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THE SALEM INN-BB - ESTABLISHMENTS- - __ T.� S=9le,�n �N � � '%Sv/ti /Ae.e ST/�¢e i '� » � � x \ _ 17 \.\ $$* 5z, %~® w / _ 17 � $$* %~® :�'__ Kimberley Driscoll Mayor City of Salem, Massachusetts Board of Health 120 Washington Street, 4th Floor, Salem, MA 01970 Tel. (978) 741-1800 Fax. (978) 745-0343 Iramdin@salem.com Permit Number: FM -16-162 Restrictions: Inn Permit Type: I FOOD ESTABLISHMENT PERMIT (must be posted on the Premises of the Food Establishment) 2016 Food Establishment >99 seats Goods & Services: I Food Service: Incidental PublicHealth Prevent. Promote, Protect. Larry Ramdin, MPH, REFS, CHO Health Agent Name of License Holder: The Salem Inn- Diane and Dick Pabich Name of Food Establishment The Salem Inn Address of Food Establishment 7 Summer Street Salem MA 01970 This License is granted in conformity with the statutes, Regulations and ordinances relating thereto,and expires on 12/31/2016 unless sooner suspended or revoked. Permit Fee: $100.00 Effective: 1/1/2016 i KIMBERLEY DRISCOLL MAYOR CITY OF SALEM, MASSACHUSETTS BOARD ov He,v,'rrl 120 WAST-11NG ION S'11tt cr, 415, FLOOR Ti:],. (978) 741-1800 FAX (978) 745-0343 Iramdin(@salem.com lu PuhticHeatth LARRY RAMDIN, RS/RFA IS, CA 10, CP -1 S He:AL n I Ac; EXT Food Establishment Permit Application (Application must be submitted at least 30 days before the planned opening date) 1) Establishment Name: -T\)'c s uxy( von RE 2) Establishment Address: �I vgt`(\c`n Pc- c -f� v -T 3) Establishment Mailing Address (if different): 4) Establishment Telephone No: `18- 1-4 t- 1) (o EMD 5) Applicant Name & Title: 1aj(\t k 6) Applicant Address: "JS W6ff f d �Q� � y� tt61x170 7) Applicant TelephoneNo:�'� -145-72774 24 Hour Emergency No: ' I �1Emai1:CCSeCv�mphs� 8) Owner Name & Title (if different from applicant): C,CyU 9) Owner Address (if different from applicant): 10) Establishment Owned by: An association cox or An individual A partnership Other legal entity 11) If a corporation or partnership, give name, title and home address of officers or partner. Name Title Home Address k c h Pre , 5 W � S �8 aC d I ZreaS�r�X 35 U0�(i�C d 12 Person Directly Res onsible For Daily Operations (Owner, Person in Charge, Supervisor, Mana er, etc.) Name & Title:n\tCX aUrc�ey- Address: s5o C3 3Q (c n (A d 1905 Telephone No: 617 91`vl13- -1-5&S Fax: [ %$V1fmail: to ma Emergency Telephone No: 13) District or Regional Supervisor (if applicable) Name & Title: 10 Address: Telephone No: Fax: Email: Check #: aa1 Date: I d a' I Amount: / 60, 0 Food Establishment Information Offers K I t PHF in bulk quantities To be completed by the Board of Health Retail Sale of Salvage, Out of Date or Reconditioned Food Total Permit Fee: Payment is due with application 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. .- f - 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: 26) Signature of Individual or Corporate N; 14) Water Source: 15) Sewage Disposal: DEP Public Water Supply No: ( if applicable) 1a "S awed 16) Days and Hours of Operation: Z PlTA- v3\4 .^ 17) No. of Food Employees: 18) Name of Person in Charge Certified in Food Protection Management: Required as of 101112001 in accordance with 105 CMR 590.003(A) 19) Person Trained in Anti -Choking Procedures ( if 25 seats or more): ❑ Yes No 20) Location: 22) Establishment Type (check all that apply) check one) ❑ Retail ( Sq. Ft) ❑ Caterer rmanen :Struc ur ❑ Food Service -( Seats) ❑ Frozen Dessert Manufacturer Mobile ❑ Food Service - Takeout ❑ Residential Kitchen for Retail Sale O Food Service - Institution ❑ Residential Kitchen for Bed and ( Meals/Day) Breakfast Home ❑ Food Delivery ------------------------------------------- ❑ Residential Kitchen for Bed and Breakfast Establishments . .... ........................................ 21) Length Of Permit: (check one) RETAIL STORE 17 Less than 1000sq.ft. $ 70 RESTAURANT ❑ Annual ✓ Less than 25 seats $140 Seasonal/Dates: ❑ 1000-10,000sq.ft. $280 ❑ Residential Kitchens $140 ❑ More than 10,OOOsq.ft. $420 ❑ 25-99 seats $280 ❑ More than 99 seats $420 - -- --------------- i h--i-I------ ----- -----I---- ---------------------------------------- ........------ Bed & BreakfasUChildcare Services /Nursing Home Temporary/DatesMme: $100 -------- --------- ADDITIONAL PERMITS ------- ...------..- ------------- - ....----- ❑ MAKE ICE CREAM, YOGURT/SOFT SERVE $25 ❑ PASTURIZATION $25 ❑ ALL NON-PROFIT' $25 *Including, church kitchens, state funded childcare B private club 23) Food Operations: Definitions: PHF-potentially hazardous food(time/temperature controls required) (Check all that apply): Non-PHFs- non -potentially hazardous food (no time/temperature controls required) pP y): RTE- read -to-eat foods(Ex. sandwiches, salads, muffins which need no further processing Sale of Commercially PHF Cooked to Order Hot PHF Cooked and Cooled or Hot Held Pre-packaged Non-PHFs 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 Susceptible Population Facility Delivery of Packaged PHFs Sate 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 I andlor HACCP Plan (including bare hand Service Within 4 hours y 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 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 K I t PHF in bulk quantities To be completed by the Board of Health Retail Sale of Salvage, Out of Date or Reconditioned Food Total Permit Fee: Payment is due with application 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. .- f - 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: 26) Signature of Individual or Corporate N; Kimberley Driscoll Mayor City of Salem, Massachusetts Board of Health lu 120 Washington Street, 4th Floor, Salem, MA 01970 Tel (978) 741-1800 Fax. (978) 745-0343 PubliCHealth .Prevent. Promote. Protect. Iramdin@salem.com Larry Ramdin RS/REHS, CHO, CP -FS Health Agent FOOD ESTABLISHMENT PERMIT (must be posted on the Premises of the Food Establishment) 2015 Permit Number: FM -15-231 Permit Type: Food Establishment >99 seats Goods & Services: Food Service: Incidental Narne of License Holder: The Salem Inn- Diane and Dick Pabich Name of Food Establishment The Salem Inn Address of Food Establishment 7 Summer Street Salem MA 01970 Restrictions: Inn This License is granted in conformity with the statutes, Regulations and ordinances relating thereto,and expires on 12/31/2015 unless sooner suspended or revoked. Permit Fee: $100.00 Issued: 1/1/2015 KIMBERLEY DRISCOLL MAYOR CITY OF SALEM, MASSACHUSETTS BOARD oI' HL'ALTH 120 WASJTINcroN S'muz. r, 4T" Ft.00it TI7j_ (978) 741-1800 FAX (978) 745-0343 Imnadin2salem.com Limy RAMDNN, RS/REI-IS, (:110, C11 -1,'S HI'iAm'I-1 AGENT Food Establishment Permit Application (Application must be submitted at least 30 days before the planned opening date) 1) Establishment Name: � Sa `tm \h� 2) Establishment Address: I m S 3) Establishment Mailing Address (if different): 4) Establishment Telephone No: 8 1— o b O D 5) Applicant Name & Title: } hb v) S 6) ApplicantAddress:3 36k \ A O1G�7� 7) Applicant Telephone No:gM'1QFJ1Z74214�Hour Emergency No:99g-1 At- 10t3 Email: v�ll�h 8) Owner Name & Title (if different from applicant): 9) Owner Address (if different from applicant): �9 , 10) Establishment Owned by: An association A torpor o An n vi ua Apartnership Other legal entityKd- 11) If a corporation or partnership, give name, title and home address of officers or partner. Name Title Home Address ( & F Ka. �� Qab� T�easUce� ( sl 12 Person Directly Res onsible For Daily OperationsPerson in Charge, Supervisor, Manager, etc. Name & Title: �(Owner, 3l t 1,`l a Address: Telephone No: 1 q1 - L� 5 Fax: - p�2Q Email: Emergency Telephone No: 13) District or Regional Supervisor (if applicable) Name & Title: DEC 05 2014 Address: BOARD O�FHEALTH Telephone No: Fax: Email: Check #: /I/ Date: /�' l /./ Amount: ninnna Clem tbm Food Establishment Information 14) Water Source: 15) Sewage Disposal: DEP Public Water Supply No: ( if applicable) - S 16 Da and Hours of Operation: Ys P A, -P C -\�W 17) No. of Food Employees: 18) Name of Person in Charge Certified in Food Protection Management: Required as of 101112001 in accordance with 105 CMR 590.003(A) 19) Person Trained in Anti -Choking Procedures ( If 25 seats or more): ❑ Yes No 20) Location: 22) Establishment Type (check all that apply) heck one) 0 Retail ( Sq. Ft) 0 Caterer Permanent Structure- ❑ Food Service - ( Seats) . 0 Frozen Dessert Manufacturer Mobile 0 Food Service - Takeout 0 Residential Kitchen for Retail Sale 0 Food Service - Institution 0 Residential Kitchen for Bed and ( Meals/Day) Breakfast Home p Food Delivery ------------........... --------------•---------------......................-.........---------------------•---.......................... 0 Residential Kitchen for Bed and ,Breakfast Establishments 21) Length Of Permit: (Chtjck one) RETAIL STORE RESTAURANT Annual ✓ 0 Less than 1000sq.ft. $ 70 0 Less than 25 seats $140 Seasonal/Dates: 0 1000-10,000sq.ft. $280 0 Residential Kitchens $140 .0 More than 10,000sq.ft. $420 0 25.99 seats $280 0 More than 99 seats $420 --......................... ............. - �Bed & BreakfasUChildcare Seryices /Nursing Hoomeme$100 Temporary/Datesmme:--------------------- --I .......................------ ADDITIONAL PERMITS -------------`--------------- --------------- - 0 MAKE ICE CREAM, YOGURT/SOFT SERVE $25 0 PASTURIZATION $25 0 ALL NON-PROFIT` $25 1ricludin , church kitchens, state funded childcare 6 private club 23) Food Operations: Definitions: PHF-potentially hazardous food(time/temperature controls required) that Non-PHFs-non-potentially hazardous food (no timeRemperature controls required) (check all apply): RTE -rea -to-eat foods Ex. sandwiches, salads, muffins which need no further processing Sale of Commercially PHF Cooked to Order Hot PHF.Cooked and Cooled or Hot Held Pre-packaged Non-PHFs 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 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 / 1 and/or HACCP Plan (including bare hand Service Within 4 hours V contact alternative, time as public health control. Customer Self -Service of Ice Manufactured and Packaged for Offers Raw or Undercooked Food of Nen-PHF and Non- Retail Sale Anima'l,Origin 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 VtrerS KI t Yhlh In CIUM 4tuantltles Retail Sale of Salvage, Out of Date or Reconditioned Food To be completed by the Board of Health Total Permit Fee: Payment is due with application 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 otherplicab a law. I �e beenninstructed by the Board of Health on how to obtain copies of 105 CMR 590.000 and the Federal Food Fqt ( JI` I^I l 24) Signature of Pursuant to MGL Ch. 62C, s6i;e49A, 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: (74- Z7 V 427 26) Signature of Individual or Corporate Name:��(ie-av0� s \n cn c 4 , Commonwealth Of Massachnsetta- City x 120 Washington Streiet, 4th Floor g t 2, a +'S S."✓<'� v` 3-n �l'u•,E s k 't a "iaL #s i' aF� } n F. - -SE, A", MA 01970 `-' i_4 Ti. mfr f" �. n x 'a4 'r' (C"'"- �! ♦ - -3,e' e 4 '^ R. :. . s :'a l x: Ft)W/R&A EstablishmentPermit pl�DATE PRINTED t 12/ 0/2012 M,. 1z ff* 14 ESTABLISHMENT NAMES : The Salem Inn' z t .>�.* iY tfi =3. F'nk e 1 .3 9 .�`€' sA' ast '.' ,$"' Ffle�Number BHF -M04-660295' 7 SUmmei Street' [ TTW Salem� . gMA 01970 :Z.,a; - y�LOCATED x SALEM, MA 01970 ✓_—' -Permit Type . -permit No.'s Perirut Issued Permit Expires , Fee Restriction h�Notes � FOOD SERVICE a `BHP 20130097 Jan 1, 2013 Dec 31, 2013 R X100 00 ESTABLISIIMENT r y E ^ 141 t ) +,�z..4. " x � Total Fees- $100 00 F z �e _ ij 'z`:. ° •z ..e^ z: „ N' ` v�` : a'" @ TLS` ?rTz TTI s r z, rir rgFz X }�¢ }. Lj aVfi �' PERMIT -EXPIRES F December 31 `2013 � )�- r Y' z s �.- G '. S Board of Healthy ., r_ —`i W ,>ara� 7 4 �, $` ✓- �, .. This Permit is not transferable and must be, rcrssued upon change of ownership or location The permit must be posted • x in a prominent location m the Establishment F In accordance With the, State Sanitary Code; beofre any revonations, improvements, or-egmpment changes are made, m ;all plans for me s such ust be to and approved by the Salem Board -of Health '{ � Pagel ` , ' axY r 498 t x c o- :5,0 ., W *+ a rlty$...s'sfs .2 AI, riSil�� 4"` 2 . KIMBERLEYDRISCOLL MAYOR CITY OF SALEM,RECEIVier) - 10 MASSACHUSETTS PubflcHealth BOARD OFI EIM11-t 120 WAS] IINGTON Srttuizr, 4'1" FI SUR Ti;t.. (978) 741-1800 FAX C OF HEALT_T�1Y� RAMDIIV, RS/REI-IS, cl Io, CP -FS s Irimdin u salem.com I-II[?;\1;I'I.1 AGL:N'I' Food Establishment Permit Application (Application must be submitted at least 30 days before the planned opening date) 1) Establishment Name: l\1 , ��e�r i1 `h r1 2) Establishment Address: Ji •'1 rne^t1P��'�i� 3) Establishment Mailing Address (if different):`` ``9 4) Establishment Telephone No: C� 9- -1 q- — 0 (01ZD 5) Applicant Name& title: aA-)C, r- q., ° - 7 (j -X!/ �g @` \\003,i nab 1 1 6) Applicant Address: 35 \�5'�I/t \`7��rC! t�17�C1 �P, b - %A 7) Applicant Telephone No:gq %'-I A t5--1:0 -124 Hour Emergency No: Email: _ 8) Owner Name & Title (if different from applicant): -) ck-"k,2- CL -10 D—lJU 9) Owner Address (if different from applicant): A 10) Establishment Owned by: AD -association 6kaor oral An individual A partnership Other legal entity 11). If a corporation or partnership, give name, title and home address of officers or partner. Name. Title p Home Address l�j - QC°S1Cf1� 3J��(lktlC��1c�94G� Q�t. Q bl�x1., l� -(� g1�✓� 5 Ui% ts�allc� 12 Person Directly Res onsible For Operations(Owner, Person in Charge, Supervisor, Manager, etc. Name & Title:pp Daily Address: �� (�.IV101'��s'f l LII IPA 1C-5 4 •� o% Telephone No: �`'-A 101 -'10 Jfl Fax:1rlX��ill11' 3114 -Email: r CX\@' OY) 50auvlv Emergency Telephone No: 7 "�t - '- `'i DLJ 7 13) District or Regional Supervisor (if applicable) Name & Title: Address: Telephone No: Fax: Email: Check #: / 3� " Date: `� ?w 1.� Amount "�� • l Mit 1pcn )t'14601 6(11 Food Establishment Information 14) Water Source: 15) Sewage Disposal: t DEP Public Water Supply No: ( if applicable) 't 40_kIgS-(Z\�eGK' kOro(" 16) Days and Hours of Operation: 17) No. of Food Employees: 18) Name of Person in Charge Certified in Food Protection Management: Required as of 101112001 in accordance with 105 CMR 590.003(A) . 19) Person.Trained in Anti -Choking Procedures ( if 25 seats or more): ❑ Yes No 20) Location: 22) Establishment Type (check all that apply) (check one) 0 Retail ( Sq. Ft) D Caterer Permanent Structure 0 Food Service -( Seats) 10 Frozen Dessert Manufacturer Mobile 0 Food Service - Takeout ❑ Residential Kitchen for Retail Sale 0 Food Service -Institution 0 Residential Kitchen for Bed and ( Meals/Day) Breakfast Home 0 Food Delivery --------------------------------------------- Q Ikesidential Kitchen for Bed and Breakfast Establishments 21) Length Of Permit:............... /_a(check one) RETAIL STORE RESTAURANT 5 1/ 0 Less than 1000sq.ft. $ 70 0 Less than 25 seats $140 n�A anu Seasonal/Dates: 01000-10,000sq.ft. $280 0 Residential Kitchens $140 ❑ More than 10,000sq.ft. $420 0 25-99 seats $280 0 More than 99 seats $420 ------------- --------------------------------------------------------- ------------------------- ---- L7 Bed & Breakfast/Childcare Services /Nursing Home $100 Temporary/Dates/Time: --------------------------------------------------------- ADDITIONAL PERMITS -------------------------------------------------------- 0 MAKE ICE CREAM, YOGURT/SOFT SERVE $25 0 PASTURIZATION $25 0 TOBACCO VENDOR $135 0 ALL NON-PROFIT $25 (Including, church kitchens, state funded childcare 8 private clubs 23) Food Operations: Definitions: PHF-potentially hazardous food(time/temperature controls required) Non-PHFs - non -potentially hazardous food (no timeltemperature controls required) check all that apply): RTE - ready -to -eat foods (Ex. sandwiches, salads, muffins which need no further processing Sale of Commercially PHF Cooked to Order Hot PHF Cooked and Cooled or Hot Held Pre-packaged Non-PHFs 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 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 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 or Reconditioned Food Total Permit Fee: Payment is due with application 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 andall other applicable law. 1 have been instructed by the Board of Health on how to obtain copies of 105 CMR 590.000 and the Federal Food Ce� 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: 61 X1 i9-1 2 0 26) Signature of Individual or Corporate Name: \nc)lgouV Gy- �� ' DATE PRINTED: 3 Commonwealth of Massachusetts City of Salem Board of Health 120 Washington Street, 4th Floor SALEM, MA 01970 Foo"etail Establishment Permit 12/20/2011 ESTABLISHMENT NAME: . File Number; BHF -2004-000295 LOCATED AT: The Salem Inn 7 Summer Street Salem SALEM, MA 01970 Kimberley Driscoll Mayor MA 01970 0414! KINIBERLE,Y DRISCOLL MAYOR LAItItY RAMD IN, ItS/It Ii IS, Clio, CP -I'S Fl AL.11t A(';kNf CITY OF SALEM) MASSACHUSE-ITS ROARD.OF HEALTH 120 WASHINGTON STREET, 4"' FLOOR TEL. (978) 741-1800 FAX (978) 745-0343 Iratnclinac s lcm com 201_ APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT NAME OF ESTABLISHMENT Salem Community Child Care TEL # 978-744-3479 ADDRESS OF ESTABLISHMENT 90-92 Congress St. FAX # 978-744-3938 MAILING ADDRESS (if different) P.O. Box 8 Salem MA 01970 EMAIL- Business': salemcc@verizon.net Website: OWNER'S NAME Salem Community Child Care Inc. TEL# 978-744-3479 ADDRESS 90-92 Congress ST. P.O.Box 8 Salem MA 01970 STREET _ CITY STATE ZIP CERTIFIED FOOD MANAGER'S NAME(S) Christin Hatch CERTIFICATE#(S) 5468009 (Required in an establishment where potentially hazardous food is prepared) EMERGENCY RESPONSE PERSON Christin Hatch HOME TEL# 978-745-0761 DAYSOF�OPERATION Monday I ,Tuesday.,-= I =.Wednesday .li,;A,4hursday- 1 7. , Saturday Sunday HOURS OF OPERATION ION 7-00 I 7 00 7; 00 1 7:00 7: 00 Please write in time of day (For example 11 am -11 pm) 5:30. 5:30 5:30 i 5:30 5:30 RETAIL YES less than 1000sq.ft. 1000-10,000sq.ft. more than 10,000sq.ft. =$ 70 =$280 =$420 ------------------------------------------ -----------`--------------------------------------- - - ------------------------------------------------------- RESTAURANT YES i)i2v less than 25 seats =$140 (Outdoor Stationary Food Cart $210) L/ 25-99 seats =$280 more than 99 seats =$420 NO $100 MAKE (not just serve) ICE CREAM, YOGURT/SOFT SERVE YES NO $25 TOBACCO VENDOR YES,, NO ALL NON-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 penaltiesof perjury that I, to my best knowledge and belief; have filed all state tax returns and paid allstate taxes required under the law. 12/15/2011 Date Updated 5/23/11 FOODAP201 Led. Check# & Date 3056 y or Federal Commonwealth of Massachusetts City of Salem Board of Health 120 Washington Street, 4th Floor SALEM, MA 01970 Food/Retail Establishment Permit DATE PRINTED: 01/03/2011 ESTABLISHMENT NAME: File Number: BHF -2004-000295 LOCATED AT: Kimberley Driscoll Mayor The Salem Inn 7 Summer Street Salem MA 01970 SALEM, MA 01970 Permit Type Permit No. Permit Issued Permit Expires Fee Restrictions / Notes FOOD SERVICE BHP -2011-0115' Jan 1, 2011 Dec 31, 2011 $100.00 ESTABLISHMENT PERMIT EXPIRES Total Fees: $100.00 Board of Health This Permit is not transferable and must be reissued upon change of ownership or location. The permit must be posted in it 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 01 KINIBERLEY DRISCOL.L, MAYOR DAVID GREENBAum,RS ACTING HEALTH AGENT CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH 120 WASHINGTON STREET, 4°' FLOOR TEL. (978) 741-1800 FAX (978) 745-0343 DGREENI1AUN1QSALEM. CONI 2011 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT c NAME OF ESTABLISHMENT l C-6VIf Y)) 1 Cion) TEL #ql S --]'A 1 O IO p ADDRtSSOF'ESTABLIS HIti1 ENT . `)Vii1n1t1f tS , 1r1 UA 09%Q FAX# 9 'V14 MAILING ADDRESS (if different`)__ SC%tYlei' EMAIL- Business':Se\ma)ClV°OWNERSNAMEaSIQ�C7I1��1tVNi(i(Q•i�AM Website: WWW SQ��I(Yllrltl�{A•CAYY1 TEL # -73-145-727.1 ADDRESS .55 WIVMV- [�)IUr)7f KWO �jPw(Y) LM ()j`i /l) y STREET - CITY STATE ZIP CERTIFIED FOOD MANAGERS NAME(S) CERTIFICATE#(S) (Required in an establishment'where potentially hazard us food is prepared) EMERGENCY RESPONSE PERSOIJ � ACA \Irks J{ p �a HOME TEL '# l S i-4� 1 - I U3% I-iAYS_.OFOP•ERATION .r Mond Juesday e .Wednesday, ,; , -::Thursday -_;(, s t ..:Saturday,,, HOURS OF OPERATION ��n ` Q M� � Please write in time of day $Q,I(YI: 1oQ(i� 0^ (c� p �'�lMng ��Ol1v'r -Friday I Q (y� (X� �/�/ -` -' -10 m -t" (For example 11 am -11 pm) V V TYPE OF ESTABLISHMENT FEE (check only) RETAIL STORE YES NO less than 1000sq.ft. =$ 70 1000-10,000sq.ft. =$280 more than 10,000sq.ft. =$420 ---------------- -- -` RESTAURANT YES NO - ......-.............. - ......------- less than 25 seats =$140 (Outdoor Siationdry Food -,art $2iu) 25-99 seats =$280 more than 99 seats =$420 --------------------F--------------------------- -- ----------------------------------------------------------------------------------------------- BED/BREAKFAST/ YES NO $100 CHILDCARE SERVICES/NURSING-----ME--------------------------- 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.. 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',r - - In accordance with the State Sanitary Code, before any renovations, improvements, or equipment changes are made, all plans for such must be submitted fo'and approved-bytheSalem 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. Social Security or Federal Identification Number Commonwealth of Massachusetts l eCity of Salem Board of Health Kimberley Driscoll 120 Washington Street, 4th Floor Mayor SALEM, MA 01970 Food/Retail Establishment Permit DATE PRINTED: 01/05/2010 ESTABLISHMENT NAME: File Number: BHF -2004-000295 LOCATED AT: The Salem Inn 7 Summer Street Salem MA 01970 SALEM, MA 01970 Permit Type Permit No. Permit Issued Permit Expires Fee Restrictions / Notes FOOD SERVICE BHP -2010-0131 Jan 4, 2010 Dec 31, 2010 $100.00 ' ESTABLISHMENT PERMIT EXPIRES Total Fees: $100.00 2010 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 KIMBF.RLEY DRISCOLL MAYOR CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH e 120 WASHINGTON STREET, 4' FLOOR 6 � two '�- TEL. (978) 741-1800 FAX (978) 745-0343 ®Fc � DGREENBAUMLr�SALEM. CUM n. 0,7/) DAN7ID GREENBAtim, - / •;; ACTING HEALTH AGENT T� 2010 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT NAME OF ESTABLISHMENT I l,e �a��m1 \`C_1f-1 \ TEL # �_IFS—� ` — �b� ADDRESS OF ESTABLISHMENT \)YnMCX_ FAX# MAILING ADDRESS (if different) SC ,C a S a-bO`I1,0 EMAIL - Business: YYIrYlY11'AG•U ebaite: WWW•Sc�VMlY1v�12 •CrYl OWNER'S NAME �n NaCnd,VD(1S�Y)C/ db 9 \Ile �a U rn �V) n TEL # q 1 G'1 ) `� '2--79 ADDRESS div\nkex- 1Sk�1Gi )P,,A �al4rn M a\q-7 U 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 # QAYSIGFdkOPER}7 , >Tuesda � - "s7ursda s�3akurda Senday" m W@dnesdaY Y )rynday-I, HOURS OF OPERATION Please write in time of day. _ p Q Q I ptr i o�-,oai 00lown^I VJM prn ) Q For example 11 am -11 pm TYPE OF ESTABLISHMENT FEE (check only) RETAIL STORE YES NO less than 1000sci t. =$ 70 1000-10,000sq.ft. =$280 l more than 10,000sq.ft. =$420 RESTAURANT YES NO less than 25 seats =$140 (Outdoor Stationary Food Cart $210) 25-99 seats =$280 more than 99 seats =$420 MAKE (not just serve) ICE CREAM, YOGURT/SOFT SERVE YES $25 TOBACCO VENDOR YES $135 ALL NON-PROFIT (such as church kitchens) YES O $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. Date Check# O4 - 2JS42-7 d Social Security or Federal Identification °�''" City of Salem, Massachusetts Board of Health 120 Washington Street, 4th Floor, Salem, MA 01970 > "a Tel. (978) 741-1800 Fax. (978) 745-0343 Cj3p1 health@salem.com - !Prevent. Promote. Protect. Kimberley Driscoll Larry Ramdin, MPH, REHS, CHO Mayor - Health Agent FOOD ESTABLISHMENT PERMIT (must be posted on the Premises of the Food Establishment) 2017 Permit Number: FM -16-597 Permit Type: Food Establishment >99 seats Goods & Services: Food Service: Incidental Name of License Holder: The Salem, Inn- Diane and Dick Pabich Name of Food Establishment The Salem Inn Address of Food Establishment 7 Summer Street Salem MA 01970 Restrictions: Inn This License is granted in conformity with the statutes, Regulations and ordinances relating thereto,and expires on 12/31/2017 unless sooner suspended or revoked. Permit Fee: $0.00 Effective: 12/15/2016 Larry Ramdin, MPH, REHS, CHO Health Agent • CITY OF SALEM, c lu MASSACHUSETTS ,q tirr yy 6'i��® Reabkh BOARD OF 11EALTH 120 WASHINGTON S'IREE r, 4T11 FLOOR DEC (J KIMBERLEY DRISCOLL TL'L. (978) 741-1800 FAx (978) 745-0343.. 52 health@salem.com — � r GF `""�tY RAMDIN, RS/APRs, CRO, CP -PS MAYOR OgRQ OFSf;«M HFAL'rLt AGENT "�ZrN Food Establishment Permit Application (Application must be submitted at least 30 days before the planned opening date) 1) Establishment Name: I\x a l l "o 2) Establishment Address: -I SommeA- ScreQ 3) Establishment Mailing Address (if different): 4) Establishment Telephone No: --I (A� - Np l p - 5) Applicant Name & Title: \ �� a q N CV\'&r O P-aA^ \ C 'K 6) Applicant Address: kh� \ b't\ A eoc'-j i � UA'I'` i " R 0 K7 0 3S W 7) Applicant Telephone No: l t' %-4 -72,744 Hour Emergency No:gj -'7t/041 00 Email: 8) Owner Name & Title (if different from applicant): Ac'rV\.t. 9) Owner Address (if different from applicant): 10) Establishment Owned by: An association cor oratio An individual A partnership Other legal entity 11) If a corporation or partnership, give name, title and home address of officers or partner. Name Title Home Address les 1 it a. G! y Tr 2SUrGr 5 h�i/C I S 12 Person Directly Res onsible For Daily Operations Owner, Person in Charge, Supervisor, Manager, etc. Name & Title: Address: Telephone No: \� ., a�jb�j Fax:91S-�L4L1—&/24 EmaiLCQ< V2IIDYI Emergency Telephone No: 13) District or Regional Supervisor (if applicable) Name & Title: Address: wig Telephone No: Fax: Email: Check #: oJ/ Date: C ho I Amount: \$I bo ' 10 " ifl(W, tcry 411 &M Food Establishment Information 14) Water Source: 15) Sewage Disposal: DEP Public Water Supply No: ( if applicable) -t �a�j� a wee1C 16) Days and Hours of Operation: 17) No. of Food Employees: 18) Name of Person in Charge Certified in Food Protection Management: Required as of 101112001 in accordance with 105 CMR 590.003(A) 19) Person Trained in Anti -Choking Procedures ( if 25 seats or more): ❑ Yes No 20) Location: 22) Establishment Type (check all that apply) (check one) 17 Retail ( Sq. Ft) ❑ Caterer Permanen ruc ure O Food Service -( Seats) ❑ Frozen Dessert Manufacturer Mobile O Food Service -Takeout 17 Residential Kitchen for Retail Sale O Food Service - Institution O Residential Kitchen for Bed and ( Meals/Day) Breakfast Home 0 Food Delivery 13 Residential Kitchen for Bed and Breakfast Establishments --------------------- 21) Length Of Permit: (check one) RETAIL STORE RESTAURANT Annual ✓ ❑ Less than 1000sq.ft. $ 70 ❑ Less than 25 seats $140 Seasonal/Dates: 13 1000-10,OOOsq.ft. $280 ❑ Residential Kitchens $140 O More than 10,OOOsq.ft. $420 0 25.99 seats $280 ❑ More than 99 seats $420 -- ----- --------- --- --------- ------------- ------ --- -------------------------------------------------------------------------- �Bed & BreakfastlChiidcare Services (Nursing Home Temporary/Dates/Time: $100 -------------------------------------------------------...............----•-........................... ADDITIONAL PERMITS 13 MAKE ICE CREAM, YOGURT/SOFT SERVE $25 O PASTURIZATION $25 0 ALL NON-PROFIT' $25 *Including, church kitchens, state funded childcare 8 prhyate club 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, mums which need no further processing Sale of Commercially PHF Cooked to Order Hot PHF Cooked and Cooled or Hot Held Pre-packaged Non-PHFs 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 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 1 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 Perishable Foods Only Preparation of Nan-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 aiHea![h Retail Sale of Salvage, Out of Date or Reconditioned Food Total Permit Fee: Payment is due with application 1, 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-Gode. '_n 1 1 - .A . - 24) Signature of 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. l 25) Social Security Number or Federal ID: 4 -12 \S 4.22 Q ` 26) Signature of Individual or Corporate Name: \ hr\APaycx-s \hC. QUESTIONAIRE - GREASE TRAPS 2013 1. NAME OF ESTABLISHMENT: 2. ADDRESS OF ESTABLISHMENT: 3. DOES YOUR ESTABLISHMENT HAVE A GREASE TRAP? 4. WHAT SIZE GREASE TRAP DOES YOUR ESTABLISHMENT HAVE? CAPACITY IN GALLONS 5. HOW IS THE GREASE TRAP MAINTAINED? ON A DAILY BASIS? BY AN IN-HOUSE PERSON OR BY AN OUTSIDE CLEANING SERVICE? 6. WHAT IS THE FREQUENCY THAT THE GREASE IS REMOVED FROM THE TRAP? 7. WHAT IS THE NAME OF THE FIRM WHO REMOVES AND/OR PICKS UP THE GREASE FROM YOUR ESTABLISHMENT? 