HomeMy WebLinkAboutC.B. PERKINS - RETAIL FOOD f
C. B. PERKINS,M3-b45
12 Enterprise Rd., Hyannis
e44
t ®.
o
�& Town of Barnstable BOARD OF HEALTH
John T.Norman
Board of Health Donald A.Guadagnoli,M.D.
B.►u,�rsrh , F.P.(Thomas)Lee
)� 200 Main Street, Hyannis, MA 02601 Daniel Luczkow Alternate
o � 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: 1037 Issue Date: 1/1/2021
DBA: C. B. PERKINS
OWNER: SAI NATH CORP
Location of Establishment: 12 ENTERPRISE ROAD HYANNIS, MA 02601
Type of Business Permit: Adult Only
Annual Seasonal
FEES YEAR: 2021
TOBACCO SALES: $85.00
Permit Expires: 12/31/2021
Thomas A. McKean, RS, CHO, Health Agent
Restrictions:
PLEASE POST CONSPICUOUSLY
Town of Barnstable For Office Use nl : Initials:
ve TOrq,� Inspectional Services Date Paid Amt Pd$ --
•
INSTABLESS. , Public Health Division �\'+ * .ash '3
a 9 ,0� 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 12/23/2020 NEW BUSINESS: NEW OWNERSHIP RENEWAL
NAME OF ADULT-ONLY RETAIL TOBACCO SALES ESTABLISHMENT. C.B. PERKINS
ADDRESS OF TOBACCO ESTABLISHMENT: 12 ENTERPRISE RD. HYANNIS MA. 02601
MAILING ADDRESS(IF DIFFERENT FROM ABOVE): N/A
E-MAIL ADDRESS: Cbperkinscigars@gmail.com K BUSINESS PHONE: 508-790-1261
TELEPHONE NUMBER OF TOBACCO ESTABLISHMENT: �A-790-1261
OWNER'S NAME: ANIL DIWAN
OWNER'S ADDRESS:
CORPORATE NAME: SAI NATH CORP.
12 ENTERPRISE RD. HYANNIS MA. 02601
CORPORATE ADDRESS: CORPORATE FID#
ANNUAL: V SEASONAL: DATES OF OPERATION: / / TO
DAYS CLOSED EXCLUDING HOLIDAYS(EX.MONDAYS) N/A
DO YOU CURRENTLY POSSESS A STATE LICENSE TO SELL CIGARETTES? Yes V No
DO YOU CURRENTLY POSSESS A STATE LICENSE TO SELL CIGARS/SMOKING TOBACCO? Yes V No
TOWN OF BARNSTABLE CODE/MA GENERAL LAW INTERNET LINKS:
TOWN OF BARNSTABLE TOBACCO CODE LINK FOR CHAPTER 371-9:
https://www.ecodc360.com/33996392
MA GENERAL LAW CHAPTER 270/SECTION 6:
httl2s:Hmalegislature.gov/Laws/General Laws/PartfVtTitlel/Chapter270/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: �'""rM_,,��w"•
PRINTED NAME. AN I L D I WAN
Q:\Application Forms\TOBACCO App 2020 ADULT Only Retail Tobacco Sales draft l.docx
12/23/2020
DATE:
C(3 ()CCIC��
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:
4-4. ANIL DIWAN 12/23/2020
Signature Printed Name Date
P/x / y" PRIYA PATEL 12/23/2020
Signature Printed Name Date
L,_, CHANDRIKA PATEL 12/23/2020
Signature Printed Name Date
Signature Printed Name 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
I
Commonwealth of Massachusetts Letter ID:L1179406656
Department of Revenue Notice Date:November 30,2020 91'
Geoffrey E.Snyder,Commissioner Account ID:CRL-11119500-009
Alir
�,1 Q mass.gov/dor
RETAILER LICENSE FOR SALE OF CIGARS AND SMOKING TOBACCO
���II"IIIIII � illll""III'II'�I�II�IIil�llll �llll�l'll'll
SAI NATH CORP
o=_ CB PERKINS,TOBACCONIST
12 ENTERPRISE RD STE 1
HYANNIS MA 02601-2253
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
•-----------------------------------------------------------------------------------------------------------------------------------------------
�55w sF� MASSACHUSETTS DEPARTMENT OF REVENUE Form CT-3T
A Retailer License for Sale of Cigars and Smoking Tobacco
g�7vr ov4 This license must be posted and visible at all times.The sale of tobacco
products to anyone under 21 years of age is prohibited.
SAI NATH CORP Account ID: CRL-11119500-009
CB PERKINS,TOBACCONIST License Number: 1628129280
12 ENTERPRISE RD
HYANNIS MA 02601-2253
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 30, 2020 Expiration Date: September 30, 2022
Commonwealth of Massachusetts Letter ID:L1501245760 -
m Department of Revenue Notice Date:November 30,2020
Geoffrey E.Snyder,Commissioner Account ID:CGL-11119500-006
rg t Olt 8 mass.gov/dor
RETAILER LICENSE FOR SALE OF CIGARETTES
SAI NATH CORD
o= CB PERKINS,TOBACCONIST
o-
N= 12 ENTERPRISE RD STE 1
HYANNIS MA 02601-2253
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
•-----------------------------------------------------------------------------------------------------------------------------------------------
55pxc sc MASSACHUSETTS DEPARTMENT OF REVENUE Form CT-3
mA I Retailer License for Sale of Cigarettes
Nv" T 0* This license must be posted and visible at all times.The sale of tobacco
products to anyone under 21 years of age is prohibited.
SAI NATH CORP Account ID: CGL-I 1119500-006
CB PERKINS, TOBACCONIST License Number: 1192007680
12 ENTERPRISE RD
HYANNIS MA 02601-2253
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 30,2020 Expiration Date: September 30, 2022
== �s Department of Revenue Notice Date:June 10,2020 U-13K
? Geoffrey E.Snyder,Commissioner Account ID:EDL-I 1119500-012
OV mass.gov/dor
LICENSE FOR SALE OF ELECTRONIC NICOTINE DELIVERY SYSTEMS
Ilnlnlll I nl hull I Inl II I III n I II
SAI NATH CORP
o= C.B PERKINS
m 12 ENTERPRISE RD STE I
HYANNIS MA 02601-2253
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
----------------------------------------------------------------------------------------------------------------------------------------------
MASSACHUSETTS DEPARTMENT OF REVENUE
J
f Retailer License for Sale of Electronic Nicotine Delivery Systems
fir: This license must be posted and visible at all times. The sale of
''E:�-r or�
tobacco products to anyone under 21 years of age is prohibited.
SAI NATH CORP Account ID: EDL-1 1 1 19500-012
C. B PERKINS License Number: 1855461376
12 ENTERPRISE RD
HYANNIS MA 02601-2253
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:June 10, 2020 Expiration Date: September 30,2022
v �
Massachusetts Departmer't of Revenue s�
E Customer Service Bureau
PCB Box 7010
Boston MA 02204
s. . qw*`,6N.,---;-,,-,;:-
e vendor herein named is registered to sell:tangible""""ersenal r€ ert at retail or, or-resales purrsuant to tl,e
General Laws, Chapters 62C, 64H and 641.. This re�i tratren is effective only for he registrant at the location
specified herein. Any charge of name or address must be reported to the Department of revenue so that a
correct STA can be issued.
MEICVO
SAI MATH CORPNUMBER
AINATHCORP 141-g48- 3tl
=12 ENTERPRISE RD,.
HYAN IS .ice 02601 m
Ot1Q t/03
. s
`This rug�sfiration must; d splaye� for customs ,to see and x .not a s ual a or Iran t .
