HomeMy WebLinkAboutPERRY LIMA CAFE - FOOD Perry Lima Cafe
573 Main Street
Hyannis
i
FORMERLY: HOMEMADE SAUSAGE
OpSNk> Town of Barnstable BOARD OF HEALTH
John T.Norman
Board of Health Donald A.Gaudagnoli,M.D.
BAWNSTAB F.P.(Thomas)Lee
MASS Daniel Luczkow,M.D.,Alt.
200 Main Street, Hyannis, MA 02601
Phone: (508) 862-4644 Fax: (508)790-6304
www.towndbarnstable.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: 1065 Issue Date: 05/20/2022
DBA: PERRY LIMA CAFE
OWNER: FABIO LIMA
Location of Establishment: 573 MAIN STREET HYANNIS MA 02601
Type of Business Permit: FOOD SERVICE
Annual: YES Seasonal:
IndoorSeating: 51 OutdoorSeating: 36 Total Seating: 87
FEES
FOOD SERVICE ESTABLISHMENT: $300.00 YEAR. 2022
RETAIL FOOD:
COTTAGE FOOD OPERATION: Permit Expires: 12/31/2022
B&B-FULL BREAKFAST:
CONTINENTAL BREAKFAST:
MOBILE- FOOD:
MOBILE- ICE CREAM: Q�
FROZEN DESSERT: Thomas A. McKean, RS, CHO, Health Agent
FOR ESTABLISHMENTS WITH SEATING:
PERMIT IS NOT VALID UNLESS ISSUED IN CONJUNCTION WITH A COMMON VICTUALER LICENSE
Restrictions:
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CUSTOMER SUBURBAN SUPPLY
P.O. Box 2606 44899
SERVICE / SURVEY Westwood, MA 02090
(781)449-1042
ACCOUNT i M 7-ime: Date: s�l� Z
Address: a1a �QV` 0/ Machine: Model:
yet(/
Tel#: () Attention: Location:
(CHECK ONE) ROUTINE CALL:& )NIGHT CALL:( )WEEKEND CALL:( )EMERGENCY SERVICE:( )
Operating Charts PreScraping Cleaning Equipment
Use of Equipment Racking Silver PreSoaking
Changing Tank Water Cleaning Scrap Screen
ITEMS Good TITRATION OK OK OK
I Dishes 8 Pre Wash Temp 15 Fill Valves 1221 Pumps
2 Glasses 9 Wash Temp 16 Wash Tank Arms 1231 Rinse Period
3 Silver 10 Rinse Tank Temp 17 Rinse Tank Arms 24 Racking
4 Pot/Pan 11 Final Rinse Temp 18 Final Rinse 25 Scraping
5 Sanitation 12 Final Rinse PSI 19 Rinse Valves 26 Curtains
6 Floors 13 Machine Sanitizer 20 Overflow 27 Water Softener
7 Meter Read 41 By Pass/Gal Min 121 Drains 28 Racks
CUSTOMER
SIGNATURE: REP.: 6' C APPROVED: _
NSE SANITIZER SILVENPRE. POT/PAN SANYPOT DELIMER FLOOR DRAIN 01'ENIGRILL HAND SOAP LAUNDRY MISC PROD.
PRODUCT:
STOCK
ON HAND:
ORDER:
ZZZZZZZZZZZZ71
PARTS l EQUIPMENT ORDERED/INSTALLED
QUANTITY QUANTITY
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oF�E r� Town of Barnstable 6V � ��
Regulatory Services Department ��/i��//,-�D is
* BA LE,MAS&
9$ 639 `0g 200 Main Street,Hyannis MA 02601
APPLICATION FOR OUTSIDE DINING/ SIDEWALK CAFE
LOCATION h q ^ U
Property Address: �'��EC`� fl�I�
Name of Establishment: G � ��ca VIE
APPLICANTS NAME: �bl0 �I� Phone# J�
SEATING Qn FACILITIES/EQUIPMENT
Total#of Seats Existing #of Restrooms Provided
Q Size of Grease Trap
Total#of Seats Proposed C1 Air Curtains(Yes or No)
(Total means overall number of seats indoors and outdoors) Hose Bib (Yes or No) t
IVV 5( 36
_ Screens (Yes or No)
Brief Description of Seating Arrangement,Type of Furniture Pro4--uB—JHours of Operation,Projected
Opening and Closing Dates .
I�Ny 36 sc-os Ivi _
I/we the undersigned certify that the above information which I/we provided is correct. Uwe have read and
fully understand the procedures as established by the Town of Barnstable in accordance with Chapter 11,
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): rVt Date:
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
THIS SECTION BELOW IS FOR OFFICIAL USE ONLY
Town Manager Approval: Public Health Division:
Licensing Board Approval: Certificate of Insurance:
License Agreement:
Comments:
w , Town of Barnstable BOARD OF HEALTH
John T.Norman
Board of Health Donald A.Gaudagnoli,M.D.
BAKNS ABUF, F.P.(Thomas)Lee,..
9 200 Main Street, Hyannis, MA 02601 Daniel Luczkow,M.D. Alt.
gaiax° 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: 1065 Issue Date: 01/01/2022
DBA: PERRY LIMA CAFE
OWNER: FABIO LIMA
Location of Establishment: 573 MAIN STREET HYANNIS„ MA 02601
Type of Business Permit: FOOD SERVICE
Annual: YES Seasonal:
IndoorSeating: 7 OutdoorSeating: 16 Total Seating: 23
FEES
FOOD SERVICE ESTABLISHMENT: $250.00 YEAR. 2022
RETAIL FOOD:
COTTAGE FOOD OPERATION: Permit Expires: 12/31/2022
B&B-FULL BREAKFAST:
CONTINENTAL BREAKFAST:
MOBILE-FOOD:
MOBILE-ICE CREAM': Q�
FROZEN DESSERT: Thomas A. McKean, IRS, CHO, Health Agent
I
FOR ESTABLISHMENTS WITH SEATING:
PERMIT IS NOT VALID UNLESS ISSUED IN CONJUNCTION WITH A COMMON VICTUALER LICENSE
Restrictions:
SHARED GREASE TRAP WITH 575 MAIN STREET: RESTRICTED TO 23 SEATS.
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i
For Offic Initials:
Town of Barnstable p
Date Paid t 21 "k Amt Ed$
: .wu WAlUX, : Inspectional Services
9 . Public Health Division
f 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 /02 NEW OWNERSHIP RENEWAL I
NAME OF FOOD ESTABLISHMENT: r - k1ma
ADDRESS OF FOOD ESTABLISHMENT: S N"
MAILING ADDRESS(IF DIFFERENT FROM ABOVE):
E-MAIL ADDRESS: L'Q' X
TELEPHONE NUMBER OF FOOD ESTABLISHMENT: i xiv ►6 ii - 1y6'2 ,x
TOTAL NUMBER OF BATHROOMS: og
WELL WATER:YES NO ...(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? ,5
IS AN AIR CURTAIN PROVIDED AT WAITSTAFF SERVICE DOOR 51
(S ?)
TYPE OF ESTABLISHMENT: (PLEASE CHECK ALL THAT APP9 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
I
OWNER INFORMATION:
FULL NAME OF APPLICANT Kam �.Pa nl 14�l p ryyA,
SOLE OWNER: ES NO D.O.B OWNER PHONE# 6gOk
ADDRESS L) (A-�LV-,O 6W I � - YIS S C
CORPORATE OWNER:
CORPORATE ADDRESS:
PERSON IN CHARGE OF DAILY OPERATIONS: �Gtb► 6 L 1w1ra
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. 1",o Lr.- - - //--- , Odo 14 Ti Yet n to /21 / zy,
2. ()�Ctb 4'52t�6 1(t�. �O t /aC g-LI
1�2- /L/c
SIGNATVRE 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 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 htti)://www.townofbarnstable.us/healthdivision/applications.asi).
OUTDOOR COOKING: Outdoor cooking,preparation,or display of any food product by a food establishment is prohibited.
NOTICE: Permits run annually from January 1 st to Dec.3V 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
�See6
r Town of Barnstable BOARD OF HEALTH
John T. Norman
Board of Health Donald A.Gaudagnoli,M.D.
BARNSTABLL Paul J.Canniff, D.M.D.
NASA. F.P. Thomas Lee Alternate
839 . 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: 1065 Issue Date: 03/24/2021
DBA: PERRY LIMA CAFE
OWNER: FABIO LIMA
Location of Establishment: 573 MAIN STREET HYANNIS, MA 02601
Type of Business Permit: FOOD SERVICE
Annual: YES Seasonal:
IncloorSeating: 7 OutcloorSeating: 0 Total Seating: 7
FEES
FOOD SERVICE ESTABLISHMENT: $250.00 YEAR. 2021
RETAIL FOOD:
COTTAGE FOOD OPERATION: Permit Expires: 12/31/2021
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:
SHARED GREASE TRAP WITH 575 MAIN STREET: RESTRICTED TO 23 SEATS.
i
r'
Town of Barnstable
BOARD OF HEALTH
John T.Norman
Board OIr Health L.l Donald A.Gaudagnoli,M.D.
aMtN8TA6u: Paul J.Canniff,D.M.D.
q ti 200 Main Street, Hyannis, MA 02601 F.P.(Thomas)Lee Alternate
¢o ' 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: 1065 Issue Date: 03/26/2021
DBA: PERRY LIMA CAFE
OWNER: FABIO LIMA
Location of Establishment: 573 MAIN STREET HYANNIS, MA 02601
Type of Business Permit: FOOD SERVICE
Annual: YES Seasonal:
IncloorSeating: 7 Outclool-Seating: 16 Total Seating: 23
FEES
FOOD SERVICE ESTABLISHMENT: $250.00 YEAR. 2021
RETAIL FOOD:
COTTAGE FOOD OPERATION: Permit Expires: 12/31/2021
B&B-FULL BREAKFAST:
CONTINENTAL BREAKFAST: - - - -- - -
MOBILE-FOOD:
MOBILE-ICE CREAM: Qn
FROZEN DESSERT: Thomas A. McKean, RS, CHO, Health Agent
FOR ESTABLISHMENTS WITH SEATING:
PERMIT IS NOT VALID UNLESS ISSUED IN CONJUNCTION WITH A COMMON VICTUALER LICENSE
Restrictions:
SHARED GREASE TRAP WITH 575 MAIN STREET: RESTRICTED TO 23 SEATS.
For Office Use
Town of Barnstable Only: Initials:
AID
Amt�$� ��+ (
11MMSCABLE. • Inspectional Services Date Paid O(
63 Public Health Division
Thomas McKean,Director .
200 Main Street,Hyannis, MA 02601
Office: 508-862-4644 Fax: 508-790-6304
APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT
DATE NEW OWNiERSHIP/ RENEWAL
NAME OF FOOD ESTABLISHMENT: ptrrt j — L,,t'yyln {.Q
ADDRESS OF FOOD ESTABLISHMENT: 6 3 hkn y"/
MAILING ADDRESS(IF DIFFERENT FROM ABOVE):
E-MAIL ADDRESS: ,.QY / 1
TELEPHONE NUMBER OF FOOD ESTABLISHMENT: �) -
1
TOTAL NUMBER OF BATHROOMS:
WELL WATER: YES/NO_ ... (ANNUAL WATER ANALYSIS REQUIRED)
ANNUAL:V" SEASONAL: DATES OF OPERATION:_/ /_ TO
NUMBER OF SEATS: INSIDE: --I-- OUTSIDE: o TOTAL: 2
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)? /UV
TYPE OF ESTABLISHMENT: (PLEASE CHECK ALL THAT APPLY.BELOW)
FOOD SERVICE
RETAIL FOOD-ONLY required for TCS foods(foods requiring refrigeration/freezer)
BED&BREAKFAST
CONTINENTAL BREAKFAST
COTTAGE FOOD INDUSTRY(formerly residential kitchen)
MOBILE FOOD
FROZEN DAIRY DESSERT MACHINES ... (MONTHLY LAB ANALYSIS REQUIRED)
CATERING ... (CATERING NOTICE REQUIRED BEFORE EVENT(SEE PAGE#2)
*** SEASONAL,MOBILE &NEW FOOD ONLY***
REQUIRED TO CALL HEALTH DIV.FOR INSPECTION PRIOR TO PERMIT BEING ISSUED
PLEASE CALL 508-862-4644
Q:\Application FormsTOODAPP 2020.doc
OWNER INFORMATION: r i n
FULL NAME OF APPLICANT fp�b'M U L( rna +- a I F2 i^ u
SOLE OWNER:6�'NO D.O.B OWNER PHONE#
ADDRESS () i L _Q�jL{ BSI BYLS I�( 1��MJT D26Q
CORPORATE OWNER:
CORPORATE ADDRESS:
PERSON IN CHARGE OF DAILY OPERATIONS: SA)j a Lima—
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
SIGWA'TU6 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 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 http://www.townofbarnstable.us/healthdivision/applications.asp.
OUTDOOR COOKING: Outdoor cooking,preparation,or display of any food product by a food establishment is prohibited.
NOTICE: Permits run annually from January I st to Dec.3 0 each calendar year. IT IS YOUR RESPONSIBILITY TO RETURN
THE COMPLETED APPLICATION(S)AND REQUIRED FEES BY DEC 1st.
i
Q:\Application FormsTOODAPP REV3-2019.doc
rist for the food permit
The bathrooms have a self close doors ,hand free sink
and meet all the requirements
The dumpster is not visible to the public and meet all
the requirements
Ne have a prep sink , a hand wash sink ,and also a
three bay sink and they all meet all the requirements
)ur closet is going to be use to put to go containers container and papper
3oods like bags etc
Ne have replaced the old fryers with 2 brand new: Vulcan 1VEG35M-1
4atural Gas 35-40 lb. Floor Fryer with Millivolt Controls - 70,000 BTU
the used oil will be picked up by
Me circles renewables
t ro
)hone number,, .:, ,._
'he Greese Trap will be pumped on Monday
1/1/21 at 8 am
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menu
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Eggs any stile
Served with home fries and toast
Breakfast sandwiches
•Egg and Cheese $3.99
*Add meat-linguisa patty, bacon or sausage (additional $2)
Breakfast BLT $8.99
Crispy bacon, lettuce & tomato topped with 2 eggs, cheddar cheese and a
spicy roasted jalapeno aioli
Corn Pancakes $9.99
A savory corn pancake, topped with slow roasted pork, topped with an egg,
corn salsa and drizzled with BBQ sauce
Pancakes and Waffles 7.99
Breakfast sandwiches
•Egg and Cheese $3.99
*Add meat-linguisa patty, bacon or sausage (additional $2)
Breakfast BLT $8.99
Crispy bacon, lettuce & tomato topped with 2 eggs, cheddar cheese and a
spicy roasted jalapeno aioli
Corn Pancakes $9.99
A savory corn pancake, topped with slow roasted pork, topped with an egg,
corn salsa and drizzled with BBQ sauce
Pancakes and Waffles 7.99
Toppings: Add $2
Banana Foster
Blueberries
Strawberries
Chocolate chips
Candied Walnuts
Homemade Corned Beef Hash $12.50
Served with Eggs,home fries and toast
Cape Verdean Jag $10.99
A traditional Cape Verdean rice made with linguisa and peas topped with
Eggs
2 Eggs (Any Style) $8.99
Served with home fries, your choice of meat (Bacon, sausage or linguisa
patty
Breakfast Burritos $7.99
Fluffy scrambled eggs and cheese served with home fries, sour cream and
salsa
Add additional toppings:
Onions, peppers, mushrooms, spinach, tomato, black beans, broccoli, pico
de galio or guacamole Add .50
Meats: Bacon, sausage, linguisa, steak, chicken Add $1.50
4,
Yq ui. ,oice of any cheese
American
Swiss
Mexican blend
Tropical French Toast $9.99
Thick cut French toast stuffed with caramelized pineapple, whipped cream
cheese and topped with toasted coconut
Carrot Cake Pancakes $9.99
Fluffy pancakes packed with carrots, topped with cream cheese frosting and
candied walnuts
Steak and Eggs $13.99
6 oz sirloin, served with eggs, home fries and toast
Build your Own!! "Charcuterie" Breakfast Board $30
Your choice of pancakes or waffles
3 toppings (chocolate chips, bananas foster, strawberries, blueberries,
candid walnuts, cream cheese frosting.
