HomeMy WebLinkAboutHYANNIS PACKAGE STORE - RETAIL FOOD 14YANX-Ts PACKAGE
W.Main STORE
Scu Scudder r
Town of Barnstable BOARD OF HEALTH
John T.Norman
Board of Health Donald A.Guadagnoli,M.D.
BARNWABLMA, F.P.(Thomas)Lee
'x 200 Main Street, Hyannis, MA 02601 Daniel Luczkow Alternate
�# Phone: (508) 862-4644 Fax: (508)790-6304
www.townofbarnstable.us
Permit to Sell Tobacco
In accordance with regulations promulgated under authority granted by Sections 5,31 and 127A of the
General Laws of the Commonwealth of Massachusetts and Chapter 371 of the Town of Barnstable Code, a
permit is hereby granted to:
Permit No: 148 Issue Date: 1/1/2021
DBA: HYANNIS PACKAGE STORE
OWNER: ANK LIQUOR INC.
Location of Establishment: 775 MAIN STREET HYANNIS, MA 02601
Type of Business Permit: Non-Flavored
Annual Seasonal
FEES YEAR: 2021
TOBACCO SALES: $85.00
Permit Expires: 12/31/2021
Thomas A. McKean, RS, CHO, Health Agent
Restrictions:
PLEASE POST CONSPICUOUSLY
For Office Usr, niv: Initials:
Town of Barnstable Date Paid Amt Pd s �
> �AB Inspectional Services
r�
Mnse Check#
Public Health Division
Thomas McKean, Director
200 Main Street, Hyannis,MA 02601
Office: 508-862-4644 Fax: 508-790-6304
TOBACCO ESTABLISHMEN.T...PERMIT.APPLICATION'(Non-Flavored)
DATE J 2 2 o NEW BUSINESS OWNERSHIP RENEWAL ✓ Y
NAME OF TOBACCO ESTABLISHMENT: 2
ADDRESS OF TOBACCO ESTABLISHMENT: CAY)Yl i-S Pei c be 1�-e.5 j7p t�e-
MAILING ADDRESS(IF DIFFERENT FROM ABOVE): 3:3:5-- rn 6A�-Y) gA-7 �AN CA-Yl- j
E-MAIL ADDRESS: T 2 P,_ 3M eA i 1• Ce 7'YL.
TELEPHONE NUMBER OF TOBACCO ESTABLISHMENT: (gS fi) 20 6
OWNER'S NAME:, i 1 e.sh 9rA�+e�_ OWNER'S PH#(gSI-)2o6 -sSw
OWNER'S ADDRESS: 2 V %1\ N g c- r G 2 6 1 6'
CORPORATE NAME: lA-YN 1C L 03 y1 e�L 1
CORPORATE ADDRESS: :f _ /AA'yj S+. 1'M all-n j.S4 CORPORATE FID#
� oze26
ANNUAL: ✓ SEASONAL: DATES OF OPERATION:_/_J TO
DAYS CLOSED EXCLUDING HOLIDAYS(EX.MONDAYS)
TOWN OF BARNSTABLE CODE/MA GENERAL LAW INTERNET LINKS:
TOWN OF BARNSTABLE TOBACCO CODE LINK FOR CHAPTER 371-9:
https://www.ecode360.com/33996392
MA GENERAL LAW CHAPTER 270/SECTION 6:
https:Hmale�islature. ov/Laws/GeneralLaws/PartIV/Titlel/Chapter270/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 E FOLLOWING REQUIRED DOCUMENTS:
y THE REQU t
1) MA State License to Sell Cigarettes 3) IRS Federal Tax ID#Document
2) MA State License to Sell Cigars and Smoking Tobacco 4) Payment of Fee(s) -see page 4
SIGNATURE:
PRINTED NAME: DATE:..q3/2 /2 0 x
Q:Wpplication FormsCIOBACCO APP-NonFavor 12-18-19.docx
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an 41-S
1
E ABLISHMENT'S NAME
i
TOBACCO SALES
Employee Signature Form
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X
This form is for official use to indicate that the employee(s)of this establishment received and understood Chapter 371 of
the Town of Barnstable Code and Chapter 270 Section 6 of the Massachusetts General Laws which describes the
penalties for selling and/or giving tobacco products to any person under the age of twenty-one (21). Below is Section
371-9. of the Town of Barnstable Board of Health Regulation:
Sales to Minors—4.371-9. Sale and Distribution of Tobacco._Products.
1. No person shall sell or provide a tobacco product,as defined herein,to a person under
The minimum legal sales age. The minimum legal sales age in the Town of Barnstable
is 21 years of age.
2. Identification: Each person selling or distributing tobacco products,as defined herein,
shall verify the age of the purchaser by means of a valid government-issued photographic
identification containing the bearer's date of birth that the purchaser is 21 years old or
older. Verification is required for any person under the age of 27.
The employee(s)below received and understood Section 371-9 of the Town of Barnstable Board of
Health Prohibition of Smoking Regulation and Chapter 270 Section 6 of the Massachusetts General Laws:
f I e1 h Q C,k d::L 12.0
Sign Printed Name Date
t
QI o3 �
Signatur Printed Name Date
Sign a a Printed Name Datef
hf
..Sign tore Printed Name Date
Signature Printed Name Date
r
Signature Printed Name Date
Signature Printed Name Date
Q\Application Forms\TOBACCO APP-NonFavor 12-18-19.docx
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Commonwealth of Massachusetts Utter iu:t,vutu9 i i2 toDepartment of Revenue Notice Date:September 2,2020Geoffrey E.Snyder,Commissioner Account lD:CRL-18835597-007
mass.gov/dor
RETAILER LICENSE FOR SALE OF CIGARS AND SMOKING TOBACCO
'�I�I'11�11'III'I11I'��'�'�"�IIII'I�il��lllll�lllll� ll"II�'��'
ANK LIQUOR INC.
0 775 MAIN ST
HYANNIS MA 02601-4327
s
Attached below is your Retailer License for Sale of Cigars and Smoking Tobacco (Form CT-3T). Cut
- --.--.--..—a.long-the-dottedJuie_and displa-y._atyouur business location. At anytime, 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
---------------------------------------------------------------------------------------------------------------------------------------------
a5s"`"l's,� MASSACHUSETTS DEPARTMENT OF REVENUE Form CT-3T
Tr
Retailer License for Sale of Cigars and Smoking Tobacco
yF�r 0* This license must be posted and visible at all times.The sale of tobacco
products to anyone under .18. years of age is prohibited.
ANK LIQUOR INC. Account ID: CRL-18835597-007
775 MAIN ST License Number: 719529984
HYANNIS MA 02601-4327
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
IR DEPARTMENT OF THE TREASURY
INTERNAL REVENUE SERVICE
CINCINNATI OH 45999-0023
Date of this notice: 01-24-2018
Employer Identification Number:
Form: 'SS-4
Number of this notice: CP 575 A
ANK LIQUOR INC
28 VILLAGE DR
QUINCY, MA 02169 For assistance you may call us at:
1-800-829-4933
IF YOU WRITE, ATTACH THE
STUB AT THE END OF THIS NOTICE.
WE ASSIGNED YOU AN EMPLOYER IDENTIFICATION NUMBER
Thank you for applying for an Employer Identification Number (EIN) . We assigned you
EIN 82-4126822. This EIN will identify you, your business accounts tax returns and
documents, even if you have no employees. Please keep this notice in your permanent
records.
When filing tax documents, payments, and related correspondence, it is very important
that you use your EIN and complete name and address exactly as shown above. Any variation
may cause a delay in processing, result in incorrect information in your account, or even
cause you to be assigned more than one EIN. If the information is not correct as shown
above, please make the correction using the attached tear off stub and return it to us.
Based on the information received from you or your representative, you must file
the following form(s) by the date(s) shown.
Form 941 07/31/2018
Form 940 01/31/2019
Form 1120 04/15/2019
If you have questions about the form(s) or the due date(s) shown, you can call us at
the phone number or write to us at the address shown at the top of this notice. If you
need help in determining your annual accounting period (tax year) , see Publication 538,
Accounting Periods and Methods.
We assigned you a tax classification based on information obtained from you or your
representative. It is not a legal determination of your tax classification, and is not
binding on the IRS. If you want a legal determination of your tax classification, you may
request a private letter ruling from the IRS under the guidelines in Revenue Procedure
2004-1, 2004-1 I.R.B. 1 (or superseding Revenue Procedure for the year at issue) . Note:
Certain tax classification elections can be requested by filing Form 8832, Entity
Classification Election. See Form 8832 and its instructions for additional information.
