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Home My WebLink AboutDub's Liquors & Wines 12/3/12018e Commonwealth of Massachusetts Town of Mansfield Town of Mansfield 6 Park Row Mansfield, MA 02048 Board of Health Permit to Operate a Retail Establishment 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:. 1 Whose place of business is: AUSTIN DEBUCAS, LLC DBA DUB'S LIQUORS & WINES 30 CHAUNCY STREET Permit Expires: December 31, 2018 License Number: RF-29 Food Fee: $100.00 Milk & Cream L BOARD OF HEALTH Aichae(NcCCean, Chairman Permit for the Sale of Tobacco Products Violation of REGULATION AFFECTING SMOKING AND THE SALE, VENDING, AND DISTRIBUTION OF TOBACCO may result in fines, suspension or revocation of this permit. Whose place of business is: AUSTIN DEBUCAS, LLC DBA DUB'S LIQUORS & WINES 30 CHAUNCY STREET License Number: RF-29 Permit Expires: December 31, 2018 BOARD OF HEALTH rwichaefNeCCean, Chairman Commonwealth of Massachusetts Town of Mansfield Town of Mansfield 6 Park Row Mansfield, MA 02048 Board of Health License to Sell Milk and Cream This is to certify that: MAS INC. having a place of business at: AUSTIN DEBUCAS, LLC DBA DUB'S LIQUORS & WINES 30 CHAUNCY STREET in the Town of Mansfield has been granted a license to sell MILK and CREAM and is subject to the Provisions of the Laws of the Commonwealth of Massachusetts, relating to the terms and conditions, and to the rules and regulations established by the Board of Health, of the Town of Mansfield governing the sale of Milk and Cream and shall remain in force until 1213112018 . unless previous to that time is suspended or revoked. Expires 1213112018 License No.: RF-29 Board of Health MichaeCMcCCean, Chairman POST THIS LICENSE IN A CONSPICUOUS PLACE This license shall not be sold, assigned or transferred FOR BOARD OF HEALTH USE ONLY Permit # Issued RF-29 FOOD ESTABLISHMENT PERMIT APPLICATION (n must be submitted at least 30 days before the planned 1) Establishment NameatioAUSTIN DEBUCAS LLC DBA DUB'S LIQUORS & W NESnm dat � 1 2) Establishment Address NOV 0 6 Z017 30 CHAUNCY STREET - -- r,rne 3) Establishment Mailing Address (if different) 50 BOSTON TURNPIKE SHREWSBURY, MA 01545 4) Establishment Telephone No (508) 339-3454 5) Applicant Name & Title: JACKIE BROGNA, V.P. ADMINISTRATION 6) Applicant Address 50 BOSTON TURNPIKE, SHREWSBURY, MA 01545 7) Applicant Telephone No.: (508) 755-1710 24 Hour Emergency No.: (774) 244-1094 8) Owners Name & Title MAS INC, j 9) Owner Address (If different from applicant) 60S*t� `jh"t, v� ktLrLi , mA Owner's telephone number (508) 755-1710 Ut 10) Establishment Owned By: 11) If a corporation or partnership, give name, title, and home address of officers An Association or partner. A oration Name Title \ c� Address An Individual I,` A Partnerrshi 1 ChC�a 1 y11 �i1 r�_ —TDW_ 1_�IA P IN S1.61�k � C MA Other legal Entity _ laY U �,tCuwv�Y�- CFOS'-$ury�si2ncl '�i._Slh,(y1Y� b sr� 12) Person Directly Responsible For Daily Operations (owner, person in charge, supervisor, manager etc.) Gi057 Name & Title: 'WAYNE SMITH, MANAGER Address: 24 Hour Emergency No: (774) 244-1094 FAX: E-mail: No: - - - -- - - -.