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Home My WebLink AboutMAIN STREET (HYANNIS) PAVILON INDIAN o2i-o9ll CUISINE - 511 FAIN STREET, HYANNIS r1 Town of Barnstable BOARD OF HEALTH John T. Norman Board of Health Donald A.Gaudagnoli,M.D. URNSrAss F.P.(Thomas)Lee,. 4AIS& Daniel Luczkow,M.D. Alt. {, ,639. 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: 24 Issue Date: 01/01/2022 DBA: PAVILION INDIAN CUISINE OWNER: PREET CORP. Location of Establishment: 511 MAIN STREET HYANNIS„ MA 02601 Type of Business Permit: FOOD SERVICE Annual: YES Seasonal: IndoorSeating: 56 OutdoorSeating: 20 Total Seating: 76 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: C,i FROZEN DESSERT: Thomas A. McKean, IRS, CHO, Health Agent FOR ESTABLISHMENTS WITH SEATING: PERMIT IS NOT VALID UNLESS ISSUED IN CONJUNCTION WITH A COMMON VICTUALER LICENSE Restrictions: I Town of Barnstable For Office Us )nbr, Initials. Date Paid , $ Inspectional Services . l(!W L� 6. Public Health Division check# Thomas McKean,Director 200 Main Street,Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENTDATE/0/ NEW OWNERSHIP RENEW NAME OF FOOD ESTABLISHMENT: EA V"1 iI 1 q ADDRESS OF FOOD ESTABLISHMENT: Hq-�%A V 1 ,(19- c11)-d v MAILING ADDRESS(IF DIFFERENT FROM ABOVE): E-MAIL ADDRESS: ik 1—1-1,,i.,'d 1 -7 67 A �,fU Ly►4 TELEPHONE NUMBER OF FOOD ESTABLISHMENT: I TOTAL NUMBER OF BATHROOMS: WELL WATER: YES NO ►"' ... (ANNUAL WATER ANALYSIS REQUIRED) ANNUAL: ✓ SEASONAL: DATES OF OPERATION•�J/J TO l l_fi 2P 1�a NUMBER OF SEATS: INSIDE: 5 OUTSIDE: 7-v TOTAL: 7(� 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? �e S IS AN AIR CURTAIN PROVIDED AT WAITSTAFF SERVICE DOOR(S)? TYPE OF ESTABLISHMENT: (PLEASE CHECK ALL THAT APPLY BELOW) FOOD SERVICE RETAIL FOOD-ONLY required for TCS foods(foods requiring refrigeration/freezer) BED&BREAKFAST CONTINENTAL BREAKFAST COTTAGE FOOD INDUSTRY(formerly residential Idtchen) MOBILE FOOD FROZEN DAIRY DESSERT MACHINES...(MONTHLY LAB ANALYSIS REQUIRED) CATERING... (CATERING NOTICE REQUIRED BEFORE EVENT(SEE PAGE#2) *** SEASONAL,MOBILE & NEW FOOD ONLY*** REQUIRED TO CALL HEALTH DIV.FOR INSPECTION PRIOR TO PERMIT BEING ISSUED PLEASE CALL 508-8624644 Q:1Application FormsTOODAPP 2020.doc OWNER INFORMATION: FULL NAME OF APPLICANTT A 6 1 ti SOLE OWNER: YES/NO / OWNER PHONE# ^�3 y ADDRESS_ 157 i /11 A W) 44 19— 02�y CORPORATE OWNER: E F C-,--az N CORPORATE ADDRESS: 5- M 1" � PERSON IN CHARGE OF DAILY OPERATIONS: d,/t A42 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. 069- )" 1Vl1Hd G�/ 0 � 2. SA Aj7 01 d2A-y SIGNATURE OF APPLICANT DATE ***FOOD POLICY INFORMATION"* * SEASONAL FOOD SERVICE: All seasonal food establishments,including mobile trucks must be inspected by the Health Div. prior to opening!! Please call Health Div.at 508-862-4644 to schedule your inspection. Please call at least(7)days in advance. FROZEN DAIRY DESSERTS: Frozen desserts must be tested by a State Certified lab prior to opening and monthly thereafter, with sample results submitted to the Health Div. Failure to do so will result in the suspension or revocation of your Frozen Dessert Permit until the above terms are met. CATERING POLICY: Anyone who caters within the Town of Barnstable must notify theTown by fax or mail prior to catering event. You must complete a catering notice found at http://www.townofbarnstable.usthealthdivision/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 1st to Dec. 315t each calendar year. IT IS YOUR RESPONSIBILITY TO RETURN THE COMPLETED APPLICATION(S)AND REQUIRED FEES BY DEC 1st. Q:\Application FonnsTOODAPP REV3-2019.doc i IKE Town of Barnstable BOARD OF HEALTH John T.Norman {{ Board of Health Donald A.Gaudagnoli,M.D. ' tisr�aec, '';1 Paul J.Canniff,D.M.D. M" ' F.P. Thomas Lee Alternate 200 Main Street, Hyannis, MA 02601 Phone: (508) 862-4644 Fax: (508)790 6304 www.townofbarnstable.us Permit to Operate a Food Establishment In accordance with regulations promulgated under authority of 105 CMR 590.000 M.G.L. Chapter 94 Sections 305A, 305B, 146, 189 and 189A; Chapter 111, Sections 5 and 127A, a permit is hereby granted to: Permit No: 24 Issue Date: 01/01/2021 DBA: PAVILION INDIAN CUISINE OWNER: PREET CORP. Location of Establishment: 511 MAIN STREET HYANNIS„ MA 02601 Type of Business Permit: FOOD SERVICE Annual: YES Seasonal: IndoorSeating: 56 OutdoorSeating: 20 Total Seating: 76 FEES FOOD SERVICE ESTABLISHMENT: $300.00 YEAR. 2021 RETAIL FOOD: COTTAGE FOOD OPERATION: Permit Expires: 12/31/2021 B&B-FULL BREAKFAST: CONTINENTAL BREAKFAST: MOBILE-FOOD: MOBILE-ICE CREAM: Q ,� FROZEN DESSERT: Thomas A. McKean, RS, CHO, Health Agent FOR ESTABLISHMENTS WITH SEATING: PERMIT IS NOT VALID UNLESS ISSUED IN CONJUNCTION WITH A COMMON VICTUALER LICENSE Restrictions: d :3 oFTr,�rFor OM Initials: 6 Town of Barnstable Date Paid V 2(Amt Pd$ BAJ AM. Inspectional Services '"�' ; 1639. `e� Public Health Division Check# '°rfn MPS s Thomas McKean, Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 AP/P1LICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT DATE `�� / ~ -LNEW OWNERSHIP RENEWAL i/r NAME OF FOOD ESTABLISHMENT: PA V ) ))(/J-/ ADDRESS OF FOOD ESTABLISHMENT: s ( f MAILING ADDRESS(IF DIFFERENT FROM ABOVE): "' E-MAIL ADDRESS: TELEPHONE NUMBER OF FOOD ESTABLISHMENT:' TOTAL NUMBER OF BATHROOMS: 12— WELL WATER: YES✓NO ...(ANNUAL WATER ANALYSIS REQUIRED) ANNUAL: SEASONAL: DATES OF OPERATION: / /_ TO NUMBER OF SEATS: INSIDE: 6�- OUTSIDE TOTAL: SEATING: MUST OBTAIN A COMMON VICTUALLER'S LICENSE FROM LICENSING DIV. ***OUTSIDE DINING REMINDER*** OUTSIDE DINING MUST BE APPROVED BY THE HEALTH DIV.AND LICENSING,AND MEET OUTSIDE DINING REQUIREMENTS. IS WAIT STAFF PROVIDED FOR OUTSIDE DINING? IS AN AIR CURTAIN PROVIDED AT WAITSTAFF SERVICE DOOR(S)? TYPE OF ESTABLISHMENT: (PLEASE CHECK ALL THAT APPLY BELOW) w/f--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*** REOUIRED TO CALL HEALTH DIV.FOR INSPECTION PRIOR TO PERMIT BEING ISSUED PLEASE CALL 508-862-4644 Q:\Application FormsWOODAPP 2020.doc OWNER INFORMATION: FULL NAME OF APPLICANT SOLE OWNER: YES/NO OWNER PHONE# `jam �- j�� L1 01 ADDRESS_ 1140 Ki i— .4)k I Lez— ti</l NNi S + CORPORATE OWNER: C_ 1"9 CORPORATE ADDRESS: �'I �1'l�,�M S l� h`/ +�1�IrS' M`� G v/ PERSON IN CHARGE OF DAILY OPERATIONS: List (2) Certified Food Protection Managers AND at least(1)Allergen Awareness Certified Staff All FOOD ESTABLISHMENTS must have 1 Certified Food Protection Manager PER SHIFT. **ATTACH COPIES OF CERTIFICATES** The Health Div. will NOT use past years' records. You must provide new copies and POST THE CERTIFICATES at your food establishment. Certified Food Managers Expiration Date Aller en Awareness Expiration Date 1. "'A / 'ZO SIGNATURE 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 oyenin2!! 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.asy. OUTDOOR COOKING: Outdoor cooking,preparation,or display of any food product by a food establishment is prohibited. NOTICE: Permits run annually from January 1 st to Dec.3 V each calendar year. IT IS YOUR RESPONSIBILITY TO RETURN THE COMPLETED APPLICATIONS)AND REQUIRED FEES BY DEC Ist. Q:\Application Fon-nsTOODAPP REV3-2019.doc Town of Barnstable BOARD OF HEALTH John T.Norman Board of Health Donald A.Gaudagnoli,M.D. D.+►MisrADIZ Paul J.Canniff,D.M.D. e 200 Main Street, Hyannis, MA 02601 F.P. Thomas Lee Alternate Phone: (508) 862-4644 Fax: (508)790-6304 www.townofbarnstable.us Permit to Operate a Food Establishment In accordance with regulations promulgated under authority of 105 CMR 590.000 M.G.L. Chapter 94 Sections 305A, 305B, 146, 189 and 189A; Chapter 111, Sections 5 and 127A, a permit is hereby granted to: Permit No: 24 Issue Date: 12/31/2019 DBA: PAVILION INDIAN CUISINE OWNER: NARINDER THIND Location of Establishment: 511 MAIN STREET HYANNIS, MA 02601 Type of Business Permit: FOOD SERVICE Annual: YES Seasonal: IndoorSeating: 56 OutdoorSeating: 20 Total Seating: 76 FEES FOOD SERVICE ESTABLISHMENT: $300.00 YEAR. 2020 RETAIL FOOD: COTTAGE FOOD OPERATION: ' Permit Expires: 12/31/2020 B&B-FULL BREAKFAST: CONTINENTAL BREAKFAST: MOBILE-FOOD: MOBILE-ICE CREAM: an 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: `s= of rq� For Office Use Only.• Initials• _ Town of Barnstable V�NbAmjza Paid� $ JMRNSTrABLEInspectional Services Date ' i6' Adv Public Health Division heck# j QED NtA�a Thomas McKean, Director 200 Main Stfeet, Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT DATE �� NEW OWNERSHIP RENEWAL—k-- o~' l NAME OF FOOD ESTABLISHMENT: ADDRESS OF FOOD ESTABLISHMENT: f-1 v MAILING ADDRESS(IF DIFFERENT FROM ABOVE): E-MAIL ADDRESS: Aj ,�1H I ] � �I� C ,N^ TELEPHONE NUMBER OF FOOD ESTABLISHMENT: TOTAL NUMBER OF BATHROOMS: �- WELL WATER: YES_NO (ANNUAL WATER ANALYSIS REQUIRED) ANNUAL:✓ SEASONAL: DATES OF OPERATION:_/_/_ TO NUMBER OF SEATS: INSIDE:5- OUTSIDE:70 TOTAL: `7 L VJ 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)? J 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 i OWNER INFORMATION: FULL NAME OF APPLICANT SOLE OWNER: YES/NO n OWNER PHONE # � 73 7`_ I ADDRESS_ ` y �•( I L j.0 I 12 11 h �1�1 G I CORPORATE OWNER: CORPORATE ADDRESS: i PERSON IN CHARGE OF DAILY OPERATIONS: List (2) Certified Food Protection Managers AND at least (1) Allergen Awareness Certified Staff All FOOD ESTABLISHMENTS must have 1 Certified Food Protection Manager PER SHIFT. **ATTACH COPIES OF CERTIFICATES** The Health Div. will NOT use past years' records. You must provide new copies and POST THE CERTIFICATES at your food establishment. Certified Food Managers Expiration Date Allergen Awareness Expiration Date 2. A 7,4,/ j-V 3 SIGNATURE OF APPLICANT DATE ***FOOD POLICY INFORMATION*** SEASONAL FOOD SERVICE: All seasonal food establishments,including mobile trucks must be inspected by the Health Div. prior to opening!! Please call Health Div.at 508-862-4644 to schedule your inspection. Please call at least(7)days in advance. FROZEN DAIRY DESSERTS: Frozen desserts must be tested by a State Certified lab prior to opening and monthly thereafter, with sample results submitted to the Health Div. Failure to do so will result in the suspension or.-evocation of your Frozen Dessert Permit until the above terms are met. CATERING POLICY: Anyone who caters within the Town of Barnstable must notify theTown by fax or mail prior to catering event. You must complete a catering notice found at http://www.townofbarnstable.us/healthdivision/applications.asi). OUTDOOR COOKING: Outdoor cooking,preparation,or display of any food product by a food establishment is prohibited. NOTICE: Permits run annually from January 1 st to Dec.3151 each calendar year. IT IS YOUR RESPONSIBILITY TO RETURN THE COMPLETED APPLICATIONS)AND REQUIRED FEES BY DEC 1st. QAApplication FormsWOODAPP REV3-2019.doc I f BOARD OF HEALTH np*rtCi , Town of Barnstable ` Paul J Canniff, D.M.D. Board of Health Donald A.Gaudagnoli,M.D. EAlinsrAUM John T.Norman es9• 200 Main Street, Hyannis, MA 02601 F.P. Thomas Lee Alternate gaa 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: 24 Issue Date: 12/20/18 DBA: PAVILION INDIAN CUISINE OWNER: NARINDER THIND Location of Establishment: 511 MAIN STREET HYANNIS MA 02601 Type of Business Permit: FOOD SERVICE Annual: YES Seasonal: IndoorSeating: 56 OutdoorSeating: 20 Total Seating: 76 FEES - FOODSERVICEESTABLISHMENT: $300.00 YEAR: 2019 RETAIL FOOD: COTTAGE FOOD OPERATION: Permit Expires: 12/31/2019 B&B-FULL BREAKFAST: CONTINENTAL BREAKFAST: -------- ---- — -- - MOBILE- FOOD: MOBILE-ICE CREAM: FROZEN DESSERT: Thomas A. McKean, IRS, CHO, Health Agent TOBACCO SALES: FOR ESTABLISHMENTS WITH SEATING: PERMIT IS NOT VALID UNLESS ISSUED IN CONJUNCTION WITH A COMMON VICTUALER LICENSE Restrictions: pUIME rbk� For Office Use Only: Initials: Town of Barnstable Date Paid �B"ASS. Inspectional Services A i679- �0 Check# I►��° 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 2-V f(-NEW OWNERSHIP RENEWAL NAME OF FOOD ESTABLISHMENT: �i�V P'"L- %ems ADDRESS OF FOOD ESTABLISHMENT: 511 M A MAILING ADDRESS(IF DIFFERENT FROM ABOVE): sc—u"-- E-MAIL ADDRESS: cocum, TELEPHONE NUMBER OF FOOD ESTABLISHMENT: MI C, �S .TOTAL NUMBER OF BATHROOMS: WELL WATER: YES NO (ANNUAL WATER ANALYSIS REQUIRED) ANNUAL: SEASONAL: DATES OF OPERATION: / / TO NUMBER OF SEATS: INSIDE: OUTSIDE:2� TOTAL: NS J' 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? yLS IS AN AIR CURTAIN PROVIDED AT WAITSTAFF SERVICE DOOR(S)? 06 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) ( Q ) CATERING ... (CATERING NOTICE REQUIRED BEFORE EVENT(SEE PAGE#2) TOBACCO SALES ... (ANNUAL TOBACCO SALES APPLICATION REQUIRED) *** SEASONAL,MOBILE & NEW FOOD ONLY*** REQUIRED TO CALL HEALTH DIV.FOR INSPECTION PRIOR TO PERMIT BEING ISSUED Q:Wpplication FormsTOODAPPREV2018.doc E .a PLEASE CALL 508-862-4644 OWNER INFORMATION: FULL NAME OF APPLICANT AJ A Vj ---, D`c—A 7� 1 t1 SOLE OWNER: YES/NO OWNER PHONE # 6\'39--7 i'7-14 0 94 f ADDRESS I!g o )< I L r--d J� 2 V:�_ -S4-,.w t% f1,1 o-- o2 6 I CORPORATE OWNER: �� C c,� FEDERAL ID NO. : 01•-I 3 I LI 3 CPS' I CORPORATE ADDRESS: 5 1) e'ltt ik, S i t�!N ti I S /14-A- 0Z 661 PERSON IN CHARGE OF DAILY OPERATIONS: Aj W )iy`bf_� --f I t %.-L a 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 gLer en Awareness Expiration Date I. (j 442 I..sD£_. � 6 / / 2-o 1. 4y /U/ f:?- / ?�`2 2. f SIGNATURE OF APPLICANT DATE ***FOOD POLICY INFORMATION*** SEASONAL FOOD SERVICE: All seasonal food establishments, including mobile trucks must be inspected by the Health Dv. prior to opening!! Please call Health Div.at 508-862-4644 to schedule your inspection. Please call at least(7)days in advance. FROZEN DAIRY DESSERTS: Frozen desserts must be tested by a State Certified lab prior to opening and monthly thereafter, with sample results submitted to the Health Div. Failure to do so will result in the suspension or revocation of your Frozen Dessert Permit until the above terms are met. CATERING POLICY: Anyone who caters within the Town of Barnstable must notify theTown by fax or mail prior to catering event. You must complete a catering notice found at http://www.townofbarnstable.us/healthdivision/applications.asp. OUTDOOR COOKING: Outdoor cooking,preparation,or display of any food product by a food establishment is prohibited. TOBACCO ESTABLISHMENTS: All tobacco establishments must complete an Application for Tobacco Sales Permit and Employee Signature Form. NOTICE: Permits run annually from January 1st to Dec. 3 1"each calendar year. IT IS YOUR RESPONSIBILITY TO RETURN THE COMPLETED APPLICATIONS)AND REQUIRED FEES BY DEC 1 st. QAApplication FormsTOODAPPREV2018.doc oFINErok TOWN OF BARNSTABLE HEALTHINSPECTOR'S Establishment Name: Date: Page: of. . qa - OFFICE HOURS PUBLIC HEALTH DIVISION soo•ssoA.nn. BARNSTABLE. ` 200 MAIN STREET s:so-a:so P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified e3q:"�0� HYANNIS,MA 02601 MON.