IMPORTANT INFORMATION FOR S CORPORATION ELECTION:
If you intend to elect to file your return as a small business corporation, an
election to file a Form 1120-S must be made within certain timeframes and the
corporation must meet certain tests. All of this information is included in the
instructions for Form 2553, Election by a Small Business Corporation.
i
I
(IRS USE ONLY) 575A 01-24-2018 ANKL B 9999999999 SS-4
If you are required to deposit for employment taxes (Forms 941, 943, 940, 944, 945,
CT-1, or 1042) , excise taxes (Form 720) , or income taxes (Form 1120) , you will receive a
Welcome Package shortly, which includes instructions for making your deposits
electronically through the Electronic Federal Tax Payment System (EFTPS) . A Personal
Identification Number (PIN) for EFTPS will- also be sent to you under separate cover.
Please activate the PI14 once you receive it, even if you have requested the services of a
tax professional or representative. For more information about EFTPS, refer to
Publication 966, Electronic Choices to Pay All Your Federal Taxes. If you need to
make a deposit immediately, you will need to make arrangements with your Financial
Institution to complete a wire transfer.
The IRS is committed to helping all taxpayers comply with their tax filing
obligations. If you need help completing your returns or meeting your tax obligations,
Authorized e-file Providers, such as Reporting Agents (payroll service providers) are
available to assist you. Visit the IRS Web site at www.irs.gov for a list of companies
that offer IRS e-file for business products and services. The list provides addresses,
telephone numbers, and links to their Web sites.
To obtain tax forms and publications, including those referenced in this notice,
visit our Web site at www.irs.gov. If you do not have access to the Internet, call
1-800-829-3676 (TTY/TDD 1-800-829-4059) or visit your local IRS office.
IMPORTANT REMINDERS:
* Keep a copy of this notice in your permanent records. This notice is issued only
one time and the IRS will not be able to generate a duplicate copy for you. You
may give a copy of this document to anyone asking for proof of your EIN.
* Use this EIN and your name exactly as they appear at the top of this notice on all
your federal tar: forms.
* Refer to this EIN on your tax-related correspondence and documents.
If you have questicns about your EIN, you can call us at the phone number or write to
us at the address shown at the top of this notice. If you write, please tear off the stub
at the bottom of this notice and send it along with your letter. If you do not need to
write us, do not complete and return the stub.
Your name control associated with this EIN is ANKL. You will need to provide this
information, along with your EIN, if you file your returns electronically.
Thank you for your cooperation.
(IRS USE ONLY) 575A 01-24-2018 ANKL B 9999999999 SS-4
Keep this part for your records. CP 575 A (Rev. 7-2007)
----------------------------------------------------------------------------------------------
Return this part with any correspondence
so we may identify your account. Please CP 575 A
correct any errors in your name or address.
9999999999
Your Telephone Number Best Time to Call DATE OF THIS NOTICE: 01-24-2018
( ) - EMPLOYER IDENTIFICATION NUMBER: 82-4126822
d FORM: SS-4 NOBOD
INTERNAL REVENUE SERVICE ANK LIQUOR INC
CINCINNATI OH 45999-0023 28 VILLAGE DR
QUINCY, MA 02169
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Bellaire, Dianna
From: Tushar Patel <tusharpatel4644@icloud.com>
Sent: Monday, November 16, 2020 5:06 PM
To: Bellaire, Dianna
Cc: ankit patel
Subject: Hyannis package store
Attachments: IMG_1410 jpg;ATT00001.txt
Hi Dianna
This is both Licence for tobacco
And also we don't sell any electronic vaping in our store
If you have any questions call us
Thank you
CAUTION:This email originated from outside of the Town of Barnstable! Do not click links,open attachments or reply,
unless you recognize the sender's email address and know the content is safe!
1
Town of Barnstable BOARD OF HEALTH
John T.Norman
Board of Health Donald A.Guadagnoli,M.D.
BAR ALE, .. Paul J.Canniff,D.M.D.
.4A-A`" F.P. Thomas Lee Alternate
1101119. 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: 148 Issue Date: 1/1/2020
DBA: HYANNIS PACKAGE STORE
OWNER: NILESH PATEL
Location of Establishment: 775 MAIN STREET HYANNIS, MA 02601
Type of Business Permit: Non-Flavored
Annual K Seasonal
FEES YEAR: 2020
TOBACCO SALES: $85.00
Permit Expires: 12/31/2020
Thomas A. McKean, IRS, CHO, Health Agent
Restrictions:
PLEASE POST CONSPICUOUSLY
rt Town of Barnstable BOARD OF HEALTH
,a John T.Norman
`Y Board of Health Donald A.Guadagnoli,M.D.
�,►nrisr,�BM Paul J.Canniff,D.M.D.
200 Main Street, Hyannis, MA 02601 F.P. Thomas Lee Alternate
Phone: (508) 862-4644 Fax: (508)790-6304
www.townofbarnstable.us
Permit to Sell Tobacco
In accordance with regulations promulgated under authority granted by Sections 5,31 and 127A of the General
Laws of the Commonwealth of Massachusetts and Chapter 371 of the Town of Barnstable Code, a permit is
hereby granted to:
Permit No: 148 Issue Date: 1/1/2020
DBA: HYANNIS PACKAGE STORE
OWNER: ANK LIQUOR INC.
Location of Establishment: 775 MAIN STREET HYANNIS, MA 02601
Type of Business Permit: Non-Flavored
Annual Seasonal
FEES YEAR: 2020
TOBACCO SALES: $85.00
Permit Expires: 12/31/2020
Thomas A. McKean, RS, CHO, Health Agent
Restrictions:
PLEASE POST CONSPICUOUSLY
THE r For Office Usg.OnIv.• Initials: dip
Town of Barnstable
Date Paid 1 Amt Pd$
BARNffrABL6. Inspectional Services
94' 019. E OQ
Public Health Division Check#
ArFD MKS A
Thomas McKean, Director
200 Main Street, Hyannis, MA 02601
Office: 508-862-4644 Fax: 508-790-6304
1-..�
TOBACCO ESTABLISHMENT PERMIT APPLICATION (Non-Flavored)
DATE 121-+119 NEW BUSINESS OWNERSHIP RENEWAL
NAME OF TOBACCO ESTABLISHMENT: �}/�y< L ma 0 e) IZ -1 d r- H arr j S
ADDRESS OF TOBACCO ESTABLISHMENT: I'Y1 CA i Y) .4
MAILING ADDRESS(IF DIFFERENT FROM ABOVE):
E-MAIL ADDRESS: /� j J 1 P 2 'YY1 CM CU'� I
TELEPHONE NUMBER OF TOBACCO ESTABLISHMENT: S( a8)-t� - 2 nS
OWNER'S NAME: pcA-}tk OWNER'SPH#(8sfi)2e6- 36Sev
OWNER'S ADDRESS: �Z- `1 .rL Q1J1�-Ni e-`/ * 1n A
CORPORATE ADDRESS: tTS Md4Myl St /-t`/a�1�n�S, /nPr CORPORATE FID#
ANNUAL: SEASONAL: DATES OF OPERATION: / / TO
DAYS CLOSED EXCLUDING HOLIDAYS(EX.MONDAYS)
TOWN OF BARNSTABLE CODE/MA GENERAL LAW INTERNET LINKS:
TOWN OF BARNSTABLE TOBACCO CODE LINK FOR CHAPTER 371-9:
https://www.ecode360.com/33996392
MA GENERAL LAW CHAPTER 270/SECTION 6:
https:Hmalegislature.gov/Laws/GeneralLaws/PartIV/TitleI/Chai)ter270/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
f2) MA State License to Sell Cigars and Smoking Tobacco 4) Payment of Fee(s) -see page 4
SIGNATURE: 1
PRINTED NAME: All L L�11 P h}"T C-'t-
DATE: J2/ 4 / (9
Q:\Application Forms\TOBACCO APP-NonFavor 11-21-19.doc
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y
ES ABLISHME T'S NAMi
TOBACCO SALES
Employee Signature Form
This form is for official use to indicate that the employee(s) of this establishment received and understood Chapter 371
of the Town of Barnstable Code and Chapter 270 Section 6 of the Massachusetts General Laws which describes the
penalties for selling and/or giving tobacco products to any person under the age of twenty-one (21). Below is Section
371-9. of the Town of Barnstable Board of Health Regulation:
Sales to Minors— &371-9. Sale and Distribution of Tobacco Products.
1. No person shall sell or provide a tobacco product, as defined herein,to a person under
The minimum legal sales age. The minimum legal sales age in the Town of Barnstable
is 21 years of age.
2. Identification: Each person selling or distributing tobacco products, as defined herein,
shall verify the age of the purchaser by means of a valid government-issued photographic
identification containing the bearer's date of birth that the purchaser is 21 years old or
older. Verification is required for any person under the age of 27.
The employee(s)below received and understood Section 371-9 of the Town of Barnstable Board of
Health Prohibition of Smoking Regulation and Chapter 270 Section 6 of the Massachusetts General Laws:
Al' )
Signature Printed Name Date
U S FOP-
Si Printed Name Date
N,IU4
Signature Printed ame Date
Signature Printed Name Date
Signature Printed Name Date
Signature Printed Name Date
Signature Printed Name Date
Q\Application Forms\TOBACCO APP-NonFavor 11-2.1-19.doc
Town of Barnstable BOARD OF HEALTH
t Paul J Canniff,D.M.D.