I
Bellaire. Dianna
From: Bellaire, Dianna
Sent: Wednesday,January 06,2021 11.41 AM
To: priyaapatell3@gmail.comrcbperkinscigars@gmail:com;anildiwan100@yahoocom-
Cc: Bellaire, Dianna
Subject: 2021 Tobacco Permits-for-CB perkins and-CB perkins Lounge
Importance: High
Ha,
I've received your applications for both but,I am still waiting for the payments to come in the mail. I am working from
home today,I will be in the office tomorrow. I will check to see if they arrived tomorrow.
We have some problems with your tobacco licenses, You will need-to-contact the person in charge of obtaining or fixing
your MA State Tobacco Licenses. The following problems need to be fixed:
CB PERKINS-12 ENTERPRISE ROAD-SAI NATH CORP
MA Cigarette License-NO License with Sai Nath Corp on the license,you gave me New Sedgwick only
MA Cigar License--NO license with Sai Nath Corp on the license,you gave me New Sedgwick only
MA Electronic License-Is correct and has the correct corporate name
CB PERKINS&LOUNGE-649 MAIN STREET-NEW SEDGEWICK INC
MA Cigarette License-Has the correct corporate name but shows the DBA as Puff the Magic-This needs to be changed
MA Cigar License-Has the correct corporate name but shows the DBA as Puff the Magic-This needs to be changed
MA Electronic Delivery-There is NO Electronic Delivery Systems License with NEW SEDGEWICK INC-you need to have
one for this corporation. You only provided SAI NATH CORP.
We require proof of Federal Tax ID Number. Please provide proof of both FED ID#'s for both businesses.You didn't
provide the proof,only the number. They must be separate.
Please let me know the status as soon as possible.You are currently operating under an expired permit and these need
to be corrected immediately.
Thank you.
Dianna Bellaire
Permit Technician
Town of Barnstable
Health Division
200 Main Street
Hyannis,MA 02601
P:508-862-4643
Fax:508-790-6304
Email:Dianna.Bellaire@town.barnstable.ma.us
The information contained in this electronic transmission("e-mail' ,including any attachment(the"Infbrmation'�,may be confidential or
otherwise exempt from disclosure.It is for the addressee only.This Information may be privileged and confidential work-product or a
privileged and confidential communication.The Information may also be deliberative and pre-decisional in nature.As such,it is for
internal use only.The Information may not be disclosed without the prior written consent of the Director of Public Health and/or the
Town Attomey's Office of the Town of Barnstable. If you have received this e-mail by mistake,please notify the sender and delete it from
your system.Please do not copy or forward it.Thank you for your cooperation.
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Town of Barnstable BOARD OF HEALTH
John T.Norman
Board of Health Donald A.Guadagnoli,M.D.
BARNSTAB e. Paul J.Canniff,D.M.D.
MAM 246539. 200 Main Street, Hyannis, MA 02601 F.P. Thomas Lee Alternate
a � 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: 1037 Issue Date: 1/1/2020
DBA: C.B. PERKINS
OWNER: C. B. PERKINS
Location of Establishment: 12 ENTERPRISE ROAD HYANNIS, MA 02601
Type of Business Permit: Adult Only
Annual Seasonal
10 FEES YEAR: 2020
TOBACCO SALES: $85.00
Permit Expires: 12/31/2020
Q"
Thomas A. McKean, RS, CHO, Health Agent
Restrictions:
PLEASE POST CONSPICUOUSLY
For Office Us
Town of Barn Initials: G•Cstable Date Paid O 1� �Amt P�$
Inspectional Services m
• MAW
p Public Health Division
" Thomas McKean,Director
200 Main Street,Hyannis,MA 02601
Office: 508-8624644 Fax: 508-790-6304
ADULT ONLY RETAIL TOBACCO SALES PERMIT APPLICATION
