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Home My WebLink AboutNIRVANA COFFEE - FOOD s, NIRVANA COFFEE 3206,Main St., Barnstable �rAL?k, Town of Barnstable BOARD OF HEALTH y John T.Norman Board of Health Donald A.Gaudagnoli,M.D. BaRNSTeABM F.P.(Thomas)Lee,. Mas:-�, Daniel Luczkow,M.D. Alt. a 200 Main Street, Hyannis, MA 02601 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: 887 Issue Date: 01/01/2022 DBA: NIRVANA COFFEE COMPANY OWNER: NIRVANA BARNSTABLE LLC. Location of Establishment: 3206 MAIN STREET BARNSTABLE„ MA 02630 Type of Business Permit: FOOD SERVICE Annual: YES Seasonal: IndoorSeating: 8 OutdoorSeating: 0 Total Seating: 8 FEES FOOD SERVICE ESTABLISHMENT: $250.00 YEAR. 2022 RETAIL FOOD: COTTAGE FOOD OPERATION: Permit Expires: 12/31/2022 B&B-FULL BREAKFAST: CONTINENTAL BREAKFAST: MOBILE-FOOD: MOBILE-ICE CREAM: Q� FROZEN DESSERT: Thomas A. McKean, IRS, CHO, Health Agent FOR ESTABLISHMENTS WITH SEATING: PERMIT IS NOT VALID UNLESS ISSUED IN CONJUNCTION WITH A COMMON VICTUALER LICENSE Restrictions: MUST POST VARIANCE LETTER. A conditional variance was granted to allow utilizing a GRD device in lieu of a 1,000 gallon grease trap. Two page menu dated 2/4/13 was approved. A daily log listing date and amount of grease removed shall be maintained. This variance is not transferable to another owner or lessee of this establishment. Dilly:For Office U4e Initials: Town of Barnstable Date Paid $ r Inspectional Services 6 3�ga� 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 L` NEW OWNERSHIP RENEWAL_ l�.lTfl GSM1� NAME OF FOOD ESTABLISHMENT: ADDRESS OF FOOD ESTABLISHMEN MA MAILING ADDRESS(IFDIFFERENT FROM ABOVE) o)( 'Me� KlApigW3 E-MAILADDRESS:itl`-e. C! TELEPHONE NUMBER OF FOOD ESTABLISHMENT:4 g TOTAL NUMBER OF BATHROOMS: WELL WATER�:Y _NO ...(ANNUAL WATER ANALYSIS REQUIRED) ��JJ DATES OF OPERATION: t i l /AO�131 L2- ANNUAL: SEASONAL: __._ NUMBER OF SEATS: INSIDE: OUTSIDE: TOTAL: 'Vt 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)? TYP OF ESTABLISHMENT; (PLEASE CHECK ALL THAT APPLY BELOW) AO OD SERVICE TAIL 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 ii2) *** SEASONAL,MOBILE&NEW FOOD ONLY*** REQUIRED TO CALL HEALTH DIV FOR INSPECTION PRIOR TO PERMIT BEING ISSUED PLEASE CALL 508-8624644 Q:\Application FormsTOODAPP 2020.doc J OWNER INFORMATIONz l ! � � .. ,_�� v „ j FULL NAME OF APPLICANT -� / SOLE OWNE ' YES/ t0 D.O.B 6 OWNER PHONE# 5(9 V.6 15W C ADDRESS Y O r CORPORATE OWNER: t CORPORATE ADDRESS:TD -60< 4 76W!�M" L1 M� 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 I Certified Food Protection Manager PER SHIFT. **ATTACH COPIES OF CERTIFICATES** The Health Div. will NOT use past years' records. You must provide new copies and POST THE CERTIFICATES at your food establishment. Certified Food Manaers Expiration Date Allergen Awareness Exlairation Date S A 4I. L)�O V 4V) � H / H z3 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 openina!! 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 htt ://wwA-.townofbarnstable.us/healthdivision/a lieations.astr. 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 1"each calendar year. IT IS YOUR RESPONSIBILITY TO RETURN THE COMPLETED APPLICATIONS)AND REQUIRED FEES BY DEC 1st. Q:1Application FormsTOODAPP REV3-2019.doc Town of Barnstable BOARD OF HEALTH John T.Norman Board of Health Donald A.Gaudagnoli,M.D. BAP.NSTAoa.E, Paul J.Canniff,D.M.D. MASS.. F.P. Thomas Lee Alternate 200 Main Street, Hyannis, MA 02601 Phone: (508) 862-4644 Fax: (508)790-6304 www.townofbarnstable.us Permit to Operate a Food Establishment In accordance with regulations promulgated under authority of 105 CMR 590.000 M.G.L. Chapter 94 Sections 305A, 3056, 146, 189 and 189A; Chapter 111,Sections 5 and 127A, a permit is hereby granted to: Permit No: 887 Issue Date: 01/01/2021 DBA: NIRVANA COFFEE COMPANY OWNER: NIRVANA BARNSTABLE LLC. Location of Establishment: 3206 MAIN STREET BARNSTABLE„ MA 02630 Type of Business Permit: FOOD SERVICE Annual: YES Seasonal: Indoor5eating: 8 OutdoorSeating: 0 Total Seating: 8 FEES FOOD SERVICE ESTABLISHMENT: $250.00 YEAR. 2021 RETAIL FOOD: COTTAGE FOOD OPERATION: Permit Expires: 12/31/2021 B&B-FULL BREAKFAST: CONTINENTAL BREAKFAST: MOBILE-FOOD: MOBILE-ICE CREAM: CA FROZEN DESSERT: Thomas A. McKean, RS, CHO, Health Agent FOR ESTABLISHMENTS WITH SEATING: PERMIT IS NOT VALID UNLESS ISSUED IN CONJUNCTION WITH A COMMON VICTUALER LICENSE Restrictions: MUST POST VARIANCE LETTER. A conditional variance was granted to allow utilizing a GIRD device in lieu of a 1,000 gallon grease trap. Two page menu dated 2/4/13 was approved. A daily log listing date and amount of grease removed shall be maintained. This variance is not transferable to another owner or lessee of this establishment. ^d �tMME r� Initials: Town of Barnstable { Date Paid Amt I'd$ _ &UMSfABLE. . Inspectional Services 8 MASS. 9. `�� Public Health Division Check# U ArED MAC A 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 lam' NEW OWNERSHIP RENEWAL NAME OF FOOD ESTABLISHMENT: ��'1 , � PA ADDRESS OF FOOD ESTABLISHMENT:` �(lJ l'J - " 6-F MAILING ADDRESS(IF DIFFERENT FROM ABOVE): B6qAr DaaJ� E-MAIL ADDRESS: v''1 'v v a VV I-) u TELEPHONE NUMBER OF FOOD ESTABLISHMENT: 6% -u '— TOTAL NUMBER OF BATHROO a WELL WATER:Y S NO @P ... ANNUAL WATER ANALYSIS REQUIRED) ( Q ) ANNUAL: SEASONAL: DATES OF OPERATION:I/ ) /dITO 12-/3/2- 1 NUMBER OF SEATS: INSIDE: D OUTSIDE: TOTAL: SEATING: MUST OBTAIN A COMMON VICTUALLER'S LICENSE FROM LICFN--TIVK 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)? TYP OF ESTABLISHMENT: (PLEASE CHECK ALL THAT APPLY BELOW) FOOD SERVICE �V//RETAIL FOOD-ONLY required for TCS foods(foods requiring refrigeration/freezer) BED& BREAKFAST CONTINENTAL BREAKFAST COTTAGE FOOD INDUSTRY(formerly residential kitchen) MOBILE FOOD FROZEN DAIRY DESSERT MACHINES ... (MONTHLY LAB ANALYSIS REQUIRED) CATERING ... (CATERING NOTICE REQUIRED BEFORE EVENT(SEE PAGE#2) *** SEASONAL,MOBILE & NEW FOOD ONLY*** REQUIRED TO CALL HEALTH DIV.FOR INSPECTION PRIOR TO PERMIT BEING ISSUED PLEASE CALL 508-862-4644 Q:\Application FormsTOODAPP 2020.doc R J� OWNER INFORMATION: FULL NAME OF APPLICANT SOLE OWNER: YES/ O .O.B 10 C bj OWNER PHONE# �1 6�f �' ADDRESS_VD (oD 1-dy"54�tf (D�N✓(—) CORPORATE OWNER: 1 t� CORPORATE ADDRESS: �i 14— (A PERSON IN CHARGE OF DAILY OPERATIONS: Y flrc 1 1 1/" 40— 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.i10VA1 \2, , Imo, 2-0 SIGNATURE OF APPLICANT DATE ***FOOD POLICY INFORMATION"* * SEASONAL FOOD SERVICE: All seasonal food establishments,including mobile trucks must be inspected by the Health Div. prior to opening!! Please call Health Div.at 508-862-4644 to schedule your inspection. Please call at least(7)days in advance. FROZEN DAIRY DESSERTS: Frozen desserts must be tested by a State Certified lab prior to opening and monthly thereafter, with sample results submitted to the Health Div. Failure to do so will result in the suspension or revocation of your Frozen Dessert Permit until the above terms are met. CATERING POLICY: Anyone who caters within the Town of Barnstable must notify theTown by fax or mail prior to catering event. You must complete a catering notice found at http://www.townofbarnstable.us/healthdivision/api)lications.asi). OUTDOOR COOKING: Outdoor cooking,preparation,or display of any food product by a food establishment is prohibited. NOTICE: Permits run annually from January 1 st to Dec.31s`each calendar year. IT IS YOUR RESPONSIBILITY TO RETURN THE COMPLETED APPLICATION(S)AND REQUIRED FEES BY DEC 1 st. Q:\Application FormsTOODAPP REV3-2019.doc . Town of Barnstable BOARD OF HEALTH John T.Norman Board of Health Donald A.Gaudagnoli,M.D. BARNSTABM Paul J.Canniff,D.M.D. Me 1 200 Main Street, Hyannis, MA 02601 F.P. Thomas Lee Alternate Phone: (508) 862-4644 Fax: (508)790-6304 www.townofbarnstable.us Permit to Operate a Food Establishment In accordance with regulations promulgated under authority of 105 CMR 590.000 M.G.L. Chapter 94 Sections 305A, 30513, 146, 189 and 189A; Chapter 111, Sections 5 and 127A, a permit is hereby granted to: Permit No: 887 Issue Date: 12/10/2019 DBA: NIRVANA COFFEE COMPANY OWNER: RICK SHECHTMAN Location of Establishment: 3206 MAIN STREET BARNSTABLE, MA 02630 Type of Business Permit: FOOD SERVICE Annual: YES Seasonal: IndoorSeating: 8 OutdoorSeating: 0 Total Seating: 8 FEES FOOD SERVICE ESTABLISHMENT: $250.00 YEAR. 2020 RETAIL FOOD: COTTAGE FOOD OPERATION: Permit Expires: 12/31/2020 B&B-FULL BREAKFAST: CONTINENTAL BREAKFAST: MOBILE-FOOD: MOBILE-ICE CREAM: Gi FROZEN DESSERT: Thomas A. McKean, RS, CHO, Health Agent TOBACCO SALES: FOR ESTABLISHMENTS WITH SEATING: PERMIT IS NOT VALID UNLESS ISSUED IN CONJUNCTION WITH A COMMON VICTUALER LICENSE Restrictions: MUST POST VARIANCE LETTER. A conditional variance was granted to allow utilizing a GRD device in lieu of a 1,000 gallon grease trap. Two page menu dated 2/4/13 was approved. A daily log listing date and amount of grease removed shall be maintained. This variance is not transferable to another owner or lessee of this establishment. INE For Office Use Onlye Initials: Town of Barnstable Date Paid I Amt I'd$ 1�� , . &UNSTABLE, , Inspectional Services eck#3( �$ Public Health Division n ,= Thomas McKean, Director �� 1 kI I Ils 200 Main Street,Hyannis,MA 02601 i� Office: 508-862-4644 Fax: 508-790-6304 �,t APPLICATION FOR PERMIT TO OPERATE A F D ESTABLISHMENT DATE �� NEW OWNERSHIP RENEWAL NAME OF FOOD ESTABLISHMENT: T v I Nwoq � 4 A fn ADDRESS OF FOOD ESTABLISHMENT: V r ' 1 L mA ®aO-0 MAILING ADDRESS(IF DIFFERENT FRO MABOVE): O „ 1 IJ�CI�.