HomeMy WebLinkAboutMiscellaneous - 398 MAIN STREET 4/30/2018 (2)Cl) (D FD' Grant, Michele To: Rich Gorzela Subject: RE: St Pauls Episcopal Church Kitchen Hi Rich, Thank you for getting back to me and thank you for the work that has been completed. Could you please put together a "Phase Plan". In other words a plan for the future. IE: Possibly over the next 5 years, St. Pauls commits too.... If you have any questions, please call me at the number listed below. Best Regards, Michele E. Grant Public Health Agent Town of North Andover 1600 Osgood St I Suite 2035 North Andover, MA 01845 Phone 978.688.9540 Fax 978.688.8476 Email merant@townofnorthandover.com Web www.TownofNorthAndover.com From: Rich Gorzela [mailto:rich.gorzela@gmail.com] Sent: Sunday, March 09, 2014 6:43 PM To: Grant, Michele Subject: Re: St Pauls Episcopal Church Kitchen Hi Michelle, The lights have been replaced, and the frp board is installed. The base board coving should be done shortly. This cost approximately $2,500. This is is half of what the vestry has approved this year in funds for the kitchen: I did get estimates for the plumbing work. Since we don't have a grease trap currently, and to bring items to health and plumbing codes, the estimate is $15k for the sinks and plumbing work. A commercial refrigerator is approximately $1 k to .$2k. I also determined that a hood for the stove to code would be approximately $ l Ok. Obviously the total additional cost (approx 27k) is much more than currently allocated this year. In addition my understanding from the plumber is that the plumbing work is not practical to parse up. I assume the same for the hood. This is a very significant outlay for the parish. At thi based on what the vestry has approved this year for funds, this may be as far as we can go this year wit] .sired changes except for a commercial fridge. I will however formulate a plan for the rest of the work fc, °: pry to consider for approval. Given we meet monthly, are volunteers, and are currently still in a rector search, I wanted to give a heads up that it may take a few months to have a plan that considers all the items. On Thursday, February 13, 2014, Grant, Michele <m rg antgtownofnorthandover.com> wrote: > Hi Rich, > Thank you for getting back to me. The list below is correct. However, your missing the prep sink and an industrial refrigerator. I have no problem with you re -using the 2 -bay sink as a prep sink. That will assist in your cost. Please call me with questions at the number listed below. > Many Thanks > Michele E. Grant > Public Health Agent > Town of North Andover > 1600 Osgood St I Suite 2035 > North Andover, MA 01845 > Phone 978.688.9540 > Fax 978.688.8476 > Email m rg ant�Ltownofnorthandover.com > Web www.TownofNorthAndover.com > </mail/u/0/s/?view=att&th=1442bflbbc10e482&attid=0.1&disp=emb&zw&atsh=l> > > > > > From: Rich Gorzela [mailto:rich.org zela(2gmail.com] > Sent: Wednesday, February 12, 2014 7:52 PM > To: Grant, Michele 2 r - 4, > Cc: Paul Bresnahan; Bill McKenna; Will MacNally > Subject: St Pauls Episcopal Church Kitchen > Hi Michelle, > This is to summarize our discussion today and put it down in writing. > Our understanding at St Paul's is that we have a few things to do to bring our kitchen in line with the town health department expectations: > 1) cover the fluorescent lights > 2) replace our 2 base sink with 3 base > 3) add a hand washing sink > 4) add a back splash per code > 5) add appropriate base boarding per code > Last month, during our usual budget planning process, the vestry approved up to $5k to put toward these improvements this year. > I have asked one of our regular contractors to cover the lights. I will also ask him about the base boarding. In addition, I've asked a plumber that has done work at the church before to provide recommendations and a quote for the sinks and back splash. > I am targeting to have this work done by end of May. As you know we are primarily a volunteer organization (including myself), so I appreciate your understanding in that we will make an honest effort but need to work within our means. We will keep you informed if we hit any issues or questions. > Thanks, > Rich Gorzela > Please note the Massachusetts Secretary of State's office has determined that most emails to and from municipal offices and officials are public records. For more information please refer to: http:Hwww.sec.state.ma.us/pre/`preidx.htm. > Please consider the environment before printing this email 3 t Grant, Michele From: Grant, Michele Sent: Tuesday, June 23, 2015 5:49 PM To: 'Tom Kooken' Subject: RE: St Paul's Episcopal Church Hi Tom, This looks great! Without pulling file was this all of Part 2. Thank you Michele E. Grant Public Health Agent Town of North Andover 1600 Osgood St I Suite 2035 North Andover, MA 01845 Phone 978.688.9540 Fax 978.688.8476 Email mgrant@townofnorthandover.com Web www.TownofNorthAndover.com From: Tom Kooken [mailtoaek108C@comcast.net] Sent: Tuesday, June 23, 2015 4:57 PM To: Grant, Michele Subject: St Paul's Episcopal Church Michelle: St Paul's proposes the attached fridge for part 2 of our upgrade program, for your approval and / or comment. Thanks. Tom Kooken 1 To: St Pauls Episcopal Church Tom Kooken 390 Main St North Andover, MA 978-685-3626 (Contact) r' ffdff— :tr raii Project: From: St Pauls Refrigerator + freezer United Restaurant Equipment Co. Pat Theodoros 1 Executive Park Drive North Billerica, MA 01862 978-439-5500 Quotation 06/22/2015 PRICES ARE VALID FOR 30 DAYS FROM DATE OF QUOTE Item Qty Description Sell Sell Total 1 1 ea REACH -IN REFRIGERATOR $1,595.00 $1,595.00 Kelvinator Commercial Model No. KCBM180RQY Reach -In Refrigerator, one -section, 18 cubic feet capacity, gray cabinet, right hinged stainless steel reversible door with lock & stainless steel handle, interior lighting, (4) heavy-duty steel shelves, heavy-duty locking casters, built-in temperature gauge, dynamic condenser, heavy-duty cooling system, 120v/60/1 -ph, 5.0 amps, 1/4 hp, NEMA 5-15P, NSF, ENERGY STAR® 1 ea 3 year limited warranty, standard lea 5 year compressor warranty 2 1 ea CHE/SST REEZER // / 1 $690.00 $690.00- Kel�iinator Com�61rcial Model Nb. KCCF0704VV chest Freezer,,7.35 cubic feetcapacity, sealed cabinet interior, white F f' 7 / exterior, lift/up lid,. power on light, defrost drain, self-contained {' � A refrigeration system, NSF certified th.e4mometer, heavy-duty wire storage�asket, heavyr,-duty casters, 20v/60/1 -ph, 5 a4ps, 1/6 hf NE fA 5-1SP, NSF, ENERGY STAR p /� 1 ea 3�rear limited warranty, standard lea 5 year compressor warranty 3 1 ea LABOR $125.00 $125.00 United Restaurant.Equipment Model No. LABOR Inside delivery, uncrate, and set in place 4 1 ea LABOR $75.00 $75.00 United Restaurant Equipment Model No. LABOR Premium- basement delivery 15-20 steps. Total $2,485.00 Acceptance: Date: Printed Name: St Pauls Refrigerator + freezer St Pauls Episcopal Church Initial: Page 1 of 1 KelvinatorKCBM180RQY'j) , �5�•tN. 7Rvl;'Z "'+.