DATE S ZO (MORITORIUM-NO NEW BUSINESSES) CHANGE IN OWNERSHIP RENEWAL
ADULT ONLY RETAIL TOBACCO SALES ESTABLISHMENT NAME: C. S. P E F-ks N 5
ADDRESS OF TOBACCO ESTABLISHMENT: I Z £ATE K?92 SE T-D. W AN N I5 M A, O Z 4a 1
MAILING ADDRESS(IF DIFFERENT FROM ABOVE): Nip,
E-MAIL ADDRESS: CbPer1CIMSciaarS OR !1MA11-Um
TELEPHONE NUMBER OF TOBACCO ESTABLISHMENT: Jr( 01 ) 790 - 12 41
OWNER'S NAME: A141L '1>IW AAl OWNER'S PH#(509)z47-_MT
OWNER'S ADDRESS: $3 006 KYANNIS A. +/14 ^cJH faI.T ft. C205
CORPORATE ADDRESS: Same as a bcve CORPORATE FID#
ANNUAL: SEASONAL: DATES OF OPERATION: / / TO
DAYS CLOSED EXCLUDING HOLIDAYS(EX.MONDAYS) A ON E
TOWN OF BARNSTABLE CODE/MA GENERAL LAW INTERNET LINKS:
TOWN OF BARNSTABLE TOBACCO CODE LINK FOR CHAPTER 371-4:
https://www.ecode360.com/33996392
MA GENERAL LAW CHAPTER 270/SECTION 6:
https://maleizislature.gov/Laws/GeneralLaws/PartIV/TitteI/Chgpter270/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:,/ PRINTED NAME: ANTL �TWAAI
DATE: Co l lS / .ZO
/Users/priyaa.patel/Downloads/TOBACCO ADULT ONLY APP Dtd 5-26-2020.doe
F� 1
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 1-
S 37 9 of the Town of Barnstable Board of
Health Prohibition of Smoking Regulation and Chapter 270 Section 6 of the Massachusetts General Laws:
AxTI bTWIAN 15 ZO-
Signature Printed Name p� Date
�igpnature Printed Name Date
ignature Printed Name Date
Signature Printed Name Date
Signature Printed Name Date
Signature Printed Name Date
Signature Printed Name Date
/Users/priyaa.patOlDownloads/TOBACCO ADULT ONLY APP Dtd 5-26-2020.doc
p4� p Town of Barnstable BOARD OF HEALTH
Paul J Canniff,D.M.D.
Board of Health Donald A.Gaudagnoli,M.D.
BAR.;x,ABLL John T.Norman
MIAS. F.P. Thomas Lee Alternate
o � 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: 1037 Issue Date: 07/24/2019
DBA: C.B. PERKINS
OWNER: C. B. PERKINS
Location of Establishment: 12 ENTERPRISE 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: QA
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:
pPrttO Town of Barnstable BOARD OF HEALTH
p t Paul J Canniff,D.M.D.
Board OI Health Donald A.Gaudagnoli,M.D.
uARNa'YABLr. John T.Norman
MAS& F.P. Thomas Lee Alternate
200 Main Street, Hyannis, MA 02601
Phone: (508) 862-4644 Fax: (508)790-6304
www.townofbarnstablems
Permit to Operate a Food Establishment
In accordance with regulations promulgated under authority of 105 CMR 590.000 M.G.L. Chapter 94 Sections
305A, 3056, 146, 189 and 189A; Chapter 111, Sections 5 and 127A, a permit is hereby granted to:
Permit No: 1037 Issue Date: 12/20/18
DBA: C.B. PERKINS
OWNER: C. B. PERKINS
Location of Establishment: 12 ENTERPRISE ROAD HYANNIS MA 02601
Type of Business Permit: RETAIL FOOD
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:
FROZEN DESSERT: Thomas A. McKean, RS, CHO, Health Agent
TOBACCO SALES: $85.00
FOR ESTABLISHMENTS WITH SEATING:
PERMIT IS NOT VALID UNLESS ISSUED IN CONJUNCTION WITH A COMMON VICTUALER LICENSE
Restrictions:
I Town of BarnstableOffice: 508-862-4644
Fax: 508-790-6304
Regulatory Services Department
enxNsrna Public Health Division
q MASS. Thomas A.McKean,CHO
s659. �$
�. 200 Main Street, Hyannis, MA 02601
Payment Receipt
'Food Service Permits Payment received: $85.00 (Cash) on 12/28/2018
I '
i
lBusiness: C.B. PERKINS Owner: BRENNER LEVY ASSOCIATES LLC
jAddress: 12 ENTERPRISE ROAD, Hyannis
Note: For Tobacco, signed and submitted new reg. YR 2019
1
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
ESTABLISHMENT NAME (DB/A)
QlA kAtxmls � MR 016, 01
ADDRESS OF BUSINESS
MAILING ADDRESS (IF DIFFERENT FROM ABOVE)
O'kv\W
v30% a0:7--SM
*A�00--Vy
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).
