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Home My WebLink About21 PLUS SMOKE SHOP - FOOD - CLOSED s 21 Plus Smoke Sh pFfcc, pq Bearse's Way/#3my t Town of Barnstable BOARD OF HEALTH John T.Norman Board of Health Donald A.Guadagnoli,M.D. BARN ISTABLC + 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: 55 Issue Date: 1/1/2021 DBA: 21 PLUS SMOKE SHOP OWNER: NEW HYANNIS CORP Location of Establishment: 489 BEARSE'S WAY-UNIT#3 HYANNIS, MA 02601 Type of Business Permit: Adult Only Annual Seasona FEES YEAR: 2021 TOBACCO SALES: $85.00 Permit Expires: 12/31/2021 ` 0"- Thomas A. McKean, RS, CHO, Health Agent Restrictions: PLEASE POST CONSPICUOUSLY "s ,►� Town of Barnstable For Office Use Onlv: Initials: oF ,� 1n Inspectional Services Date Paid �/�/•/ lARNBTABLE, Check# V 1 MAQQ 039. $ Public Health Division s63q �q, ArfO 1A°�s 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 // I,e� 2-Z(MORITORIUM-NONEWBUSINESSES) CHANGE IN OWNERSHIP RENEWAL 1/ ADULT ONLY RETAIL TOBACCO SALES ESTABLISHMENT NAME:/ p LL �'1 D/.Crf? S dzOP ADDRESS OF TOBACCO ESTABLISHMENT: �4.4-0- �J'� GG�_Z 7Y407Yt F-3 121 AL D?, 0 MAILING ADDRESS(IF DIFFERENT FROM ABOVE): E-MAIL ADDRESS: �� h l 'G Cs- TELEPHONE NUMBER OF TOBACCO ESTABLISHMENT: OWNER'S NAME:/2,�'Z,/&1 !A2A& � OWNER'S PH#( 1) G ' ' OWNER'S ADDRESS: T eje,-& �Y'1~Y�. I�1�LZ y Yl.L �Xl� 1�•� ��5�� CORPORATE ADDRESS: CORPORATE FID# 2,cll ANNUAL: SEASONAL: DATES OF OPERATION:_/_/_ TO DAYS CLOSED EXCLUDING HOLIDAYS(EX. MONDAYS) TOWN OF BARNSTABLE COMMA GENERAL LAW INTERNET LINKS: TOWN OF BARNSTABLE TOBACCO CODE LINK FOR CHAPTER 371-9: https://www.ecode360.com/33996392 MA GENERAL LAW CHAPTER 270/SECTION 6: https://malegislature.gov/Laws/GeneralLaws/PartIV/Titlel/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. 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 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: �� -f �p � PRINTED NAME: DATE: / j / 26/ ZO' Q:Wpplication Forms\TOBACCO ADULT ONLY APP Dtd 5-26-2020.doc i 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. 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: 2-o Signature Printed Name 11 I b 6 Date 00,5M�V_ 1 " �ua 11 ° I �- 2� Signature Printed Name Date Signature Printed Name Date Signature Printed Name Date Signature Printed Name Date Signature Printed Name Date Signature Printed Name Date Q:Application FormsJOBACCO ADULT ONLY APP Dtd 5-26-2020.doc 4ShCr't rF�1 Commonwealth of Massachusetts Letter ID:L2065380928 Department of Revenue Notice Date:September 9,2020 o 4P q Geoffrey E.Snyder,Commissioner Account ID:CGL-19342565-006 yt" 0" mass.gov/dor RETAILER LICENSE FOR SALE OF CIGARETTES I I I I I I I111111111"IIIII'I'I'I'IIIII"I I I'1 1"IIIII"I I'l l l l l l l l l l o= NEW HYANNIS CORP o 21 PLUS SMOKE SHOP 489 BEARSES WAY o HYANNIS MA 02601-2707 Attached below is your Retailer License for Sale of Cigarettes(Form CT-3). Cut along the dotted line and display at your business location. At any time,you can log into your MassTaxConnect account at mass.gov/masstaxconnect to view and re-print a copy of this license. - — -- -.- _.- If you have any questions about your license, call us at(617) 887-6367 or toll-free in Massachusetts at (800)392-6089, Monday through Friday, 8:30 a.m. to 4:30 p.m. DETACH HERE ------------------------------------------------------------------------------------------------------------------------------------------------ Sss`Ht's" MASSACHUSETTS DEPARTMENT OF REVENUE Form CT-3 1 Retailer License for Sale of Cigarettes b f 4F;ti.ro�� This license must be posted and visible at all times.The sale of tobacco products to anyone under 18 years of age is prohibited. NEW HYANNIS CORP Account ID: CGL-19342565-006 21 PLUS SMOKE SHOP License Number: 167872512 489 BEARSES WAY HYANNIS MA 02601-2707 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 .e- 5��}'1AsF Commonwealth of Massachusetts Letter ID: L0183924288 � Department of Revenue Notice Date:September 4,2020 ° R" 4' Geoffrey E.Snyder,Commissioner Account ID:CRL-19342565-009 q �^ Y i.�U;f�� mass.gov/dor RETAILER LICENSE FOR SALE OF CIGARS AND SMOKING TOBACCO I�I��'II'��illiilllllii ��"�I�IIII�1111�11�'�II'lllllllllll NEW HYANNIS CORP o= 21 PLUS SMOKE SHOP o— N= 489 BEARSES WAY HYANNIS MA 02601-2707 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 rnass.gov/masstaxconnect to view and re=print a-copy-cf-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.,`HUSFT� MASSACHUSETTS DEPARTMENT OF REVENUE Form CT-3T � s 4 Retailer License for Sale of Cigars and Smoking Tobacco I, r& This license must be posted and visible at all times. The sale of tobacco products to anyone under 18 years of age is prohibited. NEW HYANNIS CORP Account ID: CRL-19342565-009 21 PLUS SMOKE SHOP License Number: 1701244928 489 BEARSES WAY HYANNIS MA 02601-2707 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 ^1°t;5i> Commonwealth of Massachnsetts Letter ID:L0592900672 matg, Department of Revenue Notice Date:May 22,2020 n ' Geoffrey E.Snyder,Commissioner Account ID:EDL-19342565-01I mass.gov/dor LICENSE FOR SALE OF ELECTRONIC NICOTINE;DELIVERY SYSTIElYS llaeE�al�ala�lll�lllllrl�l�laaJill q,111111111111111[fill NEW HYANNIS CORP o 21 PLUS SMOKE SHOP 489 BEARSES WAY - = 14YANNIS MA 02601-2707 Attached below is your Retailer License for Sale of Electronic 'Nicotine Deliv(;ry Systems. Cut: . along the dotted line and display at your business location. At any tine, you can log into yotn' MassT'axConnect account at mass.gov/masstaxconiiect to view and re-print a�,.opy of this License. l 1f you have any questions about your license,call us at:(617)887-6367 or toll-free in Massachusetts at (800) 392-60891,Monday through Friday, 8:30 a.m.to 4:30 p.m. DETACH HERE MASSACITUSETTS DFPARTMENT"OF RllWENUE`, if tip Retailer License for Sale of Electronic Nicotine theliver•y Slystenas This license must be posted and visible at all thues. The sale of L.v^r oQ tobacco products to anyone under 21 years of age is pr oMbited� NEW HYANNIS CORP Account:I.P. EJ)L-19342565-011 21 PLUS SMOKE SHOP License Neet>r mein 21534515? 48913EARSES WAY Age-Restricted Store HYANNIS MA 02601-2707 This certifies that the taxpayer named above is licensed under Chapter 64('of the lViassachusetts GenPral,Laws to sell electronic nicotine delivery systems at the address shown above. This licetise in non-transferable and may be suspended or revolted for failure to comply with state laws and regu.latioos. Effective Mateo May 22,2020 lExp ratipan _Pale, September 30. 2022 (IRS USE ONLY) 575A 08-06-2019 NEWH B 9999999999 SS-4 I • Keep this part for your records. CP 575 A (Rev. 7-2007) ---------------------------------------------------------------------------------------------- Return this part with any correspondence so we may identify your account. Please CP 575 A correct any errors in your name or address. 9999999999 Your Telephone Number Best Time to Call DATE OF THIS NOTICE: 08-06-2019 ( ) — EMPLOYER IDENTIFICATION NUMBER: 84-2627631 FORM: SS-4 NOBOD INTERNAL REVENUE SERVICE NEW HYANNIS CORP CINCINNATI OH 45999-0023 489 BEARSES WAY {��n�r�i0s0�On0efn0�ln0��e��0innt��n��0�1n� HYANNIS, MA 02601 e . �K Town of Barnstable BOARD OF HEALTH John T.Norman Board of Health Donald A.Guadagnoli,M.D. BARNST BLE Paul J.Canniff,D.M.D. MAft 200 Main Street, Hyannis, MA 02601 F.P. Thomas Lee Alternate a' R 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: 55 Issue Date: 1/1/2020 DBA: 21 PLUS SMOKE SHOP OWNER: NEW HYANNIS CORP Location of Establishment: 489 BEARSE'S WAY-UNIT#3 HYANNIS, MA 02601 Type of Business Permit: Adult Only ' Annual Seasonal FEES YEAR: 2020 TOBACCO SALES: $85.00 Permit Expires: 12/31/2020 Thomas A. McKean, IRS, CHO, Health Agent Restrictions: PLEASE POST CONSPICUOUSLY 4. Town of.Barnstable _ . Insp.ectional-Services . :. - _ � Public Healtli.Division.:. Thomas Mckeata;Director 200 Mai n"Street,Hyannis,MA-02601 Office: 508-862-4644 Fax: 508-790-6304. For='Office Use On ;ImhitlsiAL2_ y Y � • Date Paid mt Pd$ q ADULT ONLY:RETAIL TOBACCO SALES REKNIT APPLICATION ,DATE 40MTOMM-NONEWBUSINESSES) CHANGE IN OWNERSHIP- RENEWAL_ 0O O. . W ADULT.ONLY,RETAIL TOBACCO SALES ESTABLISHMENT NAME: 1 'ys SYY►U�-2 ShaP. ADDRESS OF TOBACCO ESTABLISHMENT: O te�X sCS �l V CJ'�B �ahnis 020 MAILING.ADDRESS.(IF DIFFERENT FROM ABOVE): E-MAIL ADDRESS; Ch�n is(D OQ.•Co rYI TELEPHONENUMBER OF TOBACCO ESTABLISIIMENT::(_j TP 2 OWNER'S NAME.Gh4et � `�I OWNER'S PH#(2UI)�102-b223 . OWNER'S ADDRESS: 31 I eathjY 'DecK `Dr\y-e g4uTnR CORPORATE.ADDRESS:. 1. S 5.1"L� CORPORATE FID#94^Z(OZ - 74#31' 02(�U . ANNUAL: SEASONAL: DATES OF OPERATION: DAYS CLOSED EXCLUDING:HOLIDAYS(EX.MONDAYS) TOWN OF BARNSTABLE CODE/MA GENERAL LAW INTERNET LINKS: TOWN OF BAiiNSTABLE TOBACCO CODE LINK FOR CHAPTER 371-9: https//www eeode360com/33996392 MA GENERAL LAW°CHAPTER 270/SECTION 6: https://malegislature.gov/Laws/GOherAlL3W S/PartIV/TitleI/Chapter270/Section6 Y-. EA fi * NEW BUSINESSES AND NEW40WNERS ONLY"* C. ... A HEARING BEFORE TIIE BOARD OF HEAL1 H TS REQUIREb THE BOARD MEETS ON CE PER M.ON�H: e; ALLAPPLICANTS,MUST SUBMIT ITEMS 1""-5 CHANGE CI OWNERSHIP MUST SUBMIT,ITEMS 1 7: Y. I) MA State License to Se11Cigarettes _;;; - )Paxment of Feels) se epage 4: 2) MY1 State Licepse,to SelhCigars•;and,�S,moltjngotacco 6) Proposed Floor Plaq 3} MA.State License for Sale�ot Elechomc Nicotine Delivery Systems, 7)List of Prodaffi roposed to be Sold,, `: 4) HLS;Federal TagdID#Document ALL APPLICANTS ARE REQUIRED TO: .CALL HEALTH DIVISION AT 508862-4644 FOR AN INSPECTION PRIOR TO PERMIT BEING ISSUED: SIGNATURE: PRINTED NAME: DATE: ESTABLISHMENT NAME TOBACCO SALES 7 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 13arnstabW Code and,Chaptet=270 Sectton ti of the:Massachusetts•General Laws which`descrilies 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 o£Health Regulation; Sales to Minors §37.1-9 Sale`and Distribution.of"Fobacco:Products: I:No person shall sell or provide a tobacco,product,.as defined herein;to a person under The ininimum legal°sales age: The minimum legal sales age in the Town of Barnstable is 2U years of'age:' 2:Identification: Each person selling or distributing tobacco products,as defined herein,shall verify the age:of thepurchaser.by-meansof a valid government-issued photographic identification-containing the-bear&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 amployee(s)below received and understood Section 37 T 9 of the Town of Barnstable Board of ) Health Prohibition of Smoking Regulation and Ghajiter 270 Section 6 of the Massachtisetts General Laws Signature Printed Name Date IPA Signature Printed Name Date Signature Printe(,Name Date Signature Printed Name'.Date Signature Printed Name Date y Signature Printed Name Date Signature Printed Name 'Date ' TOBACCO SALES TO MINORS' PROHIBITED BY MASSA,CHUSETTS GENERAL LAWS Sales to Minors—.§371 9.Sale and Distribution:of Tobacco Products 1 No person shall sell or provide a tobacco product,as definedherein,to a:person under.the minimum legal sales age.;:The minunum;legal sales:age in,the.Town:ofBarnstable js21 years of age.; 2 Identification;Each.person selling or.distributing tobacco products,as defined herein,.shall`venfythe age of the purchaser by means of a valid goveinrrient-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: ,r Persons,firms,corporations,or agencies selling tobacco products to mmors or selling tobacco products without, a tobacco sales permit shall be punished as follows; A In the case of a firstviolation,a,fine of.,one hundred.dollars:($100 90): B. mal e:case of a second violation within 24 months.of the date of the current violation,'a fine of two hundred dollars,($200 00)'.and the Tobacco.Producf Sales.Permit'shall be suspended for up;to seven(7) consecutive`business days. C. In,the.case' of three or more violations within a 24-month, period, a .fine of three hundred. dollars ($300'00) and the:Tobacco'Prodii&t Sales_Permit,shall be suspended:for up to thirty (30) consecutive business days In the case'of four.violations or',repeated,'egregious violations of this regulation, as determined by the Board of Health,within a 24=month period,the Board of Health shall hold a hearing in accordance with subsection 4 of this section:and may permanently:revoke',Tobacco.Product Sales Permit. , h .. I i f "A Posting State Law, In conformance with Massachusetts General Laws,::Chapter.210, Section 7, a copy of Massachusetts General Laws i3hapter 2X'iSection 6,sha11 be:posted^conspicuously by the owner or other person in 6liarge4here6f m the shop'pr other place sedi to sell clgarettes at retail Fhe notice to be posted shall be that notice provided by.'the Massac�iusetts_bepartment of�ublic Health Suchynotice ahah lie at least 48 sgixare inches and shall be:'posted at the cash register which receives the greatest volume of single cigarette package sales m such a magier'so'this may`"be readily seen`by A. on standmg'af or"approaching the cash register. Such notice'shall directly;face the purchaser and' ball not-be obstructed from view;or placed at'a Height-of<less than 4 feet or gteater°than 9_feet from the.floor. For all.other cash registers that sell,cigarettes,a-notice shall be: . attached whleh{> no smaller'than 9'square inches;;which is the size of the;sign provided by the Department of 4 J. Public HealtF Such;notice must'be'posted.in'a mariner so that it,may b'e readily`seen by a person standmg;at or, approaching"Ihe cash,register!:Such-notice shall directly face..the purchaser and,shall not.be obstructed from view or placed at a height no less:than 4 feet:or more than 9 feet from the floor. MAIL4N REQUESTS Please mail the completedapplication forin with your supporting documents: 1)MA State License to Sell Cigarettes 2)MA State License to.Sell Cigars and Smoking Tobacco 3)MA State.License for Sale:of Electronic Nicotine Delivery Systems 4)IRS Federal Tax ID#document Along with a check.payable to: Town of Barnstable to.the address below: i Town.ofbarnstable .: POlic Health.Division . 200.Main Street Hyannis,MA 0260.1 FOR FAXED REQUESTs. . P. Our fax number�s (598) 790.6304: 'The fax should'•include a completed'appli6tiowform along with thethree supporting documents listed=above. 'Mail a check:Tayable- to,' Towtf6f Utd9table4o,the address listed4bove FEES :Tobacco=$85,For New Establishment.or New Ownership,additional non-refundable one-time:fee $100 plus Tobacco Fee Late°Fee $10. QMpplication'FormATOBACCO ADULT ONLY A'PP..Dtd 5-26=2020 doc O '0 Commonwealth of Massachusetts Letter ID:L1180784512 YA Department of Revenue Notice Date:August 19,2019 Christopher C.Harding,Commissioner Account ID:CGL-19342565-006 Agp44 mass.gov/dor RETAILER LICENSE FOR SALE OF CIGARETTES 11nh�Ihl�li�d�IllEil��lnllillhlll��rllh��li��lhill��, NEW HYANNIS CORP N® 21 PLUS SMOKE SHOP —BEARSES WAY HYANNIS MA 02601-2707 Attached below is your Retailer License for Sale of Cigarettes(Form CT-3). Cut along the dotted line and display at your business location. At any time,you can log into your MassTaxConnect account at mass.gov/masstaxconnect to view and re-print a copy of this license. If you have any questions about your license, call us at(617) 887-6367 or toll-free in Massachusetts at (800)392-6089,Monday through Friday, 8:30 a.m. to 4:30 p.m. DETACH HERE rodVN MASSACHUSETTS DEPARTMENT OF REVENUE Form CT-3 m * Retailer License for Sale of Cigarettes 1v r oF� This license must be posted and visible at all times.The sale of tobacco products to anyone under 18 years of age is prohibited. NEW HYANNIS CORP Account ID: CGL-19342565-006 21 PLUS SMOKE SHOP License Number: 1146398720 489 BEARSES WAY HYANNIS MA 02601-2707 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: August 19, 2019 Expiration Date: September 30, 2020 _ At" t[s Commonwealth of Massachusetts Letter ID:L0592900672 Department of Revenue Notice Date:May 22,2020 E Geoffrey E.Snyder,Commissioner Account ID:EDL-19342565-01 l mass.gov/dor LICENSE FOR SALE OF ELECTRONIC NICOTINE DELIVERY SYSTEMS II"'I'II'1'I111I111I1'II1I1"Ii11'11'Ii1'1'I Jill '111'1III11I'1I NEW HYANNIS CORP o® 21 PLUS SMOKE SHOP 489 BEARSES WAY HYANNIS MA 02601-2707 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 -------------------------------------------------------------------------------------------------------------------------------------------------- �c"Us�� MASSACHUSETTS DEPARTMENT OF REVENUE �' Retailer License for Sale of Electronic Nicotine Delivery Systems �of� This license must be posted and visible at all times. The sale of tobacco products to anyone under 21 years of age is prohibited. NEW HYANNIS CORP Account ID:EDL-19342565-011 21 PLUS SMOKE SHOP License Number: 215345152 489 BEARSES WAY Age-Restricted Store HYANNIS MA 02601-2707 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 22,2020 Expiration Date: September 30,2022 O Commonwealth of Massachusetts Letter ID:L0889042816 s Department of Revenue Notice Date:August 15,2019 f. Christopher C.Harding,Commissioner Account ID:CRL-19342565-009 pk`t mass.gov/dor RETAILER LICENSE FOR SALE OF CIGARS AND SMOKING TOBACCO (IIlII'�11�'�I'��II' III'I1�Irin�r��r�rlll�dllrl�l'I'�'nrl�lr) NEW HYANNIS CORP o= 21 PLUS SMOKE SHOP o— A—_ 489 BEARSES WAY HYANNIS MA 02601-2707 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 ------------------------------------------------------------------------------------------------------------------------------------------------ SPCNUs�� MASSACHUSETTS DEPARTMENT OF REVENUE Form CT-3T m �, Retailer License for Sale of Cigars and Smoking Tobacco .y �, oF� This license must be posted and visible at all times.The sale of tobacco products to anyone under 18 years of age is prohibited. NEW HYANNIS CORP Account ID: CRL-19342565-009 21 PLUS SMOKE SHOP License Number: 1724041216 489 BEARSES WAY HYANNIS MA 02601-2707 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:August 15, 2019 Expiration Date:September 30,2020 I - °FTKEr°w� Town of Barnstable P Board of Health BARNSPABLE. y MASS. $ 200 Main Street, Hyannis MA 02601 i679• plfD MAC A Office: 508-862-4644 John Norman. FAX: 508-790-6304 Donald A.Guadagnoli,M.D. Paul J.Canniff,D.M.D September 11, 2019 21 Plus Smoke Shop c/o Mr. Chetan Patel 31 Weatherdeck Drive Bourne, MA 02532 RE: 21 Plus Smoke Shop, 489 Bearses Way, Unit #3, Hyannis Massachusetts Dear Mr. Patel, You are granted permission to open and operate an adult-only retail tobacco store at 489 Bearses Way, Unit 3, Hyannis, Massachusetts with the following condition: • The adult-only retail tobacco store shall not open for business until after the establishment is inspected by an official of the Barnstable County Tobacco Control Program, or by an agent of the Board of Health, and the establishment satisfactorily passes the inspection. Once the establishment satisfactorily passes an inspection, you will be able to remit the required fee and obtain an adult-only retail tobacco store permit from the Board of Health. The permit can be obtained at the Public Health Division Office, located at 200 Main Street Hyannis. If you should have any questions, please feel free to telephone Thomas McKean, Director of Public Health, at 508 862-4640. Sincerely ours, n Norman hairman TOWN OF BARNSTABLE BOARD OF HEALTH Q:\WPFILES\Adu1t0nlyTobacco 21PIusSmoke 48913earsesWayHy 8-27-19.docx r A Town of Barnstable For Office Use Only: Initials: ti Inspectional Services Date Paid Amt Pd$ + /ARNBI'AHLE, ' 1� Check# cash- MASS. �m� Public Health Division �f0 MA'S A 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 r APPLICATION FOR A TOBACCO SALES PERMIT r I ti t�A e, ESTABLIS NT NA (DB/A) i� �z AdDREA Of BUSINESS MAILING ADD SS (IF DIFFERENT FROM ABOVE) OWNER'S NAME: LAST FIRST MIDDLE Ghuhy i .S� �'��yu�no:�o� � - z� C-�=tc�z- �z�,3 s�--��-� • �c3 � EMAIL PHONE # FEDERAL ID# Do you currently 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 Date3' Q:\Application Forms\TOBACCO APP2019 dob.docx I ` e v ESTABLISHN ENT'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. l. 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 Laws: Signature Printed Name Date k.A� Signa a Printed Name Date Signature Printed Name Date Signature Printed Name Date Signature Printed Name Date Signature Printed Name Date Signature Printed Name Date Q:\Application Fortes\TOBACCO APP2019 dob.docx tRUG-21-2019 02:55 From: To: 15027717095 F'aae:l' 1 60��s Commonwealth of Mnssnchusctts Letter ID:LI 180784512 y I I Dc artment of RcvcnucNotice Date:August 19,2019 P AccountdD:CQL-193425(i5-OOG Christopher C,Harding,Commissionermass.guv/dur RETAILER LICENSE FOR SALE OF CIGARETTES 11n11tlillllult111t11i1uifullllNl�lllhlt�llllllnlll� t NEW i-IYANNIS CORP o 21 PLUS SMOKE SHOP i 489 BEARSES WAY, 4t J-7- - 1,1YANNTS MA 02601-2707 ',Attached below is your Retailer License for Sale of Cigarettes(Form CT-3). Cut along the dotted line ,and display at your business location. At any time,you can log into your MassTaxC,onnect account at inass.gov/masstaaconnect to view and re-print a copy of this license. �f you have any questions about your license,call us at(617) 887-6367 or toll-free in Massachusetts at ?(800)392-6089, Monday through Friday, 8:30 a.m. to 4:30 p,m. i DETACH HERE ------------ ,.---_-----_- -_-____--___--_- ------- -------------------------------------------m_-__-__-___-_--___-___� �m-..r. k' y�1��10sF MASSACHUSETTS DFPARTMENT OF REVENUE Forin QW3,� Retailer License for Sale off Cigarettes7This license trust be posted and visible at all tunes. The sale of tobacco products to anyone under 18 years of age is prohibited. 3 4 NEW HYAN IS CORD Account iRD: CGL-19342665-006 21 'PLUS SMOKE SHOP License Number: 1146398720 48913EAR.SFS WAY 14.YANNIS MA 02601-2707 `! This certifies that the taxpayer named above is licensed under Chapter 64C of the Massachusetts General Lases to sell at retail at the address shown above. This license is non -trxnsfrrablc and may be suspended or rcvok.cd for failure to comply with state laws and regulations. ]Effective Date: August 19,2019 Expiration Date: September,30, 2020 i;. I�J�l1 common e,tlt6 of\iassaclutscUs T rue!ID 1 0889042410 T tll Department orReNenue Notice Date.August 15,2019 Chi isiopher C.Ilarding,Commissioner Account If) C.RI-19;42505-(109 .f w 111ass.eov'i.1ox RETAILER LICENSE FOR SALE OTa CIGARS AND SMOKINGI `T'+OI3ACCO Inln�lltlslrlllt�lnrttll�l��l�ll�l�t"tl,lll�lll�ltll��lil�l NP.W I I A N N I S C(7RP LL ,'-I PLUS SMOKE SLOP 489 BEARS.cs WAY U-or,4 4.3 LIYANNIS MA 02601-2707 Attached belo\.v is,our Retailer License. for Sale ol:�C:'i�?ars and Smoking Tobacco I orru �alonw the Clotted line and display, at your husinr ss location. At airy time. vcru can log into ;t1ul 1�9ass l'aNC;onncct account at m ass.go hiiassta.Nconnec.,I to view tend re-print a cope of(Ilia license. It'you have any questions about your license,call us at (.617) 887-6367 or toll-(Yee in Massachusetts at (800) 392-6089, Monday through Friday, 8:30 a.m. to 4:30 p.m, I)ETA II IlF11E y.c;)1(lr.: 1i1.,� Sr�C'1-11USE.l..'l'S D1 1':'�l��l'11� EX OF HEI LINE, I:�e)a'uIa �r q. f '� -Retailer r License Col.Sale of Cigaa•s and SmoLiisag'I"I0mcco This license must be posted and visible at all taaaees. 'flee stale of tuba ccv products to anyone undo 18 years of age is probibite d. NUW IIYANNIS CORM Account Ill: CRI.,,-l9.3/12565-009 21 PLUS SMOKIE SHOP License Nulaabea: .1724041216 489 I3EARSES WAY HYANNIS MA 02601-2707 This certifies that the taxpayer named above is licensed under Chapter 64C of the. Massachusetts General Laws, t I sell at retail at the address shown _above. This license is non-transle.rable and may he suspended or revoked f)r failure to comply with state laws and regulatiims. Effective Date: Aticust 15,2019 1 x.pi..raRtion l.)ate: Sepiclr)ht r 30. ?020 UB rI sc+fr c C.ommumvearth of Mnssachtisetts Letter II)i 1.06948144N2 r Department ol'Revenuc Notice Date August 15,2019 C'hriskipher('.(larding,CO111MISSinnE:r Account Ill SI,.S-19312 6i-t)IlA mass.gov!dor SALES:AND USE TAX REG,1S7'RATION CERTIFICATE 1�111�111111111"III�II��IIIIIIIIIInrIIIIIII��IIIIII�t��III�nI Nt?W HYANNIS CORP ® 21 PLUS SMOKE SHOP n '189 BI_ARSES WAY, cif�3 ® I-IYANNIS MA 02601-2707 Attached below is your Sales and Lase "Max.Registration Certificate (Forrrl T-1). Cut a.11or1.g tih°.CIMCd .JAIL and display at your place of bLISineSS. YOU must rt,l)ort any change of name or addrvss to us So tll,at cl revised ST-I can be issued. At any time,you can log into your Mass`faxConnect account at mass.gov/masstaxconnect.to view and re-print a Copy ofthis certificate.. DETACH I-IERtE �'1.ASSAC11I.jSE'T'TS DL±,1"'AR I'MENT OF RI+:1TI:NUE 1i+d3rm S1-ll 1' Sales and Use Tax Ilegistraation Certificate a r This re istr,aliott 111imst be posted and visible.at all fL,n.i.pr times. Nl-'W IIYA.NNIS CORD Account 10; SL.S-19342565-0114 21 PLUS SMOKE SHOP C'ertifacaste Number. 318271 1St 489 BLiARSES WAY HYANNIS MA 02601-2707 This certifies that the taxpayer na ned above Is reo.istered under L.'hapters 62C,0411 and 641 ofllie Massachusetts General 1..,a�. s to sell to lialble personal property, at retail or for resale at the address shmvn above. This registration is non-transferable and may be suspended of-revoked t'(-)r ftIIILITC to C01111)1V With state laws and regulations. Effective Date-,November 1,2019 I h3 I�U�+-r1n�S Following Items will be Sold at Store Tobacco Products and Tobacco Paraphernalia Cigarettes all kind E-Cigarettes all kind Lighter and accessories Cigars all kind Smoking cessation Cigar filtered Cigar single Cigar pack Tobacco packs Tobacco small Pipe tobacco and accessories Chewing Tobacco , Snuff and Snus Cigars Wraps Rolling Paper RYO accessories RYO Tubes & Tips Pipe, Tobacco grinder RYO Tobacco re s y FVape all kind juice Hookah & accessories Scale Incense Loose Leaf �" lirs Glass of all kind Vaporizers (Herbal)�AC / � �_ _. ' _``.. ,. - 1 (ZG�'1'C�UrGr�'� t I i j 1 i � i - - i f j j ' i � �,. I i � !I � f I � i E� j ; � 1 � �- I � �,' � � � � i � � � _ d —�--�- 1�-�or,-�- Igor r'v-o r�-t- �c�o r ��c�o-�.-�- �oo f- � , a: .. �,.. ; ; �` ,�� --. . ��<. i d.� ;.