8. WHAT IS THE DATE OF YOUR LAST INVOICE FROM THE REMOVAL FIRM? Massachusetts Department of Public Health Division of Food and Drugs FOOD ESTABLISHMENT INSPECTION REPORT Salem Board of Health 120 Washington Street, 4'" Floor em, 970-3523 Tel. (578) 741-18 ax (978) 745-0343 Name Date oOeion(s) T e of Inspection CL 43 q.225_)5 ❑ Retail U Routine ❑ Re -inspection Address Risk Level ❑ Residential Kitchen ❑ Mobile Previous Inspection Date: Telephone _ Cb �0 �) 8 - ❑ Temporary ❑ Caterer ❑ Bed & Breakfast ❑ Pre-operation L1 Suspect Illness -❑ General Complaint Owner "1110( 4 -A)WZ, P HACCP YM Person in Charge (PIC) Time In: Out: Permit No. ❑ HACCP ❑ Other Inspector AV 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,b.°i'�s,m ❑ 1. PIC Assigned / Knowledgeable / Duties n ❑ u2. Reporting of Diseases by Food Employee and PIC ❑ 3.. Personnel with Infections Restricted/Excluded r"FOOD FRQk�,APPpOUED SOURCE�l'- �i`i,. "T'aj+> ❑ 4. Food and Water from Approved Source ❑ 5. Receiving/Condition ❑ 6. Tags/Records/Accuracy of Ingredient Statements ❑ 7. Conformance with Approved Procedures/HACCP Plans PROTECTIONFROM CONTAMINATK)NX� s f ;Y� 4m i,.„Me ❑ a6 Separation/ Segregation/ Protection IlitJ 9. Food Contact Surfaces Cleaning and Sanitizing [110. Proper Adequate Handwashing ❑ 11. Good Hygienic Practices Violations Related to Good Retail Practices Critical (C) violations marked must be corrected immediately or within 10 days as determined by the Board of Health. Non-critical (N) violations must be corrected immediately or within 90 days as determined by the Board of Health. 23. Management and Personnel (FC -2)(590.003) 24. Food and Food Protection (FC -3)(590.004) 25. Equipment and Utensils (FC -4)(590.005) 26. Water, Plumbing and Waste (FC -5)(590.006) 1011 27. Physical Facility (FC -6)(590.007) 28. Poisonous or Toxic Materials (FC -7)(590.008) 29. Special Requirements (590.009) 30. Other S. 500VtFc m 14.tl /1 /r 1 ❑ 12. Prevention of Contamination from Hands ❑ 13. Handwash Facilities PROTECTION FROM CHEMICALS MuCi: .aw El 14. Approved Food or Color Additives ❑ 15. Toxic Chemicals ,. TIM &EMPERATORE CONTROLS fPotentlatty Haiardous Foopa) 90; Ro4-..'� dal ' ne^ ha.�'�eF..-,. a .Ir;.rmF Pmtc:�.�.�..m'..:e.2 ❑ 16. Cooking Temperatures ❑ 17. Reheating ❑ 18. Cooling ❑ 19. Hot and Cold Holding ❑ 20 Time As a Public Health Control .fel?EJUIREMENTS FOR HIOHI V SUSCEPTIBLE POPULATIONS(HSP) * . I] 21. Food and Food Preparation for HSP ❑ 22. Posting of Consumer Advisories Number of Violated Provisions Related To Foodborne Illnesses Interventions 1 and Risk Factors (Items 1-22): J Official Order for Correction: Based on an inspection today, the items checked indicate violations of 105 CMR 590.000/federal Food Code. This report, when signed below by a Board of Health member or its agent constitutes an order of the Board of Health. Failure to correct violations cited in this,report may result in suspension or revocation of the food establishment permit and cessation of food establishment operations. If aggrieved by this order, you have a right to a hearing. Your request must be in writing and submitted to the Board of Health at the above address within 10 days of receipt of this order. DATE OF RE -INSPECTION: 67- S Inspector's Signatur Print:-Dow) PIC's Signature: VtAA Print: `p efa I Page I of 2 Pages 'J Violations Related to Foodborne Illness Interventions and Risk Factors (items 1-22) PROTECTION FROM CONTAMINATION FOOD PROTECTION MANAGEMENT 1I 590.003(A) I Assignment of Responsibility* 590.003(B) Demstration of Knowledge" 2-103.11 "'7,,a in charge - duties EMPLOYEE HEALTH 2 590.003(,C) Responsibility of the person in charge to Compliance with Food Law* 3-201.12 require reporting by food employees and 3-201.13 Fluid Milk and Milk Products* applicants* Shell Eggs* 590.003(F) Responsibility Of A Foal Employee Or An 3-202.16 Tee Made From Potable Drinking Water* Applicant To Report To The Person In Drinking Water from an Approved System* 590.006(A) Charge* 590.006(B) 590.003(G) Reporting by Person in Charge* 3 590.003(D) Exclusions and Restrictions* 3-201.15 590.003(E) Removal of Exclusions and Restrictions C C C FOOD FROM APPROVED SOURCE 5 Food and Water From Regulated Sources 590.004(A -B) Compliance with Food Law* 3-201.12 Food in a Henneticall y Sealed Container* 3-201.13 Fluid Milk and Milk Products* 3-202.13 Shell Eggs* 3-202.1.4 Eggs and Milk Products. Pasteurized* 3-202.16 Tee Made From Potable Drinking Water* 5-101.11 Drinking Water from an Approved System* 590.006(A) Bottled Drinking Water* 590.006(B) Water Meets Standards in 310 CMR 22:0* Washing Fruits and Vegetables ShelNish and Fish From an Approved Source 3-201.14 Fish and Recreationally Caught Molluscan Shellfish* 3-201.15 Molluscan Shellfish from NSSP Listed sources* Contamination from the Consumer Game and Wild Mushrooms Approved by Regulatoty Authorit 3-202.15 Shellstock Identification Present* 590.004(C) Wild Mushrooms* 3-201.17 Game Animals* 3-701,11 Receiving/Condition 3-202.11 PHFs Received at Proper Temperatures* 3-202.15 Packajze hne it v* 3-101.11. Food Safe and Unadulterated Tags/Records: Shellstock 3-202.18 Shellstock Identification 3-203.12 Shellstock Identification Maintained* Taga(Records: Fish Products 3402.11 Parasite Destruction* 3-402.12 Records. Creation and Retention* 590.004(J) Labeling of Ingredients` Frequency of Sanitization of Utensils and Foal Contact Surfaces of Equipment* Conformance with Approved Procedures /HACCP Plans 3-502.11 Specialized Processing Methods* 3-502.1.2 Reduced oxygen packaging, criteria* 8-103.12 Conformance with Approved Procedures* 5 Cross -contamination 3-302.11(A)(]) - Raw Animal Foods Separated from - Cooked and RTE Fooxis* Contamination from Raw ingredients 3-302.11(A)(2) Raw Animal Foods Separated from Each Other* - Contamination from the Environment 3-302.11(A) Food Protection* 3-302.15 Washing Fruits and Vegetables 3-304.11 Food Contact With Equipment and Utensils* Contamination from the Consumer 3-306.14(A)(B) Returned Food and Reservice of Food* Disposition of Adulterated or Contaminated Food 3-701,11 Discarding or Reconditioning Unsafe F[wd* 9 Food Contact Surfaces 4-501.111. Manual Warewashing - Hot Water Sanitization Temperatures* - 4-501.112 Mechanical Warewashing- Hot Water Sanitization Temperatures* 4-501.114 Chemical. Sanitization- temp., pH, concentration and hardness. * 4-601.11(A) Equipment Food Contact Surfaces and Utensils Clean - 4 -602.11 Cleaning Frequency of Equipment Food - Contact Surfaces and Utensils* 4-702.11 Frequency of Sanitization of Utensils and Foal Contact Surfaces of Equipment* 4- 003.1 t Methods of Sanitization - Hot Water and Chemical* 10 Proper, Adequate Handwashing 2-301.11 Clean Condition -Hands and Anus* 2-301..12 Cleaning Procedure* 2-301.14 When to Wash* ii Good Hygienic Practices 2-401.11 Eating, Drinking or Using Tobacco* 2-401.12 Discharges From the Eyes, Nose and Mouth* 3-30112 PreventinE Contamination When Tasting* 12 Prevention of Contamination from Hands 590.004(E) Preventing Contamination from Employees* 13 Handwash Facilities Conveniently Located and Accessible 5-203.11 Numbers and Capacities* 5-204.1.1 Location and Placement* 5-205.11 Accessibility, Operation and Maintenance Supplied with Soap and Hand Drying Devices 6-301.11 Handwashing Cleanser, Availability 6-301.12 Hand Drying Provision s ' Denotas critical item in the Cederal 1999 Focus Code a 105 CIMR 590.000. CITY OF SALEM BOARD OF HEALTH Establishment Name: 5AiL_Z:x" / eJy>J Date: 11 29-) S Page: Z of 2— item Rem Code C -Critical Item DESCRIPTION OF VIOLATION / PLAN OF CORRECTION Date No. Reference R -Red Item - Verified P EASE PRINT CLEARLY 2 LW-))) d1e§�$ toss t, K 114Sdl�i �� 6115SAC a1G A i 1ipU.AV �. R l! r'• t�iZotl l o v p^ i A �I � i. J 0? ra ^ I�f' r•,a!Y�' da1n. a�w tea, 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 inspection, to observe all conditions as described, and to Exclusion violations before the next ins P O Re -inspection Scheduled Cl Emergency Suspension comply with all mandates of the Mass/Federal Food Code. I understand that noncompliance may result in daily fines of twenty-five dollars or suspension/revocation of ❑ Embargo ❑ Emergency Closure your food permit. 13 Voluntary Disposal ❑ Other: Violations Related to Foodborne Illness Interventions and Risk Factors (Items 1.22) (Cont.) PROTECTION FROM CHEMICALS 14 Food or Color Additives 3-202.12 Additives* 3-302.14 Protection from Unapproved Additives* 15 Poisonous or Toxic Substances 7-101.11 Identifying Information - Original Containers* 7-102.11 Centurion Name- Working Containers* 7-201.11 Separation - Storae* 7-202.11 Restriction- Presence and Use* 7-202.12 Conditions of Use* 7-203.11 Toxic Containers - Prohibitions* 7-204.11 Sanitizers, Criteria - Chemicals* 7-204.12 Chemicals for Washing Produce, Criteria* 7-204.14 Drying Agents, Criteria* 7-205.11 Incidental Food Contact, Lubricants* 7-206.11 Restricted Use Pesticides, Criteria* 7-206.12 Rodent Bait Stations* 7-206-13"frackinggPowders, Pest Control and Monitoring* 16 17 18 TIMEITEMPERATURE CONTROLS * Denotes entical item in the federal 1999 Food Code or 105 CMR 590.000. Proper Cooking Temperatures for Cooling Methods for Plil's PHFs 3-401.11A(I)(2) Eggs- 155aF 15 Sec. 3-801-1 I (C) Eggs- Immediate Service 145°Fl5sec* 3-401.1 1(A)(2) Comminuted Fish, Meats & Game 3-501.16(A) Animals - 155OF 15 sec. * 3-401.11(13)(1)(2) Pork and Beef Roast - 130OF 121 min' 3-401.11(A)(2) Raines, Injected MeaLs - 155'F 15 sec. 26. Time as a Public Health Control 3-401.11(A)(3) Poultry, Wild Game, Stuffed PHFs, Time as a Public Health Control* Stuffing Containing Fish, Meal, 590.004(1-1) Poultry or Ratites -1650F 15 sec. 3-401.1 1(C)(3) Whole -muscle, Intact Beef Steaks 145'F * 3-401.12 - Raw Animal Foods Cooked in a Microwave 165OF * 3-401.11(A)(1)(b) All Other PHFs -145°Fl5sec. * Reheating for Hot Holding 3-403.11(A)&(D) PFas 165'F 15 sec. 3-403.1](13) Microwave- 165° F 2 Minute Standing I une* 3-403.1 1(C) Commercially Processed RTE Food - 1400F* 3-403.11(1--) Remaining UnslicedPortions ofBeef Roasts* Proper Cooling of PHFs 3-501.14(A) Cooling Cooked f'I-IFs from 1400F to 70017 Within 2 Hours and From 700F to 410F/450F Within 4 Hours. 3-50L14(B) Cooling PHFs Made From Ambient Temperature Ingredients to 410F/450F Within 4 Horn's* 3-50L14(C) PIfFsReceived atTemperatures .According to Law Cooled to 41017/45017 Within 4 Hours. * * Denotes entical item in the federal 1999 Food Code or 105 CMR 590.000. REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS (HSP) 3-801.11(A) 3-501.15 Cooling Methods for Plil's 19 3-801-I I (D) PHF Hot and Cold Holding 3-801-1 I (C) 3-501.16(B) 590.004(F) Cold PF[Fs Maintained at or below 410/450 F* Food and Food Protection 3-501.16(A) Hot PHFs Maintained at or above 140017 * 25. 3-501.16(A) Roasts Meld at or above 1300F. 20 26. Time as a Public Health Control FC - 5 3-501.19 Time as a Public Health Control* Physical Facility 590.004(1-1) Variance Requuenhent REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS (HSP) 3-801.11(A) Unpasteurized Pre-packaged Juices and Beverages with Warning Labels* 3-801.1](13) Use of pasteurized Ea s* 3-801-I I (D) Raw or Partially Cooked Animal Food and Raw Seed Sprouts Not Served. * 3-801-1 I (C) Unopened Food Package Not Re -served. CONSUMER ADVISORY 22 3-603.11 Consumer Advisory Posted for Consumption of 590.000 23. Animal Foods That are Raw, Undercooked or FC - 2 .003 Not Otherwise Processed to Eliminate Food and Food Protection FC _-3 Pathogens.* erteCGi* "' 25. 3-302.13 Pasteurized Eggs Substitute for Raw Shell Eggs* SPECIAL REQUIREMENTS 590.009(A) -(D) Violations of Section 590.009(A) -(D) in catering, mobile food, temporary and residential kitchen operations should be debited mrder the appropriate sections above if related to foodborne illness interventions and risk factors. Other 590.009 violations relating to good retail practices should be debited under #29 - Special Requirements. VIOLATIONS RELATED TO GOOD RETAIL PRACTICES (Items 23-311) Critical and non-critical violations, which do riot relate to the foodborne illness interventions and risk factm5 listed above, can be found in Ibe following sections of the Food Code and 105 CMN 590.000. Item Good Retail Practices FC 590.000 23. Manu ement and Personnel FC - 2 .003 '24. Food and Food Protection FC _-3 .004 25. Equipment and Utensils FC -4 .005 26. Water, Plumbing and Waste FC - 5 .006 27. Physical Facility FC -6 .007 28. Poisonous or Toxic Materials 29. Special Requirements .009 30. Other S'3Nf bz462.brc Massachusetts Department of Public Health Salem Board of Health 120 Washington Street, 0 Floor Division of Food and Drugs Salem, MA 01 910-3 52 3 Tel (978) 741-1800 Fax (978) 74570343 City/Town of FOOD ESTABLISHMENT INSPFCTInN RFPnRT Address: rel Name Date TTYPe of Operations) Type of Inspection S� - ', ?,)"IQ9- Food Service ❑ Retail A Routine ❑ Re -inspection Address SJMrn� �' Risk Level ❑ Residential Kitchen Previous Inspection Telephone - .. - ❑ Mobile - Date: ❑ Temporary Caterer ❑ Bed & Breakfast [IPre-operation❑ ❑ Suspect Illness ❑ General Complaint OwnerHACCP YIN Person -in -Charge (PIC) Time In: ❑ HACCP. Inspector 1) C�f1.EsSO Out: Permit No. ❑.Other Each viotation cnecKea 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_(Red Items) - - Anti -Choking 590.009(E) ❑ Violations marked may pose an imminent health hazard and require immediate Tobacco 590.009 (F) ❑ . corrective action as determined by the Board of Health. Allergen Awareness 590.009 (G)[I FOOQ PROTECTION MANAGEM_E-NT_ El 1. PIC Assigned/Knowledgeable/Duties �EMPLOYE_E HEALTH _ _- ❑ 2. Reporting of Diseases by Food Employee and PIC 3. Personnel with Infections Restricted/Excluded ROOD_FROMAPPROVED SOURCE ❑ 4. Food and Water from -Approved Source ❑ 5. ReceivinglCondition ❑ 6. Tags/Records/Accuracy. of Ingredient Statements ❑ 7. Conformance with Approved Procedures/HACCP Plans PROTECTION FROM CONLAMINATION ❑ ❑ 8.Separation/Segregation/Protection ❑ 9. Food Contact Surfaces Cleaning and Sanitizing ❑ 10. Proper Adequate Handwashing ❑ 11. Good Hygienic Practices Violations Related to Good Retail Practices_ (Blue Items) Critical (C) violations marked must be corrected immediately or within 10 days as determined by the Board of Health. Noncritical (N) violations must be corrected immediately or within 90 days as determined by the Board of Health. _ C N 23. Management and Personnel (FC -2x590.003) 24. Food and Food Protection (FC -3x590.004) 25. Equipment and Utensils (FC -4x590.005) 26. Water, Plumbing and Waste (FC-SX59o.006) 27. Physical Facility (FC -6x590.007) 28. Poisonous or Toxic Materials (FC -7x590.008) 29. Special Requirements (590.009) 30. Other ^ . .: ,r ❑ 12. Prevention of Contamination from Hands 13. Handwash Facilities LPROTECTION FROM`CHEMI I _ ❑ 14. Approved Food or Color Additives ❑ 15. Toxic Chemicals �--^" TIMER_EMPERATURE"CONTROLS (Pot> antfelly H_ azardous Food_ e)-= ❑ 16. Cooking Temperatures ❑ 17. Reheating [118. Cooling ❑19.Hot and Cold Holding - ❑ 20. Time as a Public Health Control r tREOUIREMENTS FOR HIGHLYSU_sciii T BCE_POPULATI_ONSA ❑ 21. Food and Food Preparation for HSP i CONSUMER ADVISORY ❑ 22. Posting of Consumer Advisories Number of Violated ses Interventions Related To Foodborne Illnesses Interventions and Risk factors (Red Items 1-22): Official Order for Correction: Based on an inspection today, the items checked indicate violations of 105 CMR 590.000/federal Food Code. This report, when signed below by a Board of Health member or its agent constitutes an order of the Board of Health. Failure to correct violations cited in this report may result in suspension or revocation of the food establishment permit and cessation of food establishment operations. If aggrieved by this order, you have a right to a hearing. Your request must be in writing and submitted to the Board of Health at the above address within 10 days of receipt of this order. DATE OF RE -INSPECTION: Inspector's Signatur . tr Print: Page / of Z -Pages PICS Signature:Print: tad `l - `� t Violations Related to Foodborne Illness Interventions and Risk Factors (Items 1-22) FOOD PROTECTION MANAGEMENT 1 590.003(A) Assig tmeor ofResponsibility* 590.003(B) Demonstration of Knowledge* _ 2-103.11. Person in charge - duties EMPLOYEE HEALTH 2 590.003(C) Responsibility of the person in charge to Compliance with Food Caw* i 3-201.12 require reporting by food employees and 3-201.13 Fluid Milk and Milk Products* applicants* Shell Eggs* 590.003(F) Responsibility OCA Food Employee Or An 3-202.16 Ice Made From Potable Drinking Water* Applicant To Report To The Person In Drinkin Water from an Approved S tem* 590.006(A) Charge* 590.006(B) 590.003(G) Reporting by Person in Charee* 3 590.003(D) Exclusions and Restrictions* 3-201.15 590.003(F) Removal of Exclusions and Restrictions 191 5 7 FOOD FROM APPROVED SOURCE ' Denofcs critical item in the federal 1999 Pahl Code or 105 CMR 590.000, 8 PROTECTION FROM CONTAMINATION Food and Water From Regulated Sources 590.004(A -B) Compliance with Food Caw* i 3-201.12 F<xxi in a. Hermetically Seated Container* 3-201.13 Fluid Milk and Milk Products* 3-202.13 Shell Eggs* 3-202.14 Eggs and Milk Products, Pasteurimd 3-202.16 Ice Made From Potable Drinking Water* 5-101.11 Drinkin Water from an Approved S tem* 590.006(A) Bottled Drinkim Water 590.006(B) Water Meets Standards in 110 CMR 22.04 Frequency of Sanitization of Utensils and Food Contact Surfaces of Equipment* Shelffish and Fut Fion, an Approved Source 3-201.14 Fish and Recreationally Ctmght Molluscan Shellfish* 3-201.15 _ Molluscan Shellfish from NSSF Listed Sources* Proper, Adequate Handwashing Game and Wi+d Mushrooms Approved by Regulatoty Authority - _ 3 -20118 SheilstockidentificticmPrescnt" 590.004(C) Wild Mushrooms* 3-201.17 Game Animals* - 2-301_14 ReceivingfCondition 3-202.1.1 PHFs Received at Proper Temperatures* 3-202.1.5 Package Integrity* 3-!01.11 Food Safe and Unadulterated , ags/Rerords: r helistock 3-202.18 Shellstock Identification * 3-203.12 Shellstock Identi'f'ication Maintained` 12 _ Tags/Records:Fish Products 3-402.11 Parasite Destrucuon* 3-402.12 1 Records, Creation and Retention* 590.004(J) I Labeling of Ingredients' Handwash Facilities Conformance with Approved Procedures /HACCP Plans 3-502.11 5 ecializsd Processing Methods* 3-502:12 Reduced ox genpackagingg,cd[eria* 8-103.12 Conformance with Approved Procedures* ' Denofcs critical item in the federal 1999 Pahl Code or 105 CMR 590.000, 8 PROTECTION FROM CONTAMINATION 9 Cross -contamination 3-302.11(A)(1) Raw Animal Foods Separated from Cooked and RTE Foods* 4-501.1.11. Contamination from Raw Ingredients 3-302.11(A)(2) Raw Animal Foods Separated from Each Other* Mechanical Warewashing- Hot Water Sanitization Temperatures* Contamination from the Environment 3-302.11(A) Food Protection* 3-302.15 Washing Fruits and Vegetables 3-304.11 Food Contact with Equipment and Utensils* - 4-602. 1.1 Contamination from the Consumer 3-306.14(A)(B) Returned Food and Reservice of Food* Frequency of Sanitization of Utensils and Food Contact Surfaces of Equipment* Disposition of Adulterated or Contaminated Food 3-70J.1 1 Discarding or Reconditioning Unsafe Food* 9 Food Contact Surfaces 4-501.1.11. Manual Warewashing - Hot Water - Sanitization Te eralures* 4-501.112 Mechanical Warewashing- Hot Water Sanitization Temperatures* 4-501.114 Chemical Sanitization- temp., pH, concentration and hardness. * 4-601.11(A) Equipment Food Contact Surfaces and Utensils Clean* 4-602. 1.1 Cleaning Frequency of Equipment Food - Contact Surfaces and Utensils* 4-702.11 Frequency of Sanitization of Utensils and Food Contact Surfaces of Equipment* 4703.11 Methods of Sanitization - Hot Water and Chemical* 10 Proper, Adequate Handwashing 2-301..11 Clean Condition -Hands and Arms* 2-301.1.2 Cleaning Procedure* 2-301_14 When to Wash* 11 Good Hygienic Practices 2401.11 Eating, Drinking or Using Tobacco* 2-401.12 Discharges. From the Eyes, Nose and Mouth* " 3-301.12 Preventing Contamination When Tasting* 12 - Prevention of Contamination from Hands 590.004(F) Preventing Contamination from Employees* 13 Handwash Facilities Conveniently Located and Accessible 5-203.11. Numbers and Capacities* 5-204.11 Location and Placement* 5-205.11. - Accessibility. Operation and Maintenance Supplied with Soap and Hand Drying Devices 6-301.11 Handwashing Cleanser, Availability 6-301.t2 Hand -D ng 'Provision CITY OF SALEM BOARD OF HEALTH Establishment Name: Sni_k:� ,00 Date: Page: Z of 1 72 - Item Rem No. Code Reference C -Critical Item R - Red Item DESCRIPTION OF VIOLATION / PLAN OF CORRECTION ' PLEASE PRINT CLEARLY Date - -Verified tiTtaSF; I� SPi, Na�CK� �N� ►�vL�...�iry�'. �S'�1_1"L 'pt,.tc=�.�, �12av�s�E- So A4' �3�C� IS6t�Sn l,•� 1'r+P'ea�- V��L� t*t we�vt. ain t tVeJ 9Gr+S� 6t l ri ALA- JS 1S S--L�S l VL- — 747-_ h"ct0 u4 ASA \ ,J11_ r,wi D vc- 44 Discussion With Person in Charge: I have read this report, have had the opportunity to ask questions and agree to correct all violations before the next inspection, to observe all conditions as described, and to P comply with all mandates of the Mass/Federal Food Code. I understand that noncompliance may result in daily fines twentx-fiv Bolla s or susp r+sion/ vocation of your food permit. Corrective Action Required: ❑ No ❑: Xes ❑ Voluntary Compliance ❑ Employee Restriction / Exclusion ❑ Re -inspection Scheduled ❑ Emergency Suspension ❑ Embargo ❑ Emergency Closure ❑ Voluntary Disposal ❑ Other. Violations Related to Foodborne Riness interventions and Risk Factors fltems 1-22) (Cont.) 15 16 Im 18 _._..._ Additives 3-20252 Additives* - -� 3-302.14 Protection from Un roved Additives* Poisonous or Toxic Substances 7-10111 identifyingInformation - Original Containers* 7-102.11. Common Name - Working Containers* 7-201.11 Separation - Stora 7-202.11 . Restriction - Presence and Use* 7-202.12 Conditions of Use* 7-203.11 Toxic Containers - Prohibitions* 7-264.11 Saititizers. Criteria - Chemicals* 7-204.12 Chemicals for Washing Produce, Criteria' 7-204.14 DTying Agents. Criteria* 7-2D5.11 ficidemal Food Contact, Lubricants* 7-206.11 Restricted Use Pesticides, Criteria* 7-206.12 Rodent Bart Stances* 7-206.13 Tracking Powders, Pest Control and Monitoring* Food or Color It F7_i 14,11 T4 Mu 'A ug�. Proper Cooking Temperatures for _. 3-501..15 PHFs 3-401.I1A(1)(2) _ Eggs- 155`F 15 Sec. 3-501.16(13) 590.004(F) Eggs- immediate, Service 1450F15sec* 3-401.11(A)(2) Comminuted Fish. Meats & Game 3-501.16(A) Anitnals - 155'F 15 sec. * 3.401.11(B)(1)(2) Pork and Beef Rawl - 130OF 121 min* 3-401.11(A)(2) Ratites, injected Meats -1550F 15 590.004(H) Sec. * 3401.11(A)(3) Poultry, Wild Game, Stuffed PHFs, Stuffing Containing Fish, Meat, Poultry or Ratites -165'F 15 sec. 3-401.11(C)(3) Whole -muscle, Imact Beef Steaks 145'F * 31101.12 ,Raw Animal Foods Cooked in a Microwave 1650F 3-401.11(A)(1)(b) All Other PHFs - 145'F 15 sec. Food or Color It F7_i 14,11 T4 Mu 'A ug�. * Dernxes critical lyra in the federal 1999 Foal Code or 105 CMIZ 190.000. 2D 3-501,14(C) Proper Cooking Temperatures for _. 3-501..15 PHFs 3-401.I1A(1)(2) _ Eggs- 155`F 15 Sec. 3-501.16(13) 590.004(F) Eggs- immediate, Service 1450F15sec* 3-401.11(A)(2) Comminuted Fish. Meats & Game 3-501.16(A) Anitnals - 155'F 15 sec. * 3.401.11(B)(1)(2) Pork and Beef Rawl - 130OF 121 min* 3-401.11(A)(2) Ratites, injected Meats -1550F 15 590.004(H) Sec. * 3401.11(A)(3) Poultry, Wild Game, Stuffed PHFs, Stuffing Containing Fish, Meat, Poultry or Ratites -165'F 15 sec. 3-401.11(C)(3) Whole -muscle, Imact Beef Steaks 145'F * 31101.12 ,Raw Animal Foods Cooked in a Microwave 1650F 3-401.11(A)(1)(b) All Other PHFs - 145'F 15 sec. Reheating for Hot Holding 3-403.11(A)&(D) PHFs 165"F 15 sec. * 3-403.11(B) Microwave- 165= F 2 Minute Standing Time* 3403, 1 i(C) Commercially Processed RTE Food - 1400F* 3403.11(E) - Remaining Unsliced Portions of Beef Roasts* Proper Cooling of PHFs 3-501.14(A) Cooling Cooked PRFs from 1400F to 70'F Within 2 Hours and From 700F to 41'F/45'F Within 4 Hours. * 3-501.14(.6) Cooling PRFs .Made From Ambient Temperature Ingredients to 41'F/450F Within 4 Maim* * Dernxes critical lyra in the federal 1999 Foal Code or 105 CMIZ 190.000. 2D 3-501,14(C) PRFs Received at Temperatures According to Law Cooled to - 41'Ft45'F_Within 4 Houm 3-501..15 Coohng Methods for PHFs 3-801.i1(B PHF Hot and Cold Holding 3-501.16(13) 590.004(F) Cold P1JFs Maintained at or below 410145' F* 3-501.16(A) Hot PHFs Maintained at or above 1400F. * 3-501.16(A) Russo; Held at or above 130'F. Tdma as a Public Health Control 3-50IA9 Time as a Public Health Control* 590.004(H) Variance Requirement REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIDNS (HSP) 21 3-801.11(A) Unpasteurized Pre-packaged Juices and Beverages with Warning Labels_* 3-801.i1(B _ �Use ofPasteurimlEggs* u 3-801.1 I (Dj Raw or Partially Cooked Animal Food and Raw Seed S us Not Served. s 3-801.11(C) Unopened Food Package Not Re -served. CONSUMER ADVISORY 22 3-603.11 Consumer Advisory Pasted for Consumption of Animal Foods That are Raw, Undercooked or Not OtherwiseProcessedto Eliminate Patbo gens.* mere v,rrx, 3-302.13 Pasteurized Eggs Substitute for Raw Shell Eggs* SPECIAL REOUIREMENTS 590.009(A) -(D) Violations of Section 590.009(A) -(D) in catering, mobile food, temporary and residential kitchen operations should be debited under the appropriate sections above if related to foodborne iliness interventions and risk factors. Other 590,009 violations relating to good retail practices should be debited under X29 - Special Requirements. a • r ;t -ins - (Itettts 23-30) Critical,m,d neon -critical violations, which do not relate to the foodborne illness interventions and risk factors listed above, can he found in the following sections of the Food Code and 20S CMR Massachusetts Department of Public Health Division of Food and Drugs FOOD ESTABLISHMENT'INSPECTION REPORT Salem Board of Health .,120 Washington Street, 4'" Floor Salem,.MA 01970-3523 Tel. (978) 741-1800 Fax (978) 745-0343 Name S4 DateT S__�P-�� e of O orations . Type of Ins tion' Food Service ❑ Retail ❑ Residential Kitchen - ❑ Mobile ElTemporary ❑ Caterer ElBed & Breakfast Permit No. U Routine Re -inspection Previous Inspection Date: ❑ Pre-operation - ❑ Suspect Illness El General Complaint ❑HACCP ❑ Other Address -1 v� Telephone Risk Level OwnerHACCP `) �IG1C Q�ijl YM Person In Charge (PIC)�'�) 'r� E 1� .Yh VVl Time In: . Out: I Inspector'D, Q - 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 -ROT ECTIONMANAGEMENT ❑ 1. PIC Assigned / Knowledgeable/tDuties EMPLOYEE HEALTH < ❑ 2. Reporting of Diseases by Food Employee and PIC ❑ 3. Personnel with Infections Restricted/Excluded FOOD FROM_A_PPROVED SOURCE " ❑ 4. Food and Water from Approved Source ❑ 5. Receiving/Condition ❑ 6. Tags/Records/Accuracy of Ingredient Statements ❑ 7. Conformance with Approved Procedures/HACCP Plans PROTECTION FROM CONTAMINATION' 8.Separation/ Segregation/ Protection ❑. 9. Food Contact Surfaces Cleaning and Sanitizing . ❑ 10: Proper Adequate Handwashing El 11. Good Hygienic Practices Violations Related to Good Retail Practices Critical (C) violations marked must be corrected immediately or within 10 days as determined by the Board of Health. Non-critical (N) violations must be corrected immediately or within 90 days as determined by the Board of Health. C N - 23. Management and Personnel (Fc -2)(5,90.003) 24. Food and Food Protection (FC -3)(590.004) 25. Equipment and Utensils (FC -4)(590.005) 6. Water, Plumbing and Waste (FC -5)(596.006) jZ 27. Physical Facility (FC -6)(590.007) 28. Poisonous or Toxic Materials (FC -7)(590.008) 29. Special Requirements` (590.009) 30. Other S'S901nspe IFPo 14C ❑ 12. Prevention of Contamination from Hands ❑ 13. Handwash Facilities (PROTECTION FROM CHEMICALS -�+ r14r,'a [:114. Approved Food or Color Additives ❑ 15. Toxic Chemicals TIME/TEMPERATURE CONTROLS (Potentially Hazardous Foods_) ... ❑ 16. Cooking Temperatures ❑ 17. Reheating ❑ 18. Cooling ❑ 19. Hot and Cold Holding ❑ 20. Time As a Public Health Control ___ REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS_- (HSP)( ❑ 21. Food and Food Preparation for HSP CONSUMER ADVISORY El 22. Posting of Consumer Advisories Number of Violated Provisions Related To Foodborne Illnesses Interventions and Risk Factors (Items 1-22): Official Order for Correction: Based on an inspection today, the items checked indicate violations of 105 CMR 590.000/federal Food Code. This report, when signed below by a Board of Health member or its agent constitutes an order of the Board of Health. Failure to correct violations cited in this report may result in suspension or revocation of the food establishment permit and cessation of food establishment operations. If aggrieved by this order, you have aright to a hearing. Your request must be in writing and submitted to the Board of Health at the above address Within 10 days of receipt of this order. DATE OF RE -INSPECTION: Qin ►► %/" ��1��in��aMA 4 AAAI V , Violations Related to Foodborne Illness Interventions and Risk Factors (Items 1-22) FOOD PROTECTION MANAGEMENT 1 590.003(A) Assignment of Responsibility* 590.003(B) Demonstration of Knowledge" 2-103.11.Person in charge -duties EMPLOYEE HEALTH 2 .590.003(C) Responsibility of the person in charge to Compliance with Food Law* 3-201.12 require reporting by food employees and 3-20113 Fluid Milk and Milk Products* applicants* " Shell Eggs* 590.003(F) Responsibility Of A Food Employee Or An 3-202.16 Ice Made From Potable Drinking Water* Applicant To Report To The Person In tem* Drinking Water from an Approved System* 590.006(A) Charge* 590.