�a .�µr±Y }F n+.e� '` `t y µ .:� fi yy +`t.r;fides S i Y Dynamic Condenser improves performance in high temperature environments r q; Automatic Defrost Cooling System provides worry -free performance t 1/4 HP Compressor I p Mechanical Control 4 Internal Temperature Display t._ Adjustable Shelves Spring -Assisted Hinge with 90 -degree stay -open feature A Lock & Key protects the contents I of the unit Heavy Duty Casters r* Reversible Door `t f 1 Interior Lighting r g g Vinyl Heavy Duty Adjustable Shelves Shelves that are easy to handle and keep clean. NSF® -Certified Temperature Durable and reliable for safety in food storage. Heavy -Duty, Locking Casters Keeps unit in place but allows position adjusting. a) P° C us fCHNICAL SREC)FICATIQNS MODEL KCBM180RQY Product Line Refrigerator Capacity (Cu. Ft.) 17.89 Condenser Type Dynamic Automatic Defrost Cooling System Yes Compressor Horsepower 1/4 Exterior Finish Textured Painted Steel Interior Finish Smooth`Paihted Steel Shelves (Number/Type) 4/Vinyl-Coated Steel Control Mechanical Temperature Display Location Internal Temperature Range 32 to 441 Voltage Rating 115V/5A Run Amps 1.3 Plug Type NEMA 5-15P Shipping Weight (Lbs.) , 275 Warranty 3 Year/5 Year k0 inator com * St F alils�Refngeretbh f free e � � , Unrted,Restaurant Equ p''ment Co �� r� +Page 2 -...a _.,.,N.a ..-. .,.ag ........... _.'.�..,...,.._.....- �Itei � .,;;� 'fit• -t Ap 4Y' P' 7277 + , cow Y. 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Yes y Key for lock 216362800.., Safety Certification CSA Upright locks 216362700 Sanitation Certification NSF - USA • 10200 David Taylor Drive • Charlotte, NC 28262. 1-866-738.1640 • kelvinatoccom CANADA • 5855 Terry Fox Way • Mississauga, ON L5V 3E4 Nigh standards of quallp•or Elcttrolur Horne Praducq me mean wr xe KCRM1RnR--0i115 4! )ni5ff Cr n� H P nr11 R In[ mla Ny worA 9t pr Product W - therightoch ng �. lint c^ .»r -,.-aroma •+�• r-�u�-+z.?& r r.. -.^•�.?rt+e.�° -.8"r ".u} ;. St Fau1s Refngerator:f�freezer �N�' �Untted_Restau�ant Equlprnent Cos. s. Page 3 .:_ ... .r'..: h.k;.-.......:....'31,.:s..T._.....��.�.,..,., s.,..._.aw,.,.1..•,•.as�rt...s...•,«.w...r�s.4:.w,.arm,k,:.::saw....vds........w'y.....>,.....,.o..m- .,',,. •,..,,r .de•. 4 wa..........,.t3.wn ai u.1.-. 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Ln O F+ � O r+ 9 • • N . • • ({ () Ln r) p O O N I LA O n rD c z • • c N o O O O orq rD Ln N r+ Oro Q (D°* O< O N Q n N N (D GY C:w Q 'f -+N D- _3 CL �C O (n fD =i' IV O o •a (D Q Q. O � c -0c _a �� (DrD 3 c 3 3 m o (D (D (D = � r+ 0 o O � - � a O' rm o CL Q O � n � � K � O � O r+ O N r'F A O (D IMP GrAt; IIAAchele From: Grant, Michele Sent: Thursday, February 13, 2014 10:51 AM To: 'Rich Gorzela' Subject: RE: St Pauls Episcopal Church Kitchen Hi Rich, Thank you for getting back to me. The list below is correct. However, your missing the prep sink and an industrial refrigerator. I have no problem with you re -using the 2 -bay sink as a prep sink. That will assist in your cost. Please call me with questions at the number listed below. Many Thanks Michele E. Grant Public Health Agent Town of North Andover 1600 Osgood St I Suite 2035 North Andover, MA 01845 Phone 978.688.9540 Fax 978.688.8476 Email mgrant@townofnorthandover.com Web www.TownofNorthAndover.com From: Rich Gorzela [mailto:rich.gorzelaOgmail.com] Sent: Wednesday, February 12, 2014 7:52 PM To: Grant, Michele Cc: Paul Bresnahan; Bill McKenna; Will MacNally Subject: St Pauls Episcopal Church Kitchen Hi Michelle, This is to summarize our discussion today and put it down in writing. Our understanding at St Paul's is that we have a few things to do to bring our kitchen in line with the town health department expectations: 1) cover the fluorescent lights 2) replace our 2 base sink with 3 base 3) add a hand washing sink 4) add a back splash per code 5) add appropriate base boarding per code 1 Last month, during our usual budget planning process, the vestry approved up to $5k to put toward these improvements this year. I have asked one of our regular contractors to cover the lights. I will also ask him about the base boarding. In addition, I've asked a plumber that has done work at the church before to provide recommendations and a quote for the sinks and back splash. I am targeting to have this work done by end of May. As you know we are primarily a volunteer organization (including myself), so I appreciate your understanding in that we will make an honest effort but need to work within our means. We will keep you informed if we hit any issues or questions. Thanks, Rich Gorzela Please note the Massachusetts Secretary of State's office has determined that most emails to and from municipal offices and officials are public records. For more information please refer to: hftp://www.see.state.ma.us/pre/l)reidx.htm. Please consider the environment before printing this email. 2 b, i6h, \:x\\ . ..�..� M, 4,2 � �tL vg" #Zs�^ is r..0 i K r £'fir t t a R 4,2 R«l I v oat, IV [el� l�Wr - \ 0 . . . . . . . . . . . . . p S . IN fi m w ir Q 0 3 CD z 3 A O -w N °3 c N H �A o CL m A O �A �:L � � d d 3 n -v 0 177 z 73 r o fsm z 0 z pf r r O ((D O 0 O �1 C p j• C 7 0) N 7 n 0 O 0 A :3O n N n -0d Y. O d s C Z d 0 C_ (D m a � a O O O O O 3 3 X 3 c ca CO(Cn o m m o 0 0 m O a c c CD CD CD 7 (n j y a a m w ir Q 0 3 CD z 3 A O -w Violations Related to Foodborne Illness Interventions and Risk Factors (Red Items 1-22) FOOD PROTECTION MANAGEMENT 1 590.003(A) Assignment of Responsibility* 59(!.003(13)_Demonstration of Knowledge* 2-103.11 Person in charge - duties EMPLOYEE HEALTH 2 590.003(C) Responsibility of the person in charge to Compliance with Food Law* 3-201.12 require reporting by food employees and 3-201.13 Fluid Milk and Milk Products* applicants* Shell Eggs* 590.003(F) Responsibility Of A Food Employee Or An 3-202.16 Ice Made From Potable Drinking Water* Applicant To Report To The Person In Drinking Water from an Approved System* 590.006(A) Charge* 590,006(B) 590.003(6) ReportingReportirig by Person in Charge* 3 590.003(D) Exclusions and Restrictions* 3-201.15 590.003E Removal of Exclusions and Restrictions 4 In 6 -9 FOOD FROM APPROVED SOURCE 0 Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. PROTECTION FROM CONTAMINATION g Food and Water From Regulated Sources 590.004 A -B Compliance with Food Law* 3-201.12 Food in a HermeticaRy Sealed Container* 3-201.13 Fluid Milk and Milk Products* 3-202.13 Shell Eggs* 3-202.14 Eggs and Milk Products, Pasteurized* 3-202.16 Ice Made From Potable Drinking Water* 5-101.11 Drinking Water from an Approved System* 590.006(A) Bottled Drinking Water* 590,006(B) Water Meets Standards in 310 CMR 22.0* Washing Fruits and Vegetables Shelf6sh and Fish From an Approved Source 3-201.14 Fish and Recreationally Caught Molluscan Shellfish* 3-201.15 Molluscan Shellfish from NSSP Listed Sources* Contaminadon from the Consumer Game and Wdd Mushrooms Approved by Re ulat Auth . 