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WITCH CITY ROASTERS - ESTABLISHMENTSWitch City Roasters 3 Goodell Street h' n ti Commonwealth o£Massachusetts City of Salem Board of Health 120 Washington Street, 4th Floor SALEM, MA 01970 Food/Retail Establishment Permit DATE PRINTED: 01/22/2009 ESTABLISHMENT NAME: File Number: BHF -2008-000007 LOCATED AT: j Kimberley Driscoll Mayor Witch City Roasters 3 Goodell Street SALEM MA 01970 SALEM, MA 01970 Permit Type Permit No. Permit Issued Permit Expires Fee Restrictions / Notes RETAIL FOOD BHP -2009-0378 Jan 9, 2009 . Dec 31, 2009 $70.00 PERMIT EXPIRES Total Fees: $70.00 Board of Health This Permit is not transferable and must be reissued upon change of ownership or location. The permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code; beofre any revonations; improvements; or equipment changes are made, all plans for such must be submitted to and approved by the Salem Board of Health. Page 1 CITY OF SALEM, MASSACHUSETTS + + BOARD OF HEALTH 120 WASHINGTON STREET, 4" FLOOR TEL. (978) 741-1800 KIMBERLEY DRISCOLL FAx (978) 745-0343 L L-wOR IDIONNE SALEM. COM JANET DIONNE, ACTING HEALTH AGENT 2009 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT NAME OF ESTABLISHMENT G✓/f TEL # 926 -7Y5 602 // ADDRESS OF ESTABLISHMENT 3 C-CV,0tr6C- 57 37�166r-- FAX# MAILING ADDRESS (if different) EMAIL -Business': <ZDb, OWNER'S NAME TEL# 9��T16-6aP7 ADDRESS 3 STREET STATE ®e 9 7i-> ZIP CERTIFIED FOOD MANAGER'S NAME(S)�ir✓� �,� ✓ CERTIFICATE#(S) :-575/ (Required in an establishment where potentially) food is prepared) EMERGENCY RESPONSE PERSON L 090;-� HOME TEL #_�%�B"��6 DAYS OF -Monda .., Tuesda . ' 1 s Wednesda ,, Thursd ?:: I'= " Frid Saturda "Sunda HOURS OF OPERATION Please write in time of day. (For example Ilam -11 pm) i TYPE OF ESTABLISHMENT FEE (check only) RETAIL STORE YES NO less than 1000sq.ft. =$ 70 a- 1000-10,000sq.ft. =$280 more than 1 0,000sq.ft. =$420 -------------------------------------------------------------------O d -------------------------------------------- RESTAURANT YES Ness ie"s's--than-------2-5 --- s, se --a----------------- ts =-$140---------- (Outdoor Stationary Food Cart $210) 25-99 seats =$280 more than 99 seats =5420 - ------------------------------------------------ -- ff......- --O ---------------- -------------------------------------------------------------- BED/BREAKFAST/ YES N $100 CHILDCARE SERVICES ADDITIONAL PERMITS MAKE (notjust serve) ICE CREAM, YOGURT/SOFT SERVE YES NO $25 TOBACCO VENDOR YES NO $135 ALL NON-PROFIT (such as church kitchens) YES NO $25 'Please pay total with one check payable to the City of Salem. This Permit is not transferable and must be reissued upon change of ownership. The Permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code, before any renovations, improvements, or equipment changes are made, all plans for such must be submitted to and approved by the Salem Board of Health. Pursuant to MGL Chapter 62C, Section 49A, I certify under the pains and penalties of perjury that I, to my best knowledge and belief, have filed all state tax ret s 'anapicyll state taxes required under the 1 or Revised 424/07 FOODAP2008.adm Check# & Date 99 1 / / , 109 $ -r ) CITY OF SALEM BOARD OF HEALTH Establishment Name: L-JiTC,\i -Date: Page: of j Item No. Code��,t, Reference �C -Critical item vF R - Red Item DESCRIPTION OF,VIOLATION PLAN OF CORRECTION w� v, PLEASE PRINT CLEARLY 1, Date Date if led, r -J6 n NO I nW SOr TIC-) 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/FederahF�ood Code. I understand that noncompliance may result in daily fine your food permit. Corrective Action Required: Li No L) Yes