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HomeMy WebLinkAboutUNITED GAS / MR KEBAB - FOOD United'-44S 199 Falmouth Road j Hyannis-3tt-0119 a- oFrt" Town of Barnstable BOARD OF HEALTH John T. Norman Board of Health Donald A.Gaudagnoli,M.D. t3AIMS BLE, F.P.(Thomas)Lee,�$ $ 200 Main Street, Hyannis, MA 02601 Daniel Luczkow,M.. D. Alt. Phone: (508) 862-4644 Fax: (508)790-6304 www.townofbarnstablems Permit to Operate a Food Establishment In accordance with regulations promulgated under authority of 105 CMR 590.000 M.G.L. Chapter 94 Sections 305A, 305B, 146, 189 and 189A; Chapter 111, Sections 5 and 127A, a permit is hereby granted to: Permit No: 1056 Issue Date: 01/01/2022 DBA: UNITED GAS/MR. KABAB OWNER: BASSIL BROTHERS C STORE INC. Location of Establishment: 199 FALMOUTH ROAD HYANNIS„ MA 02601 Type of Business Permit: RETAIL WITH FOOD SERVICE Annual: YES Seasonal: IndoorSeating: 8 Outdool-Seating: 0 Total Seating: 8 FEES FOOD SERVICE ESTABLISHMENT: $250.00 YEAR. 2022 RETAIL FOOD: $20.00 COTTAGE FOOD OPERATION: Permit Expires: 12/31/2022 B&B- FULL BREAKFAST: CONTINENTAL BREAKFAST: MOBILE-FOOD: MOBILE-ICE CREAM: • FROZEN DESSERT: Thomas A. McKean, IRS, CHO, Health Agent FOR ESTABLISHMENTS WITH SEATING: i PERMIT IS NOT VALID UNLESS ISSUED IN CONJUNCTION WITH A COMMON VICTUALER LICENSE Restrictions: f of9 tool ftm�i Town of Barnstable Offi,ce UUs,Onlye Initial Date Paid lz�Amt Pd$ Inspectional Services •�639. Public Health Division Thomas McKean,Director l D rz//u 200 Main Street,Hyannis,MA 02601 f Office: 508-862-4644 Fag: 508-790-6304 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT DATE \ \\ 22 NEW OWNERSHIP RENEWAL f� ` NAME OF FOOD ESTABLISHMENT: )In rfon S st IQP m c. ADDRESS OF FOOD ESTABLISHMENT: / O O Vo I MAILING ADDRESS(IF DIFFERENT FROM ABOVE): \ F E-MAIL ADDRESS: +� 1 TELEPHONE NUMBER OF FOOD ESTABLISHMENT: OAj Wo - 4 S 11 �( TOTAL NUMBER OF BATHROOMS: WELL WATER:YES NO (ANNUAL WATER ANALYSIS REQUIRED) ANNUAL: _ SEASONAL: DATES OF OPERATION:_/ / TO NUMBER OF SEATS:INSIDE: OUTSIDE: TOTAL: SEATING: MUST OBTAIN A COMMON VICTUALLER'S LICENSE FROM LICENSING DIV. ***OUTSIDE DINING REMINDER*** OUTSIDE DINING MUST BE APPROVED BY THE HEALTH DIV.AND LICENSING AND MEET OUTSIDE DINING REQUIREMENTS. IS WAIT STAFF PROVIDED FOR OUTSIDE DINING? !U IS AN AIR CURTAIN PROVIDED AT WAITSTAFF SERVICE DOOR(S)?-do— 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 508-8624644 Q kApplication FormsTOODAPP 2020.doc �• II OWNER INFORMATION:• n FULL NAME OF APPLICANT -C SOLE OWNER: YE /NO OWNER PRONE# 1`1 l Q ADDRESS , ft IP4-,t,zll I la.1 S 421A VX,S CL t] 2 CORPORATE OWNER: CORPORATE ADDRESS: Ig q �E" a C ) / r�PERSON IN CHARGE OF DAILY OPERATIONS: List(2)Certified Food Protection Managers AND at least(1)Allergen Awareness Certified Staff All FOOD ESTABLISHMENTS must have 1 Certified Food Protection Manager PER SHIFT. **ATTACH COPIES OF CERTIFICATES** The Health Div.will NOT use past years' records.You must provide new copies and POST THE CERTIFICATES at your food establishment. Certified Food Managers Expiration Date Allergen Awareness Expiration Date 1. C— ae, �Sa S L 10 / / 22 1. F�,e_ Ra S� 12. / !n 12-:R 2. C�s� 1� i 5, i 22 2) ;,I�Qu 14 1 (3 / 2-2- SIGNATURE OF APPLICANT DATE ***FOOD POLICY INFORMATION"* * SEASONAL FOOD SERVICE: All seasonal food establishments,including mobile trucks must be inspected by the Health Div. prior to opening!! Please call Health Div.at 508-862A644 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.townofbarostable.us/healthdivision/ai)plications.asn. 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.31't each calendar year. IT IS YOUR RESPONSIBILITY TO RETURN THE COMPLETED APPLICATION(S)AND REQUIRED FEES BY DEC 1st. Q kApplication Form TOODAPP REV3-2019.doc r Town of Barnstable BOARD OF HEALTH John T.Norman Board of Health Donald A.Gaudagnoli,M.D. BARNSa'AULL Paul J.Canniff,D.M.D. �• 200 Main Street, Hyannis, MA 02601 F.P. Thomas Lee Alternate Phone:�508) 862-4644 Fax: (508)790-6304 www.townofbarnstablems Permit to Operate a Food Establishment In accordance with regulations promulgated under authority of 105 CMR 590.000 M.G.L. Chapter 94 Sections 305A, 305B, 146, 189 and 189A; Chapter 111, Sections 5 and 127A, a permit is hereby granted to: Permit No: 1056 Issue Date: 01/01/2021 DBA: UNITED GAS/MR. KABAB OWNER: BASSIL BROTHERS C STORE INC. Location of Establishment: 199 FALMOUTH ROAD HYANNIS„ MA 02601 Type of Business Permit: FOOD SERVICE Annual: YES Seasonal: IndoorSeating: 8 OutdoorSeating: 0 Total Seating: 8 FEES FOOD SERVICE ESTABLISHMENT: $250.00 YEAR. 2021 RETAIL FOOD: $20.00 COTTAGE FOOD OPERATION: Permit Expires: 12/31/2021 B&B-FULL BREAKFAST: CONTINENTAL BREAKFAST: MOBILE-FOOD: MOBILE-ICE CREAM: Qh FROZEN DESSERT: Thomas A. McKean, RS, CHO, Health Agent FOR ESTABLISHMENTS WITH SEATING: PERMIT IS NOT VALID UNLESS ISSUED IN CONJUNCTION WITH A COMMON VICTUALER LICENSE Restrictions: I '' • OFZNE tp� Town of Barnstable For Office Use Only: Initials:r � Date Paid`� �200�A.�$y�70 &MMSPABLE, : Inspectional Services 9 MASS. 8 039. Public Health Division Check# n 1 ptEO MAY� 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&/ r NAME OF FOOD ESTABLISHMENT: ADDRESS OF FOOD ESTABLISHMENT: ' / C.L-10 MAILING ADDRESS(IF DIFFERENT FROM ABOVD ): n E-MAIL ADDRESS: S5L�� ' b 3- TELEPHONE NUMBER OF FOOD ESTABLISHMENT: j :1D TOTAL NUMBER OF BATHROOMS: WELL WATER: YES ONO (ANNUAL WATER ANALYSIS REQUIRED) ANNUAL:6.� SEASONAL: DATES OF OPERATION: / /_ TO NUMBER OF SEATS: INSIDE: OUTSIDE: TOTAL: SEATING: MUST OBTAIN A COMMON VICTUALLER'S LICENSE FROM LICENSING DIV. ***OUTSIDE DINING REMINDER*** OUTSIDE DINING MUST BE APPROVED BY THE HEALTH DIV.AND LICENSING,AND MEET OUTSIDE DINING REQUIREMENTS. IS WAIT STAFF PROVIDED FOR OUTSIDE DINING? IS AN AIR CURTAIN PROVIDED AT WAITSTAFF SERVICE DOOR(S)? TYPE OF ESTABLISHMENT: (PLEASE CHECK ALL THAT APPLY BELOW) ✓FOOD SERVICE RETAIL FOOD-ONLY required for TCS foods(foods requiring refrigeration/freezer) BED&BREAKFAST CONTINENTAL BREAKFAST COTTAGE FOOD INDUSTRY(formerly residential kitchen) MOBILE FOOD FROZEN DAIRY DESSERT MACHINES ... (MONTHLY LAB ANALYSIS REQUIRED) CATERING ...(CATERING NOTICE REQUIRED BEFORE EVENT(SEE PAGE#2) *** SEASONAL,MOBILE & NEW FOOD ONLY*** REQUIRED TO CALL HEALTH DIV.FOR INSPECTION PRIOR TO PERMIT BEING ISSUED PLEASE CALL 508-862-4644 Q1Application FormsTOODAPP 2020.doc f OWNER INFORMATION: � e FULL NAME OF APPLICANT 2CA S, BeLs SOLE OWNER: YES/NO OWNER PHONE# ADDRESS Q 1 6� �. CORPORATE OWNER: CORPORATE ADDRESS: r 2-6 PERSON IN CHARGE OF DAILY OPERATIONS: List (2) Certified Food Protection Managers AND at least(1)Allergen Awareness Certified Staff All FOOD ESTABLISHMENTS must have 1 Certified Food Protection Manager PER SHIFT. **ATTACH COPIES OF CERTIFICATES** The Health Div. will NOT use past years' records. You must provide new copies and POST THE CERTIFICATES at your food establishment. Certified Food Managers Expiration Date Allergen Awareness Expiration Date 2. SIGNATURE OF APPLICANT DATE ***FOOD POLICY INFORMATION*** SEASONAL FOOD SERVICE: All seasonal food establishments,including mobile trucks must be inspected by the Health Div. prior to 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. i CATERING POLICY: Anyone who caters within the Town of Barnstable must notify theTown by fax or mail prior to catering event. You must complete a catering notice found at http://www.townofbarnstable.us/healthdivision/applications.ast). OUTDOOR COOKING: Outdoor cooking,preparation,or display of any food product by a food establishment is prohibited. NOTICE: Permits run annually from January 1 st to Dec.3 V 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 t Town of Barnstable BOARD OF HEALTH John T.Norman Board of Health Donald A.Guadagnoli,M.D. BARNSMUM F.P.(Thomas)Lee MAIMDaniel Luczkow,Alternate 14 � , 200 Main Street, Hyannis, MA 02601 Phone: (508) 862-4644 Fax: (508)790-6304 www.townofbarnstable.us Permit to Sell Tobacco In accordance with regulations promulgated under authority granted by Sections 5,31 and 127A of the General Laws of the Commonwealth of Massachusetts and Chapter 371 of the Town of Barnstable Code, a permit is hereby granted to: Permit No: 1056 Issue Date: 1/1/2021 DBA: UNITED GAS/MR. KABAB OWNER: BASSIL BROTHERS C STORE INC. Location of Establishment: 199 FALMOUTH ROAD HYANNIS, MA 02601 Type of Business Permit: Non-Flavored Annual Seasonal FEES YEAR: 2021 TOBACCO SALES: $85.00 Permit Expires: 12/31/2021 Thomas A. McKean, RS, CHO, Health Agent Restrictions: PLEASE POST CONSPICUOUSLY VY For Office Use Only: Initials: Town of Barnstable Date Paid k& 1 12DZAmtUS x > A Inspectional Services ---— • +� Public Health Division check# 1 MAN i6�q. Thomas McKean,Director 200 Main Street, Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 TOBACCO ESTABLISHMENT (Non Flavored). DATE JO O 20 NEW BUSINESS OWNERSHIP RENEWAL�_,,- NAME OF TOBACCO ESTABLISHMENT: ADDRESS OF TOBACCO ESTABLISHMENT: (6 o ' MAILING ADDRESS(IF DIFFERENT FROM ABOVE): E-MAIL ADDRESS: igussi L d "C?t,: TELEPHONE NUMBER OF TOBACCO ESTABLISHMENT: `I`1 i OWNER'S NAME: �G{ �1 ��V 1`p _IS1W OWNER'S PH#LZ� OWNER'S ADDRESS: ' Z CORPORATE NAME: � - C . �- CORPORATE ADDRESS: jqq .� DAYS CLOSED EXCLUDING HOLIDAYS(EX.MONDAYS).. TOWN OF BARNSTABLE CODE/MA GENERAL.LAW INTERNET LINKS: Y TOWN OF BARNSTABLE TOBACCO CODE LINK FOR CHAPTER 371.-9: A' https://www.ecode360,com/33996392 MA GENERAL LAW CHAPTER 270/SECTION 6: hgos://malegislature.:g.ov/Laws/GeneralLaws/PartIV/Titlel/Chapter270/Section6 ***NEW BUSINESSES AND NEW OWNERS ONLY*** REQUIRED TO CALL HEALTH DIVISION AGENT FOR AN INSPECTION PRIOR TO PERMIT BEING ISSUED. PLEASE CALL 508-375-6621 S ALL APPLICANTS ARE REQUIRED TO SUBMIT THE FOLLOWING REQUIRED DOCUMENTS: 1) MA State License to Sell Cigarettes 3) IRS Federal Tax ID#Document 2) MA State License to Sell Cigars and Smoking Tobacco 4) Payment of Fee(s) -see page 4 r SIGNATURE: . PRINTED NAME: - DATEAC QMpplication Forms\TOBACCO APP-NonFavor 12-18-19.doex U11 4d CD ESTABLISHMENT'S NAME TOBACCO SALES Employee Signature Form This form is for official use to indicate that the employee(s)of this establishment received and understood Chapter 371 of the Town of Barnstable Code and Chapter 270 Section 6 of the Massachusetts General Laws which describes the penalties for selling and/or giving tobacco products to any person under the age of twenty-one (21). Below is Section 371-9.of the Town of Barnstable Board of Health Regulation: Sales to Minors— 371-9. Sale and Distribution of Tobacco Products. 1. No person shall sell or provide a tobacco product,as defined herein,to a person under The minimum legal sales age. The minimum legal sales age in the Town of Barnstable is 21 years of age. 2. Identification: Each person selling or distributing tobacco products,as defined herein, shall verify the age of the purchaser by means of a valid government-issued photographic identification containing the bearer's date of birth that the purchaser is 21 years old or older. Verification is required for any person under the age of 27. 5 The employee(s)below received and understood Section 371-9 of the Town of Barnstable Board of Health Prohibition of Smoking Regulation and Chapter 270 Section 6 of the Massachusetts General Laws: Signa a Printed Name Dat YOv e- Signature Pnmted Name Date Signature Printed Name Date Signature Printed Name Date i Signature Printed Name Date Signature Printed Name Date Signature Printed Name Date Q:\Application Forms\TOBACCO APP-NonFavor 12-18-15.docx t F 4 SsHure Commonwealth of Massachusetts Letter ID:L1856951872 Department of Revenue Notice Date:September I,2020 Im Geoffrey E.Snyder,Commissioner Account ID:CGL-10398162-003 0& mass.gov/dor RETAILER LICENSE FOR SALE OF CIGARETTES liliilnuiii„iiinulinllulililllill��l �lilunii� BASSTLBROTHERS C STORE 199 FALMOUTH RD. CD s HYANNIS MA 02601-2755 - i Attached below is your Retailer License for Sale of Cigarettes (Form CT-3). Cut along the dotted line -and-display-.atp_uLhud ss location. At any time, ou can log into your MassTaxConnect account at mass.gov/masstaxconnect to view and re-print a copy of this license. If you have any questions about your license,call us at(617) 887-6367 or toll-free in Massachusetts at (800)392-6089, Monday through Friday, 8:30 a.m. to 4:30 p.m. DETACH HERE ------------------------------------------------------------------------------------------------------------------------------------------ s�C"t-s�T MASSACHUSETTS DEPARTMENT OF-REVENUE -Form-CT-3- �;, Retailer License for Sale of Cigarettes y ror This license must be posted and visible'at all times.-The sale of tobacco products to anyone under 18 years of age is prohibited. BASSILBROTHERS-C STORE Account ID: CGL-10398162-003 199 FALMOUTH RD License Number: 2105419776 HYANNIS MA 02601-2755 This certifies that the taxpayer named above is licensed under Chapter 64C of the Massachusetts General Laws tt sell at retail at the address shown above. This license is non-transferable and may be suspended or revoked for failure to comply with state laws and regulations. P.Metive Date! October L 2020 Expiration Date: September 30,2022 fl M1CHr sr� Commonwealth of Massachusetts Letter ID:L2123828800 ONE. ,r Department of Revenue Notice Date:September 1,2020 Geoffrey E.Snyder,Commissioner Account ID:GRL-I039$162-006 rt mass.gov/dor RETAILER LICENSE FOR SALE OF CIGARS AND SMOKING TOBACCO -" 'Itl'1'll�it��'1�111t'�11'I!�'I"� I� ) lilii�111'1'�I"�IIIII BASSILBROTHERS C STORE 199 FALMOUTH RD _HYANN[S'MA-02601-2755 Attached below is your Retailer License for Sale of Cigars and Smoking Tobacco(Form CT=3T). Cut along-the-dottPdline-ai�isp—av at your business location. At any time,you can log into your - -' MassTaxConnect account at'mass:gbv/masstaxconnec�t to view and re-print a copy_"oftliislicense: � � ,� 5 If you have any questions about your license,call us at(617) 887-6367 or toll-free in Massachusetts at (800) 392-6089, Monday through Friday, 8:30 a.m. to 4:30 p.m. ;�s; DETACH HERE e NCH['S�' MASSACHUSETTS DEPARTMENT OF REVENUE Form..CT-3 Retailer License for Sale of Cigars and Smoking Tobacco This license must be post ed and visible at all times.The sale of tobacco �,�� products-to anyone under .t8 years of age is prohibited. BASSILBROTHERS C STORE Account tD: CRL 10398162-006 . 