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Home My WebLink AboutTown News 12/31/2018Commonwealth of Massachusetts Town of Mansfield Town of Mansfield 6 Park Row Mansfield, MA 02048 Board of Health Permit to Operate a Snack 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:. BOARD OF HEALTH DINESH PATEL Whose place of business is: TOWN NEWS 165 NORTH MAIN STREET License Number: S-18 Permit Expires: December31,2018 Food Fee: $25.00 Milk & Cream IV MichaeCMcCCean, 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. BOARD OF HEALTH Whose place of business is: TOWN NEWS 165 NORTH MAIN STREET License Number: S-18 Permit Expires: December 31, 2018 NichaeCNcCCean, 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: DINESH PATEL having a place of business at: TOWN NEWS 165 NORTH MAIN 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.: S-18 Board of Health MichaeCMcCCean, Chairman POST THIS LICENSE IN A CONSPICUOUS PLACE This license shall not be sold, assigned or transferred - -1]FOR BOARD OF HEALTH USE ONLY Permit# Issued S 18 FOOD ESTABLISHMENT PERMIT APPLICATION (Application must be submitted at least 30 days before the planned ope�au7g d 1) Establishment Name TOWN NEWS 2) Establishment Address 165 NORTH MAIN STREET : ; c) t? 3) Establishment Mailing Address (if different) 165 NORTH MAIN STREET MANSFIELD, MA 02048 4) Establishment Telephone No (508) 339-6745 5) Applicant Name & Title: ANJANA PATEL, PRESIDENT 6) Applicant Address 4 OLD STABLE DRIVE, MANSFIELD, MA 02048 7) Applicant Telephone No.: (508) 261-1532 24 Hour Emergency No. (508)982-8177 8) Owners Name & Title DINESH PATEL 9) Owner Address (If different from applicant) 4 OLD STABLE DRIVE, MANSFIELD, MA 02048 Owner's telephone number 508-261-1632 10) Establishment Owned By: 11) If a corporation or partnership, give name, title, and home address of officers ❑ An Association or partner. A Corporation Name Title Address l An Individual A Partnership Other legal Entity 12) Person Directly Responsible For Daily Operations (owner, person in charge, supervisor, manager etc.) Name & Title: ',DINESH PATEL Address: 4 OLD STABLE DRIVE, MANSFIELD, MA 02048 Telephone No (508) 982-8177 24 Hour Emergency No: (508) 982.8177 FAX: ) E-mail: PDINESH6WYAHOO.COM Alt E-Mail: 13) District Or Regional Supervisor (if applicable) Name & Title: j_ Address: Telephone No: 24 Hour Emergency No: FAX: E-mail: I— _ I Food Establishment Information 14) WATER SOURCE: TOWN 15) SEWAGE DISPOSAL: DEP Public Water Supply No: (if applicable) 16) NO of Food Employees: 17) DAYS/HOURS: 7 DAYS 5:30 AM - 9 PM — 18) Name of Person In Charge Certified in Food Protection Management: If more than 3 individuals are certified, complete list is on file. TOWN 2 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) E I -_ 20) Location: J! Permanent Location 22) Establishment Type ❑ Caterer $25.00 Moblie Moblie Start Date: f a, Retail ( Sq. Fq F/ Milk & Cream $10.00 Moblie End Date: Food Service up to 100 or ❑ Mobile Food & Consession $75.00 Moblie Comments: up to 10' PHF display $125.00 ❑Manufacture Frozen Desserts/Ice Cream 21) Length Of Permit: i I Food Service up to 101 -200 $25.00/freezer IJAnnual or up to 25' PHF display $150.00 11 ❑ Pushcart $25.00 # of Pushcarts: 0 �- -- j Seasonal Food Service up to 201 + [_ ] Residential Kitchen $100.00 or 25'+ pHF display $275.00 [] Retail Food $100.00 Seasonal Dates: I r] Temporary - : Food Service - Institution [] Retail Snack Food $25.00 Temporary Start Date: ( Meals/Day) [J] Tobacco Products $25.00 Temporary End Dale: Temporary Time: Rain Date:_---- 23) Food Operations Definitions: PHF - Potentially hazardous food (limeRemperature controls required) Non-PHFs - 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 furtherprocessing) FJ'III Sale of Commercially Pre -Packaged Non-PHFs i Sale of Commercially Pre -Packaged PHFs [ Delivery of Packaged PHFs Reheating of Commercially Processed Foods for Service Within 4 Hours -I, Customer Self -Service of Nor. PHF and Non - Perishable Foods Only [ Preparation of Non-PHFs Other Food Operations PHFCooked To Order i Hot PHF Cooked and Cooled or Hot Held - -----or - ---nd - for More Than a Single Meal Service . Preparation of PHFs FHot And Cold Holding For Single Meal Service ] PHF and RTE Foods Prepared For Highly - -- ------ — -i Sale of Raw Animal Foods Intended Susceptible Population Facility to be Prepared by Consumer U Vacuum Packaging / Cook Chill C] Use of Process Requiring A Variance 1 Customer Self Service and/or HACCP Plan (Including bare hand J Ice Manufactured and Packaged for contact alternative, time as a public health Retail Sale control) Juice Manufactured and Packaged for ❑ Offers Raw Or Undercooked Food Of Retail Sale Animal Oriqin Offers RTE PHF in Bulk Quantities 1 Prepares Food/Single Meals for Catered Events or Institutional Food Service Retail Sale of Salvage, Out -Of -Date — ----- of Reconditioned Food i To be completed by the Board of Health ---------------_-- Total Permit Fee: $25.00 Payment is due with application L_1 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 of 105 CMR 590,000 and the federal Food Code. 24) Signature of Applicant: �N' — - t,- 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: 04-3333-572 26) Signature of Individual or Corporate Name: l7` NAY �RTt3L 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: TOWN NEWS ADDRESS: 165 NORTH MAIN STREET TELEPHONE AT LOCATION: (508) 339-6745 FAX NUMBER: (508) 339-6744 OWNER OF BUSINESS: DINESH PATEL TELEPHONE OF OWNER: 508-261-1532 FEDERAL IDISS NUMBER: 04-3333-572 FEE', $10.00 PERMIT NUMBER: S-18 SIGNATURE: DATE: Town of Mansfield Town of'Mansfield - Board of Health 6 Park Row Mansfield, MA 02048 PERMIT NUMBER: 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: TOWN NEWS LOCATION OF SALE OF TOBACCO PRODUCTS: 165 NORTH MAIN STREET TELEPHONE AT LOCATION: (508) 339-6745 OWNER OF BUSINESS: DINESH PATEL ADDRESS OF OWNER: 4 OLD STABLE DRIVE, MANSFIELD, MA 02048 TELEPHONE OF OWNER: (508) 261-1532 FAX NUMBER: (508) 339-6744 If a corporation or partnership, give name, title, and home address of officers or partner. * Provide a copy of current Department of Revenue CT-3T Retail Excise Unit License. FEE: $25.00 CT-3T NUMBER: 1136406528 FEDERAL ID/SS NUMBER: 04-3333-572 SIGNATURE: DATE: