HomeMy WebLinkAboutSMOKE HUB, THE - RETAIL FOOD SMOKE HUB, E
145 Barnstable Rd, DIY
f
�rF£F Town of Barnstable BOARD OF HEALTH
John T.Norman
Board of Health Donald A.Guadagnoli,M.D.
eair�neE " F.P.(Thomas)Lee
200 Main Street, Hyannis, MA 02601 Daniel Luczkow Alternate
Phone: (508) 862-4644 Fax: (508)790-6304
www.townofbarnstable.us
Permit to Sell Tobacco
In accordance with regulations promulgated under authority granted by Sections 5,31 and 127A of the
General Laws of the Commonwealth of Massachusetts and Chapter 371 of the Town of Barnstable Code, a
permit is hereby granted to:
Permit No: 1110 Issue Date: 1/1/2021
DBA: SMOKE HUB, THE
OWNER: SHR TOBACCO LLC.
Location of Establishment: 145 BARNSTABLE ROAD HYANNIS, MA 02601
Type of Business Permit: Adult Only
Annual Seasonal
FEES YEAR: 2021
TOBACCO SALES: $85.00
Permit Expires: 12/31/2021
Thomas A. McKean, RS, CHO, Health Agent
Restrictions:
PLEASE POST CONSPICUOUSLY
Town of Barnstable For Office Use Only: Initials:
o TM�rQr . Inspectional Services Date Paid qL3 Amt Pd$
BARNSTARL& ; Public Health Division
Check# OAP��1 Q
66 ,•� Thomas McKean, Director
fD AAfd s '
200 Main Street, Hyannis, MA 02601
Office: 508-862-4644 Fax: 508-790-6304
ADULT ONLY RETAIL TOBACCO SALES PERMIT APPLICATION
DATE - 2q-t NEW BUSINESS: NEW OWNERSHIP 9 R ✓
'ENEWAL
NAME OF ADULT-ONLY RETAIL TOBACCO SALES ESTABLISHMENT: , he 2(a' icz na'b
ADDRESS OF TOBACCO ESTABLISHMENT:. N5 C1.�''b' -&I'e-U, 4y l, M; 60101
MAILING ADDRESS(IF DIFFERENT FROM ABOVE): /
E-MAIL ADDRESS: ��0 ke 93 Q Outlook,C OM 4 BUSINESS PHONE:
TELEPHONE NUMBER OF TOBACCO ESTABLISHMENT: O � - o(,bts
OWNER'S NAME: A►1 c
OWNER'S ADDRESS: q ts1'ethgav0A SCA,�'���1 '� r✓�� !!?��3
CORPORATE NAME: LSAN J (9tAQed l�L.,C
CORPORATE ADDRESS:t 11P.tif1'tSiaZ 1-d . /alb f 0 �ORPORATE FID# �
ANNUAL: '� SEASONAL: DATES OF OPERATION. • / TO
DAYS CLOSED EXCLUDING HOLIDAYS(EX.MONDAYS) <V oc
DO YOU CURRENTLY POSSESS A STATE LICENSE TO SELL CIGARETTES? Yes No
DO YOU CURRENTLY POSSESS A STATE LICENSE TO SELL CIGARS/SMOKING TOBACCO?Yes'' No
4
TOWN OF BARNSTABLE CODE/MA GENERAL LAW INTERNET LINKS:
TOWN OF BARNSTABLE TOBACCO CODE LINK FOR CHAPTER 371-9:
httl2s://www.ecode360.com/33996392
MA GENERAL LAW CHAPTER 270/SECTION 6:
https://malepislature.eov/Laws/GeneralLaws/PartIVff itlel/Chanter270/Section6
PLEASE ATTACH A PROPOSED FLOOR PLAN OF THE EST.and a LIST OF PRODUCTS PROPOSED TO BE SOLD
A HEARING IS REQUIRED BEFORE THE BOARD OF HEALTH. THE BOARD MEETS ONCE PER MONTH.
APPLICANT IS REQUIRED TO CALL HEALTH DIV.FOR INSPECTION PRIOR TO PERMIT ISSUANCE
PLEASE CALL 508-862-4644
SIGNATURE:_ 01<z x���
PRINTED NAME: �_ekgd 1. o r
Q:\Application Forms\TOBACCO App 2020 ADULT Only Retail Tobacco Sales draft l.docx }'��I u ,ei S
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DATE:
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ESTABLISHMENT'S NAME
TOBACCO SALES
Employee Signature Form
This form is for official use to indicate that the employee(s) of this establishment received and understood Chapter
371 of the Town of Barnstable Code and Chapter 270 Section 6 of the Massachusetts General Laws which describes
the penalties for selling and/or giving tobacco products to any person under the age of twenty-one (21). Below is
Section 371-9. of the Town of Barnstable Board of Health Regulation:
Sales to Minors—§371-9. Sale and Distribution of Tobacco Products.
1. No person shall sell or provide a tobacco product, as defined herein,to a person under
the minimum legal sales age. The minimum legal sales age in the Town of Barnstable
is 21 years of age.
