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CHRISTOPHER COLUMBUS CLUB - ESTABLISHMENTS (Af MC PAc( -OIUM W s cl u b 21.t �ndiLOf� s�(ca� wiversal one www.myuniversalop.com phone: 1-800-756-4676 UNV16162 MADE IN USA � � �i I i i I 1 I �� i I I vg '� Commonwealth of Massachusetts r City of Salem Board of Health Kimberley Driscoll 120 Washington Street,4th Floor Mayor SALEM,MA 01970 Food/Retail Establishment Permit DATE PRINTED: 01/04/2011 ESTABLISHMENT NAME: CHRISTOPHER COLUMBUS CLUB File Number:BHF-2004-000119 P.O. Box 651 Salem MA 01970 LOCATED AT: 0024 ENDICOTT STREET SALEM, MA 01970 Permit Type Permit No. Permit Issued Permit Expires Fee Restrictions!Notes FOOD SERVICE BHP-2011-0141 Jan 1,2011 Dec 31,2011 $25.00 ESTABLISHMENT Total Fees: $25.00 PERMIT EXPIRES IDecember 31, 2011 Board of Health This Permit is not transferable and must be reissued upon change of ownership or location.The permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code, beofre any revonations,improvements,or equipment changes are made, all plans for such must be submitted to and approved by the Salem Board of Health. Page 1 • CITY OF SALEM, MASSACHUSETTS HOARD OF HEALTH 120 WASHINGTON STREET,4"FLOOR TEL. (978) 741-1800 KIb1BERLEY DRISCOLL FAX(978) 745-0343 MAYOR DGREENBAUM !SALEM.COM DAVID GREENBAUM,RS ACTING HEALTH AGENT 2011 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT NAME OF ESTABLISHMENT ��S�a�a Az1 �Gu TEL# q 7g- 7 Vzl F _33 ADDRESS OF ESTABLISHMENT_ �_ D/ - �_? FAX# MAILING ADDRESS(if different) // X. wS EMAIL- Business': Website: �— OWNERS NAME TEL# ��/� Cl- ADDRESS ADDRESS STREET CITY STATE ZIP CERTIFIED FOOD MANAGER'S NAME(S) CERTIFICATE#(S) (Required in an establishment where potentially hazardous food is prepared) EMERGENCY RESPONSE PERSON HOME TEL# DAYS OF,OP,ERATION w , .. :',Monda ':fM':Tuesday': ':Wednesday �' "' Sund y r. _Thursda Frida Saturday ay •-. HOURS OF OPERATION Please write in time of day. For example I lam-1 l pm I TYPE OF ESTABLISHMENT FEE (check only) RETAIL STORE YES less than 1000sq.ft. =$70 1000-10,000sq.ft. =$280 more than 10,000sq.ft. =$420 ----------------------------------------------- --Y------ES----- -- ---- ----------------------------------------- ------------------------------------------------- RESTAURANT N less than 25 seats =$140 (Outdoor Stationary Food Cart$210) 25-99 seats =$280 more than 99 seats =$420 ---------------------------------------------------- BED/BREAKFAST/ YES $100 CHILDCARE SERVICES/NURSING HOME ADDITIONAL PERMITS ------------------------------------------------------------------------------------------------------------------------------------ MAKE (not just serve) ICE CREAM, YOGURT/SOFT SERVE YES $25 TOBACCO VENDOR YES $135 ALL NON-PROFIT(such as church kitchens) YES $25 *Please pay total with one check payable to the City of Salem. m x' vA'Aty This Permit is not transferable and must be reissued upon change of ownership.The Permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code, before any renovations, improvements,or equipment changes are made,all plans for such jandpaidJaltate submitted to and approved by the Salem Board of Health. PursuL Chapter 62C,Section 4 A,I certify under the pains and penalties of perjury that],to my best knowledge and belief,have filed all state tax returns t x required u der the law. l �z io / o Sign Date Social Security or Federal Identification Number Revised I onli 1 FOODAP201 Ladm Check#&Date /n/S' Commonwealth of Massachusetts e City of Salem Kimberley Driscoll Board of Health 120 Washington Street,4th Floor Mayor SALEM,MA 01970 Food/Retail Establishment Permit DATE PRINTED: 01/05/2010 ESTABLISHMENT NAME: CHRISTOPHER COLUMBUS CLUB File Number:BHF-2004-000119 P.O.Box 651 Salem MA 01970 LOCATED AT: 0024 ENDICOTT STREET SALEM, MA 01970 Permit Type Permit No. Permit Issued Permit Expires Fee Restrictions/Notes FOOD SERVICE BHP-2010-0138 Jan 4,2010 Dec 31,2010 $25.00 ESTABLISHMENT Total Fees: $25.00 PERMIT EXPIRES , December 31, 2010 Board of Health AMIL �1 This Permit is not transferable and must be reissued upon change of ownership or location.The permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code,beofre any revonations,improvements,or equipment changes are made,all plans for such must be submitted to and approved by the Salem Board of Health. Page 1 CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH 120 WASHINGTON STREET,4"'FLOOR TEL. (978) 741-1800 KIMBERLEY DRISCOLL Fax(978) 745-0343 MAYOR DGREENBAUM(r�l�,SALEM.COLI DAVID GREENBAUM, ACTING HEALTH AGENT 2010 APPLICATION FOR /PERMIT �T�O LOPERATE A FOOD ESTABLISHMENT NAME OF ESTABLISHMENT (�S�vt�Oo�� a1 l��w J TEL# 9'7S -7164 t��✓� 3 ADDRESS OF ESTABLISHMENT -4i"If COD" C��f" S7— FAX# MAILING ADDRESS(if different) EMAIL- Business': /� Website: OWNER'S NAME &51noaoJ,I�w cbt,h TEL# ADDRESS -9—y j I C0 k' C-;W114q STREET CITY STATE ZIP CERTIFIED FOOD MANAGER'S NAME(S) CERTIFICATE#(S) (Required in an establishment where potentially.haazardous food is prepared) EMERGENCY RESPONSE PERSON ',/ /lam,wf/-S HOME TEL# DAYS,QOPEWIQN,W!a ,. Monday?�-.� ' Tuesd"",, '1 Wednesday � Thursday: Fntlay Saturda Sun_Gay HOURS OF OPERATION � _ Please write in time of day. Z^ r7- � 1 1 For example 11am-11 m - -- TYPE OF ESTABLISHMENT FEE (check only) RETAIL STORE YES ® less than 1000sq.ft. =$ 70 1000-10,000sq.ft. =$280 more than 10,000sq.ft. =$420 - ------ ----- - - - _ ... RESTAURANT YESl less than 25 seats $140 (Outdoor Stationary Food Cart$210) 25-99 seats =$280 more than 99 seats =$420 --- ---------------------•-- ---------•---------------------------------------------------------- BED/BREAKFAST/ YES $100 CHILDCARE SERVICES/NURSING HOME --- ----------------•--•-------------------------------------------------------------------------------=---------------------------------------------------------------------------------- ADDITIONAL PERMITS MAKE (notjust serve) ICE CREAM, YOGURT/SOFT SERVE YES NO $25 TOBACCO VENDOR YES NO $135 ALL NON-PROFIT(such as church kitchens) /i I l k YES NO 25 `Please pay total with one check payable to the City of Salem. This Permit is not transferable and must be reissued upon change of ownership.The Permit must be posted in a prominent location in the Establishment. ' In accordance with the State Sanitary Code, before any renovations, improvements,or equipment changes are made, all plans for such must be submitted to and approved by the Salem Board of Health. Pursuant to MGL Chapter 62C,Section 49A, I certify under the pains and penalties of perjury that I,to my best knowledge and belief,have filed all state tax r m and paid all st taxes required under the law. �u. = /L-eros 6�/`/O/Z3p Signtiue Date Social Security or Federal Identification Number Revised 424/07 FOODAP2008.adm Check#&Date $ s Commonwealth of Massachusetts s City of Salem Board of Health Kimberley Driscoll 120 Washington Street,4th Floor Mayor SALEM,MA 01970 Food/Retail Establishment Permit DATE PRINTED: 1211912008 ESTABLISHMENT NAME: CHRISTOPHER COLUMBUS CLUB He Nun*a:BHP-2004-Ml 19 P.Q.Box 651 Salem MA 01970 LOCATED AT: 0024 ENDICOTT STREET SALEM,MA 01970 Permit Type Permit No. Permit Issued Permit Expires Fee Restrictions i Notes FOOD SERVICE BHP-2009.0089 Dec 19,200$ Dec 31,2009 $25.00 ESTABLISHMENT Total Fees: $25.00 PERMIT EXPIRES December 31,200 Board of Health This Permit is not transferable and must be reissued upon change of ownership or location.The permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code,beofre any revonations,improvements,or equipment changes are made,all plans for such must be submitted to and approved by the Salem Board of Health. Page 1 - 1 CITY OF SALEM, MASSACHUSETTS * BOARD OF HEALTH 120 WASHINGTON STREET,4"FLOOR TEL. (978) 741-1800 KIMBERLEY DRISCOLL FAx(978) 745-0343 MAYOR ]DIONNF SALEM.COM JANET DIONNE, ACTING HEALTH AGENT 2009 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT NAME OF ESTABLISHMENT 4?A P Y7SYJlINaL (_O CLhI(UI S dk/ TEL# 9 J� 7V7 5"5i33 ADDRESS OF ESTABLISHMENT_9,V �b I Cotf- S'T FAX# MAILING ADDRESS(if different) PO 'em 5!y& , ?5r EMAIL- Business': Website: OWNER'S NAME i�ta/LfL_ TEL# ADDRESS STREET CITY STATE ZIP CERTIFIED FOOD MANAGER'S NAME(S) CERTIFICATE#(S) (Required in an establishment where potentially hazardous food is prepared) EMERGENCY RESPONSE PERSON HOME TEL# DAYS OF OPERATION.t • .Monda .