(X)6(B) 590.003(G) Reporting by Person in Char e* 3 590.003(D) Exclusions and Restrictions* 3-201.15 59 )%,(E) Removal of Exclusions and Restrictions 4 6 C FOOD FROM APPROVED SOURCE " Denotes crincid item in the federt0 1999 Foal Cale or 105 CMR 590.000. �0 -PROTECTION FROM CONTAMINATION Food and Water From Regulated Sources 590.004(A -B) Compliance with Food Law* 3-201.12 Foci in a Hermetically Sealed Container* .. 3-20113 Fluid Milk and Milk Products* 3-202.J3 Shell Eggs* 3-202.14 Eggs and Milk Products. Pasteurized* 3-202.16 Ice Made From Potable Drinking Water* " 5-101.1.1 tem* Drinking Water from an Approved System* 590.006(A) Bottled Drinkin Water* 590.(X)6(B) Water Meets Standards in 310 CMR 22.0* Frequency of Sanitization of Utensils and - Food Contact Surfaces ofEquipment* ShelHish and Fish From an Approved Source 3-201.14 Fish and Recreationally Caught Molluscan Shellfish* 3-201.15 Molluscan Shellfish from NSSP Iisted Sources* .. Game and Wild Mushrooms Approved by Regulatory Authority 3-202.18 Shellstock Identification Present* 590.004(C) Wild Mushrooms* 3-201.17 Game Animals* " 2-301.14 Receiving/Condition 3-202.11 PHFs Received at Proper Temperatures* 3-202.15 Packs e Integrity* 3-101.11. Food Safe and Unadulterated - - Tags/Records: Shellstock 3-202.18 Shellstock Identification * 3-203.12 Shellstock Identification Maintained* 12 Tags/Records:'Fish Products 3402.11 Parasite Destruction* 3-402.12 Records. Creation and Retention* 590.004(7) Labeling of Ingredients' Handwash Facilities - Conformance with Approved Procedures /HACCP Plans 3-502.11. Specialized Processing Methods* 3-502.12 Reduced os men packaging, criteria* 8-103.12 Conformance with A: roved Procedures* " Denotes crincid item in the federt0 1999 Foal Cale or 105 CMR 590.000. �0 -PROTECTION FROM CONTAMINATION 9 Cross -contamination 3-302.11(A)(]) Raw Animal Foods Separated from Cooked and RTE Foals* 4-501..1.11. Contamination from Raw Ingredients 3-302.11(A)(2) RawAninnal Foals Separated from Each Other* Mechanical Warewashing- Hot Water " Sanitization Temperatures* " Contamination from the Environment 3-302.11(A) Food Protection* 3-302.15 Washing Fruits and Vegetables 3-304.11. - Food Contact with Equipment and - Utensils* " Contamination from the Consumer 3-306.14(A)(B) Returned Food and Reservice of Food* Frequency of Sanitization of Utensils and - Food Contact Surfaces ofEquipment* Disposition of Adulterated or Contaminated - Food 3-701.11 Discarding or Reconditioning Unsafe Food* 9 Food Contact Surfaces 4-501..1.11. Manual Warewashing - Hot Water Sanitization Te ratures* 4-501.112 Mechanical Warewashing- Hot Water " Sanitization Temperatures* " 4-501.114 Chemical Sanitization- temp., pH, concentration and hardness. * 4-601.11(A) Equipment Food Contact Surfaces and " Utensils Clean* 4-602.11 Cleaning Frequency of Equipment Food -- Contact Surfaces and Utensils* - 4-70211 Frequency of Sanitization of Utensils and - Food Contact Surfaces ofEquipment* 4-703.11 Methods of Sanitization - Hot Water and Chemical* 10 Proper, Adequate Handwashing 2301.11 " Clean Condition -Elands and Arms* 2-301..12 Cleaning Procedure* 2-301.14 When to Wash* Il Good Hygienic Practices " 2401.11 Eatin , Drinking or Using Tobacco* 2-401.12 Discharges From the Eyes, Nose and Mouth* 3-30L12 - Preventing Contamination When Tasting* 12 Prevention of Contamination from Hands 590.004(E) Preventing Contamination from Employees* 13 Handwash Facilities - Conveniently Located and Accessible 5-203.11 Numbers and Capacities* 5-204.11 location and Placement* 5-205.11 Accessibility, Operation and Maintenance Supplied with Soap and Hand Drying Devices 6-301.11 Handwashing Cleanser,.Availabilit 6-301..1.2 Hand "Drying Provision CITY OF SALEM BOARD OF HEALTH Establishment Name:_ SAIur iNt•! Date: S S6—IL _ Paqe: Z of Item No. Code Reference C - Critical tram R -Red Item DESCRIPTION OF VIOLATION / PLAN OF CORRECTION - PLEASE PRINT CLEARLY Date Verlfled 03S R Lb o TNS S w Z p0*15, Vogl 9- T14 i6 -r 4i6 I l\ ) R d��b41.�' She ic�vo d ^ \ )� 1�-I�o' 1 (✓fid Discussion With Person in Charge: I have read this report, have had the opportunity to ask questions and agree to correct all violations before the next inspection, to observe all conditions as described, and to comply with all mandates of the Mass/F deral Food Code. I understad that noncompliance may result in daily fine of r enty-fav Ila or s e Si /recto ati n of your food permit. Corrective Action Required: ❑ . No ❑ Voluntary Compliance ❑ Employee Restriction / Exclusion ❑ Re -inspection Scheduled ❑ Emergency Suspension ❑Embargo ❑ Emergency Closure ❑ Voluntary Disposal ❑ Other: Violations Related to Foodborne Illness Interventions and Risk Factors (Items 1-22) (Cant.) PROTECTION FROM CHEMICALS 14 15 16, 17 18 TIMFITEMPFRATIIRE CONTROLS Food or Color Additives 3-202.12 Addifives*' 3-302.14 Protection from Unapproved Additives' 3-501.16($) 590.004(17) Poisonous or Toxic Substances 7-101.11 Identifying Information - Original Containers* 7-102.11, Common Name - Working Containers* 7-201.11 Separation - Storage - 7-202.11 . Restriction - Presence and Use* 7-202.12 Conditions of Use* 7-203.11 Toxic Containers - Prohibitions* 7-204.11 Sanitizers. Criteria - Chemicals* 7-204.12 Chemicals for Washing Produce, Criteria* 7-204.14 Drying Agents. Criteria* 7-205.11 Incidental Food Contact, Lubricants* 7-206.11- Restricted Use Pesticides, Criteria* 7-206.12 Rodent Bait Stations* 7-206.13 Tracking Powders, Pest Control and * [Monitoring* TIMFITEMPFRATIIRE CONTROLS * Denotes critical item in the federal 1999 Food Cafe M 105 CMR 590.000. 26 21 3-501:14(C) Proper Cooking Temperatures for 3-501.15 PHFs 3-401.11A(1)(2) Eggs- 155°F 15 Sea 3-501.16($) 590.004(17) Eggs- Immediate Service 145°F15sec* 3401.11(A)(2) Connninuted Fish. Meats & Game 3-501.16(A) Animals - 155°F 15 sec. * 3-401.11(B)(I)(2) Pork and Beef Roast -130°F 121 min* 3-401.11(A)(2) Rattles, Injected Meats -155°F 15 590.004(H) sec. * �3-401.11(A)(3) Poultry, Wild Game, Staffed PHFs, 27. Stuffing Containing Fish, Meat, - Poultry or Ratites -165°F 15 sec. 3-401.11(C)(3) Whole -muscle, Intact Beef Steaks FC : 7 145°F * 3401.12 Raw Animal Foods Cooked in a Microwave 165`F * 3-401.11(A)(1)(b) All Other PHFs - 145°F 15 see. ! Reheating for Hot Holding 3403AI(A)&(D) PHFs 165-F 15 sec. * 3-403.11(B) Microwave -16.5° F 2 Minute Standing Time* 3403.11(C) Conintercially Processed RTE Food - 140°F* 3-403.11(E) Remaining Unsliced Portions of Beef Roasts* Proper Cooling of PHFs 3-501.14(A) Cooling Cooked PHFs from 140°F to 70°F Within 2 Hours and From 70"F to 41°F145°F Within 4 Hours. * 3-501.14(B) Cooling PHFs Made From Ambient Temperature Ingredients to 41°F/45°F Within 4 Hours* * Denotes critical item in the federal 1999 Food Cafe M 105 CMR 590.000. 26 21 3-501:14(C) PHFs Received at Temperatures According to law Cooled to 41°F/45"F Within 4 Hours. 3-501.15 Cooling Methods for PHFs 3-801.11(D) PHF Hot and Cold Holding 3-501.16($) 590.004(17) Cold PRFs Maintained at or below 41°145°F* 3-501.16(A) Hot PRFs Maintained at or above 140°17. * 3-501.16(A) Roasts Held at or above 130°F. 25. rime as a Public Health Control 3-501.19 Time as a Public Health Control* 590.004(H) Variance Requirement REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSPI 3-801.11(A) Unpasteurized Pre-packaged Juices and Beverages with Wanting labels* 3-801.11(B) Use of Pasteurized Eggs* 3-801.11(D) Raw or Partially Cooked Animal Foci and Raw Seed Sprouts Not Served. * 3-801.11(C) Unopened Food Package Not Re -served. CONSUMER ADVISORY 22 3-603.11 Consumer Advisory Posted for Consumption of 590.000 23. Animal Foods That are Raw. Undercooked or FC -2 .003 Not Otherwise Processed to Eliminate Food and Food Protection FC -3 Patho ens.* eAe `ly'? I 25. 3-302.13 Pasteurized Eggs Substitute for Raw Shell .005 26. Eggs* 590.009(A) -(D) Violations of Section .590.009(A) -(D) in catering, mobile food, temporary and residential kitchen operations should be debited under the appropriate sections above if related to foodborne illness interventions and risk factors. Other 590.()09 violations relating to good retail practices should be debited under #29 - Special Requirements. (Items 23-30) Critical, and non-critical violations, which do not relate to the - foodborne illness interventions and risk factors listed above, can he found in the fallowing sections of the Food Code mid 105 CMR 590.000, Item Good Retail Practices .FC 590.000 23. Manauement and Personnel FC -2 .003 24. Food and Food Protection FC -3 .004 25. Equi rd and Utensils i FC -4 .005 26. Water. Plumbing and Waste FC - 5 .006 I 27. Physical Facility FC - 6 .007 28. Poisonous or Toxic Materials FC : 7 .008 29. - Special Requirements .009 30. Other ! .S: 5V.1.2� 5/24/12 Gmail - LENS IDENTIFICATION LENS IDENTIFICATION Ed Levasseur <ed@fluorolite.com> To: reservations@saleminnma.com Dear Jennifer , Thu, May 24, 2012 at 2:20 PM I appreciate you considering Fluorolite for all your replacement lens needs. Below are your estimate details: Item #: F-2139 @ 47-7/8 PLEASE NOTE IN NEW ENGLAND WE SELL THROUGH DISTRIBUTION Price: PLEASE CONTACT A LOCAL ELECTRICAL DISTRIBUTOR AND THEY CAN CONTACT US FOR PRICING ON THIS FLUOROLIfE PART # Lead Time: 2-3days Shipping Charges: FOB FRAMINGHAM , MA (prepay and charge ) Packaging fee : $3.95 We'd really like the opportunity to work with you on this job. If you have any questions feel free to contact me directly. Sincerely, m Fluorolite Plastics Tel: 50$799,12& X Fax: (Cpl - (S -.C" https://mail.google,comimail/?ui=2&ik=837b2bl 5128view=pt&search=inbox&th=1378014d6caf8blc 1/1 i o1-�hJPlast can - EN F © Webe got you covered ori Sas TRACE N FAX PROPERTY OF FLUOROLITE PLASTICS, INC. a I- Date: 51a--�ite'1 Comparryname:VVC Sa Pantfl"Y) sTel#ggT-q4t-Bl6 119-144 -Sqat 1 n Contact person: Jab reference:( WRAPS ORDER FORM Other product specific order forms are available on our website Address: -1 �MIY u sk, City/State/zip: Sa u—AYL U R at(�-1, t o Email: f9'Se-x%C1-6oY1S SA`Q,tY kno met -C-a M 2 meAsune the overall length. width & depth of old plastic tens. PLEASE BE EXACT! 3 r og" len9�• 8 dth and depth COMPLETE 6 FAX this form dve# ( . m Ili tPn fm..P_ SM -7934374 -. Overall Length: g / t Onerall Width: \� Overall Oepth: Quantity: Wrap Cular. LtEAA PHISM wHRE FI End Cap Color: aEARPPISM❑ WHITE[] N/Ag"' Special Features: tholes, clips, springs, etc.] IMPORTANT! If the lens profile is larger than the provided space, simply wave one side of the lens and s : measure the overall width Massachusetts Department of Public Health Division of Food and Drugs FOOD ESTABLISHMENT INSPECTION REPORT Salem Board of Health 120 Washington, Street, 41h Floor Salem, MA 01970-3523,- ; Tel. (978) 741-1800 Fax (978) 745-0343 Name1 C Xww Date Type of 0 eration s T of Ins tion" food Service ❑ Retail �' iI-�M 5'f Routine ❑ Re -inspection Address 7 Risk Level El Residential Kitchen Previous Inspection Telephone U ) ryU . Q El Mobile [ITemporary .. ❑ Caterer ❑ Bed & Breakfast Date:. ❑ Pre-operation ❑ Suspect Illness ❑ General Complaint OwnerHACCP lit iN� +'i) I Lx PN1 Y/N Person in Charge (PIC) SS�rr�� Time In: Out: Permit No. El HACCP ❑ Other Inspector 't J 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 ❑ 1. PIC Assigned / Knowledgeable / Duties EMPLOYEE HEALTH a ❑ 2. Reporting of Diseases by Food Employee and PIC ❑ 3. Personnel with Infections Restricted/Excluded 'FOOD FROM APPROVED SOURCE. . ❑ 4. Food and Water from Approved Source 5. Receiving/Condition ❑ 6. Tags/Records/Accuracy of Ingredient Statements , ❑ 7. Conformance with Approved Procedures/HACCP Plans L PROTECTION FROM CONTAMINATION, _„ ' �,�.,. uA ❑ 8. Separation/ Segregation/ Protection ❑ 9. Food Contact Surfaces Cleaning and Sanitizing ❑ 10. Proper Adequate Handwashing ❑ 11. -Good Hygienic Practices - Violations Related to Good Retail Practices Critical (C) violations marked must be corrected immediately or within 10 days as determined by the Board of Health. Non-critical (N) violations must be corrected immediately or within 90 days as determined by the Board of Health. _. C N -. - 2 . Management and Personnel (FC -2)(590.003) 4. Food and Food Protection (FC -3)(590.004) 25. Equipment and Utensils (FC -4)(590.005) 6. Water,. Plumbing and Waste (FC -5)(590.006) 27. Physical Facility (FC -6)(590.007) 28. Poisonous or Toxic Materials (FC -7)(590.006) 29. Special Requirements (59o.0o9) 30. Other S. S 1ms 'Fam 14, o 1 •/il X❑ 1 revention of Contamination from Hands 13. Handwash Facilities PROTECTION FROM CHEMICALS ' •' ° tIi ❑ 14. Approved Food or Color Additives [115. Toxic Chemicals TIM_ EREMPERATURE CONTROLS (Potentialty Hazardous Fooda) ❑ 16. Cooking Temperatures ❑ 17. Reheating [118. Cooling ❑ 19. Hot and Cold Holding, ❑ 20. Time As a Public Health Control REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIOy NS_(HSP ❑ 21. Food and Food Preparation for HSP CONSUMER ADYI_SORY_ ❑ 22. Posting of Consumer Advisories Number of Violated Provisions Related To Foodborne Illnesses Interventions and Risk Factors (Items 1-22): Official Order for Correction: Based on an inspection today, the items checked indicate violations of 105 CMR 590.000/federal Food Code. This report, when signed below by a Board of Health member or its agent constitutes an order of the Board of Health. Failure to correct violations cited in this.report may result in suspension or revocation of the food establishment permit and cessation of food establishment operations. If aggrieved by this order, you have a right to a hearing. Your request must be in writing and submitted to the Board of Health at the above address within 10 days of receipt of this order. DATE OF RE -INSPECTION: Inspector's Si re: WN in int° Vl 1 w,,r. M PIC's Signatu :t: a I S Page) 0f ZPages Violations Related to Foodborne Illness Interventions and Risk Factors (items 1-22) FOOD PROTECTION MANAGEMENT 1 590.003(A) Assignment of Responsibility. 590.003(B) Demonstration of Knowledge*'' El 2-103.11. Person in charge --duties FMPI nvFF HFAI TH 2 590.003(C) Responsibility of the person in charge to Compliance with Food taw* 3-201.12 require reporting by food employees and 3-201.13 Fluid Milk and Milk Products* applicants* She]] Eggs* 590.003(F) Responsibility Of A Fax! Employee Or An 3-202.16 Ice Made From Potable Drinking Water* Applicant To Report To The Person In Drinking Water from an Approved S stent' 590.006(A) Char * 590.006(B) 590.003 G) by Person in Charge* 3 -_-Reporting 590.003(D) Exclusions and Restrictions* 3-201.15 590.003(F.) Removal of Exclusions and Restrictions LE C C FOOD FROM APPROVED SOURCE * Denotes critical item in the federal 1999 rood Code or 105 CMR 590.000. PROTECTION FROM CONTAMINATION Food and Water From Regulated Sources 590.004(A B) Compliance with Food taw* 3-201.12 Food in a Hermetically Sealed Container* 3-201.13 Fluid Milk and Milk Products* 3-202.13 She]] Eggs* 3-202.1.4 Eggs and Milk Products, -Pasteurized* 3-202.16 Ice Made From Potable Drinking Water* 5-101..11 Drinking Water from an Approved S stent' 590.006(A) Bottled Drinking Water* 590.006(B) Water Meets Standards in 310 CMR 22.0* Frequency of Sanitization of Utensils and p- Food Contac Surfaces of Equipment* Shellfish and Fish From an Approved Source 3-201.14 Fish and Recreationally Caught Molluscan Shellfish* 3-201.15 Molluscan Shellfish from NSSP Listed Sources* Proper, Adequate Handwashing Game and Wild Mushrooms Approved by Re Mato Authorlt 3-202.18 Shellstock Identification Present* 590A04(C) Wild Mushrooms* 3-201.17 Game Animals* 2-301.14 Receiving/Condition 3-202.11. PHFs Received at Proper Temperatures* 3-202.15 Packa e Inte it * 3-101.11. Food Safe and Unadulterated Tags/Records: Shellstock 3-202.18 Shellstock Identification 3-203.12 Shellstock Identification Maintained* 12 TagsfRecords: Fish Products 3.402.11 Parasite Destruction* 3402:12 Records. Creation and Retention* 590.004(n labeling of Ingredients' Handwash Facilities Conformance with Approved Procedures /HACCP Plans 3-502.!1 Specialized ProcessinMethods* 3-502.12 Reduced oxygen acka "ng, criteria* 8-103.12 Conformance with Approved Procedures* * Denotes critical item in the federal 1999 rood Code or 105 CMR 590.000. PROTECTION FROM CONTAMINATION 9 Cross -contamination 3=302.11(A)(1) Raw Animal Foods Separated from Cooked and RTE Foals* 4-501.111. Contamination from Raw Ingredients 3-302.11(A)(2) Raw Annual Foods Separated from Each Other* Mechanical Warewashing- Hot Water Sanitization Tem eratures* Contamination fror» the Environment 3-302.,11(A), . Food Protection* 3-302.15 Washing Fruits and Vegetables 3-304.11 Food Contac with Equipment and Utensils* 4-602.11 Contamination from the Consumer 3-306.14(A)(,) Returned Food and Reservice of Food* Frequency of Sanitization of Utensils and p- Food Contac Surfaces of Equipment* Disposition of Adulterated or Contaminated Food 3-701.11 Discarding or Reconditioning Unsafe Food* 9 Food Contact Surfaces 4-501.111. Manual Warewashing - Hot Water Sanitization Te ratures* 4-501.112 Mechanical Warewashing- Hot Water Sanitization Tem eratures* 4-501.11.4 Chemical Sanitization- temp., pH; concentration and hardness. * 4-601.11(A) Equipment Food Contact Surfaces and Utensils Clean* 4-602.11 Cleaning Frequency of Equipment Food - Contact Surfaces and Utensils's 4-702.11. Frequency of Sanitization of Utensils and p- Food Contac Surfaces of Equipment* 4-703.11 Methods of Sanitization - Hot Water and Chemical* So Proper, Adequate Handwashing 2-301.11 Clean Condition -Hands and Arms* 2-301..12 Cleaning Procedure* 2-301.14 When to Wash* 11 Good Hygienic Practices - 2401.11. Eating, Drinking or Using Tobacco* 2-401.12 Discharges From the Eyes, Nose and Mouth*. . - 3-301.12 Preventing Contamination When Tasting* 12 Prevention of Contamination from Hinds 590.004(F) Preventing Contamination.from Employees* 13 Handwash Facilities Conveniently Located and Accessible 5-203.11 . Numbers and Capacities* 5-204.11 Location and Placement* 5-205.11 Accessibility, Operation and Maintenance Supplied with Soap and Hand Drying Devices 6-301.11 Hanlwashin Cleanser, Availability 6-301.12 Hand�D 'ng Provision i A� CITY OF SALEM BOARD OF HEALTH Establishment Name: SALZ_ -' i T-sJtJ Date: S-.) U i 1- Page: l of Z Item No. Code Reference C - Critical Item R - Red Item DESCRIPTION OF VIOLATION / PLAN OF CORRECTION Data - - Ver ffed 'PLEASE PRINT CLEARLY IW55"C,Uj) OliJi l,araj CaT+5)Vt "fin �6�D Tai,-pLVal�+ir3 r�ul" :,4) 1 _:: ��L Cpl i-i5aad'(l Ll ila Si !>G �V s�5� ',5ii'i'LV C11'1Z, 769 N6lrinto ra vj TT'i e 4LtJ >tj S S. 1<� b WrAs 1 iG i i.c5a � siC�SJ �' sat:L�'7 ,ave vS'-O >;ott 1-1 � )� -) - . G1>` is ti , T TIA I S la mitt Q n. ` r -e. of 11Q'P . -V on,40 Wn rlyY= Is WO Lt - m_. 1. 'y �'� ' -r)-V . '96>0L'� 2S .mJ Lvd� e L ra S P "' @Hutu i- 26 Does— zL )BIOS numvrV, 2a 7-4%TLY,- US A 6,0 Ll �IWJ IwT1 )i La )2 ' L1al.� ) Discussion With Person in Charger Stahl l.Q� I have read this report, have had the opportunity to ask questions and agree to correct all violations before the next inspection, to observe all conditions as described, and to comply with all mandates of the Mass/ederal Food C e. I understand that noncompliance may result in daily fine o wenty-five Orr, Sion voc t f your food permit. Corrective Action Required: ❑ . No ❑ :Yes ❑ Voluntary Compliance ❑ Employee Restriction / Exclusion ❑ Re -inspection Scheduled o Emergency Suspension ❑ Embargo ❑ Emergency Closure Voluntary Disposal ❑ Other: i -. -.�. "y. :..•..�yM1 _. w�yK_'Y�y.,s��-•' ..: .::..v*�^�+�+:.,,,..�,ir+'""NSF _ f Violations Related to Foodborne Illness Interventions and Risk Factors (items 1-22) (Cont.) PROTECTION FROM CHEMICALS 14 15 17 18 TIMFITFMPFRATURF CONTROLS Food or Color Additives 3-202.12 Additives* 3-302.14 Protection from Unapproved Additives* 3-801.11(C) Poisonous or Toxic Substances 7-101.11 Identifying Information - Original Containers* . 7-102.11. Common Name - Working Containers* 7-201.11 1 Separation - Storage* - 7-202.11 .Restriction - Presenceand Use* 7-202.12 Conditions of Use* 7-203.11 Toxic Containers - Prohibitions* 7-204.11 Sanitizers. Criteria - Chemists* 7-204.12 Chemicals for Washing Produce, Criteria* 7-204.14 Drying Agents. Criteria* I . 7-205.11 Incidental Food Contact, Lubricants* 7-206.11 Restricted Use Pesticides, Criteria* 7-206.12 Rodent Bait Stations* 7-206.13 Tracking Powders, Pest Control and Monitoring* TIMFITFMPFRATURF CONTROLS * ihnotes critical item in the federal 1999 Fuad Code or 105 CMR 590.000. 3-501.14(C) PHFs Received at Temperatures According toViri, 1� Law Cooled to I 41'Fl45°F thin 4 lNIrC Proper Cooking Temperatures for . 19 PRFs 3-401.11A(1)(2) Eggs- 155OF 15 Sec. 3-801.11(C) Eggs- Immediate Service 145°F15sec* 3401.11(A)(2) Comminuted Fish. Meats & Game 590.004(H) Animals -155°F 15 sec. * 3.401.11(B)(1)(2) Pork and Beef Roast -130°F 121 min* 3401.11(A)(2) Ratites, Injected Meats -155'F 15 26. sec: 3401.1 t(A)(3) Poultry, Wild Game, Stuffed PRFs, 27. Stuffing Containing Fish, Meat, Poultry or Ratites -165°F 15 sec. 3401.11('C)(3) Whole -muscle, intact Beef Steaks ! FC- 7 145°F i' 3-401.12 Raw Animal Foods Cooked in a Microwave 165°F 3401:11(A)(1)(b) All Other PHPs -145*F 15 see. Reheating for Hot Holding 3403.11(A)&(D) PHFs 165-F 15 sec. * 3.403.11(B) Microwave- 165` F 2 Minute Standing Tithe* 3-403.11(C) Commercially Processed RTE Food - 140°F* 3-403.11(E) Remaining Unsliced Portions of Beef Roasts* Proper Cooling of PHFs 3-501.14(A) Cooling Cooked PHFs from 140°F to 70`F Within 2 Hours and From 70'F to 41°F/45'F Within 4 Hours. * 3-501.14(B) Cooling PHFs Made From Ambient Temperature Ingredients to 41°F/45°F Within 4 Hours* * ihnotes critical item in the federal 1999 Fuad Code or 105 CMR 590.000. 3-501.14(C) PHFs Received at Temperatures According toViri, 1� Law Cooled to I 41'Fl45°F thin 4 lNIrC 21 3-501.16(B) 590.004(F) 3-501.15 CoolingMethods for PHFs 19 PHF Hot and Cold Holding 21 3-501.16(B) 590.004(F) Cold PHFs Maintained. at or below 410/450 F* 3-501.16(A) Hot PRFs Maintained at or above 140T. * 3-501.16(A) Roasts Held at or above 130°F. 3-801.11(C) Time as a Public Health Control 3-501.19 Time as a Public Health Control* 590.004(H) Variance Requirement REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULTI AONS tHSPi 3-801.11(A) Unpasteurized Pre-packaged Juices and with Waning labels* 3-801.1 t(B) _Beverages Use of Pasteurized Eggs* 3-801.11(1) Raw or Partially Cooked Animal Food and Raw Seed Sprouts Not Served. * 3-801.11(C) Unopened Food Package Not Re -served. CONSUMER ADVISORY 22 3-603.11 Consumer Advisory Posted for Consumption of 59O.Wo 1 23. Animal Foods That are Raw. Undercooked or FC - 2 .093 Not Otherwise Processed to Eliminate Food and Food Protection FC - 3 Pathogens.* Erken. rnnoet 25. 3-302A3 1 Pasteurized Eggs Substitute for Raw Shell .005 1 26. Eggs* 590.009(A) -(D) Violations of Section 590.009(A) -(D) in catering, mobile food, temporary and residential kitchen operations should be debited under the appropriate sections above if related to foodborne illness interventions and risk factors.. Other 590.009 violations relating to goal retail practices should be debited under #29 - Special Requirements. (Items 23-30) Critical. and non-critical violations, which do not relate to the foodborne illness interventions and risk factors listed above, can be found in the following sections of the Food Code and 105 CMR 590.000. Item I Good Retail Practices .FC 59O.Wo 1 23. Man�at ement and Personnel FC - 2 .093 24. Food and Food Protection FC - 3 .004 i 25. _ _ Equipment and Utensils FC -4 .005 1 26. _ Water. Plumbing and Waste - F(;-5 .006 27. -Physical FacilityFC-6 .007 26. Poisonous or Toxic Materials ! FC- 7 .008 29. Snecial Reaukernerits .009 30. Other s:iwrmm,ctr xa: KIMBERLEY DRISCOLL I MAYOR 4/27/2012 CITY OF SALEM, MASSA.CI IUSI, T'TS BOARD OF HEALTH 120 WASHINGTON STREET, 4"' FLOOR TEL. (978) 741-1800 Fax (978) 745-0343 liamdinia�salem.com Salem Inn 35 Winter Island Road Salem, MA 01970 7 Summer Street Dear Owner: IPublicHealth LARRY RANMIN, 16'/R1,11s, CHO, C11-15 HF.A7::TF1 AGENT The Salem Board of Health, Building and Fire Departments are scheduling yearly inspection of all establishments licensed as lodging houses. The Salem Licensing Board will review inspection and re -inspection reports in accordance with its license renewal procedures. The inspection will include dwelling units and common areas, therefore each tenant must be present or he/she must sign the enclosed release form which will allow the inspectors to enter the unit. Your Lodging House at 7 Summer Street has been scheduled to be inspected on Wednesday 5/16/2012 at 10:00:00 AM Thank your for your anticipated cooperation Sincerely, Larry Ramdin Health Agent cc: Michael Lutrzykowski, Assistant Inspector of Buildings Lt. Erin Griffin, Fire Prevention Robert St. Pierre, Chairman, Salem Licensing Board 0005 SUMMER STREET Area To Inspect:: Ok to Issue Certificate ?: NO Building Layout The Same ?: Yes Inspector: David Greenbaum Date & Time Requested: at Date of Inspection: !Wednesday, May.16, 2012 Reinspect By:: Certificate Number: Certificate Expires On: Status: OPEN Notes: No health code violations cited at this time. City of Salem Mass Housing (Health) - Inspection LODGING HOUSE ( Rev. May 16,2012 ) Item: Status: Nature of problem or correction: 120 Washington Street, 4th Floor * SALEM, MA * Phone:(978) 741-1800 * Fax:(978) 745-0343 GwTMS® 2012 Des Lauriers Municipal Solutio Page l of I , UNITED STATES • Sender: Please print your name, address, and ,ity of Salem u L p Board of Health G3 cc 120 Washington Street 4th Flooxijij U p Salem, MA 01970 01 III I I I IIIIIiII H I III,I if I IIIIIJml III IIIiltluhl n uh ■ Complete items 1, 2, and 3. Also complete Item 4 if Restricted Delivery Is desired. ■ Print your name and address on the reverse so that we can return the card to you. ■ Attach this card to the back of the mailpiece, or on the front if space permits. 1. Article Addressed to: Summer Street Real Estate Trust (Richard J. Pabich Diane G. Pabich, Trustees 135 Winter Island Road -Sa]em, MA 01970 V 0 Agent B. Received by (Printed Name) I C. Date of Delivery MAY 2 9 2009 3. Servicer USPS ❑ Certmed Mall Express Mall 0 Registered 13 Return Receipt for Merchandise 0 Insured Mail 0 C.O.D. 4. Restricted Delivery? (Extra Fee) 0 Yea- 2. es 2. Article Number (refer from service label) 1(t ii 1' 700$ i1140'0004 z 0,9.401,193 9 i9:40r 1939 i PS Form 3811, February,2004 Domestic Return Receipt S 0" Postage $ O Certified Fee S Postmark C3 Retum Receipt Fee Here O (Endorsement Required) I 0 Restricted Delivery Fee 1` r3 (Endorsemem Required) S r-1 Total Postage &Fees ,$ a Sent To � U.Si�Postal Servlce., t CERTIFIED MAILr�r;RECEIPT /nnirirstir. Mail OM—.