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CHICK-FIL-A - FOOD
CHICK-FIL-A 104(155)Enter rise Rci Hy� 'aye pi 4.y I �c fNF T Town of Barnstable BOARD OF HEALTH John T.Norman Board of Health Donald A.Gaudagnoli,M.D. BA&NSTABLL '' F.P.(Thomas)Lee,. xA, 200 Main Street, Hyannis, MA 02601 Daniel Luczkow,M.D. Alt. Jq'ga a. 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: 1068 Issue Date: 01/01/2022 DBA: CHICK-FIL-A OWNER: ANNEMARIE REISSNER Location of Establishment: 155 ENTERPRISE ROAD HYANNIS„ MA 02601 Type of Business Permit: FOOD SERVICE Annual: YES Seasonal: IndoorSeating: 124 OutdoorSeating: 30 Total Seating: 154 FEES FOOD SERVICE ESTABLISHMENT: $300.00 YEAR. 2022 RETAIL FOOD: COTTAGE FOOD OPERATION: Permit Expires: 12/31/2022 B&B-FULL BREAKFAST: CONTINENTAL BREAKFAST: MOBILE-FOOD: MOBILE-ICE CREAM: Q� FROZEN DESSERT: $30.00 Thomas A. McKean, RS, CHO, Health Agent FOR ESTABLISHMENTS WITH SEATING: PERMIT IS NOT VALID UNLESS ISSUED IN CONJUNCTION WITH A COMMON VICTUALER LICENSE Restrictions: Total Seats 154, Grease trap allows 166. Licensing allows 156 maximum. f� Initials: Town of Barnstable 1i Date Paid Amt Pd$ � BtJWSTABM * Inspectional Services 16 9.9.p`�� Public Health Division Check#o3� �� -� LO II f0 MAr 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: Chl C-1�.. fi 1 A C n P:�= W C� ADDRESS OF FOOD ESTABLISHMENT: `, )5 (-Aons-e— YZd , r) G2-(oo MAILING ADDRESS(IF DIFFERENT FROM ABOVE): E-MAIL ADDRESS: O,-nn e-mor%e- • re t SSr-)er a TELEPHONE NUMBER OF FOOD ESTABLISHMENT: (4PS--3 TOTAL NUMBER OF BATHROOMS: WELL WATER: YES No ... (ANNUAL WATER ANALYSIS REQUIRED) ANNUAL:_ SEASONAL: DATES OF OPERATION: / / TO NUMBER OF SEATS: INSIDEP-(-A OUTSIDE: 60 TOTAL: 15 SEATING: MUST OBTAIN A COMMON VICTUALLER'S LICENSE FROM LICENSING DIV. j ***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? O IS AN AIR CURTAIN PROVIDED AT WAITSTAFF SERVICE DOOR(S)? Ve s TYPE OF ESTABLISHMENT: (PLEASE CHECK ALL THAT APPLY BELOW) FOOD SERVICE RETAIL FOOD-ONLY required for TCS foods(foods requiring refrigeration/freezer) BED&BREAKFAST CONTINENTAL BREAKFAST COTTAGE FOOD INDUSTRY(formerly residential kitchen) MOBILE FOOD FROZEN DAIRY DESSERT MACHINES ... (MONTHLY LAB ANALYSIS REQUIRED) CATERING ... (CATERING NOTICE REQUIRED BEFORE EVENT(SEE PAGE#2) *** SEASONAL,MOBILE & NEW FOOD ONLY*** REQUIRED TO CALL HEALTH DIV.FOR INSPECTION PRIOR TO PERMIT BEING ISSUED PLEASE CALL 508-862-4644 Q:\Application FormsTOODAPP 2020.doc r OWNER INFORMATION: FULL NAME OF APPLICANT- SOLE OWNE;1� NO D.O.B OWNER PHONE # 56 6�i- ®� ADDRESS l Sborc.,N CA S4/yd uj�C__k mk o. ! '�o3—,/ CORPORATE OWNER: CORPORATE ADDRESS: PERSON IN CHARGE OF DAILY OPERATIONS: B t.,onaf e. et- 1 SS.nQ� List(2) Certified Food Protection Managers AND at least (1) Allergen Awareness Certified Staff All FOOD ESTABLISHMENTS must have I 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 pr,-�Iey ,,kr!cS �7_ `� 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 htti)://www.townofbarnstable.us/healthdivision/applications.asi). OUTDOOR COOKING: Outdoor cooking,preparation,or display of any food product by a food establishment is prohibited. NOTICE: Permits run annually from January 1 st to Dec. 3151 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 / r pp THE TOWN TOWN OF BARNSTABLE - HEALTH INSPECTOR'S Establishment Name: Date: ? / Page: of. OFFICE HOURS T' 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 9�A ,639.a�0� HYANNIS,MA 02601 M-8 -FRI. No Reference R-Red Item PLEASE PRINT CLEARLY rEo Mai 508-862�644 FOOD ESTABLISHMENT INSPECTION REPORT Name Dated Tvoe of Tyne of Insuection O ration Address >>`� Risk Re-inspection t5k��qe Level Retail Previous Inspection I l Telephone Residential Kitchen Date: Mobile Pre-operation Owner HACCP Y/N Temporary Suspect Illness Caterer General Complaint Person in Charge(PIC) Time Bed&Breakfast HACCP In: Other Inspecto 5 Out: t 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 v i� ❑ 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 SP s) ///��� ❑ 10.Proper Adequate Handwashing CONSUMER ADVISORY ❑ 11.Good Hygienic Practices ❑22.Posting of Consumer Advisorie Violations Related to Good Retail Practices(Blue Item Total Number of Critical Violations 20/0' Critical(C)violations marked must be corrected immediately. (blue&red items) � 1Corrective Action Required: o ❑ 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 it ms ❑ 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. 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 b this order,you have a right to a hearing. Your request must C=2 critical violations and less than 9 non-critical. If If critical water,sewage back-up,infestation of rodents or insects,or lack of y y )( ) y y g g' q violations observed,7 to 8rion-critical violations. If 1 critical refrigeration. 28.Poisonou 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 n tical violations=C. 29.Special quirements (590.009) within 10 days of receipt of this order. 30.Other DATE OF RE-INSPECTION: Inspe o ' ign re 31.Du{np er screened from public view j Permit Posted? 1 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 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 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* 3-501.16(A) Hot PHFs Maintained At or Above 140°F 7-102.11 Common Name-Working Containers* Require Reporting by Food Employees and Contamination from the Environment 3-501.16(A) Roasts Held At or Above 130°F* * 7-201.11 Separation-Storage* Applicants 3-302.11(A) Food Protection* 20 Time as a Public Health Control 590.003(F) Responsibility of A Food Employee or An 3-302.15 Washing Fruits and Vegetables 7-202.11 Restriction-Presence and Use* 3-501.19 Time as a Public Health Control* - Applicant To Report To The Person In Charge* 7.202.12 Conditions of Use* 590.004 Variance Requirements * 3-304.11 Food Contact with Equipment and Utensils* 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 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 * 4-501.111 Manual Wazewashing-Hot Water 7.206.12 Rodent Bait Stations 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* 3-401.11 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,Meals&Game Pathogens* effeai�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 Sanitization 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 Equipmm ent* 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 8 � 590.009(A)-(D) Violations of Section 590.009(A)-(D)in cater- Sources* ing,mobile food,temporary and residential 10 Proper,Adequate Handwashing Ratites-165°F 15 sec*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* foodborne illness interventions and risk factors. 590.004(C) Wild Mushrooms* 2-301.14 When to Wash* 3-401.11(A)(1)(b) All Other PHFs-145°F 15 sec* Other 590.009 violations relating to good retail 3-201.17 Game Animals* 11 Good Hygienic Practices 17 Reheating for Hot Holding practices should be debited under#29-Special Requirements. 5 Receiving/Condition 2-401.11 Eating,Drinking or Using Tobacco* 3-403.11(A)&(D) PHFs 165°F 15 sec* 3-202.11 PHF's Received at Proper Temperatures* 2-401.12 Discharges From the Eyes,Nose and Mouth* 3-403.11(B) Microwave-165°F 2 Minute Standing Time* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES * 3-301.12 Preventing Contamination When Tasting* 3-403.11 C Commercially Processed RTE Food-140°F* (Blue Items 23-30) 3-202.15 Package Integrity ( ) 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 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 5-204.11 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 P 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 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. t oFt�rok, TOWN OF BARNSTABLE HEALTH INSPECTOR•s Establishment Name: Gh GGC � � Date: /66 l?- M Page: of c OFFICE HOURS PUBLIC HEALTH DIVISION 6:00-9s0A.M. BARNSTABLE. • 200 MAIN STREET s:so-a:so P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified �p MASS.a. HYANNIS,MA 02601 MON.-FRI. No Reference R-Red Item PLEASE PRINT CLEARLY ,FD MAr 508-862-4644 FOOD ESTABLISHMENT INSPECTION REPORT NO}( Name Gh"a< �- t / +� Date ►!