -----___ 19 t05�_ AGE DISPOSAL PERMIT SEW Permission is granted to�'`� - r �. `SEWAGE k._ to construct Upon the Premises of —`-----------_—_ ` Sketch n the village of .. I 75 or—more feet from an sou~ art f Water _I 20 feet from building y ° supply 10 feet from property line f t H cer, s 8 6 1 investigate Primary Action Taken(1) Apparatus Personnel I I\till Property 82 (Notify other agencies. I Suppression L 0 J 0J tents_Additional Action Taken(2) Con EMS 1 I PRE-INCIDENT VALUE: optional Other �0� L o Property Additional Action Taken(3) I I ® •. ElCheck box if resource counts Include aid t received resources. Contents ! k Completed Modules H1 -Casualties ® None Hazardous Materials Release H3 7NN Property °1 Deaths Injuries Fire-2 FireN® None 'Structure-3 Service I n I n I 1 Natural gas: slow leak,no evacuation orHazMatactionsNNE] xed.rivilian Fire Cas.-4 L—=—J L=J 2 Propane gas: <21 lb•tank(as in home Be0grn) bly Use r r ❑ Education use Serv. Casualty- Civilian 0 I n I 3 Gasoline:vehicle fuel tank or portable container 133 ❑ II EKES-6 �� u Medical use 4 Kerosene:fuel burning equipment or portable storage '40 ❑ Resiential.use :uazM.at-7 Detector 5 ❑ Diesel fuel/fuel OII: vehicle fuel tank or portable storag 'S1 ® RQ.W of stores 1-Wildla'nd Fire-8 H2 6 [� Household solvents:Home/orfices ill cleanup on 553 ❑ En4lpsed mall 'i n. Required for confirmed fires. p P ry ❑ Busi f ess&residential Apparatus-9 7 Motor oil:from engine or portable container 59 P e rs o nn e 1-10 1 ❑'Detector alerted occupants 8 ❑ Paint:from paint cans totaling<55 gallons ❑ Oftice use., i 60 ❑ Inc�ustrial Use 2❑;Detector did not alert them 0 ❑ Other:Special Hazlvat actions required or spill>55 gal., it 63 (Vtary use. U❑I Unknown Please complete the HazMat form 65 ❑ Farm use: CO ❑ Ottter mixed use Property Use Structures 341 ❑ Clinic,Clinic Type infirmary 539 ❑ Hou ehold go cis sale; repairs 131 ❑ Church,place of worship 342 ❑ Doctor/dentist office J79 161 ❑ Restaurant or cafeteria ❑ Mot rvehiclel�atsal /repairs 361 ❑ Prison orjail,notjuvenile 571 1. 162 ❑ Bar/tavern orni nightclub ❑ Gas rservicestation ' g 419 ❑ 1-or 2-family dwelling 599 ❑ Bust ass office 213 ❑ Elementary school or kin dergart. 429 ❑ Multi-family dwelling 615 ❑ Electric generating plant 215 ❑ High school or junior high 439 ❑ Rooming/boarding house 629 ❑ Laboratory/science lab 241 ❑ College,adult ed. 449 [1Commercial hotel or motel 700 ❑ Manufacturing plant 311 ❑ Care facility for the aged 459 ❑ Residential,board and care 819 ❑ Livestock/poultry storage(barn) 331 Hospital 464 ❑ Dormitory/barracks 882 ❑ Non-residential parking gara e 519 [1 Food and beverage sales 891 g Outside ❑ Warehouse 124 ❑ Playground or park 936 ❑ Vacant lot 981 ❑ Construction site 655 ❑ Crops or orchard 938 ❑ Graded/cared for plot of land 984 ❑ Industrial plant yard .'669 ❑ Forest(timberland) 946 ❑ Lake,river,stream 807. ❑ Outdoor storage area 951 '❑ Railroad right of way ' 919 ❑ Dump or sanitary landfill 960 ❑ Other street Look up and enter a 931 ❑ Open land or field 961 El highway Property Use code only if Property Use 539 962 [1 Residential street/drivewayTC Property Us°e boxecked a !Household goods, sales,! 7990 - EXP 0, 101812007 HYANNIS FIRE DEPARTMENT - MFIRS REPORT PAGE 1 OF 2 _ No. to J /Q t Fe�100 . 