Bacon or sausage
Eggs (Any style)
Serves 3-4
Esfirras- Mediterranean Stuffed Pastry $2.50
Ground beef
Cheese
Chicken
Romeo and Juliet (Guava and Cheese)
Churros esfirra served with mini churros $5.99
Kibe $3.00
Fried croquettes with beef and bulger wheat and green olives.
X-Tudo (Brazilian Burger) $13.99
A 5oz beef patty topped with cheddar cheese, bacon, ham, fried egg,
lettuce, tomato, potato sticks, corn, Mayo and ketchup! Served with hand
cut fries
Tropeiro $10.99
Traditional Brazilian bean dish with linguiga, bacon, eggs, kale, pork, yuca
flour and chicharrones
Mexidao do Mineirao $12.99
Brazilian Fried rice with a variety of veggies and meat, topped with 2 eggs
Puerto Rican Pernil Plate $13.99
Slow roasted pork, served with rice, black beans, pineapple salsa, fried
tostones and a cilantro-garlic aioli
I
Traditional Brazilian Hot Dog $8.99
Topped with tomato meat sauce, corn, potato sticks, raisins, Parmesan
cheese, Mayo and ketchup
Served with hand cut fries
1Rw. e-,N $9.99
Homemade corned beef, sauerkraut, house made Thousand Island dressing,
Swiss cheese, on Grilled Marble Rye Served with hand cut fries
Lunch Burrito $7.99
12 Inch Tortilla stuffed with cheese, sour cream and salsa
Your choice of Toppings Add .50
Onions, peppers, mushrooms, spinach, tomatoes, rice, black beans,
jalapenos, pico de galio
Meats: Chicken, Steak, linguira Add $1.50
"Charcuterie" Churrasco Board $30
Sirloin and Linguiga
Rice and Beans
Choose Fried Yuca, fried tostones or hand cut fries
Served with Pico de galio
Serves 2
Charcuterie" Brazilian Desert Board $9.99
Fries bananas, Churros, Doce le leite and chocolate ganache dipping sauce,
Guava paste and cheese.
Kids Menu $4.99
Hot Dog
Cheeseburger
Chicken Fingers
All served with hand cut fries and drink
Perry-Limas "Big" Kids Plate $7.99 '� . .
Rice, beans, steak and hand cut fries
Town of Barnstable
* - 'Regulatory Services Department
ELAPPMABM
MASIL 200 Main Street,Hyannis MA 02601
1639.
APPLICATION FOR OUTSIDE DINING/SIDEWALK CAFE '
LOCATION cc /� /, c
J/
Property Address: �. { .M I N t �C �. ti/1 J
Name of Establishment:
APPLICANTS NAME: Fn h1c, L i R, . Phone# hod d '7 Q l
SEATING - FACILPTIES/•EQUIPMENT
Total#of Seats Existing #of Restrooms Provided
Size of Grease Trap
Total#of Seats Proposed Air Curtains(Yes or No), '-" ' t. C$'
(Total means overall number of seats indoors and outdoors) Hose�Bib (Yes or No)-
,- 7 4" 1/.. �y c�2 �s (Yes or No)
Brief Description of Seating Arrangement,Type of Furniture Proposed,Hours of Operation,Projected
Openin and Clos S ates CAAiT r �mAa V F ' i r
r
I/we the undersigned certify that the above information which Uwe provided is correct. I/we have read and
fully understand the procedures as established by the Town of Barnstable in accordance'with Chapter H,"
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. :i ". °?®a
Signature of Applicant(s): C5 ,Date: �"
Z i j Date: .
EMPORTANT-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
NIS SECTION BELOW IS FOR OFFICIAL USE ONLY `
Town Manager Approval: '` ' '' -' Public Health Division:
Licensing Board Approval: Certificaie of Insurance: '
License•Agreement: .•' ' .. '.. - r
Comments:
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
permitted and listing the overall seating capacity,only after it is determined by an agent of the Board of
H alth that all of the requirements"a"tbrough"n"of this Regulation#14 are met.
41 lip
(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
must be mentioned on the described premises as in the case of a Common Victualler's License. i
(d) 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.
(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
device may be installed to supplement an existing inground grease trap,after receiving the approval of the
Board of Health. '
(f) 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.-Alffood must be prepared inside the facility's kitchen and kept inside until served.- _
if,i . . 'i,.. j ; r.. . t 1.0 k. 'r'. . . �. ,t. _'i
(g) ., 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.
(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
dumpstei 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-4—
(i) - 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).
.0) Table tops must be smooth,non-porous,easily cleanable and durable;and readily maintained' 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 s
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 a s,
Department of Health Sanitary Code.
i
(m) Outside food handlers must have easy,access.to handwash sinks and cleaning cloths. Facilities,
for preparation and'dispo'sal of`sanitizing solutions must be accessible.
(n) Hair nets or other effective hair restraints,such as hats covering exposed hair,shall be worn by all
FOR MAIL-IN APPLICATIONS
outside food or drink 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 further assistance on any item above,call(508)8624W
To get an outside dining/sidewalk cafe application form, click
here. To be able to access this form, your computer must have
Acrobat Reader. Most computers have Acrobat Reader, and it will
usually activate itself automatically. If your computer does not have
Acrobat Reader, you can,download a copy of it by going to the Adobe
website. '
Back to Main Public Health Division Page
..ii,, {�
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McKenzie, Marybeth
From: Fabio Lima <fabinhoperrylima@gmail.com>
Sent: Friday, March 26, 2021 8:53 AM
To: McKenzie, Marybeth
Subject: Re:Application
• Speed: 2 Speed (1372.4-1511.4 CFM)
• Power:247-329 W
• Suitable Door Height: 137.8" (3.5m)
• Power Cord Length: 59"+71" (1.5+1.8m)
• Net Weight: 32 Ibs (14.5 kg)
• Product Dimensions: 35.4"x10.2"x10.6" (900x26Ox270mm)
On Fri, Mar 26, 2021 at 8:45 AM McKenzie, Marybeth<Marybeth.McKenziegtown.barnstable.ma.us>wrote:
You said in the application that you have an aircurtain. Did you install one? If you did where are the specifications?
From: Fabio Lima [ma i Ito:fabinhoperrylima@gmaiLcom]
Sent: Thursday, March 25, 2021 4:31 PM
To: McKenzie, Marybeth
Subject: Re: Application
Im opening this weekend
On Thu, Mar 25, 2021 at 4:24 PM McKenzie, Marybeth<Marybeth.McKenzie(c�r�,town.barnstable.ma.us>
wrote:
Yes, I have not reviewed it yet. I will try to get to it tomorrow morning.Are you open yet?
From: Fabio Lima [mailto:fa bin hoper[ylima@gmai1.com]
Sent: Thursday, March 25, 20212:38 PM
To: McKenzie, Marybeth
Subject: Application
Hello this is Fabio from Perrylima cafe
1
I dropped of the application yesterday for you .
Just wondering if you're received.
Thank you
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!
CAUTION:This email originated from outside of the Town of Barnstable! Do not click links, open
I ttachments or reply, unless you recognize the sender's email address and know the content is safe!
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!
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McKenzie, Marybeth
From: McKenzie, Marybeth
Sent: Wednesday, March 24, 2021 11:01 AM
,To: 'Fabio Lirna'
Subject: RE:
Hello Fabio,
did speak to Mitch Hodus about the seating and he said whatever the seating was approved for before will be the
seating that is allowed by them. I will be sending him an email too.The permit will be in the vestibule at 200 Main
Street for you to pick up, but I have not received your outside dining application yet so you will only be approved for the
seven inside seats at this time.
Thanks, Marybeth McKenzie R.S.
From: Fabio Lima fmai Ito:fa bin hoperrylima()gmail.com]
Sent: Wednesday, March 24, 2021 10:50 AM
To: McKenzie, Marybeth
Subject:
Hello marybeth this is Fabio from Perry Lima cafe
I spoke with my land lord and he said he addressed the seating with you .
Can I stop by and get my permit?
You can call me on 5082748771
Thank you
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!
i
oF.HE r TOWN OF BARNSTABLE HEALTH INSPECTOR'S Establishment Name: Date: Page: of .
". OFFICE HOURS
PUBLIC HEALTH DIVISION 8:00-9:30 A.M.
BARNSTABLE. • 200 MAIN STREET 3:30-4:30 P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified
�
2639. .0� HYANNIS,MA 02601 Mors.-FRI. No Reference- R-Red Item PLEASE PRINT CLEARLY -
prFD MP+°
FOOD ESTABLISHMENT INSPECTION REPORT 508-862-4644
Name Dat - e of Type of Inspection
Name Datz
era i s Routine
Address -Risk ervice Reins
Level Re P vlous Inspection
Telephone Residential Kitchen _.-.
Mobile Pre-ope
Owner HACCP YIN Temporary Suspect Illness
Caterer General Complaint
Person in Charge(PIC) Time Bed 8 Breakfast HACCP
In: Other
Inspector Out:
Each violation checked requires an explanation on the narrative page(s)and a citation of specific provision(sy)vi,�olaatte- �'lt
14
Violations Related to Foodborne Illness Interventions and Risk Factors(Red Items) Anti-Choking V" 59 ❑
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) ❑
'Le)
FOOD PROTECTION MANAGEMENT ❑ 12.Prevention of Contamination from Hands
❑ 1.PIC Assigned/Knowledgeable/Duties ❑ 13.Handwash Facilities `�I
EMPLOYEE HEALTH PROTECTION FROM CHEMICALS ti-
❑2.Reporting of Diseases by Food Employees and PIC ❑ 14.Approved Food or Color Additives
❑ 3.Personnel with Infectious Restricted/Excluded ❑ 15. Toxic Chemicals aA
FOOD FROM APPROVED SOURCE TIMEITEMPERATURE CONTROLS(Potentially Hazardous Foods) by i `
❑4.Food and Water from Approved Source ❑ 16.Cooking Temperatures ^
❑ 5.Receiving/Condition ❑ 17.Reheating (NZ♦
❑ 6.Tags/Records/Accuracy of Ingredient Statements ❑ 18.Cooling
❑ 7.Conformance with Approved Procedures/HACCP Plans ❑ 19.Hot and Cold Holding 1 91 of LAW
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
r--
❑ 10.Proper Adequate Handwashing CONSUMER ADVISORY VY
❑ 11.Good Hygienic Practices ❑22.Posting of Consumer Advisories
Violations Related to Good Retail Practices(Blue Items) Total Number of Critical Violations
Critical(C)violations marked must be corrected immediately. (blue&red items) Corrective Action Required: ❑ No ❑ Yes
Non-critical(N)violations must be corrected immediately or Overall Rating
within 90 days as determined by the Board of Health. ❑ Voluntary Compliance ❑ Employee Restriction/Exclusion ❑ Re-inspection Scheduled ❑ Emergency Suspension
C N Official Order for Correction: Based on an inspection today,the items
checked indicate violations of 105 CMR 590.000/Federal Food Code. ❑ Embargo ❑ Emergency Closure ❑ Voluntary Disposal ❑ Other:
23.Management and Personnel (FC-2)(590.003) This report,when signed below by a Board of Health member or its agent A=Zero critical violations and no more than 3 non-critical violations. F=3 or more critical violations.9 or more non-critical violations,
24.Food and Food Preparation (FC-3)(590.004) constitutes an order of the Board of Health. Failure to correct violations
25.Equipment and Utensils (FC-4)(590.005) cited in this report may result in suspension or revocation of the food 6=One critical violation and less than 4 non-critical violations regardless of the number of critical, results in an F.
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 0 non-critical violations=B. Seriously Critical Violation=F is scored automatically if: no hot
27.Physical Facility ) aggrieved y y g g q 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
Y y (FC-6)(590.007 a rieved b 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 8npn-critical violations. If 1 critical refrigeration.
29.Special Requirements (590.009) within 10 days of receipt of this order. violation,4 to 8 non-critical violations=C.
30.Other DATE OF RE-INSPECTION: Inspector's Signature Print:
31.Dumpster screened from public view
Permit Posted? y N Grease Trap Previous Pumping Date Grease Rendered Y N
#Seats Observed Frozen Dessert Machines: Outside Dining Y N P C's Print:
Self Service Wait Service Provided Grease Trap Size Variance Letter Posted Y N
Dumpster Screen Y N
�„ ,_.,.._...�,.�--..v:-..`.q--'�+i�,...w�..:?.+sr-�*.......-.-.�.-.+.'�J-'-`.rs�.-+r•-+_.-+...:.�:,w..a.....�--.......w« w•.-•...-..'•.`-...t^,.. .� ._..._. t •�.. ,-_ _. e•-r.-.--.�.�--.�-"*:�, _ �--. r-_ -e.-• -.�-..•w. �..�. ��.. • _. - -. .._...�-. �..'� . rsy r ,.-. '7«tr-r+-- :...;- ,
Violations related to Foodborne Illness Violations Related to Foodborne Illness Interventions
Interventions and Risk Factors(Red Items 1-22) and Risk Factors(Red Items 1-22) (Cont.)