199 FALMOUTK RD License Number: 2056333312 HYANN[S MA 02601-2755 This certifies that the taxpayer named above is licensed under Chapter 64C of the Massachusetts General Laws to sell at retail at the address shown above. This license is non-transferable and may be suspended or revoked for failure to comply with state laws and regulations. Effective Date:October 1. 2020 Expiration Date: September 30, 2022 Lg� Department of the Treasury 1L Sjnternai Revenue Service In reply refer to : 0438100932 OGDEN UT 84201-0038 Sep . 19, 2018 LTR 147C 0 81-1641661 000000 00 00002649 BODC: SB BASSILBROTHERS C STORE UNITED GAS 199 FALMOUTH RD HYANNIS MA 02601-2755 033749 Employer identification number : 81-1641661 Dear Taxpayer : Thank you for your inquiry of Sep . 10 , 2018. Your employer identification number (EIN) is 81-1641661 . Please keep this letter in your permanent records . Enter your name and EIN on all federal business tax returns and on related correspondence . You can get any of the forms or publications mentioned in this letter by visiting our website at www. irs . gov/forms-pubs or by calling 800-TAX-FORM (800-829-3676) . If you have questions, you can call 800-829-4933. If you prefer , you can write to us at the address at the top of the first page of this letter . When you write , include a copy of this letter , and provide your telephone number and the hours we can reach you in the spaces below. Telephone number ( ) Hours Keep a copy -of this letter for your records . Thank you for your cooperation . i Town of Barnstable BOARD OF HEALTH John T.Norman Board of Health Donald A.Gaudagnoli,M.D. BARNSUBM + Paul J.Canniff,D.M.D. 1639. �+ 200 Main Street, Hyannis, MA 02601 F.P. Thomas Lee Alternate k 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: 1056 Issue Date: 12/10/2019 DBA: UNITED GAS/MR. KABAB OWNER: BASSIL BROTHERS C STORE INC. Location of Establishment: 199 FALMOUTH ROAD HYANNIS, MA 02601 Type of Business Permit: FOOD SERVICE Annual: YES Seasonal: IndoorSeating: 8 OutdoorSeating: 0 Total Seating: 8 FEES FOOD SERVICE ESTABLISHMENT: $250.00 YEAR. 2020 RETAIL FOOD: $20.00 COTTAGE FOOD OPERATION: Permit Expires: 12/31/2020 B&B-FULL BREAKFAST: CONTINENTAL BREAKFAST: MOBILE-FOOD: MOBILE-ICE CREAM: G A FROZEN DESSERT: - Thomas A. McKean, IRS, CHO, Health Agent TOBACCO SALES: FOR ESTABLISHMENTS WITH SEATING: PERMIT IS NOT VALID UNLESS ISSUED IN CONJUNCTION WITH A COMMON VICTUALER LICENSE Restrictions: u of r For Office Initials. ' Town of Barnstable Date Paid Amt Pd$� ,ARNSPABL6, . Inspectional Services /r� MAW I,U F1639. Public Health Division Cheek# Thomas McKean, Director rat 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 ;y APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT DATE 1� NEW OWNERSHIP RENEWAL NAME OF FOOD ESTABLISHMENT: to �� ADDRESS OF FOOD ESTA-BLISHMENT: nC4 MAILING ADDRESS(IF DIFFERENT FROM ABOVE): E-MAIL ADDRESS: -J �G' .� � /V LD TELEPHONE NUMBER OF FOOD ESTABLISHMENT:(-(�qn - TOTAL NUMBER OF BATHROOMS: = WELL WATER: YES NO ✓ ... (ANNUAL WATER ANALYSIS REQUIRED) ANNUAL: _ SEASONAL: DATES OF OPERATION:_/ /_ TO NUMBER OF SEATS: INSIDE: OUTSIDE: TOTAL: SEATING: MUST OBTAIN A COMMON VICTUALLER'S LICENSE FROM LICENSING DIV. ***OUTSIDE DINING REMINDER*** OUTSIDE DINING MUST BE APPROVED BY THE HEALTH DIV.AND LICENSING,AND MEET OUTSIDE DINING REQUIREMENTS. IS WAIT STAFF PROVIDED FOR OUTSIDE DINING? c2 IS AN AIR CURTAIN PROVIDED AT WAITSTAFF SERVICE DOORS)? 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 OWNER INFORMATION: n FULL NAME OF APPLICANT 4!!5 A ee—�,/ 446 SOLE OWNER: E OWNER PHONE #_7 74 49 7 0 eC' ADDRESS >� "'Ije -Z� e�C� CORPORATE OWNER: rLo CORPORATE ADDRESS: )fq /'l v Ci P PERSON IN CHARGE OF DAILY OPERATIONS: Pat t �� ��Ir/ 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.k?4 b2 So'(— i Z—2- 2. °e C�cS�i!� 10 / 15 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 oaenine!! Please call Health Div.at 508-862-4644 to schedule your inspection. Please call at least(7)days in advance. FROZEN DAIRY DESSERTS: Frozen desserts must be tested by a State Certified lab prior to opening and monthly thereafter, with sample results submitted to the Health Div. Failure to do so will result in the suspension or revocation of your Frozen Dessert Permit until the above terms are met. CATERING POLICY: Anyone who caters within the Town of Barnstable must notify theTown by fax or mail prior to catering event. You must complete a catering notice found at http://www.townofbarnstable.us/healthdivision/applications.asp. OUTDOOR COOKING: Outdoor cooking,preparation,or display of any food product by a food establishment is prohibited. NOTICE: Permits run annually from January 1st to Dec. 3151 each calendar year. IT IS YOUR RESPONSIBILITY TO RETURN THE COMPLETED APPLICATION(S)AND REQUIRED FEES BY DEC 1st. Q:\Application Forms\FOODAPP REV3-2019.doc . h �pfME Tp� For ff1Ce Initials: Town of Barnstable Tj1T) 1b _ Date Paid Q R Amt Pd$ BAMSi'ABIE. : Inspectional Services 4 r 9� ' � `�� Public Health Division Check# �Plb :A ArFD�p Thomas McKean, Director r , 200 Main Street, Hyannis,MA 02601 , Office: 508-862-4644 Fax: 508-790-6304 r.3�t TOBACCO ESTABLISHMENT PERMIT APPLICATION (Non-Flavored) DATE\ I NEW BUSINESS OWNERSHIP RENEWAL 1,,--" NAME OF TOBACCO ESTABLISHMENT: 13CC,5;�i�1 /��J � ADDRESS OF TOBACCO ESTABLISHMENT: M t n u z) (Z 6 of I MAILING ADDRESS(IF DIFFERENT FROM /A'BOVE): E-MAIL ADDRESS: ReLss i I 1 f7"a �1, 60 TELEPHONE NUMBER OF TOBACCO ESTABLISHMENT: 0!& 470- 5Z J OWNER'S NAME: th.0 OWNER'S PH# 77 - 7D. _ OWNER'S ADDRESS: u 6-73 CORPORATE ADDRESS: CORPORATE FID# e� 026o i ANNUAL:— SE NAL: DATES OF OPERATION: / / TO DAYS CLOSED EXCLUDING HOLIDAYS(EX.MONDAYS) TOWN OF BARNSTABLE CODE/MA GENERAL LAW INTERNET LINKS: TOWN OF BARNSTABLE TOBACCO CODE LINK FOR CHAPTER 371-9: https://www.ecode360.com/33996392 MA GENERAL LAW CHAPTER 270/SECTION 6: https://malegislature.gov/Laws/GeneralLaws/PartIV/Titlel/Chgpter270/Section6 ***NEW BUSINESSES AND NEW OWNERS ONLY *** REQUIRED TO CALL HEALTH DIVISION AGENT FOR AN INSPECTION PRIOR TO PERMIT BEING ISSUED. PLEASE CALL 508-375-6621 ALL APPLICANTS ARE REQUIRED TO SUBMIT THE FOLLOWING REQUIRED DOCUMENTS: 1) MA State License to Sell Cigarettes 3) IRS Federal Tax ID#Document 2) MA State License to Sell Cigars and Smoking Tobacco 4) Payment of Fee(s) -see page 4 SIGNATURE: PRINTED NAME: 6!-if c--- S' DATE:i,\ Q:\Application Forms\TOBACCO APP-NonFavor 11-21-19.doc S ESTABLISHMENT'S NAME TOBACCO SALES Employee Signature Form This form is for official use to indicate that the employee(s) of this establishment received and understood Chapter 371 of the Town of Barnstable Code and Chapter 270 Section 6 of the Massachusetts General Laws which describes the penalties for selling and/or giving tobacco products to any person under the age of twenty-one (21). Below is Section 371-9. of the Town of Barnstable Board of Health Regulation: Sales to Minors—§ 371-9. Sale and Distribution of Tobacco Products. 1. No person shall sell or provide a tobacco product, as defined herein,to a person under The minimum legal sales age. The minimum legal sales age in the Town of Barnstable is 21 years of age. 2. Identification: Each person selling or distributing tobacco products, as defined herein, shall verify the age of the purchaser by means of a valid government-issued photographic identification containing the bearer's date of birth that the purchaser is 21 years old or older. Verification is required for any person under the age of 27. The employee(s)below received and understood Section 371-9 of the Town of Barnstable Board of Health Prohibition of Smoking Regulation and Chapter 270 Section 6 of the Massachusetts General Laws: 4 � Signature Printed Name to �` - `� �� l Signature Printed Name Date Signature Printed Name Date Signature Printed Name Date Signature Printed Name Date Signature Printed Name Date Signature Printed Name Date Q\Application FortnATOBACCO APP-NonFavor 11-21-19.doc yd ���Department of the Treasury Internal Revenue Service In reply refer to : 043810093 OGDEN UT 84201-0038 Sep . 19, 2018 LTR 147C 0 81-1641661 000000 00 0000264 BODC: SB BASSILBROTHERS C STORE UNITED GAS 199 FALMOUTH RD HYANNIS MA 02601-2755 033749 Employer identification number : 81-1641661 Dear Taxpayer : Thank you for your inquiry .of Sep. 10 , 2018. Your employer identification number (EIN) is 81-1641661 . Please keep this letter in your permanent records . Enter your name and EIN on all federal business tax returns and on related correspondence . You can get any of the forms or publications mentioned in this letter by visiting our website at www. irs . gov/forms-pubs or by calling 800-TAX-FORM (800-829-3676) . If you have questions, you can call 800-829-4933. If you prefer , you can write to us at the address at the top of the first page of this letter . When you write, include a copy of this letter , and provide your telephone number and the hours we can reach .you in the spaces below. Telephone number ( ) Hours Keep a copy of this letter for your records . Thank you for your cooperation . s�.cHt1sF� MASSACHUSETTS DEPARTMENT OF REVENUE Form CT-3T Retailer License for Sale of Cigarettes a y This license must be posted and visible at all times.The sale of tobacco F•'�'C OF products to anyone under 18 years of age is prohibite . BASSILBROTHERS C STORE Account ID: CGL-10398162-003 199 FALMOUTH RD License Number: 1380128768 HYANNIS MA 02601-2755 This certifies that the taxpayer named above is licensed under Chapter 64C of the Massachusetts General Laws to sell at retail at the address shown above.This license is non-transferable and may be suspended or revoked for failure to comply with state laws and regulations. Effective Date: October 1,2018 Expiration Date: September 30,2020 acHu MASSACHUSETTS DEPARTMENT OF REVENUE Form CT-3T .-A I �w Retailer License for Sale of Cigars and Smoking Tobacco visible at all times.The sale of tobacco ,roF�- This license must be posted and is products to anyone under 18 years of age is prohibited. BASSILBROTHERS C STORE Account ID: CRL-10398162-006 199 FALMOUTH RD License Number: 1405085696 HYANNIS MA 02601-2755 - This certifies that the taxpayer named above is licensed under Chapter 64C of the Massachusetts General Laws to sell at retail at the address shown above. This license is non-transferable and may be suspended or revoked for failure to comply with state laws and regulations. Effective.Date:October 1,2018 Expiration Date:September 30,2020 Town of Barnstable BOARD OF HEALTH John T.Norman Board of Health Donald A.Guadagnoli,M.D. 'BAR;AMBLE, Paul J.Canniff,D.M.D. 200 Main Street, Hyannis, MA 02601 F.P. Thomas Lee Alternate �- Phone: (508) 862-4644 Fax: (508)790-6304 www.townofbarnstable.us Permit to Sell Tobacco In accordance with regulations promulgated under authority granted by Sections 5,31 and 127A of the General Laws of the Commonwealth of Massachusetts and Chapter 371 of the Town of Barnstable Code, a permit is hereby granted to: Permit No: 1056 Issue Date: 1/1/2020 DBA: UNITED GAS/MR. KABAB OWNER: BASSIL BROTHERS, INC. Location of Establishment: 199 FALMOUTH ROAD HYANNIS, MA 02601 Type of Business Permit: Non-Flavored Annual 2(__ Seasonal FEES YEAR: 2020 TOBACCO SALES: $85.00 Permit Expires: 12/31/2020 Thomas A. McKean, RS, CHO, Health Agent Restrictions: PLEASE POST CONSPICUOUSLY I Town of Barnstable BOARD OF HEALTH �Y ar Paul J Canniff,D.M.D. Board of Health Donald A.Gaudagnoli, M.D. r3r�erz reBm" John T. Norman 200 Main Street, Hyannis, MA 02601 F.P. Thomas Lee Alternate Phone: (508) 862-4644 Fax: (508)790-6304 www.townofbarnstable.us Permit to Operate a Food Establishment In accordance with regulations promulgated under authority of 105 CMR 590.000 M.G.L. Chapter 94 Sections 305A, 3056, 146, 189 and 189A; Chapter 111, Sections 5 and 127A, a permit is hereby granted to: Permit No: 1056 Issue Date: 12/20/18 DBA: UNITED GAS/MR. KABAB OWNER: BASSIL BROTHERS, INC. Location of Establishment: 199 FALMOUTH ROAD HYANNIS MA 02601 Type of Business Permit: RETAIL FOOD Annual: YES Seasonal: IndoorSeating: 8 OutdoorSeating: 0 Total Seating: 8 -FEES- �--- _. _ _ FOOD SERVICE ESTABLISHMENT: $250.00 YEAR: 2019 RETAIL FOOD: $20.00 COTTAGE FOOD OPERATION: Permit Expires: 12/31/2019 B&B-FULL BREAKFAST: CONTINENTAL BREAKFAST: ---- ----- - - --- MOBILE-FOODi' MOBILE- ICE CREAM: gin FROZEN DESSERT: Thomas A. McKean, IRS, CHO, Health Agent TOBACCO SALES: $85.00 FOR ESTABLISHMENTS WITH SEATING: PERMIT IS NOT VALID UNLESS ISSUED IN CONJUNCTION WITH A COMMON VICTUALER LICENSE Restrictions: E - , Un(id,; r- FIKE Toys • Initials: o� Town of Barnstable Date Paidp�$ �&UMMAM ST" �` Inspectional Services Q7 i63q. �0 Public Health Division Check# 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 i RENEWAL NAME OF FOOD ESTABLISHMENT: &SS!, �i�c jVA %ut? ADDRESS OF FOOD ESTABLISHMENT: A� 9 1 a—Q MOO (`a o 2 6 Q MAILING ADDRESS(IF DIFFERENT FROM ABOVE): (o� E-MAIL ADDRESS: e& ��1, ���i �_ V701 NY\, C' TELEPHONE NUMBER OF FOOD ESTABLISHMENT: (7 -.4 ?2y h 8 7® S()7 TOTAL NUMBER OF BATHROOMS: WELL WATER: YES NOS/ ... (ANNUAL WATER ANALYSIS REQUIRED) ANNUAL:_t./' SEASONAL: DATES OF OPERATION: / / TO NUMBER OF SEATS: INSIDE: OUTSIDE: TOTAL: SEATING: MUST OBTAIN A COMMON VICTUALLER'S LICENSE FROM LICENSING DIV. ***OUTSIDE DINING REMINDER*** OUTSIDE DINING,MUST BE APPROVED BY THE HEALTH DIV.AND LICENSING,AND MEET OUTSIDE DINING REQUIREMENTS. IS WAIT STAFF PROVIDED FOR OUTSIDE DINING? IS AN AIR CURTAIN PROVIDED AT WAITSTAFF SERVICE DOOR(S)? TYPE OF ESTABLISHMENT: (PLEASE CHECK ALL THAT APPLY BELOW) t/ FOOD SERVICE ,/ RETAIL FOOD-ONLY required for TCS foods(foods requiring refrigeration/freezer) BED&BREAKFAST CONTINENTAL BREAKFAST COTTAGE FOOD INDUSTRY(formerly residential kitchen) MOBILE FOOD FROZEN DAIRY DESSERT MACHINES ... (MONTHLY LAB ANALYSIS REQUIRED) CATERING ... (CATERING NOTICE REQUIRED BEFORE EVENT(SEE PAGE#2) TOBACCO SALES ... (ANNUAL TOBACCO SALES APPLICATION REQUIRED) *** SEASONAL, MOBILE & NEW FOOD ONLY*** REQUIRED TO CALL HEALTH DIV.FOR INSPECTION PRIOR TO PERMIT BEING ISSUED Q\Application FormsTOODAPPREV2018.doc PLEASE