00 THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes 3ppliration for Mi5po4a[ %p5tem Consgtrurtion Permit Application for a Permit to Construct( . )Repair( Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location 1 d�ess or Lot No. 7/ 7cr�/ Owner's Name,Address and Tel.No. 7 7 4-2 3 8-01 i3 6 h4art Mein Stree , Hyannis Palio Pizzeria Assessor's a /P ,30 U -t� PO Box 1 291 , Hyannis Installer's Name,Address,and Tel.No. 7 7 5-8 7 7 6 Designer's Name,Address and Tel.No. Wm E Robinson Sr Septic PO Box 1089, Centerville Type of Building: Dwelling No. of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No. of Persons Showers ( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) Install a grease trap ( 1 0 0 0 gal ) connected to town sewer. Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Env' onmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued by this B d ealth. Signed -Date, Application Approved by Date Application Disapproved for the following reasons Permit No. 7 5 Jlp Date Issued 3 �- 0'- 215 0 High school orjunior high Q9 U Rooming/boarding house 629 ❑ Laboratory/science lab 241 College,adult ed. 449 ❑ Commercial or motel 7pp ❑ Cll d il hotel ❑ Manufacturing plant 311 Care facility for the aged 459 ❑ Residential board and care p try storage(barn) ❑ tY g � 819 ❑ Livestock/ oul 331 ❑ Hospital ❑519 464 Dormitory/barracks 882 ❑ Non-residential parking garage ❑ Food and beverage sales 891 ❑ Warehouse Outside 124 Playground or,park 936 ❑ Vacant lot 981 ❑ Construction site ..655 Crops or orchard 938 ❑ Graded/cared for plot of land 984 El Industrial plant yard _ %669.,.❑ Forest(timberland) 946 ❑ Lake,river,stream y_; . 807. ❑ Outdoor storage area 951 ❑ Railroad right of way -� 919 ❑ Dump or sanitary landfill 960 ❑ Other street Look up and enter a 931 ❑ Open land or field 961 ❑ Highway/divided highway Property Use code only if Property Useyou have 53 9 ' 962 ❑ Residential street/driveway Property Use NOT checked a (Household goods, sales, %7. 0990 - EXP 0 10/8/2007 . ....-- ---- P.4(-,F 1 nF r 4 4 4 4 4 Door 4 4 4 4 Z 2 6 4 4 . 2 To Go Counter 6 Z Bar Moots 4 � 2 Z 4 Male Restroom PALIO PIZZERIA SEATING PROPOSAL Female 32 outdoor seats Restroom 32 indoor seats (booths) 18 indoor seats (chairs) 6 indoor stools (to go) ------------------------------------------------ Door 88 seats total 82 seats for patrons who are eating 4 4 4 08-29-11 Palio Pizzeria employees can use the male and female bathrooms in the Duckmobile office. The office is connected to Palio Pizzeria. The owner of Palio Pizzeria owns the entire building at 435-441 Main Street Hyannis. Jon Britton Owner, Duck Mobiles f s I KPALIO PIZZER BRICK4 ti 435 Main Street Hyannis 508-771-7004 APPETIZERS Pasta a Fagioli: Tomato based soup with Ditalini pasta and beans from Northern Italy. 4 Italian Wedding Soup: Chicken broth based soup with fresh green vegetables and mini homemade meatballs. 4 Ministrone Soup: Seasonal fresh green vegetable soup with Ditalini pasta. 4 Breadsticks: The house made breadsticks brushed with olive oil and garlic,then topped with. Mozzerella. 3.5 SALADS Antipasto: Sliced tomatoes, pitted Kalamata olives,mozzarella,cucumbers, roasted red peppers, Italian meats, provolone and extra virgin olive oil. 7 Arugula Insalata: Baby arugula,tomatoes,shaved Parmesan and balsamic vinaigrette. 7 Caesar: Crisp romaine,garlic croutons, Parmesan and Caesar dressing. 