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HomeMy WebLinkAboutMAIN STREET (OST.) SPEEDWAY#2446 /792 Main St.—©Isf pkrt r Town of Barnstable BOARD OF HEALTH John T. Norman Board of Health Donald A.Gaudagnoli,M.D. BAMNSrAOM F.P.(Thomas)Lee,. MA Daniel Luczkow, M.D. Alt. 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: 866 Issue Date: 01/01/2022 DBA: SPEEDWAY #2446 OWNER: SPEEDWAY LLC Location of Establishment: 804 MAIN STREET OSTERVILLE„ MA 02655 Type of Business Permit: RETAIL WITH FOOD SERVICE Annual: YES Seasonal: IndoorSeating: 0 OutdoorSeating: 0 Total Seating: 0 FEES FOOD SERVICE ESTABLISHMENT; $100.00 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, IRS, CHO, Health Agent FOR ESTABLISHMENTS WITH SEATING: PERMIT IS NOT VALID UNLESS ISSUED IN CONJUNCTION WITH A COMMON VICTUALER LICENSE Restrictions: APPROVED June 15, 2018 Combo: Retail and Food, $200. LIMITED TO THE FOLLOWING MENU ITEMS: HOT DOGS, POLISH SAUSAGE,TORNADO'S (EX. RANCHERO STEAK & CHEESE, SOUTHWEST CHICKEN, AND ROLLER PIZZA), APPROVED BY DUNKIN DONUTS TO SHARE USE OF 3 BAY AND MOP SINKS. For Office Use '"E Only: Initials:�.� Town of Barnstable � Date Paid l I � Amt Pd$O ffi �,STA$ Inspectional Services 9�°rE Public Health Division Check# DMAr� 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: #2 Q% t- a ,1 7 � v ADDRESS OF FOOD ESTABLISHMENT: / (/,i(1a QSkcvil)-c A1! oz&&5— MAILING ADDRESS(IF DIFFERENT FROM ABOVE):00- 6oY, I S9 0'Uce-ru Lp-� l.03(e d,,0 E-MAIL ADDRESS: �QSataLOtl y SSDI TELEPHONE NUMBER OF FOOD ESTABLISHMENT: U UO - 03N�) TOTAL NUMBER OF BATHROOMS: WELL WATER:YES NO-Z.(ANNUAL WATER ANALYSIS REQUIRED) ANNUAL: SEASONAL: DATES OF OPERATION: /_/_ TO NUMBER OF SEATS: INSIDE: OUTSIDE: TOTAL: Jp�, SEATING: MUST OBTAIN A COMMON VICTUALLER'S LICENSE FROM LICEN I G 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:Wpplication FonnsTOODAPP 2020.doc &y3330 r OWNER INFORMATION: FULL NAME OF APPLICANT �00eJL.JQ SOLE OWNER: 0/NO � OWNER PHONE# 3��i i� ADDRESS_ P.0, ogy )S8 �CS!- JUI (l ' �t✓.t U, n S�� ► CORPORATE OWNER: S OP,eJ l,3q A CORPORATE ADDRESS: PO. (�Ox PERSON IN CHARGE OF DAILY OPERATIONS: La o("a n CQ K- YS ),%o I 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 I. ll qw o-nC M,�1i J /) 7 /Z 3 1. Avren St+n�nr 3 2. 3. 61s Asa. t 496a3 s Ucen q rdi ator 10 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. You must complete a catering notice found at litt a://wNvw.townofl)arnstable.us/healthdivision/a lications.as . 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.315t each calendar year. IT IS YOUR RESPONSIBILITY TO RETURN THE COMPLETED APPLICATION(S)AND REQUIRED FEES BY DEC Ist. Q:\Application FormsTOODAPP REV3-2019.doc r Town of Barnstable BOARD OF HEALTH John T.Norman Board of Health Donald A.Gaudagnoli,M.D. 4' 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.townofbarnstablems Permit to Operate a Food Establishment In accordance with regulations promulgated under authority of 105 CMR 590.000 M.G.L. Chapter 94 Sections 305A, 305B, 146, 189 and 189A; Chapter 111,Sections 5 and 127A, a permit is hereby granted to: Permit No: 866 Issue Date: 01/01/2021 DBA: SPEEDWAY #2446 OWNER: SPEEDWAY LLC Location of Establishment: 804 MAIN STREET OSTERVILLE„ MA 02655 Type of Business Permit: RESTAURANT Annual: YES Seasonal: IndoorSeating: 0 OutdoorSeating: 0 Total Seating: 0 FEES FOOD SERVICE ESTABLISHMENT: $100.00 YEAR. 2021 RETAIL FOOD: $100.00 COTTAGE FOOD OPERATION: Permit Expires: 12/31/2021 B&B-FULL BREAKFAST: CONTINENTAL BREAKFAST: MOBILE-FOOD: �ry MOBILE-ICE CREAM: cQ� 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: APPROVED June 15, 2018 Combo: Retail and Food, $200. LIMITED TO THE FOLLOWING MENU ITEMS: HOT DOGS, POLISH SAUSAGE, TORNADO'S (EX. RANCHERO STEAK & CHEESE, SOUTHWEST CHICKEN, AND ROLLER PIZZA), APPROVED BY DUNKIN DONUTS TO SHARE USE OF 3 BAY AND MOP SINKS. T 1 , �I WME ram, For Office Use • Initials: do Town of Barnstable , I/ Date Paid AmLPd a!�4- 1 +VBMWS ABLY, ; Inspectional Services `e Public Health DivisionCheck _ 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: J Dt-CA( a\1 0 ' L w ADDRESS OF FOOD ESTABLISHMENT: -1 q Z MG1.I n 3 1 - � III. MA 02�55 MAILING ADDRESS(IF DIFFERENT FROM ABOVE)?Q. U JrJ'&b'L11,Cn5c Dt.Sark n(�'►��dLLD L ''C E-MAIL ADDRESS: , .nsl —= 26dujcu AM TELEPHONE NUMBER OF FOOD ESTABLISHMENT: 03 0- 03 i1( TOTAL NUMBER OF BATHROOMS: L 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)9-Nb TYPE OF ESTABLISHMENT: (PLEASE CHECK ALL THAT APPLY BELOW) V 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) Tobacco sale s *** 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 APPLICANTS Q SOLE OWNER: ?I NO OWNER PHONE # ADDRESS b15W i ctr&. Spy-in 45nt- CORPORATE OWNER: CORPORATE ADDRESS: PERSON IN CHARGE OF DAILY OPERATIONS: I�w r<nce, 1 n l 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 1 � (�5/ '7 � �3 . w L 2. Flo tV120-210 SIG U F APPLICANT DATE LICENSE COORDINATOR ***FOOD POLICY INFORMATION*** SEASONAL FOOD SERVICE: All seasonal food establishments,including mobile trucks must be inspected by the Health Div. prior to oneninE!! 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/henithdivision/applications.asy. 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.3 0 each calendar year. IT IS YOUR RESPONSIBILITY TO RETURN THE COMPLETED APPLICATION(S)AND REQUIRED FEES BY DEC 1st. Q:\Application FormsTOODAPP REV3-2019.doc Town of Barnstable BOARD OF HEALTH John T.Norman Board of Health Donald A.Guadagnoli,M.D. 13ARNSUB . : F.P.(Thomas)Lee MA&P% iDaniel Luczkow,Alternate 200 Main Street, Hyannis, MA 02601 la ° 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: 866 Issue Date: 1/1/2021 DBA: SPEEDWAY #2446 OWNER: SPEEDWAY LLC. Location of Establishment: 804 MAIN STREET OSTERVILLE, MA 02655 Type of Business Permit: Non-Flavored Annual Seasonal FEES YEAR: 2021 TOBACCO SALES: $85.00 Permit Expires: 12/31/2021 cd� Thomas A. McKean, RS, CHO, Health Agent Restrictions: PLEASE POST CONSPICUOUSLY r c. �"'F Town of Barnstable For - , Initials: Date Paid • Inspectional Services Check# w BARMABIE. : MAK t679. Public Health Division ��0 200 Main Street, Hyannis MA 02601 Office: 508-790-4644 Thomas A.McKean,RS,CHO i 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 P1:GASEIN(`L,t':DE TI(I'',F2GQIIF2Fa +'E;E 4F$85.00 APPLICATION FOR A TOBACCO SALES PERMIT .-9ocedwciv C ` L ESTABLISHMENT NAME (D/B/A) I '7q2 Mal'11 0:!�eryl II e , MA 02-U55 ADDRESS OF BUSINESS pp. Box 5 - ( e ri n w MAILING ADDRESS (IF DIFFERENT FROM ABOV ) S-y v Ur- OJVNER'S NAME: LAST FIRST MIDDLE pfe .f ( (03 730a < EMAIL PHONE# FEDERAL ID# Do you currently possess a state license to sell tobacco products? Yes No Each employee who sells tobacco products must receive and understand Chapter 371 of the Town of Barnstable Code (copy provided herein) and the Massachusetts General Law Chapter 270, Section 6.00 (a copy is provided on the next page). Each employee who sells tobacco products must sign the Employee Signature Form (provided herein). Signaturej4ZjkjZV— Date �P 2 0 LIME CO RDINATOR C.'+l;sars,decolliklAppData`f ix il':Microsoft4G�`indne4s INetCache\Content(:)utlool ,Y70C I,S;:I OBACCO APP2019 dob.doex ESTABLISHMENT'S MANE TOBACCO SALES Employee Sigr►ature Farm This form.is for official use to indicate that the employee(s)of this establishment received rat Lam wb h d cr bes the LM ene the Town of Barnstable Code And Chapter roducts to any pe on ui7dersthe age;o twenty-one (21). Below.is section penalties for selling and/or giving tobacco p 371-9.of the Town of Barnstable Board of Health Regulation Sales.to Minors-- 371 9. 3a1e d Disttribution of Tobacco Prodncta.+ 1. No person shall sell, r provide a tobacco product,as defined herein,to a person under. The minimum legsl sales age .The minimum legs1 sales age in the Town of Barnstable is 21 years of age. 2. Identification Each person selling or distributing tobacco prod acts,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�7 The employee(s)below received and understood Section 371-9 of thf the Massachuue Town of seettsbGeBneral oard Ls: Health Prohibition of Smoking Regulation and Chapter 270 Sectlori 6 0 01 9Mbate . Signature Printed Name INS,CIJV Printed Name Signature . Date lDla c f oL G' r Printed Name. Signatuue .. .�.. 1 ^Signature Printed Name Date . Signature Punted Name Date Signature Printed Name Date Signature Printed Name . Data Q:Wpplicetlon Fc=\*T08ACCA APP•A1oaFavor 12-18-19.dmx Commonwealth of Massachusetts Letter ID:L1498494528 w Department of Revenue Notice Date:September 11,2020 Geoffrey E.Snyder,Commissioner Account ID:CGL-11945027-224 MYmass.gov/dor RETAILER LICENSE FOR SALE OF CIGARETTES SPEEDWAY LLC SPEEDWAY LLC 2468 539 S MAIN ST RM 3212 FINDLAY OH 45840-3229 Attached below is your Retailer License for Sale of Cigarettes(Form CT-3). Cut aloe the dotted line 8 d me 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. I DETACH HERE ----------------------------------------------------------------------------- �ts��� MASSACHUSETTS DEPARTMENT OF REVENUE Form CT-3 c Retailer License for Sale of Cigarettes ova This license must be posted and visible at all times. The sale of tobacco products to anyone under 18 years of age is prohibited. SPEEDWAY LLC Account ID: CGL-11945027-224 SPEEDWAY 02446 Location ID: 11945027-0206 792 MAIN ST License Number:253794304 OSTERVILLE MA 02655-2051 This certifies that the taxpayer named above is licensed under Chapter 64C of the Massachusetts General Laws to sell at retail at the address shown above. This license is non-transferable and may be suspended or revoked for failure to comply with state laws and regulations. Effective Date: October 1,2020 Expiration Date: September 30,2022 Commonwealth of Massachusetts Letter ID:L0096972352 N m Department of Revenue Notice Date:September 22,2020 r4 Geoffrey E.Snyder,Commissioner Account ID:CRL-11945027-227 o'} mass.gov/dor RETAILER LICENSE FOR SALE OF CIGARS AND SMOKING TOBACCO I' 'h'llllll����l��nilll�l'll'1�11"�II'Inl�'1'J1l1116111�'��I SPEEDWAY LLC SPEEDWAY LLC 2468 539 S MAIN ST RM 3212 FINDLAY OH 45840-3229 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 ____—_ ---------------- crtts� MASSACHiTSETTS DEPARTMENT OF REVENUE Form CT-3T Retailer License for Sale of Cigars and Smoking Tobacco 044 This license must be posted and visible at all times.The sale of tobacco products to anyone under 18 years of age is prohibited. SPEEDWAY LLC Account ID: CRL-11945027-227 SPEEDWAY 02446 Location ID: 11945027-0318 792 MAIN ST License Number:2040109056 OSTERVILLE MA 02655-2051 This certifies that the taxpayer named above is licensed under Chapter 64C of the Massachusetts General Laws to sell at retail at the address shown above. This license is non-transferable and may be suspended or revoked for failure to comply with state laws and regulations. Effective Date:October 1,2020 Expiration Date:September 30,2022 I Commonwealth of Massachusetts Letter ID:L0468047424 0 Department of Revenue Notice Date:September 11,2020 Geoffrey E.Snyder,Commissioner Account ID:EDL-11945027-239 g q4 mass. ov/dor LICENSE FOR SALE OF ELECTRONIC NICOTINE DELIVERY SYSTEMS SPEEDWAY LLC SPEEDWAY LLC 539 S MAIN ST RM 3212 FINDLAY OH 45840-3229 Attached below is your Retailer License for Sale of Electronic Nicotine Delivery Systems. Cut along the dotted line and display at your business location.At any time,you can log into your MassTaxConnect account at mass.gov/masstaxconnect to view and re-print a copy of this license. If you have any questions about your license,call us at(617) 887-6367 or toll-free in Massachusetts at (800)392-6089,Monday through Friday, 8:30 a.m.to 4:30 p.m. DETACH HERE ----------------------------------------------------------------------------------------------------------------------------------------- Of MASSACHUSETTS DEPARTMENT OF REVENUE Retailer License for Sale of Electronic Nicotine Delivery Systems This license must be posted and visible at all times.The sale of tobacco products to anyone under 21 years of age is prohibited. SPEEDWAY LLC Account ID:EDL-11945027-239 SPEEDWAY#2446 Location ID: 11945027-0460 792 MAIN ST License Number: 1485539328 OSTERVILLE MA 02655-2051 This certifies that the taxpayer named above is licensed under Chapter 64C of the Massachusetts General Laws to sell electronic nicotine delivery systems at the address shown above.This license is non-transferable and may be suspended or revoked for failure to comply with state laws and regulations. Effective Date:September 11,2020 Expiration Date: September 30,2022 Town of Barnstable BOARD OF HEALTH John T.Norman Board of Health Donald A.Gaudagnoli,M.D. a+cnnsr,�BIA Paul J.Canniff,D.M.D. MASS 200 Main Street, Hyannis, MA 02601 IF.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: 866 Issue Date: 12/10/2019 DBA: SPEEDWAY #2446 OWNER: SPEEDWAY LLC Location of Establishment: 804 MAIN STREET OSTERVILLE, MA 02655 Type of Business Permit: RESTAURANT Annual: YES Seasonal: IndoorSeating: 0 OutdoorSeating: 0 Total Seating: 0 FEES FOOD SERVICE ESTABLISHMENT: $100.00 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: Q� FROZEN DESSERT: Thomas A. McKean, RS, CHO, Health Agent TOBACCO SALES: r FOR ESTABLISHMENTS WITH SEATING: PERMIT IS NOT VALID UNLESS ISSUED IN CONJUNCTION WITH A COMMON VICTUALER LICENSE Restrictions: A/0 June 15, 2018 Combo: Retail and Food, $200 and Tobacco $ 85. LIMITED TO THE FOLLOWING MENU ITEMS: HOT DOGS, POLISH SAUSAGE, TORNADO'S (EX. RANCHERO STEAK & CHEESE, SOUTHWEST CHICKEN, AND ROLLER PIZZA), APPROVED BY DUNKIN DONUTS TO SHARE USE OF 3 BAY AND MOP SINKS. t r For Office Initials: _ ti Town of Barnstable Use OnIV. Q' Date Paid\ Amt Pd$ BMMSPABLE. : Inspectional Services �, i6 9: �� Check# �-r✓'�;J�� � �� "I �EOMo+> 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, ` NEW OWNERSHIP RENEWAL X NAME OF FOOD ESTABLISHMENT: ADDRESS OF FOOD ESTABLISHMENT: IQ c�inS ,e,� U S�(yi t�G, a 6S5 MAILING ADDRESS(IF DIFFERENT FROM ABOVE): �( 15%0 1� `�` � � ::IV w ` vI� E-MAIL ADDRESS: t1UffiS U Yj .