2. Identification: Each person selling or distributing tobacco products, as defined herein,
shall verify the age of the purchaser by means of a valid government-issued photographic
identification containing the bearer's date of birth that the purchaser is 21 years old or
older. Verification is required for any person under the age of 27.
The employee(s)below received and understood Section 371-9 of the Town of Barnstable Board of
Health Prohibition of Smoking Regulation and Chapter 270 Section 6 of the Massachusetts General Laws:
bef
Signature Printed Name Date
111dhuyf4lel-d # Il_,�y AA
Signature Printed Name fDate
Signature Printed Name Date
Signature Printed Narfie Date
Signature Printed Name Date
Signature Printed Name Date
Signature Printed Name Date
Q:\Application Forms\TOBACCO App 2020 ADULT Only Retail Tobacco Sales draft l.docx
cHasF MASSACHUSETTS DEPARTMENT OF REVENUE Form CT-3T
Retailer License for Sale of Cigars and Smoking Tobacco
FM oti� This license must be posted and visible at all times.The sale of tobacco
products to anyone under 18 years of age is prohibited.
SHR TOBACCO LLC Account ID: CRL-19214909-006
145 BARNSTABLE RD License Number: 1146578944
HYANNIS MA 02601-2901
This certifies that the taxpayer named above is licensed under Chapter 64C of the Massachusetts General Laws to
sell at retail at the address shown above. This license is non-transferable and may be suspended or revoked for
failure to comply with state laws and regulations.
Effective Date:October 1,2020 Expiration Date:September 30,2022
Zz
CJ IU MASSACHUS ET DEPA
RTMENT OF REVENUE
ti Retailer License for Sale of Electronic Nicotine Delivery Systems
9
O This license must be posted and visible at all times. The sale of
tobacco products to anyone under 21 years of age is prohibited.
SHR TOBACCO LLC Account ID: EDL-19214909-012
THE SMOKE HUB „License Number: 175835136
145 BARNSTABLE RD Age-Restricted Store
$ ..
HYANNIS MA 02601-2901
This certifies that the taxpayer named above is licensed under Chapter 64C of the Massachusetts
General Laws to sell electronic nicotine delivery systems at the address shown above. This license is
non-transferable and may be suspended or revoked for failure to comply with state laws and regulations.
Effective Date:May 8,2020 Expiration Date: September 30,2022 J
M.Aw.SSAr=HUSF f I'S DEP,tRTNIENT OF REVENUE Form C`I`-I
Rctaitcr License for Sale of Cigarettes
sFt�r l•�4sti This license must be posted and visible at all times.The.sale of tobacco
\I
products to anyone under is years of age is prohibited.
SHR TOBACCO LLC: Acconut ID:C'61-4.921490940
145 DARNSTABLF RD License Number:442353€04
HYANNIS MA 02601-2901
This certifies that the taxpayer named above is licensed under Chapter f:•4C'ofihc ma sachusetts ocncral Laws to
sell at retail at the address shown above.This license is non-transferable and may lac susp nded or ravAcd for
failure to comply%vah state laws and regulations.
Effective Bate. 0110bcr 1._10-10 Expiration Date: September 30.2022 v
THE . FOLLOWING
IS/ARE THE BEST
IMAGES FROM POOR
QUALITY ORIGINAL (S)
M /- IL
DATA
i
ocy�
Commonwealth of Massachusetts Letter ID:L1109220224 _' +Department of Revenue Notice Date:June 20,2019 £Christopher C.Harding,Commissioner Account ID:CGL-19214909-003
mass.gov/dor
RETAILER LICENSE FOR SALE OF CIGARETTES i �i 'lC2LC(p
®_ R CHAUDHRY
o= SHR TOBACCO LLC
145 BARNSTABLE RD
HYANNIS MA 02601-2901
Attached below is your Retailer License for Sale of Cigarettes(Form CT-3T). Cut along the dotted line
and display at your business location. At any time,you can log into your MassTaxConnect account at
mass.gov/masstaxconnect to view and re-print a copy of this license.
If you have any questions about your license, call us at(617) 887-6367 or toll-free in Massachusetts at
(800)392-6089,Monday through Friday, 8:30 a.m.to 4:30 p.m.
DETACH HERE
..-----------------------------------------------------------------------------------------------------------------------------------------------
,cr�t�s�'A MASSACHUSETTS DEPARTMENT OF REVENUE Form CT-3T
Retailer License for Sale of Cigarettes
ov This license must be posted and visible at all times.The sale of tobacco
products to anyone under 18 years of age is prohibited.
SHR TOBACCO LLC Account ID: CGL-19214909-003
145 BARNSTABLE RD License Number: 1048668160
HYANrIIS MA 02601-2901
This certifies that the taxpayer named above is licensed under Chapter 64C of the Massachusetts General Laws to
sell at retail at the address shown above. This license is non-transferable and may be suspended or revoked for
failure to comply with state laws and regulations.