-FRi" No Reference R-Red Item - PLEASE PRINT CLEARLY. �prFD MPS n - - 508-862-4644 FOOD ESTABLISHMENT INSPECTION REPORT Name 7 Date Type o T of Ins tion utieo 1p Address �l Risk ood Sery Re-inspectio �'1 Level ection Telephone Residential Kitchen Date: t 9 Mobile Pre-operation �-� Owner HACCP Y/N Temporary Suspect Illness Caterer General Complaint Person in Charge(PIC) Time Bed&Breakfast HACCP L G In: Other Inspector Out: L 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 TIME/TEMPERATURE CONTROLS(Potentially Hazardous Foods) ❑4.Food and Water from Approved Source ❑ 16.Cooking Temperatures ❑ 5.Receiving/Condition ❑ 17.Reheating ❑ 6.Tags/Records/Accuracy of Ingredient Statements ❑ 18.Cooling ❑ 7.Conformance with Approved Procedures/HACCP Plans ❑ 19.Hot and Cold Holding PROTECTION FROM CONTAMINATION ❑ 20.Time As a Public Health Control ❑ 8.Separation/Segregation/Protection REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) ❑ 9.Food Contact Surfaces Cleaning and Sanitizing ❑ 21.Food and Food Preparation for HSP , ❑ 10.Proper Adequate Handwashing CONSUMER ADVISORY ❑ 11.Good Hygienic Practices ❑ 22.Posting of Consumer Advisories Violations Related to Good Retail Practices(Blue Items) Total Number of Critical Violations Critical(C)violations marked must be corrected immediately. (blue&red items) , , I Corrective Action Required: ❑ No El Yes Non-critical(N)violations must be corrected immediately or Overall Rating i 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 insp tion today,the items ❑ Embargo ❑ Emergency Closure ❑ Voluntary Disposal ❑ Other: checked indicate violations of 105 CMR 590.000/Federal Food Code. 23.Management and Personnel (FC-2)(590.003) This report,when signed below by a Board of Health member or its agent A=Zero critical violations and no more than 3 non-critical violations. F=3 or more critical violations.9 or more non-critical violations, 24.Food and Food Preparation (FC-3)(590.004) constitutes an order of the Board of Health. Failure to correct violations regardless of the number of critical,results in an F. 25.Equipment and Utensils (FC-4)(590.005) cited in this report may result in suspension or revocation of the food B=One critical violation and less than 4 non-critical violations 9 26.Water,Plumbing and Waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If if no critical violations observed,4 to 6von-critical violations=B. Seriously Critical Violation=F is scored automatically if: no hot 27.Physical Facility (FC-6)(590.007) aggrieved by this order,you have a right to a hearing. Your request must C=2 critical violations and less than 9 non critical. If no critical water,sewage back-up,infestation of rodents or insects,or lack of 28.Poisonous or Toxic Materials (FC-7)(590.008) be in writing and submitted to the Board of Health at the above address violations observed,7 to 8 non-critical violations. If 1 critical refrigeration. 29.Special (590.009) within 10 days of receipt of this order. violation,4 to 8 non-critical violations=C. P Requirements q 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 Signature ` Print: Self Service Wait Service Provided Grease Trap Size Variance Letter Posted Y N d �� 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 a 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.* 1.9 - ___ ..PHF.Hot and Cold Holding._ 2-103.11 Person-in-Charge Duties - 3-302.14 Frotection�from Unappioved Additives* Contamination from Raw Ingredients 15 Poisonous&Toxic•Substarices 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.I1 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 _ 3-302.15_ - _ Washing Fruits and Vegetables 3-501.19 Time as a Public Health Control* Applicant To Report To-The Person In Charge* * 7.202.12 Conditions of Use* 590.004(11 Variance Requirements * 3-304.11 Food Contact with Equipment and Utensils 7-203.11 Toxic Containers-Prohibitions* ) q 590.003(G) Reporting by Person in Charge Contamination from the Consumer 3 590.003(D) Exclusions and Restrictions* 7-204.11 Sanitizers,Criteria-Chemicals* REQUIREMENTS FOR _ _ _ 3-306.14-(A)(B)Returned Food and Reservice of Food* 7-204.12 Chemicals for WashingProduce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP 590.003(E) Removal of Exclusions and Restrictions Disposition of Adulterated or Contaminated Food 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels* 4 Food and Water From Regulated Sources 9 Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs* 590.004 A-B Compliance with Food Law* * 3-801.11(D) Raw or Partially Cooked Animal Food and ( ) P 4-501.111 Manual Wazewashing-Hot Water 7.206.12 Rodent Bait Stations * 3-201.12 Food in a HermeticallySealed Container* Sanitization Temperatures* Raw Seed Sprouts Not Served Pe 7-206.13 Tracking Powders,Pest Control and 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Wazewashing-Hot Water Moriitoring* 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* 3-401.11 A(1)(2) Eggs-155°F 15 sec 22 3-603.11 Consumer Advisory Posted for Consumption of 5-101.11 Drinking Water from an Approved System* l 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* Efjective 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* 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* 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS• 4-703.11 Methods of Sanitization-Hot Water and Stuffing Containing Fish,Meat,Poultry or 590.009(A)-(D) Violations of Section 590.009(A)-(D)in cater- 3-201.15 Molluscan Shellfish from NSSP_Listed Chemical* Ratites-165°F 15 sec* Sources* ing,mobile food,temporary and residential 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 K 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* Cleaning Procedure* 165°F* foodbome illness interventions and risk factors. * When to Wash* * Other 590.009 violations relating to good retail 590.004(C) Wild Mushrooms 3�01.11(A)(1)(b) All Other PHFs-145°F 15 sec* 11Good Hygienic Practices 17 Reheating for Hot Holding practices should bedebited under#29-Special 3-201.17 Game Animals Requirements. 5 Receiving/Condition Eating,Drinking or Using Tobacco* 3-403.11(A)&(D) PHFs 165°F 15 sec*3-202.11 PHF's Received at Proper Temperatures* Discharges From the Eyes,Nose and Mouth* 3-403.11(B) Microwave-165°F 2 Minute Standing Time* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES * Preventing Contamination When Tasting* 3-003.11 C Commercially Processed RTE Food-140°F* Blue Items 23-30) 3-202.15 Package Integrity ( ) Y Prevention of Contamination from Hands * Critical and non-critical violations,which do not relate to the foodbome 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 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. 1 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* 130. 1 Other 3-502.12 Reduced-Oxygen Packaging Criteria* 8-103.12 1 Conformance with Approved Procedures* S:590Formback6-2doc *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. . oF. rqr TOWN OF BARNSTABLE HEALTH INSPECTOR,s Establishment Name: Date: Page: . of P. ttio OFFICE HOURS PUBLIC HEALTH DIVISION 7 800-9:30A.M. BARNSTABLE. • 200 MAIN STREET 3.30-4:30 P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified MASS. MON.-FRI. HYANNIS,MA 02601 508-862-4 No Reference R.-Red Item PLEASE PRINT CLEARLY reoMa+ FOOD ESTABLISHMENT INSPECTION REPORT Name Date T4oe of ction e outine Address " Risk 5d,Servi2 e- Ion _ Level Previous Inspection a Telephone A ` Residential Kitchen Date: t � _ b u Mobile Pre-operation x Owner HACCP YIN Temporary Suspect illness Caterer General Complaint Person in Charge(PIC) Time Bed&Breakfast HACCP In: Other t 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( ❑ 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 r-- ❑3.Personnel with Infectious Restricted/Excluded ❑ 15. Toxic Chemicals FOOD FROM APPROVED SOURCE TIMEITEMPERATURE CONTROLS(Potentially Hazardous Food ❑4.Food and Water from Approved Source ❑ 16.Cooking Temperatures ❑ 5.Receiving/Condition ❑ 17.Reheating ❑6.Tags/Records/Accuracy of Ingredient Statements ❑ 18.Cooling ❑ 7.Conformance with Approved Procedures/HACCP Plans ❑ 19.Hot and Cold Holding PROTECTION FROM CONTAMINATION ❑20.Time As a Public Health Control ❑ 8.Separation/Segregation/Protection REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) ❑ 9.Food Contact Surfaces Cleaning and Sanitizing ❑21.Food and Food Preparation for HSP ❑ 10.Proper Adequate Handwashing CONSUMER ADVISORY ❑ 11.Good Hygienic Practices ❑22.Posting of Consumer Advisories Violations Related to Good Retail Practices(Blue Items) Total Number of Critical Violations } Critical(C)violations marked must be corrected immediately. (blue&red items) Corrective Action Required: ❑ No ❑ Yes Non-critical(N)violations must be corrected immediately or Overall Rating )t�' 0,14 within 90 days as determined by the Board of Health. ; ❑ Voluntary Compliance ❑ Employee Restriction/Exclusion ❑ Re-inspection Scheduled ❑ Emergency Suspension C N Official Order for Correction:Based on an inspection today,the items ❑ Embargo ❑ Emergency Closure ❑ Voluntary Disposal ❑ Other: checked indicate violations of 105 CMR 590.000/Federal Food Code. 23.Management and Personnel (FC-2)(590.003) This report,when signed below by a Board of Health member or its agent A=Zero critical violations and no more than 3 non-critical violations. F=3 or more critical violations.9 or more non-critical violations, 24.Food and Food Preparation (FC-3)(590.004) constitutes an order of the Board of Health. Failure to correct violations regardless of the number of critical,results in an F. 25.Equipment and Utensils (FC-4)(590.005) cited in this report may result in suspension or revocation of the food 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 (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: ".0 61 31.Dumpster screened from public view %.A Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y N ff 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 \ '1 Dumpster Screen? Y IN \J J.J-.+�.- -_.r�.. � ..-....-.�--..__ -T' n..� �-r r- .. -`.,3 ..� a. +•..._ +`1w--�..v r-^.n.___.�_ ___ � ._.� �� ..,.Y_�/- - � "`^\f '4�T'�.Y_'_--:1�-�. ...- w-�++... ..�.�,.. I^_ �_��.�..a.%. _. ° :. �", „�..�_.-_..�.�.��-.-r ^r.-4F _-. v» � .tee..-- �. �.�.. w -- 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.) r 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.* - 1.9 _ _ _ • 2-103.11 Person-in-Charge Duties - - 3-302.14, _ Protection'fiom Unapproved Additives* _ _ PHF Hot and-Cold-Holding. Contamination from Raw Ingredients 3-501.16(B) Cold PHFs Maintained At or Below 41°F/45°F 15 Poisonous or Toxic Substances 590.004(F)- -- EMPLOYEE HEALTH 'T 3-302.11(A)(2) Raw Animal Foods Separated from Each 7-101.11 Identifying Information-Original Containers* Other* 3-501.16(A) Hot PHFs Maintained At or Above 140°F 2 590.003(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 7-201.11 Se 3-501.16(A) Roasts Held At or Above 130°F 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* 3-304.11 Food Contact with Equipment and Utensils* - Applicant To Report To The Person In Charge* 7-203.12 Conditions of Use* - Variance Requirements * 590.004(11) - 590.003(G) -.Reporting by Person in.Charge* _ _ _ - _ 720 .11 Toxic Containers-Prohibitions Contamination from the Consumer 3 590.003(D) Exclusions and Restrictions* 7-204.11 Sanitizers,Criteria-Chemicals* REQUIREMENTS FOR _ 3-306._14(A)(B)Returned Food and Reservior of Food* 7-204.12 Chemicals for Washing Produce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP 590.003(E) Removal of Exclusions and Restrictions _ g � � Disposition of Adulterated or Contaminated Food 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Wanting 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* 590.004A-B Compliance with.Food Law* * 3-801.11(D) Raw or Partially Cooked Animal Food and ( ) P _. _ _ _ _ _ -- 4-50.1.111-- Manual Wazewashin Hot 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.J3 - Fluid Milk-arid 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 Tem.peranues* TIME/TEMPERATURE CONTROLS 3-202.14 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. 16 Proper Cooking Temperatures for PHFs CONSUMER ADVISORY 3-202.16 Ice Made From Potable Drinking Water* _ Concentration and Hardness* - 3-401.11A(1)(2) Eggs-155°F 15 sec 22 3-603.11 Consumer Advisory Posted for Consumption of 4-601.11(A) Clean Utensils and Food Contact Surfaces of Eggs-Immediate Service 145°F 15 sec* Animal Foods That are Raw,Undercooked or 5-101.11 Drinking Water from an Approved System* g8 ;1; Not Otherwise Processed to Eliminate Equipment* ( )( ) Pathogens* d 590.006(A) Bottled Drinking Water* 3-401.11 A 2 Comminuted Fish,Meats&Game g * e me�e mnoor -_ t 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 _. 3-0Ol.11(B)(1)(2) Pork and Beef Roast-130°F 121 min Eggs* 4 702.1T 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* - -- i Shellfish* ' - - - - - 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS 4-703.11 Methods of Sanitization-Hot Water and Stuffing Containing Fish,Meat,Poultry or 590.009(A)-(D) Violations of Section 590.009(A)-(D)in cater- 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* Ratites-165°F 15 sec* Sources* ing,mobile food,temporary and residential 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 Arens* Regulatory Authority 3-401.12 Raw Animal Foods Cooked in a Microwave the appropriate sections above if related to 3-202.i 8- Shellstock Identification Present*-' - - - 27301.12_-_ Cleaning Procedure* 165°F* foodborne illness interventions and risk factors. 2-30L14 When[o Wash* Other 590.009 violations relating to good retail 590.004(C) Wild Mushrooms* _ _ 3-401.11(A)(1)(b) All Other PHFs-145°F 15 sec* practices should be debited under#29-Special 3-201.17 Game Animals* 11 Good Hygienic Practices 17 Reheating for Hot Holding 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* 3403.11 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 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 * 13L5-205.11 Handwashing Facilities 3-501.14 A CoolingCooked PHFs from 140°F to 70°F 3-202.18 Shellstock Identification ( ) Item Good Retail Practices FC 590.000 3-203.12 Shellstock Identification Maintained* Conveniently Located and Accessible Within 2 Hours and From 70°F to 41°F/45°F Tags/Records:Fish Products Numbers and Capacities* Within 4 Hours* 23. Management and Personnel FC-2 .003 Location and Placement* 3-501.14(B) Cooling PHFs Made from Ambient 24. Food and Food Protection FC-3 .004 3-402.11 Parasite Destruction* Temperature Ingredients to 41°F/45°F 25. Equipment and Utensils FC-4 .005 3-402.12 Records,Creation and Retention* Accessibility,Operation and Maintenance Within 4 Hours* 26. Water,Plumbing and Waste FC-5 .006 590.004(J) Labeling of Ingredients' Supplied with Soap and hand Drying Devices 27. Physical Facility FC-6 .007 7 Conformance with Approved Procedures/ 6-301.11 Handwashing Cleanser,Availability 28. Poisonous or Toxic Materials I 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 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. °FINE r TOWN OF BARNSTABLE HEALTH INSPECTOR,s Establishment Name: Date: Page:. of OFFICE HOURS PUBLIC HEALTH DIVISION 800-9:30A.M. BARNSTABLE. ' 200 MAIN STREET 3:30-4:30 P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified �A O}q,s�0� - HYANNIS, MA 02601 MON.-FRI. No Reference- R-.Red.Item PLEASE PRINT CLEARLY --__ - IE. MAC 508-862-4644 FOOD ESTABLISHMENT INSPECTION REPORT Name _ D'at� e o o sec ion ` O ions .tine 1 r Address Risk d Sery ection Level a ai Previous Inspection � Q 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 ' ei In: i. Other \A r Inspecto Out. I 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) ❑ cc 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) \!v� . T C FOOD PROTECTION MANAGEMENT ❑ 12.Prevention of Contamination from Hands 6 ❑ 1.PIC Assigned/Knowledgeable/Duties ❑ 13.Handwash Facilities tie EMPLOYEE HEALTH PROTECTION FROM CHEMICALS 444"' 9 ❑ 2.Reporting of Diseases by Food Employees and PIC ❑ 14.Approved Food or Color Additives l ❑3.Personnel with Infectious Restricted/Excluded ❑ 15. Toxic Chemicals ` FOOD FROM APPROVED SOURCE f TIME/TEMPERATURE CONTROLS(Potentially Hazardous F81ods) ❑4.Food and Water from Approved Source ❑ 16.Cooking Temperatures la ` ❑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) � s ❑ 9.Food Contact Surfaces Cleaning and Sanitizing ❑ 21.Food and Food Preparation for HSP C ❑ 10.Proper Adequate Handwashing CONSUMER ADVISORY -1 Ai 1 _0A CA ❑ 11.Good Hygienic Practices ❑ 22.Posting of Consumer Advisories i Violations Related to Good Retail Practices(Blue Items) Total Number of Critical Violations s 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, i 24.Food and Food Preparation (FC-3)(590.004) constitutes an order of the Board of Health. Failure to correct violations 6=One critical violation and less than 4 non-critical violations regardless of the number of critical,results in an F. 25.Equipment and Utensils (FC4)(590.005) cited in this report may result in suspension or revocation of the food if no critical violations observed,4 to 6von-critical violations=B. 26.Water,Plumbing and Waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If Seriously Critical Violation=F is scored automatically if: no hot C=2 critical violations and less than 9 non-critical. If no critical water,sewage back-up,infestation of rodents or insects,or lack of 27.Physical Facility (FC-6)(590.007) aggrieved by this order,you have a right to a hearing. Your request must be in writing and submitted to the Board of Health at the above address violations observed,7 to anon-critical violations. If 1 critical refrigeration. 