3-202.18 Shellstock Identification Present* 590.004 C Wild Mushrooms* 3-201.17 Game Animals* 3-701.11 Receiving/Condition 3-202.11 I'IiFs Received at Proper Temperatures* 3-202.15 Package Irate * 3-101.11 Food Safe and Unadulterated TagslRecords: Shellstock 3-202.18 Shellstock Identification * 3-203.12 Shellstock Identification Maintained* Tags/Records: Fish Products 3402.11 Parasite Destruction* 3102.12 Records, Creation and Retention* 590.004 J Labeling of Ingredients' Frequency of Sanitization of Utensils and Food Contact Surfaces of Equipment* Confomtance with Approved Procedures MACCP Plans 3-502.11 Specialized Process' Methods* 3-502.12 Reduced oxygen packaging, criteria* 8-103.12 Conformance with Approved Procedures* 0 Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. PROTECTION FROM CONTAMINATION g Cross -contamination 3-302A 1(AX 1) Raw Animal Foods Separated from Cooked and RTE Foods* Contamination from Raw Ingreafents 3-302.11(Ax2) Raw Animal Foods Separated from Each Other* Contamination from the Environment 3-302.11 A Food Protection* 3-302.15 Washing Fruits and Vegetables 3-304.11 Food Contact with Equipment and Utensils* Contaminadon from the Consumer 3-306.14 A B Returned Food and Reservice of Food* Disposition of Adulterated or Contaminated Food 3-701.11 Discarding or Reconditioning Unsafe Food* 9 Food Contact Surfaces 4-501.111 Manual Warewashing - Hot Water Sanitization Temperatures* 4-501.112 Mechanical Warewashing- Hot Water Sanitization Temperatures* 4-501.114 Chemical Sanitization- temp., pH, concentration and hardness. * 4-601.11(A) Equipment Food Contact Surfaces and Utensils Clean* 4-602.11 Cleaning Frequency of Equipment Food - Contact Surfaces and Utensils* 4-702.11 Frequency of Sanitization of Utensils and Food Contact Surfaces of Equipment* 4-703.11 Methods of Sanitization - Hot Water and Chemical* 10 Proper, Adequate Handwashing 2-301.11 Clean Condition - Hands and Arms* 2-301.12 Cleaning Procedure* 2-301.14 When to Wash* 11 Good Hygienic Practices 21101.11 Eating, Drinking or Using Tobacco* 2401.12 Discharges From the Eyes, Nose and Mouth* 3-301.12 Preventing Contamination When Tast' * 12 Prevention of Contamination from Hands 590.004(E) Preventing Contamination from Employees* 13 Handwash Facilities Conveniently Located and Accessible 5-203.11 Numbers and Capacities* 5-204.11 Location and Placement* 5-205.11 Accessibility, tion and Maintenance Supp5ed with Soap and Hand Drying Devices 6-301.11 flandwashing Cleanser, Availability 6-301.12 Hand DryW Provision Grant, Michele From: Marlene Smith [mariene.g.smith@me.com] Sent: Tuesday, November 05, 2013 8:41 AM To: Grant, Michele Subject: Re: St Paul's Church Hi Michele I have a couple of questions about the five things you asked us to address in the kitchen at St Paul's Church. The following is the list I made during your visit to St Paul's: 1. The "splash zone" behind the sink over to the dishwasher needs to be FRP approved. 2. The fluorescent lights need to be covered with plastic sleeves or covers. 3. A hand washing sink is needed. 4. If we want to use the dishwasher, we need a plumber to get the dishwasher water up to 180 degrees we only got it to about 150 after 4 tries. 5. Put "Curved Cove" where the floor meets the walls. Have I included everything necessary to get a permit for our kitchen? What type of material do you recommend for the "splash zone"? What does FRP stand for? What type of material is "Cove Molding"? Is it a vinyl molding? How wide is it? Will reminded me that we also need a slop sink added to the list. Thanks for your help. Marlene Smith Please note the Massachusetts Secretary of State's office has determined that most emails to and from municipal offices and officials are public records. For more information please refer to: htto://www.sec.state.ma.us/ore/l)reidx.htm. Please consider the environment before printing this email. J/z Ocean Conservancy S— . �� ch�q� wwwoceanconservancy.org 4 ov n North Andover Health Department Community Development Division November 4, 2013 St. Paul's Episcopal Church 396 Main Street North Andover, MA 01845 Attn: William MacNally Re: Kitchen — St Paul's Episcopal Church Dear Mr. MacNally, The Health Department received your Plan Review application submitted on October 28th, 2013 for the kitchen at St. Paul's Episcopal Church located at 390 Main Street, North Andover, MA. 01845.On October 29th, 2013 the North Andover Health Department did a walk through of St. Paul's establishment in the effort to assist the owner of items that may need to be brought up to code. This is a common practice for the Health Department. The application was found to be incomplete and requires some correction; unfortunately, there are a several issues that prevent the issuance of an approval at this time. Please see attached. In response to the walk through that was conducted by the Health Department on November 29th, to determine the overall condition of the establishment, the kitchen is in very good condition. There are a few things that will need to be addressed prior to the issuing of a permit. Those items are also listed on the attachment. It is important that the health office ensure compliance to the food code and provide safe food to the public. A simple response of how you will address each item along with the resolution of the hand sink, prep sink issues and 3 -bay sink will result in the Health approval. Thank you for your cooperation in this important matter of public health. Sincerely, Vk G�i JLC Michele Grant North Andover Health Agent Items of_Deficiency-.noted Corrective Action r ITEMS' NOTED On APPLICATION MUST BE ADDRESSEp — .,.e .._. _-.—..a.._... 