CALL 508-862-4644 OWNER INFORMATION: FULL NAME OF APPLICANTy e_ CAS5 i L SOLE OWNER: YES/NO LOWNER PHONE # r -7 Li ADDRESSXA Q CORPORATE OWNER:1�(yLC'__ �vrl_ FEDERAL ID NO. . CORPORATE ADDRESS: t'1 ek g ram" PERSON IN CHARGE OF DAILY OPERATIONS: List (2) Certified Food Protection Managers AND at least(1) Allergen Awareness Certified Staff All FOOD ESTABLISHMENTS must have 1 Certified Food Protection Manager PER SHIFT. **ATTACH COPIES OF CERTIFICATES** The Health Div. will NOT use past years' records. You must provide new copies and POST THE CERTIFICATES at your food establishment. Certified Food Managers Expiration Date Allergen Awareness Expiration Date s 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.aso. OUTDOOR COOKING: Outdoor cooking,preparation,or display of any food product by a food establishment is prohibited. TOBACCO ESTABLISHMENTS: All tobacco establishments must complete an Application for Tobacco Sales Permit and Employee Signature Form. NOTICE: Permits run annually from January 1st to Dec. 3l't each calendar year. IT IS YOUR RESPONSIBILITY TO RETURN THE COMPLETED APPLICATION(S)AND REQUIRED FEES BY DEC 1 st. Q:\Appfication FonnsTOODAPPREV2018.doc Y tNE, , Town of Barnstable • - Regulatory Services Department DMWErrABM 9MAW Public Health Division 200 Main Street, Hyannis MA 02601 Office: 508-7904644 Thomas A.McKean,RS,CHO FAX: 508-790-6304 Director of Public Health Fee: $85.00 MAIL TO: TOWN OF BARNSTABLE PUBLIC HEALTH DIVISION ; 200 Main Street HYANNIS,MA 02601 FAX 508 790-6304 PLEASE INCLUDE THE REQUIRED FEE OF$85.00 APPLICATION FOR A TOBACCO SALES PERMIT • a LAST NAME OF APPLICANT FIRST NAME MIDDLE INITIAL r It _ o. DB/A STREET ADDRESS -7 TELEPHONE # FID# Do you currently possess a state license to sell tobacco products? Yes No Each employee who sells tobacco products must receive and understand the Sections VII b. and VII c. of the Board of Health Prohibition of Smoking Regulation, (copy provided herein) and the Massachusetts General Law Chapter 270, Section 6.00 (a copy is provided-on the next page). Each employee who sells tobacco products must sign th&EMIee Signature Form (provided herein). r _ Signature Date Q:\Application Forms\TOBACCO APP2018 dob.docx -- --------- TOBACCO SALES TO MINORS PROHIBITED BY MASSACHUSETTS GENERAL LAWS Sales.to Minors — Massachusetts General Laws Chapter 270, Section 6, whoever sells a cigarette, chewing tobacco, snuff, or any tobacco in any of its forms to any person under the age of eighteen (18) or, not being his parent or guardian, gives a cigarettes, chewing tobacco, snuff, or tobacco in any of its forms to any person under the age of(18), shall be punished by a fine of not less than one hundred dollars ($100) for the first offense, not less than two hundred dollars ($200) for the second offense, and not less than three hundred dollars ($300) for any third or subsequent offense. Posting State Law — In conformance with Massachusetts General Laws, Chapter 270, Section 7, a copy of Massachusetts General Laws Chapter 270, Section 6 shall be posted conspicuously by the owner or other person in charge thereof in the shop or other place used to sell cigarettes at retail. The notice to be posted shall be that notice provided by the Massachusetts Department of Public Health. Such notice shall be at least 48 square inches and shall be posted at the cash register which receives the greatest volume of single cigarette package sales in such a manner so this may be readily seen by a person standing at or approaching the cash register. Such notice shall directly face the purchaser and shall not be obstructed from view or place at a height of less than 4 feet or greater than 9 feet from the floor. For all other cash registers that sell cigarettes, a notice shall be attached which is no smaller than 9 square inches, which is the size of the sign provided by the Department of Public Health. Such notice must be posted in a manner so that it may be readily seen by a person standing at or approaching the cash register. Such notice shall directly face the purchaser and shall not be obstructed from view or laced at a height no less than 4 feet or more than 9 feet from the floor. Q:\Application Forms\TOBACCO APP2018 dob.docx J Establishment TOBACCO SALES Employee Signature Form This form is for official use to indicate that the employee(s) of this establishment received and understood sections VII b. and VII c, of the Barnstable Board of Health Prohibition of Smoking Regulation and the enclosed copy of Chapter 270 Section 6 of the Massachusetts General Laws which describes the penalties for selling and/or giving tobacco products to any person under the age of eighteen(18). Below are sections VII b.and VII c.of the Barnstable Board of Health Regulation: SECTION VII—SALE AND DISTRIBUTION OF TOBACCO PRODUCTS b. Sales To Minors—In conformance with the Massachusetts General Laws Chapter 270, Section 6, no person, firm, corporation, establishment, or agency shall sell tobacco products to, a minor. Each employee working in an establishment licensed to sell tobacco product shall be required to receive a copy of the Board of Health regulations and State Law regarding the sale of tobacco and sign a form indicating that such regulations/laws have been received and understood, a copy of which must be placed on file, in the office of the employer and retained. Such signed forms must be made available for inspection,during the license holders normal business hours upon request of an agent of the Board of Health. c. All distributors/retailers of tobacco products or tobacco merchandise must require that, if a customer appears to possibly be under 25 years of age, the customer present a valid State issued picture identification card or drivers license with appropriate photograph to confirm that the customer is of legal age to purchase the tobacco product. The following employee(s) received and understood Sections VIIb. and VIIc. of the Barnstable Board of Health Prohibition of Smoking Regulation and Chapter 270 Section 6 of the Massachusetts General Laws: Signature Printed Name Date Signature Printed Name Date Signature Printed Name Date Signature Printed Name Date Signature Printed Name Date Signature Printed Name Date Signature Printed Name Date Q:\Application Forms\TOBACCO APP2018 dob.docx /24,014 21:44 5084326956 #3240 P.001 /006 i� r� Town .of Barnstable ForOffice Use Onl _ Zoitiak _ X_ 1. bate paw _Amt P-tt S_ t Inspectional Sem ices l" Public Health Division `�` Z 200 Main Street,Hyannis MA 02601 Mov.=-,90-e6M Mom& A.lNc KMN U.,CHO FAX SM-740.630e Aitecta oP Paalic tlr.11t� . �E MBKAS& i. M� _Fee:$85.00 MAM TO,TOW.OFRARNSTABLE ' _ PUBLIC HE:ALM DI rMOn 200Main Street HYANNIS,MA 0-401 FAX M 790-004 PLEasE LNCLUDE THE REQrUZM FEE OF$85.00 APPLICATION FOR A TOBACCO SALES PERMIT CL fs� ~ESTA.BLIS NIENT NAME (DB/a) �J/m did, o Ua I ADDRESS OF BUSINESS MA,ILNG ADDRESS (IF DIFFERENT FROM ABOVE) OVINER'S NAME: LAST FIRST NIIDllY,E ss,val L(h 25/ O14 21:44 5084326956 #3240 P.002 /006 Do you earTeatly possess a state licVnse to sell tobacco products? No Each employee who sells tobacco products must receive and understand Chapter 371 of the Town of Barnstable Code(copy provided Herein)and the.Massachusetts General Law Chapter 270,Section 6.00(a copy is provided on the hest pag Each employee who sells tobacco products mast sign the Employee Signature p'orm (provided herein). . S� 1-- bate \Z EsraBl.rst�vl����s;s.� TOBACCO SALES Emplovee Silkmature Porm This form is for official use to indicx a that the employee(s)of this establishment received and understood Chapter 371 of the Town of Barnstable Code and Chapter 270 Section 6 of the Massnchuszus Genera! Laws which describes the penalties for selling and/or giving tobacco products to any person under the age of twenty-one(21). Below is Section 371-9.of the Town of Barnstable Board of Health Regulation: Sales to Nfinors—>z 371_,9�ak a„d I err;butirm of Tobacco ProRuet4 -I.No persoa shall sell or provide a tobacco product,as defined herein,to a.person under The minimum.legal sales age. The minimum legal sales age in t1w Town of Barnstabic is 21 years of W. 2.Identification: Each person senia;or distributir;tobacco products,as domed herein, shall verify the age of the purchaser by means of a valid government issued phoft ra*c identification eomaining the bearers dark of birth that the purchaser is 21 ycs[s old or older.Verification is required for any person under the age of 27 The following cmployee(s)received and understood Section 37I-9 of the Town of Barnstable Board of Health Prohibition of S0101* Regulation and Chapter 270 Section 6 of the Massacbuseus General laws: SozW, Printed 2Vanrc DaTe 14-t—fta-d 511E h Tr 25Ab14 21:44 5084326956 #3240 P.003 /006 - ignaltue tedN sipatm Oinw Nam S'Pan= P=t0d\'z= Sigra Ntarnc jDatc TOBACCO SALES TO MANORS PROHIBITED BY MIASSACHUSETTS GENERAL LAWS Sales to Minors—§,371-9 Sale and_7A�rtnbbuticat o Tobacco ProdtrcL� 1.No person shall sell or provide a tobacco pfodwt,as donned hercirn to a person under the minimum legal sales age. The minimum legal riles age in the Town of Barnstable is 21 years of age 2.Identification:F,acb person selling or distributing tobacco products,as defined bereitr_shall verify the age of the pumbaser by means of a valid government issued photogrepbie` identification containing the bearer's date of birth that the purchaser is 21 years old or older. Verification is required for any person,under the age of 27. Persons,ems.corporations,or aZencies selling tobacco products to minors or selling tobacco products wiitbout a tobacco sales permit shall be punisbod as follows: A.in the case of a first violation,a fine of one hundred dollars(SI00.00), B.In the case of second violation within 24 months of the date of the current violation,a fine of two hundred doIlsxs(5200.00)and the Tobacco Product Sales Permit shall be suspended for up to seven(7)consecutive business;days. C.In the case of throe or more violations within a 24-month period a fine of three hundred dollars(5300.00)and the Tobacco Product Sales Permit shall be suspended for up to thir6y (30)consecutive business days. • In the case of four violations or repeated,egregious violations of this regulation.as determined by the Board of Health.within a 24-month period,the Board of Health shall hold a hearing in accordance with subsection 4 of this section and may permanently revoke a Tobacco Product Sales Permit. Postbag State IAw —IA conformance with Massachwetts General Laws. Chapter 270, Suction 7,a copy of Massachusetts General Laws Chapter 270, Section 6 shall be posted conspicuously by the owner or other person in charge thereof in the shop or other place used to sell eigareats at retail. The notice to be posted shall be that notice provided by the Massachusetts Department of Public Health- Such notice shall be at least 48 squme,inches and shall be posted at the cash register winch receives the greatest volume of single cigarette package salsa m such a manner so this may be readily seen by a person standing at or approaching the cash register. Such notice:shall directly face the purchaser and shall not be obstructed from view or placed at a height of less than 4 felt or greaser than 9 feet from the floor. For all other cash registers that sell*arettes,a notice shall be attached which is no smaller than 9 square inches,which is the stze of the sign provided by the Department of Public Health. Such notice must:be postod in a manner so that it may be readily seem by a person standmg at or approaching the cash register. Such notice shall directly face the purchaser and shall not be obstructed from view or placed at a height no less than 4 feet or more than 9 foot from the flooL tME Tp TOWN OF BARNSTABLE, HEALTH..INSPECTOR-s Establishment Name: � �Xvv ate: /�" .Page: of OFFICE HOURS ' PUBLIC HEALTH DIVISION, 800-9:30A.M. BARNSTABLE. • 200 MAIN STREET 3:30-a:3o P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified v Ma3q. �0� HYANNIS, MA 02601 MON.-FRI. No Reference R-.Red Item PLEASE PRINT CLEARLY �OrFO MAC° 508-862-4644 FOOD ESTABLISHMENT INSPECTION REPORT Name i a./1�� *l-� DaC) �I �t Tvoe of T e of sec ion U , 1 Y LJ 1 O Routine Address pq - 1 Risk a Re-Inspection ce Level etail Previous Inspection 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 Inspector ] Out: Each violation checked requires an explanation on the narrative page(s)and a citation of specificprovision(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) ❑ v, FOOD PROTECTION MANAGEMENT ❑ 12.Prevention of Contamination from Hands ❑ 1.PIC Assigned/Knowledgeable/Duties ❑ 13.Handwash Facilities C EMPLOYEE HEALTH PROTECTION FROM CHEMICALS ❑ 2.Reporting of Diseases by Food Employees and PIC ❑ 14.Approved Food or Color Additives ❑ 3.Personnel with Infectious Restricted/Excluded ❑ 15. Toxic Chemicals [ FOOD FROM APPROVED SOURCE TIME/TEMPERATURE CONTROLS(Potentially Hazardous Foods) �L ❑4.Food and Water from Approved Source ❑ 16.Cooking Temperatures ❑ 5.Receiving/Condition ❑ 17.Reheating ❑ 6.Tags/Records/Accuracy of Ingredient Statements ❑ 18.Cooling ❑ 7.Conformance with Approved Procedures/HACCP Plans ❑ 19.Hot and Cold Holding PROTECTION FROM CONTAMINATION ❑20.Time As a Public Health Control ❑8.Separation/Segregation/Protection REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) ❑9.Food Contact Surfaces Cleaning and Sanitizing ❑21.Food and Food Preparation for HSP ❑ 10.Proper Adequate Handwashing CONSUMER ADVISORY ❑ 11.Good Hygienic Practices ❑22.Posting of Consumer Advisories _ Violations Related to Good Retail Practices(Blue Items) Total Number of Critical Violations Critical(C)violations marked must be corrected immediately. (blue 8�red items) Corrective Action Required: ❑ No Non-critical(N)violations must be corrected immediately or Overall Rating within 90 days as determined by the Board of Health. ❑ Voluntary Compliance ❑ Employee Restriction/Exclusion ❑ Re-inspection Scheduled ❑ Emergency Suspension C N Official Order for Correction: Based on an inspection today,the items checked indicate violations of 105 CMR 590.000/Federal Food Code. ❑ Embargo ❑ Emergency Closure ❑ Voluntary Disposal ❑ Other: 23.Management and Personnel (FC-2)(590.003) This report,when signed below by a Board of Health member or its agent A=Zero critical violations and no more than 3 non-critical violations. F=3 or more critical violations.9 or more non-critical violations, 24.Food and Food Preparation (FC-3)(590.004) constitutes an order of the Board of Health. Failure to correct violations regardless of the number of critical,results in an F. 