(0 rqySSJI TELEPHONE NUMBER OF FOOD ESTABLISHMENT: TOTAL NUMBER OF BATHROOMS: WELL WATER: YES NO ... (ANNUAL WATER ANALYSIS REQUIRED) ANNUAL: SEASONAL: DATES OF OPERATION:_/ /_ TO NUMBER OF SEATS: INSIDE: OUTSIDE: TOTAL: PENMNGD:1V. SEATING: MUST OBTAIN A COMMON VICTUALLER'S LICENSE FROM LI ***OUTSIDE DINING REMINDER*** OUTSIDE DINING MUST BE APPROVED BY THE HEALTH DIV.AND LICENSING,AND MEET OUTSIDE DINING REQUIREMENTS. f� IS WAIT STAFF PROVIDED FOR OUTSIDE DINING? 1 �� IS AN AIR CURTAIN PROVIDED AT WAITSTAFF SERVICE DOOR(S)?N V �TYPE OF ESTABLISHMENT: (PLEASE CHECK ALL THAT APPLY BELOW) f 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 l i Oil Y OWNER INFORMATION: FULL NAME OF APPLICANT SOLE OWNER: E /NO OWNER PHOiiNE# ADDRESS U U T� � s, CORPORATEOWNER: QS� LC CORPORATE ADDRESS: LA , N PERSON IN CHARGE OF DAILY OPERATIONS: LdG� 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� DR i9Z r I� Al SIGNATIURE JF APPLICANT DATE LICE E C ORDINATOR ***FOOD POLICY INFORMATION*** SEASONAL FOOD SERVICE: All seasonal food establishments,including mobile trucks must be inspected by the Health Div. prior to oveninz!! 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/at)plications.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.31"each calendar year. IT IS YOUR RESPONSIBILITY TO RETURN THE COMPLETED APPLICATION(S)AND REQUIRED FEES BY DEC 1st. Q\Application FormsTOODAPP REV3-2019.doc Town of Barnstable BOARD OF HEALTH John T.Norman Board of Health Donald A.Guadagnoli,M.D. MRNSTAOM Paul J.Canniff,D.M.D. MA ft, F.P. Thomas Lee Alternate a 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: 866 Issue Date: 1/1/2020 DBA: SPEEDWAY #2446 OWNER: SPEEDWAY LLC Location of Establishment: 804 MAIN STREET OSTERVILLE, MA 02655 Type of Business Permit: Non-Flavored Annual �( Seasonal FEES YEAR: 2020 TOBACCO SALES: $85.00 Permit Expires: 12/31/2020 Q Thomas A. McKean, RS, CHO, Health Agent Restrictions: A/0 June 15, 2018 Combo: Retail and Food, $200 and Tobacco $ 85. PLEASE POST CONSPICUOUSLY i I IKE '�ti� Town of Barnstable For Office Us Initials• Date Paid( Amt Pd$ RUWWABL6, : Inspectional Services � p ycb 039. `0$ Check# Ilif% '07FpMpYa r , Public Health Division Thomas McKean, Director 200 Main Street, Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 TOBACCO ESTABLISHMENT PERMIT APPLICATION on-Flavored DATE / I NEW BUSINESS OWNERSHIP RENEWAL NAME OF TOBACCO ESTABLISHMENT: LLC dba c-,Wfiu�w � C ADDRESS OF TOBACCO ESTABLISHMENT: a� 1Ay' N55-(;�5 1 MAILING ADDRESS(IF DIFFERENT FROM ABOVE): PQ 1, J U1 E-MAIL ADDRESS: TELEPHONE NUMBER OF TOBACCO ESTABLISHMENT: ( Lz- 1J� OWNER'S NAME: �l A �, . Qq Ll OWNER'S PH#66LQ-0�41 OWNER'S ADDRESS: "I /V LCIi(1 (:E'kAo%k t A V W b5S- �5 1 CORPORATE ADDRESS: 0T U, J T)n L(MV. Aj 1 CORPORATE FID# ANNUAL: k-- SEASONAL: AS1�OP RATION:_/_/_ TO 7 ` DAYS CLOSED EXCLUDING HOLIDAYS(EX.MONDAYS) TOWN OF BARNSTABLE CODE/MA GENERAL LAW INTERNET LINKS: TOWN OF BARNSTABLE TOBACCO CODE LINK FOR CHAPTER 371-9: https://www.ecode360.com/33996392 MA GENERAL LAW CHAPTER 270/SECTION 6: https://malegislature.gov/Laws/GeneralLaws/PartIV/TitleI/Chgpter270/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 nd Smoking Tobacco 4) Payment of Fee(s) -see page 4 NA E- �.�A-�, SIG TUR . PRINTED NAME: DATE: 77/ Q:\Application Forms\TOBACCO APP-NonFavor 11-21-19.doc Dec 27 2019 0326PM HP FaxSpeedway 5084200538 page 1 cuct�k Mato ESTABLISHMENtIS NAME TOBACCO SALES Employee Signature Form This form is for official use to indicate that the employee(s)of this establishment received and understood Chapter 371 of the Town of Barnstable Code and Chapter 270 Section 6 of the Massachusetts General Laws which describes the penalties for selling and/or giving tobacco products to any person under the age of twenty-one (21). Below is Section 371-9.of the Town of Barnstable Board of Health Regulation: Sales to Minors—$371-9.Sale and Distribution of Tobacco Products l. No person shall sell or provide a tobacco product,as defined herein,to a person under The minimum legal sales age. The minimum legal sales age in the Town of Barnstable is 21 years of age. 2. Identification: Each person selling or distributing tobacco products,as defined herein, shall verify the age of the purchaser by means of 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 employce(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: / nature Printed Name mate - "_7 SignaMre Printed Name Date Sig tune Printed Name Date JU l^ � cc� K Z �Z/A t Signature Printed Name Date Signature Printed Name Date Signature Printed Name Date Signature Printed Name Date QAApplication PormslTOBACCO APP.Nonravor 11-21-19.doc n ss Commonwealth.of Massachusetts LcttcrlD:L2130854528' n ��Ok s Department of Revenue. .. " Nohcc'Date Scptember4,2018 A, Christopher C.Harding,Commissioner AccountlD.CGL-11945027 224 1. de mass.govIdoe RETAILER LICENSE FOR SALE:.OF CIGARETTES ���hl�l�n ��ll�lll'I'11111��I'IIII'�I�I11�1�I11� 1�1"�I'I�I� SPEEDWAY LLC - SPEEDWAY LLC 2468 • ; 539'S MAW STRM3212 FINDLAY.OH,45840-3229 Attached below is your Retailer License for Sale of Cigarettes(Form CT=3T). Cut along the dotted line. and.display at your business location:.At any time,you can log into your MassTaxConnect account at mass.gov/masstaxconnect to view and re-print a copy of this license: If you have any questions about your license,call us at(617) 887-6367 or toll-free in Massachusetts at (800)392-6089,Monday through Friday, 8:30 a.m.to 4:30 p.m.. DETACH HERE p►cxUse MASSACHUSETTS DEPARTMENT OF REVENUE Form CT-3T ' Retailer License for Sale of Cigarettes oV This license must be posted and visible at all times:The sale of tobacco products to anyone under 18 years of age is prohibited. SPEEDWAY LLC Account ID: CGL-1 1945027-224:i,, SPEEDWAY 02446 ' Location IDt 11945027-0206 792 MAIN ST License Number: 1377267712 OSTERVILLE MA 02655-2051 This certifies that the taxpayer named above is licensed under Chapter 64C of the Massachusetts General Laws to sell at retail at the address shown above.This license is non-transferable and may be suspended or revoked for failure to comply with state laws and regulations. Effective Date: October 1,2018 Expiration Date: September 36,2020 • o0 st` }tus� Commonwealth of Massachusetts Letter ID:L0196612736 Department of Revenue Notice Date:September 4,2018 Christopher C.Harding,Commissioner Account ID:CRL-I 1945027-227 ftvsog' mass.gov/dor RETAILER LICENSE FOR SALE OF CIGARS AND SMOKING TOBACCO SPEEDWAY LLC SPEEDWAY LLC 2468 539 S MAIN ST RM 3212 FINDLAY OH 45840-3229 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 ------------------------------------------------------------------------------------------------------------------------------------------------- ,��ss*cHtrsF�� MASSACHUSETTS DEPARTMENT OF REVENUE Form CT-3T Retailer License for Sale of Cigars and Smoking Tobacco oF�'` This license must be posted and visible at all times.The sale of tobacco products to anyone under 18 years of age is prohibited. SPEEDWAY LLC Account ID: CRL-11945027-227 SPEEDWAY 02446 Location ID: 11945027-0318 792 MAIN ST License Number: 448141312 OSTERVILLE MA 02655-2051 This certifies that the taxpayer named above is licensed under Chapter 64C of the Massachusetts General Laws to sell at retail at the address shown above. This license is non-transferable and may be suspended or revoked for failure to comply with state laws and regulations. Effective Date:October 1, 2018 Expiration Date:September 30, 2020 r ' i DEPARTMENT OF THE TREASURY ° INTERNAL REVENUE SERVICE pY F3'�4 WASHINGTON, DC 20224 LAR6B BUSINESS AND INTERNATIONAL DIVISION I January 11, 2013 Charles VanBelle Team Manager Large Business & International Nicole Busey Internal Revenue Service Income Tax Audit & Legal Manager 433 N. Summit Street, Marathon Petroleum Corporation Toledo, Ohio 43604 419-213-5166 IRS Badge#1000220353 Dear Ms. Busey, Per our discussion I have researched the Federal Employer Identification Number (FEIN)for Speedway LLC. The FEIN for this entity is 31-1551430. Sincerely, K67C B Vo"nae K�6h.So mal/dharlmT. DateuOu.01.31 I536:23.Osoa Charles VanBelle, Team Manager, LB&I art , Town of Barnstable BOARD OF HEALTH Paul J Canniff,D.M.D. Board of Health Donald A.Gaudagnoli,M.D. a,,R,NSTABM = John T.Norman 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, 30513, 146, 189 and 189A; Chapter 111, Sections 5 and 127A, a permit is hereby granted to: Permit No: 866 Issue Date: 12/20/18 r DBA: SPEEDWAY #2446 OWNER: SPEEDWAY, LLC; Location of Establishment: 792 MAIN STREET OSTERVILLE MA 02655 Type of Business Permit: RESTAURANT Annual: YES Seasonal: IndoorSeating: 0 OutdoorSeating: 0 Total Seating: 0 FEES (� FOOD SERVICE ESTABLISHMENT: $100.00 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�� FROZEN DESSERT: Thomas A. McKean, RS, CHO, Health Agent TOBACCO SALES: $85.00 I FOR ESTABLISHMENTS WITH SEATING: PERMIT IS NOT VALID UNLESS ISSUED IN CONJUNCTION WITH A COMMON VICTUALER LICENSE Restrictions: A/0 June 15, 2018 Combo: Retail and Food, $200 and Tobacco $ 85. LIMITED TO THE FOLLOWING MENU ITEMS: HOT DOGS, POLISH SAUSAGE, TORNADO'S (EX. RANCHERO STEAK & CHEESE, SOUTHWEST CHICKEN, AND ROLLER PIZZA), APPROVED BY DUNKIN DONUTS TO SHARE USE OF 3 BAY AND MOP SINKS. IKE For Office Use Onlv: Initials: t Town of Barnstable Amt Pd$ � MAMWWST"LE, Inspectional ServicesCheck �prEoA,. Public Health Division Thomas McKean, Director ;3,1 _ 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fag: 508-790-6304 1�5 AjP/PLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT DATE IIU/ 3 NEW OWNERSHIP RENEWAL NAME OF FOOD ESTABLISHMENT: ('� �'��� .� ADDRESS OF FOOD ESTABLISHMENT: 19 d hI n 61- Im MA O 5�5 MAILING ADDRESS(IF DIFFERENT FROM ABOVE): E-MAIL ADDRESS: 3e J- �s)' ct , Mal jj TELEPHONE NUMBER OF FOOD ESTABLISHMENT: l wo l - 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? v IS AN AIR CURTAIN PROVIDED AT WAITSTAFF SERVICE DOOR(S)?Jj 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) TOBACCO 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 FormsTOODAPPREV2018.doc PLEASE CALL 508-862-4644 OWNER INFORMATION: FULL NAME OF APPLICANT SOLE OWNER: (YE'/NO OWNER PHONE# I ADDRESS CORPORATE OWNER: ('FEDERAL ID NO. : , - CORPORATE ADDRESS: ® - n PERSON IN CHARGE OF DAILY OPERATIONS: &A�(PX1('C? IC 'Y►i I'll 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 .� / 17 190Z 1. �.Glf,�(eme Qt� /�!"I /�" (��lj �Z�ahi 2. /o- 1 SIGNAT OF APPLICANT DATE JOEY K ALLEN, TREASURER FOR SPEEDWAY LLC ***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 1 st to Dec. 3 1"each calendar year. IT IS YOUR RESPONSIBILITY TO RETURN THE COMPLETED APPLICATION(S)AND REQUIRED FEES BY DEC 1 st. Q\Application FormsT00DAPPREV2018.doc -------- - - . t �IKETown of Barnstable sAvsrns�, Regulatory Services Department 9Q �. Public Health Division �O g6 i639' 10 �F a 200 Main Street, Hyannis MA 02601 Office: 508-790-4644 Thomas A.McKean,RS,CHO FAX: 508-790-6304 Director of Public Health Fee: $85.00 MAIL TO: TOWN OF BARNSTABLE PUBLIC HEALTH DIVISION , 200 Main Street HYANNIS,MA 02601 FAX 508 790-6304 PLEASE INCLUDE THE REQUMED FEE OF$85.00 APPLICATION FOR A TOBACCO SALES PERMIT z wo,1 LA T NAME O APPLICANT FIRST NAME MIDDLE INITIAL D /A "NQ MoR.