3 Name of owner or the person in charge Provide a name Provide a site -plan for the property, to include the dumpster area Provide site -plan Cold Storage Section: Questions 2 and 3: Provide correct answers Cross Contamination Prevent Purchase hanging thermometers for all freezer, Thermometers refrigerators and ovens Did not provide Spec Sheets Provide Spec Sheets on all equipment Did not provide MSDS Sheets Please provide MSDS Sheets on all Chemicals Please answer questions properly on: + Provide correct answers Page 6 — Thawing food and Questions 1 and 2 Page 7 — Questions 4, 5, 7 For 7, describe sanitation procedure Page 8 — Questions 8 and 9 and Cooking Section Question 1 Page 9 — Hot/Cold Holding - Questions 1 and 2, and Cooling Section Page 10 — Questions 1 and 2, and complete Finish Schedule Section Page 11 — Insect/Rodent Section, Question 8 = An IP Plan Page 12 — Question 16 i.e.: 3 bay sink Page 13 & 14 — Please complete the Plumbing Connections Section (Someone in the Plumbing field might be able to assist you) Page 14 — Question 23 Page 15 — Question 29 Page 16 — Please complete Question 40 Page 17 — Please complete Questions 41, 42, 43, 45, 46, 47 Page 18 — Please complete Questions 49, 50, 51 -Need test kits, 52-61 Page 19 - Please complete Question 62 Application must be signed ITEMS NOTED ON SITE VISIT MUST BE ADDRESSED +FRP is required along the entire splash zone of the Oven and Sink area Utilize 3 -bay sink properly - Y -- Cover Ceiling Lights with either shatter proof bulbs or covers All permitted Kitchens must have industrial grade equipment All commercial kitchens are required by the Federal/State Food Code To have adequate Hand Sinks and Prep Sinks when serving food Make sure Dish Machine is holding the correct temps. 1600 Osgood Street, North Andover, Massachusetts 01845 Phone 978.688.9540 Fax 978.688.8476 Web www.townofnorthandover.com North Andover Health Department fommunity Development Division November 4, 2013 St. Paul's Episcopal Church 396 Main Street North Andover, MA 01845 Attn: William MacNally Re: Kitchen — St Paul's Episcopal Church Dear Mr. MacNally, The Health Department received your Plan Review application submitted on October 28th, 2013 for the kitchen at St. Paul's Episcopal Church located at 390 Main Street, North Andover, MA. 01845.On October 29th, 2013 the North Andover Health Department did a walk through of St. Paul's establishment in the effort to assist the owner of items that may need to be brought up to code. This is a common practice for the Health Department. The application was found to be incomplete and requires some correction; unfortunately, there are a several issues that prevent the issuance of an approval at this time. Please see attached. In response to the walk through that was conducted by the Health Department on November 29th, to determine the overall condition of the establishment, the kitchen is in very good condition. There are a few things that will need to be addressed prior to the issuing of a permit. Those items are also listed on the attachment. It is important that the health office ensure compliance to the food code and provide safe food to the public. A simple response of how you will address each item along with the resolution of the hand sink, prep sink issues and 3 -bay sink will result in the Health approval. Thank you for your cooperation in this important matter of public health. F fi Sincerely, Vr �� Micliele Grant North Andover Health Agent Items of Deficiency�noted y Corrective Action , -ITEMS~ NOTED On -APPLICATION MUST BE ADDRESSED Name of owner or the person in charge Provide a name - Provide a site -plan for the property, to include the dumpster area _ Providesite-plan Cold Storage Section: Questions 2 and 3: Provide correct answers Cross Contamination Prevent Purchase hanging Thermometers thermometers for all freezer, refrigerators and ovens Did not provide Spec Sheets Provide Spec Sheets on all equipment Did not provide MSDS Sheets Please provide MSDS Sheets on all Chemicals _ Please answer questions properly on: �- Provide correct answers Page 6 — Thawing food and Questions 1 and 2 Page 7 — Questions 4, 5, 7 For 7, describe sanitation procedure Page 8 — Questions 8 and 9 and Cooking Section Question 1 Page 9 — Hot/Cold Holding - Questions 1 and 2, and Cooling Section Page 10 — Questions 1 and 2, and complete Finish Schedule Section Page 11 — Insect/Rodent Section, Question 8 = An IP Plan Page 12 — Question 16 i.e.: 3 bay sink Page 13 & 14 — Please complete the Plumbing Connections Section (Someone in the Plumbing field might be able to assist you) Page 14 — Question 23 Page 15 — Question 29 Page 16 — Please complete Question 40 Page 17 — Please complete Questions 41, 42, 43, 45, 46, 47 Page 18 — Please complete Questions 49, 50, 51 -Need test kits, 52-61 Page 19 - Please complete Question 62 Application must be signed ITEMS NOTED ON SITE VISIT MUST BE ADDRESSED FRP is required along the entire splash zone of the Oven and Sink area Utilize 3 -bay sink properly Cover Ceiling Lights with either shatter proof bulbs or covers �� All permitted Kitchens must have industrial grade equipment _ _ All commercial kitchens are required by the Federal/State Food Code To have adequate Hand Sinks and Prep Sinks when serving food Make sure Dish Machine is holding the correct temps. 1600 Osgood Street, North Andover, Massachusetts 01845 Phone 978.688.9540 Fax 978.688.8476 Web www.townofnorthandover.com Grant, Michele From: Will MacNally [wmacnally@Grove-Marketing.com] Sent: Monday, October 28, 2013 1:58 PM To: Grant, Michele; Sawyer, Susan Cc: marlene.g.smith@me.com Subject: St. Paul's Kitchen Pictures Attachments: image.jpeg; image.jpeg; image.jpeg; image.jpeg; image.jpeg; image.jpeg; image.jpeg; image.jpeg; image.jpeg; image.jpeg; image.jpeg; image.jpeg Hi Michele & Susan, Thanks again for taking the time today to meet with Marlene and I about the kitchen permit for St. Paul's. We are going to fill out the temporary event permit form tonight and will look forward to meeting you over at our church tomorrow at 10:00. I'm not sure that I can make it, but Marlene will be there and we are trying to get Rusty Porter there as well (and maybe some other members who will be working on the food this weekend). Attached are some of the pictures I took last night of the kitchen for you to get a quick peak before coming over tomorrow. Let me know if you have any questions. Thanks again, Will ------------------- Will MacNally Grove p: 978.451.0280 f: 978.451.0288 c: 781.789.0199 www.cirove-marketinci.com Please note the Massachusetts Secretary of State's office has determined that most emails to and from municipal offices and officials are public records. For more information please refer to: http://www.sec.state.ma.us/ore/preidx.htm, Please consider the environment before printing this email. I �lal G►�'1'11`N %,� (G3) 6q2 -3g?