/fib/ IN 1Le of n s T of I s e ti n -V/alk /�® .Q�IS routine Address i5� �� � r;� (d �pu� Risk od Service Previous IRe-melTectnon spection J Level Re P /► Telephone Residential Kitchen Date: VJu Mobile Pre-operation Owner HACCP YIN Temporary Suspect Illness t)(4 o ca b;tx - LJ Caterer General Complaint Person in Charge(PIC yy C,y_' e T e Bed&Breakfast HACCP - } a 0 1 ota • l�Q 1 SS Ir Other _ Fr b Inspector C1 Out: ?fir" O 0 J�C n Ui' s - 3- -sin Lc -1I�► 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 t ( ) Anti-Choking 590.009(E)_❑ ./ c� Violations marked may pose an imminent health hazard and require immediate corrective Tobacco 590.009(F) ❑ / La to✓'� Se✓ Action as determined by the Board of Health. Allergen Awareness 590.009(G) ❑ S .n V _ ',06 grill- 1(,0, FOOD PROTECTION MANAGEMENT ❑ 12.Prevention of Contamination from Hands fi - vo �0 ❑ 1.PIC Assigned/Knowledgeable/Duties ❑ 13.Handwash Facilities #� EMPLOYEE HEALTH PROTECTION FROM CHEMICALS (i fs el'-b a ❑ 2.Reporting of Diseases by Food Employees and PIC ❑ 14.Approved Food or Color Additives _ rnG(�h�t ❑ 3.Personnel with Infectious Restricted/Excluded ❑ 15. Toxic Chemicals r ' (j FOOD FROM APPROVED SOURCE TIME/TEMPERATURE CONTROLS(Potentially Hazardous Foods) (c f 1%ll�yl0�S ❑4.Food and Water from Approved Source ❑ 16.Cooking Temperatures - ra J l'` ❑ 5.Receiving/Condition ❑ 17.Reheating Ptrth I f s ❑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 -T-a - ❑ 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: M No ❑ Yes Non-critical(N)violations must be corrected immediately or Overall Rating r� 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 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. 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 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. violation,4 to anon-critical violations=C. 29.Special Requirements (590.009) within 10 days of receipt of this order. Inspector's Signature Print: 30.Other DATE OF RE-INSPECTION: 31.Dumpster screened from public view Ja CJKI 9 0 ► F, 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 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* a 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.* 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 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* 3-501.16(A) Hot PHFs Maintained At or Above 140`F 7-102.11 Common Name-Working Containers* Require Reporting by Food Employees and Contamination from the Environment 3-501.16(A) Roasts Held At or Above 130°F* Applicants* 3-302.11(A) Food Protection* 7-201.11 Separation-Storage*g 20 Time as a Public Health Control 590.003(F) Responsibility of A Food Employee or An - 3-302.15 Washing Fruits and Vegetables 7-202.11 Restriction-Presence and Use** 3-501.19 Time as a Public Health Control* ••. Applicant To Report To The Person In Charge* * 7.202.12 Conditions of Use 590.004 11 Variance Requirements 3-304.11 Food Contact with Equipment and Utensils * ( ) 4 590.003(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 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 Hermetical) Sealed Container* Sanitization Temperatures* Raw Seed Sprouts Not Served* Y P 7-206.13 Tracking Powders,Pest Control and 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-Hot Water Monitoring* 3-801.11(C) Unopened Food Package Not Re-Served* 3-202.13 Shell Eggs* Sanitization Temperatures* TIME/TEMPERATURE CONTROLS 3-202.14 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. 16 Proper Cooking Temperatures for PHFs CONSUMER ADVISORY 3-202.16 Ice Made From Potable Drinking Water* Concentration and Hardness* 3-401.11A(l)(2) Eggs-155°F 15 sec 22 3-603.11 Consumer Advisory Posted for Consumption of 4-601.11(A) Clean Utensils and Food Contact Surfaces of Eggs-Immediate Service 145'F 15 sec* Animal Foods That are Raw,Undercooked or 5-]01.11 Drinking Water from an Approved System* gg Equipment* Not Otherwise Processed.to Eliminate 590.006(A) Bottled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* Ef crive/11/2001 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* g g � 590.009(A)-(D) Violations of Section 590.009(A)-(D)in cater- Ratites-165°F 15 sec* Sources* ing,mobile food,temporary and residential 10 Proper,Adequate Handwashing 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 145°F* kitchen operations should be debited under Game and Wild Mushrooms Approved By 2-301.11 Clean Condition-Hands and Arms* Regulatory Authority 3-401.12 Raw Animal Foods Cooked in a Microwave the appropriate sections above if related to 3-202.18 Shellstock Identification Present* 2-301.12 Cleaning Procedure* 165'F* foodbome illness interventions and risk factors. 590.004(C) Wild Mushrooms* 2-301.14 When to Wash* 3-401.11(A)(1)(b) All Other PHFs-145°F 15 sec* Other 590.009 violations relating to good retail 3-201.17 Game Animals* 11 Good Hygienic Practices 17 Reheating for Hot Holding practices should be debited under#29-Special Requirements. 5 Receiving/Condition 2-401.11 Eating,Drinking or Using Tobacco* 3-403.11(A)&(D) PHFs 165°F 15 sec* 3-202.11 PHF's Received at Proper Temperatures* 2-401.12 Discharges From the Eyes,Nose and Mouth* 3-403.11(B) Microwave-165°F 2 Minute Standing Time* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES }s, * 3-301.12 Preventing Contamination When Tasting* 3-403.11 C * (Blue Items 23-30) 3-202.15 Package Integrity ( ) Commercially Processed RTE Food-140'F Critical and non-critical violations,which do not relate to the foodbome * 12 Prevention of Contamination from Hands 3-403.11E Remaining 3-101.11 Food Safe and Unadulterated ( ) g 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* 16 Proper Cooling of PHFs following sections of the Food Code and 105 CMR 590.000 Handwashing Facilities 3-202.18 Shellstock Identification* 13 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 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 1.009 3-502.11 Specialized Processing Methods* 30. Other 3-502.12 Reduced-Oxygen Packaging Criteria* 8-103.12 1 Conformance with Approved Procedures* S: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. ' A�p1MET TOWN OF BARNSTABLE. .HEALTH INSPECTOR'S Establishment Name: �if.I I 61, Date: & Page: of . o OFFICE HOURS PUBLIC HEALTH DIVISION. a:oo-9:30A.M. 200 MAIN STREET 3:30-4:30 P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified MASS, �. MO -464 ,639. �0 HYANNIS, MA 02601 508-862 as4a No Reference R Red Item PLEASE PRINT CLEARLY ""`gyp ( FOOD ESTABLISHMENT INSP TION REPORT Name ✓ Date Tvipe of T Inspection outine Address Risk Food Se pection Level Ret�f Previous Inspection Telephone Residential Kitchen Date: f Mobile Pre-operation Owner HACCP Y/N Temporary Suspect Illness Caterer General Complaint Person in Charge(PICLOV A) Time Bed&Breakfast HACCP b Other Inspector Ou: , i Each viola ion checked requires an explanation on the narrati a page(s)and a citation of specific provision(s)violated. T 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 ` a ❑ 2.Reporting of Diseases by Food Employees and PIC ❑ 14.Approved Food or Color Additives �; Ej 0/6-mugl) ❑ 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 ` Mn El 10.Proper Adequate Handwashing CONSUMER ADVISORY L'� ❑ 11.Good Hygienic Practices ❑ 22.Posting of Consumer Advisories L�V �AAlp 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 I❑ 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 it ms ❑ 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 B=One critical violation and less than non-critical violations 9 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 von-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 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. vio n,4 to 8non-critical vio ionsC. 29.Special Requirements (590.009) within 10 days of receipt of this order. 