28.Poisonous or Toxic Materials (FC-7)(590.008) 9 violation,4 to 8non-critical violations=C. 29.Special Requirements (590.009) within 10 days of receipt of this order. ' 30.Other Inspector's Signature Print: DATE OF RE-INSPECTION: 31.Dumpster screened from public viewof Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y N #Seats Observed Frozen Dessert Machines: Outside Dining Y N PIC's Signature Print: Self Service Wait Service Provided Grease Trap Size Variance Letter Posted Y N Dumpster Screen? Y N 79 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.) a 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 L14 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 Unappioved Additives Contamination from Raw Ingredients 15 Poisonous or Toxic Substances 3-501.16(B) Cold PHFs Maintained At or Below 41°F/45°F 590.004(F)- * -- EMPLOYEE HEALTH 3-302.11(A)(2) Raw Animal Foods Separated from Each 7-101.11 Identifying Information-Original Containers* 2 590.003(C) Responsibility of the Person-in-Charge to _ Other* _ 3-501.16(A) Hot PHFs Maintained At or Above 140°F 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* - - - 3-302.11(A) Food Protection* - 7-201.11 Separation-Storage* 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* 3-304.11 Food Contact with Equipment and Utensils Applicant To Report To The Person In Charge* * 7.202.12 Conditions of Use* 590.004 11) Variance Requirements 590.003(G) Reporting by Person in Charge* _ 7-203.11 Toxic Containers-Prohibitions* ( Contamination from the Consumer 3 590.003(D) Exclusions and Restrictions* 7-204.11 Sanitizers,Criteria-Chemicals* --REQUIREMENTS FOR 3-306.14(A)(B)Returned Food and Rrated or of Food_* 1 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* 59.0.004(A-B) Compliance with Food Law* * 3-801.11(D) Raw or Partially Cooked Animal Food and P 4-501.111 Manual Warewashing-Hot Water 7.206.12 Rodent Bait Stations * 3-201.12 Food in a 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(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* gg 3 i Not Otherwise Processed to Eliminate + 590.006(A) Bottled Drinking Water* i! 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* Effect-trtrzooi _ 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* L Frequency rf 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* _ Methods of Sanitization-Hot Water and 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS Stuffing Containing Fish,Meat,Poultry or590.009(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 10Proper,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* foodbome illness interventions and risk factors. 2-301.14 When to Wash* * Other 590.009 violations relating to good retail 590.004(C) Wild Mushrooms* __ _ -_ 3 401.11(A)(1)(b)All Other PHFs-145°F 15 sec 3-201.17 Game Animals* 11 Good Hygienic Practices 17 Reheating,for Hot Holding practices should be debited under#29-Special 2-401.11- Eating,Drinking or Using Tobacco* * Requirements. $ Receiving/Condition - g, g g 3-403.11(A)&(D) PHFs 165°F 15 sec 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 3-202.11 PHF's Received at Proper Temperatures ( ) g * 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 d not Prevention of Contamination from Hands - - * Cri ca o o relate to the foodbome 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 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 * 3-501.14 A 3-202.18 Shellstock Identification 13 Handwashing Facilities ( ) Cooling Cooked PHFs from 140°F to 70°F 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 1.003 * 5-204.11 Location and Placement* 3-501.14(B) Cooling PHFs Made from Ambient 24. Food and Food Protection FC-3 .004 3-402.11 Parasite Destruction Temperature Ingredients to 41°F/45°F 25. Equipment and Utensils FC-4 .005 3-402.12 Records,Creation and Retention* 5-205.11 Accessibility,Operation and Maintenance Within 4 Hours* 26. Water,Plumbing and Waste FC-5 .006 590.004(J) labeling of Ingredients* Supplied with Soap and hand Drying Devices 27. Physical Facility FC-6 .007 7 Conformance with Approved Procedures 1 6-301.11 Handwashing Cleanser,Availability 28. Poisonous or Toxic Materials FC-7 .006 HACCP Plans 6-301.12 Hand Drying Provision 29. 1 Special Requirements .009 3-502.11 Specialized Processing Methods* 130. 1 Other 3-502.12 Reduced-Oxygen Packaging Criteria* - 8-103.12 Conformance with Approved Procedures* S:590Formback6-2doc *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.00q. *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. oFIKE row TOWN OF BARNSTABLE HEALTH INSPECTOR'S Establishment Name: Date: Page: of v� 10 OFFICE HOURS � PUBLIC HEALTH DIVISION 8:00-9:30 A.M. 200 MAIN STREET 3:30-4:30 P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION /PLAN OF CORRECTION Date Verified BARNSTABLE. v 019, ��0p HYANNIS, MA 02601 MON.-FRi. No Reference R-Red Item PLEASE PRINT CLEA LY 'An�°' 508-862-4644 FOOD ESTABLISHMENT INSPECTION REPORT NNAV ( -, Namkol Datef � Tvoe of Tyoe of Inspection O er 'o.n Routine Address - /� Risk / ood Service Re-inspection Level Re Previous Inspection Telephone Residential Kitchen Date: Mobile Pre-operation Owner HACCP Y/N Temporary S sGpeecct-Itlnes Caterer eneral Complai Person in Charge(PIC) Time Bed&Breakfast 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 ❑ 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 17113.Personnel with Infectious Restricted/Excluded ❑ 15. Toxic Chemicals FOOD FROM APPROVED SOURCE TIME/TEMPERATURE CONTROLS(Potentially Hazardous Foods) ❑4.Food and Water from Approved Source ❑ 16.Cooking Temperatures ❑5.Receiving/Condition ❑ 17.Reheating ❑6.Tags/Records/Accuracy of Ingredient Statements ❑ 18.Cooling ❑7.Conformance with Approved Procedures/HACCP Plans ❑ 19.Hot and Cold Holding PROTECTION FROM CONTAMINATION ❑ 20.Time As a Public Health Control ❑8.Separation/Segregation/Protection REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) ❑9.Food Contact Surfaces Cleaning and Sanitizing ❑21.Food and Food Preparation for HSP ❑ 10.Proper Adequate Handwashing CONSUMER ADVISORY ❑ 11.Good Hygienic Practices ❑22.Posting of Consumer Advisories Violations Related to Good Retail Practices(Blue Items) Total Number of Critical Violations ------ Critical(C)violations marked must be corrected immediately. (blue&red items) Corrective Action Required: ❑ No ❑ Yes Non-critical(N)violations must be corrected immediately or Overall Rating ��- within 90 days as deter Voluntary m I Restriction/Exclusion Re-inspection Scheduled Emergency Suspension y mined by the Board of Health. � ❑ ❑ E p Employee ❑ P ® 9 Y P C N Official Order for Correction:Based on an inspection today,the items ® Embargo ❑ Emergency Closure ❑ Voluntary Disposal ❑ Other: checked indicate violations of 105 CMR 590.000/Federal Food Code. 23.Management and Personnel (FC-2)(590.003) This report,when signed below by a Board of Health member or its agent A=Zero critical violations and no more than 3 non-critical violations. F=3 or more critical violations.9 or more non-critical violations, 24.Food and Food Preparation (FC-3)(590.004) constitutes an order of the Board of Health. Failure to correct violations regardless of the number of critical,results in an F. 25.Equipment and Utensils (FC-4)(590.005) cited in this report may result in suspension or revocation of the food B-One critical violation and less than 4 non -crib violations 9 if no critical violations observed,4 to 6vocncal violations=B. Seriously Critical Violation=F is scored automatically if: no hot 26.Water,Plumbing and Waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If 27.Physical Facility (FC-6)(590.007) aggrieved by this order,you have a right to a hearing. Your request must C=2 critical violations and less than i non-critical. If no critical water,sewage back-up,infestation of rodents or insects,or lack of be in writing and submitted to the Board of Health at the above address violations observed,7 to anon-critical violations. If 1 critical refrigeration. 28.Poisonous or Toxic Materials (FC-7)(590.008) 9 violation,4 to 8non-critical violations=C. 29.Special Requirements (590.009) within 10 days of receipt of this order. 30.Other DATE OF RE-INSPECTION: Inspector's Signatpre Print: 31.Dumpster screened from public view e/ k Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y N #Seats Observed Frozen Dessert Machines: Outside Dining Y N PIC's Signa re Print: Self Service Wait Service Provided Grease Trap Size Variance Letter Posted Y N S 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* $ Cross-contamination1q 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 * 590.004(F) 7-101.l 1 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 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 Reservice 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 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* P 7-206.13 Tracking Powders,Pest Control and 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-Hot Water Monitoring* 3-801.11(C) Unopened Food Package Not Re-Served* 3-202.13 Shell Eggs* Sanitization Temperatures* TIMEITEMPERATURE CONTROLS 3-202.14 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. 16 Proper Cooking Temperatures for PHFs CONSUMER ADVISORY 3-202.16 Ice Made From Potable Drinking Water* Concentration and Hardness* 3-401.11 A(1)(2) Eggs-155°F 15 sec 22 3-603.11 Consumer Advisory Posted for Consumption of 5-101.11 Drinking Water from an Approved System* 4-601.11(A) Clean 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* cf eye uu2om 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 Equipmu 3-302.13 Pasteurized Eggs Substitute for Raw Shell Shellfish and Fish From an Approved Source 3-401.1 l(B)(I)(2) Pork and Beef Roast-130°F 121 min* Eggs* 4-702.11 Frequency Sanitization of Utensils and Food 3-401.11(A)(2) Ratites,Injected Meats-155°F 15 sec* 3-201.14 Fish and Recreationally Caught Molluscan Contact Surfaces of Equipment* Shellfish* 4-703.11 Methods of Sanitization-Hot Water and 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* Stuffing Containing Fish,Meat,Poultry or 590.009(A)-(D) Violations of Section 590.009(A)-(D)in cater- Sources* Ratites-165°F 15 sec* in mobile food,temporary and residential 10 Proper,Adequate Handwashing g° P Y 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 IS 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 Plcvuiiting Contamination When Tasting* 3-403.11(C) .%'Commercially Processed-K1 E hood-140'F* (Blue Items 23:'ill) 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 3-402.11 Parasite Destruction* 5-204.11 Location and Placement* 3-501.14(B) Cooling PHFs Made from Ambient 24. Food and Food Protection FC-3 .004 5-205.11 Accessibility,Operation and Maintenance Temperature Ingredients to 41°F/45°F 25. Equipment and Utensils FC-4 .005 3-402.12 Records,Creation and Retention* y' Within 4 Hours* 590.004(J) Labeling of Ingredients' Supplied with Soap and hand Drying Devices 27. Water,Plumbing and Waste FC-5 .007 6-301.11 Handwashing Cleanser,Availability 28. Physical Facility FC-6 .008 7 Conformance with Approved Procedures/ g y 28. Poisonous or Toxic Materials FC-7 .008 HACCP Plans 6-301.12 1 Hand Drying Provision 3-502.11 Specialized Processing Methods* 30. 009 Special Requirements 0. 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,MEr TOWN OF BARNSTAB.LE HEALTH.INSPECTOR'S' Establishment Name: Date: Page: of 4.. j OFFICE HOURS BARa E° PUBLIC 0 MAN STREET DIVISION _ - - 3:30-4:30A.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified +N�� 3:30-4:30 P.M. .A- q MON.-FRI. �A ,,79,per• HYANNIS,MA 02601 sos-as2 as4a No Reference R-Red Item PLEASE PRINT CLEARLY 'FDN1�` FOOD ESTABLISHMENT INSP CTION REPORT L 07,1 Name Date A, Type o Type of Inspection V s p Routine Address Risk cod Service R pection Levelon Telephone Residential Kitchen Date: Mobile Pre-operation Owner HACCP Y/N Temporary Suspect Illness we") ( �� 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 ❑ 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 ❑ 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) Corrective Action Required: ❑ No ❑ Yes Non-critical(N)violations must be corrected.immediately or Overall Rating within 90 days as determined by the Board of Health. ❑ Voluntary Compliance ❑ Employee Restriction/Exclusion ❑ Re-inspection Scheduled ❑ Emergency Suspension C N Official Order for Correction: Based on an inspection today,the items ❑ Embargo ❑ Emergency Closure ❑ Voluntary Disposal ❑ Other: checked indicate violations of 105 CMR 590.000/Federal Food Code. 23.Management and Personnel (FC-2)(590.003) This report,when signed below by a Board of Health member or its agent A=Zero critical violations and no more than 3 non-critical violations. F=3 or more critical violations.9 or more non-critical violations, 24.Food and Food Preparation (FC-3)(590.004) constitutes an order of the Board of Health, Failure to correct violations regardless of the number of critical,results in an F. 25.Equipment and Utensils (FC-4)(590.005 B=One critical violation and less than 4 non-critical violations 9 ) cited in this report may result in suspension or revocation of the food if no critical violations observed,4 to 6 non-critical violations=B. Seriously Critical Violation=F is scored automatically if: no hot 26.Water,Plumbing and waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If C=2 critical violations and less than 9 non-critical. If no critical water,sewage back-up,infestation of rodents or insects,or lack of 27.Physical Facility (FC-6)(590.007) aggrieved by this order,you have a right to a hearing. Your request must be in writing and submitted to the Board of Health at the above address violations observed,7 to anon-critical violations. If 1 critical refrigeration. 28.Poisonous or Toxic Materials (FC-7)(590.008) 9 violation,4 to 8npn-critical violations=_C. 29.Special Requirements. ._ (590.009) within 10 days of receipt of this order. 30.Other DATE OF RE-INSPECTION,• Inspector's Signature Print: 31.Dumpster screened from public 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 Signature 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 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* * 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 1307-102.11 Common Name-Working Containers* * 7-201.11 Separation-Storage* Applicants 3-302.11(A) Food Protection* 20 Time as a Public Health Control 590.003(F) Responsibility of A Food Employee or An 3-302.15 Washing Fruits and Vegetables 7-202.11 Restriction-Presence and Use** 3-501.19 Time as a Public Health Control* Applicant To Report To The Person In Charge* * 7.202.12 Conditions of Use 590.004 11 Variance Requirements 3-304.11 Food Contact with Equipment and Utensils * ( ) 4 590.003(G) Reporting by Person in Charge* 7-203.11 Toxic Containers-Prohibitions Contamination from the Consumer 3 590.003(D) Exclusions and Restrictions* 7-204.11 Sanitizers,Criteria-Chemicals* REQUIREMENTS FOR 3-306.14(A)(B)Returned Food and Reared or of Food* 7-204.12 Chemicals for Washing Produce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP 590.003E Removal of Exclusions and Restrictions g � ) ( ) Disposition of Adulterated or Contaminated Food 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels* 4 Food and Water From Regulated Sources 9 Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs* 590.004 A-B Compliance with Food Law* * 3-801.11(D) Raw or Partially Cooked Animal Food and ( ) P 4-501.111 Manual Wazewashing-Hot Water 7.206.12 Rodent Bait Stations * 3-201.12 Food in a HermeticallySealed Container* Sanitization Temperatures* Raw Seed Sprouts Not Served P 7-206.13 Tracking Powders,Pest Control and 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-Hot Water Monitoring* 3-801.11(C) Unopened Food Package Not Re-Served* 3-202.13 Shell Eggs* Sanitization Temperatures* TIME/TEMPERATURE CONTROLS 3-202.14 1 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. 