Effective Date: June 20, 2019 Expiration Date: September 30, 2020
ti
Commonwealth of Massachusetts Letter ID:L1731783552
-S Department of Revenue Notice Date:June 19,2019
JP Christopher C.Harding,Commissioner Account
ID:
\CRL-1y/9'214910I99-,006
SyrJ SrXJD
cfti`v mass.gov/dor
RETAILER LICENSE FOR SALE OF CIGARS AND SMOKING TOBACCO
RCHAUDHRY
o— SHR TOBACCO LLC
o—
A—_ 145 BARNSTABLE RD
HYANNIS MA 02601-2901
Attached below is your Retailer License for Sale of Cigars and Smoking Tobacco(Form CT-3T). Cut
along the dotted line and display at your business location. At any time, you can log into your
MassTaxConnect account at mass.gov/masstaxconnect to view and re-print a copy of this license.
If you have any questions about your license, call us at(617) 887-6367 or toll-free in Massachusetts at
(800)392-6089,Monday through Friday, 8:30 a.m. to 4:30 p.m.
DETACH HERE
-----------------------------------------------------------------------------------------------------------------------------------------------
S�Cttrs� MASSACHUSETTS DEPARTMENT OF REVENUE Form CT-3T
At Retailer License for Sale of Cigars and Smoking Tobacco
7
F;vro�4 This license must be posted and visible at all times.The sale of tobacco
products to anyone under 18 years of age is prohibited.
SHR TOBACCO LLC Account ID: CRL-19214909-006
145 BARNSTABLE RD License Number: 1422469120
HYANNIS MA 02601-2901
This certifies that the taxpayer named above is licensed under Chapter 64C of the Massachusetts General Laws to
sell at retail at the address shown above. This license is non-transferable and may be suspended or revoked for
failure to comply with state laws and regulations.
Effective Date:June 19, 2019 Expiration Date:September 30, 2020
s� Commonwealth of Massachusetts Letter ID:L0389606272
Fi�tea...
Department of Revenue Notice Date:June 19,2019 J
Christopher C.Harding,Commissioner Account ID:SLS-19214909-007
mass.gov/dor
SALES AND USE TAX REGISTRATION CERTIFICATE
rl��llr�i�lnliln11�111�1��ilhlilmll�i��i�i11111�i���uill�
R CHAUDHRY
-_ SHR TOBACCO LLC
145 BARNSTABLE RD
HYANNIS MA 02601-2901
Attached below is your Sales and Use Tax Registration Certificate (Form ST-1). Cut along the dotted line
and display at your place of business. You must report any change of name or address to us so that a
revised ST-1 can be issued.
At any time, you can log into your MassTaxConnect account at mass.gov/masstaxconnect to view and
re-print a copy of this certificate.
DETACH HERE
-----------------------------------------------------------------------------------------------------------------------------------------------
�s�``"'�Sf,� MASSACHUSETTS DEPARTMENT OF REVENUE Form ST-1
! f
Sales and Use Tax Registration Certificate
9 fk
�r1o �4� This registration must be posted and visible at all
times.
SHR TOBACCO LLC Account ID: SLS-19214909-007
145 BARNSTABLE RD Certificate Number: 885598208
HYANNIS MA 02601-2901
This certifies that the taxpayer named above is registered under Chapters 62C, 64H and 641 of the
Massachusetts General Laws to sell tangible personal property at retail or for resale at the address shown
above. This registration is non-transferable and may be suspended or revoked for failure to comply with
state laws and regulations.
Effective Date:June 19, 2019
Town of Barnstable BOARD OF HEALTH
John T.Norman
Board of Health Donald A.Guadagnoli,M.D.
A®M Paul J.Canniff,D.M.D.
MAM .� 200 Main Street, Hyannis, MA 02601 F.P. Thomas Lee Alternate
Phone: (508) 862-4644 Fax: (508)790-6304
www.townofbarnstable.us
Permit to Sell Tobacco
In accordance with regulations promulgated under authority granted by Sections 5,31 and 127A of the General
Laws of the Commonwealth of Massachusetts and Chapter 371 of the Town of Barnstable Code, a permit is
hereby granted to:
Permit No: 1110 Issue Date: 1/1/2020
DBA: SMOKE HUB, THE
OWNER: SHR TOBACCO LLC.
Location of Establishment: 145 BARNSTABLE ROAD HYANNIS, MA 02601
Type of Business Permit: Adult Only
Annual Seasonal
FEES YEAR: 2020
TOBACCO SALES: $85.00
Permit Expires: 12/31/2020
Thomas A. McKean, RS, CHO, Health Agent
Restrictions:
PLEASE POST CONSPICUOUSLY
1
• ,
Town of Barnstable ForOfficeUsInitials:
Inspectional Services Date Paid
�_
+�MENSr" L ,Check#
�� Public Health Division
Thomas McKean, Director
200 Main Street, Hyannis, MA 02601
Office: 508-862-4644 Fax: 508-790-6304
ADULT ONLY RETAIL TOBACCO SALES PERMIT APPLICATION
DATE -NO NEW BUSINESSES) CHANGE IN OWNERSHIP RENEWAL
ADULT ONLY RETAIL TOBACCO SALES ESTABLISHMENT NAME:
5 h n
ADDRESS OF TOBACCO ESTABLISHMENT: I06
MAILING ADDRESS IF DIFFERENT FROM ABOVE):
E-MAIL ADDRESS: SrVo��htl690(/Ala axe14 '94hRtdhq��r�u/�G//•�—f �
TELEPHONE NUMBER OF TOBACCO ESTABLISHMENT:
, / j
OWNER'S NAME: 4te l Agtl ,�r OWNER'S PH# 5(��Z aZ-3 W
OWNER'S ADDRESS: Cl �YeC,,Atjj Pt. S014WILA 0 /K4 , OZ �G_?