-si ._1uesda ' r Wednesda . Thursda -Edda ., 1 "Saturday. Sunda e HOURS OF OPERATION Please write in time of day. (For example I1am-1lpm) TYPE OF ESTABLISHMENT FEE (check onlvl RETAIL STORE YES NO less than 1000sq.ft. =$ 70 1000-10,000sq.ft. =$280 more than I0,000sq.ft. =$420 - -- ---------------------------------------------- - - ------------------------------------------------------------------------------_---------- RESTAURANT YES less than 25 seats $140 (Outdoor Stationary Food Cart$210) 25-99 seats =$280 more than 99 seats =$420 BED/BREAKFAST/ YES 0 $100 CHILDCARESERVICES ---------------------------------------------------------------------------------------------------------------------------- ADDITIONAL PERMITS MAKE (not just serve) ICE CREAM, YOGURT/SOFT SERVE /11/A- 2-s Na— $25 TOBACCO VENDOR YES q4W $135 ALL NON-PROFIT(such as church kitchens) YES $25 *Please pay total with one check payable to the:City of Salem. This Permit is not transferable and must be reissued upon change of ownership.The Permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code,before any renovations,improvements,or equipment changes are made,all plans for such ust be submitted to and appro by the Salem Board of Health. Pu t to MGL Chapter 6 �,Section 49 certify under the pains and penalties of perjury that I,to my best knowledge and belief,have fled all state tax retu s nd paid al tate t as requireyn the law. Q U Si a Date Social Security or Federal Identification Number --------------- ------- -- --- R sed 424/07 FOODAP2008.adm Check#&Dat e P�� YI $ Waltham Services 226 Lowell St. Service Inspection Report Wilmington, MA 01887 5-9S. ds1.fl�S.. 800-423-6933 Service Report #2371373 Client 929631 Service Location: 929631 COSMOPOLITAN CLUB COSMOPOLITAN CLUB P 0 BOX 651 MANAGER SALEM, MA 01970-0751 24 ENDICOTT STREET SALEM, MA 01970 Customer Signature: Technician Signature: Licenses/Certifications MA-36553o v Time I 5/31/13 12:21 PM Terms: DUE UPON RECEIPT Tim TiOut: 5/31/13 12:37 PM PO#: bob ward Nicholas Carbone Order # Service Description Quantity 2371373 COMMERCIAL PEST CONTROL 1 Service Comments Tech Comment: regular service for may INTERIOR-> BAR: inspected area no activity found at this time INTERIOR-> DISHWASHING: inspected area no activity found at this time INTERIOR-> FOOD STORAGE: inspected area no activity found at this time INTERIOR-> KITCHEN: inspected area no activity found at this time replaced monitors as needed INTERIOR-> RECEIVING: inspected area no activity found at this time INTERIOR-> RESTROOMS: inspected area no activity found at this time INTERIOR->Upstairs bar: inspected area no activity found at this time Material Summary EPA F Active Ingredient Finished Quantity Application MethoJ Applisetio Par- Material Applied Lot# AI Concentration Undiluted Quantity Application Equipment Sq/r. f� None Noted Severity Cre. - open Conditions Responsibility Lase [n.;pected No Conditions Added or Updated this Service. Severity Conditions Resolved This Visit Responsibility _ _a'r L pr a None Noted. With Without Total Device Exceptir,iu Pest Summary Quantity Device Summary Activity Activity Inspected Replaced Removed SkippzJ None Noted. RODENT BAIT STATION INTERIOR 0 1 1 0 0 0 -Totals 0 1 1 0 0 0 Additional pest findings may have been observed. Please see conditions and comments for more details. RECEIVE® JUN 112013 CITY OF SALEM BOARD OF HEALTH Printed:5)31/13 ' 0024 Endicott Street CHRISTOPHER COLUMBUS CLUB City of Salem FOOD SERVICE ESTABLISHMENT - FOOD SERVICE Inspection HACCP: ❑ Item Status Violation Critical Urgency Telephone: Violations Related to Good Retail Practices (Blue Items) 744-9533 Equipment and Utensils FAIL Non-Critical BLUE Owner: Comment:The microwave needs a thorough cleaning. ' COSMOPOLITAN CLUB The Glenco refrigerator needs a thorough cleaning. PIC: Ed Morgan! The floor in the upstairs kitchen needs a thorough cleaning. Inspector: The freezer compartment in the upstairs unit needs a visible,accurate thermometer. d David Greenbaum Physical Facility FAIL Non-Critical BLUE Date Inspected:Correct By: Comment:There are water stained ceiling tiles in the downstairs kitchen. Investigate the source of the leak and repair. Replace all 8/22/2008 stained tiles. Risk Level: Permit Number: BHP-2008-0155 Status: SIGNED OFF '#of Critical Violations: 0 Time IN: - - Time OUT: Urgency Description(s): BLUE: Violations Related to Good Retail Practices (Critical violations must be corrected immediately or within 10 days)(Non-critical violations must be corrected immediately or within 90 days) City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741.1800 GeoTMS®2008 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Aug 25,2008 ) Page I of2 Item Status Violation Critical Urgency Violations Related to Foodborne Illness Interventions' and Risk Factors(Require immediate corrective action) City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeoTMS®2008 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Aug 25,2008 ) Page 2 oft �d •t t,l'aw � t� - a 'wF n. �� f� y.. x + � -�1�-Y. W. '` n�stis�'.t- ahi?'. n, .s. *..t`"*j�r��.+. 0 _. I} 7s k - '.T r. !: " e F .F »; �'�� °Commonwealth of Ma sachus'�etts-��8' '� 'meq 3'�`�'r�rw '°4�� '�'frw'§•a�+'.u7 . ' - _ r.. A FA?y^1 x •'4 tT4 -+},.� ..2 `IA p .� t' `• ~ Board of Health 1Gmbedey Drlsooli 120 Washington Street,4th Floor --a Mayor, .. SALEM,MA "01970 Food/Retail Establishment Permit DATE PRINTED: 01/03/2008 ESTABLISHMENT NAME: CHRISTOPHER COLUMBUS CLUB File Number:BHF-2004-000119 P.O.Box 651 - - - Salem MA 01970 LOCATED AT: 0024 ENDICOTT STREET SALEM, MA 01970 Permit Type Permit No. Permit Issued Permit Expires Fee Restrictions/Notes FOOD SERVICE BHP-2008-0155 Jan 3,2008=_Dec:'31,2008 $25.00 ESTABLISHMENT Total Fees: $25.00 PERMIT EXPIRES December3l;2008 Board of Health This Permit is not transferable and must be reissued upon change of ownership orlocation.The permit;must be posted in eP rominent location in the Establishment. In accordance with the State Sanitary Code,beofre any revonations,.improvements,or equipment changes-are made,all -- plans for such must be submitted to and approved by the Salem Board of Health..: --- page3"of 37 CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH 120 WASHINGTON STREET,4"FLOOR TSL. (978) 741-1800 KIMBERLEY DRISCOLL FAX(978) 745-0343 MAYOR ISCOTTaSALEM.00M RECEIVED JOANNE SOOTT, NOV 2 g2007 HEALTH AGENT CITY OF SALEM BOARD OF HEALTH 2008 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT 45"33 NAME OF ESTABLISHMENT P2i S-& n 1,w s . r c , Z TEL# R 7. 