76 _ Proper Cooking Temperatures for PHFs CONSUMER ADVISORY 3-202.16 Ice Made From Potable Drinking Water* 3-401.11A(1)(2) Eggs-155°F 15 sec Concentration and Hardness* 22 3-603.11 Consumer Advisory Posted for Consumption of 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* Effe cti-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* 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS 4-703.11 Methods of Sanitization-Hot Water and 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* Stuffing Containing Fish,Meat,Poultry or 590.009(A)-(D) Violations of Section 590.009(A)-(D)in cater- Sources* Ratites-165°F 15 sec* ing,mobile food,temporary and residential 10 Proper,Adequate Handwashing 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 145°F* kitchen operations should be debited under Game and A Mushrooms Approved By 2-301.11 Cl Condition-Hands and Arms* Regulatory Authority Clean 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* P2-401.12 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* 11Good Hygienic Practices 17 Reheating for Hot Holding Requirements. radicsshud be debited under 929-Special 5 Receiving/Condition Eating,Drinking or Using Tobacco* 3-403.11(A)&(D) PHFs 165°F 15 sec* 3-202.11 PHF's Received at Proper Temperatures* Discharges From the Eyes,Nose and Mouth* 3-403.11(B) Microwave-165°F 2 Minute Standing Time* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES * Preventing Contamination When Tasting* 3-403.11 C Commerciall Processed RTE Food-140°F* (Blue Items 23-30) 3-202.15 Package Integrity ( ) Y12Prevention 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* L18 Proper Cooling of PHFs following sections of the Food Code and 105 CMR 590.000 * ( )13 Handwashing Facilities 3-202.18 Shellstock Identification 3-501.14 A CoolingCooked 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 9 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. oFTHE A TOWN OF BARNSTABLE HEALTH INSPECTOR'S Establishment Name: Date: Page: . of �4 OFFICE HOURS PUBLIC HEALTH DIVISION 8:00-9:30 A.M. BARNSrABLE. • 200 MAIN STREET 3:30-4:30 P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified fib, M43q:.m� HYANNIS,MA 02601 MON.-FRI. No Reference R-Red Item PLEASE PRINT CLEARLY 508-862-4644 FOOD ESTABLISHMENT INSPECTION REPORT Name i Dat` / Type of f Inspect ion [ je tonsRo04Address / Risk od Service e-inspection Level Previous Inspection Telephone Residential Kitchen Date: Mobile Pre-operation Owner V I HACCP Y/N Temporary Suspect Illness AI t 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) ❑ WWI 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 00, r ❑ 3.Personnel with Infectious Restricted/Excluded ❑ 15. Toxic Chemicals e FOOD FROM APPROVED SOURCE TIME/TEMPERATURE CONTROLS(Potentially Hazardous oods) ❑4.Food and Water from Approved Source ❑ 16.Cooking Temperatures i ❑ 5.Receiving/Condition ❑ 17.Reheating r ❑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 ❑ 1.0.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) 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. ❑ g ❑ Emergency Closure ❑ Voluntary Disposal ❑Other:. 23.Management and Personnel (FC-2)(590.003) This report,when signed below by a Board of Health member or its agent A=Zero critical violations and no more than 3 non-critical violations. F=3 or.more critical violations.9 or more non-critical violations, 24.Food and Food Preparation (FC-3)(590.004) constitutes an order of the Board of Health. Failure to correct violations regardless of the number of critical,results in an F. 25.Equipment and Utensils (FC 4)(590.005) cited in this report may result in suspension or revocation of the food B=One critical violation and less than 4 non-critical violations 9 if no critical violations observed,4 to 6nnn-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 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 9 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 V v #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 A R � 1�r � � + � Dumpster Screen? Y N �/ _ P 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 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*7-]02.11 Common Name-Working Containers 590.004(F) * 2 590.003(C) Responsibility of the Person-in-Charge to Other* * 3-501.16(A) Hot PHFs Maintained At or Above 140°F Require Reporting by Food Employees and Contamination from the Environment 3-501.16(A) Roasts Held At or Above 130°F* Applicants* 3-302.11(A) Food Protection* 7-201.1 l 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* 3-501.19 Time as a Public Health Control*Applicant To Report To The Person In Charge* 7.202.12 Conditions of Use* 3-304.11 Food Contact with Equipment and Utensils* 590.004(11) Variance Requirements 590.003(G) Reporting by Person in Charge* 7-203.11 Toxic Containers-Prohibitions* Contamination from the Consumer 3 590.003(D) Exclusions and Restrictions* 7-204.11 Sanitizers,Criteria-Chemicals* REQUIREMENTS FOR 3-306.14(A)(B)Returned Food and Reated or of Food* 7-204.12 Chemicals for WashingProduce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP 590.003(E) Removal of Exclusions and Restrictions Disposition of Adulterated or Contaminated ( ) Food 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels* 4 Food and Water From Regulated Sources 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. Proper Cooking Temperatures for PHFs CONSUMER ADVISORY 3-202.16 Ice Made From Potable Drinking Water* Concentration and Hardness* 163-401.11A(1)(2) Eggs-155°F 15 sec 22 3-603.11 Consumer Advisory Posted for Consumption of Eggs 5-101.11 Drinking Water from an Approved System* 4-601.11(A) Clean Utensils and Food Contact Surfaces of E s-Immediate Service 145°F 15 sec* Animal Foods That are Raw,Undercooked or Equipment* Not Otherwise Processed to Eliminate 590.006(A) Bottled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* E.ff ctiw 11112001 4-602.11 Cleaning Frequency of Utensils and Food Animals-155°F 15 sec* 590.006(B) Water Meets Standards in 310 CMR 22.0* Contact Surfaces of Equipment* * 3-302.13 Pasteurized Eggs Substitute for Raw Shell Shellfish and Fish From an Approved Source 3-401.11(B)(1)(2) Pork and Beef Roast-130°F 121 min Eggs* 4-702.11 Frequency of Sanitization of Utensils and Food 3-401.11(A)(2) Ratites,Injected Meats-155°F 15 sec* 3-201.14 Fish and Recreationally Caught Molluscan Contact Surfaces of Equipment* Shellfish* 4-703.11 Methods of Sanitization-Hot Water and 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS Stuffing Containing Fish,Meat,Poultry or 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* g g �' S90.009(A)-(D) Violations of Section 590.009(A)-(D)in cater- Ratites-165°F 15 sec* Sources* 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* 3-40L11(A)(1)(b) All Other PHFs-145°F 15 sec* Other 590.009 violations relating to good retail 3-201.17 Game Animals* 11 Good Hygienic Practices 17 Reheating for Hot Holding practices should be debited under#29-Special Requirements. 5 Receiving/Condition 2-401.11 Eating,Drinking or Using Tobacco* 3-403.11(A)&(D) PHFs 165°F 15 sec* 3-202.11 PHF's Received at Proper Temperatures* 2-401.12 Discharges From the Eyes,Nose and Mouth* 3-403.11(B) Microwave-165°F 2 Minute Standing Time* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3-202.15 Package Integrity* 3-301.12 Preventing Contamination When Tasting* 3-403.11(C) Commercially Processed RTE Food-140°F* Blue Items 23-30) 12 Prevention of Contamination from Hands Critical and non-critical violations,which do not relate to the foodborne 3-101.11 Food Safe and Unadulterated* 3-403.11(E) Remaining Unsliced Portions of Beef Roasts* illness interventions and risk factors listed above,can be found in the 6 Tags/Records:Shellstock 590.004(E) Preventing Contamination from Employees* 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 * Conveniently Located and Accessible Within 2 Hours and From 70'F to 41°F/45°F Item Good Retail Practices FC 590.000 3-203.12 Shellstock Identification Maintained Tags/Records:Fish Products 5-203.11 Numbers and Capacities* Within 4 Hours* 23. Management and Personnel FC-2 .003 * 5-204.11 Location and Placement* 3-501.14(B) Cooling PHFs Made from Ambient 24. Food and Food Protection FC-3 .004 3 402.11 Parasite Destruction Temperature Ingredients to 41°F/45°F 25. Equipment and Utensils FC-4 .005 3-402.12 Records,Creation and Retention* 5-205.11 Accessibility,Operation and Maintenance Within 4 Hours* 26. Water,Plumbing and Waste FC-5 .006 590.004(J) Labeling of Ingredients' Supplied with Soap and hand Drying Devices 27. Physical Facility FC-6 .007 7 Conformance with Approved Procedures/ 6-301.11 Handwashing Cleanser,Availability 28. Poisonous or Toxic Materials FC-7 .008 HACCP Plans 6-301.12 Hand Drying Provision 29. Special Requirements .009 3-502.11 Specialized Processing Methods* 130. 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. n r � oFaE rq, TOWN OF BARNSTABLE. HEALTH INSPECTOR s Establishment Name: �,n/�r rn� /�G-✓ �[()✓I Date: 14 Page:._ of 1 OFFICE HOURS nn PUBLIC HEALTH DIVISION 8:00-9130 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 Mayq. wag HYANNIS,MA 02601 508 862-4� No Reference R-Red Item , PLEASE PRINT CLEARLY P'EDN1Pya ESTABLISHMENT INSP CTION REPORT Un J�� G �. Name ' Date Tvoe of T Ins ection ' o T rcJPt- Address HM r^n� �J Risk ood Se ' Re-inspection Level Real Pre Re sp ction Telephone C Residential Kitchen Date: �� U0Mobile Pre-oaI Owner HACCP Y/N Temporary„ Suspect Illness J Caterer General Complaint - v Person in Charge(PIC) Time Bed&Breakfast HACCP In: Other Inspector Gvl Out: 6 c VJ 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 6` 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 D ❑ 1.PIC Assigned/Knowledgeable/Duties ❑ 13.Handwash Facilities 41 EMPLOYEE HEALTH PROTECTION FROM CHEMICALS ❑2.Reporting of Diseases by Food Employees and PIC ❑ 14.Approved Food or Color Additives ❑ 3.Personnel with Infectious Restricted/Excluded ❑ 15. Toxic Chemicals FOOD FROM APPROVED SOURCE TIME/TEMPERATURE CONTROLS(Potentially Hazardous Foods) ❑4.Food and Water from Approved Source ❑ 16.Cooking Temperatures ❑ 5.Receiving/Condition ❑ 17.Reheating ❑ 6.Tags/Records/Accuracy of Ingredient Statements ❑ 18.Cooling ❑ 7.Conformance with Approved Procedures/HACCP Plans ❑ 19.Hot and Cold Holding PROTECTION FROM CONTAMINATION ❑20.Time As a Public Health Control ❑8.Separation/Segregation/Protection REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) ❑ 9.Food Contact Surfaces Cleaning and Sanitizing ❑ 21.Food and Food Preparation for HSP ❑ 10.Proper Adequate Handwashing CONSUMER ADVISORY ,vV\ ❑ 11.Good Hygienic Practices ❑22.Posting of Consumer Advisories Violations Related to Good Retail Practices(Blue Items) Total Number of Critical Violations /l Critical(C)violations marked must be corrected immediately. (blue&red items) (V/°f 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. L5ins Voluntary Compliance ❑ EmployeeRestriction/Exclusion ❑ Re-inspection Scheduled ❑ Emergency Suspension ffiC N Ocial Order for Correction:Based o� ', pection today,the i ems Embargo.. checked indicate violations of 105 CMR 590.000/Federal Food Code. ❑ 9 ❑ Emergency Closure ❑ Voluntary Disposal ❑ Other: 23.Management and Personnel (FC-2)(590.003) This report,when signed below by a Board of Health member or its agent A=Zero critical violations and no more than 3 non-critical violations. F=3 or more critical violations.9 or more non-critical violations, 24.Food and Food Preparation (FC-3)(590.004) constitutes an order of the Board of Health. Failure to correct violations 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 6von-critical violations=B. 26.Water,Plumbing and Waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If Seriously Critical Violation=F is scored automatically if: no hot 27.Physical Facility (FC-6)(590.007) aggrieved by this order,you have a right to a hearing. Your request must C=2 critical violations and less than 9 non-critical. If no critical water,sewage back-up,infestation of rodents or insects,or lack of 28.Poisonous or Toxic Materials (FC-7)(590.008) be in writing and submitted to the Board of Health at the above address violations observed,7 to 8 non-critical violations. If 1 critical refrigeration. 29.Special Requirements (590.009) within 10 days of receipt of this order. violati . to 8 n-critical violations=C. 30.Other DATE OF RE-INSPECTION: Inspecto 's Sign t t: 31.Dumpster screened from public view, Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y N #Seats Observed Frozen Dessert Machines: Outside Dining Y N PIC' ign re Print: Self Service Wait Service Provided Grease Trap Size Variance Letter Posted. Y. N /1. �,:�4 h Dumpster Screen? Y N t� '/ Violations related to Foodborne Illness Violations Related to Foodborne Illness Interventions Interventions and Risk Factors(Red Items 1-22) and Risk Factors(Red Items 1-22) (Cont.) FOOD PROTECTION MANAGEMENT PROTECTION FROM CONTAMINATION PROTECTION FROM CHEMICALS 3-501.14(C) PHFs Received at Temperatures According to 1 590.003(A) Assignment of Responsibility* 8 Cross-contamination 14 Food or Color Additives Law Cooled to 41°F/45°F Within 4 Hours* 590.003(B) Demonstration of Knowledge* 3-302.11(A)(1) Raw Animal Foods Separated from 3-202.12 Additives* 3-501.15 Cooling Methods for PHFs Cooked and RTE Foods.* * 19 PHF Hot and Cold Holding 2-103.11 Person-in-Charge Duties 3-302.14 Protection from Unapproved Additives Contamination from Raw Ingredients 15 Poisonous or Toxic Substances 3-501.16(B) Cold PHFs Maintained At or Below 41°F/45°F 590.004(F)- EMPLOYEE HEALTH 3-302.11(A)(2) Raw Animal Foods Separated from Each 7-101.11 Identifying Information-Original Containers* Other* g3-501.16(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 3-302.1I(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* 3-304.11 Food Contact with Equipment and Utensils Applicant To Report To The Person In Charge* * 7.202.12 Conditions of Use* 590.00411 Requirements ontamination from the Consumer 590.003(G) Reporting by Person in Charge* 7-203.11 Toxic Containers-Prohibitions* ( ) Variance C 3 590.003(D) I 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 Washing Produce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP 590.003(E) Removal of Exclusions and Restrictions g � ) • Disposition of Adulterated or Contaminated Food 7.204.14 Drying Agents,Criteria* 21 3-80L11(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 HermeticallySealed Container* Sanitization Temperatures* Raw Seed Sprouts Not Served* P 7-206.13 Tracking Powders,Pest Control and 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-Hot Water Monitoring* 3-801.11(C) Unopened Food Package Not Re-Served* 3-202.13 Shell Eggs* Sanitization Temperatures* TIME/TEMPERATURE CONTROLS 3-202.14 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. L16 Proper Cooking Temperatures for PHFs CONSUMER ADVISORY 3-202.16 Ice Made From Potable Drinking Water* Concentration and Hardness* 3-401.11A(1)(2) Eggs-155°F 15 sec 22 3-603.11 Consumer Advisory Posted for Consumption of 4-601.11(A) Clean Utensils and Food Contact Surfaces of Eggs-Immediate Service 145°F 15 sec* Animal Foods That are Raw,Undercooked or 5-101.11 Drinking Water from an Approved System* * gg Not Otherwise Processed to Eliminate 590.006(A) Bottled Drinking Water* Equipment 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* e//cri�trvzom 4-602.11 Cleaning Frequency of Utensils and Food Animals-155°F 15 sec* 590.006(B) Water Meets Standards in 310 CMR 22.0* Contact Surfaces of Equipment* 3-302.13 Pasteurized Eggs Substitute for Raw Shell Shellfish and Fish From an Approved Source 3-401.11(B)(1)(2) Pork and Beef Roast-130°F 121 min* Eggs* 3-201.14 Fish and Recreationally Caught Molluscan Contact Surfaces 4-702.11 Frequency Sanitization of Utensils and Food 3-401.11(A)(2) Ratites,Injected Meats-155°F 15 sec* faces of Equipment* Shellfish* 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS 4-703.11 Methods of Sanitization-Hot Water and StuffingContaining Fish,Meat,Poultry or 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* 8 590.009(A)-(D) Violations of Section 590.009(A)-(D)in cater- Ratites-165°F 15 sec* 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 17 Reheating for Hot Holding practices should be debited under#29-Special Requirements. 