Ell Voluntary Compliance 0 Employee Restriction Exclusion LI Re -inspection Scheduled Lj Emergency Suspension Z) Embargo 0 Emergency Closure Cl Voluntary Disposal a Other: I Violations Related to Foodborne illness interventions and Risk Factors (Itches 1-22) (Cont.) PROTECTION FROM CHEMICALS i -A7 ---- ---T —Food or Color Additives 3-30114 Pao tectionfrom Una rovotlAdditives' Poisonous or Toxic Substances Identifying kiftattration -- Origimo 1 Containers* 1 1 Couirtaillislame - Worki"', Cowairw�n,* 7.2m.11 Se Al,uon 3--%� 1,) ---1 —nm" as a' Public —Health Control' 7-;;03_I1 Toxic Contaitim,,, - Prollabitiono' 7-204.11 sanalivil. Criteria CheinicaW 7-204.12 Chcrucak for Wa�hijai ProdIlce, clitc(ial 7-204,14 !�� Criteri -, 7- 20�, 11 lactate III al F(" Cot it act, I 4ila i tau it s 246. 11 pctricied Cs�c Peqicrdes, Critmm' 200 li RIde�il Pita 7-206.73 I Trackiag Powderi� Icst Control ard j slonitolin- TIMErrEMPERATURE CONTROLS Proper Cooking Temperatures for PHFs �TOL 1, 1 A(l )(2) F. 1,55'F 15 14VF15secl T401.1 I(A)(2) GaInt nimals 73,461.1111P(J)(2) APoik and Iiket Rwfarain* 130T 121 401.11(A)(2) KiiliteN, Ifir-cfal Meats- I �,S'F 15 3-40tAI(A)tT) Pouln-.s_ Wild (iawe, $tuffed PHFs, ','toffjng Cortaiwir- Fish, Meal, Poultry (,I- katites-1651-' 15 sec. intact Beef Steaks (4Y)F* 3=171.12a Awraid Foisk Conked in a Microwave 105'F I(Ail Iffbi I All Other PlIF,-- 145"F 15 Iaic, 40111 JAW D) Pili s 165t'F I se 3Mic -403.11(b) rowave- 165' F -2 lshmae Standing I I" -T-4 I)Tl if C) Gfutam=cIally Pro,�cssed RTFKOw- 140'F� 403 11 (H Rcalainin", uIrshced Portions of Bee( Cooling at PH—Fs 3-561 14(A) Cfslit)ii Cookett PKI -'s from 1,11YT to 7' DOF Within 2 flours and From 70OF - h) 41'7145 'F'IVithiiq 4 titers. ' - 73,5(Ti. 14(b) Cooluju PI -(Fs Made From Ambient c, Tempe-rature Ingreditarts to 41 `F/45'F - [)Lwlies allical Item III the reder'd I :1)4 Rx"I Ogle or 10 1, NIR 591) WO, 3-501-id(C) PHFs Received atTemperatures According to I awe Cooled of ' 1 0 F145'P Within ! Hours, * REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS (HSP) 217 3-561 t I t�A-) —Unp-aqwwrized Pre -padaged Juices wra i Bevericets Avitti WT±11j�e1i;* -T-7,86, I1(1;) -!,'�-uf PA mize 5-80i. I I (D) Rawor Paiti;ill,, Cfokedkaimnl Food and Rat S,�ed SproumNkr SIirteif, k7w-I I I if', T' -i P, -f,,- N." 22 3 4aW 11 Coasuoivrisdisory Posted for Anitn,)l ftxtd, Mal! arc. Raw. Undencsoked cI NkIt OtherWise l"RcCtise.d M FNITORIVC Paoho eeO0 T I Pzxteui hsIirfhe fo) Raw Shell 590,009(1)-d)) Violations of section 590A09(Pk)-(D) in caterin , gbdc, � moRxiii, tempuras v and refid,mllai kitchen ciperaflons5hcfuld be debited under the appropriate iection's above if related to f6odhonh illness Other 1 590.009 violations relating to Food veto l I placticesAitedd Iv debited under f29 - i Special Requircillonts. {Iters 23-31)) alcii,al w,dn,)ti-rnI;ca! iihich do no re,wte to the foodborne, diness inu I I, ealions aad It kjm tors li.vIed ah;Ove, (tin be found in ih4:jfIVou-,wg seofwfs o; the, Food Code Ioul 10-3 CMR 5()01()()(), 3-501.16(B) Cold PHF,,, Maincimed at or bolow 59or()f)4(F) 41'145" F' 501 W(A) Hot PRFS klaitil aiatd at r abwe I-501,16(iii) j Roams Ikld at or above 134'E 20__1 Time as a Public Health Control 3--%� 1,) ---1 —nm" as a' Public —Health Control' REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS (HSP) 217 3-561 t I t�A-) —Unp-aqwwrized Pre -padaged Juices wra i Bevericets Avitti WT±11j�e1i;* -T-7,86, I1(1;) -!,'�-uf PA mize 5-80i. I I (D) Rawor Paiti;ill,, Cfokedkaimnl Food and Rat S,�ed SproumNkr SIirteif, k7w-I I I if', T' -i P, -f,,- N." 22 3 4aW 11 Coasuoivrisdisory Posted for Anitn,)l ftxtd, Mal! arc. Raw. Undencsoked