8' ?JCL ADDRESS OF ESTABLISHMENT o2 ENDf" 77— S'T FAX# ^— MAILING ADDRESS(if different) EMAIL-Business': Website: OWNER'S NAME t) h�i1Nf/t�f ( /�t/J TEL# ADDRESS tg ) id .9rf7L 1r Ail /]— O I C70 STREET CITY STATE ZIP CERTIFIED FOOD MANAGER'S NAME(S) CERTIFICATE#(S) (Required in an establishment where potentially hazardous foodisprepared) EMERGENCY RESPONSE PERSON HOME TEL# 9-79 55-.2 19093 DAYS OF OPERATION 1 Monday Tuesda Wedn Ma Thursda Friday Saturday Sunda HOURS OF OPERATION Please write in time of day. For example 11 am-11 m TYPE OF ESTABLISHMENT FEE (check only) RETAIL STORE YES A0 less than 1000sq.ft. =$70 1000-10,000sq.ft. =$280 more than 10,000sq.ft. =$420 --------------------------------------------- - - ------------------------------.....----------------- -- RESTAURANT YES O less than 25 seats =$140 (Outdoor Stationary Food Cart$210) 25-99 seats =$280 more than 99 seats =$420 -------------------------------------------------------------------------------------- - - - - BED/BREAKFAST/ YES O $100 CHILDCARESERVICES-.... -------------------------------------------------- ------- -------------------- ADDITIONAL PERMITS MAKE (not just serve) ICE CREAM, YOGURT/SOFT SERVE YES NO $25 TOBACCO VENDOR YES $135 ALL NON-PROFIT(such as church kitchens) XE NO $25 *Please pay total with one check payable to the City of Salem. This Permit is not transferable and must be reissued upon change of ownership. The Permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code, before any renovations, improvements,or equipment changes are made,all plans for such must be submitted to and approved by the Salem Board of Health. Pursuan GL Chapter 62C,Section 49A,I,cerjify,under'(he pains and penalties of perjury that I,to my best knowledge and belief,have filed all state tax return and aid all st to equired nder'the law. °'' I ., & �1.." - ��.Z7 Q 7 Sig re Date Social Security or Federal Identification Number Revised 4/24/07 FOODAP2008.adm Checkq&Date e 5rr) $ a r 0024 Endicott Street CHRISTOPHER COLUMBUS CLUB City of Salem FOOD SERVICE ESTABLISHMENT - FOOD SERVICE Inspection HACCP: ❑ Item Status Violation Critical Urgency Telephone: Violations Related to Good Retail Practices (Blue Items) 744-9533 Equipment and Utensils FAIL Non-Critical BLUE Owner: Comment:The Glenco cooling unit needs a thorough cleaning of all shelves and the bottom. COSMOPOLITAN CLUB PIC: The mop found stored in the bucket. Clean mop and store upside down not touching any surface to air dry. Wendy Boulay The men's room needs a sign stating"Employees Must Wash Hands Before Returning To Work" Inspector: Physical Facility FAIL Non-Critical BLUE David Greenbaum Comment:There are some water stained/missing ceiling tiles in the kitchen. Investigate the source of the leak and repair. Replace Date Inspected:Correct By: all stained/missing ceiling tiles. 5/31/2007 Risk Level: There is water damage on the ceiling and walls of the beer storage room. Investagate the source of the leak and repair. Repaint the ceiling and walls. Permit Number: BHP-2007-0385 Status: SIGNED OFF #of Critical Violations: 0 Time IN: Time OUT: I Urgency Description(s): BLUE: Violations Related to Good Retail Practices (Critical violations must be corrected immediately or within 10 days)(Non-critical violations must be corrected immediately or within 90 days) City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeoTMS®2007 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. May 31,2007 ) Page I oft ?,s Item Status Violation Critical Urgency RED: Violations Related to Foodborne Illness Interventions and Risk Factors (Require immediate corrective action) City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741.1800 GeoTMSO 2007 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. May 31,2007 ) Page 2 oft - ��' "in �brt.%*,w "" �� *� hi<iM�`\eW� � by=,��* � f � F.t. n �f.• . *s 'Sq i .Commonwealth of Massachusetts ;; � I'�.,'.,x" ��4 =�t*r..�ha�e .„ City of Salem Board of Health IGmbefley Driscoll 120 Washington Street,4th Floor Mayor SALEM,MA 01970 Food/Retail Establishment Permit DATE PRINTED: 01/12/2007 ESTABLISHMENT NAME: CHRISTOPHER COLUMBUS CLUB File Number:BHF-2004-000119 P.O.Box 651 Salem MA 01970 LOCATED AT: 0024 ENDICOTT STREET SALEM, MA 01970 Permit Type Permit No. Permit Issued Permit Expires Fee Restrictions/Notes FOOD SERVICE BHP-2007-0385 Jan 12,2007 Dec 31,2007 $25.00 ESTABLISHMENT Total Fees: $25.00 PERMIT EXPIRES !December 31, 2007 Board of Health This Permit is not transferable and must be reissued upon change of ownership or location. The permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code, beofre any revonations, improvements,or equipment changes are made,all plans for such must be submitted to and approved by the Salem Board of Health. Page 1 of 1 1 CITY OF SALEM, MASSACHUSETTS • , BOARD OF HEALTH 120 WASHINGTON STREET,4TH FLOOR - SALEM, MA 01970 TEL. 978-741-1800 FAx 978-745-0343 Kimberley Driscoll WWWSALEM.COM Mayor JOANNE SCOTT, MPH, AS, CHO HEALTH AGENT 2007 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT NAME OF ESTABLISHMENT CSL ,��c c /�+ �( %_- [ TEL# ADDRESS OF ESTABLISHMENT Z7 FAX# MAILING ADDRESS (if different) ,�3 O-LI /'s— EMAIL 's—EMAIL--Business': Owner's: OWNER'S NAME TEL# `�'�� 7</�,/ �"3 G ADDRESS STREET CITY STATE ZIP CERTIFIED FOOD MANAGER'S NAME(S) CERTIFICATE#(S) (Required in an establishment where potentially hazardous food is prepared) EMERGENCY RESPONSE PERSON HOME TEL# OAYSOEOPERATION Monday Tuesday_ Wednesday_Thursday Friday Saturday ' Sunday HOURS Of OPERATION fPlease yfile In time of day. Por example Ilam-110m) TYPE OF ESTABLISHMENT FEE (check only) RETAIL STORE YES NO less than 1000sq.ft. =$ 50 1000-10,400sgft =$100 more than 10,000sq.ft. =$250 _ _ _..... ................_.---- -- - ---- ..--- -- -_--- ..-.....-------- -,s--- ...._...- - -... ...- - -- RESTAURANT YES NO less than 25 seats =$100 25-99 seats =$150 more than 99 seats =$200 BED/BREAKFA ...ST...---- YES ----NO---------- - ------- - - --.--- -.---- ------- -$..100.- ----- -.-_ --------- --------- *-------- - -- ..-..-... ... -- _.... ............... ...._. ....... ..... ......---------- ----- ------ - -----...----- -- ADDITIONAL PERMITS MAKE (not just serve) ICE CREAM. YOGURT, SOFT SERVE YES NO $5 TOBACCO VENDOR YES NO $50 ALL NON-PROFIT(such as church kitchens) YES NO $25 `Please pay total with one check payable to the City of Salem. This Permit is not transferable and must be reissued upon change of ownership. The Permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code, before any renovations, improvements, or equipment changes are made, all plans for such must be submitted to and approved by the Salem Board of Health. Pursuant to MGL Chapter 62C, Section 49A, I certify under the pains and penalties of perjury that I, to my best knowledge and belief, have filed all state tax returns and paid all state taxes required under the law. Signature n pate social Security or Federal Identification Number ------------------------------ ---------- --- ----------------------- — - - -------- ---- ----- ------- -- -- . _ Revised 11113106 FOOOAP2007.adm Check#&Date 0024 Endicott Street CHRISTOPHER COLUMBUS CLUB City of Salem FOOD SERVICE ESTABLISHMENT - FOOD SERVICE Inspection HACCP: ❑ Item Status Violation Critical Urgency Telephone: Violations Related to Good Retail Practices (Blue Items) _744-9533 Equipment and Utensils FAIL Non-Critical BLUE Owner: Comment:The Kenmore freezer needs a thorough cleaning and defrosting. COSMOPOLITAN CLUB PIC: The Glenco cooling unit needs thorough cleaning. I Physical Facility FAIL BLUE Inspector: I Comment:There is a missing light sheild in the kitchen. Replace the light sheild. David Greenbaum Replace the ceiling tiles that are out. Date Correct By: I17M)A4 gl6 The kitchen floor needs to be repainted by the next routine inspection. Risk Level: GENERAL COMMENTS: 695: Permit Number: BHP-2006-0329 Status: SIGNED OFF #of Critical Violations: 0 Time IN: Time OUT: Urgency Description(s): BLUE: Violations Related to Good Retail Practices (Critical violations must be corrected immediately or within 10 days)(Non-critical violations must be corrected immediately or within 90 days) City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeoTMS®2006 Des Ladders Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Jul 18,2006 ) Page ! of ' Item Status Violation Critical Urgency RED: Violations Related to Foodborne Illness Interventions and Risk Factors (Require immediate corrective action) City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeoTMS®2006 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Jul 18,2006 ) Page 2 oft City of o Salem .Massachusetts -ire Department 48 Lafayette Street David`W. Cody Salem, Massachusetts 01970-3695 Fire Prevention Chief Tel. 978-744-1235 Bureau 978-744-6990 Fax 978-745-4646 978-745-7777 dcody@salem.com Order#2005-2 Mr. Joseph Correnti Cosmopolitan Club of Salem Inc. 24 Ends Sttco�treet Salem,MA 01970 January 17,2006 Dear Mr. Correnti: As a result of the tragic nightclub fire in Warwick,Rhode Island,the Commonwealth of Massachusetts enacted Chapter 304 of the Acts of 2004,An Act Relative to Fire Safety in the Commonwealth. Section 5 of this new law added Massachusetts General Law chapter 148, section 26G1/2 which requires every building or portion thereof,of public assembly,with a capacity of 100 persons or more that is designed or used for occupancy as a nightclub,dancehall,discotheque,bar or for similar entertainment purposes to be equipped with an adequate system of automatic sprinklers. Upon review it has been determined that the above referenced establishment falls under this new law. You are hereby ORDERED to comply with the provisions of the statute in accordance with the following schedule: 1. Plans and specifications for an adequate sprinkler system as required by statute shall be submitted to this office with a copy to the building inspector no later than May 15,2006. 2. The sprinkler system must be completed no later than November 15, 2007. You are strongly urged to take appropriate action at this time in order to meet the compliance deadlines of the new law. Under provisions of M.G.L.c. 148,s. 26G1/2,you have the right to appeal this order to the Commonwealth's Automatic Sprinkler Appeals Board,P.O.Box 1025, State Road, Stow,MA 01775, within 45 days after service of this letter. If you have any questions please contact Salem Fire Prevention at(978)745-7777. So f d Chief Cc: File Building Licensing Health City of Salem, Massachusetts Fire Department �4 48 Lafayette Street David'W. Cody Salem, Massachusetts 01970-3695 Fire Prevention Chief Tel. 978-744-1235 Bureau 978-744-6990 Fax 978-745-4646 978-745-7777 dcody@salem.com Order 42005-2 Mr. William Comeau `Columbus Society of Salem,Inc. 94 Waslung-to—ft Square East Salem,MA 01970 January 17, 2006 Dear Mr. Comeau: As a result of the tragic nightclub fire in Warwick,Rhode Island,the Commonwealth of Massachusetts enacted Chapter 304 of the Acts of 2004,An Act Relative to Fire Safety in the Commonwealth. Section 5 of this new law added Massachusetts General Law chapter 148,section 26G1/2 which requires every building or portion thereof,of public assembly,with a capacity of 100 persons or more that is designed or used for occupancy as a nightclub,dancehall,discotheque,bar or for similar entertainment purposes to be equipped with an adequate system of automatic sprinklers. Upon review it has been determined that the above referenced establishment falls under this new law. You are hereby ORDERED to comply with the provisions of the statute in accordance with the following schedule: 1. Plans and specifications for an adequate sprinkler system as required by statute shall be submitted to this office with a copy to the building inspector no later than May 15,2006. 2. The sprinkler system must be completed no later than November 15,2007. You are strongly urged to take appropriate action at this time in order to meet the compliance deadlines of the new law. Under provisions of M.G.L. c. 148,s. 26G1/2,you have the right to appeal this order to the Commonwealth's Automatic Sprinkler Appeals Board,P.O.Box 1025, State Road,Stow,MA 01775, within 45 days after service of this letter. If you have any questions please contact Salem Fire Prevention at(978)745-7777. So Or eyed Chief Cc: File Building Licensing Health ka.ad� 4R'yA� �,v�u�� '.�T��T�� }+.rt�`aN.iti 4 k�"f�s3'�"` x,'x•,��Tit i e- ' e,��r S e�" '� Y�,. '�'' -�',�;,`�s i� ��: +ra.�e� Wim.. 9;.k( etiG�TN�hRSlikich 'ls:,. ara��..r-.rfi. ,� 'n. ,.'.�� w 1. .d,.w,r- •K4�,.t nrs .+^rr.; .a.......,. , ., Commonwealth of Massachusetts City of Salem , • ° Kimberley Driscoll Board of Health Mayor 120 Washington Street,4th Floor SALEM,MA 01970 Food/Retail Establishment Permit DATE PRINTED: 01/11/2006 WHO'S PLACE OF BUSINESS IS: CHRISTOPHER COLUMBUS CLUB File Number:BHF-2004-0119 P.O.Box 651 Salem MA 01970 LOCATED AT: 0024 ENDICOTT STREET SALEM, MA 01970 Permit Type Permit No. Permit Issued Permit Expires Fee Restrictions/Notes FOOD SERVICE BHP-2006-0329 Jan 11,2006 Dec 31,2006 $25.00 ESTABLISHMENT Total Fees: $25.00 PERMIT EXPIRES December 31, 2006 Board of Health This Permit is not transferable and must be reissued upon change of ownership or location.The permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code,beofre any revonations, improvements,or equipment changes are made,all plans for such must be submitted to and approved by the Salem Board of Health. Page 3 of 10 CITY OF SALEM9 MASSACHUSETTS BOARD OFHEALTH S 120 WASHINGTON STREET, 4TH FLOOR SALEM, MA 01970 TEL. 978-741-1800 STANLEY J. USOVICZ, JR. FAx 978-745-0343 MAYOR W W W.SALEM.COM JOANNE SCOTT, MPH, RS, CHO HEALTH AGENT 2006 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT NAME OF ESTABLISHMENT NAIeg, �,/U-had u.s /v TEL# l 79 7yY-" 2 3? ADDRESS OF ESTABLISHMENT 2 C AJ 10 t U S% MAILING ADDRESS (if different) S/1s19 OWNER'S NAME S/} YIP q-4 IlQye_ TEL# ADDRESS CITY STATE ZIP CERTIFIED FOOD MANAGER'S NAME(S) CERTIFICATE#(s) (required in an establishment where potentially hazardous food is prepared.) EMERGENCY RESPONSE PERSON HOME TEL# HOURS OF OPERATION: Mon.—Tue.—Wed.—Thu.—Fri. Sat. Sun. TYPE OF ESTABLISHMENT FEE (check only) RETAIL STORE YES O less than 1000sq.ft. =$ 50 0,000 =$100 more t V/ more than 10,00000sq.ft. =$250 RESTAURANT YES O less than 25 seats $100 25-99 seats =$150 more than 99 seats =$200 ---- - ---- - ---- - ------ BE D BR E AK F AST -----BED/BREAKFAST YES $100 - ----------------------------------------------------------------------------------------------------------------.....