6 Greek: Crisp romaine,tomatoes, red onions, cucumbers, pepperoncini,feta cheese, Kalamata olives, parsley and Greek dressing. 7 House Garden: Crisp romaine,tomatoes,cucumbers,green peppers, red onions and Italian dressing. 6 Tomato & Homemade Mozzarella: Sliced tomatoes, mozzarella,extra virgin olive oil and basil. 6 BRICK OVEN GRINDERS Served with provolone or American cheese, lettuce,tomato,onion, pickles and potato chips. 7 Italian Grinder Imported Ham BLT Grinder Roasted Turkey Italian Roast Beef Veggie Grinder PAL1O HOT GRINDERS All grinders come with potato chips. 7.5 Homemade Meatball Chicken Parmigiana Homemade Italian Sausage Meatball and Sausage PANINI All made on rosemary foccacia bread and served with chips. 7 Chicken Pesto: Homemade pesto sauce,grilled chicken,fresh mozzarella cheese Italian: Italian cold cuts,extra virgin olive oil, roasted red peppers,fresh mozzarella and provolone cheese Pesto and Portabella: Roasted portabella mushrooms, roasted red peppers, homemade pesto sauce, provolone cheese Grilled Chicken: Grilled chicken,mayo, roasted mushrooms,sliced tomatoes, basil and provolone cheese. Roasted Eggplant: Extra virgin olive oil, roasted eggplant, red onions, roasted red peppers and provolone cheese. 1 SPECIALTY PIZZA AND CALZONES 14"Regular: 15 18" Family: 20 Broccoli Rabe: Fresh minced garlic, mozzarella cheese,broccoli rabe&fennel sausage. Margherita: Fresh mozzarella cheese, garlic and fresh basil& sliced tomatoes. White Veggie: Caramelized onions, roasted red peppers&artichoke hearts. BBQ Chicken: Chicken, BBQ sauce and caramelized onions. Cape Codder: Mozzarella cheese,shrimp, clams,fresh garlic and lemon. Buffalo Chicken: Grilled chicken marinated in Palio's hot sauce and blue cheese on the side. Quattro Funghi: Mozzarella cheese topped with oyster,shitake, portabella&crimini mushrooms. Polio Pepper: Italian chicken, ricotta cheese and roasted red peppers. Arugula:Fresh minced garlic and mozzarella cheese, baked, topped with Baby Arugula Insalata. Polio Pesto: Pesto,chicken,fresh garlic&caramelized onions. CREATE YOUR OWIN 14" Regular: 10 Toppings: 2 18"Family: 14.5 Toppings: 2.5 Cheese Meats Veeeies Fresh Mozzarella Anchovies Artichoke Hearts Ricotta Bacon Caramelized Onions Feta Canadian Bacon Fresh Basil Ham Black Olives Italian Chicken Green Peppers Other Linguica Jalapenos Crushed Garlic Meatball Mushrooms Pineapple Pepperoni Onions Prosciutto Roasted Broccoli Sausage Roasted Eggplant Roasted Red Peppers Spinach Tomatoes PIZZA BY THE SLICE Cheese 3.04 Pepperoni 3.27 Slice of the Day 3.27 ITALIAN PASTA Meatballs: Homemade meatballs and sauce,with linguini or ziti,topped with Parmigiano-Reggianno. 7 Pesto: Homemade pesto sauce,with your choice of linguini or ziti,topped with Parmigiano-Reggianno.7 Lasagna: Ricotta cheese, parmesan cheese, mozzarella cheese,tomato meat sauce, pasta. 7 DRINKS Fountain Soda: Pepsi, Diet Pepsi, Mountain Dew,Sierra Mist, Root Beer, Pink Lemonade. 