Board of Health Donald A.Gaudagnoli,M.D.
aARNSTASM, = 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: 148 Issue.Date: 12/20/18
DBA: HYANNIS PACKAGE STORE
OWNER: NILESH PATEL
Location of Establishment: 775 MAIN STREET HYANNIS, MA 02601
Type of Business Permit: TOBACCO
Annual: YES Seasonal:
IndoorSeating: 0 OutdoorSeating: 0 Total Seating: 0
FEES
FOOD SERVICE ESTABLISHMENT: YEAR: 2019
RETAIL FOOD:
COTTAGE FOOD OPERATION: Permit Expires: 12/31/2019
B&B-FULL BREAKFAST:
CONTINENTAL BREAKFAST: — ------ - - ------ ----
MOBILE-FOOD:
MOBILE-ICE CREAM: Q�
FROZEN DESSERT: Thomas A. McKean, IRS, CHO, Health Agent
TOBACCO SALES: $85.00
FOR ESTABLISHMENTS WITH SEATING: ,
PERMIT IS NOT VALID UNLESS ISSUED IN CONJUNCTION WITH A COMMON VICTUALER LICENSE
Restrictions:
P
' A
%d
.y�114E Town of Barnstable For Office Use Only: Initials:
„� �.a Date Paid Inspectional Services Check# Amt Pd$Cash
R&RNSPABLE,9MASS.039. Public Health Division
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
H�CAY\r; s �CACKeAq--e— s+V/Z-C_
ESTABL SHMENT NAME (D/B/A)
---i--S-- Ir-n c,6-0 O 2 60 �.
ADDRESS OF BUSINESS
MAILING ADDRESS (IF DIFFERENT FROM ABOVE)
Q j}-T&J- 0 =.t_c-S!
y\ 600 c�S-j-206- IS67
EMAIL PHONE# FEDERAL ID#
Do you currently possess a state license to sell tobacco products?
Yes No
Each employee who sells tobacco products must receive and understand Chapter 371 of
the Town of Barnstable Code (copy provided herein) and the Massachusetts General
Law Chapter 270, Section 6.00 (a copy is provided on the next page). Each employee
who sells tobacco products must sign the Employee Signature Form (provided
herein).
Signature 1 Date
Q:\Application Forms\TOBACCO APP2019 dob.docx
ESTABLISHMENT'S NAME
TOBACCO SALES
Employee Signature Form
This form is for official use to indicate that the employee(s) of this establishment received and
understood Chapter 371 of the Town of Barnstable Code and Chapter 270 Section 6 of the
Massachusetts General Laws which describes the penalties for selling and/or giving tobacco
products to any person under the age of twenty-one (21). Below is Section 371-9. of the Town of
Barnstable Board of Health Regulation:
Sales to Minors—� 371-9. Sale and Distribution of Tobacco Products.
1. No person shall sell or provide a tobacco product, as defined herein,to a person under
The minimum legal sales age. The minimum legal sales age in the Town of Barnstable
is 21 years of age.
2. Identification: Each person selling or distributing tobacco products,as defined herein,
shall verify the age of the purchaser by means of a valid government-issued photographic
identification containing the bearer's date.of birth that the purchaser is 21 years old or
older. Verification is required for any person under the age of 27.
The following employee(s) received and understood Section 371-9 of the Town of Barnstable
Board of Health Prohibition of Smoking Regulation and Chapter 270 Section 6 of the
Massachusetts General Laws:
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S' nab Printed Name Date
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Si tore Printed Name Date -
x?a",� "_(�
Signature Printed Name Date
Signature Printed Name Date
SU r\6,z4 , T 'S • ) . `Pck�,e Z t - - I
Signature Printed Name Date
Signature Printed Name Date
Signature Printed Name Date
QAApplication Foans\TOBACCO APP2019 dob.docx
I
n ^
Town of Barnstable
• Regulatory Services Department
i « snRrrarnsi.E,
" ��� Public Health Division
200 Main Street, Hyannis MA 02601
Office: 508-790-4644 Thomas A.McKean,RS,CHO
FAX: 508-790-6304 Director of Public Health
Pd-- 1a�3� g ctc 2 �
Fee: $85.00 I �
MAIL TO: TOWN OF BARNSTABLE I— � 2-19 I It
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
C L- S
LAST NAME OF APPLICANT ..FIRST NAME MIDDLE INITIAL
PRCK-A &�g- STOP-
DB/A
TD--S— AI A"3- N ki-j A—NN'1S MA — e 26o i
STREET ADDRESS
gSt - LO 6— gS-CID
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 mployee Signature Form (provided herein).
7YIZril4'
Signa ure Date
Q:\Application Forms\TOBACCO APP2018 dob.docx
TOBACCO SALES TO MINORS
PROHIBITED BY MASSACHUSETTS GENERAL LAWS
Sales to Minors — Massachusetts General Laws Chapter 270, Section 6, whoever sells a
cigarette, chewing tobacco, snuff, or any tobacco in any of its forms to any person under
the age of eighteen (1;8) or, not being his parent or guardian, gives a cigarettes, chewing
tobacco, snuff, or tobacco in any of its forms to any person under the age of(18), shall be
punished by a fine of not less than one hundred dollars ($100) for the first offense, not less
than two hundred dollars ($200) for the second offense, and not less than three hundred
dollars ($300) for any third or subsequent offense.
Posting State Law — In conformance with Massachusetts General Laws, Chapter 270,
Section 7, a copy of Massachusetts General Laws Chapter 270, Section 6 shall be posted
conspicuously by the owner or other person in charge thereof in the shop or other place
used to sell cigarettes at retail. The notice to be posted shall be that notice provided by the
Massachusetts Department of Public Health. Such notice shall be at least 48 square inches
and shall be posted at the cash register which receives the greatest volume of single
cigarette package sales in such a manner so this may be readily seen by a person standing
at or approaching the cash register. Such notice shall directly face the purchaser and shall
not be obstructed from view or place at a height of less than 4 feet or greater than 9 feet
from the floor. For all other cash registers that sell cigarettes, a notice shall be attached
which is no smaller than 9 square inches, which is the size of the sign provided by the
Department of Public Health. Such notice must be posted in a manner so that it may be
readily seen by a person standing at or approaching the cash register. Such notice shall
directly face the purchaser and shall not be obstructed from view or laced at a height no
less than 4 feet or more than 9 feet from the floor.
Q:\Application FonnATOBACCO APP2018 dob.docx
TOBACCO SALES Establishment
Employee Signature Form
This form is for official use to indicate that the employee(s) of this establishment received and understood
sections VII b. and VII c. of the Barnstable Board of Health Prohibition of Smoking Regulation and the
enclosed copy of 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 eighteen(18). Below are sections
VII b. and VII c.of the Barnstable Board of Health Regulation:
SECTION VII—SALE AND DISTRIBUTION OF TOBACCO PRODUCTS
b. Sales To Minors—In conformance with the Massachusetts General Laws Chapter 270, Section 6,
no person, firm, corporation, establishment, or agency shall sell tobacco products to. a minor.
Each employee working in an establishment licensed to sell tobacco product shall be required to
receive a copy of the Board of Health regulations and State Law regarding the sale of tobacco and
sign a form indicating that such regulations/laws have been received and understood, a copy of
which must be placed on file, in the office of the employer and retained. Such signed forms must
be made available for inspection, during the license holders normal business hours upon request of
an agent of the Board of Health.
c. All distributors/retailers 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 confirm that the
customer is of legal age to purchase the tobacco product.
The following employee(s) received and understood Sections VIlb. and VIIc. of the Barnstable Board of
Health Prohibition of Smoking Regulation and Chapter 270 Section 6 of the Massachusetts General Laws:
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Si Printed Name Date
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Signature Printed Name Date
S
Signature Printed Name Date
z 5�x /,,�;;,— ed,,,,( &
Signature Printed Name Date
Signature Printed Name Date
Signature Printed Name Date
Signature Printed Name Date
Q:\Application Forms\TOBACCO APP2018 dob.docx
sutsg� Commonwealth of Massachusetts Le D:L1095295616 t
Department of Revenue Notice Date:September 4,2018
Christopher C.Harding,Commissioner Account ID:CGL-18835597-004
y �vrco mass.gov/dor
RETAILER LICENSE FOR SALE OF CIGARETTES
lllrillilllh�I1111111111114 Jill 111111111llhhlil1lh1111
ANK LIQUOR INC.
o— 775 MAIN ST
N C
m HYANNIS MA 02601-4327
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
--------------------------------------------------------------------------------------------------------------------------------------------------
SSac"�se�h 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.