-3 v 1`4 -5/)C,Q L / -s "("o o zi'J Z uOsp �jL 1 � _ G s i a� 4J s a ono �I t�6,J� - Owy^y,��- �eA,on, �a3 54�A 6 qCV, bA-P-� NVY) 5 Q G -q �1 N� ntWJG,ohi1�� RTH q� O IM o` od Establishment Plan Review Guide TOWN EA OH �EPgRTNDOVER MENT M0 FOOD ESTABLISHMENT PLAN REVIEW APPLICATION IS TO BE COMPLETED BY THE OPERATOR AND SUBMITTED TO THE REGULATORY AUTHORITY — at least 60 days in advance before commencement of any food establishment planned openings. TOWN OF N40RTH ANDOVER, MA Regulatory Authority 1600 Osgood Street, Suite 2035, North Andover, MA 01845 Date: O� 03 NEW - New construction, not yet built REMODEL - partial or major renovation of existing establishment _CONVERSION — existing establishment that you are purchasing Name of Establishment: ST • ?fit, t;s b-w,",q Corporate Name: Category: Restaurant , Institution X , Daycare , Retail Market , Other. Establishment Address: 3�o MAAto S; • , ),� , Arioo,yz , *%4 Phone: (at location if available) 9_1 - 6"3 - 66? E-mail Contacts: S-(PAVI.5"PsC6_CzrMA-. ', Wxv Name of Owner: Mailing Address: 3g17 Kgyr ij <,--F. Qo 4jo6,tt12- Telephone: 17Y- 603- 06-7 C Applicant's Name (if different than owner): V tu_ A , A AV_,tQ rU Town of North Andover, Health Department, 1600 Osgood Street, Suite 2035, North Andover, MA 01845 --Phone: 978.688.9540-- Fax: 978.688.8476 Page 1 of 19 Title (owner, manager, architect, etc.): '?Aa,.st'yO-X� Mailing Address: ��� ;�,�°� �2 , (� nth- ! (Wk Telephone: q 1 '�( Date Received: BOH office use only ate Review completed: BOH office use only: Approved / Denied' ate Revised application Received: BOH office use only bate Review completed: BOH office use only: Approved / Denied Technical Assistance with the Permitting Process The Town Planning Department offers the option of attending a Technical Review Committee (TRC) meeting to all applicants. As the applicant, I acknowledge that I have received an explanation and understand that the purpose of the TRC meeting is it to assist me in the various town processes needed to open my establishment. If declined I understand that I have forfeited this opportunity to learn more about the North Andover permitting process. I wish �t— r decline (circle one) participation in the TRC process. Date of TRC (BOH onl y). General Information Hours of Operation: Sun Thurs Mon Fri Tues Sat _ Wed ➢ Number of Seats for customers: 50 ➢ Number of Staff:_ (Maximum per shift) ➢ Total Square Feet of Facility: Z°Jv ➢ Number of Floors on which operations are conducted ➢ Maximum Daily Meals to be Served: (approximate number) �,S b Sre.-V- Na4-1 Aoo -bc- ^020—s- ""I"I ➢ Breakfast 5 D ➢ Lunch ➢ Dinner 6b Town of North Andover, Health Department, 1600 Osgood Street, Suite 2035, North Andover, MA 01845 --Phone: 978.688.9540-- Fax: 978.688.8476 Page 2 of 19 Type of Service: (check all that apply) Please enclose the following documents: Sit Down Meals _ Take Out Caterer Mobile Vendor Other / Proposed Menu (including seasonal, off-site and banquet menus) Manufacturer Specification sheets for each piece of equipment shown on the plan Site plan showing location of business in building; location of building on site including alleys, streets; and location of any outside equipment (dumpsters, well, septic system - if applicable) Plan drawn to scale of food establishment showing location of equipment, plumbing, electrical services and mechanical ventilation Z Equipment schedule CONTENTS AND FORMAT OF PLANS AND SPECIFICATIONS 1. Provide plans that are a minimum of 11 x 14 inches in size including the layout of the floor plan accurately drawn to a minimum scale of 1/4 inch = 1 foot. This is to allow for ease in reading plans. .2�Include: proposed menu, seating capacity, and projected daily meal volume for food service operations. 3. Show the location of each piece of equipment. Each must be clearly labeled on the plan with its common name. Each unit must be sequentially numbered and the numbers must correspond to the equipment specification sheets and an equipment schedule. All self-service hot and cold holding units must have sneeze guards. 5. Label and locate separate food preparation sinks when the menu dictates to preclude contamination and cross -contamination of raw and ready -to -eat foods. 6. Clearly designate adequate hand washing lavatories for each toilet fixture and in the immediate area of food preparation, cooking and ware washing. (a hand sink should be located within 10 feet of each area for easy access for all food handlers) 7. Provide the room size, aisle space, space between and behind equipment and the placement of the equipment on the floor plan. 8. On the plan, represent auxiliary areas such as storage rooms, garbage rooms, toilets, basements and/or cellars used for storage or food preparation. Show all features of these rooms. 9. Include and provide specifications for: Town of North Andover, Health Department, 1600 Osgood Street, Suite 2035, North Andover, MA 01845 --Phone: 978.688.9540-- Fax: 978.688.8476 Page 3 of 19 a. Entrances, exits, loading/unloading areas and docks; b. Complete finish schedules for each room including floors, walls, ceilings and coved juncture bases; c. Plumbing schedule including location of floor drains, floor sinks, water supply lines, overhead waste -water lines, hot water generating equipment with capacity and recovery rate, backflow prevention, and wastewater line connections; d. Lighting schedule with protectors; (1) At least 110 lux (10 foot candles) at a distance of 75 cm (30 inches) above the floor, in walk-in refrigeration units and dry food storage areas and in other areas and rooms during periods of cleaning; (2) At least 220 lux (20 foot candles): (a) At a surface where food is provided for consumer self-service such as buffets and salad bars or where fresh produce or packaged foods are sold or offered for consumption; (b) Inside equipment such as reach -in and under -counter refrigerators; (c) At a distance of 75 cm (30 inches) above the floor in areas used for handwashing, warewashing, and equipment and utensil storage, and in toilet rooms; and (3) At least 540 lux (50 foot candles) at a surface where a food employee is working with food or working with utensils or equipment such as knives, slicers, grinders, or saws where employee safety is a factor. e. Food Equipment schedule to include make and model numbers and listing of equipment that is certified or classified for sanitation by an ANSI accredited certification program (when applicable). f. Source of water supply and method of sewage disposal. Provide the location of these facilities and submit evidence that state and local regulations are complied with; g. A mop sink or curbed cleaning facility with facilities for hanging wet mops; h. Garbage can washing area/facility; i. Cabinets for storing toxic chemicals; j. Dressing rooms, locker areas, employee rest areas, and/or coat rack as required; k. Site plan (plot plan for new construction) PLEASE CIRCLE/ANSWER THE FOLLOWING QUESTIONS FOOD PREPARATION REVIEW Town of North Andover, Health Department, 1600 Osgood Street, Suite 2035, North Andover, MA 01845 --Phone: 978.688.9540-- Fax: 978.688.8476 Page 4 of 19 1 Check categories of Potentially Hazardous Foods (PHF's) to be handled, prepared and served. `CATEGORY* — (YESI (LO) 1. Thin meats, poultry, fish, eggs (hamburger; sliced meats; fillets) () ( ) 2. Thick meats, whole poultry (roast beef; whole