KEN ROTHWELLS CUSTOM CATERING INC - ESTABLISHMENTS Ken Rothwell's
Custom Catering Inc
7 Franklin Street
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Commonwealth of Massachusetts
e City of Salem
Board of Health Kimberley Driscoll
120 Washington Street,4th Floor Mayor
SALEM,MA 01970
Catering Annual Permit
DATE PRINTED: 07/30/2009
ESTABLISHMENT NAME: Ken Rothwell Custom Catering Inc.
File Number:BHF-2009-000027 7 Franklin Street
SALEM MA 01970
LOCATED AT:
SALEM, MA 01970
Permit Type Permit No. Permit Issued Permit Expires Fee Restrictions/Notes
CATERING BHP-2009-0522 Jun 10,2009 Dec 31,2009 $200.00
Total Fees: $200.00
PERMIT EXPIRES December 31, 2009
Board of Health
Page 1
f
CITY OF SALEM, MASSACHUSETTS
i
BOARD OF HEALTH
120 WASHINGTON STREET,4`FLOOR
'I"EL. (978)741-1800
KIMBERLEY DRISCOLL FAx(978)745-4343
K)'YOR 1Q10NNE ALEM COM
J 3NEI"DIONNE,
ACTING HEALTH AGENT
CATERING NO`T'IFICATION FORM 2008
FEE: $25/Event
$2001Year
Date of Application: Ob- Cc\ - b�I
Date of Event: sC of
Check#:
Check Date:
Name of Catering Business: Y-,Cvl `\�ov�tw2« Goskuw,C3a"4 .iwc
Address of Catering Business: '4 C,ct:w-�..1�A- yi Sir-
Owner of Catering Business: V-P-�v\e-k-1n OVA Uj CA I
Address of Owner: 3lw�Tts l2cS r1e�c wr -c- V-1 .
Name of Customer: ,
Address of Event:
Menu:
CITY OF SALEM, MASSACHUSETTS
• BOARD OF HEALTH
120 WASHINGTON STREET,4"'FLOOR
TEL. (978) 741-1800
K]MBERLEY DRISCOLL FAx(978) 745-0343
MAYOR IDIONNP:([7�SALEM.COM
JANET DIONNE,
ACTING HEALTH AGENT
MEMORANDUM
Date: 9/3/08
To: CATERERS SERVING FOOD IN SALEM
From: Janet Dionne,Acting Health Agent
RE: Board of Health REQUIREMENTS
A reminder that the Salem Board of Health requires:
• All food establishments(this includes catering)preparing food for service in Salem employ at lease one Certified Food
Manager. Such establishments which employ 10 or more full time employees directly involved in food preparation shall employ at
least two Certified Food Managers. The Board of Health office maintains listing of classes of which we are notified.
The Massachusetts Department of Public Health "Minimum Sanitation Standards for Food Establishments, State Sanitary Code Chapter X, "
105 CMR 590.000, regulates all food establishments in the State including catering operations. Section 590.033 requires that
• Each caterer have as its base of operation a food establishment that complies with the regulations and is permitted by the
local Board of Health, and
• Each caterer notify the Board of Health of the city in which it plans to serve food, prior to serving it elsewhere than its own
establishment,and
• The caterer give notice to the board, on a form provided by the Board, prior to or within 72 hours of serving food elsewhere
than its own establishment
The Salem Board of Health has determined that the fee for this notification procedure shall be$25 per event up to a maximum fee of$200
per calendar year. A caterer may pay$200 atone time if he or she expects to cater more than eight events before December 31sT
To summarize: Caterers must notify the Salem Board of Health, on the enclosed forth, of any events being catered in Salem, and each
catering business must have at least one Certified Food Manager in order to serve food in Salem. Enclosed are the notification forms as
described. You may make copies of this form or call the Board of Health for additional forms. Please call me if you have any questions
regarding these requirements.