- Insurance Co...... Provided) 6 S 0" Postage $ O Certified Fee S Postmark C3 Retum Receipt Fee Here O (Endorsement Required) I 0 Restricted Delivery Fee 1` r3 (Endorsemem Required) S r-1 Total Postage &Fees ,$ a Sent To or O Box No. PS Form 3800 August See Reverse (or lnstrucaons Certified Mail Provides: ■ A mailing receipt Is A unique identifier for your mailpiece ■ A record of delivery kept by the Postal Service for two years Important Reminders: ■ Certified Mail may ONLY be combined with First -Class Mail, or Priority Mail,. Is Certified Mail is not available for any class of international mail. ■ NO INSURANCE COVERAGE IS PROVIDED with Certified Mail. For valuables, please consider Insured or Registered Mail. ■ For an additional fee, a Return Receipt may be requested to provide proof of delivery. To obtain Return Receipt service, please complete and attach a Return Receipt (PS Form 3811) to the article and add applicable postage to cover the fee. Endorse mailpiece "Return Receipt Requested". To receive a fee waiver for a duplicate return receipt, a USPS, postmark on your Certified Mail receipt is required. ■ For an additional fee, delivery may be restricted to the addressee or addressee's authorized agant. Advise the clerk or mark the mailpiece with the endorsement "Restricted Defivery". ■ If a postmark on the Certified Mail receipt is desired, please present the arti- cle at the post office for postmarking. If a postmark on the Certified Mail receipt is not needed, detach and affix label with postage and mail. IMPORTANT: Save this receipt and present it when making an inquiry. PS Form 3800, August 2006 (Reverse) PSN 7530-02-000-9047 CITY OF SALEM, MASSACHUSETTS / BOARD OF HEALTH a 120 WASHINGTON STRSHT, 4" FLOOR TEL. (978) 741-1800 KIMBERLEY DRISCOLL FAX (978) 745-0343 MAYOR INIANCiNI&AIENI MI JANE': I' MANCI.NI AC'1'INa Hr,%I:n I AGENT May 27, 2009 Summer Street Real Estate Trust Richard J. Pabich & Diane G. Pabich, Trustees 35 Winter Island Road Salem, MA 01970 Dear Sir/Madam: In accordance with Chapter III, Sections 127A and 127B of the Massachusetts General Laws, 105 CMR 400.00; State Sanitary Code, Chapter 1: General Administrative Procedures and 105 CMR 410.00: State Sanitary Code, Chapter 11: Minimum Standards of Fitness for Human Habitation, an inspection was conducted of the property at 7 Summer Street (Lodging House) conducted by David Greenbaum, Sanitarian, Wednesday May 20, 2009 @ 11:00am. Notice: if this rental unit is occupied by a child or children under the age of 6 years, it is the property owner's responsibility to notify tenants of lead related reports and tests, and to ensure that this unit complies fully with 105 CMR 460:000: Regulations for Lead Poisoning Prevention and Control. For further information or to request an inspection, contact the Salem Board of Health at 978-741-1800. You are hereby ORDERED to make a good -faith effort to correct the violations listed on the enclosed inspection report. Failure on your part to comply within the time specified on the enclosed inspection report will result in a complaint being sought against you in Salem District Court. Time for compliance begins with receipt of this Order. Should you be aggrieved by this Order, you have the right to request a hearing before the Board of Health. A request for said hearing must be received in writing in the office of the Board of Health within 7 days of receipt of this Order. At said hearing, you will be given an opportunity to be heard and to present witness and documentary evidence as to why this Order should be modified or withdrawn. An attorney may represent you. Please also be informed that you have the right to inspect and obtain copies of all relevant inspection in investigation reports, orders and other documentary information in the possession of this Board, and that any adverse party has the right to be present at the hearing. Please be advised that the conditions noted may enable the occupant(s) to use one or more of the statutory remedies available to them as outlined in the enclosed inspection report form. ,IZ?r the Board of Health Reply to: gie4t Mancini David Greenbaum ng Health Agent Sanitarian Sent certified mail — 7008 1140 0004 0940 1939 0005 SUMMER STREET City of Salem Mass Housing (Health)- Inspection LODGING HOUSE ( Rev. May 27,2009 ) Item: Status: Nature of problem or correction: _Owners Installation & Maintenance Resp Not Done Sinks, tubs/showers, toilets, heating FAIL The freezer door in the kitchen is in disrepair. Repair or replace the freezer door. equipment, gas pipes, water heating provide thermometers in all refrigerators and freezers in the kitchen.. equipment, stove & ovens, electrical fixtures & wiring. The above equipment Maintain the hand wash sinks in the kitchen stocked with soap and disposable is maintained in good working order paper towels at all times. (410.351(A)) Owners Responsibility to Maintain Struc Not Done Windows,floors, doors, ceilings, roof in FAIL There are water stains and chipping/peeling paint above the front door in the good condition (410.500) foyer of 5 Summer Street. Investigate the source of the leak and repair. Scrape and repaint all chipping/peeling paint. 120 Washington Street, 4th Floor * SALEM, MA GeoTMS® 2009 Des Lauriers Municipal Solutio • Fax:(978) 745-0343 Page I of I KIMBERLEY DRISCOLL MAYOR JANF:I' MANCINI ACTING HF:ALTII AGEN'r 4/28/09 Salem Inn 35 Winter Island Road Salem, MA 01970 7 Summer Street Dear Owner: CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH 120 WASHINGTON STREET, 4" �� FLOOR TEL. (978) 741-1800 FAX (978) 745-0343 1NIANC1NI@SA1..L:NIC0 M The Salem Board of Health, Building and Fire Departments are scheduling yearly inspection of all establishments licensed as lodging houses. The Salem Licensing Board will review inspection and re -inspection reports in accordance with its license renewal procedures. The inspection will include dwelling units and common areas, therefore each tenant must be present or he/she must sign the enclosed release form which will allow the inspectors to enter the unit. Your Lodging House at 7 Summer Street has been scheduled to be inspected on Wednesday 5/20/2009 at 11:00:00 AM Thank your for your anticipated cooperation. Sincerely, 4-Ma�nci i, Acting Health Agent cc: Building Department Erin Griffin, Fire Prevention David Shea, Chairman, Salem Licensing Board Commonwealth of Massachusetts City of Salem Board of Health 120 Washington Street, 4th Floor SALEM, MA 01970 Food/Retail Establishment Permit DATE PRINTED: 12/18/2008 ESTABLISHMENT NAME: File Number: BHF -2004-000295 LOCATED AT: IGmberiey Driscoll Mayor The Salem Inn 7 Summer Street Salem MA 01970 SALEM, MA 01970 Permit Type Permit No. Permit Issued Permit Expires Fee Restrictions / Notes FOOD SERVICE BHP -2009-0006 Dec 18, 2008 Dec 31, 2009 $100.00 ESTABLISHMENT PERMIT EXPIRES Total Fees: $100.00 Board of Health This Permit is not transferable and must be reissued upon change of ownership or location. The permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code, beofre any revonations, improvements, or equipment changes are made, all plans for such must be submitted to and approved by the Salem Board of Health. Page 1 KIMBERLEY DRISCOLL MAYOR JANET DIONNE, ACTING HEALTH AGENT CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH 120 WASHINGTON STREET, 4"r FLOOR TEL. (978) 741-1800 FAX (978) 745-0343 IDIONNE&ALGM. COM 2009 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT NAME OF ESTABLISHMENT Th—I� C�lf'1j�(i `�(1 1 TEL # I_ 0 ` '0620 ADDRESS OF ESTABLISHMENT l IYYI(Ylel( 5±. f)nUM FAX# ql'a- —I'q I MAILING ADDRESS (if different) EMAIL - Business': OWNER'S ADDRESS 'n —TEL# r<cr= CITY STATE CERTIFIED FOOD MANAGER'S NAME(S) CERTIFICATE#(S) (Required in an establishment where potentially hazardous food is prepared) EMERGENCY RESPONSE PERSON HOME TEL # MI5 DAYS:OFOP,ERATION Monda ';L :,Tuesda`.-Wetlnesda Thursd FriAa h SatuMa Sahtla:,,.°i HOURS OF OPERATION i Please write in time of day. For exampleIlam-11pm -iO�MIgA1M'101�1�i:c'b Yi%,�-gyp TYPE OF ESTABLISHMENT FEE (check only) RETAIL STORE YES NO less than 1000sq.ft. =$ 70 1000-10,000sq.ft. =$280 more than 10,000sq.ft. =$420 -------------------------- R---E--S--T---A--U--R---A--N---T---oi�ib-----------------------------------------------------............---YES- less than 25 seats ------------- =$140 (Outdoor Stationary Food Ca,, tt $210) 25-99 seats =$280 more than 99 seats =$420 -------------------------------- --------------- -------- .... ..........................................-------------- YES NO --------------------- $100 CHILDCARE SERVICES ----------------------------------------------------------------------- ADDITIONAL PERMITS MAKE (not just serve) ICE CREAM, YOGURT/SOFT SERVE YES N $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. 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 palnll state taxes reauired under the law. 11�2ZJ()7 U.F- 'Ll 7A27D Social Security or Federal Identification Number 424/07 FOODAP2008.adm Check# & Date V I'L 0'? - 7-1 k9 $ -M. 00 117:VYAW9IC1ID1131 Commonwealth of Massachusetts . City of Salem Board of Health IGmbedey Driscoll 120 Washington Street, 4th Floor Mayor SALEM, MA 01970 Food/Retail Establishment Permit 01/03/2008 ESTABLISHMENT NAME: File Number. BHF -2004-000295 LOCATED AT: The Salem Inn 7 Summer Street Salem MA 01970 SALEM, MA 01970 Permit Type Permit No. Permit Issued Permit Expires Fee Restrictions / Notes FOOD SERVICE BHP -2006-0167 Jan 3, 2008 Dec 31, 2008 $100.00 ESTABLISHMENT Total Fees: $100.00 PERMIT EXPIRES December 31, 2008 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 8 of 9 n �� WP KIMBERLEY DRISCOLL MAYOR JOANNE SGOTT, HEALTH AGENT QTY OF SALEM, MASSAQ iUSEM BOARD OF HEALTH 120 WASHINGTON STREET, 4'm FLOOR 'ISL. (978) 741-1800 FAx (978) 745-0343 isconf@sAI_EM. COM RECEIVE® NOV 2 g2007 CITY OF SALEM BOARD OF HEALTH 2008 APPLICATION FOR PERMIT TO OPERATE A FOOD n ESTABLISHMENT NAME OF ESTABLISHMENT�e. �I� (-I v II SA -0M TEL # 911 —�l' OC%C) Tc.a ADDRESS OF ESTABLISHMEN_ nvlMC4' ST SA___FAX # 1% MAILING ADDRESS (if different) EMAIL EMAIL - Business': r6,64 -V T t)oyis Q� �lalllonna Website: WNIN , Uen Inn 1_' FI - cloin OWNER'S NAME knd eQNS 16C� I1 A% nf-p Scile I l✓In TEL # l71788 65 --V7`A - ADDRESS 3S W� Ind tl��i �IIP�I M� 01q7() CITY STATE ZIP CERTIFIED FOOD MANAGER'S NAME(S) CERTIFICATE#(S) (Required in an establishment where potentially hazardous food is prepared) EMERGENCY RESPONSE PERSOOKii& Ano HOME TEL # DAYS OF OPERATION i Monday Tuesday i Wednesday Thursday i Friday i Saturday - Sunday HOURS OF OPERATION Please write in time of day. !SAM- IQ, ..' 0ki ( g"I tAN.-ow $AM� 10�N $ N- iol�M %� M - 100 QOM - Io M TYPE OF ESTABLISHMENT RETAIL STORE YES NO ------------*----------- YES - - - RESTAURANT NO (Outdoor Stationary Food Cart $210) BED/BREAKFASTI YNO CHILDCARE SERVICESE ---------- - - - --------------------- - -- --------- ADDITIONAL PERMITS MAKE (not just serve) ICE CREAM, YOGURT/SOFT SERVE TOBACCO VENDOR ALL NON-PROFIT (such as church kitchens) FEE (check onl less than 1000sq.ft. =$ 70 1000-10,000sq.ft. =$280 more than 10,000sq.ft. =$420 ------------------------------------------------- less than 25 seats =$140 25-99 seats =$280 more than 99 seats =$420 ....................... .... $100 YES $25 YES $135 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 must be submitted to and approved by the Salem Board of Health. PupSuanAto MG pier 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 ret a paid s to taxes required under the law. II /QF, o9- or Federal Identification Number ------------------------ —-------- -------- ---- ----- ----------j- --------------------------------------- Revised 4/24/07 FOODAP2008.adm Checkg & Date Kimberley Driscoll Mayor CITY OF SALEM, MASSACHUSETTS RECEIVED BOARD OF HEALTH f-1 120 WASHINGTON STREET, 4TH FLOOR SALEM, MA 01970 TEL. 978-741-1800 FAx 978-745-0343 W W W.SALEM.COM JOANNE SCOTT, MPH, RS, CHO HEALTH AGENT DEC 7 2006 CITY OF SALEM BOARD OF HEALTH 2007 APPLICATION FOR' PERMIT TO OPERATE A FOOD ESTABLISHMENT NAME OF ESTABLISHMENT16 it6q 11`10 TEL # 91% - J+1 - 0GV ADDRESS OF ESTABLISHMENT 1 Ml' er St Sgl P'y� FAX # -Va+ MAILING ADDRESS (if different) EMAIL--Susiness':(OY1SlviSG �vv"II'i)11t•r-g • C8 Owner's: OWNER'S ADDRESS STREET CITY TEL # ql%- -M - 10 `T fill 01g70 CERTIFIED FOOD MANAGER'S NAME(S) CERTIFICATE#(S) ZIP (Required in an establishment where potentially hazardous food is prepared) ( - EMERGENCY RESPONSE PERSON HO-INC)A -COr rfl��O HOME TEL # �I�(Y�. DAYS OF Monday Tuesday Wednesday Thursday Friday Saturday Sunday HOURS OF p n' (QAfI onM lOIW) ;qA)(-10�� RM`lo�t1 Please write in unniefday. -,.�pitH._PRM AF1H-10'fil'�,9AW_I0A •b�M� A [For example Ilam -119m) TYPE OF ESTABLISHMEN RETAIL STORE YES NO' RESTAURANT BED/BREAKFAST ------ YES NO YES NO -------------------------- ------ ADDITIONAL PERMITS MAKE (not just serve) ICE CREAM, YOGURT, TOBACCO VENDOR ALL NON-PROFIT (such as church kitchens) FEE (check only► less than 1000sq.ft. =$ 50 1000-10,000sq.ft. =$100 more than 10,000sq.ft. =$250 --- --- -- ------ - -------------------------------------------------- ----- less than 25 seats =$100 25-99 seats =$150 more than 99 seats =$200 - -..---_$1 -- ----- ------- ------ ------ -- -- SOFT SERVE YES NO $5 YES NO $50 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, tomy best -knowledge and belief, have filgo all AAte tax returns and paid all state taxes required under the law. Social Se re Date curity or Federal Identification Number V----------------------- ---------------------------------------------------- ---------------------------------------------------------------------------------- Revised 11113/06 FOODAP2007.adm vCheckd&.Date 2lioy 7Z Y/1 S 1Q.f. 0 s Food/Retail Establishment Permit DATE PRINTED: 12/20/2006 ESTABLISHMENT NAME: File Number: BHF -2004-000295 LOCATED AT: The Salem Inn 7 Summer Street Salem MA 01970 SALEM, MA 01970 Permit Type Permit No. Permit Issued Permit Expires Fee Restrictions / Notes FOOD SERVICE BHP -2007-0132 Dec 20, 2006 Dec 31, 2007 $100.00 ESTABLISHMENT PERMIT EXPIRES Total Fees: $100.00 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 7 of 8 FROM :SALEM ELECTRICAL DEPT FEBRUARY 2, 2006 FIRST MAILING FAX NO. :9787454638 Feb. 02 2006 12:04PM P1 CITY Olt SALEM9 MASSACHUSETTS ELECTRIC DEPARTMENT-, 44 LAFAV6TT6 ST*99T SAUCK MA 01970 TBL. (978) 7466300 FAX(O78)7464030 MARK ROCHON, WIRE INSPECTOR TO: THE SALEM INN ATT: MELMA CONTINO 7 SUMMER ST. SALEM, MA 01970' SUBJECT: FIRST FLOOR WAITING ROOM FIRE DEAR MELINDA CONTINO, THE SALEM FIRE DEPARTMENT AND MARK ROCHON WIRE INSPECTOR WERE SENT TO INVESTIGATE ELECTRICAL FIRE FEBRUARY 12, 2005. THF.. FISH TANK TIMER PLUG STRIP CAUGHT FIRE. THE RIGHT WALL RECEPTACLE OUTLET CONTACTS WERE LOOSE. THIS OFFICE REQUESTED THE RECEPTACLE TO BE REPLACED WITH A. PERMIT FROM THIS OFFICE. THIS OFFICE.. HAS NOT RECEIVED AN ELECTRICAL PERMIT AND COMPLETED FINAL INSPECTION OF THESE REPAIRS: PLEASE TAKE THE NECESSARY STEPS -TO REPAIR THESE ELECTRICAL HAZARDS. THIS WORK SHALL BE DONE BY A LICENSED ELECTRICIAN WITH A PERMIT FROM THIS OFFICE, IF YOU HAVE ANY QUESTIONS, PLEASE CONTACT ME AT MY OFFICE. MARK ROC14ON WIRE INSPECTOR CC: FIRE PREVENTIONFAX: 402. BUILDING DEPARTMENT FAX: 846 HEALTH DEPARTMENT FAX: 343 Commonwealth of Massachusetts s e City of Salem Board of Health 120 Washington Street, 4th Floor SALEM, MA 01970 Food/Retail Establishment Permit DATE PRINTED: 01/03/2006 0 WHO'S PLACE OF BUSINESS IS: File Number: BHF -2004-0295 LOCATED AT: The Salem Inn 7 Summer Street Salem MA 01970 SALEM, MA 01970 Permit Type Permit No. Permit Issued Permit Expires Fee Restrictions / Notes FOOD SERVICE BHP -2006-0241 Jan 3, 2006 Dec 31, 2006 $100.00 ESTABLISHMENT Total Fees: $100.00 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 13 of 13 °iAR�u „ STANLEY J. USOVICZ, JR. MAYOR CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH 120 WASHINGTON STREET, 4TH FLOOR SALEM, MA 01970 TEL. 978-741-1800 FAx 978-745-0343 W W W.SALEM.COM JOANNE SCOTT, MPH, RS, CHO HEALTH AGENT ?,rp=,,,,1 DEC 0 5 2005 CITY OF SALEM BOARD OF HEALTH 2006 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT NAME OF ESTABLISHMENT p TEL # /'7o` 7 541 d� ADDRESS OF ESTABLISHMENT 7 �U vywt S7 Jcy�%j �L'7� MAILING ADDRESS (if different) OWNER'S NAME ThP, cf e-& VrNS L,.TEL # 97f- 71'4-S_-72_71" ADDRESS 3S -,Zs 4A CITY STATEZIP '�ZI7U CERTIFIED FOOD MANAGER'S NAME(S) CERTIFICATE#(s) (required in an establishment where potentially hazardous food is prepared.) q EMERGENCY RESPONSE PERSON Je�yH �ig,I 7 n HOME TEL # C 7� - 7 Z � HOURS OF OPERATION: Mon. t/Tue. Wed. vThu. ✓ Fri. L -Sat. Surma /cam TYPE OF ESTABLISHMENT FEE (check only), RETAIL STORE YES --co) less than 1000sq.ft. 450 1000-10,000sq.ft. =$100 more than 10,000sq.ft. =$250 - ...... ........ ..............;. Y..ES ........-' O ------......------------------------------ less - -than ---------25 ---s-ea--t-- s- ........... .$100 - ................ RESTAURANTs 25-99 seats =$150 more than 99 seats =$200 BED/BREAKFAST (SES,) NO .-- .._---------- --- -- -------------------------------------......---------------------------- 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 K1 *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 most 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. Date Social Security or Federal Identification Number Revised 11/03/05 FOODAP2.adm Check#& m /Os' CITY OF SALEM, MASSACHUSETTS PUBLIC PROPERTY DEPARTMENT '�60 Bid 120 WASHINGTON STREET, 3RD FLOOR $TAN Lf:V J. USOVICZ, JR. SALEM, MASSACHUSETTS 01970 �'1 I'',0yd` �`•'-`��11'1d 1� o MAYOR TELEPHONE: 978-745-9595 EXT. 380 j! o FAX: 978-740-9846 SEP 0 ) 2005 CITY OF SALEM BOARD OF HEALTH VIOLATION NOTICE r-zI: sQlellr CNV September 6, 2005 JRM Hauling and Recycling Services, Inc. / 265 Newbury Street Peabody, MA 01960 Dear Sirs: The above listed property has been found to be in violation of the following State Codes and/or City Ordinances: City of Salem, Code of Ordinance, Section 24-23, states that without extenuating circumstances and prior approval, emptying, and/or placing of Dumpsters between the hours of II pm and 7 am is not allowed. Said violations must begin to be corrected, repaired, and/or brought into compliance within 2 days of your receipt of this notice. Failure to do so may result in further actions being brought against you, up to and including the filing of complaints at District'Court. If you have any questions regarding this letter, please contact the Building Inspectors Office at (978) 745-9595, extension 386. Sincerely, Joseph E. Barbeau, Jr. Assistant Building Inspector CC: file, Mayor's Office, Health Dept., Police Dept. ;Myr�,ty..#.y a: Tay. CITY OF SALEM, MASSACHUSETTS �. BOARD OF HEALTH _ 9 . 120 WASHINGTON STREET, 4TH FLOOR - a SALEM, MA 01970 .) TEL. 978-741-1800 FAX 978-745-0343 - STANLEY J. USOVICZ, JR. JOANNE SCOTT, MPH, RS, CHO. - MAYOR I 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: FOOD SERVICE Name of Establishment: The Salem Inn Address of Establishment: '7 Summer Street Owner's Name: Diane and Dick Pabich. Restrictions: Application Date: 11/22/2004 Permit for Food Establishment 42-05 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 7 - .' CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH µ t� -a Lt lvV U � - 120 WASHINGTON STREET, 4TH FLOOR SALEM, MA 01970 TEL. 978-741-1800 1 UV 19 2004 FAX 978-745-0343 STANLEY J. UISOVICZ, JR. JOANNE SCOTT, MPH, RS, CHO CITY OF SALEM MAYOR I HEALTH AGENT BOARD OF HEALTH 2005 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT NAME OF ESTABLISHMENT_nE M INrJ TEL # ADDRESS OF ESTABLISHMENT -I &)HMGQ STZ007 M4q 014-70 MAILING ADDRESS (if different) OWNER'S NAME 1NrJ0e1nV0P'S INC- (DIArJE 4 RORRo P60 9EL# Q ADDRESS -5S W1rQTC--12 (SLANG) R0�0 CITY W- LC—OA STATE HR ZIP CERTIFIED FOOD MANAGER'S NAME(S) CERTIFICATE#(s) (required in an establishment where potentially hazardous food is prepared.) nn c� EMERGENCY RESPONSE PERSON HCUl`IA CONMNO HOME TEL#q-?� _7'g( -o63 -U HOURS OF OPERATION:Mon. ✓ Tue. "'-Wed. "� Thu. Fri. ZSat_LSun._ NnH -(01111) TYPE OF ESTABLISHMENT. FEE check only RETAIL STORE „YES NO less than ,1000sq.ft. _$ 50 .. 1000-10,000sq.ft. u =$100 more than 10,000sq.ft. =$250 a �5 RESTAURANT YES NO 1 less than 25 seats 25-99 seats BED/BREAKFAST YE NO more than 99 seats $100 ADDITIONAL PERMITS MAKE (not just serve) ICE CREAM, YOGURT, SOFT SERVE YFS $5 TOBACCO VENDOR YES $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 chariges are made, all plans for such must be submitted to and approved by the Salem Board of Health. Pursuant to L Chapter 62C, Section 49A, I certify under the pains and penalties of perjury that I, to my bM�t ��}},owe and belief, have filed all tate tax returns and paid all state taxes required under the law. } du (I P, 04-21 ,_+a�0 Signature Datb Social Security or Federal Identification Number -------------------------------- -------------\-7----------------- Revised 11/03/03 FOODAP2.adm Check#& Date �)C_4 /I ) Robert'W Turner Chief 978-744-6990 City of Salem, Massachusetts Fire Department Diane Pabich The Salem Inn 10 Summer St. Salem, MA 01970 Dear Ms. Pabich: 48 Lafayette Street Salem, ;Massachusetts 01970-3695 Tel.. 978-744-1235 FaX 978-745-4646 March 19, 2004 MAR 2 5 2004 On Tuesday March 16, The Salem Fire Prevention Office along with the Health Dept. and Licensing Board conducted our annual lodging house inspections at The Curwen House at 331 Essex St, and The Salem Inn at 10 Summer St. At 331 Essex St, the emergency lighting is not operating. Immediate attention needs to be taken. The numbering system in this particular building is easily remedied. By removing the number one which preceeds each unit at 331 Essex St—would satisfy our request. At The Salem Inn (10 Summer St.) we are requesting the removal of all gas stoves in all units that this applies. Whereas this building is unsprinkled, the stoves are a potential disaster waiting to happen. The numbering system at The Salem Inn needs to be renumbered so that city emergency personnel ,can be better directed. We are willing to discuss this so this will have a minimal financial impact on the Inn. Our thoughts are to preceed each room number with the floor number ie 1, 2 and 3. Then end the room number with the building number ie -5, -7 and -9. Respectfully, Kathleen Deschene Fire Inspector Salem Fire Dept. Health Licensing Building Prevention Bureau i-745-7777 3 s STANLEY J. LISOVICZ, JR. MAYOR Diane & Richard Pabich 35 Winter Island Road Salem, MA 01970 Dear Sir/Madam: CITY OF SALEM9 MASSACHUSETTS BOARD OF HEALTH 120 WASHINGTON STREET, 4TH FLOOR SALEM, MA 01970 .. _ TEL. 978-741-1800 FAX 978-745-0343 JOANNE SCOTT, MPH, RS, CHO HEALTH AGENT March 23, 2004 In accordance with Chapter III, Sections 127A and 127B of the Massachusetts General Laws, 105 CMR 400.00; State Sanitary Code, Chapter 1: General Administrative Procedures and 105 CMR 410.00: State Sanitary Code, Chapter 11: Minimum Standards of Fitness for Human Habitation, an inspection was conducted of the property Salem Inn @ 5-7-9 Summer Street (Bed & Breakfast) conducted by David Greenbaum & Virginia Moustakis, Sanitarians on Tuesday March 16, 2004 @ 10:45 a.m. + Notice: if this rental unit is occupied by a child or children under the age of 6 years, it is the property owner's responsibility to notify tenants of lead related reports and tests, and to ensure that this unit complies fully with 105 CMR 460:000: Regulations for Lead Poisoning Prevention and Control. For further information or to request an inspection, contact the Salem Board of Health at 978-741-1800. You are hereby ORDERED to make a good -faith effort to correct the violations listed on the enclosed inspection report.. Failure on your part to comply within the time specified on the enclosed inspection report will result in a complaint being sought against you in Salem District Court. Time for compliance begins with receipt of this Order. Should you be aggrieved by this Order, you have the right to request a hearing before the Board of Health. A request for said hearing must be received in writing in the office of the Board of Health within 7 days of receipt of this Order. At said hearing; you will be given an opportunity to be heard and to present witness and documentary evidence as to why this Order should be modified or withdrawn. You may be represented by an attorney. Please also be informed that you have the right to inspect and obtain copies of all.relevant inspection in investigation reports, orders and other documentary information in the possession of this Board, and that any adverse party has the right to be present at the hearing. Please be advised that the conditions noted may enable the occupant(s) to use one or more of the statutory remedies available to them as outlined in the enclosed inspection report form. For the Board of Health Reply to: Joanne Scott David Greenbaum & Virginia Moustakis Health Agent Sanitarians cc: Licensing Fire Prevention Building Department Councillor Jean M. Pelletier CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH • i 120 WASHINGTON STREET. 4TH FLOOR SALEM, MA 01970 TEL. 978-741-1800 nn FAX 978-745-0343 Pagel of STANLEY USOVICZ. Jr' JOANNE SCOTT. MPH. RS. CHO MAYOR HEALTH AGENT State Sanitary Code, Chapter 11: 105 CMR 410.000 Minimum Standards of Fitness for Human Habitation Occupant: &jle, A/ Civ G Phone. Address: s- -7- v PAUOas Floor -, n Owner:—z>,,,,,,- (1z��3/(-h Address: 35 GU, yir /Slim it !Yc% Inspection Date: 3— /i -o /V Time: /0. y,5— /gym Conducted By: A,xle >6&111s,-1,r-erdmm Accompanied By:` �'?Z7, Anticipated Reinspection Date: �` ya,r�vaci /Yuy�� hry� 4xt1 `r Gla'cV n�.�r^ �I SoecifiedTime Reg.#410.. VIOlatlorl(S)' - �r)�Lr,v;:a (;vn�iNc G C One or more of the above violations may endanger or materially impair the health C('.' LIC V,5//✓9 safety, and well being of the occupant(s) fiR-t Ret�fM-l�o� Code Enforcement Inspector :: �i�ur� % �� - A� --- a, AaAaj k Este es documento letaal importante. Puede que afecte sus derechos. frn,i„nn1n...f....-4- f........ ...n,...n..PcoA^ It 1 fP1Pfnnn 7d1-1 RnO 5' fS5 �c /00*0v< R /l Uaa �+.' i � - ?/53 � GC /';1U/:I � ✓ r' ` rC"•ud a .oP r.� - - , ? -7 - FiJXi; I -L ,i' j(o t Nl Ale ✓/r G0 - nvs G C One or more of the above violations may endanger or materially impair the health C('.' LIC V,5//✓9 safety, and well being of the occupant(s) fiR-t Ret�fM-l�o� Code Enforcement Inspector :: �i�ur� % �� - A� --- a, AaAaj k Este es documento letaal importante. Puede que afecte sus derechos. frn,i„nn1n...f....-4- f........ ...n,...n..PcoA^ It 1 fP1Pfnnn 7d1-1 RnO Appendix II (14) Legal Remedies for Tenants of Residential Housing The following is a brief summary of some of the legal remedies tenants may use in order to get housing code violations corrected : 1. Rent Withholding (Massachusetts General Laws, Chapter 239, section 8A): If Code Violations Are Not Being Corrected you may be entitled to hold back your rent payments. You can do this without being evicted if You can prove that your dwelling unit or common areas contain code violations which are serious enough to endanger or materially impair your health of safety and that your landlord knew about the violations before you were behind in your rent_ You did not cause the violations and they can be repaired while you continue to live in the building. You are prepared to pay any portion of the rent into court if a judge orders you to pay it. ( For this, it is best to put the rent money aside in a safe place) . 2. Repair and Deduct (Massachusetts General Laws, Chapter III, section 127L): The law sometimes allows you to use your rent money to make the repairs yourself. If your local code enforcement agency certifies that there are code violations which may endanger or materially impair your health, safety, or well-being, and your landlord has received written notice of the violations, you may be able to use this remedy. If the owner fails to begin necessary repairs (or to enter into a written contract to have them made) within five days after the notice or to complete repairs within 14 days after notice, you can use up to four months rent in any year to make repairs. 3. Retaliatory Rent Increases or Evictions Prohibited (Massachusetts General Laws, Chapter 186, section 18, and Chapter 239, Section 2A): The owner may not increase your rent or evict you in retaliation for making a complaint to your local code enforcement agency about code violations. If the owner raises your rent to try to evict within six months after you have made the complaint, he or she will have to show a good reason for the increase or eviction which is unrelated to your complaint. You may be able to sue the landlord for damages or if he or She tries this. 4. Rent Receivership (Massachusetts General Laws Chapter U, section 127 C -H): The occupants and/or the Board of Health may petition the District or Superior Court to allow rent to be paid into court rather than to the owner. The court may then appoint a "receiver" who may spend as much of the rent money as is needed to correct the violation. The receiver is not subject to a spending limitation of four months'rent. 5. Breach of Warranty of Habitability You may be entitled to sue your landlord to have all or some of your rent returned if your dwelling unit does not meet minimum standards of habitability. 6. Unfair & Deceptive Practices (Massachusetts General Laws, Chapter 93A) : Renting an apartment with code violations is a violation of the consumer protection act and regulations, for which you may sue an owner. The information presented above is only a summary of the law. Before you decide to withhold rent or take anv other legal action, it is advisable that you consult an attorney. If you can not afford to consult an attorney. you should contact the nearest legal services office, which is North Shore Community Action Northeast Housing Court Programs Inc. 2 Appleton Street 98 Main Street Lawrence, MA. 01840 Peabody, MA. 01960 (978) 689-7833 (978) 531-0767 CITY OF SALEM HEALTH DEPARTMENT • Salem, Massachusetts 01970 Page Z Of ,X• Date: s-i� Oso Name: Th zZm Address: 4-7-2 r, •�. s e STANLEY J. USOVICZ, JR. MAYOR - 1 CITY OF SALEM, MASSACHUSETTS ~ BOARD OF HEALTH 120 WASHINGTON STREET, 4TH FLOOR SALEM, MA01970 TEL. 978-741-1800 FAX 978-745-0343 JOANNE SCOTT, MPH, RS, CHO 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: FOOD SERVICE Name of Establishment: The Salem Inn Address of Establishment: 7 Summer Street Owner's Name: Diane and Dick Pabich Restrictions: Application+ Date: 11/26/2003 Permit for Food Establishment 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. �J HEALTH AGENT CITY OF SALEM, MASSACHUSETTS t �� FAX 978-745-0343 ',� BOARD OF HEALTH s �. 