The URL can be used to link to this page

GREENLAND CAFE - ESTABLISHMENTS �ree�n�uR� �QJ. �C' EA "Mom upc 1om4r smwdoom UmbIn USA Me Eft I W W I k r �I��, e Y i -` ,. 'i� .. �> .. � y': 1 _ ,. � � .: r. -. ,. ! :. '.- � -..., .. � � .. r ,< '. � � nF.: i , ' - `f' i. � �.. R � _ .J ,.� '_ '. �. - ,. � i - ^ .. a � � - _` ' � ` � . . - �5 i „ �� -.. +. �� r d t �� '- .. � .'. .. - ,. q �- _ r i I� �� .. �, <<y -.: .� .. , � � �� t d �.. < I` � _ ��. _ � �. r. i d �; i f�i �� 1 t, r .� .'. - � � .�.. � - r' n V e ,: ,: / (+ .: � E � ,, o-.� ` _ r• � , . �( ,. + -. i .._ �- . . � �� _ � _ -' `` 1 . :, r. t � �, '. � ,� -. ,,, � .. � - � -: r. `. ,. -. ,.. . .; - '. � a .. ., w i ,. �i ..... ",3 .. o n ti v �. : .l r .. � a' F �� i .. _. .. ,., , �, 1� � .. .. .,:. .. r, � s T.. 0 CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH • KIMBERLEY DRISCOLL 120 WASHINGTON STREET,4"FLOOR MAYOR TEL.(978)741-1800 FAx(978)745-0343 LARRY RAMDIN,RS/REHS,CHO,CP-FS LRAMDIN(@,,SALEM.COM HEALTH AGENT COMPLAINT INTAKE FORM r i Date: I Time: ti q Received By: Complaint Number: 0215 ComplainantD/—an ((� v b yn �OL1 cA PtP Address: "[ W Phone: JOA/1 1 C4 ✓t 6 I C W-4.5f � 9 IA6 CI Biu 1 Investigated By: Date: Property Owner/Occupant Name Telephone#: • �J blJACCs d �rC�e� �G✓� d � �e., CITY OF SALEM, . �R MASSACHUSETTS RIFCC,V PublicHealth BOARD OF HEAUH-1 120 WASHINGTON S'I'REE1',4T FLOOR R•pd► KIMBERLEY DRISCOLL TEL.(978)741-1800 FAx(978)745-0343 JUL 23 2Y;�� A&RY RAMI>IN,lts/REI3s,CHo,CP-FS MAYOR Iramdin&salem.com CIN OF SALEM HGAI,FN AGENT BOARD OF HEALTH Food Establishment Permit Application (Application must be submitted at least 30 days before the planned opening date) 1) Establishment Name: OPUS 2) Establishment Address: 87 WASHINGTON STREET,SALEM, MA 01970 3) Establishment Mailing Address(if different): 4 Establishment Telephone No: 978-744-7766 5) Applicant Name&Title: NOLO OPUS, INC.—MARK MCDONOUGH, PRESIDENT AND TREASURER 6) Applicant Address: 185 MAIN STREET, GLOUCESTER, MA 01930 7) Applicant Telephone No:978 835-8064 24 Hour Emergency No:978 835-8064 Email: northshorerestaurantgroup@gmail.com 8) Owner Name&Title(if different from applicant): 9) Owner Address(if different from applicant): 10) Establishment Owned by: 11) If a corporation or partnership, give name,title and home address of officers or partner. An association Name Title Home Address A corporation x An individual MARK MCDONOUGH PRESITREAS 25 RAYMOND STREET. A partnership MANCHESTER MA Other legal entity 12 Person Directly Res onsible For Daily Operations(Owner, Person in Charge,Supervisor, Manager,etc. Name&Tine: GARRETT CAULFIELD, GENERAL MANAGER Address: 10 EVERGREEN DRIVE, BEVERLY, MA 01915 Telephone No: 978-744-7766 Fax: 978-910-0484 Email: SERENITEEMGMT GMAIL.COM Emergency Telephone No: 978-500-3066 13) District or Regional Supervisor(if applicable) Name&Title: Address: Telephone No: Fax: Email: r Food Establishment Information 14) Water Source: MUNICIPAL 15) Sewage Disposal: Municipal DEP Public Water Supply No: ( if applicable) 16) Days and Hours of Operation:7 DAYS 11:30-10:00 17) No.of Food Employees: 12 18) Name of Person in Charge Certified in Food Protection Management: JUSTIN Required as of 101112001 in accordance with 105 CMR 590.003(A) 19) Person Trained in Anti-Choking Procedures(if 25 seats or more): 4; Yes No 20) Location: 22) Establishment Type(check all that apply) (check one) ❑ Retail ( Sq. Ft) ❑ Caterer Permanent Structure 8 Food Service-(150 Seats) ❑ Frozen Dessert Manufacturer Mobile ❑ Food Service-Takeout ❑ Residential Kitchen for Retail Sale ❑ Food Service-Institution ❑ Residential Kitchen for Bed and ( Meals/Day) Breakfast Home ❑ Food Delivery ❑ Residential Kitchen for Bed and 21) Length Of Permit: BreakfastEstablishments (check one) RETAIL STORE RESTAURANT Annual 17 Less than 1000sq.ft. $70 ❑Less than 25 seats $140 Seasonal/Dates: ❑ 1000-10,OOOsq.ft. $280 ❑ Residential Kitchens $140 ❑More than 10,000sq.4t. $429 ❑25-99 seats $280 E3 More than 99 seats $420 Temporary/Dates/Time: --------------------------I----------- ------------------------------------------------------------ ❑ Bed& Breakfast/Childcare Services/Nursing Home $100 .. ----------------------------------------------------------------- ----------------------------------------- ADDITIONAL PERMITS ❑ MAKE ICE CREAM, YOGURT/SOFT SERVE $25 ❑TOBACCO VENDOR $135 ❑ALL NON-PROFIT $25 (including,church kitchens,state funded childcare&private clubs 23) Food Operations: Definitions: PHF-potentially hazardous food(time/temperature controls required) Non-PHFs-non-potentially hazardous food(no time/temperature controls required) check all that apply): RTE-ready-to-eat roods(Ex.sandwiches,salads,muffins which need no further processing Sale of Commercially PHF Cooked to Order x Hot PHF Cooked and Cooled or Hot Held Pre-packaged Non-PHFs x for More Than a Single Meal Service Sale of Commercially Preparation of PHFs For Hot And PHF and RTE Foods Prepared For Highly Pre-packaged PHFs Cold Holding for Single Meal Service x Susceptible Population Facility Delivery of Packaged PHFs Sale of Raw Animal Foods Intended to be Vacuum Packaging/Cook Chill Prepared by Consumer Reheating of Commercially Customer Self-Service Use of Process Requiring A Variance Processed Foods for and/or HACCP Plan (including bare hand Service Within 4 hours contact alternative,time as public health control. Customer Self-Service of Ice Manufactured and Packaged for Offers Raw or Undercooked Food of Non-PHF and Non- Retail Sale Animal Origin x Perishable Foods Only Preparation of Non-PHFs Juice Manufactured and Packaged for Prepares Food/Single Meals for Catered Retail Sale Events or Institutional Food Service Offers RTE PHF in Bulk Quantities To be completed by the Board of Health Retail Sale of Salvage, Out of Date �OjD /,146 or Reconditioned Food Total Permit Fee: Payment is due with applicatio ll ,! I,the undersigned,attest to the accuracy of the information provided in this application and I 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: 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: 45-5569531 )) 26) Signature of Individual or Corporate Name: !�_,"Z, Z22zS_!___�✓MARK MCDONOUGH, PRES AND TREAS MANN & MANN, P.C. COUNSELLORS AT LAW JILL ELMSTROM MANN* KuRT P.MANN* MELISSA GNOZA OGDEN Admitted to ractice in Massachusetts *Admitted to practice in New York July 19, 2012 Health Department, Larry Ramdin City of Salem 120 Washington Street Salem, MA 01970 RE: Routing Slip and Health Department Notification Liquor License Transfer Green Land Cafe to Nolo Opus, Inc. Mr. Ramdin: Please be advised that Nolo Opus, Inc. is in the process of acquiring the business assets of Green Land Cafe LLC and intends to continue to operate Green Land's restaurant, which is located at 87 Washington Street. As part of its acquisition, Nolo Opus is seeking the City's approval for the transfer of the existing liquor license. As local legal counsel for Nolo Opus, I am responsible for handling the liquor license transfer to Nolo Opus and submitting all necessary paper work to the licensing authority. Prior to granting the transfer request, the licensing authority for the Cit of Salem requires that Nolo Opus secure the signatures of various City commissions and boards, including but not limited to the Health Department, to ensure that the current licensee is in good standing with the City. Accordingly, I have been contacting the various departments and obtaining their signature on the attached routing slip. On behalf of Nolo Opus, I am requesting that the Health Department sign the routing slip as well as the Health Department Notification Form, which both must be submitted to the LLA as part of the transfer request for the liquor license. If you have any questions please call me at your earliest convenience. Thank you in advance for your kind attention to this matter. Very truly yours, MANN & MANN, P.C. Jill Elmstrom Mann S:ISerenitee 1077-10IGreen Land Cafelltr to health deparlment.doc 191 South Main Street,Suite 104 Direct Email: fill@mannpc com Middleton,Massachusetts 01949 kurt@marml2c.co Telephone:978-762-6238 melissa@mannpc.com Facsimile:978-762-6434