Sincerely yours,
Janet Dionne, Senior Sanitarian (caterers memo)
Commonwealth of Massachusetts
x ` City of Salem
Board of Health Kimberley Driscoll
120 Washington Street,4th Floor Mayor
SALEM,MA 01970
Catering Annual Permit
DATE PRINTED: 03/07/2012
ESTABLISHMENT NAME: Ken Rothwell Custom.Catering Inc.
File Number:BHF-2009-000027 7 Franklin Street -
SALEM MA 01970
LOCATED AT:
SALEM, MA 01970
Permit Type Permit No.. Permit Issued Permit Expires Fee Restrictions/Notes
CATERING . slip-2012-0381Mar 7,.2012- Dec 31,2012 $200.00
Total Fees: $200.00
PERMIT EXPIRES ecember31, 2012
Board of Health
Page l
CITY OF SALEM, MASSACHUSETTS
BOARD OF HFALI I-I
120 WASHINGTON STREET,4".FLOOR
TFL. (978) 741-1800
HIMBER]:LY DRISCOLL FAX(978) 745-0343
MAYOR lramdin@salem.com
LARRY RM4Dm,RS/REI IS,C110,CRFs
HFAi xi I A(;I?NI'
CATERING NOTIFICATION FORM 2011
FEE: $25/Event
$200/Year
Date of Application:
Date of Event:
Check#:
Check Date:
Name of Catering Business: -Lev\ Qp�ll U sho IhL ,
Address of Catering Business: (�S� e- �
Business Phone Number: l/q4b `"
-744 Ll U Sb
Owner of Catering Business: (\KEN V—t-t w ALL
Address of Owner: �j` `Pj a (; Y Vl ( AAa C)c 1 ►v A
Name of Customer:
Address of Event:
Menu:
Updated 523/11
3Y "� 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: 07/22/2009
ESTABLISHMENT NAME: Run-A-Muck Child Care
File Number:BHF-2009-000023 3 Colby Street
SALEM MA 01970
LOCATED AT:
SALEM, MA 01970
Permit Type Permit No. Permit Issued Permit Expires Fee Restrictions/Notes
FOOD SERVICE BHP-2009-0512 Jul 22,2009 Dec 30,2009 $100.00
ESTABLISHMENT
Total Fees: $100.00
PERMIT EXPIRES December 30, 2009
At A
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. Pagel
CITY OF SALEM, MASSACHUSETTS
` BOARD OF HEALTH
120 WASHINGTON STREET,4r"FLOOR
TEL. (978) 741-1800
KIIvIBERLEY DRISCOLL FAX(978) 745-0343
MAYOR IMANCINI[niSALEM.COM
-JUL 16 2009
JANET MANCINI,
ACTING HEALTH AGENT tri SALEM
BO BOARD OF HEALTH
2009 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT
NAME OF ESTABLISHMENT 15Un- At ' wIVL-K CL \tld CC(-f=TEL# G- 4o- yo¢5
ADDRESS OF ESTABLISHMENT 3 C 01 to 1,J 5t . )c.jeYn FAX#
MAILING ADDRESS(if different)
EMAIL- Business': Website:
OWNER'SNAME LOJ`('t-Yl 12,0rY10GnC) 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 , Mon I -,.Tueiday weds esd - ,. rThursda , ! Fdd S'atuNa Sund
HOURS OF OPERATION
Please write in time of day.
For example Ilam-11 pm) ( !
TYPE OF ESTABLISHMENT FEE (check only)
RETAIL STORE YES NO less than 1000sq.ft. =$70
1000-10,000sq.ft. =$280
more than 10,000scift =$420
--- --- - - --------------------------------------------le------------------- ---------------------- -----
RESTAURANT YES NO less than 25 seats =$140
(Outdoor Stationary Food Cart$210) 25-99 seats =$280
more than 99 seats =$420
BED/BREAKFAST/ YES NO $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) 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 stale taxes required under the law.
Signal — , _Date a 0 Social Security or Federal Identification Number
Revised 424/07 FOODAP200 dm OCheci#&Date s $ ao
IN 60(
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