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HomeMy WebLinkAboutSEA STREET FOOD MART - RETAIL FOOD Sea Street Food Mart St. , 231 Sea 'HYA 36`7- 6a_; � _ Town of Barnstable BOARD OF HEALTH John T.Norman Board of Health Donald A.Gaudagnoli,M.D. BARN9TAB,E, F.P.(Thomas)Lee,. p MASS. $ Daniel Luczkow,M.D. Alt. j51q �� 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: 751 Issue Date: 01/01/2022 DBA: SEA STREET FOOD MART OWNER: KSMP ENTERPRISES, INC. Location of Establishment: 231 SEA STREET HYANNIS„ MA 02601 Type of Business Permit: RETAIL FOOD Annual: YES Seasonal: IndoorSeating: 0 OutdoorSeating: 0 Total Seating: 0 FEES FOOD SERVICE ESTABLISHMENT: YEAR. 2022 RETAIL FOOD: $100.00 COTTAGE FOOD OPERATION: Permit Expires: 12/31/2022 B&B-FULL BREAKFAST: CONTINENTAL BREAKFAST: MOBILE-FOOD: MOBILE- ICE CREAM: Q� FROZEN DESSERT: Thomas A. McKean, RS, CHO, Health Agent FOR ESTABLISHMENTS WITH SEATING: PERMIT IS NOT VALID UNLESS ISSUED IN CONJUNCTION WITH A COMMON VICTUALER LICENSE Restrictions: For Office Ilse Only: Initials: Town of Barnstable t Date Paid ( Amt Pd$I Inspectional Services Cash Public Health Division Thomas McKean, Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT DATE_l[� 2 dzf NEW OWNERSHIP RENEWAL ' c NAME OF FOOD ESTABLISHMENT: ADDRESS OF FOOD ESTABLISHMENT: 92601 MAILING ADDRESS(IF DIFFERENT FROM ABOVE): �(,,�.•-c.ry E-MAIL ADDRESS: TELEPHONE NUMBER OF FOOD ESTABLISHMENT: (TS TOTAL NUMBER OF BATHROOMS: WELL WATER:YES NO ... (ANNUAL WATER ANALYSIS REQUIRED) ANNUAL: SEASONAL: DATES OF OPERATION: / / TO NUMBER OF SEATS: INSIDE: OUTSIDE:. TOTAL: SEATING: MUST OBTAIN A COMMON VICTUALLER'S LICENSE FROM LICENSING DIV. ***OUTSIDE DINING REMINDER*** OUTSIDE DINING,MUST BE APPROVED BY THE HEALTH DIV.AND LICENSING.AND MEET OUTSIDE DINING REQUIREMENTS. IS WAIT STAFF PROVIDED FOR OUTSIDE DINING? IS AN AIR CURTAIN PROVIDED AT WAITSTAFF SERVICE DOOR(S)? TYPE OF ESTABLISHMENT: (PLEASE CHECK ALL THAT APPLY BELOW) FOOD SERVICE RETAIL FOOD-ONLY required for TCS foods(foods requiring refrigeration/freezer) BED&BREAKFAST CONTINENTAL BREAKFAST COTTAGE FOOD INDUSTRY(formerly residential kitchen) MOBILE FOOD FROZEN DAIRY DESSERT MACHINES ... (MONTHLY LAB ANALYSIS REQUIRED) CATERING ... (CATERING NOTICE REQUIRED BEFORE EVENT(SEE PAGE#2) *** SEASONAL,MOBILE & NEW FOOD ONLY*** REQUIRED TO CALL HEALTH DIV.FOR INSPECTION PRIOR TO PERMIT BEING ISSUED PLEASE CALL 508-862-4644 Q:\Application FormsTOODAPP 2020.doc I OWNER INFORMATION: FULL NAME OF APPLICANT SOLE OWNER: YES/NO OWNER PHONE # 27 k �7'; /-1f ADDRESS_ 44 a&44 9-I4a C,- CORPORATEOWNER: �,Sm P In(-_.. CORPORATE ADDRESS: r PERSON IN CHARGE OF DAILY.OPERATIONS: List(2) Certified Food Protection Managers AND at least(1)Allergen Awareness Certified Staff All FOOD ESTABLISHMENTS must have 1 Certified Food Protection Manager PER SHIFT. **ATTACH COPIES OF CERTIFICATES** The Health Div. will NOT use past years' records. You must provide new copies and POST THE CERTIFICATES at your food establishment. Certified Food Managers Exviration Date Allergen Awareness Egniration Date 2. �_l�l Ldd J SIGNATURE OF APPLICANT DATE ***FOOD POLICY INFORMATION*** SEASONAL FOOD SERVICE:All seasonal food establishments,including mobile trucks must be inspected by the Health Div. prior to opening!! Please call Health Div.at 508-862-4644 to schedule your inspection. Please call at least(7)days in advance. FROZEN DAIRY DESSERTS: Frozen desserts must be tested by a State Certified lab prior to opening and monthly thereafter, with sample results submitted to the Health Div. Failure to do so will result in the suspension or revocation of your Frozen Dessert Permit until the above terms are met. CATERING POLICY: Anyone who caters within the Town of Barnstable must notify theTown by fax or mail prior to catering event. Youmust complete a catering notice found at httn://www.townofbarnstable.us/hcaithdivision/ai)i)iicatiosi+ ,all). OUTDOOR COOKING: Outdoor cooking,preparation,or display of any food product by a food establishment is prohibited. NOTICE: Permits run annually from January Ist to Dec.31$`each calendar year. IT IS YOUR RESPONSIBILITY TO RETURN THE COMPLETED APPLICATIONS)AND REQUIRED FEES BY DEC lst. I Q:1Application FonnsTOODAPP REV3-2019.doc r f Town of Barnstable BOARD OF HEALTH John T.Norman Board of Health Donald A.Gaudagnoli,M.D. SAWNSTABLE 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 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: 751 Issue Date: 01/01/2021 DBA: SEA STREET FOOD MART OWNER: KSMP ENTERPRISES, INC. Location of Establishment: 231 SEA STREET HYANNIS„ MA 02601 Type of Business Permit: RETAIL FOOD Annual: YES Seasonal: IndoorSeating: 0 OutdoorSeating: 0 Total Seating: 0 FEES FOOD SERVICE ESTABLISHMENT: YEAR. 2021 RETAIL FOOD: $100.00 COTTAGE FOOD OPERATION: Permit Expires: 12/31/2021 B&B-FULL BREAKFAST: CONTINENTAL BREAKFAST: MOBILE-FOOD: MOBILE-ICE CREAM: FROZEN DESSERT: Thomas A. McKean, IRS, CHO, Health Agent FOR ESTABLISHMENTS WITH SEATING: PERMIT IS NOT VALID UNLESS ISSUED IN CONJUNCTION WITH A COMMON VICTUALER LICENSE Restrictions: �I rOnly: Initials: � � Town of Barnstable 1f / BARNWABLE, : Inspectional Services � Public Health Division Check# I �53 P prED MA'S� Thomas McKean, Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT DATE,44;,4/,C._ NEW OWNERSHIP RENEWAL NAME OF FOOD ESTABLISHMENT: `j PGr� dzbxd' �I �d ADDRESS OF FOOD ESTABLISHMENT: 2 1 CM !!5&4--d P14 4,414"Tl MAILING ADDRESS(IF DIFFERENT FROM ABOVE): E-MAIL ADDRESS: 2Z ,. TELEPHONE NUMBER OF FOOD ESTABLISHMENT: (&L) wr TOTAL NUMBER OF BATHROOMS: /— WELL WATER: YES NO ✓ ...(ANNUAL WATER ANALYSIS REQUIRED) ANNUAL: SEASONAL: DATES OF OPERATION: / / TO NUMBER OF SEATS: INSIDE: OUTSIDE: TOTAL: SEATING: MUST OBTAIN A COMMON VICTUALLER'S LICENSE FROM LICENSING DIV. ***OUTSIDE DINING REMINDER*** OUTSIDE DINING,MUST BE APPROVED BY THE HEALTH DIV.AND LICENSING,AND MEET OUTSIDE DINING REQUIREMENTS. IS WAIT STAFF PROVIDED FOR OUTSIDE DINING? IS AN AIR CURTAIN PROVIDED AT WAITSTAFF SERVICE DOOR(S)? TYPE OF ESTABLISHMENT: (PLEASE CHECK ALL THAT APPLY BELOW) FOOD SERVICE RETAIL FOOD-ONLY required for TCS foods(foods requiring refrigeration/freezer) BED&BREAKFAST CONTINENTAL BREAKFAST COTTAGE FOOD INDUSTRY(formerly residential kitchen) MOBILE FOOD '✓FROZEN DAIRY DESSERT MACHINES ... (MONTHLY LAB ANALYSIS REQUIRED) 4//� CATERING ...(CATERING NOTICE REQUIRED BEFORE EVENT(SEE PAGE#2) *** SEASONAL,MOBILE & NEW FOOD ONLY*** REOUIRED TO CALL HEALTH DIV.FOR INSPECTION PRIOR TO PERMIT BEING ISSUED PLEASE CALL 508-862-4644 Q:\Application FounsTOODAPP 2020.doc I r OWNER INFORMATION: FULL NAME OF APPLICANT- jwr�tj /j 0 SOLE OWNER: YES/NO OWNER PHONE# 2K/ ADDRESS _i;D - t' �Gcavle' 114 0 1 CORPORATE OWNER: CORPORATE ADDRESS: Z3/ S>v Vr7- --[i1 /`PyA�,,t t,g /yI PERSON IN CHARGE OF DAILY OPERATIONS: 1i/1/ �-' List(2) Certified Food Protection Managers AND at least(1)Allergen Awareness Certified Staff All FOOD ESTABLISHMENTS must have 1 Certified Food Protection Manager PER SHIFT. **ATTACH COPIES OF CERTIFICATES** The Health Div. will NOT use past years' records. You must provide new copies and POST THE CERTIFICATES at your food establishment. Certified Food Managers Expiration Date Allergen Awareness Expiration Date 1. At 2. SIGNATURE OF APPLICANT DATE ***FOOD POLICY INFORMATION"* * SEASONAL FOOD SERVICE: All seasonal food establishments,including mobile trucks must be inspected by the Health Div. prior to openin8!! Please call Health Div.at 508-862-4644 to schedule your inspection. Please call at least(7)days in advance. FROZEN DAIRY DESSERTS: Frozen desserts must be tested by a State Certified lab prior to opening and monthly thereafter, with sample results submitted to the Health Div. Failure to do so will result in the suspension or revocation of your Frozen Dessert Permit until the above terms are met. CATERING POLICY: Anyone who caters within the Town of Barnstable must notify theTown by fax or mail prior to catering event. You must complete a catering notice found at htti)://www.townofbarnstable.us/healthdivision/api)lications.asp. OUTDOOR COOKING: Outdoor cooking,preparation,or display of any food product by a food establishment is prohibited. NOTICE: Permits run annually from January 1 st to Dec.3151 each calendar year. IT IS YOUR RESPONSIBILITY TO RETURN THE COMPLETED APPLICATION(S)AND REQUIRED FEES BY DEC 1st. QAApplication FormsTOODAPP REV3-2019.doc I �► _ Town of Barnstable BOARD OF HEALTH +1� John T.Norman Board of Health Donald A.Guadagnoli,M.D. HAfONSTABM ; F.P.(Thomas)Lee AM � Daniel Luczkow,Alternate 200 Main Street, Hyannis, MA 02601 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: 751 Issue Date: 1/1/2021 DBA: SEA STREET FOOD MART OWNER: KSMP ENTERPRISES, INC. Location of Establishment: 231 SEA STREET HYANNIS, MA 02601 Type of Business Permit: Non-Flavored 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 A + QP- i na GIB e,L For Office Us Initials: Town of Barnstable Date Paid Amt Pd s ABjE Inspectional Services BAMW MASS. .�; 39•.�� : Public Health Division i Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-61k TOBACCO ESTABLISHMENT.....PERMIT.APPLICATION(Non Flavored). DATE NEW BUSINESS OWNERSHIP RENEWAL . NAME OF TOBACCO ESTABLISHMENT:,E'� s ✓� 40� ADDRESS OF TOBACCO ESTABLISHMENT: �•�� �p(3' UfQ�p.Q MAILING ADDRESS(IF DIFFERENT FROM ABOVE):. E-MAIL ADDRESS: L7� ./� 7 TELEPHONE NUMBER OF TOBACCO ESTABLISHMENT: - OWNER'S NAME: _L � � _ _ _ OWNER'S PH# 'p & � OWNER'S ADDRESS: �� A�:1 1 , �l .�.�. ' �"��t LQ`r.��-t�� /L/� �Z� C CORPORATE NAME: CORPORATE ADDRESS: Z3( S _�G�� ,,( - D y)CORPORATE FID# 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: htt-ps://www.ecode360.com/33996392 MA GENERAL LAW CHAPTER 270/SECTION 6: httgs:Hmalegislature gov/I,aws/GeneralLaws/PartlV/Titlel/Chapter2:/0/Section6 { ***NEW BUSINESSES AND NEW OWNERS ONLY*** REQUIRED TO CALL HEALTH DIVISION AGENT FOR AN INSPECTION PRIOR TO PERMIT BEING ISSUED. PLEASE CALL 508-375-6621 ALL APPLICANTS ARE REQUIRED TO SUBMIT.THE FOLLOWING REQUIRED DOCUMENTS: 1) MA State License to Sell Cigarettes 3) IRS Federal Tax ID#Document 2) MA State License to Sell Cigars and Smoking Tobacco 4) Payment of Fee(s) -see page 4 1 SIGNATURE: PRINTED NAME: 114iti A A,ti DATE: / ZtJ Q:1Application Forms\TOBACCO APP-NonFavor 12-18-19.docx AJ � � d 5 taS u,4- tf W ESTABLISHMENT'S NAME t 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 an person under the age of twenty-one 21 Below is Section p g g g p Y P g tY- ( )• 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. f 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. F 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: g p Sign re Printed Name Date Sigtta a Printed me / Signature Printed N e atu e i Sig ature Printed Name Date u � Signature Printed Name Date � I Signature Printed Name Date tt Signature Printed Name Date a' x Q:\Appfication Forms\TOBACCO APP-NonFavor 12-18-19.docx Town of Barnstable BOARD OF HEALTH John T.Norman Board of Health Donald A.Gaudagnoli,M.D. R►xxMMM Paul J.Canniff,D.M.D. NAM a3� �� 200 Main Street, Hyannis, MA 02601 F.P. Thomas Lee Alternate Phone: (508) 862-4644 Fax: (508)790-6304 www.townofbarnstable.us Permit to Operate a Food Establishment In accordance with regulations promulgated under authority of 105 CMR 590.000 M.G.L. Chapter 94 Sections 305A, 305B, 146, 189 and 189A; Chapter 111, Sections 5 and 127A, a permit is hereby granted to: Permit No: 338 Issue Date: 12/10/2019 DBA: SEVEN G'S LIQUOR OWNER: PAUL GOVONI Location of Establishment: 990 ROUTE 6A W. BARNSTABLE, MA 02668 Type of Business Permit: RETAIL FOOD Annual: YES Seasonal: IndoorSeating: 0 OutdoorSeating: 0 Total Seating: 0 FEES FOOD SERVICE ESTABLISHMENT: YEAR. 2020 RETAIL FOOD: $20.00 COTTAGE FOOD OPERATION: Permit Expires: 12/31/2020 B&B-FULL BREAKFAST: CONTINENTAL BREAKFAST: MOBILE-FOOD: MOBILE-ICE CREAM: Gi FROZEN DESSERT: Thomas A. McKean, RS, CHO, Health Agent TOBACCO SALES: FOR ESTABLISHMENTS WITH SEATING: PERMIT IS NOT VALID UNLESS ISSUED IN CONJUNCTION WITH A COMMON VICTUALER LICENSE Restrictions: off t For Office Use Only: Initials: Lo- Town of Barnstable Date PaidOR Amt Pd$ S * snaNsrnsLe, ' Inspectional Services _f r. t639. Public Health Division Check# Y gFD MA't A Thomas McKean, Director ' 200 Main Street, Hyannis, N A 02601 Office: 508-862-4644 Fax: 508-790-6304 t r' APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT DATE N NEW OWNERSHIP RENEWAL NAME OF FOOD ESTABLISHMENT: ADDRESS OF FOOD ESTABLISHMENT: MAILING ADDRESS(IF DIFFERENT FROM ABOVE):`-?, E-MAIL ADDRESS: TELEPHONE NUMBER OF FOOD ESTABLISHMENT: 65 30- TOTAL NUMBER OF BATHROOMS: l WELL WATER: YES ENO ... (ANNUAL WATER ANALYSIS REQUIRED) ANNUAL: Ll� SEASONAL: DATES OF OPERATION:_/ / TO NUMBER OF SEATS: INSIDE: OUTSIDE: TOTAL: SEATING: MUST OBTAIN A COMMON VICTUALLER'S LICENSE FROM LICENSING DIV. ***OUTSIDE DINING REMINDER*** OUTSIDE DINING MUST BE APPROVED BY THE HEALTH DIV.AND LICENSING,AND MEET OUTSIDE DINING REQUIREMENTS. IS WAIT STAFF PROVIDED FOR OUTSIDE DINING? IS AN AIR CURTAIN PROVIDED AT WAITSTAFF SERVICE DOOR(S)? TYPE OF ESTABLISHMENT: (PLEASE CHECK ALL THAT APPLY BELOW) FOOD SERVICE RETAIL FOOD-ONLY required for TCS foods(foods requiring refrigeration/freezer) BED&BREAKFAST CONTINENTAL BREAKFAST COTTAGE FOOD INDUSTRY(formerly residential kitchen) MOBILE FOOD FROZEN DAIRY DESSERT MACHINES ... (MONTHLY LAB ANALYSIS REQUIRED) CATERING ... (CATERING NOTICE REQUIRED BEFORE EVENT(SEE PAGE#2) *** SEASONAL,MOBILE & NEW FOOD ONLY*** _REQUIRED TO CALL HEALTH DIV.FOR INSPECTION PRIOR TO PERMIT BEING ISSUED PLEASE CALL 508-862-4644 QAApplication FormsTOODAPP 2020.doc OWNER INFORMATION• FULL NAME OF APPLICANT ! �� W �u '�` SOLE OWNER: YES NO OWNER PHONE# 50pj — ZUG' 250 ADDRESS_ 95 d ?k ��� (,U.Q.Sk CORPORATE OWNER:_ _Se C�, l c�4 ya�S O CORPORATE ADDRESS: —C{o PERSON IN CHARGE OF DAILY OPERATIONS:`` List (2) Certified Food Protection Managers AND at least(1)Allergen Awareness Certified Staff All FOOD ESTABLISHMENTS must have 1 Certified Food Protection Manager PER SHIFT. **ATTACH COPIES OF CERTIFICATES** The Health Div. will NOT use past years' records. You must provide new copies and POST THE CERTIFICATES at your food establishment. Certified Food Managers Expiration Date Allergen Awareness Expiration Date 1. / 2. t 1 SIGNATIJRE OF APPLICANT DATE ***FOOD POLICY INFORMATION*** SEASONAL FOOD SERVICE: All seasonal food establishments,including mobile trucks must be inspected by the Health Div. prior to openine!! Please call Health Div.at 508-862-4644 to schedule your inspection. Please call at least(7)days in advance. FROZEN DAIRY DESSERTS: Frozen desserts must be tested by a State Certified lab prior to opening and monthly thereafter, with sample results submitted to the Health Div. Failure to do so will result in the suspension or revocation of your Frozen Dessert Permit until the above terms are met. CATERING POLICY: Anyone who caters within the Town of Barnstable must notify theTown by fax or mail prior to catering event. You must complete a catering notice found at http://www.townofbarnstable.us/healthdivision/applications.asi). OUTDOOR COOKING: Outdoor cooking,preparation,or display of any food product by a food establishment is prohibited. NOTICE: Permits run annually from January 1st to Dec.3151 each calendar year. IT IS YOUR RESPONSIBILITY TO RETURN THE COMPLETED APPLICATION(S)AND REQUIRED FEES BY DEC 1st. QAApplication FormsTOODAPP REV3-2019.doc OFy41E For Office Use On Initials: Town of Barnstable } R Date Paid( ld � Amt Pd$ BARNSTABLE, Inspectional Services '"ASS' 16J9' `° Public Health Division AlFO�p Thomas McKean, Director 200 Main Street, Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 TOBACCO ESTABLISHMENT PERMIT APPLICATION (Non-Flavored) DATE 11 36 1� NEW BUSINESS OWNERSHIP RENEWAL r� NAME OF TOBACCO ESTABLISHMENT: Si✓VcN G 0 e r �ko Ve P ADDRESS