30.Other DATE OF RE-INSPECTION: Insp is . re P rint: 31.Dumpster screened from public view I / Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y N 1 JJJ #Seats Observed Frozen Dessert Machines: Outside Dining Y N PI 's ig at a 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) dDerronstration 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 EMPLOYEE HEALTH 3-302.11(A)(2) Raw Animal Foods Separated from EachIdentifying * 590.004(F) 7-101.11 Information-Original Containers 2 590.003(C) Responsibility of the Person-in-Charge to Other* 7-10211 Common Name-Workin 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** P g 2Q Time as a Public Health Control * 590.003(F) Responsibility of A Food Employee or An 3-302.15 Washing Fruits and Vegetables 7-202.11 Restriction-Presence and Use* 3-501.19 Time as a Public Health Control* Applicant To Report To The Person In Charge* 7.202.12 Conditions of Use* 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) 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* 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 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* Effective 1112001 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 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* g g � 590.009(A)-(D) Violations of Section 590.009(A)-(D)in cater- Sources* Proper,Adequate Handwashing Ratites-165°F 15 sec* ing,mobile food,temporary and residential 10 3-401.11 C 3 Game and weld Mushrooms Approved By ( )O 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* 4 2-301.14 When to Wash* 3-401.11(A)(1)(b) All Other PHFs-145°F 15 sec* Other 590.009 violations relating to good retail 3-201.17 Game Animals* 11 Good Hygienic Practices 17 Reheating for Hot Holding practices should be debited under#29-Special 2-401.11 Eating,Drinking or Using Tobacco* * Requirements. 5 Receiving/Condition g• g g 3-403.11(A)&(D) PHFs 165°F 15 sec 3-202.11 PHF's Received at Proper Temperatures* 2-401.12 Discharges From the Eyes,Nose and Mouth* 3-403.11(B) Microwave-165°F 2 Minute Standing Time* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES ,. 3-301.12 Preventing Contamination When Tasting* 3-403.11 * (Blue Items 23-30) 3-201.11 Package Integrity (C) Commercially Processed RTE Food-140°F Critical and non-critical violations,which do not relate to the foodborne 3-10 .1 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* 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 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�Yin Provision . Special Requirements .009 3-502.11 Specialized Processing Methods* 30. 1 Other 3-502.12 Reduced-Oxygen Packaging Criteria* _ 8-103.12 I 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. Irl Op THE ro�Y TOWN OF BARNSTABLE. HEALTH INSPECTOR'S Establishment Name: _Date: ;9 Page: of � qo OFFICEE HOURS / BARNSTABLE. PUBLIC 2 0 MAN STREEETSION 3:30-4:30A.M. 3:MON--FP.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified MASS, g• MO8 -FRI. �b bsv .e HYANNIS,MA 02601 508-asz asaa No Reference R.-Red Item PLEASE PRINT CLEARLY 1DrED MP'�p CA OD gSTABLISHMENT INSP C ION REPORT _ _ C_ Name i' Date (� Type of s e tion Routine - Address .Risk Food Servl ectio Level a' - Previous I s e _ Telephone Residential Kitchen Date: Mobile Pre-opera i Owner HACCP Y/N Temporary Suspect III ess Caterer General Complaint Person in Charge(PIC) Time Bed&Breakfast HACCP Other gfcz Inspecto Each violatidh checked requires an explanation on the narrativPagand 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) ❑ I AY 8 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 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 Asa Public Health Control i ❑8.Separation/Segregation/Protection REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) ❑9.Food Contact Surfaces Cleaning and Sanitizing ❑21.Food and Food Preparation for HSP ❑ 10.Proper Adequate Handwashing CONSUMER ADVISORY N ❑ 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) 60 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 B-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 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 )( ) be in writing and submitted to the Board of Health at the above address violations observed,7 to anon-critical iolatio s. If 1 critical refrigeration. 28.Poisonous or Toxic Materials (FC-7 590.008 g vio to 8non-critical violation C. 29.Special Requirements (590.009) within 10 days of receipt of this order. 30.Other DATE OF RE-INSPECTION: Insp t s Si r 31.Dumpster screened from public view i Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y N #Seats Observed Frozen Dessert Machines: Outside Dining Y N nature Print: Self Service Wait Service Provided Grease Trap Size Variance Letter Posted .Y_ N Dumpster Screen? Y N Violations related to Foodborne Illness- - - " Violations Related to Foodborne 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 - Taw 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 31202:12"` 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 3-501.16(B) Cold PHFs Maintained At or Below 41°F/45°F 15, Poisonous or Toxic Substances _ 590.004- *- - . - - - EMPLOYEE HEALTH 3-302.11(A)(2) Raw Animal Foods Separated from Each 7-101.11 Identifying Information-Original Containers* (� Other* g g 3-501.16(A) Hot PHFs Maintained At or Above 140°F* 2 590.003(C)-j Responsibility of the Person-in-Charge to - - - - - - - - - - 7-102.11 Common Name-Working Containers* * - Require Reporting by Food Employees and Contamination from the Environment * 3-501.16(A) Roasts Held At or Above 130°F 7-201.11 Separation-Storage* - Applicants*' - - _' - " � 3-302.11(A) Food Protection* p g 20 Time as a Public Health Control 590.003(F) Responsibility of A Food Employee or A 7-202.11 Restriction-Presence and Use*n 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-.00,3(G) + Reporting-4y Person in-Charger`- 7-203.11 Toxic Containers-Prohibitions* 1 Contamination from the Consumer 3 590.003(D) Exclusions and Restrictions* 7-204.11 Sanitizers,Criteria-Chemicals* o� ,° _REQUIREMENTS.FOR 3-306.14(A)(B)Returned Food and Reated 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 t - - - - - - - - - - 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 Warewashing-Hot Water 7.206.12 Rodent Bait Stations 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 no Package Not Re-Served* 3-202.13 Shell Eggs* - . __ Sanitization Temperatures* TIME/TEMPERATURE CONTROLS 3-202.14 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. 16 Proper Cooking Temperatures for PHFs CONSUMER ADVISORY 3-202.16 Ice Made From Potable Drinking Water* Concentration and Hardness* 3-401.11A(1)(2) Eggs-155°F 15 sec 22 3-603.11 Consumer Advisory Posted for Consumption of 4-601.11(A) Clean Utensils and Food Contact Surfaces of Eggs-Immediate Service 145°F 15 sec* Animal Foods That are Raw,Undercooked or 5-101.11 Drinking Water from-an Approved System* _ gg Equipment* Not Otherwise Processed to Eliminate 590.006(A) Bottled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* Eg cope 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* 4-703.11 Methods of Sanitization-Hot Water and 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* Stuffing Containing Fish,Meat,Poultry or 590.009(A)-(D) Violations of Section 590.009(A)-(D)in cater- Ratites-165°F 15 sec* Sources* 10 Proper,Adequate Handwashing ing,mobile food,temporary and residential - - - Game and-Wild Mushrooms Approved By- - - 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 145°F* kitchen operations should be debited under Regulatory Authority 2-301.11 Clean Condition-Hands and Arms* 3-401.12 Raw Animal Foods Cooked in a Microwave the appropriate sections above if related to 3-202.18 Shellstock Identification Present* - 2-301.12- Cleaning Procedure* 165°F* foodborne illness interventions and risk factors. 590.004(C) Wild Mushrooms* 2-301.14 When to Wash* 3-401.11(A)(1)(b) All Other PHFs-145°F 15 sec* Other 590.009 violations relating to good retail practices 3-201.17 Game Animals* Ell Good Hygienic Practices 17 Reheating for Hot Holding Requirem noald be debited under 929-Special 5 Receiving/Condition 2-401.11 Eating,Drinking or Using Tobacco* 3A03.