�✓1 i I �il 3"' 0 E-MAIL ADDRESS: LA0 6AVY1 - o TELEPHONE NUMBER OF FOOD ESTABLISHMENT: 5L 77-*- 6ftk3 TOTAL NUMBER OF BATHROO WELL WATER ES NO (ANNUAL WATER ANALYSIS REQUIRED) ANNUALO SEASONAL: DATES OF OPERATION:_/_/_ TO LIM NUMBER OF SEATS: INSIDE: OUTSIDE: D 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)? TYU OF ESTABLISHMENT: (PLEASE CHECK ALL THAT APPLY BELOW) OOD SERVICE RETAIL FOOD-ONLY required for TCS foods(foods requiring refrigeration/freezer) BED&BREAKFAST CONTINENTAL BREAKFAST COTTAGE FOOD INDUSTRY(formerly residential kitchen) MOBILE FOOD t 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 QAApplication FormsTOODAPP 2020.doc w OWNER INFORMATION: FULL NAME OF APPLICANT �Icg Wf N/ SOLE OWNER: YES/CD.O.B�0 OWNER PHONE# 364� So1w ADDRESS A (�[� Y �-1 OJRF�VLJ CORPORATE OWNER: A -9 L!E5 l � CORPORATE ADDRESS: PO a)( 4- FJA `)a6'30 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. Kr"CWV�Kt � L-2,3 1. / tI , �3 SIGNATURE OF APPLICANT DATE ***FOOD POLICY INFORMATION*** SEASONAL FOOD SERVICE: All seasonal food establishments,including mobile trucks must be inspected by the Health Div. prior to opening!! Please call Health Div.at 508-862-4644 to schedule your inspection. Please call at least(7)days in advance. FROZEN DAIRY DESSERTS: Frozen desserts must be tested by a State Certified lab prior to opening and monthly thereafter, with sample results submitted to the Health Div. Failure to do so will result in the suspension or revocation of your Frozen Dessert Permit until the above terms are met. CATERING POLICY: Anyone who caters within the Town of Barnstable must notify theTown by fax or mail prior to catering event. You must complete a catering notice found at http://www.townofbarnstable.us/healthdivision/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.31"each calendar year. IT IS YOUR RESPONSIBILITY TO RETURN THE COMPLETED APPLICATION(S)AND REQUIRED FEES BY DEC 1st. Q;\Application FormsTOODAPP REV3-2019.doc CT Town of Barnstable BOARD OF HEALTH Paul J Canniff,D.M.D. Board of Health Donald A.Gaudagnoli,M.D. aARMSTADM, John T.Norman $ 9 IMA 200 Main Street, Hyannis, MA 02601 F.P. Thomas Lee Alternate Phone: (508) 862-4644 Fax: (508)790-6304 www.townofbarnstable.us Permit to Operate a Food Establishment In accordance with regulations promulgated under authority of 105 CMR 590.000 M.G.L. Chapter 94 Sections 305A, 305B, 146, 189 and 189A; Chapter 111,Sections 5 and 127A, a permit is hereby granted to: Permit No: 887 Issue Date: 12/20/18 DBA: NIRVANA COFFEE COMPANY OWNER: RICK SHECHTMAN Location of Establishment: 3206 MAIN STREET BARNSTABLE MA 02630 Type of Business Permit: FOOD SERVICE Annual: YES Seasonal: IndoorSeating: 8 OutdoorSeating: 0 Total Seating: 8 FEES (� FOOD SERVICE ESTABLISHMENT: $250.00 YEAR. 2019 RETAIL FOOD: COTTAGE FOOD OPERATION: Permit Expires: 12/31/2019 B&B- FULL BREAKFAST: CONTINENTAL BREAKFAST: - - MOBILE-FOOD: MOBILE-ICE CREAM: C�iA FROZEN DESSERT: Thomas A. McKean, IRS, CHO, Health Agent TOBACCO SALES: i I FOR ESTABLISHMENTS WITH SEATING: PERMIT IS NOT VALID UNLESS ISSUED IN CONJUNCTION WITH A COMMON VICTUALER LICENSE Restrictions: MUST POST VARIANCE LETTER. A conditional variance was granted to allow utilizing a GRD device in lieu of a 1,000 gallon grease trap. Two page menu dated 2/4/13 was approved. A daily log listing date and amount of grease removed shall be maintained. This variance is not transferable to another owner or lessee of this establishment. FIKE For Office Use Onlv: Initials: o� Town of Barnstable la ate aid Amt I'd$D P 9 $ Inspectional Services 44 {:, °Tec +°�0 Public Health Division Check# $ � Thomas McKean,Director _V d 3 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 ` APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT DATE NEW OWNERSHIP RENEWAL NAME OF FOOD ESTABLISHMENT: � WE - J ?A(J _ ADDRESS OF FOOD ESTABLISHMENT: 3�0 9d 635 MAILING ADDRESS(IF DIFFERENT FROM ABOVE):�A � � L( E-MAIL ADDRESS: MORA TELEPHONE NUMBER OF FOOD ESTABLISHMENT: TOTAL NUMBER OF BATHROO WELL WATER:YES NO ... (ANNUAL WATER ANALYSIS REQUIRED) ANNUAL: SEASONAL: DATES OF OPERATION: / / TO NUMBER OF SEATS: INSIDE: OUTSIDE: 0 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 REQUMEMENTS. 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) OOD SERVICE RETAIL FOOD-ONLY required for TCS foods(foods requiring refrigeration/freezer) BED&BREAKFAST CONTINENTAL BREAKFAST COTTAGE FOOD INDUSTRY(formerly residential kitchen) MOBILE FOOD FROZEN DAIRY DESSERT MACHINES ... (MONTHLY LAB ANALYSIS REQUIRED) CATERING... (CATERING NOTICE REQUIRED BEFORE EVENT(SEE PAGE#2) TOBACCO SALES ... (ANNUAL TOBACCO SALES APPLICATION REQUIRED) *** SEASONAL,MOBILE & NEW FOOD ONLY*** REQUIRED TO CALL HEALTH DIV.FOR INSPECTION PRIOR TO PERMIT BEING ISSUED Q:\Application FormsT00DAPPREV2018.doc I --- ----- (Ar . J M PLEASE CALL 508-862-4644 OWNER INFORMATION: FULL NAME OF APPLICANT a SOLE OWNER:jYYES� xl- O D`.O,.B 10 Z � OWNER IPHONE # Of� �(0 �CO ADDRESS PO `T �4a. oa,00 CORPORATE OWNER:_IPV A wt-wo d1 #A&6LE 1,m NO. : 46 a§e- 8- c 3 CORPORATE ADDRESS: 6 V b OX 4 age N)311"!Ut,7C j MA N630 PERSON IN CHARGE OF DAILY OPERATIONS: L J y M List (2) Certified Food Protection Managers AND at least (1)Allergen Awareness Certified Staff All FOOD ESTABLISHMENTS must have 1 Certified Food Protection Manager PER SHIFT. **ATTACH COPIES OF CERTIFICATES** The Health Div. will NOT use past years' records. You must provide new copies and POST THE CERTIFICATES at your food establishment. Certified Food Managers Expiration Date Allergen Awareness Expiration Date I. SP LLB / l /a 1. �2 / C � Z PA 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. CATERING POLICY: Anyone who caters within the Town of Barnstable must notify theTown by fax or mail prior to catering event. You must complete a catering notice found at http://www.townofbarnstable.us/healthdivision/applications.asp. OUTDOOR COOKING: Outdoor cooking,preparation,or display of any food product by a food establishment is prohibited. TOBACCO ESTABLISHMENTS: All tobacco establishments must complete an Application for Tobacco Sales Permit and Employee Signature Form. NOTICE: Permits run annually from January 1 st to Dec.3 I'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 wJ PERMIT NO: TOWN OF BARNSTABLE 01/01/2018 887 BOARD OF HEALTH PERMIT TO OPERATE A FOOD ESTABLISHMENT In accordance with regulations promulgated under authority of Chapter 94, Section 395A and Chapter 111,Section 5 of the General Laws,a permit is hereby granted to: NIRVANA BARNSTABLE, LLC D/B/A: NIRVANA COFFEE COMPANY Whose place of business is: 3206 MAIN STREET , BARNSTABLE MA 02630 Type of business and any restrictions: FOOD SERVICE ESTABLISHMENT .To operate a food establishment in the TOWN OF BARNSTABLE RESTRICTIONS IF ANY: MUST POST VARIANCE LETTER. A conditional variance was granted to allow utilizing a GRID device in lieu of a 1,000 gallon grease trap. Two page menu dated 2/4/13 was approved. A daily log listing date and amount of grease removed shall be maintained. This variance is not transferable to another owner or lessee of this establishment. SEATING: 0 ANNUAL: YES SEASONAL: TEMPORARY: F E E S BOARD OF HEALTH RETAIL FOOD STORE: Paul J. Canniff, D.M.D, Chairperson FOOD SERVICE ESTABLISHMENT: $250.00 Junichi Sawayanagi RESIDENTIAL KITCHEN FOR RETAIL SALE: Donald A. Guadagnoli, M.D RESIDENTIAL KITCHEN FOR BED+BREAKFAST MOBILE FOOD UNIT: Permit expires: TOBACCO SALES: 12/31/2018 FROZEN DESSERT: Thomas A. McKean, RS, CHO CATERER: Director of Public Health " �OF'THE Tp Town of Barnstable ��f2 o„ Regulatory Services t : BMWST Bi a Richard V. Scali,Director to E y Mass. $ N15i639' Public Health Division Thomas McKean, Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT DATE: NAME OF FOOD ESTABLISHMENT: L ADDRESS OF FOOD ESTABLISHMENT: / CQ 630 MAILING ADDRESS(IF DIFFERENT FROM ABOVE):® 4 E-MAIL ADDRESS: N c. C�AI� ��V ' - TELEPHONE NUMBER OF FOOD ESTABLISHMENT: q-- NUMBER OF SEATS*: INSIDE: _ OUTSIDE: C�— TOTAL: * Note: If indoor seating provided, see Li using regarding Common Victuallers License TOTAL NUMBER OF BATHROOMS: _ ANNUAL OR SEASONAL OPERATION: !V V TYPICAL HOURS OF OPERATION MON-FRI: :�(7 TO b: ® 0 DAYS CLOSED EXCLUDING HOLIDAYS (I.E. MONDAYS) IF SEASONAL: APPROXIMATE DATES OF OPERATION: / / TO ***RElVIMER*** SEASONAL ESTABLISHMENTS MUST CALL FOR INSPECTION PRIOR TO OPENING TW OF ESTABLISHMENT: PLEASE CHECK ALL THAT APPLY OOD SERVICE RETAIL FOOD BED & BREAKFAST CONTINENTAL BREAKFAST *IF SEATING: ALSO,MUST OBTAIN RESIDENTIAL KITCHEN A COMMON VICTUALLER'S LICENSE MOBILE FOOD FROM LICENSING DIVISION. TOBACCO SALES FROZEN DAIRY DESSERT MACHINES CATERING OUTSIDE DINING (OVER) Q:\Application Forms\Foodappldoc ***REMINDER*** IF OUTSIDE DINING,YOU MUST BE APPROVED BY THE HEALTH DIVISION AND LICENSING,AND MEET ALL OF THE OUTSIDE DINING CRITERIA IS WAIT STAFF PROVIDED FOR OUTSIDE DINING? IS AN AIR CURTAIN PROVIDED AT WAITSTAFF SERVICE DOOR(S)? CONTACT INFORMATION: FULL NAME OF APPLICANT la 's SOLE OWNE : YES/ O D.O.B ADDRESS P�& q PHONE# S-5-0D 0 IF APPLICANT IS A PARTNERSHIP, �FULL NAME AND HOME ADDRESS OF ALL P T /v 7� 40pp-�3 II�V IF APPLICANT IS A CORPORATION: FEDERAL IDENTIFICATION NO. �) STATE OF INCORPORATION: m a, FOOD SERVICE ESTABLISHMENTS CONDUCTING FOOD PREPARATION (EXCLUDES RETAIL FOOD ESTABLISHMENTS THAT DO NOT PREPARE FOOD AND CONTINENTAL BREAKFAST): EFFECTIVE JANUARY 1, 2004, EACH FOOD SERVICE ESTABLISHMENT IS REQUIRED TO HAVE AT LEAST TWO CERTIFIED FOOD PROTECTION MANAGERS. AT LEAST ONE CERTIFIED FOOD PROTECTION MANAGER IS REQUIRED TO BE ONSITE DURING ALL HOURS OF OPERATION.***PLEASE PUT THE NAME OF THE ESTABLISHMENT ON EACH OF THE CERTIFICATES*** LIST THE NAMES OF YOUR; CERTIFIED FOOD PROTECTION MANAGERS (I.E. SERVSAFE.) �1. h� � � ��C.(/� I r l ,T(►`-' EXPIRATION DATE: R J a / Y2.j4r-O 't3 Z5 �- e EXPIRATION DATE: y / e/ C?c EFFECTIVE FEBRUARY 1, 2011 EACH FOOD ESTABLISHMENT THAT COOKS, PREPARES, OR SERVES FOOD INTENDED FOR IMMEDIATE CONSUMPTION EITHER ON OR OFF THE PREMISES SHALL HAVE AT LEAST ONE CERTIFIED FOOD ALLERGEN AWARENESS TRAINEA STAFF MEMBER. *** PLEASE PUT THE NAME OF THE ESTABLISHMENT ON THE CE FICATE*** LIST W , I_ AME OF Y-UR CERTIFED FOOD ALLERGEN AWARENESS TRAINED STAFF. 1. EXPIRATION DATE: (�z/ o I SIGNATURE OF APPLICANT AND DATE Q:Wpplication Forms\Foodapp3.doc oFiKE ror TOWN OF BARNSTABLE _ HEALTH INSPECTOR,s Establishment Name: Date: O sage: . of 1. OFFICE HOURS p ° 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. q MON.