OF TOBACCO ESTABLISHMENT: 9 A (Aj esh- (30kr�ska-6 G MAILING ADDRESS(IF DIFFERENT FROM ABOVE): G . e w�� r*'s ��iC.1 NAA ° E-MAIL ADDRESS: ::p/k.S`�o vc^', @ TELEPHONE NUMBER OF TOBACCO ESTABLISHMENT: 5j( dt )3 OWNER'S NAME: ya-A OWNER'S PH#60�)Lib- Z5a OWNER'S ADDRESS: < < A� `.tee CORPORATE ADDRESS: t � �A ►-'S'4a(Q CORPORATE 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•//malep,islature.gov/Laws/GeneralLaws/ParLIV/TitleI/Chuter270/Sectioi16 ***NEW BUSINESSES AND NEW OWNERS ONLY *** REQUIRED TO CALL HEALTH DIVISION AGENT FOR AN INSPECTION PRIOR TO PERMIT BEING ISSUED. PLEASE CALL 508-375-6621 ALL APPLICANTS ARE REQUIRED TO SUBMIT THE FOLLOWING REQUIRED DOCUMENTS: 1) MA State License to Sell Cigarettes 3) IRS Federal Tax ID#Document 2) MA State License to Sell Cigars and Smoking Tobacco 4) Payment of Fee(s) -see page 4 SIGNATURE: PRINTED N ME: DATE: 11 /-30 / Q\Application Forms\TOBACCO APP-NonFavor 11-21-19.doc L i ` F MASSACHUSETTS DEPARTMENT OF REVENUE Form CT-3 W e y Retailer License for Sale of Cigarettes This license must be posted and visible at all times.The sale of tobacco products to anyone under 18 years of age is prohibited. SEVEN GS DISCOUNT LIQUORS INC Account ID: CGL-10469428-006 SEVEN G'S LIQUORS Location ID: 10469428-0006 990 MAIN STREET BLDG 1 License Number: 1865226240 WEST BARNSTABLE MA 02668 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: December 10,2019 Expiration Date: September 30,2020 MASSACRUSETTS DEPARTMENT OF REVENUE Form CT-3T Retailer License for Sale of Cigars and Smoking Tobacco y ( K This license must be posted and visible at all times.The sale of tobacco products to anyone under 18 years of age is prohibited. SEVEN GS DISCOUNT LIQUORS INC Account ID: CRL-10469428-009 SEVEN G'S LIQUOR SHOPPE Location ID: 10469428-0007 990 MAIN STREET BLDG 1 License Number: 984639488 NEST BARNSTABLE MA 02668 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:December 9,2019 Expiration Date:September 30,2020 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 371r 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: r' ' ✓°fin ��'J�v r'� Signature Printed Name Date 'gna Printed.Name Date . Si nature Printed Name Date Signa a Printed Name Date nature Printed Name Date ATV Signatu a Prin ed Name Date Signature Printed Name Date Q;\ApplicationFo O�ACCOAPP-NonFavorl1-21-19.doc fl �� KOL r,rt Ga ry o ii MassTaxConnect Page 1 of 1 Mass, GONNXEC Important Information from Mass DOR Welcome,Paul A.Govoni Settings Log Off Home Messages Important Information from Mass DOR Contact Us Frequently Asked Questions Video Tutorials e-Message 8 1 Want To SEVEN GS DISCOUNT LIQUORS INC Reply 04-2830600 Sales Tax Delete Monthly SEVEN GS DISCOUNT LIQUORS SLS-10469428-005 e-Message Basic Request Email Received:Thursday,Dec 12,2019 1:22:34 PM Subject: Important Information from Mass DOR This is an automated email and is unable to receive replies. Your submission information is below.Please note that your submission may take several days to complete. Confirmation Summary . Submission: Sales and Use Tax Form ST-9 and Payment Confirmation 0-437-411-712 Number: Submission Date and Time:PM ec-2019 01:22:31 Legal Name: SEVEN GS DISCOUNT LIQUORS INC Account SLS-10469428-005 ID: You can view details about your submission at any time by logging into your MassTaxConnect account and selecting the Submissions tab. Back ©2019 Commonwealth of Massachusetts Site Policies I Web Browsers https://mtc.dor.state.ma.us/mtc/­,/ 12/12/2019 MassT/axConnect Page 1 of 1 Mass.�av MassT-ax--'� 0 `CONNECT 30-Nov-2019 Welcome,Paul A.Govoni Settings Log Off Home Sales Tax 30-Nov-2019 Contact Us Frequently Asked Questions Video Tutorials t.J Period Period Alerts 1 Want To SEVEN GS DISCOUNT LIQUORS INC x" J There are no alerts File or amend a return 04-2830600 fi Sales Tax Make a payment Monthly SEVEN GS DISCOUNT LIQUORS SLS-10469428-005 30-Nov-2019 Balance:$0.00 Summary Period Activity View Activity There has been no financial activity 12-Dec-2019 Submitted Sales and Use Tax Form ST-9 and Payment ©2019 Commonwealth of Massachusetts Site Policies I Web Browsers https://mtc.dor.state.ma.us/mtc/­/ 12/12/2019 I Town of Barnstable BOARD OF HEALTH John T.Norman Board of Health Donald A.Guada noli oa g ,M.D. BARNSTABLE, : Paul J.Canniff,D.M.D. F.P. Thomas Lee Alternate aa. 200 Main Street, Hyannis, MA 02601 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: 338 Issue Date: 1/1/2020 DBA: SEVEN G'S LIQUOR OWNER: PAUL GOVONI Location of Establishment: 990 ROUTE 6A WEST BARNSTABLE, MA 02668 Type of Business Permit: Non-Flavored Annual _X _ Seasonal FEES YEAR: 2020 TOBACCO SALES: $85.00 Permit Expires: 12/31/2020 Q Thomas A. McKean, RS, CHO, Health Agent Restrictions: PLEASE POST CONSPICUOUSLY 1 4 BOARD OF HEALTH Town of Barnstable John T.Norman Board of Health Donald A.Gaudagnoli,M.D. • BARNSTAU e. t Paul J.Canniff,D.M.D. smm 200 Main Street, Hyannis, MA 02601 F.P. Thomas Lee Alternate Phone: (508) 862-4644 Fax: (508)790-6304 www.townofbarnstable.us Permit to Operate a Food Establishment In accordance with regulations promulgated under authority of 105 CMR 590.000 M.G.L. Chapter 94 Sections 305A, 305B, 146, 189 and 189A; Chapter 111, Sections 5 and 127A, a permit is hereby granted to: Permit No: 751 Issue Date: 12/10/2019 DBA: SEA STREET FOOD MART OWNER: KSMP ENTERPRISES, INC. Location of Establishment: 231 SEA STREET HYANNIS, MA 02601 Type of Business Permit: RETAIL FOOD Annual: YES Seasonal: IndoorSeating: 0 Outdoor5eating: 0 Total Seating: 0 FEES FOOD SERVICE ESTABLISHMENT: YEAR. 2020 RETAIL FOOD: $100.00 COTTAGE FOOD OPERATION: Permit Expires: 12/31/2020 B&B-FULL BREAKFAST: CONTINENTAL BREAKFAST: MOBILE-FOOD: MOBILE-ICE CREAM: Ga� FROZEN DESSERT: Thomas A. McKean, IRS, CHO, Health Agent TOBACCO SALES: FOR ESTABLISHMENTS WITH SEATING: PERMIT IS NOT VALID UNLESS ISSUED IN CONJUNCTION WITH A COMMON VICTUALER LICENSE Restrictions: F ofIMEr Initials: ti Town of Barnstable For Office 75q, Am Pd$ BARNSfAB Inspectional Services It 639 ` Check# P '0'FDrrlAyp Public Health Division i Thomas McKean, Director 200 Main Street,Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT DATE NEW OWNERSHIP RENEWAL NAME OF FOOD ESTABLISHMENT: S�GI =�� 1 MAC—' ADDRESS OF FOOD ESTABLISHMENT: 213 I N414 I rs MA ortp MAILING ADDRESS(IF DIFFERENT FROM ABOVE): JYVI� - E-MAIL ADDRESS: �Ji.� j / �sly `�l�r�t Cac�-y► TELEPHONE NUMBER OF FOOD ESTABLISHMENT: Cat—)-:746- D Z TOTAL NUMBER OF BATHROOMS: WELL WATER: YES_NO f/... (ANNUAL WATER ANALYSIS REQUIRED) ANNUAL: SEASONAL: DATES OF OPERATION:_/ / TO NUMBER OF SEATS: INSIDE: OUTSIDE: TOTAL: SEATING: MUST OBTAIN A COMMON VICTUALLER'S LICENSE FROM LICENSING DIV. ***OUTSIDE DINING REMINDER*** OUTSIDE DINING MUST BE APPROVED BY THE HEALTH DIV.AND LICENSING,AND MEET OUTSIDE DINING REQUIREMENTS. IS WAIT STAFF PROVIDED FOR OUTSIDE DINING? IS AN AIR CURTAIN PROVIDED AT WAITSTAFF SERVICE DOOR(S)? TYPE OF ESTABLISHMENT: (PLEASE CHECK ALL THAT APPLY BELOW) FOOD SERVICE �ETAIL FOOD-ONLY required for TCS foods(foods requiring refrigeration/freezer) BED& BREAKFAST CONTINENTAL BREAKFAST COTTAGE FOOD INDUSTRY(formerly residential kitchen) MOBILE FOOD ROZEN DAIRY DESSERT MACHINES ... (MONTHLY LAB ANALYSIS REQUIRED) fl' ' CATERING ... (CATERING NOTICE REQUIRED BEFORE EVENT(SEE PAGE#2) ***SEASONAL, MOBILE & NEW FOOD ONLY*** REQUIRED TO CALL HEALTH DIV.FOR INSPECTION PRIOR TO PERMIT BEING ISSUED PLEASE CALL 508-862-4644 QAApplication FormsTOODAPP 2020.doc w OWNER INFORMATION: ..FULL NAME OF APPLICANT Q 0, SOLE OWNER: YES/NO / OWNER PHONE ADDRESS? ,/aye�V!(�S M��2/l� CORPORATE OWNER: 1` �) CORPORATE ADDRESS: 4 h aULXii n 4 l )�1 PERSON IN CHARGE OF DAILY OPERATIONS: List (2) Certified Food Protection Managers AND at least(1)Allergen Awareness Certified Staff All FOOD ESTABLISHMENTS must have 1 Certified Food Protection Manager PER SHIFT. **ATTACH COPIES OF CERTIFICATES** The Health Div. will NOT use past years' records. You must provide new copies and POST THE CERTIFICATES at your food establishment. Certified Food Managers Expiration Date Allergen Awareness Expiration Date 2. SIGNATURE OF APPLICANT DATE ***FOOD POLICY INFORMATION*** SEASONAL FOOD SERVICE: All seasonal food establishments,including mobile trucks must be inspected by the Health Div. prior to ovenine!! Please call Health Div.at 508-862-4644 to schedule your inspection. Please call at least(7)days in advance. FROZEN DAIRY DESSERTS: Frozen desserts must be tested by a State Certified lab prior to opening and monthly thereafter, with sample results submitted to the Health Div. Failure to do so will result in the suspension or revocation of your Frozen Dessert Permit until the above terms are met. CATERING POLICY: Anyone who caters within the Town of Barnstable must notify theTown by fax or mail prior to catering event. You must complete a catering notice found at http://www.townofbarnstable.us/healthdivision/applications.asp. OUTDOOR COOKING: Outdoor cooking,preparation,or display of any food product by a food establishment is prohibited. NOTICE: Permits run annually from January 1st to Dec. 3151 each calendar year. IT IS YOUR RESPONSIBILITY TO RETURN THE COMPLETED APPLICATION(S)AND REQUIRED FEES BY DEC 1st. Q:Wpplication FormsTOODAPP REV3-2019.doc , « Ogi1f Town of Barnstable BOARD OF HEALTH John T.Norman Board of Health Donald A.Guadagnoli,M.D. BARNSTABLE, Paul J.Canniff,D.M.D. Ani' F.P. Thomas Lee Alternate 200 Main Street, Hyannis, MA 02601 ' 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: 751 Issue Date: 1/1/2020 DBA: SEA STREET FOOD MART OWNER: KSMP ENTERPRISES, INC. Location of Establishment: 231 SEA STREET HYANNIS, MA 02601 Type of Business Permit: Non-Flavored Annual Seasonal FEES YEAR: 2020 TOBACCO SALES. $85.00 Permit Expires: 12/31/2020 c�-man Thomas A. McKean, IRS, CHO, Health Agent Restrictions: PLEASE POST CONSPICUOUSLY �a THE • Initials: �p � Town of Barnstable For Office Use Date Paid � Amt Pd$ �AB�. : Inspectional Services 1� � 1 9ebp ,"�; `0� rFa,, p Public Health Division Check# 1V(ry q Thomas McKean, Director 200 Main Street, Hyannis,MA 02601 { I Office: 508-862-4644 Fax: 508-790-6304 n TOBACCO ESTABLISHMENT PERMIT APPLICATION (Non-Flavored) DATE NEW BUSINESS OWNERSHIP RENEWAL NAME OF TOBACCO ESTABLISHMENT: PA C auz &.1 ADDRESS OF TOBACCO ESTABLISHMENT: 23i SPA r��� M!441114t1 114. GG f MAILING ADDRESS(IF DIFFERENT FROM ABOVE): E-MAIL ADDRESS: e✓21�;-LL 6-151TELEPHONE NUMBER NUMBER OF TOBACCO ESTABLISHMENT: (5A) - — OWNER'S NAME: I� OWNER'S PH# '��f`� OWNER'S ADDRESS: CORPORATE ADDRESS: ���-f CORPORATE FID# 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.g_ov/Laws/GeneralLaws/I'a_rt-IV/Titiel/Chapter270!S ection6 ***NEW BUSINESSES AND NEW OWNERS ONLY *** REQUIRED TO CALL HEALTH DIVISION AGENT FOR AN INSPECTION PRIOR TO PERMIT BEING ISSUED. PLEASE CALL 508-375-6621 ALL APPLICANTS ARE REQUIRED TO SUBMIT THE FOLLOWING REQUIRED DOCUMENTS: 1) MA State License to Sell Cigarettes 3) IRS Federal Tax ID#Document 2) MA State License to Sell Cigars and Smoking Tobacco 4) Payment of Fee(s) -see page 4 , SIGNATURE: , PRINTED NAME: DATE: Q:\Application Forms\TOBACCO APP-NonFavor 11-21-19.doc 5 FCCA - 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— 4 371-9. 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: blu <� °,fin; ` �' h L-f A Sigtiature Printed Name Date lixk 5k C Signa re rinted Name Date P Signature Printed Na de Date Signature Printed Name Date Signature Printed Name Date Signature Printed Name Date Signature Printed Name Date Q:\Application Forms\TOBACCO APP•NonFavor 11-21-19.doc Town of Barnstable BOARD OF HEALTH John T.Norman Board of Health Donald A.Gaudagnoli,M.D. Paull.Canniff,D.M.D. yea . 200 Main Street, Hyannis, MA 02601 F.P. Thomas Lee Alternate Phone: (508) 862-4644 Fax: (508)790-6304 www.townofbarnstable.us Permit to Operate a Food Establishment In accordance with regulations promulgated under authority of 105 CMR 590.000 M.G.L. Chapter 94 Sections 305A, 3056, 146, 189 and 189A; Chapter 111,Sections 5 and 127A, a permit is hereby granted to: Permit No: 751 Issue Date: 10/07/2019 DBA: SEA STREET FOOD MART OWNER: KSMP ENTERPRISES, INC Location of Establishment: 231 SEA STREET 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: $100.00 COTTAGE FOOD OPERATION: Permit Expires: 12/31/2019 B&B-FULL BREAKFAST: CONTINENTAL BREAKFAST: MOBILE-FOOD: MOBILE-ICE CREAM: C,ih FROZEN DESSERT: Thomas A. McKean, RS, CHO, Health Agent TOBACCO SALES: $85.00 FOR ESTABLISHMENTS WITH SEATING: PERMIT IS NOT VALID UNLESS ISSUED IN CONJUNCTION WITH A COMMON VICTUALER LICENSE Restrictions: f?t,) OLOYWCf @n For Office Use Only: Initials: `�"�'�. Town of Barnstable Date Paid 10 Amt Pd$ 3 BAMSfABLE, : Inspectional Services �' �.�, ,,� ` 16.39. `� ea Public Health Division check# QED MAr A ip {� 0 CaRb Thomas McKean, Director NSD-)k 1 r] ,-VO 95N AP rj'51 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 % J4 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT DATE 10/03/2019 NEW OWNERSHIP X RENEWAL NAME OF FOOD ESTABLISHMENT: Sea Street Food Mart ADDRESS OF FOOD ESTABLISHMENT: 231 Sea Street Hyannis, MA 02601 MAILING ADDRESS(IF DIFFERENT FROM ABOVE):�30 An&Z E-MAIL ADDRESS: mingmasherpa1522@gmail.com TELEPHONE NUMBER OF FOOD ESTABLISHMENT: 5( O8 ) 292 - 8566 4t.p h6 jLQ k TOTAL NUMBER OF BATHROOMS: 1 / 7oc^®6o-2 / WELL WATER:YES NO X ...(ANNUAL WATER ANALYSIS REQUIRED) ANNUAL: X SEASONAL: DATES OF OPERATION: / / TO NUMBER OF SEATS: INSIDE: OUTSIDE: �&—TOTAL: SEATING: MUST OBTAIN A COMMON VICTUALLER'S LICENSE FROM LICENSING DIV. ***OUTSIDE DINING REMINDER*** OUTSIDE DINING,MUST BE APPROVED BY THE HEALTH DIV.AND LICENSING AND MEET OUTSIDE DINING REQUIREMENTS. IS WAIT STAFF PROVIDED FOR OUTSIDE DINING? N/A IS AN AIR CURTAIN PROVIDED AT WAITSTAFF SERVICE DOOR(S)? N/A TYPE OF ESTABLISHMENT: (PLEASE CHECK ALL THAT APPLY BELOW) FOOD SERVICE X RETAIL FOOD-ONLY required for TCS foods(foods requiring refrigeration/freezer) BED&BREAKFAST CONTINENTAL BREAKFAST COTTAGE FOOD INDUSTRY(formerly residential kitchen) MOBILE FOOD FROZEN DAIRY DESSERT MACHINES ...(MONTHLY LAB ANALYSIS REQUIRED) CATERING... (CATERING NOTICE REQUIRED BEFORE EVENT(SEE PAGE#2) *** SEASONAL,MOBILE & NEW FOOD ONLY*** REQUIRED TO CALL HEALTH DIV.FOR INSPECTION PRIOR TO PERMIT BEING ISSUED PLEASE CALL 508-862-4644 Q\Application FormsTOODAPP REV3-2019.doc OWNER INFORMATION: _. ... . .... FULL NAME OF APPLICANT: :Mingma N. Sherpa, President KSMP Enterprises,Inc. d/b/a Sea:Street Food Mart SOLE OWNER: YES/NO:: OWNER PHONE #508-292-8566 C a Q 4 ADDRESS V o Steers du ck CORPORATE OWNER:KSMP_Enterprises, Inc.. d/b/a Sea Street Food Mart CORPORATE ADDRESS: 231 Sea Street Hyannis, MA 02601 PERSON IN CHARGE OF.DAILY OPERATIONS: Pasang.D. Sherpa, Manager List:(2) Certified Food Protection Managers AND at least(1)Allergen Awareness Certified Staff All FOOD ESTABLISHMENTS must have.1 Certified Food Protection Manager.PER SHIFT. **ATTACH COPIES OF CERTIFICATES**:The Health Dive will NOT use past years' records. You; must provide new copies and POST:THE CERTIFICATES at your food establishment. Certified Food Managers Expiration Date Allergen Awareness Expiration Date v '' :2. 1 77 03 / /9 SIGNATURE OF APPLICANT DATE *.