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Home My WebLink AboutHYANNIS SMOKE SHOP - RETAIL FOOD tHyannis Smoke Shop �---- -- --- - - - - �� -276 Falmouth Rd #6, H � t BOARD OF HEALTH Town of Barnstable John T.Norman Board of Health Donald A.Guadagnoli,M.D. BAST i l'ADM r F.P.(Thomas)Lee 0 200 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: 1109 Issue Date: 1/1/2021 DBA: HYANNIS SMOKE SHOP OWNER: SATYA PATEL CORPORATION Location of Establishment: 276 FALMOUTH ROAD HYANNIS, MA 02601 Type of Business Permit: Adult Only Annual Seasonal FEES YEAR: 2021 TOBACCO SALES: $85.00 Permit Expires: 12/31/2021 Thomas A. McKean, RS, CHO, Health Agent Restrictions: PLEASE POST CONSPICUOUSLY For Office Use Only: Initials: oFIHKE Town of Barnstable do Date Paid lk ZoAmt Pd$ ^ Inspectional Services BARNSTABLE t0 9 , • Check# I MASS 039. 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 - 5'20 (MORITORIUM-NO NEW BUSINESSES) CHANGE IN OWNERSHIP RENEWAL✓ ADULT ONLY RETAIL TOBACCO SALES ESTABLISHMENT NAME:—TQ)S 6420&P 614 ADDRESS OF TOBACCO ESTABLISHMENT: 2 g rLnad to R��Ryun is /' 67Q/ MAILING ADDRESS(IF DIFFERENT FROM ABOVE): E-MAIL ADDRESS: TELEPHONE NUMBER OF TOBACCO ESTABLISHMENT: OWNER'S NAME: ��,i �p�� O..�P,l OWNER'S PH# I� j -, OWNER'S ADDRESS: L+S jr/0[,(ZGrL f}vj 1'S L-c /c%G/KIpA m I k? l CORPORATE ADDRESS: �/ J ii /i / CORPORATE ANNUAL: 14 T 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://www.ecode360.com/33996392 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 1S 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: ��, „-A D im PRINTED NAME: DATE: Q:\Application Forms\TOBACCO ADULT ONLY APP Dtd 5-26-2020.doc n Mae �t w ✓s ram• an z l - � s� 'u. rhiraoCc 4 �sw � 3mr'P� ' J,F -- ({gy 4y4y Yil�y:,��p ,,yyam� ♦ .vON v v � ` �S �ssa°'s1119 ��1vl+` i [Li3i,F, y4T ■ "✓ / ,�� e " kiss i fr. �c� at, „ttp1tbshtv� d � t Ctp� th ;`lCsi �at %t�tid iik` r�hi` sti �nStt fakir ` tbAMM tsA � i .� z � is eti mn N '. OW < flow �* "' "% prtsrkk kkpi v do ritkt67 lliliit'rNii to < 10 c � xl1 #3 ° L ktas � tAr tr2 �x�ck up t 4 .�itr 'ik tan 5G l ri y itt c ffi=tas r: r kt�t ct irrt �WE t i r ph itrictfixstrii the 47 Aat kii�rxt �kittr �. MugNz 0. gym VVII z � ta a lO € all k1itrrn rnil; K0is tri a� it �C aril ? �. � K Al ift ? ' � a � �yf q y �p q \k .if , '" K q:, "' e}#,Ie 2 F N.•.n � 3y'€ - U14 7Y;� i:�i t#�*1: N� 4R#f i�C kma.@. „ �q.,:'kp� sS „yak/ :-: sryl�' �5( ,, shy,� s �€ .''�i `� � •n xqw, . i s � < ..a. OR �s TMO y� -�' *� woA�p � Sw. �33k yf h 7A k � a q 5�a' � aW `� o f j 3 z 3 3 six �.' I. rilz a,H 4rr F " '� <•' r.w �� - .r,.ox' /fir c"�" 4� �.✓ gn Q 1 �•. f/ aF� ' ' '" " j> As3� x� aww,zr •eas - ,� 4 '3sF sc, 'S» W— 3 y{ 3 ¢•,Y,i. / "' "9,%3 �wah, y 1 �E2'"k,3t 3tLYStq i�,;,q'€, •�" /•�'�9"'" ,k E'� s\A.. k` +,N saw /j r y pn A2loft C v Anxsz. az�rr'l' /ar �'✓.lH'.' cr<� ,,,, xE yd ' r Lsva ,w k a-x ' ✓.c .ayhn,,.,-:� n,+ �F A3 .....<:.