-FRI. HYANNIS,MA 02601 50B-862-4644 No Reference R-Red Item PLEASE PRINT CLEARLY FOOD ESTABLISHMENT INSPEC.ION REPORT Name Date Tvoe of T e of Inspection Ah eration s Address Risk Food Ser - Re-inspection Level etail Previous Inspection Telephone Residential Kitchen Date: + r-- Mobile Pre-operation if Owner HACCP YIN Temporary Suspect Illness j Caterer General Complaint Person in Charge(PIC) Time Bed&Breakfast HACCP In: Other t c Inspector �( Out: "C5<4 1 Each violation checked requires an explanation on the narrative page(s)and a citation of specific provision(s)violated. U 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) ❑ �� _ � 1 FOOD PROTECTION MANAGEMENT ❑ 12.Prevention of Contamination from Hands ❑ 1.PIC Assigned/Knowledgeable/Duties ❑ 13.Handwash Facilities (LPC& EMPLOYEE HEALTH PROTECTION FROM CHEMICALS ❑2.Reporting of Diseases by Food Employees and PIC ❑ 14.Approved Food or Color Additives ❑ 3.Personnel with Infectious Restricted/Excluded ❑ 15. Toxic Chemicals FOOD FROM APPROVED SOURCE TIMEITEMPERATURE CONTROLS(Potentially Hazardous Foods) ❑4.Food and Water from Approved Source ❑ 16.Cooking Temperatures ❑5.Rccciving/Condition ❑ 17.Reheating 1 j ❑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&red items) 3 1 I� Corrective Action Required: ❑ No es 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,�itm, ❑ Embargo ❑ Emergency Closure ❑ Voluntary Disposal ❑ Other: checked indicate violations of 105 CMR 590.000/Federal Food Code. 23.Management and Personnel (FC-2)(590.003) This report,when signed below by a Board of Health member or its agent A=Zero critical violations and no more than 3 non-critical violations. F=3 or more critical violations.9 or more non-critical violations, 24.Food and Food Preparation (FC-3)(590.004) constitutes an order of the Board of Health. Failure to correct violations B=One critical violation and less than 4 non-critical violations regardless of the number of critical,results in an F. 25.Equipment and Utensils (FC-4)(590.005) cited in this report may result in suspension or revocation of the food if no critical violations observed,4 to 6 non-critical violations=B. 26.Water,Plumbing and Waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If Seriously Critical Violation t F is scored automatically o la hot 27.Physical Facility (FC-6)(590.007) aggrieved by this order,you have a right to a hearing. Your request must C=2 critical violations and less than i non-critical. If no critical water,sewage 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 8non-critical violations. If 1 critical refrigeration. )( ) violation, n ritical violations=C. 29.Special Requirements (590.009) within 10 days of receipt of this order. 30.Other DATE OF RE-INSPECTION: Inspecto' igna re ri 31.Du psned from public view Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y N #Seats Observe- Frozen Dessert Machines: Outside Dining Y N PIC' Si ature Print: Self Service Wait Service Provided Grease Trap Size Variance Letter Posted, Y. N \ Dumpster Screen? Y N s 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 1q 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 75 Poisonous or Toxic Substances 3-501.16(B) Cold PHFs Maintained At or Below 41°F/45°F EMPLOYEE HEALTH 3-302.11(A)(2) Raw Animal Foods Separated from Each 7-101.11 Identifying Information-Original Containers* 590.004(F) 590.003(C) Responsibility of the Person-in-Charge to * 7-102.11 Common Name-Working Containers* Other* 3-501.16(A) Hot PHFs Maintained At or Above 140°F 2 Require Reporting by Food Employees and Contamination from the Environment 3-501.16(A) Roasts Held At or Above 130°F* Storage* - Applicants* 3-302.11(A) Food Protection* 7-201.11 Separation g 20 Time as a Public Health Control 7-202.11 Restriction-Presence and Use* 590.003(F) Responsibility of A Food Employee or An 3-302.15 Washing Fruits and Vegetables 3-501.19 Time as a Public Health Control* Applicant To Report To The Person In Charge* 7.202.12 Conditions of Use* * 3-304.11 Food Contact with Equipment and Utensils* 7-203.11 Toxic Containers-Prohibitions* 1590.004(11) 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 7.9,04.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels* q Food and Water From Regulated Sources 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* * 3-801.11(D) Raw or Partially Cooked Animal Food and ( P 4-501.111 Manual Warewashing-Hot Water 7.206.12 Rodent Bait Stations 3-201.12 Food in a Hermetically Sealed Container* Sanitization Temperatures* 7-206.13 Tracking Powders,Pest Control and Raw Seed Sprouts Not Served* 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-Hot Water Monitoring* 3-801.11(C) I Unopened Food Package Not Re-Served* 3-202.13 Shell Eggs* Sanitization Temperatures* TIME/TEMPERATURE CONTROLS 3-202.14 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. 16 Proper Cooking Temperatures for PHFs CONSUMER ADVISORY 3-202.16 Ice Made From Potable Drinking Water* Concentration and Hardness* 3-401.11A(1)(2) Eggs-155°F 15 sec 22 3-603.11 Consumer Advisory Posted for Consumption of 4-601.11(A) Clean Utensils and Food Contact Surfaces of Eggs-Immediate Service 145' Not Otherwise Processed to Eliminate F 15 sec* Animal Foods That are Raw,Undercooked or 5-101.11 Drinking Water from an Approved System* * gg Equipment 590.006(A) Bottled Drinking Water* 3-401.11(A)(2). Comminuted Fish,Meats&Game Pathogens* sff crave mrzooi 4-602.11 Cleaning Frequency of Utensils and Food Animals-155°F 15 sec* 590.006(B) Water Meets Standards in 310 CMR 22.0* Contact Surfaces of Equipment* * 3-302.13 Pasteurized Eggs Substitute for Raw Shell Shellfish and Fish From an Approved Source 3-401.11(B)(1)(2) Pork and Beef Roast-130°F 121 min Eggs* 4-702.11 Frequency of Sanitization of Utensils and Food 3-401.11(A)(2) Ratites,Injected Meats-155°F 15 sec* 3-201.14 Fish and Recreationally Caught Molluscan Contact Surfaces of Equipment* Shellfish* 4-703.11 Methods of Sanitization-Hot Water and 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS 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 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 145°F* kitchen operations should be debited under Game and Wild Mushrooms Approved By 2-301.11 Clean Condition-Hands and Arms* Regulatory Authority 3-401.12 Raw Animal Foods Cooked in a Microwave the appropriate sections above if related to 3-202.18 Shellstock Identification Present* 2-301.12 Cleaning Procedure* 165°F* foodborne illness interventions and risk factors. 2-301.14 When to Wash* A 1 b All Other PHFs-145°F practices 15 sec* Other es should be debited under#29-Special 9 violations relating to good retail 590.004(C) Wild Mushrooms* 3-401.11( )( )( ) 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 Commercially Processed RTE Food-140°F* Blue Items 23-30) 3-202.15 Package Integrity ( ) y Critical and non-critical violations,which do not relate to the foodborne * 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 8 Tags/Records:Shellstock 590.004(E) Preventing Contamination from Employees* 18 Proper Cooling of PHFs following sections of the Food Code and 105 CMR 590.000 * 13 Handwashing Facilities 3-501.14 A CoolingCooked PHFs from 140°F to 70°F 3-202.12 Shellstock Identification ( ) Item Good Retail Practices FC 590.000 3-203.12 Shellstock Identification Maintained* Conveniently Located and Accessible Within 2 Hours and From 70°F to 41°F/45°F Tags/Records:Fish Products 5-203.11 Numbers and Capacities* Within 4 Hours* 23. Management and Personnel FC-2 .003 5-20411 Location and Placement* 3-501.14(B) Cooling PHFs Made from Ambient 24. Food and Food Protection FC-3 .004 . 3-402.11 Parasite Destruction* Temperature Ingredients to 41°F/45°F 25. Equipment and Utensils FC-4 .005 * 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(J) Labeling of Ingredients' Supplied with Soap and hand Drying Devices 27. Physical Facility FC-6 .007 7 Conformance with Approved Procedures/ 6-301.11 Handwashing Cleanser,Availability 28. 1 Poisonous or Toxic Materials FC-7 .008 HACCP Plans 6-301.12 Hand Drying Provision 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. i l p THE T TOWN OF BARNSTABLE - HEALTH INSPECTORS Establishment Name: /�` Date: „ Page: of OFFICE HOURS PUBLIC HEALTH DIVISION 8:00-9:30 A.M. BARNSTAHLE. ' 200 MAIN STREET 3:30-4:30 P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified mAss MON.-FRI. �A t6sv,a 0� HYANNIS,MA 02601 508-8624644 No Reference .R-Red Item PLEASE PRINT CLEARLY . 'fDN1�` FOOD ESTABLISHMENT INSP CTION REPORT Name Date ls�' T e of j0ea jU"section s ' Address + Risk _Food_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 (PIC) �� Ti a Bed&Breakfast HACOther CPr- Inspect or ` - Out: Each violation checked requires an explanation on the narrative page(s)and a citation of specific provision(s)violated. 1 L Violations Related to Foodborne Illness Interventions and Risk Factors(Red Items) Anti-Choking 590.009(E) ❑ d Violations marked may pose an imminent health hazard and require immediate corrective Tobacco 590.009(F) ❑ Action as determined by the Board of Health. Allergen Awareness 590.009(G) ❑ FOOD PROTECTION MANAGEMENT ❑ 12.Prevention of Contamination from Hands ❑ 1.PIC Assigned/Knowledgeable/Duties ❑ 13.Handwash Facilities \ \ EMPLOYEE HEALTH PROTECTION FROM CHEMICALS ❑2.Reporting of Diseases by Food Employees and PIC ❑ 14.Approved Food or Color Additives ❑3.Personnel with Infectious Restricted/Excluded ❑ 15. Toxic Chemicals FOOD FROM APPROVED SOURCE TIME/TEMPERATURE CONTROLS(Potentially Hazardous Foods) ❑4.Food and Water from Approved Source ❑ 16.Cooking Temperatures ❑ 5.Receiving/Condition ❑ 17.Reheating ❑6.Tags/Records/Accuracy of Ingredient Statements ❑ 18.Cooling ❑7.Conformance with Approved Procedures/HACCP Plans ❑ 19.Hot and Cold Holding PROTECTION FROM CONTAMINATION ❑20.Time As a Public Health Control ❑8.Separation/Segregation/Protection REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP ❑ 9.Food Contact Surfaces Cleaning and Sanitizing ❑21.Food and Food Preparation for HSP ❑ 10.Proper Adequate Handwashing CONSUMER ADVISORY ( �� I ❑ 11.Good Hygienic Practices ❑22.Posting of Consumer Advisories Violations Related to Good Retail Practices(Blue Items) Total Number of Critical Violations J Critical(C)violations marked must be corrected immediately. (blue&red items) Corrective Action Required: ❑ No s Non-critical(N)violations must be corrected immediately or Overall Rating within 90 days as determined by the Board of Health. Avoluntary Compliance ❑ Employee Restriction/Exclusion ❑ Re-inspection Scheduled ❑ Emergency Suspension C N Official Order for Correction:Based on an inspection today, a items jo,❑ Embargo ❑ Emergency Closure ❑ Voluntary Disposal ❑ Other: checked indicate violations of 105 CMR 590.000/Federal Food Code. 23.Management and Personnel (FC-2)(590.003) This report,when signed below by a Board of Health member or its agent A=Zero critical violations and no more than 3 non-critical violations. F=3 or more critical violations.9 or more non-critical violations, 24.Food and Food Preparation (FC-3)(590.004) constitutes an order of the Board of Health.