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 n-critical violations 9 if no critical violations observed,4 too 6 von-critical violations=B. Seriously Critical Violation=F is scored automatically if: no hot 26.Water,Plumbing and waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If( C=2 critical violations and less than 9non-critical. If no critical water,sewage back-u 27.Physical Facility (FC-6)(590.007) aggrieved by this order,you have a right to a hearing. Your request must g p,infestation of rodents or insects,or lack of 28.Poisonous or Toxic Materials (FC-7)(590.008) be in writing and submitted to the Board of Health at the above address violations observed,7 to 8 non-critical violations. If 1 critical refrigeration. 29.Special Requirements (590.009) within 10 days of receipt of this order. iol 'on,4 n-critical violations=C. 30.Other DATE OF RE-INSPECTION- Insp tor' i atu 31.Dumps r screened from public view Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y N #Seats Observed Frozen Dessert Machines: Outside Dining Y IN PIC's Sig at a Print: Self Service Wait Service Provided Grease Trap Size; Variance Letter Posted Y N n Dumpster Screen? Y N cq 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 3L202.12 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 75 Poisonous or Toxic Substances 3-501.16(B) Cold PHFs Maintained At or Below 41°F/45°F 590.004(F)- EMPLOYEE HEALTH 3-302.11(A)(2) Raw Animal Foods Separated from Each 7-101.11 Identifying Information-Original Containers* _ Other* � g g 3-501.16(A) Hot PHFs Maintained At or Above 140°F* 2 590.003(C) Responsibility of the Person-in-Charge to 7-102.11 Common Name-Working Containers* Require Reporting by Food Employees and Contamination from the Environment -7-201.11 Separation-Storage* 3-501.16(A) Roasts Held At or Above 130°F Applicants* 3-302.11(A) Food Protection* 20 Time as a Public Health Control 7-202.11 Restriction-Presence and Use* 590.003(F) Responsibility of A Food Employee or An 3-302.15 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 * ( ) q 590.003(G) Reporting by Person in Charge* _ - 7-203.11 Toxic Containers-Prohibitions Contamination from the Consumer 3 590.003(D) Exclusions and Restrictions* 7-204.11 Sanitizers,Criteria-Chemicals* REQUIREMENTS FOR. - 3-306.14(A)(B)Returned Food and Reservice of Food* 7-204.12 Chemicals for WashingProduce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP 590.003(E) Removal of Exclusions and Restrictions Disposition of Adulterated or Contaminated Food 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels* 4 Food and Water From Regulated Sources 9 Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs* 590.004 A-B)_Com liance with Food Law* * 3-801.11(D) Raw or Partially Cooked Animal Food and ( P _. -_ - - -4-501.111 - -Manual Warewashing-Ho[Water 7.206.12 Rodent Bait Stations * 3-201.12 Food in a HermeticallySealed Container* Sanitization Temperatures* Raw Seed Sprouts Not Served P 7-206.13 Tracking Powders,Pest Control and 3-201.13 Fluid Milk and Milk Products* - 4-501.112 Mechanical Warewashing-Hot Water Monitoring* 3-801.11(C) Unopened Food Package Not Re-Served* 3-202.13 Shell Eggs* _ Sanitization Temperatures* TIMEITEMPERATURE CONTROLS 3-202.14 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. 16 Proper Cooking Temperatures for PHFs CONSUMER ADVISORY 3-202.16 Ice Made From Potable Drinking Water* Concentration and Hardness* 3-401.11A(1)(2) Eggs-155°F 15 sec 22 3-603.11 Consumer Advisory Posted for Consumption of 4-601.11(A) Clean Utensils and Food Contact Surfaces of Eggs-Immediate Service 145°F 15 sec* Animal Foods That are Raw,Undercooked or 5-101.11 Drinking Water from an Approved System* * gg Not Otherwise Processed to Eliminate Equipment ( )O Pathogens* d 590.006(A) Bottled Drinking Water* 3-401.11 A 2 Comminuted Fish,Meats&Game g * e ecri�e utnoot 4-602.11 Cleaning Frequency of Utensils and Food Animals-155°F 15 sec* 590.006(B) Water Meets Standards in 310 CMR 22.0* Contact Surfaces of Equipment* * 3-302.13 Pasteurized Eggs Substitute for Raw Shell Shellfish and Fish From an Approved Source 3-401.11(B)(1)(2) Pork and Beef Roast-130°F 121 min Eggs* 4-702.11 Frequency of Sanitization of Utensils and Food 3-401.11(A)(2) I Ratites,Injected Meats-155°F 15 sec* 3-201.14 Fish and Recreationally Caught Molluscan Contact Surfaces of Equipment* Shellfish* 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS 4-703.11 Methods of Sanitization-Hot Water and Stuffing Containing Fish,Meat,Poultry or 590.009(A)-(D) Violations of Section 590.009(A)-(D)in cater- 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* Ratites-165°F 15 sec* Sources* ing,mobile food,temporary and residential 10 per,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 Proper, Clean Condition-Hands and Arms* Regulatory Authority 3-401.12 Raw Animal Foods Cooked in a Microwave the appropriate sections above if related to 3-202.18 Shellstock Identification Present* 2-301.12 Cleaning Procedure* 165°F* foodborne illness interventions and risk factors. * 2-301.14 When to Wash* 3-401.11 A 1 b All Other PHFs-145°F 15 sec* Other 590.009 violations relating to good retail 590.004(C) Wild Mushrooms ( )( )( ) 3-201.17 Game Animals* 11 Good Hygienic Practices 17 Reheating for Hot Holding practices should be debited under#29-Special Requirements. $ Receiving/Condition 2-401.11 Eating,Drinking or Using Tobacco* 3-403.11(A)&(D) PHFs 165°F 15 sec* 3-202.11 PHF's Received at Proper Temperatures* 2-401.12 Discharges From the Eyes,Nose and Mouth* 3-403.11(B) Microwave-165°F 2 Minute Standing Time* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES * 3-301.12 Preventing Contamination When Tasting* 3-403.11(C) Commercially Processed RTE Food-140°F* (Blue Items 23-30) 3-202.15 Package Integrity Critical and non-critical violations,which do not relate to the foodborne * 12 Prevention of Contamination from Hands 3-403.11E Remaining Unsliced Portions of Beef Roasts* 3-101.11 Food Safe and Unadulterated ( ) g illness interventions and risk factors listed above,can be found in the 6 Tags/Records:Shellstock 590.004(E) Preventing Contamination from Employees* 18 Proper Cooling of PHFs following sections of the Food Code and 105 CMR 590.000 * 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 Supplied with Soap and hand Drying Devices Within 4 Hours* 26. Water,Plumbing and Waste FC-5 .006 590.004(J) Labeling of Ingredients' 27. Physical Facility FC-6 .007 7 Conformance with Approved Procedures/ 6-301.11 Handwashing Cleanser,Availability 28. Poisonous or Toxic Materials FC-7 .008 HACCP Plans 6-301.12 Hand Drying Provision 129. 1 Special Requirements 1.009 3-502.11 Specialized Processing Methods* 130. 1 Other 3-502.12 Reduced-Oxygen Packaging Criteria* 8-103.12 Conformance with Approved Procedures* S:590Formback6-2doc *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. _1 oFTHE TOWN OF BARNSTABLE HEALTH INSPECTORS Establishment Name: V 4\)�Qs / � r �� Date:' 1 I31 I Page: of ti OFFICE HOURS BAR E.O PUBLIC 2 0 MAN STREET 3:30-4:30 P.M.DIVISION : 0- :30A.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified "All: HYANNIS,MA 02601 MON.-FRI" No Reference" R-Red Item PLEAS PRINT CLEARLY " �'OIFD MPS° 506-862-4644 FOOD E TABLISHMENT INSPECTION REPORT Name 4 ) � Date Tvoe of a of Ins ectio Opera lion Routi Address a Risk < ood S Re-inspection Level Retail Previous Inspection Telephone Residential Kitchen Date: Mobile Pre-operation Owner HACCP Y/N Temporary Suspect Illness _ Caterer General Complaint Person in Filarile(PIC) Time Bed 8 Breakfast HACCP In: Other Inspector ,. Out: Each violation checked requires an explanation on the narrative page(s)and a citation of specific provision(s)violated. Violations Related to Foodborne Illness Interventions and Risk Factors(Red Items) Anti-Choking 590.009(E) ❑ Violations marked may pose an imminent health hazard and require immediate corrective Tobacco 590.009(F) ❑ \ 'r1 io,k Action as determined by the Board of Health. Allergen Awareness 590.009(G) ❑ _ FOOD PROTECTION MANAGEMENT ❑ 12.Prevention of Contamination from Hands ❑ 1.PIC Assigned/Knowledgeable/Duties ❑ 13.Handwash Facilities EMPLOYEE HEALTH PROTECTION FROM CHEMICALS ❑2.Reporting of Diseases by Food Employees and PIC ❑ 14.Approved Food or Color Additives ❑ 3.Personnel with Infectious Restricted/Excluded ❑ 15. Toxic Chemicals FOOD FROM APPROVED SOURCE TIME/TEMPERATURE CONTROLS(Potentially Hazardous Foods) ❑4.Food and Water from Approved Source ❑ 16.Cooking Temperatures ❑ 5.Receiving/Condition ❑ 17.Reheating ❑6.Tags/Records/Accuracy of Ingredient Statements ❑ 18.Cooling ❑7.Conformance with Approved Procedures/HACCP Plans ❑ 19.Hot and Cold Holding PROTECTION FROM CONTAMINATION ❑ 20.Time As a Public Health Control ❑ 8.Separation/Segregation/Protection REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) ❑ 9.Food Contact Surfaces Cleaning and Sanitizing ❑21.Food and Food Preparation for H P ❑ 10.Proper Adequate Handwashing CONSUMER ADVISORY LO ❑ 11.Good Hygienic Practices ❑22.Posting of Consumer Advisories lv 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 Plfts 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,th items ❑ Embargo ❑ Emergency Closure ❑ Voluntary Disposal ❑ Other: checked indicate violations of 105 CMR 590.000/Federal Food Code. 23.Management and Personnel (FC-2)(590.003) This report,when signed below by a Board of Health member or its agent A=Zero critical violations and no more than 3 non-critical violations. F=3 or more critical violations.9 or more non-critical violations, 24.Food and Food Preparation (FC-3)(590.004) constitutes an order of the Board of Health. Failure to correct violations regardless of the number of critical,results in an F. 25.Equipment and Utensils FC-4 590.005 6=One critical violation and less than 4non-critical violations 9 ( )( ) cited in this report may result in suspension or revocation of the food if no critical violations observed,4 to 6 non-critical violations=B. Seriously Critical Violation=F is scored automatically if: no hot 26.Water,Plumbing and Waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If g p,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 C=2 critical violations and less than i non-critical. If no critical water,sewage back-up, 28.Poisonous or Toxic Materials (FC-7)(590.008) be in writing and submitted to the Board of Health at the above address violations observed,7 to 8 non-critical violations. If 1 critical refrigeration. 29.Special Requirements (590.009) within 10 days of receipt of this order. Fn,4 to 8non-critical violations=C. 30.Other DATE OF RE-INSPECTION: g to 31.Dumpster screened from public view Permit Posted Y N Grease Trap Previous Pumping Date Grease Rendered Y N t� *Seats Observed Frozen Dessert Machines: Outside Dining Y N ature Pri Self Service Wait Service Provided Grease Trap Size Variance Letter Posted Y. N Dumpster Screen? Y N Violation related to Foodborne Illness Violations Related to Foodborne Illness Interventions Interventions and Risk Factors(Red Items 1-22) and Risk Factors(Red Items 1-22) (Cont.) FOOD PROTECTION MANAGEMENT PROTECTION FROM CONTAMINATION PROTECTION FROM CHEMICALS 3-501.14(C) PHFs Received at Temperatures According to 1 590.003(A) Assignment of Responsibility* 8 Cross-contamination 14 Food or Color Additives Law Cooled to 41°F/45'F Within 4 Hours* 590.003(B) Demonstration of Knowledge* 3-302.11(A)(1) Raw Animal Foods Separated from 3-202.12 Additives* 3-501.15 Cooling Methods for PHFs 2-103.11 Person-in-Charge Duties Cooked and RTE Foods.* 3-302.14 Protection from Unapproved Additives* 19 PHF Hot and Cold Holding Contamination from Raw Ingredients 15 Poisonous or Toxic Substances 3-501.16(B) Cold PHFs Maintained At or Below 41'F/45°F EMPLOYEE HEALTH 3-302.11(A)(2) Raw Animal Foods Separated from Each * 590.004(F) 7-101.11 Identifying Information-Original Containers 2 590.003(C) Responsibility of the Person-in-Charge to Other* 7-102.11 Common Name-Working Containers* 3-501.16(A) Hot PHFs Maintained At or Above 140°F* Require Reporting by Food Employees and Contamination from the Environment - - 3-501.16(A) Roasts Held At or Above 130'F* * 7-201.11 Separation-Storage* Applicants 3-302.11(A) Food Protection* 7-202.11 Restriction-Presence and Use* 3-501.19 Time as a Public Health Control 20 Time as a Public Health Control 590.003(F) Responsibility of A Food Employee or An 3-302.15 Washing Fruits and Vegetables * Applicant To Report To The Person In Charge* * 7.202.12 Conditions of Use 3-304.11 Food Contact with Equipment and Utensils 590.004(11) Variance Requirements 590.003(G) Reporting by Person in Charge* 7-203.11 Toxic Containers-Prohibitions* Contamination from the Consumer 3 590.003 Exclusions and Restrictions* 7-204.11 Sanitizers,Criteria-Chemicals* �) 3-306.14(A)(B)Returned Food and Reservice of Food* REQUIREMENTS FOR 590.003(E) Removal of Exclusions and Restrictions Disposition of Adulterated or Contaminated 7-204.12 Chemicals for Washing Produce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS(HSP) Food 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels* 4 Food and Water From Regulated Sources g Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs* 590.004(A-B) Compliance with Food Law* 4-501.111 Manual Warewashing-Hot Water 7.206.12 Rodent Bait Stations* 3-801.11(D) Raw or Partially Cooked Animal Food and 3-201.12 Food in a Hermetically Sealed Container* Sanitization Temperatures* 7-206.13 Tracking Powders,Pest Control and Raw Seed Sprouts Not Served* 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-Hot Water Monitoring* 3-801.11(C) Unopened Food Package Not Re-Served* 3-202.13 Shell Eggs* Sanitization Temperatures* TIME/TEMPERATURE CONTROLS 3-202.14 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. 