<. ,.,,�,,,.:...,,.u;, ..s:.,., ,5 00 u� Commonwealth of Massachusetts Letter ID:L0575462976 s Department of Revenue Notice Date:October 7,2020 Geoffrey E.Snyder,Commissioner Account ID:CRL-19355429-006 mass.gov/dor RETAILER LICENSE FOR SALE OF CIGARS AND SMOKING TOBACCO 111111111111if111111111 Jill 111111'111111111111111111111111111Jill SATYA PATEL CORPORATION o= HYANNIS SMOKE SHOP o— o= 45 ENDLEIGH AVE BILLERICA MA 01821-6242 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 •----------------------------------------------------------------------------------------------------------------------------------------------- 4�sSAc"us MASSACHUSETTS DEPARTMENT OF REVENUE Form CT-3T Retailer License for Sale of Cigars and Smoking Tobacco Y ran r 0* This license must be posted and visible at all times.The sale of tobacco products to anyone under 18 years of age is prohibited. SATYA PATEL CORPORATION Account ID: CRL-19355429-006 HYANNIS SMOKE SHOP License Number: 1628538880 276 FALMOUTH RD HYANNIS MA 02601-2708 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 7, 2020 Expiration Date:September 30, 2022 I po sLs� Commonwealth of Massachusetts Letter ID:L2015326784 °t s Department of Revenue Notice Date:September 1,2020 Geoffrey E.Snyder,Commissioner Account ID:CGL-19355429-003 mass.gov/dor RETAILER LICENSE FOR SALE OF CIGARETTES SATYA PATEL CORPORATION o= HYANNIS SMOKE SHOP N� o= 45 ENDLEIGH AVE BILLERICA MA 01821-6242 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 •----------------------------------------------------------------------------------------------------------------------------------------------- MASSACHUSETTS DEPARTMENT OF REVENUE Form CT-3 Retailer License for Sale of Cigarettes 0* This license must be posted and visible at all times. The sale of tobacco products to anyone under 18 years of age is prohibited. SATYA PATEL CORPORATION Account ID: CGL-19355429-003 HYANNIS SMOKE SHOP License Number: 357509120 276 FALMOUTH RD HYANNIS MA 02601-2708 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. 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F4f ,g ; v}wM fH' ( l�)p #illE i�i N„K k. �""A1 $ � ��ri / c r y 3 v v " v � a,�i3' (i/f .� �� 3$m _auk a y - :. i Mgr �a'era 3r' "' �"` {�y ','�^•e�z Y�y a, ,4 r ,,:..xK��r l�k � ��" � A r `ems ,;_ r a l/. rr ' ;.: `✓ z z�c ra: - �. �h cr". v AH�z ' v rsc ",r' i ''" ''� ", , �� .r , „a.,, r 75 �a6 n R r, ss� ,"t`s ; t �:fi i � 1 # 3 t [ § l�( 9 { �5+� 1L1 y� , , YW a :z� Cx4 ,z,. ram. xk �' t � 1 t t€ itrayyyyit �� ' �iii25 a xv „f` �,y f sa t 0"3 r p C to �, �Rv� a and . '', t r 3 c y iy s H, ,� � k�uz3 �ffls } .ft ,� . ,v/ 1 � � � sae' e .:y 'eve w,as; � }� a i+ ��r :`i t^eD 7 ,4 a •z ,47 l ri�nr �5 may, - fx.p,�� 'Ws` ` u i -`�` `��£ t� 'sww s f s Town of Barnstable BOARD OF HEALTH John T.Norman Board of Health Donald A.Guadagnoli,M.D. �►RNnAnce, Paul J.Canniff,D.M.D. 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: 1109 Issue Date: 1/1/2020 DBA: HYANNIS SMOKE SHOP OWNER: SATYA PATEL CORPORATION Location of Establishment: 276 FALMOUTH ROAD HYANNIS, MA 02601 Type of Business Permit: Adult Only Annual Seasonal FEES YEAR: 2020 TOBACCO SALES: $85.00 Permit Expires: 12/31/2020 Thomas A. McKean, RS, CHO, Health Agent Restrictions: PLEASE POST CONSPICUOUSLY Town of Barnstable Inspectional Services Public Health Division Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 MAM tbsq For Office Use OnlK. Initials: Date Paid G6o7-ZOAmt Pd$ ADULT ONLY RETAIL TOBACCO SALES PERMIT APPLICATION DATE �l (MORITORIUM-NONEWBUSINESSES) CHANGE IN OWNERSHIP_ RENEWAL I/ ADULT ONLY RETAIL TOBACCO SALES ESTABLISHMENT NAME: HTS S'MO kE .SHOP ADDRESS OF TOBACCO ESTABLISHMENT: --l-�A�r1(9 V �OT r/1 AIS M 9&/ MAILING ADDRESS(IF DIFFERENT FROM ABOVE): P&o,)A 90 H.yandLS 1%4 02So/ E-MAILADDRESS: Z��y_ ?. 2 - TELEPHONE NUMBER OF TOBACCO ESTABLISHMENT: ( - ?30-9 OWNER'S NAME: 2 /161 IL✓4 h P �L OWNER'S PH#j ) j2'a OWNER'S ADDRESS: ik 5 d-lZe.6161;:X, /YID/e CORPORATE ADDRESS: U^S G/V 1�L TGr AVM CORPORATE FID# ?, 3ZLLe1elcA `MA. 0/6"a I 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://www.ecode360.com/33996392 MA GENERAL LAW CHAPTER 270/SECTION 6: https://malegislature.govALaws/GeneralLaws/PartIV/TitleUChapter270/Section6 ***NEW BUSINESSES AND NEW OWNERS ONLY*** A HEARING BEFORE THE BOARD OF HEALTH IS REQUIRED. THE BOARD MEETS ONCE PER MONTH. I 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 �r PRIOR TO PERMIT BEING ISSUED. SIGNATURE:_ PRINTED NAME: , az DATE: l ES BLISHMENT 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: ` p�.pZ_Zo2o Si a Printed ame Date ure Printed Name Date Signature Printed Name Date Signature Printed Name Date Signature Printed Name Date Signature Printed Name Date Signature Printed Name Date TOBACCO SALES TO MINORS PROHIBITED BY MASSAC14USETTS GENERAL LAWS 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. Persons,firms,corporations,or agencies selling tobacco products to minors or selling tobacco products without a tobacco sales permit shall be punished as follows: A.In the case of a first violation,a fine of one hundred dollars($100.00). B. In the 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 Product 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 Product 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 a Tobacco Product Sales Permit. Posting State Law — In conformance with Massachusetts General Laws, Chapter 270, Section 7, a copy of Massachusetts General Laws Chapter 270,Section 6 shall be posted conspicuously by the owner or other person in charge thereof in the shop or other place used to sell cigarettes at retail. The notice to be posted shall be that notice provided by the Massachusetts Department of Public Health. Such notice shall be at least 48 square inches and shall be posted at the cash register which receives the greatest volume of single cigarette package sales in such a manner so this may be readily seen by a person standing at or approaching the cash register. Such notice shall directly face the purchaser and shall not be obstructed from view or placed at a height of less than 4 feet or greater than 9 feet from the floor. For all other cash registers that sell cigarettes,a notice shall be attached which is no smaller than 9 square inches, which is the size of the sign provided by the Department of Public Health. Such notice must be posted in a manner so that it may be readily seen by a person standing at or approaching the 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. oa Commonwealth of Massachusetts Letter ID:L0481061440 Department of Revenue Notice Date:May 14,2020 Geoffrey E.Snyder,Commissioner Account ID:EDL-19355429-010 00 mass.gov/dor LICENSE FOR SALE OF ELECTRONIC NICOTINE DELIVERY SYSTEMS II'��I�I�I�IyI��III�I�I� I��l��lilll��'ll�'I�II ��1�11111�11i ® SATYA PATEL CORPORATION o® HYANNIS SMOKE SHOP 45 ENDLEIGH AVE ® BILLERICA MA 01821-6242 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 -------------------------------------------------------------- �cHc�S�� MASSACHUSETTS DEPARTMENT OF REVENUE Retailer License for Sale of Electronic Nicotine Delivery Systems This license must be posted and visible at all times. The sale of tobacco products to anyone under 21 years of age is prohibited. SATYA PATEL CORPORATION Account ID: EDL-19355429-010 HYANNIS SMOKE SHOP License Number: 1753356288 276 FALMOUTH RD Age-Restricted Store HYANNIS MA 02601-2708 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. 