2 Bottled Drinks: San Pellegrino, Poland Springs water, Motts Apple Juice,Orange Juice. (prices vary) Bottle Beer: Domestic 3.5 Import 4.5 Draft Beer: Budweiser 4 Specialty 4.5 Pitcher of Beer: Budweiser 12 Specialty 13.5 Italian Wines: Our wine selections change seasonally. Glass 5 Bottle 20 Dine In —Delivery —To Go 435 Main Street Hyannis 508-771-7004 1 No. a �f 0& c Fed 1 0 0.0 0 THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS 2ppliCotion for ]3i$poga1 *potem Construction Permit Application for a Permit to Construct( . )Repair( yj Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Aye ss or Lot No. 7c q Owner's Name,Address and Tel.No. 7 7 4—2 3 8—01 3 6 4 � Palio Pizzeria Assessor's a�IP�rc in Street, Hyannis �j a PO Box 1 291 , Hyannis 3p-� Installer's Name,Address,and Tel.No. 7 7 5—8 7 7 6 Designer's Name,Address and Tel.No. Wm E Robinson Sr Septic PO Box 1.089, Centerville Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other 'lope of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) Install a grease trap (1 0 0 0 gal) _ connected to town sewer. Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with.the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued by this B d o ealth. Signed -Date Application Approved by - Date Application Disapproved for the following reasons Permit No. ''e-4m '�!p Date Issued �' ®' Fegi 00.00 THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS t 01pprication for Zigponl 6potem Construction Permit Application for a Permit to Construct( . )Repair( X)Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location ffges5 or Lot No. ?7 7Gb4/ Owner's Name,Address and Tel.No. 774--238-0136 Assessor ,,Mrcelin street, Hyannis Palio Pizzeria 30 9 go PO Box 1291 , Hyannis Installer's Name,Address,and Tel.No. 7 7 5—8 7 7 Designer's Name,Address and Tel.No. ' Wm E Robinson Sr Septic PO Box 1089, . Centervi.11e Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures E Design Flow gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title f Size of Septic Tank Type of S.A.S. Description of Soil ,1 Nature of Repairs or Alterations(Answer when applicable) Install a grease trap (1000 gal) connected to town seer. Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with,the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued by this d i Health. Q Signe Application Approved by Date ZID. US Application Disapproved for the following reasons 'f l Permit No. c3 > 5 U Date Issued 3 THE COMMONWEALTH OF MASSACHUSETTS t_ Palio Pizzeria BARNSTABLE, MASSACHUSETTS _w Certificate of Compliance THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed ( )Repaired (Y )Upgraded( ) Abandoned( )by Wm E Robinson Sr Septic at 435 Main Street, Hyannis has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. dated Installer Designe The issuance of this pe t sh A not be construed as a guarantee that he system wall functi n as designed. Date �� Inspecto�, `. ry _a►-- No. rTE-�`� rJ ———————————————————————— - _ _ Feel 0 0 00 Palio Pizzeria THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS liopozar *potem Con5tructiou hermit Permission is hereby granted to Construct( )Repair(X )Upgrade( )Abandon( ) System located at 435 Main .Street, Hyannis _ and as described in the above Application for Disposal System Construction Permit. The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Constru tion-�mu t be completed within three years of the dat of this' o� Date: Approved by THE FOLLOWING i IS/ARE THE BEST IMAGES FROM POOR QUALITY ORIGINALS) m A , I / �C(�'-J L DATA r I Not OF TH E TO OFFICE OF THE BOARD OF HEALTH OF THE I o BAB89TA13LE, o° TOWN OF BARNSTABLE, MASS. q MASS. 4pA 1639. ,bQr� ; . , .. --- -- - --------- 19 h MP►Y&- SEWAGE DISPOSAL PERMIT Permission is granted to' 1-------------------f �^ � to construct __------------------------------------- Upon the Premises of Sketch In the village of -- 75 or more feet from any soui6 of water supply - 20 feet from building 10 feet from property line 1 tJ' ,ry fiee4h-094eer. per, �1itE DATE: Town of Barnstable $95.00 FEE � � • �nRr►arnstE, ` NA M Board of Health REEC.BY: 200 Main Street, Hyannis MA 02601 SCHED.DATE: Office: 508-862.4644 John T.Norman FAX: 508-790-6304 Donald A.Guadagnoli,M.D. F.P.