cI NkIt OtherWise l"RcCtise.d M FNITORIVC Paoho eeO0 T I Pzxteui hsIirfhe fo) Raw Shell 590,009(1)-d)) Violations of section 590A09(Pk)-(D) in caterin , gbdc, � moRxiii, tempuras v and refid,mllai kitchen ciperaflons5hcfuld be debited under the appropriate iection's above if related to f6odhonh illness Other 1 590.009 violations relating to Food veto l I placticesAitedd Iv debited under f29 - i Special Requircillonts. {Iters 23-31)) alcii,al w,dn,)ti-rnI;ca! iihich do no re,wte to the foodborne, diness inu I I, ealions aad It kjm tors li.vIed ah;Ove, (tin be found in ih4:jfIVou-,wg seofwfs o; the, Food Code Ioul 10-3 CMR 5()01()()(), CITY OF SALEM BOARD OF HEALTH Date: March 13, 2008 Name of Establishment: Witch City Roaster's Inc Address: 3 Goodell Street Owner(s): Darren Thompson Phone: 978-745-6211 Darren Thompson, owner of this residential kitchen establishment, presented a Floor Plan and Menu for review in accordance with the State Food Code. Mr. Thompson has received approval, for this home business, by the Zoning Board of Appeals. FLOOR PLAN The plan as presented is approved. The roasting operation will take place in the kitchen. The roasting machine is kept in another room when not in use. The raw beans and finished product will be stored in a cabinet in another room. This cabinet must be kept locked. Utensils/equipment must be stored in a separate cabinet or drawer. All food contact surfaces must be sanitized prior ro use. This includes the roaster, equipment, and tabletop. MENU/FOOD PREP Hands must be washed with warm water and soap prior to beginning operation and before weighing and packaging beans. There may be no bare hand contact of ready -to -eat foods. Gloves, tongs, or tissues must be used when handling such food. Coffee must be purchased from a company holding a Wholesale Permit from their state. The sanitizer must have an EPA Reg. #. Test strips must be used to verify that the sanitizer is at 200 ppm. The results of this test must be recorded on a log sheet and maintained for inspection by the Board of Health. Massachusetts and federal labeling requirements must be met including the street address. Coffee will be shipped in zip locked, heat -sealed plastic bags. Please call three days prior to the start of the new operation to schedule an inspection. �I '! o f Cf) ' f C CITY OF SALEM BOARD OF HEALTH Date: March 13, 2008 Name of Establishment: Witch City Roaster's Inc Address: 3 Goodell Street Owner(s): Darren Thompson Phone: 978-745-6211 Darren Thompson, owner of this residential kitchen establishment, presented a Floor Plan and Menu for review in accordance with the State Food Code. Mr. Thompson has received approval, for this home business, by the Zoning Board of Appeals. FLOOR PLAN The plan as presented is approved. The roasting operation will take place in the kitchen. The roasting machine is kept in another room when not in use. The raw beans and finished product will be stored in a cabinet in another room. This cabinet must be kept locked. Utensils/equipment must be stored in a separate cabinet or drawer. All food contact surfaces must be sanitized prior ro use. This includes the roaster, equipment, and tabletop. MENU/FOOD PREP Hands must be washed with warm water and soap prior to beginning operation and before weighing and packaging beans. There may be no bare hand contact of ready -to -eat foods. Gloves, tongs, or tissues must be used when handling such food. Coffee must be purchased from a company holding a Wholesale Permit from their state. The sanitizer must have an EPA Reg. #. Test strips must be used to verify that the sanitizer is at 200 ppm. The results