5 Receiving/Condition 2-401.11 Eating,Drinking or Using Tobacco* 3-403.11(A)&(D) PHFs 165°F 15 sec* 3-202.11 PHF's Received at Proper Temperatures* 2-401.12 Discharges From the Eyes,Nose and Mouth* 3-403.11(B) Microwave-165°F 2 Minute Standing Time* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES * 3-301.12 Preventing Contamination When Tasting* * (Blue Items 23-30) 3-202.15 Package Integrity g g 3 403.11(C) Commercially Processed RTE Food-140°F Critical and non-critical violations,which do not relate to the foodborne 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* 1g Proper Cooling of PHFs following sections of the Food Code and 105 CMR 590.000 3-202.18 Shellstock Identification* 13 Handwashing Facilities 3-501.14(A) Cooling Cooked PHFs from 140°F to 70°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 1.003 5-204.11 Location and Placement* 3-501.14(B) Cooling PHFs Made.from Ambient 24. Food and Food Protection FC-3 .004 3-402.11 Parasite Destruction*.a 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. 1 Poisonous or Toxic Materials FC-7 .008 HACCP Plans 6-301.12 Hand Drying Provision 129. 1 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 1990 Food Code or 105 CMR 590:000. DATE &A OF THE Tp� yP� ti� FEE PD. snxxsrABLE, Town of Barnstable CHKLST(1-14) 9 MASS. 4� 1634• .m Regulatory Services Department AIEp ,ta 200 Main Street,Hyannis MA 02601 APPLICATION FOR OUTSIDE DINING/SIDEWALK CAFE LOCATION " Name of Establishment: !PA V J 1C2 J &j Establishment Address: ( � /� /�(,i :i 14 �1 q Li o[3 APPLICANTS NAME: �� .�M�i E --F-1i11,, c Phone# 0 71 o -011 SEATING FACILITIES/EQUIPMENT Total#of Seats Existing 2 4 #of Restrooms Provided 2— !5�6 fi 20 Size of Grease Trap ((- Total#of Seats Proposed S Air Curtains(Yes or No) r�' 3 (Total means overall number_of seats indoors plus outdoors) Hose Bib (Yes or No) N Screens (Yes or No) Brief Description of Seating Arrangement,Type of Furniture Proposed,Hours of Operation,Projected Opening and Closing Dates Uwe the undersigned certify that the above information which I/we provided is correct. Uwe have read and fully understand the Town of Barnstable Code Chapter 322 and further understand that failure to comply with said procedures may result in the immediate revocation of this permit. Signature of Applicant(s): Date: a 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) I Copy of the Menu FOR OFFICIAL USE ONLY Town Manager Approval: Public Health Division: Licensing Board Approval: Certificate of Insurance: License Agreement: Comments: Q:\Appfication Forms\OUM NAP.DOC i r DATE FEE PD. CHKLST(1-14) t r Q:\Application Forms\OUTDINAP.DOC Message t • • Page 1 of 1 Ade, Christine From: Ade, Christine Sent: Wednesday, October 12, 2005 11:49 AM To: Geiler, Tom Subject: RE: Pavilion Indian Cuisine outside dining Good! I will put it away with this email inside the folder cll s -----Original Message----- From: Geiler, Torn Sent: Wednesday, October 12, 2005 11:16 AM To: Ade, Christine Subject: RE: Pavilion Indian Cuisine outside dining If they did a change of description for the outside dining they do not need anything else. The license should indicate outside dining on their own property. -----Original Message----- From: Ade, Christine Sent: Wednesday, October 12, 2005 10:57 AM To: Geiler,Tom Subject: Pavilion Indian Cuisine outside dining Back in June the Pavilion came in to alter premises to add outside dining. They were approved for front dining. However,before issuing the new license Tom Broadrick told me they needed to see Danielle about some historic issues. I told the Manager he needed to do so. I emailed Danielle some time later(August)and they had never gone to her. We have a plan-it looks like the tables/chairs are NOT on sidewalk. I had prepared the license agreements to send to John Klimm but never sent them as the plan did not show any on sidewalk and they had not gone to historic. Also,the copies of photos do not show the furniture in place. Should I send them a letter asking why they never went to see Danielle and that they need to do so for next year? And what else is needed? cfin� 10/12/2005 Sidewalk 19' F1 16.5' ❑ 2 n ❑ 3 ❑ ❑ 4 ❑ ' F1 F1 0 0 F1 0 srar�LEs 20 GHHIRS Indian Pavilion (Restaurant) VV/'V G/ LVV,I 1V.VV rZIL1 VVV Ito LY� anAV1%Za Lvj VVL I ' I The Commonwealth of Massachusetts Alcoholic Beverages Control Commission FORM 43 007000162 Barnstable 5123/05 License Number City/Town Date Type of Transaction (Please check all relevant transactions) ( ) New License ( ) New Officer/Director ( ) Pledge of License ( ) Transfer of License ( ) Change of Location ( ) Pledge of Stock ( ) Change of Manager (X ) Alter Premises ( ) Other ( ) Transfer of Stock (Specify) Pro et Corp. 04-3143051 Name of Licensee FID of Licensee Pavilion Indian Cuisine Narinder Thind D/B/A Manager 511 Main Street Hyannis, MA 02601 Address: Number Street Zip Code Annual Wine & Malt Restaurant Annual or Seasonal Category: All Alcohol, Type: Restaurant, Club, Wine and Malt, Wine only Package store, etc. Malt Only Description of Licensed Premises: Restaurant at 511 Main Street, Hyannis with one front entrance, on rear exit consisting of dining room. kitchen, offices, storage, cooler and restrooms. Outside dining in front of the restaurant. Application was filed: May 6, 2005 2:15 pm 5113/05 Barnstable Patriot nn DATE AND TIME DATE AND PUBLICATION t�►y�1 �olD0 Person to contact regarainp thle transaction: Abutters Notified; X YES NO Name: Narinder Thind Address: 140 Kilkore Dr., Hyannis, MA 02601 Phone #: 508 790-0985 Remarks: � by. y)U ; Las'+.' f t it ( P The Loc"ensjtg Agt.h ritlG Alcoholic Beverages Control Commission y �* Ellen Moriarty Executive Director1009 D D D Remarks: A D • JUN 0 9 ,2005 OaK Epp 1ME pp� � of -- p� Regulatory Services BAMSrnste, : Thomas F. Geller,Director nines. 9°0 039. 6. Licensing Authority 200 Main Street Hyannis,MA 02601 www.town.barnstable.ma.us Telephone: (508) 862-4674 Fax: (508) 778-2412 l copy to Licensing, l copy to Health ID Application for Outside Dining/Sidewalk Cafe LOCATION: Property Address: I ^J 'r Name of establishment: A v11_P' __ .i_ -� ra ,�= APPLICANT'S NAME: 1;1 A c21.c�f) E >2 Q . �7, ,� SEATING FACILITIES/EROULPMENT - Total#of Seats Existing _ #Restrooms provided Total#Seats Proposed Size of Grease Trap (Total means overall#seats mdoors&outdoors) Air Curtains(yes or no) Imo �.• + Hose Bib(yes or no) ZD Screens(yes or no) Brief description of seating arrangement, type of furniture proposed, hours of operation, projected opening and closing dates. Please attach three (3) copies of a neatly drawn sketch plan of the seating arrangement and showing the proposed separation distance to the curbing, to any trees, to any rubbish containers, and any other obstacles in pedestrian walkway. Plan must be 8 ''/2" x 1 l." Also please attach three (3) copies of pictures (photos) showing front and side views of the proposed dining area set with tables and chairs that will be used for the outdoor dining and a copy of the menu. D&,gST1c- fuQ.yrsyae , 1180 %o �260 ��i ©��028 7-0 ®9I3o �E .�KETGH ,�CA,J O F' %HE' S�sa Tr.J� i s f7 T i a c-JfF�. I/We,the undersigned, certify that the above information which I/We provided is correct. I/We have read and fully understand the procedures as established by the Town of Barnstable in accordance with Chapter II,Article 8,Section 2 of the General ByLaws and the Board of Health Regulation#14, and further understand that failure to comply with said procedures may result in the immediate revocation of this permit. Signature of Applicant(s): Date: _ FOR OFFICIAL USE ONLY Town Manager Approval: Public Health Div.: � Licensing Approval: Certificate of Insurance: License Agreement: 11 1 Comments:((`l�A�,Yt fl n - --�� e, h 0 b M 5 0Y'- S t AP, W►"ry S A S T-0"t nr:_7 e FTati Town of Barnstable M Regulatory.Services w r + BAMSfABLM r MASS. g Thoma§ F. Geiler, Director 4� =bs� .m A'FDN'9YA Public Health Division Thomas McKean, Director 367 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 SEATING J ANNUAL_� SEASONAL ASSESSORS MAP AND PARCEL NO. DATE APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT FULL NAME OF APPLICANT & 4 P P NAME OF FOOD ESTABLISHMENT �� v l I I O'J l ti �I Iq /y Ch►S I•ti z ADDRESS OF FOOD ESTABLISHMENT / M �~iv S 1 V AN4.1'S TELEPHONE NUMBER 7 ° O �7 TYPE OF ESTABLISHMENT: FOOD SERVICE RETAIL FOOD BED AND BREAKFAST CONT.BR. RES.KITCHEN L-- MOBILE FOOD TOBACCO SALES FROZEN DESSERT CATERING SOLE OWNER: . YES NO IF APPLICANT IS A PARTNERSHIP, FULL NAME AND HOME ADDRESS OF ALL PARTNERS: IF APPLICANT IS A CORPORATION: FEDERAL IDENTIFICATION NO. STATE OF INCORPORATION A FULL NAME AND HOME ADDRESS OF: r PRESIDENT WAG � � �7 ,��•� r TREASURER / CLERK A.Xre�Vf SIGNATURE OF APPLICANT RESTRICTIONS: HOME ADDRESS HOME TELEPHONE # foodesddb/q r y Sidewalk 19' 1F1 ❑ ❑ 5 ❑ ❑ 16.5' ❑ ❑ ❑ ❑ ❑ ❑ 2 3 4 •y ❑ U E ❑ ❑ ❑ sr?6cES Indian Pavilion (Restaurant) 26 CRA-1kG v� I. K �,• �o�U1"1 io 0�1 e1,h CUisi►� J F�►+E'ati awn ot .Barnstable o� aw MA= Board of Health P.O.Box 534,Hyannis MA 02601 vuwc. ��o-ovm-�rw FAX 508-790-6304 REGULATION 14—OUTDOOR DINING CHECKLIST . Checklist (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 Health that all of the requirements'W'through"n"of this Regulation#14 are met. (b) A menu shall be submitted to the Board at the time of application. (c) The dining area must be appurtenant and contiguous to the restaurant property. The —Z dining area"must be mentioned on the described premises as in the case of a Common Victualler's License. (d) Sufficient restrooms,both for customers and employees,must be furnished counting the k�� r00YY\S 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. 0 p p A\ M All entrance and exit doors used by food service personnel and customers ust be screened Ck i r` co I- oht in kA -C, and provided with air curtains meeting National Sanitation Foundation standards All windows or openings used for the transfer of food will be screened and provided with air curtains. Food cannot be stored or kept outside. All food must be prepared inside the facility's kitchen and kept inside until served. (g) A drainag:system designed to eliminate odors will be required for all outdoor dining areas. Hose'nibs wi.h vacuum breakers must be ac � v�ailabiie for was ars= � n ;he dining area. (h) Trash dumpsters shall be situated no closer than 50 feet from an outdoor dining area. If such a dumpster is in the line of sight from the dining area,it must be hidden from view. The area around the dumpster and stockade must be kept clean and free of litter. Dumpsters must be closed with adequate covers designed to prevent entrance of rodents and birds and sealed to control odors. (i) The patio or other ground surface must be of constructed of material readily cleanable and not susceptible to dust, mud,or debris. (Brick,tile,and concrete are examples of acceptable materials). (j) Table tops must be smooth,non-porous,easily cleanable and durable;and readily maintained in a clean and sanitary condition. r-- (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 as needed to prevent overflowing. 0) 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 Fo od Service Establishments,of the Commonwealth of Massachusetts, Department of Health Sanitary Code. / (m) Outside food handlers must have easy access to handwash sinks and cleaning cloths. 0 Facilities for preparation and disposal 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 outside food or drink handlers. Beards and mustaches must be neatly trimmed. NOTE: Exemption from doorway air curtain requirement in section'f'above: The Board of Health may waive the requirement to provide air curtains at the doorways only if no waitstaff services will be provided to the outside dining area(self-service only). VEGETARIAN SPECIALTIES DAkERTS • �NNWERS,i �, BainganBhartha....:...........:.....................................................................12.95 Gulab Jamun(2).......................................................................................3.95 An eggplant specialty baked over open flame,mashed and then sauteed with Deep fried wheat and milk balls,soaked in syrup. onions,garlic,ginger and other spices g g gMango Ice Cream........................................ 3.95 Saag Paneer..............................................................................................12.95 Ice cream made with mangoes and milk and flavored with nuts and rose water. Spicy spinach cooked with pieces offresh home-made cheese. Badami Kulri..........:..................................................................................3.95 Mutter Paneer..........................................................................................12.95 Exotic ice cream from India made with saffron,almonds and nuts. Fresh green peas cooked with home-made cheese chunks and a variety of herbs Kheer.........................................................................................................2.95 and light spices. Rice cooked in sweetened milk,raisins and almonds. MixedVegetables.....................................................................................10.95 Mixed garden fresh vegetables cooked with herbs and spices. AlooPalak................................................................................................11.95 Potatoes and spinach cooked with cream,onions,tomatoes and ginger. BEVERAGES , AlooMutter..............................................................................................10.95 a Fresh green peas cooked in a delicately spiced sauce with potatoes. KabuliChana...........................................................................................11.95 Lassi(sweet)..............................................................................................2.95 Whole chick-peas cooked with onions and tomatoes. A delicious yogurt shake VegetableKorma.....................................................................................12.95 Fresh garden vegetable cooked in a creamy sauce with nuts and spices. Mango-Lassi..............................................................................................3.25 OUR SPECIALTIES AlooGobhi...............................................................................................11.95 Cauliflower and potatoes cooked with tomatoes and spices. Mango Milk Shake...................................................................................3.25 CHICKEN ITEMS ShahiBhindi.............................................................................................13.95 Fresh Okras,cooked with onions,ginger,tomatoes and Indian spices. Mango Juice..............................................................................................2.95 DalMakhani......................................................:......................................11.95 / Lentils cooked with fresh herbs and spices,sauteed in butter and garnished with Soda(large)...............................................................................................1.50 1ion / fresh coriander. ShahiPaneer Korma...............................................................................13.95 Tea&Coffee..............................................................................................1.50 pave Home-made cheese sauteed with fresh ginger,garlic,onion,tomato,garnished / / / with nuts and raisins and cooked in..creamy sauce............