- E-mail: ICABERNET(cDDUBSONLINE.COM Alt E-Mail: 13) District Or Regional Supervisor (if applicable) Name & Title: Address: Telephone No: ',OWNER (508) 754-7733 24 Hour Emergency No: FAX: E-mail: Town of Mansfield Town of Mansfield - Board of Health 6 Park Row Mansfield, MA 02048 Application for Milk and Cream Permit I hereby make application for a MILK AND CREAM PERMIT, which expires on December 31st of each year. NAME OF BUSINESS: AUSTIN DEBUCAS, LLC DBA DUB'S LIQUORS & WINES ADDRESS: 30 CHAUNCY STREET TELEPHONE AT LOCATION: (508) 339-3454 FAX NUMBER: (508) 300-0587 OWNER OF BUSINESS: MAS INC. TELEPHONE OF OWNER: (508) 755-1710 FEDERAL ID/SS NUMBER: 47-1090248 FEE: $10.00 PERMIT NUMBER: RF-29 SIGNATURE: DAT� I U ' aN — � / Town of Mansfield Tovnn of Mansfield - Board of Health 6 Park Row Mansfield, MA 02048 PERMIT NUMBER: RF-29 Application for the Sale of Tobacco Products I hereby make application for a permit to sell tobacco products in compliance with the Board of Health Regulation Affecting Smoking and the Sale, Vending and Distribution of Tobacco. This permit expires on December 31st of each year. Violation of this Regulation may result in fines, suspension or revocation of this permit. NAME OF BUSINESS: AUSTIN DEBUCAS, LLC DBA DUB'S LIQUORS & WINES LOCATION OF SALE OF TOBACCO PRODUCTS: 30 CHAUNCY STREET, MANSFIELD, MA 02048 TELEPHONE AT LOCATION: (508) 339-3454 OWNER OF BUSINESS: MAS, INC. ADDRESS OF OWNER: 50 BOSTON TURNPIKE, SHREWSBURY, MA 01545 TELEPHONE OF OWNER: (508) 755-1710 FAX NUMBER: U� WoO us'b�) If a corporation or partnership, give name, title, and home address of officers or partner. ARII? SKOWYRA,MANAGER 225 BUMSTEAD ROAD, MONSON, MA 01057 *Provide a copy of current Department of Revenue CT-3T Retail Excise Unit License. FEE: $25.00 CT-3T NUMBER: 490352640 1114689536 FEDERAL ID/SS NUMBER: 47-1090248 SIGNATURE: C-Lt�e-.G DATE �o "DQ - l-) (v) MASSACHUSETTS DEPARTMENT OF REVENUE Letter ID: L0417244160 PO BOX 7044 Notice Date: September 1, 2016 BOSTON, MA 02204-7044 Account ID: CGL-12086867.005 CONTACT CENTER ltYhAT OFF (617) 887-6367 RETAILER LICENSE FOR SALE OF CIGARETTES IIP'Illull^IuPu'dllill'lllllhl'1"hIIh]111„1'Ihulhl AUSTIN DEBUCAS LLC DUBS'S LIQUORS & FINE WINES �= 50 BOSTON TFKE STE I SIIREWSBURY MA 01545-3540 Attached below is your Retailer License for Sale of Cigarettes (Form CT-3T). Cut along the dotted line and display at your business location. At any time, you can log into your MassTaxConnect account at mass.gov/masstaxconnect to view and re -print a copy of this license. If you have any questions about your license, call us at (617) 887-6367 or toll -free in Massachusetts at (800) 392-6089, Monday through Friday, 8:30 a.m. to 4:30 p.m. DETACH HERE Ps4 `h{OSeT MASSACHUSETTS DEPARTMENT OF REVENUE Form CT-3T B a Retailer License for Sale of Cigarettes This license must be posted and visible at all times. The sale of tobacco products to anyone under 18 years of age is prohibited. AUSTIN DEBUCAS LLC Account ID: CGL-12086867-005 DUBS'S LIQUORS & FINE WINES License Number: 490352640 30 CHAUNCY ST MANSFIELD MA 02048-1958 This certifies that the taxpayer named above is licensed under Chapter 64C of the Massachusetts General Laws to sell at retail at the address shown above. This license is non -transferable and may be suspended or revoked for failure to comply with state laws and regulations. Effective Date: October 1, 2016 Expiration Date: September 30, 2018