ANK LIQUOR INC. 'K new Car 10 Account ID: CGL-18835597-004
775 MAIN ST License Number: 1058662400
HYANNIS MA 02601-4327
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
1
I
PERMIT NO: ,, TOWN OF BARNSTABLE 05/31/2018
148 BOARD OF HEALTH
PERMIT TO OPERATE A FOOD ESTABLISHMENT
In accordance with regulations promulgated under authority of Chapter 94,
Section 395A and Chapter 111,Section 5 of the General Laws,a permit is hereby granted to:
NILESH PATEL D/B/A: HYANNIS PACKAGE STORE
Whose place of business is: 775 MAIN STREET , HYANNIS, MA 02601 0
Type of business and any restrictions: RETAIL FOOD ESTABLISHMENT
To operate a food establishment in the TOWN OF BARNSTABLE
RESTRICTIONS IF ANY:
SEATING: 0 ANNUAL: YES
SEASONAL: TEMPORARY:
F E E S BOARD OF HEALTH
RETAIL FOOD STORE: $20.00 Paul J. Canniff, D.M.D,Chairperson
FOOD SERVICE ESTABLISHMENT: JuniChi Sawayanagi
RESIDENTIAL KITCHEN FOR RETAIL SALE: Donald A. GUadagnoli, M.D.
RESIDENTIAL KITCHEN FOR BED+BREAKFAST:
MOBILE FOOD UNIT: Permit expires:
TOBACCO SALES: $85.00 12/31/2018 �
FROZEN DESSERT: Thomas A. McKean, RS, CHO
CATERER: Director Of Public Health
A
* ,o ,y'0"
Town Of Barnstable
of IME r 0� m R6 eA4CCo p�
P
b ' J1.
R.
� ulato Set���cs '�� .�---
w six e�e Richard.V. Scali,Dixect:or BARN.y aUSS. �. � vugat.�+yrzrevatx ar r.z±unri
sbgq. .�W Public
4�'( '�"� / - axa ra:t s[raxuu.�r uaas;se:a.
ArFpIvlP�a .L ublic Health Division !n yei�aaxa
Thomas McKean,Director' JJJ
200 INA Stxee- Ilyannis,W,02601
Office: 508-862-46 4 7V..gj
APPLICATION FOR PERMIT TO OPERATE A FOOD ESTA.B:LISIT� ENm��
...-. DATE:
02/17/2018 (y (7
NAME OF FOOD ESTABLISIU N'T: 9"j a. 5
ADDRESS OF FOOD ST LISHINIENsT 11 t 4 H4.011i'sl (c
-- MAILING ADllW' :SS ff, DEFERENT I+I"tOM ABOVE):
,_,r, E=MA.I:L ADDRESS: Nildip27@gmail.com W
TELL PHONE,NUMBER 0�F00I EST BLISHI ENT: CS-0-5i
NUiYfBE4,R OF SEATS*t I.t� E.- OUTSIDE: `T`0TA.L:.
Note: If indoor senfing provided,set?Licensing regarding Common ViefuallersLicense
TOT.4,LiNUll113ER.OF.B-A.TIIIZOOMS: &- tmpo c,f 4/?ly
ANNUAL OR SEASONAL OPER.A.TION: AMMI
TYPICAL HOURS OF Q.PRRATION IWON-FRI: 00 AM TO 1704
DAYS CLOSED.EXCLUDING 11OLIDAYS (I.E.MONDAYS) b10 n&
IF SEASONAL: APPROXIMATE DATES OF OPERATION: /.. / TO / /.
***REM'1;N ) +`C **
,,SEASONAL ESTABLiS11MENTS MUST"C.ALI..FOR INSPECTION PRIOR TO OPENING
TYPE OF FSTA. LIS.Hi1'IENT: PLE A,SE C T CK AI.,I.THAT APPLY
FOOD SERVICE
RETAIL.1`001)
BED &.BIIE'AK AST
CONTIN.F1,NTAL BREAI0AST *IC SEA7r]'.N'O: ALSO,,,MUST: OBTAIN
RESIDENTIAL KITCHEN A COMMON'V'IC`I`UALLER'S LICENSE
MOBILE.FOOD FROtiNI LICENSING DIVISION.
_�,_TOB. CCO SALES
FROZEN
RO ZEN�D�^.�IRY DESSERT MACHINES
CATERING
OUTSIDE:DINING (OVER)
1';1,.tApplic�Fian.Fo�nsstF"caQa�p��.d�c
***.REMER***
IF OUTSIDE DINL\G,YOU MUST BE APPROVED BY 'r[-YE4 HEALT.R DIVISION AND
LICENNSTNG,AND MME,ET ALL OF THE OULSIDE DINING CRITE'R.IA
IS WAIT STAFF PROVIDED FOR OUTSIDE DINING?
IS AN AIR CURTAIN PROVIDED AT WAITSTA F SERVICE DOOR.(S)?
— CON't;AC r.]N'I,O'kNI.A TION:
FULL NAME OF APPLICANT Nilesh Patel
SOLE OWNER: YES/NO
ADDRESS 28 village drive, quincy, MA - 02169
PHONE## 857 206 9500
IF APPLICANT IS A PARTNERSHIP,FULL'NAMMM A:N'D IIONTE ADDRESS OF ALL
PARTNERS.
..---.I'F A:PPLIC AN'T IS A COR:POI2ATION: $ +UEI,LAL IDENTI,'FICATION NO. 82-4126822
STA'I E OF INCORPORATION: MA
FOOD SERVICE. ESTABLISHATENTS CONDUCTING, FOOD PREPARATION (EXCLUDES
RETAIL FOOD ESTABLISHMENTS THAT DO NOT PREPARE' FOOD AND CONTINENTAL
T'INENTAL
BREAKFAST):
EFIi'ECTIVE JANUARY 1, 2004, EACI'I FOOD SERVICE ESTAI3LTSIEMENT IS REQUIRED TO
HAVE AT LEST TWO CERTIFIED FOOD PROTECTION MANAGERS. AT LEAST ONE
CERTIFIED FOOD PROTECTION MANAGER IS RE UIBZD-TO BE ONSITE DURING ALL,
HOURS OF OPERA.TION.***PLEASE PTJT THE NAME OF TIME ESTABLISHMENT ON EACH
OE' `IIE CERTII+ICATES***
LIST'I'TIE NA NIES OF VOU.I2 C.ERTIFI +'D FOOD P.ROTEC PION MANAGERS (I.E.ST.RVSAFE.)
1. i EXPITZA.TION DATE: f /
2, EXIMIATIO:N DATE: l t
EFFECT.IVE T'EBRM,,RY 1, 2011 EACH T=O'OD ESTABLISI`I.IIEi' T THAT COOTiS, PREPARES,.
OR SERVES FOOD INTI+,,NDED FOR ENINIEMATE CONSUMPTION EITHER ON OR. OFF THE
PREMISES SfMLL HAVE AT LEAST ONE CERTIFIED FOOD ALLERGEN ANNVARENESS
TRAINED STAFF NI TE {tBER. "* PLEAS)f, PUT THE NAME OF TM' ES` A13LISMIE SIT ON
TIC CERTIFICATES**
LIST`TIIE NA Ert,, OF YOUR CER'T"IFED FOOD ALLERGEN AWAIZENESS TR.4,IN�;.D ST,A.F I..
1.. EXPIRATION DATE: / f
02 / 17 l 2017
SIGNATURE Off'APPLICANT AND DATE
QAApplicmi in FormsVoodapp .doc
Crocker, Sharon
From: Crocker, Sharon ,�n
Sent: Friday, May 25, 2018 12:35 PM 0. �k
To: 'cecelia@careycommercial.com'
Subject: FW: Hyannis Package Store
Attachments: HPS Food Permit.pdf;ATT00001.htm;TOBACCO APP2016.docx
That's great. Thanks for sending over.
Attached is the tobacco permit application. Along with this, we must have the MA State license to
sell/tax cigarettes
Thank you.
From: Cecelia Carey [maiIto:cecelia@careycommercial.com]
Sent: Friday, May 25, 2018 12:09 PM
To: Crocker, Sharon
Subject: Hyannis Package Store
Hi Sharon,
Here are the completed applications for the tobacco and food permits. Will you need each employee's signature
on this form or will the existing one suffice?
Cecelia Carey
Carey Commercial, Inc.
146 Main Street Hyannis, MA 02601
Office: 508-790-8900
Fax: 508-790-8998
Mobile: 508-566-2787
cecelia(a)careycommercial.com
www.careycommercial.com
1
o �- ram,
Crocker, Sharon
From: Crocker, Sharon f� h
Sent: Friday, May 25, 2018 12:52 PM
To: 'cecelia@careycommercial.com'
Subject: FVJ: Hyannis Package Store
Attachments: HPS Food Permit .pdf,ATT00001.htm; TOBACCO APP2016.docx
Cecelia,
The t ee ' e s open are:
e need a copy of their MA Dept.of Revenue Retailer's License for Sale of Cigarettes
2 Need Tobacco Forms back, signed,
Need payment for Food-Retail$20,Tobacco $ 85, and new Establishment fee (one-time fee) $100 =
Total Due $205.00
Thank you.