-Failure to correct violations B=One critical violation and less than 4 non-critical violations regardless of the number of critical,results in an F. 25.Equipment and Utensils (FC-4)(590.005) cited in this report may result in suspension or revocation of the food if no critical violations observed,4 to 6 non-critical violations=B. 26.Water,Plumbing and Waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If Seriously Critical Violation=F is scored automatically o la hot 27.Physical Facility (FC-6)(590.007) aggrieved by this order,you have a right to a hearing. Your request must C=2 critical violations and less than i non-critical. If no critical water,sewage back-up,infestation of rodents or insects,or lack of be in writing and submitted to the Board of Health at the above address violations observed,7 to 8 non-critical violations. If 1 critical refrigeration. 28.Poison s or Toxic Materials (FC-7)(590.008) 9 violation,4 to 8non-critical violations=C. 29.Speci Requirements (590.009) within 10 days of receipt of this order. 30.of a DATE OF RE-INSPECTION: Inspect re t: 31.Du Aster screened from public view Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y N #Seats Observed Frozen Dessert Machines: Outside Dining Y N PIC's Signature Print: Self Service Wait Service Provided Grease Trap Size Variance Letter Posted Y N �. Dumpster Screen? Y N Violations related to Foodborne Illness Violations Related to Foodborne Illness Interventions Interventions and Risk Factors(Red Items 1-22) and Risk Factors(Red Items 1-22) (Cont.) FOOD PROTECTION MANAGEMENT PROTECTION FROM CONTAMINATION PROTECTION FROM CHEMICALS 3-501.14(C) PHFs Received at Temperatures According to 1 590.003(A) Assignment of Responsibility* L 8 Cross-contamination 1 q Food or Color Additives Law Cooled to 41°F/45°F Within 4 Hours* 590.003(B) Demonstration of Knowledge* 3-302.11(A)(1) Raw Animal Foods Separated from 3-202.12 Additives* 3-501.15 Cooling Methods for PHFs Cooked and RTE Foods.* Additives* 19 PHF Hot and Cold Holding 2-103.11 Person-in-Charge Duties 3-302.14 Protection from Unapproved Contamination from Raw Ingredients 15 Poisonous or Toxic Substances 3-501.16(B) Cold PHFs Maintained At or Below 41°F/45°F EMPLOYEE HEALTH 3-302.11(A)(2) Raw Animal Foods Separated from Each 7-101.11 Identifying Information-Original Containers* 590.004(F) 590.003(C) Responsibility of the Person-in-Charge[0 * 7-102.11 Common Name-Working Containers* Other* 3-501.16(A) Hot PHFs Maintained At or Above 140°F 2 Require Reporting by Food Employees and Contamination from the Environment 3-501.16(A) Roasts Held At or Above 130°F* Storage* - Applicants* 3-302.11(A) Food Protection* 7-201.11 Separation g L.2O_ Time as a Public Health Control 590.003(F) Responsibility of A Food Employee or An 3-302.15 Washing Fruits and Vegetables 7-202.11 Restriction-Presence and Use* 3-501.19 Time as a Public Health Control* Applicant To Report To The Person In Charge* * 7.202.12 Conditions of Use* 590.004 11 Variance Re uirements 3-304.11 Food Contact with Equipment and Utensils 7-203.11 Toxic Containers-Prohibitions* ( ) q 590.003(G) Reporting by Person in Charge* Contamination from the Consumer 3 590.003(D) Exclusions and Restrictions* * 7-204.11 Sanitizers,Criteria-Chemicals* REQUIREMENTS FOR 3-306.14(A)(B)Returned Food and 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* * 3-801.11(D) Raw or Partially Cooked Animal Food and ( ) P 4-501.111 Manual Wazewashing-Hot Water 7.206.12 Rodent Bait Stations 3-201.12 Food in a 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 * Concentration and Hardness* 22 3-603.11 Consumer Advisory Posted for Consumption of 3-202.16 Ice Made From Potable Drinking Water -- 3-401.1 lA(1)(2.) Fggs-155°F 15 sec Animal Foods That arc Raw,Undercooked or 5-101.11 Drinking Water from an Approved System* 4-601.11(A) Clean Utensils and Food Contact Surfaces of Eggs-Immediate Service 145°F 15 sec* Equipment* Not Otherwise Processed to Eliminate 590.006(A) Bottled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* Effective 1112001 4-602.11 Cleaning Frequency of Utensils and Food Animals-155°F 15 sec* 590.006(B) Water Meets Standards in 310 CMR 22.0* Contact Surfaces of Equipment* 3-302.13 Pasteurized Eggs Substitute for Raw Shell Shellfish and Fish From an Approved Source 3-401.11(B)(1)(2) Pork and Beef Roast-130°F 121 min* Eggs* 4-702.11 Frequency of Sanitization of Utensils and Food 3-401.11(A)(2) Ratites,Injected Meats-155°F 15 sec* 3-201.14 Fish and Recreationally Caught Molluscan Contact Surfaces of Equipment* Shellfish* 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS 4-703.11 Methods of Sanitization Hot Water and StuffingContaining Fish,Meat,Poultry or 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* g ry 590.009(A)-(D) Violations of Section 590.009(A)-(D)in cater- * Ratites-165°F 15 sec* in mobile food,temporary and residential Sources 10 Proper,Adequate Handwashing g' p �'Y Game and Wild Mushrooms Approved By 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 145°F* kitchen operations should be debited under Regulatory Authority 2-301.11 Clean Condition-Hands and Arms* 3-401.12 Raw Animal Foods Cooked in a Microwave the appropriate sections above if related to 3-202.18 Shellstock Identification Present* 2-301.12 Cleaning Procedure* 165°F* foodbome illness interventions and risk factors. 590.004(C) Wild Mushrooms* 3-401.11 2-301.14 When to Wash* A 1 All Other PHFs-145°F 15 sec* Other 590.009 violations relating to good retail ( )( )(b) 3-201.17 Game Animals* 11 Good Hygienic Practices 17 Reheating for Hot Holding practices should be debited under#29-Special 2-401.11 Eating,Drinking or Using Tobacco* * Requirements. $ Receiving/Condition g. g g 3-403.11(A)&(D) PHFs 165°F 15 sec 3-202.11 PHF's Received at Proper Temperatures* 2-401.12 Discharges From the Eyes,Nose and Mouth* 3-403.11(B) Microwave-165°F 2 Minute Standing Time* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES * 3-301.12 Preventing Contamination When Tasting* 3 403.11 C Commercial] Processed RTE Food-140°F* (Blue Items 23-30) 3-202.15 Package Integrity ( ) y Critical and non-critical violations,which do not relate to the foodborne * 12 Prevention of Contamination from Hands 3-403.11(E) Remaining Unsliced Portions of Beef Roasts* 3-101.11 Food Safe and Unadulterated 8 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 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 * 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(J) Labeling of Ingredients` Supplied with Soap and hand Drying Devices 27. Physical Facility FC-6 .007 7 Conformance with Approved Procedures/ 6-301.11 Handwashing Cleanser,Availability 28. 1 Poisonous or Toxic Materials I FC-7 1.008 HACCP Plans 6-301.12 Hand Drying Provision 129. 1 Special Requirements 1 1.009 3-502.11 Specialized Processing Methods* 130. 1 Other 3-502.12 Reduced-Oxygen Packaging Criteria* r8-103.12 Conformance with Approved Procedures* S:590Formback6-2doc *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.0.00. *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. ME Tp� TOWN OF BARNSTABLE - .:HEALTH INSPECTOR'S Establishment Name: II �� Date: Page: of q OFFICE HOURS PUBLIC HEALTH DIVISION 8:00-9:30A.M. 57'ABLE. • 200 MAIN STREET 3:30-4:30 P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified BARN STABLE. g, MON.-FRI. HYANNIS,MA 02601 soa-as2�s44 No Reference R-Red Item PtVtSE PRINT CLEARLY �,EDMP,a. Qz FOOD ESTABLISHMENT INSPFCTIO-N REPORT Name Dat Type of ns ec ion Cal Routine Address Risk Food Serwc e:insp fon ' Level aRetai PateioIt, q Telephone Residential Kitchen Date: 7(J> Mobile Pre-opOwner HACCP Y/N Temporary Suspeness Caterer General Complaint Person in Charge(PIC) Time Bed&Breakfast HACCP l . Other Inspector u Each violation checked requires 4n explanation on the narrativ page(s)and a citation of specific provision(s)violated. ¢ Violations Related to Foodborne Illness Interventions and Risk Factors(Red Items) Anti-Choking 590.009(E) ❑ n Violations marked may pose an imminent health hazard and require immediate corrective Tobacco 590.009(F) ❑ Action as determined by the Board of Health. Allergen Awareness 590.009(G) ❑ r - FOOD PROTECTION MANAGEMENT IOTECTION 2.Prevention of Contamination from Hands ❑ 1.PIC Assigned/Knowledgeable/Duties _ 3.Handwash Facilities EMPLOYEE HEALTH FROM CHEMICALS ❑2.Reporting of Diseases by Food Employees and PIC ❑ 14.Approved Food or Color Additives ❑ 3.Personnel with Infectious Restricted/Excluded ❑ 15. Toxic Chemicals FOOD FROM APPROVED•SOURCE TIMEITEMPERATURE CONTROLS(Potentially Hazardous Foods) ❑4.Food and Water from Approved Source ❑ 16.Cooking Temperatures ❑ 5.Receiving/Condition ❑ 17.Reheating ❑ 6.Tags/Records/Accuracy of Ingredient Statements ❑ 18.Cooling ❑ 7.Conformance with Approved Procedures/HACCP Plans ❑ 19.Hot and Cold Holding PROTECTION FROM CONTAMINATION ❑20.Time As a Public Health Control - ❑8.Separation/Segregation/Protection REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) zYi ❑ 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 Itemsl Total Number of Critical Violation !gi 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 today, s ❑ 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. )(590.005 25.Equipment and Utensils (FC-4 B=One critical violation and less than 4von-critical violations ) 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 6.Water,Plumbing and Waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If 27.Physical Facility (FC-6)(590.007) aggrieved by this order,you have a right to a hearing. Your request must C=2 critical violations and less than 9 non-critical. 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 non-critical vi lations. If 1 critical refrigeration. 