HomeMy WebLinkAboutSarcastic Sweets (Mansfield Art Show) - 5/9/2019Commonwealth of Massachusetts
Town of Mansfield
Town of Mansfield 6 Park Row
Mansfield, MA 02048
Board of Health
Permit to Operate a Food Service Establishment
Type: TEMPORARY FOOD PERMIT
In accordance with Regulations promulgated under authority of Chapter 94, Section
305A and Chapter 111, Section 5 of the General Laws, a Permit is hereby granted to:.
NINA REED, OWNER
Whose place of business is:
SARCASTIC SWEETS - MANSFIELD ART SHOW
MANSFIELD SCHOOL COMPLEX - EAST STREET
PERSON(S) IN CHARGE:
NINA REED, OWNER
Permit Expires: May 09, 2019
Food Fee: $50.00
License Number: T-46
BOARD OF HEALTH
MlchaeCHeatey, Chairman
16) Food will be prepared:
Onsite for immediate consumption
Onsite and held at proper hot/ cold holding temperatures
Offsite and held at proper hoV cold holding temperatures
Offsite, cooled and reheated on site
Other:
17) If PHF is being served, please list the person who has completed the following trainings and attach appropriate
certificates:
Food Safety Manager: C(/ pati C i i-�� t ems_ g
Allergen Awareness: v GI
18) If applicable, please describe your FOG management plan or attach the written plan:
19) For caterers: City[Town where food establishment permit is held. Please attach a copy of the caterer's permit:
For food trucks, please list additional communities where a food permit is held and attach copies of the permits:
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I, the undersigned, attest to the accuracy of the Information provided in this application and 1 affirm that the food
establishment operation will comply with 105 CMR 590.000 and all other applicable law. l have been instructed
by the board of health on how to obtain copies of 105 CMR 590.000 and the federal Food Code.
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19) Signatureof
Pursuant to MGL Ch. 62C, sec. 49A, I certify under the penalties of perjury that 1, to my best
knowledge and belief, have filed all state tax returns and paid state taxes required under law.
20) Social Security Number or Federal ID: 14 55, -LC) 1 2 3 �J _
21) Signature of Individual or Corporate Name:
60 r a0b)' 3 y(, 1/ 3,)3
Food Protection Questionnaire for Catered Events
Date of Event: l c) 12u i Event Thee: �o n _S
Location of Event: (til ,Srn. I .I 1A,,; r 99
List all foods that youwill be drilling, holding, coolcmg, and/orreheating at the event location
On ice/Reffigerated Cooking Reheating
Food Manage• Certification Person TYained On Site? dY'es m No
Allergen Awareness Meer Label Present? bYes o No
List the regrtired terperature for eadl food as it leaves yourprepmtlon site:
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HowwM the PHF be kept at orbelow41OF? V\ /
How will the PHF be kept at or above 140°F? V\/a
Time of PHF? Setup Served Removed
List all equprmtthatwill be supplied form event, indudirtgbut not lirrutedto food
thermometers, clemw%wipes, utensils, non latex gloves, heating utensils, ice etc.
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Sole Proprietor Declaration Statement
I Nina Reed, the owner of Sarcastic Sweets operates as the Sole Proprietor for the
establishment. I am the employee and operator of the vehicle. Therefo rg, I qrn not
required to supply workman's comp insurance paperwork for person. I QM POrsonally
liable for my personal insurance of person.
Nina W.C. Reed
03/15/2019
TAX CERTIFICATION FORM
I certify under the penalties of perjury that I, to my best knowledge and
belief, have filed all state tax returns and paid all state taxes required
under law.
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Signature of Individual or Corporate Name By: Corporate Officer (Mandatory, i Applicable)
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*"Social Security No. (Vohmtary) or Federal
Identification Number
*This license will not be issued unless this certification clause is signed
by the applicant.
** Your social security number will be furnished to the Massachusetts
Department of Revenue to determine whether you have met tax filing or
tax payment obligations. Licensees who fail to correct their non -filing or
delinquency will be subject to license suspension or revocation. This
request is made under the authority of Massachusetts General Law
Chapter 62C, section 49A.
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I ama emplo3u'Aith employees (full and/ S. j 3letail
orpart-tare).* 6. ❑ Restamant/Bar/Eaft EstalIst ent
2& I ama sole proprietor or pattrierslup and have no 7. ❑ Office md/or Sales (incl. real estate, auto, etc.)
employees vw ift forme in my capacity.
[No workers' comp. insurance required] 8. ❑ Non-profit
3. ❑ We are a corporation and its officers have exercised 9. ❑ Enteraruunent
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Insurer's
City/State/Zip:
Policy # or Self -ins. Lie. # Expiration
Attach a copy of theworla s' era Wtsatim policy cleclaralim page (showing thepolicymmiber and expiration date).
Failure to secrue covemge as required under Section 25A of MGL c.152 can lead to the imposition of airnutial penalties of a
fore up to $1,500.00 and/or care -year ingnisormut, as well as civil penalties in the fotmof a STOP WORK ORDER and a fine
of up to $250.00 a day against the violator. Be advised that a copy of this statement maybe forwarded to the Office of
Investigations of the DIA for insurmce coverage verification.
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Jane Doucette
From:
Sent:
To:
Subject: )iY_P
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Hi Jenn, (J'� rtl
Amy Donovan -Palmer
Thursday, April 25, 2019 8:50 AM
Jenn Walsh
Jane Doucette
RE: Mansfield Public Schools District Wide Art Show
The fee was increased in January. We are actually about where surrounding towns are at for temporary food permits so
hopefully you won't lose anybody because of it. It sounds like the trucks have been very successful at these events.
Everybody loves a food truck! O
I'll cc'ed Jane, the secretary, so she can contact you directly when she receives completed permits.
Amy
From: Jenn Walsh [mailto:jenners35@hotmail.com]
Sent: Thursday, April 25, 2019 8:40 AM
To: Amy Donovan -Palmer
Subject: Re: Mansfield Public Schools District Wide Art Show "
The fee was raised from $25 to $50?
I'll let the trucks know, we might have some that will back out due to the high fee, I'll keep you posted.
I'll check in with Nina and ask her to touch base with you regarding the fee in the fall.
Thanks,
Jenn
Sent from my iPhone
On Apr 25, 2019, at 8:00 AM, Amy Donovan -Palmer <adoalmer(a�mansfieldma.com> wrote:
Hi Jenn,
Attached is the temporary permit. There is a $50 fee for a one day temporary permit to the
Health Department. Everybody needs to submit the forms with payment no later than May 6th.
Last year we implemented a new fee waiver form for any non -profits or for -profits who are
donating ALL their proceeds to a non-profit. If you feel like anybody would qualify for this, I'll
send along the waiver.
Last year at the Open House, Sarcastic Sweets did not pay in advance and Nina was going to
send in a check. We don't have any record of receiving a check, even though she says she sent
one in. I asked her to provide us with a cancelled check which would clear everything up and I
never heard back from her. I'll be happy to re -address this if she chooses to submit an application
but we can't issue a permit without payment (or proof of payment) from last year.
Let me know how else we can help to make this a successful event.
Amy
-----Original Message -----
From: Jenn Walsh[mailto:jenners35(a7hotmail.com]
Sent: Wednesday, April 24, 2019 4:03 PM
To: Amy Donovan -Palmer
Subject: Mansfield Public Schools District Wide Art Show
Hi Amy,
I'm again planning food trucks for our District Wide Art Show on May 9th. I have 4 trucks lined
up. Sarcastic Sweets (returning from previous years), Championship Melt (also returning),
Haven Brothers, and Burgundian Waffles.
How should I handle the permitting process? I couldn't find the application on the new website.
Let me know if you have any questions.
Thanks,
Jenn
Sent from my iPhone
FUM
The information contained in this communication from the Town of Mansfield is confidential. It is intended solely for
use by the recipient and others authorized to receive it. If you are not the recipient, you are hereby notified that
any disclosure, copying, distribution or taking action in relation of the contents of this information is strictly
prohibited and may be unlawful.
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<I'emporary food permit application.pdf>
frLp -
(-3pj-)-
Jane Doucette
From:
Amy Donovan -Palmer
Sent:
Monday, April 29, 2019 9:35 AM
To:
Jane Doucette
Subject:
Fwd: Voicemail Message (Stephanie Buono > BrdHealth) From:84019423557
Attachments:
MSG00949.WAV; ATT00001.htm
Hi Jane, could you send a temp permit to this person? Also, can you ask them what time they will be at the art
show? I may be able to do the inspection before the art show so they don't have to come twice.
They can email me directly with any questions.
Thanks
Amy
Amy Donovan -Palmer, MPH, RS
Health Agent
508-261-7366
Sent from my Whone
Begin forwarded message:
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so
From: voice mail <vmailamansfieldma.com> /
Date: April 26, 2019 at 2:21:10 PM EDT /N . �'�`�t
To: Amy Donovan -Palmer <adpalmer@mansfieldma.com> N �—
Subject: Voicemail Message (Stephanie Buono > BrdHealth) From: 84019423557
IP Office Voicemail redirected message
Jane Doucette
From: Stephen Buono <sbuono1972@gmail.com>
Sent: Tuesday, April 30, 2019 9:33 AM
To: Jane Doucette
Subject: Re: Temporary food permit application_print.pdf
How about 3pm? Also can I set up a fire inspection (propane) as well before or after that time?
On Tue, Apr 30, 2019, 8:41 AM Jane Doucette <Jdoucette@mansfieldma.com> wrote:
Here is the temporary food permit application for the Art Show in Mansfield. What time will you be coming
to the event; will need to set up a time to have the food truck inspected.
The information contained in this communication from the Town of Mansfield is confidential. It is intended solely for use by the
recipient and others authorized to receive it. If you are not the recipient, VOL] are hereby notified that any disclosure, copying,
distribution or taking action in relation of the contents of this information is strictly prohibited and may be unlawful.
This email has been scanned for viruses and malware, and may have been automatically archived by Mimecast Ltd, an innovator
'in Software as a Service (SaaS) for business. Providing a safer and more useful place for your human generated data.
.Specializing in; Security, archiving and compliance. To find out more Click Here.
On Tue, Apr 30, 2019, 8:41 AM Jane Doucette <Jdoucette@mansfieldma.com> wrote:
Here is the temporary food permit application for the Art Show in Mansfield. What time will you be coming
to the event; will need to set up a time to have the food truck inspected.
offlapff rim,
The information contained In this communication from the Town of Mansfield is confidential. It is intended solely for use by the
recipient and others authorized to receive it. If you are not the recipient, you are hereby notified that any disclosure, copying,
distribution or taking action in relation of the contents of this information is strictly prohibited and may be unlawful.
This email has been scanned for viruses and malware, and may have been automatically archived by Mimecast Ltd, an innovator
in Software as a Service (SaaS) for business. Providing a safer and more useful place for your human generated data,
Specializing in; Security, archiving and compliance. To find out more Click Here.