------- ADDITIONAL PERMITS MAKE (not just serve) ICE CREAM, YOGURT, SOFT SERVE YES $5 TOBACCO VENDOR YES $50 ALL NON-PROFIT(such as church kitchens) YESN 25- *Please pay total with one check payable to the City of Salem . This Permit is not transferable and must be reissued upon change of ownership. The Permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code, before any renovations, improvements, or equipment changes are made, all plans for such must be submitted to and approved by the Salem Board of Health. Pur ant to MGL Chapter 62C, Sectio 9A, I certify under the pains and penalties of perjury that I, to my best k owl dge and belie , ve filed all a tax returns and paid all state taxes required under the law. cl I natu a Date Social Security or Federal Identification Number -------------------------- ......................................................... ------ -------------------------- -------------------------------------------------- Revised 11/03/05 FOODAP2.adm Check##,,&//Datebi,5 14:414 (�L /✓-e 0/4 flue- �S f DAWuii�- /+i/ DPA, by d�eArF9/s vw'!*W'-fK"vp>'gw'Mr'. . -• ,.Tfi+4'n+'x'+?<�.nww- ' '4.fi Ld' ,�, °� �-5. '"M r"",5'^s ,kn- ♦ Y :N .$" w t bili.it R 1 e� X51 TS1^'Wf�i��Y . �x f fl hk 4 h i s i R R �r 66ke SM SY�X n],., a'ro-ee. -�,d-.Y «v^n1a: +.va+.r:✓v .$..'X ev �»+S .. '-+r.Y W � s_ 4r..'�k�#«-i}tt a s Y} ✓n F ..ecaY`1"?.:�.4::.r -. ,... .�.4ne a-.-+.. CITY,.OF SAL.FM�#jAASSACHIUSEd.TTS BOARDZ3FL HEALTH - 120 WASHINGTON STREET, 4TH FLOOR - SALEM, MA 01970 TEL. 978-741-1800 FAX 978-74S-0343 STANLEY J. USOVICZ, JR. JOANNE SCOTT, MPH, RS, CHO MAYOR HEALTH AGENT COMMONWEALTH OF MASSACHUSETTS PERMIT TO OPERATE A FOOD ESTABLISHMENT In accordance with regulations promulgated under authority of Chapter 94, Section 305A and Chapter III, Section 5 of the General Laws, to operate a Food Establishment in the City of Salem is hereby granted to: Type of Establishment: CLUB Name of Establishment: Cosmopolitan Club of Salem Inc. Address of Establishment: 24 Endicott Street Owner's Name: Cosmopolitan Club of Salem Restrictions: Application Date: 12/2/2004 Permit for Food Establishment 123-05 Frozen Desserts/Ice Cream Permit for the Sale of Tobacco Products These Permits Expire December 31, 2005 This permit is not transferable and must be reissued upon change of ownership or location. The permit must be posted in a prominent location in the Establishment, In accordance with the State Sanitary Code, before any renovations, improvements, or equipment changes are made, all plans for such must be submitted to and approved by the Salem Board of Health. HEALTH AGENT CITY OF SALEM, MASSACHUSETTS BOARO OF4EALTH r, 120 WASHINGTON STREET, 4TH FLOOR sc SALEM, MA 01970 TEL. 978-741-1800 P*' FAX 978-745-0343 STANLEY J. USOVICZ, JR. JOANNE SCOTT, MPH, RS, CHO .MAYOR HEALTH AGENT 2005 APPLICATION FOR PERMIT TO OPERATE A/FOOD ESTABLISHMENT NAME OF ESTABLISHMENT Cc-5V'I,)Q rasC ✓� l IJJTEL# q?S 7q({ ADDRESS OF ESTABLISHMENT QZj t=VIA 'c eA4 MAILING ADDRESS (if different) 7?- OWNER'S NAME ::VnC�,q g L PJ S TEL# ADDRESSr 6� CITY STATE /1') ✓-)- ZIP r71O'17b CERTIFIED FOOD MANAGER S NAME(S) CERTIFICATE#(s) (required in an establishment where potentially hazardous food is prepared.) EMERGENCY RESPONSE PERSON tti omglS L-eA,,S HOME TEL HOURS OF OPERATION: Mon.�TueA'\Wed. ��ya hu. V`aFri. \ \Sat. \>- Sun. \a TYPE OF ESTABLISHMENT FEE check only RETAIL STORE YES O less than 1000sq.ft. =$ 50 1000-10,000sq.ft. =$100 more than 10,000sq.ft. =$250 RESTAURANT YES ! 3'G� less than 25 seats =$100 j a 25-99 seats =$150 //� more than 99 seats =$200 BED/BREAKFAST YES /NO/ $100 ADDITIONAL PERMITS l/ MAKE (not just serve) ICE CREAM, YOGURT, SOFT SERVE YES $5 TOBACCO VENDOR YES INO $50 ALL N0,1V-PROFIT(such as church .kitchens) ES NO $25 Please pay total with one check payable to the City of Salem This Permit is not transferable and must be reissued upon change of ownership. The Permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code, before any renovations, improvements, or equipment changes are made, all plans for such must be submitted to and approved by the Salem Board of Health. Pursuant to MGL Chapter 62C, Section 49A, I certify under the pains and penalties of perjury that I, to my best knowledge and belief, have file state tax returns and paid all state taxes required under the law. Signatur Dat Social Security or Federal Identification Number Revised 11/03/03 FOODAP2.adm 4& Dat€,-S 27/ %l// 'I� 0024 Endicott Street CHRISTOPHER COLUMBUS CLUB City of Salem FOOD SERVICE ESTABLISHMENT - FOOD SERVICE Inspection HACCP: ❑ Telephone: Item Status Violation Critical Urgency Nature of problem or correction 744-9533 Non-compliance with: Not Done - Owner: ^` ,; - Anti-Choking PASS ❑ COSMOPOLITAN CLUB Tobacco PASS ❑ PIC —_ FOOD PROTECTION MANAGEMENT Not Done Nicole Lewis Inspector: PIC Assigned/Knowledgeable/Duties PASS ❑d RED ' ,, _ � • �' David Greenbaum EMPLOYEE HEALTH Not Done Date Inspected:I Correct By: '- Reporting of Diseases by Food Employee and PIC PASSd❑ RED 9/21/2005 ; - Personnel with Infections Restricted/Excluded PASS ❑J RED Risk Level: FOOD FROM APPROVED SOURCE Not Done Permit Number: Food and Water from Approved Source PASS �/❑ RED BHP-2005-0195 Receiving/Condition PASS ❑d RED Status: Tags/Records/Accuracy of Ingredient Statements PASS ❑d RED SIGNED OFF - Conformance with Approved Procedures/HACCP PASS RED #of Critical Violations.- „ Plans PROTECTION FROM CONTAMINATION Not Done Time IN: .!Time OUT: m. Separation/Segregation/Protection PASS ❑d RED Notes: Food Contact Surfaces Cleaning and Sanitizing PASS ❑d RED 311: - a Proper Adequate Handwashing PASSJ❑ RED d Urgency Description(s): Good Hygienic Practices PASS RED BLUE: Violations Related to Good Prevention of Contamination from Hands PASS RED Retail Practices (Critical Handwash Facilities PASS ❑D RED violations must be corrected immediately or within 10 days)(Non-critical violations .; GeOTMS®2005 Des Lauriers Municipal Solutions, Inc. ( Rev. Sep 21,2005 ) Page 1 of 0024 Endicott Street CHRISTOPHER COLUMBUS CLUB must be corrected Immediately PROTECTION FROM CHEMICALS Not Done or Within 90 days); - Approved Food or Color Additives PASSd❑ RED RED Violations Related to - toxic chemicals PASS ❑D RED Foodborne Inness Interventions TIME/TEMPERATURE CONTROLS(Potentially Haz Not Done and Risk Factors (Require cooking Temperatures N/A RED immediate corrective action) ' Reheating N/A ❑Q RED Cooling N/A RED Hot and Cold Holding PASS RED Time As a Public Health Control PASS RED REQUIREMENTS FOR HIGHLY SUSCEPTIBLE PO Not Done Food and Food Preparation for HSP N/A 0 RED CONSUMER ADVISORY Not Done Posting of Consumer Advisories N/A RED Violations Related to Good Retail Practices (Blue Not Done Management and Personnel PASS ❑ BLUE Food and Food Protection PASS ❑ BLUE Equipment and Utensils FAIL Non-Critical ❑ BLUE Provide visible,accurate thermometers in the Kenmore refrigerator/freezer in upstairs kitchen. Same unit needs a thorough cleaning. Water, Plumbing and Waste PASS ❑ BLUE Physical Facility PASS ❑ BLUE Poisonous or Toxic Materials PASS ❑ BLUE Special Requirements PASS ❑ BLUE Other-See Notes PASS ❑ BLUE GeoTMS®2005 Des Lauriers Municipal Solutions, Inc. ( Rev. Sep 21,2005 ) Paee 2 of 0024 Endicott Street CHRISTOPHER COLUMBUS CLUB GeoTMS®2005 Des Lauriers Municipal Solutions, Inc. ( Rev. Sep 21,2005 ) Poke 3 of CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH .4 120 WASHINGTON STREET, 4TH FLOOR SALEM, MA 01970 TEL. 978-741-1800 FAX 