Signat>re'
r �� Date
19, i
h � -
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 Date
Signature Printed Name Date
elk
Signature Printed Name Date
Signature Printed Name Date
Signature Printed Name Date
Signature Printed Name Date
s _
;Y.. Town of Barnstable G� 0
Public Health Division j4k 6a66i
' '"M `E 200 Main Street, Hyannis MA 02601
s6;9.
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 you should have any questions,please contact Thomas McKean,Director of Public Health, at(508)
862-4644.
QDU LV4D
Persons under the age of 21 are not
permitted to enter this establishment
TOWN OF BARNSTABLE
a � �
B"R"/S& ' BOARD OF HEALTH
e
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.
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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
LOCATION SEWAGE PERMIT NO.
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VILLAGE
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A & B CESSPOOL SERVICE
128 BISHOPS TERRACE, HYANNIS, MA 02601
BUILDER OR OWNER
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DATE PERMIT ISSUED
DATE COMPLIANCE ISSUED
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THE COMMONWEALTH OF MASSACHUSETTS
BOAR® OF HEALTH
Town............OF.......B aM5.t able....
Appliration for Disposal Works Tonotrurtion rrntit
Application is hereby made for a Permit to Construct ( ) or Repair (x) an Individual Sewage Disposal
System at:
..12 Enterer se..Roa,.._IiYxl�ls � Q �4� ........... ...... ....-
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Location-Address or Lot No.
..Dubois & Thurston .................................................. 1 ntex�x e..F30 .c1,--.Hyat�.nz .....D26L......_.
Owner Address
aA & B Cesspool ServiceInc.
Installer Address
Type of Building Size Lot............................Sq. feet
Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( )
Other—Type of Building No. of persons............................ Showers
� YP g ---------------------------- P ( ) -- Cafeteria ( )
Otherfixtures ...--•--------------------------------------------••--.••------•-••-•--•-----.....---••-
W Design Flow............................................gallons per person per day. Total daily flow............................................gallons.
04 W Septic 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 ( )
aPercolation Test Results Performed by.......................................................................... Date........................................
Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................
f3;q Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
---•--••----------------------•-------•---------------.....•-----........-----•......----..._...............................................................
ODescription of Soil-••-••--•--....Sand................................................................................................................................................
x
W -•---------------------------------•-•-••-------•-•--------------------------....------•---------------------------------------------------- -------------- .......................CGrease_:TraP)
U Nature of Repairs or Alterations—Answer when applicable.....installation of a_ 1,000 gallonseptic__-tall,
distribution box,--and_ a 600___.a1. leach.Pitoverflow)
Agreement:
The undersigned agrees to install the ,.foredescribed Individual Sewage Disposal System in accordance with
the provisions of TITLij 5 of the State Sanitary Code— The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has been issued by th board of ealth.
j
Signed/.---•... . ..i_°�. ... -.. ._ 91181. ...
Application Approved By...............••• 911 '
Date
Application Disapproved for the following reasons: ---------------------------•-•------------------------•--------- ...........................................
.................•-•-----•----•••---------•-•-•-......--•••-.._...--••••-••---------------...•----........---...--•-•••--------------------•••--•--•-------•-----••-•-----•---•••----•••-•••---------•---
Permit No......8 ----•--•..................•-•------••....... Issued-_---9�18/84
au
Date
.e:....�.._��.....