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 Preventing Contamination When Tasting* 3-403.11 C Commercial] Processed RTE Food-140°F* (Blue Items 23-30) 3-202.11 Package Integrity ( ) y Critical and non-critical violations,which do not relate to the foodborne 12 Prevention of Contamination from Hands 3-403.11E Remaining Unsliced Portions of Beef Roasts* 3-101.11 Food Safe and Unadulterated* ( ) g illness interventions and risk factors listed above,can be found in the 6 Tags/Records:Shellstock 590.004(E) Preventing Contamination from Employees* 16 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 5-203.11 Numbers and Capacities* Within 4 Hours* 23. Management and Personnel FC-2 .003 * 5-204.11 Location and Placement* 3-501.14(B) Cooling PHFs Made from Ambient 24. Food and Food Protection FC-3 .004 3-402.11 Parasite Destruction Temperature Ingredients to 41°F/45°F 25. Equipment and Utensils FC-4 .005 3-402.12 Records,Creation and Retention* 5-205.11 Accessibility,Operation and Maintenance Within 4 Hours* 26. Water,Plumbing and Waste FC-5 .006 590.004(J) Labeling of Ingredients* Supplied with Soap and hand Drying Devices 27. Physical Facility FC-6 .007 7 Conformance with Approved Procedures/ 6-301.11 Handwashing Cleanser,Availability- 28. 1 Poisonous or Toxic Materials FC-7 .008 HACCP Plans 6-301.12 Hand Drying Provision "r 29. 1 Special Requirements 1.009 3-502.11 Specialized Processing Methods* 130. 1 Other 3-502.12 Reduced-Oxygen Packaging Criteria* _ l 8-103.12 Conformance with Approved Procedures* S:590Formback8 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. i Town of Barnstable BOARD OF HEALTH John T.Norman Board of Health Donald A.Gaudagnoli,M.D. BARNSTAUM Paul J.Canniff,D.M.D. Mom. F.P. Thomas Lee Alternate 200 Main Street, Hyannis, MA 02601 Phone: (508) 862-4644 Fax: (508)790-6304 www.townofbarnstable.us Permit to Operate a Food Establishment In accordance with regulations promulgated under authority of 105 CMR 590.000 M.G.L. Chapter 94 Sections 305A, 305B, 146, 189 and 189A; Chapter 111, Sections 5 and 127A, a permit is hereby granted to: Permit No: 1068 Issue Date: 01/01/2021 DBA: CHICK-FIL-A OWNER: ANNEMARIE REISSNER Location of Establishment: 155 ENTERPRISE ROAD HYANNIS„ MA 02601 Type of Business Permit: FOOD SERVICE Annual: YES Seasonal: IndoorSeating: 124 OutdoorSeating: 30 Total Seating: 154 FEES FOOD SERVICE ESTABLISHMENT: $300.00 YEAR. 2021 RETAIL FOOD: COTTAGE FOOD OPERATION: Permit Expires: 12/31/2021 B&B-FULL BREAKFAST: CONTINENTAL BREAKFAST: MOBILE-FOOD: MOBILE-ICE CREAM: FROZEN DESSERT: $30.00 Thomas A. McKean, IRS, CHO, Health Agent FOR ESTABLISHMENTS WITH SEATING: PERMIT IS NOT VALID UNLESS ISSUED IN CONJUNCTION WITH A COMMON VICTUALER LICENSE Restrictions: Total Seats 154, Grease trap allows 166. Licensing allows 156 maximum. Town of Barnstable For Office Use Only: Initials:� _ Date Paid(1 Amt Pd$ 33 a �,,,mAB,� : Inspectional Services v 639. Check#a3'467-1�d — 4'p•Eo +a`e 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 1 _2_2A26-C) NEW OWNERSHIP RENEWAL X NAME OF FOOD ESTABLISHMENT: QU PL-- uz�.d C-k,L1CQ n L-Lc ►� d LG C_I7`i C I(- R 1- A Cc�pe Cod ADDRESS OF FOOD ESTABLISHMENT: )4&j n S AA Pr 62-(o V MAILING ADDRESS(IF DIFFERENT FROM ABOVE): E-MAILADDRESS: (Ann.e r)',U ( e d (� %3Sner (2, (fVFGfta rlCh 13ee . CAP TELEPHONE NUMBER OF FOOD ESTABLISHMENT: (�g� �7 - 600 t TOTAL NUMBER OF BATHROOMS: WELL WATER: YES NO )K...(ANNUAL WATER ANALYSIS REQUIRED) ANNUAL: SEASONAL: DATES OF OPERATION:L 1/3_0/?040 NUMBER OF SEATS: INSIDE: o u o OUTSIDE:`5� TOTAL: 13 y 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. p IS WAIT STAFF PROVIDED FOR OUTSIDE DINING? tV IS AN AIR CURTAIN PROVIDED AT WAITSTAFF SERVICE DOOR(S)?JkJ 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 aFROZEN 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 FonnsTOODAPP 2020.doc OWNER INFORMATION: FULL NAME OF APPLICANT ' )0 e IY)Q{ i•e � ge rssn Q SOLE OWNER: ES NO D.O.B Y'.L 2 lq'O OWNER PHONE# 't)b 11 C0 ADDRESS I C � 1( �Y-I - f U,q ✓� I S M ft 5L(D O CORPORATE OWNER:�Jjac— coa C6 ce n L1—G __11 CORPORATE ADDRESS: 1 aD �JCD S Sj6 w e--� C I r _ .SUS U wi l Ch AA P- 62-AP0 ) PERSON IN CHARGE OF DAILY OPERATIONS: An Q ".S S-A 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. Annerr+u�-e- /0-1 1.Annu,ar,.Q-, ,i s-W 69 og 2/cs' SIG O P DATE ***FOOD POLICY INFORMATION*** SEASONAL FOOD SERVICE: All seasonal food establishments,including mobile trucks must be inspected by the Health Div. prior to opening!! Please call Health Div.at 508-862-4644 to schedule your inspection. Please call at least(7)days in advance. FROZEN DAIRY DESSERTS: Frozen desserts must be tested by a State Certified lab prior to opening and monthly thereafter, with sample results submitted to the Health Div. Failure to do so will result in the suspension or revocation of your Frozen Dessert Permit until the above terms are met. CATERING POLICY: Anyone who caters within the Town of Barnstable must notify theTown by fax or mail prior to catering event. You must complete a catering notice found at http://www.townofbarnstable.us/healthdivision/api)lications.asp. OUTDOOR COOKING: Outdoor cooking,preparation,or display of any food product by a food establishment is prohibited. NOTICE: Permits run annually from January 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 FonnsTOODAPP REV3-2019.doc r y Town of Barnstable BOARD OF HEALTH John T.Norman Board of Health Donald A.Gaudagnoli,M.D. IRMA Paul J.Canniff,D.M.D. MASS 5% �� 200 Main Street, Hyannis, MA 02601 F.P. Thomas Lee Alternate Phone: (508) 862-4644 Fax: (508)790-6304 www.townofbarnstable.us Permit to Operate a Food Establishment In accordance with regulations promulgated under authority of 105 CMR 590.000 M.G.L. Chapter 94 Sections 305A, 305B, 146, 189 and 189A; Chapter 111, Sections 5 and 127A, a permit is hereby granted to: Permit No: 1068 Issue Date: 12/10/2019 DBA: CHICK-FIL-A OWNER: ANNEMARIE REISSNER Location of Establishment: 155 ENTERPRISE ROAD HYANNIS, MA 02601 Type of Business Permit: FOOD SERVICE Annual: YES Seasonal: IndoorSeating: 124 OutdoorSeating: 30 Total Seating: 154 FEES FOOD SERVICE ESTABLISHMENT: $300.00 YEAR. 2020 RETAIL FOOD: COTTAGE FOOD OPERATION: Permit Expires: 12/31/2020 B&B-FULL BREAKFAST: CONTINENTAL BREAKFAST: MOBILE-FOOD: MOBILE-ICE CREAM: Ci FROZEN DESSERT: $30.00 Thomas A. McKean, RS, CHO, Health Agent TOBACCO SALES: FOR ESTABLISHMENTS WITH SEATING: PERMIT IS NOT VALID UNLESS ISSUED IN CONJUNCTION WITH A COMMON VICTUALER LICENSE Restrictions: Total Seats 154, Grease trap allows 166. Licensing allows 156 maximum. F i J tom„ ofIKKE For Office Onlye Initials. Town of Barnstable In r Date PaidTogAmt Pd$ &ARNSI'ABLE., Inspectional Services ow, 4E5 3 ;� - _ Q "ASS' Check# s639. .0 Public Health Division �f0 MAy a Thomas McKean, Director Wq 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 V NAME OF FOOD ESTABLISHMENT:0-0-oe., GrJ ChtGkPn LLC d La— Ch t C L- I'A, 6-t GpQ-6�4 ADDRESS OF FOOD ESTABLISHMENT: �5 E'er-+'C�r�S� Pam. • 4v%o rnrits mN MAILING ADDRESS(IF DIFFERENT FROM ABOVE): E-MAIL ADDRESS: 1 (��tA-�t r�i'i�S h(�j{�' � r1 (� �1 b >7 C,0 TELEPHONE NUMBER OF FOOD ESTABLISHMENT: Q-J TOTAL NUMBER OF BATHROOMS: WELL WATER: YES NO J ... (ANNUAL WATER ANALYSIS REQUIRED) .ANNUAL: " SEASONAL: DATES OF OPERATION:_/_/_ TO NUMBER OF SEATS: INSIDE: 120 OUTSIDE: 2 q 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? D IS AN AIR CURTAIN PROVIDED-AT WAITSTAFF SERVICE DOOR(S)? �S TYPE OF ESTABLISHMENT: (PLEASE CHECK ALL THAT APPLY BELOW) FOOD SERVICE RETAIL FOOD-ONLY required for TCS foods(foods requiring refrigeration/freezer) BED&BREAKFAST CONTINENTAL BREAKFAST COTTAGE FOOD INDUSTRY(formerly residential kitchen) MOBILE FOOD FROZEN DAIRY DESSERT MACHINES . (MONTHLY LAB ANALYSIS REQUIRED) CATERING ... (CATERING NOTICE REQUIRED BEFORE EVENT(SEE PAGE#2) *** SEASONAL.MOBILE &NEW FOOD ONLY*** REQUIRED TO CALL HEALTH DIV.FOR INSPECTION PRIOR TO PERMIT BEING ISSUED PLEASE CALL 508-862-4644 Q:\Application Forms\FOODAPP.2020.doc ' OWNER INFORMATION: n_ejMee�i FULL NAME OF APPLICANT SOLE