978-745.0343 STANLEY J. USOVICZ, JR. JOANNE SCOTT, MPH, RS, CHO MAYOR HEALTH AGENT COMMONWEALTH OF MASSACHUSETTS PERMIT TO OPERATE A FOOD ESTABLISHMENT In accordance with regulations promulgated under authority of Chapter 94, Section 305A and Chapter III, Section 5 of the General Laws, to operate a Food Establishment in the City of Salem is hereby granted to: Type of Establishment: RETAIL FOOD Name of Establishment: Cosmopolitan Club of Salem Inc. Address of Establishment: 24 Endicott Street Owner's Name: Cosmopolitan Club of Salem Restrictions: Application Date: 12/1/2003 Permit for Food Establishment 61-04 Frozen Desserts/Ice Cream Permit for the Sale of Tobacco Products These Permits Expire December 31, 2004 This permit is not transferable and must be reissued upon change of ownership or location. The permit must be posted in a prominent location in the Establishment, In accordance with the State Sanitary Code, before any renovations, improvements, or equipment changes are made, all plans for such must be submitted to and approved by the Salem Board of Health. HEALTH ENT tv ' CITY OF SALEM, MASSACHUSETTST BOARD OF HEALTH (, y ' s 120 WASHINGTON STREET, 4TH FLOOR NOV 2 1 2003 SALEM, MA 01970 TEL. 978-741-1800 CITY n - SALEM FAX 978-745-0343 BOARD F HEALTH STANLEY USOVICZ, JR. JOANNE SCOTT, MPH, RS, CHO MAYOR HEALTH AGENT 2004 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT NAME OF ESTABLISHMENT ub iEL# g 7 7YY S}�C> 3 ADDRESS OF ESTABLISHMENT eZ �i) n i I�0 577—) ..��// MAILING ADDRESS (if different) �� f_� 0X 65-1 S��Pi✓! ////4 OWNER'S NAME ' TEL# ADDRESS CITY STATE ZIP CERTIFIED FOOD MANAGER'S NAME(S) CERTIFICATE#(s) (required in an establishment where potentially hazardous food is prepared.) EMERGENCY RESPONSE PERSON HOME TEL# HOURS OF OPERATION: Mon.—Tue.—Wed--Thu.—Fri.—Sat.—Sun.— TYPE on. Tue. Wed. Thu. Fri. Sat. Sun.TYPE OF ESTABLISHMENT FEE check only RETAIL STORE YES N less than 1000sq.ft. =$ 50 1000-10,000sq.ft. =$100 more than 10,000sq.ft. =$250 RESTAURANT YES N0= less than 25 seats =$100 25-99 seats =$150 more than 99 seats =$200 BED/BREAKFAST YES NQ $100 ADDITIONAL PERMITS MAKE (not just serve) ICE CREAM, YOGURT, SOFT SERVE YES $5 TOBACCO VENDORY $50 ALL NON-PROFIT(such as church kitchens) &/-0N0 $25 Please pay total with one check payable to the City of Salem This Permit is not transferable and must be reissued upon change of ownership. The Permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code, before any renovations, improvements, or equipment a b changes are made, all plans for such must be submitted to and approved y the Salem Board of Health. Pur nt to MGL Chapter 62C, Section 49A, I certify under the pains and penalties of perjury that I, to my b st nowledg anelief, have filed all state tax returns and paid all state taxes required under the law. /-/ _23 0 Y 2 - o - nature Date Social Security or Federal Identification Number ------------------------------------------------------------------------------------------------------------------------------------- Revised 11/03/03 FOODAP2.adm Check#&Date_S O V7 //—/bl 03 X •a3� Massachusetts Department of Public Health Salem Board of Health 120 Washington Street,4`" Floor Division of Food and Drugs Salem, MA 01970-3523 FOOD ESTABLISHMENT INSPECTION REPORT Tel. (978) 741-1800 Fax(978) 745-0343 Name Da T e of Operation(s) T e.of In ection $ DC C 6W1 27 Food Service �]' outias Address O Risk ❑ Retail ElRe-inspection A 4VTelephone Level El Residential Kitchen Previous Inspection Z-- ❑ Mobile Date: Owner HACCP Y/N ❑ Temporary ❑ Pre-operation $A El Caterer El Suspect Illness Person in Charge(PIC) Time ❑ Bed&Breakfast ❑ General Complaint Inspector 01k Out: Permit No. ElOther Each violation checked requires an explanation on the narrative page(s) and a citation of specific provision(s)violated. Non-compliance with: Violations Related to Foodborne Illness Interventions and Risk Factors Anti-Choking Tobacco Violations marked may pose an imminent health hazard and require immediate corrective 590.009(E) ❑ 590.009(F) ❑ action as determined by the Board of Health. FOOD PROTECTION MANAGEMENT El 12. Prevention of Contamination from Hands ❑ 1. PIC Assigned/Knowledgeable/Duties EMPLOYEE HEALTH ❑ 13. Handwash Facilities PROTECTION FROM CHEMICALS .- ❑ 2. Reporting of Diseases by Food Employee and PIC El 14. Approved Food or Color Additives El3. Personnel with Infections Restricted/Excluded ❑ 15.Toxic Chemicals FOOD FROM APPROVED SOURCE ❑ 4. Food and Water from Approved Source TIME/TEMPERATURE CONTROLS(Potentially Hazardous Foods) ❑ 5. Receiving/Condition ❑ 16. Cooking Temperatures ❑ 6. Tags/Records/Accuracy of Ingredient Statements ❑ 17. Reheating ❑ 7. Conformance with Approved Procedures/HACCP Plans ❑ 18. Cooling PROTECTION FROM CONTAMINATION "-"'. ❑ 19. Hot and Cold Holding ❑ 8. Separation/Segregation/Protection ❑ 20.Time As a Public Health Control ❑ 9. Food Contact Surfaces Cleaning and Sanitizing REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) El21. Food and Food Preparation for HSP El 10. Proper Adequate Handwashing ❑ 11. Good Hygienic Practices CONSUMER ADVISORY, ❑22. Posting of Consumer Advisories Violations Related to Good Retail Practices Number of Violated Provisions Related Critical (C)violations marked must be corrected To Foodborne Illnesses Interventions Q immediately or within 10 days as determined by the Board and Risk Factors(Items 1-22): of Health. Non-critical (N) violations must be corrected Official Order for Correction: Based on an inspection immediately or within 90 days as determined by the Board today, the items checked indicate violations of 105 CMR of Health. 590.000/federal Food Code. This report, when signed below 23. Management and Personnel (FC-2)(590.003) by a Board of Health member or its agent constitutes an 24!Food and Food Protection (FC-3)(590.004) order of the Board of Health. Failure to correct violations .00s) cited in this report may result in suspension or revocation of K Equipment and Utensils (FC-4)(590 the food establishment permit and cessation of food 2 . Water, Plumbing and Waste (Fc-5)(590.006) establishment operations. If aggrieved by this order, you 27. Physical Facility (FC-6)(590.007) have a right to a hearing. Your request must be in writing 28. Poisonous or Toxic Materials (FC-7)(510.008) and submitted to the Board of Health at the above address 29. Special Requirements (590.009) within 10 days of receipt of this order. 30. Other DATE OF RE-INSPECTION: S'59010sp clFom 14.0 Inspector's Signature: rint: PIC's Signature: I P l.Pl� Print: 0 A a IZ ekFh Pagel of'vPages Violations Related to Foodborne Illness Interventions and Risk Factors(items 1-22) PROTECTION FROM CONTAMINATION FOOD PROTECTION MANAGEMENT 8 Cross-contamination :1 1 590.003(A) Assignment ofResponslbihty" 3-302.11(A)(1) Raw Animal I'cxxtsSeptn'aieditom j 590.003(13) Demonstration of Knowledge* Cooked and RIF Foods" 2-103.t 1�-Verson in charge-duties Contamination from Raw ingredients 3-302.11(A)(2) Raw Animal Foods Separated from Each EMPLOYEE HEALTH Other* 2 590.003(7) Responsibility of the person in charge to Contamination from the Environment require repotting by food employees and 330211(A) FoodPlotectton* applicants* 3-302.15 WashinL Faits and Ver etablds 590.003(F) Responsibility Of A Food Employee Or An 3-304.11 Food Contact with Equipment and Applicant To Report To The Person In Utensils* -2lin e" Contamination from the Consumer 590.003(73) Re orcin -b Person in Char e* 3-306.14(A)(B) Returned Food and Reservice of Food* 3 1 590-003(D) 1 Exclusions and Restrictions* Disposition of Adulterated or Contaminated 590.003(E) Removal of Exclusions and Restrictions Food 3-701.11 Discarding or Reconditioning Unsafe FOOD FROM APPROVED SOURCE Foot]* 4 Food and Water From Regulated Sources 9 Food Contact Surfaces 590.004{A-B} CompliancewithFoodLaw* _ 4-501-111 Manual Warewashing-[lotWater 3-201.12 Food in a Hermetically Sealed Container* Sanitisation Tem.g"am"es* 3-201.13 Fluid Milk and Milk Products'` 4-501-112 Mechanical Warewashing Hot Water 3-202.13 Shell E aO Sanitization Temperatures* 3-202.14 E e and Milk&gleets.Pasteurized"` 4-501.114 Chemical Sanitization-temp.,p13, 3-202.16 Ice Made Frain Potable Drinking Water* concentration and hardness. 