� I Town of Barnstable Regulatory Services BA BM Public Health Division jbrFayA Thomas McKean,Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 TO: SEPTEMBER 11, 2019 2.1. PLUS SMOKE SHOP 489 BEARSES WAY, UNIT # 3 HYANNIS, MA 02601 IMPORTANT NOTICE 14/11 ADULT-ONLY RETAIL TOBACCO PERMITTED ESTABLISHMENTS MUST RECEIVE A COMPLIANCE INSPECTION BEFORE THEY MAY OPERATE. Q:\TOBACCO\Notice-Must Receive Compliance Inspect Before Operation 9-11-19.docx I �T Town of Barnstable Public Health Division ;w How DAMSTABM Mess. �, 200 Main Street,Hyannis MA 02601 -fc� L►cvne,e: ,/�, �� ,Zl-� 039• fD Mid� 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 ofpersons under the age of 21 is prohibited at all times, and maintains a validpermit 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 you should have any questions,please contact Thomas McKean, Director of Public Health, at(508) 862-4644. Persons under the age of 21 are not permitted to enter this establishment TOWN OF BARNSTABLE `"R M� BOARD OF HEALTH 0 9• e jOfFp�A s Crocker, Sharon 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. ---------------------------------------------------------------------------------------------------------------------------------------------------------------- ------------------- i" 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 ' 4 Town of Barnstable BOARD OF HEALTH ' ? r Paul 1 Canniff, D.M.D. Board of Health Donald A.Gaudagnoli, M.D. ' L�.aJd:v'TAB t,&3. John T. Norman %639 1, 200 Main Street, Hyannis, MA 02601 F.P. Thomas Lee Alternate -0"�' 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: 55 Issue Date: 08/28/2019 DBA: 21 PLUS SMOKE SHOP OWNER: NEW HYANNIS CORP Location of Establishment: 489 BEARSE'S WAY-UNIT#3 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: C-C,6,Q (3-0 oFINEr°� Town of Barnstable For Office Use Only: Initials: ti Inspectional Services k CheDatc W $ BARNBra " Public Health Division s6�q. ♦0 200 Main Street Hyannis MA 02601 y 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 i tt's < mo '5%'6'0 P ESTABLIS NT NA (DB/A) DRES Of BUSINESS � MAILING ADD SS (IF DIFFERENT FROM ABOVE) OWNER'S NAME: LAST FIRST MIDDLE l - zc) t✓22-3 6"*- ?,6 e'—' .. 631 EMAIL PHONE # FEDERAL ID# Do you currently 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 �--/— ..L Date Cy', Q:\Application Forms\TOBACCO APP2019 dob.docx Plus SWo ��e 516P . ESTABLISEWMNT 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 Laws: Signature Printed Name Date N\Uu W M1,Yj kai Signa a Printed Name Date Signature Printed Name Date Signature Printed Name Date Signature Printed Name Date Signature Printed Name Date Signature Printed Name Date Q:\Application Forms\TOBACCO APP2019 dob.docx AUG-21-2019 02.55 From: To: 15027717095 Paae:1!1 O 'b Commonwealth of Mnssnchusctts Lencr m:LI 180784512 ! �.n Department of Rcvcnuc Notice Date:August 19.2019 Christopher C.Harding,Commissioner Account ID:CGL-19342565-006 cfR mass.guv/dur RETAILER LICENSE FOR SALE OF CIGARETTES llnlrlilll{tllltliltiltludlinllliltlrllirtlt,lllrlllnlll��r NEW HYANNIS CORP o� 21 PLUS SMOKE SHOP r 489 BrA.RSES.WAY, 4617-- 3 1TVANNTS MA 02601-2707 `,Attached below is your Retailer License for Sale of Cigarettes(Form CT-3). Cut along the dotted line land display at your business Location. At any time,you can log into your MassTaxConnect account at a.ass.gov/masstaxconnect to view and re-print a copy of this license, f you have any questions about your license,call us at(617)887-6367 or toll-free in Massachusetts at e(800)392-6089,Monday through Friday, 8:30 a.m. to 4:30 p.m. zj 1, i l DETACH HERE mm, .. ____--------------------------------------- ------------------------------------------------ •- k' sf-"w MMASSACHUSETTS DFPARTMENT OF REVENUE Form CT-3Retailer License for Sale of Cigarettes This license must be posted and visible at all tires. The sale of tobacco products t0 anyone under 18 years of age is prohibited. 1, NEW 14YANN1S CORD Account W: CGL-19342565-Q06 21 PLUS SMOKE SHOP License Nutxtber: 1146398720 48913EARSES WAY HYANNIS MA 02601-2707 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 failure and may be suspended or rcvok.cd fen failure to comply with state laws and regulations. 1 Effective Date: August 19, 2019 Expirations Date: September 30, 2020 Communwrllhf P t of Letlor ID:L08890,12816 OR- k y. Department of Revenue notice Date August IS,2019 Christopher C.Ilarding;Commissioner Account 11) ('RI-191f?ir;i.IIQ9 Illass.goo dor RETAILER LICENSE FOR SAIL Oil CIGARS AND SMOKING `I'(( BAC:CO hIInllltlslr1111111I1�nllrl�11111�1�1nllnhlllrrllll�llttl NIM IiYANNIS C(:)RP 21 PLI1S SMOKE SHOP a 489 BEAKS.ES WAY HYANNIS MA 02661-2707 Attached laclovv I; your Retailer License t-or Sale u :Ci O ag gt ti along;the dotted line and display at your business; location At any time,. you(:.an 1061, into wt)ul MassTaxConnect account at mass.govimasstax Coll ner.,l to view and re-print a copy of this heense. Ifyou have any questions about ,our license,Call us at (617) 837-6367 or toll-flee in Massachusetts at (800) 392-6089_ Monday through Priday, 8:30 a.m. to 4:30 p.m. D ETA 0-1 11L11E f�'1,i 4:1(",1811 1:"i'"I' 1�I @':�1 TM 9?;+v'A' 01, i�➢i:�'I,l?yl l l ii, �> Idetailer l.iicense for dale ol'Cignirs and Smoking'l"obaacco f' 01 This license must be posted apad visible