3 Effective Date:May 14, 2020 Expiration Date: September 30, 2022 1 l Town of Barnstable THE BOARD OF HEALTH Paul J Canniff,D.M.D. " 1 Board of Health Donald A.Gaudagnoli,M.D. �'"l6Alit 7AIb4t.I John T. Norman F.P. Thomas Lee Alternate 200 Main Street, Hyannis, MA 02601 Phone: (508) 862-4644 Fax: (508)790-6304 www.townofbarnstable.us Permit to Operate a Food Establishment In accordance with regulations promulgated under authority of 105 CMR 590.000 M.G.L. Chapter 94 Sections 305A, 305B, 146, 189 and 189A; Chapter 111, Sections 5 and 127A, a permit is hereby granted to: Permit No: 1109 Issue Date: 06/13/2019 DBA: HYANNIS SMOKE SHOP OWNER: SATYA PATEL CORPORATION Location of Establishment: 276 FALMOUTH ROAD HYANNIS, MA 02601 Type of Business Permit: TOBACCO Annual: YES Seasonal: IndoorSeating: 0 OutcloorSeating: 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: a� 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: ► — 03 y FIHE r � Town of Barnstable For Office Use Qnly:Date Paid Amt P Initials' als`sy, _ '_ i Inspectional Services Check# CpSh ='"x sb3q.�� Public Health Division °7 =ry ,0 200 Main Street,Hyannis MA 02601 I W T'•1(D Office: 508-790-4644 Thomas A.McKean,RS,CHO 4X: FAX: 508-790-6304 Director of Public Health Fee: $85.00 x°; 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 HMN&L91y7oKb-Sho te ESTABLISHMENT NAME (D/B/A) d�5' &Zy77otvM Rd, U �e�- 64 H '71ANIMIS;Ind- 0-�6 01 -Mk ADDRESS OF BUSINESS a 1- 1 Ste, 8(kkk'i - ®-?L 3 C I MAILING ADDRESS (IF DIFFERENT FROM ABOVE) Pd;W ._.__.-.__OWNE 'S NAME:---LAST— _._FIRST------._- ___.. _ 66C Liyzj9 -(c '91y14SW- h�&6 EMAIL PHONE# FEDERAL ID# Do you currently possess a state license to sell tobacco products? Yes V/ 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 Signature S 4 el Date Q:Wpplication Forms\TOBACCO APP2019 dob.docx 7o Act 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: o f Signature Printed Name Date e 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 Of Commonwealth of Massachusetts Letter ID:L0468069248 Department of Revers" Notice Date:June 12,2019 •, %vol Christopher C.Harding,Commissioner Account ID:SLS-19355429-007 , mass.gov/dor SALES AND USE TAX REGISTRATION CERTIFICATE ��''ll'�III�I'��Illhlldll�r"II�II��'I�rirlllll'rlrllrr'll'1�� ® SATYA PATEL CORPORATION g HYANNIS SMOKE SHOP 45 ENDLEIGH AVE s� BILLERICA MA 01821-6242 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 ------ -----------------------------------------------------------------------------------------------------------M---------------------------- �`"`'SF� MASSACIIUSETTS DEPARTMENT OF REVENUE Form ST-1 ' Sales and Use Tax Registration Certificate 9 �M p This registration must be posted and visible at all Fm ov times. SATYA PATEL CORPORATION Account ID: SLS-19355429-007 HYANNIS SMOKE SHOP Certificate Number:439756800 276 FALMOUTH RD HYANNIS MA 02601-2708 This certifies that the taxpayer