CORPORATE ADDRESS: 141,5 g6407f a b(•e �U u� CORPORATE
y/yaw,q i7 .4111 9,4 e__/
ANNUAL:_ SEASONAL: DATES OF OPERATION: / / TO
DAYS CLOSED EXCLUDING HOLIDAYS(EX.MONDAYS)
TOWN OF BARNSTABLE CODE/MA GENERAL LAW INTERNET LINKS:
TOWN OF BARNSTABLE TOBACCO CODE LINK FOR CHAPTER 371-9:
https://NNww.ecode360.com/33996392
i
MA GENERAL LAW CHAPTER 270/SECTION 6:
https://malegislature.gov/Laws/GeneralLaws/PartIV/TitleI/Chapter270/Section6
***NEW BUSINESSES AND NEW OWNERS ONLY***'
A HEARING BEFORE THE BOARD OF HEALTH IS REQUIRED. THE BOARD MEETS ONCE PER MONTH.
ALL APPLICANTS MUST SUBMIT ITEMS 1-5. CHANGE OF OWNERSHIP MUST SUBMIT ITEMS 1-7. j
1) MA State License to Sell Cigarettes 5) Payment of Fee(s)—see page 4
2) MA State License to Sell Cigars and Smoking Tobacco 6) Proposed Floor Plan }
3) MA State License for Sale of Electronic Nicotine Delivery Systems 7) List of Products Proposed to be Sold 1
4) IRS Federal Tax ID#Document
ALL APPLICANTS ARE REQUIRED TO: CALL HEALTH DIVISION AT 508-862-4644 FOR AN INSPECTION
PRIOR TO PERMIT BEING ISSUED.
SIGNATURE: PRINTED NAME:
DATE.
i
C:\Users\smoke\Downloads\TOBACCO ADULT ONLY APP Dtd 5-26-2020.doc
�hQ �rnal�e N6
ESTABLISHMENT NAME
TOBACCO SALES
Employee Signature Form
This form is for official use to indicate that the employee(s)of this establishment received and understood Chapter 371 of
the Town of Barnstable Code and Chapter 270 Section 6 of the Massachusetts General Laws which describes the
penalties for selling and/or giving tobacco products to any person under the age of twenty-one (21). Below is Section
371-9. of the Town of Barnstable Board of Health Regulation:
Sales to Minors—�371-9. Sale and Distribution of Tobacco Products.
1. No person shall sell or provide a tobacco product, as defined herein,to a person under
The minimum legal sales age. The minimum legal sales age in the Town of Barnstable
is 21 years of age. i
i
2. Identification: Each person selling or distributing tobacco products, as defined herein,
shall verify the age of the purchaser by means of a valid government-issued photographic
identification containing the bearer's date of birth that the purchaser is 21 years old or
older. Verification is required for any person under the age of 27.
The employee(s)below received and understood Section 371-9 of the Town of Barnstable Board of
Health Prohibition of Smoking Regulation and Chapter 270 Section 6 of the Massachusetts General Laws:
Cl' 5 z p —ZuZt
U e2 GfGtdfl.� �
Signature Printed Name Date
24ign�ature Printed Name Date
Signature Printed Name Date
i
Signature Printed Name Date
i
Signature Printed Name Date
,
i
Signature Printed Name Date j
Signature Printed Name Date
C:\Users\smoke\Downloads\TOBACCO ADULT ONLY APP Dtd 5-26-2020.doc
i
oa
Commonwealth of Massachusetts Letter ID:L0244632128 21
's, Department of Revenue Notice Date:May 8,2020
Geoffrey E.Snyder,Commissioner Account ID:EDL-19214909-012
rro� mass.gov/dor
LICENSE FOR SALE OF ELECTRONIC NICOTINE DELIVERY SYSTEMS
�����I�I��II�IIII�IIIIII�I�II��IIII�III��I���1111�11��1�11���1�11
R CHAUDHRY
SHR TOBACCO LLC
THE SMOKE HUB
145 BARNSTABLE RD
HYANNIS MA 02601-2901
Attached below is your Retailer License for Sale of Electronic Nicotine Delivery Systems. Cut
along the dotted line and display at your business location. At any time, you can log into your
MassTaxConnect account at mass.gov/masstaxconnect to view and re-print a copy of this
license.