FOOD PROTECTION MANAGEMENT PROTECTION FROM CONTAMINATION PROTECTION FROM CHEMICALS 3-501.14(C) PHFs Received at Temperatures According to
1 590.003(A) Assignment of Responsibility* 8 Cross-contamination 14 Food or Color Additives
Law Cooled to 41°F/45°F Within 4 Hours*
590.003(B) Demonstration of Knowledge* 3-302.11(A)(1) Raw Animal Foods Separated from 3-202.12 Additives* 3-501.15 Cooling Methods for PHFs
Cooked and RTE Foods.* * 19 PHF Hot and Cold Holding,
2-103.11 Person-in-Chazge 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 3-302.1](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*
2 590.003(C) Responsibility of the Person-in-Charge to 7-102.11 Common Name-Working Containers*
Require Reporting by Food Employees and Contamination from the Environment 3-501.16(A) Roasts Held At or Above 130°F*
7-201.11 Separation-Storage*
Applicants* 3-302.11(A) Food Protection* P g * 20 Time as a Public Health Control
7-202.11 Restriction-Presence and Use
590.003(F) Responsibility of A Food Employee or An 3-302.15 Washing Fruits and Vegetables 3-501.19 Time as a Public Health Control*
590.003(G) Reporting by Person in Charge*
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 7-203.11 Toxic Containers-Prohibitions*
Contamination from the Consumer
3 590.003(D) Exclusions and Restrictions* 77204.11 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 F9 - Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs*
590.004(A-B) Compliance with Food Law* 4-501.111 Manual Warewashing-Hot Water 7.206.12 Rodent Bait Stations* 3-801.11(D) Raw or Partially Cooked Animal Food and
3-201.12 Food in a HermeticallySealed Container* Sanitization Temperatures* Raw Seed Sprouts Not Served
P 7-206.13 Tracking Powders,Pest Control and
3 201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-Hot Water Monitoring* 3-801.11(C) Unopened Food Package Not Re-Served*
3-202.13 Shell Eggs* Sanitization Temperatures* TIMErrEMPERATURE CONTROLS
3-202.14 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. 16 Proper Cooking Temperatures for PHFs
CONSUMER ADVISORY
Concentration and Hardness* 22 3-603.11 Consumer Advisory Posted for Consumption of
3-202.16 Ice Made From Potable Drinking Water* 3-401.11A(1)(2) Eggs-Immediate
is sec Animal Foods That are Raw,Undercooked or
5-101.11 Drinking Water from an Approved System* 4-601.11(A) Clean Utensils and Food Contact Surfaces of Eggs-Immediate Service 145°F 15 sec*
Equipment* Not Otherwise Processed to Eliminate
590.006(A) Bottled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* Eg c1-11112001
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 15 sec*
3-201.14 Fish and Recreationally Caught Molluscan Contact Surfaces of Equipment*
t Shellfish* 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS
4-703.1.1 Methods of Sanitization-Hot Water and Stuffing Containing Fish,Meat,Poultry or 590.009(A)-(D) Violations of Section 590.009(A)-(D)in cater-
3-201.15 Molluscan Shellfish from NSSP Listed Chemical* Ratites-165°F 15 sec*
Sources* ing,mobile food,temporary and residential
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.
* 2-301.14 When to Wash* 3 401.11 A 1 b All Other PHFs-145°F 15 sec* Other 590.009 violations relating to good retail
590.004(C) Wild Mushrooms ( )( )( )
3-201.17 Game Animals* 11 Good Hygienic Practices 17 Reheating for Hot Holding practices should be debited under#29-Special
Requirements.
5 Receiving/Condition 2-401.11 Eating,Drinking or Using Tobacco* .3-403.11(A)&(D) PHFs 165°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 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* 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 ( ) r5.
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* Management and Personnel FC-2 .003
3-402.11 Parasite Destruction* 5-204.11 Location and Placement* 3-501.14(B) Cooling PHFs Made from Ambient Food and Food Protection FC-3 .004
Temperature Ingredients to 41°F/45°F Equipment and Utensils FC-4 .005
3-402.12 Records,Creation and Retention* 5-205.11 Accessibility,Operation and Maintenance Within 4 Hours* Water,Plumbing and Waste FC-5 .006
590.004(J) Labeling of Ingredients• Supplied with Soap and hand Drying Devices Physical Facility FC-6 .007
7 Conformance with Approved Procedures/ 6-301.11 Handwashing Cleanser,Availability 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.
I
TOWN OF BARNSTABLE-, HEALTH INSPECTOR'S Establishment Name: Date: age: of
OFFICE HOURS
PUBLIC HEALTH DIVISION 8:00-9:30A.M.
BARNSTABLE. ` 200 MAIN STREET 3:30-a:3o P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified
639. ,•� HYANNIS,MA 02601 More.-FRI. No Reference R-Red Item PLEA P INT CLEARLY
p, 508-862-4644 -
IFDMP'� FOOD ESTABLISHMENT INSPECTION REPORT - -
Name a Dat Type of Tyne of Inspection
Routine
i
Address Risk Food Service Re-inspection
Level Previous Inspection r
Telephone Residential Kitchen Dat
Mobile e-operation
Owner HACCP Y/N Temporary ss
Caterer General Complaint "
Alf
Person in Charge(PIC) Time Bed&Breakfast HACCP .�
In: Other
Inspector Out:
Each violation checked requires an explanation on the narrative page(s)and a citation of specific provision(s)violat d. 34
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 ttl
❑ 1.PIC Assigned/Knowledgeable/Duties ❑ 13.Handwash Facilities EMPLOYEE HEALTH PROTECTION FROM CHEMICALS �"
❑ 2.Reporting of Diseases by Food Employees and PIC ❑ 14.Approved Food or Color Additives
❑ 3.Personnel with Infectious Restricted/Excluded ❑ 15. Toxic Chemicals
FOOD FROM APPROVED SOURCE TIMEITEMPERATURE CONTROLS(Potentially Hazardous Foods) a
❑4.Food and Water from Approved Source ❑ 16.Cooking Temperatures
❑5.Receiving/Condition ❑ 17.Reheating -
❑ 6.Tags/Records/Accuracy of Ingredient Statements ❑ 18.Cooling
❑ 7.Conformance with Approved Procedures/HACCP Plans ❑ 19.Hot and Cold Holding
PROTECTION FROM CONTAMINATION ❑20.Time As a Public Health Control
❑ 8.Separation/Segregation/Protection REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP)
❑ 9.Food Contact Surfaces Cleaning and Sanitizing ❑.21.Food and Food Preparation for HSP
❑ 10.Proper Adequate Handwashing CONSUMER ADVISORY
❑ 11.Good Hygienic Practices. ❑ 22.Posting of Consumer Advisories 11✓�(y7rjv[)
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: ❑ o 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 st Icti /Ex lu n ❑ Re-inspection Scheduled ❑ Emergency Suspension
C N Official Order for Correction:Based on an inspection today,the items
checked indicate violations of 105 CMR 590.000/Federal Food Code. ❑ Embargo ❑ Emergency Closure ❑ Voluntary Disposal ❑ Other:
23.Management and Personnel (FC-2)(590.003) This report,when signed below by a Board of Health member or its agent A=Zero critical violations and no more than 3 non-critical violations. F=3 or more critical violations.9 or more non-critical violations,
24.Food and Food Preparation (FC-3)(590.004) constitutes an order of the Board of Health. Failure to correct violations regardless of the number of critical,results in an F.
25.Equipment and Utensils (FC-4)(590.005) cited in this report may result in suspension or revocation of the food B=One critical violation and less than non-critical violations
26.Water,Plumbing and Waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If if no critical violations observed,4 too 6 von-critical violations=B. Seriously Critical Violation=F is scored automatically if: no hot
27.Physical Facility ) aggrieved y y g g, q 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
Y y (FC-6)(590.007 a rieved b 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 i observed,7 to 8non-critical violations. If 1 critical refrigeration.
29.Special Requirements (590.009) within 10 days of receipt of this order. violat on,4 to 8 non-critical violations=C.
30.Other DATE OF RE-INSPECTION: Inspector's Signature Print:
31.Dumpster screened from public view - otil
Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y N
#Seats Observed Frozen PIC's Si
Dessert Machines: Outside Dining Y N 9n� � � Print:
Self Service Wait Service Provided Grease Trap Size Variance Letter Posted Y N
Dumpster Screen? Y N
Violations related to Foodborne Illness Violations Related to Foodborne Illness Interventions
Interventions and Risk Factors(Red Items 1-22) and Risk Factors(Red Items 1-22) (Cont.)
FOOD PROTECTION MANAGEMENT PROTECTION FROM CONTAMINATION PROTECTION FROM CHEMICALS 3-501.14(C) PHFs Received at Temperatures According to
1 590.003(A) Assignment of Responsibility* 8 Cross-contamination 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-Chazge-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*
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
2 .
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* P g 20 Time as a Public Health Control
7-202.11 Restriction-Presence and Use*
590.003(F) Responsibility of A Food Employee or An 3-302.15 Washing Fruits and Vegetables 3-501.19 Time as a Public Health Control*
Applicant To Report To The Person In Charge* 7.202.12 Conditions of Use*
Requirements
3-304.11 Food Contact with Equipment and Utensils* 7-203.11 Toxic Containers-Prohibitions* 590.004(11) Variance Re q
590.003(G) Reporting by Person in Charge* Contamination from the Consumer
3 590.003(D) Exclusions and Restrictions* 7-204.11 Sanitizers,Criteria-Chemicals* _ REQUIREMENTS FOR
3-306.14(A)(B)Returned Food and AdulteReserrated
or of Food* 7-204.12 Chemicals for Washing Produce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP
590.003(E) Removal of Exclusions and Restrictions g ( )
Disposition ofAdulterated or Contaminated
. _ Food 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and
FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels*
4 Food and Water From Regulated Sources - 9 Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs*
590.004(A-B) Compliance with Food Law* 4-501.111 Manual Warewashing-Hot Water 7.206.12 Rodent Bait Stations* 3-801.11(D) Raw or Partially Cooked Animal Food and
3-201.12 Food in a Hermetical] Sealed Container* Sanitization Temperatures* Raw Seed Sprouts Not Served
Y P 7-206.13 Tracking Powders,Pest Control and
3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-Hot Water Monitoring* 3-801.11(C) Unopened Food Package Not Re-Served*
3-202.13 Shell Eggs* Sanitization Temperatures* TIME/TEMPERATURE CONTROLS
3-202.14 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. 16 Proper Cooking Temperatures for PHFs CONSUMER ADVISORY
3-202.16 Ice Made From Potable Drinking Water* Concentration and Hardness* 3-401.11A(1)(2) Eggs-155°F 15 sec 22 3-603.11 Consumer Advisory Posted for Consumption of
4-601.11(A) Clean Utensils and Food Contact Surfaces of Eggs-Immediate Service 145°F sec
Equipment 15 * Animal Foods That are Raw,Undercooked or
5-101.11- Drinking Water from an Approved System* * gg mme ery Not Otherwise Processed to Eliminate
590.006(A) Bottled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* e$critic mnom
4-602.11 Cleaning Frequency of Utensils and Food Animals-155°F 15 sec*
590.006(B) Water Meets Standards in 310 CMR 22.0* Contact Surfaces of Equipment* * 3-302.13 Pasteurized Eggs Substitute for Raw Shell
Shellfish and Fish From an Approved Source 3-401.11(B)(1)(2) Pork and Beef Roast-130°F 121 min Eggs*
4-702.11 Frequency of Sanitization of Utensils and Food 3-401.11(A)(2) Ratites,Injected Meats-155°F 15 sec*
3-201.14 Fish and Recreationally Caught Molluscan Contact Surfaces of Equipment*
Shellfish* 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS
4-703.11 Methods of Sanitization-Hot Water and StuffingContaining Fish,Meat,Poultry or
3-201.15 Molluscan Shellfish from NSSP Listed Chemical* g 590.009(A)-(D) Violations of Section temporary
and a ide in cater-
* - Ratites-165°F 15 sec* in mobile food,rem or 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 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 es should
violations relating to good retail
3-201.17 Game Animals* 11 Good Hygienic Practices 17 Reheating for Hot Holding practices should be debited under#29-Special
Requirements.
5 Receiving/Condition 2-401.11 Eating,Drinking or Using Tobacco* 3-403.11(A)&(D) PHFs 165°F 15 sec*
3-202.11 PHF's Received at Proper Temperatures* 2-401.12 Discharges From the Eyes,Nose and Mouth* 3-403.11(B) Microwave-165°F 2 Minute Standing Time* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES
3-202.15 Package Integrity* 3-301.12 Preventing Contamination When Tasting* 3-403.11(C) Commercially Processed RTE Food-140°F* Blue Items 23-30)
12 Prevention of Contamination from Hands Critical,and non-critical violations,which do not relate to the foodborne
3-101.11 Food Safe and Unadulterated* 3-403.11(E) Remaining Unsliced Portions of Beef Roasts* illness interventions and risk factors listed above,can be found in the
6 Tags/Records:Shellstock 590.004(E) Preventing Contamination from Employees* 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
3-202.12 Shellstock Identification ( ) Item Good Retail Practices FC 590.000
3-203.12 Shellstock Identification Maintained* Conveniently Located and Accessible Within 2 Hours and From 70°F to 41°F/45°F
Tags/Records:Fish Products 5-203.11 Numbers and Capacities* Within 4 Hours* 23. Management and Personnel FC-2 .003
5-20411 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, 1 Physical Facility FC-6 .007
7 Conformance with Approved Procedures I 6-301.11 1Handwashing Cleanser,Availability 28. Poisonous or Toxic Materials FC-7 1.008
HACCP Plans 6-301.12 1 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 1 Conformance with Approved Procedures* 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.
�F(NE rpm TOWN OF BARNSTABLE HEALTH INSPECTOR'S Establishment Name: Date: age: of
jr OFFICE HOURS
PUBLIC HEALTH DIVISION 8:00-9:30 A.M.
BARN57'ABLE. ` 200 MAIN STREET 3:30-4:30 P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified
'qp M63• `0� HYANNIS, MA 02601 MON.-FRL No Reference R-Red Item PLEASE PRINT CLEARLY
508-862-4644
FOOD ESTABLISHMENT INSPECTION REPORT
Name Date :!Xpe of T section i
t O tine
Address Risk d Service Re-Inspection
Level Real Previous Inspection
Telephone Residential Kitchen Date:
Mobile Pre-operation '
Owner HACCP Y/N Temporary Suspect Illness
Caterer General Complaint
Person in Charge(PIC) Time Bed&Breakfast HACCP --
Illy
In: Other Zo
Inspector Out:
Each violation checked requires an explanation on the narrative page(s)and a citation of specific provision(s)violated.