named above is registered under Chapters 62C,64H and 64I 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:July 1,2019 AlQ,1' e� y Town of Barnstable ti Regulatory Services &1 A&%LE X • Public Health Division A$S. 9 i639 ,�� Thomas McKean,Director 200 Main Street, Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 M: SEPTEMBER 11, 2019 HYANNIS Sn70KE SHOP c/o SHAILESH PATEL 1666 MAIN STREET BROCKTON, MA 02301 IMPORTANT NOTICE 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 a Town of Barnstable y Public Health Division snMsTAetE. mass. 200 Main Street, Hyannis MA 02601 1p6.39. p1 Office: 508-862-4644 FAX: 508-790-6304 r` ptember 10,2019 _p'`� NOTICE TO ALL OWNERS OF ADULT-ONLY RETAIL TOBACCO STORES 91' k Entrance of Persons All owners of adult-onlyretail tobacco stores are reminded to ensure full compliance with Section 371-1 p 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. r _ IREU UL Persons under the age of 21 are not permitted to enter this establishment TOWN OF BARNSTABLE BOARD OF HEALTH �MO 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. --------------------------------------------------------------------------------------------------------------------------------------------------- ------------------- 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 r Town of Barnstable s Building Department Services ��F THE Tp� P ti� Brian Florence, CBO AAA. Building Commissioner BARNSTABLE + BARNSTABLE, i — `ai�ss'x is MASS. ' 'u'— n ;iee,e 200 Main Street, Hyannis, MA 02601 OVE b,,,o„ AIEDMA'�A www.town.barnstable.ma.usg Office: 508-862-4038 Fax: 508-790-6230 August 20, 2019 Bhadresh Patel 88 Constance Avenue West Yarmouth,MA 02673 _5L-Cl RE: Site Plan Review#049-19 New Convenience Store and Smoke Shop 276 Falmouth Rd, Hyannis Map 293, Parcel 031 Proposal: Applicant is seeking to establish a new Convenience Store "Lucky Mart" in Unit 5 and a new smoke shop "Hyannis Smoke Shop" in unit 6. Dear Mr. Patel: At the informal site plan review meeting held August 20, 2019,the above proposal was found to be approvable by the Site Plan Review Committee with the following conditions: At the Building Permit stage: 1. The Applicant will be required to submit a Building Code Analysis by a registered Architect. rr%mt 2. The u �rmust be shown as permanently separated4ith no access between. 3. An adequate set of plans must be submitted. Sincerely, Brian Floren e Building Co issioner CC: Site Plan Review Staff Town of Barnstable oFtHE l Building Department Services Brian Florence, CBO Building Commissioner BARNSTABLE * BAMSTABLE, 200 Main Street Hyannis MA 02601 MASS. .Ssmss vnu.rxncr;u•.:xsacnea;= 9^ 1639, 10 '/ / Efi39-2°14 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 August 20, 2019 " Bhadresh Patel 88 Constance Avenue West Yarmouth, MA 02673 RE: Site Plan Review#049-19 New Convenience Store and Smoke Shop 276 Falmouth Rd, Hyannis Map 293, Parcel 031 Proposal: Applicant is seeking to establish a new Convenience Store "Lucky Mart"in Unit 5 and a new smoke shop"Hyannis Smoke Shop" in unit 6. Dear Mr. Patel: At the informal site.plan review meeting held August 20, 2019,the above proposal was found to be approvable by the Site Plan Review Committee with the following conditions: At the Building Permit stage: 1. The Applicant will be required to submit a Building Code Analysis by a registered Architect. r ��0 �� a 2. The uirits must be shown as permanently separated4 ith no access between. 