OWNER: ES/ O D.O.B ,2� (o OWNER PHONE# ;5 Q —I �D OVJ ADDRESS 15 5 F— I �JY—&—rS� 421A CL)11 1.IL A A CORPORATE OWNER: CORPORATE ADDRESS: PERSON IN CHARGE OF DAILY OPERATIONS: List(2) Certified Food Protection Managers AND at least (1)Allergen Awareness Certified Staff All FOOD ESTABLISHMENTS must have 1 Certified Food Protection Manager PER SHIFT. **ATTACH COPIES OF CERTIFICATES** The Health Div. will NOT use past years' records. You roust provide new copies and POST THE CERTIFICATES at your food establishment. Certified Food Managers .Expiration Date Allergen Awareness Expiration Date 1. Y'1tlY`�'ASF ell' � 2. t-q Ala 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 http://www.townofbarnstable.us/healthdivision/ai)plications.ast). OUTDOOR COOKING: Outdoor cooking,preparation,or display of any food product by a food establishment is prohibited. t NOTICE: Permits run annually from January 1st to Dec.31s`each calendar year. IT IS YOUR RESPONSIBILITY TO RETURN THE COMPLETED APPLICATION(S)AND REQUIRED FEES BY DEC 1st. Q:Wpplication FormsTOODAPP REV3-2019.doc y� MAIL-IN REQUESTS Please mail the completed application form to the address below. Also include copies of your employees' food protection manager training certificates (at least two) and food allergen awareness training certificate (at least one.) In addition, please include the required fee amount (see fees at bottom of this page). Make check payable to:Town of Barnstable. Our mailing address is: Town of Barnstable Public Health Division 200 Main Street Hyannis,MA 02601 FOR FAXED REQUESTS Our fax number is (508) 790-6304. Please fax a completed application form. Also, please fax copies of your employees' food protection manager training certificates (at least two) and food allergen awareness training certificate (at least one.) In addition, you must mail the required fee amount(see box below). Please make the check payable to: Town of Barnstable. The check must be mailed to the address listed above. FEES: Bed &Breakfast Permit= $55;Food Service Permit 0-49 seats=$250; 50 or more seats $300; Continental Breakfast=$30; Retail Food (only TCS Foods)= $20; Retail Food Store—Less than 8,000 S.F. _ $100, more than 8,000 S.F. =$285; less than 1,000 S.F.; Retail Food Combo/Limited Prep. - $200.00; Cottage Food Industry=$75; Mobile Truck=$50; Mobile Ice Cream Truck=$35; Frozen Dessert License= $30; Additional non-refundable Fee for New Establishment or New Ownership=$100-$500(see staff),Late Fee= $10 } 1 Q:\Application FormsW00DAPP REV3-2019.doc p4T Town of Barnstable BOARD OF HEALTH Paul J Canniff,D.M.D. Board of Health Donald A.Gaudagnoli,M.D. MusrAade John T.Norman k, 200 Main Street, Hyannis, MA 02601 F.P. Thomas Lee Alternate Phone: (508) 862-4644 Fax: (508)790-6304 www.townofbarnstable.us Permit to Operate a Food Establishment In accordance with regulations promulgated under authority of 105 CMR 590.000 M.G.L. Chapter 94 Sections 305A, 305B, 146, 189 and 189A; Chapter 111, Sections 5 and 127A, a permit is hereby granted to: Permit No: 1068 Issue Date: 12/20/18 DBA: CHICK-FIL-A OWNER: ANNEMARIE REISSNER Location of Establishment: 155 ENTERPRISE ROAD HYANNIS MA 02601 Type of Business Permit: FOOD SERVICE Annual: YES Seasonal: IndoorSeating: 124 OutdoorSeating: 30 Total Seating: 154 FEES FOOD SERVICE ESTABLISHMENT: $300.00 YEAR: 2019 RETAIL FOOD: COTTAGE FOOD OPERATION: Permit Expires: 12/31/2019 B&B-FULL BREAKFAST: CONTINENTAL BREAKFAST: --- — ---- - - — MOBILE-FOOD: MOBILE-ICE CREAM: �� FROZEN DESSERT: $30.00 Thomas A. McKean, RS, CHO, Health Agent TOBACCO SALES: I FOR ESTABLISHMENTS WITH SEATING: PERMIT IS NOT VALID UNLESS ISSUED IN CONJUNCTION WITH A COMMON VICTUALER LICENSE Restrictions: Total Seats 154, actual seats as of 124+30 = 154, Grease trap allows 166. Licensing allows 156 max at this time. I ,�OFtNE� Town of Barnstable For Office Use Only-1 Initials: • "o Date aid s' J� Aid$P �1 c� �szABrE•MAN Inspectional Services 9�pTE s`0� Check# D3b°�I52btkmtL Public Health Division Thomas McKean, Director P )blpg � 200 Main Street, Hyannis,MA 02601 Office: 508-862-4644 Fag: 508-790-6304 VC APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT DATE I 1 01 LO 1,� NEW OWNERSHIP RENEWAL NAME OF FOOD ESTABLISHMENT: .Cod Cap-e— y ADDRESS OF FOOD ESTABLISHMENT: fan0anX I'- 0210 U 1 MAILING ADDRESS(IF DIFFERENT FROM ABOVE): E-MAIL ADDRESS: g � � Q3Sq S nnCC-IC' � CO AA TELEPHONE NUMBER OF FOOD ESTABLISHMENT: ( -I y 0 TOTAL NUMBER OF BATHROOMS: WELL WATER: YES NO ... (ANNUAL WATER ANALYSIS REQUIRED) ANNUAL: SEASONAL: DATES OF OPERATION: / / TO NUMBER OF SEATS: INSIDE:I A OUTSIDE: 3y TOTAL: ['�-A 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 REOUIREMENTS. IS WAIT STAFF PROVIDED FOR OUTSIDE DINING? 1`� 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) 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 FormsT00DAPPREV2018.doc L n PLEASE CA2 508-862-4644 OWNER INFORMATION:(Ail r sc ryn u r�\e i ss� FULL NAME OF APPLICANT C.a n e, Co C C h 1 C)L e n u-c d b a C i C k: -r� I�T GY cc C-rj SOLE OWNER: /NO D.O.B Z 2g OWNER PHONE#ADDRESS _ U (o 0 CORPORATE OWNER: bov-f. FEDERAL ID NO. : j 1 —q l (.o 9 Y? CORPORATE ADDRESS: I? 11�QS S NQ' '� CC S �1 l,( li C. Aj\.& PERSON IN CHARGE OF DAILY OPERATIONS: on ae,.MCIT -eJ P .I SSfI-4 f 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 ller en Awareness Expiration Date 1. �P <�•� e 1SSn�f �l �D ZcV-) 1. U1{1Y1q S GI $ 2O1, 2. ID /ZyZZ 1 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 htti)://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. 3151 each calendar year. IT IS YOUR RESPONSIBILITY TO RETURN THE COMPLETED APPLICATION(S)AND REQUIRED FEES BY DEC 1 st. Q\Application FormsT00DAPPREV2018.doc GENERALNOTES I @ E1E a rsrRuc,�oR s,w,.s F=„wE,.,<.s,_. R LLv T- RE.o.s '6E ore u.sRE E°.,,m�ES E..�v,ou,000R SEvivwrsa.unna+o. L.11Ai%(L O""A WALL TYPE LEGEND smo 6uMngbn Rd. sEo iR ueuor vwRr FxEo Ad—Georg® Keu Rbr oouw.,R.,s� wu�,.v. � maszsse '. _ am urwr c,weFi Revisiers: b' 'i°w.'m st�w°�rOEETEE I-EE.MEI1�ao.�ffsneTM a�,u IT. IT. i 1 � MaM DaM BY � ,i E txoEwrJroLL,o EwAurwinE�'ounnsEWa..Clbu w.va a�ru s„n wulISSUED ,P wEiu siwwut �OR M EM El. REVIEW b. wsuE HNuru.TVRER.oc.ro ocoRawiEw EoumuErn E ,,.s WrutE,Ewu. MaM EMw 6y wsiAUER. wfY U%/.nW - Q MaM Oats By mTa� ,63FA sE. Q A g C C.2 D E u� MaM mw 6y 7 —�--------- -----—--—I — — --— s•al T orsrvE u p ll I 00 OO R 00 — ---- --- ----- I 5 J--- 00 - --- I I d �I I crna csrr°nER�'o• ERA `J S I ' —' ^ ' re rt RvffRliral , m,ot L /_ , ._.__euR�Aos gTCHEN I C cTx� O o n E== \ IAT PXEA I Z P ————l �' 16' ORDER AREA "Ppp1P t O I 4rZ ® wrEs, E R $ sv STORE: � M s P — G3sgs ax,ry RESTROdA I I ° i OFFICE L mtDT —J I 112s— _ STREET.HYANMS,—_— ---_ — — —_ — 1 — SKEET _ ae SHEET WILE O I I I b e I _ T-sx svr NAMEN's vesnau O' 101 I I I r RFSTRoor� 115o M VERSION: nF ISSUE DATE:12YN16 I I I - 106 I 118 bb No: 10.61 T6 v,•® - S.- OJ6J5 I I I Dab: 0125116 Ry: BGIRD 1 I I I 7 FLOOR PLAN ®. Gb—dBy:Rc sbael O NOTFOR A-1.1A .A r � Bsy°B 2 � � E CONSTRUCTION ACCESSIBILITY LEGEND WALL TYPE LEGEND LEGEND: PM ■E9 Fuiu.Es sr.rE ai L_�J ete� srwvau`�i"k � rxt] tuE Ral �.v uen.o ,i0j wA.EM�R.�.4�E.M.� ptlaMa Ge.r9a E w]Oss . {.S 6a�u raK�1F 303A91990 11Ess A�RI]%sLOPEO RaNsiers: 1 1 111 1 MaM D.. By ISSUEDA acruvfA �� I111I11111 I I11 Q 012FOR REVIEW Date By MaM Dal. By sv,v.wrw..n,a sl JL 7 � I¢.uFawua � � W,. By G s.1 IF .eiFR xi y�+MT{ -,of F'M€PM% I I I I FREF2ER 641 � .. i I 1� 11111 I 1 I 1 ®®®® I L L.�.. I1111111III III I.IIMIII CgS-. BCLOSET CLOSET TO J"ll - I ERVICE ARD I i'1_ I :.. ,RVI Y— f . 4 113 I I I-' -,SERVICE Y �T . .