Violations Related to Foodborne Illness Interventions and Risk Factors(Red Items) Anti-Choking 590.009(E) ❑
Violations marked may pose an imminent health hazard and require immediate corrective Tobacco 590.009(F) ❑
Action as determined by the Board of Health. Allergen Awareness 590.009(G)
FOOD PROTECTION MANAGEMENT ❑ 12.Prevention of Contamination from Hands
❑ 1.PIC Assigned/Knowledgeable/Duties ❑ 13.Handwash Facilities
EMPLOYEE HEALTH PROTECTION FROM CHEMICALS
❑ 2.Reporting of Diseases by Food Employees and PIC ❑ 14.Approved Food or Color Additives
❑ 3.Personnel with Infectious Restricted/Excluded ❑ 15. Toxic Chemicals
FOOD FROM APPROVED SOURCE TIMEITEMPERATURE CONTROLS(Potentially Hazardous Foods)
❑4.Food and Water from Approved Source ❑ 16.Cooking Temperatures `
❑ 5.Receiving/Condition ❑ 17.Reheating
Y
❑ 6.Tags/Records/Accuracy of Ingredient Statements ❑ 18.Cooling �}
❑ 7.Conformance with Approved Procedures/HACCP Plans ❑ 19.Hot and Cold Holding
PROTECTION FROM CONTAMINATION ❑ 20.Time As a Public Health Control
❑8.Separation/Segregation/Protection REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) �.
❑9.Food Contact Surfaces Cleaning and Sanitizing ❑ 21.Food and Food Preparation for HSP
❑ 10.Proper Adequate Handwashing CONSUMER ADVISORY
❑ 11.Good Hygienic Practices ❑22.Posting of Consumer Advisories.
Violations Related to Good Retail Practices(Blue Items) Total Number of Critical Violations
Critical(C)violations marked must be corrected immediately. (blue&red items) 9 n Corrective Action Required: ❑ No ❑ Yes
Non-critical(N)violations must be corrected immediately or Overall Rating
within 90 days as determined by the Board of Health. ❑ Voluntary Compliance ❑ Employee Restriction/Exclusion ❑ Re-inspection Scheduled ❑ Emergency Suspension
C N Official Order for Correction: Based on an inspection today,the items ❑ Embargo
checked indicate violations of 105 CMR 590.000/Federal Food Code. ❑ Emergency Closure ❑ Voluntary Disposal ❑ Other:
23.Management and Personnel (FC-2)(590.003) This report,when signed below b a Board of Health member or its agent p 9 Y 9 A=Zero critical violations and no more than anon-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.
• re B=One critical violation and less than 4non-critical violations 9
25.Equipment and Utensils (FC-4)(590.005) cited in this report may result in suspension or revocation of the food if no critical violations observed,4 to 6 non-critical violations=B. Serious) 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 Y Y
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
( )( ) 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.
28.Poisonous or Toxic Materials FC-7 590.008 g =
29.Special R quirements (590.009) within 10 days of receipt of this order. violation,4 to 8non-Critical violations C.
30.Other DATE OF RE-INSPECTION: Inspector's Signature Print:
31.Dum ter screened from public view
Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y N
#Seats Observed Frozen Dessert Machines: Outside Dining Y N PIC's�ignatu / Print:
Self Service Wait Service Provided Grease Trap Size Variance Letter Posted Y N
Dumpster Screen? Y N
C. +. _ - �.,� +..� -.-..-r -- �-.�:a�"�....t -..ry..�-+-.-•_..F�-.y'^,{..-� .a^a... r. •'. __ _ .- - _ � «.. . ...w.i.. _,r..-..-....-�\- - .. *f •--�v': •^ _ -_ �--.'�..�.w. _ - -^-+. -ram .` _.. .w., --.. f_
Violations related to Foodborne Illness Violations Related to Foodborne Illness Interventions
Interventions and Risk Factors(Red Items 1-22) and Risk Factors(Red Items 1-22) (Cont.)
FOOD PROTECTION MANAGEMENT PROTECTION FROM CONTAMINATION PROTECTION FROM CHEMICALS 3-501.14(C) PHFs Received at Temperatures According to
1 590.003(A) Assignment of Responsibility* 8 Cross-contamination 1q Food or Color Additives Law Cooled to 41°F/45°F Within 4 Hours*
*
590.003(B) Demonstration of Knowledge 3-302.11(A)(1) Raw Animal Foods Separated from 3-202.12 Additives* 3-501.15 Cooling Methods for PHFs
Cooked and RTE Foods.* 19 PHF Hot and Cold Holding
2-103.11 Person-in-Charge Duties 3-302.14 Protection from Unapproved Additives*
Contamination from Raw Ingredients 15 Poisonous or Toxic Substances 3-501.16(B) Cold PHFs Maintained At or Below 41°F/45°F
EMPLOYEE HEALTH 3-302.11(A)(2) Raw Animal Foods Separated from Each 7-101.11 Identifying Information-Original Containers* 590.004(F)-
590.003(C) Responsibility of the Person-in-Charge to *
Other* 7-]02.11 Common Name-Working Containers* 3-501.16(A) Hot PHFs Maintained At or Above 140°F
2
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 Washing Fruits and Vegetables * 3-501.19 Time as a Public Health Control*
Applicant To Report To The Person In Charge* * 590.004(11)7.202.12 Conditions of Use
* 3-304.11 Food Contact with Equipment and Utensils 7-203.11 Toxic Containers-Prohibitions* Variance Requirements
590.003(G) Reporting by Person in Charge Contamination from the Consumer
3 590.003(D) Exclusions and Restrictions* * 7-204.11 Sanitizers,Criteria-Chemicals* REQUIREMENTS FOR
3-306.14(A)(B)Returned Food and Reated or of Food 7-204.12 Chemicals for WashingProduce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP
590.003(E) Removal of Exclusions and Restrictions Disposition of Adulterated or Contaminated � )
Food 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and
FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels*
q 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 Warewashin Ho[Water 7.206.12 Rodent Bait Stations
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 Wazewashing-Hot Water Monitoring* 3-801.11(C) Unopened Food Package Not Re-Served*
3-202.13 Shell Eggs* Sanitization Temperatures* TIME/TEMPERATURE CONTROLS
3-202.14 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. 16 Proper Cooking Temperatures for PHFs CONSUMER ADVISORY
3-202.16 Ice Made From Potable Drinking Water* Concentration and Hardness* 3-401.1]A(1)(2) Eggs-155°F 15 sec 22 3-603.11 Consumer Advisory Posted for Consumption of
4-601.11(A) Clean Utensils and Food Contact Surfaces of E s-Immediate Service 145°F 15 sec* Animal Foods That are Raw,Undercooked or
5-101.11 Drinking Water from an Approved System* Equipment* 88 Not Otherwise Processed to Eliminate
590.006(A) Bottled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* Effective uuzoor
4-602.11 Cleaning Frequency of Utensils and Food Animals-155°F 15 sec*
590.006(B) Water Meets Standards in 310 CMR 22.0* Contact Surfaces of Equipment* 3-302.13 Pasteurized Eggs Substitute for Raw Shell
Shellfish and Fish From an Approved Source 3-401.11(B)(1)(2) Pork and Beef Roast-130°F 121 min* Eggs*
4-702.11 Frequency of Sanitization of Utensils and Food 3-401.11(A)(2) Ratites,Injected Meats-155°F 15 sec*
3-201.14 Fish and Recreationally Caught Molluscan Contact Surfaces of Equipment*
Shellfish* 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS
4-703.11 Methods of Sanitization-Hat Water and StuffingContaining Fish,Meat,Poultry or
3-201.15 Molluscan Shellfish from NSSP Listed Chemical* g 590.009(A)-(D) Violations of Section temporary
and - ide in cater-
* - Ratites-165°F 15 sec* in mobile food,tem or 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 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
Requirements.
5 ReceivingiCondition 2-401.11 Eating,Drinking or Using Tobacco* 3-403.11(A)&(D) PHFs 165°F 15 sec*
3-202.11 PHF's Received at Proper Temperatures* 2-401.12 Discharges From the Eyes,Nose and Mouth* 3-403.11(B) Microwave-165°F 2 Minute Standing Time* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES
* 3-301.12 Preventing Contamination When Tasting* 3-403.11 C Commercial) Processed RTE Food-140°F* (Blue Items 23-30)
3-202.15 Package Integrity ( ) Y Critical and non-critical violations,which do not relate to the foodborne
3-101.11 Food Safe and Unadulterated* 12 Prevention of Contamination from Hands 3-403.11(E) Remaining Unshced 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 Cooling Cooked PHFs from 140°F to 70°F
(A) 8
* 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
Within 4 Hours* 23. Management and Personnel FC-2 .003
Tags/Records:Fish Products 5-203.11 Numbers and Capacities*
5-20411 Location and Placement* Temperature
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 1.009
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.
OF ISE toy, TOWN OF BARNSTABLE HEALTH INSPECTOR'S Establishment Name: Date: ° G Page: O'er of
OFFICE HOURS
PUBLIC HEALTH DIVISION 8:00-9:30 A.M.
BARNSTABLE. • 200 MAIN STREET _ 3:30-4:30 P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION /PLAN OF CORRECTION Date Verified
ASS. `0� HYANNIS,MA 02601 MON.-FRI. NO Reference R-Red Item PLEASE PRINT CLEARLY
OlFo 39- 508-862-4644
FOOD ESTABLISHMENT INSPECTION REPORT
Name Da 1 Tvoe of T .e•6if"ThIt . ec ion
O er ' s utine .
Address Ris jg;Service Aspect on
Level Previous Inspection
Telephone Residential Kitchen Date: -
Mobile Pre-operation
Owner HACCP Y/N Temporary Suspect Illness
Caterer General Complaint
Person in Charge(PIC) Time Bed&Breakfast HACCP ,
In: Other
Inspector Out:
Each violation checked requires an explanation on the narrative page(s)and a citation of specific provision(s)violated.
Violations Related to Foodborne Illness Interventions and Risk Factors(Red Items) Anti-Choking 590.009(E) ❑ _
Violations marked may pose an imminent health hazard and require immediate corrective Tobacco 590.009(F) ❑
Action as determined by the Board of Health. Allergen Awareness 590.009(G)
FOOD PROTECTION MANAGEMENT ❑ 12.Prevention of Contamination from Hands ,P "
❑ 1.PIC Assigned(Knowledgeable/Duties ❑ 13.Handwash Facilities
EMPLOYEE HEALTH PROTECTION FROM CHEMICALS L'Z;o
❑ 2.Reporting of Diseases by Food Employees and PIC ❑ 14.Approved Food or Color Additives
❑3.Personnel with Infectious Restricted/Excluded, ❑ 15. Toxic Chemicals
FOOD FROM APPROVED SOURCE TIME/TEMPERATURE CONTROLS(Potentially Hazardous Foods)
❑4.Food and Water from Approved Source ❑ 16.Cooking Temperatures
❑ 5.Receiving/Condition ❑ 17.Reheating
41 e
❑6.Tags/Records/Accuracy of Ingredient Statements ❑ 18.Cooling
1717.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 {.�O
❑ 11.Good Hygienic Practices ❑22.Posting of Consumer Advisories
Violations Related to Good Retail Practices(Blue Items) Total Number of Critical Violations
Critical(C)violations marked must be corrected immediately. (blue&red items) Corrective Action Required: El 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 toda , e 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.
B=One critical violation and less than 4von-critical violations 9
25.Equipment and Utensils (FC-4)(590.005) cited in this report may result in suspension or revocation of the food if no critical violations observed,4 to 6 non-critical violations=B. - Seriously Critical Violation=F is scored automatically if: no hot
26.Water,Plumbing and Waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If
27.Physical Facility (FC-6)(590.007) aggrieved by this order,you have a right to a hearing. Your request must C=2 critical violations and less than 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 8 non-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.
Inspector's Signature Print:
30.Other DATE OF RE-INSPECTION:
31.Dump er screened from public view
Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y N
#Seats Observed Frozen Dessert Machines: Outside Dining Y N 777re Print:
Self Service Wait Service Provided Grease Trap Size Variance Letter Posted Y N
Dumpster Screen v Y N 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 3-503.14(C) PHFs Received at Temperahs According to
1 590.003(A) Assignment of Responsibility* 8 Cross-contamination 14 Food or Color Additives Law Cooled to 41°F/45°F Within 4 Hours*
590.003(B) Demonstration of Knowledge* 3-302.11(A)(1) Raw Animal Foods Separated from 3-202.12 Additives* 3-501.15 Cooling Methods for PHFs
2-103.11 Person-in-Charge Duties Cooked and RTE Foods.* 3-302.14 Protection from Unapproved Additives* 19 . PHF Hot and Cold Holding
Contamination from Raw ingredients Poisonous or Toxic Substances 15 3-501.16(B) Cold PHFs Maintained At or Below 41°P/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*
590,003(F) Responsibility of A Food Employee or An 3-501.19 Time as a Public Health Control*
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* 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* 4-501.111 Manual Warewashing-Hot Water 7.206.12 Rodent Bait Stations* 3-801.11(1) Raw or Partially Cooked Animal Food and
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* TIMEITEMPERATURE CONTROLS
3-202.14 Eggs and Milk Products,Pasteurized* 4-501_114 Chemical Sanitization-Temp.,pH. 16 Proper Cooking Temperatures for PHFs CONSUMER ADVISORY
3-202.16 Ice Made From Potable Drinking Water* Concentration and Hardness* 3-401.11A(1)(2) Eggs-155°F 15 sec 22 3-603.11 Consumer Advisory Posted for Consumption of
4-601.11(A) Clean Utensils and Food Contact Surfaces of Eggs-Immediate Service 145°F 15 sec* Animal Foods That are Raw,Undercooked or
5-101.11 Drinking Water from an Approved System* Equipment* Not Otherwise Processed to Eliminate
590.006(A) Bottled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* Ef aroe 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 Surf 4-702.11 Frequency Sanitization of Utensils and Food 3-401.11(A)(2) Ratites,Injected Meats-155°F 15 sec*
faces of Equipment* `
Shellfish* 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*
Sources* '` 10 Proper,Adequate Handwashing ing,mobile food,temporary and residential
Game and Wild Mushrooms Approved By 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 145°F* kitchen operations should be debited under
Regulatory Authority 2-301.11 Clean Condition-Hands and Arms* 3-401.12 Raw Animal Foods Cooked in a Microwave the appropriate sections above if related to
3-202.18 Shellstock Identification Present* 2-301.12 Cleaning Procedure* 165°F* foodborne illness interventions and risk factors.
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 Re
practices should be debited under#29-Special
Reheating for Hot Holding Requirements..
5 Receiving/Condition 2-401.11 Eating,Drinking or Using Tobacco* 3-403.11(A)&(D) PHFs 165°F M 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)
3-202.11 Package Integrity y Critical and non-critical violations,which do not relate to the foodborne
12 Prevention of Contamination from Hands
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 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
Supplied with Soap and hand Drying Devices
590.004(J) Labeling of Ingredients' 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. 1 Special Requirements 1.009
3-502.11 Specialized Processing Methods* 130. 1 Other
3-502.12 Reduced-Oxygen Packaging Criteria*
8-103.12 Conformance with Approved Procedures* S:590Formback&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.
roy TOWN OF BARNSTABLE HEALTH INSPECTORS Establishment Name: Date: Page: of
v` q OFFICE HOURS
PUBLIC HEALTH DIVISION 8:00-9:30 A.M.
BARNST,.9BLE. ' 200 MAIN STREET 3:3o-a:3o P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified
. MON.-FRI.