3. An adequate set of plans must be submitted. Sincerely, Brian Floren e Building Co issioner CC: Site Plan Review Staff I ` •r, __. .: .,_. ... � _ ; � •� .•ACV' f,, � - C . � 40 4> 41-' I► t ` <�S�r SIC0 ke-- IRDEPARTMENT OF THE TREASURY li�►J INTERNAL REVENUE SERVICE CINCINNATI OH 45999-0023 Date of this notice: 06-11-2019 Employer Identification Number: 84-2054205 Form: SS-4 Number of this notice: CP 575 A SATYA PATEL CORPORATION 45 ENDLEIGH AVE BILLERICA, MA 01821 For assistance you may call us at: 1-800-829-4933 IF YOU WRITE, ATTACH THE STUB AT THE END OF THIS NOTICE. WE ASSIGNED YOU AN EMPLOYER IDENTIFICATION NUMBER Thank you for applying for an Employer Identification Number (EIN). We assigned you EIN 84-2054205. This EIN will identify you, your business accounts, tax returns, and documents, even if you have no employees. Please keep this notice in your permanent records. When filing tax documents, payments, and related correspondence, it is very important that you use your EIN 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 the attached tear off stub and return it to us. Based on the information received from you or your representative, you must file the following form(s) by the date(s) shown. Form 941 01/31/2020 Form 940 01/31/2020 Form 1120 04/15/2020 If you have questions about the form(s) or the due date(s) shown, you can call us at the phone number or write to us at the address shown at the top of this notice. If you need help in determining your annual accounting period (tax year), see Publication 538, Accounting Periods and Methods. We assigned you a tax classification based on information obtained from you or your representative. It is not a legal determination of your tax classification, and is not binding 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 2004-1, 2004-1 I.R.B. 1 (or superseding Revenue Procedure for the year at issue). Note: Certain tax classification elections can be requested by filing Form 8832, Entity Classification Election. See Form 8832 and its instructions for additional information. II4POF4MM INFORMATION FOR S CORPORATION REACTION: If you intend to elect to file your return as a small business corporation, an election to file a Form 1120-S must be made within certain timeframes and the corporation must meet certain tests. All of this information is included in the instructions for Form 2553, Election by a Small Business Corporation. j (IRS USE ONLY) 575A 06-11-2019 SATY B 9999999999 SS-4 If you are required to deposit for employment taxes (Forms 941, 943, 940, 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 the 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 immediately, you will need to make arrangements with your Financial Institution to complete a wire transfer. The IRS is committed to helping all taxpayers comply with their tax filing obligations. If you need help completing your returns or meeting your tax obligations, Authorized e-file Providers, such as Reporting Agents (payroll service providers) are available 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, telephone numbers, and links to their Web sites. To obtain tax forms and publications, including