16 Proper Cooking Temperatures for PHFs CONSUMER ADVISORY 3-202.16 Ice Made From Potable Drinking Water* Concentration and Hardness* 3-401.11A(1)(2) Eggs-155°F 15 sec 22 3-603.11 Consumer Advisory Posted for Consumption of 5-101.11 Drinking Water from an Approved System* 4-601.11(A) Clean 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* 4-602.11 Cleaning Frequency of Utensils and Food 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* Effe eve 11112001 590.006(B) Water Meets Standards in 310 CMR 22.0* Contact Surfaces of Equipment* Animals-155`F 15 sec* 3-302.13 Pasteurized Eggs Substitute for Raw Shell Shellfish and Fish From an Approved Source 3-401.11(B)(1)(2) Pork and Beef Roast-130°F 121 min* Eggs* 3-201.14 Fish and Recreationally Caught Molluscan Contact Surf 4-702.11 Frequency Sanitization of Utensils and Food 3-401.11(A)(2) Ratites,Injected Meats-155`F 15 sec* aces of Equipment* Shellfish* 4-703.11 Methods of Sanitization-Hot Water and 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS Poultry or Meat, 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* Stuffing Containing Fish, 590.009(A)-(D) Violations of Section 590.009(A)-(D)in cater- Ratites-165°F 15 sec* Sources* CO Proper,Adequate Handwashing ing,mobile food,temporary and residential Game and Wild Mushrooms Approved By 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 145`F* kitchen operations should be debited under Regulatory Authority 2-301.11 Clean Condition-Hands and Arms* 3-401.12 Raw Animal Foods Cooked in a Microwave the appropriate sections above if related to 3-202.18 Shellstock Identification Present* 2-301.12 Cleaning Procedure* 165°F* foodbome illness interventions and risk factors. * 2-301.14 When to Wash* 3-401.11 A 1 b All Other PHFs-145'F 15 sec* Other 590.009 violations relating to good retail 590.004(C) Wild Mushrooms ( )( )( ) 3-201.17 Game Animals* 11 Good Hygienic Practices 17 Reheating for Hot Holding practices should be debited under#29-Special 2-401.11 Eating,Drinking or Using Tobacco* * Requirements. $ Receiving/Condition g� g g 3-403.11(A)&(D) PHFs 165'F 15 sec 3-202.11 PHF's Received at Proper Temperatures* 2-401.12 Discharges From the Eyes,Nose and Mouth* _ 3-403.11(B) ' Microwave-165°F 2 Minute Standing Time* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3-202.15 Package Integrity* 3-301.12 Preventing Contamination When Tasting* - - 3-403.11(C) Commercially Processed RTE Food-140°F* (Blue Items 23-30) 3-101.11 Food Safe and Unadulterated * 12 Prevention of Contamination from Hands 3-403.11( ) g Unsliced Portions of Beef Roasts*E Remaining Critical and non-critical violations,which do not relate to the foodbome 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 CMR 5 be 90.000 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 * 5-205.11 Accessibility,Operation and Maintenance 3-402.12 Records,Creation and Retention Within 4 Hours 26. Water,Plumbing and Waste FC-5 .006 590.004 Labeling of Ingredients* Supplied with Soap and hand Drying Devices (J) 9 9 k;i_ 27. Physical Facility FC-6 007 7 Conformance with Approved Procedures/ 6-301.11 Handwashing Cleanser,Availability 28. Poisonous or Toxic Materials FC-7 .008 HACCP Plans 6-301.12 Hand Drying Provision 29. Special Requirements 009 3-502.11 Specialized Processing Methods* 30. 1 Other 3-502.12 Reduced-Oxygen Packaging Criteria* 8-103.12 Conformance with Approved Procedures* S:590Fonnback6-2doc *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 °p INE ro TOWN OF BARNSTAB.LE HEALTH INSPECTOR'S Establishment Name:()(1 I kd (7dS Date: kOLof Page:�_of Y OFFICE HOURS PUBLIC HEALTH DIVISION 8:00-9:30 A.M. BARNSTABLE. • 200 MAIN STREET 3:30-4:30 P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified MASS. g MON.-FRI. A 039.a m HYANNIS, MA 02601 508-862-4644 No Reference R-Red Item PLEASE PRINT CLEARLY rFo MpY FOOD ESTABLISHMENT INSPECTION REPORT Name Va Date��1b�(9 Type of Inspection U01 , b Operation(s) oubne wq(V f1 CD tr ya Address F� Risk Fo ervice Re-inspection �+���� r Level etail Previous Inspection �� I �iS v� Telephone Residential Kitchen Date: - V -1,0 O Mobile Pre-operation Owner HACCP Y/N Temporary Suspect Illness C n � Caterer General Complaint - Person HACCPin Charge(PIC)�e0AW Time Bed&Breakfast Other ..S cS I�t In: - �a{Iti� I"( Cott (.l,( ��t0' Inspector j� ar) Sums Out: S Each violation checked requires an explanation on the narrative page(s)and a citation of specific provision(s)violated. b nt Violations Related to Foodborne Illness Interventions and Risk Factors Red Items) Anti-Choking 590.009(E) _ l I ( ❑ 4 ++ Violations marked may pose an imminent health hazard and require immediate corrective Tobacco 590.009(F) ❑ "Y I Cp0 S Action as determined by the Board of Health. Allergen Awareness 590.009(G) ❑ �1 n '18 s 4 J r C '.� FOOD PROTECTION MANAGEMENT ❑ 12.Prevention of Contamination from Hands J- R�'!I' i 5 _o\J O e ❑ 1.PIC Assigned/Knowledgeable/Duties ❑ 13.Handwash Facilities , `t� EMPLOYEE HEALTH PROTECTION FROM CHEMICALS bGI S r'n k - )lob ❑ 2.Reporting of Diseases by Food Employees and PIC ❑ 14.Approved Food or Color Additives qq(jAW0jcSh 6 fqrr(9 ❑ 3.Personnel with Infectious Restricted/Excluded ❑ 15. Toxic Chemicals V m < Ciro FOOD FROM APPROVED SOURCE TIMEITEMPERATURE CONTROLS(Potentially Hazardous Foods) 1" J 1y/ ❑ 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 H P ❑ 10.Proper Adequate Handwashing CONSUMER ADVISORYOr� �]J�� - ❑ 11.Good Hygienic Practices ❑22.Posting of Consumer Advisories -\ /' ` Violations Related to Good Retail Practices Blue ) I ems Total Number of Critical Violations �J Items) Critical(C)violations marked must be corrected immediately. (blue&red items) Corrective Action Required: J No ❑ Yes Non-critical(N)violations must be corrected immediately or Overall Rating within 90 days as determined by the Board of Health. A ❑ Voluntary Compliance ❑ Employee Restriction/Exclusion ❑ Re-inspection Scheduled ❑ Emergency Suspension C N Official Order for Correction:Based on an inspection today,the items ❑ Embargo ❑ Emergency Closure ❑ Voluntary Disposal ❑ Other: checked indicate violations of 105 CMR 590.000/Federal Food Code. 23.Management and Personnel (FC-2)(590.003) This report,when signed below by a Board of Health member or its agent A=Zero critical violations and no more than 3 non-critical violations. F=3 or more critical violations.9 or more non-critical violations, 24.Food and Food Preparation (FC-3)(590.004) constitutes an order of the Board of Health. Failure to correct violations regardless of the number of critical,results in an F. 25.Equipment and Utensils (FC-4 590.005 B=One critical violation and less than 4non-critical violations 9 )( ) cited in this report may result in suspension or revocation of the food if no critical violations observed,4 to 6 non-critical violations=B. 26.Water,Plumbing and Waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If Seriously Critical Violation t F is scored automatically la hot 27.Physical Facility (FC-6)(590.007) aggrieved by this order,you have a right to a hearing. Your request must C=2 critical violations and less than 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 B non-critical violations. If 1 critical refrigeration. within 10 days of receipt of this order. violation,4 to Bnon-critical violations=C. 29.Special Requirements (590.009) y p 30.Other DATE OF RE-INSPECTION: Inspector's Signature Print: 31.Dumpster screened from public view 0-n R.r/ 5 ,. Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y N O #Seats Observed Frozen Dessert Machines: Outside Dining Y N PIC's's Signature Print: Self Service Wait Service Provided Grease Trap Size Variance Letter Posted Y N Dumpster Screen? Y N &a, 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-contamination14 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 3-202.1-2--. 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* Other* 3-501.16(A) Ho[PHFs Maintained At or Above 140°F* 2 590.003(C) Responsibility of the Person-in-Charge to 7-102.11 Common Name-Working Containers* Require Reporting by Food Employees and Contamination from the Environment 3-501.16(A) Roasts Held At or Above 130°F Applicants* 3-302.11(A) Food Protection* 7-201.11 Separation-Storage* 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 * 3-304.11 Food Contact with Equipment and Utensils ( ) Variance Requirements 590.003(G) Reporting by Person in Charge Contamination from the Consumer 7-203.11 Toxic Containers-Prohibitions* 3 590.003(D) Exclusions and Restrictions* 7-204.11 Sanitizers,Criteria-Chemicals* REQUIREMENTS FOR-- 3-306.14(A)(B)Returned Food and AdulteReserrated force,of Food* 7-204.12 Chemicals for WashingProduce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP 590.003(E) Removal of Exclusions and Restrictions Disposition ofAdulterated or Contaminated � ) Food 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels* 4 Food and Water From Regulated Sources 9 Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs* 590.004(A-B) Compliance with Food Law* 4-501.111 Manual 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* I 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* TIMErfEMPERATURE CONTROLS 3-202.14 Eggs and Milk Products,Pasteurized* - 4-501.114 Chemical Sanitization-Temp.,pH. 18 Proper Cooking Temperatures for PHFs CONSUMER ADVISORY 3-202.16 Ice Made From 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 * Eggs 4-601.11(A) Clean Utensils and Food Contact Surfaces of E s-Immediate Service 145°F 15 sec* Animal Foods That are Raw,Undercooked or 5-101.11 Drinking Water from an Approved System Equipment* Not Otherwise Processed to Eliminate 590.006(A) Bottled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* Eg cri-11112001 4-602.11 Cleaning Frequency of Utensils and Food Animals-155°F 15 sec* 590.006(B) Water Meets Standards in 310 CMR 22.0* Contact Surfaces of Equipment* 3-302.13 Pasteurized Eggs Substitute for Raw Shell Shellfish and Fish From an Approved Source 3-401.11(B)(1)(2) Pork and Beef Roast-130°F 121 min* Eggs* 4-702.11 Frequency of Sanitization of Utensils and Food 3-401.11(A)(2) Ratites,Injected Meats-155°F 15 sec* 3-201.14 Fish and Recreationally Caught Molluscan Contact Surfaces of Equipment* Shellfish* 3-40 1.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS 4-703.11 Methods of Sanitization-Hot Water and StuffingContaining Fish,Meat,Poultry or 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* g 590.009(A)-(D) Violations of Section 590.009(A)-(D)in cater- Sources Ratites-165°F 15 sec* * 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. * 2-301.14 When to Wash* 3-401.11 A 1 b All Other PHFs-145°F 15 sec* Other 590.009 violations relating to good retail 590.004(C) Wild Mushrooms ( )( )( ) 3-201.17 Game Animals* 11 Good Hygienic Practices 17 Reheating for Hot Holding Requirementpractices sld be debited under#29-Special g Receiving/Condition 2-401.11 Eating,Drinking or Using Tobacco* 3-403.11(A)&(D) PHFs 165°F 15 sec* 3-202.11 PHF's Received at Proper Temperatures* 2-401.12 Discharges From the Eyes,Nose and Mouth* 3-403.11(B) Microwave-165°F 2 Minute Standing Time* VIOLATIONS RELATED TO'GOOD RETAIL PRACTICES * 3-301.12 Preventing Contamination When Tasting* 3-403.11(C) Commercially Processed RTE Food-140°F* Blue Items 23-30) 3-202.15 Package Integrity Critical and non-critical violations,which do not relate to the foodbome 3-101.11 Food Safe and Unadulterated* 12 Prevention of Contamination from Hands 3-403.11(E) Remaining Unsliced Portions of Beef Roasts* illness interventions and risk factors listed above,can be found in the 6 Tags/Records:Shellstock 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 Within 4 Hours* 26. Water,Plumbing and Waste FC-5 .006 Supplied with Soap and hand Drying Devices 590.004(J) Labeling of Ingredients' 27. Physical Facility FC-6 .007 7 Conformance with Approved Procedures/ 6-301.11 Handwashing Cleanser,Availability 28. 1 Poisonous or Toxic Materials FC-7 .008 HACCP Plans 6-301.12 Hand Drying Provision 129. 1 Special Requirements 009 3-502.11 Specialized Processing Methods* 130. 1 Other 3-502.12 Reduced-Oxygen Packaging Criteria* 8-103.12 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. SNFr TOWN OF BARNSTABLE HEALTH INSPECTOR'S Establishment Names W 1 AAU 1 o ate: F Page: of - - OFFICE HOURS PUBLIC HEALTH DIVISION 8:00-9:30 A.M. BARNSTABLE. • 200 MAIN STREET 3: :-FRI.P.M.MON. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified MASS. 0 - - - 508-862-4644 No Reference R-Red Item . PLEASE PRINT CLEA HYANNIS,MA 02601 MON. rFD MP'� FO D ESTABLISHMENT INSP C PON REPORT - p Name L V Date Tvoe of T Ins ection 1 �M Routine Address Risk �/ Foo`d Serv'� i sY�e . l Level to PrevioTelephone Residential Kitchen Date:Mobile Pre-ooOwner HACCP Y/N Temporary Suspes f n I Caterer General Complaint ? Person in Charge(PIC) Time Bed&Breakfast HACCP -�4 „ n• Other I �' `� Ain Inspector / O lli , a Each violation checked requires an explanation on the narrative ages)and a citation of specific provision(s)violated. Violations Related to Foodborne Illness Interventions and R sk Factors(Red Items) Anti-Choking 590.009(E) ❑ / Violations marked may pose an imminent health hazard and require immediate corrective Tobacco 590.009(F) ❑ V11) �1 / ; Action as determined by the Board of Health. Allergen Awareness 590.009(G) ❑ / A FOOD PROTECTION MANAGEMENT ❑ 12.Prevention of Contamination from Hands / ❑ 1.PIC Assigned/Knowledgeable/Duties ❑ 13.Handwash Facilities ( . EMPLOYEE HEALTH PROTECTION FROM CHEMICALS 1 Q ! IP ❑ 2.Reporting of Diseases by Food Employees and PIC ❑ 14.Approved Food or Color Additives I i ❑ 3.Personnel with Infectious Restricted/Excluded ❑ 15. Toxic Chemicals FOOD FROM APPROVED SOURCE TIME/TEMPERATURE CONTROLS(Potentially Hazardous Foods) y' ❑4.Food and Water from Approved Source ❑ 16.Cooking Temperatures (� � X ❑ 5.Receiving/Condition ❑ 17.Reheating ❑6.Tags/Records/Accuracy of Ingredient Statements ❑ 18.CoolingAA A ' ❑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) r� 0 ❑9.Food Contact Surfaces Cleaning and Sanitizing ❑ 21 Food and Food Preparation for HSP r i^ ❑ 10.Proper Adequate Handwashing CONSUMER ADVISORY LXy. r r ❑ 11.Good Hygienic Practices ❑22.Posting of Consumer Advisories j Violations Related to Good Retail Practices(Blue Items) Total Number of Critical Violations Critical(C)violations marked must be corrected immediately. (blue&red items) Corrective Action Required: ❑ No ❑ Yes Non-critical(N)violations must be corrected immediately or Overall Rating within 90 days as determined by the Board of Health. ❑ Voluntary Compliance ❑ Employee Restriction/Exclusion ❑ Re-inspection Scheduled ❑ Emergency Suspension C N Official Order for Correction:Based on an inspection today,the I checked indicate violations of 105 CMR 590.000/Federal Food Code. ❑ Embargo. ❑ Emergency Closure ❑ Voluntary Disposal ❑ Other: 23.Management and Personnel (FC-2)(590.003) This report,when signed below by a Board of Health member or its agent A=Zero critical violations and no more than 3 non-critical violations. F=3 or more critical violations.9 or more non-critical violations, 24.Food and Food Preparation (FC-3)(590.004) constitutes an order of the Board of Health. Failure to correct violations B=One critical violation and less than 4 non-critical violations regardless of the number of critical,results,in an F. 25.Equipment and Utensils (FC-4)(590.005) cited in this report may result in suspension or revocation of the food if no critical violations observed,4 to 6 non-critical violations=B. 26.Water,Plumbing and Waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If Seriously Critical Violation=F is scored automatically if: no hot 27.Physical Facility (FC-6)(590.007) aggrieved by this order,you have a right to a hearing. Your request must C=2 critical violations and less than 9 non-critical. If no critical ' water,sewage back-up,infestation of rodents or insects,or lack of 28.Poisonous or Toxic Materials (FC-7)(590.008) be in writing and submitted to the Board of Health at the above address violations observed,'7 to 8 non=critical violations. If 1 critical refrigeration. ation,4 to 8 non-critical viations 4 C. 29.Special Requirements (590.009) within 10 days of receipt of this order. 30.Other DATE OF RE-INSPECTION: ns for s Signet r Print: 31.Dumpster screened from public view Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y N #Seats Observed Frozen Dessert Machines: Outside Dining Y N P 's Signature Print: Self Service Wait Service Provided Grease Trap Size Variance Letter Posted Y. N �,Y1 Dumpster Screen? Y N i 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 . . .. L Law Cooled to 41°F/45°F Within 4 Hours* 590.003(B) Demonstration of Knowledge* 3-302.11(A)(1) Raw Animal Foods Separated from 3-202'12--. Additives* 3-501.15 Cooling Methods for PHFs 2-103.11 Person-in-Charge Duties - - Cooked and RTE Foods.* 3-302.14 Protection frdm Uuappioved Additives* 19 PHF Hot and Cold Holding Contamination from Raw Ingredients 115, Poisonous or Toxic Substances 3-501.16(B) Cold PHFs Maintained At or Below 41°F/45°F - * - EMPLOYEE HEALTH 3-302.11(A)(2) Raw Animal Foods Separated from Each 7-101.11 Identifying g in Information-Original Containers* 590.004(F) 590.003(C) Responsibility of the Person-in-Charge to _ Other* 3-501.16(A) Hot PHFs Maintained At or Above 140°F* 2 - - - •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 _ _ ._ I 7-202.11 Restriction-Presence and Use** 3-501.19 Time as a Public Health Control* i Applicant To Report To The Person In Charge* * 7.202.12 Conditions of Use 590.004 11 - Variance Requirements 3-304.11 Food Contact with Equipment and Utensils * ( ) 9 590.003(G) Reporting by Person in Charge* - - 7-203.11 Toxic Containers-Prohibitions Contamination from the Consumer 3 590.003(D) Exclusions and Restrictions* 3-306.14(A)(B)Returned Food and Reservice.of Food* 7-204.11 Sanitizers,Criteria-Chemicals* REQUIREMENTS FOR- . 590.003(E) Removal of Exclusions and Restrictions Disposition of Adulterated or Contaminated 7-204.12 Chemicals for Washing Produce,Criteria* t HIGHLY SUSCEPTIBLE POPULATIONS(HSP) -- - 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* 590.004A-B with Food Law * 3-801.11(D) Raw or Partially Cooked Animal Food and ( ) Compliance *P - 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* l TIMEITEMPERATURE CONTROLS 3-202.14 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. 16 Proper Cooking Temperatures for PHFs - CONSUMER ADVISORY 3-202.16 Ice Made From Potable Drinking Water* - Concentration and Hardness* 3 401.11A(1)(2) Eggs-155°F 15 sec 22 3-603.11 Consumer Advisory Posted for Consumption of 4-601.11(A) Clean Utensils and Food Contact Surfaces of Eggs-Immediate Service 145°F 15 sec* Animal Foods That are Raw,Undercooked or 5-10.1.1.1 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 c"e 11112001 4-602.14 .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* i 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* Ratites-165°F 15 sec 590.009(A)-(D) Violations of Section 590.009(A)-(D)in cater- _ * 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 t' Shellstock Identification Present* - - - 2-301.12- _ _Cleaning Procedure* 165°F* foodbome illness interventions and risk factors. * 2-301.14 When to Wash* 3-401.11 A 1 All Other PHFs-145°F 15 sec* Other 590.009 violations relating to good retail 590.004(C) Wild Mushrooms _ ( )( )(b) * 11 Good Hygienic Practices ,-17 Reheating for Hot Holding practices should be debited under#29-Special 3-201.17 Game Animals 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 Commercial] Processed RTE Food-140°F* (Blue Items 23-30) 3-202.15 Package Integrity ( ) y Critical and non-critical violations,which do not relate to the f rodborne * 12 Prevention of Contamination from Hands -, 3 403.11 Remaining Unsliced Portions of Beef Roasts* 3-101.11 Food Safe and Unadulterated t �) g illness interventions and risk factors listed above,can be found in the 6 Tags/Records:Shellstock 590.004(E) Preventing Contamination from Employees* 18 Proper Cooling of PHFs following sections of the Food Code and 105 CMR 590.000 3-202.18 Shellstock Identification* 13 Handwashing Facilities 3-501.14(A) Cooling Cooked PHFs from 140°F to 70°F * Conveniently Located and Accessible Within 2 Hours and From 70°F to 41°F/45°F Item Good Retail Practices FC 590.000 3-203.12 Shellstock Identification Maintained 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 5-205.11 Accessibility,Operation and Maintenance 3-402.12 Records,Creation and Retention* Within 4 Hours 26. Water,Plumbing and Waste FC-5 .006 590.004 Labeling of Ingredients* Supplied with Soap and hand Drying Devices (J) 9 9 27. Physical Facility FC-6 .007 7 Conformance with Approved Procedures/ 6-301.11 Handwashing Cleanser,Availability 28. Poisonous or Toxic Materials FC-7 .008 HACCP Plans 6-301.12 Hand Drying Provision t I 29. Special Requirements .009 3-502.11 Specialized Processing Methods* 30. Other 3-502.12 Reduced-Oxygen Packaging Criteria* 8-103.12 Conformance with Approved Procedures* I S:590Fomrback6-2doc *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. THE r TOWN OF BARNSTABLE HEALTH INSPECTOR s Establishment Name: Date: Page: of . OFFICE HOURS PUBLIC HEALTH DIVISION 8:00-9:30 A.M. BARNSTABLE. • 200 MAIN STREET 3:30-4:30 P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified A ''a39.a�m� HYANNIS,MA 02601 M-8 -FRI. No Reference R-Red Item PLEASE PRINT CLEARLY rFo M� 508-862-4644 FOOD E TABLISHMENT INSP CT ON REPORT Name Dat yRe of Ins ec io Routin Address Risk ood Sery msp ction Level PreviotT�p� Telephone Residential Kitchen Mobile Pre-ope Owner HACCP YIN Temporary Suspe Illness Caterer General Complaint Person in Char a(PIC) Time Bed&Breakfast HACCP , Other ki Inspector ut: Each violation checked requires an explanation on the narrati page(s)and a citation of specific provision(s)violated. Violations Related to Foodborne Illness Interventions and Risk Factors(Red Items) Anti-Choking 590.009(E) ❑ Violations marked may pose an imminent health hazard and require immediate corrective Tobacco 590.009(F) ❑ . Action as determined by the Board of Health. Allergen Awareness 590.009(G) ❑ FOOD PROTECTION MANAGEMENT ❑ 12.Prevention of Contamination from Hands ❑ 1.PIC Assigned/Knowledgeable/Duties ❑ 13.Handwash Facilities EMPLOYEE HEALTH PROTECTION FROM CHEMICALS ❑2.Reporting of Diseases by Food Employees and PIC ❑ 14.Approved Food or Color Additives ❑ 3.Personnel with Infectious Restricted/Excluded ❑ 15. Toxic Chemicals FOOD FROM APPROVED SOURCE TIME/TEMPERATURE CONTROLS(Potentially Hazardous Foods) ❑4.Food and Water from Approved Source ❑ 16.Cooking Temperatures ❑ 5.Receiving/Condition ❑ 17.Reheating El6.Tags/Records/Accuracy of Ingredient Statements ❑ 18.Cooling t ❑ 7.Conformance with Approved Procedures/HACCP Plans ❑ 19.Hot and Cold Holding PROTECTION FROM CONTAMINATION ❑20.Time As a Public Health Control a ❑ 8.Separation/Segregation/Protection REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) ❑ 9.Food Contact Surfaces Cleaning and Sanitizing ❑ 21.Food and Food Preparation for HSP ❑ 10.Proper Adequate Handwashing CONSUMER ADVISORY ❑ 11.Good Hygienic Practices ❑ 22.Posting of Consumer Advisories Violations Related to Good Retail Practices(Blue Items) Total Number of Critical Violations Critical(C)violations marked must be corrected immediately. (blue&red items) Corrective Action Required: ❑ No ❑ Yes Non-critical(N)violations must be corrected immediately or within 90 days as determined by the Board of Health. Overall Rating ❑ Voluntary Compliance ❑ Employee Restriction/Exclusion ❑ Re-inspection Scheduled ❑ Emergency Suspension C N Official Order for Correction: Based on an inspection oday,th ite s checked indicate violations of 105 CMR 590.000/Federal Food Code. ❑ Embargo Emergency Closure El Voluntary Disposal ❑ Other: 23.Management and Personnel (FC-2)(590.003) This report,when signed below by a Board of Health member or its agent A=Zero critical violations and no more than 3 non-critical violations. F=3 or more critical violations.9 or more non-critical violations, 24.Food and Food Preparation (FC-3)(590.004) constitutes an order of the Board of Health. Failure to correct violations regardless of the number of critical,results in an F. 25.Equipment and Utensils (FC-4 590.005 B=One critical violation and less than 4non-critical violations 9 )( ) cited in this report may result.in suspension or revocation of the food if no critical violations observed,4 to 6 non-critical violations=B. 26.Water,Plumbing and Waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If Seriously Critical Violation t F is scored automatically lack of no hot 27.Physical Facility (FC-6)(590.007) aggrieved by this order,you have a right to a hearing. Your request must C=2 critical violations and less than 9 non-critical. If critical water,sewage back-up,infestation of rodents or insects,or la 28.Poisonous or Toxic Materials (FC-7)(590.008) be in writing and submitted to the Board of Health at the above address violations observed,7 to 8 non=c ical violations. If f 1 critical refrigeration. 29.Special Requirements (590.009) within 10 days of receipt of this order. ol l ion s vi n,4 to 8non-critical vio - 30.Other - DATE OF RE-INSPECTION: nspe tor' n ure 0 Print: 31.Dumpster screened from public view X eke ' Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y N #Seats Observed Frozen Dessert Machines: Outside Dining Y N C's Si ature �� Print: Self Service Wait Service Provided / �� ra Size ``� Van'artce�er Wed Y � M Dumpster Screen? Y N A llI (F . Violations related to Foodborne Illness Violations Related to Foodbome 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-contamination14 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 41 590.004(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 7-202.11 Common Name-Working Containers* 3-501.1(i A Require Reporting by Food Employees and Contamination from the Environment ( ) Roasts Held At or Above 130°F* Applicants* 3-302.11(A) Food Protection* 7- 01.11 Separation-Storage* 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 * 3-304.11 Food Contact with Equipment and Utensils 7-203.11 Toxic Containers-Prohibitions* ( ) Variance Requirements 590.003(G) Reporting by Person in Charge Contamination from the Consumer 3 590.003(D) Exclusions and Restrictions* 7-204.11 Sanitizers,Criteria-Chemicals* REQUIREMENTS FOR 3-306.14(A)(B)Returned Food and Rrated or of Food* 7-204.12 Chemicals for WashingProduce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP 590.003(E) Removal of Exclusions and Restrictions Disposition of Adulterated or Contaminated ( ) Food 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and FOOD FROM APPROVED SOURCE 3-701.11_ Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels* 4 Food and Water From Regulated Sources 9 Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs* 590.004(A-B) Compliance with Food Law* 4-501.111 Manual Warewashing-Hot Water 7.206.12 Rodent Bait Stations* 3-801.11(D) Raw or Partially Cooked Animal Food and 3-201.12 Food in a Hermetical] Sealed Container* Sanitization Temperatures* Raw Seed Sprouts Not Served Y P 7-206.13 Tracking Powders,Pest Control and 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-Hot Water Monitoring* 3-801.11(C) Unopened Food Package Not Re-Served* 3-202.13 Shell Eggs* Sanitization Temperatures* TIME/TEMPERATURE CONTROLS 3-202.14 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. 16 Proper Cooking Temperatures for PHFs CONSUMER ADVISORY 3-202.16 Ice Made From Potable Drinking Water* Concentration and Hardness* 3-401.11A(1)(2) Eggs-155'F 15 sec 22 3-603.11 Consumer Advisory Posted for Consumption of 4-601.11(A) Clean Utensils and Food Contact Surfaces of E Equipment Eggs-Immediate Service 145°F 15 sec* Animal Foods That are Raw,Undercooked or 5-101.11 Drinking Water from an Approved System* * Not Otherwise Processed to Eliminate 590.006(A) Bottled Drinking Water* 3=401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* eg crier mnom 4-602.11 Cleaning Frequency of Utensils and Food Animals-155°F 15 sec* 590.006(B) Water Meets Standards in 310 CMR 22.0* Contact Surfaces of Equipment* 3-302.13 Pasteurized Eggs Substitute for Raw Shell Shellfish and Fish From an Approved Source 3-401.11(B)(1)(2) Pork and Beef Roast-130°F 121 min* Eggs* 4-702.11 Frequency of Sanitization of Utensils and Food 3-401.11(A)(2) I Ratites,Injected Meats-155°F 15 sec* 3-201.14 Fish and Recreationally Caught Molluscan Contact Surfaces of Equipment* Shellfish* 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS 4-703.11 Methods of Sanitization-Hot Water and Stuffing Containing Fish,Meat,Poultry or 590.009(A)-(D) Violations of Section 590.009(A)-(D)in cater- 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* Ratites-165°F 15 sec* Sources* ing,mobile food,temporary and residential 10 Proper,Adequate Handwashing Game and.Wild Mushrooms Approved By 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 145°F* kitchen operations should be debited under RegulatoryAuthoriry 2-301.11 Clean Condition-Hands an rms*d A 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. 