MAS3�
HYANNIS,MA 02601 508-862-4644 No Reference R-Red.Item PLEASE PRINT CLEARLY
rFD MP�p FOOD ESTABLISHMENT INSPECTION REPORT -
14
^_
Name Date Type of T of nspection
O Inutine I i
Address Risk ood Service Re-Inspection
Level a Previous Inspection
Telephone Residential Kitchen Date:
Mobile Pre-operation
Owner HACCP Y/N Temporary Suspect Illness
Caterer General Complaint
Person in Charge(PIC) Time Bed&Breakfast HACCP ^
In: Other
Inspector Out: ,
5� -
Each violation checked requires an explanation on the narrative page(s)and a citation of specific provision(s)violated. a AA
Violations Related to Foodborne Illness Interventions and Risk Factors(Red Items) Anti-Choking 590.009(E) ❑ ot
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 l
❑ 1.PIC Assigned/Knowledgeable/Duties ❑ 13.Handwash Facilities + 1�q �®-
EMPLOYEE HEALTH PROTECTION FROM CHEMICALS 11l"A4�j�i�/ '
❑ 2.Reporting of Diseases by Food Employees and PIC ❑ 14.Approved Food or Color Additives R
❑3.Personnel with Infectious Restricted/Excluded ❑ 15. Toxic Chemicals Fv
FOOD FROM APPROVED SOURCE TIME/TEMPERATURE CONTROLS(Potentially Hazardous Foo
❑4.Food and Water from Approved Source ❑ 16.Cooking Temperatures J
❑ 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 r
Critical(C)violations marked must be corrected immediately. (blue&red items) Corrective Action Required: y
Non-critical(N)violations must be corrected immediately or Overall Rating
within 90 days as determined by the Board of Health. ❑ Voluntary Compliance ❑ Emp Ion/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 B=One critical violation and less than 4 non-critical violations regardless of the number of critical,results in an F.
25.Equipment and Utensils (FC-4)(590.005) cited in this report may result in suspension or revocation of the food if no critical violations observed,4 to 6 non-critical violations=B.
26.Water,Plumbing and Waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If Seriously Critical Violation t F is scored automatically o la hot
27.Physical Facility (FC-6)(590.007) aggrieved 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) g violation,4 to 8non-critical violations=C.
29.Special Requirements (590.009) within 10 days of receipt of this order.
30.Other DATE OF RE-INSPECTION: Ins ector's Signature Print:
i
31.Dumpster screened from public view A.
Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y N
#Seats Observed Frozen Dessert Machines: Outside Dining y N PIC's Signature Print:
Self Service Wait Service Provided Grease Trap Size Variance Letter Posted Y N
d Cs Si '
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.)
y
FOOD PROTECTION MANAGEMENT PROTECTION FROM CONTAMINATION PROTECTION FROM CHEMICALS 3-501.14(C) PHFs Received at Temperatures According to
1 590.003(A) Assignment of Responsibility* 8 Cross-contamination 14 Food or Color Additives Law Cooled to 41°F/45°F Within 4 Hours*
590.003(B) Demonstration of Knowledge* 3-302.11(A)(1) Raw Animal Foods Separated from 3-202.12 Additives* 3-501.15 Cooling Methods for PHFs
2-103.11 Person-in-Charge Duties Cooked and RTE Foods.* 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*
Storage*
-
Applicants* 3-302.11(A) Food Protection* 7-201.11 Separation g 20 Time as a Public Health Control
7-202.11 Restriction-Presence and Use*
590.003(F) Responsibility of A Food Employee or An � 3-501.19 Time as a Public Health Control*
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* 7-203.11 Toxic Containers-Prohibitions*
Contamination from the Consumer
3 590.003(13) Exclusions and Restrictions* 7-204.11 Sanitizers,Criteria-Chemicals* REQUIREMENTS FOR
3-306.14(A)(B)Resumed 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 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 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 Prodncts* 4-501.112 Mechanical Warewashing-Hot Water Monitoring* 3-801.11(C) Unopened Food Package Not Re-Served*
3-202.13 Shell Eggs* Sanitization Ternperatares* TIME/TEMPERATURE CONTROLS
3-202.14 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. L16 Proper Cooking Temperatures for PHFs - _ CONSUMER ADVISORY
* Concentration and Hardness* 22 3-603.11 Consumer Advisory Posted for Consumption of
3-202.16 Ice Made From Potable Drinking Water 3-401.11A(1)(2) Eggs-155°F 15 sec Animal Foods That are Raw,Undercooked or
5-101.11 Drinking Water from an Approved System* 4-601.11(A) Clean Utensils and Food Contact Surfaces of 1 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,five 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 15 sec*
3-201.14 Fish and Recreationally Caught Molluscan Contact Surfaces of Equipment*
Shellfish* 4-703.11 Methods of Sanitization-Hot Water and 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS
Stuffing Containing Fish,Meat,Poultry or
3-201.15 Molluscan Shellfish from NSSP Listed Chemical* g 8 � 590.009(A)-(D) Violations of Section 590.009(A)-(D)in cater-
*
Sources. Proper,Adequate Handwashing 1 p Ratites-165°F 15 sec* ing' P �
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
3-201.17 Game Animals* 11 Good Hygienic Practices 17 Reheating for Hot Holding practices should be debited under#29-Special
2-401.11 Eating,Drinking or Using Tobacco* * Requirements.
5 Receiving/Condition g. g g 3-403.11(A)&(D) PHFs 165°F 15 sec
3-202.11 PHF's Received at Proper Temperatures* 2-401.12 Discharges From the Eyes,Nose and Mouth* 3-403.11(B) Microwave-165°F 2 Minute Standing Time* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES
* 3-301.12 Preventing Contamination When Tasting* 3-403.11(C) Commercially Processed RTE Food-140°F* Blue Items 23-30)
3-102.11 Package Integrity y Critical and non-critical violations,which do not relate to the foodborne
* 12 Prevention of Contamination from Hands 3403.11E 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 Handwashin Facilities 3-501.14 A CoolingCooked PHFs from 140°F to 70°F
3-202.18 Shellstock Identification* g ( ) Item Good Retail Practices FC 590.000
3-203.12 Shellstock Identification Maintained* Conveniently Located and Accessible Within 2 Hours and From 70°F to 41°F/45°F
Tags/Records:Fish Products 5-203.11 Numbers and Capacities* Within 4 Hours* 23. Management and Personnel FC-2 .003
5-204.11 Location and Placement* 3-501.14(B) Cooling PHFs Made from Ambient 24. Food and Food Protection FC-3 .004
3 402.11 Parasite Destruction* Temperature Ingredients to 41°F/45°F 25. Equipment and Utensils FC-4 .005
3-402.12 Records,Creation and Retention* 5-205.11 Accessibility,Operation and Maintenance Within 4 Hours* 26. Water,Plumbing and Waste FC-5 .006
590.004(J) Labeling of Ingredients' Supplied with Soap and hand Drying Devices 27. Physical Facility FC-6 .007
7 Conformance with Approved Procedures/ 6-301.11 Handwashing Cleanser,Availability 28. Poisonous or Toxic Materials FC-7 .008
HACCP Plans 6-301.12 Hand Drying Provision 129. 1 Special Requirements 1.009
3-502.11 Specialized Processing Methods* 30. 1 Other
3-502.12 Reduced-Oxygen Packaging Criteria*
8-103.12 Conformance with Approved Procedures* S: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.
F1He, TOWN OF BARNSTABLE HEALTH INSPECTOR,s Establishment Name: Date: Page: of
OFFICE HOURS
PUBLIC HEALTH DIVISION 8:00-9:30 A.M.
BARNSTABLE. a 200 MAIN STREET 3:30-a:3o P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified
MONMA55. HYANNIS,MA 02601 08-8 -FRI.
508-862-4644 No Reference R-Red Item PLEASE PRINT CLEARLY
'EDN1 FOOD ESTABLISHMENT INSPECTION REPORT _
Name Date/ e of Tvoe of Inspection
6 Operathftt� R
Address Risk od Service j e-inspection
Level r ion
Telephone Residential Kitchen Da e: 1 f
Mobile Pr ion 1 [
Owner HACCP Y/N Temporary
Caterer General Complaint
Person in Charge(PIC) Time Bed&Breakfast HACCP
In: Other 7- 4
Inspector Out:
Each violation checked requires an explanation on the narrative page(s)and a citation of specific provision(s)violated. 1/ W - ;;;q-- - IC11-1 . - I
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 47J74
❑ 1.PIC Assigned/Knowledgeable/Duties ❑ 13.Handwash Facilities L
EMPLOYEE HEALTH PROTECTION FROM CHEMICALS
❑2.Reporting of Diseases by Food Employees and PIC ❑ 14.Approved Food or Color Additives ah AA
❑ 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 PAP
❑ 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 424
PROTECTION FROM CONTAMINATION ❑20.Time As a Public Health Control If
❑8.Separation/Segregation/Protection REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP)
❑9.Food Contact Surfaces Cleaning and Sanitizing ❑21.Food and Food Preparation for HSP r�
❑ 10.Proper Adequate Handwashing CONSUMER ADVISORY s441
❑ 11.Good Hygienic Practices ❑22.Posting of Consumer Advisories
Violations Related to Good Retail Practices(Blue Items) Total Number of Critical Violations Critical(C)violations marked must be corrected immediately. (blue&red items) C)f
Non-critical(N)violations must be corrected immediately or Corrective Action Required: ❑ No ❑ Yes
11
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
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
24.Food and Food Preparation (FC-3)(590.004) constitutes an order of the Board of Health. Failure to correct violations A=Zero critical violations and no more than 3 non-critical violations. F=3 or more critical violations. If no critical violations observed,
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 9 or more non-critical violations=F.
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 water,sewage back-up,infestation of rodents or insects,or lack of
Y ty ) C=2 critical violations and less than 4non-critical. If no critical refri
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=C. geration.
590.009 within 10 days of receipt of this order.
29.Special Requirements ( ) Inspector's Signature Print:
30.Other DATE OF RE-INSPECTION:
31.Dumpster screened from public view
Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y N
#Seats Observed PIC' ignature Pri t:
Frozen Dessert Machines: Outside Dining Y N '
Self Service Wait Service Provided Grease Trap Size Variance Letter Posted Y N
AA
C
Dumpster Screen? Y N �rvY>� �I•� i
-. :.rro.w. y y-vim..-.._Y g_,�,., -.-y..�. '.:,"•.�.,,,•= "':+vim _ ti -�..- ti _ i-�. _ ---- __.._�..,�-„�. - .�_-. _ i'�...� - r1 ..�.-t .. "••-•. ,-a r-. _ _
Violations related to Foodborne Illness Violations Related to Foodborne Illness Interventions
Interventions and Risk Factors(Red Items 1-22) and Risk Factors(Red Items 1-22) (Cont.)
FOOD PROTECTION MANAGEMENT PROTECTION FROM CONTAMINATION PROTECTION FROM CHEMICALS 3-501.14(C) PHFs Received at Temperatures According to
1 590.003(A) Assignment of Responsibility* 8 Cross-contamination 14 Food or Color Additives Law Cooled to 41°F/45°F Within 4 Hours*
590.003(B) Demonstration of Knowledge* 3-302.11(A)(1) Raw Animal Foods Separated from 3-202.12 Additives* 3-501.15 Cooling Methods for PHFs
g
2-103.11 Person-in-Charge Duties Cooked an 3-302.14 Protection from Unapproved Additives
d RTE Foods.* * 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* * 3-501.16(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*
*
Applicants 3-30211(A) Food Protection* 7-201.11 Separation-Storage* 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* 3-50119 Time as a Public Health Control*
Applicant To Report To The Person In Charge* 7.202.12 Conditions of Use*
* 3-304.11 Food Contact with Equipment and Utensils* 7-203.11 Toxic Containers-Prohibitions* 590.004(11) Variance Requirements
590.003(G) Reporting by Person in Charge
Contamination from the Consumer
3 F590.003(E)
0.003 D Exclusions and Restrictions* 7-204.11 Sanitizers,Criteria-Chemicals*
( ) 3-306.14(A)(B)Returned Food and Reservice of Food* REQUIREMENTS FOR
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* 4-501.111 Manual Warewashing-Hot Water 7.206.12 Rodent Bait Stations* 3-801.11(D) Raw or Partially Cooked Animal Food and
3-201.12 Food in a Hermetically Sealed Container* Sanitization Temperatures* Raw Seed Sprouts Not Served*
7-206.13 Tracking Powders,Pest Control and
3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-Hot Water Monitoring* 3-801.11(C) Unopened Food Package Not Re-Served*
3-202.13 Shell Eggs* Sanitization Temperatures* TIME/TEMPERATURE CONTROLS
3-202.14 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. 16 Proper Cooking Temperatures for PHFs CONSUMER ADVISORY
* Concentration and Hardness* 22 3-603.11 Consumer Advisory Posted for Consumption of
3-202.16 Ice Made From Potable Drinking Water 3-401.11A(1)(2) Eggs-155°F 15 sec 5-101.11 Drinking Water from an Approved System* 4-601.11(A) Clean Utensils and Food Contact Surfaces of Eggs-Immediate Service 145°F 15 sec* 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* Effective 1/1/2001
4-602.11 Cleaning Frequency of Utensils and Food Animals-155°F 15 sec*
590.006(B) Water Meets Standards in 310 CMR 22.0* Contact Surfaces of Equipment* 3-302.13 Pasteurized Eggs Substitute for Raw Shell
Shellfish and Fish From an Approved Source 3-401.11(B)(1)(2) Pork and Beef Roast-130°F 121 min* Eggs*
3-201.14 Fish and Recreationally Caught Molluscan Contact Surf 4-702.11 Frequency Sanitization of Utensils and Food 3-401.11(A)(2) Ratites,Injected Meats-155°F 15 sec*
faces of Equipment*
Shellfish* 4-703.11 Methods of Sanitization-Hot Water and 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS
Stuffing Containing Fish,Meat,Poultry or
3-201.15 Molluscan Shellfish from NSSP Listed Chemical* g ry 590.009(A)-(D) Violations of Section 590.009(A)-(D)in cater-
3 Ratites-165°F 15 sec* ing,mobile food,temporary and residential
10 Proper,Adequate Handwashing
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
3-201.17 Game Animals* 11 Good Hygienic Practices 17 Reheating for Hot Holding practices should be debited under#29-Special
Requirements.