at Al (imes. The sale of tobaacc.a) products to anyone under 13 years of age is Iprobibited. NEW IIYANNIS CORP AcQ.omit Ili: CRL.,-1.9342565-00y 21 PLUS SMOKE?SHOP License Number: .172404 1216 489 BEARSES WA I1Y NNIS MA 02601-2707 This certifies that the taxpayer named 'above is licensed under Chapter 64C of(lie Massachusetts Genciall Law,,, tv sell at retail at the address shown above. This license Is non-transferable and may be Suspended or rcvoked fi r failure to comply with state la«s and regulations. Effective Batc: August 15,2011) Expiration Date: September 30. ::'.020 C7n hI r ^t a cf< Commomvealth of Massachusells Letter ID.1.,01948 14�92 x^ j Department or 9 L Revenue Not Datc.August 15,_01 '��' ('hristopherC.Harding.Comonssimlef Account ID $1 S-19.A42+65-004 y SALES AND t.S E TAX REGISTRATION C ER,r[FIC'.=ATE 11111�111h1111. 111.1h-III Hill 111fr11If 1111111111,r-111-n1 NFW I IYANNrs CORP 3® 21 PLUS SMOKE SHOP I89 131_AKSf_7S WAY, 61ni#43 ® HYANNIS MA 02601-2707 Attached below is Your Sales and l'sc Tax.Registration Certificate(Form ST-1;. Cut ralon.g the clotted .dirk and display at_your place of business. You must report WIV change of'name or addicss to us st) that:;.1 revised ST-I can be issued. At any time, you can log in:to your Mass'I'axConnect:account at to view and re-print a copy of this certificate. DETACH IIP.Rr N'I.ASS AC HT)S1;TTS DEPARTMENT OF RI+:NTENNUE 1't➢9'eAn ST-R :-... r. r' to Siales a n(.1 Use Tax Regish-atio.at Ceut.ificate This registration imist be posted ► d visible al all 1. t and times. NEW FIYA.NNIS CORD Aacamol 1.0; SI..S-l9342565-004 21 PLUS SMOKE SHOP (`ertitacate N u inter'; -1132 71 489 B ARSFS WAY HYANNIS MA 0260 1-2 71Y7 11his certifies that the taxpayer named above is registered under Chapters 62C,(AfI and 641 of(lie Massachusetts General 1..m.vs to sell tangible personal properh at retail or for resale at the address shomin ` above.. 11-iis registration is non-transferable and may be suspended or revoked for failure to comply :with state laws and regulations. Effective 2019 . 14 c�tr�e l)a.le.November 1,�11, . Following Items will be Sold at Store Tobacco Products and Tobacco Paraphernalia Cigarettes all kind E-Cigarettes all kind Lighter and accessories Cigars all kind Smoking cessation l Cigar filtered Cigar single Cigar pack Tobacco packs Tobacco small Pipe tobacco and accessories Chewing Tobacco , Snuff and Snus Cigars Wraps Rolling Paper RYO accessories RYO Tubes & Tips Pipe, Tobacco grinder RYO Tobacco Cbd & Cbd related products Vape all kind E juice Hookah & accessories Scale Incense Other Tobacco products and accessories Loose Leaf Souvenirs Glass of all kind Vaporizers (Herbal) Ghin�5 2 ! Ur -I- CC,V-� 4 j i Z i t - j oid bm l.nos Town of Barnstable For Office Use Only: Initials: ti Date Paidp�$ r sARN9TAs[E Inspectional Services Check# Cash y MAW. i639, Public Health Division 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 r APPLICATION FOR A TOBACCO SALES PERMIT ESTABLISHMENT NAME (DB/A) ADDRESS OF BUSINESS p Z6'0 , MAILING ADDRESS (IF DIFFERENT FROM ABOVE) /7 �t y f ,�-697(0 Lff,[J�nod o� 'i - 2DI—G62- G22-3 f5-*—?,1�2--7G3P EMAIL PHONE# FEDERAL ID# Do you•currently 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 Q:\Application Forts\TOBACCO APP2019 dob.docx i ESTABLISHMENT'S NAME TOBACCO SALES Employee Signature Form This form is for official use to indicate that the employee(s) of this establishment received and understood Chapter 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 Laws: Signature Printed Name aa Date Si6afGe Printed Name Date Signature Printed Name Date Signature Printed Name Date Signature Printed Name Date Signature Printed Name Date Signature Printed Name Date Q:\Application Forms\TOBACCO APP2019 dob.docs /Z L 17 TOWN OF BARNSTABLE LOCATION ,P 7 t SEWAGE VLLLAGE dZ s ASSESSOR'S MAP & LOT INSTALLER'S NAME PHONE NO. 1A:!f errncy `I`/S,-kfGS� x r'APACITY LEACHING FACILITY:(type) (size) NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER- BUILDER OR OWNER /-1/22 •9- DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: 7 d VARIANCE GRANTED: Yes No ^ r I r � i D IUs SMO&- Town of Barnstable Board of Health &V$A$M 200 Main Street, Hyannis MA 02601 y MAI& t53q. ♦� John T.Norman Office:508-862-4644 Donald A.Guadagnoli,M.D FAX: 508-790-6304 Paul J.Canniff,D.M.D. F.P.(Tom)Lee,P.E.,Alternate BOARD OF HEALTH MEETING RESULTS Tuesday, August 27, 2019 at 3:00 PM Town Hall, Hearing Room 367 Main Street, 2nd Floor, Hyannis, MA I. Deed Restriction to be changed — Septic: Paul Rufo, owner - 54 Briarwood Avenue, Hyannis, Map/Parcel 289-127, request to ratify acceptance of the one bedroom restriction with conditions as per the submitted deed restriction. (Original deed restriction was two bedroom with condition that an innovative-alternative septic system be used.) The Board voted to grant the change in the deed restriction from two bedrooms with a I/A septic system to one bedroom with a standard system with the following condition: The health staff will inspect 12 months from meeting to verify still operating as a bedroom. (two voted in favor, Dr. Canniff opposed.) II. Proposed Regulation: Moritorium on Permitting of New Adult-Only Tobacco Retail