(Thomas)Lee Dan Luckowz,D.M.,Alternate VARIANCE REQUEST FORM LOCATION Property Address: 2 p �: 6tA nis Assessor's Map and Parcel Number: 3 0 b `0 90 Size of Lot: Wetlands Within 300 Ft. Business Name: PA-LI o PAZye tyZ_t+ Subdivision Name: APPLICANT'S NAME: 0 f O PaC..Phone Did the owner of the grope authorize you to relfresent&m or her? Yes No PROPERTY OWNER'S NAME CONTACT PERSON Name: Name: LO Address: Address: 115- Mau R.tjnjr OZ,06, Phone: Phone: 7 EMAIL: VARIANCE FROM REGULATION pncl.Re&Code a) REASON FOR VARIANCE(May attach sep4ate sheet if more space ne ed) �b 4t NATU OF O t�K:H e Addition House Renovation U Repair of Failed Septic System Checklist (to be completed by office staff-person receiving variance request application) Please submit first four on list as S collated packets. A. Five(5)copies of the completed variance request form B. Five(5)copies of MA DEP approval letters for Innovative/Alternative septic system(when proposing an I/A system or secondary treatment unit(S.T.U.). C. Five(5)hard copies of engineered plan submitted(e.g.septic system plans)and one(1)electronic version submitted to email: healthna,town.bamstable.ma.us *(Pool Plan—5 hard copies) D.Five(5)copies of labeled dimensional floor plans submitted(e.g.house plans or restaurant kitchen plans)and one(1)electronic version. A completed seven(7)page checklist confirming review of engineered septic system plan by submitting engineer or R.S. Signed letter stating that the property or business owner authorized you to represent him/her for this request Applicant must notify abutters 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—Five(5)copies of full menu submitted(for grease trap variance requests only). Fee Submitted*$95.00 for the following variances: 1) New construction, 2) Septic repairs with increase in flows, and 3)New owner/new lessee applying for food, pool or body art variances. Exemptions from Variance Fee: 1) Septic repair without an increase in flow and variances granted at the counter,2)Monitoring Plans,and 3)Temporary Food(not a"variance"). Variance request submitted at least 15 days prior to meeting date VARIANCE APPROVED John T.Norman NOT APPROVED Donald A.Guadagnoli,M.D. REASON FOR DISAPPROVAL Paul J.Canniff,D.M.D. C:\Users\bellaird\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\NYXFBPRB\VARIREQ Rev Sep 2 2020.docx wk, -4 P For Office Us lv; : .°�'"` ►.$ Town of Barnstable �- 1I I itials i 1 1 Inspectional Services$ p �',�• Public Health Division Chgck# �� 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 12/21/21 NEW OWNERSHIP_X RENEWAL NAME OF FOOD ESTABLISHMENT. Palio Pizzeria ADDRESS OF FOOD ESTABLISHMENT: 435 Main St, Hyannis MA 02601 MAILING ADDRESS(IF DIFFERENT FROM ABOVE): PO Box 201, Hyannis, MA 02601 E-MAIL ADDRESS: Paulo@kandykomer.com TELEPHONE NUMBER OF FOOD ESTABLISHMENT: 5( 08 ) 771 - 5313 TOTAL NUMBER OF BATHROOMS: 2 WELL WATER:YES NO,X ...