5 Receiving/Condition 2-401.11 Eating,Drinking or Using Tobacco* 3-403.11(A)&(D) PHFs 165°F 15 sec*
3-202.11 PHF's Received at Proper Temperatures* 2-401.12 Discharges From the Eyes,Nose and Mouth* 3-403.11(B) Microwave-165°F 2 Minute Standing Time* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES
* 3-301.12 Preventing Contamination When Tasting* * (Blue Items 23-30)
3-202.11 Package Integrity g g 3 403.11(C)., Commercially Processed RTE Food-140°F Critical'and non-critical violations,which do not relate to the foodborne
Prevention of Contamination from Hands
3-101.11 Food Safe and Unadulterated* 12 3-403.11(E) Remaining Unsliced Portions of Beef Roasts* illness interventions and risk factors listed above,can be found in the
5 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 590.000
Tags/Records:Fish Products 5-203.11 Numbers and Capacities* Within 4 Hours* 23. Management and Personnel FC-2 .003
* 5-204.11 Location and Placement* 3-501.14(B) Cooling PHFs Made from Ambient 24. Food and Food Protection FC-3 .004
3-402.11 Parasite Destruction Temperature Ingredients to 41°F/45°F 25. Equipment and Utensils FC-4 .005
3-402.12 Records,Creation and Retention* 5-205.11 Accessibility,Operation and Maintenance
Within 4 Hours* 26. Water,Plumbing and Waste FC-5 .006
590.004(J) Labeling of Ingredients* Supplied with Soap and hand Drying Devices 27, Physical Facility FC-6 .007
7 Conformance with Approved Procedures/ 6-301.11 Handwashing Cleanser,Availability 28. Poisonous or Toxic Materials FC-7 .008
HACCP Plans 6-301.12 Hand Drying Provision 129. 1 Special Requirements 1.009
3-502.11 Specialized Processing Methods*
30. 1 Other
3-502.12 Reduced-Oxygen Packaging Criteria*
8-103.12 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.
F IME r TOWN OF BARNSTABLE HEALTH INSPECTOR'S Establishment Name: Date: Page: of
OFFICE HOURS
An E PUBLIC
2 0 MAW STREET
DIVISION 3:30-4:30A.M.
3:M - .- P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified
HYANNIS,MA 02601 08-8 -FRI.
+679•see 508-862-4644 No Reference R-Red Item PLEASE PRINT CLEARLY
rFD MP+ FOOD ESTABLISHMENT INSPECTION REPORT
Name Date a of Tvoe of Inspection
O Routine
Address Risk ood Service Re-inspection Nell 1
Level Previous Inspection
Telephone Residential Kitchen Date:
Mobile perati
Owner HACCP Y/N Temporary
Caterer General Complaint Aqe
Person in Charge(PIC) Time Bed&Breakfast HACCP _
In: Other
Inspector Out:
Each violation checked requires an explanation on the narrative page(s)and a citation of specific provision(s)violated.
Violations Related to Foodborne Illness Interventions and Risk Factors(Red Items) Anti-Choking 590.009(E) ❑
Violations marked may pose an imminent health hazard and require immediate corrective Tobacco 590.009(F) ❑
Action as determined by the Board of Health. Allergen Awareness 590.007(G) ❑
FOOD PROTECTION MANAGEMENT ❑ 12.Prevention of Contamination from Hands �\wC
❑ 1.PIC Assigned/Knowledgeable/Duties 1-7
❑ 13.Handwash Facilities �O�
EMPLOYEE HEALTH PROTECTION FROM CHEMICALS /�,G�S�I{ (/
❑ 2.Reporting of Diseases by Food Employees and PIC ❑ 14.Approved Food or Color Additives )°v
❑ 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 yjv
❑ 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)
1-14 i
❑ 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 3 012
Critical(C)violations marked must be corrected immediately. (blue&red items)
Non-critical(N)violations must be corrected immediately or Corrective Action Required: ❑ No Yes
within 90 days as determined by the Board of Health. Overall Rating
F 4 ❑ Voluntary Compliance ❑ Employee Restriction/Exclusion ❑ Re-inspection Scheduled ❑ Emergency Suspension
C N Official Order for Correction.Based on an inspection today,the items
checked indicate violations of 105 CMR 590.000/Federal Food Code. ❑ Embargo ❑ Emergency Closure ❑ Voluntary Disposal ❑ Other:
23.Management and Personnel (FC-2)(590.003) This report,when signed below by a Board of Health member or its agent
24.Food and Food Preparation (FC-3)(590.004) constitutes an order of the Board of Health. Failure to correct violations A=Zero critical violations and no more than 3 non-critical violations. F=3 or more critical violations. If no critical violations observed,
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 9 or more non-critical violations=F.
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 FacilityFC-6 590.007 aggrieved by this order,you have a right to a hearing. Your request must water,sewage back-up,infestation of rodents or insects,or lack of
( )( ) C=2 critical violations and less than 4non-critical. If no critical refri er
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=C. 9 ation.
29.Special Requirements (590.009) within 10 days of receipt of this order.
Inspector's Signature Print:
30.Other DATE OF RE-INSPECTION:
31.Dumpster screened from public view
Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y N
Y N P s Si tune Print:
#Seats Observed
Frozen Dessert Machines: Outside Dining
Self Service Wait Service Provided Grease Trap Size Variance Letter Posted Y N
Dumpster Screen? Y N
Violations related to Foodborne Illness Violations Related to Foodborne Illness Interventions
Interventions and Risk Factors(Red Items 1-22) and Risk Factors(Red Items 1-22) (Cont.)
FOOD PROTECTION MANAGEMENT PROTECTION FROM CONTAMINATION PROTECTION FROM CHEMICALS 3-501.14(C) PHFs Received at Temperatures According to '
1 590.003(A) Assignment of Responsibility* F 8 Cross-contamination F 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
2-103.11 Person-in-Charge Duties Cooked and RTE Foods.* 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
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* 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*
Applicants* 7-201.11 Separation-Storage*
pp 3-302.11(A) Food Protection* 20 Time as a Public Health Control
3-302.15 Washing Fruits and Vegetables 3-501.19 Time as a Public Health Control*
590.003(F) Responsibility of A Food Employee or An 7-202.11 Restriction-Presence and Use*
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 Reseryice of Food* REQUIREMENTS FOR
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 9 Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.l l(B) Use of Pasteurized Eggs*
590.004(A-B) Compliance with Food Law* 4-501.111 Manual Warewashing-Hot Water 7.206.12 Rodent Bait Stations* 3-801.11(D) Raw or Partially Cooked Animal Food and
3-201.12 Food in a Hermetically Sealed Container* Sanitization Temperatures* + 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.,pH. 16 Proper Cooking Temperatures for PHFs CONSUMER ADVISORY
3-202.16 Ice Made From Potable Drinking Water* Concentration and Hardness* 3-401.11A(l)(2) Eggs-155°F 15 sec 22 3-603.11 Consumer Advisory Posted for Consumption of
5-101.11 Drinking Water from an Approved System* 4-601.11(A) Clean Utensils and Food Contact Surfaces of Eggs-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* Ery-li-////2001
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 3-40111(A)(2) Ratites,Injected Meats-155°F 15 sec*
3-201.14 Fish and Recreationally Caught Molluscan Contact Surfaces of Equipment*
Shellfish* 4-703.11 Methods of Sanitization-Hot Water and 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS
3-201.15 Molluscan Shellfish from NSSP Listed * Stuffing Containing Fish,Meat,Poultry or 590.009 A - D Violations of Section 590.009(A)-(D)in cater-
Chemical ( ) ( )
Sources* Ratites-165`F 15 sec* in mobile food,temporary and residential
10 Proper,Adequate Handwashing g, P D
Game and Wild Mushrooms Approved By 3401.11(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 17
* 11 Good Hygienic Practices Reheating for Hot Holding practices should be debited under#29-Special
Requirements.
5 Receiving/Condition 2-401.11 Eating,Drinking or Using Tobacco* 3-403.11(A)&(D) PHFs 165°F 15 sec*
3-202.11 PHF's Received at Proper Temperatures* - 2-401.12 Discharges From the Eyes,Nose and Mouth* 3-403.11(B)- Microwave-165°F 2 Minute Standing Time* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES
3-202.15 Package Integrity* 3-301.12 Preventing Contamination When Tasting* 3-403.11(C) Commercially Processed RTE Food-140°F* (Blue Items 23-30)
12 Prevention of Contamination from Hands Critical and non-critical violations,which do not relate to the foodborne
3-101.11 Food Safe and Unadulterated* 3-403.11(E) Remaining Unsliced Portions of Beef Roasts* illness interventions and risk factors listed above,can be found in the
6 Tags/Records:Shellstock 590.004(E) Preventing Contamination from Employees* 18 Proper Cooling of PHFs following sections of the Food Code and 105 CMR 590.000
3-202.18 Shellstock Identification* 13 Handwashing Facilities 3-501.14(A) Cooling Cooked PHFs from 140°F to 70°F
3-203.12 Shellstock Identification Maintained* Conveniently Located and Accessible Within 2 Hours and From 70'F to 41°F/45°F Item Good Retail Practices FC 1590.000
Tags/Records:Fish Products 5-203.11 Numbers and Capacities* Within 4 Hours* 23. Management and Personnel FC-2 .003
* 3-501.14 B Cooling PHFs Made from Ambient 24. Food and Food Protection FC-3 .004
3-402.11 Parasite Destruction* 5-204.11 Location and Placement ( ) g
* 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
of
590.004(J) LabelingIngredients* Supplied with Soap and hand Drying Devices 27. Physical Facility FC-6 .007
7 Conformance with Approved Procedures/ 6-301.11 Handwashing Cleanser,Availability 28. Poisonous or Toxic Materials FC-7 .008
HACCP Plans 6-301.12 Hand Drying Provision
29. Special Requirements 009
3-502.11 Specialized Processing Methods* 30. 1 Other
3-502.12 Reduced-Oxygen Packaging Criteria*
8-103.12 Conformance with Approved Procedures*
S:590Formback6-2doc
'Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. 'Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000.
Ftr+r r HEALTH INSPECTORS Establishment Name: Date: Page: of
TOWN OF BARNSTABLE
OFFICE HOURS
PUBLIC 0 HEALTH
N ST RETSION 8:00-9:30 A.M.
MA 3:30-4:30 P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified
HYANNIS,MA 02601 MON.-FRI.
508-862-4644 No Reference R-Red Item PLEASE PRINT CLEARLY
rFOMa+ FOOD ESTABLISHMENT INSPECTION REPORT
Name Dat 1- Tvoe of Tyne of Inspection
{ O Routine
Address Ris dod Service Re-inspection
Level Previous Inspection
Telephone Residential Kitchen Dat
Mobile re-operatio
Owner HACCP Y/N Temporary ess
Caterer General Complaint
Person in Charge(PIC) Time Bed&Breakfast HACCP tL
` v In: Other
Inspector Out:
Each violation checked requires an explanation on the narrative page(s)and a citation of specific provision(s)violated.
Violations Related to Foodborne Illness Interventions and Risk Factors(Red Items) Anti-Choking 590.009(E) ❑
Violations marked may pose an imminent health hazard and require immediate corrective Tobacco 590.009(F) ❑ L
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
E32.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
❑ 5.Receiving/Condition ❑ 17.Reheating
❑6.Tags/Records/Accuracy of Ingredient Statements ❑ 18.Cooling y
❑7.Conformance with Approved Procedures/HACCP Plans ❑ 19.Hot and Cold Holding
PROTECTION FROM CONTAMINATION E320.Time As a Public Health Control v
❑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 42
Violations Related to Good Retail Practices(Blue Items) Total Number of Critical Violations 47A p V
Critical(C)violations marked must be corrected immediately. (blue&red items) ,
Non-critical(N)violations must be corrected immediately or Corrective Action Required: ❑ No ❑ Yes
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
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 anon-critical violations. F=3 or more critical violations. n no critical violations observed,
24.Food and Food Preparation (FC-3)(590.004) constitutes an order of the Board of Health. Failure to correct violations 9 or more non-critical violation
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 s=F.
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 water,sewage back-up,infestation of rodents or insects,or lack of
Y ty ( )( ) C=2 critical violations and less than 4npn-critical. If no critical refri eration.
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=C. 9
29.Special Requirements (590.009) within 10 days of receipt of this order.
30.Other DATE OF RE-INSPECTION: Inspector's Signature Print:
31.Dumpster screened from public view
Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y N
Y N 5✓ ignatur Print:
#Seats Observed
Frozen Dessert Machines: Outside Dining � n
Self Service Wait Service Provided Grease Trap Size Variance Letter Posted Y N
Dumpster Screen? Y N 1� IIttW✓✓
_.....�;; -... -,<---.-...._ ....Y_�-.�.-..�.,-.-_�...,�- ;�, �--_� .;- _�Z.T..�_ ✓--... . �-�. .u _ - {_ ..yp,.'��v,--.'^ "' .. -'"L.� -•�. _.__ �..^_ -�i�..+ _ - _`--yam__-', 1 �-r..� �. ��-_.�� yam-...�..�. ;i..���..,._�--•_---�'.:=•.v
Violations related to Foodborne Illness Violations Related to Foodborne Illness Interventions
Interventions and Risk Factors(Red Items 1-22) and Risk Factors(Red Items 1-22) (Cont.) _
FOOD PROTECTION MANAGEMENT PROTECTION FROM CONTAMINATION PROTECTION FROM CHEMICALS 3-501.14(C) PHFs Received at Temperatures According to
1 590.003(A) Assignment of Responsibility* 8 Cross-contamination 14 Food or Color Additives Law Cooled to 41'F/45°F Within 4 Hours*
590.003(13) Demonstration 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.* * 19 PHF Hot and Cold Holding
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 590.004(F)
p 7-101.11 Identifying Information-Original Containers*
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*
Applicants* * 7-201.11 Separation-Storage*
3-302.11(A) Food Protection 20 Time as a Public Health Control
• 590.003(F) Responsibility of A Food Employee or An 3-302.15 Washing Fruits and Vegetables 7-202.11 Restriction-Presence and Use* 3-501.19 Time as a Public Health Control*
Applicant To Report To The Person In Charge* 7.202.12 Conditions of Use*
3-304.11 Food Contact with Equipment and Utensils* 590.004(11) Variance Requirements
590.003(G) Reporting by Person in Charge* Contamination from the Consumer 7-203.11 Toxic Containers-Prohibitions*
3 590.003(D) I Exclusions and Restrictions* 3-306.14(A)(B)Returned Food and Reservice of Food* 7-204.11 Sanitizers,Criteria-Chemicals* 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 a 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and
FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels*
4 Food and Water From Regulated Sources 9 Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs*
590.004(A-B) Compliance with Food Law* * 3-801.11(D) Raw or Partially Cooked Animal Food and
4-501.111 Manual Warewashing-Hot Water 7.206.12 Rodent Bait Stations
3-201.12 Food in a Hermetically Sealed Container* Sanitization Temperatures* Raw Seed Sprouts Not Served*
7-206.13 Tracking Powders,Pest Control and
3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-Hot Water Monitoring* 3-801.11(C) Unopened Food Package Not Re-Served*
3-202.13 Shell Eggs* Sanitization Temperatures* TIMEITEMPERATURE CONTROLS
3-202.14 Eggs and Milk Products,Pasteurized* 4-5.01.114 Chemical Sanitization-Temp.,pH. 16 Proper Cooking Temperatures for PHFs CONSUMER ADVISORY
3-202.16 Ice Made From Potable Drinking Water* Concentration and Hardness* 3-401.11A(1)(2) Eggs-155°F 15 sec 22 3-603.11 Consumer Advisory Posted for Consumption of
5-101.11 Drinking Water from an Approved System* 4-601.11(A) Clean Utensils and Food Contact Surfaces of. Eggs-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 cli`1112001
590.006(B) Water Meets Standards in 310 CMR 22.0* 4-602.11 Cleaning Frequency of Utensils and Food Animals-155°F 15 sec*
Contact Surfaces of Equipment* 3-302.13 Pasteurized Eggs Substitute for Raw Shell
Shellfish and Fish From in Approved Source 3-401.11(B)(1)(2) Pork and Beef Roast-130°F 121 min* Eggs*
4-702.11 Frequency r f Sanitization of Utensils and Food 3-401.11(A)(2) Ratites,Injected Meats-155°F 15 sec*
3-201.14 Fish and Recreationally Caught Molluscan Contact Surfaces of Equipment*
Shellfish* 4-703.11 Methods of Sanitization-Hot Water and 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS
3-201.15 Molluscan Shellfish from NSSP Listed _ * Stuffing Containing Fish,Meat,Poultry or 590.009(A)-(D) Violations of Section 590.009 A
Chemical ( )-(D)in cater-
* Ratites-165°F 15 sec*
Sources 10 Proper,Adequate Handwashing ing,mobile food,temporary and residential
Game and Wild Mushrooms Approved By
3-401.11 C 3 Whole-muscle,Intact Beef Steaks 145°F* kitchen operations should be debited under
Regulatory Authority 2-301.11 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 1 Reheating for Hot Holding practices should be debited under#29-Special
Requirements.
