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Home My WebLink AboutTasty Ray's 12/31/2018Commonwealth of Massachusetts Town of Mansfield Board of Health Town of Mansfield 6 Park Row Mansfield, MA 02048 Permit to Operate a Food Service Establishment Type: FOOD SERVICE 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:. RAYMOND DEAGRELA Whose place of business is: TASTY RAY'S LLC 20 SOUTH MAIN STREET PERSON(S) IN CHARGE: RAYMOND DEAGRELA, OWNER MANAGER Permit Expires: December 31, 2018 Food Fee: $125.00 License Number: FS-87 BOARD OF HEALTH Michael 9McCCean, Chairman Milk & Cream V Commonwealth of Massachusetts Town of Mansfield Board of Health License to Sell Milk and Cream This is to certify that: RAYMOND DEAGRELA having a place of business at: TASTY RAY'S LLC 20 SOUTH MAIN STREET Town of Mansfield 6 Park Row Mansfield, MA 02048 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.: FS-87 Board of Health MichaeCwlcCCean, Chairman POST THIS LICENSE IN A CONSPICUOUS PLACE This license shall not be sold, assigned or transferred Commonwealth of Massachusetts Town of Mansfield Board of Health Town of Mansfield 6 Park Row Mansfield, MA 02048 Permit to Operate a Food Service Establishment Type: CATERER 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:. RAYMOND DEAGRELA Whose place of business is: TASTY RAY'S LLC 20 SOUTH MAIN STREET PERSON(S) IN CHARGE: RAYMOND DEAGRELA, OWNER/MANAGER Permit Expires: December 31, 2018 Food Fee: $25.00 License Number: C-2 BOARD OF HEALTH MichaeCMcCCean, Chairman Milk & Cream O FOR BOARD OF HEALTH USE ONLY Permit # Issued FS 87 FOOD ESTABLISHMENT PERMIT APPLICATION (Application must be submitted at least 30 days before the planned opening date) 1) Establishment Name TASTY RAY'S LLC 2) Establishment Address 20 SOUTH MAIN STREET 3) Establishment Mailing Address (if different) 20 SOUTH MAIN STREET MANSFIELD, MA 02048 4) Establishment Telephone No (508) 339-1839 5) Applicant Name & Title: RAYMOND DEAGRELA 6) Applicant Address 50 MAYNARD STREET, APT. 128, ATTLEBORO, MA 02703 7) Applicant Telephone No.: (508) 965-7268 24 Hour Emergency No.: (508) 966.7258 8) Owners Name & Title RAYMOND DEAGRELA 9) Owner Address (If different from applicant) 50 MAYNARD STREET, APT. 128, ATTLEBORO, MA 02703 Owner's telephone number (508) 965-7258 10) Establishment Owned By. 11) If a corporation or partnership, give name, title, and home address of officers I I An Association or partner. J.. A Corporation Name Title Address I An Individual A Partnership _ Cl Other legal Entity_-- 12) Person Directly Responsible For Daily Operations (owner, person in charge, supervisor, manager etc.) Name & Title: 'RAYMOND DEAGRELA, OWNER MANAGER Address: 50 MAYNARD STREET, APT. 128, ATTLEBORO, MA 02703 Telephone No: (508) 965-7258 24 Hour Emergency No (508) 965-7258 FAX: (508)226-3860 E-mail: TASTYRAYS@YAHOO.COM Alt E-Mail: 13) District Or Regional Supervisor (if applicable) Name & Title: Address Food Establishment'Information 14) WATER SOURCE: TOWN 15) SEWAGE DISPOSAL: TOWN DEP Public Water Supply No (If applicable) 16) No. of Food Employees: O 17) DAYS/HOURS: 18) Name of Person In Charge Certified in Food Protection Management: If more than 3 individuals are certified, complete list is on file. Required as of 101112001 in accordance with 105 CMR 590.003(A) Please attach copy of certificate 19) Person Trained in Anti -Choking Procedures (If 25 Seats or more): I 20) Location: Permanent Location 22) Establishment Type ❑ Moblie Moblie Start Date: ❑ Retail ( Sq. Ft) Moblie End Date: Mobile Comments: 21) Length of Permit. F] Annual [] Food Service up to 100 or up to 10' PHF display $125.00 Food Service up to 101 -200 or up to 25' PHF display $160.00 RAYMOND DEAGRELA [Caterer $25.00 J❑ Milk & Cream $10.00 ❑ Mobile Food & Consession $75.00 ❑ Manufacture Frozen Desserts/Ice Cream $25.00/freezer ❑ Pushcart $25.00 # of Pushcarts: 0 Seasonal ] Food Service up to 201 + ❑ Residential Kitchen $100.00 i. or 25'+ PHF display $275.00 -"- Retail Food $100.00 Seasonal Dates: I Temporary - 'I___I Food Service - Institution ❑ Retail Snack Food $25.00 Temporary Start Date: ( Meals/Day) ❑Tobacco Products $25.00 Temporary End Date: Temporary Time: Rain Date: 23) Food Operations Definitions:PHF- Potentially hazardous food(time/temperature controls required) Non-PHF's - non -potentially hazardous food(no time/temperature controls required) Check all that apply): RTE- ready -to -eat foods (Ex. sandwiches, salads, muffins which need no further processing) [] Sale of Commercially Pre -Packaged Non PHFs �J PHFCooked To Order I ❑J Hot PHF Cooked and Cooled or Hot Held - --- --- - - for More Than a Single Meal Service [./I Sale of Commercially Pre Packaged PHFs J, Preparation of PHFs For Hot And - ---- - -- - Cold Holding For Single Meal Service [ 1 PHF and RTE Foods Prepared For Highly [./I Delivery of Packaged PHFs - -- - F -- �J! Sale of Raw Animal Foods Intended Susceptible Population Facility [JJ Reheating of Commercially to be Prepared by Consumer ❑ Vacuum Packaging / Cook Chill Processed Foods for Service Within 4 Hours - . -- -- - - I ----------- --- - _--- .--- I l Use of Process Requiring A Variance [/I Customer Self -Service of Non PHF and Non- Customer Self -Service and/or HACCP Plan (including bare hand Perishable Foods Only [ I Ice Manufactured and Packaged for contact alternative, time as a public health [� Preparation of Non-PHFs F _ Retail Sale control) __.....—"...._._ Other Food Operations Juice Manufactured and Packaged for ❑ Offers Raw Or Undercooked Food Of Retail Sale Animal Origin Offers RTE PHF in Bulk Quantities [l Prepares Food/Single Meals for ] Retail Sale of Salvage, Out -Of -Date Catered Events or Institutional Food Service --"- -- or Reconditioned Food To be completed by the Board of Health ---_- - -- -------- _ """ Total Permit Fee: $125 00 Payment is due with application ❑waived I, the undersigned, attest to the accuracy of the information provided in this application and affirm that the food establishment operation will comply with 105 CMR 590.000 and all other applicable law. I have been instructed by the board of health on how to obtain copies A05 CMR 590.000 and the Ifteral Food Code. 24) Signature of Applicant: /I / \- V V N_& /-�_ Pursuant to MGL Ch.62C, sec. 49A, I certify under the penalties of perjury that I, to my best knowledge and belief, have filed all state tax returns and paid state taxes required under law. 25) Social Security Number or Federal ID: 46-0546 ,S 26) Signature of Individual or Corporate Name: QJ a y 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: TASTY RAY'S LLC ADDRESS: 20 SOUTH MAIN STREET TELEPHONE AT LOCATION: (508) 339-1839 FAX NUMBER: OWNER OF BUSINESS: (508)226-3860 RAYMOND DEAGRELA TELEPHONE OF OWNER: (508) 965-7258 FEDERAL ID/SS NUMBER: 46-0546835 FEE: $10.00 PERMIT NUMBER: FS-87 v SIGNATURE: DATE: I'1 /3c)/I