120 WASHINGTON STREET, 4TH FLOOR NOV 2 4 2003 SALEM, MA 01970 • TEL. 978-741-1800 LI I Y Ili"JrLpE L� STANLEY USOVICZ, JR. KARL) OF u`iEALTH JOANNE SCOTT, MPH, RS, CHO MAYOR HEALTH AGENT 2004 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT xfl NAME OF ESTABLISHMENT Me �M JA6 TEL #`13S ' AL I - 0690 ADDRESS OF ESTABLISHMENT Sli4M1IMI .4 OIq_7O . MAILING ADDRESS (if different) OWNER'S NAME (t)Y d(2QVOf S 10C; %Qr)P_ 4P& d f A6'd�TEL # CERTIF (required in an establishment where potentially hazardous food is prepared.) EMERGENCY RESPONSE PERSON Undn lCadoo HOME TEL# 2-' I l—O HOURS OF OPERATION: Mon. Tue. Wed. % Thu. / Fri. / Sat. Sun,"'R 6 f — (0� H TYPE OF ESTABLISHMENT RETAIL STORE YES RESTAURANT YES BED/BREAKFAST IVES }--NO FEE check only less than 1000sq.ft. =$ 50 1000-10,000sq.ft. =$100 .more than 10,000sq.ft. =$250 less than 25 seats =$100 25-99 seats =$150 more than 99 seats $ 100 , ADDITIONAL PERMITS MAKE (notjust serve) ICE CREAM, YOGURT, SOFT SERVE YES $5 TOBACCO VENDOR YES $50 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 must be submitted to and approved by the Salem Board of Health. L Chapter 62C, Section 49A, I certify under the pains and penalties of perjury that I, to my and belief, have file all s ate tax returns and pa'd all state tax s required under the law. jl f, 103 n -a��-gam Date Social Security or Federal Identification Number Revised 11/03/03 FOODAP2.adm _ Check# & Date /a( (O 7-7 �t f 1, a } STANLEY USOVICZ, JR. MAYOR CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH 120 WASHINGTON STREET, 4TH FLOOR SALEM, MA 01970 TEL. 978-74 1 -1 800 FAX 978-745-0343 JOANNE SCOTT, MPH. R5, CHO HEALTH AGENT If COMMONWEALTH OF MASSACHUSETTS i��1:7uFwr�r�Zg9�1:aeV4�a�a[iZ�)�7�F�1Ca` I+F�F9.I�il�M�l 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: Diane & Dick Pabich Name of Establishment: The Salem Inn Address of Establishment: 7 Summer Street Type of Establishment: FOOD SERVICE Application Date: 12/10/2002 Restrictions: Permit for Food Establishment 42-03 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 F• .f" caeolr' CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH DEC q 20D2 3 120 WASHINGTON STREET, 4TH FLOOR U L a SALEM, MA 01970 TEL. 978-741-1800 Ci I Y OF SALEM FAX 978-745-0343 BOARD OF HEALTH STANLEY LISOVICZ, JR. JOANNE SCOTT, MPH, RS. CHO MAYOR HEALTH AGENT 2003 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT NAME OF ESTABLISHMENT {r1-! �J Qk inn _TTEL#"I /p-%-yt —%Do '7 C ADDRESS OF ESTABLISHMENT I 0kJMlJVef Sk� �QkWl ("A M-70 MAILING ADDRESS (if different) OWNER'S RI'C I FLb'C- ) TEL #R%O -_715 a IAf CITY�t� W? STATE_ WA ZIP UI qgo CERTIFIED FOOD MANAGER'S NAME(S) CERTIFICATE#(s) (required in an establishment where potentially hazardous food is prepared.) EMERGENCY RESPONSE PERSON I'tdndO CD6 nO HOME TEL #q3L_ l `0 HOURS OF OPERATION: Mon. V1 Tue._J/Wed. ✓ Thu. Fri. Sat. '._� Sun. 1 � RH-IQ AM TYPE OF ESTABLISHMENT RETAIL STORE YESNO 3 RESTAURANT YES NO BED/BREAKFAST YE NO ADDITIONAL PERMITS MAKE ICE CREAM, YOGURT, SOFT SERVE YES N TOBACCO VENDOR YES ALL NON-PROFIT (such as church kitchens) YES N FEE check only less than 1000sq.ft. =$ 50 1000-10,000sq.ft. =$100 more than 10,000sq.ft. =$250 less than 25 seats =$100 25-99 seats =$150 more than 99 seats $100 $5 $50 $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 knowledw and belief,Oe fileb,all state tax returns and Paid all state taxes required under the law. ir'l . _ �i-- _ n ), 7 —n ) _ !'14_ — 'l—mv -. Signature Date Social Security or Federal Identification Number Revised 11/25102 FOODAP2.adm Check# 8 Date i .o STANLEY LISOVICZ, JR. MAYOR Diane & Richard Pabich 35 Winter Island Road Salem, Ma. 01970 Dear Mr. & Mrs. Pabich: CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH 120 WASHINGTON STREET, 4TH FLOOR SALEM, MA 01970 TEL. 978-741-1800 FAX 978-745-0343 JOANNE SCOTT, MPH, RS, CHO HEALTH AGENT March 28, 2003 In accordance with Chapter II, Sections 127A and 127B of the Massachusetts General Laws, 105 CMR 400.00; State Sanitary Code, Chapter I: General Administrative Procedures and 105 CMR 410.00: State Sanitary Code, Chapter II: Minimum Standards of Fitness for Human Habitation, an inspection was conducted of the property at 5-7-9 Summer Street) conducted by Virginia Moustakis &.Jeae4 ia&,Sanitarianq on Tuesday March 25, 2003, At 11:00 A.M. Notice: If this rental unit is occupied by a child or children under the age of 6 years, it is the property owner's responsibility to notify tenants of lead related reports and tests, and to ensure that this unit complies fully with 105 CMR 460.000: Regulations for Lead Poisoning Prevention and Control. For further information or to request an inspection, contact the Salem Health Department at 978-741-1800. You are hereby ORDERED to make a good -faith effort to correct the violations listed on the enclosed inspection report. Failure on your part to comply within the time specified on the enclosed inspection report will result in a complaint being sought against you in Salem District Court. Time for compliance begins with receipt of this Order. Should you be aggrieved by this Order, you have the right to request a hearing before the Board of Health. A request for said hearing must be received in writing in the office of the Board of Health within 7 days of receipt of this Order. At said hearing, you will be given an opportunity to be heard and to present witness and documentary evidence as to why this Order should be modified or withdrawn. You may be represented by an attorney. Please also be informed that you have the right to inspect and obtain copies of all relevant inspection or investigation reports, orders and other documentary information in the possession of this Board, and that any adverse party has the right to be present at the hearing. Please be advised that the conditions noted may enable the occupant(s) to use one or more of the statutory remedies available to them as outlined in the enclosed inspection report form. For the Board of Health: oanne Scott Health Agent Reply to: Virginia Moustakis 8Diaa Sanitarians j cc: Councillor, Joan B. Lovely Licensing Board, Fire Prevention, & Building Inspector JS/ vm o -h -violet CITY OF SALEM, MASSACHUSETTS v '� BOARD OF HEALTH • 120 WASHINGTON STREET. 4TH FLOOR SALEM, MA 01970 �?r TEL. 978-74 1-1800 �qMr�1 FAz 978-745-0343 Page 1 of ;7— STANLEY USOVICZ, JR JOANNE SCOTT. MPH. RS. CHO MAYOR HEALTH AGENT State Sanitary Code, Chapter II: 105 CMR 410.000 Minimum Standards of Fitness for Human Habitation Occupant : <A,� , > ✓ (7�BPFrzkras>> Phone: Address- 6 -7- Apt.# Floors /-a-s. Owner: „gNP ty,5eiPic/xrQI 461ch Address: 3sglltile,e %st��r�L Inspection Date: /✓/y�c/i ate,v� Conducted By: K/ jA Ka Anticipated Reinspection Date: 0/9 7a Time: /'oo a -m rr ni tQ,�eee�i__q0' Accompanied By: sm/em bol� "" 7e-t- Fi"e i°,�£de�fian T ,SPt Jo�/a[�{ r7/Es?87'/�n/o �/cri+tct PR. CITY OF RALEM HEALTH DEPARTMENT 120 WASHINGTON STREET 4TH FLOOR Salem, Massachusetts 01970 Page a of 2 Name: a/r» T,yn/ Address: S— °1- 9 �him�p. Sf SDecified time Req.#410.. Violation(S) y -Ivadio oxS � �f TF,PonT e 2 ✓e n�',Yr .� 10 dl,74 1'9a �✓ ee ao d Nvm da,,er 13oof- Pe-tvie,1,V L e ike e�n�/D�? rxde�.P ed' C7 t1- Fie � S eo erea - of 7E, - ' Mb�'mea+t.r,4"w��"re'r�.:+�,¢M�-.-wr+:.....irr..,�w`-•----•.r-.....:.vv-r-a-,..,..--'.-^:� .,THE'COMMONWEALTH OF MASSACHUSETTS CITY OF SALEM BOARD OF HEALTH FOOD ESTABLISHMENT INSPECTION REPORT Address: 120 Washington Street, 4th Floor Salem, MA 01970-3523 Tel: (978) 741-1800 Fax: (978) 745-0343 Name Date ,Type of Operation(s) Type of Inspection /d P. Y- .g ❑ Food Service ❑ Retail Vaoutine Y ❑ Re -inspection Address - Risk d 111/12 Level ❑ Residential Kitchen ❑ Mobile ❑ Temporary Previous Inspection Date: ❑ Pre-operation - _ Telephone 7411.- 0 6 0 Owner HACCP Y/N .s ❑ Caterer Bed & Breakfast ❑ Suspect Illness ❑ General Complaint Person in Charge (PIC) , Time 119je 411VA90 V6 In: Out: Permit No. El HACCP ❑ Other Inspector VZ!Z/�-IWAIIS 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 (Red Items) 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. Local Law F1 FOOD PROTECTION MANAGEMENT ❑ 1. PIC Assigned / Knowledgeable / Duties EMPLOYEE HEALTH ❑ 2. Reporting of Diseases by Food Employee and PIC ❑ 3. Personnel with Infections Restricted / Excluded FOOD FROM APPROVED SOURCE ❑ 4. Food and Water from Approved Source ❑ 5. Receiving / Condition ❑ 6. Tags / Records / Accuracy of Ingredient Statements ❑ 7. Conformance with Approved Procedures / HACCP Plans PROTECTION FROM CONTAMINATION ❑ 8. Separation / Segregation / Protection ❑ 9. Food Contact Surfaces Cleaning and Sanitizing ❑ 10. Proper Adequate Handwashing ❑ 11. Good Hygienic Practices Violations Related to Good Retail Practices (Blue Items) Critical (C) violations marked must be corrected immediately or within 10 days as determined by the Board of Health. Non-critical (N) violations must be corrected immediately or within 90 days as determined by the Board of Health. C N 23. Management and Personnel (FC -2)(590.003) 24. Food and Food Protection (FC -3)(590.004) 25. Equipment and Utensils (FC -4)(590.005) 26. Water, Plumbing and Waste (FC -5)(590.006) 27. Physical Facility (FC -6)(590.004,7) 28. Poisonous or Toxic Materials (FC -7)(590.008) 29. Special Requirements (590.009) 30. Other 6 i ❑/ 12. Prevention of Contamination from Hands 0 13. Handwash, Facilities PROTECTION FROM CHEMICALS ❑ 14. Approved Food or Calor Additives ❑ 15. Toxic Chemicals TIMEITEMPERATURE CONTROLS (Potentially Hazardous Foods) ❑ 16. Cooking Temperatures ❑ 17. Reheating ❑ 18. Cooling ❑ 19. Hot and Cold Holding ❑ 20. Time as a Public Health Control REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS (HSP) ❑ 21. Food and Food Preparation for HSP CONSUMER ADVISORY ❑ 22. Posting of Consumer Advisories Number of Violated Provisions Related To Foodborne Illnesses Interventions and Risk Factors (Red Items 1-22): Official Order for Correction: Based on an inspection today, the items checked indicate violations of 105 CMR 590.000/Federal Food Code. This report, when signed below., by a Board of Health member or its agent constitutes an_i*--' order of the Board of Health. Failure to correct violations cited in this report may result in suspension or revocation of the food establishment permit and cessation of food establishment operations. If aggrieved by this order, you have a right to a hearing. Your request must be in writing and submitted to the Board of Health at the above address within 10 days of receipt of this order. DATE OF RE -INSPECTION: Inspector's Signature: /�/� T Print: PIC's Signature: n k4"l Print Page / of ?- Pages �' V - /- `/ j,,,41 FORM 734A HOBBS & WARREN -BOSTON Violations Related to Foodborne Illness Interventions and Risk Factors (Red Items 1-22) FOOD PROTECTION MANAGEMENT 1' 590.003(A) Assi nment of Responsibility* 590.003(B) Demonstration of Knowledge* 2-103.11 Person in Charge - Duties EMPLOYEE HEALTH 2 590.003(C) Responsibility of the Person in Charge to Compliance with Food Law* 3-201.12 require reporting by Food Employees and 3-201.13 Fluid Milk and Milk Products* Applicants* Shell Eggs* 590.003(F) Responsibility of a Food Employee or an 3-202.16 Ice Made from Potable Drinking Water* Applicant to Report to the Person in Drinking Water from an Approved System* 590.006(A) Charge* 590.006(B) 590.003(G) Reporting by Person in Charge* 3='' 590.003(D) Exclusions and Restrictions* 3-201.15 590.003(E) Removal of Exclusions and Restrictions 4i 5< FOOD FROM APPROVED SOURCE * Denotes critical item in the federal 1999 Food Code or 105 CNIR 590.000. C C 10; 12 13 PROTECTION FROM CONTAMINATION Food and Water From Regulated Sources 590.004(A -B) Compliance with Food Law* 3-201.12 Food in a Hermetically Sealed Container* 3-201.13 Fluid Milk and Milk Products* 3-202.13 Shell Eggs* 3-202.14 Eggs and Milk Products, Pasteurized* 3-202.16 Ice Made from Potable Drinking Water* 5-101.11 Drinking Water from an Approved System* 590.006(A) Bottled Drinking Water* 590.006(B) Water Meets Standards in 310 CMR 22.0* Shellfish and Fish From an Approved Source 3.201.14 Fish and Recreationally caught Molluscan Shellfish* 3-201.15 Molluscan Shellfish from NSSP Listed Sources* 4-501.111 Game and Wild Mushrooms Approved by Regulatory Authority 3.202.18 Shellstock Identification Present* 590.004(C) Wild Mushrooms* 3-201.17 Game Animals* 4-602.11 Receiving/Condition 3-202.11 PHFs Received at Proper Temperatures* 3-202.15 Package Integrity* 3-101.11 Food Safe and Unadulterated* 2-301.11 Tags/Records: Shellstock 3-202.18 Shellstock Identification* 3-203.12 Shellstock Identification Maintained* Tags/Records: Fish Products 3-402.11 Parasite Destruction* 3-402.12 Records, Creation and Retention* 590.004(1) Labeling of Ingredients* Conformance with Approved Procedures /HACCP Plans 3-502.11 Specialized Processing Methods* 3-502.12 Reduced Oxygen Packaging, Criteria* 8-103.12 Conformance with Approved Procedures* * Denotes critical item in the federal 1999 Food Code or 105 CNIR 590.000. C C 10; 12 13 PROTECTION FROM CONTAMINATION Cross -contamination 3-302.11(A)(1) Raw Animal Foods Separated from Cooked and RTE Foods* Contamination from Raw Ingredients 3-302.11 (A)(2) Raw Animal Foods Separated from Each Other* Contamination from the Environment 3-302.11(A) Food Protection* 3-302.15 Washing Fruits and Vegetables 3.304.11 Food Contact with Equipment and Utensils* Contamination from the Consumer 3-306.14(A)(B) Returned Food and Reservice of Food* Disposition of Adulterated or Contaminated Food 3-701.11 Discarding or Reconditioning Unsafe Food* Food Contact Surfaces 4-501.111 Manual Warewashing - Hot Water Sanitization Temperatures* 4-501.112 Mechanical Warewashing - Hot Water Sanitization Temperatures* 4-501.114 Chemical Sanitization - temp., pH, Concentration and Hardness* 4-601.11(A) Equipment Food Contact Surfaces and Utensils Clean* 4-602.11 Cleaning Frequency of Equipment Food - Contact Surfaces and Utensils* 4-702.11 Frequency of Sanitization of Utensils and Food Contact Surfaces of Equipment* 4-703.11 Methods of Sanitization - Hot Water and Chemical* Proper, Adequate Handwashing 2-301.11 Clean Condition - Hands and Arms* 2-301.12 Cleaning Procedure* 2-301.14 When to Wash* Good Hygienic Practices 2-401.11 Eating. Drinking or Using Tobacco* 2-401.12 Discharges From the Eyes. Nose and Mouth* 3-301.12 Preventing Contamination When Tasting* Prevention of Contamination from Hands 590.004(E) Preventing Contamination from Employees* Handwash Facilities Conveniently Located and Accessible 5-203.11 Numbers and Capacities* 5-204.11 Location and Placement* 5-205.11 Accessibility, Operation and Maintenance Supplied with Soap and Hand Drying Devices 6-301.11 Handwashing Cleanser, Availability 6-301.12 Hand Drying Provision tsLaD11snmeni Name; G CITY OF SALEM BOARD OF HEALTH :.:.n.. , e.1 • a �r Annr.rwr.�u i'. % ^3 ca 1.; .. Discussion With Person in Charge: Corrective Action Required: 0'No ❑Yes I have read this report, have had the opportunity to ask questions and agree to correct all ❑ Voluntary Compliance O Employee Restriction/ violations before the next inspection, to observe all conditions as described, and to comply Exclusion with all mandates of the Mass/Federal Food Code. I understand that noncompliance may ❑ Re -inspection Scheduled ❑ Emergency Suspension result in daily fines of twenty-five dollars or suspension/revocation of your food permit. ❑ Embargo ❑ Emergency Closure 7_ �� ❑ Voluntary Disposal ❑ Other , o m� Violations Related to Foodborne Illness Interventions and Risk Factors (Red Items 1-22) (Cont) PROTECTION FROM CHEMICALS 14 15 Food or Color Additives 3-202.12 Additives* 3-202.14 Protection from Unapproved Additives* 3-501.16(B) 590.004(F) Poisonous or Toxic Substances 7-101.11 Identifying Information - Original Containers* 7-102.11 Common Name-WorkingContainers* 7-201.11 Separation - Storage* 7-202.11 Restriction - Presence and Use* 7-202.12 Conditions of Use* 7-203.11 Toxic Containers - Prohibitions* 7-204.11 Sanitizers, Criteria - Chemicals* 7-204.12 Chemicals for Washing Produce, Criteria* 7-204.14 Drying Agents, Criteria* .7-205.11 Incidental Food Contact, Lubricants* 7-206.11 Restricted Use Pesticides, Criteria* 7-206.12 Rodent Bait Stations* 7-206.13 Tracking Powders, Pest Control and Monitoring* TIME/TEMPERATURE CONTROLS „1 6. PHFs Received at Temperatures According to Law Cooled to 41*F/45*F Within 4 Hours.* Proper Cooking Temperatures for Cooling Methods for PHFs 3-801.11(6) PHFs 3-501.16(B) 590.004(F) 3-401.1IA(1)(2) Eggs - 155°F 15 Sec. Hot PHFs Maintained at or above 140°F.* 3-501.16(A) Eggs - Immediate Service 145°F 15 Sec.* 25. 3-401.11(A)(2) Comminuted Fish, Meats & Game Time as a Public Health Control* 590.004(H) Animals - 155°F Sec.* FC - 5 3-401.11(6)(1)(2) Pork and Beef Roast - 130°F 121 Min.* Physical Facilit 3-401.11(A)(2) Ratites, Injected Meats- 155°F 15 Sec.* 28. 3-401.11(A)(3) Poultry, Wild Game, Stuffed PHFs, .008 29. Stuffing Containing Fish, Meat, .009 Poultry or Ratites - 165°F 15 Sec.* Other 3-401.11(C)(3) Whole -muscle, Intact Beef Steaks 145°F* 3-401.12 Raw Animal Foods Cooked in a Microwave 165°F* 3-401.11(A)(1)(b) All Other PHFs -145°F15Sec.* ,.:17 - Reheating for Hot Holding 3-403.11(A)&(D) PHFs 165*F 15 Sec.* 3-403.11(B) Microwave- 165°F 2 Minute Standing Time* 3-403.11(C) Commercially Processed RTE Food - 140°F* 3-403.11(E) Remaining Unsliced Portions of Beef Roasts* .,18w Proper Cooling of PHFs 3-501.14(A) Cooling Cooked PHFs from 140°F to 70°F Within 2 Hours and from 70°F to 41°F/45°F Within 4 Hours.* 3-501.14(8) Cooling PHFs Made From Ambient Temperature Ingredients to 41°F/45°F Within 4 Hours* * Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. 19 . 20 3-501.14(C) PHFs Received at Temperatures According to Law Cooled to 41*F/45*F Within 4 Hours.* 3-501.15 Cooling Methods for PHFs 3-801.11(6) PHF Hot and Cold Holding 3-501.16(B) 590.004(F) Cold PHFs Maintained at or below 41°F/45°F* 3-501.16(A) Hot PHFs Maintained at or above 140°F.* 3-501.16(A) Roasts Held at or above 130°F.* 25. Time as a Public Health Control 3-501.19 Time as a Public Health Control* 590.004(H) Variance Requirement REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS (HSP) '.'21"" 3-801.11(A) Unpasteurized Pre-packaged Juices and Beverages with Warning Labels* 590.00 3-801.11(6) Use of Pasteurized Eggs* FC - 2 3-801.11(D) Raw or Partially Cooked Animal Food and Raw Seed Sprouts Not Served.* Food and Food Protection 3-801.11(C) Unopened Food Package Not Re -served.* CONSUMER ADVISORY i' 22. 3-603.11 Consumer Advisory Posted for Consumption of 590.00 23. Animal Foods that are Raw, Undercooked or FC - 2 .003 not Otherwise Processed to Eliminate Food and Food Protection FC - 3 Pathogens.* Effective 11112001 25. 3-302.13 1 Pasteurized Eggs Substitute for Raw Shell Eggs* SPECIAL REQUIREMENTS 590.009(A) -(D) Violations of Section 590.009(A) -(D) in catering, mobile food, temporary and residential kitchen operations should be debited under the appropriate sections above if related to foodborne illness interventions and risk factors. Other 590.009 violations relating to good retail practices should be debited under #29 - Special Requirements. VIOLATIONS RELATED TO GOOD RETAIL PRACTICES (Blue Items 23-30) Critical and non-critical violations, which do not relate to the foodborne illness interventions and risk factors listed above, can be found in the following sections of the Food Code and 105 CMR 590.00. Item Good Retail Practices FC 590.00 23. Management and Personnel FC - 2 .003 24. Food and Food Protection FC - 3 .004 25. Equipment and Utensils FC - 4 .005 26. Water, Plumbing and Waste FC - 5 .006 27. Physical Facilit FC-6 .007 28. Poisonous or Toxic Materials FC - 7 .008 29. Sp ecial Requirements .009 30. Other GME�.uN y; l STANLEY USOVIGZ, JR. MAYOR CITY OF SALEM; MASSACHUSETTS 'BOARD OF HEALTH' 120 WASHINGTON STREET, 4TH FLOOR..- • SALEM, MA 01970 TEL. 978-741-1800 FAX 978-745-0343 - JOANNE SCOTT, MPH, RS, CHO 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: ,,Owners. Name: Diane &.,Dick Pabich Name.'of Establishment: The Salem Inn, Address: of 'Establishment: 7 Summer Street ,Type of Establishment i;FOOD :SERVICE . Application Date: 11/27/2001':;; { Restrictions "r }• � � r' � s - £+..,6 It �SPermit fora Food Establishment'. 7-02 Frozen Desserts/Ice Cream . Permit for; the Sale' of. Tobacco Products A _- These Permits Expire_December;.31;:20.02 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. pY HEALTH AGENT cn .r � �MnB STANLEY LISOVICZ, JR. MAYOR CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH 120. WASHINGTON STREET, 4TH FLOOR SALEM, MA 01970 TEL. 978-741-1800 FAX 978-745-0343 JOANNE SCOTT, MPH, RS, CHO HEALTH AGENT 110'4272001 CITY Or SALEM HEALTH DEPT. 507 2002 APPLICATION FOR'PE/RMIT TO OPERATE A FOOD ESTABLISHMENT NAME OF ESTABLISHMENT ll t% c7G/IPtin -h'h TEL # / 7P" 7 411 ED ADDRESS OF ESTABLISHMENT 7 Sy" , ZU Sl_ MAILING ADDRESS (if different) OWNER'S Tom) nce ea ✓a- LAJ��Y zF, � TEL # 7 ADDRESS 3� nom- -EG, A�: CITY,S, ,w STATE Ik71` ZIP CERTIFIED FOOD MANAGER'S NAME(S) CERTIFICATE#(s) (required in an establishment where potentially hazardous food is prepared.) EMERGENCY RESPONSE PERSON Ae-11 KAP C1' -n A/ 4_J HOME TEL # % % e- 7W 06 Z ? DAYS/ HOURS OF OPERATION: Mon.Tue.=GGed. ✓Thu. tri. Sat. Sun.= A+'.1-io�i� TYPE OF ESTABLISHMENT FEE check only RETAIL STORE YES �O$40 RESTAURANT BED & BREAKFAST Y 'NO $40 ADDITIONAL PERMITS MAKE ICE CREAM, YOGURT SOFT SERVE YES NO $5 TOBACCO VENDOR YES NO NO CHARGE FOR NON-PROFIT (such as church kitchens) PLEASE INCLUDE COPY OF TAX EXEMPT FORM 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 Revised 1111/01 foodapZadm Check#& f/ -.z3 o1 ®'f-a-_ey;170 Date Social Security or Federal Identification number V-0, crZ April 26, 2002 Daniel J. Kolzet, D.M.D. 900 Broad Street Suite B Durham, North Carolina 27705 Dear Dr. Kolzet: With reference to your 3/27/02 letter regarding the Salem Inn, we enclose the following: Copy of 2/19/02 inspection report indicating that at that time there were no violations In Room 54. Copy of 4/11/02 inspection of Room 54. Room 54 was unoccupied and was clean and sanitary. There was both hot and cold running Water at the sink and in the shower. The toilet was clean and flushed without difficulty. Water temperature was recorded at 119 degrees Fahrenheit, which was within the State Code Mandates of no less than 110 degrees F. nor more than 130 degrees F. Thank you for your inquiry regarding this establishment. For The Board of Health oanne Scott Health Agent Cc: Diane & Richard Pabich ENCLS. Reply to: Virginia Moustakis Sanitarian CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH 3 • 120 WASHINGTON{ STREET, 4TH FLOOR ] a. SALEM, MA 01970 TEL. 978-741-1800 FAX 978-745-0343 STANLEY USOVICZ, JR. JOANNE SCOTT, MPH, RS, CHO MAYOR I HEALTH AGENT April 26, 2002 Daniel J. Kolzet, D.M.D. 900 Broad Street Suite B Durham, North Carolina 27705 Dear Dr. Kolzet: With reference to your 3/27/02 letter regarding the Salem Inn, we enclose the following: Copy of 2/19/02 inspection report indicating that at that time there were no violations In Room 54. Copy of 4/11/02 inspection of Room 54. Room 54 was unoccupied and was clean and sanitary. There was both hot and cold running Water at the sink and in the shower. The toilet was clean and flushed without difficulty. Water temperature was recorded at 119 degrees Fahrenheit, which was within the State Code Mandates of no less than 110 degrees F. nor more than 130 degrees F. Thank you for your inquiry regarding this establishment. For The Board of Health oanne Scott Health Agent Cc: Diane & Richard Pabich ENCLS. Reply to: Virginia Moustakis Sanitarian FOR OF PHONE 62 A CODE NUMBER EXTENSION ❑ FAX O MOBILE AREA CODE NUMBER TIME TO CALL TELEPHONED PLEASE CALL CAME TO SEE YOU WILL CALL AGAIN WANTS TO SEE YOU RUSH RETURNED YOUR CALL WILL FAX TO YOU , SIGNED NOTES Aur' Postmark Here Street, b,r PEO Box No;— r C3 Sty ~_�LDfJ�...__._.....§tatPN O ' � firQiCl1 lCHFlQ%J a Postage $ N Q- Certified Fee ,c[3 Return Receipt Fee O (Endorsement Required) O Restricted Delivery Fee O (Endorsement Required) 0 Total Postage & Pees ,$ - fTl FFYine (Please Pnn(Cl�y) (to be completed Aur' Postmark Here Street, b,r PEO Box No;— r C3 Sty ~_�LDfJ�...__._.....§tatPN Certified Mail Provides: 0 mailing receipt ■ A un,qdentifier for your mailpiece ■ A signZt�te upon delivery ■ A record -of delivery kept by the Postal Service for two years Important Reminders. ■ Cemfied Mail may ONLY be combined with First -Class Mail or Priority Mail. ■ Certified Mail is not available for any class of international mail. ■ NO INSURANCE COVERAGE IS PROVIDED with Certified Mail. For valuables, please consider Insured or Registered Mail. ■ For an additional fee, a Return Receipt may be requested to provide proof of delivery. To obtain Return Receipt service, please complete and attach a Return Receipt (PS Form 3811 to the article and add applicable postage to cover the fee. Endorse mailpiece 'Return Receipt Requested". To receive a fee waiver for a duplicate return receipt, a USPS postmark on your Certified Mail receipt is required. ■ For an additional fee, delivery may be restricted to the addressee or addressee's authorized agent. Advise the clerk or mark the mailpiece with the endorsement "Restricted Delivery". ■ If a postmark on the Certified Mail receipt is desired,please present the arti- cle at the post office for postmarking. If a postmark on the Certified Mail receipt is not needed, detach and affix label with postage and mail. IMPORTANT: Save this receipt and present it when making an inquiry. PS Form 3800, July 1999 (Reverse) - _' 102595-99-M-2087 A 9 STANLEY USOVICZ, JR. MAYOR Diane & Richard Pabich 35 Winter Island Road Salem, MA 01970 Dear Sir or Madam : CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH 120 WASHINGTON STREET, 4TH FLOOR SALEM. MA 01970 TEL. 978-741-1800 FAX 978-745-0343 JOANNE SCOTT, MPH, RS, CHO HEALTH AGENT February 20, 2002 In accordance with Chapter III, Sections 127A and 127B of the Massachusetts General Laws, 105 CMR 400.00, State Sanitary Code, Chapter I: General Administrative Procedures and 105 CMR 410.00: State Sanitary Code, Chapter II Minimum Standards of Fitness for Human Habitation, an inspection was conducted of the property at 5-7-9 Summer Street occupied by (The Salem Inn) conducted by, Virginia Moustakis, Sanitarian on Tuesday, February 19, 2002 at 10:15 A.M. Notice: If this rental unit is occupied by a child or children under the age of 6 years, it is the property owner's responsibility to notify tenants of lead related reports and tests, and to ensure that this unit complies fully with 105 CMR 460.000 : Regulations for Lead Poisoning Prevention and Control. For further information or to request an inspection, contact the Salem Health Department at 741-1800. You are hereby ORDERED to make a good -faith effort to correct the violations listed on the enclosed inspection report. Failure on your part to comply within the time specified on the enclosed inspection report will result in a complaint being sought against you in Salem District Court. Time for compliance begins with receipt of this Order. Should you be aggrieved by this Order, you have the right to request a hearing before the Board of Health. A request for said hearing must be received in writing in the office of the Board of Health within 7 days of receipt of this Order. At said hearing, you will be given an opportunity to be heard and to present witness and documentary evidence as to why this Order should be modified or withdrawn. You may be represented by an attorney. Please also be informed that you have the right to inspect and obtain copies of all relevant inspection or investigation reports, orders and other documentary information in the possession of this Board, and that any adverse party has the right to be present at the hearing. Please be advised that the conditions noted may enable the occupant(s) to use one or more of the statutory remedies available to them as outlined in the enclosed inspection report form. For the Board of Health Reply to: Joanne a Scott Virginia Moustakis Health Agent Sanitarian cc: Councillor Joan Lovely, Licensing, Building Inspector, & Fire Prevention . Certified Mail # 7099 3400 0008 9218 4505 JS/ sjk c -h -violet I !.. Page 1 of SALEM HEALTH DEPARTMENT k. 64mrb.,Sal6m, MA 01970 State Sanitary Code, Chapter 11: 105 CMR 410.000 Minimum Standards of Fitness for Human Habitation Occupant: v ZF/y jitIAl Phone: Address: 9 \511) t'JP'e J f Apt. Floor i-2- 3 Owner. PL,21yP_ 1 Wk/ce'ece, IQZICi Address: 3S Inspection Date: 12- /9 -OA ,. Time. le, - i r Al- n Conducted By: J/ it%ac.sraKrt Accompanied By: �k mam Anticipated Reinspection Date: goer e le eAlved zn ti7y v f i by r-iee %y mvP -tG -,nae rt�rs' ,(��iadivY /fts�4EZ'{dR �,tii�lK.D/eta/-o AleGitiot< Specified Reg # Violation ." Time 410.... One or more of the above violations may endanger or materially impair the health, safety and well-being or the occupants(s) Code Enforcement Inspector Este es un documento legal imporiante. Puede que afecte sus derechos. Puede adquiriruna traduccion de esta forma. &'e'l VeyNelGL�R/ �7Ge/gyp rt fi ak A✓O U/o o77s / - e-ct /t/o cGU •ecQ. S vccd i ece. K itf� a S e d. cuv ecG One or more of the above violations may endanger or materially impair the health, safety and well-being or the occupants(s) Code Enforcement Inspector Este es un documento legal imporiante. Puede que afecte sus derechos. Puede adquiriruna traduccion de esta forma. &'e'l VeyNelGL�R/ �7Ge/gyp APPENDIX H (14) Legal Remedies for Tenants of Residential Housing The following Is a brief summary of some of the legal remedies tenants may use In order to get housing code violations corrected: 1. Rent W� ithholdino (Massachusetts General Laws, Chapter 239, section 8A): If Code Violations Are Not Being Corrected you may be entitled to hold back your rent payments. You can do this without being evicted if: A. You can prove that your dwelling unit or common areas contain code violations which are serious enough to endanger or materially impair your health or safety and that your landlord knew about the violations before you were behind in- your rent B. You did not cause the violations and they can be repaired while you continue to live in the building. C. You are prepared to pay any portion of the rent into court if a judge orders you to pay it (For this, it is best to put the rent money aside in a safe place.) 