**FOOD.POLICY INFORMATION*** SEASONAL FOOD SERVICE:All:seasonal food establishments,including mobile-trucks must:be:inspected by the Health:Div. prior to opening!!: Please call Health Div.at 50&862=4644 to schedule your.inspection.:Please call at least(7)days in advance. FROZEN DAIRY DESSERTS: Frozen desserts must"be.tested by a State Certified:lab prior to openirig and monthly thereafter, .: with sample results submitted to the Health Diva Failure to do so will result in the suspension or revocation of your Frozen Dessert Permit until the above terms are meta CATERING POLICY: Anyone who caters within the Town of Barnstable must notify theTownby.fax or mail prior to catering event. You must complete a catering notice found at.htti)://www.towno6arnstable.us/healthdivis*ion/anytications.asp: OUTDOOR COOKING: Outdoor cooking,preparation,or display of any food product by_a food establishment is,prohibited. .. . NOTICE:: Permits run annually from January l st to Dec.315`each.calendar year. "IT IS YOUR RESPONSIBILITY:TO RETURN THE COMPLETED APPLICATION(S)AND:REQUIRED FEES BY DEC lst,. . :. I Q:WpplicationFormmoobmP REVS 20t9.doc 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—lz 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: )Al Pasang D. Sherpa /0 le_7 Si nature Printed Name Date Al/� to/a 3 /',;-; Signature Printed Name Date Signature Printed Name Date Signature Printed Name Date Signature Printed Name Date Signature Printed Name Date Signature Printed Natne Date C:\Users\decollik\AppData\Local\Microsoft\Windows\INetCache\Content.Outlook\YZOF4J38\TOBACCO APP2019 dob.docx f .: TIN Town of Barnstable For ofr�e use Only Initials: Date Paid Amt Pd$ » »B]'ABLE, Inspectional Services jneCj # i �ABN 9 MASS. - Public Health Division - i679 1� FD MA'I A — 200 Main:Street, Hyannis MA 02601 Office: 508-790-4644 Thomas A.McKean,M,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 KSMP Enterprises,: Inc. d/b/a.Sea Street Food:Mart ESTABLISHMENT NAME (D/B/A).. . i 231 Sea Street Hyannis; MA 02601 ADDRESS OF:BUSINESS Gt MAILING ADDRESS (IF DIFFERENT FROM ABOVE) ... Sherpa : Mingma N. mingmasherpa1522@gmail:com 508=292-8566 . EMAIL. PHONE,# Do you currently possess a state:license.to:sell tobacco products? Yes X 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). - Si natur g - Date"6F t5 3 l Mingma N. Sherpa; President:KSMP Enterprises, Inc. C:\Users\decollik\AppDita\Local\Microsoft\W1ndows\INetCache\Content.Outlook\YZOF4J38\TOBACCO APP2019 dob.docx i I I Commonwealth of Massachusetts Letter ID:L0212877184 °t �s Department of Revenue Notice Date:October 4,2019 i Christopher C.Harding,Commissioner Account ID:CGL-19541155-003 mass.gov/dor RETAILER LICENSE FOR SALE OF CIGARETTES i�lili�l��l�ll� illl�lni�lllli �lililli��l� nl � illll KSMP ENTERPRISES INC o= SEAS STREET FOOD MART N 0 231 SEA ST HYANNIS MA 02601-4573 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 ---------------------------------------------------------------------------------------------------------------------------------------------- 00 sP MASSACHUSETTS DEPARTMENT OF REVENUE Form CT-3 Retailer License for Sale of Cigarettes o�� This license must be posted and visible at all times.The sale of tobacco M,- products to anyone under 18 years of age is prohibited. KSMP ENTERPRISES INC Account ID: CGL-19541155-003 SEAS STREET FOOD MART License Number: 1911379968 231 SEA ST HYANNIS MA 02601-4573 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 4, 2019 Expiration Date: September 30, 2020 r Oct 03 2019 02:32PM HP Fax page 2 IRS DEPARTMENT OF THE TREASURY lt►J INTERNAL, REVENUE SERVICE CINCINNATI OH 45999-0023 Date of this notice: 06-07-2019 Employer Identification Number: 84-2017070 Form: SS-4 KSMP ENTERPRISES INC Number of this notice: CP 575 A 231 SEA ST HYANNIS, MA 02601 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 84-2017070. 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 nay 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. IMPORTANT INFORMATION FOR S CORPORATION HZECTION: If you intend to elect to file your return as a small business corporation, at election to file a Form 2120-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 sma11 Business Corporation. oo St`�Ft�`cA Commonwealth of Massachusetts Letter ID: L1091248000 Department of Revenue Notice Date:October 3,2019 Christopher C.Harding,Commissioner Account ID:SLS-1 954 1 1 55-009 �'tircp mass.gov/dor SALES AND USE TAX REGISTRATION CERTIFICATE o= KSMP ENTERPRISES INC a= SEA STREET FOOD MART W= —_ 231 SEA ST HYANNIS MA 02601-4573 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 ----------------------------------------------------------------------------------------------------------------------------------------------- �sartits�T MASSACHUSETTS DEPARTMENT OF REVENUE Form ST-1 Sales and Use Tax Registration Certificate This registration must be posted and visible at all :yFti r o� �. times. KSMP ENTERPRISES INC Account ID: SLS-19541155-009 SEA STREET FOOD MART Certificate Number: 2053965824 231 SEA ST HYANNIS MA 02601-4573 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: December 1, 2019 crtr �. sF Commonwealth of Massachusetts Letter ID: L2 114658 176 r' �f Department of Revenue Notice Date:October 3,2019 Ga I Christopher C.Harding,Commissioner Account ID:CRL-1 9541 1 55-007 F4TOFP mass.gov/dor RETAILER LICENSE FOR SALE OF CIGARS AND SMOKING TOBACCO I �III�III�III � IIIII����I��'�'I�I�I"'�'lll�'��IIIIIIIII o= KSMP ENTERPRISES INC SEAS STREET FOOD o MART� i N=_ 231 SEA ST HYANNIS MA 02601-4573 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 ----------------------------------------------------------------------------------------------------------------------------------------------- aCH(Is MASSACHUSETTS DEPARTMENT OF REVENUE Form CT-3T s ;— r Retailer License for Sale of Cigars and Smoking Tobacco 7 �1l 4 r'Fv°r01i�` This license must be posted and visible at all times.The sale of tobacco products to anyone under 18 years of age is prohibited. KSMP ENTERPRISES INC Account ID: CRL-19541155-007 SEAS STREET FOOD MART License Number: 1517094912 231 SEA ST HYANNIS MA 02601-4573 This certifies that the taxpayer named above is licensed under Chapter 64C of the Massachusetts General Laws p a s 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 3, 2019 Expiration Date: September 30, 2020 o4�rr Town of Barnstable BOARD OF HEALTH Paul J Canniff,D.M.D. ` Board of Health Donald A.Gaudagnoli,M.D. rae�aruu� John T. Norman Maw 200 Main Street, Hyannis, MA 02601 F.P. Thomas Lee Alternate Phone: 508 862-4644 Fax: 508 790-6304 www.townofbarnstable.us Permit to Operate a Food Establishment In accordance with regulations promulgated under authority of 105 CMR 590.000 M.G.L. Chapter 94 Sections 305A, 305B, 146, 189 and 189A; Chapter 111, Sections 5 and 127A, a permit is hereby granted to: Permit No: 751 Issue Date: 12/20/18 DBA: SEA STREET FOOD MART OWNER: M.A. GENERAL, INC. Location of Establishment: 231 SEA STREET 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: $100.00 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: $85.00 FOR ESTABLISHMENTS WITH SEATING: PERMIT IS NOT VALID UNLESS ISSUED IN CONJUNCTION WITH A COMMON VICTUALER LICENSE Restrictions: J FIKE�byti ' Initials: JM Town of Barnstable ( Date Paid 1 Amt Pd$ LAS& Inspectional Services �pr l � Eon. Public Health Division Thomas McKean, Director �OcqR 200 Main Street,Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT DATE NEW OWNERSHIP RENEWAL NAME OF FOOD ESTABLISHMENT: � �iy� /'�B� ) .S /� 7 lwll�eI ADDRESS OF FOOD ESTABLISHMENT: 23 MAILING ADDRESS(IF DIFFERENT FROM ABOVE): SA7;171n-� E-MAIL ADDRESS: Z04e��l o9e _qzV AeL 6042 TELEPHONE NUMBER OF FOOD ESTABLISHMENT: 62—)Z- 0 of TOTAL NUMBER OF BATHROOMS: VWGs' WELL WATER: YES —NO ANNUAL WATER ANALYSIS REQUIRED) ANNUAL:tlf� SEASONAL: DATES OF OPERATION: / / TO NUMBER OF SEATS: INSIDE: OUTSIDE: TOTAL: SEATING: MUST OBTAIN A COMMON VICTUALLER'S LICENSE FROM LICENSING DIV. ***OUTSIDE DINING REMINDER*** OUTSIDE DINING,MUST BE APPROVED BY THE HEALTH DIV.AND LICENSING,AND MEET OUTSIDE DINING REQUIREMENTS. IS WAIT STAFF PROVIDED FOR OUTSIDE DINING? IS AN AIR CURTAIN PROVIDED AT WAITSTAFF SERVICE DOOR(S)? TYPE OF ESTABLISHMENT: (PLEASE CHECK ALL THAT APPLY BELOW) FOOD SERVICE L/- TAIL FOOD-ONLY required for TCS foods(foods requiring refrigeration/freezer) BED&BREAKFAST CONTINENTAL BREAKFAST COTTAGE FOOD INDUSTRY(formerly residential kitchen) MOBILE FOOD FROZEN DAIRY DESSERT MACHINES ... (MONTHLY LAB ANALYSIS REQUIRED) CATERING ... (CATERING NOTICE REQUIRED BEFORE EVENT(SEE PAGE#2) �I'OBACCO SALES ... (ANNUAL TOBACCO SALES APPLICATION REQUIRED) *** SEASONAL,MOBILE & NEW FOOD ONLY*** REQUIRED TO CALL HEALTH DIV.FOR INSPECTION PRIOR TO PERMIT BEING ISSUED Q:\Application For risTOODAPPREV2018.doc -- ---- ---- PLEASE CALL 508-862-4644 OWNER INFORMATION: FULL NAME OF APPLICANT . SOLE OWNER:CVS/ O OWNER PHONE # ADDRESS CORPORATE OWNER: FEDERAL ID NO. : CORPORATE ADDRESS: ;2 J/ PERSON IN CHARGE OF DAILY OPERATIONS: hIGC List (2) Certified Food Protection Managers AND at least(1)Allergen Awareness Certified Staff All FOOD ESTABLISHMENTS must have 1 Certified Food Protection Manager PER SHIFT. **ATTACH COPIES OF CERTIFICATES** The Health Div. will NOT use past years' records. You must provide new copies and POST THE CERTIFICATES at your food establishment. Certified Food Managers Expiration Date Allergen Awareness Expiration Date 2. SIGN T OF APPLICANT DATE ***FOOD POLICY INFORMATION*** SEASONAL FOOD SERVICE:All seasonal food establishments,including mobile trucks must be inspected by the Health Div. prior to opening!! Please call Health Div.at 508-862-4644 to schedule your inspection. Please call at least(7)days in advance. FROZEN DAIRY DESSERTS: Frozen desserts must be tested by a State Certified lab prior to opening and monthly thereafter, with sample results submitted to the Health Div. Failure to do so will result in the suspension or revocation of your Frozen Dessert Permit until the above terms are met. CATERING POLICY: Anyone who caters within the Town of Barnstable must notify theTown by fax or mail prior to catering event. You must complete a catering notice found at http://www.townofbarnstable.us/healthdivision/applications.asp. OUTDOOR COOKING: Outdoor cooking,preparation,or display of any food product by a food establishment is prohibited. TOBACCO ESTABLISHMENTS: All tobacco establishments must complete an Application for Tobacco Sales Permit and Employee Signature Form. NOTICE: Permits run annually from January 1st to Dec. 3 1"each calendar year. IT IS YOUR RESPONSIBILITY TO RETURN THE COMPLETED APPLICATION(S)AND REQUIRED FEES BY DEC 1st. Q:\Application FomsTOODAPPREV2018.doc Op IKE ro r, TOWN OF BARNSTABLE HEALTH INSPECTOR-s Establishment Name: Date: Page: of c` ti OFFICE HOURS PUBLIC HEALTH DIVISION 8:00-9:30 A.M. BARNSTABLE. = 200 MAIN STREET 3:30-a:3o P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified 9 M6}9• �0� HYANNIS,MA 02601 " More.-FRI. No Reference R-Red Item PLEASE PRINT CLEARLY �prED MPr a, - 508-862-4644 FOOD,ESTABLISHMENT INSPECTION REPORT ef c) Name Date �' e o Inspection oerationfsl Routine Address Risk Fo Service ection Level etail Previous Inspection Telephone ential Kitchen Date: Mobile Pre-operation Owner HACCP Y/N Temporary Suspect Illness Caterer General Complaint _ Person in Charge(PIC) Time Bed&Breakfast HACCP `^'Y►'�✓ In: Other ' fig Inspector Out: EL Each violation checked requires an explanation on the narrative page(s)and a citation of specific provision(s)violated. Violations Related to Foodborne Illness Interventions and Risk Factors(Red Items) Anti-Choking 590.009(E) ❑ ..� Violations marked may pose an imminent health hazard and require immediate corrective Tobacco 590.009(F) ❑ Action as determined-by the Board of Health. Allergen Awareness 590.009(G) ❑ FOOD PROTECTION MANAGEMENT ❑ 12.Prevention of Contamination from Hands ❑ 1.PIC Assigned/Knowledgeable/Duties ❑ 13.Handwash Facilities EMPLOYEE HEALTH PROTECTION FROM CHEMICALS ❑2.Reporting of Diseases by Food Employees and PIC ❑ 14.Approved Food or Color Additives ❑3.Personnel with.lnfectious Restricted/Excluded ❑ 15. Toxic Chemicals FOOD FROM APPROVED SOURCE TIME/TEMPERATURE CONTROLS(Potentially Hazardous Foods) ❑4.Food and Water from Approved Source ❑ 16.Cooking Temperatures ❑ 5.Receiving/Condition ❑ 17.Reheating ❑6.Tags/Records/Accuracy of Ingredient Statements ❑ 18.Cooling ❑ 7.Conformance with Approved Procedures/HACCP Plans ❑ 19.Hot and Cold Holding PROTECTION FROM CONTAMINATION ❑20.Time As a Public Health Control ❑8.Separation/Segregation/Protection REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) ❑9.Food Contact Surfaces Cleaning and Sanitizing ❑21.Food and Food Preparation for HSP ❑ 10.Proper Adequate Handwashing CONSUMER ADVISORY ❑ 11.Good Hygienic Practices ❑22.Posting of Consumer Advisories Violations Related to Good Retail Practices(Blue Items) Total Number of Critical Violations Critical(C)violations marked must be corrected immediately. (blue&red items) Corrective Action Required: ❑ No ❑ Yes Non-critical(N)violations must be corrected immediately or within 90 days as determined b the Board of Health. Overall Rating Y Y � ®Voluntary Compliance ❑ Employee.Restriction/Exclusion ❑ Re-inspection Scheduled ❑ Emergency Suspension C N Official Order for Correction: Based o[,r2 n today,the items Embar o Emergency Closure Voluntary Disposal checked indicate violations of 105 CMR 590.000/Federal Food Code. ® 9 ❑ g y rY P ❑ Other: 23.Management and Personnel (FC-2)(590.003) This report,when signed below by a Board of Health member or its agent A=Zero critical violations and no more than 3 non-critical violations. F=3 or more critical violations.9 or more non-critical violations, 24.Food and Food Preparation (FC-3)(590.004) constitutes an order of the Board of Health. Failure to correct violations regardless of the number of critical;results in an F.- 25.Equipment and Utensils (FC-4)(590:005 B=One critical violation and less than 4non-critical violations g ) cited in this report may result in suspension or revocation of the food if no critical violations observed,4 to 6 non-critical violations=B. Seriously Critical Violation=F is scored automatically if: no hot 26.Water,Plumbing and Waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If 27.Physical Facility (FC-6)(590.007) aggrieved by this order,you have a right to a hearing. Your request must C=2 critical violations and less than 9 non-critical. If no critical water,sewage back-up,infestation of rodents or insects,or lack of 28.Poisonous or Toxic Materials (FC-7)(590.008) be in writing and submitted to the Board of Health at the above address violations observed,7 to 8 non-critical violations. If 1 critical refrigeration. 29.Special Requirements (590.009) within 10 days of receipt of this order. violation,4 to 8 non-critical violations=C. 30.Other DATE OF RE-INSPECTION: Inspector's Signature Print: 31.Dumpster screened from public view /� Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y IN i l ( - #Seats Observed Frozen Dessert Machines: Outside Dining Y N PIC's Signature Print: Self Service Wait Service Provided Grease Trap Size Variance Letter Posted Y N d Dumpster Screen? Y% N i d Violations related to Foodborne Illness Violations Related to Foodborne Illness Interventions Interventions and Risk Factors(Red Items 1-22) and Risk Factors(Red Items 1-22) (Cont.) FOOD PROTECTION MANAGEMENT PROTECTION FROM CONTAMINATION PROTECTION FROM CHEMICALS 3-501.14(C) PHFs Received at Temperatures According to 1 590.003(A) Assignment of Responsibility* 8 Cross-contamination L 14 Food or Color Additives Law Cooled to 41°F/45'F Within 4 Hours* 3-501.15 Cooling Methods for PHFs 590.003(B) Demonstration of Knowledge* 3-302.11(A)(1) Raw Animal Foods Separated from 3-202.12 Additives* Cooked and RTE Foods.