2-301.14 When to Wash* 3-401.11(A)(1)(b) All Other PHFs-145°F 15 sec* Other 590.009 violations relating to good retail 590.004(C) Wild Mushrooms* practices should be debited under#29-Special 3-201.17 Game Animals* 11 Good Hygienic Practices 17 Reheating for Hot Holding 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 Commercial] Processed RTE Food-140°F* Blue Items 23.30) 3-202.15 Package Integrity ( ) Y Critical and non-critical violations,which do not relate to the foodbome * 12 Prevention of Contamination from Hands 3-403.11E Remaining Unsliced Portions of Beef Roasts* 3-101.11 Food Safe and Unadulterated O g illness interventions and risk factors listed above,can be found in the 6 Tags/Records:Shellstock 590.004(E) Preventing Contamination from Employees* 1 g Proper Cooling of PHFs following sections of the Food Code and 105 CMR 590.000 * 13 Handwashing Facilities 3-501.14(A) Cooling Cooked PHFs from 140°F to 70°F 3-202.18 Shellstock Identification g 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 Supplied with Soap and hand Drying Devices Within 4 Hours* 26. Water,Plumbing and Waste FC-5 .006 590.004(J) Labeling of Ingredients' 27. Physical Facility FC-6 .007 7 Conformance with Approved Procedures I 6-301.11 Handwashing Cleanser,Availability 28. 1 Poisonous or Toxic Materials I FC-7 .008 HACCP Plans 6-301.12 1 Hand Drying Provision 129. 1 Special Requirements .009 3-502.11 Specialized Processing Methods* 130. 1 Other 3-502.12 Reduced-Oxygen Packaging Criteria* 8-103.12 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. ~ 1 _IL i 9 VIP t - EXISTINGFRONT ELEVATION ®. Exie*wD:uur-w ex E¢e 1�! D k 3.-6... a FAST FOOD EQUIPMENT LEGEND O d _ Iry arT IT@I ceeawnlw w0 _ m-Dr.:.FRYER casFON eRLFwB(ur acHFxn �O0. O +YIREPTnBtE COSTQM tNE•iw0(BS'OIHERS) -. � �Q( �� �� � O . b�SIOSTiiOP.OYEH Cl'Sipu PRF iaelOV ODIENS) II1—^ ICE O O ) F'OIALST HOOD N� G1RESloAC9lRv fYSTEwt "t � � EO IF'FLAT iOt DRILL CCRTDM PREiwB IBY DiilERSI i 5 t !f' 0 NPDISeEHSER UCUPS) �© -f�' �� © NarD SIR /SEEPCUNBI�G) ♦,1 9dLEl aQFa fO HO COL"RER IRi TD.N FRE-FABIBY OTI(E0.11 PROPOSED EQUIPMENT LAYOUT lawc Dnl<:ljYMIT Project Numf•er 144b9 PD,jm. P.<Parca F« Rcvi>nu: Scuk:AS SHOWN SBccl Tnk: PROPOSED MODIF10NTIONS ELIE DASSIL umF o..,cPli.r orvWu Ei),CCS PROPOSED EQUIPMENT a PvoeP+<bR..Er.Rx+FeRe -f0 I FALMOLJ-Ili ROAD 570 ROUTE 28 ne�iERea Dy:Les Cnecwea Ry.H.C. IAl•OUF 22 EXISTING HYANNIS,MA 02601 HARWICH PORT.MA 0264e FRONT ELEVATION �l+,ti`n,rtli,Tu u:-.' SRaH�bM+m 2 C PART POOR M6g1N"WT LE000 ImT nir' rtn+ Q � w DarrM� amrm rlm-Pae rBY rnw@rB1 ® I Y`POP TALLX Q1STm PIS-PaB rC'mW�a © I ee•wom tar.Dr191 O.laTm PRE-Pd0 rEtt mNERO) rtvn!D® I CW�AL IEr6eM DTAMLEeB BT@@L WI dNCLL p01YMr HOED PIRH dll•IS901eJN BYBTEH \\, COY alrook4do ® 1 m•MAT 1Or a1m.L germ PRE-Pm rBY EmERe) ® 1 Oar Dwmm rB cUPB) — — O I NATO ONC r0@@PW'®trVa) -.^ ® 1 TOED emortm tnVIEeR WBTm PIB@adB rBY oTuwol :�; nw 'li :' �� �`'� 0 , ra•rwxD.crA�ICED rzerm PISiAB rBY En+eRe) DwLrr elm+ Z. l J QI 1 VMW6" M"M M LOCATED BY pWBA ,__ __,\ FMIBHED BCFEDULE ( RAMO T4.P Cl P IFlT@RB -- dm PdCCTLB PAeEL fT'PICAl1 / � � 1107/�ALL PNIBIiED eT'LEB dim(:GLCR9 i0 BE DETERIINED BY OWEp OF ION io Qb LYF�d Qy3 ' ya 000 r� I ......... ....._., .,_._ .... ......__...._....._.......... ......... .. .: � III .. .... ..... ... _.......... _..,...._,.. FF Td O @�BBTPIp W4LK-M CalXgtB ExbTIG WdI.K-W EOOLERF�OD 50PPLY$TOR/d@ oar a�f///> ',, 1 as ELEC1RtGAf. Pu i D e� y�fgg l�% f%jl`��J OMYlA DODR®.r Qe 9'.B• —_ Jy�!I -OGNDELA % ITJOWOLA AWrEMOR FMIALFEVIBYB I ! J�j��i 1//1 �/> I�f����'��✓f�,,,A4i � criEiep ® CQMCT FIIm OIABPR6BICM� © �� _. _.... .... .. 6T67EM TO EW6TMO FM &AW"MI MR PIRA —.— 0 MAM APPIWK 206 6Q PT.cP 11RAIL SPAM TO MW IOOD C011 M(4E6 PROMOM R.00R AI'm R410w'M LAYOUT TM OHM) EXISTING FLOOR LAYOUT PROPOSED FLOOR AND EQUIPMENT LAYOUT L—D—Qs* ? ft**MB bh.14109 ERBlmwmelmAr OAae.P.n „q.m 'Eq. Bub:A96HOWM sBBBI71.5. C PROPOSED MOMWATIONS ELZE EASSIL Na DEB DBBalplm D—Br.LCB� TO 199 FALMOUTH ROAD rro Rovlsxs E%IFMO FLOOR LAYOUT& � HYANNR MA HARWICH PORT,MA M646 D � Ce°Am E9T Sc PROPOSED EQUUWE TLAYLOOR UT B FAv�Marrr urovr W@Al T�QBS4RIB PAi'LO)DAW •ndlWtAEB� ®aTNmRD.2 OF 2 1YJllA99lltYO(9Mi<A ' W.DARIN N.A THILG16 KAXMA l FF L M�;U T;H <ASSA o€a 0 7� H/GHWAYJ ROAD PROPOS�MOOOHgC'n0NS EJ LOCUS MAP TO 10 AUMOUM ROAD HYANMBIAOM 1 I \� NM LEGEND PCB u dpw. \ r o ._i:- "\ (., \ "'�°'° i SYMBOL DESCRIPTION 8MBASSB. 1J9.91 EP..N 7BII420'E ' —_— PROPER" ul■ S70 AOE71E 28 HARWIEAi FORT,MA02W .;°Ao O i KB th ;� --•.�-. IDW.OONMR P A' OR9f.8P0t OMOL ® I Exisirtg aA drmp \. ��� ® u u u % Spy ,} - ow.r9NCE 6pVj�.7t1/ OOR. TR LINE �'� C\ i I Ex/to Cortto%mxf Pad I � vY EXIST.EXIST.WATER LINE \i --- ------ - ,� EXIST.Ezmw LINE C—pY r pUbp O � \.\ EM tin'B/fun)DtiB/ Exim'GAS LIKE mar.DRIPPOE LINE IV am,m7mm WIRE Y?a ■[B Eg9T.GTCII 61EW pO p / mA II�IiliYii N ® ptea most.■FAm mom me / �./ f/ eb'�;a6'o IN O— SM ERR MANN61E % 'iO i 1 O • mDn.umm Paa / - 1J poi' Owl LIGHT POTS + r/I ® e w!p Q r'`Y l� JO/sr.ow PNLws Buddhp V 9GLLwRG' I , t.TlO A/. --�� CYL9f.E09E OI PAVAIDR / I BOl1ARDS SPACING PROPOSED a DIA /2T! A. EXIST,tIDN / o O rus 1 6'TYPICAL SEVIER MANHOLE s D c JOIST.GATE w.NIT RIMMIATCX EfOSTIN I OR. A 6 �, O NM JOIST.MOMIOpING WELL MASS _O�p�, TWO TABLES TENDLRUSH0 snY.'E — C4U4rtD smni _ A�—SEATS ULE EACH FOR Plyut Nu�1440D E E SEATING S 78J�1I�'W /8$BJ' TABLE R - :.'.�A,UP —CH 6mOm AS SHOWN PROPt •� CONNwr KITCHEN � GALLON 1O C 1,000 GALL OREASEITUP � �p PARKING DATA DTnnentm eaBddBr.Rc GRAPHIC SCALE (H-20 LOADING) RETAIL PARKING REQUIRED aINT61G RETAIL,CONSUMER SDNICE 1 SPACE/200 S.F.GROSS FLOOR AREA PItOPO9EDSTI8 LAYOUT TOTAL AREA-965 S.F.OF RETAIL PARKING SPACES REQUIRED ORETAIU -955 S.F/200&F. -5 SPACES 10 PALMOUIH RQAA HYANN !LA ZONINO ANALYSIS TAHLB B 6P Sm °ATA' RESTAURANT PARING REQUIRED ZONRNOCMIDUA R 11' Po ADDRESS:199 FALMOUTH RD, RESTAUILWT HYANNI%MA 1 SPACE/EVERY S SEATS(4 OUTSIOE/INSIDE SEATS TOTAL) MIN. SQ 40 S.. 76000S.F. 1 A DEAN BOOK 2EB,PAGE 92 MIN. AGE 1 9.91 9 B DEED BOOK/662,PAGE 226 +5 SPACE FOR TAKE OUT AREA) -6 SPACES MAIL BLDG.HEIGHT-- 70 LOT COVERAGE +- +- ZONING DISTRICT.DISTRICT. EMPLOYEE PARKING REQUIRED ' HB GP 2 EMPLOYF�-1 SPACE/2 EMPLOYEES -1 SPACE I. Can CI LOT AMA�1�.000 BQ.R.t ''. O (0.54 ACRES) TOTAL PARKING REQUIRED :12 SPACES USES DG4RNG CONVENIENCE skwm~.1 OR 2 STORE WRNI Fl111N0 81A110N TOTAL PMN010 PR=m �12 6PAOE4 �NLY. Kabab qqqkL Mediterranean JMW grill&food ATE Served with 2 sides&pita bread FALAFEL .................................. 9.99 8 Pieces,Lettuce,Tomato,Pickles,Tahini sauce. CHICKEN KABAB ................. 11.99 Chunks,Lettuce,Tomato,Pickles,Garlic Paste. KAFTA KABAB ..................... 11.99 4 Pieces,Lettuce,Tomato,Onion,Pickles. BEEF KABAB ......................... 11.99 i Chunks,Lettuce,Tomato,Onion,Pickles. SHAWARMA BEEF .............. 11.99 Thin Slices,Lettuce,Grilled Tomato,Onion, r Pickles,Tahini Sauce. SHAWARMA CHICKEN ...... 11.99 Thin Slices,Lettuce,Tomato,Pickles,Garlic Paste. i HUMMUS TZATZIKI TAB(09 FRIES RICE COLE SLOW q.; s frm your server a : _"ifpair any-one.in yo o uriparty has a�food aller� gy -� !T. � I 4; i 1vIY. Kabob p Mediterranean grill&food 1 1 Served on pita bread. FALAFEL ....... ....................... 4.99 Lettuce,Tomato,Pickles,Tahini sauce. CHICKEN KABAB ................ 6.99 Lettuce,Tomato,Pickles,Garlic Paste. KAFTA KABAB .................... 6.99 Lettuce,Onion,Tomato,Pickles,Hummus. BEEF KABAB . .................. 6.99 Lettuce,Hummus,Tomato,Onion,Pickles. SHAWARMA BEEF ............ 6.99 Lettuce,Grilled tomato,Onion,Pickles, Tahini Sauce. I SHAWARMA,CHICKEN ..... 6.99 'lettuce,Tomato,Pickles,6 arlic Paste. e �HUI�IMUS .... ..... . 3 SU A ....•. .... ... •••F�. TABOULE ...... . ....:k4i99 wA RICE .2.99 TZATZIKI .2.5U FRIES .2.99 COL` ESLOW *: 2.51U � sw 199 Falmouth Rd- Hyannis MA 02601 f 77447A 51 ,"% t rj Number Fee 1235 THE COMMONWEALTH OF MASSACHUSETTS $50.0o Town of Barnstable Board of Health This is to Certify that United Gas 199 Falmouth Road, Hyannis, MA Is Hereby Granted a License For: Storing or Handling 26 - 100 gallons of Hazardous Materials. ------------------------------------------------------------------------------------------------------------------------------------------------------------------- This license is granted in conformity with the Statutes and ordinances relating there to, and li and expires 06/30/2017 unless sooner suspended or revoked. ---------------------------------------- WAYNE MILLER,M.D.,CHAIRMAN PAUL J.CANNIFF, D.M.D. 07/01/2016 JUNICHI SAWAYANAGI THOMAS A.MCKEAN,R.S.,CHO Director of Public Health yqq� "F Town of Barnstable Regulatory Services Richard V. Scali, Director nuam `"R" $ Public Health Division BA�NSTABI,E �j 1639• �0 w""nrosn ru sm°osrtx 'e n Thomas McKean, Director 16 57��g 14 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE HAZARDOUS MATERIALS IN ACCORDANCE WITH THE TOWN OF BARNSTABLE GENERAL ORDINANCE, CHAPTER 108, HAZARDOUS MATERIALS,ALL BUSINESSES THAT HANDLE OR STORE HAZARDOUS MATERIALS GREATER THAN HOUSEHOLD QUANTITIES ARE REQUIRED TO OBTAIN AN ANNUAL PERMIT(RUNS JULY 1st—JUNE 30th). APPLICATION FEES CATEGORY I PERMIT 26— 110 Gallons: $ 50.00 t/ CATEGORY 2 PERMIT 111 —499 Gallons: $125.00 ' ❑ 1 CATEGORY 3 PERMIT 500 or more Gallons: $150.00 ❑ 1 A late charge of$10.00`will be assessed if payment is not received by July Ist. ASSESSORS MAP AND PARCEL NO. DATE 0 6 d— FULL NAME OF APPLICANT: L -s NAME OF ESTABLISHMENT: ADDRESS OF ESTABLISHMENT: Nct CA (� � MAILING ADDRESS (IF DIFFERENT): TELEPHONE NUMBER OF ESTABLISHMENT: L ' c EMAIL ADDRESS SOLE OWNER: PEES O/NO IF NO,NAME OF PARTNER: cx FULL NAME,HOME ADDRESS,AND TELEPHO NF # OF: CORPORATION NAME €1 t PRESIDENT L Le s, z TREASURER t �---- CLERK IF PREPARED BY OUTSIDE PARTY: SIGN F PPLICANT Name: Company Address Telephone#: Email: Q:\Application FormsUTAZZAPP Revl6.docx -_ ! Page 1 of 2 _ _ _ ier SMEAR No. 10339 smead cam • Made in USA �abo� r - - Fol uth Rd CHOUBAH ENGINEERING GROUP,P.C. _ ' CONSULTING PROFESSIONAL ENGINEERS PROJECT. LOCATION 112 SI'ATE ROAD(ROUTE 6), - No.DARTMOUTH,.MA02747 TEL(508)858.5040 FAX:(508)858-5041 www.choubahgroup.wm (ROUTE 28) Project: MASSACHUSETTS STA TE HIGHWAY PROPOSED MODIFICATIONS EALM ; �'l 80=0" WIDE) ) ROAD _ \ ( ) N LOCUS MAP TO 199 FALMOUTH ROAD NOT TO SCALE HYANNIS,MA 02601 L.: \ ,•.i j t~Xlstrng.�CB Prepared For: LEGEND I sepacotpr, SYMBOL DESCRIPTION ELIEBASSIL \ IJ9.91= EP— N 783420n E O EP 3 • O --- PROPERTY LINE 570 ROUTE 28 °LP Exist HARWICH PORT;MA 02646 ...:...... . ExO g to .......:E-xis. Sign - — — - SETBACK LINE w/Oil ter I I RAG I Seporo r I Existin - ' / .POLE I \ I _ i O Leoc g � HAYBALES sin / i ls� EXIST. CONTOUR Existing I � - I I n Pump n n n {a Soxao EXIST:SPOT GRADE I Existing Leaching 10® 0 -0 O U O \ I Basin Existing TOO. EXIST. FENCE Pump i - O 0 �ry. - -S- EXIST. SEWER LINE .. �6 -w- - -EXIST.WATER LINE - D GRASS I - -- -Existing Cant Pod /�gj - -E- - EXIST. ELECTRIC LINE AIRExisting Canopy �^y..r��) l 1 / PUMP O I -�\ Existin Bitum us ULC - - -G- - EXIST. GAS LINE ,O 1 _ Con to Po ment 0 - - - -0- - EXIST. DRAINAGE LINE WILM A. O i / O 1 - 1 W -O/T - EXIST. OVERHEAD WIRE . X OHO O\ bDy�j\ BE 6B EXIST. CATCH BASIN O I 00 / A fib% EfZE P . TRASH CB Q OMN EXIST. DRAIN MANHOLE OO I ,O.O J/ /00 \b a•"Q° .. .. Q EMN EXIST. ELECTRIC MANHOLE ' +® "�-{ v SMH EXIST. SEWER MANHOLE uP -EXIST. UTILITY POLE .. - .O I.p :. ED.[P EXIST. LIGHT POLE o i ZO O � 3 Existing Op EXIST. GAS PUMPS Building 01 EP 1.270 s.f. -- EXIST. EDGE OF PAVEMENT BOLLARD I PROPOSED STEEL - - - ° I BOLLARDS SPACING g 223 B LA g EXIST. SIGN J 0 OUST I 5' TYPICAL AS - O G EXIST. GATE VENTS I El' L R Issue Date:05/302017 u n _ _ O O Mw EXIST. MONITORING WELL- - Revisions l �� 7 LP BLUE p - - - No. Date Description GRASS \ TYP. RHIN ® 5 �..' MULCH s -GAS � ° '. - ® /NE---SMH----___C/0 y.. Dumpste .. PROPOSED 4' [IA. CRUSHED STONE SEWER MANHOLE — O1- CRUSHED STONE RIM=MATCH EXISTING GRADE -Rg1LR0A0 77E MULCH Project Number:14-409 S 783420" W 165.63' •O°uP I Scale:AS SHOWN WOOD FENCE - PROPOSED S CONNECT KITCHEN Designed By:LCS i 0-_ PROPOSED 1,000 PARKING DATA Drawn By:LCS 6-SE TING) FLOW To 1.000 Checked By:HC GRAPHIC SCALE GALLON GREASETRAP GALLON GREASE TRAP RETAIL PARKING REQUIRED (H-20 LOADING) Sheet Title: \ RETAIL, CONSUMER SERVICE 1 SPACE/200 S.F. GROSS FLOOR AREA PROPOSED SITE rear I LAYOUT r=lo TOTAL AREA = 985 S.F. OF RETAIL PARKING SPACES REQUIRED (RETAIL) =985 S.F/200 S.F. =5 SPACES 199 FALMOUTH ROAD,HYANNIS,MA ZONING ANALYSIS TABLE (HB)(GP) SITE DATA RESTAURANT PARKING REQUIRED ADDRESS: 199 FALMOUTH RD. RESTAURANT ZONING CRITERIA REQUIRED EXISTING PROPOSED HYANNIS, MA 1 SPACE/EVERY 3 SEATS (4 OUTSIDE/INSIDE SEATS TOTAL) MIN. LOT SIZE 40,000 S.F. 15,000S.F. 15,000S.F. PLAN BOOK 258, PAGE 92 + 5 SPACES FOR TAKE OUT AREA) =6 SPACES MIN. FRONTAGE 20' 139.91' 139.91' DEED BOOK 1682, PAGE 226 MAX. BLDG. HEIGHT 30' 20'+/- 20'+/- PARCEL ID: 079 MAX. LOT COVERAGE 30%" s2.o� s2.ox ZONING DISTRICT: EMPLOYEE PARKING REQUIRED HB, GP 2 EMPLOYEES =1 SPACE/2 EMPLOYEES =1 SPACE MIN. FRONT SETBACK 60' 5' (Canopy) 5' (Canopy) LOT AREA: = 15,000 SQ.Ff.t MIN. REAR SETBACK 20' 3' 3' (0.34 ACRES) TOTAL PARKING REQUIRED MIN. SIDE SETBACK 30 25' 28 USE: EXISTING CONVENIENCE SheetNumbcr. 1 OF 2 "15% MAX LOT COVERAGE IN WP.& GP DISTICTS STORE WITH FILLING STATION TOTAL PARKING PROVIDED =12 SPACES' FAST FOOD EQUIPMENT LEGEND �- ---' ` KEY QTY ITEH DESCRIPTION 2 16"DP_F_P FRYF_R CUSTOM PRF-FAR(BY OTHERS) W O 1 48"PREP TABLE CUSTOM PRE-FAB(BY OTHERS) - .. 