•.....•...•••....... Darsalajeeling Tea.................................................................................................1.95 Indian Cuisine Malai Kofta................... 13.95 Darjeeling tea made with spices and milk boiled together in water. Vegetable balls cooked in a creamy nut sauce wish fresh herbs and spices. We deliver to the Islands. SIDE-ORDERS Raita...........................................................................................................1.95 DELICIOUS INDIAN BREADS Yogurt with shredded cucumbers,potato and mint. III, Nan........................... .....................................................2.95 Plain Yogurt...............................................................................................1.50 Sunday Lunch Buffet MondMonday-Friday ec h Lunc 5a Unleavened bread baked in clay oven tandoor. ]1 y y StuffedNan.................................................................................................3.50 Papadurn....................................................................................................1.50 Unleavened bread stuffed with potatoes and spices and baked in tandoor. Lightly spiced lentil wafer OnionKulcha.............................................................................................3.50 Unleavened bread stuffed with onions and spices and baked in tandoor Mango Pickle........................................................................................... 1.95 Aloo Paratha:.............................................................................:...............3.50 5 1 1 Main Street Whole wheat bread stuffed with spiced potatoes,cooked on a griddle with Muted Pickle............................................................................................ 1.95 butter Hyannis, MA GobhiParatha.........................................................:..................................3.50 Garden Salad............................................................................................3.95 Whole wheat bread stuffed with cauliflower,cooked on a griddle with butter. (508) 790--0985 Keema Nan.................................................................................................3.95 Mango Chutney.........................................................................................1.95 1 j Multi-layered unleavened white bread stuffed with spices and minced lamb. FAX (508) 790-91 1 9 PlainParatha..............................................................................................3.50 Multi-layered whole wheat bread,cooked with butter on griddle. Bhatura.......................................................................................................3.25 Refined flour,deep fried puffy bread. Pooris(2).....................................................................................................3.50 OPEN 7 DAYS Whole wheat,deep fried puffed bread Minimum per person $6 00 All dinners served with rice and chutney. Chapati(2)..................................................................................................3.50 590 Massachusetts Meal Tax Extra Thin.unleavened bread,cooked on griddle served with or without butter. 2 as gratuity will be added. GarlicNan..................................................................................................3.95 Unleavened bread sniffed with chopped garlic. PasuriNan...................:................................................................................3.95 S*S RICE SPECIALTIES OUR *CIALTIES Mulligatawny Soup...................................................................................3.25 (We use Basmati Rice which is India's famous Long-grained,flavorfid thin rice.) Spicy hot soup,made with lentils,vegetables and spices. Chicken Biryani.............................................................................................13.95 CHICKEN ITEMS Basmati rice cooked with chicken chunks,nuts and spices. Chicken Curry...............................................................................................11.95 ChickenSoup............................................................................................3.95 Lamb Biryani................................................. ................................................. 14.95 Boneless chicken cooked in thick carry sauce. Boneless chicken soup,with herbs and spices. Juicy pieces of lamb cooked with basmati rice,spices and garnished with nuts. Chicken Tikka Masala..................................................................................13.95 BeefBiryani....................................................................................................13.95 Aariyal Soup..............................................................................................3.95 Diced chicken tandoori style,and cooked in rich cream sauce. Basmati rice and spicy beef chunks cooked with huts and flavored with saffron. Chicken Jalfrazi.............................................................................................12.95 Creamy shredded coconut soup,with mints and spices Shrimp Biryani........................... .........................15.95 ''" ''"""•"""•"""""""""""' Boneless chicken pieces cooked with vegetables and fresh herbs and exotic Saffron flavored basmati rice cooked with shrimps and nuts. ndian spices. Vegetable Biryani...........................................................................................12.95 Chicken Vindaloo................. 12.95 PAVILION SPECIAL DINNERS p h g ....................................................................... Basmati rice cooked with exotics tees,herbs and fresh vegetables. Boneless chicken cooked with potatoes and tmngy snuce. Basmati Chawal...............................................................................................2.75 Chicken Saagwala...............:.................... 12.95 ................................................... variety of vegetarian and non-vegetarian dishes Saffron flavored plain boiled basmati rice. Boneless chicken cooked with spinach and freshly ground spices. Pavilion Special Biryani................................................................................15.95 Chicken Mushroom.......................................................................................12.95 Vegetable Dinner For One......................................................................18.95 Basmati rice cooked in butter with pieces of shrimp,fish,chicken,lamb,beef, Boneless chicken cooked with mushrooms and exotic herbs and spices. Vegetable soup,vegetable samosa,rice,choice of one curry,non. paneer(cheese),vegetables,nuts,raisins and garnished with fresh coriander. Chicken Do-Piaza..........................................................................................12.95 Vegetable Dinner For Two......................................................................36.95 All biryani served with raita. Boneless chicken,pan roasted with onions,tomatoes and spices. Vegetable soup,vegetable samosa,rice,choice of two vegetables,nan,raita, Chicken Korma..............................................................................................13.95 dessert. TANDOORI SPECIALS from Our Tandoor Chicken cooked with exotic spices,herbs,nuts and a mild cream sauce. ChickenMakhni............................................................................................13.95 Special Dinner For One...........................................................................21.95 What is a Tandoor? Boneless marinated tandoori chicken cooked in tomato sauce and touched Soup,meat samosa,sizzling tandoori chicken,rice,chicken tikka,seekh Tandoor is a traditional,pitcher shaped oven made of Indian clay which bums with charcoal with cream and spices. kabab,lamb curry,nan,dessert. fire.Its slow and steady heat does not leave the meat completely dry,rather it helps in retaining the juices and flavors of meats and bakes them to perfection.Some Indian breads I Royal Dinner For Two.............................................................................45.95 like kulcha,tandoori roti are also baked in a tandoor giving them distinct taste and flavor. LAMB ITEMS Soup,meat samosa,seekh kabab,chicken tandoori,chicken tikka,boti kabab, Tandoori Chicken.................................................................................Half 10.95 pullau,nan,dessert and teacoffee,choice of any two curries. .......Full 18.95 Lamb Curry..:................................................................................................12.95 Tender chicken,marinated in yogurt and spices and baked on skewers in our Cubes of lanhb cooked in thick gravy of exotic spices and herbs. tandooroven. Bhuna Lamb...................................................................................................14.95 APPETIZERSTandoori Tikka..............................................................................................15.95 Cubes of lamb cooked with tontntoes,onions and rich spices. Tender chicken pieces,marinated in yogurt and spices,and cooked on skewers in Lamb Vindaloo...............................................................................................13.95 HOT APPETIZERS our tandoor oven. Lamb pieces marinated in vinegar and spices,cooked with potatoes in a Boti Kabab.....................................................................................................16.95 spicy tomato and onion sauce. I,I Meat Samosas(2).......................................................................................3.25 Cubed succulent leg of lamb,marinated in yogurt sauce and baked in tandoor. Lamb Korma..................................................................................................14.95 Spicy turnovers stuffed with minced lamb and spices. Seekh Kabab..................................................................................................15.95 Lamb cooked with exotic spices,herbs and nuts and a mild cream sauce. Vegetable Samosas(2).................••••••••••••••••••••••................................. Finely minced lamb,seasoned with chopped onions,herbs and spices then baked Lamb Do-Piaza..............................................................................................13.95 .......2.95 on skewers in our tandoor oven. Pieces of tandoori lanhb roasted with onions,tomatoes and spices. Spicy turnovers snuffed with potatoes and green peas. Tandoori Shrimps..........................................................................................18.95 Lamb Saag......................................................................................................13.95 Vegetable Tikki..................................................................................... Fresh jumbo shrimps marinated in delicately spiced yogurt and baked on skewers Chunks of boneless lamb,cooked with spinach and spices. ....2.95 in our tandoor. Spicy potato patties deep fried. Lamb Mushrooms..........................................................................................13.95 Tandoori Mixed Grill....................................................................................18.95 Pieces of boneless lamb cooked with nnuushrooms,a blend of fresh herbs Chicken Tikka............................................................................................8.95 Combination of sizzling tandoori specialties like tandoori chicken,chicken tikka, and spices. Tender pieces of chicken marinated in spices and yogurt and cooked on boti kabob,seekh kabab,piece of shrimp and pieces of lemon. Lamb Beti Kebab Masala.............................................................................14.95 skewers in tandoor(a clay oven). All tandoori dishes served with rice,onion and chutney. Tandoori lamb pieces cooked in a cream sauce and exotic spices. KeemaMutter................................................................................................14.95 Vegetable Pakoras......................................................................................3.95 ti SEAFOOD SPECIALTIES Minced lamb cooked with peas,onions,herbs an spices. Fresh cut vegetables,deep fired in chick-pea batten: Chicken Pakoras........................................................................................5.95 Sword Fish Tikka Masala...................... .......16.95 BEEF ITEMS ................................................ Boneless tender pieces of chicken,deep fried in chick-pea batter. Swordfish cooked in rich cream&tomato sauce&spices. ShrimpCurry.................................................................................................15.95 Beef Curry......:...............................................................................................11.95 Cheese Pakoras..........................................................................................5.95 Fresh jumbo shrimp cooked in:a spicy curried sauce. Chunks of beef cooked in mild sauuce of tomatoes and onions. Fresh home-made cheese,deep fried wheat bread. Shrimp Saa 15.95 Beef Saag........................................................................................................12.95 Fresh shrimp cooked with spicy spinach. Beef cubes cooked with fresh spinach and exotic spices. FriedShrimp With Poori............................. .................10.95......................... Shrimp Korma............... .. . . .............. Beef Vindaloo.................................................................................................1...95 Sauteed shrimps,served with deep fried wheat bread(poori). ""a" s u • with nuts. . 16.95 Jumbo shrimp cooked in a creamy sauce flavored with newts. Beef cooked with potatoes in a spicy sauce of tomatoes,onions and Indian Pavilion Vegetarian Platter............................................................... 9.95 Shrimp Vindaloo............................................................................................15.95 spices. ..... Assorted combination ofvegetable pakoras,snnnosa,tikki and cheese pakora. Shrinnp cooked ina spicy sauce with tomatoes and onions. Beef Mushroom..............................................................................................12.95 Shrimp Do-Piaza............................................................................................15.95 Chunks of beef cooked with Mushrooms and a blend of fresh ground spices. Pavilion Non-Vegetarian Platter............................................................10.95 Juicy shrimp part roasted with ginger,garlic,onions and spices. Beef Korma....................................................................................................13.95 Meat samosa,chicken tikka,lamb kabab,seekh kabab and chicken pakoras. Tandoori Shrimp Masala..............................................................................16.95 Beef cooked with exotic spices,herbs and nuts and a mild cream sauce. All appetizers served with house salad,mint,onion,tamarind chutney. Fresh jumbo shrimp tandoori style,cooked in a rich cream sauce of tomato sauce. All dinners served with rice. All seafood dinners served with rice.. VEGETARIAN SPECIALTIES Wellcome t0 Baingan Blsartha ........................... 