* 19 PHF Hot and Cold Holding 2-103.11 Person-in-Charge Duties 3-302.14 Protection from Unapproved Additives* Contamination from Raw Ingredients 15 590.004(F) Poisonous or Toxic Substances 3-501.16(B) Cold PHFs Maintained At or Below 41°F/45°F EMPLOYEE HEALTH 3-302.11(A)(2) Raw Animal Foods Separated from Each 7-101.11 Identifying Information-Original Containers* Other* 3-501.16(A) Hot PHFs Maintained At or Above 140'F* 2 590.003(C) Responsibility of the Person-in-Charge to 7-102.11 Common Name-Working Containers* Require Reporting by Food Employees and Contamination from the Environment 3-501.16(A) Roasts Held At or Above 130°F Applicants* 3-302.11(A) Food Protection* 7-201.11 Separation-Storage*7-202.11 Restriction-Presence and Use* 20 Time as a Public Health Control 590.003(F) Responsibility of A Food Employee or An 3-302.15 Washing Fruits and Vegetables 3-501.19 Time as a Public Health Control* Applicant To Report To The Person In Charge* * 7.202.12 Conditions of Use* 590.004(11) Variance Requirements 3-304.11 Food Contact with Equipment and Utensils 7-203.11 Toxic Containers-Prohibitions* 590.003(G) Reporting by Person in Charge* Contamination from the Consumer 3 590.003(D) Exclusions and Restrictions* 7-204.11 Sanitizers,Criteria-Chemicals* REQUIREMENTS FOR 3-306.14(A)(B)Resumed Food and Rrated or of Food* 7-204.12 Chemicals for Washing Produce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP 590.003(E) Removal of Exclusions and Restrictions g ( ) Disposition of Adulterated or Contaminated Food 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* I Beverages with Warning Labels* 4 Food and Water From Regulated Sources 9 Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs* 590.004(A-B) Compliance with Food Law* 4-501.111 Manual Warewashin Hot Water 7.206.12 Rodent Bait Stations* 3-801.11(D) Raw or Partially Cooked Animal Food and 3-201.12 Food in a Hermetically Sealed Container* Sanitization Temperatures* 7-206.13 Tracking Powders,Pest Control and Raw Seed Sprouts Not Served* 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-Hot Water Monitoring* 3-801.11(C) Unopened Food Package Not Re-Served 3-202.13 Shell Eggs* Sanitization Temperatures* TIMEITEMPERATURE CONTROLS 3-202.14 1 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. 16 Proper Cooking Temperatures for PHFs CONSUMER ADVISORY Concentration and Hardness* 22 3-603.11 Consumer Advisory Posted for Consumption of 3-202.16 Ice Made From Potable Drinking Water* 3-401.11A(1)(2) Eggs-155°F 15 sec Animal Foods That are Raw,Undercooked or 5-101.11 DrinkingWater from an Approved System* 4-601.11(A) Clean Utensils and Food Contact Surfaces of Eggs-Immediate Service 145°F 15 sec* PP Y Not Otherwise Processed to Eliminate Equipment* ( )( ) Pathogens 590.006(A) Bottled Drinking Water* 3-401.11 A 2 Comminuted Fish,Meats&Game * Effective uinooi 4-602.11 Cleaning Frequency of Utensils and Food Animals-155°F 15 sec* 590.006(B) Water Meets Standards in 310 CMR 22.0* Contact Surfaces of Equipment* * 3-302.13 Pasteurized Eggs Substitute for Raw Shell Shellfish and Fish From an Approved Source 3-401.11(B)(1)(2) Pork and Beef Roast-130'F 121 min Eggs* 4-702.11 Frequency of Sanitization of Utensils and Food 3-401.11(A)(2) I Ratites,Injected Meats-155°F 15 sec* 3-201.14 Fish and Recreationally Caught Molluscan Contact Surfaces of Equipment* Shellfish* 3A01.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS 4-703.11 Methods of Sanitization-Hot Water and Stuffing Containing Fish,Meat,Poultry or 590.009(A)-(D) Violations of Section 590.009(A)-(D)in cater- 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* Ratites-165°F 15 sec* Sources* ing,mobile food,temporary and residential 10 Proper,Adequate Handwashing 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 145°F* kitchen operations should be debited under Game and Wild Mushrooms Approved By 2-301.11 Clean Condition-Hands and Arms* Regulatory Authority 3-401.12 Raw Animal Foods Cooked in a Microwave the appropriate sections above if related to 3-202.18 Shellstock Identification Present* 2-301.12 Cleaning Procedure* 165°F* foodbome illness interventions and risk factors. 590.004(C) Wild Mushrooms* 2-301.14 When to Wash* 3-401.11(A)(1)(b) All Other PHFs-145°F 15 sec* Other 590.009 violations relating to good retail 3-201.17 Game Animals* 11 Good Hygienic Practices 17 Reheating for Hot Holding practices should be debited under#29-Special Requirements. 5 Receiving/Condition 2-401.11 Eating,Drinking or Using Tobacco* 3-403.11(A)&(D) PHFs 165°F 15 sec* 3-202.11 PHF's Received at Proper Temperatures* 2-401.12 Discharges From the Eyes,Nose and Mouth* 3-403.11(B) Microwave-165'F 2 Minute Standing Time* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES * 3-301.12 Preventing Contamination When Tasting* 3-403.11(C) Commercially Processed RTE Food-140°F* Blue Items 23-30) 3-202.15 Package Integrity I . Critical and non-critical violations,which do not relate to the foodborne 3-101.11 Food Safe and Unadulterated* 12 Prevention of Contamination from Hands 3-403.11(E) Remaining Unsliced Portions of Beef Roasts* illness interventions and risk factors listed above,can be found in the 6 Tags/Records:Shellstock 590.004(E) Preventing Contamination from Employees* 18 Proper Cooling of PHFs following sections of the Food Code and 105 CMR 590.000 * 13 Handwashing Facilities 3-501.14(A) Cooling Cooked PHFs from 140'F to 70'F 3-202.18 Shellstock Identification Item Good Retail Practices FC 590.000 3-203.12 Shellstock Identification Maintained* Conveniently Located and Accessible Within 2 Hours and From 70°F to 41°F/45°F Tags/Records:Fish Products 5-203.11 Numbers and Capacities* Within 4 Hours* 23. Management and Personnel FC-2 .003 5-204.11 Location and Placement* r501,141131 Cooling PHFs Made from Ambient 24. Food and Food Protection FC-3 .004 1 3 402.11 Parasite Destruction* Temperature Ingredients to 41°F/45°F 25. Equipment and Utensils FC-4 .005 3-402.12 Records,Creation and Retention* 5-205.11 Accessibility,Operation and Maintenance Within 4 Hours* 26. Water,Plumbing and Waste FC-5 .006 Labeling of Ingredients* Supplied with Soap and hand Drying Devices 27. Physical Facility FC-6 .007 590.004(J) 9 9 Y� DIY 7 Conformance with Approved Procedures/ 6-301.11 Handwashing Cleanser,Availability 28. Poisonous or Toxic Materials FC-7 .008 HACCP Plans 6-301.12 Hand Drying Provision 129. 1 Special Requirements 1 1.009 3-502.11 Specialized Processing Methods* 30. Other 3-502.12 Reduced-Oxygen Packaging Criteria* 8-103.12 1 Conformance with Approved Procedures* S:59oFormback6-2doc *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. �r °p THE Tq TOWN OF BARNSTABLE HEALTH INSPECTOR,s Establishment Name: Date: Page:- of q OFFICE HOURS PUBLIC HEALTH DIVISION 8:00-9:30 A.M. BARNSTABLE. • 200 MAIN STREET 3:3o-a:3o P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified MA. g, MON.-FRI. �A .63q.ate• HYANNIS,MA 02601 508-862-4644 No Reference R-Red Item PLEASE PRINT CLEARLY 'EDN1�' FOOD ESTABLISHMENT INSPECTION REPORT Name Date T e o e of sec ion ]ZI _ Ooeration(s) Routin . Address / Risk F ice � spection CQa Level E.-il. Previous InspectionTelephone ntial Kitchen Date: Mobile Pre-operation Owner HACCP Y/N Temporary Suspect Illness Caterer General Complaint Person in Charge(PIC) Time Bed&Breakfast HACCP In: Other Inspector - Out: u' Each violation checked requires an explanation on the narrative page(s)and a citation of specific provision(s)violated. Violations Related to Foodborne Illness Interventions and Risk Factors Red Items) ( Anti-Choking 590.009(E) ❑ Violations marked may pose an imminent health hazard and require immediate corrective Tobacco 590.009(F) ❑ Action as determined by the Board of Health. Allergen Awareness 590.009(G) ❑ Iota FOOD PROTECTION MANAGEMENT ❑ 12.Prevention of Contamination from Hands ❑ 1.PIC Assigned/Knowledgeable/Duties ❑ 13.Handwash Facilities EMPLOYEE HEALTH PROTECTION FROM CHEMICALS ❑ 2.Reporting of Diseases by Food Employees and PIC ❑ 14.Approved Food or Color Additives ❑ 3.Personnel with Infectious Restricted/Excluded ❑ 15. Toxic Chemicals FOOD FROM APPROVED SOURCE TIMEITEMPERATURE CONTROLS(Potentially Hazardous Foods) ❑4.Food and Water from Approved Source ❑ 16.Cooking Temperatures ❑ 5.Receiving/Condition ❑ 17.Reheating ❑ 6.Tags/Records/Accuracy of Ingredient Statements ❑ 18.Cooling ❑ 7.Conformance with Approved Procedures/HACCP Plans ❑ 19.Hot and Cold Holding PROTECTION FROM CONTAMINATION ❑ 20.Time As a Public Health Control 4 I','. , ❑ 8.Separation/Segregation/Protection REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) ( !� ❑ 9.Food Contact Surfaces Cleaning and Sanitizing ❑21.Food and Food Preparation for HSP ' ❑ 10.Proper Adequate Handv✓ashing CONSUMER ADVISORY ❑ 11.Good Hygienic Practices ❑ 22.Posting of Consumer Advisories 44 na Violations Related to Good Retail Practices(Blue Itemsj Total Number of Critical Violations 8 Critical(C)violations marked must be corrected immediately. (blue&red items) Corrective Action Required: ❑ No ❑ Yes Non-critical(N)violations must be corrected immediately or Overall Rating �� within 90 days as determined by the Board of Health. ❑ Voluntary Compliance ❑ Employee Restriction/Exclusion ❑ Re-inspection Scheduled ❑ Emergency Suspension C N Official Order for Correction: Based on an inspection today,the items ❑ Embargo C] Emergency Closure ❑ Voluntary Disposal ❑ Other: checked indicate violations of 105 CIMR 590.000/Federal Food Code. 23.Management and Personnel (FC-2)(590.003) This report,when signed below by a Board of Health member or its agent A=Zero critical violations and no more than 3 non-critical violations. F=3 or more critical violations.9 or more non-critical violations, 24.Food and Food Preparation (FC-3)(590.004) constitutes an order of the Board of Health. Failure to correct violations regardless of the number of critical,results in an F. 25.Equipment and Utensils (FC-4)(590.005 B=One critical violation and less than 4nora-critical violations 9 ) cited in this report may result in suspension or revocation of the food if no critical violations observed,4 to 6 non-critical violations=B. 26.Water;Plumbing and Waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If Seriously Critical Violation=F is scored automatically if: no hot 27.Physical Facility (FC-6)(590.007) aggrieved by this order,you have a right to a hearing. Your request must C=2 critical violations and less than 9 non-critical. If no critical water,sewage back-up,infestation of rodents or insects,or lack of 28.Poisonous or Toxic Materials (FC-7)(590.008) be in writing and submitted to the Board of Health at the above address violations observed,7 to 8 non-critical violations. If 1 critical refrigeration. violation,4 to 8 non-critical violations=C. 29.SpeciaLRequirements (590.009) within 10 days of receipt of this order.R Inspector's Signature Print: 30.Other PATE OF RE-INSPECTION; 31.Dum ter screened from public view ) Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y IN #Seats Observed Frozen Dessert Machines: Outside Dining Y N PIC%s Signatur Pri t: Self Service Grease Trap Wait Service Provided p Size Variance Letter Posted Y N Dumpster Screen o Y N r Violations related to Foodborne Illness Violations Related to Foodborne Illness Interventions Interventions and Risk Factors(Red Items 1-22) and Risk Factors(Red Items 1-22) (Cont.) FOOD PROTECTION MANAGEMENT PROTECTION FROM CONTAMINATION PROTECTION FROM CHEMICALS 3-501.14(C) PHFs Received at Temperatures According to 1 590.003(A) Assignment of Responsibility* 8 Cross-contamination 1 q Food or Color Additives Law Cooled to 41°F/45°F Within 4 Hours* 590.003(B) Demonstration of Knowledge* 3-302.11(A)(1) Raw Animal Foods Separated from 3-202.12 Additives* 3-501.15 Cooling Methods for PHFs Cooked and RTE Foods.* 19 PHF_Hot and Cold Holding 2-103.11 Person-in-Charge Duties 3-302.14.. Protection from Unapproved Additives* Contamination from Raw Ingredients 15 Poisonous or Toxic Substances 3-501.16(B) Cold PHFs Maintained At or Below 41°F/45°F 590.004(F) EMPLOYEE HEALTH 3-302.11(A)(2) Raw Animal Foods Separated from Each 7-101.11 Identifying Information-Original Containers* 590.003(C) Responsibility of the Person-in-Charge to Other* 7-102.11 Common Name-Working Containers* 3-501.16(A) Hot PHFs Maintained At or Above 140°F P g 2 Require Reporting by Food Employees and Contamination from the Environment 3-501.16(A) Roasts Held At or Above 130°F* 7-201.11 Separation-Storage* Applicants* 3-302.11(A) Food Protection* 1 20 Time as a Public Health Control 590.003(F) Responsibility of A Food Employee or An 3-302.15 Washing Fruits and Vegetables 7-202.11 Restriction-Presence and Use* 3-501.19 Time as a Public Health Control* Applicant To Report To The Person In Charge* * 7.202.12 Conditions of Use* 590.004 11 Variance Re uirements 590.003(G) Reporting by Person in Charge * 3-304.11 Food Contact with Equipment and Utensils 7-203.11 Toxic Containers-Prohibitions* ( ) q Contamination from the Consumer Exclusions and Restrictions* 7-204.11 Sanitizers,Criteria-Chemicals* REQUIREMENTS FOR. D� 3-306.14(A)(B)Returned Food and Reservice of Food* 7-204.12 Chemicals for Washin Produce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP 15 0.003(E) Removal of Exclusions and Restrictions Disposition of Adulterated or Contaminated g Food 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels* 4 Food and Water From Regulated Sources 9 Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs* 590.004(A-B). Compliance with Food Law* * 3-801.11(D) Raw or Partially Cooked Animal Food and P 4-501.111 Manual Wazewashing-Hot Water 7.206.12 Rodent Bait Stations 3-201.12 Food in a Hermetical] Sealed Container* Sanitization Temperatures* Raw Seed Sprouts Not Served* Y P 7-206.13 Tracking Powders,Pest Control and 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Wazewashing-Hot Water Monitoring* 3-801.11(C) Unopened Food Package Not Re-Served* 3-202.13 Shell Eggs* Sanitization Temperatures* TIME/TEMPERATURE CONTROLS 3-202.14 1 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. 16 Proper Cooking Temperatures for PHFs CONSUMER ADVISORY 3-202.16 Ice Made From Potable Drinking Water* Concentration and Hardness* 3-401.11A(1)(2) Eggs-155°F 15 sec 22 3-603.11 Consumer Advisory Posted for Consumption of 4-601.11(A) Clean Utensils and Food Contact Surfaces of E s-Immediate Service 145°F 15 sec* Animal Foods That are Raw,Undercooked or 5-101.11 Drinking Water from an Approved System* gg Equipment* Not Otherwise Processed to Eliminate 590.006(A) Bottled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* Ef cde 11112001 4-602.11 Cleaning Frequency of Utensils and Food Animals-155'F 15 sec* 590.006(B) Water Meets Standards in 310 CMR 22.0* Contact Surfaces of Equipment* 3-302.13 Pasteurized Eggs Substitute for Raw Shell Shellfish and Fish From an Approved Source 3-401.11(B)(1)(2) Pork and Beef Roast-130°F 121 min* Eggs* 4-702.11 Frequency of Sanitization of Utensils and Food 3-401.11(A)(2) Ratites,Injected Meats-155°F 15 sec* 3-201.14 Fish and Recreationally Caught Molluscan Contact Surfaces of Equipment* Shellfish* 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS 4-703.11 Methods of Sanitization-Hot Water and Stuffing Containing Fish,Meat,Poultry or 590.009(A)-(D) Violations of Section 590.009(A)-(D)in cater- 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* Sources* Mushrooms Approved By Ratites-165°F 15 sec* ing,mobile food,temporary and residential Authority 10 Proper,Adequate Handwashing 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 145°F* kitchen operations should be debited under Game and 2-301.11 Clean Condition-Hands and Arms* Regulatory Authority 3-401.12 Raw Animal Foods Cooked in a Microwave the appropriate sections above if related to 3-202.18 Shellstock Identification Present* 2-301.12. Cleaning Procedure* 165°F* foodborne illness interventions and risk factors. * 2-301.14 When to Wash* * Other 590.009 violations relating to good retail 590.004(C) Wild Mushrooms 3-401.11(A)(1)(b) All Other PHFs-145°F 15 sec 3-201.17 Game Animals* Good Hygienic Practices 17 Reheating for Hot Holding practices should be debited under#29-Special Requirements. 