(ANNUAL WATER ANALYSIS REQUIRED) ANNUAL: X SEASONAL: DATES OF OPERATION:_/ / TO NUMBER OF SEATS: INSIDE: 56 OUTSIDE: 32 TOTAL: 88 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? no IS AN AIR CURTAIN PROVIDED AT WAITSTAFF SERVICE DOOR(S)? no 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 508-8624644 Q:\Application ForinsTOODAPP REV3-2019.doc OWNER INFORMATION: FULL NAME OF APPLICANT Paulo Paraguay SOLE OWNER: YES/ O OWNER PHONE# 774-836-6432 ADDRESS 21 LIBERTY LANE, MARSTONS MILLS_ MA 02648 CORPORATE OWNER: CORPORATE ADDRESS: PERSON IN CHARGE OF DAILY OPERATIONS: Paulo Paraguay 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.Paulo Paraguay 3 / 1 /2026 1. Paulo Paraguay / 11 / 23 2. Jeniffer Lechenchem 12 / 19 / 2024 GNATURE O APPLIC T DATE ***FOOD POLICY INFORMATION*** SEASONAL FOOD SERVICE:All seasonal food establishments,including mobile trucks must be inspected by the Health Div. urior to onenine!! 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 httn://www.townoibarnstable.us/bealthdivision/annlications asp. OUTDOOR COOKING: Outdoor cooking,preparation,or display of any food product by a food establishment is prohibited. NOTICE: Permits run annually from January 1st to Dec.31s'each calendar year. IT IS YOUR RESPONSIBILITY TO RETURN THE COMPLETED APPLICATIONS)AND REQUIRED FEES BY DEC 1st. Q\Application FonnsTOODAPP REV3-2019.doc f2evksed %Pe.2.-rM r Town of Barnstable BOARD OF HEALTH 1 John T.Norman I 1 Board of Health Donald A.Gaudagnoli,M.D. RAILNSI'A66&I-�I F.P. Thomas,Lee MA4a / �` �� ` Daniel Luczkow,M.D.,Alt. �bxa� 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: 834 Issue Date: 01/01/2022 DBA: PALIO PIZZERIA, INC. -TEMPORARY FOOD PERMIT OWNER: PALIO P INC Location of Establishment: 435 MAIN STREET HYANNIS MA 02601 Type of Business Permit: FOOD SERVICE Annual: YES Seasonal: IndoorSeating: 56 OutdoorSeating: 0 Total Seating: 56 FEES FOOD SERVICE ESTABLISHMENT: $300.00 YEAR. 2022 RETAIL FOOD: COTTAGE FOOD OPERATION: Permit Expires: 04/30/2022 B&B-FULL BREAKFAST: CONTINENTAL BREAKFAST: MOBILE-FOOD: MOBILE-ICE CREAM: ' 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: TM-Approved for TCS Food -Pizza may be left out at room temperature for a maximum of 2 hours. f ' q3.� Haih 31 FT DOOR 4 4 4 4 2 2 2 2 4, tz 4. N 4 6 2 4 PAUO PIZZERIA SEATING PROPOSAL SODA FOUNTAIN STATION 32 INDOOR SEAT(BOOTHS) 18INDOOR SEATS(CHAIRS) 56 SEATS TOTAL I DOOR / MEN'S BATHROOM TO GO COUNTER BARSTOOLS ✓ 6 COUNTER PIZZA TABLE PIZZA UNIT LREG 2 BEER TAP REG 1 MOP/CHEMICAL STORAGE ROOM DOUGH TABLE z LADIES BATHROOM 0 a N m F SINK F- OVENS OVENS Li Hot Plate N COKE co 4 FURNACE SINK WALL WALL Grease TrapDISH ICE 3 BAY SINK t7 IWASHER ICE h a o; O CAN CART DOOR WALK-IN REFRIGERATOR FREEZER TABLE MIXER STORAGE RACK Palio P Inc Palio Pizzeria 435 Main Street Hyannis, MA 02601 December 21, 2021 Town of Barnstable Board of Health Division, Procedure for pizza slices. • Pizza shall be kept at room temperature for slices of pizza. The time help at room temperature shall not exceed 2 hours. • Food will clearly be marked with a "discard time that is two hours past the point of removal from the pizza oven. • The food shall be cooked and served, ready-to-eat or discarded within two hours from the point time the food is removed from the temperature control. • Any food in unmarked containers or packages or marked to exceed a two