9.95 Kabuli Chanaa................................ 8.95 An eggplant specialty baked over open flnme, Whole chick-Pens cooked with onions and tomatoes. mashed and then sauteed with onions, Vegetable Korma........................... 9.95 garlic,ginger and other spires Fresh garden vegetable cooked in a Saag Paneer.................................... 9.95 creamy sauce with nuts and spices. Spiryspinach cooked with pieces of fresh Aloo Gobhi.................................... 8.95 home-made cheese Cauliflower and and patatoes cooked -a Mutter Paneer.................................. 8.95 With tomatoes ans spires. Fresh green peas cooked with home-made Shahi Bhindi.................................... 8.95 cheese chunks and a variety of Fresh Okras,rooked with onions,ginger tomalaoes Indian d Inan herbs and light spires. an spires. Mixed Vegetables............................ 8.95 Dal Makhani................................... 8.95 s e w rah herbs and spices, sauteed in Mixed garden fresh vegetables rooked with � Lentil cooked I l herbs and spices. bunter and garnished with fresh coriander. Aloo Palak ..................................... 8.95 Shahi Paneer Korma .....................10.95 t $ Potatoes and spinach rooked with cream,onions, Homemade cheese sauteed with fresh ginger,garlic onoin, tomatoes and ginger. tomato,garnished with nuts and raisins and cooked in Aloo Mutter ...... 8.95 a cream_ sauce. Fresh een ens cooker!in a delirrstelY Malas Kofta....................................10.95 µ �' spired sauce with potatoes. Vegetable balls cooked in a creamy nut sauce .;• with fresh herbs and spires. DELICIOUS INDIAN BREADS Nan................................................ 2.25 ............. Keema Nan .................................... 2.95 Unleavened bread baked in clay oven Tandoor Multi-layered unleavened while bread Stuffed Nan.................................... 2.50 stuffed with spices and minced lamb. Unleavened bread stuffed with potatoes Plain Paralha 2.50 a ................................. and spires and baked in Tandoor Multi-Layered whole wheat bread, Onion Kuleha ................................ 2.50 cooked wiih butter on a griddle. Unleavened bread stuffed with potatoes Bhatura 195 . .......................................... . and spires and baker/in Tandoor Refined jolur,deep fried puffy bread. Aloo Paratha.................................. 2.50 Poories (2) .......... 2.50 Whole wheat bread,stuffed with spired potatoes, pfrie puffed""d. cooled on a griddle with butter. Whole wheal,deep fried puffed bread. Gobhi Paratha Cha ad (2) .................................... 2.50 2.50 P Whole wheat bread stuffed with cauliflower, Thin unleavened bread,rooked on griddle $ 0 rooked on a griddle with butter. served with or without butter. T15V DESSRERTS l .- moo Gulab Jamunm (2).......................... 2.25 Badami Kulfi.................................. 2.25 Deep friers wheat and mi//k balls,soaked in syrup. Exotic ire rreav+from Indian made with saffron, .+ Mango Ice Cream.ngoe.................... 2.50 almondKheers ....nuts. f7ann Ice cream made resit/r mangoes sane!earth Kheer............................................. 1.95 and flavored with nuLr and rase water. Rice cvokrd in sweetener[milk,raisins and almonds. RndRan Lu N)> VIL-, BEVERAGES Lassi (Sweet) ................................. 1.95 Soda Large....................................... 1.00 511 Main Street A delirious yogurt shake Tea&Coffee................................. 1.00 Mango Milk Shake.......................... 2.25 Mango Juice 1.95 MasalaTea......... ...................... 1.50 Hyannis, MA """"""""""""""""" (Darjeeling lea made ices s/rues and milk SIDE ORDERS boiled together in water). (508) 790-0985 Mango Juice .................................. 1.95 Mango Pickle ............................... .95 FAX 508-790-9119 Raita.............................................. 95 95 Yogurt with shredded cucumbers,potato and mint. Mixed Pickle............................... Plain Yogurt.................................... 75 Garden Salad ............................. 3.25 Papadum ...................................... 1.25 Mango Chutney........................... .95 Lightly spired lentil wnftr OPEN 7 DAYS All Dinners Serval with Papadum,Rrrr and Chuteney OPEN DAYS 5%Massachusetts Meal Tax Extra Minimum American Express/VISA/Masirr Card inu.st be over$10.00 40-"Is TAND ��ZZI SPECIALS FROM (7UR TANDOOR r----i What is a Tandoor ? Mulligatawny Soup ......................... 1.75 Nariyal Soup ....................................... 1.95 Tandoor is a traditional,pitcher shaped oven made of Indian clay which bur ns with charcoal fire. Spiry hot.soup,made with lentils, Creamy shredded coconut soup Its slow and.slearly heal does not leave the meal completely dry,rather it helps in retaining the juires l'egelable and spices. with nuts and spices. and flavours ajntealsand bakes them to perferlion.Some Indian breads like,Kulcha, Tandoori Boni are also baked in aTandoor giving them distinct taste and flavour. Chicken Soup ................................ 2.25 Tandoori Chicken....................Half 9.95 Seekh Kabab .................................. 11.95 Boneless chicken soup, with herbs and spires. ....................Full 15.95 Finely minced lamb, seasoned with Tender chicken, marinated in yogurt and spires and chopped onions, herbs and.spices then PAVILIONSPECIAL DINNERS linked on sketvers in our 7'andoor oven. baked on skewers in our Tandoor oven. Tandoori Shrimps .......................... 14.95 Tandoori Tikka .............................. 11.45 hiesh jumbo A,im a rnarinaled in delicalcly s p+ed A variety of vegetarian and non-vegetarian dishes 7 1 1 r' Tender chirken pieres, mnrinnled in yogurt and spires, yogurt and baked on shewvrc in our Tandoor. Vegetable Dinner for one ...............13.95 Special Dinner for One..................16.95 and.%pices and cooker!on skewrs in our7'andour oven. Tandoore Mixed Grill .................... 14.95 lr'velaGle soup, veg. inmost Rice, Choice n one Soup, Meat.Samosa, Sizzling Tandoori Chicken Combination of sizzling Tandoori specialties (.L,el , f 1 g Boli Kabab.....................................12.95 like 7'angari Chicken, Chicken %'ikka, y Rice Chicken Tikka, .Seekh Kabab, Cubed succulent leg of lamb, mminaled in Boli Knbab,Seekh Kabab and 7'andoon Vegetable Dinner for two ...............28.95 Lamb Curry, Nan dessert. 1''egelnble soup, veg. .somosa!lire, Choice of two Y yogurt sutcP and token in %'nndnnr. sluimp srnrrr!Dille sauteed onions nu/pieces of l mans vegetable, Nan, Raila, dessert Royal Dinner for Two 32.95 All 7andooii dishes server!with )ire, onion and Chutney. Soup,Meat Samosa, Seekh Kabab, OUR SPECIALTIES Chicken Tandoori,Chicken Tikka,Bofi Kabab, APPETIZERS Ch i Nan,dessert and lea/ea„rr. sealerce a,rimy chat cm.,irs. CHICKEN ITEMS Lamb Vindaloo...............................11.95 Lomb pieces mnrinnled in vinegar and spires,cooked Chicken Curry................................. 9.95 with pointors in n shirPy tannlo and Doran snurr. HOTAPPETIZERS Boneless chirken cooked in thick curia saure. Lamb Korma ..................................12.95 Chicken Tikka Masala ....................11.45 lamb cooked with explic spices herbs, Meat Somosas (2)........................... 2.75 Chicken Pakoras............................. 3.50 Diced chirken Tandoori style, and conked nuts and n mild cream sauce. .Spicy turnovers stuffed with minced Boneless tender pieces of chicken, in rich reprint inure Lamb DO-Piaza ...............................11.95 pfried in bailer. Chicken falfrazi ............................ 9.95 Pieces tJ Tandoori lamb rormird urith onions, lame and spices. dee chick-pea Boneless chirken pirr'e.s ranked with wgelnbin tomatoes and spins. Vegetable Somosas.......................... 2.50 Cheese Pakoras................................ 3.25 and fresh herbs and exotic Indian.spires. Lamb Saag .....................................11.95 Spicy turnovers slujjed with potatoes Fresh home made cheese, Chicken Vindaloo........................... 9.95 Chunks vJ'boneless lamb,cooked with onions, and green peas. deep fried wheal bread. Boneless chicken rooked with Potntovs and langy sauce. tomatoes and spices. Vegetable Tikki 2.50 Chicken Saagwala........................... 9.95 Lamb Mushrooms...........................11.95 g """"""""""' Fried Shrimpwith l oori................. 6.95 Boneless chicken rooked with s pinorh Spicy potato patties deep fried. 1 blend nj rr.sh he lamb r:oolrerl with rnnslovonu, Sauteed sltrim, served with and freshly ground spires. Glenn of Jresh herbs and spices. Chicken Tikka................................ 5.25 deep fried wheat bread. Chicken Mushroom......................... 9.95 Lamb Boti Kebab Masala ...............12.95 %ender pieces of chicken marinated in Boneless rkirken cooker!with mushrooms Tnndomilnmb pines rooked in crenrn sauce and exotic spires. Pavilion Vegaetarsan Platter............ 5.95 aril exotic herbs and spires. Keema Mutter ..................11.95 . ............. spires arud yogurt and conked on Assorted combination of vege table ble Pakoras Chicken Do-Piaza............................ 9.95 g rlfincpr!(nob cooked with pros,moots and barbs and spices. sleewers in lancdoor(a day oven). Somosa, Tikki and cheese Pakora. Boneless chicken,pan run.sterd with onions, BEEF ITEMS Vegetable Pakoras........................... 2.50 tomatoes and spices. Ve g Pavilion Non-Vegetarian Planter...... 6.95 Chicken Korma .............................. 10.95 Beef Curry...................................... 9.95 Fresh cut vegetables, deep fried in Meat.Samosa, chirken Tikha, Lanhp Kabob, Chicken conker[tuith exotic:storteos, I hribs. Chunks n,berf rooked in spiry.snurr of +P)b chick-pea batter. > nuts and a mild cream snore. hunatoes and onions. Seekh KaGuaG and chirken l thorns. Beef Saa Chicken Makhni ............................. 10.95 Saag........................................ 9.95 All appetizers served with house salad, mint, onion, Tamarind Chutney. Boneless marainnlyd'i'andnori chirken rooked in Beef cubes rooked with Jrrsh spinach and exotic spires. tomnlo saure and lourhed with crenrn and spins. Beef Vindaloo................................ 9.95 RICESPECIALTIES LAMB ITEMS Beep o.1rd with potatoes in a spiry snurr vj Lamb Curry ........ 10.45 lomalnes,onions and Indian spires. """""""""' Reef Mushroom . 9.95 (We use Basmali Rice which is India's famous long-grained, flavored thin rice.) Cubes ojlamb cooked in thick grevs•n, """"""""ms and a Chunks of beef conked nrith mushrooms and a Chicken Bir ani ......... ........10.95 Vegetable Bir ani exotic Spices anti hells. y ............ g y .......................... 10.95 1 " blend n,/loch grnuml srir'rs. llasmali Ricecooked taiUt Chickenifasmati Rice rooked with exotic spices,herbs an Bhuna Lamb ............ al ..................................11.95 Beef Korma....................................10.95 Chunks, nuts-and.spices. fresh vegetables. Cubes of dumb rooked with tnntnton, Bref conked with exulir spices, herbs and nuts g onions and rich spices. and a mild rrenm saure. Lamb Biryani .................................11.95 Basmali Chawal ............................. 2.25 juicy pieces rflamb conked with Basmati Saffron flavored lain boiler!Basmali Rice SEAFOOD SPECIALTIES Rice, spices and garnished with reels. Pavilion Special Birany................... 13.95 Sword Fish Tikka Masala.................12.95 Shrimp Vindaloo.............................12.95 Beef Biryani ................................. 11.95 Idasmali Rice cooked in better with pieces t f Swordfish cooked in rich cream,tomato saure and spires. Shrimp tanked in a spices sniice with tomatoes anti onions. Basmali Rice and spiry bref chunks Shrimp,fish chicken, lamb beef panrer Shrimp Curry ................................12.95 Shrimp Do-Piaza ............................12.95 cooked with nuts and flavored with saffron. (cheese), vegetables, nuts raisins and First,jumbo shrimp coked in a spiricy a fuiry shrimp pan masted with huger,gnrlir, garnished wit/t fresh coriander. spiry curried saure. onions anti spices Shrimp Biryani.............................. 12.95 Shrimp Saag ..................................12.95 Tandoori Shrimp Masa...................13.95 Saffron flavored QAsmadi Rice cooked with shrimp Fresh shrimp rooked with spiry spinach. Fresh jumbo shrimp, '/}unrlumi sry[r, cnulurd in tj anti nuts. Shrimp Korma ..............................12.95 rich cream saure of tomnlo saure. All Gir anti served with Raita. jumbo shrimp cooked in a creamy snore Jlavorrd with y nuts. All Dinner's.Served with Rice 0 No�q �. 2� . Fmc...&.d.0......_ THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH ................OF........ aJLI Appliration for Bispnaal Works Tnnstxnrtion ramit Application is hereby made for a Permit to Construct ( ) or Repair (X) an Individual Sewage Disposal System at: . 971 VA( C ku:Sr............................................................... ......---------•••-•--........._•---..._..... ---•--•---.................------.......-- Location-Address r Lot No. ......................t....1:4. ........................................... ......-��! t...--�°'"��-- t'-.:14.Y ! � ................L� � Address Installer Address Type of Building / Size Lot............................Sq. feet Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) 0.' Other fixtures ..................... W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid'capac Q,'_40� allons Length................ Width---------------- Diameter---_--__--_--_- Depth................ x Disposal Trench-No..................... Width.................... Total Length.................... Total leaching area_-__--_-------------sq. ft. Seepage Pit No..................... Diameter.-______---_--__--•- Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) `-� Percolation Test Results Performed by.......................................................................... Date........................................ 4 ,.� Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ Gi, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water....._.............._... a -••--••---•-------------------•---•---•------------------•••-••--------...........-•----•-----••----......................................................... 0. Description of Soil.................................................................................------- -----------•--------------•----------------------------------...........-•--- x U .....--•-------------••------•--•-------.....---••....--------•-----•---------------•-•--••-•-••--------••---•--•-------------•---------•••---•--------................................................ w --------------------------------------------------------- ----------------------------•- -•••-----------•-------------------•------•----•-------- -----•--- U ure of Repairs or Alterations—Answer when applicable.___�•�.S. t-�-_.__ _� .��.............................................. --------------------------•-----------•------ Agreement: The undersigned agrees to install the aforedesc abed Individual S age Disposal System in accordance with the provisions of iI 1'11 5 of the State Sanitary C —The undersi ed rtl:er agrees not to place the system in operation until a Certificate of Compliance has bee iss ed by he boa o iealth. Sied.... .............----- ----• ---------•-•--••--•---------------------••......- <._._._..._ eAppl - 2ate ication Approved By---------------- ----•-.. ..�...............--••--...... � `......--•--- ------ Application Disapproved for the f ollowi reasons----------------•----------------------------------------------------------------------------------.....