29.Special Requirements (590.009) within 10 days of receipt of this order. violation,4 to 8non-critical viola' ns- 30.Other PATE OF RE-INSPECTION: Insp ct is ig tur - •nt: 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 PI 'l Signature Print: Self Service Wait Service Provided Grease Trap Size Variance Letter Posted Y N Dumpster Screen? Y N Violations related to Foodborne Illness Violations Related to Foodborne Illness Interventions Interventions and Risk Factors(Red Items 1-22) and Risk Factors(Red Items 1-22) (Cont.) FOOD PROTECTION MANAGEMENT PROTECTION FROM CONTAMINATION PROTECTION FROM CHEMICALS 3-501.14(C) PHFs Received at Temperatures According to 1 590.003(A) JAssignment of Responsibility* 8 Cross-contamination 14 Food or Color Additives Law Cooled to 41°F/45°F Within 4 Hours* 590.003(B) Demonstration of Knowledge* 3-302.11(A)(1) Raw Animal Foods Separated from 3-202.12 Additives* 3-501.15 Cooling Methods for PHFs Cooked and RTE Foods.* * 19 PHF Hot and Cold Holding 2-103.11 Person-in-Charge Duties 3-302.14 Protection from Unapproved Additives Contamination from Raw Ingredients 15 Poisonous or Toxic Substances 3-501.16(B) Cold PHFs Maintained At or Below 41°F/45°F 590.004(F) EMPLOYEE HEALTH 3-302.11(A)(2) Raw Animal Foods Separated from Each 7-101.11 Identifying Information-Original Containers* 2 590.003(C) Responsibility of the Person-in-Charge to Other* g7-102.11 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* 20 Time as a Public Health Control 590.003(F) Responsibility of A Food Employee or An 3-302,15 Washing Fruits and Vegetables 7-202.11 Restriction-Presence and Use* 3-501.19 Time as a Public Health Control* Applicant To Report To The Person In Charge* * 7.202.12 Conditions of Use* 590.004 11 Variance Requirements * 3-304.11 Food Contact with Equipment and Utensils 7-203.11 Toxic Containers-Prohibitions* ( ) q 590.003(G) Reporting by Person in Charge Contamination from the Consumer 3 590.003(D) Exclusions and Restrictions* * 7-204.11 Sanitizers,Criteria-Chemicals* REQUIREMENTS FOR 3-306.14(A)(B)Returned Food and 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 y Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs* 590.00 A-B) Compliance with Food Law* * 3-801.11(D) Raw or Partially Cooked Animal Food and 4( P - 4-501.111 Manual Warewashing-Hot Water 7.206.12 Rodent Bait Stations * 3-201.12 Food in a Hermetical] Sealed Container* Sanitization Temperatures* Raw Seed Sprouts Not Served Y P 7-206.13 Tracking Powders,Pest Control and 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-Hot Water 1 Monitoring* 3-801.11(C) Unopened Food Package Not Re-Served* 3-202.13 Shell Eggs* Sanitization Temperatures* TIME/TEMPERATURE CONTROLS 3-202.14 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. 1 g 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 s-Immediate Service 145°F 15 sec* Animal Foods That are Raw,Undercooked or 5-101.11 Drinking Water from an Approved System* gg Equipment* Not Otherwise Processed to Eliminate 590.006(A) Bottled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* Effective 11112001 4-602.11 Cleaning Frequency of Utensils and Food Animals-155°F 15 sec* 590.006(B) Water Meets Standards in 310 CMR 22.0* Contact Surfaces of Equipment* * 3-302.13 Pasteurized Eggs Substitute for Raw Shell Shellfish and Fish From an Approved Source 3-401.11(B)(1)(2) Pork and Beef Roast-130°F 121 min Eggs* 3-201.14 Fish and Recreationally Caught Molluscan Contact Surfaces of Equipment*4-702.11 Frequency Sanitization of Utensils and Food 3-401.11(A)(2) Ratites,Injected Meats-155°F 15 sec* f Shellfish* P 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 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 145°F* kitchen operations should be debited under Game and Wild Mushrooms Approved By 2-301.11 Clean Condition-Hands and Arms* Regulatory Authority 3-401.12 Raw Animal Foods Cooked in a Microwave the appropriate sections above if related to 3-202.18 Shellstock Identification Present* 2-301.12 Cleaning Procedure* 165°F* foodbome illness interventions and risk factors. 590.004(C) Wild Mushrooms* 2-301.14 When to Wash* 3-401.11(A)(1)(b) All Other PHFs-145°F 15 sec* Other 590.009 violations relating to good retail 3-201.17 Game Animals* 11 Good Hygienic Practices 17 Reheating for Hot Holding practiceRequres rhos ld be debited under#29-Special $ Receiving/Condition 2-401.11 Eating,Drinking or Using Tobacco* 3-403.14(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 Tune* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3-202.15 Package Integrity* 3-301.12 Preventing Contamination When Tasting* 3-403.11(C) Commercially Processed RTE Food-140°F* Blue Items 23-30) 12 Prevention of Contamination from Hands Critical and non-critical violations,which do not relate to the foodborne 3-101,11 Food Safe and Unadulterated* 3-403.11(E) Remaining Unsliced Portions of Beef Roasts* illness interventions and risk factors listed above,can be found in the g Tags/Records:Shellstock 590.004(E) Preventing Contamination from Employees* 'b"' 1 S Proper Cooling of PHFs following sections of the Food Code and 105 CMR 590.000 13 Handwashing Facilities 3-202.18 Shellstock Identification* 3-501.14(A) Cooling Cooked PHFs from 140°F to 70°F Item Good Retail Practices FC 590.000 3-203.12 Shellstock Identification Maintained* Conveniently Located and Accessible Within 2 Hours and From 70°F to 41°F/45°F Tags/Records:Fish Products 5-203.11 Numbers and Capacities* Within 4 Hours* 23. Management and Personnel FC-2 .003 5-204.11 Location and Placement* 3-501.14(B) Cooling PHFs Made from Ambient 24. Food and Food Protection FC-3 .004 3-402.11 Parasite Destruction* Temperature Ingredients to 41°F/45°F 25. Equipment and Utensils FC-4 .005 3-402.12 Records,Creation and Retention* 5-205.11 Accessibility,Operation and Maintenance Within 4 Hours* 26. Water,Plumbing and Waste FC-5 .006 590.004(J) Labeling of Ingredients* Supplied with Soap and hand Drying Devices 27. 1 Physical Facility FC-6 .007 7 Conformance with Approved Procedures/ 6-301.11 Handwashing Cleanser,Availability 28. Poisonous or Toxic Materials I FC-7 1.008 HACCP Plans 6-301.12 Hand Drying Provision 29. Special Requirements 1.009 3-502.11 Specialized Processing Methods* 30. Other 3-502.12 Reduced Oxygen Packaging Criteria* 8-103.12 Conformance with Approved Procedures* S:590Formback6-2doc *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.006. *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. dF Barnstable Town of Barnstable MATS $ Board of Health i639' `` fo ram" 200 Main Street,Hyannis MA 02601 2007 Office: 508-862-4644 Wayne Miller,M.D. FAX: 508-790-6304 Paul Canniff,D.M.D. Junichi Sawayanagi February 20,2013 Mr. Rick Schectman P.O. Box 4 Barnstable, MA 02630 RE Nirvana Coffee Company, 3206 Main Street, Barnstable n.. ,..... . _ . _._ Dear Mr. Schectman, You are granted a conditional variance from Section 322-3 of the Town of Barnstable Code, which requires minimum 1,000 gallon capacity grease traps at all food establishments. This variance will allow you to operate a food establishment, utilizing a grease recovery (GRD) device at 3206 Main Street, Barnstable with the following conditions: (1) The grease recovery device (GRD) shall continue to be utilized and maintained properly in accordance with the MA Plumbing Code. (2) The menu is restricted to two page list of foods filed with your application at the Board of Health meeting dated 2/4/13. (3) This variance decision letter shall be posted on a wall adjacent to your food service permit in an easily accessible location for viewing by a health inspector during inspections. (4) A daily log listing the amount of grease removed and the date will be maintained and will be kept posted on the wall and easily accessible for the health inspectors. (5) This variance is not transferable to another owner or lessee of this establishment. This variance is granted because it has been demonstrated that a grease recovery device has been very effective in removing grease, fats, and oils. Si 'cerely, Wayn Miller, M.D. Chair an QAVariances 2013WirvanaGRDVariance2013.doe CaN is . THE t0� DATE: Abs �P O r y FEE: * BARNSTABLE, + y MASS. � 1639• $ REC. BY ' �r�°MAMA Town of Barnstable SCHED. DATE: /3 Board of Health 200 Main Street, Hyannis MA.02601 Office: 508-862-4644 Wayne A. Miller,M.D. FAX: 508-790-6304 Junichi Sawayanagi Paul J.Canniff,D.M.D. VARIANCE REQUEST FORM LOCATION - Property Address: 3206 Main Street (Route 6A) Rarnstable Village Assessor's Map and Parcel Number- 3 0 0/0 0 8 Size of Lot: 8 2 0 5 S F +/= Wetlands Within 300 Ft. Yes X Business Name: Nirvana Barnstable, LLC No Subdivision Name: APPLICANT'S NAME: Rick Shechtman. Phone 508-364-5200 Did the owner of the property authorize you to represent him or her? Yes X No PROPERTY OWNER'S NAME CONTACT PERSON Name: John Field and M. Kristen Bear Warne: �� ' i s� i9w)_A✓) Address: 570 Grand Street #1305 Address: Po New York, New York, 10002 Moo Phone: 91 7—3 5 9—2 3 4 0 Phoneak�� : 0 VARIANCE FROM REGULATION(List Reg.) REASON FOR VARIANCE(May attach if more space needed) ; Section 322-3 Grease Traps See attached C3 ' NATURE OF WORK: House Addition El House Renovation El Repair of Failed Sepi Ic Systern_❑ ra t Checklist (to be completed by office staff-person receiving variance request application) •� Please submit copies in 4 separate completed sets. P _ Four(4)copies of the completed variance request form tiZ;; _ Four(4)copies of engineered plan submitted(e.g.septic system plans) Completed seven(7)page checklist confirming review of engineered septic system plan by submitting engineer or registered sanitarian _ Four(4)copies of labeled dimensional floor plans submitted(e.g.house plans or restaurant kitchen plans) Signed letter stating that the property owner authorized you to represent him/her for this request Applicant understands that the abutters must be notified by certified mail at least ten days prior to meeting date at applicant's expense (for Title V and/or local sewage regulation variances only) Full menu submitted(for grease trap variance requests only) Variance request application fee collected(no fee for lifeguard modification renewals,grease trap variance renewals[same owner/lessee only], outside dining variance renewals[same owner/leasee only],and variances to repair failed sewage disposal systems[only if no expansion to the building proposed]) Variance request submitted at least 15 days prior to meeting date f VARIANCE APPROVED Wayne Miller,Chairman NOT APPROVED Junichi Sawayanagi REASON FOR DISAPPROVAL Paul J.Canniff,D.M.D. I . aC:.