HomeMy WebLinkAboutGone Acai DNL ODD Chg Hrs 05 15 23Common Victualler License
This application is for restaurant establishments with seating. Please contact staff if you have questions
regarding the online application at 508-862-4774 or at erin.logan@town.barnstable.ma.us
Name of Corporation
Gone Açai Hyannis INC
If applicible.
Doing Business As:
Gone Açai Hyannis
d/b/a
Name of Applicant
Camilla
First
Vailante
Last
Applicant Email
goneacaihyannis@gmail.com
Applicant Cell Phone
(774) 444-1032
Address of Business
Address Line 1
City State Zip Code
Mailing Address (if different)
Address Line 1
City State Zip Code
Name of Manager
Camilla
First
Vailante
Last
561 main st
Hyannis Massachusetts 02601
Manager's Email
camillavailante@gmail.com
Manager's Cell Phone
(774) 444-1032
Type of Application
Amend License Application - $100.00
Type of amendments being requested
Floor Plan Change in Manager
Change in
Corporation
Change in DBA
Change in Location Change in Hours of
Operation
Change in
Entertainment
Check all that apply
*Abutter notification will be required - Fees
associated will depend on number of direct abutters.
The Licensing Division will guide applicant through
the process once application is submitted.
Do you have Entertainment?
Yes No
TV's & Music (below conversation
level) are considered Non-Live
Entertainment and require a
license.
Types of Entertainment
Daily Live Entertainment -
$275.00
Live Amplified Music, Bands,
DJ, etc.
Daily Non Live
Entertainment - $75.00
TV's and music (radio below
conversation level)
# of TV's
3
Live Theater - $100.00
Karaoke - $100.00
Cinema Entertainment -
$85.00
$85 per movie screen
Video/Coin Operated
Machines
$100 per device
Pool Table(s)
$75 per table # of Tables
Mini Golf - $50.00
$50
Carousel/Auto
Amusements
Hours of Operation
9am to 11pm
Liability Insurance Visual
Example
Workers' Comp
Visual Example
To access a blank Workers'
Comp form:
Step One: Click here;
Step Two: Fill out blank fields;
Step Three: Save to desktop; and,
Step Four: Upload to this
application.
NOTICE: Any misstatement in this application or violation of the applicable town ordinances, bylaws or
regulations shall be considered sufficient cause for refusal, suspension, or revocation of any and all
licenses.
I warrant the truth of the forgoing statement under the penalty of perjury.
Signature
Form of Payment
Credit Card (Online Only)
Credit Card Processing Fees will be applied.
Payment
Type of Application - Amend
License Application $100.00
Do you have Entertainment? - Yes $0.00
Daily Non Live Entertainment -
Daily Non Live Entertainment $75.00
Subtotal:$175.00
Processing Fees:$5.54
Amount Due: $180.54