If you have any questions about your license, call us at(617) 887-6367 or toll-free in Massachusetts at
(800) 392-6089, Monday through Friday, 8:30 a.m. to 4:30 p.m.
DETACH HERE
•-----------------------------------------------------------------------------------------------------------------------------------------------
SPCus' MASSACHUSETTS DEPARTMENT OF REVENUE
N Retailer License for Sale of Electronic Nicotine Delivery Systems
o � ' This license must be posted and visible at all times. The sale of
tobacco products to anyone under 21 years of age is prohibited.
SHR TOBACCO LLC Account ID: EDL-19214909-012
THE SMOKE HUB License Number: 175835136
145 BARNSTABLE RD Age-Restricted Store
HYANNIS MA 02601-2901
This certifies that the taxpayer named above is licensed under Chapter 64C of the Massachusetts
General Laws to sell electronic nicotine delivery systems at the address shown above. This license is
non-transferable and may be suspended or revoked for failure to comply with state laws and regulations.
Effective Date:May 8,2020 Expiration Date: September 30, 2022
---------------------------------"---------------------------------------------------------------------------------------------------------------
Ac"USA� MASSACHUSETTS DEPARTMENT OF REVENUE
Form CT-3T.
Retailer License for Sale of Cigars and Smoking Tobacco
ti,.r.Ole This license must be posted and visible at all times. The sale of tobacco
products to anyone under 18 years of age is prohibited.
SHR TOBACCO LLC Account ID: CRL-19214909-006
145 BARNSTABLE RD License Number: 1422469120
HYANNIS MA 02601-2901
This certifies that the taxpayer named above is licensed under Chapter 64C of the Massachusetts General Laws to
sell at.retail at the address shown above. This license is non-transferable and may be suspended or revoked for
failure to comply with state laws and regulations.
Effective Date:June 19, 2019 Expiration Date:September 30, 2020
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'� MASSACHUSETTS DEPARTMENT OF REVENUE Form CT-3T
Retailer License for Sale of Cigarettes
b
M 01� This license must be posted and visible at all times. The sale of tobacco
products to anyone under 18 years of age is prohibited.
SHR TOBACCO LLC Account ID: CGL-19214909-003
145 BARNSTABLE RD License Number: 1048668160
HYANNIS MA 02601-2901
This certifies that the taxpayer named above is licensed under Chapter 64C of the Massachusetts General Laws to
sell at retail at the address shown above. This license is non-transferable and may be suspended or revoked for
failure to comply with state laws and regulations.
Effective Date: June 20, 2019 Expiration Date: September 30, 2020
i
X
fart IR`'DEPARTMENT OF THE TREASURY
INTERNAL REVENUE SERVICE
CINCINNATI OH 45999-0023
Date of this notice: 06-20-2019
Employer Identification Number:
000609.158960.13742.3831 1 MR 0.428 914 84-2111470
Form: SS-4
Number of this notice: CP 575 A
SHR TOBACCO .LLC
M. RAHEEL A CHAUDHRY �MBR For assistance you may call us at
4 .GREENFIE.LD DR'_ 1-800-829-4933
SANDWICH MA 62563
000609 IF YOU WRITE, ATTACH THE
STUB OF THIS NOTICE,.
WE ASSIGNED YOU' AN EMPLOYER IDENTIFICATION NUMBER`
Thank you for applying for °an EEmployer Identification Number (EIN)'. We 'assigned.
you EIN 84-211147.0. This EIN .will identify you, your business accounts, tax returns,
and documents, even if you have, no employees. Please keep this notice in your f
Permanent records.
When filing tax documents, payments, ;and related correspondence, it is very
important that you use. your ESN and complete name and address exactly as ;shown above.
Any variation may cause a delay in processing, result in incorrect information in your
account, or even cause: you to be assigned more than one EIN. 'If the information
is not correct as shown above:, please make the correction using thea"ttached. tear-off
stub and return it to us.
:Based on 'the information received sfrom you or your representative, you must file
the following' form(s) by the date(s) shown.
Form 941 10/31/2019
Form 1065 03/15/2020
Form 940 01/31/2020
If you have questions about the fo"rm(s) or the due dates(s) "shown, you can call
us at the phone number or :write to us ,A the address shown rat .the= top of this notice.
.h If yg4,n ed 1w in determining your annual .eJ4c' u"nting', period (tax year), see
Publicat166"538, Accounting; 'periods and' Methads.
We assigned you a tax classification based on information obtained from you or
Your representative. It is ;not 'a legal determination ,'6 f, ,your talc: classification
and is .not b-iidng on the= iRS'. If you: want ;a legal determination of your tax
classification, you may request >a private letter ruling from the IRS under the:
guidelines in Revenue Procedure. 2.004-1,,,. 2004-1 I.R.B. 1 (or superseding Revenue
Note:z. Certain tax cloftifit6iion elections can
be requested by ,filing' Form `8832, `-Entity Classification Election. See": Form 8832
And its instructions for additional information.
s
(IRS USE ONLY) 575A 06-20-2019 SHRT B 0509909623 SS-4
If you ar.`e required to deposit for ,employment taxes ('Forms 941, 943:, 94.0„ :944,;
945, CT-1, or 1042), .excise taxes (Form 720), or income taxes (Form 1120), you will
receive a Welcome Package shortly which includes, instructions. for making, your
deposits electronically through't'he Electronic•Federal Tax Payment System (EFTPS). A
Personal Identification Number (PIN) for EFTPS will also be sent to you under separate
cover. Please activate the °PIN once, you receive it, even if you have requested the
services of .a tax professional or representative. For more: information about .EFTPS,
refer to Publication 966, Electronic Choices to Pay All Your Federal Taxes. If you
need to make a deposit iRUdled' ttly, you gill need to make~ arrangements with your
Financial Institution to complete a wire transfer.