hour limit shall be discarded • The TPHC variance decision statement shall not be posted immediately adjacent to and /or included onto the food establishment permit, in a location which is easily viewable by health inspector during inspections. Paulo Paraguay Owner Palio P Inc THE COMMONWEALTH OF MASSACHUSETTS Entered in computer. PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS Yes fipfication for 30iopolal Opotem Conotruttion Permit Application for a Permit to Construct( . )Repair( )0 Upgrade( )Abandon( ) O Complete System O Individual Components Location s or Lot No. 7 Owner's �� / 7GN4 s Name,Address and Tel.No. 774-238-0136 Assessor' 'min .Stree , Hyannis Palio Pizzeria G& !>�Cy PO Box 1291 , Hyannis Installer's Name,Address,and Tel.No. 7 7 5—8 7 7 6 Designer's Name,Address and Tel.No. Wm E Robinson Sr Septic PO Box 1.089, Centerville Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design.Flow gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title . Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) Install a grease trap (1000 gal) connected to town sewer. Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Env onmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued by this d ealth. Signed Dat Application Approved by Date Application Disapproved for the following reasons Permit No. " .5 — d FrDate Issued �v THE COMMONWEALTH OF MASSACHUSETTS 1 Palio Pizzeria BARNSTABLE, MASSACHUSETTS Certificate of (COMO[,"arice THIS IS TO CERTIFY,that the On-site Sewagge Dispposal System Constructed( )Repaired )Upgraded( ) Abandoned(( )by Wm E Robinson Sr :Septic at 43-5 Main Street, Hyannis i has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. dated , � i Installer : Design. The issuance of this pe t not be construed as a guar_antee that a system 1 r ti n as designed. Date Inspector PALIO PIZZERU BRICK OVEN PIZZA 435 Main Street Hyannis 508-771-7004 APPETIZERS Pasta a Fagioli: Tomato based soup with Ditalini pasta and beans from Northern Italy. 4 Italian Wedding Soup: Chicken broth based soup with fresh green vegetables and mini homemade meatballs. 4 Ministrone Soup: Seasonal fresh green vegetable soup with Ditalini pasta. 4 Breadsticks: The house made breadsticks brushed with olive oil.and garlic,then topped with Mozzerelle. 3.5 SALADS Antipasto: Sliced tomatoes,pitted Kalamata olives,mozzarella,cucumbers, roasted red peppers,Italian meats, provolone and extra virgin olive oil. 7 Arugula Insalata: Baby arugula,tomatoes,shaved Parmesan and balsamic vinaigrette. 7 Caesar: Crisp romaine,garlic croutons, Parmesan and Caesar dressing. 6 Greek: Crisp romaine,tomatoes,red onions,cucumbers,pepperoncini,feta cheese, Kalamata olives,parsley and Greek dressing. 7 House Garden: Crisp romaine,tomatoes,cucumbers,green peppers, red onions and Italian dressing. 6 Tomato & Homemade Mozzarella: Sliced tomatoes,mozzarella,extra virgin olive oil and basil. 6 BRICK OVEN GRINDERS Served with provolone or American cheese,lettuce,tomato,onion,pickles and potato chips. 7 Italian.Grinder Imported Ham BLT Grinder Roasted Turkey Italian Roast Beef Veggie Grinder PAL1O HOT GRINDERS All grinders come with potato chips. 7.5 Homemade Meatball Chicken Parmigiana Homemade Italian Sausage Meatball and Sausage PANINI All made on rosemary foccacia bread and served with chips. 