2. Repair nd D r r (Massachusetts General Laws, Chapter III, section 127L): The law sometimes allows you to use your rent money to make the repairs yourself. If your local code enforcement agency certifies that them are code violations which endanger or materially impair your health, safety, or well-being, and your landlord has received written notice of the violations, you may be able to use this remedy. If the owner fails to begin necessary repairs (or to enter into a written contract to have thetjti made) within five days after notice or to complete repairs within 14 days after notice, you can use up to four months' rent in any year to make the repairs. 3. ReLiatory Rent Increases or Evictions Probibited (Massachusetts General Laws, Chapter. 186, section 18, and Chapter 239,-, _ section 2A): The owner may not increase your rent or evict you in retaliation for making a complaint to your local code enforcement agency about code violations. If the owner raises your rent to tries to evict within six months after you have made the complaint, be -or shewill:have to-show.a good.reason for the increase or eviction which is unrelated to your complaint. You may be able to sue the landlord for damages of he or she tries this. 4. Rent Receiversbin (Massachusetts General Laws, Chapter 11, section 127 C -H): The occupants and/or the Board of Health may petition the District or Superior Court to allow rent to be paid into.court rather than to the owner. The corm may then appoint a "receiver" who may spend as much of the rent money as is needed to correct the violation. The receiver is not subject to a spending limitation of four months' rent- 5. ent5. Breach of Warranty of Habitability: You may be entitled to sue your landlord to have all or some of your rent returned if your.. dwelling unit does not meet minimum standards of habitability. 6. Unfairand Deceptive Pra i rs (Massachusetts General Laws, Chapter 93A): Renting an apartment with code violations is a violation of the consumer protection act and regulations, for which you may sue an owner. The information presented above is only a summary of the law. Before you decide to withhold your rent or take any other legal action, it is advisable that you consult an attorney. If you cannot afford to consult an attorney, you should contact the nearest legal services office, which is: Neighborhood Legal Services 37 Friend St Lynn, MA 01902 (617)599-7730 r, CITY OF SALEM HEALTH DEPARTMENT ' Salem, Massachusetts 01970 Page _,g of�_ Date: Name: Silelll Tni.✓ Address:.-- -7 - 9 &o /,,2 In c2 ,S -f - Specified Time Reg.#410.. Violatioti(s) 7 7A Ir` ;Z e 71, /un d 615 S" oiK Ncv'�c la , 7y ti ilio rai0-n5 - - ✓ S - �2 ..C' ._ e C'!<ti ' a^"1 ...S�O � S !�7 tG"!✓ ' J , P T - d� C P[ �' a �C'_ 3c( .SG„ - .c J✓c ,rd.Pa's ve L, �U.t1 O 1&ax i / j o O e. Page of Date: ■ Complete items 1, 2, and 3. Also complete item 4 if Restricted Delivery is desired. ■ Print your name and address on the reverse so that we can return the card to you. ■ Attach this card to the back of the mailpiece, or on the front if space permits. 1. Article Addressed to: Diane Pabich 35 Winter Island Road Salem, MA 01970 5-7-9 Summer St A. Received by (Please Print Clearly) B. Date of Del 4 ❑ Agent D. Is delivery address different from item 1? ❑ ye; If VES, enter delivery address below: ❑ No 3. Service Type . Y7 Certified Mail ❑ Express Mail ❑ Registered ❑ Return Receipt for Merchandise ❑ Insured Mail ❑ C.O.D. 4. Restricted Delivery? (Extra Fee) ❑ Yes 2. Article Number (Copy from service label) 7099,:3400;_0008x9218,4505 PS Form 3811, July 1999 Domestic Return Receipt 102595-00 M-0952 U BTED STATES POSTAL SERu Cf E S—ZX B --rHostage-&,F PM — =UsPs -.Permit No-.-=G-],O9 • Sender: Please O tyo *Arne, City of Salem Board of Health 120 Washington Street -4th Floor W;N. MA 01970-3523 FEB 2 6 2002 --'-------- --ii rmYYi�+.t.ltttIII tttttlIII a <' CITY OF SALEM, MASSACI-iUSETTS 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 r April 18, 2002 Diane and Richard Pabich The Salem Inn 5-7-9 Summer Street Salem, Ma 01970 Dear Mr. & Mrs.Pabich: A It inspection was conducted at your establishment in accordance with Chapter II, State Sanitary Code, CMR 410.000.(room 54). No Health Code violations were observed at this time. Thank you for your cooperation. For The Board of Health Reply to: oann�# Virginia Moustakis Health Agent Sanitarian cc: Licensing Board, Fire Prevention, Building Inspector City Councillor Regina Flynn DANIEL J. KOLZET, D.M.D. A2� American Association Practice Limited to Endodontics AOL 0 of Endodontists Diplomate, American Board of Endodontics 5 (f Il n 900 BROAD STREET, SUITE B R V TELEPHONE 919/286-7660 DURHAM, NORTH CAROLINA 27705 �V APR 4 -2002 CITY U� Sr';LEM BOARD OF HEALTH Joanne Scott City of Salem Health Department 9 North Street Salem, Mass 01970 Greetings Joanna Scott, March 27, 2002 I hope this letter finds you well. The purpose of this letter is to follow up on a conversation that I had with one of your office staff members relative to a very unfortunate and unhealthy situation that I experienced at the Salem Inn located on 7 Summer Street in Salem, Massachusetts. As I indicated to one of your staff members last week I explained that while being a guest at the Salem Inn on Friday, March 15`h — March 17 , I experienced some very unhealthy conditions within room number #54. After checking in on Friday, March 15`h I reported to the very pleasant staff members of this particular Inn that the room did not have any adequate toilet facilities, since the toilet was not operational, there was no hot water in the shower, and the beat was not functioning.. I later learned that the boiler was not working and that was one of the major problems. Unfortunately the commode would not work and I was able to scout around and find another bathroom on the first floor. The very pleasant staff members Melinda, Jennifer and Nicole tried to reach the owners Dick & Diane Pabich, but unfortunately I have not heard from these proprietors. Moreover, I have left three messages regarding my displeasure and dissatisfaction with the facilities that were rented to me. Fortunately, with a lot of insistence I was transferred the next day to room number #52 that had capable facilities. The purpose of my stay in Salem Inn was to participate in the funeral of my mother who passed the previous Sunday. I was directed to park the rental car that I used for the funeral services in a parking lot accessible through a second driveway on the left of the front door. On Saturday morning unfortunately, I learned that this driveway was the private residence of an adjacent neighbor who indicated that there is often in -guest parking there and my car was towed. In an incredible downpour I jogged from Salem Inn to Bill's Auto Clinic on Commercial Street in order to obtain my towed rental car. Bear in mind I was looking forward to being a pallbearer in my mother's funeral mid-morning on Saturday, March 16`h. The additional stress and strain of this difficulty was certainly not easy to bear. DANIEL J. KOLZET, D.M.D. Practice Limited to Endodontics Diplomate, American Board of Endodontics 900 BROAD STREET, SUITE B DURHAM, NORTH CAROLINA 27705 American Association 0 of Endodontists TELEPHONE 919/286-7660 Fortunately, the police department contacted Bill's Auto Clinic and after running through the rain I was able to obtain the car and make the funeral in Lynn, Massachusetts. Aside from the unsanitary conditions involving the backed -up toilet commode, it is my objective opinion that the room should not have been rented to me and a charge not made. The charge for the room I will once again request from the owners, the Pabich's. I strongly believe their certificate of occupancy for renting to guests should be seriously re-examined. I look forward to receiving a copy of the report to your inspector, who I trust will evaluate this facility. I appreciate your help in this important matter. Very best regar s, aniel olz cc: Better Business Bureau of Eastern Massachusetts City of Salem City Hall, Inspections Department DJK/jcl -...•-..-...-.._..r.....�..,..gakW.�.,�..'�r-wn:pirwriwriy„srm+.C'Yvt�i.....�.:u+^4y+..:.--:�x�.W TH� COMM'ONWEALTH;OF MASSACHUSETTS c' CITY OF SALEM Board of Health FOOD ESTABLISHMENT INSPECTION REPORT Address: 9 North Street Salem, MA 01970-3928 Tel: (978) 741-1800 Fax: _(978) 740-9705 Name PRS 11 �iWG Date Tvoe of Operation(s) Tvoe of Inspection ❑ Food Service ❑ Retail Sa/2 Zvi v :, r� � /W hr,; �° Pa«sfs a- 9 Od L"Routine ❑ Re -inspection Address - Sf Risk S __ 9 Level ❑ Residential Kitchen El Mobile Previous Inspection Date: Telephone l 9%r �6ffG Ll eterer L1Pre-operationOwner El Suspect Illness / /� HACCP YIN cLcr c L(�Bed & Breakfast L1 General Complaint Person in Charge (PIC) Time 27�,Al In: El HACCP ❑ Other Inspector V /'%n Out: Permit No. Each violation checked requires an explanation on the narrative page(s) and a citation of specific provision(s) V101ateCi• Non-compliance with: RED Violations (1-22) 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) ❑ 5so.00g (F) ❑ action as determined by the Board of Health. Local Law ❑ FOOD PROTECTION MANAGEMENT - ❑ 1. PIC Assigned / Knowledgeable / Duties EMPLOYEE HEALTH ❑ 2. Reporting of Diseases by Food Employee and PIC ❑ 3. Personnel with Infections Restricted / Excluded FOOD FROM APPROVED SOURCE ❑ 4. Food and Water from Approved Source ❑ 5. Receiving / Condition ❑ 6. Tags/ Records/ Accuracy of Ingredient Statements ❑ 7. Conformance with Approved Procedures / HACCP Plans PROTECTION FROM CONTAMINATION ❑ 8. Separation / Segregation / Protection ❑ 9. Food Contact Surfaces Cleaning and Sanitizing ❑ 10. Proper Adequate Handwashing ❑ 11. Good Hygienic Practices BLUE Violations (23-30) Related to Good Retail Practices Critical (C) violations marked must be corrected Immediately or within 10 days as determined by the Board of Health. Non-critical (N) violations must be corrected immediately or within 90 days as determined by the Board of Health. C. N, 23 Management and Personnel (FC -2)(590.003) ,24. Food and Food.Protection (FC -3)(590.004) 25. Equipment and Utensils (FC -4)(590.005) 26. Water, Plumbing and Waste (Fc -5)(54o.006) 27. Physical Facility (FC -6)(590.007) 28. Poisonous or Toxic Materials (FC -7)(590.006) 29. Special Requirements (590.009) 30. Other s: ssoinw.iro,,,,s-ra.do ❑ 12. Prevention of Contamination from Hands ❑ 13. Handwash Facilities PROTECTION FROM CHEMICALS ❑ 14. Approved Food or Color Additives ❑ 15. Toxic Chemicals TIME/TEMPERATURE CONTROLS (Potentially Hazardous Foods) ❑ 16. Cooking Temperatures ❑ 17. Reheating ❑ 18. Cooling ❑ 19. Hot and Cold Holding ❑ 20. Time As a Public Health Control REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS (HSP) ❑ 21, Food and Food Preparation for HSP CONSUMER ADVISORY ❑ 22. Posting of Consumer Advisories Number of violated Provisions Related To Foodborne Illnesses Interventions and Risk Factors (RED Items 1-22): Official Order of Correction: Based on an inspection today, the items checked indicate violations of 105 CMR 590.000/Federal Food.Code. ,This report; when signed below by a Board of Health member or its agent constitutes an order of the Board of Health. Failure to correct violations cited in this report may result in suspension or revocation of the food establishment permit and cessation of food establishment operations. If aggrieved by this order, you have a right to a hearing. Your request must be in writing and submitted to the Board of Health"at the above address within 10 days of receipt of this order. DATE OF RE -INSPECTION: Inspector's Signature:,- /. Print: PIC's Signature: % Print: 17 CW10iSlr', �^^rAcer)- Page,� g Violations Related to Foodborne Illness Interventions and Risk Factors (Red Items 1-22) FOOD PROTECTION AND MANAGEMENT 51" 590.003(A) Assignment of Responsibility* 590.003(B) Demonstration of Knowledge* 2-]03.11 Person in charge- duties EMPLOYEE HEALTH i2f 590.003(C) Responsibility of the person in charge to if -0 3-201.12 require reporting by food employees and :t' W. Fluid Milk and Milk Products* applicants* Shell Eggs* 590.003(F) Responsibility Of A Food Employee Or An 3-202.16 Ice Made From Potable Drinking Water* Applicant To Report To The Person In Drinking Water from an Approved System* 590.006(A) Charge* 590.006(B) 590-003G Reporting by Person in Chare* F'3 s 590.003(l)) Exclusions and Restrictions* 3-201.15 590.003E Removal of Exclusions and Restrictions IN FOOD FROM APPROVED SOURCE *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. C at PROTECTION FROM CONTAMINATION Food and Water From Regulated Sources 590.004(A -B) Compliance with Food Law* 3-201.12 Food in a Hermetically Sealed Container* 3-201.13 Fluid Milk and Milk Products* 3-202.13 Shell Eggs* 3-202.14 Eggs and Milk Products, Pasteurized* 3-202.16 Ice Made From Potable Drinking Water* 5-101.11 Drinking Water from an Approved System* 590.006(A) Bottled Drinking Water* 590.006(B) Water Meets Standards in 310 CMR 22.0* Shellfish and Fish From an Approved Source 3-201.14 Fish and Recreationally Caught Molluscan Shellfish* 3-201.15 Molluscan Shellfish From NSSP Listed Sources* 4-501.111 Game and Wild Mushrooms Approved by Regulatory Authority 3-202.18 Shellstock Identification Present* 590.004(C) Wild Mushrooms* 3-201.17 Game Animals* 4-602.11 Receiving/Condition 3-202.11 PHFs Received at Proper Temperatures* 3-202.15 Package Integrity* 3-101.11 Food Safe and Unadulterated* 2-301.11 Tags/Records: Shellstock 3-202.18 Shellstock Identification* 3-203.12 Shellstock Identification Maintained* Tags/Records: Fish Products 3-402.11 Parasite Destruction* 3-402.12 Records Creation and Retention* 590.004(7) Labeling of Ingredients* Conformance with Approved Procedures /HACCP Plans 3-502.11 Specialized Processing Methods* 3-502.12 Reduced oxygen packaging, criteria* 8-103.12 1 Conformance with Approved Procedures* *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. C at PROTECTION FROM CONTAMINATION 4i Cross -contamination 3-302.11(A)(1) Raw Animal Foods Separated from Cooked and RTE Foods* Contamination from Raw Ingredients 3-302.11(A)(2) Raw Animal Foods Separated from Each Other* Contamination from the Environment 3-302.11(A) Food Protection* 3-302.15 Washing Fruits and Vegetables 3-304.11 Food Contact with Equipment and Utensils* Contamination from the Consumer 3-306.14(A)(B) Returned Food and Reservice of Food* Disposition of Adulterated or Contaminated Food 3-701.11 Discarding or Reconditioning Unsafe Food* Food Contact Surfaces 4-501.111 Manual Warewashing - Hot Water Sanitization Temperatures* 4-501.112 Mechanical Warewashing - Hot Water Sanitization Temperatures* 4-501.114 Chemical Sanitization - temp., pH, concentration and hardness* 4-601.11(A) Equipment Food Contact Surfaces and Utensils Clean* 4-602.11 Cleaning Frequency of Equipment Food - Contact Surfaces and Utensils* 4-702.11 Frequency of Sanitization of Utensils and Food Contact Surfaces of Equipment* 4-703.11 Methods of Sanitization - Hot Water and Chemical* Proper, Adequate Handwashing 2-301.11 Clean Condition - Hands and Arms* 2-301.12 Cleaning Procedure* 2-301.14 When to Wash* Good Hygienic Practices 2-401.11 Eating, Drinking or Using Tobacco* 2-401.12 Discharges from the Eyes, Nose and Mouth* 3-301.12 Preventing Contamination When Tasting* Prevention of Contamination from Hands 590.004(E) Preventing Contamination from Employees* Handwash Facilities Conveniently Located and Accessible 5-203.11 Numbers and Capacities* 5-204.11 Location and Placement* 5-205.11 Accessibility, Operation and Maintenance Supplied with Soap and Hand Drying Devices 6-301.11 Handwashing Cleanser, Availability 6-301.12 Hand Drying Provision 4i ,A CITY OF SALEM ',.BOA.R.D OF HEALTH Establishment Name: 7-;vAl (HlrrAe-v -Date: Q- 19-0.2 Page: 12_ of — 7 - Item Code C - critical Item 11 DESCRIPTIONOF VIOLATION /PLAN OF CORRECTION Date �No., R nce, ,Reference R - Red Item RIW CLEARL4 verified &&�-/4- 7/e yf%61151,4117SI-- � IPSIC :;;—AIAI 42 %0R Zoi'v'Aa (vlee- .7 a24� V D/i /V'l -t- e //wu A"V11'4 111711"le /J,E 'C/ Ii ii 1h1_4'P'0 e�iZX ZK 71� r'L'/ AtlqspVS-~/,od /ST CjAk,4" P0047 V4,IeAl 4 7� t,�rCl G01 Mui ��/F C Il -1-7 1A IQ LS'e; le, 7i* >i if-'6q2�!Lf7 7 SAP, /7-C -Z A 4ACZ42 1JLa 6k AkAla„ Aejle ,2n4 rfmC7' P fi, Cirzl? Discussion With Person in Charge: CorrectiveActl6rihequired:" [�o�� N X yer 1 71 U Voluntary Compliance U Employee Restriction have read this report, have had the opportunity to ask questions and agree to correct all violations before the next inspection, to observe all conditions as described, and to comply Exclusion with all mandates of the Mass/Federal Food Code. I understand that noncompliance may U Re -inspection Scheduled 0 Emergency Suspension result in daily fines of twenty-five dollars or suspension/revocation of your food permit. Q Embargo Q Emergency Closure U Voluntary Disposal U Other FORM 734e HOBBS&WARREN - BOSTON Violations Related to Foodborne Illness Interventions and Risk Factors (Red Items 1-22) (Cont.) PROTECTION FROM CHEMICALS 14 Food or Color Additives 3-202.12 Additives* 3-202.14 Protection from Unapproved Additives* 15'x: Poisonous or Toxic Substances 7-101.11 Identifying Information - Original Containers* 7-102.11 Common Name - Working Containers* 7-201.11 Separation - Storage* 7-202.11 Restriction - Presence and Use* 7-202.12 Conditions of Use* 7-203.11 Toxic Containers - Prohibitions* 7-204.11 Sanitizers, Criteria - Chemicals* 7-204.12 Chemicals for Washing Produce, Criteria* 7-204.14 Drying Agents, Criteria* 7-205.11 Incidental Food Contact, Lubricants* 7-206.11 Restricted Use Pesticides, Criteria* 7-206.12 Rodent Bait Stations* 7-206.13 Tracking Powders, Pest Control and Monitoring* TIMEITEMPERATURE CONTROLS 16,- PHFs Received at Temperatures According to Law Cooled to 41°F/45'F Within 4 Hours.* Proper Cooking Temperatures for Cooling Methods for PHFs 3-801.11(B) PHFs 3-501.16(B) 590.004(F) 3-401.11A(1)(2) Eggs- 155°F 15 Sec. Hot PHFs Maintained at or above 140°F.* 3-501.16(A) Eggs - Immediate Service 145°F 15 Sec.* FC 3-401.11(A)(2) Comminuted Fish, Meats & Game Time as a Public Health Control* 590.004(H) Animals - 155°F Sec.* - 4 3-401.11(B)(1)(2) Pork and Beef Roast - 130°F 121 Min.* Water, Plumbing and Waste 3-401.1 I (A)(2) Ratites, Injected Meats - 155°F 15 Sec.* 27. 3-401.11(A)(3) Poultry, Wild Game, Stuffed PHFs, .007 Stuffing Containing Fish, Meat, Poisonous or Toxic Materials FC Poultry or Ratites - 165°F 15 Sec.* .008 3-401.1l(C)(3) Whole -muscle, Intact Beef Steaks 145°F* 30. 3-401.12 Raw Animal Foods Cooked in a Microwave 165°F* 3-401.11(A)(1)(b) All Other PHFs - 145*F 15 Sec.* ;4x17- Reheating for Hot Holding 3-403.11(A)&(D) PHFs 165°F 15 Sec.* 3-403.11(B) Microwave - 165°F 2 Minute Standing Time* 3-403.11(C) Commercially Processed RTE Food - 140°F* 3-403.11(E) Remaining Unsliced Portions of Beef Roasts* Proper Cooling of PHFs 3-501.14(A) Cooling Cooked PHFs from 140°F to 70°F Within 2 Hours and from 70°F to 41`F/45°F Within 4 Hours.* 3-501.14(B) Cooling PHFs Made From Ambient Temperature Ingredients to 41°F/45°F Within 4 Hours* * Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. 19 20', 3-501.14(C) PHFs Received at Temperatures According to Law Cooled to 41°F/45'F Within 4 Hours.* 3-501.15 Cooling Methods for PHFs 3-801.11(B) PHF Hot and Cold Holding 3-501.16(B) 590.004(F) Cold PHFs Maintained at or below 41°F/45°F* 3-501.16(A) Hot PHFs Maintained at or above 140°F.* 3-501.16(A) Roasts Held at or above 130°E* FC Time as a Public Health Control 3-501.19 Time as a Public Health Control* 590.004(H) Variance Requirement REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS (HSP) --21 '.: 3-801.11(A) Unpasteurized Pre-packaged Juices and Beverages with Warning Labels* 3-801.11(B) Use of Pasteurized Eggs* Management and Personnel 3-801.1 I (D) Raw or Partially Cooked Animal Food and Raw Seed Sprouts Not Served.* .003 3-801.11(C) Unopened Food Package Not Re -served.* CONSUMER ADVISORY 22 3-603.11 Consumer Advisory Posted for Consumption of 590.00 Animal Foods that are Raw, Undercooked or Management and Personnel FC not Otherwise Processed to Eliminate .003 24. Pathogens.* E*d,,e 11112001 FC 3-302.13 1 Pasteurized Eggs Substitute for Raw Shell Eggs* SPECIAL REQUIREMENTS 590.009(A) -(D) Violations of Section 590.009(A) -(D) in catering, mobile food, temporary and residential kitchen operations should be debited under the appropriate sections above if related to foodbome illness interventions and risk factors. Other 590.009 violations relating to good retail practices should be debited under #29 - Special Requirements. VIOLATIONS RELATED TO GOOD RETAIL PRACTICES (Blue Items 23-30) Critical and non-critical violations, which do not relate to the foodborne illness interventions and risk factors listed above, can be found in the following sections of the Food Code and 105 CMR 590.00. Item Good Retail Practices FC 590.00 23. Management and Personnel FC - 2 .003 24. Food and Food Protection FC - 3 .004 25. Equipment and Utensils FC - 4 .005 26. Water, Plumbing and Waste FC - 5 .006 27. Physical Facility FC -6 .007 28. Poisonous or Toxic Materials FC - 7 .008 29. Sp ecial Requirements .009 30. Other CITY OF SALEM BOARD OF HEALTH Salem, Massachusetts 01970-3928 JOANNE SCOTT, MPH, RS, CHO HEALTH AGENT April 19, 2001 I ndeavors, I nc. Diane & Richard Pabich 35 Winter Island Road Salem. MA 01970 Dear Sir or Madam: NINE NORTH STREET Tel: (978) 741-1800 Fax: (978) 740-9705 In accordance with Chapter III, Sections 127A and 1276 of the Massachusetts General Laws, 105 CMR 400.00; State Sanitary Code, Chapter I: General Administrative Procedures and 105 CMR 410.00: State Sanitary Code, Chapter 11 Minimum Standards of Fitness for Human Habitation, an inspection was conducted of the property 5-7-9 Summer Street occupied by (Salem Inn) conducted Virginia Moustakis, Sanitarian on Wednesday, April 18, 2001 at 11:45 A.M.. Notice: If this rental unit is occupied by a child or children under the age of 6 years, it is the property owner's responsibility to notify tenants of lead related reports and tests, and to ensure that this unit complies fully with 105 CMR 460.000 : Regulations for Lead Poisoning Prevention and Control. For further information or to request an inspection, contact the Salem Health Department at 741-1800. You are hereby ORDERED to make a good -faith effort to correct the violations listed on the enclosed inspection report. Failure on your part to comply within the time specified on the enclosed inspection report will result in a complaint being sought against you in Salem District Court. Time for compliance begins with receipt of this Order. Should you be aggrieved by this Order, you have the right to request a hearing before the Board of Health. A request for said hearing must be received in writing in the office of the Board of Health within 7 days of receipt of this Order. At said hearing, you will be given an opportunity to be heard and to present witness and documentary evidence as to why this Order should be modified or withdrawn. You may be represented by an attorney. Please also be informed that you have the right to inspect and obtain copies of all relevant inspection or investigation reports, orders and other documentary information in the possession of this Board, and that any adverse party has the right to be present at the hearing. Please be advised that the conditions noted may enable the occupant(s) to use one or more of the statutory remedies available to them as outlined in the enclosed inspection report form. F rthe Boardo Reply to: Joanne Scott Virginia Moustakis Health Agent Sanitarian cc: Councillor Joan Lovely, Fire Prev ration, Building Inspector & Licensing Board Certified Mail #7099 3400 0009 4093 2423 JS/ sjk c -h -violet CITY OF SALEM HEALTH DEPARTMENT Nine North Street • Salem, Massachusetts 01970 5 Page 1 of / State Sanitary Code, Chapter II: 105 CMR 410.000 �Minimum Standards of Fitness for Human Habitation Occupant: Sg�m Z&Al -- Phone: .,li o6g-o Address: -7.9 ,,o nmee St Apt.# a�� Floor /-P 3 Owner:i4pea,,o es Address: . S4LYPm/ a Oif 92 Inspection Date: y-19-ann4 Time: // 6<5 - Conducted By:t1466AS ZW A� LS Accompanied Bye /v Anticipated Reinspection Date: •� C76Ei�75�ldK'JYId Ri�ic� C a elns lailv4PPQ Specified Time Reg.#410.. Violation(s) aeLE/v /A15 _ o a /%/D.P .Q.fn < ///O.e?P /3iiYhb/P� V" �' "f"n-/ir.^. PC C I 0 One or more of the above violations may endanger or materially impair the health ueWs/^'9 safety, and well being of the occupant(s) Code Enforcement Inspector Este es documento legal importante. Puede que afecte sus derechos. /� %e V&4 `/ Puede adquirir una traduccion de esta forma sies necesario Ilamar al telefono 741-1800. ■ Complete items 1, 2, and 3. Also complete item 4 if Restricted Delivery is desired. ■ Print your name and address on the reverse so that we can return the card to you. ■ Attach this card to the back of the mailpiece, or on the front if space permits. 1. Article Addressed to: A. Received by (Please Print Clearly) I B. Dat YDeliv C. Sig ure X �� Agent n ,delivery address diff6r"ent from tri 19 ❑ Yes YES, enter delivery address belo ❑ No IndeaV.ois, Inc. - DianeA&&jiRichard Pabich I 35 Winf"A Island Road Salem, f MA 01970 3. Service Type UCertified Mail ❑ Express Mail .❑ Registered ❑ Return Receipt for Merchandise ❑ Insured Mail ❑ C.O.D. 5-7-9 Summer Street VM 4. Restricted Delivery? (Extra Fee) ❑ Yes rticle Number (Copy from service label) 9 3400: 0009;4093;Z42-3 m 381 1 ,'July 1999 ' " ` � � ` i ' ; Domestic Return Receipt 102595.00-M-0952 UNITED STATES POSTAL SERVICE First -Class Mail Posta age & Fees Paid US Permit No. G-10 • Sender: Please print your name, address, and ZIP+4 in this box BOARD OF HEALTH LEM, MA 01970 10Ei `°\Yj/► E i Health Department lonth St. APR 2 3 2001 Salem, Mass. 01970 392e CITY OF SALEM HEALTH DEPT. 1 THE COMMONWEALTH OF MASSACHUSETTS City of Seiem,� RWLDING INSPECTOR V ; __--• _-_.--!! _�e!JSe_ . /�� -�,Le__ . 77Z./JS/� _� %i✓_.c.�_�p_A�ceC___-�liT/-ii�- --TrS�G-4;�_:�7/�Z�J'.