F�s...$...,.5.,.QQ...
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THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TQZaTn OF.......Pc127�5 .........................................................
Appltratiun for Biopootti Workii Tonitrurtion ramit
Application is hereby made for a Permit to Construct ( ) or Repair (x ) an Individual Sewage Disposal
System
at:
•-il+5i �i}TRa._-7�e'i.. Y...iz v7i buy...P:�.....kllv�J01..... ------•---------------------------------•------------------.-------_---•--•-•-------••--_-•--•--._
t Location-Address or Lot No.
.-Dubin.s-&- la Stow..------. ---•------•---------- 12—Entar.Ix .. o T- 3T i_ ,..^?- -----02&.!Address
W A-&_�._Ger3s�oo1 Sex�ryc�, Tani¢----------------------------- 12 -- i�la� s--'I erxa ce, '•,3 rax:i�,._Tr A....D?.601.......
1.4 Installer
M Address
UType of Building Size Lot............................Sq. feet
Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder
pa,I Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( )
Otherfixtures ---------------------------------------------------------------------------------•-•---------•--------... 1\
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........................................ .r
Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................
fZq Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
r
a ••••••-•-•••--------•-------••••-••-•••••-•••-••-•••••--------•-•••-•--•----••--._....-•--•-•-------------••----•-------------•-........----•-.............•
DDescription of Soil---------------Saxd............................................................................................................................................... �.
U -- t
c -------------•••••••••......••-•-----•----...•----••••.......-----..........---••-•••••••--_.....----•--•-•--•-••----••••••••••••----..._.....-•-------•••............•••••.
W ....................•---...------••••-•••-•-------------------------------•---.....••••••--------••••-••-•••-•---------......__...••••-------•••-•••......-•-•----••---•••••• (Gxvase...ra )
P
VNature of Repairs or Alterations—Answer when applicable....insta,llatioU--Qf._.--.!_,000..t;allon,_seFtic--ta�C,
9...............---••••••-•--•••••.............•---•--------•-•-.•----
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TITLE:, 5 of the State Sanitary Code—The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has been issued by the board—of health.
.............
Application Approved B ���/ 9/1�
Date
Application Disapproved for the following reason : ------------------••-------------------------------------------------......--••--. ---••--------_..._
...........................................................................................•---...---....._...........---------------------------------------------------------------...................
Date
Permit No...... ........................................... Issued......2/1 /
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
........................Ta n......OF..���.�nstable
... .........................................................••-
Tutifiratr of Toutphaurr--
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired )
T►:n............12P-Ui b9Ps_Te -------------------•-•----
12 EnterpriseInstaller
at.................. . Plaza,_--Hyannis,-• ?A-----0�0 ---'- 0uho3s_&__Thurston-----........-•-------•-----------------------
has been installed in accordance with the provisions of TITLE 5 of The''State Sanitary Code, as described in the
application for Disposal Works Construction Permit NoA,?2---I'________________-..... dated_9/01 /.8:..._______.___............_...
THE ISSUANCE OF THIS CERTIFICATE: SHALL NOT BE CONSTRU AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE.................................. ............................. Inspector........ -• •-•---------•••-••......---------••----•--•--•----------••............
F ,�I
i
I
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
..........................701M......OF.....1? xx>�atAble......----.....--;a . �
.--....... ..................... 15.00
No.... --•-� ........................
wtup000l Workv Twonufrttrtiou 1phrmit
Permission is hereby granted......A & I''.Ce i2491..��� !3�C8+ ................•---,-----------•--------•-------.....--•--.....------
to Construct ( ) or;Repair (Y. ) an Individual Sewage Disposal System
at No.--12•-2r1teX.M1 4..?'laZ �_.uYannis,...NA.....02601__ Dubois & Th1rtQn
Street
as shown on the application for Disposal Works Construction Permit No.&4n.....__..... Dated........ ..................
---------------- ....................................................
............................................................
Board of Health
DATE .. 1834
FORM 1255 A. M. SULKIN, INC., BOSTON
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