----•-. ------•----------------------------•-----------.....••--•--------•---•-----------•-••---•-------•-••------------------•-•---•-•------•-•-----••-----•-•-•••-•-----------••-------------......--•--•----- ` I Date —� PermitNo......................................................... Issued....................................................... Date No................_...... Fxs...�. ....w ........ THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH �U ..............OF........ a {J9 Appliraiion for Uiippiittl Works Towitrnrtiun ramit Application is hereby made for a Permit to Construct ( ) or Repair (k an Individual Sewage Disposal System at: .. [: 4�. f- - :. . ........- -----------------------------•-••---- Location.Address jor Lot No. G?v r r v �? `G ` ....................................' r _l r,°f-• N` .t tii r -............... Owner Address a die. C.. e„ .............((( t-S ��rze� 1 � Installer Address UType of Building Size Lot____-•--------•---_---.-.--Sq. feet .., Dwelling—No. of Bedrooms.............................................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ____•_______________________ No. of persons............................ Showers ( ) — Cafeteria ( ) Otherfixtures -------------------------------•----------------------•--•--••••••••....-•---••------------------••-•••--••--••---•---••......•....-----•-•--•-...... w Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid*capacity............gallons Length---------------- Width................ Diameter................ Depth................ x Disposal Trench—No. .................... Width.................... Total Length..................... Total leaching area....................sq. ft. Seepage Pit No--------------------- Diameter.................... Depth below inlet......_............. Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date........................................ a Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water........................ Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ a' •-••-•---•••-----------•----•••••••••••••••-••.....--••--•--••••.....•--•-•-•••-••-•------------------------ -------------- •------•-•-•-------------.--------- 0 Description of Soil...................................................................................................................................................-.................... x U ------•-•••---••---•----•--••----•--•----•••••-••••••----•••-•-•--....---•---•••-•-•......_...-•-•--.....---•-•-•••••-•••••••----•-•---•-•-••......•--•-•-••-•••••..................................... w ---------------------------------- V N ure of Repairs or Alterations—Answer when applicable__ '_S. " --._.__A'-._1.0_v __..._._ T_••R_S..___ ............................ Agreement The undersigned agrees to install the aforedes.'ibed Individual S age Disposal System in accordance with r,-rrP-^ the provisions of ii.IE 5 of the State Sanitary Code—The undersig ed �rtl:er agrees not to place the system in operation until a Certificate of Compliance has bee issued by he boarrdrQiealth --- _. Signed - ....................................... -•----.....--.....-......---•-- L-1- Z:-5 i_w. -/% Date Application Approved By.......................il----- -- ............................ ... l =;J ri Da te Application Disapproved for the f ollowi� easons--------------------------------------------------------•----------------------------------.. ••............- ................................... • ••-•. ••-•-•----------------------------•-------•----•----....----•--------------------------------------------------------------••-•-•--- U 1 (" x_- Date PermitNo......................................................... Issued-....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH { ...................OF................ ... -t!,q "!" .............................. Trrtifiratr of Tomplianrr THIS IS TO CERTIFY, That the Lndividual Sewage Disposal System constructed ( ) or Repaired 04 ) by------------------------ t1x .....- ..�...�-..V.................................................................................................... at S Install- t has been installed in accordance with the provisions':zof`"r"71 The State Sanitary ode as described in the t ° . application for Disposal Works Construction Permit 'ro........................................ dati✓ed?_/C? _'l____.._......___._._._..__.. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE........ ............. Inspector-, ,��......0221ve--bl, THE COMMONWEALTH OF MASSACHUSETTS BOARD HEALTH� ..............................OF...................-............ ----------....---............. No......................... FEE wisposlal Iforks C nn rn ilanUpantit Permission is hereby granted...... ?! . ~?! ......-�_...�! ...... ._�_01 r— .___.._.................................................. to Construct ( ) or Repair (*) an Individual Sewage Disposal System Sire t f as shown on the application for Disposal Works Con_structio Per mi 0...................... D �?:f-----------..................... Board of Health DATE.........................................-------------------------------------- FORM 1255 HOBBS & WARREN. INC., PUBLISHERS EQUIPMENT SCHEDULE p FLOOR PLAN KEY NOTES U � U 6O w w o w W A TRASH ENCLOSURE TO BE FURNISHED AND INS"ALLED BY GENERAL CONTRACTOR C7 > z � I m ap a V w IF REQUIRED BY CODE. Z} m m am O Orrar�i m W c Y DESCRIPTION OF EQUIPMENT o c w �,W W W CA ` �W � I W w c� � � ALL DIMExsloxs ARE za ROUGH vxLEss NOTE) OTHERWISE. O r r W w = p J = J p 0 0 r 00 4 to wm a 3 NEW CONSTRUCTION IS SHOWN AS SHADED: 3- ./2" WOOD STUDS UNLESS NOTED z z H y_j z J N J z Y 2 i s Z > z Q J (L Y OTHERWISE WITH 1/2" DRYWALL EACH SIDE TO 6" ABOVE CEILING (TYP.). J V a z cr H ¢ t- I y Q U)p r j p W u, �r a a NEW WALL BEHIND OVEN TO HE CONSTRUCTED -IF 3-1/2" METAL STUDS WITH u,J) � ¢tn N U) -j -� ►' G�NJ ~ 5!S" FIRE CODED DRYWALL EACH SIDE. 1/2' WATER RESISTANT DRYWALL IN ur � Oz Mz0 XW Xw Xw J Zz O ►_p O u. Z U. a - u. o w or w Ix w 2 < >-O z TOILET ROOMS. 1 1 ✓ EN S/GN A Q PAINT ALL WALLS NOT COVERED BY 'GLASBOR;)' WITH GLIDDEN SANIGENE ENAMEL 05609 - GLOSS WHITE: (1) COAT PRIMER, (1) TWO COATS FINISH 2 I ��U" [ Fi29Cj. 1r4AKE :.i►a y 1% 'Si p/p t l [y�i /J p4i j 9 BY GENERAL CONTRACTOR. NOTE: (FOR COW BETE BLOCK PER 3 I 3 COMPARTMENT` S/S SINK MANUFACTURER'S RECOMMENDATIONS) . 4 FRP- P-1C?O ry-( MASON ME t,c;LA9FaiC>RP) A ' ) 55 GENERAL CONTRACTOR TO FLASH AND COUNTER FLASH ALL SUPPORT RAILS AND/OR ROOF CURBS AS REQUIRED TO RETAIN THE INTEGRITY OF ROOF: SEE _ } 5 I WS NAND SINK A THIS SHEET FOR LOCATION OF RAILS AND CURBS AND RESPONSIBILITY OF 1 I LANDLORD AND TENANT. VERIFY IN FIELD. 6 I STAND►C1RP OPP-r-E PACKAGE I 7 RQD Q GENERAL CONTRACTOR SHALL PROVIDE ALL BL)CKING AS REQUIRED FOR WALL ; CGa 7"flEj fSRAC.fCET • MOUNTED FIXTURES BY TENANT, UNLESS NOTED OTHERWISE. 8 I TI O�tE G.G OGK • GENERAL CONTRACTOR SHALL PROVIDE QUARRY TILE AND 6" BASE BY 9 I WALL CslrkAPl4IC ® "SUMMIITVILLE' 'STRATE' 055 SANDROCK 4" X 8" HERRING BONE WITH BLACK i 10 I MENU MOACiD q GROUT STRUCK FLUSH WITH TOP OF FLOOR TI-E. 11 OVEN - CTAS a /8\ GENERAL CONTRACTOR TO CUT OPENING FOR DRYER VENT AND PATCH AFTER Q HVAC CONTRACTOR IS FINISHED WITH WORK. SEE HVAC PLAN SHEET H-1. 12 UL.ECTRIC A 13 Cn/t:'N NC70Q Vt/ L�t�R -�CANOP`( NP"E CErILIN MTD A9 GENERAL CONTRACTOR TO CUT 19" X 19" ROC F OPENING FOR EXHAUST FAN / (A . O DUCT FRAME WITH 2" X 3" X 1/4"; PATCH A3 REQUIRED. GENERAL 3a 14 I OVEN NOON W/ FILTER'- CAN017Y 'T(1t OVEN MTD• • CONTRACTOR SHALL PROVIDE 2-40UR RATED SHAFT, 13" X 13" CLEAR INSIDE DIMENSION FROM HOOD EXHAUST TIGHT TO DECK EQUAL TO U.S.G. 075032 OR 15 I EXHAUST FAN - UP (5LA3T • APPROVED EQUAL. (IF REQUIRED BY CODE). 16 I W.A97-E2 146-#9 E • A 'GLASBORD' SHALL HE INSTALLED TO BUTT _NTO NEW CEILING GRID. I 17 MWVErRS TAN-C �$=0r') s - Al GENERAL CONTRACTOR SHALL BE RESPONSIBLE. FOR VISITING THE SITE AND 18 f 5JS MoLoNq TAI!,Lx • FAMILIARIZING HIMSELF WITH THE PREMISES AND WORK TO BE DONE. ova _ GENITAL COWrPAr"','O 3HAI,L ""IT)INATF. ALT. ROPY IRT?'N OWNr? ^oTOR TO FLJc v 19 SIS WORK r^Is.B SPArCAR l� 4- . -j' `; k AG N • ORDERING ANY MATERIAL, DOING ANY WORK AND SHALL FIELD VERIFY ALL 20 1 WAL.W -I!v L00Le$X W/ 'Sip" r"oft • DIMENSIONS. - 21 ( V- O" S/S PHONA C.DUNTER A GENERAL CONTRACTOR SHALL FURNISH AND INSTALL VINYL ASBESTOS TILE • AND 4" VINYL BASE - 12" X 12" X 1/8' A- MANUFACTURED BY ARMSTRONG o ="_ ! OR APPROVED EQUAL AS INDICATED ON DRAWINGS. SAMPLES TO BE 22 m'r SI3 WT TA►tyik W� Lr+ OVEN SHE EnngE� \ SUBMITTED TO OWNER FOR PATTERN AND COLi;R APPROVAL- PPROVAL_ 23 GCJR GAG-!h� G a N C�ENJ 2 tiIs � - 1�151D"� OP GN�� ?O 24 oOP COOLAR GENERAL CONTRACTOR SHALL FURNISH AND INSTALL NEW 2 X 4 LAY-IN \�_ I M1�IFR/gL a� LI _P • ACOUSTIC TILE WASHABLE CEILING - 'ARMAyHIELD' AS MANUFACTURED. BY �V F1 BEt�wl� ��T x+TL 25 1, EGEG T2tC9'" �ANEL • ARMSTRONG OR APPROVED EQUAL AS INDICATED ON DRAWINGS WITH STANDARD WOOL- TEE BAR GRID SUSPENSION SYSTEM. FINISH CEILING HEIGHT Imo' TO JE 26 � . n � pu7� DE c�1a� i Gc/x47"F2 lVe7W-c • Np1.J4EiZ I I_INE[� W 2 ��' GENERAL CONTRACTOR SHALL REMOVE EXISIT.NC FLOOR AND WALL FINISHE] � 8 GA SST MIL, 27 FIPM EXTINCjUISHAR>5 • AS REQUIRED AND PREPARE SUB-SURFACES F"-R INSTALLATION OF NEW 02o�K�iS /01 28 ln/ASNi'ieR./ CJRYeR COM17f? R FINISHES AS INDICATED ON DRAWINGS. COORDINATF. AND VERIFY WITH 25 I C,,A.� .mE�E2 , s - AA EXISTING TOILET ROOM FIXTURES TO REMAIN. 30 • EXISTING DOORS TO REMAIN COORDINATE KEYING OF HARDWARE WITH TENANT. 7 „ I•D• 31 ! Moto SINK QLac, MCUNTRP) A 32 I ptSPoSAL. g �xIS fINCr 5 tU[ZI;:FtiDC IN�LUL''lNit LGG'( iG i�c-MAIN, I PANr_L'S C 9 '-D'' A, FF (VEr<IFY} F'EC3QL:�. SIDE QU'T, GU(._- ice . \VIII-IrE ��//�v-Il-t� T' Iht, GLASS •A '~l ME SPREAD Z 5 Or' LE55, � HI ELECTRICAL KEY NOTES HVAC KEY NOTES E�LUMBING KEY NOTES o/ RU"I A 3i4" COND. UP TO ABOVE CEILING TO TELEPHONE TERMINAL BOARD: � FUP.NIt5H P.110 INSTALL A DRYER VENT CAP WITH BACK DRAFT DAMPER.. (D PLUMBING CONTRACTOR TO VERIFY WATER PRESSURE WITH LOCAL WATER EQUIP WITH PULL WIPE (PROVIDE HORIZONAL EXTENSION TO APPROPRIATE �.•..// DEPP.PTMENT. DRAWING INDICATES AN ASSUMED PRESSURE OF 40 P.S.I. TO COUNTER - ONE LOCATION). FUP.NISH PND INSTALL A METAL DRYER VENT. VEF.IFY SIZE AND LOCATION 60 P.S.I. WITH ^GINEP. �� O FURNISH AND INSTALL A JUNCTION BOX ABOVE CEILING FOR MENU BOARD, 2 PLUMBING CONTRACTOR SHALL EXTEND NEW SANITARY SEWER LINES TO MOUNT ON BOTTOM CORD OF JOIST. FUP.NISH AND INSTALL A 7" Y 7", 16 GA. GALVANIZED METAL DUCT EXISTING MAIN LINES AS REQUIRED; (VERIFY WITH LANDLORD'S FLUMBING 12� CONTINUOUSLY WELDED FROM EXHAUST FAN TO OPENING IN HOOD. Duct CONTRACTOR) THREE-COMPARTMENT SINK (P-2) 3", HAND SINK (P-3) C-� I r� 540GFM , O3 FURNISH AND INSTALL A DUPLEX OUTLET ABOVE CEILING FOR OPEN SIGN, 1-1/2". DISPOSER (P-5) 2", AND WASHER (P-6) 2". r f�1�WA�1c,=Q 1 MS � MOUNT ON BOTTOM CORD OF JOIST. Q )WNER TO FURNISH AND HVAC CONTRACTOR TO INSTALL A "VENT MASTER" � B120 LK-&-rS DELUXE PIZZA OVEN CANOPY HOOD, 78" LONG, 43" WIDE, 20-1/2" HIGH, S a 2� SANITARY EWER PIPING LINE SIZES AREA GENERAL MANUFACTURER'S GUIDE. I r(o O RUN A 1" CONDUIT TO JUST ABOVE CEILING AND CAP WITH A JUNCTION BOX. CONSTRUCTED OF 19 GAUGE STAINLESS STEEL, U.L. AND N.S.F. LABEL THE PLUMBING CONTRACTOR SHALL VERIFY ACTUAL SIZING WITH LOCAL AND d� u8"'-AT 3Z± � " " -a 3/4 N�" } AND ALSO N.F.P.A. 96. STATE CODES. I 5 " (Z) Kn VJ k 10 µ (2)20 W x 10 N S T. OS 30 AMP-2P, W.P. DISCONNECT SWITCH FUSED @ 9 AMP FURNISHED ARID �I �i" y5� ALLU./...MESA F1tTFi25 - INSTALLED BY ELECTRICAL CONTRACTOR. SEE FEEDER IN NOTE 7. OWNER TO FURNISH EXHAUST FAN EF-1, THE H.V.A.C. CONTRACTOR SHALL ,041j PLUMBING CONTRACTOR SHALL FURNISH AND INSTALL HOT AND COLD wP.TEP ' � INSTALL THE EXHAUST FAN. �•/ CONNECTIONS FOR THE ITEMS LISTED IN NOTE 2 (EXCEPT THE DISPOSER) O FURNISH AND INSTALL A JUNCTION BOX ABOVE CEILING FOR BUILDING SIGN. FROM THE ROUGHED-IN WATER PIPING AT THIS POINT. FINAL CONNECTION BY ELECTRICAL CONTRACTOR. 6 ALL ':')NTP.O-L WIPING FOR HVAC UNIT TO BE FURNISHED AND INSTALLED BY �}3''r.} ± - 4E HVAC CONTRACTOR. RELOCATE T'STAT IF REQUIRED, FIELD VcRIFY O EXIFTI,NG GAS WATFP HEATER - LOCATED ON THE LOFT LFVEL ABOVE THIS40 O� 2 7O RUN 2 - 012 AND 1 - 012 GRD IN 3/4" CONDUIT TO PANEL AS INDICATED. AREA. - �`+' a ALL DUCT WORK TO BE MADE OF SHEET METAL IN ACCORDANCE WITH "SMACNA" O 2' -0" X 2'-0" X 3/4" PLYWOOD TERMINAL BOARD (IF NOT EXISTING) . AND TO BE INTERNALLY LINED WITH 1" "JOHNS-MANVILLE" DUCT LINER. G r SYSTEM. _ 40/8' f A Orr, r SERVICE G art r t 6 EXISTING SPRINKLER ' E,JZP WITH A k6 RD. . RUN TO SERVICE ENTRANCE ROUND. IF RE__IPE7) TO RELOCATE IXISTIN, DIFFISERSI . FIELD VERIFY EXISTING1 p! � V DIFFUSER LOCATIONS AND CONSULT DOMINO'S FOR FINAL LOCATION. t J 4' WIDE LOWED x 6` ^ 7 EXISTING TOILET ROOM. O �I9 PROVIDE A 1" CONDUIT SLEEVE THRU WALL FOR TELEPHONE CO. SERVICE V 21 Q p• " A.F.F. (IF REQUIRED) . U INSULATED FLEXIBLE DUCT MAY BE UTILIZED IN MAXIMUM LENGTHS OF 7 FT. a PosT�h 7o OVEN ENTRANCE MOUNTED AT 9'-6 Q 8 EXISTING IN-FLOOR WATER SEWER FLUSH VALVE. ! OV -v --'kJ PEP. BRANCH RUN. FLEXIBLE DUCT SHALL BE GLEN-FLEX NSL-181, OR � hIE_ _ T 10 EXISTING UNIT DISCONNECT. CONDUCTORS, AND CONDUIT ARE TO REMAIN. EQUAL. PRODUCT BY WIPEMOLD OR CLECON. THE BALANCE OF THE BRANCH O PLUMBING PLAN IS SCHEMATIC ONLY. PLUMBINC CONTRACTOR SHALL VERIFY " I !/2 RUN SHALL BE HARD PIPE OF SIZE INDICATED• WITH SLEEVE INSULATION. EXISTING CONDITIONS AND ADJUST AS REQUIRED. 8 21 /L 21 /2" 11 PROVIDE W.P. DUPLEX OUTLET AND TROUBLE'LIGHT (HUBBELL OAOW-10100 (TYPICAL) . - lY ram--- - - ---� ` W! 1-IOCA19 LAMP) ON H.V.A.0 ROOF TOP UNIT (IF REQUIRED BY CODE) IF 10 PLUMBING CONTRACTOR TO FUP.NISH AND INSTALL A RECESSED ENCLOSURE 0 -j NOT EXISTING. F] EXISTING RETURN AIR DIFFUSER LOCATION. WITH HOT AND COLD WATER. SHUT-OFF VALVE AND PROVISIONS FOR DRAIN. 12 EXISTING ELECTRICAL SEJRVICE DISCONNECT F 11 RELOCATE THE EXISTING RETURN AIR. DIFFUSER TO A NEW LOCATION MANUFACTURED BY OATEY 538759 OR EQUAL. lL V INDICATED ON THE DRa.WING. REFER TO NOTE 7 FOR DUCT REQUIREMENTS. -2 13 EXISTING 240V. 3-PHASE, 225 AMPERE ELECTRICAL PANEL - TYPICAL OF TWO (2) - DO NOT CONNECT ANY SINGLE PHASE CIRCUITS TO THE HIGH LEG 11 EXISTING ROOF TOP H.V.A.C. UNIT. OF THIS 3-PHASE SYSTEM. EXISTING SUSPENDED H.V.A.C. UNIT. l� 14 EXISTING 120/240, 1-PHASE, 100 AIATERE ELECTRICAL PANEL. Lll 15 PROVIDE A DRYER CONNECTION/OUTLET; 30A-2P, 240V, 1-PHASE AT 36" AFF AND CIRCUIT (2N10 & 1#12 GRD. IN 3/4" CONDUIT) TO PANELS INDICATED I IN NOTE 13. PROVIDE NEW 30A-2P CIRCUIT BREA.KiR IF REQUIRED. L� 16 PROVIDE ELECTRIC OVEN CONNECTION/DISC. SWITCH; 100A-2P(F`USEl) @70A), 204V. 1-PHASE AT 66" A!FF AND CIRCUIT (204 & 108 ORD. IN 1" CONDUIT) X157"I GO�/EK�D r' /� i1�t TO PANELS INDICATED IN NOTE 13. PROVIDE NEW 7OA-2P CIRCUIT BREAKER 1 1 \ A , IF REQUIRED. PICK LJ F` AREA ,17 FURNISH AND INSTALL MISC. OUTLETS INDICATED AND CIRCUIT (THREE CIRCUITS REQUIRED) TO THE PANEL INDICATED IN NOTE 14. 1 - -- - - -- ---- - 1- -1 EX Hc,uST F+o(-I sty. CEF-I) ry A_ C2"G3-2 .4 P. F,7 B.U. 2GYiF— :.XiSt. irJsu(-�TIo�1 - Z it ---- EKIS'T. M?L. DFL - rl • • i 2� I5 10. 4 . i 7 CST CIF P-rz. c I � -- � II p-Z p-5 �' t�l I`i_ ' T�T -- 2 ;x �R. zaTcc INAPT elf 4i R �I i= z , I I (� �J / L/ .,olsT-( oa�J. F2A>�E J s G.B-G• M717.2.2 .VEuric.PL EZ �� C1C l=�l,y� EXITINc� W 5 - E 1 ,. — - iTEn. PL E LO � _- - - -7 x _1 ✓UCf W 540 LF.M. caw I, �-:i F.P.M. �Iq STL 20� Fog -_LtPZ�T C1/ U r ( (F �A -� c;c B o a sTA w amass ...-_-..,r......- -.... ` \�� Vl (V -7 K -7 ri STEEL. Lr,.IEK !i C I it III i C 1 (]j � .�- 21 LOUVEes 1a GA. STAhICESS s7L ,.'' 98 A��F P-I a Ca OVEQ FLJE Ex Lc JST 1l�oD r 4, '•,. C` _ uA✓r,B ElZ 'V E tJT snesTE e'1J.S.F �rx vj JAI' �j 17 ES 6 `J 2 I� 12 — - . _ .— — 15 ;E Ic� - F, zz4, ovE'JS MO 4, 12 Fir, 07 /CF-1q) :DlP 1 LJ6`• EY15T'//V Gn1 E�CI STING P-q I3 I _ r1 I i EIS . E��VATID � G S� TiO @ OV'E