✓ � — �_ OUTS_. %,_v_/ i_c�. �/� ___O/✓— /J7�lc` _ SicXt_G�A LLt- 1 _ &z, ce-) t JOANNE SCOTT, MPH, RS, CHO HEALTH AGENT Indeavors Inc. Diane 5 Richard Pabich 35 Winter Island Road Salem, MA 01970 Dear Sir & Madam: CITY OF SALEM BOARD OF HEALTH Salem, Massachusetts 01970 August 8, 2001 120 Washington Street -4'h Floor Tel: (978)-741-1800 Fax (978)-745-0343 In accordance with Chapter III, Sections 127A and 1278 of the Massachusetts General Laws, 105 CMR 400.00; State Sanitary Code, Chapter 1: General Administrative Procedures and 105 CMR 410.00: State Sanitary Code, Chapter II Minimum Standards of Fitness for Human Habitation, a reinspection was conducted of the property 5-7-9 Summer Street occupied by (Salem Inn) conducted Virginia Moustakis, Sanitarian on Tuesday, August 7, 2001 at 10:30 A.M.. Notice: If this rental unit is occupied by a child or children under the age of 6 years, it is the property owner's responsibility to notify tenants of lead related reports and tests, and to ensure that this unit complies fully with 105 CMR 460.000 : Regulations for Lead Poisoning Prevention and Control. For further information or to request an inspection, contact the Salem Health Department at 741-1800. You are hereby ORDERED to make a good -faith effort to correct the violations listed on the enclosed inspection report. Failure on your part to comply within the time specified on the enclosed inspection report will result in a complaint being sought against you in Salem District Court. Time for compliance begins with receipt of this Order. Should you be aggrieved by this Order, you have the right to request a hearing before the Board of Health. A request for said hearing must be received in writing in the office of the Board of Health within 7 days of receipt of this Order. At said hearing, you will be given an opportunity to be heard and to present witness and documentary evidence as to why this Order should be modified or withdrawn. You may be represented by an attorney. Please also be informed that you have the right to inspect and obtain copies of all relevant inspection or investigation reports, orders and other documentary information in the possession of this Board, and that any adverse party has the right to be present at the hearing. Please be advised that the conditions noted may enable the occupant(s) to use one or more of the statutory remedies available to them as outlined in the enclosed inspection report form. F the Board of Health: Reply to: oanne Scott Virginia Moustakis Health Agent Sanitarian cc: Councillor Joan Lovely, Licensing Board, Building Inspector, & Fire Prevention JS/ sjk c -h -violet CITY OF SALEM HEALTH DEPARTMENT N a Nine NorthStreet Salem, Massachusetts01970 Page 1 of I F State Sanitary Code, Chapter II: 105 CMR 410.000 Minimum Standards of Fitness for Human Habitation Occupant: 5ala , �v/y Phone: Address: s--7-9 Apt.# Floor Lg----3 Owners 2�rto,� in e.. Address:_ 6�SG6&.vk., /sed 1041 22�iL 0/996) Inspection Date: -o, Time: iU:-ao Conducted By: Accompanied By: 10",r� Anticipated Reinspection Date: Specified Time Reg.# 410.. Violation(s) ... /. _ ! ®— / / IF 00.1. ./ One or more of the above violations may endanger or materially impair the health CC: 11Ce1HSI'✓q safety, and well being of the occupant(s) Code Enforcement Inspector Este es documento legal importante. Puede que afecte sus derechos Puede adquirir una traduccion de esta forma sies necesario Ilamar al telefono 741-1800. APPENDIX II (14) Legal Remedies for Tenants of Residential Housing The following Is a brief summary of some of the legal remedies tenants may use In order to get housing code violations corrected: 1. Rent Withholdinp (Massachusetts General laws, Chapter 239, section 8A): If Code Violations Are Not Being Corrected you may be entitled to hold back your rent payments. You can do this without being evicted if: A- You can prove that your dwelling unit or common areas contain code violations which are serious enough to endanger or materially impar your health or safety and that your landlord knew about the violations before you were behind in - your rent_ B. You did not cause the violations and they can be repaired while you continue to live in the budding. C. You are prepared to pay any portion of the renfinto court if a judge orders you to pay it. (For this, it is best to put the rent money aside in a safe place.) 2- Repair and Deduct (Massachusetts General laws, Chapter 111, section 127L): The law sometimes allows you to use your pmt money to make the repairs yourself. If your local code eaforecmeat agency certifies that there are code violations which endanger or materially impair your health, safety, or wel}-being, and your landlord has received written notice of the violations; you may be able to use this remedy. If the owner fails to begin necessary repairs (or to enter into a written contract to have thedr made) within five days after notice or to complete repairs within 14 days after notice, you can use up to four months' rent in,any year to make the repairs. 3. Retaliatory Rent Increases or Evictions Prohibited (Massachusetts General Laws, Chapter 186, section 18, and Chapter 239,; section 2A):1he owner may not increase your rent or evict you in retaliation for making a complaint to your local code enforcement agency about code violations. If the owner raises your rent to tries.to evict within six months after you have made the complaint, he or she. will:have.to'sbow.a good.reason for the increase or eviction which is unrelated to your complaint. -You may be able to sue the landlord for damages of he or she tries this. 4. Rent R Priv :chin (Massachusetts General Laois, Chapter 11, section 127 C -H): The occupants and/or the Board of Health may petition the District or Superior Court to allow rent to be paid into court rather than to the owner. The court may then appoint a "receiver" who may spend as much of the rent money as is needed to correct the violation. The receiver is not subject to a spending limitation of four months' rent 5. Breach of Warranty of Habitability: You may be entitled to sue your landlord to have all or some of your rent retumed if your. dwelling unit does not meet minimum standards of habitability. 6. Unfair and D=D iv . Practices (Massachuscus General laws, Chapter 93A): Renting an apartment with code violations is a violation of the consumer protection act and regulations, for which you may sue an owner. The information presented above is only a summary of the law. Before you decide to withhold your rent or take any other legal action, it is advisable that you consult an attorney. If you cannot afford to consult an attorney, you should contact the nearest legal services office, which is: Neighborhood Legal Services 37 Friend St Lynn, MA 01902 (617) 599-7730 THE COMMONWEALTH OF MASSACHUSETTS City of Salem BUILDING INSPECTOR Name Address In the space below describe all violations. Time to A(n) - inspection of this establishment was conducted Complete Massachusetts State Building Code 780 CMR. The following violations were observed: r C k- Q _ 1 r iv C.D�J ti� U I�{— ON f,_ r v I lity i E� br lid ,e Discussion with ManagernenUOwner I have read this report, have had the opportunity to ask questions and agree to correct all violations before the next inspection, to observe all conditions as described. I understand that noncompliance may result in daily fines and/or legal action being taken against you in Salem District Court. �n /.n �i.rn.f.-. .. JOANNE SCOTT, MPH, RS, CHO HEALTH AGENT CITY OF SALEM BOARD OF HEALTH Salem, Massachusetts 01970-3928 OF MASSACHUSETTS PERMIT TO OPERATE A FOOD ESTABLISHMENT NINE NORTH STREET Tel: (978) 741-1800 Fax: (978) 740-9705 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: Diane Pabich Name of Establishment: The Salem Inn Address of Establishment: 7 Summer Street Type of Establishment: FOOD SERVICE Application Date: 12/21/2000 Restrictions: Permit for Food Establishment 145-01 Frozen Desserts/Ice Cream Permit for the Sale of Tobacco Products These Permits Expire December 31, 2001 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. 440�i�/4� HEALTH AGENT y� J `, CITY OF SALEM BOARD OF HEALTH Salem, Massachusetts 01970-3928 pwvq DEC � 1 2oco CITY OF SALEM HEALTH DEPT. JOANNE SCOTT, MPH, RS, CHO NINE NORTH STREET HEALTH AGENT Tel: (978) 741-1800 Fax: (978) 740-9705 2001 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT Fy NAME OF ESTABLISHMENT I t Mr) TEL #n -N4 -oligo ADDRESS OF ESTABLISHMENT-] MA 01q-73 MAILING ADDRESS (if different) I^ p OWNER'S NAME DI C�If, Pahl TEL I I-, -IiS9" w WPI ST CERTIFIED FOOD MANAGER'S ZIP (required in an establishment where potentially hazardous food is prepared .) EMERGENCY RESPONSE PERSONGU ) I I CY .1 HOME TEL # CTM I 47T- 7a-� TYPE OF ESTABLISHMENT ?c- I M 7 FEE 'check only RETAIL STORE YES $40 RESTAURANTS UO # seats_ # nonsmoking $40 BED & BREAKFAST ES. ; NO - $40 ADDITIONAL PERMITS MAKE ICE CREAM, YOGURT SOFT SERVE I YES $5 TOBACCO VENDOR YES 10 NO CHARGE FOR NON-PROFIT (such as church kitchens) PLEASE INCLUDE COPY OF TAX EXEMPTFORM 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 bgshknowl dge an b lief,,have filed all state tax returns and paid all state taxes required under the law. s'Vt1U . It'IQ-g /no Social Security or Federal Identification Number Revised 11/21/00 foodap2.adm Check# & Date %D � �i.• d `��` JOANNE SCOTT, MPH, RS, CHO HEALTH AGENT CITY OF SALEM BOARD OF HEALTH Salem, Massachusetts 01970-3928 COMMONWEALTH OF MASSACHUSETTS PERMIT TO OPERATE A FOOD ESTABLISHMENT NINE NORTH STREET Tel: (978) 741-1800 Fax: (978) 740-9705 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: Dee & Jill Cote' & Sally Flint Name of Establishment: The Inn at Seven Winter Street Address of Establishment: 7 'Winter Street Type of Establishment: Bed &,Breakfast Application Date: 11/30/2000 Restrictions: Permit for Food Establishment 12-01 Frozen Desserts/Ice.Cream Permit for the Sale of Tobacco.Products These Permits Expire December 31, 2001 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 BOARD OF HEALTH Salem, Massachusetts 01970-3928. JOANNE SCOTT, MPH, RS, CHO HEALTH AGENT M CITY OF SALEM HEALTH DEPT. NINE NORTH STREET Tel: (978) 741-1800 Fax: (978) 740-9705 2001 APPLICATION F�FOR PERMIT TO OPERATE AI FOOD ESTABLISHMENT NAME OF ESTABLISHMENT be Lill rA(-3%" Q;:62 � l TEL # 7 �S ADDRESS OF ESTABLISHMENT 7 W.h2I�A x i MAILING ADDRESS (if /different) C, OWNER'S NAME / Ij4 G4� ( J c,�L c✓�� TEL # AnnRFSS 49-7 e--'iF CITY ST CERTIFIED FOOD MANAGER'S NAME(S) ZIP (required in an establishment where potentially hazardous food is prepared.) EMERGENCY RESPONSE PERSON 1) • 7 f HOME TEL # '7 NO CHARGE FOR NON-PROFIT (such as church kitchens) PLEASE INCLUDE COPY OF TAX EXEMPTFORM Please pay total with one check payable to the City of Salem This Permit isnot 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 knowleedde and belief, have filed all state tax returns and paid all /state taxes required under the law. Social Security or Kede�al Identification Number Revised 11/21/00 foodap2.adm TYPE OF ESTABLISHMENT Z —6 FEE check only RETAIL STORE YES $40 RESTAURANT YES # seats_ # nonsmoking_ $40 BED & BREAKFAST O C— ADDITIONAL PERMITS MAKE ICE CREAM, YOGURT SOFT SERVE YES $5 TOBACCO VENDOR YES NO CHARGE FOR NON-PROFIT (such as church kitchens) PLEASE INCLUDE COPY OF TAX EXEMPTFORM Please pay total with one check payable to the City of Salem This Permit isnot 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 knowleedde and belief, have filed all state tax returns and paid all /state taxes required under the law. Social Security or Kede�al Identification Number Revised 11/21/00 foodap2.adm CLERK JUDY DAVENPORT J CITY, OF SALEM, MASSACHUSETTS LICENSING BOARD 95 MARGIN STREET P.O. BOX 1042 TEL. 744-0171 EXT. 30 HEALTH DEPARTMENT NOTIFICATION FORM Chairman, John A. Boris James M. Fleming John H. Casey IF YOUR APPLICATION INCLUDES THE SERVING OF FOOD YOU MUST HAVE THIS FORM SIGNED BY THE HEALTH DEPARTMENT PRIOR TO SUBMITTING YOUR APPLICATION TO THE LICENSING BOARD. (thiS form MUST be signed by the Heath Deptartment and returned with your application). NAME OF CONCERN LOCATION: 7 TELE. # 6- ) TYPE OF LICENSE: APPLICANTS NAME: 7N -068 G ,5?�r-s TX -00.4-x T 'i?[ ��61Ci f RESIDENCE: c34- 'en1 CITY: SX z,61-7 TELE#: CQ?g_� STATE: h/' 7,x7 -4e ZIP: 0142 HEALTH AGENT/INSPECTORS COMMENTS:__ Fla An In --p op -en SLS �tiYp--C f a 50 no H LTH AGENT- JOANNE SCOTT, MPH, RS, CHO HEALTH AGENT CITY OF SALEM BOARD OF HEALTH Salem, Massachusetts 01970-3928 COMMONWEALTH OF MASSACHUSETTS PERMIT TO OPERATE A FOOD ESTABLISHMENT NINE NORTH STREET Tel: (978) 741-1800 Fax: (978) 740-9705 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: Diane Pabich Name of Establishment: The'Salem Inn Address.of Establishment: 7 Summer'Street Type of Establishment: FOOD SERVICE Application Date: 09/13/2000 Restrictions: Permit for Food Establishment; iM 290-00" Frozen Desserts/Ice Cream b -Permit for the Sale of Tobaccd'Products These Permits -Expire December'31, 2000 # M This permit is not transferable. and must be reissued upon change -of ownership or location. In accordance with the State Sanitary Code, all plans of renovations,.improvements, equipment changes must be approved by the Health Department. r , HEALTH AGENT CITY OF SALEM BOARD OF HEALTH Salem, Massachusetts 01970-3928 p(CEIVED SEP 1 2 2000 CITY OF SALEM HEALTH DEPT. JOANNE SCOTT; MPH, RS. CHO NINE NORTH STREET HEALTH AGENT Tel: (978) 741-18w . Fax: (979) 740.9705 2000 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT NAME OF ESTABLISHMENT GTI JYiV) �I71U� l "1 l` OC$0 ADDRESS OF ESTABLISHMENT 1 c kA'hWr �+�IT,E,L_#1 V'e1 -itGt 1 Mfl ()1Gi�O MAILING ADDRESS (if different) OWNER'S NAMES 1'ffi/itl &bio) - TEL CERTIFIED FOOD MANAGER'S (required in an establishment where potentially hazardous food is prepared.) r EMERGENCY RESPONSE PERSONI!H_II �ALi (�dno r' TEL #-(q7$2 ESTABLISHMENTS DAYS &HOURS OF OPERATION_�iOi��QM 40 T71t�QA TYPE OF ESTABLISHMENT RETAIL STORE YEI NO RESTAURANT /YES'l NO ADDITIONAL PERMITS MAKE FROZEN DESSERTS YES NO TOBACCO VENDOR YES NO FEE check only $40 # seats.4 nonsmoking—ii $40 $5 $10 Pismo pay total with one check payable to the City of Salem This permit is not transferable and must be reissued upon change of ownership. 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 82C, Section 49A, I certify under the pains and penalties of perjury that I, to my "knowlWge arid)beAef, have filed all state tax returns and paid all state taxes required under the law. Social Security or Revised 1020/98 foodepZadm Che tldr 8 Date Number Date Phone Area Code Number Extension TELEPHONED PLEASECALL CALLEDTOSEEYOU WILLCALLAGAIN WANTSTOSEEYOU URGENT YOUR CALL Message �'+� AMPAD 2}021 - 20 EfS 0% EFFICIENCY& 2+621-400 SETS CARBONVU F' To r Date /� � Time.2 -c WHIL YOU WERE OUT M of Phone Area Code Number. Extension TELEPHONED PLEASE CALL CALLED TO SEE YOU WILLCALLAGAIN WANTSTOSEEYOU URGENT R TURNED YOUR CALL Mee age OpereWr AMPAD 20-021 - 200 SEES �Jj] EFFICIENCYm 23321.400 SETS CARE To Date /i a -� - 97 TiTe WHILf YOU WERE OUT M &&u of Phone Area Code Number Extension TELEPHONED I L�KPLEASE CALL CALLED TO SEE YOU WILLCALLAGAIN WANTSTOSEEYOU URGENT RETURNED YOUR CALLNT 07 3 0 opera or 0M��1 AMPAD 13-021-200SETS EFFICIENCY& 23x21-400 SETS CARBONLESS To Dete 17 WHILE YOU , M ERE OUT of Phone Area Code Numhe Extension TELEPHONED PLEASE CALL CALLEOTOSEEYOU I WILLCALLAGAIN WANTSTOSEEYOU I URGENT RETURNED YOUR CALL Mees Opera '% AMPAD 23-021 •2U0 SETS �Jjl EFRCIENCYe 73-421 • CW SETS CM80 AMPAD 23-021 - 200 SETS ' offi EFFICIENCY® 23-421.400 SETS CWLESS MUM f . . . AMPAD 23-021 - 200 SETS ' offi EFFICIENCY® 23-421.400 SETS CWLESS Time WHILE YOU WERE OUT M Phone Area Code Number TELEPHONED P ASE CALL CALLEDTOSEEYOU WILLCALLAGAIN WANTSTOSEEYOU URGENT YOURCALL Message 5� AMPAD 23-021 -200 SETS EFFICIENCY* 23-421.400 SETS Area Code Number Extension TELEPHONED P ASE CALL CALLEDTOSEEYOU WILLCALL AGAIN WANTS TO SEE YOU URGENT 01 AMPAD EFFICIENCY® M YOUR CALL 23-021 - 200 SEES 23-421 -400 SETS To ++ Dete —Time 3 WHILE YOU WERE OUT Phone �z `T/— Q Cn.O Area Code Number Extension TELEPHONED PLEASE CALL CALLEOTOSEEYOU WILLCALLAGAIN WANTSTOSEEYOU URGENT I RETURNED YOUR CALL I I Message -7�f 2?7 ZM21 - 20a sets On EFFICIENCYm 23-421.400 SETS CARBONLESS Z 447 277 791 US Postal Service Receipt for Certified Mail No Insurance Coverage Provided. Do not use for International Mail (See reverse) to 7— N� Stre,et & Number �lo3S a7tx en - ) , D . Po Office, State, &ZIP o� TV z Q 7C1 Postage $ cerfified Fee Special Delivery Fee Restricted Delivery Fee Return Receipt Showing to Whom & Date Delivered Rehm Receipt Showing to Whom, Date, & Addressee's Address TOTAL Postage & Fees $ Postmark or Date Stick postage stamps to article to Cover First -Class postage, certified mail fee, and charges for any selected optional services (See front). 1. If you want this receipt postmarked, stick the gummed stub to the right of the return address leaving the receipt attached, and present the adide at a post office service window or hand it to your rural tamer (no extra charge). 2. If you do not want this receipt postmarked, stick the gummed stub to the right of the return address of the article, date, detach, and retain the receipt, and mail the article. 3. If you want a return receipt, write the certified mail number and your name and address on a return receipt card, Form 3811, and attach it to the front of the article by means of the gummed ends if space permits. Otherwise, affix to back of article. Endorse front of article RETURN RECEIPT REQUESTED adjacent to the number. 4. If you want delivery restricted to the addressee, or to an authorized agent of the addressee, endorse RESTRICTED DELIVERY on the front of the aside. 5. Enter tees for the services requested in the appropriate spaces on the front of this receipt. If return receipt is requested, check the applicable blocks in item 1 of Form 3811. 6. Save this receipt and present 4 if you make an inquiry. 102595-9edN-0548 +tea. rA �. -... 4 CITY OF SALEM BOARD OF HEALTH. Salem, Massachusetts 01970-3928 JOANNE SCOTT, MPH, RS, CHO HEALTH AGENT April 5, 2000 Indeavors Inc. C/o Richard Pabich 35 Winter Island Road Salem, MA 01970 F, Dear Mr. Pabich : ez NINE NORTH STREET Tel: (978) 741-1800 Fax: (978) 740-9705 In accordance with Chapter III, Sections 127A and 1278 of the Massachusetts General Laws, 105 CMR 400.00. State Sanitary Code, Chapter 1: General Administrative Procedures and 105 CMR 410.00: State Sanitary Code, Chapter II Minimum Standards of Fitness for Human Habitation, an inspection was conducted of the property 5-7 Summer Street occupied by (Salem Inn) conducted Virginia Moustakis, Sanitarian on Wednesday, April 5, 2000 at 10:00 A.M.. Notice: If this rental unit is occupied by a child or children under the age of 6 years, it is the property owner's responsibility to notify tenants of lead related.reports and tests, and to ensure that this unit complies fully with 105 CMR 460.000 : Regulations for Lead Poisoning Prevention and Control. For further information or to request an inspection, contact the Salem Health Department at 741-1800. You are hereby ORDERED to make a good -faith effort to correct the violations listed on the enclosed inspection report. Failure on your part to comply within the time specified on the enclosed inspection report will result in a complaint being sought against you in Salem District Court. Time for compliance begins with receipt of this Order. Should you be aggrieved by this Order, you have the right to request a hearing before the Board of Health. A request for said hearing must be received in writing in the office of the Board of Health within 7 days of receipt of this Order. At said hearing, you will be given an opportunity to be heard and to present witness and documentary evidence as to why this Order should be modified or withdrawn. You may be represented by an attorney. Please also be informed that you have the right to inspect and obtain copies of all relevant inspection or investigation reports, orders and other documentary information in the possession of this Board, and that any adverse party has the right to be present at the hearing. Please be advised that the conditions noted may enable the occupant(s) to use one or more of the statutory remedies available to them as outlined in the enclosed inspection report form. For the Board of Health: Reply to: �`a Joanne Scott Virginia Moustakis Health Agent Sanitarian cc: Fire Prevention & Building Inspector, t/C&7c5/1V6 �ePt Certified Mail # Z 447 277 791 JS/ sjk c -h -violet Page 1 of / StatenSanitarylCode, Chapter'llp,105 CMR 41,0:0.00 JJ1 Minimum Standards of Fitness for Human Habitation 0bcU-`-Phone: 'A o z,� Address:. 6-:,7 sy,21nee-S Apt .# Floor A*AJAYP 9E, Owner: aomfwk,s iw,Addres�s: Y -Rlid axi kf& c.6 rr' /1,: -i "In W 4 W 14, 1 Insppption ,1Date:L;gbea_ : 6F; eogyla-o ,j, Conducted By: y 1;1oa5i,, ks /j.- P/q Accompanidd'B *25j" ;Z 1V9 Anticipated Reinspection Date: ' IV 0 Ale— T*', 0'�* rIf. 11 �%� -4 -�, VIA 7`,t -'_X Specified Time Reg.# 410.. Violation(s) One or more of the above violations may endanger or materially impair the health safety, and well being of the occupant(s) Code Enforcement Inspector Este es documento legal importante. Puede que afecte sus derechos.- . i, _Y1 r .. _ cc: 61d q )CIke, X Based on 4 tenant complaint 4fispecti6n was an conducted iri accio'rdance-'_,4,,�_e'-' with Akiae Sanitar d6105 C -1l'of the ttd�` _y Co I Upon inspection :the follo.Wng>wer.enoted.t n.tt,� '76 Z 40 roo rX 2 ZIV ilf A/Z e f 12 n &MV 0 L9 Z� 7 N, 7— I '411, 2 11101OXn77 re oe IAI r- lk AIM dRovqv�nz,�' dt- Le-SAt6&__s &7;le4i a� vl.Tf-mse�4 9&4z Z44 �Zaczcz r(2X11Vr?1_ o(les Y�� ztl�4�_ One or more of the above violations may endanger or materially impair the health safety, and well being of the occupant(s) Code Enforcement Inspector Este es documento legal importante. Puede que afecte sus derechos.- . i, _Y1 r .. _ cc: 61d q )CIke, X Appendix II (14) Legal Remedies .for Tenaits ,of Residential Hou"sing =3' •<`i.5 7 _.,^?t eF : ft -L'"..3 a F� 7ltiL, :h.5p ,:.'�r>r. } e..�'b Fri k< The following is a brief summaryof some of the legal remedies tenants may use, in order, to get - _ --`housing code violations corrected: "- 1. Rent Withholding (Massachusetts General Laws; :Chapter239, section 8A) If Code Violations Are'N6V+ Being Corrected you may be entitled to hold back your rent payments You can do this without being evicted if: You can-provethatyo urdwellirigvnit•or common areas contain code violations which are serious enough to endanger or materially impairyou�heahthrof safety -and that your :landlord'kiew alioutthe violations before you were behind .i! your rent ., - You did not cause the violations and they can be repaired while you continue to live in the building. You are prepared to pay any portion of the rent into court if a judge orders you to pay it. ( For this, . it is best to put the, rent money aside in a safe place) 2. Repair and Deduct,(Massachusetts,General Laws; Chapter III, section<127L): The law sometimes allows you to use your rent money to make the repairs yourself If your local :code enforcement agency certifies that where -are code viola6oris'whicli may`eridanger or it a`ten"'allunpair-your health safety, Orwell -being, and your landlord has received written notim of the vrolatio_nsl you may be -able to use this remedy : If the owner fails _to begin necessary, repairs (or to enter into a written contract to have:them made).within five days after the notice or to'complete repairswithir , l'4 days�after'notice;you can'use up to''four months rent in any year to make repairs. 3. Retaliatory Rent Increases or Evictions Prohibited (Massachusetts General Laws, Chapter 186, section 18, and Chapter 239; Section 2A): The owner may not increase your rentor evict you in retaliation for making a complaint to your local code enforcement agency about code violations. If the owneryaises your rent to try to evict within six months after you -have made the complaint, he or she will have to show a good reason for the increase or eviction which is unrelated to your complaint. You may be able to sue the landlord for damages or if he or she tries this. 4. Rent Receivership (Massachusetts General Laws Chapter_ II, section 127 C -H): The occupants and/or the Board of Health may petition the District or Superior Court to allow rent to be paid into court rather than to the owner. The court may then appoint a "receiver" who may spend as much of the rent money as is needed to correct the violation. The receiver is not subject to,a spending limitation of four months'rent. 5. Breach of Warranty of Habitability: You may be entitled to sue your landlord to have all or some of your rent returned if your dwelling unit does not meet minimum standards of habitability. 6. Unfair &. Deceptive Practices (Massachusetts. General Laws, Chapter 93A) ::Renting an apartment with code. violations is a violation of the consumer protection act and regulations, for which you may sue an owner. The information presented above is only a summary of the law: Before you decide to withhold rent or take any other legal action, it is advisable that you consult an attorney. If you can not afford to consult an attorney, you should contact the nearest legal, services office, which is Neighborhood Legal Services 37 Friend Street Lynii, MA. 01902 (781)=599-7730 _ 102595-97-B-0179 m SENDER: o acomplete nems t anNor 2 for additional services. I also wish to receive the is •Complete items 3, 4a, and 4b. following services (for an ' a Prim your name and addrees on the reverse of this form so that we can return Ws wd to u. extra fee): -Attach this form to the from of the mailpiece, or on the bad if apace does rwt 1. ❑ Addressee's Address 0 permit. a Receipt Requested'on the mailpiece below the article number. 2. ❑ Restricted Delivery y pj aThe Retum Receipt will show to whom the article was delivered and the date C delivered. Consult postmaster for fee. 0 na 3. Article Addressed to: 4a. Article Number I Z 447 277 791 c � E Indeavors Inc. - 4b. Service Type g c/o Richard Pabich ❑ Registered gg CerBfied 35 Winter Island Road ❑ Express ❑Insured Salem, MA 01970 - ❑ RetumReceipt for Merchandise ❑ COD 0 c 7. Date of Iv (5-7 Summer Street Salem Inn—VM a. eceived By:(Hd 2 8. re v ti's Address (Only if requested an tie is paid) i kill ilk+i !ki Ago.=`re: d e i+ > sor. t If 102595-97-B-0179 UNITED STATES POSTAL SERVICE • Print your APR 13 90no CITY OF SALEM HEALTH DEPT. FFir Feels Paid"nG•10".' ZIP Code in this box • Salem Health Department 9 Willi St. Salem, Mass. 01970 'J ��'lllllll�l1�11 �1II�I'illll'II'1111111 ��'1II1 ��11111 (1111�1�1 JOANNE SCOTT, MPH, RS, CHO HEALTH AGENT CITY OF SALEM BOARD OF HEALTH Salem, Massachusetts 01970-3928 March 24, 2000, The Salem Inn c/o Richard & Diane Pabich 35 Winter Island Road Salem, MA 01970 Dear Owner/Manager: NINE NORTH STREET Tel: (978) 741-1800 Fax: (978) 740-9705 The Board of Health, Building and.Fire Departments are - scheduling yearly inspection'of all establishments licensed as rooming houses. The Salem Licensing Board will review inspection and reinspection reports in accordance with its license renewal procedures. The inspection will include -.dwelling units and common areas, therefore each tenant must be present or he/she must sign the enclosed release form which will allow the inspectors to enter the unit. Your establishment at 7 Summer Street has been scheduled to be inspected on Wednesday April 5, 2000 at 10:00 am. Thank you for your anticipated cooperation. Sincerely, For the Board of Health Joanne Scott Health Agent CC: Frank DiPaolo, Inspector of Buildings Charles Latulippe, Fire Prevention Peter Merry, Chairman, Salem Licensing Board JOANNE SCOTT, MPH, RS, CHO HEALTH AGENT CITY OF SALEM BOARD OF HEALTH Salem, Massachusetts 01970-3928 November 5, 1999 The Salem Inn c/o Richard & Diane Pabich 35 Winter Island Road Salem, MA 01970 Dear Owner/Manager- The Board of Health, Building and Fire Departments are scheduling yearly inspection of all establishments licensed as rooming houses. The Salem Licensing Board will review inspection and reinspection reports in . accordance with its license renewal procedures. NINE NORTH STREET Tel: (978) 741-1800 Fax: (978) 740-9705 The inspection will include dwelling units and common areas, therefore each tenant must be present or he/she :r must sign the enclosed release form which will allow the inspectors to enter the unit. Your establishment at 7 Summer Street.has been scheduled to be inspected on Wednesday November 17, 1999 at 10:00 am. Thank you for your anticipated cooperation. Sincerely, For the Board of Health oanne Scott w, Health Agent F a` cc: Frank DiPaolo;c'Inspector,of Buildings Charles Latulippe, Fire 'Prevention Peter Merry, Chairman, Salem Licensing Board I CITY OF SALEM BOARD OF HEALTH Salem, Massachusetts 01970-3928 JOANNE SCOTT, MPH, RS, CHO NINE NORTH STREET HEALTH AGENT Tel: (978) 741-1800 June 15, 1999 Fax: (978) 740.9705 The Salem Inn 35 Winter Island Road Salem, MA 01970 Dear Owner/Manager: The Board of Health, Building and Fire Departments are scheduling yearly inspection of all establishments licensed as rooming houses. The Salem Licensing Board will review inspection and reinspection reports in accordance with its license renewal procedures. The inspection will include dwelling units and common areas, therefore each tenant must be present or he/she must sign the enclosed release form which will allow the inspectors to enter the unit. Your establishment at .7 Summer Street has been scheduled to be inspected on Wednesday November 18,'1999 at 10:00 am. Thank you for your anticipated cooperation. Sincerely, For the Board of Health �— V `. (/Joanne Scott Health,Agent CC: Kevin Goggin, Inspector of Buildings Charles Latulippe, Fire Prevention Peter Merry, Chairman, Salem Licensing Board DATE 5^H- 11 7 TIME id.'w fP'M M w c¢� PHONE 71/ 1- gs8 (o AREA CODE NUMBER EXTENSION ❑ FAX O MOBILE AREA CODE NUMBER TIME TO CALL TELEPHONED - PLEASE CALL CAME TO SEE YOU WILL CALL AGAIN WANTS TO SEE YOU RUSH RETURNED YOUR CALL WILL FAX TO YOU SIGNED �YTv FORM 4009 pl�Y MADE IN U.S.A. 71 z \ Y i� CITY OF SALEM BOARD OF HEALTH Salem, Massachusetts 01970-3928 JOANNE SCOTT, MPH, RS, CHO HEALTH AGENT May 5, 1999 Richard & Diane Pabich 35 Winter Island Road Salem, MA. 01970 Dear Sir / Madam : 00, NINE NORTH STREET Tel: (978) 741 -1800 Fax: (978) 740-9705 In accordance with Chapter 111, Sections 127A and 1278 of the Massachusetts General laws, 105 CMR 400.00: State Sanitary Code, Chapter I: General Administrative Procedures and 105 CMR 410.000: State Sanitary Code, Chapter It: Minimum Standards of Fitness for Human Habitation, an inspection was conducted of your property at 5-7 Summer Street in the City of Salem, Massachusetts, Jeffrey Vaughan, Senior Sanitarian of the Salem Board of Health on Tuesday, May 4, 1999 at 7:30 A.M.. The following violations of the State Sanitary Code were noted, as checked; _ CMR 410:600 Storage of Rubbish and Garbage CMR 410:601 Collection of Rubbish and Garbage CMR 410:602 Maintenance of Areas Free From Garbage and Rubbish (A through D) X BOH Regulation #7 Description of Violations: See Enclosure(s) 410.600: Storaae of Rubbish and Garbaae (A) ,Garbage or.mixed garbage and rubbish shall be stored in watertight receptacles with tight -fitting covers. Said receptacles and covers shall be of metal or other durable, rodent -proof material. Rubbish shall be stored in receptacles of metal or other durable, rodent -proof material. Garbage and rubbish shall be put out for collection no earlier than the day of collection. (B) Plastic bags shall be used to store garbage or mixed rubbish and garbage only if used as a liner in watertight receptacles with tight -feting covers as required in 105 CMR 410.600(A) provided that the plastic bags may be put out for collection except in those places where such practice is prohibited by local rule or ordinance, or except in those cases where the Department of Public Health determines that such practice constitutes a health problem. For purposes of the preceding sentence, in making its determination, the Department shall consider, among other evidence of strewn garbage, torn garbage bags, or evidence of rodents. (C ) The owner of any dwelling that contains three or more dwelling units, the owner of any rooming house, and the occupant of any other dwelling place shall be responsible for providing as many receptacles for the storage of garbage and rubbish as are sufficient to contain the accumulation before finaPcollection or ultimate disposal, and shall so locate them to be convenient to the tenant that no objectionable odors enter any dwelling. (D) The occupants of each dwelling, dwelling unit, and rooming unit shall be responsible for the proper placement of her or his garbage and rubbish in the receptacles required in 105 CMR 410.600(C) or at the point of collection by the owner. 