—— 8 ,] m 5 wsa — 3.81 1 1 ] .cooLER T COOLER ROOM J -i" STORE' waa 110 s 1 i J 1, —ENTERPRISE 'I _ 1• '� ° _ 2.6 i. EGVIPFIE! BARN6TM ENM6.Mp _ I COUNTY EOUIPMEM a YAMEMS 1... EMSE! LOMEE REEh5TLR000l.Tj YEEt RES M ♦prycF I PN�ENES TTLE i V .. �.:..' SERVICEYPRD O .2 VERSION: WO s I MEMS EpVLOYEE6 ISSUE GATE:I2YID16 EMPLOYEE RESTROOM { I MEWS EMPLO 1 bE Ne: 1a-51 T6 RESTROOM 1 tt9 RESTROOMI 116 YgStEN'S 119 I Srore: O35C5 -,r EMPLOYEE RESTTROOM I Deb: 0125I16 I Drawn BY. BGIRGIp 8 Cireckoa By:,BG SN el .) ACCESSIBILITY FLOOR PLAN 2 FLOOR PLAN 3 FLOOR FINISH PLAN NOT FOR A-1.9 CONSTRUDTIDN SEATING CO UIi EGRESS PA SCHEDULE INTERIOR SEATING EGRESS PATH LINE LENGTH CAFE SEATING: 48 SEATS PATH 1 92'-10" BAR HEIGHT SEATING: 40 SEATS IPATH 2 94'-10" BOOTH: 16 SEATS BANQUETTE: 22 SEATS OUTDOOR SEATING EGRESS ,-PATH 2 CAFE SEATING: 30 SEATS o TOTAL SEATS: 156 SEATS o0 ORDER ARI _ 22'-0"x 9'-011 =18'-5"x 13'-2" L C-i J L. r-i r '1 L N N N o 1p, o r io co w=1 ItErM EXIT #1 -o DINING„ oo 51-0 x 32 0 L EGR SS P H2 EXIT #2 VESTIBULE 8'-10"x 13'-5 1/2" 09/13/16 �� ACC . . . . . . . . . . . . . . . . . . . . . . .. . . . ... . . . . . . . . . . . . . . . . . . . . . . . . . . �, . . . . . . . . . . Cape Cod FSU, Hyannis, MA - Store #03545 t�ajz � The Chick-fil A Schematic Design Package represents a b -nd compliant design solution. Site adapt professionals are responsible for application of design and compliance of ordim L grand opening ® look for choices "= original meals„ FM grilled meals oounder350cal meals include Chick-fil-A Chicken Grilled Chicken waffle potato fries+ $6.85 meal 840-1070 cal 5 with lettuce&tomato tea or soft drink $3.65 entree 440 cal " $8.29 meal 710 930 cal n Waffle Potato Fries $5.19 entree 310 cal\I M$1.89 400 cal TOMATO ` CHEESEGrilled Nuggets L $2.15 520 cal ' 68-ct z Spicy Deluxe $7.75 meal 540-760 cal SUBSTITUTE your with lettuce,tomato& $4.59 entree 140 cal CO side for $1.30 more Pepper Jack cheese 12-ct $7.75 meal 940-1160 cal $9,99 meal 610-830 c' -� R Fruit Cup CO $4.55 entree 540 cal $6.85 entree 210 cal CO M$3.19 45 cal Chick-fil-A' Nuggets Grilled Chicken Club L $4.69 80 cal38 ct with lettuce,tomato,bacon& $6.85 meal 660-880 cal `4. Colby-Jack cheese a, Superfood Side CO $3.65 entree 260 cal t' -' $9,69 meal 840-1060 cat 4 $6.59 entree 430 cal S $3.09 150 cal 12-ct w L $4.29 190 cat $8.49 meal 790-1010 cat Grilled Cool Wrap' $5.35 entree 390 cal 8 with grilled chicken,lettuce, 4 Chick-n-Strips"" cabbage,carrots&shredded # Chicken Soup\O cheese - S $3.09 140 cal 3 ct 7 $9.35 meal 750-970 cal, } L $5.25 270 cat $7.15 meal 750-970 cal $6.29 entree 350 cal\%'� $3.99 entree 350 cal f,.,. r-D 4-ct Chicken Salad Sandwich .: Side Salad CO $8.45 meal 870-1090 cal 9 with green leaf lettuce on 4,0 $3.35 80 cal $5.29 entree 470 cal toasted wheatberry bread $7.75 meal 900-1120 cal $4.65 entree 500 cal look ces salads o o undeorr350cho1cal- treats drinks . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Market Hand-Spun Milkshakes , Freshly-Brewed Iced Tea Grilled chicken with Cookies&Cream,Chocolate, Unsweetened or Sweet - mixed greens,carrots, I '"i Strawberry or Vanilla M $1.79 0/120 cat red cabbage,blue cheese, l . L $2.09 0/170 cat apples&berries L $3.95 620-750 cal 59 200 cal i .. Fresh-Squeezed Lemonade $8. CO\i 8. cal with toppings 10059 / _ Frosted Lemonade Y ,, ,_ Diet or Regular Available with Diet Lemonade-, _- M$1.99 20/220 cat Cobb S $3.49 240/330 cal L $2.39 25/300 cal Nuggets with mixed greens, L $3.95 290/410 cal Soft(Drinks carrots,red cabbage,cheese,eggs,bacon,tomatoes&corn Frosted Coffee M $1.79 0 210 cal $8.59 430 cal CO 510 cal with toppings S $3.49 240 cal L $2.09 0-340 cat L $3.95 300 cat Cold Brew Iced Coffee Spicy Southwest Icedream' Cone Original or vanilla Grilled spicy chicken with mixed greens, S $1.39 170 cal M $2.69 150/160 cal carrots,red cabbage,cheese,peppers,corn&black beans L $1.89 260 cal L $2.99 180/200 cat $8.59 290 cal Co 450 cal with toppings Chocolate Chunk Cookie DASANI. 1-ct$1.39 350 cal $1.79 0 cat 6-ct$7.69 350 cal per serving include small side,kid's size drink kids meals +a special surprise . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . sides drinks Chick-fil-A Nuggets Grilled Nuggets\i Chick-n-Strips' Waffle Potato Fries"S 310 cal organic Honest Kids Appley Ever After'0 35 cai 4-ct $4.15 130 cal 4-ct $4.59 70 cal 1-ct $3.75 120 cal Fruit Cup Co S 35 cal Fresh-Squeezed Lemonade S 15/170 cal 6-ct $5.09 190 cal 6-ct $5.69 110 cal 2-ct $4.99 230 cal Cinnamon Apple Sauce O 60 cal 1%Milk Plain or Chocolate Co 90/150 cal . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . �]1 o�covEa Chick-fil-A Cape Cod - 155 Enterprise Road - Hyannis,MA 02601 - P: 508-774-0001 �,.�, (� ►SA - Store Hours: 6:30 a.m.- 10:00 p.m. - Breakfast served 6:30-10:30 a.m. - Closed Sundays Before placing your order,-please inform your server if a person in your party has a food allergy. ._.Breaded chicken is cooked in 100%peanut oil.Waffle Potato FriesTm are cooked in canola oil. 2,000 calories a day is used as the basis for general nutrition advice,but calorie needs vary.Additional nutrition information available upon request. ©2016 CFA Properties,Inc.All trademarks shown are the property of their respective owners.Prices subject to change.FSR-LOW_GO_REV0716-PG19 dl* d you know? �a WE DIDN'T INVENT THE CHICKEN, JUST THE CHICKEN SANDWICH® - ' Good ingredients prepared fresh.It's the Chick-fil-A®way. " Every Chick-fil-A Restaurant starts with quality ingredients, , preparing all foods fresh daily.First and foremost,we use only 100%whole-breast chicken that's hand-breaded and cooked in peanut oil,which is naturally trans fat and cholesterol free. OUR MENU IS 100% TRANS FAT FREE �R FRESHLY PREPARED EVERY DAY ;. Our wraps and salads are handcrafted daily with freshly cut vegetables.And it doesn't stop there.Even Chick-fil-A Lemonade S' is freshly squeezed daily by hand.Freshness:it's key to cur - famous Chick-fil-A taste,and it always will be. " �+ ,• VON ..r " y . r" Grilled Chicken Breakfast Chicken Biscuit Freshly-Brewed Sandwich Chick-n-Minis" Iced Tea WHAT THEY ARE SAYING Chick-fil-Ns recent industry awards include: •One of 25 national Customer Service Champs by Business Week 000O •Men's Health America's Healthiest Chain Restaurant for Kids • P •QSR magazine's Best Drive-Thru in America(6-time winner) •Restaurants&Institutions prestigious"Choice in Chains"Customer • 0 C 1 h 1 v l k f 1 1 I . a Satisfaction(Chicken Category)award every year(except one)since 1993 CLOSED SUNDAY? HOW DO YOU SAY IT? Our founder,Truett Cathy,made the decision to close on Sundays in 1946 Think filet of chicken and you've got it!Our name when he opened his first restaurant in Hapeville,Georgia.He has often comes from the boneless breast of chicken sandwich- shared that his decision was as much practical as spiritual.He believes the cornerstone of our Restaurant. that all franchised Chick-fil-A Operators and their Restaurant employees should have an opportunity to rest,spend time with family and friends, and worship if they choose to do so.That's why all Chick-fil-A Restaurants are closed on Sundays.It's part of our recipe for success. Wo, 00 . 25,000th scholarship representing$25,000,000 The first Chick-fil-A Chick-fil-A becomes the Renegade cows paint their first donated to extend students' Restaurant opens in first Restaurant chain to sell billboard urging people to education beyond high school /� Atlanta's Greenbriar Mall chicken nuggets nationally "Eat Mor Chikin"" to Restaurant Team Members Chick-fil-A® �967 1982 1995 2009 ................................. HISTORY 9 1977 1986 2000 2012 Chick-fil-A introduces !First free-standing Thanks to a great and with over 1,700 Fresh-Squeezed Lemonade Chick-fil-A growing fanbase,company Restaurants Restaurant sales surpassed$1 billion coast-to-coast,sales opens in Atlanta reached$4.6 billion on North Druid P Hills Road ; ` �Chiekafil�! 9f s rS7pp� . Visit our website at chick-fil-a.com (EDsCh Ick-Ft 0 served until 10:30 a.m. breakfast . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . SUBSTITUTE your side for more Fruit Cup pp _ Greek Yogurt Parfait pp f M with cookie crumbs or granola lChick-fil-N Biscuit 2 Ch ick-n-M i n is'M Original 3-ct 4-ct meal meal meal entree entree entree "-..t• � ,� �"''��`'mks • Breaded chicken is cooked in 100% peanut oil - cholesterol and trans fat free. Waffle Potato Fries TM and Hash Browns are cooked in canola, oil. f t include hash browns + COFPii .