5 Receiving/Condition 2-401.11 Eating,Drinking or Using Tobacco* 3-403.11(A)&(D) PHFs 165°F 15 sec* 3-202.11 PHF's Received at Proper Temperatures* 2-401.12 Discharges From the Eyes,Nose and Mouth* 3-403.11(B) Microwave-165°F 2 Minute Standing Time* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES * 3-301.12 Preventing Contamination When Tasting* 3A03.11 C Commercial] Processed RTE Food-140°F* (Blue Items 23.30) 3-202.15 Package Integrity ( ) Y Critical and non-critical violations,which do not relate to the foodborne 12 Prevention of Contamination from Hands 3-403.11E Remaining Unsliced Portions of Beef Roasts* 3-101.11 Food Safe and Unadulterated* ( ) g illness interventions and risk factors listed above,can be found in the 6 Tags/Records:Shellstock 590.004(E) Preventing Contamination from Employees* 18 Proper Cooling of PHFs following sections of the Food Code and 105 CMR 590.000 3-202.18 Shellstock Identification* 3-501.14(13 Handwashing Facilities A) g Coolin Cooked PHFs from 140°F to 70F °. 3-203.12 Shellstock Identification Maintained* Conveniently Located and Accessible Within 2 Hours and From 70°F to 41°F/45°F Item Good Retail Practices FC 590.000 Tags/Records:Fish Products 5-203.11 Numbers and Capacities* Within 4 Hours* 23. Management and Personnel FC-2 .003 * 5-204.11 Location and Placement* 3-501.14(B) Cooling PHFs Made from Ambient 24. Food and Food Protection FC-3 .004 3-402.11 Parasite Destruction Temperature Ingredients to 41°F/45°F 25. Equipment and Utensils FC-4 .005 3-402.12 Records,Creation and Retention* 5-205.11 Accessibility,Operation and Maintenance Within 4 Hours* 26. Water,Plumbing and Waste FC-5 .006 590.004(J) Labeling of Ingredients* Supplied with Soap and hand Drying Devices 27. Physical Facility FC-6 .007 7 - Conformance with Approved Procedures/ 6-301.11 Handwashing Cleanser,Availability 28. 1 Poisonous or Toxic Materials FC-7 .008 HACCP Plans 6-301.12 Hand Drying Provision 129. 1 Special Requirements 009 3-502.11 Specialized Processing Methods* 130. 1 Other 3-502.12 Reduced-Oxygen Packaging Criteria* 8-103.12 1 Conformance with Approved Procedures* S:590Formback6-2doc *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. °p tr+e 1pk, TOWN OF BARNSTAB.LE - HEALTH INSPECTORS Establishment Name: Date: � ( Page: of ' 4 OFFICE HOURS AR E PUBLIC HEALTH MA N ST RETSION 6:00-9:30A.M. 3:30-4:30 P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified �p Mssq:e 0� HYANNIS,MA 02601MON -FRI. 508-862-4644 No Reference, R-Red Item PLEASE PRINT CLEARLY 8-8 FOOD ESTABLISHMENT INSPECTION REPORT - L Name Date k% Type of Type of Inspection Operation(s) Rou lM. G Address Risk F ervice e-inspectio Level et s nspection Telephon 5� �� Q [ 2 i ential Kitchen Date: �„�/ V Mobile Pre-operation Owner HACCP Y/N Temporary Suspect Illness Caterer General Complaint Person in Charge(PIC) " Time Bed&Breakfast HACCP In: Other Inspector.A Out: Each violation checked requires an explanation on the narrative page(s)and a citation of specific provision(s)violated. JA Violations Related to Foodborne Illness Interventions and Risk Factors(Red Items) Anti-Choking 590.009(E) ❑ Violations marked may pose an imminent health hazard and require immediate corrective Tobacco. 590.009(F) ❑ Action as determined by the Board of Health. Allergen Awareness 590.009(G) ❑ FOOD PROTECTION MANAGEMENT ❑ 12.Prevention of Contamination from Hands ❑ 1.PIC Assigned/Knowledgeable/Duties ❑ 13.Handwash Facilities EMPLOYEE HEALTH PROTECTION FROM CHEMICALS ❑2.Reporting of Diseases by Food Employees and PIC ❑ 14.Approved Food or Color Additives ❑ 3.Personnel with Infectious Restricted/Excluded ❑ 15. Toxic Chemicals FOOD FROM APPROVED SOURCE TIME/TEMPERATURE CONTROLS(Potentially Hazardous Foods) ❑4.Food and Water from Approved Source ❑ 16.Cooking Temperatures ❑ 5.Receiving/Condition ❑ 17.Reheating ❑ 6.Tags/Records/Accuracy of Ingredient Statements ❑ 18.Cooling .r ❑ 7.Conformance with Approved Procedures/HACCP Plans ❑ 19.Hot and Cold Holding PROTECTION FROM CONTAMINATION ❑20.Time As a Public Health Control ❑ 8.Separation/Segregation/Protection REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) ❑ 9.Food Contact Surfaces Cleaning and Sanitizing ❑ 21.Food and Food Preparation for HSP ❑ 10.Proper Adequate Handwashing CONSUMER ADVISORY �`(� � ��♦�'�-Iq ❑ 11.Good Hygienic Practices ❑22.Posting of Consumer Advisories (B lue ) V Violations Related o Good Retail Practices Blue Items Total Number of Critical Violations Critical(C)violations marked must be corrected immediately. (blue&red items) Corrective Action Required: ❑ No ❑ Yes Non-critical(N)violations must be corrected immediately or Overall Rating within 90 days as determined by the Board of Health. ❑ Voluntary Compliance ❑ Employee Restriction/Exclusion ❑ Re-inspection Scheduled ❑ Emergency Suspension C N Official Order for Correction:Based on an inspection today,the items Embargo Emergency Closure Voluntary Disposal Other: checked indicate violations of 105 CMR 590.000/Federal Food Code. ❑ g ❑ g y ❑ ry p ❑ 23.Management and Personnel (FC-2)(590.003) This report,when signed below by a Board of Health member or its agent A=Zero critical violations and no more than 3 non-critical violations. F=3 or more critical violations.9 or more non-critical violations, 24.Food and Food Preparation (FC-3)(590.004) constitutes an order of the Board of Health. Failure to correct violations regardless of the number of critical,results in an F. 25.Equipment and Utensils (FC-4)(590.005) cited in this report may result in suspension or revocation of the food B-One critical violation and less than non-critical violations 9 if no critical violations observed,4 too 6.non-critical violations=B. Seriously Critical Violation=F is scored automatically if: no hot 26.Water,Plumbing and Waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If C=2 critical violations and less than 9 non-critical. If no critical water,sewage 27.Physical Facility (FC-6)(590.007) aggrieved by this order,you have a right to a hearing. Your request must non-cr ga back-up,infestation of rodents or insects,or lack of violations observed,7 to 8oull-critical violations. If 1 critical refrigeration. 28.Poisonous or Toxic Materials (FC77)(590.008) be in writing and submitted to the Board of Health at the above address within 10 days of receipt of this order. violation,4 to Boon-critical violations=C. 29.Special Requirements (590.009) 30.Other DATE OF RE-INSPECTION: Inspector's Signature Print: 31.Dumpster screened from public view Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y N ma"UPza�;7 #Seats Observed Frozen Dessert Machines: Outside Dining Y N PIC's Signature Print: r Self Service Wait Service Provided Grease Trap Size Variance Letter Posted .Y N Dumpster Screen Y N (-�j Violations related to Foodborne Illness Violations Related to Foodborne Illness Interventions Interventions and Risk Factors(Red Items 1-22) and Risk Factors(Red Items 1-22) (Cont.) FOOD PROTECTION MANAGEMENT PROTECTION FROM CONTAMINATION PROTECTION FROM CHEMICALS 3-501.14(C) PHFs Received at Temperatures According to 1 590.003(A) Assignment of Responsibility* 8 Cross-contamination 14 Food or Color Additives Law Cooled to 41°F/45°F Within 4 Hours* 590.003(B) Demonstration of Knowledge* 3-302.11(A)(1) Raw Animal Foods Separated from 3-202.12 Additives* 3-501.15 Cooling Methods for PHFs Cooked and RTE Foods.* 19 PHF Hot and Cold Holding 2-103.11 Person-in-Chazge Duties 3-302.14 Protection from Unapproved Additives* Contamination from Raw Ingredients 15 ,,_ Poisonous or Toxic Substances 3-501.16(B) Cold PHFs Maintained At or Below 41°F/45°F EMPLOYEE HEALTH 3-302.11(A)(2) Raw Anima]Foods Separated from Each 7-101.11 - Identifying Information-Original Containers* 590.004(F) 590.003(C) Responsibility of the Person-in-Charge to Other* 7-102.11 Common Name-Working Containers* 3-501.16(A) Hot PHFs Maintained At or Above 140°F* 2 Require Reporting by Food Employees and Contamination from the Environment 3-501.16(A) Roasts Held At or Above 130°F* 7-201.11 Separation-Storage* Applicants* 3-302.11(A) Food Protection* P g 20 Time as a Public Health Control 7-202.11 Restriction-Presence and Use* 590.003(F) Responsibility of A Food Employee or An 3-302.15 Washing Fruits and Vegetables * 590.00411 3-501.19 Time as a Public Health Control* Applicant To Report To The Person In Charge* * 7.202.12 Conditions of Use * 3-304.11 Food Contact with Equipment and Utensils 7-203.11 Toxic Containers-Prohibitions* ( ) Variance Requirements 590.003(G) Reporting by Person in Charge Contamination from the Consumer 3 590.003(D) Exclusions and Restrictions* 7-204.11 Sanitizers,Criteria-Chemicals* REQUIREMENTS FOR 3-306.14(A)(B)Returned Food and Rrated or of Food* 7-204.12 Chemicals for WashingProduce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP 590.003(E) Removal of Exclusions and Restrictions Disposition of Adulterated or Contaminated � ) Food 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels* 4 Food and Water From Regulated Sources 9 Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs* 590.004(A-B) Compliance with Food Law* - 4-501.111 Manual Warewashing-Hot Water 7.206.12 Rodent Bait Stations* 3-801.11(D) Raw or Partially Cooked Animal Food and 3-201.12 Food in a Hermetically Sealed Container* Sanitization Temperatures* 7-206.13 Tracking Powders,Pest Control and Raw Seed Sprouts Not Served* 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-Hot Water Monitoring* 3-801.11(C) Unopened Food Package Not Re-Served* 3-202.13 Shell Eggs* Sanitization Temperatures* TIME/TEMPERATURE CONTROLS 3-202.14 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. 16 Proper Cooking Temperatures for PHFs CONSUMER ADVISORY 3-202.16 Ice Made From Potable Drinking Water* Concentration and Hardness* 3-401.11A(l)(2) Eggs-155°F 15 sec 22 3-603.11 Consumer Advisory Posted for Consumption of 4-601.11(A) Clean Utensils and Food Contact Surfaces of Eggs-Immediate Service 145°F 15 sec* Animal Foods That are Raw,Undercooked or Equipment 5-101.11 Drinking Water from an Approved System* * gg Not Otherwise Processed to Eliminate 590.006(A) Bottled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* Effective inrzooi 4-602.11 Cleaning Frequency of Utensils and Food Animals-155°F 15 sec* 590.006(B) Water Meets Standards in 310 CMR 22.0* Contact Surfaces of Equipment* 3-302.13 Pasteurized Eggs Substitute for Raw Shell Shellfish and Fish From an Approved Source 3-401.11(B)(1)(2) Pork and Beef Roast-130°F 121 min* Eggs* 3-201.14 Fish and Recreationally Caught Molluscan Contact Surf 4-702.11 Frequency Sanitization of Utensils and Food 3-401.11(A)(2) Ratites,Injected Meats-155°F 15 sec* faces of Equipment* Shellfish* 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS 4-703.11 Methods of Sanitization-Hot Water and 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* Stuffing Containing Fish,Meat,Poultry or 590.009(A)-(D) Violations of Section 590.009(A)-(D)in cater- Ratites-165°F IS sec* Sources* 10 Proper,Adequate Handwashing ing,mobile food,temporary and residential Game and Wild Mushrooms Approved By 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 145°F* kitchen operations should be debited under Regulatory Authority 2-301.11 Clean Condition-Hands and Arms* 3-401.12 Raw Animal Foods Cooked in a Microwave the appropriate sections above if related to 3-202.18 Shellstock Identification Present* 2-301.12 Cleaning Procedure* 165°F* foodbome illness interventions and risk factors. 590.004(C) Wild Mushrooms* 2-301.14 When to Wash* 3-401.11(A)(1)(b) All Other PHFs-145°F 15 sec* Other 590.009 violations relating to good retail 3-201.17 Game Animals* 11 Good Hygienic Practices 17 Reheating for Hot Holding practices should be debited under#29-Special 2-401.11 Eating,Drinking or Using Tobacco* * Requirements. 5 Receiving/Condition g. g g 3-403.11(A)&(D) PHFs 165°F 15 sec 3-202.11 PHF's Received at Proper Temperatures* 2-401.12 Discharges From the Eyes,Nose and Mouth* 3-403.11(B) Microwave-165°F 2 Minute Standing Time* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES * 3-301.12 Preventing Contamination When Tasting* 3-403.11 * (Blue Items 23-30) 3-202.15 Package Integrity (C) Commercially Processed RTE Food-140°F 12 Prevention of Contamination from Hands Critical and non-critical violations,which do not relate to the foodbome 3-101.11 Food Safe and Unadulterated* 3 403.11(E) Remaining Unsliced Portions of Beef Roasts* illness interventions and risk factors listed above,can be found in the 8 Tags/Records:Shellstock 590.004(E) Preventing Contamination from Employees* Lu Proper Cooling of PHFs following sections of the Food Code and 105 CMR 590.000 3-202.18 Shellstock Identification* LL3 Handwashing Facilities 3-501.14(A) Cooling Cooked PHFs from 140°F to 70°F 3-203.12 Shellstock Identification Maintained* Conveniently Located and Accessible Within 2 Hours and From 70°F to 41°F/45°F Item Good Retail Practices FC 590.000 Tags/Records:Fish Products 5-203.11 Numbers and Capacities* Within 4 Hours* 23. Management and Personnel FC-2 .003 5-204.11 Location and Placement* 3-501.14(B) Cooling PHFs Made from Ambient 24. Food and Food Protection FC-3 .004 3-402.11 Parasite Destruction* Temperature Ingredients to 41°F/45°F 25. Equipment and Utensils FC-4 .005 3 402.12 Records,Creation and Retention* 5-205.11 Accessibility,Operation and Maintenance Within 4 Hours 590.004(J) Labeling of Ingredients* Supplied with Soap and hand Drying Devices 2 Water,Plumbing and Waste FC-5 .00 27.. Physical Facility FC-6 007 2 7 Conformance with Approved Procedures/ 6-301.11 Handwashing Cleanser,Availability 8 Poisonous Toxic Materials FC-7 .008 HACCP Plans 6-301.12 Hand Drying Provision . u . 9 29 Special Requirements .009 3-502.11 Specialized Processing Methods* 30. 1 Other 3-502.12 Reduced-Oxygen Packaging Criteria* 8-103.12 Conformance with Approved Procedures* S:590FormbackE2doc *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. ail - -- `gyp THE Tp� TOWN OF BARNSTABLE, HEALTH INSPECTOR-s Establishment Name: Date: Page: of q OFFICE HOURS P ° PUBLIC HEALTH DIVISION 8:00-.9:30A.M. RARNSTABLE. • 200 MAIN STREET 3:30-4:30 P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified HYANNIS,MA 02601 MON.