From: Crocker, Sharon `7 `
Sent: Friday, May 25, 2018 12:35 PM
To: 'cecelia@careycommercial.com'
Subject: FW: Hyannis Package Store
That's great. Thanks for sending over. "b
Attached is the tobacco permit application. Along with this, we must have the MA State license to
sell/tax cigarettes
Thank you.
From: Cecelia Carey [ma i Ito:cecel ia(abca reycommercia Lcom]
Sent: Friday, May 25, 2018 12:09 PM
To: Crocker, Sharon
Subject: Hyannis Package Store
Hi Sharon,
Here are the completed applications for the tobacco and food permits. Will you need each employee's signature
on this form or will the existing one suffice?
Cecelia Carey
Carey Commercial, Inc.
146 Main Street Hyannis, MA 02601
Office: 508-790-8900
Fax: 508-790-8998
Mobile: 508-566-2787
cecelia careycommercial.com
www.careycommercial.com
1
PSSACHSF MASSACHUSETTS DEPARTMENT OF REVENUE / ' Form CT-3T
Retailer License for Sale of Cigars and Smoking Tobacco
This license must be posted and visible at all times.The sale of tobacco
products to anyone under 18 years of age is prohibited.
HYANNIS PACKAGE STORE INC Account ID: CRL-10154895-013
HYANNIS PACKAGE STORE License Number: 205025280
775 MAIN ST
HYANNIS MA 02601-4391
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 mayy be suspended or revoked for
failure to comply with state laws and regulations.
Effective Date:September 12,2017 Expiration Date:September 30, 2018
�P 'SF�� MASSACHUSETTS DEPARTMENT OF REVENUE Form CT-3T
A Retailer License for Sale of Cigarettes
Irn
.,,lr OR This license must be posted and visible at all.times. The sale of tobacco
products to anyone under 18 years of age is prohibited.
HYANNIS PACKAGE STORE INC Account ID: CGL-10154895-010
HYANNIS PACKAGE STORE License Number: 357150720
775 MAIN ST
HYANNIS MA 02601-4391
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: September 13, 2017 „_ . Expiration Date: September 30, 2018
r
Town of Barnstable
Regulatory Services Department
Vub►I c' Ie i th IVI ion
bra; p
200 Main Strut., Hyannis:MA 02d01
ef'x": 508-790 4644 Thomas A,NICKCM 9S.CI O
FAX 508490-6304 niremor.o.f Public Health
Fee: .$$5.00
iYIAIL To;TOWN Of BARNSTABLE
VUBLIC.11EALT*&DIVISION
Zt)C! 5fr�et
t1 VANN IS.IVIA 02601
FAX sos 7.40-6304
PLEASE INCLUDE THE I2EQUIREA FEE QFIS9,51M,
.APPLICATION FOR A TOAACCO SALES PERMff
Patel N.ilesh
AST`NA1E t3F -VIItST NAMEIL.E'IP�1T°IAL
Hyannis package store
775 Main Street, Hyannis, MA
TRE,FT;ADDRESS
8572069500
TEI. Pt3:NE# FII3
3o yo c.urrently possess a:state license to sell tobacco products?
Yes V No JJ,
Each ernplgyse N�ho sells`tob eco products must.receive an d understand the Sections
VUb. and VIIc; of the Board of Health Prohibition of.Sinokin Re ulation, (,copy
provided herein) and the Massachusetts General Law Chapter 17.9, Section 600 (a,
copy is provided on the next page): Each employee who sells tobacco products must.
sign the Employee Signature Form (provided herein).
.I .
02/17/2018
Srgliafure Date
u�'IiPI ieasan:F�a�nstTOB�Pt'.I1ClC
TOBACCO SALES TO MINORS
PROHIBITED BYMASSAC HUSETTS GENERAL LAWS
Saks to Minors—Massachusetts General Laws Chapter 270, Section 6, whoever sells a
cigarette, chewing tobacco, snuff, or any tobacco,in any of its forms to any per-son under
the age of eighteen (18) or-, not being his parent or guardian, gives a cigarettes., chewing
tobacco, snaff; or tobacco.in any of its forms to any person under the age of(IS),shall be
punished by a. fine of not less than one hundred dollars (S 100) far the first offense,.not
less than two hundred dollars, ($20.0) for the second offense, and not less than 'three
hundred dollars (S300) for any third or'subsequent offense.
Posting State Law — In conformance "with Massachusetts General Laws, Qhaoter .270, -
Section 7, a copy of Massachusetts-General Laws Chapter 27.0. Section 6 shall be posted
conspicuously by the owner or other person in charge thereof in the shop or other place
used to set] cigarettes at retail. The notice to be posted shall, be that notice provided by
the :Massachusetts Ddparttrient of Public Health. Such notice shallbe-at least 48 square
inches. and shall be posted at the cash register which receives, the greatest volume of
single cigarette package.sales in, such a,manner so this may be readily seen by A person
standing at or approaching the cash register. Such notice shall directly:facetbe.pure'liastir
and shall not be obstructed from -view or place at.-a height of less than.4 :feet or greater
than-9 feet from the floor. For all other cash registers that sel I I cigarettes, a notice shall be
:attached which is no smaller than 9 square inches, which is the size of the sign provided
by the Department of Public Health. Such notice must be posted in a .manner so that it
'ay be readily seen.by a person standing at,,or approaching the cash register. Such notice
shall directly-.face the purchaser and shall not be obstructed frbm view or laced at a height
no less than 4.feet or more than 9 ,feet from:the floor-
Q:'%,Applicafion FomtskTOSAPPDOC
)eldfiffis /94&eel 3�294_11
Establish" etl
TOBACCO SALES
Employee Signature Form
This form is for official use to indicate.that the employee(s).of this establishment received and understood
sections VIIb..and V11c. of the Barnstable Board of f Health Prohibition of Smoking Regulation and the
enclosed copy of Chaptet 27O Section G of the Massachusetts Gcnearal Laws which describes the penalties:
for selling andlor giving tobacco products to arty person under:the age of c`►gliteen(1$). 13 w are sections
VHb.and VIIc.of the Barnstable Board of Health Regulation:
SECTION VII—SALE IND DISTIUB'UTION OF TOBACCO Pl ODUCTS
b. Sales To Minors—In conformance with the Massachusetts General Laws Chapter 27.01 Section S;
no person, firm, corporation, establishment;.or agency shall sell tobacco products to a minor, .
Each employee working in-'an establishment licensed to sell tobacco product shall be required to
receive a copy of the hoard of l Iealth regulations and State Law regarding the sale of tobacco and
sigii-a form indicating that such reggiationsllaws have been:received.and understood, a copy of
which must be placed on Zile,in.the office 1 the e,rnplpyer and retained. :S�uch signed fracn�s trtust.
be 3nalc evadable for inspection, during the license holds rs norir7al busitacss hours upon rezluest:
of an agent of the Board of 14ealth.
c. All .distributors/fetailers of tobacco products. or.tobacco merchandise must require that, if a
customer appears to p6ssibly be under 25 Yeats of age,.th.:customer present a valid State issued
pictttfe identili.cadon card .or drivers license with appropriate photograph :tp contirrn that .the
cust:otner`is of le al a e to put6as6 the.Wbaoco. roduet.
The following:etnplvyee(s) received and understood Sections Vilb. and V7Ic. of the Barnstai i..e Board of
Health Prohibition of Smoking Regulation and Chapter 270 Section.6:of.:the.Massachusetts General Laws:
Signature Printed Nar ne gate
`�
S gna:ure Printed Name Date
Si afore Printed-Name ,Date
ease I
Sig ire Pffitted:Name Date
Signature Printed Nafir��
Signature Printed Name Date
Signature Printed Name Date
C?vttipJJ.Cj6on Fa.nm',T0 APP.D0C
o� Town of Barnstable
snRrrsr,►st,e.
9$ AM Board of Health
QED MAt p 200 Main Street,Hyannis MA 02601
Office: 508-862-4644 John T.Norman
FAX: 508-790-6304 Donald A.Guadagnoli,M.D.
F.E.(Thomas)Lee,P.E.
Daniel Luczkow,M.D.,Alternate
August 20, 2021
Nilesh Patel
Hyannis Package Store
775 Main Street
Hyannis, MA 02601
Email: nildip27@gmail.com
NOTICE OF SHOW CAUSE HEARING
Violation visit: # 1000527
On 08/02/2021, flavored.products or flavor enhancers (including mint/menthol flavors)
sold.
According to State of MA Tobacco regulations, "any proprietor(s) or other person(s) ...
who fail(s) to comply with these regulations shall be subject to the following actions for
each offense: A fine of$1,000.00 for the first offense.