� small coffee 3 Egg White Grill Bacon or Sausage, meal Egg & Cheese entree fo Biscuit meal entree O f 4 Chicken or Sausage Sausage or Bacon, Burrito Egg & Cheese meal M uffi n entree meal entree *77 look for choices r � r t� under 350 cal 7 Chicken, Egg dlrn*nk & Cheese Bagel mealTj entree 7t.Simply * , . Orange. 00 x . M r Cold Brew r .� Iced Coffee , o� Original or Vanilla also servnng- S 0 . . . . . . . . . . . . .ygfnea�s,a. Hot, Coffee f . Regular or Decaf Qb'y SO4, S M FAR LCOFFraait meals 1* nclude waff le potato fries TM + tea or soft drink L Waffle Potato FriesTM M L SUBSTITUTE your side for more .�. !:�'® Fruit Cup, O Su �perfood fO Chicken o o Side o 0 M Side Soup Salad S S L L L 0 t011.,CrA I'¢•ry mrs.Inc.MI p idrma@.umwu.;u,M,pnryNatp nl ffnm u..p�+.hrr n:ea h. I - original • • • • • • • • • • • It • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • Chick-fil-N Chicken meal entree Chick-fil-N Deluxe' with lettuce, tomato & cheese meal entree 77.5,., ', . a SPoCyDeluxe with lettuce, tomato & Y" Pepper Jack cheese meal entree - 4 Breaded chicken is cooked in 100% peanut oil - cholester ol and trans fat free. Waffle Potato Fries TM and Hash Browns are cooked in canola oil. r • r s r r • • r r r r • r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r Chick-fil-N Nuggets 8-ct ✓ meal entree 12-ct meal entree M k . x Chick-n-Strips� 3-ct meal entree r —Ct meal e ntree . , ' r r 4p SAUCES f look for ch-Dices gr1* 11ed meals Q 0under 350 cal Grilled Chicken with lettuce & tomato 0 meal entree_ fo Grilled Nuggets . ......8-ct meal entree fo 12-ct meal entree ` ; h ~` Yt Before placing your order, please inform your server if a person in your party has a food allergy. Grilled Chicken Club 9 with lettuce, tomato, bacon r & Colby-Jack cheese meal entree _f- Grilled Cool Wra ° p 8with grilled chicken, lettuce, cabbage, carrots & shredded cheese meal entree fo i 9 r, t ■ is :. r .' Chicken Salad Sa ndwich .-,, with green leaf lettuce on toasted wheatberry !bread meal entree • • look for choices salads under 350 cal • • • • • • • a • • • • r • • a • • • • • • • • • r r • • • r • • • • • • • • • • • • a • • r • • • • • • • • • • Cobb Nuggets with mixed greens, carrots, red cabbage, cheese, eggs, bacon, tomatoes & corn with toppings Market Grilled chicken with mixed greens, carrots, red cabbage, blue cheese, apples & berriestill with toppings Q Spocy Southwest Grilled spicy chicken with mixed greens, carrots, red cabbage, cheese, peppers, corn & black beans Mk with toppings DRESSINGS drl* nks . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . • . . . . . . . . . . . . . . . . •..rrrr. . . . . • . • . Freshly-Brewed Iced Tea Unsweetened or Sweet M L y Fresh-Squeezed Lemonade l Diet or Regular M L .� Soft Drinks M : L Dr DASAN I. fo , Cold Brew Iced Coffee Original or Vanilla Y £. . 2,000 calories a day is used for general nutrition advice, but calorie needs may vary. :r: treats • • • • • • • • • • • • • • • • • • • • s • • • • • o • • • • • • • • • • s • • • • • • • • e • • • • • • • • • • Hand-Spun Milkshakes Cookies & Cream, Chocolate, Strawberry or Vanilla S L Frosted Lemonade Available with Diet Lemonade :< ' S { .t t Frosted Coffee Icedream® Cone' . . L ' Chocolate Chunk Cookie .'- . ...... .... I-ct ~ 6_ct Additional nutrition information available upon request. Gypsum Ceilings ACT-1 PERFORMAT" Vi nylrockT" w ,. ' q d° wr" `ti•r^ + `4. '"" r� w+x' aw w,{ •,� ... +, +ra _.os ' �' w�' KW w, �. " ` rs x tea., UK, �` ...+ v:^.* - ..k" t +;, ,�;d.. .rmt,�. 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Performance -Vinyl-faced,highly durable gypsum panel ✓Building Reuse -Appropriate for use in ceilings that require repeated cleaning,and suitable for ✓,Regional Materials cleaning with common disinfecting chemicals ✓Daylight and Views -Satisfies USDA/FSIS guidelines for sanitary applications IEQ: Low-Emitting -Exceeds FGI Guidelines for cleanability * -Approved for use in federally registered Canadian food establishments -Suitable Clean Room component to ISO Class 5 No added formaldehyde ,RECYCLED CONTENT', APPLICATIONS 8:. O/Q x , 'o%T -Hospitals -Restrooms Pre consumer wrPost•consumr it E � a -Food Processing -Loading Docks -Commercial Kitchens AVAILABLE EDGE DETAILS Trim 15/1 ti"Grid " CertainTeed Ceilings decoustics' CCo�o; C;gua Gyptone PERFORMA" f xr a. a 1 u �� ��� �AST 1,d � jb / u a,.. ^+�+� "Mr, T ` l � T s W � o ATTRIBUTES ® ® U a ® ® a L 13 ITEM NUMBER DIMENSIONS EDGE DETAIL NRC CAC SAG MOLD LR WASHABLE SCRATCH FIRE RATING' EMISSIONS RECYCLED (INCHES) RESISTANT RESISTANT RESISTANT CONTENT 1142-CRF-I 24 x 24 x 1/2 Trim — 38 Yes — 0.76 Yes — Class A Cerhhad 0% 1140-CRF-1 24 x 48 x V2 Trim — 40 Yes — 0.76 Yes — Class A Certified 0% - I r PHYSICAL DATA MATERIAL VOC EMISSIONS WARRANTY Gypsum Independently certified compliant with California 1C year 104/e()Lhmtod Warranty ASTM E7284 CLASSIFICATION Depanmenl of Public Health CDPH/EH.B/Standard Method Version 1,1.2010, Type XX,Pattorn G MAINTENANCE FIRE PERFORMANCE Wipe with a soft cloth or vacuum with brush attachment. Par ASTM Et 264 Class A,Plamo Spread 25 or less Cleanable wih sanitizing chemicals. Per ASTM C84.Smoke Devolopod 50 or less CertainTeed Technical Support I certainteed.com/ceilings 1-800-233-8990 SAINT-GOBAIN Ceilings r Crocker, Sharon From: Crocker, Sharon Sent: Friday, December 02, 2016 5:04 PM To: Crocker, Sharon Subject: FW: Restaurant Seating From: Crocker, Sharon Sent: Friday, December 02, 2016 5:03 PM To: Coyle, Brenda Subject: FW: Restaurant Seating R � ` Brenda, Please let me know how many seats the.Building Division is listing for Chick-Fil-A. Thank you. {� Sharon From: Crocker; Sharon Sent: Tuesday, November 22, 2016 11:53 AM To: Coyle, Brenda; Flynn, Margaret Subject: Restaurant Seating Hello Brenda, Chick-Fil-A is looking to pick up their permit today. Can you tell me what the Building Division approved for seating. (We are using 126 inside and 30 Outside= 156) Thank you. Sharon . Hello Brenda and Maggie, We have a new person,Vanessa Beck, starting December 2nd and her prime concern will be handling food permits. I am hoping our data shows the minimal number of approved seating between our three divisions. Do you have a list you can forward to me of your department's approved seats for each of the Restaurants so we can check this as we go along. Please let me know. Thank you. 1 No.----•-......•---- � 'PHE COMMONWEALTH OF MASSACHUSETTS ,,, s BOARD OF HEALTH 0�e �) TOWN OF BARNSTABLE Applira#inn for Disposal Workii Tonstrnr#inn Prrmit Application is hereby made for a Permit to Construct X) or Repair ( ) an Individual Sewage Disposal stem at: 31. ...... ........Loca--•---•-•--••---•- --- ---------------------- --•----- . .................................................... ............... _ .........._........__..�'..-•----......-•---------•-----......................--- (� Own `\ Q/� �(p5 Wj�GY,g� . Installer Address QType of Building Size Lot__lfl �!..........Sq. feet U Dwelling—No. of Bedrooms................................ .Expansion Attic ( ) Garbage Grinder ( ) Other—T e of Building No. of persons............................ Showers — Cafeteria Other firms ------er C.e. [ `' ---------_-- W Design Flow......................... ........gallons pe"r er day. Total daily flow......../�aA..........................gallons. WSeptic Tank—Liquid capacity/ A-gallons Length__�'�..... Width._`_ . .... Diameter__.__—__-__- Depth-4....fir.._... x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No........../-------- Diameter....4:S....... Depth below inlet.... Total leaching area....44 ._..__sq. ft. Z Other Distribution box ( v� , Dosing tank ( ) '-' Percolation Test Results Performed - ? .... Date... ,aa Test Pit No. 146�t ._minutes per inch Depth of Test Pit-------- Depth to ground water........................ Test Pit No. 2-------- ......minutes per inch Depth of Test Pit..... 3 ----- Depth to ground water...... -------------------------------------------•--•-••-----•--.........