those referenced in this notice, visit our Web site at www.irs.gov. If you do not have access to the Internet, call 1-800-829-3676 (TTY/TDD 1-800-829-4059) or visit your local IRS office. IMPORTANT REM33MERS: * Keep a copy of this notice in your permanent records. This notice is issued only one time and the IRS will not be able to generate a duplicate copy for you. You may give a copy of this document to anyone asking for proof of your EIN. * Use this EIN and your name exactly as they appear at the top of this notice on all your federal tax forms. * Refer to this EIN on your tax-related correspondence and documents. If you have questions about your EIN, you can call us at the phone number or write to us at the address shown at the top of this notice. If you write, please tear off the stub at the bottom of this notice and send it along with your letter. If you do not need to write us, do not complete and return the stub. Your name control associated with this EIN is SATY. You will need to provide this information, along with your EIN, if you file your returns electronically. Thank you for your cooperation. (IRS USE ONLY) 575A 06-11-2019 SATY B 9999999999 SS-4 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: 06-11-2019 ( ) - EMPLOYER IDENTIFICATION NUMBER: 84-2054205 FORM: SS-4 NOBOD IWERNAL REVENUE SERVICE SATYA PATEL CORPORATION CINCINNATI OH 45999-0023 45 ENDLEIGH AVE BILLERICA, MA 01821 I Crocker, Sharon From: Crocker, Sharon Sent: Wednesday, October 02, 2019 9:56 AM To: Aaron Bornstein (tbusby@hollymanagement.com) Subject: Tobacco Employee Signatures - Attachments: Tobacca Employee Signatures -.pdf Stu 508-328-9090 Stu, Here is the form for Hyannis Smoke Shop employees—looking for employees who do not work at Lucky's Convenience. And as mentioned, once store is all set, we'll have tobacco inspector do a quick inspection and it'll be up and running. Regards, Sharon Crocker 1 Town of Barnstable pOHE ram, Building Department Services gyp` y0 Brian Florence, CBO SARNbTABLE Building Commissioner BARNSTABLE p, MASS, f s%ti a osiiiv`LLiiecDzisv h i;r Cb t639 `�$ 200 Main Street, Hyannis,MA 02601 ,69-2014 iOTEa MAC a www.town.barnstable.ma.as5 Office: 508-862-4038 Fax: 508-790-6230 August 20,2019 Bhadresh Patel 88 Constance Avenue West Yarmouth,MA 73 RE: Site Plan Review#049-19 New Convenience Store and Smoke Shop aietxth�a;Hyannis Map 293,Parcel 031 Proposal: Applicant is seeking to establish anew Convenience Store "Lucky Mart"in Unit 5 and anew smoke shop-"I�i� .yanriis Sm ce Shoplt4n unit 6. Dear Mr. Patel: At the informal site plan review meeting held August 20,2019,the above proposal was found to be approvable by the Site Plan Review Committee with the following conditions: At the Building Permit stage: 1.The Applicant will be required to submit a Building Code Analysis by a registered Architect. 2. The units must be shown as permanently separated with no access between. 3.An adequate set of plans must be submitted. Sincerely, f 1 I Brian Floren e Building Co missioner -< f CC: Site Plan Review Staff f 22 S I APPLICATION FOR SITE PLAN"REVIEW Subdivision Plan ANR Plan LOCATION: Cn' �L Site Plan Business Name: Assessor's Map# Par el# Y C7j Property Address: Q � Hqaml- 6 APPLICANT / /J !