5-101.11 Drinking Water from an Approved roved System'" d-b0t.'11(A) UteEqunsils Foots Contact Surfaces and 590.006(0} Bottled Drinkin;Water" Utensils Clean* 590.006(13) Water Meets Standards in 310 CMR 220" 4-60111 Cleaning Frequency of Equipment Faxl- Contact Surfaces mrd Utensils* Shellfish and Fish From an Approved Source 4-70211 Frequency or Sanitization of Utensils and :3-201.14 Fish and Recreational ly Caught Molluscan Food Contact Surfaces of E-ui nett* Shellfish* 4-703.1 f Methods of Sanitizamon -Hot Water and 3-201.15 Molluscan Shellfish from NSSP Listed Chemical- Sources), 10 Proper,Adequate Handwashing Game and Wild Mushrooms Approved by 2-301.11 Clean Condition--Hands and Arms" Re ulato Authorit 3-202.15 Shelistock Identification Present' 2-301-12 Cleaning Procedure* 590.004(0) Wild Mushrooms" 2-301.14 When to Wash" 3-201.17 Game Animals" 1.1 Goad Hygienic Practices $ Receiving/Condition 2-401.11 Latina, Drinkin or Using Tobacco- 3-202.11 PHFs Received at Pro ter Tem g"am"es* 2401.12 'Discharges Frout the Eyes.Vose and 3-20215 Package Lttegrity* Month* 3-101.11 Food Safe and Unadultetxtetf* 3-301.12 Preva.nting Contamination When Tastin,* TagstRecords:Sheilstock 12 Prevention of Contamination from Hands 3-202.13 Shellstock Identification* 590904(E) Preventing Contamination from 3-203.12 Shellstock Identification Maintained* Ym lovees* Tags/Records: Fish Products 13 Handwash Facilities 3-002.!7. Parasite Destmerion* Conveniently Located and Accessible 3-402.12 Records.Creation and Retention" 5-203.11 Numbers and Ca -cities` 590.00447) Labeling ofingradients* S-204.11 Location and Placement" 1 Conformance with Approved Procedures 5-205.11 Accessibility,O>eration and Mainteumtca lHACCP Plans Supplied with Soap and Hand Drying 3-502.1.1 Specialized Processing Methods* Devices 3-502.12 Reduced oxy-n ackaging,criteria" fi-361.11 HandwashingCleanser.Availability 8-103.12 Conformance with Approved Procedtael,* 6-301.12 Hand Drying=Provision `"Denote,critical item in Inc federal 1999 Food(ode or 105 CMR 59(1600. CITY OF SALEM BOARD OF HEALTH Establishment Name:C6sr+O,o#dtg-4,t ru,.a ar 3mc&m Date: :r10-71w Page: ; 2 of 2 Item Code C Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference R—Red Item Verified PLEASE PRINT CLEARLY 2.45- tr F//+i ar 2450 /97 of S `-erK_ FAcw a-96 v15r C rs o . A oY crK Pt4eft 044_Cjc.1as ntL Z7 d/Sa RrrANAIVA C99.0.f92 V-fC4Q. Nve-T rrG,ftr JbLq'e.G& C)'f Z,4&w Av- tA Ai NK L� 9A ar c j4 t✓rat—_ L � ArkG co R+t; < r rnAi u rf .mikeet'�t 15 w cs iC. 4/1 O a vrs t ee_v4EA &7 d;- F 13 Aa _ � K ti(Afio t Ka�i Discussion With Person in Charge: Corrective Action Required: ❑ No ❑ Yes I have read this report, have had the opportunity to ask questions and agree to correct all ❑ Voluntary Compliance ❑ Employee Restriction/ violations before the next inspection, to observe all conditions as described, and to Exclusion P ❑ Re-inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal Food Code. I understand that noncompliance may result in daily fines ofatCnty-five do la o/ruspension/revocationof ❑ Embargo ❑ Emergency Closure your food permit. � �� ❑ Voluntary Disposal ❑ Other: 7 '1 3-503.14(() PHFs Received at Temperatures Violations Related to Foodborne fitness Interventions and Risk According to Law Cooled to Factors(items 1-22) (Cont.) 1 4PF1451F Within 4Hours. * PROTECTION FROM CHEMICALS 3-501.15 Conlin,Methods for PHFs -- Food 14 PHF Hot and Cold Holding 14 Food or Color Additives "- 3-501.16(B) Cold PFII� Maintained at or below 3-202.12 Additive.`...- 590.t104(F) 4(_`145°F' 3-302.14 Protection from Unar roved Additives'15 Poisonous or Toxic Substances Her P"t_501,16{A) PHFs Maintained at or above k 7-101.11 Identifying,informatron-Original 3-SOLIIi A' -> Containers* ( ) Roasts Field at or above 130'I. 7-1.02.11 Common Name-Workim*Containers* 20 Time as a Public Health Control 7-201.1 I Separation-Stogy nee"` 3-501.19 Time as a Public Health Centro'.* 7-202.11 Restriction-Presence and Use" 590.0)04(H) Variance Requirement 7-202.12 Ccaritions of Use* 7-203.11 Toxic Containers-Prohibitions* REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(NSP) 7-204.17. Sanmzers,Criteria Chemicals,* 7-1-04.12 Chemicals for W rshrn Produce,Criteria* 21 3-80'1.11(A) Unpasteurized Pre-packaged Juices and Beverages with R'anung labels* 7-204.14 Dr'in Aeats,Criteria" 3-801_17($) Use of PasteurizedEsans 7-205.1.4 incidental Food Contact.Lubricants* 7-206.11 Restricted Use Pesticides.Criteria* 3-801.11{D) Raw or Partially s NotCookS Animal Food and Raw Seed Sprouts Not Served. .r 7-206.12 Rodent Bait Stations* 3$Oi.l l(C) Uno erred Poai Parka�e Not Re-served, " 7-206.13 Trucking Powders,Pest Control and Monitorrna* CONSUMER ADVISORY TIMEfTEMPERATURE CONTROLS 22 3�03.I1 Consumer Advisory Posted for Consumption of Animal Foods That are Raw. Undercooked or 16 Proper Cooking Temperatures for PHFs Not Otherwise Processed to Eliminate 3-401.1 lA(i)(2) Fggs- 1.55"F t5 Sec. Pathogens.' E gqs-Immediate Service 145°1715sec* .13 Pasteurized Eggs Substitute for Raw Shell 3-401.11(A)(2) Comminuted Fish,Meals &Came 3-302Eggs* Animals-155°F 15 sec. * 3-401.11(13)(1)(2) Pork and Beef Roast-130°F 121 min* SPECIAL REQUIREMENTS 3-401.11(A)(2) Ratites,InjectedMeats-155°F 15 590.009(A)-(D) Violations of Section 540.009(A)-(D)in sea * catering, mobile food, temporary and 3-401.11(A)(3) Poultry,Wild Game, Stuffed PHFs, residential kitchen operations should be Stuffing Containing Fish,Meat, debited under the appropriate sections Point 'or Ratites-165 F IS sec. * above if related to foodborne illness 3-401.11(C)(3) Whole-muscle, Intact Beef Steaks interventions and risk factors. Other 145°F* 590.009 violations relating to good retail 3-401.12 Raw Animal Foods Cooked in a practices should be debited under 7(29- Mierowave 165°F* Special Requirements. 3401_l1(A)(1)(b) All Other PHFs- 1,45°F 15 sec. I7 Reheating for Hot Holding wIOLATlONS REtATEO TO GOOD RETAIL PRACT/CES 3403.I1(A)&(D) PRFs 165'F 15 sec. * (Items 23-30) 3403.11(B) Microwave 165°F 2 Minute Standing Critical and non-(ritical violations, which do not relate to fixe Time* foodborne illness interventions and risk factors listed above, can be 3-403.11(C) Commercially Processed RTE Fail- ,found in the f)l1ol,ing sections of the Pood Code and 10.5 CMR 140°F" .590.000. 3-403.11(F) Retraining Unsliced Poitiers of Beef Item Good Retail practices FC 580.000 - - - Roast* 23. Management and Personnel FC--2 .003 18 Proper Cooling of PHFs 24. Food and Food Protection _ __ FC-3 .004 20. __ �pmenr and Utensils FC 4_ .005__ 3-501.14(A) Cool Cooked PHFs from 140°F to 26. Water,PWmbin and Waste FC 5 .066 ---------- 70°F Within 2 Flours and From 70°F g7. Ph slcai Faci(i FC-6 .007 _ to 41.°F/45°F Within 4 Hours.* 26. Poisonous or Toxic Materials _ FC-7 .008 3-`01.'14(B) Cooling PHFs Made:From Ambient 29. S ecial Re uirements - .009 Temperature Ingredients to 41`F/45°F 31- Other Within 4 FIours" *Denotes oitu ai item in the federal 1999 Food Code or 105 CMR 590000. u CITY OF SALEM, MASSACHUSETTS ' BOARD OF HEALTH 120 WASHINGTON STREET, 4TH FLOOR SALEM, MA 01970 TEL. 978-741-1800 FAX 978-745-0343 STANLEY LISOVICZ, JR. JOANNE SCOTT, MPH, RS, CHO MAYOR HEALTH AGENT COMMONWEALTH OF MASSACHUSETTS PERMIT TO OPERATE A FOOD ESTABLISHMENT In accordance with regulations promulgated under authority of Chapter 94, Section 305A and Chapter III , Section 5 of the General Laws, to operate a Food Establishment in the City of Salem is hereby granted to: Owner' s Name : Cosmopolitan Club of Salem Name of Establishment : Cosmopolitan Club of Salem, Inc . Address of Establishment : 24 Endicott Street Type of Establishment : RETAIL FOOD Application Date : 12/24/2002 Restrictions: Permit for Food Establishment 154-03 Frozen Desserts/Ice Cream Permit for the Sale of Tobacco Products These Permits Expire December 31, 2003 This permit is not transferable and must be reissued upon change of ownership or location. . The permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code, before any renovations, improvements, or equipment changes are made, all plans for such must be submitted to and approved by the Salem Board of Health. HEALTH AGENT - ."':y ~ `. t ;. ; q.a , r.ti _.y.. •e .. 'Gk'�'yyrr afi'��yy.`i�,`. {�i � t:{nc r ..�,'. .,'-t r .t;, .: 01& CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH 120 WASHINGTON STREET, 4TH FLOOR SALEM, MA 01970 TEL, 978-741.1800 FAX 978-745-0343 STANLEY USOVICZ, JR, JOANNE SCOTT, MPH, RS, CHO MAYOR HEALTH AGENT 2403 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT NAME OF ESTABLISHMENT lei NAME Jio Ie:^�_TEL# `f7 7 1-q�3� ADDRESS OF ESTABLISHMENT Fvy 2(o S-Je+', MAILING ADDRESS if different OWNER'S NAME_ LWIv lJ !Ilam f IIID ��e TEL# IJ � ADDRESS _.� goGII ley- S CITY ��c" STATE V4 A ZIP (9 19 SIJ CERTIFIED FOOD MANAGER'S NAME(S) CERTIFICATE#(s) (required in an establishment where potentially hazardous food is prepared.) EMERGENCY RESPONSE PERSON komcg E be , C HOME TEL# US 11 r-371 HOURS OF OPERATION: Mon.0 Tue,0 Wed.H Thu. 1-1 Fri, \'-t Sat. Ik I „Sun, TYPE OF ESTABLISHMENT FEE check only RETAIL STORE YES NO less than 1000sq.ft. =$ 50 1000-10,000sq.ft. =$100 more than 10,000sq.ft. =$250 RESTAURANT YES NO less than 25 seats =$100 25-99 seats =$150 more than 99 seats =$200 BED/BREAKFAST YES NO $100 ADDITIONAL PERMITS MAKE ICE CREAM, YOGURT, SOFT SERVE YES NO $5 TOBACCO VENDOR =5 NO $50 ALL IVv^h-P4JFiT(such as chu:ch. kitchen.V No S cv a 3 $25 Please pay total with one check payable to the City of Salem This Permit is not transferable and must be reissued upon change of ownership. The Permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code, before any renovations, improvements, or equipment changes are made,all pians for such must be submitted to and approved by the Salem Board of Health. Pursuant to MGL Chapter 62C, Section 49A, I certify under the pains and penalties of perjury that I, to my best knowledge and belief, have filed all state tax returns and paid all state taxes required under the law. Signature —Date ,Social Security or Federal Identification Number Revised 11/25/02 FOODAP2.adm C&Ick#&Date "' —0 Pss a� c • F : w • � 20 WASHIflGTO STRk�ESET.e4TH�F 00 $ a - s" '" LEM4 F!',,��O' 1 97 - bZ yy ' S A LEY 1�50VICZ'RJ R:'' � a axl {ai�awe ' " r, )ANN COTT MP-,N RSe CIi O�� F'�is " HEAL�W"AGEN�T I ` � �� r accordance w� egu at1 ns : r mu ate ' oder ut`Yi�orty oft Chapter . e t2 ii A OSA �d 'ha to KI; Se�on'�5of�re�Gene `a�l�aws to operatel '��ti, a ob swab �s`hmen ':n e :ity o "a�'�lem ' s .he ;eby �granted toy � �h, �, ' �' Nae stab s en CosmoDO F 'ocl s me oen esseYt �c _ se _m r �:> i o •; a a� ,e o ac o o-u;t: �r -� 'his , a of raps er e _ - s ' eisued up. c an e o 1 owaer�s ip r o�cataan. he ,p'ermit 'mus � e > osted ar>< a p o aent 1'oc�a�tion �� tithe Es abl shment � � ,� .t��y 3 �'"' ''+�TIn-,accordance with'Lthe '. %tate ASaaitary bode, before any zenouations � � rovements; or aqui ant chaages are made, a7:�1� lans .for such*must= be �f��mi�te'd oto and pproved" h ft the'�x`Sa1em o�ai"d of ea th. a �'.� a 4 � r $,�, S^r d fa+ ;l ;; Jr ,x A 40 CITY OF SALEM, MASSACHUSETTS '„� BOARD OF HEALTH �' 724 WASHINGTON STREET, 4TH FLOOR - , n'r Le"rt' {�. SALEM, MA 01970 TEL. 978-741-1800 ttif`•71 FAX 978-745-0843 P 9 p o f STANLEY USOVICZ, JR. JOANNE SCOTT, MPH, RS, CHO V L+ 1 MAYOR HEALTH AGENT Cl H�°,i ,,C PT, 2002 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT NAME OF ESTABLISHMENT Cosmopolitan Club of Salem. Inc.TEL# (978) 744-9533 ADDRESS OF ESTABLISHMENT 2.4 Endicott Street Salem, Ma, 01970 MAILING ADDRESS (if different) PO Box 651 Salem, Ma. 01970 Managers QMW.DNAME "' Roberc"T B11bano- -- TEL# (9781 744-6653 ADDRESS1719 Nbaler'S Lane CITY Salem STATE Ma- ZIP 01970 _ CERTIFIED FOOD MANAGER'S NAME(S) CERTIFICATE#(s) (required in an establishment where potentially hazardous food is prepared.) EMERGENCY RESPONSE PERSON Robert T Rnhano HOME TEL# (978) 744-6653 DAYS If HOURS OF OPERATION: Mon.- Tue.-Wed.-Thu.-FO.-Sat.-Sun.-TYPE OF ESTABLISHMENT FEE check only RETAIL STORE YES NO �?i .,{Y� $40 RESTAURANT YES NO I $40 BED& BREAKFAST YES NO $40 ADDITIONAL PERMITS MAKE ICE CREAM, YOGURT SOFT SERVE YES NO $5 TOBACCO VENDOR YES NO CHARGE FOR NON-PROFIT(such as ciurch kitchens) PLEASE INCLUDE COPY OF TAX EXEMPTFORM Please pay total with one check 50.00 payable to the City of Salem This Permit is not transferable and must be reissued upon change of ownership. The Permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code, before any renovations, improvements, or equipment changes are made,all plans for such must be submitted to and approved by the Salem Board of Health. Pursuant to MGL Chapter 62C, Section 49A, 1 certify under the pains and penalties of perjury that 1, to my best ow ad le and belief, have filed all state tax returns and paid all state taxes required under the law. 126/01 n4_?664F61 Signature Date Social Security or Federal Identification number Revised 11/1/01 foodap2.adm Check#&Date_ Z��/-. 7-Q/ mM� A!,d' ery CITY Or SALEM, MASSACHUSE'ITS BOARD OF HEAIATI 120 WASHINGTON STREET,4"'17 UOR TEL. (978) 741-1800 IQMBFRI,LY DRISCOLL FAX(978) 745-0343 MAYOR Ixamdin Cwsalcinxom LrARRY R,�MI)IN,RS/RN IS,CI-10,CP-FS HIAJAIi AGI',NP This f=oray will be collected during your next Board of Health inspection. QUESTIONAIRE - GREASE TRAPS 2009 1. NAME OF ESTABLISHMENT: O&A;e an lam hu-s mi 2. ADDRESS OF ESTABLISHMENT: SI- 3. DOES YOUR ESTABLISHMENT HAVE A GREASE TRAP? Yr5 4. WHAT SIZE GREASE TRAP DOES YOUR ESTABLISHMENT HAVE? CAPACITY IN GALLONS A 5. HOW IS THE GREASE TRAP MAINTAINED? ON A DAILY BASIS? BY AN IN-HOUSE PERSON OR BY AN OUTSIDE CLEANING SERVICE? y I nrS 6. WHAT IS THE FREQUENCY THAT THE GREASE IS REMOVED FROM THE TRAP? D /U c.e_ I zr 4,2 7. WHAT IS THE NAME OF THE FIRM WHO REMOVES AND/OR PICKS UP THE GREASE FROM YOUR ESTABLISHMENT? 1,' l S 4 1 (�/1 RiAAeA1f e 8. WHAT IS THE DATE OF YOUR LAST INVOICE FROM THE REMOVAL FIRM? � v