-FRI. No Reference R-Red Item PLEASE PRINT CLEARLY 508-862-4644 TFD MP�p FOOD ESTABLISHMENT INSPECTION REPORT Name Date Tyne of T Inspection Ofteration(s) outi r� Address Risk Food Service Re4ftspection / Level Previous Inspection Telephone si ential Kitchen Date: Mobile Pre-operation 62 Owner HACCP Y/N Temporary Suspect Illness Caterer General Complaint Person.in Charge(PIC) Time Bed&Breakfast HACCP In: Other Inspector Out: 44 A Pk, Each violation checked requires an explanation on the narrative page(s)and a citation of specific provision(s)violated. Violations Related to Foodborne Illness Interventions and Risk Factors(Red Items) Anti-Choking 590.009(E) ❑ p Violations marked may pose an imminent health hazard and require immediate Corrective Tobacco 590.009(F) ❑ Action as determined by the Board of Health. Allergen Awareness 590.009(G) ❑ FOOD PROTECTION MANAGEMENT ❑ 12.Prevention of Contamination from Hands ❑ 1.PIC Assigned/Knowledgeable/Duties ❑ 13.Handwash Facilities EMPLOYEE HEALTH PROTECTION FROM CHEMICALS ❑ 2.Reporting of Diseases by Food Employees and PIC ❑ 14.Approved Food or Color Additives ❑ 3.Personnel with Infectious Restricted/Excluded ❑ 15. Toxic Chemicals 12 FOOD FROM APPROVED SOURCE TIME/TEMPERATURE CONTROLS(Potentially Hazardous Foods) ❑4.Food and Water from Approved Source ❑ 16.Cooking Temperatures ❑ 5.Receiving/Condition ❑ 17.Reheating ❑6.Tags/Records/Accuracy of Ingredient Statements ❑ 18.Cooling ❑ 7.Conformance with Approved Procedures/HACCP Plans ❑ 19.Hot and Cold Holding PROTECTION FROM CONTAMINATION ❑20.Time As a Public Health Control ❑ 8.Separation/Segregation/Protection REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) ❑9.Food Contact Surfaces Cleaning and Sanitizing ❑ 21.Food and Food Preparation for HSP ❑ 10.Proper Adequate Handwashing CONSUMER ADVISORY Lo ❑ 11.Good Hygienic Practices ❑22.Posting of Consumer Advisories Violations Related to Good Retail Practices(Blue Items) Total Number of Critical Violations I �� Critical(C)violations marked must be corrected immediately. (blue&red items) Corrective Action Required: ❑ No - ❑ Yes Non-critical(N)violations must be corrected immediately or Overall Rating within 90 days as determined by the Board of Health. ❑ Voluntary Compliance ❑ Employee Restriction/Exclusion ❑ Re-inspection Scheduled ❑ Emergency Suspension C N' Official Order for Correction:Based on an inspection today,the items ❑ Embargo Emergency Closure ❑ Voluntary Disposal ❑ Other: checked indicate violations of 105 CMR 590.000/Federal Food Code. 23.Management and Personnel (FC-2)(590.003) This report,when signed below by a Board of Health member or its agent A=Zero critical violations and no more than 3 non-critical violations. F=3 or more critical violations.9 or more non-critical violations, 24.Food and Food Preparation (FC-3)(590.004) constitutes an order of the Board of Health. Failure to correct violations regardless of the number of critical,results.in an F. 25.Equipment and Utensils )(590.005 6=One critical violation and less than 4non-critical violations 9 (FC-4 ) cited in this report may result in suspension or revocation of the food if no critical violations observed,4 to 6 non-critical violations=B. Seriously Critical Violation=F is scored automatically if: no hot 26.Water,Plumbing and Waste (FC-5)(590.006) establishment permit and cessation of food.establishment operations. If 27.Physical Facility (FC-6)(590.007) aggrieved by this order,you have a right to a hearing. Your request must C=2 critical violations and less than 9 non-critical. If no critical ' water,sewage back-up,infestation of rodents or insects,or'lack of 28.Poisonous or Toxic Materials (FC-7)(590.008) be in writing and submitted to the Board of Health at the above address violations observed,7 to l3 rion-critical violations. If 1 critical refrigeration. within 10 days of receipt of this order. violation,4 to 8rfon-critical violations=C. 29.Special Requirements (590.009) Y P 30.Oth�Pr DATE OF RE-INSPECTION: Inspector's Signature Print: 31.Ducreened from public viewPermit Posted? N Grease Trap Previous Pumping Date Grease Rendered Y N , r�• i'� V #Seats Observed Frozen Dessert Machines: Outside Dining Y N PIC's Signature Print: Self Service Wait Service Provided Grease Trap Size Variance Letter Posted Y N Dumpster Screen 7 Y N z Violations related to Foodborne Illness Violations Related to Foodborne Illness Interventions Interventions and Risk Factors(Red Items 1-22) and Risk Factors(Red Items 1-22) (Cont.) FOOD PROTECTION MANAGEMENT PROTECTION FROM CONTAMINATION PROTECTION FROM CHEMICALS 3-501.14(C) PHFs Received at Temperatures According to 1 590.003(A) Assignment of Responsibility* 8 Cross-contamination 14 Food or Color Additives Law Cooled to 41°F/45°F Within 4 Hours* 590.003(B) jDemonstration of Knowledge* 3-302.11(A)(1) Raw Animal Foods Separated from 3-202.12 Additives* 3-501.15 Cooling Methods for PHFs 2-103.11 Person-in-Charge Duties Cooked and RTE Foods.* 3-302.14 Protection from Unapproved Additives* 19 PHF Hot and Cold Holding Contamination from Raw Ingredients 15 590.004(F) 590.003(C) Responsibility of the Person-in-Charge to 7-102.11 Common Name-Working Containers*Poisonous or Toxic Substances 3-501.16(B) Cold PHFs Maintained At or Below 41°F/45°F EMPLOYEE HEALTH 3-302.11(A)(2) Raw Animal Foods Separated from Each 7-101.11 Identifying Information-Original Containers* Other* 3-501.16(A) Hot PHFs Maintained At or Above 140°F* 2 Require Reporting by Food Employees and Contamination from the Environment 3-501.16(A) Roasts Held At or Above 130°F* 7-201.11 Separation-Storage* Applicants* 3-302.11(A) Food Protection* P g 20 Time as a Public Health Control 7-202.11 Restriction-Presence and Use* 590.003(F) Responsibility of A Food Employee or An 3-302.15 Washing Fruits and Vegetables 3-501.19 Time as a Public Health Control* Applicant To Report To The Person In Charge* * 7.202.12 Conditions of Use* 590.004 11 Variance Re uirements 590.003(G) Reporting by Person in Charge * 3-304.11 Food Contact with Equipment and Utensils 7-203.11 Toxic Containers-Prohibitions* ( ) q Contamination from the Consumer 3 590.003(D) Exclusions and Restrictions* 7-204.11 Sanitizers,Criteria-Chemicals* REQUIREMENTS FOR 3-306.14(A)(B)Returned Food and Reservice of Food* 7-204.12 Chemicals for WashingProduce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP 590.003(E) Removal of Exclusions and Restrictions Disposition of Adulterated or Contaminated Food 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels* 4 Food and Water From Regulated Sources 9 Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs* 590.004(A-B) Compliance with Food Law* 4-501.111 Manual Warewashing-Hot Water 7.206.12 Rodent Bait Stations* 3-801.11(D) Raw or Partially Cooked Animal Food and 3-201.12 Food in a HermeticallySealed Container* Sanitization Temperatures* Raw Seed Sprouts Not Served* P 7-206.13 Tracking Powders,Pest Control and 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-Hot Water Monitoring* 3-801.11(C) Unopened Food,Package Not Re-Served* 3-202.13 Shell Eggs*. Sanitization Temperatures* TIMEITEMPERATURE CONTROLS 3-202.14 1 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. 16 Proper Cooking Temperatures for PHFs CONSUMER ADVISORY 3-202.16 Ice Made From Potable Drinking Water* Concentration and Hardness* 3-401.11 A(l)(2) Eggs-155°F 15 sec 22 3-603.11 Consumer Advisory Posted for Consumption of 5-101.11 Drinking Water from an Approved System* Eggs 4-601.11(A) Clean Utensils and Food Contact Surfaces of E s-Immediate Service 145°F 15 sec* Animal Foods That are Raw,Undercooked or Equipment* � Not Otherwise Processed to Eliminate 590.006 A Bottled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meats&Game * s r 1112001 ( ) g Pathogens "°e 4-602.11 Cleaning Frequency of Utensils and Food Animals=155°F 15 sec* 590.006(B) Water Meets Standards in 310 CMR 22.0* Contact Surfaces of Equipment* + 3-302.13 Pasteurized Eggs Substitute for Raw Shell Shellfish and Fish From an Approved Source 3-401.11(B)(1)(2) Pork and Beef Roast-130°F 121 min* Eggs* 4-702.11 Frequency of Sanitization of Utensils and Food 3-401.11(A)(2) Ratites,Injected Meats-155°F 15 sec* 3-201.14 Fish and Recreationally Caught Molluscan Contact Surfaces of Equipment* Shellfish* 4-703.11 Methods of Sanitization-Hot Water and 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS Stuffing Containing Fish,Meat,Poultry or 590.009(A -(D) Violations of Section 590.009 A D m cater- 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* ) ( )-( ) Ratites-165°F 15 sec* Sources* 10 Proper,Adequate Handwashing ing,mobile food,temporary and residential Game and Wild Mushrooms Approved By * 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 145°F* kitchen operations should be debited under Regulatory Authority 2-301.11 Clean Condition-Hands and Arms 3-401.12 Raw Animal Foods Cooked in a Microwave the appropriate sections above if related to 3-202.18 Shellstock Identification Present* 2-301.12 _ Cleaning Procedure* 165°F* foodbome illness interventions and risk factors. 590.004(C) Wild Mushrooms* 2-301.14 When to Wash* 3-401.11(A)(1)(b) All Other PHFs-145'F 15 sec* Other 590.009 violations relating to good retail 3-201.17 Game Animals* 11 Good Hygienic Practices 17 Reheating for Hot Holding practices should be debited under#29-Special Requirements. 5 Receiving/Condition 2-401.11 Eating,Drinking or Using Tobacco* 3-403.11(A)&(D) PHFs 165°F 15 sec* 3-202.11 PHF's Received at Proper Temperatures* 2-401.12 Discharges From the Eyes,Nose and Mouth* 3-403.11(B) Microwave-165°F 2 Minute Standing Time* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3-202.15 Package Integrity* 3-301.12 Preventing Contamination When Tasting* 3-403.11(C) Commercially Processed RTE Food-140°F* (Blue Items 23-30) * 12 Prevention of Contamination from Hands * Critical and non-critical violations,which do not relate to the foodborne 3-101.11 Food Safe and Unadulterated 3-403.11(E) Remaining Unsliced Portions of Beef Roasts illness interventions and risk factors listed above,can be found in the 6 Tags/Records:Shellstock 590.004(E) Preventing Contamination from Employees* L18 Proper Cooling of PHFs following sections of the Food Code and 105 CMR 590.000 3-202.18 Shellstock Identification* 13 Handwashing Facilities 3-501.14(A) Cooling Cooked PHFs from 140°F to 70°F 3-203.12 Shellstock Identification Maintained* Conveniently Located and Accessible Within 2 Hours and From 70°F to 41'F/45°F Item I Good Retail Practices FC 590.000 Tags/Records:Fish Products 5-203.11 Numbers and Capacities* Within 4 Hours* 23. Management and Personnel FC-2 .003 5-204.11 Location and Placement* 3-501.14(B) Cooling PHFs Made from Ambient 24. Food and Food Protection FC-3 .004 - - 3-402.11 Parasite Destruction* Temperature Ingredients to 41°F/45°F 25. Equipment and Utensils FC-4 .005 3-402.12 Records,Creation and Retention* 5-205.11 Accessibility,Operation and Maintenance Within 4 Hours* 26. Water,Plumbing and Waste FC-5 .006 590.004(J) Labeling of Ingredients* Supplied with Soap and hand Drying Devices 27. Physical Facility FC-6 .007 7 Conformance with Approved Procedures/ 6-301.11 Handwashing Cleanser,Availability PP 28. Poisonous or Toxic Materials FC-7 .008 HACCP Plans 6-301.12 Hand Drying Provision 29. 1 Special Requirements 009 3-502.11 Specialized Processing Methods* 30. 1 Other 3-502.12 Reduced-Oxygen Packaging Criteria* 8-103.12 Conformance with Approved Procedures* S:590Formback6-2doc *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. TOWN OF BARNSTABLE HEALTH INSPECTOR-s Establishment Name: r,, yu 'T Date: o Page: of °F the r �-�-C S�f - r] M c r �- -,� q OFFICE HOURS AR E PUBLIC 0 MAIN STREET 3:30-4:30A.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified 3:30-4:30 P.M. aS �m�, HYANNIS, MA 02601 sos N.-FRRI. No Reference R Red Item PLEASE PRINT CLEARLY. FOOD ESTABLISHMENT INSPECTION REPORT Name , /1 Date Type of T o Ins ection �� ° Operation(s) outi Address 2 Risk Food Service -inspection Level etai Previous Inspection Telephone Residential Kitchen Date: ( S-1119 ` Mobile Pre-opefa i n Owner HACCP Y/N Temporary Suspect Illness r Caterer General Complaint Person in Charge(PIC) Time Bed&Breakfast HACCP In: Other q r' Inspector ^ Out: t d `&r �- Each violation checked requires an explanation on the narrative page(s)and a citation of specific provision(s)violated. Violations Related to Foodborne Illness Interventions and Risk Factors(Red Items) Anti-Choking 590.009(E) ❑ Violations marked may pose an imminent health hazard and require immediate corrective Tobacco 590.009(F) ❑ Action as determined by the Board of Health. Allergen Awareness 590.009(G) ❑ FOOD PROTECTION MANAGEMENT ❑ 12.Prevention of Contamination from Hands ❑ 1.PIC Assigned/Knowledgeable/Duties ❑ 13.Handwash Facilities © �� Z-� °^ EMPLOYEE HEALTH PROTECTION FROM CHEMICALS ❑ 2.Reporting of Diseases by Food Employees and PIC ❑ 14.Approved Food or Color Additives ❑ 3.Personnel with Infectious Restricted/Excluded ❑ 15. Toxic Chemicals FOOD FROM APPROVED SOURCE TIME/TEMPERATURE CONTROLS(Potentially Hazardous Foods) ❑4.Food and Water from Approved Source ❑ 16.Cooking Temperatures ❑ 5.Receiving/Condition ❑ 17.Reheating 6.Tags/Records/Accuracy of Ingredient Statements ❑ 18.Cooling 7.Conformance with Approved Procedures/HACCP Plans ❑ 19.Hot and Cold Holding PROTECTION FROM CONTAMINATION ❑ 20.Time As a Public Health Control ❑ 8.Separation/Segregation/Protection REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) ❑ 9.Food Contact Surfaces Cleaning and Sanitizing ❑21.Food and Food Preparation for HSPS ❑ 10.Proper Adequate Handwashing CONSUMER ADVISORY ❑ 11.Good Hygienic Practices ❑ 22.Posting of Consumer Advisories Violations Related to Good Retail Practices(Blue Items) Total Number of Critical Violations (( Critical(C)violations marked must be corrected immediately. (blue&red items) 1 1 Corrective Action Required: ❑ No ffYes Non-critical(N)violations must be corrected immediately or Overall Rating within 90 days as determined by the Board of Health. ❑ Voluntary Compliance ❑ Employee Restriction/Exclusion ❑ Re-inspection Scheduled ❑ Emergency Suspension C N Official Order for Correction:Based on an inspection todPth, tems ❑ Embargo ❑ Emergency Closure ❑ Voluntary Disposal ❑ Other: checked indicate violations of 105 CMR 590.000/Federal Food Code. 23.Management and Personnel (FC-2)(590.003) This report,when signed below by a Board of Health member or its agent A=Zero critical violations and,no more than 3 non-critical violations. F=3 or more critical violations.9 or more non-critical violations, 24.Food and Food Preparation (FC-3)(590.004) constitutes an order of the Board of Health. Failure to correct violations 9 re ardless of the number of critical,results in an F. 25.Equipment and Utensils (FC-4)(590.005) cited in this report may result in suspension or revocation of the food B-One critical violation and less than 6 non-critical violations if no critical violations observed,4 too von-critical violations=B. Seriously Critical Violation=F is scored automatically if: no hot 26.Water,Plumbing and Waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If 27.Physical Facility (FC-6)(590.007) aggrieved by this order,you have a right to a hearing. Your request must C=2 critical violations and less than i non-critical. If no critical water,sewage back-up,infestation of rodents or insects,or lack of 28.Poisonous or Toxic Materials' (FC-7)(590.008) be in writing and submitted to the Board of Health at the above address violations observed,7 to 8 non-critical al violations. If'I critical refrigeration. within 10 days of receipt of this order. violation,4 to 8non-critical violatio C. 29.Special Requirements. (590.009) y p r S 3 Pr t: .Other DATE OF RE-INSPECTION: Inspecto ign r v(� 31.Dumpster screened from public view Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y N i #Seats Observed Frozen Dessert Machines: Outside Dining Y N PIC's nature Print: Self Service Wait Service Provided Grease Trap Size - Variance Letter Posted Y N Dumpster Screen? Y N Violations related to Foodborne Illness Violations Related to Foodborne'111ness Interventions Interventions and Risk Factors(Red Items 1-22) and Risk Factors(Red Items 1-22) (Cont) FOOD PROTECTION MANAGEMENT PROTECTION FROM CONTAMINATION PROTECTION FROM CHEMICALS 3-501.14(C) PHFs Received at Temperatures According to 1 590.003(A) Assignment of Responsibility* 8 Cross-contamination 14 Food or Color Additives Law Cooled to 41°F/45°F Within 4 Hours* 590.003(B) Demonstration of Knowledge* 3-302.11(A)(1) Raw Animal Foods Separated from 3-202.12- Additives* 3-501.15 Cooling Methods for PHFs 2-103.11 Person-in-Charge Duties Cooked and RTE Foods.