The IRS is: committed to helping all taxpayers comply with their text filing
obligations. If you need help completing your returns or meeting ,your tax obligations,
Authorized e-file"Providers, such as Reportitng. Agen:ts (payro11 service Providers)'
are e 1.vadable to assist you. Visit the °IRS Web site :at www:.irs.:gov for a list of
companies that offer IRS e-file for business products and services. The list provides
addresses, te"lephon,a numbers, and links to their Web sites.
IMPORTANT ;REM,1NMRSs
* Xeep a copy of this notice in your permanent records. This notice is issued
:only one., time. and: IRS will not be able to generate a duplicate copy for you.
You may give; a copy of "this document to anyone "king for proof of Your EIN.
e Use this EI=N and your name exactly, as, they appear at the top of this notice
on all your fede.ral"'tax forms.
Refer to this t on your .tax-related correspondence and documents.
* Provide future officers of your organization with a :copy of this notice.
Your 'name' 'control associated with this EIN is' S;HRT. You will need to provide
this informationi along with your EIN, if you file :your returns electronically.
If you 'have questions about your EIN, you can contact us .at the phone number or
address listed at the :top .of this notice If you write, please tear off the stub at
the bottom of this notice and include it with your letter. Thank you for your
cooperation.
tt�
t
I
(IRS USE ONLY) 575A 06-20-2019 SHRT b 0509409623 SS-4
00609
Keep this part for your records. CP 575 A (Rev. 1=1013)
------- ----------------------------------------------------------------- --
_-----'{ --------- _
Return this part =with any correspondence - - 1
so we may identify your ,account. Please CP 575 A
correct any errors in your name or address,,:
0509909623
Your Telephone Number. Best Time, to Call DATE OF THIS NOTICE: 66-20-2014
t' EMPLOYER IDENTIFICATION NUMBER: 84-2111470
_.. FORN: SS-4 NOBOD
m,
SHR TOBACCO LLC
RAHEEL A CHAUDORY MBR
INTERNAL REVENUE SERVICE 4 GREENFIELD DR
CINCINNATI OH 459,99-0023 SANDWICH MA 02563 I
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Town of Barnstable BOARD OF HEALTH
Paul J Canniff,D.M.D.
�.
Board of Health Donald A.Gaudagnoli,M.D.
j B,,,RNST,ULL`. John T.Norman
MASS 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, 3056, 146, 189 and 189A; Chapter 111, Sections 5 and 127A, a permit is hereby granted to:
Permit No: 1110 Issue Date: 07/24/2019
DBA: THE SMOKE HUB
OWNER: SHR TOBACCO LLC
Location of Establishment: 145 BARNSTABLE ROAD HYANNIS, MA 02601
Type of Business Permit: TOBACCO -ADULT ONLY
Annual: YES Seasonal:
IndoorSeating: 0 OutdoorSeating: 0 Total Seating: 0
FEES (�
FOOD SERVICE ESTABLISHMENT: YEAR. 2019
RETAIL FOOD:
COTTAGE FOOD OPERATION: Permit Expires: 12/31/2019
B&B-FULL BREAKFAST:
CONTINENTAL BREAKFAST:
MOBILE-FOOD:
MOBILE-ICE CREAM: C
FROZEN DESSERT: Thomas A. McKean, RS, CHO, Health Agent
TOBACCO SALES: $85.00
FOR ESTABLISHMENTS WITH SEATING:
PERMIT IS NOT VALID UNLESS ISSUED IN CONJUNCTION WITH A COMMON VICTUALER LICENSE
Restrictions:
i
Town of Barnstable
Public Health Division
.�- .� �
e 200 Main Street, Hyannis MA 02601
'ED6NIA'�A` f'�
Office: 508-862-4644
FAX: 508-790-6304
September 10,2019
NOTICE TO ALL OWNERS OF ADULT-ONLY RETAIL TOBACCO STORES
Entrance of Persons
All owners of adult-only retail tobacco stores are reminded to ensure full compliance with Section 371-1
of the Town of Barnstable Code,which became effective as of July 28, 2019. Specifically,this Section of
the Code requires the permit holder to prohibit any and all persons who are under the age of 21 from
entering the store at any time.