-----------------._...._.................................................................. 0 Description of Soil......Mn.Z -- Sv�3......... . s == t,v s%`'- ---------------------------------•---- x U. Nature of Repairs or Alterations—Answer when applicable............. ._................................................................... i -••--------------------------------••---------------•---•------------------------..7...-•-••-••--•-•----......----------------------•------...-----------------------...----------------....._---•------ Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of`the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance s be n issue by tboard of health. Signed � 1.r'---- ... Application Approved :............ ----------------'---- ..-... .........................----'--....-----------............................-..... --.. .....Dace.....----....... Application Disapproved for the following reasons: ---------------------------------------------------------------------------------------------- - ------------------- .---.-.-...--------......---...................... ........................................ --- Permit No. ............................................................ Issued ....../7 � ........ - Dace ♦/ p i Q �N& Fim/ THE COMMONWEALTH OF MASSACHUSETTS C ' ,c- BOARD OF HEALTH TOWN OF BARNSTABLE Appliration for Disoosal Works Toust.rnr#ion jkrmit Application is hereby made for a Permit to Construct (X) or Repair ( ) an Individual Sewage Disposal qXretem at: ....................................................... ;.. .�_ ��.- __ r A Location-Address f or Lot No. ...............•------_-_- --...... - ----- ......................................... ...-••••----•-------•-•-•-••-----------------------•-- W /i Own�O/�1.5 Z�[Je:716,ti-1 7&`� Gtl l y `� s /�'�_ '1'_L[._$_ •-- -----------------.._......._.._...._._.......---•--•-------------------•------........--- --•--•--•--------------.._..-----...------------•-•--............... -- Sq. feet Installer Address ������ � ^ Type of BuildingSize Lot___:__=__ __.... Dwelling—No:_of:Bedrooms....................._._.___.__________._.__Expansion Attic ( ) Garbage Grinder ( ) Other—T e of Building ....................... No. of persons............................ Showers ( ) — Cafeteria ( ) Q' Other •fixttnes .....=��'......�, �r�-..i��...-...........---------------------------- ----•---•------ -----------------•-•----•. -•-------- W Design Flow......................... O':_!�__gallons,per person•per day. Total daily flow_____.:°�?14_n...........................gallons. WSeptic Tank—Liquid ca.pacity:�4�.gallons Length__ _____ Width_,S_�!'___ Diameter.... Depth 4..'F.__. x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area...... ----------- ft. Seepage Pit No._..____" ______.. Diameter..._ x_ ..... Depth below inlet_._3 :__:____ Total leaching area.... ..-.sq. ft. . - Z Other Distribution box ( v) Dosing tank Percolation,Test Results Performed by........ - _.:! c................ Date___ ............................. =.. aTest,Pit No. minutes per inch Depth of Test Pit-----���'�''_.�. Depth to ground water...... Test Pit No. 2................minutes per inch Depth of Test Pit----- 3= .w . Depth to ground water.....'.... .......... ' I .........---................................................................................................................................................. D Description of Soil--•-T��_.. ........ .%�?=z_s <r �.:_ � r r� --�G r��:- ...................................... ...'-----•-••----•_....._.__._._.._..._..__.._.._______...__.__...._.__._... ._._.--------------------------------- ---------- *-------------------------------------------------------------------------- .... .................'-•-•--•-•••-------•-------•---------------------------•--•_..______...____......_.________.........._.._._.._.._._. ._ VNature of Repairs or Alterations—Answer when applicable__.._.._....5��_-___- L. ,.j---------------------------------------- •-•-------------------------•---•------••-------------------------------.---......--.....-•-----•----•-•...----------------------------------------•••••-------------------.........-------••-•-•-•-- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has be n issue by�te board of health. Avj ' Signed ---- --- 1�.�- ---------------- ..................------------------------ �...--------.::;:�::�• Application Approved f�---------- ---- ---v- /� -- .... Date Application Disapproved for the following reasons- --- -----------------------6.............................................................................................. . . . -- ....... . -- ---------------------------------------------------------------------------------------------------------------- ----------------------- r 9 - Permit No. - �....'.... L --- - Issued ...../`...- ----------- Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Cer#ifirate of l!��1 V�omi plianu THIS IS TO CERTIFY, That (��7 Ct the Individual Sewage Disposal stem constructed ( ) or Repaired ( ) 6 r�s i CLcx�6 w by ,C3Ql----------------------------------------------- ----------- ---------------------------------------- ------------------------------------------- ------------------- ----- -- Installer at -�v. ............. ��......-../ - - ---- y ...... has been installed in accordance with the provisions of TITLE of—The %tat E -ironmental Code as_4� c gibed i the application for Disposal Works Construction Permit No. dated .. "'.. + ..-. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION/ SATISFACTORY. DATE..-------- ------'-�--� ... Inspector .. .... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE , No. _-••••-•.'..._ F ........................ Raposat Vorks Tunstrnr#Uan famit Permission is hereby granted ---------------------- --•--•----••--•-----------•-•-•--..............................•...._. to Construct ( C)'�-Gor Repair ( )- an Individual Sewage Disposal Sysee at No......................................... �D �.� /� _ _ ... - l.�/�� ..._ -- - ------•-------------------------- Street as shown on the application for Disposal-Works Construction Permit o. -_.�b_ ....................... ,�Pt Board of Health ,I DATE....... ----•-•--------------•-•----•--------------- � Y FORM 36508 HOBBS 6 WARREN.INC..PUBLISHERS t. c fi DEDICATION I , William J. Russell , Jr. , of 46 Pond View Drive, East Sandwich, Massachusetts 02537 , owner of Lots 14 and 10 shown on Land Court Plan No . 13216I , dated January 20 , 1993 , hereby dedicate the useage of Lot 10 to the maintenance of the septic system for the proposed ice cream parlor to be located on Lot 14 all as shown on the attached sketch plan approved by the Barnstable Board of Health. Said dedication to continue for two years until January 25 , 1995 or when Lot 14 is tied into the municipal sewage system, whichever is sooner. For title see Certificate of Title No. 124, 185 . Signed as a sealed instrument this 25th day of January, 1993 William J. Russell, Jr. Then personally appeared the above named William J. Russell , Jr. , and acknowledged the foregoing to be his free act and deed before me. Notary Public My commission expires: i igoute 1?2 9yanno* Road 70.&o pep-trc d:e�.i,r�rc �v gee steam pa2Co-t ate' �eCY 4s7- qs•4 /per ec,Ny ~�� ' 19itea4e th!�p 1000 t g C.4CS C,<�srrNc, \5iC4?, -t z tank 1000topoded gattey pit 150pCheam pp•tovi,ded � 1 re• iW ndow .C'eac lief a4 a 6LI of S ExIyr�-Iv I I / l�eaeiuJe rr 6�I .4 �v 47 18 Capacity ?2rl ypd __ �� ! i 4 Jaoa \ 47.3 .Cott 114 E(I --1 �•a i S0.0 r .�o-t 10 �a gM /9,904 5�4 150.8 gpd b No dea e � I (,`53' 4S �I I VN c�cG.Le 1 rr-40 •N o bate 1-20-93 0 0 ,qt t Cap e £nytinee mi t r19 Idaiclioti load c ldyanni�., Nq 02601 �nd�— 40' ivay r , I 9eA.t pat #P-7984 Site Ptan of And Made I-1 LI-9 3 .9o-t wi)," 121w�e f c wit. 10 G shown on X.C.# 13216 9 No wateit encounte�ced 1�e4c. Ce yr 2 ,win eat ! " Ctwation,, on ad&wned da zm. 9P1 f 2 4E.4 49.9 Date: 47.9 - 48•� I o 0 coaA.e come -to 7 -to �cedtiux � nZef�iU.Utt' ��;��� �• �, `r. ���` Ash I ; sand ArtILNE " -" � , A . 32490 +� lAt