You are hereby notified to appear before the Board of Health on Tuesday, September 28,
2021 at 3:00 pm to show-cause why your tobacco sales permit should not be suspended
and to discuss any future plans you may have to comply with this regulation. The hearing
will be held in the Town Hall, James H. Crocker,Jr. Hearing Room,367 Main Street,
Hyannis, Massachusetts.
PER ORDER OF THE BOARD OF HEALTH
Thomas A. McKean, RS, CHO
Director of Public Health
Q:\Order letters\Tobacco\Tobacco Viol.Hear Rev BOH 09-28-21 Hy Package Store.docx
P
P 0 �T ®�COUNTER
��TOOLS
POINT Of SALE TOOLKIT "1Q-06F0
Violation visit #1000527 summary:
Retailer info:
• Retailer name: hyannis package store
• Address line 1: 775 Main St
• Address line 2:
• City, State: Barnstable, MA
• Zip: 02601-4327
Submission info:
• Survey Submitted Date: Aug 02, 2021
• Survey Submitted Time: 10:45:18 AM EDT (UTC
+0400)
• Visit Completed By: Bob Collett (# 821)
Visit info:
• If violations were found, check all that apply:
Flavored products or flavor enhancers (including
mint/menthol flavors) sold, M4ssiag sigftftge
• Specify other violation:
• What action was taken? Check all that apply
Referral given to another agency (e.g.
Department of Revenue, Attorney General's office,
local Board of Health)
• Specify other fine:
• Employee/merchant name:
• Employee/merchant title:
• Enter field notes Black and Mild cigarillos for sale
(flavored product)
Visit link: http s://mass.countertools.or org/education//1000527
PDF generated on: Aug. 2, 2021
Town of Barnstable
Board of Health
200 Main Street, Hyannis MA 02601
BARNSTABLE.
v mass.
�ptFO MA'I�
John T.Norman,Chair
Office:508-862-4644 Donald A.Guadagnoli,M.D
FAX: 508-790-6304 F.P.(Thomas)Lee,P.E.
Daniel Luczkow,M.D,Alternate
BOARD OF HEALTH MEETING MINUTES Original 9/23/21, 1:35 pm
Tuesday, September 28, 2021 3:00 PM
James H. Crocker Jr. Hearing Room, Town Hall
367 Main Street, 2"d Floor, Hyannis, MA
A regularly scheduled and duly posted meeting of the Barnstable Board of Health was held on Tuesday,September 28,2021.
The meeting was called to order at 3:00 pm by John Norman,Chair. Also in attendance were Board Members Donald
Guadagnoli,Vice Chair,Thomas Lee,and Daniel Luczkow,M.D.,Alternate. Thomas McKean,Director of Public Health,
and Sharon Crocker,Administrative Assistant,were also present.
I. Tobacco Violations:
A. Nilesh Patel, Hyannis Package Store —775 Main Street, Hyannis, tobacco violation
Mr. Patel was present and explained there were two menthol cigars purchased prior to the change
in regulations which an employee was to purchase and bring home. He admitted it was still on
the shelf.
Bob Collette, Barnstable County Tobacco Enforcement Officer stated the State of MA imposes the
issuance of their fines in cases of menthol sales and stated all vendors had ample notice.
Upon a motion duly made and seconded, with the acknowledgement of admission of violation, the
Board voted to assess the appropriate fine of$1,000 for the first State offense. (Unanimously,
voted in favor.)
B. Asim Jamal, Mini Food Mart—252 Main Street, Hyannis, tobacco violation
Asim Jamal was present and stated an employee forgot to relock the cigar humidor.
Bob Collette stated this violation falls under the local tobacco code and, thus, would be subject to
the local regulation's fine— not the State.
Dr. Guadagnoli stated with the past two years of hardship during Covid , he would be willing to
reconsider the local regulations fines for tobacco at a future date.
Upon a motion duly made and seconded, the Board voted to assess the appropriate local fine of
$100. (Unanimously, voted in favor.)
II. Variances —Septic:
A. Daniel Ojala, Down Cape Engineering, representing Merrill Davis, owner—660 Main
Street, West Barnstable, Map/Parcel 156-011, 45,000 square feet parcel, requesting
three variances and a pump chamber.
Page 1 of 5 BOH 09/28/2021
a
Mr. Ojala presented the septic plan and had a revised plan showing a filter for outlet on tank.
Mr. Norman said that outlet will require cover to grade so the owner can service the filter.
Mr. McKean brought up that the staff would like something from Brian Dudley if engineer wanted
to use 3 feet separation without an Innovative/Alternative (I/A) system.
Mr. Norman and Mr. Lee stated they would prefer the four foot separation as the perch level is
constantly shifting and the effluent may go into the perched area and run into wetlands. They
agreed it does not call for a strip-out.
Upon a motion duly made by Dr. Guadagnoli, and seconded by Mr. Lee, the Board voted to grant
the variances as presented with the following conditions: 1) a 2-bedroom deed restriction is
required, 2) revise plan with a four foot separation from system to groundwater which includes
3.1 naturally occurring pervious material and the system will have an approximate one foot
mound, 3) remove variance for 15.415 of separation to groundwater, 4) add sieve analysis, and
5) filter cover to grade so serviceable. (Unanimously, voted in favor.)
B. John O'Dea, Sullivan Engineering, representing Hard-A-Lee, Inc, owner— 299 Eel River
Road, Osterville, Map/Parcel 115-003 1.06 acre parcel, requesting three variances from
coastal bank.
John O'Dea was present and discussed plan.
Mr. McKean said the staff had no objections and mentioned the test hole done on August 27,
2021 should be included in the plan. Mr. O'Dea said he will adjust the plan.
Upon a motion duly made by Mr. Lee, seconded by Dr. Guadagnoli, the Board voted to grant the
variances as submitted. (Unanimously, voted in favor.)
III. Innovative/Alternative (I/A) — Septic (NitROE):
A. Daniel Ojala, Down Cape Engineering, representing Matthew MacKinnon, Trustee — 33
Oyster Place Road, Cotuit, Map/Parcel 035-101, 14,571 square feet parcel, proposed
using the NitROE innovative alternative septic system, requesting six variances.
Mr. Ojala was present and discussed plan proposed.
Upon a motion duly made and seconded, the Board voted to grant the I/A system and variances
with the following conditions: 1) Health staff must verify a four bedroom permit exists and 2) plan
needs to show water line. (Unanimously, voted in favor.)
B. Daniel Ojala, Down Cape Engineering, representing Donald MacKinnon, Trustee— 910
Main Street, Cotuit, Map/Parcel 035-090, 30,443 square feet parcel, proposed using the
NitROE innovative alternative septic system, requesting two variances.
Mr. Ojala and Mr. D.J. MacKinnon were present.
Upon a motion duly made and seconded, the Board voted to grant the variances as presented,
with no conditions. (Unanimously, voted in favor.)
Page 2 of 5 BOH 09/28/2021
C. Joseph Henderson and Mark Nelson, Horsley Witten Group, representing 2 owners,
requesting septic variances using the NitROE innovative alternative (I/A) septic system:
1. Mary and Dennis Healy, owners —26 Barberry Lane, Marstons Mills, Map/Parcel
102-145, 0.21 acre parcel, requesting three variances.
Mr. Henderson and Mr. Nelson presented the proposed plan.
Upon a motion duly made and seconded, the Board voted to grant the use of the NitROE I/A
System and the three variances with the following conditions on a revised plan: 1) show the test
pit log on plan, 2) remove the liner that is around the soil absorption system (SAS), 3) install two
sections of liner— one to protect the water line close to SAS, and one to protect the drainage
area. (Unanimously, voted in favor.)
2. Roger and Celeste Derosier, owners —295 Lakeside Drive, Marstons Mills, Map/Parcel
102-163, 0.23 acre parcel, no variances requested.
Upon a motion duly made and seconded, the Board voted to grant the use of the NitROE I/A
System with the following conditions: the engineer must verify that the storage room is
unfinished. (Unanimously, voted in favor.)
IV. Informal Discussion — Fuii Clean System (Pilot Program):
Brian Braumgaertel, Alternative Septic System Test Center and a representative from Fuji
Clean will have informal discussion on system.
Brian Braumgaertel said the proposed system is similar to the Fuji Pilot Program in how it
addresses reduction in nitrogen and the FujiClean is also designed to help reduce phosphates
and would be interested in putting a system in at 125 Blantyre Avenue, Centerville. He is
submitting to the State for consideration and the State would like to know whether the Board of
Health would consider the product before going further with application for a pilot program.
V. Sewer Connection — Exempt:
William Swift, owner— 32 Bow Lane, Barnstable, Map/Parcel 299-049-001, 86,472
square feet parcel, requesting an exemption from connecting to town sewer due to
difficulty connecting with natural obstacles.
Mr. Swift stated he spoke with an engineer and the cost to connect to sewer due to difficult
obstacles along with the connection of water which the water company told him would require
digging under the drainage ditch and would require a new 8" main with an estimated cost of$40-
50K. It currently has a 2" main put in around 1930-1940s. That cost was estimated at $40-50K.