� P llt MA nZ,,--� "/,,51 STREET ADDRESS TELEPHONE # FID# Do you currently possess a state license to sell tobacco products? Yes No Each employee who sells tobacco products must receive and understand the Sections VII b. and VII c. of the Board of Health Prohibition of Smoking Regulation, (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). SigRa'tureVDate JOEY K ALLEN, TREASURER FOR SPEEDWAY LLC Q:\Application Forms\TOBACCO APP2018 dob.docx I Bscabiishment TOBACCO SAns Eratployee Signature Form This farm is for official use to indicate that the employee(a)of this esteb6hment received and understood sections VII b,and VTI c. of the Barnstable,Board of Health Prohibition of SuaOldng Regulation and the t enclosed copy of t 270 ScntiOa 6 of the Massachusetts General Laws which describes the penalttea , for seftg and/or giving tabacoo products to any person under the age of eighteen(18� Below are sections VII b,and VTI c,of the Barnstable Board of Health Regulation: SECTION VII SALE AND DISTRTBU MN OF TOBACCO PRODTJCT'S b. Sales To Minors—in conformance with the Massachusetts General Laws Chapter 270,Section 6, no person, Tian, corporation, establishment, Or agency slW2 sett tobacco products to,a minor. Each employee wocidng in an establishment licensed to sell tobacco product sball be required to receive it copy Of the Board Of Health regulations and State Law regarding the sale of tobacco and sigo a form indicating tfiat such rcgulatians&ws have been received and understood, a copy of which must be placed on file,in the Office of the employer and retained. Such signed.fM=must be made available fox,inspecpon,during the license holders normal business hours upon request of an agent of the Board ofRcaith. c, 'All-distrl'btttorslretallers of.tobacco products or tobacco merchandise must require that, if a customer appears to possibly be under 25 years of age,the customer present a valid State issued Picture identification card or drivers license with appropriate photograph to confum that the customer is of'le al age to Purchm the tobacco product The following employ*4—received and understood Sections VIIb, and VIIc, of the Barnstable Board of Health Pro'Oitina of Smoking Regulation and Chapter 270 Section 6 of the Massachusetts General Laws. 6C Mu Printed Name Date red Name Date Si r Printed Name Date Si p24S �1f-,livu 1 oq Signature Printed Name Date Signer Printed Name Date S'gnsture Printed Nance Date Signature Printed Name Date Q kApplication FomtATOR4CCC APP2019 dob.dm 114E Town of Barnstable For Office Use Only: Initials: o� Date Paid Amt Pd$ Inspectional Services Check# Cash * BARNSTABU& MASS. � Public Health Division �F0 r"ps a 200 Main Street, Hyannis MA 02601 Office: 508-790-4644 Thomas A.McKean,RS,CHO FAX: 508-790-6304 Director of Public Health Fee: $85.00 MAIL TO: TOWN OF BARNSTABLE PUBLIC HEALTH DIVISION 200 Main Street HYANNIS,MA 02601. FAX 508 790-6304 PLEASE INCLUDE THE REQUIRED FEE OF$85.00 APPLICATION FOR A TOBACCO SALES PERMIT tedOM/ ESTABLISHMENT/NAME (DB/A) a7q mo, n C ron I le JUA o - D5 ADDRESS OF BUSINESS PO x ) - i a/ 0A yks-01 MAILING ADDRESS (IF DIFFERENT FROM ABOVE OWNER'S �/ LLc NAM LAST FIRST MIDDLE and EMA PHONE# FEDERAL ID# Do you currently possess a state license to sell tobacco products? Yes No Each employee who sells tobacco products must receive and understand Chapter 371 of the Town of Barnstable Code (copy provided herein) and the Massachusetts General Law Chapter 270, Section 6.00 (a copy is provided on the next page). Each employee who sells tobacco products must sign the Employee Signature Form (provided herein). Signature Date / JOEY K ALLEN, TREASURER FOR SPEEDWAY LLC C:\Users\C7_54\AppData\Local\Microsoft\Windows\INetCache\Content.Outlook\86NF5QTD\'FOBACCO APP2019 dob.docx r a Sqq& E AIRUSHMED T'S NAME TOBACCO SALES Employee Signature Form This form is for official use to indicate that the employees) 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 Mirrors-- 371-9. Sale and p)istributign ofTobwo 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 7. The following employee(s) received and understood Section 371-9 of the Town of Barnstable Board of Health Prohibition of Smoking Regulation and Chapter ?70 Section 6 of the g1e //��',rinied Numo pate Si o " . tad Nome gate Sl PrhttedT�laute Date �t CN 75 A0/,l f s $jp prit:iccl�lxt�e w Date signature Printed Name Date - Signature Printed Name pate - Signature Printed Name Date . ` _ �1UiGfa'.(.f?•t1A,tt�)at,+'I-c�4�slaAitc:rc>so(fitt�'inc><nts'1NriC':�cSulCUns�vu.Osulook'ktbNl>SC?TfY:tt)};I�GCQ t1Pl�?b!9 d��h doc� i Commonwealth of Massachusetts Letter ID:L0196612736 a Department of Revenue Notice Date:September 4,2018 — — 9 Christopher C.Harding,Commissioner Account ID:CRL-11945027-227 pQ4` mass.gov/dor RETAILER LICENSE FOR SALE OF CIGARS AND SMOKING TOBACCO d�l�l�l ���rll�l�lih�l� li�hh��hll��ulnulilll�il SPEEDWAY LLC SPEEDWAY LLC 2468 539 S MAIN ST RM 3212 FINDLAY OH 45840-3229 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 ------------------------------------------------------------------------------------------------------------------------------------------------- cliv, MASSACHUSETTS DEPARTMENT OF REVENUE Form CT-3T Retailer License for Sale of Cigars and Smoking Tobacco 7 og This license must be posted and visible at all times.The sale of tobacco products to anyone under 18 years of age is prohibited. SPEEDWAY LLC Account ID: CRL-11945027-227 SPEEDWAY 02446 Location ID: 11945027-0318 792 MAIN ST License Number:448141312 OSTERVILLE MA 02655-2051 This certifies that the taxpayer named above is licensed under Chapter 64C of the Massachusetts General Laws to sell at retail at the address shown above. This license is non-transferable and may be suspended or revoked for failure to comply with state laws and regulations. Effective Date:October 1,2018 Expiration Date:September 30,2020 �p TMB r TOWN OF BARNSTABLE HEALTH INSPECTOR'S Establishment Name: Date: Page: of y, OFFICE HOURS :T BARNSTABLE.O� PUBLIC 2 0 MAN STREET 3:30-4:30 P.M. DIVISION - : 0-4:30 A.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified M6 v. �0� HYANNIS, MA 02601 M-8 -FRI. No Reference R-Red Item PLEASE PRINT CLEARLY p n 50862�644 FOOD ESTABLISHMENT INSPECTION REPORT , LIB U � Name Date3. 1 Tyne of T f Ins ction 1V12) / outine L C Coo Address C Risk ood Servic Re-Inspection Level a al Previous Inspection t� Telephone Residential Kitchen Date: Mobile Pre-operation Owner HACCP Y/N Temporary Suspect Illness ,g u� / Caterer General Complaint Person in Charge(PIC) ° UJ L�� Time n Bed&Breakfast HACOther CIP V Inspector / J Out: /' Each violation checked re ires 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 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 POP LATIONS(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 ViolationsjX Critical(C)violations marked must be corrected immediately. (blue&red items) Corrective Action Required: ❑ No ❑ Yes Non-critical N mediate) or ( )violations must be corrected immediately Overall Rating within 90 days as and of Health. Re- inspection determined by the Bo � 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 25.Equipment and Utensils (FC-4)(590.005) cited in this report may result in suspension or revocation of the food regardless of the number of critical, results in an F. B=One critical violation and less than non-critical violations 9 FC-5 590.006 if no critical violations observed,4 too 6von-critical violations=B. Seriously Critical Violation=F is scored automatically if: no hot 26.Water,Plumbing and Waste ( )( ) 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 FC-7 590.008 be in writing and submitted to the Board of Health at the above address violations toobserved,7 to 8 non-critical violations. If 1 critical refrigeration. 28.Poisonous or Toxic Materials ( )( ) violation,4 to 8 non-critic 16 ations=C. 29.Special Requirements (590.009) within 10 days of receipt of this order. 30.Other DATE OF RE-INSPECTION: Inspector's Signature Print: 31.Dumpsta reened from public view Permit Posted? ✓Y N Grease Trap Previous Pumping Date Grease Rendered Y N #Seats Observed Frozen Dessert Machines: Outside Dining Y N PIC's Signature ` Print: Self Service Wait Service Provided Grease Size Variance Letter Posted Y N Trap Dumpster Screen? Y N Violations related to Foodborne Illness Violation 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 7 5 590.004(F)Poisonous or Toxic Substances 3-501.16(B) Cold PHFs Maintained At or Below 41°F/45°F * 590.003(C) Responsibility of the Person-in-Charge to 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* 7-IO2.11 Common Name-Working Containers* 2 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* 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 3-304.11 Food Contact with Equipment and Utensils 7-203.11 Toxic Containers-Prohibitions* ( ) q 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 Reservice of Food* 7-204.12 Chemicals for Washing Produce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP 590.003(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* q 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 Warewashin Hot Water 7.206.12 Roden[Bait Stations 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 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. Clean Utensils and Food Contact Surfaces of *. Animal Foods That are Raw,Undercooked or 5-101.11 Drinking Water from an Approved System* 11A( ) Eggs-Immediate Service 145°F 15 sec Equipment* t Not Otherwise Processed to Eliminate 590.006(A) Bottled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* Effective 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 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* 590.009(A)-(D) Violations of Section 590.009(A)-(D)in cater- * Ratites-165°F 15 sec* in mobile food,tern and residential Sources 10 Proper,Adequate Handwashing g' Por� 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. 4(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 590.00 - 11 Good Hygienic Practices 17 Reheating for Hot Holding Requirements. radicsshould be debited under#29-Special 3-201.4( Game Animals* 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 Critical and non-critical violations,which do not relate to the foodborne 3-101.11 Food Safe and Unadulterated* r 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* 1 g 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 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 .e 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 i 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 FC-7 .008 HACCP Plans 6-301.12 Hand Drying Provision 29. Special Requirements .009 3-502.11 Specialized Processing Methods* 30. 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.Ob0. 'Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. oFTHE I TOWN OF BARNSTABLE HEALTH INSPECTOR'S Establishment Name:��� Date: Page! of 'Y OFFICE HOURS TH BARN STABLE. PUBLIC 0 MAIN LST STREET 3:30-4:30 P.M. 6: 0- :30A.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified MON� HYANNIS,MA 02601 08-8 -FRi.62-4644 58� No Reference R-Red Item PLEASE PRINT CLEARLY MP prFD y� FOOD ESTABLISHMENT INSPECTION REPORT Name S Date �� � T of Inspection -Type s Routine' ? v 1/V Address Risk oo Servi e ection oI Level a ai Previous Inspection Telephone esidential Kitchen Date: Mobile Pre-operation Owner HACCP Y/N Temporary Suspect Illness Caterer General Complaint Person in Charge(PIC) �� S Time _ Bed&Breakfast HACCP In: 1� Other Inspector 94Z, Out: -��Q� iGw w - 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) ❑ ` r Action as determined by the Board of Health. Allergen Awareness 590.009(G) FOOD PROTECTION MANAGEMENT ❑ 12.Prevention of Contamination from Hands 1 A f� ❑ 1.PIC Assigned/Knowledgeable/Duties ❑ 13.Handwash Facilities (4 p A , EMPLOYEE HEALTH PROTECTION FROM CHEMICALS ❑2.Reporting of Diseases by Food Employees and PIC ❑ 14.Approved Food or Color Additives c�C c (/✓�Q� ❑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 ❑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.ProperAdequate Handwashing CONSUMER ADVISORY 1 ^� ❑ 11.Good Hygienic Practices ❑22.Posting of Consumer Advisories L 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 Overall Rating 24 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 checked indicate violations of 105 CMR 590.000/Federal Food Code. ® g ❑ Emergency Closure ❑ Voluntary Disposal ❑ 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,re B=One critical violation and less than 4non-critical violations g 24.Food and Food Preparation (FC-3)(590.004) constitutes an order of the Board of Health. Failure to correct violationsment and Utensils (FC-4)(590.005 regardless of the number of critical,results in an F. 25.E Equipment p ) 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 o la 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 i non-critical. If no critical water,sewage bade-Up,infestation of rodents or insects,or lack of be in writing and submitted to the Board of Health at the above address violations observed,7 to anon-critical violations. If 1 critical refrigeration. 78.Poisonous or Toxic Materials � (FC-7)(590.008) 9 violation,4 to anon-critical violations=C. 29.Special Requirements (590.009) within 10 days of receipt of this order. 30.Other DATE OF RE-INSPECTION: Inspector's Signatur Pri t 31.Dumps r screened from public view v/� Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y N #Seats Observed Frozen Dessert Machines: Outside Dining Y N PIC's Signaturre1 (� 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 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* F 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.* 2-103.11 Person-in-Charge Duties 3-302.14 Protection from Unapproved Additives* 19 PHF Hot and Cold Holding 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* 2 590.003(C) Responsibility of the Person-in-Charge to Other* * 3-501.16(A) Hot PHFs Maintained At or Above 140°F* Require Reporting by Food Employees and Contamination from the Environment 7-102.11 Common Name-Working Containers P g 3-501.16(A) Roasts Held At or Above 130°F* 7-201.11 Separation-Storage* Applicants* 3-302.11(A) Food Protection* 20 Time as a Public Health Control 590.003(F) Responsibility of A Food Employee or An 3-302.15 Washing Fruits Restriction-Presence and Use*i[s 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 Reated 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 Sources9 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 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. 1g 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 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,Meals&Game Pathogens* ey cn-innoot 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 3-40 1.11(A)(2) Ratites,Injected Meats-155'F 15 sec* aces 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 temporary and - ide in cater- * Ratites-165°F 15 sec* in mobile food,tem or and residential Sources 10 Proper,Adequate Handwashing g' P 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 U2401.11 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* Cleaning Procedure* 165°F* foodbome illness interventions and risk factors. 