1 36"STOVETOP/OVEN CUSTOM PRE-FAB(BY OTHERS) EOXHAUSTHOODI7'CHEN FIRE SUPRESSION SYSTEM STAINLESS STEEL W/ L VY✓ 1 48"FLAT TOP GRILL CUSTOM PRE-FAB(BY OTHERS) MEN - MEN I !/ FO 1 CUP DISPENSER (3 CUPS) .. © 1 HAND SINK (SEE PLUMBING) t FOOD SERVICE COUNTER CUSTOM PRE-FAB(BYOTHERS) - - FINISHED SCHEDULE —� WOMEN WOMEN / ROp NAM£ FLOOR CEILING WALLS FAST FOOD CERAMIC TILE ACOUSTICAL PANEL CEILING FRP-FIBER`sLASS REINFORCED COUNTER (PLASTIC CEILING TILES) POLYESTER PANEL(TYPICAL) NOTE:ALL FINISHED ST,Y'LES ND COLORS TO BE DIEET)E INED BY OWNER 0. i ® In W ® In Q .. 7 D m Q 1(J 9'' N EXISTING WALK-IN COOLERS EXISTING WALK-IN COOLERS OFFICE w OFFICE /! mm J AD d m0 �. - SHELVES SHELVES SHELVES MEL SHELVES SHELVES ME—SHELVES SHELVES SHELVES EL EL EL SHELVES SHELVES SHELVES MEL EL EL EL EXISTING - . . . f a I ELECTRICAL 4 PUMP a Q 1 'ih LL CONTROLS WITH NEW G LL t WALLS 4 DOORS 1 - 4' O" O � GONDOLA GONDOLA.. E OW � zo C 7777 i _ GONDOLA fJ E Au LI�g� SALES AREA - - I I SALES AREA� 1 .C.r II � O� REACH-I _ ® OF TAN ACH-I CONVERT APPROX. 85 Q.FT. RETAIL SPACE TO F FOOD COUNTER(SEE PROPO D FLOOR AND EQUIPMENT LAYOUT 18 SHEET) xl/ ExISTINCx FLOOiz L,�''r OUT / PRbPOSED FLOOR AND EQUIPMENT LAYOUT SGAL£: I/ •1-0 / SCALE: 1/ 1•1.-0 -' Issue Dale:05/30/2017 - Project Number:14-409 CHOUBAH ENGINEERING GROUP,P.C. Project: prepared For: _ Scale:AS SHOWN Sheet Title:- C E G PROPOSED MODIFICATIONS ELIE BASSIL No. Date Description Drawn By:LCs EXISTING FLOOR LAYOUT& �A.CONSULTING PROFESSIONAL ENGINEERS TO 199 FALMOUTH ROAD 570 ROUTE 28 - 00A Designed By:LCS Checked By:H.C. PROPOSED FLOOR AND cr4L HYANNIS,MA 02601 HARWICH PORT,MA 02646 taa�aa H 2 STATE ROAD(ROUTEE 6). - EQUIPMENT LAYOUT No.DARTMOUTH.MA 02747 TEL:(508)858-5040 FAX:(508)858-5041 wLvw.choubahgroup.com. .. - �y— - ' - - Sheet Number. 2 OF 2 o„th Rd 7` Farm Choubah Engineering Group, p.c. r. �oUte 2a low Consulting Professional Engineers 3> PROJECT a LOCATION 112 STATE ROAD(ROUTE 6), No.DARTMOUTH,MA 02747 05 TEL:(508)858-5040 FAX:(508)858-5041 www.choubahgroup.com (ROUTE 28� F� FA MOU H SSA CHUSETTS S TA TE H h Project: (IVA HIGH Y (80 —0 WIDEN s ROAD O` PROPOSED MODIFICATIONS i '+ LOCUS MAP TO 199 FALMOUTH ROAD i N NOT TO SCALE HYANNIS, MA 02601 Ep�E OF Pg VEMENrI EXISTING EDGE OF PA VEMENT �� ► �H/drop t LEGEND MULCH M/H Prepared For: (� I re 0 MULCH Existing CB MULCH0 (Dwl OillWater SYMBOL DESCRIPTION ELIE BASSIL Separator 28 I 570 ROUTE 139. 91 ' EP N 78'34 '20 E P 0. 00 ------ PROPERTY LINE HARWICH PORT, MA 02646 DLP ® Exist. _ _ — Existing CB — — — — — — — — — — — — — — — Sign — SETBACK LINE w/ Oil/Water O I Separator Exis tin g HAYBALES f ; . .s, . I. leaching FLAG � ,: .. s: . t,� ,. . , . , • , 1 POLE I I Basin / --'--sa _ EXIST. CONTOUR = I I existing O Pump 50140 EXIST. SPOT GRADE n n n n _ I Existing Leaching I U U 0 0 0 1 , EXIST. FENCE Basin I Existing I O Pump 1 ( r� — 1 I O. — 5— -- EXIST. SEWER LINE. .� i I I �0 6� / — RA I / —w— — EXIST. WATER LINE GRASS I ) Existing Containment Pad I n _ — — — — — — — — — — — — Vh EXIST. ELECTRIC LINE 0 I — Existing Canopy �j — G— — EXIST. GAS LINE V AIR O 1W Existing Bitumous ULCH LINE 0 ' PUMP — —D— — EXIST. DRAINAGE (v I ® Concrete Pa vem en t o � � EXIST. OVERHEAD WIRE �tN 4F 4lgs��c � Q a ® CB EXIST. CATCH BASIN h o, e, �� HALtM A _ J a REEZER va � OMN EXIST. DRAIN MANHOLEQ O CB O TRA SH COQT � EXIST. ELECTRIC MANHOLE o�O � SMH EXIST. SEWER MANHOLE O . � / I 10-1 UP EXIST. UTILITY POLE I [:�a CP EXIST. LIGHT POLE I o o ° I O Existing 0 EXIST. GAS PUMPS Building EP EXIST. EDGE OF PAVEMENT V BLUE 1,270 s.f. t c RHINO BOLLARD I PROPOSED STEEL CONCRETE GAS # 22J BOLLARD I BOLLARDS SPACING BARRIERS g EXIST. SIGN / O J ° I 5' TYPICAL GAS o G EXIST. GATE Issue Date:05/16/2017 I/EN TS E UST I P S METER O p EXIST. MONITORING WELL Revisions Q 0 0 5, o LP ® � � Q Description o No. Date \ IYP GRASS s �" I SEWER LINE_ — SMH C fl0 Dumpster OER - -U 0 • .. CRUSHED STONE PROPOSED 4' DI A. Protect Number: 14-409 SEWER MANHOLE CRUSHED STONE e• AS SHOWN �� RIM=MATCH EXISTING GRADE 8,. RAILROAD TiE SUP -� MULCH Scale: 5 78 34 20 W 165. 63 WOOD FENCE PARKING DATA Designed By:LCS CONNECT KITCHEN PROPOSED PICNIC TABLES RETAIL PARKING REQUIRED (SEASONAL SEATING) FLOW TO 1 000 Drawn By:LCS Checked By:HC PROPOSED 1 000 RETAIL CONSUMER SERVICE GALLON GRE ' , GALLON GREASE TRAP GRAPHIC SCALE 1 SPACE/200 'S.F. GROSS FLOOR AREA Sheet Title: ASETRAP 10 0 10 20 40 (H-20 ' LOADING) + 1/SEPARATE ENTERPRISE PROPOSED SITE TOTAL AREA = 985 S.F. OF RETAIL LAYOUT ( W FEET ) PARKING SPACES REQUIRIED (RETAIL) =990 S.F/200 S.F. + 1 SEPARATE ENTERPRISE =6 SPACE 199 FALMOUTH ROAD, HYANNIS, MA RESTAURANT PAR K I N I G REQUIRED SITE DATA RESTAURANT ZONING ANALYSIS TABLE (HB) (GP) ADDRESS: 199 FALMOUTH RD, 1 SPACE/EVERY 3 SEATS + 1/EVERY (2) EMPLOYEES ZONING CRITERIA REQUIRED EXISTING PROPOSED HYANNIS, MA MIN. LOT SIZE 40,000 S.F. 15,000S.F. 15,000S.F. PLAN BOOK 258, PAGE 92 PARKING SPACES =1 SPAACE/ 3 SEATS (8 SEATS TOTAL) =3 SPACES MIN. FRONTAGE 20' 139.91 ' 139.91 DEED BOOK 1682, PAGE 226 2 EMPLOYEES =1 SPACE/2 EMPLOYEES MAX. BLDG. HEIGHT 30' 20'+/— 20'+/— PARCEL ID: 079 EMPLOYEE FOR RETAIIL + 1 EMPLOYEE FOR RESTAURANT) =1 SPACE 620� ZONING DISTRICT: (1 EMPL , MAX. LOT COVERAGE 30%* 62 0 o . HB, GP - MIN. FRONT SETBACK 60' 5' (Canopy) , 5' (Canopy), LOT AREA: = 15,000 SQ.FT.f TOTAL PARKING REQUIRED =10 SPACES MIN. REAR SETBACK 20 3' 13' (0.34 ACRES) MIN. SIDE SETBACK 30' 25' 25' USE: EXISTING CONVENIENCE PARKING PROVIDED =12 SPACES Sheet Number. 1 OF 2 *15% MAX LOT COVERAGE IN WP Se GP DISTICTS STORE WITH FILLING STATION PLUS 4 SPACES ® PUMPS =4 SPACES TOTAL PARKING PROVIDED =16 SPACES FAST FOOD EQUIPMENT LEGEND KEY OTY ITEM DESCRIPTION C 2 16"DEEP FRYER CUSTOM PRE-FAB(BY OTHERS) C/ 1 48"PREP TABLE CUSTOM PRE-FAB(BY OTHERS) MEN MEN C� 1 36"STOVE TOP/OVEN CUSTOM PRE-FAB(BY OTHERS) D 1 COMMERCIAL KITCHEN STAINLESS STEEL W/ANCUL EXHAUST HOOD FIRE SUPRESSION SYSTEM 1 48"FLAT TOP GRILL CUSTOM PRE-FAB (BY OTHERS) El 1 CUP DISPENSER (3 CUPS) 1 HAND SINK (SEE PLUMBING) WOMEN WOMEN FOOD SERVICE COUNTER CUSTOM PRE-FAB(BY OTHERS) � Y z O � Oz F= w Z 3 (1 ® Z ~ Cl �- w `� w Q -� m � � -3p � 3 cA _ - r- -0 EX15TING WALK-IN COOLER5 N N mM rn OFFICE b EX151TING WALK-IN COOLERS n z r- OFFICE m N - t. r- SHELVES SHELVES SHELVES SHELVES SHELVES SHELVES SHELVES SHELVES SHELVES SHELVES SHELVES SHELVES SHELVES: SHEL'LVES SHELVES SHELVES SHELVES SHELVES SHELVES SHELVES --,- IL a / , .. ram,.w. i. ��,. „ ;t ., .r�,. .. . �`. .. -' . :. . .. � .�� � " • ,"'� '✓�/!1, /� __ _ , F- ® •,,ma.. ,.. z Q � y 1Z (L4 r/r I � GONDOLA %Cs4�1pq�-Ay% i j GONDOLA Q 4 q z r xx :07Q 0 , , .,,,, /z /f i Q Z Z AO u w r, z o SQi1. i�r ,!/r, O,I;A�� �i%� GONDOLA ~ ' C ~ ; GONDOLA El SALES AREA O SALES AREA REACH-IN . LOTT. RE COOLER F ACH-IN OTT TAN O TAND COOLER qTM 1, 67-7 pi CONVERT APPROX. 285 50. FT. OF RETAIL SPACE TO FAST FOOD COUNTER (SEE PROPOSED FLOOR AND EQUIPMENT LAYOUT TWIS SWEET) EX15TING FLOOR LANT'OUT SCALE: 1/4"=I' fi fitOFCeE h FLOOR AND EaUIF IENT LA%T`0UT SCALE: 1/4 =1 -0' 5; , Issue Date: 05/16/2017 Project Number: 14-409 Choubah Engineering Group, p.c. Project: Prepared For: Revisions Scale:AS SHOWN Sheet Title: PROPOSED MODIFICATIONS" ELIE BASSIL No. ' 'Date ' DesCripti'on" r... .Drawn By:Y.CS. 0H GF rrsa,,9 EXISTING FLOOR LAYOUT & Consulting Professional Engineers TO 199 FALMOUTH ROAD 570 ROUTE 28 Designed By:LCS Checked By:H.C. PROPOSED FLOOR AND HYANNIS, MA 02601 HARWICH PORT, MA 02646 112 STATE ROAD(ROUTE 6), EQUIPMENT LAYOUT -; No.DARTMOUTH,MA 02747 0 n TEL:(508)858-5040 FAX:(508)858-5041 TJ www.choubahgroup.com Sheet Number. 2 OF 2 - — 1 I 1 FAST FOOD EQUIPMENT LEGEND KEY OTY ITEM DESCRIPTION I AO 2 b6"DEEP PRYER CUSTOM FIRE-FAB(BY OTHERS) ® 1 48"PREP TABLE CUSTOM PRE-FAB(BY OTHERS) 1 36"STOVE TOPIOVEN CUSTOM PM-FAB(BY OTHERS) (TYPE 1)CVr11ERGIAL KITCHEN STAINLESS STEEL W/ANCUL I V EXHAUST HOOD FIRE SUPRESSION SYSTEM DRY STORAGE CLOSET O I 48"FLATTOP GRILL CUSTOM PRE-FAB(BY OTHERS) V 1 CUP DISPENSER (3 CUPS) (SEE PLUMBING) l FOOD SERVICE COUNTER CUSTOM PRE-FAB(BY OTHERS) II MEN ` I MENfIREP O I DISPLAY SHED Fob CUSTOM PRE-FAB(BY OTHERS) 1 V l REGISTER wl INTERCOM LOCATED BY OWNER FIN1544ED 604EQULE �..... . Root NAME FLOOR CEILING WALLS FAST FOOD CERAMIC TILE ACOUSTICAL PANEL CEILING FRP-FI5ER3LA55 REINFORCED WOMEN ♦ WOMEN GOLAJTER (PLASTIC CEILING TILER) POLYESTER PANEL(TYPICAL) NOTE: ALL FINISHED STYLES AND COLORS TO BE DETERMINED BY OWNER --- FOOD SERVICE HOURS OF OPERATION R Q Y Im;mmAM , 9:HDmPM i;. W w H- ♦ c rv3 m O Q � m Q Q N v ! t, EXISTING WALK-IN COOLERS � ��, EXISTfNG WALK-IN COOLER/FOOD SUPPLY STORAGE �^ (� D OFFICE 1S►C1 L"�T�S tom, OFFICE i E N GJ zM q SIELVES1'SHELVES 51'E'LVES SHELVES ri.SHELVES 91ELVE5�'SELVESIi SHEL��SHELVES SHELVES! SNEtVES SHELVES SHELVES SHELVES SHELVES SHELVES SFIELVES'SHELVES SIEI.VES SHELVES - . i%fL i/• r•, ;.... a �L� \ If ,, g _ I , F- ,, 0 d ENCLOSE EXISTING tL d ,,. _ r ELECTRICAL PIJfrIP LL r ',rrr.' r• ir`> +r' ',,;' ,, " CONTROLS WITH NEW G " - r rfi..� ."f r t // ✓r r:r r. t ,f. .�, \ -:� � a - r WALLS 4 ODORS.(SUISJECt _ - � TO LOCAL£LEGTRIGAL .., / Jrr ,f / f,,r, f GONDOLA �i GONDOLA INSPECTOR REVIEW ; to r/ .1 i f'_`+ ` r' AFOPROVAL). O _ a z 5 srn 1 i f GONDOLA: , GONDOLA A p ru Or I H-W O ® U p r z )• r _,..1 r/fr i f r/ r f%r / ,✓/,. _ _ ® Q 11 r f lr QIL"� f/1.,; r� ,' J .rrf.rr. Z�� Z� v . �--J Al +Q J - v /, GONDOLA.:: i/', GONDOLA Q Q f • r -- '� ;!i 3 GONDOLA iA � 4C ` � J nl cp �/;;qqI� r J.%-j t ! .`'/ f f'✓ r, - - - _y 71 4' .'I 1 SALES AMA �y ' "U SALES AREA r OTL AGH-1 F AGH- LOTT. f r `'/� f%r.f COOLER O COOLER %. /r, r`rk< TAM :. CG�AddEGt FIRE SUPPRESSION 7 dN SYSTEM TO EXISTING FIRE \ : -- ALARM SYSTEM PER FIRE - - CODES. CONVERT APPROX.285 W.FT.OF RETAIL SPACE TO FAST FOOD COUNTER.(SEE PROPOSED FLOOR ` AND ECUIPMENT LAYOUT THIS SWEET) EX15TING FLOOR LAYOUT PROPOSED FLOCR AND EQUIPMENT LAYOUT SCALE: 1/4"z l'-O" SCALE: 1/4H a l'-OH Issue Date:OS/30P2017 Project Number_14-409 CHOUWW ENGINEERING GROUP,P.C. project Prepared For: Revisions Scale:AS SHOWN- Sheet title: �'�'�` �" PROPOSED MODIFICATIONS ELIE BASSIL No. Date Description Drawn By.LGS EXISTING FLOOR LAYOUT�c CONsuLTING PRoFessloNAL ENGwww TO 199 FALMOUTH ROAD 570 ROUTE 28 HYANNIS,MA 02601 HARWICH PORT,MA 02646 Designed By LCS Checked By H.0 PROPOSED FLOOR AND U:� T) ; 112 STATE ROAD(ROUTS s)> EQUIPMENT LAYOUT ` No.DARTMOUTH,MA 02747 , * TEL:(508)858-5040 FAX:(508)858-Wl / www.choabahgroup.00m Sheet Number.:2 OF 2 fololouth Rd CHOUBAH ENGINEERING GROUP,P.C. Route Za v CONSULTING PROFESSIONAL ENGINEERS PROJECT C=EE: ° LOCATION 112 STATE ROAD(ROUTE 6), ° No.DARTMOUTH,MA 02747 TEL:(508)858-50Q FAX:(508)858-5041 www.choubahgroup.com (ROUTE 28) FALMOUTH (MA SSA CHUSETTS STA TE HIGH WA Y) ROAD � h (80 _O WIDE) .ramar R A Project: PROPOSED MODIFICATIONS N LOCUS MAP TO 199 FALMOUTH ROAD NOT TO SCALE HYANNIS,MA 02601 EDGE OF P,4 L-EMENTI EX/STING EDGE OF PA VEMENT \� I �Fire }� , Hydrant MH LEGEND (� I MULCH MULCH Existing CB MULCH O Prepared For: i w/ 017Cater Separator SYMBOL DESCRIPTION ELIEBASSIL I 139.91' EP N 78 34 20" E P 30.00, — PROPERTY LINE 570 ROUTE 28 i DLP O Exist. HARWICH PORT,MA 02646 Existing CB --------------- Sign - — — — SETBACK LINE w/ Oil/Water FLAG Leaching O I Separator I I Existing HAYBALES I I / POLE I I 0 Basin ' I I Existing O I r' 'scz_ EXIST. CONTOUR fl Pump n n n I O 5OX40 EXIST. SPOT GRADE Existing Leaching I U � U U ® U Basin I Existing I lO QO — EXIST. FENCE I I O Pump I , QQ. �, ,� —S— — EXIST. SEWER LINE —!�'— — EXIST. WATER LINE GRASS I I Existing Containment Pad —E EXIST. ELECTRIC LINE Az ---- V� AlR ——— Existing Canopy - — C) —G— — EXIST. GAS LINE I PUMP O i \ Existing Situmous VULCHOF Concrete Pavement j°'�I — —D— — EXIST. DRAINAGE LINE N"I A. EXIST. OVERHEAD WIRECNL 1SAH / 1 O 0 / / No 3873e EXIST. CATCH BASIN �a�// / 0 �a / a o TRASH CB O DMH EXIST. DRAIN MANHOLE O REEZE� d d L J EA1H EXIST. ELECTRIC MANHOLE O -- St'r� EXIST. SEWER MANHOLE CO / Qi� / o� UP EXIST. UTILITY POLE LP EXIST. LIGHT POLE 70 ° i ,\ O •° Existing �� I r 0 EXIST. GAS PUMPS Building a � Rl G BLUE 1,270 s.f. EP EXIST. EDGE OF PAVEMENT BOLLARD I PROPOSED STEEL CONCRETE GAS 1�11LRD EXIST. SIGN I BOLLARDS SPACING BARRIERS # 22J OL O UST° I 5' TYPICAL GAS 0 G EXIST. GATE vENTs I EP METER Issue Date:05/16/2017 O o ° ° LP O YH EXIST. MONITORING WELL Revisions \ TYP. -' B e ;d . , MULCH p No. Date Description GRASS a .d — SEWER LINE__ SMH————————/OO Dumps ter d " OCRUSHED STONE PROPOSED 4 DIA. _ CRUSHED STONE SEWER MANHOLE Project Number:l4-409 RIM=MATCH EXISTING GRADE 8.. RAILROAD TIEMULCH S 78 34 20 W 165.63' _ - 'o-up - Scale:AS SHOWN wooD FENCE PARKING DATA PROPOSED PICNIC TABLES CONNECT KITCHEN RETAIL PARKING REQUIRED Designed By:LCS SEA ONAL SEATING S � FLOW TO 1 000 PROPOSED 1,000 Drawn By:LCS Checked By:HC p e5`fl b GALLON GREASE TRAP RETAIL, CONSUMER SERVICE GRAPHIC SCALE GALLON LOADING) 1 SPACE/200 S.F. GROSS FLOOR AREA Sheet Title: 10 0 ,o 20 40 (H-20 LOADING) + 1/SEPARATE ENTERPRISE PROPOSED SITE IN FM TOTAL AREA = 985 S.F. OF RETAIL LAYOUT ( Ito PARKING SPACES REQUIRED (RETAIL) =990 S.F/200 S.F. + 1 SEPARATE ENTERPRISE =6 SPACE 199 FALMOUTH ROAD,HYANNIS,MA RESTAURANT PARKING REQUIRED ZONING ANALYSIS TABLE (HB) (GP) SITE DATA : RESTAURANT ADDRESS: 199 FALMOUTH RD, 1 SPACE/EVERY 3 SEATS + 1/EVERY (2) EMPLOYEES ZONING CRITERIA REQUIRED EXISTING PROPOSED HYANNIS, MA MIN. LOT SIZE 40,000 S.F. 15,000S.F. 15,000S.F. PLAN BOOK 258, PAGE 92 PARKING SPACES =1 SPACE/ 3 SEATS (8 SEATS TOTAL) =3 SPACES MIN. FRONTAGE 20' 139.91, 139.91' DEED BOOK 1682, PAGE 226 2 EMPLOYEES =1 SPACE/2 EMPLOYEES MAX. BLDG. HEIGHT 30' 20'+/ 20'+/— PARCEL ID: 079 MAX. LOT COVERAGE 30%* 62.0% 62.0% ZONING DISTRICT: (1 EMPLOYEE FOR RETAIL + 1 EMPLOYEE FOR RESTAURANT) =1 SPACE HB, GP MIN. FRONT SETBACK 60' 5' (Cano y) 5' (Canopy) LOT AREA: = 15,000 SQ.FT.f TOTAL PARKING REQUIRED =10 SPACES MIN. REAR SETBACK 20 3' 3' (0.34 ACRES) MIN. SIDE SETBACK 30, 25' 25' USE: EXISTING CONVENIENCE PARKING PROVIDED =12 SPACES Sheet Number. 1 OF 2 *15% MAX LOT COVERAGE IN WP & GP DISTICTS STORE WITH FILLING STATION PLUS 4 SPACES ® PUMPS =4 SPACES TOTAL PARKING PROVIDED. =16 SPACES