$ 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* 2401.12 Discharges From the Eyes,Nose and Mouth* 3-403.11(B) Microwave-165°F 2 Minute Standing Time* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES
3-202.15 Package Integrity* 3-301.12 Preventing Contamination When Tasting* 3 403.11(C) Commercially Processed RTE Food-140°F* (Blue Items 23-30)
* 12 Prevention of Contamination from Hands Critical and non-critical violations,which do not relate to the foodborne
3-101.11 Food Safe and Unadulterated 3-403.11(E) Remaining Unsliced Portions of Beef Roasts* illness interventions and risk factors listed above,can be found in the
6 Tags/Records:Shellstock 590.004(E) Preventing Contamination from Employees* 1 g Proper Cooling of PHFs following sections of the Food Code and 105 CMR 590.000
3-202.18 Shellstock Identification* 13 Handwashing Facilities 3-501.14(A) Cooling Cooked PHFs from 140°F to 70'F
3-203.12 Shellstock Identification Maintained* Conveniently Located and Accessible Within 2 Hours and From 70°F to 41°F/45°F Item Good Retail Practices FC 590.000
Tags/Records:Fish Products 5-203.11 Numbers and Capacities* Within 4 Hours* 23. Management and Personnel FC-2 .003
* 5-204.11 Location and Placement* 3-501.14(B) Cooling PHFs Made from Ambient 24. Food and Food Protection FC-3 .004
3-402.11 Parasite Destruction Temperature Ingredients to 41°F/45°F 25. Equipment and Utensils FC-4 .005
3-402.12 Records,Creation and Retention* 5-205.11 Accessibility,Operation and Maintenance
Within 4 Hours 26. Water,Plumbing and Waste FC-5 .006
590.004(J) Labeling of Ingredients' Supplied with Soap and hand Drying Devices 27. Physical Facility FC-6 .007
7 Conformance with Approved Procedures/ 6-301.11 Handwashing Cleanser,Availability 28. Poisonous or Toxic Materials FC-7 .008
HACCP Plans 6-301.12 Hand Drying Provision
29. Special Requirements 009
3-502.11 Specialized Processing Methods*
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.
McKenzie, Marybeth
From: Anderson, Dave
Sent: Friday, January 24, 2020 9:59 AM
To: McKenzie, Marybeth
Subject: RE: 575 Main Street, Hyannis
Attachments: 573-575MainB.pdf
'573`575-Main-does have-a-common-GT(1-i 00-gaI+out-back, The plumbing for 575 goes under the ceiling in the
basement. A tee connection from 573 intersects the plumbing, which then exits the bldg near the west wall in the
basement. A single pipe, servicing both 575 & 573, exits the bldg and flows into the GT. An outlet pipe then goes back
into the basement, travels through to the front of the bldg, and then connects to the sewer connection under the front
patio, which then connects to the muni sewer in Main St.
The story concerning the three GTs for 561 and 569 is another convoluted and confusing explanation. The GTs for 561
and 569 are not associated with, nor anywhere near, the GT for 573—575.
The 'As-Built' for the GT connection at 573—575 is attached.
DJA
From: McKenzie, Marybeth
Sent: Friday, January 24, 2020 9:24 AM
To: Anderson, Dave
Subject: 575 Main Street, Hyannis
Importance: High
Hello Dave,
I am contacting you in regards to the grease trap at 575 Main Street, Hyannis. We have a record of a grease trap being
install in the back of the building, which 573 Main Street is connected too, but no record of 575 Main street being
connected to it too. 575 Main is a closed restaurant and someone is looking into going into the unit to open a new
restaurant. I contacted Mike Dibuono,who installed the grease trap, and he thought that it was only connected to one
unit-573 Main. He also said that you were present and would have an as built for it. I do have a copy of the grease trap
locations for 561 Main to 573 Main street.
Could you please confirm that 575 Main St. does or doesn't have a connection to a grease trap and could you confirm
the size of the grease trap. Also, could you confirm what size was installed at 573 Main Street. If you could include a
copy of the as built for our records,that would be great.Thanks you for your time and I appreciate the help and if you
have any questions please feel free to contact me.
Regards,
Marybeth McKenzie R. S.
Health Inspector
Town of Barnstable
(508) 862-4644
1
I
Town of Barnstable 4857
Department of Public Works Permit Number
Sewer Connection Ft Trench Opening Permit
Connection Disconnect Mod or Repair X
Map Et Parcel# : 308 - 111 - OOB Water Supplier DPW - Water Div
Street : 573 - 575 Main Street Sewer Account#village Hyannis Permit Fee 8t Check# : $50.00 Chck # 179
1. Residential Bldg Fee-$420.00 ; Commercial/Industrial Bldg Fee-$875.00
Septic Abandonment Permit# N/A 2. Surcharge for Each Additional Bldg on Same Service-$200.00
3. Surcharge for Pump Station-$300.00
4. Minor Repair or Disconnect of Existing Service-$50.00
Project Contact Information
Contractor Name : DiBuono Sewer Et Drain
Owner Name : C Shore Contact Name : Mike DiBuono
Mailing Address 1418 Commonwealth Ave Business Address 8 .Johns Path
W Newton , Mass 02165 So Yarmouth , Mass 02664
Contact Phone : 508 - 364 - 9587
Telephone Contact Fax
Property Use Information
Residential Commercial : ,1 Commercial Use : Retail / Restaurant
Industrial Standard Industrial Code
Number of Bldgs 1 Size of Parcel (acres) 1/4 Acres
Pipe Dia ft Material 4" Cast Iron Pipe Length : 100 ft
Before excavating in a Town Way or on Town owned property, the sewer installer must obtain a Road Opening/Trench
Permit and comply with the Construction Standards Et Specifications outlined therein. Applicant must notify DPW
48 hours prior to installation. Failure to comply with the regulations shall be grounds to revoke this permit.
The Sewer Et Trench Permit is valid for 180 calendar days from DPW approval and the installation must be completed within
that time period. Engineered drawings must be submitted, with this application form, to the DPW for all commercial or
industrial installations. The drawings must be approved before a permit will be issued.
Contractor Signature Et Date : M DiBuono
DPW Approval Signature Et Date : DJ Anderson 5/20/2016
Sewer Permit Expires : Nov , 2016
Sewer Connection Form Rev• 2010 Page : 1 of 4
l_
TOWN OF BARNSTABLE
Date: 5/20/2016 DEPARTMENT OF PUBLIC WORKS Permit: 4857
SEWER CONNECTION COMPLIANCE
Installer: DiBuono Sewer 8t Drain
Property Owner: C Shore
Property Location: 573 - 575 Main Street Village: Hyannis
Map ii Parcel : 308 - 111 - 00B Pipe Length: 50 ft Pipe Dia&Material: 4" Cast Iron
The work has been done in conformance with the Rules and Regulations of the Department of Public Works
Signature : DJ Andlerson Date : 21-Jun-16
I Depa dent of Public Works
LQ I
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arcel
3 - 11 - 00B
1,500 gal
grease tr
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573 6 575
Main 'lStreet
Hyannis
I
#561 Main Unit#8
1 MQ nitP 308-111 -OOC #577 Main
#561 Main U #A #569 Main
M8P 308•111•OOA MaP 308-111-OOD thru 000
Unit#A thru Unit#L tie in
May 7 , 16
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Sewer Connection Form I Rev; 2010) Page 1 of 4
Message Page 1 of 1
Miorandi, Donna
From: Bernazzani, Diane (DPH) [diane.bernazzani@state.ma.us]
Sent: Monday, June 20, 2016 10:00 AM
To: Miorandi, Donna
Subject: RE: Homemade Sausage
Hi Donna,
If the restaurant will be making and' using the sausage only on their own premises ("retail')then USDA does not
get involved.
Diane Bernazzani, REHS,CP-FS
Retail Food Safety&Training Coordinator
MDPH/BEH Food Protection Program
305 South Street,Jamaica Plain, MA 02130
phone:617-983-6765 fax:617-983-6770
diane.bernazzani@state.ma.us
From: Miorandi, Donna [mailto:Donna.Miorandi@town.barnstable.ma.us]
Sent: Monday, June 20, 2016 9:46 AM
To: Bernazzani, Diane (DPH)
Subject: Homemade Sausage
Good Morning Diane: I have a proposed new"Homemade Sausage" restaurant in Hyannis. They speak
Portuguese and a little English. I have required them to obtain a HACCP plan which I have not received yet-I
don't know if they understand the depth and breadth of it.
Question is should I be referring them to someone in USDA as well. If so do you have a contact person in mind.
Thanks for all your help.
Donna Miorandi
Barnstable Health Department
6/20/2016
LJ -
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[� 4 TABLES, 16 SEATS EXTERIOR 16
'- INTERIOR -a
TOTAL 23
{6 eet O EMPLOYEES
3 PER SHIFT
VICINITY MAP W/4 SEATS
1 4'-6"
SCOPE OF WORK HOSE BIB
INSTALL A FOOD SERVICE 3/0
SELF SERVE FACILITY
2/8 7000
KEY TO SYMBOLS -7 STOOLS O
1'-3"
0 GOLD MERCHANDISER 1.1 O
GOLD MERCHANDISER
1 O O CASHIER
O COLD DELI CASE O
O FOOD PICK UP
O TRIPLE WASH SINKS
_ O PREP SINK J 1 0 LINE OF S" O O O
QUARRY TILE
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1 O CONDIMENT5,15TORAGE BELOW
14
1 i GAS HOT PLATE r
1 1 2 GAS GHARBR r
OILER I 00
m '
C) GREASE TRAP BELOW r 1
3'-1" 1 1 0 0
114) GAS FRYER(2) 1 6
HALL 18
C> GAS GRIDDLE
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C) FREEZER ° ❑ 5
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NOTES O ro EC W/H NALL LL TP.YF.
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ALL APPLIANCES TO MEET
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INFILL WALL NICHE, 2 LAYERS 5/8
ALL APPLIANCES TO BE UL TYP. TYPE X 5.R.
LISTED. OVERHEAD
FLOORPLAN 1/4- 1,
O 2016.Greg DeLory,,AIBD
Map-30a Greg De Lory,AIBD
AlI\I n I I I I I HOMEMADE SAUSAGE P.O.Box 206
FLOORPLAN Block-111
Lot OOB 573 Main St Hyannis 21 Tom's Hollow Lane
Use Code Lessor Luiz Lemos South-2207-Orleans,
251,Mass 02662
�' Use Parce130811100B greg@gregdelorycom
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Town of Barnstable, Mass
Department of Pubk Works
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Equipment List, Homemade Sausage 573 Main St. Hyannis MA
8/21/16 1 of 1
Item Quan. Equipment Description and Model # NSF
No. ANSI
1 1 Cold Merchandiser 47 Cu. Ft. 2 slide door Berg ISO
EDMD-47SD-B 9001
i.1 1 Cold Merchandiser 10 Cu Ft Fogel DECK10 NSF-7
2 1 Cashier station Casework with P-Lam top
3 1 Refrigerated Deli Case Self contained Howard &McCray NSF-7
SC-CDS35-4
4 1 Food pickup counter Casework with P-Lam top
5 1 Stainless 3 Sauber 54" 3 sink with 2, 10"
compartment sink drainboards.
6 1 Prep sink Stainless 24 X 24 with splash
7 1 Hand wash sink Stainless Sauber SEHS-17X
8 1 Mop Sink Zurn high density Z1996-24 NSF
9 1 Employee coats Casework with P-Lam doors
10 1 Condiments P-Lam counter and splash with
melamine doors and shelving
below.
11 1 Hot Plate Patriot gas 4 burner hot plate
FMCTH-24 100K BTU
12 1 Charbroiler Patriot gas radiant Charbroiler, ETL
60K BTU FMECTC-24 listed
13 1 Grease Interceptor Per plumbing code
14 2 Fryer Patriot Gas Fryer with stainless ANSI
pot Z83.11 B-
FM-90/NG 2009
15 1 Griddle Patriot manual control gas griddle ETL
FMTECTG-24 listed
16 1 Freezer Arctic Air Model AF-49 NSF Y
17 1 Refrigerator drawers Turbo-Air 2 drawer refrigerated NSF Y
equipment stand TCBE-52SDR-E
18 1 Range Hood 9' MUA box hood w/ all nec.
welded and fire wrapped exhaust
duct from hood to upblast exhaust r
fan on roof w/ all nec. insulated
intake duct from fire damper on
hood to filtered exterior)blower.
19 1 Meat Grinder Weston #22 grinder/ uffer 08- NSF-8
2201-W
Finish Schedule, Homemade Sausage 573 Main St. Hyannis Mass.