\cache\Temporary Internet Fi1es\0LKAE\VARIREQ.D0C , s Attachment to Variance Request Form Re: Location: 3206`Main Street (Route 6A), Barnstable, MA Applicant: Nirvana Barnstable, LLc Reason for Variance: Section 322-3 Grease Traps: Applicant is seeking permission to install a grease recovery device instead of a grease trap due.to cost of installing a grease trap and nature of business. i i - I . j I i y 10 P,�Y 1OPL Nirvana Coffee Company: Menu Items This list is exclusive of prepared to order Coffee and milk/soy milk based coffee drinks,cocoas and freshly brewed teas and chaff tea drinks(hot and cold for all). All drinks are to be served in take-away disposable containers. Assembled Sandwiches- Served either as wraps or as sandwiches on artisan breads ciabatta or Foccaccia. These sandwiches are assembled on site in early morning and are sold `as is'in wrapped butchers'paper. They are not made to order. There will be 3 sandwiches/wraps each day and,will rotate throughout the week. Roast Beef Thinly Sliced Roast Beef stacked high with Sliced Cucumber, herbed cream cheese, Tomato, and Lettuce Chicken Salad Homemade chicken salad. (Served with lettuce and tomato) Garden Vegetarian sandwich: Red Sliced Tomato, Crisp Cucumber, Fresh Avocado, havarti Cheese, sliced carrots, walnuts, cranberries and honey Mustard (all local vegetables in season) Fresh sliced turkey, cranberry chutney, mayonnaise, lettuce and Tomato Ham/Swiss Cheese-Thinly sliced spiral cut ham with Swiss cheese. Lettuce, Tomato, mayo, sweet fig relish Tuna Salad wrap- house tuna salad with lettuce, chopped tomatoes Chipotle Chicken Club Roasted chicken, bacon with chipotle mayonnaise and cheese and veggies Assembled Salads: These are assembled on site and are served as is in plastic takeaway containers. They are not prepared to order. There will be two salads per day offered and will rotate throughout the week. Mixed Greens: Mixed lettuce, cherry tomatoes, sliced Red onion, yellow peppers, shaved carrots, and balsamic vinaigrette Caprese: Fresh Buffalo mozzarella, vine ripened tomatoes, thinly sliced red onion, fresh basil, olive oil/balsamic dressing Tuna Salad: Tuna salad on a bed of fresh greens with creamy ranch dressing � I p Greek: Feta, black/kalamata olives, green peppers, shaved red onion, cherry tomatoes on a bed of field greens w/ oil and vinegar Caesar Salad: Romaine lettuce with fresh grated parmesan cheese, with roasted croutons with Caesar dressing and chicken breast Goat cheese Salad: Fresh field greens with caramelized onions, balsamic dressing, roma tomatoes and crumbled goat cheese Chop Salad: Fresh Romaine lettuce, chopped (garbanzo beans, tomatoes, blue cheese, carrots, salami, red onion and Parmesan cheese) with house dressing Grab/Go Items • Chips • Yogurt Parfaits (yogurt/granola) C San Pellegrino-water and orangina • Tynant Water • Pastries: Daily pastries brought in from 3rd party vendor • Sodas • Sandwiches (see above descriptions) 0 Salads: Seasonally (see above descriptions) • Fruit Cups: prepared and served in take away plastic containers • Pasta Salads: seasonally prepared and pre-measured served in plastic take away containers Soup: Heated Soups (Kettle Cuisine): Frozen Soups to be heated onsite and served in take away containers Ancillary Sales Items Nirvana Chocolates (variety)-prepackaged and brought in Nirvana t� Cape Cod... Nirvana Coffee Co Barnstable Village,MA Cape Cod-USA Ii b i t Q STATIONCLEANIN VrNYL .�' min 0,jk a m 4 11�11111111 V 0 ►• _--- _ _ t yi - ,r.� • ........ '��?' dilr, ..�.�,n ..•l.•n ��:�irn .:�ti.i., Fiirn�o � �b1��`�T.� .'�r_ �.Z.q` �ii w—►' ��. :%�_ %':c 7Z:r ';�.Z.�;� ��$�_,- yrr.,'y - y.. , Er \ Barnst\ Wn o able Barnsta ble��tA- Board of Health All-amaica city �!- RAR�ISTWIE,� Ii a \,� MASS. //0 200 Main Street, Hyannis MA 02601 } 2007 Office: 508-862-4644 Wayne Miller,NI.D. FAX: 508-790-6304 Paul Canniff,D.M.D. }uniehi Sawayanagi March 31 , 2008 John W. Kenne y, Esquire 1550 Falmouth Road, Suite 12 Centerville, MA 02632 RE: Nirvana Coffee Company, 3206 Main Street Barnstable Dear Mr. Kenney, You represented your client, David Lancaster, for Nirvana Coffee Company, at the Barnstable Board of Health meeting March 11, 2008, with two variance requests for a food operation. The Board approved one of the variances and denied one of the variances. A) You are granted a conditional variance from Section 322-3 of the Town of Barnstable Code, which requires minimum 1,000 gallon capacity grease traps at all food establishments. This variance will allow you to operate a food establishment, utilizing a grease recovery (GRD) device at Nirvana Coffee Company, 3206 Main Street, Barnstable with the following conditions: (1) A grease recovery device (GRD) shall be installed and maintained in accordance with the MA Plumbing Code. (2) The dishwasher shall be connected to the grease recovery device (GRD). (3) The menu is restricted to menu filed at the Board of Health meeting dated 3/11/08. (4) This variance decision letter shall be posted on a wall adjacent to your food service permit in an easily accessible location for viewing by a health inspector during inspections. (5) A daily log listing the amount of grease removed and the date will be maintained and will be kept posted on the wall and easily accessible for the health inspectors. Q:\WPFILES\Kenney NIRVANA COFFEE 3206 Main St B 2008.doc (6) This variance is not transferable to another owner or lessee of this establishment. This variance is granted because it has been demonstrated that a grease recovery device (G.R.D.) would be effective in removing grease, fats, and oils. B) Your request for a variance to utilize the existing toilet facility for the operation of a food establishment at 3206 Main Street, Barnstable, is not granted. Section 322-4 Toilet Facilities To utilize one restroom in lieu of the requirement to two provide separate male and female toilet facilities for male and female patrons and employees. The variance is not granted for the following reasons: The location of 3206 Main Street, Barnstable, has not been used as a food establishment in the past and does, not have a pre-existing use as a food establishment w' h only one toilet facility. PER RDER L RD OF HEALTH W yne iller, M.D. Cl air n 1 Q:\WPFILES\Kenney NIRVANA COFFEE 3206 Main St I3 2008.doc I DATE: )IA FEE: BARNSTABLE, MAS& 16346 a�4,� REC. BY Town of Barnstable SCHED. DATE: 3• l y O$ Board of Health 200 Main Street, Hyannis MA 02601 Office: 508-862-4644 Wayne A.Miller,M.D. FAX: 508-790-6304 -� Paul J.Canniff,D.M.D. VARIANCE REQUEST FORM LOCATION 3206 Main Street (Route 6A) , Barnstable Property Address: . Assessor's Map and Parcel Number: 3 0 0/0 0 8 Size of Lot: 8, 205 s q, f t. Wetlands Within 300 Ft. Yes X Business Name: Nirvana Cof fee Company, Inc. No Subdivision Name: N A Nirvana• Coffee. Company, Inc- 206-276-4355 APPLICANT'S NAME:- Phone Did the owner of the property authorize you to represent him or her? Yes X No PROPERTY OWNER'S NAME CONTACT PERSON John Field and M. Kristen Bearse John W. Kenney, Esq. Name: Name: 85 Fourth Avenue #4J 1550 Falmouth Road, Suite 12 Address: New York, NY 10003 Address: Centerville, MA 02632 Phone: 91 7-359-2340 Phone: 508-771 -9300 VARIANCE FROM REGULATION(List Reg.) REASON FOR VARIANCE(May attach if more space needed) Section 322-4 Toilet , Facilities and SEE. ATTACHED Section 322-3 Grease raps -r1 t 1�1 NATURE OF WORK: House Addition 0❑❑❑❑❑ House Renovation ❑ Repair of Failed Septic System El Checklist (to be completed by office staff-person receiving variance request application) ~t� Please submit copies in 4 separate completed sets: _ Four(4)copies of the completed variance request form Four(4)copies of engineered plan submitted(e.g.septic system plans) Four(4)copies of labeled dimensional floor plans submitted(e.g.house plans or restaurant kitchen plans) _ Signed letter stating that the property owner authorized you to represent him/her for this request _ Applicant understands that the abutters must be notified by certified mail at least ten days prior to meeting date at applicant's expense (forTi e V and/or local sewage regulation variances only) Full menu submitted(for grease trap variance requests only) Variance request application fee collected(no fee for lifeguard modification renewals,grease trap variance renewals[same owner/leasee only], outside dining variance renewals [same owner/leasee only],and variances to repair failed sewage disposal systems [only if no expansion to the building proposed]) Variance request submitted at least 15 days prior to meeting date VARIANCE APPROVED Wayne Miller,Chairman NOT APPROVED Paul J.Canniff,D.M.D. REASON FOR DISAPPROVAL rL) G C:\Documents and Settings\decollik\Local Settings\Temporary Internet Fi1es\0LK1\VARIREQ.D0C t, �� John A Field M.Kristen Bearse 85 Fourth Avenue#4J New York,NY 10003 November 8, 2007 Mr.David Lancaster Nirvana Coffee Company c/o 6 Cross Hill Road Forestdale, MA 02644 email david@nirvanacoffeecompany.com Re: Ground Floor,3206 Main Street Barnstable Village To Whom it may concern: John Field and Kristen Bearse as owners of the above captioned premises authorize David Lancaster and his agents on behalf of Nirvana Company to represent our interests -as required to secure approvals for their proposed new business in the ground floor of 3206 Main Street Barnstable Village. We respect their efforts and support their applications. Subject to approvals and finalization of terms, we will enter into a Lease with the Company for the front space which we are holding in good faith for a reasonable period so they may secure approvals and permits. Nothing herein shall be construed as approval for work to be performed or the space to be occupied until all jurisdictional requirements are met, a lease is in force and business proposal, signage and construction plans are approved in writing by the owner. Please contact the undersigned directly should you have any questions. i John Field (917) 359-2340 jbafield@gmail.com Mixed Greens: Mixed lettuce, cherry tomatoes, sliced Red onion, yellow peppers, shaved carrots, and balsamic vinaigrette Caprese: Fresh Buffalo mozzarella, vine ripened tomatoes, thinly sliced red onion, fresh basil, olive oil/balsamic dressing Tuna Salad: Tuna salad on a bed of fresh greens with creamy ranch dressing Greek: Feta,black/kalamata olives, green peppers, shaved red onion, cherry tomatoes on a bed of field greens w/oil and vinegar Caesar Salad: Romaine lettuce with fresh grated parmesan cheese, with roasted croutons with Caesar