It is his understanding that to be connected to town sewer; he must also be connected to public
water and is, thus, looking for an exemption.
Mr. Norman stated this is a vacant piece of land in a nitrogen sensitive area and sewer has been
available since 1975. The connection to sewer cost should have been factored into the cost of
building home. It is not required to be hooked up to water in order to hook up to sewer. Mr.
Norman stated that owners are not required to connect to public water in order to connect to
sewer. Therefore, the additional cost to put in the water main should not factor in. The property
can have well water.
Page 3 of 5 BOH 09/28/2021
The Board expressed confusion and wondered whether the builder was actually issued a
building permit for the home without a septic permit in hand. The builder was not in attendance.
John Norman asked Tom McKean to obtain a copy of the building permit and septic permit, if
applicable, prior to the next meeting.
Upon a motion duly made and seconded, the Board voted to continue this to the next meeting,
October 26, 2021.. (Unanimously, voted in favor.)
VI. Bedroom Count Determination:
Attorney Jeffery Johnson representing Robin Kroopnick, owner— 175 Scudder
Avenue, Hyannis, Map/Parcel 289-167, requesting a determination as a four-
bedroom.
Attorney Johnson along with Robin Kroopnick and her brother, Jonathan Rosen, were
present. He stated the original purchase paper did state it was a four bedroom and field
card showed in 1988 Assessor's visited house and identified as four bedroom home.
Upon a motion duly made by Mr. Lee, seconded by Dr. Guadagnoli, the Board voted to
approve as a four-bedroom dwelling with the following conditions: 1) the septic plan will
be redesigned to include a denitrification system with a monitoring plan of quarterly
monitoring/year for a minimum of two years, at which time the Board may review for a
reduction, and 2) the permit may be approved by staff at the Health counter.
(Unanimously, voted in favor.)
VII. Hearing: Uninhabitable
Audrey and Miguel Gomes, owners —42 Tonela Lane, Barnstable, Map/Parcel 336-066,
Their MicroFast Innovative/Alternative (I/A) Septic System has not been operating with an
Operation and Maintenance (O&M) contract in effect.
Mr. Gomes said he had begun using a contractor; however, the contractor has not been
responding to owner and has not cashed his payment.
The Board instructed him to seek out other contractors and begin testing so the system may be
evaluated.
Mr. Gomes also mentioned his pump broke two weeks ago and expects it may take time to get a
replacement due to supply chain. He inquired into how many tests/year may be required. Mr.
Norman suggested to let a contractor know the initial test will be required and depending upon
results, testing may be required once a year or up to four times a year.
Upon a motion duly made by Dr. Guadagnoli, seconded by Mr. Lee, the Board voted to continue
this item for one month to October 26, 2021 to see any progress and if contract in hand, will
await first test results. (Unanimously, voted in favor.)
• Board member Tom Lee recused himself from the next item and will not be returning.
VIII. Food —Variance (Grease Trap):
Page 4 of 5 BOH 09/28/2021
Dan O'Rourke, Jr., owner, Jake's Clambakes —3821 Falmouth Rd, Windmill Square, Unit#
6, Marstons Mills, Map/Parcel 057-004, requesting a grease trap variance.
Dan O'Rourke expressed that there will not be any tables. His main business is catering, along
with some pickup and deliveries. He is planning to purchase the Big Dipper from his prior
landlord and install at this location. The property is on a septic system; not on sewer.
Mr. McKean said the staff felt the menu, including the Italian sausage, was extensive the Italian
sausage. Big Dipper Grease Recovery Device should be fine with proper maintenance and
ensuring it is plugged in.
Upon a motion duly made by Dr. Guadagnoli, seconded by Dr. Luczkow, the Board voted to
grant the grease trap variance with the use of the Big Dipper grease recovery device.
(Unanimously, voted in favor.)
IX. Body Artist (New):
Sorivel Rosario, West Yarmouth, MA, is applying to L'Atelier Permanent Makeup, 8 West
Bay Road, Osterville, is requesting a variance from the N.E. accredited college course of
Anatomy and Physiology course, has completed the Anatomy, Physiology and Skin Course
for Body Art Practitioners" course through "Save Each Life ".
Sorivel Rosario was present, submitted all necessary documents, and is looking forward to
training at L'Atelier Permanent Makeup.
Mr. McKean stated her application was all set and he had no issue.
Upon a motion duly made by Dr. Guadagnoli, seconded by Dr. Luczkow, the Board voted to
approve the variance for Body Artist Sorivel Rosario. (Unanimously voted in favor.)
X. MINUTES:
Voted to continue the Minutes to October 24, 2021 meeting.
VOTED TO ADJOURN — 5:50pm
Notice of Recording• This meeting of the Board of Health will be recorded and transmitted by the Information
Technology Department of the Town of Barnstable on Channel 18. Under MGL Chapter 30A Section 20, anyone
else desiring to make such a recording or transmission must note the Chair.
Page 5 of 5 BOH 09/28/2021
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OR YOU HAVE THE FOLLOWING ALTERNATIVES WITH REGARD TO DISPOSITION OF THIS MATTER.EITHER OPTION(1)OR OPTION(2)WILL OPERATE AS A FINAL a
DISPOSITION WITH NO RESULTING CRIMINAL RECORD. Lu
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REGULATION (1)You may elect to pay the above fine,either by appearing in person between 8:30 A.M.and 4:00 P.M.,Monday through Friday,legal holidays excepted, IQ
before:The Barnstable Clerk,200 Main Street,Hyannis,MA 02601,or by mailing a check,money order or postal note to Barnstable Clerk,P.O.Box 2430, a
Hyannis,MA 02601,WITHIN TWENTY-ONE(21)DAYS OF THE DATE OF THIS NOTICE.
(2)If you desire to contest this matter in a noncriminal proceeding,you may do so by making written request to DISTRICT COURT DEPARTMENT,FIRST
BARNSTABLE DIVISION,COURT COMPOUND,MAIN STREET,BARNSTABLE,MA 02630,Attn:21 D Noncriminal Hearings and enclose a copy of this
citation for a hearing.
(3)If you fail to pay the above offense or to request a hearing within 21 days,or if you fail to appear for the hearing or to pay any fine determined at the
hearing to be due,criminal complaint may be issued against you.
❑ 1 HEREBY ELECT the first option above,confess to the offense charged,and enclose payment in the amount of$
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M" before.The Barnstable Clerk,'200 Maln Streat;Y ann s MA 0260A;or byy malllhg a check,'rhone o'er or ay ys
Hyannls,•MA OQ91;.1NITI'IN,TWENTYONE(21)DAYS OF ND TF1IS NOTICE: p� postal note t�Bamstable Clerli PO:Bbx 2430,
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� d 2 If, ou,desire to.contest thismatter m a.noncrimirial.proceeding,.:oo ma do,so by making wMttenrequest to DISTRICT xew�
It ° "� y yy yy COIJRTDEPARTMENT,,FIRSTM , ' ':r
> ' i f"ram. r v}, RN ldr;d E DIVISION COURT COMPOUND,MAIN STREET:BARNSTABLE MA 02630 Attn 21,D Noncriminal Hearin and enclose a copy of this "t
�, 0 3 :citation for a hearing,' r' ., t-
bpi (3)If you;fail to pay the above,offense onto-request e:headng wittiih 21 days.or If you fall'to appeArfor,the hearirig or tq'pay any fine:date ihed at the r c+M�sx�J, 3� �,t� heanng to'be due criminal complaint may be issued against you _ �• a a a t '
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Town of Barnstable 014
4 MMSTARM
MA ' Board of Health
1 ° 200 Main Street,Hyannis MA 02601
Office: 508-862-4644 John T.Norman
FAX: 508-790-6304 Donald A.Guadagnoli,M.D.
F.E.(Thomas)Lee,P.E.
Daniel Luczkow,M.D.,Alternate
August 20, 2021
Nilesh Patel
Hyannis Package Store
775 Main Street
Hyannis, MA 02601
Email: nildip27@gmail.wm
NOTICE OF SHOW CAUSE HEARING
Violation visit: # 1000527
On 08/02/2021, flavored products or flavor enhancers (including mint/menthol flavors)
sold.
According to State of MA Tobacco regulations, "any proprietor(s) or other person(s) ...
who fail(s) to comply with these regulations shall be subject to the following actions for
each offense: A fine of$1,000.00 for the first offense.
You are hereby notified to appear before the Board of Health on Tuesday, September 28,
2021 at 3:00 pm to show-cause why your tobacco sales permit should not be suspended
and to discuss any future plans you may have to comply with this regulation. The hearing
will be held in the Town Hall, James H. Crocker,Jr. Hearing Room,367 Main Street,
Hyannis, Massachusetts.