turkey, chickens, hams) ( ) (j() 3. Cold processed foods (salads, sandwiches, vegetables) 4. Hot processed foods (soups, stews, rice/noodles, gravy, chowders, casseroles) 5. Bakery goods (pies, custards, cream fillings & toppings) ( ) (K) 6. Other FOOD SUPPLIES:) rL Are all food supplies from inspected and approved sources? � / NO �j S 2. What are the projected frequencies (daily, weekly, etc) of deliveries for Frozen foods Refrigerated foods ,i2 , and Dry goods P.rovide information on the amount of space (in cubic feet) allocated for: Dry storage C , Refrigerated Storage M i -al WFI'Land Frozen storage mil 7_ 1.v 91 e ftwwi�n2 4: How will dry goods be stored off the floor? �,3 v -zv_%-� *s 5,n<L�ro COLD STORAGE: 1. Is adequate and approved freezer and refrigeration available to store frozen foods frozen, and refrigerated 0- foods at 41'F (5°C) and below -<2)/ NO ,eV'Will raw meats, ultryand seafood be stored in the same refrigerators and freezers with cooked/ready-to- eat foodsU19'1'1_ AEfq0 If yes, how will cross -contamination be prevented? 63! Does each refrigerator/freezer have a thermometer? YES NO Number of refrigeration units: Number of freezer units: t Town of North Andover, Health Department, 1600 Osgood Street, Suite 2035, North Andover, MA 01845 --Phone: 978.688.9540-- Fax: 978.688.8476 Page 5 of 19 4. Is there a bulk ice machine available? YESNO Is ice packaged and sold for retail? YES THXWING_FROZEN=POTENTIALLY HAZARDOUS`FOOD: Please indicate by checking the appropriate boxes how frozen potentially hazardous foods (PHF's) in each category will be thawed. More than one method may apply. Also, indicate where thawing will take place. Food Thawing Method *Thick or Bulk Frozen *Thin/Portioned Frozen Refrigeration Running Water Less than 70'F(21 -C) Microwave (as part of cooking process) Cooked from Frozen state Other (describe) *Frozen foods: approximately one inch or less = thin, and more than an inch = thick. PREPARATION Please list categories of foods prepared more than 12 hours in advance of service. i� is t. -I'% ,ZWill food employees be trained in good food sanitation practices? YESNO Method of training: Number(s) of employees Dates of completion: r 3. WillAisDosable gloves and/or utensils and/or food grade paper be used to prevent handling of ready -to -eat foods. YE { NO Town of North Andover, Health Department, 1600 Osgood Street, Suite 2035, North Andover, MA 01845 --Phone: 978.688.9540-- Fax: 978.688.8476 Page 6 of 19 4!ts the a written policy to exclude or restrict food workers who are sick or have infected cuts and lesions? YES /please describe briefly: D � ID Will employees have paid sick leave? YES /NO u:4 -How will cooking equipment, cutting boards, counter tops and other food contact surfaces which cannot be submerged in sinks or put through a dishwasher be sanitized? Chernical-TypF Concentration: -7 jest.1 i�YES / 10 6. Will ingredients for cold ready -to -eat foods such as tuna, mayonnaise and eggs for salads and sandwiches be pre -chilled before being mixed and/or assembled. YES O If not, how will ready -to -eat foods be cooled to 41 T? 7. Will all produce be washed on-site prior to use? S / NO Is there a planned location used for washing produce? E�SNO Describe Food Rte, i j�c. 41 not;-describe_tlre:procedure-furcleanin= g.and_sanitizing.multiple.use.sinks between -uses- �/`�j Ll'1'`L..rt. ++5f.. `,�v'i L+'Z �(.�� �y�i'^�7►�+w�-L.. (NH4.� %%Qe.� Town of North Andover, Health Department, 1600 Osgood Street, Suite 2035, North Andover, MA 01845 --Phone: 978.688.9540-- Fax: 978.688.8476 Page 7 of 19 8. Describe the procedure used for minimizing the length of time PHF's will be kept in the temperature danger zone (41 °F - 140°F) during preparation. J 12c 14-T �J 64!Where raw meats, poultry and seafood are prepared in the same work area or using the same equipment as cooled/ready to eat foods, how will cross contamination be prevented? �'�s3��L �;-�f��+3 �'VT :•.>oyNirJ C�-�/}r� `34�;L.ic�� i157�3 10. Please list all PHF's you plan to serve which will/may not be cooked to the previously listed minimum temperatures. A proper "consumer advisory" warning notation must be printed on menu or menu boards. U Nati 11. Provide a HACCP plan for specialized processing methods such as vacuum packaged food items prepared on-site or otherwise required by the regulatory authority. 12. Will the facility be serving food to a highly susceptible population? YES NO If yes, List measures taken to comply with code requirements. COOKING: (I Will food product thermometers be used to measure final cooking/reheating temperatures of PHF's? YES LN,O what type of temperature measuring device: Minimum cooking time and temperatures of product utilizing convection and conduction heating equipment: ➢ ➢ beef roasts 130°F (121min) ➢ solid seafood pieces ➢ 145°F (15 sec) ➢ other PHF's ➢ 145°F (15 sec) ➢ eggs: ■ Immediate service 145°F (15 sec) pooled* 155°F (15 sec) (*pasteurized eggs must be served to a highly susceptible population) ➢ pork ➢ 145°F (15 sec) ➢ comminuted meats/fish ➢ 155°F (15 sec) ➢ poultry ➢ 165°F (15 sec) ➢ reheated PHF's ➢ 165°F (15 sec) Town of North Andover, Health Department, 1600 Osgood Street, Suite 2035, North Andover, MA 01845 --Phone: 978.688.9540-- Fax: 978.688.8476 Page 8 of 19 2. List types of cooking equipment. Gas S-/ojt- 02''00.-f- . J�*NIc.0-awgvE- HST/COLDHOL-9ING: CL IHow will hot PHF's be maintained at 1407 (60°C) or above during holding for service? Indicate type and number of hot holding units. i . How will cold PHF's be maintained at 417 (5°C) or below during holding for service? Indicate type and number of cold holding units. COOL- ING;� Please indicate by checking the appropriate boxes how PHF's will be cooled to 41'F (5°C) within 6 hours (140°F to 70°F in 2 hours and 70°F to 4l °F in 4 hours). Also, indicate where the cooling will take place. Town of North Andover, Health Department, 1600 Osgood Street, Suite 2035, North Andover, MA 01845 --Phone: 978.688.9540-- Fax: 978.688.8476 Page 9 of 19 COOLING THICK THIN MEATS THIN SOUPS/ THICK RICE/ METHOD MEATS GRAVY SOUPS/ NOODLES GRAVY Shallow Pans Ice Baths Reduce Volume or Size Rapid Chill =therribe) Town of North Andover, Health Department, 1600 Osgood Street, Suite 2035, North Andover, MA 01845 --Phone: 978.688.9540-- Fax: 978.688.8476 Page 9 of 19 H ATING: ,How will PHF's that are cooked, cooled, and reheated for hot holding be reheated so that all parts of the food reach a temperature of at least 165°F for 15 seconds. Indicate type and number of units used for reheating foods. Y-_� I./�_ d How will reheating food to 165°F for hot holding be done rapidly and within 2 hours? cA. FI-NIS-H SCHEDUL-E-1 Materials selected must be durable and appropriate to the area and its intended use. High