590.004(C) Wild Mushrooms* When to Wash* 3-401.11(A)(1)(b) All Other PHFs-145°F 15 sec* Other 590.009should violations relating to good retail 3-201.17 Game Animals* 11Good Hygienic Practices 17 Reheating for Hot Holding practices should be debited under#29-Special Eatin Drinkin or Usin Tobacco* * Requirements. $ 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) Commercial] Processed RTE Food-140°F* (Blue Items non-critical 23-30) 3-202.15 Package Integrity Y Critical and non-critical violations,which do not relate to the foodbome 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 r5-2O3.1 04(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 CoolingCooked 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 1 Numbers and Capacities* Within 4 Hours* 23. Management and Personnel FC-2 .003 * .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 FC-7 .008 HACCP Plans 6-301.12 Hand Drying Provision 29. Special Requirements 009 3-502.11 Specialized Processing Methods* 30. 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. 50 P)A Op.WE ro TOWN OF BARNSTABLE _ HEALTH INSPECTORS Establishment Name: V Date: Page: of 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 HYANNIS, MA 02601 MON.-FRI. 508-862-4644 No Reference R-.Red Item PLEASE PRINT CLEARLY rn n+a, YOOP ESTABLISHMENT INSPfqTION REPORT NameWA 11 Date T e o f Ins pection r g outinc Address Risk ice Re-in ctio Level Retail Previous I s i Telephone idential Kitchen Date: Mobile Pre-oper i n Sus ect III es� Owner HACCP YIN Temporary P Caterer General Complaint Person in Charge(PIC) Time Bed&Breakfast HACCP 114 5, z/) Other // t Inspector [� Each violation checked requires an explanation on the narrativ 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 Ly ❑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 A ❑ 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 r Critical(C)violations marked must be corrected immediately. (blue&red items) , i 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 (FC-4)(590.005 6=One critical violation and less than 4von-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. . f 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 t0 8 non-cr cal violations. If 1 critical refrigeration. within 10 days of receipt of this order. violatio 4 to 8 `on-critical viol ns= 29.Special Requirements (590.009) Y P _ t ature ,P t ec 30.Other _DATE OF RE-INSPECTION: Inspect 31.Dumpster screened from public view Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y N L, tVVr/ #Seats Observed Frozen Dessert Machines: Outside Dining Y N PIC, to 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 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.* Additives* 19 PHF Hot and Cold Holding 2-103.11 Person-in-Charge Duties 3-302.14 Protection from Unapproved 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 Animal Foods Separated from Each 7-101.11 Identifying Information-Original Containers* 590.004(F) 590.003(C) Responsibility of the Person-in-Charge to 7-102.11 Common Name-Working 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* 20 7-202.11 Restriction-Presence and Use* 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* 3-304.11 Food Contact with Equipment and Utensils Applicant To Report To The Person In Charge* * 7.202.12 Conditions of Use* 590.004(11) Variance Requirements 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 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* * 3-801.11(D) Raw or Partially Cooked Animal Food and ( ) P 4-501.111 Manual Wazewashing-Hot Water 7.206.12 Roden[Bait Stations 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 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 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. Proper Cooking Temperatures for PHFs - CONSUMER ADVISORY 3-202.16 Ice Made From Potable Drinking Water* Concentration and Hardness* 163-401.11 A(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* Effective tiinoot 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 3-401.1](B)(1)(2) Pork and Beef Roast-130°F 121 min* Eggs* 4-702.11 Frequency 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 Surf aces 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 or590.009(A)_(D) 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* g 590.009(A)-(D) Violations of Section in cater- * Ratites-165°F 15 sec* in mobile food,temporary and residential Sources 10 Proper,Adequate Handwashing g' P � 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 All Other PHFs-145°F 15 sec* Other 590.009 violations relating to good retail ( )( )(b) 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. $ Receiving/Condition g� g g 3�03.11(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* 3-403.1](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 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 6 Tags/Records:Shellstock 590.004(E) Preventing Contamination from Employees* 1 g Proper Cooling of PHFs following sections of the Food Code and 105 CMR 590.000 * 13 Handwashing Facilities 3-501.14 A Cooling 3-202.18 Shellstock Identification ( ) g Cooked PHFs from 140°F[0 70°F ItemGood 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 5204.11 Location and Placement* 3-501.14(B) Cooling PHFs Made from Ambient 24. Food and Food Protection FC-3 .004 402.11 Parasite Destruction* - 3- * 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 I FC-7 .008 HACCP Plans 6-301.12 Hand Drying Provision F29 I Special Requirements 1.009 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. Ft r TOWN OF BARNSTABLE HEALTH INSPECTORS Establishment Name: S LM,`�-cpl Date: Page: of yp O .OFFICE HOURS •.• - °� PUBLIC HEALTH DIVISION 8:00-9:30 A.M. BARNSTABLE. ` 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 �A .639.e e 508-862-4644 reo►A"� FOOD ESTABLISHMENT INSPECTION REPORT Name S d f Date /(+�) a of a of Inspection fteration(s) Routln Ad 01-I Risk F ervice e- ection _ d lg�hold f � I 5 op Level- ail Previous Inspection �7 Telephone ential Kitchen Date: r t7 Mobile Pre-operation Owner HACCP Y/N Temporary Suspect Illness Caterer General Complaint Person in Charge(PIC) Time Bed 8 Breakfast HACCP In: Other Inspector Out: y r3a+n fO fl G j f Ac/Utd 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 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 HS \ I ❑'10.Proper Adequate Handwashing _ CONSUMER ADVISORY ❑ 11.Good Hygienic Practices ❑ 22.Posting of Consumer Advisories ( I 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 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 checked indicate violations of 105 CMR 590.000/Federal Food Code. ❑ Embargo ❑ Emergency Closure ❑ Voluntary Disposal ❑ 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. B=One critical violation and less than 4 non-critical violations 25.Equipment and Utensils (FC-4)(590.005) 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 C=2 critical violations and less than 9nOn-critical. If no critical water,sewage back-up,infestation of rodents or insects,or lack of 27.Physical Facility (FC--6)(590.007) aggrieved by this order,you have a right to a hearing. Your request must violations observed,7 to 8 non-critical violations. If 1 critical refrigeration. 28.Poisonous or Toxic Materials (FC-7)(590.008) be in writing and submitted to the Board of Health at the above address violation,4 to 8 non-critical violations=C. 29.Special Requirements (590.009) within 10 days of receipt of this order. Inspector's Signature Print: ( / 30.Other RATE OF RE-INSPECTION: �'v tJ �� 31.Dumpster screened from public view Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y N #Seats Observed Frozen Dessert Machines: Outside Dining Y N PIC's Signat _- - ' 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 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 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 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* 590.004(F) 2 Other*590.003(C) Responsibility of the Person-in-Charge to 7-102.11 1 Common Name-Working Containers* 3-501.16(A) Hot PHFs Maintained At or Above 140°F* 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* 20 Time as a Public Health Control Employee 3-302.15 Washing Fruits and Vegetables 7-202.11 Restriction-Presence and Use* 590.003(F� Responsibilityof A Food Em to ee or An 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 3-304.11 Food Contact with Equipment and Utensils ( ) Variance Requirements 590.003(G) Reporting by Person in Charge* Contamination from the Consumer 7-203.11 Toxic Containers-Prohibitions* 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 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* 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 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(1)(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* 4-601.11(A) Clean Eggs 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 Pathogens* Ef°ti°°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 3-201.14 Fish and Recreationally Caught Molluscan Contact Surfaces of Equipment* 3-401.11(A)(2) Ratites,Injected Meats-155°F 15 sec* 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 or590.009(A)_�) 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* g g 590.009(A)-(D) Violations of Section in cater- Ratites-165°F 15 sec* Sources* 1 p 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* 3401.12 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 Reheati practices should be debited under#29-Special ng for Hot Holding Requirements. 5 Receiving/Condition 2-401.11 Eating,Drinking or Using Tobacco* 3-403.l l(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 PreventingContamination When Tasting* * (Blue Items 23-30) 3-202.15 Package Integrity* g 3 403.11(C) 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 PBF's 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 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 () 9 9 27. Physical Facility FC-6 .007 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 29. Special Requirements .009 3-502.11 Specialized Processing Methods* 30. 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. ��,� �d� X tk�F, r TOWN OF BARNSTABLE HEALTH INSPECTOR'S Establishment Name: Date: age: of HEALTHOFFICE HOURSly : BAR E. PUBLIC 200 MAN STREEETSION 3:3:3 0-s:30A.M.0-4:30 P.M.- .M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified MA- e `0 HYANNIS,MA 02601 soa-862 asaa No Reference R-Red Item PLEASE PRINT CLEARLY p'``ON1Aye OOD ESTABLISHMENT INSP TI N EPORT_ tf Name Date T e of T o ns ection go ton outine Address Risk ;ds e ' spection Level Previous Inspection io Telephone Residential Kitchen Date: Mobile Pre-operation Owner HACCP Y/N Temporary Suspe Caterer Person in Charge(PIC) Time Bed&Breakfast P Other Inspector Out: 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 i L IL ❑ 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 In ❑ 5.Receiving/Condition ❑ 17.Reheating .,/ Ir 1 v ❑ 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 ❑ &Separation/Segregation/Protection REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) / ❑ 9.Food Contact Surfaces Cleaning and Sanitizing ❑ 21.Food and Food Preparation for HSP , J� ❑ 10.Proper Adequate Handwashing CONSUMER ADVISORY `v ❑ 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 Overall Rating within 90 days as determined by the Board of Health. 10 `g ❑ Voluntary Compliance ❑ Employee Restriction/Exclusion ❑ Re-inspection Scheduled ❑ Emergency Suspension C N Official Order for Correction:Based o 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 B=One critical violation and less than 4 non-critical 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 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 t F is scored automatically lack of 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 non-critical. If no critical water,sewage back-up,infestation of rodents or insects,or la 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 anon-critical violations. If 1 critical refrigeration. ) violation,4 to 8non-critical violations=C. 29.Special Requirements (590.009) within 10 days of receipt of this order. 30.Other DATE OF RE-INSPECTION: Inspector's Signature Print: 31.Dumpster screened from public view AA Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y N ZAA PAIL�14 #Seats Observed Frozen Dessert Machines: Outside Dining Y N IC's Signature Print: Self Service Wait Service Provided Grease Trap Size Variance Letter Posted. Y N Dumpster Screen? Y N rF .� �.. ._ ....r,._ _... _ ___ _ _ _ _ _ __ a ....Y.+t• _ - �.. Y- ti..-..- -r _ -L,��-_-..� - �--a•� „ram- e a _ ,� !- 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 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-Charge Duties3-302.14 Protection from Unapproved Additives ' Contamination from Raw Ingredients 15 Poisonous or Toxic Substances 3-501.16(B) Cold PI-IF's 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* 2. 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 Require Reporting by Food Employees and Contamination from the Environment 3-501.16(A) Roasts Held At or Above 130°F* 7-201.11 Se azation-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 Requirements 3-304.11 Food Contact with Equipment and Utensils * ( ) 9 590.003(G) Reporting by Person in Charge* 7-203.11 Toxic Containers-Prohibitions 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 Dispgsition ofAdulterated 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 Wazewashing-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 Wazewashing-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 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 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 Pathogens* Ep ca°°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* 4-703.11 Methods of Sanitization-Hot Water and 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS Chemical Stuffing Containing Fish,Meat,Poultry or 3-201.15 Molluscan Shellfish from NSSP Listed _ * g t g t �' 590.009(A)-(D) Violations of Section 590.009(A)-(D)in cater- Ratites-165°F 15 sec* in mobile food,temporary and residential Sources* 10 Proper,Adequate Handwashing g' P � 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* 3-40L11 2-301.14 When to Wash* 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. $ 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 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 3-101.11 Food Safe and Unadulterated* 12 Prevention of Contamination from Hands 3-403.11 O 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 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 5-20411 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 FC-7 .008 HACCP Plans 6-301.12 Hand Drying Provision 129. 