An adult only retail tobacco store is defined as follows: An establishment which is not required to
possess a retail food permit whose primary purpose is to sell or offer for sale to consumers, but not for
resale, tobacco products and paraphernalia in which the sale of other products is merely incidental, and
in which the entry of persons under the age of 21 is prohibited at all times, and maintains a valid permit
for the retail sale of tobacco products as required to be issued by the Barnstable Board of Health.
To comply with this Section of the Code,you will need to:
1. Station an employee at the front entrance door to check dates of birth(i.e. driver's licenses)of
any and all persons before entrance into the store or keep the front entrance door locked until
such time an employee is available to the check dates of birth before each customer has the ability
to enter the front entrance door into the store and it is suggested you;
2. Post a sign at the front entrance door which reads as follows: `Adult-Only Retail Tobacco Store
Persons under the age of 21 years of age prohibited(see suggested sign provided on back of this
page)
If Y q you should have an questions,please contact Thomas McKean Director of Public Health at 508
Y
862-4644.
' r
Persons under the age of 21 are not
permitted to enter this establishment
TOWN OF BARNSTABLE
&kRNAM . . BOARD OF HEALTH
Crocker, Sharon J v
From: McKean, Thomas
Sent: Wednesday, September 11, 2019 9:50 AM
To: Poyant,Lynne; elizabeth@hyannismainstreet.com; BOb Collett
(bcollette@barnstablecounty.org); Spillane, Geoff(gspillane@capecodonline.com);Todd
Deluca (todd@hyannis.com); 'advertising@barnstablepatriot.com'
Cc: Crocker, Sharon
Subject: ANNOUNCEMENT - Workshop Regarding Adult Only Retail Tobacco Stores/ Discussion
Topics: Design Standards, Other Products Which May or May Not Be Sold, Discussion of
Whether or Not to Establish a Permit Cap
ANNOUNCEMENT
The Board of Health will be holding a public workshop on Wednesday October 16,2019 at 4:00 p.m. at
the Town Hall, in the second floor Hearing Room, 367 Main Street Hyannis, Massachusetts. Bob Collett,
Director of the Cape Cod Regional Tobacco Control Program will be present at the workshop. This
workshop is open to the public.
The discussion topics will include suggestions regarding design/construction requirements of adult-only
tobacco retail stores wherever flavored tobacco products are sold, including nicotine products used in
electronic devices and vaping devices. Also to be discussed will be the types of products which may or
may not be sold at adult-only tobacco retail stores. Also open for discussion will be whether or not to
establish an adult-only tobacco retail store permit cap within the Town of Barnstable.
The Board of Health encourages public participation.
----------------------------------------------------------------------------------------------------------------------------------------------------------------
-------------------
NOTE: Also, approx. one month later, a public meeting of the Board of Health will be held on Tuesday
November 19, 2019 at 3:00 p.m.in the Hearing Room at Town Hall, 367 Main Street,Hyannis, Ma. The public is
invited to this meeting also.
1
�a 1
Town of Barnstable BOARD OF HEALTH
0 Paul J Canniff,D.M.D.
Board of Health Donald A.Gaudagnoli, M.D.
� [tn1RNS4'AlltF = John T. Norman
N.\kti. A
r F.P. Thomas Lee Alternate
200 Main Street, Hyannis, MA 02601
f 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, 3056, 146, 189 and 189A; Chapter 111, Sections 5 and 127A, a permit is hereby granted to:
Permit No: 1110 Issue Date: 07/03/2019
DBA: THE SMOKE HUB
OWNER: SHR TOBACCO LLC
Location of Establishment: 145 BARNSTABLE ROAD HYANNIS, MA 02601
Type of Business Permit: TOBACCO
Annual: YES Seasonal:
IncloorSeating: 0 OutcloorSeating: 0 Total Seating: 0
FEES
f
FOOD SERVICE ESTABLISHMENT: } YEAR: 2019
RETAIL FOOD: I
COTTAGE FOOD OPERATION:
Permit Expires: 12/31/2019
B&B-FULL BREAKFAST:
CONTINENTAL BREAKFAST: I
MOBILE- FOOD:
MOBILE-ICE CREAM:
FROZEN DESSERT: Thomas A. McKean, IRS, CHO, Health Agent
TOBACCO SALES: $85.00
FOR ESTABLISHMENTS WITH SEATING:
PERMIT IS NOT VALID UNLESS ISSUED IN CONJUNCTION WITH A COMMON VICTUALER LICENSE
Restrictions:
1
M/P = 3X -a-1iA- poi
Town of Barnstable For offi, Init�
' Inspectional Services Date Paid - -1 $
aARMANE, ; Check# 00 �Q
• 5 a �� Public Health Division Lo - r
"AAA 200 Main Street, Hyannis MA 02601
Office: 508-790-4644 Thomas A.McKean,RS,CHO
FAX: 508-790-6304 Director of Public Health
Fee: $85.00
MAIL TO:TOWN OF BARNSTABLE
PUBLIC HEALTH.DIVISION
200 Main Street
HYANNIS,MA 02601
FAX 508 790-6304
PLEASE INCLUDE THE REQUIRED FEE OF$85.00
APPLICATION FOR A TOBACCO SALES PERMIT
T�4 �6
ESTABLISHMENT NAME (D/B/A)
y5- "/, 0,6 � I eA 0z513
ADDRESS OF BUSINESS
MAILING ADDRESS (IF DIFFERENT FROM ABOVE)
PCIA a'9Z w, -0 ZFli-adry,4
MAIL A PHONE# FEDERA ID#
SOg-aV-3(ot to(CW)
Do you curr ntly possess a state license to sell tobacco products?