moisture and food splash areas must be non-absorbent, smooth and easily cleanable. All openings must be tight fitting, properly sealed and without voids. Applicant must indicate which materials (ie. quarry tile, stainless steel, 4" plastic coved molding, etc.) will be used in the following areas. (be specific) Kitchen FLOOR COVING WALLS CEILING Bar Food Storage Other Storage Toilet Rooms Dressing Rooms Town of North Andover, Health Department, 1600 Osgood Street, Suite 2035, North Andover, MA 01845--Phone: 978.688.9540-- Fax: 978.688.8476 Page 10 of 19 Kitchen YES NO N/A 1. Will all outside doors be self-closing and rodent proof? Garbage & 2. Are screen doors provided on all entrances left open to the outside? Refuse Storage x 3. Do all openable windows have a minimum #16 mesh screening? x. Mop Service 4. Is the placement of electrocution devices identitied on the plan? 1-1 Basin Area exhaust and intakes protected? Warewashing 6. Is area around building clear of unnecessary brush, litter, boxes and other Area harborage? Walk-in 7. Will air curtains be used? If yes, where? Refrigerators and e8' Do you have a plan to have a contract pest control company? If yes, list Freezers company name, describe frequency of inspection and type of service. �,B: INSECT & RODENT CONTROL APPLICANT: PLEASE CHECKAPPROPRIATE BOXES. Town of North Andover, Health Department, 1600 Osgood Street, Suite 2035, North Andover, MA 01845 --Phone: 978.688.9540-- Fax: 978.688.8476 Page 11 of 19 YES NO N/A 1. Will all outside doors be self-closing and rodent proof? 2. Are screen doors provided on all entrances left open to the outside? x 3. Do all openable windows have a minimum #16 mesh screening? x. 4. Is the placement of electrocution devices identitied on the plan? 1-1 65!Will all pipes & electrical conduit chases be sealed; ventilation systems exhaust and intakes protected? 6. Is area around building clear of unnecessary brush, litter, boxes and other harborage? 7. Will air curtains be used? If yes, where? e8' Do you have a plan to have a contract pest control company? If yes, list company name, describe frequency of inspection and type of service. Town of North Andover, Health Department, 1600 Osgood Street, Suite 2035, North Andover, MA 01845 --Phone: 978.688.9540-- Fax: 978.688.8476 Page 11 of 19 C. GARBAGE AND REFUSE INSIDE YES NO N/A 9. Do all containers have lids? x 1.0. Will refuse be stored inside? If so, where? 11. Is there an area designated for a garbage can or floor mat cleaning? X OUTSIDE 12. Will a dumpster be used? Number: Size of: a. Number: b. Size of - c. Frequency of Pick -Up? Indicate days and how often 13. Will a compactor be used? k Number: Size: Frequency of Pick -Up 14. Will garbage cans be stored outside? 15. Describe surface and location where dumpster/compactor/garbage cans are to be stored. (Do -r- toe, 4.�_—rzi& yep "f_t" X16: Describe location of grease storage receptacle Gct�,as� � o N s-ravf Gig+ A-P:c,r_ 17. Is there an area to store recycled containers? ,C 18. Is there any area to store returnable, damaged goods? Town of North Andover, Health Department, 1600 Osgood Street, Suite 2035, North Andover, MA 01845 --Phone: 978.688.9540-- Fax: 978.688.8476 Page 12 of 19 (1'PA- MBING CONNECTIONS The FDA Food code and plumbing requirements do not replace or supersede the MA State Plumbing Code, which also must be fully met; instead, it highlights potential hazardous circumstances and particular types of equipment common to food service operations that, if through improper design or installation, could result in contamination of food or water supply. Please indicate proposed properly installed equipment. Equipment Code Confirmed Describe/ Comments Requirements by Operator i please initial Dish Machine Backflow prevention device Indirect Waste Steam Jacketed Backflow prevention Kettle device Indirect Waste Steamer Backflow prevention device Indirect Waste Garbage Disposals Backflow prevention or dish table device troughs; Submerged inlets At all hose Backflow prevention connections device Garbage can Backflow prevention washer device Carbonated Carbonated Backflow beverage prevention device dispenser Town of North Andover, Health Department, 1600 Osgood Street, Suite 2035, North Andover, MA 01845 --Phone: 978.688.9540-- Fax: 978.688.8476 Page 13 of 19 Refrigerator condensate/ drain lines Indirect Waste Ice storage bins Indirect Waste All sinks Air Gap Ice Cream dipper wells Air Gap Other 19. Are floor drains provided & easily cleanable, if so, indicate location: E. WATER SUPPLY 20. Is water supply public Qt, or private ( ) ? 21. If private, has source been approved? YES ( ) NO ( ) PENDING ( ) Please attach copy of written approval and/or permit. 22. Is ice made on premises (sQ or purchased commercially (�)? M"-- i o A-,7 4Afvs 06 de. t f T If made on premise, are specifications for the ice machine provided? YES () NO () Describe provision for ice scoop storage: Provide location of ice maker or bagging operation�ou�+ /iCr12z�Z 23. What is the capacity of the hot water generator? Town of North Andover, Health Department, 1600 Osgood Street, Suite 2035, North Andover, MA 01845 --Phone: 978.688.9540-- Fax: 978.688.8476 Page 14 of 19 24. Is the hot water generator sufficient for the needs of the establishment? Provide calculations for necessary hot water ye -3 ^) oaf 140'.j e2�Is there a water treatment device? YES ( ) NO If yes, how will the device be inspected & serviced? t & How are backflow prevention devices inspected & serviced? ._SEW --AGE DISP SALE 27. Is building connected to a municipal sewer? 28. If no, is private disposal system approved? Please attach copy of written approval and/or permit. 29. Are grease traps provided? If so - where? YES (�NO ( ) YES ( ) NO ( ) PENDING ( ) YES( )NO( ) Note: Grease Traps must have the following sign. The language in bold is specific; please do not change it in any way. If you have one or more interior grease traps please note the plumbing code 248 CMR 10.09 (m): 1. A laminated sign shall be stenciled on or in the immediate area of the grease trap or interceptor in letters one -inch high. The sign shall state the following in exact language: IMPORTANT This grease trap/interceptor shall be inspected and thoroughly cleaned on a regular and frequent basis. Failure to do so could result in damage to the piping system, and the municipal or private drainage system(s). G. DRESSING ROOMS 30. Are dressing rooms provided? YES( ) NO% 1v) 31. Describe storage facilities for employees' personal belongings (i.e., purse, coats, boots, umbrellas,etc.) 0 Town of North Andover, Health Department, 1600 Osgood Street, Suite 2035, North Andover, MA 01845 --Phone: 978.688.9540-- Fax: 978.688.8476 Page 15 of 19 R GENERAL 32. Are insecticides/rodenticides stored separately from cleaning & sanitizing agents? YES ( ) NO ( ) K) 4 Indicate location: 7\�A 33. Are all toxics for use on the premise or for retail sale (this includes personal medications), stored away from food preparation and storage areas? YES( )NO( ) W-4 34. Are all containers of toxics including sanitizing spray bottles clearly labeled? YES( NO ( ) Note: Material Safety Data Sheets (MSDS) are required to be kept for all chemicals on the premises. Where will the MSDS information be kept on display for easy access in an emergency? 