� Name: I7u c��s' 9i n T S 5�"1( v Yl l� Address: nee OWNER OF ROP�ERTY n_ w� °L'I Name: k 57 �4U'd9" /5�1 nS t n Telephoner 1d3 (o�-'� )�j Address: Fax- 4 • C9� Telephone: ( 5 0 •, bb Cz-&6-e-s" ed l q Yl T e V�Do WA_ Fax: : AGENT/ATTORN Y "Name- M rf- 2_— ,61 _11-w-)" Address: ARCH ITECT/DEVELOPER/CONTRACTOR/EN GINEER Name: Telephone•�a �- U Address: Fax: Telephone: Fax: ZONING D -TRICT CLASSIFICATION District _ Overlay(s)__Aj0 Lot Area Sq.Ft. Ac. STORAGE TANKS(HASMAT/FUEL OR WASTE OIL) Fire District Setbacks(ft.) Existing Proposed Number Number Front Side Rear Size . Size Above Ground Above Ground Number of Buildings Underground Underground Existing Proposed Contents Contents Demolition TOTAL FLOOR AREA BY USE: UTILITIES Basement Ex' ' .M. ro oso Fil•_ Residential _ Sewer-f Public ❑ Private Size gal #of Bedrooms Water-; ,Public ❑ Private Restaurant Retail' ` M� Electric- ❑ Aerial ❑ Underground Office Gas; ❑Natural ❑ Propane Medical Office Commercial(specify Grease Trap- ❑ Size gal Wholesale(specify) Sewage Daily'Flow * gal Institutional(specify) Industrial(specify) All Other Uses On Site PARKING SPACES CURB CUTS Gross Floor Area Required Existing_"",,� Provided Lr Proposed On-Site To Close_ I Off-Site Totals Handicapped o * GP or WP areas restrict wastewater discharge to 330 gallons per acre per day into on-site system. E i Old King's Highway Regional Historic District File# Approved? ❑ Yes ❑ No Hyannis Main Street Waterfront Historic District-File# Approved? ❑ Yes ❑ No Listed in National and/or State Register of Historic Places? ❑ Yes ❑ No Previous Site Plan Review File# Approved? ❑ Yes ❑ No Previous Zoning Board of Appeals File# Approved? 0 Yes ❑ No Is the site located in a Flood Area(Section.3-5 1) 0 Yes ❑ No In:Area of Critical Environmental Concern? ❑ Yes ❑ No Isthe Project within 100' of Wetland Resource Area? ❑ Yes ❑ No Site sketch—informal presentation ❑ Yes ❑ No Site Plan prepared,wet stamped and signed by a Registered PE and/or PLS. ❑ Yes ❑ No Parking and Traffic Circulation Plan ❑ Yes ❑ No Landscape Plan and Lighting Plan ❑ Yes ❑ No Drainage Plan with calculations and Utility Plan ❑ Yes ❑ No Building Plans,(all floor plans,elevations and cross sections) ❑ Yes ❑ No Note that all siQna¢e must be approved by Code Enforcement Office at the Building Department Lot area in sq.ft. sq.ft: Total.Building(s)footprint sq ft. Maximum Lot Coverage as%of Lot % GROUND WATER PROTECTION OVERLAY DI'SCTICT REQUREMENTS: DISTRICT; Lot Coverage(%) Required. Proposed Site Clearing(%)Required Proposed PRINCIPAL BUILDING ACCESSORY BUILDINGf) ❑ Yes ❑ No Number of floors Height' ft. Number of floors Height: ft. FLOOR AREA: FLOOR AREA: Basement sq. ft. Second sq.ft. Basement sq.ft. Second. sq.ft. First sq.ft. Attic sq,ft. First sq.ft. Attic sq:ft. Other(Specify) sq.ft. Please provide a brief narrative of your proposed project: 1 assert that I have completed(or caused to be completed)this page and the Site Plan Review Application and that; to the best of my knowledge,the information submitted here is true. Signature of Applicant Date JAac6sL &kl( Printed Name of Applicant 1� � i _��1'`\\ .q,a.M ��•�— 'L r i�"�.v.,-.sue,r ,� u,n��•'•• ��-, SltF PGN Rd'yl;fr 41 TA: -- i PROPOSED 22.2b SF� a i o 5 SITE PLAN -}- �'' �P� ✓' HYANNfS (EARNSTABLE)MA. 16 ERAS..._ rm.�roa.rtrt HOLLY MANAGEMENT CO. 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