dressing. Goat cheese Salad: Fresh field greens with caramelized onions,balsamic dressing, roma tomatoes and crumbled goat cheese Chop Salad: Fresh Romaine lettuce, chopped (garbanzo beans, tomatoes,blue cheese, carrots, salami, red onion and Parmesan cheese) with house dressing Grab/Go Items • Chips • Yogurt Parfaits (yogurt/granola) • San Pellegrino-water and orangina • Tynant Water • Pastries: Daily pastries brought in from 3rd party vendor • Sodas + Sandwiches (see above descriptions) • Salads: Seasonally (see above descriptions) • Fruit Cups: prepared and served in take away plastic containers • Pasta Salads: seasonally prepared and pre-measured served in plastic take away containers Soup: Heated Soups (Kettle Cuisine): Frozen Soups to be heated onsite and served in take away containers Ancillary Sales Items Nirvana Chocolates (variety)-prepackaged and brought in Nirvana Coffee Company: Menu Items This list is exclusive of prepared to order Coffee and milk/soy milk based coffee drinks, cocoas and freshly brewed teas and chaff tea drinks (hot and cold for all). There are to be no blended drinks(e.g. smoothies) only hot/cold/iced drinks. All drinks are to be served in take-away disposable containers. Assembled Sandwiches- Served either as wraps or as sandwiches on artisan breads ciabatta or Foccaccia. These sandwiches are assembled on site in early morning and are sold 'as Win wrapped butchers'paper. They are not made to order. There will be 3 sandwiches/wraps each day and will rotate throughout the week. Roast Beef Thinly Sliced Roast Beef stacked high with Sliced Cucumber, Tomato, and Red Onion and Lettuce Chicken Salad Homemade chicken salad. (Served with lettuce and tomato) Garden Vegetarian sandwich: Red Sliced Tomato, Crisp Cucumber, Fresh Avocado, Red Onion, Alfalfa Sprouts, havarti Cheese, and honey Mustard (all local vegetables in season) Fresh sliced turkey, cranberry chutney, herbed cream cheese, lettuce and Tomato Ham/Swiss Cheese-Thinly sliced spiral cut ham with Swiss cheese. Lettuce, 7 Tomato, mayo, sweet fig relish Tuna Salad wrap-house tuna salad with lettuce Chipotle Chicken Club Roasted chicken, bacon with chipotle mayonnaise and cheese and veggies Assembled Salads: These are assembled on site and are served as is in plastic takeaway containers. They are not prepared to order. There will be two salads per day offered and will rotate throughout the week. Attachment to Variance Request Form Re: Location: 3206 Main Street (Route 6A), Barnstable, MA Applicant: Nirvana Coffee Company, Inc. Reason for Variance: Section 322-4 Toilet Facilities: Applicant is seeking permission to renovate an existing bathroom to make it a handicap accessible, uni-sex bathroom due to space and financial limitation. Section 322-3 Grease Traps: Applicant is seeking permission to install a grease recovery device instead of a grease trap due.to cost of installing a grease trap and nature of business. r JOHN W. KENNEY ATTORNEY AT LAW 12 CENTER PLACE 1550 FALMOUTH ROAD CENTERVILLE, MASSACHUSETTS 02632 TELEPHONE 771-9300 FAX NO. 775-6029 AREA CODE 508 e-mail:john@jwkesq.com February 26, 2008 Town of Barnstable Board of Health 200 Main Street Hyannis, Massachusetts 02601 Re: Nirvana Coffee Company, Inc. 3206 Main Street (Route 6A), Barnstable, MA Dear Sir or Madam: Enclosed please find copies of the Notices sent to the abutters regarding the variances requested by Nirvana Coffee Company, Inc. and advising when the hearing date is scheduled. I certify that I have mailed the original notices by certified mail on February 26, 2008. Please file the enclosed together with the other documents in this matter. I will submit the return receipt cards at the hearing. Please feel free to contact me if you have any questions regarding this matter. Very truly yours, '`'� ( John W. Kenney`,`E-�q. Attorney for Nirvana Coffee Company, Inc. tj E CO JWK/mmc —' F17 � Enclosures JOHN W. KENNEY ATTORNEY AT LAW 12 CENTER PLACE 1550 FALMOUTH ROAD CENTERVILLE, MASSACHUSETTS 02632 TELEPHONE 771-9300 FAX NO.775-6029 AREA CODE 508 e-mail:john@jwkesq.com February 26, 2008 John J. Meldon, Trustee Barnstable Inn Realty Trust P.O. Box 10 Chatham, Massachusetts 02633 -NOTICE TO ABUTTER REGARDING VARIANCE REQUEST Re: Nirvana Coffee Company, Inc. 3206 Main Street (Route 6A), Barnstable, MA Dear Mr. Meldon: Please allow this letter to serve as notice that Nirvana Coffee Company, Inc., has requested two (2) Variances from the Town of Barnstable Board of Health pertaining-to the property located at 3206 Main Street (Route 6A), Barnstable, Massachusetts. The reasons for the variance requests are as follows: (1) Section.322-4 Toilet Facilities: Applicant is seeking permission to renovate an existing bathroom to make it a handicap accessible, uni-sex bathroom thus providing one bathroom on the premises instead of two due to space and financial limitations; and (2) Section 322-3 Grease Traps: Applicant is seeking permission to install a grease recovery device instead of a grease trap due to cost of installing a grease trap and nature of business. The hearing is scheduled for Tuesday, March 11, 2008 at 3:00 p.m. in the main hearing room of Barnstable Town Hall, 367 Main Street, Hyannis, Massachusetts. nJ �; Very truly yours, N-1 ohn W. Kenney, Esq. Attorney for Nirvana Coffee Company, Inc. JWK/mmc Certified mail, return receipt requested no. 7006 0100 0004 3235 4261 i JOHN W. KENNEY ATTORNEY AT LAW 12 CENTER PLACE 1550 FALMOUTH ROAD CENTERVILLE, MASSACHUSETTS 02632 TELEPHONE 771-9300 FAX NO. 775-6029 AREA CODE 508 e-mail:John@Jwkesq.com February 26, 2008 County of Barnstable 6000 Sheriff's Place Bourne, Massachusetts 02532 NOTICE TO ABUTTER REGARDING VARIANCE REQUEST Re: Nirvana Coffee Company, Inc. 3206 Main Street (Route 6A), Barnstable, MA Dear Sir or Madam: Please allow this letter to serve as notice that Nirvana Coffee Company, Inc., has requested two (2) Variances from the Town of Barnstable Board of Health pertaining to.the property located at 3206 Main Street (Route 6A), Barnstable, Massachusetts. The reasons for the variance requests are as follows: (1) Section 322-4 Toilet Facilities: Applicant is seeking permission to renovate an existing bathroom to make it a handicap accessible, uni-sex bathroom thus providing one bathroom on the premises instead of two due to space and financial limitations; and (2) Section 322-3 Grease Traps: Applicant is seeking permission to install a grease recovery device instead of a grease trap due to cost of installing a grease trap and nature of business. The hearing is scheduled for Tuesday, March 11, 2008 at 3:00 p.m. in the main hearing room of Barnstable Town Hall, 367 Main Street, Hyannis, Massachusetts. Very truly yours, ohn W. Kenney, Esq. Attorney for Nirvana Coffee Company, Inc. JWK/mmc Certified mail, return receipt requested no. 7006 0100 0004 3235 4223 TOWN OF BARNSTABLE - UNDERGRUUND FUEL AND CHEMICAL STORAGE REGISTRATION MAP NO. 3 cv .. PARCEL NO. Oo �? TAG NO.� , ADDRESS OF TANK: 3D'o e YYlc�ir, �'�, VILLAGE LI Ir I� MAILING ADDRESS ( I F DIFFERENT FROM ABOVE ) : aq 1 Sk"o n i OWNER NAME: �?Q � PHONE : INSTALLATION 'DATE : Ci�i Lo BY : INSTALLER ADDRESS: ( I cf fl -CERT . NO. *TANK LOCATION: ABOVE BELOW ( DCaQM Z aW TANK LOCAT 2 ON W Z TH RQOPW CT TO CAPACITY 17, TYPE OF TANK AGE YRS. FUEL/CHEMICAL TESTING CERTIFICATION [ ] PASS [ ] FAIL DATE t LEAK DETECTION [ ] CHECK - IF N/A TYPE/BRAND ZONE OF CONTRIBUTION [ ] YES [ ] NO DATE TO BE REMOVED FIRE DEPT. PERMIT ISSUED [ ] YES [ ] NO DATE CONSERVATION [ ] CHECK IF N/A DATE BOARD OF HEALTH TAG NO. [ ] DATE PLEASE PROVIDE A SKETCH SHOWING THE TANK LOCATION ON THE BACK OF THIS CARD , r s Fe Officials of the Regulatory Boards and authorities of the Town of Barnstable Manager: John Klimm Licensing Authority: Tom Geiler, Director; Martin Hoxie, Chairman Zoning Board of Appeals: Gail Nightingale, Chairman Town Legal Department: Ruth Weil,Town Attorney Town Health Division:Tom McKean, Director; Dr. Wayne Miller,Chairman Town Building Department: Tom Perry, Commissioner As patrons of the Village of Barnstable I (we), as signed on this petition, are very opposed to the town permitting Nirvana Coffee to be in business at 3206 Main Street in Barnstable Village. By having NO Parking this coffee shop will certainly become a burden to the existing businesses in the village and their customers who all have to deal with the severe parking shortage that already exists here. We do not understand where the cars for Nirvana Coffee are required to park because the ` businesses that are here, all have had to provide parking for their employees and their customers. We also are concerned with 4 deliveries because the trucks will have to unload from the middle of 6A(there are no spaces in front of this location), and this is quite a public safety problem especially in an area that is already very congested. Name Address -------- r - T 7 L J1-{ Ga;b�'c A, _Cy ,- 'd- 3 0 V " l4� Y - C ,C-/,u t ` L3 3c�,r-w- e_ M�4. —' ALI .1i1 t L - I�� l� - r r lqc L ( ry(� • ls 1 d'F P(y., !4, r, To the Officials of the Regulatory Boards and authorities of the Town of Barnstable Town Manager: John Klimm Town Licensing Authority.- Tom Geiler, Director;*,Martiri Hoxie, Chairman Zoning Board of Appeals: Gail Nightingale, Chairm ^ Town Legal Department: Ruth Weil, Town Attorney Town Health Division: Tom McKean, Director; Dr. Wayne Miller,Chairman Town Building Department: Tom Perry, Commissioner As patrons of the Village of Barnstable I (we), as signed on this petition, are very opposed to the town permitting Nirvana Coffee to be in business at 3206 Main Street in Barnstable Village. By having NO Parking this coffee shop will certainly become a burden to the existing businesses in the village and their customers who all have to deal with the severe parking shortage that already exists here. We do not understand where the cars for Nirvana Coffee are required to park because the businesses that are here, all have had to provide parking for their employees and their customers. We also are concerned with deliveries because the trucks will have to unload from the middle of 6A( there are no spaces in front of this location), and this is quite a public safety problem especially in an area that is already very congested. Name Address ;- tom -..5/ � Pj- ell vim. �u�e_ EeLrA . lLIf YlS' ---- .