35. Will linens be laundered on site? YES) NO ( ) If yes, what will be laundered and where? 7Pescqcr_,u>-,.vks va-A--rte o -j s 1 r,*— If no, how will linens be cleaned? 36. Is a laundry dryer available? YES K) NO ( ) 37. Location of clean linen storage: SfluUkimc- 38. Location of dirty linen storage:asr-'wsr"�u�ti 39. Are containers constructed of safe materials to store bulk food products? YES ( ) NO ( ) Indicate type: lyy 90Li-- men S1y2<.o t4O%Indicate all areas where exhaust hoods are installed: LOCATION FILTERS WOR SQUARE FEET _ RE IR CAPACITY MR-MAKE__UP EXTRACTION PROTECTION---, CFM CFM DEVICES XFM-u$7' V�1aDU<-+ �j g�uv�t Town of North Andover, Health Department, 1600 Osgood Street, Suite 2035, North Andover, MA 01845 --Phone: 978.688.9540-- Fax: 978.688.8476 Page 16 of 19 How is each listed ventilation hood system cleaned? I. SINKS 42. Is a mop sink present? YES( ) NO (X) Tf.no,-pleasedescrilsefacility-for-leaning-of-mops-and-other equipment: If the menu dictates, is a food preparation sink present? YES ( ) NO ( ) detail answer J. DISHWASHING FACILITIES 44. Will sinks or a dishwasher be used for warewashing? Dishwasher (< Two compartment sink k<) Three compartment sink ( ) t45-7 D-ishw—as Type -of-sanitization-used: qHd _water_(temp-provided)_ ,Boosterhea"`tern ChemtaIAype--� CIs-ventilation-provided? YES-(_) NO (=)7 L46.o all dish machines have templates with operating instructions? YES( )NO( ) 4[ 6. -Do dish machines have temperature/pressure gauges as required that are accurate? YES( )NO( ) 48. Does the largest pot and pan fit into each compartment of the pot sink? YES JKJ NO ( ) If no, what is the procedure for manual cleaning and sanitizing? Town of North Andover, Health Department, 1600 Osgood Street, Suite 2035, North Andover, MA 01845 --Phone: 978.688.9540-- Fax: 978.688.8476 Page 17.of 19 ><49 Are there drain boards on both ends of the pot sink? YES( )NO( ) c5O. What type of sanitizer is used? ❑Chlorine ❑Iodine ❑Quaternary ammonium ❑Hot Water ❑Other (517 Are test papers and/or kits available for checking sanitizer concentration? YES ( ) NO W K-HANDWASHING%TOILET FACIL-ITIES (51'11s there a handwashing sink in each food preparation, cooking and warewashing area? YES ( ) NO ( ) �Do all handwashing sinks, including those in the restrooms, have a mixing valve or combination faucet? YES( ) NO ( ) (SDo self-closing metering faucets provide a flow of water for at least 15 seconds without the need to reactivate the faucet? YES ( ) NO ( ) t55. Is hand cleanser available at all handwashing sinks? YES ( ) NO ( ) J-6.'Are hand drying facilities (paper towels, air blowers, etc.) at all handwashing sinks? YES ( ) NO ( ) 517Are covered waste receptacles available in each restroom? YES ( ) NO ( ) 58 Is hot and cold running water under pressure available at each handwashing sink? YES ( ) NO ( ) X59 Are all toilet room doors self-closing? YES O NO ( ) 606re all toilet rooms equipped with adequate ventilation? YES ( ) NO ( ) c 1. Are handwashing signs and instructions posted in each employee restroom? YES ( ) NO ( ) Town of North Andover, Health Department, 1600 Osgood Street, Suite 2035, North Andover, MA 01845 --Phone: 978.688.9540-- Fax: 978.688.8476 Page 18 of 19 Lti,SM-A—Ut E-OIfiIP T_REQUIREMENTS c-62� ;lease specify the number, location, and types of each of the following proposed for on site use: Sli-c Cutting -boards Can,openers Mixer K Floe Ot he� STATEMN'T7I7hereby certify that the above information is correct, and I fully understand that any deviation from the above without prior permission from this Health Regulatory Office may nullify final approval. Sig u s) Print: owner(s) or responsible representative(s) Date '� Approval of these plans and specifications by this Regulatory Authority does not indicate compliance with any other code, law or regulation that may be required --federal, state, or local. It further does not constitute endorsement or acceptance of the completed establishment (structure or equipment). A preconstruction inspection with equipment in place and a preopening inspection of the establishment will be necessary to determine if it complies with the local and state laws governing food service establishments. Page Last Updated: 1/29/2013 Town of North Andover, Health Department, 1600 Osgood Street, Suite 2035, North Andover, MA 01845 --Phone: 978.688.9540-- Fax: 978.688.8476 Page 19 of 19 P p uesto Map of: North Andover, Town Of, MA i (f 100ft U@St 50m Notes AVVTEQ I Terms I Privacy ©2013 MapQuest, Inc. Use of directions and maps is subject to the MapQuest Terms of Use. We make no guarantee of the accuracy of their content, road conditions or route usability. You assume all risk of use. View Terms of Use dhale99@comcast.net To: jack.mariene@me.com Pub breakfast and lunch Marlene, October 28, 2013 9:42 PM This is what I have planned for the English Pub for breakfast and lunch: Can I buy something at the store (like coffee cake and muffins and resell them? Let me know the outcome of tomorrows inspection. Debbie Breakfast: Pancakes & Sausage Egg Cheese & Sausage on an English muffin Baked Goods: Muffins Coffee Cake Beverages: Coffee, Tea, Milk, OJ Lunch: Sandwiches: Chicken Salad with Cranberries and nuts Chicken Salad (plain) Tuna Salad Egg Salad �Q TOSCO Tosco Marketing Company A Division of Tosco Corporation 72 Cummings Point Road Stamford, Connecticut 06902 Telephone: 203-326-7500 Ham Salad Cream Cheese & Olive Grilled Cheese Hot Dog Soups: Corn Chowder Tomato Soup Chili (Rusty?) Maybe one more but not sure what Desserts: Fruit Salad (pre -made) Apple Pie (store bought) Cookies (store bought) Cupcakes (homemade or store bought) Drinks: Coffee, Tea, Bottles Water Soda (Coke, Diet Coke, Sprite, Dr. Pepper) OOSL-9ZE-60Z :euoydelal Z0690 lnopewoo 'piolwelS peon lwod s6uiwwno ZL uoilmodioo oosol to uoiSinia y Ruedwo:) 6upa)laeW oosol o0soi Ln -0 ° 9 79�[ B22 - \\\\\ \ !il,, \ \ \ M a FD rD ( / CL §, G { _ / / $ a\ 7 y � cu \ \ sz . cr (�(® n=oynC wf<mEyu*I 0= /// - \(§(W)\\�\/��22®�ƒt2/ 1M „ 000 . \ MU \kDrD k§)� _�� //\�\2, !\ \ /7 \\m\ } \ ?:3 coE$ 0 W=. ID M o0 (D 3 rD :3 7 _ ��i$�=7|/ %%$ \\ �\�� \\ WaorD CL 9^ ƒ « 0 . ; ! . 0 { \ { { \ \. 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