1 Special Requirements 1.009 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. oFISE ro TOWN OF BARNSTABLE HEALTH INSPECTOR-s Establishment Name: Date: Page:_�of p• 1 OFFICE HOURS xann-srne�E.o� PUBLIC 0 MAN STREET EEVT 3:30-4:30 P P.M. DIVISION • : 0- :30A.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified �p a39:a m� HYANNIS, MA 02601 MON.-FRI. No Reference R-Red Item PLEASE PRINT CLEARLY 508-862-4644 FOOD ESTABLISHMENT INSPECTION REPORT Name Dat r1C( &%q Tyoe of Inspection aC s Routine �] ddress I r l Risk e Re-inspection LevelPrevious InspectionTelephone Kitchen Date: Mobile Pre-operation Owner HACCP Y/N Temporary Sus Caterer e�ComplamtPerson in Charge(PIC) Time Bed&Breakfast In: Other Inspector Out: Each violation checked requires an explanation on the narrative page(s)and a citation of specific provision(s)violated. / L Violations Related to Foodborne Illness Interventions and Risk Factors(Red Items) Anti-Choking 590.009(E) ❑ 5 (-, _( 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. ❑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 Lb/�,),d❑ 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 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 9 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 6=One critical violation and less than non-critical violations re 26.Water,Plumbing and Waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If if no critical violations observed,4 too.6 non-critical violations=B. 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 violations observed,7 to anon-critical violations. If 1 critical refrigeration. 28.Poisonous or Toxic Materials (FC-7)(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 anon-critical violations C. w 29..Special Requirements (590.009) y p 30.Other DATE OF RE-INSPECTION: Inspector's Signature Print: 31.Dumpster screened from public view a Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y N 4_ZZ�45 #Seats Observed Frozen Dessert Machines: Outside Dining Y N PIC's Signiliture Prin. 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 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) I Assignment of Responsibility* S 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 _ P.HE Hot and Cold Holding _ 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* 2 590.003(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* Require Reporting by Food Employees and Contamination from the Environment Separation-Storage* 3-501.16(A) Roasts Held At or Above 130°F* 7-201:1'1• Applicants 3-302.11(A) Food Protection* 20 Time as a Public Health Control 7-202.11 Restriction-Presence and Use* 590.003(F) Responsibility of A Food Employee or An 3-501.19 Time as a Public Health Control* 3-302.15 Washing Fruits and Vegetables Applicant To Report To The Person In Charge* 7.202.12 Conditions of Use* 3-304.11 Food Contact with Equipment and Utensils* 590.004(11) Variance Requirements 590.003(G) Reporting by Person in Charge* Contamination from the Consumer 7-203.11 Toxic Containers-Prohibitions* 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 Hermetically Sealed Container* Sanitization Temperatures* Raw Seed Sprouts Not Served* 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* 3-401.11 A(1)(2) Eggs-155°F 15 sec 22 3-603.11 Consumer Advisory Posted for Consumption of I 5-101.11 Drinking Water from an Approved System* 4-601.11(A) Clean ContactEggs Utensils and Food 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 Pathogens* Ef t-11112001 4-602.11 Cleaning Frequency of Utensils and Food Animals-155`17 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 r f ces of Equipment* 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 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* g g �' S90.009(A)-(D) Violations of Section 590.009(A)-(D)in cater- Ratites-165°F 15 sec* Sources* 1 p 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 17 Reheating for Hot Holding Good Hygienic Practices 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* * (Blue Items 23.30) 3-2A2.15 Package Integrity g g 3-403.11(C) Commercially Processed RTE Food-140'F Critical and non-critical violations,which do not relate to the foodborne 12 Prevention of Contamination from Hands g illness interventions and risk factors listed above,can be found in the 3-101.11 Food Safe and Unadulterated* 3-403.11(E) Remaining Unsliced Portions of Beef Roasts* 6 Tags/Records:Shellstock 590.004(E) Preventing Contamination from Employees* 1 g 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 140'17 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 1590.000 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 3402.12 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 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. °Ft r TOWN OF BARNSTABLE HEALTH.INSPECTORs Establishment Name: Date Page: of ti OFFICE HOURS PUBLIC HEALTH DIVISION 8:00-9:30A.M. BARNSTABLE. • 200 MAIN STREET 3:30-4:30 P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified MON�p ,639,a m� - HYANNIS,MA 02601 08-8 -FRI. No Reference R-Red Item PLEASE PRINT CLEARLY rFo MPy 508-862-4644 FOOD ESTABLISHMENT INSPECTION REPORT i5otj�nV Name Date5P 'I I yoe of Tvoe of Inspection L 15t.il Routine �� 6�- Addres Risk ervi Re-inspection Level Previous Inspection Telepho ential Kitchen Date' Mobile re-operati Owner HACCP Y/N Temporary ess Caterer General Complaint 4 Person in Charge(PIC) Time Bed&Breakfast HACCP k / In: Other Inspector Out: Each violation checked requires an lanation on the narrative page(s)and a citation of specific provision(s)violated. Violations Related to Foodborne In Red Items)ess Interventions and Risk Factors ( 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 �.fJLS ❑ 1.PIC Assigned/Knowledgeable/Duties ❑ 13.Handwash Facilities 1 EMPLOYEE HEALTH PROTECTION FROM CHEMICALS lU`� J ❑ 2.Reporting of Diseases by Food Employees and PIC ❑ 14.Approved Food or Color Additives ❑ 3.Personnel with Infectious Restricted/Excluded ❑ 15. Toxic Chemicals 444 FOOD FROM APPROVED SOURCE TIMEITEMPERATURE CONTROLS(Pote ally Hazardous Foo s) ❑4.Food and Water from Approved Source ❑ 16.Cooking Temperatures ❑ 5.Receiving/Condition ❑ 17.Reheating G ❑ 6.Tags/Records/Accuracy of Ingredient Statements ❑ 18.Cooling ✓�\ ❑ 7.Conformance with Approved Procedures/HACCP Plans ❑ 19.Hot and Cold Holding r PROTECTION FROM CONTAMINATION ❑20.Time As a Public Health ontrol �-� ❑ 8.Separation/Segregation/Protection REQUIREMENTS FOR HIGH L SUSCEPTIBLE POP NS(HSP) (i ❑9.Food Contact Surfaces Cleaning and Sanitizing ❑21.Food and Food Preparatio or HSP _5�, ❑ 10.Proper Adequate Handwashing CONSUMER ADVISORY. J/ ❑ 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 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 (FC-4)(590.005) cited in this report may result in suspension or revocation of the food 6=One critical violation and less than non-critical violations if no critical violations observed,4 too 6 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 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 27.Physical Facility (FC-6)(590.007) aggrieved by this order,you have a right to a hearing. Your request must 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, C. to anon-critical violations. If 1 critical refrigeration. c violation,4 to Snon- ritical violations 29.Special Requirements (590.009) within 10 days of receipt of this order. = 30.Other DATE OF RE-INSPECTION: Inspector's Signature Print: M 31.Dumpster screened from public view Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y #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 �lil� ECG r � ti Dumpster Screen? Y N Violations related to Foodbbrne-Illness - Violations Related to Foodborne Illness Interventions Interventions and Risk Factors(Red Items 1-22) rK 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 a Cooling Methods for PHFs Cooked and RTE Foods.* * _ 19 _ PHF Hot and Cold Holding, - 2-1033�' Person-in-Charge Duties - 3-302.14 Protection from Unapproved Additives Contamination from Raw Ingredients 3-501.16(B) Cold PHFs Maintained At or Below 41°F/45°F 15 Poisonous o`r Toxic Substances 590.004(F) EMPLOYEE HEALTH 3-302.11(A)(2) Raw Animal Foods Separated from Each 7-101.11 Identifying Information-Original Containers* * 3-501.16(A) Hot PHFs Maintained At or Above 140°F 2 590:003 C Responsibility of the Person--in-Charge to - - - - Other, ( ) Y - * P g 7-102.11 Common Name-Working Containers - * Require Reporting by Food Employees and Contamination from the Environment ,..,, 3-501.16(A) Roasts Held At of Above 130°F * _ - _ _- 7-201.11 Separation-Storage* - Applicants 3-302.11(.A) �- Food Protection* 20 Time as a Public Health Control 590.003(F) Responsibility of A Food Employee or An 7-202.11 Restriction-Presence and Use*_ 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 Variance Re uirements 3-304.11 Food Contact with Equipment and Utensils* 1 7-203.11 Toxic Containers-Prohibitions* (11) q 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 andReservice 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* 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 * 4-501.111 - Manual Wazewashing-Hot Water 7.206.12 Roden[Bait Stations Raw Seed Sprouts Not Served* 3-201.12 Food in a Hermetically Sealed Container Sanitization Temperatures 7-206.13 Tracking Powders,Pest Control and 3-20f.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 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. 18 Proper Cooking Temperatures for PHFs CONSUMER ADVISORY 3-202.16 Ice Made From Potable5�rinking 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 Equipment Eggs-Immediate Service 145°F 15 sec* Animal Foods That are Raw,Undercooked or 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* sJ/°"°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 Equipment* 3-302.13 Pasteurized Eggs Substitute for Raw Shell i Shellfish and Fish From an Approved Source _ 3-401.1.1_(B)(1)(2) Pork and Beef Roast-130°F 121 min* Eggs* 3-201.14 Fish and Recreationally Caught Molluscan Contact Surfaces of Equipment* 4-702 11" - Frequency Sanitization of Utensils and'Food 3-401.11(A)(2) Ratites,Injected Meats-155°F 15 sec* 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 cater- 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* Sources ( ) ( ) ( ) ( ) in 10 - Proper,Adequate Handwashing Ratites-165°F 15 sec* g' in mobile food,temporaryand residential - Game and Wild Mushrooms Approved-By * 3-40 1.11(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 3401.12 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. * 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 590.004(C) Wild Mushrooms __ _ _ - _ - - ( )( )( ) 11 Good Hygienic Practices practices should be debited under#29-Special 3-201.17 Game Animals* 17 Reheating for Hot Holding 2-401.11 Eating,Drinking or Using Tobacco* * Requirements. $ Receiving/Condition g� g g 3-003.11(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-d65°F 2 Minute Standing Time* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES * 3-301.12 PreventingContamination When Tasting* * (Blue Items 23-30) 3-202.15 Package Integrity g 3-403.11(C) 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 3-003.11(E) Remaining Unsl iced 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 3-202.18 Shellstock Identification* (A) Cooling Cooked PHFs from 140°F to 70°17 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* 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 FC-7 1.008 HACCP Plans 6-301.12 Hand Drying Provision 29. Special Requirements 1.009 3-502.11 Specialized Processing Methods* 30. 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. �F.NE rq TOWN OF BARNSTABLE - HEALTH INSPECTOR'S Establishment Name: Date: Page: - of ti OFFICE HOURS - PUBLIC HEALTH DIVISION 8:00-9:30 A.M. BARNSTABLE, 200 MAIN STREET 3:30-4:30 P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified mass. MON.-FRI. 94A ,63v,eNO� HYANNIS,MA 02601 608-862-4644 No Reference R-Red Item PLEASE PRINT CLEARLY rFD MPS FOOD ESTABLISHMENT INSP C ION EPORT Name , Date of Tvae of Inspection - � ( tential ation(s) Routine C.RiUk Address sk ervice Re-inspection Level i Previous Inspection �` C�1Telephone Kitchen Date: Mobile Pre-operation Owner HACCP Y/N Temporary Suspect Illness �� J Caterer General Complaint HACCP Person in Charge(PIC) Time Bed&Breakfast Other In: Inspector Out: r e 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) A -- Anti-Choking 590.009(E) f �� ❑ � 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) ❑ r f^ f FOOD PROTECTION MANAGEMENT ❑ 12.Prevention of Contamination from Hands ❑ 1.PIC Assigned/Knowledgeable/Duties ❑ 13.Handwash Facilities EMPLOYEE HEALTH PROTECTION FROM CHEMICALS 1,-- - ,❑ 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 MD A J, eL`C, it VLChi in ❑6.Tags/Records/Accuracy of Ingredient Statements ❑ 18.Cooling It / /t ❑ 7.Conformance with Approved Procedures/HACCP Plans ❑ 19.Hot and Cold Holding (� 24 CC PROTECTION FROM CONTAMINATION ❑20.Time As a Public Health Control d�-1 ❑ 8.Separation/Segregation/Protection REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) \LA / L �/.