410.601: Collection of Garbage and Rubbish The owner of any dwelling that contains three or more dwelling units, the owner of any rooming house, and the occupant of any other dwelling place shall be responsible for the final collection or ultimate disposal or incineration of garbage and rubbish by means of: (A) The regular municipal collection system; or (B) Any other collection system approved by the Board of Health; or (C) When otherwise lawful, a garbage grinder which grinds garbage into the kitchen sink drain finely enough to ensure its free passage, and is otherwise maintained so as not to create a safety or health hazard; or (D) When otherwise lawful, a garbage or rubbish incinerator located within the dwelling which is properly installed and which is maintained so as not to create a safety or health hazard; or (E) Any other method of disposal which does not endanger any person and which is approved in writing by the Board of Health (see 10410.840) �o CITY OF SALEM HEALTH DEPARTMENT Nine North Street Salem, Massachusetts 01970 410.602: Maintenance of Areas Free From Garbage and Rubbish (A) Land: The owner of any parcel of land, vacant or otherwise, shall be responsible for maintaining such parcel of land in a clean and sanitary condition and free from garbage, rubbish, or other refuse. The owner of such parcel of land shall correct any condition caused by or on such parcel or its appurtenance which affects the health or safety and well-being of the occupants of any dwelling or of the general public. (B) Dwelling Units: The occupant of any dwelling unit shall be responsible for maintaining in a clean and sanitary condition and free of garbage, rubbish, other filth or causes of sickness that part of the dwelling which s/he exclusively occupies or controls. (C) Dwellings Containing Fewer Than Three Dwelling Units: In a dwelling that contains fewer than three dwelling units, the occupant shall be responsible for maintaining in a clean and sanitary condition free of garbage, rubbish, other filth or causes of sickness the stairs or stairways leading to her or his dwelling unit and the landing adjacent to her or his dwelling unit if the stairs, stairways, or landing are not used by another occupant. (D) Common Areas: In any dwelling, the owner shall be responsible for maintaining in a clean and sanitary condition free of garbage, rubbish, other filth or causes of sickness that part of the dwelling which is used in common by the occupants and which is not occupied or controlled by the occupant exclusively. (1) The owner of any dwelling abutting a private passageway or right-of-way owned or used in common with other dwellings or which the owner or occupants under her or his control have the right to use or are in fact using shall be responsible for maintaining in a clean and sanitary condition free from garbage, rubbish, other filth or cause of sickness that part of the passageway or right-of-way which abuts her or his property and which s/he or the occupants under her or his control have the right to use, are in fad using, or which s/he owns. Board of Health Regulation #7 Section 3.10: Containers or Bundles of Household and Ordinary Commercial Waste Garden and Lawn Waste: These shall be placed at the outer edge of the sidewalk appurtenant to the premises of the owner not later than 7:00 a.m. on the day of collection and not before 6:00 p.m. on the day preceding the day of collection, and shall be removed from the sidewalk on the same day as emptied. No commercial establishment shall place or cause to be placed more than four barrels or other containers of ordinary commercial wastes or any extraordinary commercial or industrial wastes or tree waste upon any sidewalk or way for disposal. You are hereby Ordered to make a good faith effort to correct these violations within 24 (twenty four) hours of receipt of this notice. -'\ Failure on your part to comply within the specified time will result in a complaint being sought against you in Salem District Court. Should you be aggrieved by this order, you have the right to request a hearing before the Board of Health. A request for said hearing must be received in writing in the office of the Board of Health within 7 Days of receipt of this order. At said hearing, you will be given an opportunity to be heard and to present witness and documentary evidence as to why this order should be modified or withdrawn. You may be represented by an attorney. Please also be informed that you have the right to inspect and obtain copies of all relevant inspection or investigation reports, orders, and other documentary information in the possession of this Board, and that any adverse party has the right to be present at the hearing. One or more of the above' iolations constitutes a condition which may endanger or materially impair the health or safety and well-being of the occupant(s) or the general public. - If you have any questions, kindly contact this office at (508) 741-1800. For he Board of Health: oanne Scott J�� Health Agent JS/sjk c -9 -hash Reply to: Jeffrey Vaughan Senior Sanitarian CITY OF SALEM HEALTH DEPARTMENT 1 . ' Nine North Street Salem, Massachusetts 01970 Trash Letter Violations To: e;ttiv u�;hin e Pah cff Address: 3T - City / State: sod T syia. Q,�7o Property At: Dater Violation Numbers: 600: Storage of Rubbish and Garbage 601: Collection of Rubbish and Garbage 602: Maintenance of Areas From Rubbish and Garbage B.O.H. Regulation #7 T -e ,e cc: Mayor's Oftice_ Ward Councillor N.I.TT Other °?r,.ytF.-. n: CITY OFKSALE &BOARD OF'.HEALTH Salem, Massachusetts 01970-3928 r i :pYR .X.^r'; may. Ar �. ��A 3t.i �y+a _•,.":::' JOANNE SCOTT, MPH, RS, CHO HFAI TH A(:FNT - r.- Pabch The violatid'ns noted imthe report of,Noven corrected " .- . Thank you°foryour cooperation in this matter. For the Board of Health oanne Scott Health Agent cc: Lt. Charles Latulippe c/o Fire Prevention, John Casey clo Licensing Board JS/sjk Com, NINE NORTH STREET Tel: (978) 741-1800 Fax: (978) 740-9705 Was tent on Thursday, January' 29, ier 18,'1997have been Reply to: Virginia Moustakis Senior Sanitarian Goggin c/o Building Address s � t :•��AI'- tessliorYNman nI it tml Phone:' r}�'i@�Yta€i@gg3 Ia8 3<. x�� a Y�xnr,;,�e;a 1537ttiu s y rrl. ; . Flodr woe sattSY m rr )t'F 7Tt zhi �N iSaafi� l r . t+; F�-�rEm'ztas�Tr:taszl�r&:m�sicasv'ca��+ru:a+;r , .RPS Firt �id195ffi T%7�`d'3i� - 7^ • `fi� �. � !1$�fi .�"5d�' /fl hJ.Y fit^q�R'37'F))9'FS3 �ilF .' R - ';' t T-000.61 H 1q i144./.�eT✓N xhg Y "itW4 ii3414 .}i ii L �" V Y41 w Jfi F+ pu}. 1= S k`.i IS M+ �� C. � .cu.Y.+ { � ro u �,..atn �.-...w, a • n ,1 `, S d yJ $7&ritt aiF 3C'n rsb ?A R r;] Ili, ,1 t 1. . „ •y(:2:� t i ">1S!3=.) u 'f, iS . Yfiffur. 3C. £ t.t.., t�..hsiT �flriUa:ib.1 .Lt1,1 �Y 1.. )'s)� ..(. ,.aLt�., t, ..7-:-,,,.' I � u _ '• .'-•: _tG 4.fl. ..,-)f nJ .I--e-.p7 +it'f.>E..�'i)..17^i a. 1,t'i>1. ..Y �,:., •�? ..,. _: '_ A.>. _1^d - /x ISA41 /c One or more of the,'above violations may endanger or materially impair the heaflh,.salety and well -tieing or the occuPanti,(s) =i `code Enforcement Inspector Este es un'documento',legal importante. Puede que afecte sus derechos. Puede adquirinna traduccion'de'esta fomta. CITY OF SALEM BOARD OF HEALTH Salem, Massachusetts 01970-3928 JOANNE SCOTT, MPH, RS, CHO HEALTH AGENT December 17, 1997 The Salem Inn 35 Winter Island Road Salem, MA 01970 Dear Owner/Manager: The Salem Health, Building and Fire Departments are scheduling yearly inspection of all establishments licensed as rooming houses. The Salem Licensing Board will review inspection and reinspection reports in accordance with its license renewal procedures. NINE NORTH STREET Tel: (978) 741-1800 Fax: (978) 740-9705 The inspection will include dwelling units and common areas, therefore each tenant must be present or he/she must sign the enclosed release form which will allow the inspectors to enter the unit. Your establishment at 7 Summer Street has been scheduled to be Reinspected on Thursday January 29, 1998 at 10:00 am. Thank you for your anticipated cooperation. Sincerely, For the Board of Health Joanne Scott Health Agent CC: Leo Tremblay, Inspector of Buildings Charles Latulippe, Fire Prevention John Boris, Chairman, Salem Licensing Board To: K.R_✓........................................................................................................... Fax: From: N.;....�:A:'.................................................. Date: ....'.../.11. 9../ .................................... �. page(s) including this page. From the desk of_ Joanne Scott, MPH, RS, CHO Health Agent Salem Board of Health 9 North Street Salem, Ma. 01970 (508)141-1800 Fax (508) 740-9705 JOANNE SCOTT, MPH, RS, CHO HEALTH AGENT The Salem Inn 7 Summer Street Salem, MA 01970 Dear Sir/Madam CITY OF SALEM BOARD OF HEALTH Salem, Massachusetts 01970-3928 November 26, 1997 NINE NORTH STREET Tel: (978) 741.1800 Fax: (978) 740-9705 In accordance with. Chapter III, Sections 127A and 1278 of the Massachusetts General Laws, 105 CMR 400.00: State Sanitary Code, Chapter I: General Administrative Procedures and 105 CMR 410.00: State Sanitary Code, Chapter It: Minimum Standards of Fitness for' Human Habitation, a reinspection was conducted of your property located at 7 Summer Street occupied by Rooming House conducted by Virginia Moustakis, Senior Sanitarian on Tuesday November 18, 1997 @, 9:00 am. Notice: If this rental unit is occupied by a child or children under the age of 6 years, it is the property owner's responsibility.to ensure:that this unit complies fully with 105 CMR 460.000: Regulations for Lead Poisoning Prevention and Control For further information or to request an inspection, contact the Salem Health Department at 741-1800. You are hereby ORDERED to make a good -faith effort to correct the violations listed on the enclosed inspection report. Failure on your part to comply within the time specified on the enclosed inspection report will result in a complaint being sought against you in Salem District Court. Time for compliance begins with receipt of this . Order. Should you be aggrieved by this Order, you have the right to request a hearing before the Board of Health. A request for said hearing must be received in writing in the office of the Board of Health within 7 days of receipt of this Order. At said hearing, you will be given an opportunity to be heard and to present witness and documentary evidence as to why this Order should be modified or withdrawn. You maybe represented by an attorney. Please also be informed that you have the right to inspect and obtain copies of all relevant inspection or investigation reports, orders and other documentary information in the possession of this Board, and that any adverse party has the right to be present at the hearing. Please be advised that the conditions noted may enable the occupant(s) to use one or more of the statutory remedies available to them as outlined in the enclosed inspection report form. ,10 or a Board of Health Reply to �_. nne Scott Virginia Moustalds Health Agent Senior Sanitarian CERTIFIED MAIL P 173 155 306 JS/mfp cc: Charles Latulippe, Fire Prevention Maurice Martineau, Building Inspector John Casey, Licensing Board Member Councillor Regina Flynn Page 1 of 02 SALEM HEALTH DEPARTMENT 9 North Street S I MA 01970 a em, State Sanitary Code, Chapter.11: 105 CMR 410.000 Minimum Standards of Fitness for Human Habitation Occupant: PI Address:7&C'Apt. Floor. Owner. Z�y V ea o12,45, i A/rAddress: % .Yc1m m eP_ 5/ - Inspection Date: //-iK-9� �.Tima. Io 0o ry-m Conducted By: L9dz ,tSrarhrs Accompanied By: c3L(Jnie,4, ee aks t r chu44es 7. Anticipated Reinspection Date: Z&nise✓e / /49'7 df /o•aoRm t3cdq ivs� 7n2 �/Z� �Rlce. /Ylu..��,•veduJ Specified Reg # Violation Time 410.:.. One or more of the above violations may endanger or materially impair the health, safety and well--bbeing or the occupants(s) Code Enforcement Inspector Este es un documento legal importante. Puede que afecte sus derechos. Puede adquirinma traduccion de esta forma. .V N ��6 LYP . C Z 4 O. P � zed v,o uYJ2 # r ? P c v — iLo + "W _ # H/ Ya i7 Ar. If v o 1 3,e A �� 3R _ s �s One or more of the above violations may endanger or materially impair the health, safety and well--bbeing or the occupants(s) Code Enforcement Inspector Este es un documento legal importante. Puede que afecte sus derechos. Puede adquirinma traduccion de esta forma. APPENDIX II (14) Legal Remedies for Tenants of Residential Housing The following is a brief summary of some of the legal remedies tenants may use In order to get housing code violations corrected: 1. Rent Withholding (Massachusetts General Laws, Chapter 239, section 8A): If Code Violations Are Not Being Corrected you may be entitled to hold back your rent payments. You can do this without being evicted if: A. You can prove that your dwelling unit or common areas contain code violations which are serious enough to endanger or materially impair your health or safety and ibat your landlord knew about the violations before you were behind in- yourrent B. You did not cause the violations and they can be repaired while you continue to live in the building. C. You are prepared to pay any portion of the rent iiito court if a judge orders you to pay it (For this, it is best to put the , rent money aside in a safe place.) 2. Rcpair and Deduct (Massachusetts General Laws, Chapter 111, section 127L): The law sometimes allows you to use your rent money to make the repairs yourself. if your local code enforcement agency certifies that there are code violations which endanger or materially impair your health, safety, or well-being, and your landlord has received written notice of the violations. you may be able. to use this remedy. If the owner fails to begin necessary repairs (or to enter into a written contract to have thettt• made) within five days after notice or to complete repairs within 14 days after notice, you can use up to four months' rent in;any, , year to make the repairs. 3. Retaliatory Rent Increasc_s or Evictions Prohibit (Massachusetts General Laws, Chapter 186, section 18, and Chapter 2,39,-. _ section 2A): The owner may not increase your rent or evict you in retaliation for making a complaint to your local code enforcement agency about code violations. If the owner raises your rent to tries to evict within six months after you have made the complaint, he or she wiB:have.to-show .a good reason for the increase or eviction which is unrelated to your complaint. You may be able to sue the landlord for damages of he or she tries this. 4. Rent Receivership (Massachusetts General Laws, Chapter I I, section 127 C -H): The occupants and/or the Board of Health may petition the District or Superior Court to allow rent to be paid into court rather than to the owner. The court may then appoint a . "receiver" who may spend as much of the rent money as is needed to correct the violation. The receiver is not subject to a spending limitation of four months' rent 5. Breach of Warranty of liabitability_: You may be entitled to sue your landlord to have all or some of your rent returned if your.. dwelling unit does not meet minimum standards of habitability. 6. Unfair nnd Deceptive Practices (Massachusetts General Laws, Chapter 93A): Renting an apartment with code violations is a violation of the consumer protection act and regulations, for which you may sue an owner. The information presented above is only a summary of the law. Before you decide to withhold your rent or take any other legal action, it Is advisable that you consult an attorney. If you cannot afford to consult an attorney, you should contact the nearest legal services office, which is: Neighborhood Legal Services 37 Friend St Lynn, MA 01902 (617)599-7730 Page 2 01 SALEM HEALTH DEPARTMENT Date: /L/9'-27 g o, 9 North Street Salem..MA 01970 r Name: 77ff,r c.4/-E7y? / v N Address: 7, 5r»hm e P df, Specified Reg # Violation Tme 410.... Ge W& ZoG1<7AIQI✓I P_7 Q fAY Ire, T sz&L C2 { //IR n/ a 2 C e L o s 7Z,21 I�IJPIM Ar P / W GU . ,3 S -e c 8Ma.4nlrazAJ U, N tN SALEM HEALTH DEPARTMENT g 9 North Street Salem -MA 01970 Name: - Specified Reg # Violation r o 410 --- Address: rage _ ui COURTDOCKETNO'.CITATION NC i ACITY OF SALEM R • VIOLATION NOTICE Ni 452 'NAME (LAST, FIRST, INITIAL) - STREETADDRESS CITY/TOWN STATE ZIP <lY LICENSE NO. LIC. EXP. DATE DATE OF BIRTH OWNER'S NAME (LAST, FIRST, INITIAL) : Cylli=.� -rc.,. �eAYar•7 J, c STREETADDRESS CITY/TOWN STATE ZIP REGISTRATION NO. STATE EXP. DATE MAKE/TYPE YEAR COLOF DATE OF VIOLATION TIME DATE CITATION WRITTEN PERSCNPL J1/del J;. �M //d5 /�7 El NO LOCATION OF VIOLATION ENFORCING DEPT. OFFENSE CHAP. SECT. FINES A tJVI% !� y% PCT S -_.i a C OFFICER ° '� LD. NO- TOTAL I/ fes' �✓ .�G.-7"/ DL OFFICER CERTIFIES COPY GIVEN TO VIOLATOR ❑ IN RANI x � ice' � ®BY MAII ',P(D IpTRv1AIL,OKSH - PAY.O V BY POSTAL NOTE, MONEY ORbER OR BY CHECK MADE PAYABLE TO: CITY CLERK CITY HALL 93 WASHINGTON STREET SALEM, -MA 01970 TEL. (508) 745-9595 X 251 1 HEREBY ELECT TO EXERCISE THE FIRST OPTION AS STATED OI REVERSE, CONFESS TO THE. OFFENSE CHARGED, AND ENCLOSI PAYMENT IN THE AMOUNT OF $ CASE N SEE OTHER SIDE FOR FURTHER INFORMATION ENCLOSE PAYMENT IN THIS ENVELOPE, PEEL AND SEAL CITY OF SALEM BOARD OF HEALTH Salem, Massachusetts 01970-3928 JOANNE SCOTT, MPH, RS, CHO HEALTH AGENT Debbie Burkinshaw City Clerk 93 Washington Street Salem, MA. 01970 Dear Ms. Burkinshaw : December 8, 1997 NINE NORTH STREET Tel: (978) 741.1800 Fax: (978) 740-9705 4 Please accept this written request to rescind the following violation notice. Citation # X1452 Issued To: Pabich, Richard Mailed To: 7 Summer Street Location of Violation: 7 Summer Street Issued By: Jeffrey Vaughan Date of Violation: November 12, 1997 Thank you as always for your cooperation. Sincerely, For the Board of Health Joanne Scott Health Agent c: Street File Chrono File sS F Y Robert`W. Turner Chief 978-744-6990 City of Salem, Massachusetts Fire Department Mr. Richard Pabich 7 Summer Street Salem Mass Dear Mr. Pabich: 48 Lafayette street $a(em, Massachusetts 01970-3695 Tel. 978-7441235 Fax 978-7454646 November 18, 1997 On November 18, 1997 an inspection on your properties at 331 Essex Street and 5-9 Summer Street was conducted and the following violations were found. For 331 Essex Street: 1. Emergency light 1st floor front hall out. 2. Mattress and other debris in attic to be removed. 3. Recommendation for fire extinguisher on each floor. For 5-9 Summer Street: 1. Fold up beds in rear hall of 5 Summer Street must ? be removed. 2. Paint in basement must be stored in metal cabinet. 3. Fire door rear 2nd floor at 9 Summer Street not closing properly. 4. Slide bold rear exit door at 9 Summer Street must be removed. Since r lC Lt. Charles Latuli Fire Marshal Fire Prevention Bureau 978-745-7777 3 CITY OF SALEM BOARD OF HEALTH Salem, Massachusetts 01970-3928 JOANNE SCOTT, MPH, RS, CHO HEALTH AGENT November 4, 1997 The Salem Inn 35.441-n.ter•. Es -land Road Salem, MA 01970 Dear Owner/Manager: The Salem Health, Building and Fire Departments are scheduling yearly inspection of all establishments licensed as rooming houses. The Salem Licensing Board will review inspection and reinspection reports in accordance with its license renewal procedures. NINE NORTH STREET Tel: (508)741-1800 Fax: (508) 740-9705 The inspection will include dwelling units and common areas, therefore each tenant must be present or he/she must, sign the enclosed release form which will allow the inspectors to enter the unit. Your establishment at 7 Summer Street has been scheduled to be inspected on Tuesday November 18, 1997 at 10:00 am. Thank you for your anticipated cooperation. Sincerely, For the Board of Health Joanne Scott Health Agent Cc: Leo Tremblay, Inspector of Buildings Charles Latulippe, Fire Prevention John Boris, Chairman, Salem Licensing Board diAMPAD 23-021-2o0SETS EFFICIENCY® 73s2i-aooSETS cAnsoNLEss To_�' J Date �6"Z2- 9 % Time WHILE YO�Un{ WERE OUT M of hone Phone- (� Q Area Code Area Number Extension TELEPHONED PLEASE CALL CALLED TO SEE YOU WILLCALL AGAIN WANTSTOSEEYOU URGENT RETURNED YOUR CALL Message l�G D Operator diAMPAD 23-021-2o0SETS EFFICIENCY® 73s2i-aooSETS cAnsoNLEss To— Date Idl2l /92 Tima -):'50 WHILE YOU WERE OUT oo M Of.IQLvNriL) // ,(–Uih�vt .iT Phone— hone Area Area Code Nurrlber Extension TELEPHONED X PLEASE CALL RETURNEDYOURCALL Maeeege Operator 0MANIPAD 23 -a21 -20a SETS EFFICIENCY® 23.421 .4005EiS CARBONLESS CALLED TO SEE YOU WILL CALL AGAIN WANTS TO SEEYOU URGENT il CITY OF SALEM BOARD OF HEALTH Salem, Massachusetts 01970-3928 JOANNE SCOTT, MPH, RS, CHO HEALTH AGENT October 23, 1997 The Salem Inn Go Richard Pabich 7 Summer Street Salem, MA. 01970 Dear Mr. Pabich: NINE NORTH STREET Tel: (978) 741-1800 Fax: (978) 740-9705 Due to complaints received by the Health Department an inspection of the area between 7 and 11 Summer Street was conducted on Monday, October 20, 1997. The following violation was noted; Trash placed on front of 11 Summer Street. This is a violation of City of Salem Board of Health Regulation #7 Section 5.2 which states wastes "shall be placed on the outer curb of the sidewalk appurtenant to the place such person, firm or corporation resides or has its place of business. Thank you for your cooperation. For the Board of Health: Janne Health Agent JS/sjk -ysum Jeffrey Vaughan Sanitarian r -t i 4y � SALEM HEALTH DEPARTMENT, North Street Satem_ MA . 01870 - State San".. Code, ChaptorJ1 105 CMR 411U11 Mcf*vuin Standards of IFitnassfor Human Habitation Phone: - Address: The Salem .Inn, 7 Summer Street _ Owner. Inndeavors. Inc. - Page t of z - Address: 7 Summer Srrpat Salem. -11a• O1972 --.-- Inspection Date: Jan. 29, 1997 ;rms _ 10:30 a.m. Conducted By: , ' Jeffrey W. Vaughan Accompanied By: Anticipated Reinspection Date: N/A Specified Reg # Violation - me 410.... One or more of the above violations may endanger or materially impair the health, safety and well-being or the occupants(s) - ' Code Enfoktement Inspector Este es un documento legal importante. Puede que afecte sus derechos Puede adquirimna traduccion de esta forma.' An inspection was conducted in accordance .with Article II, State Sanitary Code, 105 CMR":410. "Minirium Standards for Human Habitation". , i i LUpon inspection no violations.were' noted. The Courtyard Cafe (at --1 i I� —i Thank you for your cooperation, One or more of the above violations may endanger or materially impair the health, safety and well-being or the occupants(s) - ' Code Enfoktement Inspector Este es un documento legal importante. Puede que afecte sus derechos Puede adquirimna traduccion de esta forma.' CFI Y OF SALEM BOARD OF HEALTH Salem, Massachusetts 01970-3928 JOANNE SCOTT, MPH, RS, CHO HEALTH AGENT January 23, 1997 The Salem Inn 7 Summer Street Salem, MA 01970 NINE NORTH STREET Tel: (508) 741-1800 Fax: (508) 740-9705 Dear Owner/Manager: , The Salem Health, Building and Fire Departments are scheduling yearly inspections of all establishments licensed as rooming houses. The Salem Licensing Board wilf;eview inspection and reinspection reports in accordance with its license renewal procedures. The inspection will include dwelling units and common areas, therefore each tenant must be present or he/she must sign the enclosed release form which will allow the inspectors to enter the unit. Your establishment at 7 Summer Street will be inspected on Wednesday January 29, 1997 11:00 a.m.. Thank you for your anticipated cooperation. Sincerely, For the Board of Health Joanne Scott Health Agent cc: Leo Tremblay, Inspector.of Buildings Norman LaPointe, Fire Prevention John Boris, Chairman, Salem Licensing Board Salem Inn Joanne Scott To: David Shea Cc: Heather Lyons Subject: RE: Salem Inn Page I of Hi Dave: Thank you for the feedback. We will contact Melissa for the categories of licenses and schedule yearly inspections with each owner under the different categories. Don't forget to smell the roses, especially while they are still blooming! Joanne From: David Shea [mailto:dshea@SJ-SERVICES.COM] Sent: Monday, August.04, 2008 4:56 PM To: Joanne Scott Subject: RE: Salem Inn Hi Joanne, We did talk about this issue at our last meeting and I re -confirmed today with the other Board members. Since the Salem Inn has an Innkeepers License and not a Lodging House License then they would not be on the Lodging House list for our inspections. They would still have to be inspected by all relevant City inspectional agencies just not in the Lodging House category. Hope that helps. Summer is definitely flying by and I have not enjoyed a lot of it yet but hope to do so soon. I still think you have the best location in Salem and one of the best places to enjoy the summer. Thanks David -----Original Message ----- From: Joanne Scott [mailto:]Scott@Salem.com] Sent: Monday, August 04, 2008 11:42 AM To: David Shea Subject: RE: Salem Inn Hi David: Has the Licensing Board decided whether to include the Inns in our annual inspection schedule? I hope you are enjoying the summer. Itis flying by! Thank you, Joanne 8/5/2008 Salem Inn From: David Shea [mailto:dshea@SJ-SERVICES.COM] Sent: Thursday, July 10, 2008 4:07 PM To: Joanne Scott Cc: Rick Lee (E-mail); John Casey (E-mail); Melissa Pagliaro Subject: RE: Salem Inn Hi Joanne, Hope all is well with you. I will raise this topic at our meeting on Monday and we will get back to you. Melissa, pls put this item under new business. Thanks David -----Original Message ----- From: Joanne Scott [mailto:JScott@Salem.com] Sent: Thursday, July 10, 2008 3:16 PM To: David Shea Subject: Salem Inn Dear David: Page 2 of 2 Mr. Pabich, owner of the Salem Inn, has expressed concern about the yearly inspections conducted for the Licensing Board by the Board of Health, Building, Fire, and Licensing that include rooming houses, bed & breakfasts, inns (including the Coach House Inn), etc. He says that he has an "inn- keepers" License so that he should not be included. Last year he stated that he should not be inspected if the hotels and motels were not inspected. Since then, the Board of Health enacted regulations that include yearly inspections of hotels and motels. Please advise as to whether the Licensing Board wants the Salem Inn included, and if not, what other establishments are in that same category and should be excluded. Thank you. Sincerely, Joanne 8/5/2008