Yes No
Each employee who sells tobacco products must receive and understand Chapter 371 of
the Town of Barnstable Code (copy provided herein) and the Massachusetts General
Law Chapter 270, Section 6.00 (a copy is provided on the next page). Each employee
who sells tobacco products must sign the Employee Signature Form (provided
herein).
Signature Date ��lZ�112
C:\Usersldeco11ik1AppDatalLocal',MicrosoftCWindows\lNetCachelContent,Out1ook1YZOF4J381TOBACCO APP201I dob.docx
ESTABLI HMENT'S NAME
TOBACCO SALES
Employee Signature Form
This form is for official use to indicate that the employee(s) of this establishment received and
understood Chapter 371 of the Town of Barnstable Code and Chapter 270 Section 6 of the
Massachusetts General Laws which describes the penalties for selling and/or giving tobacco
products to any person under the age of twenty-one (21). Below is Section 371-9. of the Town of
Barnstable Board of Health Regulation:
Sales to Minors—&371-9. Sale and Distribution of Tobacco Products.
1. No person shall sell or provide a tobacco product,as defined herein,to a person under
The minimum legal sales age. The minimum legal sales age in the Town of Barnstable
is 21 years of age.
2. Identification: Each person selling or distributing tobacco products,as defined herein,
shall verify the age of the purchaser by means of a valid government-issued photographic
identification containing the bearer's date of birth that the purchaser is 21 years old or
older. Verification is required for any person under the age of 27.
The following employee(s) received and understood Section 371-9 of the Town of Barnstable
Board of Health Prohibition of Smoking Regulation and Chapter 270 Section 6 of the
Massachusetts General
04[41kl
Signature Printed Name Date
& P1 061471
Signature Printed Name Date
Signature Printed Name Date
Signature Printed Name Date
Signature Printed Name Date
Signature Printed Name Date
Signature Printed Name Date
C:\Users\decollik\AppData\Local\Microsoft\Windows\INe[Cache\Content.0utlook\YZOF4J38\TOBACCO APP2019 doh.docx
`"ET° Town of Barnstable
sAxxsxASLE,
Board of Health
9 'Al
P.O.Box 534,Hyannis MA 02601
PIED MA'1�
vuicc. wo-oo�-4044 Paul J.Canniff,DMD
FAX: 508-790-6304 John Norman
-�—�- Donald A.Guadagnoli,M.D.
- TOBACCO REGULATION
AMENDMENTS May 29, 2019
LEGAL NOTICE
The Board of Health of the Town of Barnstable Massachusetts in accordance with and under the authority
granted by Section 31 of Chapter 111 of the General Laws of the Commonwealth of Massachusetts,
hereby announces that during the public hearing held on May 28, 2019, the Board voted unanimously to
adopt amendments to Chapter 371 of the Town of Barnstable Code, Smoking.
The following Paragraph "G is hereby added to Section 371-11 of the Town of Barnstable Code:
G. Sale of Flavored Tobacco Products Prohibited:
No person shall sell or distribute or cause to be sold or distributed any flavored tobacco product, except in
smoking bars and adult-only retail tobacco stores.
The following two definitions are hereby added to Section 371-1 of the Town of Barnstable Code:
Characterizing Flavor: A distinguishable taste or aroma, other than the taste or aroma of tobacco,
imparted or detectable either prior to or during consumption of a tobacco product or component thereof,
including, but not limited to, tastes or aromas relating to fruit, chocolate, vanilla, honey, candy cocoa,
dessert, alcoholic beverage, menthol, mint, wintergreen, herb or spice; provided however that no tobacco
product shall be determined to have a characterizing flavor solely because of the provision ingredient
information or the use of additives or flavorings that do not contribute to the distinguishable taste or
aroma of the product
Flavored Tobacco Product: Any tobacco product or component part thereof that contains a constituent
that has or produces a characterizing flavor. A public statement, claim or indicia made or disseminated by
the manufacturer of a tobacco product, or by any person authorized or permitted by the manufacturer to
make or disseminate public statements concerning such tobacco product, that such tobacco product has
or produces a characterizing flavor shall constitute presumptive evidence that the tobacco product is a
Flavored Tobacco Product.
These amendments to Chapter 371 of the Town of Barnstable Code go into,effect on .J, , 2019.
Copies of the amendments are available at the Public Health Division Office at 200 Main°Street Hyannis,
Massachusetts and will be posted online at www.townofbarnstable.us
Paul J. Canniff, D.M.D., Chairman
John Norman
Donald A. Guadagnoli, M.D.
TOWN OF BARNSTABLE
BOARD OF HEALTH