- (FYI K0 2q406- , z�-�'' � �'✓�Cd' (� v(/ ,r k, -- (o Ail- - I t To the Officials of the Regulatory Boards and authorities of the Town of Barnstable Town Manager: John Klimm Town Licensing Authority: Tom Geiler, Director; Martin Hoxie, Chairman Zoning Board of Appeals: Gail Nightingale, Chairman Town Legal Department: Ruth Weil, Town Attorney Town Health Division: Tom McKean, Director; Dr. Wayne Miller,Chairman Town Building Department: Tom Perry, Commissioner As patrons of the Village of Barnstable I (we), as signed on this petition, are very opposed to the town permitting Nirvana Coffee to be in business at 3206 Main Street in Barnstable Village. By having NO Parking this coffee shop will certainly become a burden to the existing businesses in the village and their customers who all have to deal with the severe parking shortage that already exists here. We do not understand where the cars for Nirvana Coffee are required to park because the businesses that are here, all have had to provide parking for their employees and their customers. We also are concerned with deliveries because the trucks will have to unload from the middle of 6A(there are no spaces in front of this location), and this is quite a public safety problem especially in an area that is already very congested. Name Address 20 (/* zz — — - ._..._..._....... To the Officials of the Regulatory Boards and authorities of the Town of Barnstable Town Manager: John Klimm Town Licensing Authority: Tom Geiler, Director; Martin Hoxie, Chairman Zoning Board of Appeals: Gail Nightingale, Chairman Town Legal Department: RuitiYVeil, Town Attorney Town Health Division: Tom McKean, Director; Dr. Wayne Miller,Chairman Town Building Department: Tom Perry, Commissioner As patrons of the Village of Barnstable I (we), as signed on this petition, are very opposed to the town permitting Nirvana Coffee to be in business at 3206 Main Street in Barnstable Village. By having NO Parking this coffee shop will certainly , become a burden to the existing businesses in the village and their customers who all have to deal with the severe parking shortage that already exists here. We do not understand where the cars for Nirvana Coffee are required to park because the businesses that are here, all have had to provide parking for their employees and their customers. We also are concerned with deliveries because the trucks will have to unload from the middle of 6A(there are no spaces in front of this location), and this is quite a public safety problem especially in an area that is already very congested. N e Address arrl �C� __ -- -------- ►wog` I� -��.+�� }��_P 1 �o I�-- - - � : � � s DAY I r - LEGEND. _.- ' ------�"` � O 60"X19" S.S. KITCHEN SINK WITH DRAIN BOARDS � ''��. � ,� /�� C1 / AND GRD BELOW, yy / 55 _ 20- q 24 X24 MOP SINK, A'�'s doely`� t PL 36"X36" REFRIGERATED FOOD PREP. COUNTER. , 1 36"X24" . 7 FR EZ R - - 48"X24" S.S. COUNTER W/SHELF BELOW, - - - - - - < A �6 AUTOMATIC COFFEE/TEA MAKER AREA. •V A''' v ' V n'7' v A,^♦ v A]'- v AJ>-v'"J,' v V -. 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A (A (A A (A (AA (A (A (A -1L -L -Y_ -1L _tL -1L Yy 4- -1L -Y aL -!L Y_ -Y_ -1L -1l_ -tL -y- 4- i Y , FoR0 f0 a ED LootLAN t , D� REVISION DRAY P� 8_ �oU� . 1 dJ5 ,0463Ign6 5S0 CO�� .U1. �1� 30u t gC31�1$, INC& NIRVANA C01`5�� CC�1''r�'�4�11'' Pfi?Oi='OS�D C�Ol�R1�i�t �5�'R� 03-13-08 „� • .L-. of -A-- Ir4"•�-0' WILLOW ��R �, � 320( MAN A I \/TR5ET : f Y 4 Y • 1 • 71 10 A 0 IY H r Y /� + (U P4lRCK48E OF DRAU1/NGS LEAVER PLOWNAMM RESPONSIBLE F COMPLIANCE IINTH ALL tV E)c"ACT SaE AND RE/NFURCEMENT OF ALL CONCRETE FOOTINGS (.�l AtLL FOiDT/NGB SHALL DCIE?1(11 SEL101!!/FROBTLINE VER/t7 OEPTH. P.C. BOX m8 SANDU111CH, 1'1A, O � � 1""'� ��LJ�.. VILLAGE, 1 ' COG4L oULD/MG GODEB AND OROINANGE�A .v c"laN8 MAY NOT BE HELD REB�''ONd/CIiLE MUST BE DETERMINED BY LOCAL BOIL CONDITIONS AND ACCEPTABLE (4) VlERI�'ETRIJGTtAr?AL ELE�IEN?l FOR DESIGN I SIZE ' FOR BITE CONDITIONS OR FOR THE 118E OF THE6E DRA(lIlNGB DIAQ/NG GONBTRUGT/ONL PR.4GT/GE8 OF GONBrRUGT/DN: VBR/fY L?E$lGN lf/?H LO�GAL ENG/NEk7� lUl'ITH L0�4L +�lG/NEER AND lIIY.D/NG DIG/ALB. tUEBT BARNBTAI3LE HA. 4?1i618 1 'II - _ __ --T—. . I - A_ .. . . I _ . _ A. . ,,,.,..y ..... .. si 1 - , L - .. .,, : - .. . • - : ✓ ,. .. :,. :.. 11 - I -.. -. 3:. .:, -. I i : . I 1 - i,.q P { .�} . �g is ,. -6:'::. +.. jo 5° 4: 4r,j1. � r.,...-n- ..^+n- .: . - . . .,, .. .......,. *,.. j, ,.¢ d, i a a . :: i -:. .. 7 k. ,.,. 1. 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A Y A >A V A �A V A >A:V A >A V A >r V A >A V 11 y r A �'A V +� I ' v 3 w 3 v. 3 v _3 V. v 3 V 3 v 3 3 V S V A V 1 A ;. '(A to (A to I COUNTER'' MICROWAVE. • • * D Y A V l A V l A Y t t A - _ II V/�/Yk.+!'�F�M/ TRf"+IKTIN� I r . A Y A v r EXISTING . I V "3> v ",> v "!] v � . • (A �; g EMPLOYEES LfJCI4,EI2+ I I' A ; II A V A V �� TWO C ." AR GARAGEI 46 X 4 REFR{ ER�4TE0 CASE. l COLC'� SANDWICH AREA � i Aj ",t AV "lt Aw As(^ V y V V V YS v ' II4i , ' ' Yv w VV A YV A YY , r' ' V -' V A Y + Y r V ♦ V ♦ V ly i ... Y A3> V A!> w ",] A.> A'.3 A..A w I., V A3> w A3> r AA V A3,1' r A3>' w I IEXHAUST FAN. �jy�w �} " to (A �. V lA V to Y to r to r (A r (A pAfRfll::�' , O ING ►ELOW EXISTINes A y A >A V A >A VtE IST'N1//1• V A ,>A YA >• V A >A V.A yA y A �" V A >A w 4 _ ., II " 1�3 PAPER TOWELS-MOUNTED, Iw 3 V ! v S V A V i MATH Ic►bTrra ,TUJO CAR OUTS rt WWA y; VIr `A v �A � �t1A �tc� _ Ib EXISTING NEAT REC�ISTEI'�♦ V 3 u S V A V I I I I ^" PARKING AREA v `, I� LOCKAMLE CATS, FOR POISONOUS 4 TOXIC MATERIALS. 1 1 V , V 3 v1 w 'J V ! V S v ! J A SEL CLOSING DOOR c r y Y V Y Y Y A Y ...J' .. I♦ F VR 1. > w �Mr.Q h j �( a V ! v V 3 V V Ib 1 i (� (/,4�aFFEE STATION. } I I A t o t o A t o (A -" ' i Y v r V v 41 " " V CLEANING ,I' + r A >A Y A >' Y" 'JP Y" >, V V A> V ...« ',. , . V 4 COUNTER,Pq AY (A t� r (" r to ___«-. STATION «_q , (�rE MAKER 1 A N V , V Y ♦ V 1• .A V A A V A A V ...+++..r,+.•+-r". 1 }y y+. /�,V / /'��(� �w +� I�,/� /1� �+ \ : . v ",> w ^,] v ^ !> v !> v 3> V 1Vy VINYL. �i .4+rR i $T4/RA�.i AREA LVW COUNTER R l LV �tw(. 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LcAL�uuniNr t AND+a,�n�NAn ,ra�c4Nd rfAr�uor r R ►oNa�tter crERM/Nv��cc�cAL emu. aanrorn�ua Anm Act:, rA�i r+v en�ucndL ALLN1"d t+ r�N t ur xcwerae MA, crab F SANDWICH, MAri > "' it W,:oAo r/O A t�1�Q'" rNE 1'lA,E'IOF �DRAu#MM C�'MG►C•GM�181RUCri 11DRAcr1G d G+� COIWsl7�lJcrk C 1+ Qrlflr 1>,EL'1/dN tGY17t!Lt!�CAL IN cwrN A,IIr+pAVAN. ,E�AND tlU/L G1�lGIA .dA i i . .. __-__._-._...__- .__-__--,_.._. _ ,.,, _. .. - . _. ,.... .-.... -_.__.. _�.__._. . 1. _ ----— . r - A -___- - _. _ _.__._._. --- : NOTES: �o1 ti NOTE: BUILDING CORNERBOARD LOCATIONS AND eoa�oce WETLAND FLAGS BY INSTRUMENT SURVEY. OFFSITE o� a DETAIL AND OTHER FEATURES FROM GIS DATA AND ARE APPROXIMATE, FOR REFERENCE ONLY. `S�r 6,' NOTE: THIS PLAN DOES NOT REPRESENT A FULL I- RETRACEMENT PERIMETER SURVEY, DATA IS FROM FIELD EVIDENCE„ PLANS AND DEEDS OF RECORD, BUT IS SUITABLE ONLY FOR SITE PLAN REVIEW PERMITTING. ''oule 64 AIL PLAN NOT TO BE USED FOR LOT LINE STAKING, `S j FENCING, ETC. (FULL RETRACEMENT SURVEY NEEDED) L CU UTILITIES ARE APROXIMATE, NOTIFY DIGSAFE IF EXCAVATING NOTE: NO CHANGES TO EXTERIOR SITEWORK PROPOSED t/oushop e NOTE: ELEVATIONS NGVD FROM COURTHOUSE STEP BM A`e tio� NOTE: WEST DRIVEWAY TO BE UTILIZED FOR PARKING PARCEL 8 o OF 3-4 VEHICLES AND DELIVERIES AS NEEDED. oe 5 2ND FLOOR RESIDENTIAL PARKING IS OFFSITE. Qr�c Bn°99 5,608 SF UPLAND± LEGAL ONSTREET PARKING AND PUBLIC PARKING Lane 6 2,597 SF WETLAND± ARENAS ARE PROXIMATE TO THE SITE, COFFEE SHOP USE EXPECTED TO BE PRIMARILY 8,205 SF TOTAL SF± PEDESTRIAN BASED DUE TO LOCATION. BVW 2 EMPLOYEES PLANNED ROule 6 CB FND SITE DATA: LOCUS MAP SCALE: 1" = 2,000't ADDRESS: #3206 MAIN STREET (ROUTE 6A), BARNSTABLE, MA ASSESSORS MAP 300 PARCEL 8 LOCUS IS WITHIN FEMA FLOOD ZONE "C" o VW12 o� AND A3 (EL 11) AS SHOWN o '� •F� 6--� ON COMMUNITY PANEL #250001 001 D �APRROX- NHESP PRIORITY HABITAT oo DATED JULY 2, 1992 MIT SCALED FROM MASS AREAS OF SITE SEAWARD OF FLOOD ZONE LINE ARE IN AN ACEC "^ NHESP/MESA PRIORITY HABITAT MAPPED IN WETLAND AREA GIS LOCUS IS WITHIN AP OVERLAY DISTRICT, OLD KINGS HIGHWAY HISTORIC. o-A-* 8 W14 BVW15 REFERENCES Q�v� DB 13513 PG 299 APPLICANT. DAVID LANCASTER PB 145 PG 65 NIRVANA COFFEE COMPANY #6 CROSS HILL ROAD, FORESTDALE, MA 02644 • Q , C5 OWNER OF RECORD LEGAL: ROUTE KE NESUITE 12 EXIS GAL. TANKS 10 JOHN A. FIELD & M. KRISTEN BEARSE CENTERVILLE, MA 02632 (UTILIZED AS TIGHT ,�, 85 FOURTH AVENUE, APT. J 1-508-771-9300 PH. MAP 300 o2v qA 23 Off' R TO SEWER �o FLOOD EL 11 NEW YORK, NY 10003 1-508-775-6029 FAX 007 A 3' CO ONE A OX. DB 13513 PG 299 # 3200 ��' O'F�0�- F-1'A�'R° Q MDEQE APPROVAL ,�^) ONE C . y PPPR PB 92 PG 151 &N'Oq T/�Vc 9/°/77 Z ACEC ZONING SUMMARY v (ALSO O 12 ZONING DISTRICT: VB�-A BUSINESS DISTRICT C, so, O 81 REQUIRED: EXISTING: MIN. LOT SIZE 10,000 S.F. 8,205 SF± TOT. FP QQFo h ��' MIN. LOT FRONTAGE` 20' , 57' 0 UNA . �0c' �`� MIN. LOT WIDTH 100 57 4�F �'I'O TWn CAR h QP MIN. FRONT SETBACK 10' 2.8' A� o GARAGE �� MIN. SIDE SETBACK 30'* 0.3' MIN. gVFp UNDER (YPOWO WELL �� J``� MIN. REAR SETBACK 20' 80' 71 MAX. BUILDING COVERAGE 25% 1571/5608=28% MAX. BUILDING HEIGHT 30' <30' O *MINIMUM TOTAL SIDE{LOT SETBACK SHALL BE 30', PROVIDED THAT NO 76 ••\ , , ALLOCATION OF SUCH TOTAL RESULTS IN LESS THAN 10'. • • • • }�P EXISTING USE: OFFICE/RETAIL W/RESIDENTIAL APT. (FRMR. FOOD SERVICE) EXISTING c�� MAP 300 PROPOSED USE: COFFEE SHOP, RETAIN EXIST. RESIDENTIAL APT. 21VD TWO STORY P # 3322114 PROPERTY ON TOWN WATER & TOWN SEWER PER MAP �2 oECK WOODFRAME ALL SIGNAGE TO CONFORM TO ZONING ORDINANCE. �4V �tiF BUILDING #3206 0 } WALKWAYS/DOORS TO HAVE LIGHTING PER CODE. C8 C�FFU FFp 3- MAP 300 OF 008SHMgss c� # 3206 -\H o"m,4&.9 �� DA q°y �o NIEL DANIELLAA. O ALA CIV ^ o No.4 SITE PLAN �No.465020 °F s s�°`�P ��" l'�I Fss ST ,� S 3206 MAIN STREET �S > o�G� h6 DATE DANI JALA, P.E., P.L.S. BARNSTABLE, MA FpJ tioo off 508-362-4541 a, B CB � fax 508-362-9880 PREPARED FOR ry downcape.com © NIRVANA COFFEE COMPANY p Sip DAVID LANCASTER ce w III- F�q 00WO cape en ineeria , Saco „ _ SCALE: 1 - 10 civil engineers DATE: JANUARY 17, 2008 land surveyors Scale:1"= 10' Ty�s SEC ® 939 Main Street ( R to 6A) T/°N) YARMOU THPOR T MA 02675 0 s 10 15 20 25 FEET DCE #08-006 08-006 LANCASTER.DWG i