PER ORDER OF THE BOARD OF HEALTH
Thomas A. McKean, RS, CHO
Director of Public Health
Q:\Order letters\Tobacco\Tobacco Viol.Hear Rev BOH 09-28-21 Hy Package Store.docx
I P
P 0 S T ®®T o UN TER
0 S
POINT OF SALE TOOLKIT ®APIUMPUCE
"M
Violation visit #1000527 summary:
Retailer info:
• Retailer name: hyannis package store
• Address line 1: 775 Main St
• Address line 2:
• City, State: Barnstable, MA
• Zip: 02601-4327
Submission info:
• Survey Submitted Date: Aug 02, 2021
• Survey Submitted Time: 10:45:18 AM EDT (UTC
+0400)
• Visit Completed By: Bob Collett (# 821)
Visit info:
• If violations were found, check all that apply:
Flavored products or flavor enhancers (including
mint/menthol flavors) sold, A4&sing sigftage
• Specify other violation: '
• What action was taken? Check all that apply
Referral given to another agency (e.g.
Department of Revenue, Attorney General's office,
local Board of Health)
• Specify other fine:
• Employee/merchant name:
• Employee/merchant title:
• Enter field notes Black and Mild cigarillos for sale
(flavored product)
Visit link: https:/lmass.countertools.orcf/education/1000527
PDF generated on: Aug. 2, 2021
TOWN OF BARNSTABLE BAR_W 4249
Ordinance or Regulation
WARNING NOTICE
Name of Offender/Manager �10f-KJA G tt)Aer
Address of Offender MV/MB Reg.#
Village/State/Zip
Business Name 4waft#i1s. �e%cwagc am/pm, on�._ _n 20.L3
Business Addressci� '}CQQ
Signa ru e.of Enforcing Officer
Village/State/Zip 02f"o 1
Location of Offense T145 AVIA � �6a Rs, �M N _ [tJl_W`.G.
f r * kil
i Enforcing�D^,ept/Division
Offenses C+01 Z11
Facts til�((O t.a3&___, _4SOU �VO 0 MAOr �c� lX*cSOr 4-)h3 WaN (APJCr hoe .sac.
0( 18� 6A d 150n 41?1%IP)04A a1 W,nut She
This will Fserve) only as a warn ng.1 At this-time no legal action has been taken.
It is the goal of Town agencies to.- achieve voluntary compliance of Town
Ordinances, Rules and Regulations. Education efforts and warning notices are
attempts to gain voluntary compliance. Subsequent violations will result in
appropriate legal action by the Town.
WHITE-OFFENDER CANARY-ORD./REG.-PROG. PINK-ENFORCING OFFICER GOLD-ENFORCING DEPT.
►" •TOWN OF BARNSTABLE 1:. '_ 0
BAR-W {
Ordinance or Regulation
WARNING NOTICE
Name of Offender/Manager t^s `;- , , tb)
, ' Address of Offender MV/MB Reg.#
Village/State/Zip
`Business Name t�4 n+'?�.. �6(4"afot rCa am' nN on',14rr ..?s 201Z
Business Address " ; # _
Signat"tre .of Enforcing Officer
Village/State/Zip
trrsnt
Location of Offense ''? �rn t . ,y . M(\ A_W-,C_ 64
�^ -j Enforcing Dept/Division
Offensee- -, ,rL ""'`` ;. � ► �;i � ta�J�► C �'h�> & lam:# .
Facts . c:r 0*%0 it,1::;% tAr+, er ��� �r"'�c.
1
�� t� 1 tit --'. �'i;'�i�z'3n �'t`� �� �+n,t-��i` --�1 �!►:�t.rf ��7'`#'C'
This 'Will -serve]only' as a warning:-I At this -time no legal action has been taken.
It is the goal of Town agencies to achieve voluntary compliance of Town
Ordinances, Rules and Regulations. Education efforts and warning notices are
attempts to gain voluntary compliance. Subsequent violations will result in
appropriate legal action by the Town.
WHITE-OFFENDER CANARY-ORD.IREG.-PROG. PINK-ENFORCING OFFICER GOLD-ENFORCING DEPT.
Town of Barnstable i
oFTHE 1p� Regulatory Services
Barnstable
Thomas F. Geiler, Director Ail-America Chy
µ > MASS. * Public Health Division I '
9�A i6;q. A�0 Thomas McKean,Director 2007
lFD Mp'l
200 Main Street
Hyannis, MA 02601
Office: 508-862-4644 Fax: 508-790-6304
July 2, 2013
Hyannis Package Store
Donald Burch,owner
775 Main Street
Hyannis, MA 02601
NOTICE OF SHOW CAUSE HEARING
On 06/21/13, cigarettes were sold to a minor(a person who was under the age of 18 years) by a
person employed at your store.
According to Section 371-7(B) of the Town of Barnstable Code,no person, firm, corporation,
establishment, or agency shall see tobacco products to a minor. According to Section 371-8 of
the Town of Barnstable Code, "any proprietor(s) or other person(s) ... who fail(s)to comply
with these regulations shall be subject to the following actions for each offense: A warning
shall be issued for the first offense. A fine of$100 may be issued for the second offense, $200
for the third offense, $300 for the fourth offense, and $300 for any subsequent offense.
You are hereby notified to appear before the Board of Health on Tuesday, July 9, 2013, at
3:00 pm to showy-cause why your tobacco sales permit should not be suspended and to discuss
any future plans you may have to comply with this regulation. The hearing will be held in the
Town Hall;Hearing Room,367 Main Street, Hyannis, Massachusetts.
PER ORDER OF THE BOARD OF HEALTH
Thomas A. McKean, RS, CHO t
Director of Public Health
QATOBACCOMP Files\tobacco hearing letter Hy Package St M2013.DOC
w I
MTCP ID: Tobacco Compliance _
p Check Form . 2011 2012
Section 1•
Establishment Survey.Participants
Name:_ �l/9N/V 1-!r P/9�/�/� ,�+{�. srno/ C T
/y ID of Purchaser;
Address: �` !-r ��7 ��✓ (-P I- Age:C3 15 1 _ 17
Sex:O Male�Female
v / Name of Adult Supervisor:
City: �y/9/✓n// Zip Code: �� I
Time of Check: .S'�� O� am 0 p�
Type of Establishment: 13 Chain 0 Independent Not Known Date of Check: el,;
Day of the VVO Mon O Tues 0 Wed
0 Thurs W Fri 0 Sat 0 Sun
Style of Establishment(Check Only One):
13 "Convenience Store 13 Groc Store 13 Bar
C 1 Department Store Liquor Store 0 Private Club MW,Le'onetc.
0 Gas Station Onl C7 Pharma Store 0 Restaurant
0 Gas Mini-Mart 0 Other(bowliM all ,.golfclub etc. 0 Tobacconist
Section 2:
Was Compliance Check completed?Yqs. NO 13
VYes please eonliiraue onto the next question,JfNo please slap this section amigo to section 3.
How was tobacco marketed?
Over-the-counter youth asks the clerk for the product.
From a vending machine Milk a lockout device.
1] Other'
Describe: QZIE
; --;
Was the Purebaser.asked for ID? Yes 17 No,V Was this an Wbawd check? Yes 0,140
Was the Purchaser Asked his/her age? Yes 13 N�Ak--" C�"
Sex of Clerk: Mal Female C7 Approximate age of clerk:0 Teen. Young Adult 0 Adult 0 OIde r Adult
Type of tobacco asked for: Cigarettes Brand of cigarettes asked for: Marlboro C7 Newport) 0 Othei:_
C] Chew/Dip D Cigars 0 Other Brand: wl '
Was the sale made? Yes No C3 ♦ C) r"
If"Yes"how much did the product cost: $ Was a receipt given?Yes 0 No 'I
Purchaser made payment using:Ca$1 bills 0 $3 bill(s)0 $S bill and$I bills/or change $10 bill(s) 0 $20 bill 0 change
Section 3:
N the youth did not enter the premises or did not attempt to purchase tobacco products.please indicate why:
:0 Out of Business 11 Temp.-19491 terra closure Q. In operation,closed at time of visit 0 Drive thru only
13 Does not sell tobacco 0 Unlocatable O Unsafe to access 0 -Tobacco out of stock.
0 Inaccessible b X24 0 Wholesale only/cartons O Presence of police a permit Sus ed
vote clut9personat U mactune brolm A 7MMm—eCtDX KnOWS s 'e n
residence 0 "Don't sell"but tobacco seers in
store/has R nn�111A00*)A1j R11
.�
1 IV
r
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OFFICE OF THE BOARD OF HEALTH
BAHI TABLE, o OF THE
i 9p0A �639,
Tfnmnce.• TOWN OF BARNSTABLE, MASS.
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S WAGE DISPOSAL PERMIT
Permission is granted to ___ to construct ________ _ __________________'
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Upon the Premises of "C. €"�{ ?-�-�-�---
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In the vill, g/f
100 or me r eet from any source of water supply
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20 feet from building
10 feet from property line
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Health fficer.