� 1 ❑9.Food Contact Surfaces Cleaning and Sanitizing ❑ 21.Food and Food Preparation for HSP -q f , ` O ❑ 10.Proper Adequate Handwashing CONSUMER ADVISORY i ❑ 11.Good Hygienic Practices ❑22.Posting of Consumer Advisories f ( l 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 Overall Rating within 90 days as determined by the Board of Health. J, ❑ 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 FC-4 590.005 B=One critical violation and less than 4non-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. 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 Physical C=2 critical violations and less than non-critical. If no critical water,sewage back-up,infestation of rodents or insects,or lack of 27. Facility (FC-6)(590.007) aggrieved by this order,you have a right to a hearing. Your request must violations observed,7 to anon-cri 28.Poisonous or Toxic Materials (FC-7)(590.008) be in writing and submitted to the Board of Health at the above address non-critical violations. If 1 critical refrigeration. 29.Special Requirements (590.009) within 10 days of receipt of this order. violation,4 to 8non-critical violations=C. 30.Other t 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 #Seats Observed Frozen Dessert Machines: Outside Dining Y N V-14 gnature 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 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-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 - EMPLOYEE HEALTH 3-302.11(A)(2) Raw Animal Foods Separated from Each 7-101.11 Identifying Information-.Original Containers* 590.004(F) *- 590.003(C) Responsibility of the Person-in-Charge to 7-102.11 Common Name-Working 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 1-1 Variance Requirements 3-304.11 Food Contact with Equipment and Utensils ( ) q 590.003(G) Reporting by Person in Charge* 7-203.11 Toxic Containers-Prohibitions* 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 Reated or C Foodi 7.204.12 Chemicals for Washing Produce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP 590.003(E) Removal of Exclusions and Restrictions r. 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* 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(1)) Raw or Partially Cooked Animal Food and 3-201.12 Food in a Hermetical] Sealed Container*- Sanitization Temperatures* Raw Seed Sprouts Not Served y Pe 7-206.13 Tracking Powders,Pest Control and 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-Hof Water 1 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 145F 15 see* 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,Meals&Game Pathogens* eg crave mnooi 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 StuffingContaining Fish,Meat,Poultry or 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* - I g 590.009(A)-(D) Violations of Section temporary and a ide in cater- Sources* Ratites-165°F 15 sec* ing,mobile food,temporary and residential 10 Proper,Adequate Handwashing on on-Hands an 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 Hdd 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. to 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.ou violations relating#good retail 3-201.17 Game Animals* 11 Good Hygienic Practices 17 Reheating for Hot Holding practices shhould be debited under 29-Special Requirements. $ 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 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 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 8 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 3-202.19 Shellstock Identification* 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*' 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_ A 6-301.11 Handwashing Cleanser,Availability ?•- 7 Conformance with Approved Procedures/ � 28. Poisonous or Toxic Materials HACCP Plans 6-301 12 Hand Drying Provision 129. Special Requirements 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: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. t IQ `Op tHE ram, TOWN OF BARNSTABLE HEALTH.INSPECTOR Establishment Name: Date: a e; of q OFFICE HOURS p ° PUBLIC HEALTH DIVISION 8:00-9:30 A.M. BARN ABLE. • 200 MAIN STREET 3:30-4:30 P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified '4 a 9.a 0� ( 2 HYANNIS,MA 02601 M-8 -FRI. No Reference R-Red Item PLEASE PRINT CLEARLY rF0 MAC ` �wv 508-862-4644 FOOD ESTABLISHMENT INSPE TION REPORT me DateJype of Type of Inspection a ' Routine - Risk ice Re-inspection Level ection Telephone '` ential Kitchen Date: Mobile Pre-operation Owner HACCP Y/N Temporary Suspect Illness „ ` , 1 Caterer General Complaint L. Person in Charge(PIC) Time Bed&Breakfast HAC In: her Inspector Out: " 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)Fr Violations marked may pose an imminent health hazard and require immediate corrective Tobacco 590.0 i Action as determined by the Board of Health. Allergen Awareness 590Q (G '❑ RA _ FOOD PROTECTION MANAGEMENT ❑ 12.Prevention of Contamination from Hands r, ❑ 1.PIC Assigned/Knowledgeable/Duties ❑ 13.Handwash Facilities \ EMPLOYEE HEALTH PROTECTION FROM CHEMICALS \ i ❑2.Reporting of Diseases by Food Employees and PIC ❑ 14.Approved Food or Color Additives I� ❑ 3.Personnel with Infectious Restricted/Excluded ❑ 15. Toxic Chemicals J' FOOD FROM APPROVED SOURCE TIME/TEMPERATURE CONTROLS(Potentially Hazardous Foods) ❑4.Food and Water from Approved Source ❑ 16.Cooking Temperatures W 11� �J_ ---� I( -1 ic 61- 'A &r_� ❑ 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 , p PROTECTION FROM CONTAMINATION ❑20.Time Asa Public Health Control r �✓ - ❑ 8.Separation/Segregation/Protection REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) Q� ❑9.Food Contact Surfaces Cleaning and Sanitizing ❑ 21.Food and Food Preparation for HSP Al -• L �� 10.Pro erA CONSUMER ADVISORY de u❑ p q ate Handwashing k ❑ 11.Good Hygienic Practices ❑22.Posting of Consumer Advisories Violations Related to G Practices Blue Items Good Retail Pract e t ) Total Number of Critical Violations Critical(C)violations marked must be corrected immediately. (blue&red items) Corrective ActioT equired: I ❑ No ❑ Yes Non-critical(N)violations must be corrected immediately or within 90 days as determined by the Board of Health. Overall Rating TIE IVoluntary Compliance Employee Io ee Restriction/Exclusion Re-inspection Scheduled Emergency Suspension ❑ rY ❑ P Y ❑ ❑ 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 (FC-4 590.005 6=One critical violation and less than 4non-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. 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 than9 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 9a back-up,infestation of rodents or insects,or lack of violations observed,7 to a noncritical violations. If 1 critical refrigeration. 28.Poisonous or Toxic Materials (FC-7)(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 8non-critical violations=C. 29.Special Requirements' (590.009) Y P 30.Other DATE OF RE-INSPECTION: Inspector's Signature Print: 31.Dumpster screened from public view G ,Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y N nature Print:Si #Seats Observed Frozen Dessert Machines: Outside Dining Y N pIC's g Self Service Wait Service Provided Grease Trap Size Variance Letter Posted Y N a ---- Dumpster Screen? Y N _'- Violations related to Foodborne Illness Violations Related to Foodborne Illness Interventions i 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* F 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-Chazge Duties 3-302.14 Protection from Unapproved Additives Contamination from Raw Ingredients 3-501.16(B) Cold PHFs Maintained At of Below 41°F/45°F 15 Poisonous or Toxic Substances 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 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* 590.003(G) Reporting by Person in Charge* Applicant To Report To The Person In Charge* * 7.202.12 Conditions of Use* 590.004 I1 Variance Re uirements 3-304.11 Food Contact with Equipment and Utensils*- tensils 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 Rated or of Food*Contaminated 7-204.12 Chemicals for Washing Produce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP 590.003(E) Removal of Exclusions and Restrictions Disposition of Adulterated or 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* q 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* 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. 76 Proper Cooking Temperatures for PHFs - CONSUMER ADVISORY 3-202.16 Ice Made From Potable Drinking Water* Conceiiiration and Hardness* 3-401.11A(l)(2) Eggs-155°F 15 sec 22 3-603.11 Consumer Advisory Posted for Consumption of Eggs 5-101.11 Drinking Water from an Approved System* 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 Pathogens* Ed i"11!12001 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 155 Shellfish and Fish From an Approved Source 3-401.11(B)(1)(2) Pork and Beef Roast-1 1 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 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* g g �' S90.009(A)-(D) Violations of Section 590.009(A)-(D)in cater- Sources* Ratites-165°F 15 sec* ing,mobile food,temporary and residential 1p 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 11 Good Hygienic Practices 17 Reheating for Hot Holding practices should be debited under#29-Special 3-201.17 Game Animals* 2-401.11 Eating,Drinking or Using Tobacco* * Requirements. $ 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 Commercially 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 foodbome 12 Prevention of Contamination from Hands 3-403.11 Remaining Unsliced Portions of Beef Roasts* 3-101.11 Food Safe and Unadulterated* (E) g illness interventions and risk factors listed above,can be found in the 6 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 * 13 Handwashing Facilities 3-501.14 A CoolingCooked PHFs from 140°F to 70°F 3-202.12 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* 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' I 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 FC-7 .008 HACCP Plans 6-301.12 Hand Drying Provision 29. 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. V�"�- ��' EXHIBIT B- lom CS ts LL 00 4 ins O Y k t VV" x 1 CS I I " lk Ul; a IL ul i i I } V i EXHIBIT 11(13-2" z. �N B I h� 3 Nei .¢„ SS QQ22L�W- .S�e bct..c.tc,,C�✓ �-cr�5 �' '(TOWN OF BARNSTABLE L LOCATIvN h'ju,�.�, S j✓iza�' SEWAGE # VILLAGE O-�-,vie ASSESSOR'S MAP & LOT I () 2. INSTALLER'S NAME&PHONE NO. R,�w eo • 2Qac. �a�-�/3d2-O S'3a SEPTIC TANK CAPACITY LEACHING FACILITY: (type) /y-S'Uv� �+�-1`u^^Q P^' (size) NO.OF BEDROOMS r2IAJ °-ems BUILDER OR OWNER Ct PERMITDATE: 0 COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility no`16-JW, Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) mxy- Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) ;fkg-A _ = Feet Furnished by 001 o C a- o o (3- F- - y7, -r- o 0 0 0 C 1 aSDo t Iov-, I-C Iy-Svo��Q�wc�uu , 1- 3 rJ 8ox. �. TOWN OF BARNSTABLE q1 L xAT�O" l9� 1 Cn �� x�x c n SEWAGE AGE # V:'LT AGEQS�f C:�) ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY )SCt2 LEACHING FACILITY: (type) (size) NO.OF BEDROOMS BUILDER OR OWNER PERMTTDATE: COMPLIANCE DATE: Ail Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet .Furnished by r r v 1 41/1 I NOTES O 1. THE LOCATION OF EXISTING UTILITIES AND SEWER SYSTEMS WERE OBTAINED FROM A THE LOCATION PARKING DATA PLAN PREPARED FOR DUNHILL COMPANIES, LTD, 776 MAIN STREET, OSTERVILLE, MA 02655 �• �NGU -N�N ,NEEPN R REQUIRED: BY CAPESURV, 7 PARKER ROAD, OSTERVILLE, MA. m 6 • BUILDING AT 804 MAIN STREET 2. THE LOCATION OF BUILDINGS, PAVEMENT AND PROPERTY LINE INFORMATION IS TAKEN CONOULTING PROFEBSIONAL ENGINEERS UNITS A, B & C FROM A PLAN PREPARED FOR DUNHILL DEVELOPMENT CO. LTD. 776 MAIN STREET, Oi a 3119 CRANBERRY HIGHWAY,UNIT 5B, TOTAL AREA 9,860 S.F. OF OFFICE SPACE OSTERVILLE, MA 02655 BY CAPESURV 7 PARKER ROAD, OSTERVILLE, MA. DATED 07/20/2000. BOY SUr t F 9 WAREHAA1,MA 02538 PARKING = 9,860 S.F./300 S.F/SPACE. = 33 SPACES j 3. PROPOSED MODIFICATIONS SHOWN ON THE PLANS ARE ASSOCIATED WITH THE CONVERSION d �;� o • BUILDING AT TEL•(508)759.6260 FAX:(508)759-6230 f Q FIRST FLOOR CH MAIN STREE T RISTY'S C—STORE (RETAIL) 1,400 S.F. 1,400 S.F./200 S.F. = 7 SPACES OF EXISTING FIRST FLOOR RESTAURANT TO CONVENIENCE STORE WITH DUNKIN DONUTS p1 goy q vrww.choubahgroup.com DUNKIN DONUTS 4/5 EMPLOYEES, 1 SPACE PER 2 EMPLOYEES = 2 SPACES TAKE—OUT WITH NO DRIVE THRU/NO SEATING AT 792 MAIN STREET, OSTERVILLE MA. o TAKE—OUT (DUNKIN DONUTS) 5 PER TAKE OUT AREA = 5 SPACES Ic� Project SEPARATE ENTERPRISE = 2 SPACES 4. FLOOR MODIFICATIONS ARE TO ACCOMMODATE NEW CONVENIENCE STORE WITH DUNKIN DONUTS AS SHOWN ON NEW FLOOR LAYOUT (SHEET #2). a PROPOSED MODIFICATIONS SECOND FLOOR OFFICE AREA: 1,000 S.F. 1.000 S.F./300 S.F. = 3 SPACES 5. THERE WILL NE NO CHANGES TO BUILDING EXTERIOR FROM PROPOSED MODIFICATIONS. AT TOTAL PARKING REQUIRED = 52 SPACES LOCUS MAP 792&804 MAIN STREET 6. PROPOSED MODIFICATIONS ARE SUBJECT TO THE INSPECTION AND APPROVAL OF THE NOT TO SCALE OSTERVILLE TOTAL PARKING PROVIDED = 52 SPACES LOCAL BUILDING INSPECTORS IN COMPLIANCE WITH THE APPLICABLE BUILDING CODES. MA 02655 t LEGEND SYMBOL DESCRIPTION Prepared For. \ t CHRISTY'S OF CAPECOD,LLC p —sue EXIST. CONTOUR 105 PLEASANT STREET TOTAL AREA `ROpfR�IGYf S2 PROP. CONTOUR HYANNIS,MA 02601 45,082 +/- S.F. Bs�� IJ.Y40 EXISTING SPOT GRADE oW PROPOSED SPOT GRADE SMfO � --- PROPERTY UNE 0 pARklttNS NG. ARkI ——————— SETBACK LINE 0000 FIELD STONE WALL EXIST. RETAINING WALL J EXIST. SEWER LINE S PROP. SEWER UNE Q� � %:•',{ :''ram " C?U �m, oum I —K'— — EXIST. WATER LINE N !•,` / ,"% .'l' P Rkl COS',p.. P:ler W PROP. WATER LINE / .::. —E— — EXIST. ELECTRIC UNE }/ / �, '.•�.. ( E— PROP. ELECTRIC LINE r/ -J, \ •,i-/';' O� . —C— — EXIST. GAS UNE Cn`b`n G— PROP. GAS UNE —T— — EXIST. TELEPHONE UNE Issue Date:620/06 T— PROP. TELEPHONE UNE� I Revisions %': — — NW— — OVERHEAD WIRE�''•%j J / 0 EXIST. 0 E EAD Description TivP � / No. Date I _ 80a MNN STREET ex�• J�'O l�r/ 0 PROP. OVERHEAD WIRE Revised Parldng Data&Notes s 1 `,J ...�, oir� 9 ! l l / �/• ® CB EXIST. CATCH BASIN �; I ! ■CB PROP. CATCH BASIN ' 0 9&h' EXIST. DRAIN MANHOLE o '"ALL f \ OYa) / J / �. ` DMH PROP. DRAIN MANHOLE / , /: / I C° 792 MAIN STREET iO SL/.v EXIST. SEWER MANHOLE v Project Number.06-167 /�/})�/// I, m SMH PROP. SEWER MANHOLE I� 0 EMN EXIST. ELECTRIC MANHOLE Deli: edB3r. 'nJ •/; / / / , / / LJ i �EMH PROP. ELECTRIC MANHOLE Designed By. _ uP EXIST..UTILITY POLE Drawn By.RAA Checked By:HC ':.,J - ! LANDSCAPE AREA '0-UP PROP. UTILITY POLE Sheet Title: / \ i n I / OLl LP EXIST. LIGHT POLE 0o LP PROP. LIGHT POLE PARIQNG LAYOUT PLAN CRUSHED STONE AREA �pER71 CI / 0 O EXIST. GAS PUMPS CONCRETE AREA O PROP. GAS PUMPS, • � ' „`�•)a f. TREE GRAPHIC SCALE �� - EXISTING NUMBER OF --�"'lT A T /� 3 PARKING SPACES r sfr �7 l� �/�'//'_;-.,.'.�.'.�., 1 I j .,� O EXIST. EDGE OF PAVEMENT PROP. EDGE OF PAVEMENT ti CUT & MATCH PAVEMENT 0 [0 20 40 80 v, �; EXIST. SIGN (SCALE IN FEED 'jC Tr- �is gyy P� p c, �U j @{t f cy >' i. PROP. SIGN C 1"=201 �2� / nvSnFs1.`-='.nu� w T S� L7 SB EXIST. GRANITE BOUND N Sheet Number. 1 OF 2 -� SB PROP. GRANITE BOUND 008 EXIST. CONCRETE BOUND El CB PROP. CONCRETE BOUND ■ R.I.H.B. R.I. HIGHWAY BOUND ..v I- I � NOTES g x 1. THE LOCATION OF EXISTING UTILITIES AND SEWER SYSTEMS WERE OBTAINED FROM A '8. PROJECT o«o�..«.«.,«.�,.,«..,.o�.,..a. PLAN PREPARED FOR DUNHILL COMPANIES, LTD, 776 MAIN STREET, OSTERVILLE, MA 02655 BY CAPESURV, 7 PARKER ROAD, OSTERVILLE; MA. � 6 2. THE LOCATION OF BUILDINGS, PAVEMENT AND PROPERTY LINE INFORMATION IS TAKEN CONSULTING PNOPQ//ZONAL/Na1N6[q/ FROM A PLAN PREPARED FOR, DUNHILL DEVELOPMENT CO. LTD. 776 MAIN STREET, Oi 3119 CRANBERRY HIGHWAY,UNIT 5A OSTERVILLE, MA 02655 BY CAPESURV 7 PARKER ROAD, OSTERVILLE, MA. DATED 07/20/2000. BOy SI, r F WAREHAM,MA 02538 o ` ep 3. PROPOSED MODIFICATIONS SHOWN ON THE PLANS ARE ASSOCIATED WITH THE CONVERSION 6 �;� TEI_(508)759-6260 FAX-(508)759-6230 OF EXISTING FIRST FLOOR RESTAURANT TO CONVENIENCE STORE WITH TAKE-OUT AT 792 MAIN o Pa a www.choubahgroup.com STREET, OSTERVILLE MA. 0 oO 1 4. FLOOR MODIFICATIONS ARE TO ACCOMMODATE NEW CONVENIENCE STORE WITH DUNKIN Project: DONUTS AS SHOWN ON NEW FLOOR LAYOUT (SHEET #2). 0. PROPOSED MODIFICATIONS 5. THERE WILL NE NO CHANGES TO BUILDING EXTERIOR FROM PROPOSED MODIFICATIONS. AT LOCUS MAP 792&804 MAIN STREET 6. PROPOSED MODIFICATIONS ARE SUBJECT TO THE INSPECTION AND APPROVAL OF THE NOT TOSCALF, OSTERVILLE LOCAL BUILDING INSPECTORS IN COMPLIANCE WITH THE APPLICABLE BUILDING CODES. MA 02655 PARKING DATA LEGEND REQUIRED: SYMBOL DESCRIPTION Prepared For: ' BUILDING AT 804 MAIN STREET \ CHRISTY'S OF CAPECOD,LLC UNITS A, B k C EXIST. CONTOUR 105 PLEASANT STREET TOTALPARKI AREA 9,860 S.F./300 9 F/SPACECE TOTAL AREA `PROPfR�uNP S? PROP. CONTOUR HYANNIS,MA 02601 9,860 S.F. OF OFFICE 33 SPACES 45,082 +/- S.F. sy /7X40 EXISTING SPOT GRADE BUILDING AT 792 MAIN STREET 4t-"" . \ FIRST FLOOR C-STORE • 1,400 S.F. 1,400 S.F./200 S.F. „'D ow ` ® PROPOSED SPOT GRADE 7 SPACES CRU 2 EMPLOYEES 1 SPACE PER 2 EMPLOYEES = 1 SPACE ?�HEp'Sro' \ —-- PROPERTY LINE TAKE-OUT (DUNKIN DONUTS) 5 PER TAKE OUT AREA = 5 SPACES p'1Rk, Nr'p -_-_--- N IN C ARk SETBACK LINE EMPLOYEES 1 SPACE PER 2 EMPLOYEES = 1 SPACE / 9pACFsft m0000c�SECOND FLOOR OFFICE STONE WALL : AREA: 1,000 S.F. 1,000 S.F./300 S.F. = 3 SPACES r TOTAL PARKING REQUIRED = 50 SPACES EXIST. RETAINING WALL � —S— — EXIST. SEWER LINE r TOTAL PARKING PROVIDED = 52 SPACES —5 PROP. SEWER LINE h e pk t�A!TGNF QumP.!ar ' — —v— — EXIST. WATER LINE 6P, 0 —W— PROP. WATER LINE—E— — EXIST. ELECTRIC LINE —E— PROP. ELECTRIC LINE EXIST. GAS LINE Czc" —G— PROP. GAS LINE i 9 (� J SeP/c rook C9osg (V '�'/ /J':', r•- ; —r— — EXIST. TELEPHONE LINE �/ T— PROP. TELEPHONE LINE L0 0)J 1 I (_ I � �, ..� �� •4n�,rw1 a N Revisions e ��rro O p -ONIY-- - EXIST. OVERHEAD WIRE Description s �'N7 P V I ,. ��t No. Date P 804 MAIN STR ET A �"9 % // l rO� I 12 CML N —DHw— r PROP. OVERHEAD WIRE �,r si q �i �, �NO,o3 .M ® CS EXIST. CATCH BASIN ��/8Y ■CB PROP. CATCH BASIN ' St t8 p O,uN EXIST. DRAIN MANHOLE 792 AWN STR �l f/� 0 OMH PROP. DRAIN MANHOLE C> '.r :'� 0 SUN EXIST. SEWER MANHOLE SMH PROP. SEWER MANHOLE Project Number:IXrl67 0 1 )T/ /)/► VL(jJ v Scale:1"=20' O I-w EXIST. ELECTRIC MANHOLE Designed � EMH PROP. ELECTRIC MANHOLE gned By: LANDSCAPE AREA ^o'uv EXIST. UTILITY POLE Drawn By:RAA Checked By:HC 1¢'UP PROP. UTILITY POLE Sheet Title: EXIST. LIGHT POLE PROP y.�+>yry / CRUSHED STONE AREA On LP PROP. LIGHT POLE PARKING LAYOUT PLAN \fRly t.. > �(..I— I�7 EXIST. GAS PUMPS F CONCRETE AREA PROP. GAS PUMPS � TREE GRAPHIC SCALE \O /' 3 EXISTING NUMBER OF S , -'Y /` PARKING SPACES EXIST. EDGE OF PAVEMENT PROP. EDGE OF PAVEMENT 0 10 20 40 AO 40 �' •? f � •+-�*'��n'�> CUT h MATCH PAVEMENT LJC (SCALE IN F'EE'T) tf �� -�- EXIST. SIGN �Y / 1°=20' f h '"•r!"f. ,' i PROP. SIGN lJ 1� GI S9 EXIST. GRANITE BOUND Sheet Number. I OF 2 L O 58 PROP. GRANITE BOUND 0 69 EXIST. CONCRETE BOUND O CB PROP. CONCRETE BOUND ■ R.I.H.B. R.I. HIGHWAY BOUND COMPRESSOR GENERAL NOTES: ❑ 'AO.SMITH C E �� ., 4FUSNWA45 I. IT SHALL BE THE CONTRACTOR'S SOLE RESPONSIBILITY TO OBTAIN ANY AND ALL Eft PERMITS REQUIRED BY THE STATE OF MASSAGHUSETTS AND THE TOWN OF OSTERVILLE7L:� LK-M COOLER GAS PRIOR TO COMMENCING ANY WORK CONSULTING PROFESSIONAL ENGINEERS "X B'-m" 2. PROPOSED MODIFICATIONS 4 CONSTRUCTION SHALL CONFORM TO THE REQUIREMENTS OF 3119 CRANBERRY HIGHWAY,UNrrSB, ® Q Y INK TURBO Q ®� 60 Fllirn z TABLE 0 O THE STATE AND LOCAL BUILDING AND FIRE CODES. WAREHAM,MA02538 FE 36 BA KE z 5 FAGP HEF S O DONUTS C ) B B KTS c CUTTING BOARD z'.s' 3. THE CONTRACTOR SHALL VERIFY ALL DIMENSIONS AND CONDITIONS ON THE JOB SITE.BA ELS TEL•(508)759-6260 FAX:(508)759-6230 SLICER METAL RACK DISCREPANCIES SHALL BE BROUGHT TO THE ATTENTION OF THE ENGINEER BEFORE ...... :..............._I 1......... 34-FILLER 7'-f3-SANDWICH STATION r \ W/DELFIELD UNDER PREPARATION AREA pzo PROCEEDING WITH THE PORTION OF THE WORK www.choubahgroup.com e SERVING AREA 3'_0• O RA 4. DETAILS NOT SPECIFICALLY SHOWN SHALL BE SIMILAR TO THOSE FOR MOST NEARLY Project: W CTR. i0 c CUSTOM 9'-6-COFFEE w/ICE CADDY W/uCR SIMILAR CONDITION AS DETERMINED BY THE ENGINEER S'-B' CASH &DDCM ROVAL COOLATTA 5'-6-POT SINK PROPOSED MODIFICATIONS m 342 HANDMECE W® ® so 5. THE CONTRACTOR SHALL SHORE,BRACE,SHEET PILE OR OTHERWISE SUPPORT THE AT 3-0- BINSTRUCTURE AS REQ.TO MAINTAIN STRUCTURAL INTEGRITY AT ALL TIMES.SHORING DESIGN 792&804 MAIN STREET ® ® SPR R GATE SHALL BE PROVIDED BY THE GENERAL CONTRACTOR OSTERVILLE p cusroM ro. HEADERS SHALL BE PLACED ACROSS TOP OF SHORING POSTS AND SHALL BE TIGHT MA 02655 FlLLER BY G.C. BR 1 'Q AGAINST UNDERSIDE OF STRUCTURE ABOVE. B SALES DROP 12-FOR ICB N 9 AREA SALES RE r 1\ 1. SHORING SHALL BEAR ON SLEEPERS TO PREVENT DAMAGE TO STRUCTURE BELOW. Prepared For: m ' 8.TEMPORARY SHORES SHALL BE DESIGNED,ERECTED,SUPPORTED,BRACED AND CHRISTY'S OF CAPECOD,LLC ? MAINTAINED BY THE CONTRACTOR TO SUPPORT SAFELY ALL DEAD LOADS PRESENTLY 105 PLEASANT STREET A A CARRIED BY THE STRUCTURAL WORK BEING SHORED,AND ANY CONSTRUCTION LIVE LOADS. 3'-0" / 9.NEW STRUCTURAL SYSTEMS SHALL BE COMPLETELY INSTALLED AND CAPABLE OF HYANNIS,MA 02601 SUPPORTING DESIGN LOADS BEFORE SHORES ARE REMOVED.SHORES SHALL BE RELEASED 3'-0" Mj uj BR 1 GRADUALLY. 10. ALL ELECTRICAL AND PLUMBING TRADE WORKS MUST BE COORDINATED WITH 1S / STRUCTURAL WORK PRIOR TO CONSTRUCTION,ANY DISCREPANCY SHALL BE REPORTED TO pt===A THE GENERAL CONTRACTOR IMMEDIATELY. 1 II. ELECTRICAL AND PLUMBING WORK SHALL BE IN ACCORDANCE WITH THE GOVERNING Of CODES,REGULATIONS AND ORDINANCES. THESE REQUIREMENTS ARE MINIMUM CRITERIA AND ® NO REDUCTIONS IN STANDARDS PERMITTED BY CODES WILL BE ALLOWED. A. �✓Wy � �® CASHIER 0 inEl r PROPOSED FLOOR LAYOUT SCALE: / -m REMOVE EXISTING �® O 0 Issue Date:6 /06 Revisions EXISTING ARE ALARM LEGEND DECORATIVE WALL KS No. Date Description FZ_P FIRE ALARM PANEL © FULL STATION BLOCK EXISTING DOOR TOISREMAINI ACCOMMODATEDONUTS DUNKIN DONUTS Q NEAT DETECTOR(CEILNG BELOW) PROVIDE A FIRE ALARM SYSTEM TO AMA(PER PROPOSED FLOOR 0• NEAT DETECTOR(ABOVE CEILNG) COMPLY WITH THE MA FIRE SAFETY LAYOUT) TOXIREMASTIW.COLUMNS -6-POT SINK SQ• SMOKE DETECTOR CODE 4 THE REQUIREMENTS OF THE REMOVE AND DISPOSE VHORN)STROBE UNIT SUPERINTENDENT OF FIRE ALAN1 REOUIR MENTS. EXISTING SINKS Project Number.06r167 . ®• STROBE ONLY WIT / Scale:1/4"=1'-0" Kp. KNOX BOX 0 0 �. EMEFYaENCY LK+NTNG REMOVE / 1 Desired By EXISTDVG COLUMNS EXISTING DOOR BR N • 9 TO REMAIN REMOVE AND DISPOSE ` Drawn By.RAA Checked By:HC ® EXIT SIGN EXISTRJG WALL L EXTERIOR LIGHTNG EXISTING COLUMN / YQ Sheet Title: OS Ib DRY ABC EXTINWISI-ER , TO REMAIN 3 EXISTING&PROPOSED _ / \ FLOOR LAYOUT NOTES REMOVE AND DISPOSE BR 1 NG EXISTI DECO EXISTING WALLS RE RATIVE MOVE AND DISPOSE 1 1.PROPOSED MODIFICATIONS SHOWN ON THE PLANS ARE ASSOCIATED WITH THE CONVERSION WALL TO REMAIN EXISTING COUNTER / OF EXISTING FIRST FLOOR RESTAURANT TO CONVENIENCE STORE WITH TAKE-OUT AT 192 MAIN STREET,OSTERVILLE MA. 2. FLOOR MODIFICATIONS ARE TO ACCOMMODATE NEW CONVENIENCE STORE WITH DUNKIN DONUTS AS SHOWN ON NEW FLOOR LAYOUT. 3.THERE WILL NE NO CHANGES TO BUILDING]EXTERIOR FROM PROPOSED MODIFICATIONS. 4.PROPOSED MODIFICATIONS ARE SUBJECT TO THE INSPECTION AND APPROVAL OF THE �� LOCAL BUILDING INSPECTORS IN COMPLIANCE WITH THE APPLICABLE BUILDING CODES. 5` Sheet Number. 2 OF 2 ❑ SCALE EXISTING FLOOR LAYOUT C� I �o NOTES l 0 1. THE LOCATION OF EXISTING UTILITIES AND SEWER SYSTEMS WERE OBTAINED FROM A o� PROJECT PARKING DATA A LOCATION �No�•-�6No Ns�w No mwo P,P.�. PLAN PREPARED FOR DUNHILL COMPANIES, LTD, 776 MAIN STREET, OSTERVILLE, MA 02655 0. REQUIRED: BY CAPESURV, 7 PARKER ROAD, OSTERVILLE, MA. m • BUILDING AT 804 MAIN STREET O PROFESSIONAL ENGINEERS UNITS A, B & C 2. THE LOCATION OF BUILDINGS, PAVEMENT AND PROPERTY LINE INFORMATION IS TAKEN CONSULTING TOTAL AREA 9,860 S.F. OF OFFICE SPACE FROM A PLAN PREPARED FOR DUNHILL DEVELOPMENT CO. LTD. 776 MAIN STREET, ai 3119 CRANBERRY HIGHWAY,UNIT5B, S OSTERVILLE, MA 02655 BY CAPESURV 7 PARKER ROAD, OSTERVILLE, MA. DATED 07/20/2000. Bay PARKING = 9,860 S.F. 300 S.F/SPACE. sI, WAREHAM,MA02538 / / = 33 SPACES t F 6 • BUILDING AT 792 MAIN STREET 3. PROPOSED MODIFICATIONS SHOWN ON THE PLANS ARE ASSOCIATED WITH THE CONVERSION �a ^� a Rd TET-(508)759-6260 FAX:(508)759-6230 FIRST FLOOR : CHRISTY'S C-STORE (RETAIL) 1,400 S.F. 1,400 S.F./200 S.F. = 7 SPACES OF EXISTING FIRST FLOOR RESTAURANT TO CONVENIENCE STORE WITH DUNKIN DONUTS oI O qd www.choubahgroup.com DUNKIN DONUTS 4/5 EMPLOYEES, 1 SPACE PER 2 EMPLOYEES = 2 SPACES TAKE-OUT WITH NO DRIVE THRU/NO SEATING AT 792 MAIN STREET, OSTERVILLE MA. 9 0 TAKE-OUT (DUNKIN DONUTS) 5 PER TAKE OUT AREA = 5 SPACES 4. FLOOR MODIFICATIONS ARE TO ACCOMMODATE NEW CONVENIENCE STORE WITH DUNKIN Proles' SEPARATE ENTERPRISE = 2 SPACES DONUTS AS SHOWN ON NEW FLOOR LAYOUT (SHEET #2). C. PROPOSED MODIFICATIONS SECOND FLOOR OFFICE : AREA: 1,000 S.F. 1,000 S.F./300 S.F. = 3 SPACES 5. THERE WILL NE NO CHANGES 'TO BUILDING EXTERIOR FROM PROPOSED MODIFICATIONS. AT TOTAL PARKING REQUIRED = 52 SPACES LOCUS MAP 792&804 MAIN STREET 6. PROPOSED MODIFICATIONS ARE SUBJECT TO THE INSPECTION AND APPROVAL OF THE NOT TO SCALE OSTERVILLE TOTAL PARKING PROVIDED = 52 SPACES LOCAL BUILDING INSPECTORS IN COMPLIANCE WITH THE APPLICABLE BUILDING CODES. MA 02655 LEGEND SYMBOL DESCRIPTION Prepared For: \ ( CHRISTY'S OF CAPECOD,LLC —sue EXIST. CONTOUR 105 PLEASANT STREET TOTAL AREA \pROpfR�VNf 0 S? PROP. CONTOUR HYANNIS,MA 02601 45,082 +/- S.F. J>X40 EXISTING SPOT GRADE Joff \ 11X40 PROPOSED SPOT GRADE --- PROPERTY LINE s. ?0 PAR SroNt I KtN.. pA ------- SETBACK LINE / 00000mo FIELD STONE WALL EXIST. RETAINING WALL w. —S— — EXIST. SEWER LINE Q� Foy. —S PROP. SEWER LINE 'C,?. —W— — EXIST. WATER LINE �Otf!f �umorle —W PROP. WATER LINE EXIST. ELECTRIC LINE —E PROP. ELECTRIC LINE _ —C— — EXIST. GAS LINE c —G PROP. GAS LINE '�'e B�idiiq SeP�=Tank 01 mC ��0 11 —T— — EXIST. TELEPHONE LINE Issue Date:6/20/06 T PROP. TELEPHONE LINE Revisions J / % -oHw- - EXIST. OVERHEAD WIRE No. Date Description 804 MAIN STREET-ooh.9 J�'O i/ j;j,,: I /Q/ / O —OHW— PROP. OVERHEAD WIRE 1 8/Ol/06 Revised ParkingData&Notes 0 CB EXIST. CATCH BASIN � ■CB PROP. CATCH BASIN 18 p 9"H EXIST. DRAIN MANHOLE J DMH PROP. DRAIN MANHOLE yo o', j ,O ,.i;i 0 SMH EXIST. SEWER MANHOLE Project Number:06-167 SMH PROP. SEWER MANHOLE Scale:1"=20' y l fi'� //' j'r- - 0 FA/H EXIST. ELECTRIC MANHOLE L L,/ / - ` /�"�"� 0 EMH PROP. ELECTRIC MANHOLE Designed By J n P uP EXIST. UTIUTY POLE Drawn By RAA Checked By:HC / ��'//" LANDSCAPE AREA - FQ�UP PROP. UTILITY POLE Sheet Title: i lm LP EXIST. UGHT POLE PARKING LAYOUT PLAN CRUSHED STONE AREA CDa LP PROP. LIGHT POLE EXIST. GAS PUMPS f CONCRETE AREA C] C7 PROP. GAS PUMPS �O EXISTING NUMBER OF � TREE GRAPHIC SCALE �22JJJJ Ss, �f� , // / PARKING SPACES EXIST. EDGE OF PAVEMENT PROP. EDGE OF PAVEMENT OF r CUT & MATCH PAVEMENT P 0 10 20 40 80 8 (SCALE IN FEET IC �r EXIST. SIGN F'=20' j /":%. ! YBs . i PROP. SIGN w.a� Ida'et"i 0 SB EXIST. GRANITE BOUND Sheet Number. 