* 3-302.14 Protection from Unapproved Additives* 19 PHF Hot and Cold Holding Contamination from Raw Ingredients 5 Poisonous or Toxic Substances 3-501.16(B) Cold PHFs Maintained At or Below 41°F/45°F 590.004(F) - * EMPLOYEE HEALTH 3-302.11(A)(2) Raw Animal Foods Separated from Each 7-101.11 Identifying Information-Original Containers* Other* g3-501.16(A) Hot PHFs Maintained At or Above 140°F* 2 590.003(C) Responsibility of the.Person-in-Charge to - - - 7-102.11 Common Name-Working Containers* * Require Reporting by Food Employees and Contamination from the Environment 3-501.16(A) Roasts Held At or Above 130°F 7-201.11 Separation-Storage* Applicants* 3-302.11(A) Food Protection* p g 20 Time as a Public Health Control 590.003(F) Responsibility of A Food Employee or An 3-302.15. Washing Fruits and Vegetables 7-202.11 Restriction-Presence and Use** 3-501.19 Time as a Public Health Control* Applicant To Report To The Person In Charge* * 7.202.12 Conditions of Use 590.004 11 Variance Requirements 3-304.11 Food Contact with Equipment and Utensils * ( ) e9 590.003(G) Reporting by Person in Charge* 7-203.11 Toxic Containers-Prohibitions Contamination from the Consumer 3 590.003(D) I Exclusions and Restrictions* 7-204.11 Sanitizers,Criteria-Chemicals* REQUIREMENTS FOR 3-306.14(A)(B)Returned Food and Reated or of Food* 7-204.12 Chemicals for WashingProduce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP 590.003(E) Removal of Exclusions and Restrictions]E� Disposition of Adulterated or Contaminated � ) Food 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels* 4 Food and Water From Regulated Sources g Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs* 590.004(A-B) Compliance with Food Law* 4-501.111 Manual Warewashing-Hot Water 17.206.12 Rodent Bait Stations* 3-801.11(D) Raw or Partially Cooked Animal Food and 3-201.12 Food in a Hermetical) Sealed Container* Sanitization Temperatures* Raw Seed Sprouts Not Served* Y P 7-206.13 Tracking Powders,Pest Control and 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-Hot Water Monitoring* 3-801.11(C) Unopened Food Package Not Re-Served* 3-202.13 Shell Eggs* Sanitization Temperatures* TIME/TEMPERATURE CONTROLS 3-202.14 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. 16 Proper Cooking Temperatures for PHFs CONSUMER ADVISORY 3-202.16 Ice Made From Potable Drinking Water* Concentration and Hardness* 3-401.11A(1)(2) Eggs-155°F 15 sec 22 3-603.11 Consumer Advisory Posted for Consumption of 4-601.11(A) Clean Utensils and Food Contact Surfaces of Eggs-Immediate Service 145°F 15 sec* Animal Foods That are Raw,Undercooked or Equipment 5-101.11 Drinking Water from an Approved System* * gg Not Otherwise Processed to Eliminate 590.006(A) Bottled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* effe°"°e 11112001 4-602.11 Cleaning Frequency of Utensils and Food Animals-155°F 15 sec* 590.006(B) Water Meets Standards in 310 CMR 22.0* Contact Surfaces of ui " 3-302.13 Pasteurized Eggs Substitute for Raw Shell Shellfish and Fish From an Approved Source Equipment* Pment* 3-401.11(B)(1)(2) Pork and Beef Roast-130°F 121 min* Eggs* 4-702.11 Frequency of Sanitization of Utensils and Food 3-401.11(A)(2) Ratites,Injected Meats-155°F 15 sec* 3-201.14 Fish and Recreationally Caught Molluscan Contact Surfaces of Equipment* Shellfish* 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS 4-703.11 Methods of Sanitization-Hot Water and StuffingContaining Fish,Meat,Poultry or 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* g 590.009(A)-(D) Violations of Section 590.009(A)-(D)in cater- Ratites-165°F 15 sec* Sources* i0 Proper,Adequate Handwashing ing,mobile food,temporary and residential Game and Wild Mushrooms Approved By 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 145°F* kitchen operations should be debited under Regulatory Authority 2-301.11 Clean Condition-Hands and Arms* 3-401.12 Raw Animal Foods Cooked in a Microwave the appropriate sections above if related to 3-202.18 Shellstock Identification Present* 2-301.12 Cleaning Procedure* 165°F* foodborne illness interventions and risk factors. 590.004(C) Wild Mushrooms* 2-301.14 When to Wash* 3-401.11(A)(1)(b) All Other PHFs-145°F 15 sec* Other 590.009 violations relating to good retail 3-201.17 Game Animals* 11 Good Hygienic Practices practices should be debited under#29-Special 7 Reheating for Hot Holding 2-401.11 Eating,Drinking or Using Tobacco* * Requirements. 5 Receiving/Condition g. g g 3-403.11(A)&(D) PHFs 165°F 15 sec 3-202.11 PHF's Received at Proper Temperatures* 2-401.12 Discharges From the Eyes,Nose and Mouth* 3-403.11(B) Microwave-165°F 2 Minute Standing Time* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES * 3-301.12 Preventing Contamination When Tasting* 3-403.11 C * (Blue Items 23.30) 3-202.15 Package Integrity ( ) Commercially Processed RTE Food-140°F Critical and non-critical violations,which do not relate to the foodborne 3-101.11 Food Safe and Unadulterated* 12 Prevention of Contamination from Hands 3-403.11(E) Remaining Unsliced Portions of Beef Roasts* illness interventions and risk factors listed above,can be found in the 6 Tags/Records:Shellstock 590.004(E) Preventing Contamination from Employees* 18 Proper Cooling of PHFs following sections of the Food Code and 105 CMR 590.000 3-202.18 Shellstock Identification* 13 Handwashing Facilities 3-501.14(A) Cooling Cooked PHFs from 140°F to 70°F * Conveniently Located and Accessible Within 2 Hours and From 70°F to 41°F/45°F Item Good Retail Practices FC 590.000 3-203.12 Shellstock Identification Maintained Within 4 Hours* 23. Management and Personnel FC-2 .003 Tags/Records:Fish Products 5-203.11 Numbers and Capacities* * 5-204.11 Location and Placement* 3-501.14(B) Cooling PHFs Made from Ambient 24. Food and Food Protection FC-3 .004 3-402.11 Parasite Destruction Temperature Ingredients to 41°F/45°F 25. Equipment and Utensils FC-4 .005 3-402.12 Records,Creation and Retention* 5-205.11 Accessibility,Operation and Maintenance Within 4 Hours* 26. Water,Plumbing and Waste FC-5 .006 590.004(J) Labeling of Ingredients* Supplied with Soap and hand Drying Devices 27. Physical Facility FC-6 .007 7 Conformance with Approved Procedures/ 6-301.11 Handwashing Cleanser,Availability 28. Poisonous or Toxic Materials 1.008 HACCP Plans 6-301.12 Hand Drying Provision 29. 1 special Requirements 009 3-502.11 Specialized Processing Methods* 130. 1 Other 3-502.12 Reduced-Oxygen Packaging Criteria*_ 8-103.12 Conformance with Approved Procedures* S:590Formback6-2doc *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. r Awn of Barnstable • of tae Regulatory Services JS IDC,ciSA �cJz— Thomas F. Geiler, Director * BAiuvsrABLE, MASS $ Public Health Division 1639. �0 ATED N10r s Thomas McKean,Director 200 Main Street Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 May 2, 2007 JENED, Inc. Attn: Jennifer Cullum Sea Street Market 231 Sea Street Hyannis, Massachusetts 02601 NOTICE OF HEARING On April 19, 2007, cigarettes were sold to a minor (a person who was under the age of .18 years) by a person employed at your store. According to Section 371-7(B) of the�Town of Barnstable Code, no person, firm, corporation, establishment, or agency shall see tobacco products to a minor. According to Section 371-8 of the Town of Barnstable Code, "any proprietor(s) or other person(s) ... who fail(s) to comply with these regulations shall be subject to the following actions for each offense: A warning shall be issued for the first offense. A fine of$100 may be issued for the second offense, $200 for the third offense, $300 for the fourth offense, and $300 for any subsequent offense. You are hereby notified to appear before the Board of Health on Tuesday, May 22, 2007 at 3:00 pm to discuss any future plans you may have to comply with this regulation. The hearing will be held in the Town Hall, Hearing Room, 367 Main Street, Hyannis, Massachusetts. PER ORDER OF BOARD OF HEALTH Thomas A. McKean, RS, CHO Director of Public Health q:\tobacco\wp files\tobacco hearing letter.doc QATOBACCOMP Files\tobacco hearing letter SeaSt Market.DOC APR-19-2007 12:36 BARNS COUNTY HEALTH 15083756880 P.03iO3 Sec3ibu:L: Establishment Survey Participants- Name:_ Sea Street Market I 3 n 231 Sea�Street ID ofPurchas 0' I Address: Hyannis,MA 02601 _ Age:Q l5 1 -Q 17 Sex: CI Male �d Female Name of Adult Supervisor. City: .-.r d9l Time of Check d a>rr 'pm Q TypeofEsmblisbment:. Q Chain Independent. CINot.Known Date oJL�� fChecic . Oo f the week Q Mon. 12 Tues aWed L. hurs Q Fri. Q Sat 12 Sun sty .of EstabiW=em(Check.Only One), Convenience Store ❑Grocery Store Q Bar Q D artmeat Store ❑Liquor Store Q Private Club(VFW. Legion.etc.) ❑. Gas Station Only Q Pbarmac /Dry Store ❑Restaurant ❑ Gas Mini-Mart ❑Other(bowfin all olf club etc.) Q Tobacconist Section I. Was.Compurmce Cbr,- crimpleted'; des No if Yes-please concnue on to the neu question,if No please 51p,this section and go to secsfon 3. fH urns tobacco'mnrketd;d?vez`the-counter youth asls the clew forttie productrom a vending machine with a lockout device. ❑ Other Describe: ¢ Was the Purchaser asked for ID? Yes❑ No® Was this an ID-based check? Yes❑ No Was the Purchaser asked his/her age? Yes h❑ No Sex of Clerk Male 0 Female Approximate age of cleric ❑Teem Young Adult Pdult. ❑Older Adult Type of tobacco-asked for. Cigarettes Brand of cigarettes asked for. ❑ Marlboro Q�Newport �Other. ❑ Chew/Dip Q Cigars Q. Other Brand: Was the sale.made?' Yes�No 12 1f"Yes"how much did the product cosy. Was a receipt given?Yes❑ No Q Purchaser made payment using: ❑S1 bills CI $5 bill(s) Q $S bill and$1 bills/or changO�sl0 bill(s) ❑ $20 bill 0 change Section 3: If the youth did not eater tine premises.or didnot atternpt to purchase tobacco products please indicate why: Q out ofBusiness Q Teen .long term closure 1❑ In oueration.elosed at time of visit ❑ Drive tbru oBLLI Does not sell tobacco U Unloe$rable O. Unsafe to access ❑ Tobacco out of stock Q Inaccemble by Q Wholesale only'carMW Q Presence ofpolice.— Q Permit Suspended Q Private club/pemonal . Q Machine brdcea Q Other residence Q "Don't sell bur tobacco sem im storetbas 3ermit 611106 _ TOTAL P.03 APR-19-2007 12:35 BARNS COUNTY HEALTH 15083756880 P.01iO3 o BARNSTABLE COUNTY Phone (508)375-6621 o '; DEPARTMENT OF HEALTH AND ENVIRONMENT c� 3 FAX(508)375-6880 BARNSTABLE SUPERIOR COURT HOUSE TDD(508)382-5885 4 3195 MAIN STREET P.O. BOX 427 BARNSTABLE, MASSACHUSETTS 02630 FAX TRANSMITTAL . DATE: f v TO: �lltiv1 ------....., FAX #: FROM: PHONE #: PAGES: - (including this cover sheet) MESSAGE SUBJECT: ba. �� ) Town of Barnstable `j Regulatory Services Barnstable OF ZME Tp� do Thomas F. Geiler, Director AlfteficaCitr Public Health Division snxxsrnsLE, 9 MASS. g Thomas McKean, Director 2Q07 q'AT i639• A`0 200 Main Street FD MA't Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 May 30, 2011 Attention: Jennifer Cullum Sea Street Market 231 Sea Street Hyannis, MA 02601 You have requested information pertaining to selling local eggs from "backyard farms" at your establishment, Sea Street Market. Mr. Edward Hageman, from the State Agricultural Department, was contacted and informed me about the following criteria which must be met to sell eggs from local farms. • The eggs must be cleaned by dry wiping them or lightly "sanding" the stains or minimal dirty areas with sand paper, or briefly rinsing them with running water spray and immediately wiping dry with a single service paper towel. The rinse water should be a minimum of 90 degrees. Unacceptable cleaning methods include submerging shell eggs in water or any other solution or using cleaners that are not food grade and approved for shell egg cleaning. Note that porous eggshell is not impervious to odors, chemicals, and "off' flavors. • The egg cartoon must be clean, unused and the label must contain the following: L Common name of the food-"Eggs"; o Quantity, the number of eggs, "One/Dozen"; o Name and address of the egg producer; o The statement"Keep Refrigerated" o If the eggs are not graded and not weighed, do not label with a grade or size. o Pull date or "best buy" date. Recommended dates are 30 days after production, not to exceed 45 days. • Eggs should be maintained at a 45 degree temperature and should be transported in Coolers with cold packs to maintain this temperature in the warmer months. If you have any questions lease call the Barnstable Health Department, 508-862-4644. G- Thomas McKean R. S., C.H. 0. Director of Public Health Town of Barnstable Town of Barnstable Barnstable OFI r Regulatory Services gyp`' do Thomas F. Geiler, Director AN-Mefta Public Health Division ( �e BAPNSrnate, 9 MASS. Thomas McKean, Director 2007 i639. A`� 200 Main Street ED MA'S Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 May 30, 2011 Attention: Jennifer Cullum Sea Street Market 231 Sea Street Hyannis, MA 02601 You have requested information pertaining to selling local eggs from "backyard farms" at your establishment, Sea Street Market. Mr. Edward Hageman, from the State Agricultural Department, was contacted and informed me about the following criteria which must be met to sell eggs from local farms. • The eggs must be clean. A_ recommended method would be to dry wipe them or lightly "sand" the stains or minimal dirty areas with sand paper, or briefly rinse them with running water spray and immediately wipe them dry with a single service paper towel. The rinse water should be a minimum of 90 degrees and no higher than 20 degrees of the egg temperature. Unacceptable cleaning methods include submerging shell eggs in water or any other solution or using cleaners that are not food grade and approved for shell egg cleaning. Note that porous eggshell is not impervious to odors, chemicals, and "off' flavors. • The egg cartoon must be clean, unused and the label must contain the following: o Common name of the food-"Eggs"; o Quantity, the number of eggs, "One/Dozen"; o Name and address of the egg producer; o The statement "Keep.Refrigerated" o If the eggs are not graded and not weighed, do not label with a grade or size. o Pull date or "best buy" date. Recommended dates are 30 days after production, not to exceed 45 days. • Eggs should be maintained at a 45 degree temperature and should be transported in Coolers with cold packs to maintain this temperature in the warmer months. If you have any questions please call the Barnstable Health Department, 508-862-4644. Thomas McKean R. S., C.H. O. Director of Public Health Town of Barnstable r � LLi " "+. :AA _ d 4. `' Mi -4 v The Counter-Top Oven That Tarns Your Business Into A Pizzeria! Special Features include: Thermostat- adjustable up to 6500 F. ✓ Built-in Adjustable Timer-Set the cooking time for up to 60 minutes. The timer alerts the operator when the food is ready. Oven Ready Light-Lets the operator know that the oven is hot and ready to be used. ✓ Stainless Steel Construction Combining an oven with - compactability, gives you the versatility needed to create additional - profit centers for your foodservice establishment. The Pizza Oven and Baking Oven ; offers you effortless cooking of Pizza, - Heros / Subs, Pretzels, .Baked Dishes and much more. Model# Oven Electrical Overall Width Ship Shelf Depth Weight Pizza Oven PO-18 18.25" 120V/15A/ 180OW 32.50" 97.50" 138 lbs. PO-18-220 18.25" 220V/13A/ 285OW 32.50" 22.50" 138 lbs. PO-22 21" 220V/ 16.4A/ 360OW 35.50" 25.50" 145 lbs. Baking Oven BK-18 18.25" 120V/14.2A/1700W 32.50" 22.50" 116lbs. BK-18-220 18.25" 220V/8.5A/1850W 35.5" 25.50" 1231bs. BK-22* 21" 220V/10A/2200W 35.5" 25.50" 1231bs. Comes with Corderite ceramic baking deck PO-22 uses NEMA 6-20P P0-18,BK-18 uses NEMA 5-15P; PO-18-220,BK-18-220,BK-22 uses NEMA 6-15P Feature Description ✓ Baking Deck - The Pizza Oven comes with (2) Corderite ceramic baking decks, 3" clearance, which gives the operator the ability to cook pizza, pretzels and bread products directly on the baking surface. The Baking Oven comes with (1) 14 gauge high heat Aluminized Steel baking deck (except for BK-22 which comes with (1) Corderite ceramic baking deck), 7" clearance. Perfect for cooking pan pizza, breads or any product that is encased in a pan. Both decks distribute heat evenly and won't burn the bottom surfaces. ✓ Heating Elements - For proper heating, all ovens come equipped with heavy duty incoloy steel tubular heating elements located on the top of the oven and underneath each baking deck. The Pizza Oven comes with(3)heating elements. The Baking Oven comes with(2)heating elements. ✓ Electrical-120V or 220V.Can connect to 208V or 240V. ✓. Interior-constructed of 18 gauge high heat aluminized steel ✓ Exterior and Door-constructed of 20 gauge Stainless Steel type 430,#4 finish ✓ Insulation-1.5"duck industrial grade insulation ✓ Timer-The timer is an alert timer and does not shut off the oven. The Pizza Oven timer can be set for up to 15 minutes The Baking Oven timer can be set for up to 60 