7/17/16 1 of 1
Floor Wall Coiling
Kitchen
Cooking Quarry tile with Stainless steel same White .090 FRP
coving with epoxy width as hood. Wallboard. Fiberglas
grout Reinforced Polyester
panel with plastic
joint trim
Food Prep Quarry tile with Stainless splash
coving with epoxy panels above White .090 FRP
grout counters plus Wallboard. Fiberglas
White .090 FRP Reinforced Polyester
Wallboard, Fiberglas panel with plastic
Reinforced Polyester joint trim
panel with plastic
joint trim
Bar NA NA NA
Food Storage Quarry the with White .090 FRP Painted sheetrock
coving with epoxy Wallboard. Fiberglas High gloss finish
grout Reinforced Polyester
panel with plastic
joint trim
Other storage VCT the Painted sheetrock Painted sheetrock
High gloss finish High gloss finish
Toilet Room Commercial grade Epoxy painted Epoxy painted
VC sheet with sheetrock sheetrock
coving High gloss finish High gloss finish
Dressing Rooms NA NA NA
Garbage and Refuse NA, exterior NA, exterior NA, exterior
Mop Service Area Quarry tile with White .090 FRP White .090 FRP
coving with epoxy Wallboard. Fiberglas Wallboard. Fiberglas
grout Reinforced Polyester Reinforced Polyester
panel with plastic panel with plastic
joint trim joint trim
Warehousing Area NA NA NA
Walk-in Freezer NA NA NA
08 Wb NA$i 1ne
40
Equipment List, Homemade Sausage 573 Main St. Hyannis MA
7/17/16 1 of 1
Item Quan. Equipment Description and Model # NSF
No. ANSI
1 1 Cold Merchandiser 47 Cu. Ft. 2 slide door Berg ISO
EDMD-47SD-B 9001
1.1 1 Cold Merchandiser 10 Cu Ft Fogel DECK10 NSF-7
2 1 Cashier station Casework with P-Lam top
3 1 Refrigerated Deli Case Self contained Howard &McCray NSF-7
SC-CDS35-4
4 1 Food pickup counter Casework with P-Lam top
5 1 Stainless 3 Sauber 54" 3 sink with 2, 10"
compartment sink drainboards.
6 1 Prep sink Stainless 24 X 24 with splash
7 1 Hand wash sink Stainless Sauber SEHS-17X
8 1 Mop Sink Zurn high density Z1996-24
9 1 Employee coats Casework with P-Lam doors
10 1 Condiments P-Lam counter and splash with
melamine doors and shelving
below.
11 1 Hot Plate Patriot gas 4 burner hot plate
FMCTH-24 100K BTU
12 1 Charbroiler Patriot gas radiant Charbroiler, ETL
• 60K BTU FMECTC-24 listed
13 1 Grease trap Per plumbing code
14 2 Fryer -)Patriot Gas Fryer with stainless ANSI
pot Z83.11 B-
FM-90/NG 2009
15 1 Griddle Patriot manual control gas griddle ETL
FMTECTG-24 listed
16 1 Freezer Arctic Air Model AF-49 NSF Y
17 1 Refrigerator drawers Turbo-Air 2 drawer refrigerated NSF Y
equipment stand TCBE-52SDR-E
18 1 Range Hood 9' MUA box hood w/ all nec.
welded and fire wrapped exhaust
duct from hood to upblast exhaust
fan on roof w/ all nec. insulated
intake duct from fire damper on
hood to filtered exterior blower.
19 1 Meat Grinder Weston #22 grinder/stuffer 08- NSF-8
2201-W
I
SYMBOL KEY
Q1 1 OV DUPLEX CONVENIENCE OUTLET
1 1 OV QUAD CONVENIENCE OUTLET
G IFI 1 1 OV CONVENIENCE OUTLET W/
GROUND FAULT INTERRUPTER
llll) 220 V OUTLET
T� SWITCH
SD I
3 WAY 5WITGH
5WITGH W/DIMMER j
3 Y,IAY SNITCH W/DIMMER I OFF
c SWTCH W/TIMER I F F 7ff j
I 1
FS FOOT 5WITGH
O b"RECESSED CAN O=FLOURESGENT �I
EXTERIOR WALL SCONCE / IF — F'
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INTERIOR WALL SGONSE CJ
OS MANUAL ON,AUTO OFF OCCUPANCY n
SENSOR
PG PHOTO CELL ACTIVATION j
I
SURFACE MOUNT FLOURE5CENT `
FIXTURE
O00
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�I MIN.5 AIR CHAN&E5 PER HR.
F
101
FAN LIGHT MAIN
NAT.GAS LOG. I � J ELEC.
i SD ' �° L..._...._....._....__ :... PANEL
D TELEPHONE JACK LID
io
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011 GABLE TV LA F
SURFACE MOUNT FLUORESCENT —
FIXTURE,MIN.40 LUMENS PER F HD
WATT W/ELECTRONIC BALLAST
I 0 i
SHEILDED FLUORESCENT ( l F I
® FIXTURE,MIN.40 LUMENS PER
W F i
ATT W/ELECTRONIC BALLAST
MS/PG MOTION 5EN50K +PHOTOCELL \
HD, HD,
�{ THERMOSTAT
H05E BIB L 50 GAL.
ELEC.
5MOK=/GO GOMBI DETECTOR W/H
SD HARDWIRED
CO CO DETECTOR HARDWIRED MEGH. PLAN 1/4',- 1'
HD HEAT DETECTOR HARDWIRED
ALARM HORN STROBE
ALARM STROBE
NOTES:
"ALL NEW LIGHTING SOURCES TO BE 50%EFFIGIAGY
'ALL FLOURE56ENT FIXTURES TO
HAVE ELECTRONIC BALLAST
•ALL FIXTURES TO BE UL LISTED
02018,Greg DeLory.AIBD
j n I oil'
Map-308 Greg De Lory,AIBD
A2 "- n Block-ill HOMEMADE SAUSAGE P.O.Box 206
MEGH.PLAN x I I I"I I I I Lot 006 573 Main St.Hyannla 21 Tom's Hollow Lane
Use Code Lessor Lulz Lem— 774-207-0 51'Odeui Mass 02662
Use Parcel 308111008 grog@gregdelorycom
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From: Fabio Lima <fabinhoperrylima@gmail.com>
Sent: Monday, March 22, 20214:31 PM
To: McKenzie, Marybeth
Subject: Fwd: Concerning grease trap clean out:
---------- Forwarded message ---------
From: Taylor Shore <tUlor shoregyahoo.com>
Date: Mon, Mar 22, 2021 at 3:33 PM
Subject: Concerning grease trap clean out:
To: <Fabinhoperrylima@gmail.com>
March 22, 2021
Fabio Lima
Concerning grease trap clean out:
It shall be done every six months or sooner, cost will be split equally (Divided in half) with
the restaurant at 573 and 575. If one restaurant is closed the restaurant that is open assumes
full responsibility.
Thank you,
Mitch Hodus, property manager of 573-575 LLC
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!
i
J
McKenzie, Marybeth
From: McKenzie, Marybeth
Sent: Wednesday, March 24, 2021 11:01 AM
To: Tabio Lima'
Subject: RE:
Hello Fabio,
I did speak to Mitch Hodus about the seating and he said whatever the seating was approved for before will be the
seating that is allowed by them. I will be sending him an email too.The permit will be in the vestibule at 200 Main
Street for you to pick up, but I have not received your outside dining application yet so you will only be approved for the
seven inside seats at this time.
Thanks, Marybeth McKenzie R.S.
From: Fabio Lima [ma i Ito:fabinhoperrylima@gmaiLcom]
Sent: Wednesday, March 24, 2021 10:50 AM
To: McKenzie, Marybeth
Subject:
Hello marybeth this is Fabio from Perry Lima cafe
I spoke with my land lord and he said he addressed the seating with you .
Can I stop by and get my permit?
You can call me on 5082748771
Thank you
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!
1
TOWN OF BARNSTABLE
Date : 5/20/2016 DEPARTMENT OF PUBLIC WORKS Permit: 4857
SEWER CONNECTION COMPLIANCE
Installer: DiBuono Sewer Ft Drain
Q �
Property Owner: C Shore
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Property Location : 573 - 575 Main Street Village: Hyannis
Map It Parcel : 308 - 111 - OOB Pipe Length: _ SO ft Pipe Dia&Material : 4" Cast Iron �
The work has been done in conformance with the Rules and Regulations of the Department of Public Works
Signature : DJ! And rson Date : 21-Jun-16
Depa ment of Public Works
i !
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M p tt Parcel
----- i 30 - 111 - 00B I
S
1,500 eat !
Tease trap
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1 9 f
of
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573 Ft 575 j
i Main :Street
I
' Hyannis
McKenzie, Marybeth
From: Fabio Lima <fabinhoperrylima@gmail.com>
Sent: Saturday,April 24, 2021 1:39 PM
To: McKenzie, aryls beth�
Subject: Pictures
Hello Marybeth this is Fabio lima from Perrylima cafe
All ,�- , tL&4
2
Town of Barnstable, Mass
Department of Public Warts
Map& Parcel T7
308- I I I -various
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173 Main k575
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Plan View Grease Trap Locations for Cordo Units
Scab: 1,-W at Map 8 Parcel306-111-various
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McKenzie, Marybeth
From: Anderson, Dave
Sent: Friday,January 24, 2020 9:59 AM
To: McKenzie, Marybeth
Subject: RE: 575 Main Street, Hyannis i
Attachments: 573-575MainB.pdf
l5_7.3 575'Main does have-a•common GT_(1-,500-gaI-}tout back.,vT_heTplumb ag, or 575 goes under the ceiling in the
- 1
basement. A tee connection from 573 intersects the plumbing-.�-- �-r, which th�en exits the bldg near the west wall in the
basement. A single pipe, servicing both 575 & 573, exits the bldg and flows into the GT. An outlet pipe then goes back
into the basement, travels through to the front of the bldg, and then connects to the sewer connection under the front
patio, which then connects to the muni sewer in Main St.
The story concerning the three GTs for 561 and 569 is another convoluted and confusing explanation. The GTs for 561
and 569 are not associated with, nor anywhere near,the GT for 573—575.
The 'As-Built' for the GT connection at 573—575 is attached.
DJA
From: McKenzie, Marybeth
—
Sent: Friday, January 24, 2020 9:24 AM
To: Anderson, Dave
Subject: 575 Main Street, Hyannis
Importance: High
Hello Dave,
I am contacting you in regards to the grease trap at 575 Main Street, Hyannis. We have a record of a grease trap being
install in the back of the building, which 573 Main Street is connected too, but no record of 575 Main street being
connected to it too. 575 Main is a closed restaurant and someone is looking into going into the unit to open a new
restaurant. I contacted Mike Dibuono,who installed the grease trap, and he thought that it was only connected to one
unit- 573 Main. He also said that you were present and would have an as built for it. I do have a copy of the grease trap
locations for 561 Main to 573 Main street.
Could you please confirm that 575 Main St. does or doesn't have a connection to a grease trap and could you confirm
the size of the grease trap.Also, could you confirm what size was installed at 573 Main Street. If you could include a
copy of the as built for our records,that would be great.Thanks you for your time and I appreciate the help and if you
have any questions please feel free to contact me.
Regards,
Marybeth McKenzie R. S.
Health Inspector
Town of Barnstable
(508) 862-4644
i
i
Town of Barnstable 4857
Department of Public Works Permit Number
Sewer Connection Ft Trench Opening Permit
Connection Disconnect Mod or Repair X
Map Et Parcel# : 308 - 111 - 00B water Supplier DPW - Water Div
Street 573 - 575 Main Street Sewer Account#
Village : Hyannis Permit Fee a Check# : $50.00 ChCk # 179
1. Residential Bldg Fee-$420.00 ; Commercial/Industrial Bldg Fee-$875.00
Septic Abandonment Permit# N/A 2. Surcharge for Each Additional Bldg on Same Service-$200.00
3. Surcharge for Pump Station-$300.00
4. Minor Repair or Disconnect of Existing Service-$50.00
Project Contact Information
Contractor Name : DiBuono Sewer Ft Drain
Owner Name : C Shore Contact Name : Mike DiBUono
Mailing Address 1418 Commonwealth Ave Business Address 8 Johns Path
W Newton , Mass 02165 So Yarmouth , Mass 02664
Contact Phone : 508 - 364 - 9587
Telephone Contact Fax
Property Use Information
Residential Commercial : I Commercial Use Retail / Restaurant
Industrial Standard Industrial Code
Number of Bldgs 1 Size of Parcel (acres) 1/4 Acres
Pipe Dia F1 Material 4" Cast Iron Pipe Length 100 ft
Before excavating in a Town Way or on Town owned property, the sewer installer must obtain a Road Opening/Trench
Permit and comply with the Construction Standards It Specifications outlined therein. Applicant must notify DPW
48 hours prior to installation. Failure to comply with the regulations shall be grounds to revoke this permit.
The Sewer fr Trench Permit is valid for 180 calendar days from DPW approval and the installation must be completed within
that time period. Engineered drawings must be submitted,with this application form, to the DPW for all commercial or
industrial installations. The drawings must be approved before a permit will be issued.
Contractor Signature Et Date : M D1BUono
DPW Approval Signature a Date : DJ Anderson 5/20/2016
Sewer Permit Expires : Nov , 2016
Sewer Connection Form (Rev; 2010) Page : 1 of 4
TOWN OF BARNSTABLE
Date: 5/20/2016 DEPARTMENT OF PUBLIC WORKS Permit: 4857
SEWER CONNECTION COMPLIANCE
Installer: DiBuono Sewer Et Drain
Property Owner: C Shore
Property Location: 573 - 575 Main Street Village: Hyannis
Map & Parcel : 308 - 111 - 00B Pipe Length: 50 ft Pipe Dia&Material: 4" Cast Iron
The work has been done in conformance with the Rules and Regulations of the Department of Public Works
Signature : DJ, And rson Date : 21-Jun-16
Depaknient of Public Works c
M p &t Parcel
30 - 111 - OOB
1,500 gat
grease trap
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�T
a
a � a
i
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i
I
i
i
i
573 &t 575
Main jStreet
Hyannis
I
#561 Main Unit#B
MEW 308-111 -OOC #577 Main
#561 Main Unit#A #569 Main
M&P 308-111-OOA M&P -111-OOD 000
Unnitit#A thru Unit t#L tie in
May 7 , 16
L2 Li
Sewer Connection Form (Rev; 2010) Page 1 of 4
Crocker, Sharon
From: McKean, Thomas
Sent: Wednesday, September 04, 2013 10:46 AM
To: Crocker, Sharon
Subject: FW: Grease Trap Variance 575 Main Street Hyannis
-----Original Message----- „-
From: Parsons, Roger
Sent: Wednesday,September 04, 2013 9:53 AM
To: McKean,Thomas
Subject: Grease Trap Variance 575 Main Street Hyannis
Good morning Tom -To address the condition (5) contained in your dept. letter dated July 24th , 2013 with reference to
the above application I would like to state the following:
For the proposed use (again as identified and limited in the July 24th letter) no grease trap is required.
This decision is also based upon the following review separately:
A) No "cooking/baking"with various ingredients and utensil use is proposed except for additive in controlled area
(popcorn machine).
B) No washing of popcorn machine is proposed (stated it will be wiped clean by operator)
therefore minimal sink wash will occur.
C) No dishes will be created -therefore no washing thereof- product will be sold in take away
bags.
lk
1