1 OF 2 1 El PROP. GRANITE BOUND El CB EXIST. CONCRETE BOUND l8 CB PROP. CONCRETE BOUND r` _ 5 �9ry ■ R.I.H.B. R.I. HIGHWAY BOUND t I 50'_c COMPRESSORGENERAL NOTES: ❑ A.O.SMITH c...........R.N BRe. R 4PJSN93A45 I. IT SHALL THE CONTRACTOR'S SOLE RESPONSIBILITY T OBTAIN ANY AND ALL � PERMITS REQUIRED THE BY THE STATE OF MASSACHUSETTS AND THE TOWN OF OSTERVILLE 5 DOOR WALK-IN COOLER cn8 PRIOR TO COMMENCING ANY WORK 15-3"X 8'-0" CON-ING PROCEBBIONAL ENOINCCRB �® O 11FILLER 5 H F E 2. PROPOSED MODIFICATIONS 4 CONSTRUCTION SHALL CONFORM TO THE REQUIREMENTS OF 3119 CRANBERRY HIGHWAY,UNI�T5B, 60-FILL 2 TABLE, v THE STATE AND LOCAL BUILDING AND FIRE CODES. WAREHAM,MA02538 � 36 BA KE S SINK C EF(S) DONUTS BBKTS ----I "" BA ELS CUTTING BOARD 2'.s' 3. THE CONTRACTOR SHALL VERIFY ALL DIMENSIONS AND CONDITIONS ON THE JOB SITE. TEL(508)759-6260 FAX(508)759-6230 METAL RACK ;;::::;;� :::: """"'I ""' """"'I 34• DISCREPANCIES SHALL BE BROUGHT TO.THE ATTENTION OF THE ENGINEER BEFORE www.cboubabgroup.com T'-9•SANDWICH ST UNDER SERVING AREA w/DELFIELD UNDER PREPARATION AREA °dzc PROCEEDING WITH THE PORTION OF THE WORK. (DUNKIN DONUTS) 3•-0• �05 Project: 1O BEV.CTR. OO 4. DETAILS NOT SPECIFICALLY SHOWN SHALL BE SIMILAR TO THOSE FOR MOST NEARLY I �p a CUSTOM 9'-6•COFFEE r/ICE CADDY W/UCR SIMILAR CONDITION AS DETERMINED B7 THE ENGINEER - APPROVAL DDCM APPROVAL COOLATTA 5'-6-POT SINK PROPOSED MODIFICATIONS 5'-8 CASH O�D m 342 HAND CE W so 5. THE CONTRACTOR SHALL SHORE,BRACE,SHEET PILE OR OTHERWISE SUPPORT THE AT ci 3_D- BIN STRUCTURE AS REQ.TO MAINTAIN STRUCTURAL INTEGRITY AT ALL TIMES.SHORING DESIGN 792&804 MAIN STREET ❑ ® ® 8 sPR SHALL BE PROVIDED BY THE GENERAL CONTRACTOR OSTERVILLE 0 C nv 4 BTP DISPLAY1 CUSTOM 14• 9 fo. HEADERS SHALL BE PLACED ACROSS TOP OF SHORING POSTS AND SHALL BE TIGHT MA 02655 FILLERBY A SALES DROP 12'FOR C.ICE 1/ BR n AGAINST UNDERSIDE OF STRUCTURE ABOVE. 9 AREA SALES SEATS r \ 1. SHORING SHALL BEAR ON SLEEPERS TO PREVENT DAMAGE TO STRUCTURE BELOW. 4 � � � / Prepared For: S.TEMPORARY SHORES SHALL BE DESIGNED,ERECTED,SUPPORTED,BRACED AND CHRISTY'S OF CAPECOD,LLC i MAINTAINED BY THE CONTRACTOR TO SUPPORT SAFELY ALL DEAD LOADS PRESENTLY 105 PLEASANT STREET uJ w CARRIED BY THE STRUCTURAL WORK BEING SHORED,AND ANY CONSTRUCTION LIVE LOADS. HYANNIS,MA02601 / 9.NEW STRUCTURAL SYSTEMS SHALL BE COMPLETELY INSTALLED AND CAPABLE OF SUPPORTING DESIGN LOADS BEFORE SHORES ARE REMOVED.SHORES SHALL BE RELEASED 1 GRADUALLY. 10. ALL ELECTRICAL AND PLUMBING TRADE WORKS MUST BE COORDINATED WITH STRUCTURAL WORK PRIOR TO CONSTRUCTION,ANY DISCREPANCY SHALL BE REPORTED TO �p THE GENERAL CONTRACTOR IMMEDIATELY. 11. ELECTRICAL AND PLUMBING WORK SHALL BE IN ACCORDANCE WITH THE GOVERNING CODES,REGULATIONS AND ORDINANCES. THESE REQUIREMENTS ARE MINIMUM CRITERIA AND 9 ® O NO REDUCTIONS IN STANDARDS PERMITTED BY CODES WILL BE ALLOWED. CASHIEREl 0 in f ❑ PROPOSED FLOOR LAYOUT SCALE: / 4q® Issue Date:6l20/06 REMOVE EXISTING c Revisions DECORATIVE WALL O O EXISTING RRE ALARM LEGEND F'"� No. Date Description 1 8/01/06 Revised Notes F®. FIRE ALARM PANEL © PULL STATION BLOCK EXISTING DOOR TO EXISTING SINKS QN E NEAT DETECTOR(CEILING BELOW) PROVIDE A FIRE ALARM SYSTEM TO AREA(PER A PRROPTE OOS D NKIN DONUTS TO REMAIN QN HEAT DETECTOR(ABOVE CEIL.W.) COMPLY WITH THE MA FIRE SAFETY LAYOUT) EXISTING COLUMNS ©• SMOKE DETECTOR CODE 4 THE REQUIREMENTS OF 714E REMOVE AND DISPOSE TO '-6•POT SINK © HORN/STROBE UNIT LOCAL SUPERINTENDENT OF FIRE ALARM EXISTING SINKS REQUIREMENTS. ®• STROBE ONLY UNIT 3; - _ Project Number:06 167 0• KNOX BOX © / � 9 Scale:1/4"=1'-W v REMOVE �. EMERGENCY LIGHTING / 1 Designed By: EXISTING COLUMNS^ EXISTING DOOR BR TO REMAIN REMOVE AND DISPOSE 1 Drawn By RAA Checked By:HC ® EXIT SIGN• A EXISTING WALL ©• EXTERIOR LIGHTING M I EXISTING COLUMN \ / O• 5 IL'DRY ABC EXTINGUISHER TO REMAIN Q Sheet Title: J EXISTING&PROPOSED _ / —_ FLOOR LAYOUT NOTES REMOVE AND DISPOSE BR 1 EXISTING WALLS I.PROPOSED MODIFICATIONS SHOWN ON THE PLANS ARE ASSOCIATED WITH THE CONVERSION EXISTING DECORATIVE REMOVE AND DISPOSE WALL TO REMAIN EXISTING COUNTER OF EXISTING FIRST FLOOR RESTAURANT TO CONVENIENCE STORE WITH DUNKIN DONUTS / TAKE-OUT WITH NO DRIVE THRU/NO SEATING AT-I92 MAIN STREET,OSTERVILLE MA. ` 2. FLOOR MODIFICATIONS ARE TO ACCOMMODATE NEW CONVENIENCE STORE WITH DUNKIN - �+� DONUTS AS SHOWN ON NEW FLOOR LAYOUT. 3.THERE WILL NE NO CHANGES TO BUILDING EXTERIOR FROM PROPOSED MODIFICATIONS. O �d �'���� pp, .-,�✓ . r. 4.PROPOSED MODIFICATIONS ARE SUBJECT TO THE INSPECTION AND APPROVAL OF THE LEG Sheet Number. 2 OF 2AL BUILDING INSPECTORS IN COMPLIANCE WITH THE APPLICABLE BUILDING CODES. I � �� � 1 EXISTING FLOOR LAYOUT Gy .0 i NOTESPROJECT CHOLIBAH ENGINEERING GROUP, P.C. 1 . THE LOCATION OF EXISTING UTILITIES AND SEWER SYSTEMS WERE OBTAINED FROM A o LOCATION PLAN PREPARED FOR DUNHILL COMPANIES, LTD, 776 MAIN STREET, OSTERVILLE, MA 02655 BY CAPESURV, 7 PARKER ROAD, OSTERVILLE, MA. CONSULTING PROFESSIONAL ENGINEERS ° 3119 CRANBERRY HIGHWAY, UNIT 5B, 2. THE LOCATION OF BUILDINGS, PAVEMENT AND PROPERTY LINE INFORMATION IS TAKEN a� WAREHAM, MA 02538 FROM A PLAN PREPARED FOR DUNHILL DEVELOPMENT CO. LTD. 776 MAIN STREET, Street OSTERVILLE, MA 02655 BY CAPESURV 7 PARKER ROAD, OSTERVILLE, MA. DATED 07/20/2000. day so et F an TEL:(508) 759-6260 FAX:(508) 759-6230 e �� www.choubahgroup.com 3. PROPOSED MODIFICATIONS SHOWN ON THE PLANS ARE ASSOCIATED WITH THE CONVERSION �a a OF EXISTING FIRST FLOOR RESTAURANT TO CONVENIENCE STORE WITH DUNKIN DONUTS gyp% o Project: TAKE—OUT WITH NO DRIVE THRU/NO SEATING AT 792 MAIN STREET, OSTERVILLE MA. PROPOSED MODIFICATIONS 4. FLOOR MODIFICATIONS ARE TO ACCOMMODATE NEW CONVENIENCE STORE WITH DUNKIN o- AT DONUTS AS SHOWN ON NEW FLOOR LAYOUT (SHEET #2). 792 & 804 MAIN STREET 5. THERE WILL NE NO CHANGES TO BUILDING EXTERIOR FROM PROPOSED MODIFICATIONS. LOCUS MAP OSTERVILLE N01 '1'O SCALE MA 02655 6. PROPOSED MODIFICATIONS ARE SUBJECT TO THE INSPECTION AND APPROVAL OF THE LOCAL BUILDING INSPECTORS IN COMPLIANCE WITH THE APPLICABLE BUILDING CODES. PARKING DATA LEGEND REQUIRED: SYMBOL DESCRIPTION Prepared For: * BUILDING AT 804 MAIN STREET UNITS A, B & C TOTAL AREA 9,860 S.F. OF OFFICE SPACE � CHRISTY S OF CAPECOD, LLC PARKING = 9,860 S.F./300 S.F/SPACE. = 33 SPACES PRO'°ER�, �''� �sz -- EXIST. CONTOUR 105 PLEASANT STREET TOTAL AREA ��NE S2 PROP. CONTOUR HYANNIS, MA 02601 45,082 +/- S.F. ��� ��s * BUILDING AT 792 MAIN STREET- fi�9 »X4a EXISTING SPOT GRADE FIRST FLOOR CHRISTY'S C—STORE (RETAIL) 1 ,400 S.F. 1 ,400 S.F./200 S.F. = 7 SPACES '% \ef"'� .9 i �� �vo�i 1 1 X40 PROPOSED SPOT GRADE DUNKIN DONUTS 4/5 EMPLOYEES, 1 SPACE PER 2 EMPLOYEES = 2 SPACES O�U TAKE-OUT (DUNKIN DONUTS) 5 PER TAKE OUT AREA = 2 SPACESSPACES 20 pqR SrONf P - PROPERTY LINE SEPARATE ENTERPRISE / KING SPgAES N� �� - - - - - - - SETBACK LINE SECOND FLOOR OFFICE AREA: 1 ,000 S.F. 1 ,000 S.F./300 S.F. = 3 SPACES Fd FIELD STONE WALL TOTAL PARKING REQUIRED = 52 SPACES ?�v � J� ?'�'" _- EXIST. RETAINING WALL TOTAL PARKING PROVIDED = 52 SPACES EXIST. SEWER LINE -� pQ<v S PROP. SEWER LINE EXIST. WATER LINE s W— -- PROP. WATER LINE / J I KING SPA' EXIST. ELECTRIC LINE 1 . • � S E PROP. ELECTRIC LINE EXIST. GAS LINE t R G PROP. GAS LINE " $ ; , Ch6!z-b EXIST. TELEPHONE LINE '�,°S¢ STSF ; j, r -L - 1 / / / / ' j' T PROP. TELEPHONE LINE 1 EXIST. OVERHEAD WIRE Issue Date: 6/20/2006 804 MAIN STREET ��och,� .�D i / I /OS l > OHW PROP. OVERHEAD WIRE Revisions ® CB EXIST. CATCH BASIN No. Date Description ■ CB PROP. CATCH BASIN l 8/01/06 Revised Parking Data & Notes OMH EXIST. DRAIN MANHOLE s P) 0 DMH PROP. DRAIN MANHOLE / 792 MAIN STREET O Jb ]0 0 SMH EXIST. SEWER MANHOLE 0/ / �a� �\ SMH PROP. SEWER MANHOLE 0 EMH EXIST. ELECTRIC MANHOLE Project Number: 06-167 EMH PROP. ELECTRIC MANHOLE Scale: ] — 20 EXIST. UTILITY POLE c41 LANDSCAPE AREA Designed B r _UP PROP. UTILITY POLE g y' 0�0 LP EXIST. LIGHT POLE Drawn By: RAA Checked By: HC O �" 'C_:n, CRUSHED STONE AREA �o LP PROP. LIGHT POLE Sheet Title: []—) EXIST. GAS PUMPS �iNF ps PARKING LAYOUT PLAN 1 CONCRETE AREA ❑ ❑ PROP. GAS PUMPS TREE 1'"l �''� ��,\O EXISTING NUMBER OF ``�r''���,.'' GRAPHIC SCALE s �-� j O PARKING SPACES ! �\ ...�� �� 1�` - EXIST. EDGE OF PAVEMENT �� PROP. EDGE OF PAVEMENT CUT & MATCH PAVEMENT 0 10 20 40 80 (SCALE IN FEET) chlr.'' EXIST. SIGN I = 20' vv j PROP. SIGN -----j a Sa EXIST. GRANITE BOUND O S8 PROP. GRANITE BOUND El CB EXIST. CONCRETE BOUND Sheet Number. 1 OF 2 El Ce PROP. CONCRETE BOUND ■ R.I.H.B. R.I. HIGHWAY BOUND CHOUBAH ENGINEERING GROUP, P.C. -�I_/1111 CONSULTING PROFESSIONAL ENGINEERS 50'-g GENERAL NOTES: 3119 CRANBERRY HIGHWAY, UNIT 5B, WAREHAM, MA 02538 1. IT SHALL BE THE CONTRACTOR'S 50LE RESPONSIBILITY TO OBTAIN ANY AND ALL PERMITS REQUIRED BY THE STATE OF MA55ACHU5ETT5 AND THE TOWN OF 05TERVILLE TEL:(508) 759-6260 FAX:(508) 759-6230 PRIOR TO COMMENCING ANY WORK. www.choubahgroup.com 2. PROPOSED MODIFICATIONS 4 CONSTRUCTION SHALL CONFORM TO THE REQUIREMENTS OF a D� H FE THE STATE AND LOCAL BUILDING AND FIRE CODES. Project: REMOVE EXISTING FE FAGP DECORATIVE WALL 3. THE CONTRACTOR SHALL VERIFY ALL DIMEN51ON5 AND CONDITIONS ON THE JOB SITE. PROPOSED MODIFICATIONS D15CREPANCIE5 SHALL BE BROUGHT TO THE ATTENTION OF THE ENGINEER BEFORE AT PROCEEDING WITH THE PORTIONI OF THE WORK. BLOCK EXISTING DOOR TO EXISTING SINKS 792 & 804 MAIN STREET ACCOMMODATE DUNKIN DONUTS TO REMAIN 4. DETAILS NOT SPECIFICALLY SHOWN 'SHALL BE SIMILAR TO THOSE FOR M05T NEARLY OSTERVILLE, MA 02655 AREA (PER PROPOSED FLOOR EXISTING COLUMNS SIMILAR CONDITION AS DETERMINED BY THE ENGINEER. LAYOUT) TO REMAIN '-6 POT SINK REMOVE AND DISPOSE 5. THE CONTRACTOR SHALL SHORE, BRACE, SHEET PILE OR OTHERWISE SUPPORT THE EXISTING SINKS STRUCTURE AS REQ, TO MAINTAIN STRUCTURAL INTEGRITY AT ALL TIMES. SHORING DESIGN DrSHALL BE PROVIDED BY THE GFENERAL CONTRACTOR. QH \ (o. HEADERS SHALL BE PLACED ACROSS TOP OF SHORING POSTS AND SHALL BE TIGHT REMOVE I AGAINST UNDER51DE OF STRUCTURE ABOVE. EXISTING COLUMNS EXISTING DOOR BR. 1 N TO REMAIN -1. SHORING SHALL BEAR ON SL'.EEP'ERS TO PREVENT DAMAGE TO STRUCTURE BELOW. � REMOVE AND DISPOSE Prepared For: I EXISTING WALL � 8. TEMPORARY SHORES SHALL BE DESIGNED, ERECTED, SUPPORTED, BRACED AND m EXISTING COLUMN �. „ MAINTAINED BY THE CONTRACTOR TO SUPPORT SAFELY ALL DEAD LOADS PRESENTLY CHRISTY,S OF CAPECOD, LLC ; To REMAIN / 9 CARRIED BY THE STRUCTURAL UUORK BEING SHORED, AND ANY CONSTRUCTION LIVE LOADS. 105 PLEASANT STREET i HYANNIS, MA 02601 14 /- 9. NEW STRUCTURAL SYSTEMS SHALL BE COMPLETELY INSTALLED AND CAPABLE OF SUPPORTING DESIGN LOADS BEFORE SHORES ARE REMOVED. SHORES SHALL BE RELEASED GRADUALLY. � REMOVE AND DISPOSE E3R• EXISTING WALLS ` 10. ALL ELECTRICAL AND PLUMBING TRADE WORKS MUST BE COORDINATED WITH EXISTING DECORATIVE REMOVE AND DISPOSE J STRUCTURAL WORK PRIOR TO CONSTRUCTION, ANY DISCREPANCY SHALL BE REPORTED TO WALL TO REMAIN EXISTING COUNTER / THE GENERAL CONTRACTOR IM1"EDIATELY. 11. ELECTRICAL AND PLUMBING WORK SHALL BE IN ACCORDANCE WITH THE GOVERNING CODES, REGULATIONS AND ORDIINANCES. THESE REQUIREMENTS ARE MINIMUM CRITERIA AND NO REDUCTIONS IN STANDARDS PERMITTED BY CODES WILL BE ALLOWED. FE EX15TING FOO AYOUT SCALE: 1/4"=1'-0" i 16'-311 50'-9" i V� ' II< P �. �" COMP 1r RESSOR ��' iSG �� A.O. SMITH ` s ❑ 4FU8NS3A45 Fs i rugs Issue Date: 6 20 06 EXISTING FIRE ALARM LEGEND 5 DOOR WALK-IN COOLER Revisions 15'-3"' X 8'-0" RO� 1'-6' � H FE No. Date Description FRCP * FIRE ALARM PANEL FE HAND 0[ffi=0 60' FILLER 2 2 x 3' 36 BASKETS LZ SINK TURBO 5TABLE 1 8/01/06 Revised Notes © * PULL STATION DONUTS g BSKTS CHEF(S) C� H * NEAT DETECTOR (CEILING BELOW) ......_ CUTTING BOARD 2?' x 5' O PROVIDE A IFIRE ALARM SYSTEM TO _ ; .._ �� „ SLICER METAL RACK H = HEAT DETECTOR (ABOVE CEILING) COMPLY WITH THE MA. FIRE SAFETY - -_ --- 34 FILLER 7'- AN STATION Q "`-' i 9 SANDWICH ST 0 CODE < THE REQUIREMENTS OF THE SERVING AREA W/DELFIELD UNDER (PREPARATION AREA aola 0 SMOKE DETECTOR I LOCAL SUPERINTENDENT OF FIRE ALARM (DUNKIN DONUTS) 3'-0" O gN OH = MORN / STROBE UNIT _ `� BEV. CTR. REQUIREMENTS. CUSTOM 9 -6" COFFEE w/ 'I'CE CADDY W/ UCR I W DDCM APPROVAL 5-6 POT SINK II © = STROBE ONLY UNIT 5-8 CASH COOLATTA 342 HAND cE w Project Number: 06-167 K] = KNOX BOX ®7 ® m SINK 50 LB o 0 0 A=�* v 3 -0" EMERGENCY LIGHTING �8 O� 111811 SPR GATE BIN Scale: 1/4"= 1'-0" , ❑ Ix H ® ® TAYLOR / - ne Desi d By: O * EXIT SIGN CBTP DISPLAY CUSTOM g y FILLER BY G.C. ! BR Drawn By: RAA Checked By: HC DROP 12" FOR ICB = EXTERIOR LIGHTING _ @ SALES�L ` cv I AREA SALES AREA FE = 5 Ib DRY ABC EXTINGUISHER c{l (No SEATS) - Sheet Title: 4[ III m a EXISTING & PROPOSED [ IL U- U- _ FLOOR LAYOUT J SG/ NOTES 3'-0" -1 3 -5" BR. 1 1. PROPOSED MODIFICATIONS SHOWN ON THE PLANS ARE ASSOCIATED WITH THE U- J U. UL CONVERSION OF EX15TING FIRST FLOOR RESTAURANT TO CONVENIENCE STORE WITH w w w w / DUNKIN DONUTS TAKE-OUT WITH NO DRIVE THRU/NO SEATING AT '192 MAIN STREET, 0 N N N -� 05TERVILLE MA. 2. FLOOR MODIFICATIONS ARE TO ACCOMMODATE NEW CONVENIENCE STORE WITH DUNKIN DONUTS AS SHOWN ON NEW FLOOR LAYOUT. 3, THERE WILL NE NO CHANGES TO BUILDING EXTERIOR FROM PROPOSED ® O E ZE �U OU MODIFICATIONS. Sheet Number. 2 OF 2 4. PROPOSED MODIFICATIONS ARE 5U5JECT TO THE INSPECTION AND APPROVAL OF CASHIER 0 THE LOCAL BUILDING INSPECTORS IN COMPLIANCE WITH THE APPLICABLE BUILDING m i CODES. i 1(0'-3" 50'-GII PROPOSED FLOOR LANT"OUT SCALE: 1/4"=1'-O"