minutes ✓ Line Cord-Standard with a 6'line cord ✓ Stackable-Both ovens are stackable. ✓ PO-18,BK-18-can fit up to a 16"pizza;PO-22,BK-22-can fit up to a 18"pizza. ✓ Options: 4"adjustable legs Corderite ceramic hearth baking deck for The Baking Oven(BK 18) Model A B C A PO-18,BK18 22.5° 23.5° 18.25" — PO-22,BK-22 25.5" 26.5° 21° Shelf not available 0 in Baking Oven Models 4 ` C 8 3.125 — --------- 'ter:; i i ------------------ pSSlfj�, rig �00 11.5 NSF cQQus I ; 10 7.5 e Cecilware Corporation 43-05 20th Ave.LIC,NY 11105 Teh 800.935.2211 718.932.1414 Fax:718.932.7860 Visit us on the internet:www.cecilware.com i Ice Cream Dipping and Storage HS HD HDF—Fountainette Design Optional Accessories Cabinet top is one piece stainless steel with curved edges - Lid Lock Kit - Caster Kit and a 33/4"flange front and back for added durability. - Dipper Well Kit - Stainless Steel Exterior Lids are heavy gauge stainless steel top and bottom with - Clear Plastic Lids (by special order) molded rubber frame and foamed-in-place urethane - Leg Kit insulation.Molded rubber handles are sturdy and easy to use.Lids won't rust,warp or wobble in place. Refrigeration Cold wall refrigeration system maintains product � , {- temperature for dipping or storage of ice cream. ' Adjustable control for selecting desired temperature. Bare tube condenser requires minimum maintenance. Slide out condensing unit for easier,faster servicing. Construction HS/HD models are fully insulated with CFC-free foamed-in-place urethane.Assures maximum efficiency and added cabinet rigidity.Exterior and interior surfaces are finished in durable,easy-to-clean powder coated paint 8-HDF FOUNTAtNETTE- Warranty Complete Ice Cream Serving Department Five years against insulation failure or leaks in the insulated area Five years against failure of compressor. The 8-HDF self-contained cabinet is finished on all One year against defective materials or faulty sides so it may be used as a counter or backbar and workmanship,including labor is equipped with a one-piece stainless steel top and two single lids.The optional pump and jar set to serve high profit sundaes,malts and shakes �gr9RFA_M__NJ 127� includes one heavyduty chocolate pump,three V"81FiF L O syrup pumps,five fruit jars with ladles,and one UC* ® O a spoon holder. NOTE:For opbmn pertormarrce,triese models are designed for use in air-conditioned NEMA 5-15P sues where temperature and hurnldAy are maintained at 75T and 55%R.H.Locate case All HSMD/H DF Models away from shed su*K rapid&currents and extreme temperature dwVw. ft reserve the right to change or revise specifications and product design in connection wdh any feature of our products.Such drarges do not entitle bra hW to corresponding dranges,W Vvv *rd%additions,or replacements for equipment previously sold or Specifications stopped Capacity Outside Dimensions(inches) Electrical . Model Cubic 2'h W. 3 Gal. Haight To Unit Recap- Ship Feet Cans Cans Length Width Stainless H.R Volts ° mended Weight Top Ps Breaker 2HS 4.5 4 4 301h 197/18 32% 1/4 115 5.1 15 amp 188 4HD 7.8 13 8 301/2 30% 32h 1/4 115 5.1 15 amp238 6HD 12.7 21 14 43 301/2 1 32lb 1/3 115 6.2 15 amp 307 8HD 17.0 33 21 5491e 301h 3212 1/3 115 6.2 15 am 355 10HD 21.9 41 29 669/1s 3092 32lh 1/2 115 9.0 15 amp 419 8HDF 17.0 33 21 541/16 301h '321h 113 T 115 1 6.2 15 amp 386 'Add 8'to top of syrup rail. Hussmann Corporation 140 East State Street (�,1�U a 2 Anne Gloversville188)72r�,WNY 12078 f 3 er 4�EI (800)753.7790 Web Site:www.hussmann.com Fax:(518)7253801 i Printed In USA 02003 Hussnarn Corporation 032SSM An ilusam r _ Curved Gass Ice Cream Dipping Display Merchandisers s { DCCG-4, DCCG-8, DCCG-12, DCCG-16, DCCG-8-D, DCCG-12-D, DCCG-16-D Design "-D"Models with Rear Storage Doors Sleek new curved glass front and top looks great and improves For easy"in and out"of tubs without disrupting service product visibility.Maximum attention placed on product visibility to customers(not applicable to DCCG-4). by lowering the merchandiser front 2".Improved lid pivot design and lid gasketing. A Display ` DCCG maximizes product display area within merchandiser. 2 . Interior canopy light provides added illumination of ' = product display. iA i Refrigeration All models feature R404A CFC-free refrigerant.Rear air intake DCCG Models and discharge allow front and sides of merchandiser to be built into a fixed counter area.Merchandisers can be converted to rear ~—t03J4� air intake and front air discharge if required.Equipped with 115 79h , volt,15 amp power cord. �' 15318 20` 17 3/e Warranty Five years against insulation failure or leaks in insulated area.Five years b >. against failure of compressor.One f � P 1 I , year against defective materials Or ��--_--21 1/2 faulty workmanship,including labor. I LOAD LINE Optional Accessories _ t Optional Gelato Pan Racks -————————— —I 51 1/2 I I I I • Dipper Well •Choice of x M 11 •Lid Lock Kit Exterior Colors 36119 —I uNr�T sTEP I 34 va •Night Cover for •Caster Kit Case Opening �"�_!' ► I • Six-Inch Leg Kit .Stainless Steel a _ 14 1/a i DOOR OPENING i • Flavor Tabs Exterior Canholder Kit With Side Rails I _i� I • Frost Sheilds t------------� j Optional Display Kits 2513n6 z„ Now Available...a choice of two �t8 different ice cream canholder kits Case shown is the"-D°Model with rear storage doors. and a Gelato kit so you can choose the display accessories that best fit �P a we reserve the right to change or revise spec uiaatlons and product design in connection with your needs. any feature of our products.Such changes do not entitle the buyer to corresponding changes, Canholder Kit-New Style 4r improvements,additions,or replacements;for equipment previously sold or s40W. With Plastic Hood and NOS;For optirrarm performance,these models are designed for use in air conditioned Wire Rack System stores vmere temperature and humidity am maintained at 75°F and 55%R.H.Locale case Specifications away from rW sunlight,rapid air currents and extreme temperature c hangm Capacity Dimensions Electrical-60 Hz 9r.2-Dia.3-Gal.Cens No. F-XterlOi Interior Unit Run LRA Fuse Ship. UL Display I Storagie Lids L W H L W H.P. Volts Amps Amps Amps wt. . DCCG-4 4 0 1 25ms 25h3ns 502 21 21'/2 113 115 6.9 33.0 15 250 . V DCCG-8 8 4 1 477"6 25hme 5172 43% 2172 1/2 115 9.5 58.0 15 405 DCCG-12 12 8 2 67sns 25wns 5172 63 202 i/2 115 92 45.0 . 15 515 t: ® �+ DCCG-16 16 12 r 2 87ms 25sms 502 83% 21'/2 3/4 1 115 10.5 59.8 1 15 625 Hussmann Corporation Web Site: wlvw hassmann.com 140 East State Street GloversviAe,NY 12078 (518)725-0844 An(UR psi btlSN12SS (800)753-7790 (;��� 77��1Iii�� Printed in USA 02W5 Hussman Corporation °sos-076-s-2.51a Fax:(518)725-3801 Proven source.Proven soWons. 10 inch standard Dipwell !1 ` ` d 11IMELL Rft standwd WE ft the nwe pc ft D4>weu paodaat ft hOkb 14MM to Sk 9COqX Of Paddlos cM is used in conprvolvn Wtih a freezer ho sik$. tom favors of too aeon, 1 - Y _ SPECIRCATIONS: Length: 10 Inches VAdth:3 inches .Height:6 inches Drain Ho4e: 1-11168Inch diameter 3 Mounting Hales l/An Diamete;.4 inches Apart,1 -inch Qt an sides U.S.FOOD&DRUG ��"• ADMINISTRATION ---4a The D#wmo compiles WM to FDA'o Food t Service soul on Maua Z- Chapter 3-=12 trtd),m Momis Setweerww °VEA'aw GLAND FTTTfNQ DRt�IN srArivt. sue, Dipwell installation kit LLATION: KIT The full installation kit is ordered separately. Note: t°or your convenlende,(and by p.opt.utar -demand),we,offer fFtls kit contalnIng-all1he :cormcl s[zee;and number of,part&These are 2 � also avatlable at your 16cal hardware,or et plumbtngstore,however our bulk ordering generatiy results In 6 lower prices. " G Ueattaer gast{st 2;couplIng taut Vatl piece d.bard valve 5.mate oonneotor 6:8errule 6.plastic tt bEng 7.saddle valve and -accoutrement I I i1 SERVICE WINDOW MODELS NOTES: EW25 ELECTRIC HEATED& W-25 UNHEATED Q This product is designed to comply with the National Electric Code (NEC) and the Unheated Models are CUL and UL Listed. g 1" Offset 2�All units have a self contained one piece molded white (Heated Units Only) high density polyethylene cabinet. Cabinets feature a self-extinguishing characteristic and ore resistant to high Junction Box location '`NOTE: for unheated unite humidity, chemical and climate exposures. ordered with microswitch. Junction boxes ore mounted on 3 Cabinet has sufficient strength for fastening to wall on r _____-__ Junction 4 upper right side for electric heated g g L_ -� O units and top middle center for un- both ends without intermediate support. O heated units when ordered with ®Electrical junction boxes are used for all electric heated optional Inkroswiitek Specify altemate units and unheated units ordered for a microswitch locations when ordering, application. Standard unheated units have on 8 ft., three 1 TOP VIEW 2 conductor cord and plug. Q5 Offset mounting brackets with (2) mounting slots on each � A B side 3/4" x 1/4". Brackets for unheated W-25s are flush Brackett— B �— —� to the back wall and are not offset. Bracket ©AC phase control and heot-off-fan switch are only used © intAir ake for the electric heated EW-25 models. ® o O AC Phase Q7 Units is to be installed such that air flow is unobstructed. Control Air discharge nozzle containing adjustable air directional LIF - Aluminum vanes with 40' sweep front to back. Mesh Inlet C ®Continuous duty, direct drive, variable speed, double shaft Air Inlet Opening 8 Filter Potentiometer motor with automatic thermal overload protection. Overload (Aluminum Mesh Filter not shown) Heat-Off-Fan® protects motor from burnout minimizing costs. NOTE: Switch MA RS The actual length may (D Optional microswitch is field installed and is to be wired vary up to 1 1/4"over to the terminal block in panel. Switch to be mounted such model number. that air curtain turns on as door starts to open. FRONT VIEW 1" Directional Vanes SIDE VIEW C U` US (UNHEATED ONLY) 7 LISTED W-25 UNHEATED MODEL PROJECT MODEL NO. WIDTH" DEPTH HEIGHT �� 'A TYPICAL LOCATION DRAWING NO. DATE (A) (B) (C) INSTALLATION ® ARCHITECT SHEET OF 25" 8 1/2" 10" 1.Connect supply Voltage from power parm to Oriellm box. DRAWN BY ® opptional ENGINEER Microewitch 2.Optional microswitch field CHECKED BY EW-25 ELECTRIC HEATED MODEL 4kW inns ri swnsthee hoot we Service Window ��� ® PROJECT NO. WIDTH" DEPTH HEIGHT (A) (B) tC} COUNTERTOP BRAND AIR CURTA field corxtuti'wirinp' 14716 S. BROADWAY ^ GARDENA, CA 90246 25" 8 1/2" 17' Phone: 310-532-1555 e 800-421-1266 • Fax: 310-324-3030 WEB SITE:www.marsair.com " E-MAIL:morsinfoOmarsair.com il EW-251 W-25 SERVICE (TAKE-OUT) WINDOW MODELS SW4FX 4/6/07 WCD -, JOB: ARCHITECT/ENGINEER: DRWO.: CONTRACTOR: SHEET of DATE: ............ ........................................................................................................................................... .... ........ ...... ................. ............................ ................. ..................................... .................... UNHEATED W-25 SPECIFICATIONS ........................ .. ..... .. . . ...... ... .................... ......... ........................................ .................... ..........................................................................................I.............I...................................................... ................... .......... ................ ....... MOTOR FAN DATA FLA(AMPACITY) Max Max MARK HP SINGLE PHASE FPM CFM REMARKS UNHEATED NO. WEIGHT 3400 MODEL REWD LENGTH (LOS) RPM VOLTAGE 208V at at 115V 240V Nozzle Nozzle W-25 25 20 1/20 12.8 (3.5) 1,3 (1.7.) , 1400 1900 ............................ .............. .......................... . .................._.............................................................................................I....................................................................................I.................................I........ ......... ............... EW-25SPECIFICATIONS . ........ELECTRIC HEATED.. .. . . .................. ....... MOTOR, HEATER AND FAN DATA FLA(AMPACITY) Max Max MARK ELECTRIC HP TEMP* HEAT SINGLE PHASE FIRM CFM REMARKS HEATED NO. WEIGHT 3400 RISE INPUT at at MODEL REQ*D LENGTH (LBS) RPM VOLTAGE *F kW 208V I 240V Nozzle Nozzle EW-25 25 23 , 1/20 1 6.6 1 4 122.0 (27.5)119.0 (23.8), 1400 1900 AIR VELOCITY Shall be no less than 600 feet per minute across the entire opening of the service An equipment specification can be prepared by combining the standardJeatures window measured two feet above the counter. with the checked boxes below indicating the selection of the optional features. APPROVALS Unheated air curtain model W-25 shall be Underwriters Laboratory and Canadian Underwriters OPTIONAL FEATURES Laboratory Listed and shall meet the requirements of the National Electric Code (NEC). When checked below, the air curtain will be supplied with the following special CABINET features. Housing shall be manufactured of one piece molded high impact Pat#ars'resistant to 0 Control Panel (Shipped Loose) high humidity and all chemical and climatic conditions, with a washable aluminum mesh filter. MOTORS AND SLOWER WHEELS Door switch (20 amp)for automatic on/off control. turns air curtain on when Motor shall be suitable for continuous heavy duty operation, engineered to provide door Is opened and off when door Is closed. (Control Panel Required) many years of maintenance free service. The motor shall contain lifetime pre- lubricated sealed ball bearings, resilient mounted and protected by on automatic Field Installed thermal overload switch. (3 Plunger type C3 Roller type INSTALLATION Air curtains shalt be provide with attached mounting brackets for easy installation over pass—thru window. 0 Speed Controller with On/Off Switch(Heated Units Only) ELECTRIC WIRING Unheated Units -An 8 ft., three wire cord and plug standard. Units ordered with optional microswitch also Include factory mounted junction box on top center of unit. optional microswitch includes junction box factory mounted on top center of unit. Electric Heated Units -Junction box mounted on upper right hand side of unit standard. Variable speed controller and Heat/Off/Fan switch included. Units contain 4000 watt coil with 13,700 Btu/Hr., protected with manual reset thermal overload switch. GUARANTEE Shall be five years for unheated units and 18 months for electric heated units. MADE WITH PRIDE IN THE U.S.A. EW-259 W-25 SERVICE (TAKE-OUT) WINDOW MODELS SW49X 4/6/07 WCD 00 co N N �. c� � . sk ' I O co co co co Nil- -7;- Town of Barnstable '41&� Building Department Brian Florence, CBO cot Building Commissioner 200 Main Street, Hyannis, MA 02601 www.town.bamstable.ma.us Pre-application for Business Certificate Date 6? Z!�!f' Map 30 7 Parcel OZ Applicant Information Ap licants Name �i�l C. A _.. _ . ... - p. - _ ._.. _. ._ _.....- Applicants Address. Email Address e Telephone Number 5-Oe --638 - 7�11 Listed&I Unlisted ❑ Business Information New Business? Yes ----------------------------------------. Business is a registered corporation? -----------------------I. Yes No If yes Name of Corporation .S�f��J`Py '/ � -� Does business operate under the registered corporate name? Yes No Is the business a sole proprietorship or home occupation? --------- Yes <� If yes then a Home Occupation Registration is required—See Building Division Staff 7 Name of Business � r Business Address 11 3 i e 7-71 Type of Business Building Commissioner Office Use Only on ' 'o � l Building Commissio r Dale (T— Clerk Office Use Only nty .SEA STREET MARKET ICE CREAM SERVICE DETAILS SCALE '/Z IN= I FT z _ P J FRONT DOOR START OF INDOOR SHELVING I I FT 5 IN FROM FRONT DOOR g %SHELVES 7 I_CE CREAM FREEZERS , 1 SCOOP SINK HAND SINK CONDIMENTS -55 �or_ I 1' I i ' RIGHT SIDE SERVING WINDOW 1/2 " = I FT NEW REPLACEMENT WINDOW 60"X 34"\ DEPENDING ON OLD R.O. WIDTH t WINDOW SILL RAISED TO 30"FROM FLOOR EXISTING FLOOR 'a. FOUNDATION EXISTING PAVING. OF DRIVEWAY `r t i 1