Stores. The Board will consider and potentially vote upon a proposed regulation to establish a temporary moratorium on the consideration and approval of licenses for new adult-only tobacco retail stores until such time as appropriate regulations regarding their location, design, internal controls, and related matters can be developed, publicly discussed, and potentially adopted. The Board voted to grant a moratorium until December 30, 2019, on adult-only retail tobacco permits; none will be reviewed, with the exception of the four which applied to the Board below. III. Tobacco — Adult Only A. Caren Hazart-Roshan, owner of Quick Stop Convenience Store, 3821 Falmouth Road Marstons Mills, Map/Parcel 057-004, desire to reduce product line and become adult-only retail tobacco with the sale of tobacco only products and the lottery. WITHDRAWN. Caren was present and asked the Board to consider in addition to tobacco products, to allow her to sell lottery, power bars. The Board noted that the CBD products on Page 1 of 3 BOH 8/27/19 her list are not considered tobacco products and the Board expressed that they were not interested in allowing anything over then tobacco related products. They determined the application would only be voted on as submitted and she was given the option to have them take a vote or to withdraw. Applicant decided to withdraw her request without prejudice. B. Qaswa, Inc d/b/a Tobacco Master — 606 Main Street, Unit# 4, Hyannis, Map/Parcel 308-066. GRANTED. Asim Jamal was present. The Board noted that there were two items on their product list which the Board said is not permitted: CBD oils and jewelry scales. The Board voted to accept an amended list without these two items. The Board voted to accept the application for an adult-only retail tobacco permit. C. K and E Plus Three Enterprises LLC — 577 West Main Street, Hyannis, Map/Parcel 269-003. DENIED. Attorney David Lawler was present for his client, Khalil Jos. Naoum. Attorney Lawler explained that there would be a separate door installed to the right of the current door. It would lead into a room approximately 7' x 10' and would have an exit door out the back which would only open from the 7' x 10' room. The door would only be used as a second egress in case of an emergency and that door would open into the convenience store. Other than that, the store would be separate from the convenience store. Attorney Lawler said the staff pumping gas would most likely be the ones which sell the tobacco products. The store would not be expected to support a full-time employee to just sell tobacco products. The Board explained that the set-up described would not represent the intent of the regulation and voted to deny the application. D. 21 Plus Smoke Shop — 489 Bearses Way, Unit# 3, Hyannis, Map/Parcel 292-077 A-3. GRANTED. Chetan Patel's nephew was present. The items on product lisit inquired about were: RYO accessories (Roll Your Own) and E juice, which is a flavored tobacco, and the vaporizers are for tobacco. The Board stated there were a couple of items on the product list they were not interested in: CBD and CBD related products, souvenirs, and other tobacco products and accessories. The Board voted to accept the amended list and voted to accept the business as a adult-only retail tobacco applicant. IV. Housing: Page 2 of 3 BOH 8/27/19 I Tenant Charlene Mahoney, 168 Barnstable Road, Unit 7A, Hyannis, MA, Map/Parcel 328-013, request hearing on unit unfit for human habitation. The issue has been resolved. No further action necessary. V. Temporary Food Permit Application; C-hristopher Siderwicz, Manager, The Mills Air Service,1000 Race Lane, Marstons Mills, Map/Parcel 104-002-T00, is requesting a temporary food permit for "The Mills Airport 90th Anniversary on Saturday, September 21 from 10:00 — 3:00pm with three mobile food trucks. The rain date is Sunday, September 22. The Board voted to grant The Mills Airport 90th Anniversary celebration with a temporary food permit for September 21. VI. Variance — Pool Jay Patel, General Manager at Best Western Cape Cod, 1470 lyannough Rd, Hyannis, is requesting a variance to allow a qualified swimmer as coverage at their pool. The Board voted to grant a variance to allow qualified swimmers at Best Western Cape Cod. VII. Body Art Permit: Bronwen Baxter, has taken Anatomy and Physiology course, applying for body artist and micro-blading permit. Bronwen Baxter worked for three years to meet our requirements which kept increasing. Submitted all necessary requirements. The Board voted to grant a body artist permit with microblading. Vill. Minutes: The Board voted to adopt the minutes for July 23, 2019. IX. Correspondence: A. Letter from Frederick O'Connor regarding desire to purchase menthol in many locations. B. Letter from Saeed A. Chaudhry regarding flavored tobacco regulation. X. Old / New Business: Robert Murphy, owner of Portside Tavern — 72 North Street, Map/Parcel 309-193-001, establish a deadline for relocation of dumpster as agreed to with the Board at previous meeting. The Board voted to place a 60-day deadline to have the dumpster moved. The 60 days will be from the date of the letter to Robert Murphy. Page 3 of 3 BOH 8/27/19