7 Chicken Pesto: Homemade pesto sauce,grilled chicken,fresh mozzarella cheese Italian: Italian cold cuts,extra virgin olive oil,roasted red peppers,fresh mozzarella and provolone cheese Pesto and Portabella: Roasted portabella mushrooms,roasted red peppers, homemade pesto sauce, provolone cheese Grilled Chicken:Grilled chicken,mayo,roasted mushrooms,sliced tomatoes, basil and provolone cheese. Roasted Eggplant: Extra virgin olive oil,roasted eggplant,red onions, roasted red peppers and provolone cheese. SPECIALTY PIZZA AND CALZONES 14"Regular: 15 18"Family: 20 Broccoli Rabe:'Fresh minced garlic,mozzarella cheese,broccoli rabe&fennel sausage. Margherita: Fresh mozzarella cheese,garlic and fresh basil&sliced tomatoes. White Veggie: Caramelized onions,roasted red peppers&artichoke hearts. BBQ Chicken: Chicken,BBO sauce and caramelized onions. Cape Codder: Mozzarella cheese,shrimp,clams,fresh garlic and lemon. Buffalo Chicken: Grilled chicken marinated in Palio's hot sauce and blue cheese on the side. Quattro Funghi: Mozzarella cheese topped with oyster,shitake,portabella&crimini mushrooms. Polio Pepper: Italian chicken,ricotta cheese and roasted red peppers. Arugula:Fresh minced garlic and mozzarella cheese,baked,topped with Baby Arugula Insalata. Polio Pesto: Pesto,chicken,fresh garlic&caramelized onions. CREATE YOUR OWN 14"Regular: 10 Toppings: 2 18"Family: 14.5 Toppings: 2.5 Cheese Meats Velgrales Fresh Mozzarella Anchovies Artichoke Hearts Ricotta Bacon Caramelized Onions Feta Canadian Bacon Fresh Basil Ham Black Olives Italian Chicken Green Peppers Caller Linguica Jalapenos Crushed Garlic Meatball Mushrooms Pineapple Pepperoni Onions Prosciutto Roasted Broccoli Sausage Roasted Eggplant Roasted Red Peppers Spinach Tomatoes PIZZA BY THE SLICE Cheese 3.04 Pepperoni 3.27 Slice of the Day 3.27 ITALIAN PASTA Meatballs: Homemade meatballs and sauce,with linguini or ziti,topped with Parmigiano-Reggianno. 7 Pesto: Homemade pesto sauce,with your choice of linguini or ziti,topped with Parmigiano-Reggianno.7 Lasagna: Ricotta cheese,parmesan cheese,mozzarella cheese,tomato meat sauce,pasta. 7 DRINKS Fountain Soda: Pepsi, Diet Pepsi,Mountain Dew,Sierra Mist,Root Beer,Pink Lemonade. 2 Bottled Drinks: San Pellegrino,Poland Springs water,Motts Apple Juice,Orange Juice. (prices vary) Bottle Beer: Domestic 3.5 Import 4.5 Draft Beer: Budweiser 4 Specialty 4.5 Pitcher of Beer: Budweiser 12 . Specialty 13.5 I Italian Wines: Our wine selections Bottle change seasonally. Glass 5 g y e 20 Dine in —Delivery —To Go 435 Main Street Hyannis 508-771-7004 Town of Barnstable BOARD OF HEALTH John T.Norman • Board of Health Donald A.Gaudagnoli,M.D. MAW _ F.P.(Thomas)Lee,. 200 Main Street, Hyannis, MA 02601 Phone:(508)862-4644 Fax: (508)790-6304 www.townofbarnstablems 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: 834 Issue Date: 01/01/2022 DBA: PALICI PIZZERIA, INC. OWNER: PALIO PIZZERIA INC Location of Establishment: 435 MAIN STREET HYANNIS„ MA 02601 Type of Business Permit: FOOD SERVICE Annual: YES Seasonal: IndoorSeating: 56 Outdoor5eating: 32 Total Seating: 88� FEES FOOD SERVICE ESTABLISHMENT: $300.00 YEAR. 2022 RETAIL FOOD: COTTAGE FOOD OPERATION: Permit Expires: 12/31/2022 B&B-FULL BREAKFAST: CONTINENTAL BREAKFAST: MOBILE-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: TM-Approved for TCS Food -Pizza may be left out at room temperature for a maximum of 2 hours. i