of this test must be recorded on a log sheet and maintained for inspection by the Board of Health. Massachusetts and federal labeling requirements must be met including the street address. Coffee will be shipped in zip locked, heat -sealed plastic bags. Please call three days prior to the start of the new operation to schedule an inspection. Owner KIMBERLEY DRISCOLL MAYOR CITY OF SALEM MASSACHUSETTS BOARD OF APPEAL 120 WASHINGTON STREET, 3RD FLOOR SALEM. MASSACHUSETTS 01970 TELEPHONE: 978-745-9595 FAX 978-740-9846_3 P12 3O March 3, 2008 Decision City of Salem Zoning Board of Appeals Petition of Darren Thompson seeking a Special Permit for a home occupation to operate an internet sales and coffee roasting business at 3 Goodell Street JR -21. A public hearing on the above Petition was held on February 13, 2008 pursuant to Mass General Law Ch. 40A, §§ I 1 with the following Zoning Board members present: Robin Stein, Elizabeth Debski, Richard Dionne, Rebecca Curran, and Bonnie Belair. Petitioner seeks a special permit pursuant to section § 5-3 of the Salem Zoning Ordinance to allow for a home occupation at 3 Goodell Street. Statements of fact: Darren Thompson has been roasting coffee as a hobby in his two-family home at 3 Goodell Street. 2. He would like to obtain a special permit to operate a coffee roasting and internet sales business. He plans to call the business Witch City Roasters. 3. Customers would purchase coffee through a website and not at the home. 4. The petitioner stated that 90% of the odor is eliminated by a new machine he purchased. 5. JB Master (7 Goodell Street) and Gregory Turpin (a resident of Peabody) spoke in favor of the petition. They also stated that they have not been disturbed by odors. 6. There was no opposition to the request for a special permit at the public hearing. The Board of Appeal, after careful consideration of the evidence presented at the public hearing, and after thorough review of the plans and petition submitted, makes the following findings: 1. The home occupation meets the criteria set forth in 5-3 (b)(1 ) and is a use allowed by special permit in an Residential Two Family (R-2) Zoning District. 2 2. A special permit may be granted to allow this request without substantial detriment to the public good and without nullifying or substantially derogating from the intent or purpose of the Salem Zoning Ordinance. On the basis of the above findings of fact and all evidence presented at the public hearing including, but not limited to, the Plans, Documents and testimony, the Zoning Board of Appeals concludes: 1. To allow for the home occupation, a special permit may be granted under the Salem Zoning Ordinance § 5-3 Special Permit Uses. 2. In permitting such change, the Board of Appeals requires certain appropriate conditions and safeguards as noted below. In consideration of the above, the Salem Board of Appeals voted, five (5) in favor (Stein, Debski, Dionne, Belair, and Curran) and none (0) opposed, to grant petitioner's request for a special permit subject to the following terms, conditions, and safeguards: Petitioner shall comply with all city and state statues, ordinances, codes, and regulations. 2. All requirements of the Salem Fire Department relative to smoke and tire safety shall be strictly adhered to. 3. Petitioner is to obtain approval from any City Board or Commission having jurisdiction including, but not limited to, the Planning Board 4. No retail sales out of the home shall be allowed. Robin Stein, Chair Salem Zoning Board of Appeals A COPY OF TIIIS DEC IS ION IIAS BEEN FI LEI) WITH THE PLANNING BOARD ANU THF CiIN( LERK Appeal from this decision, if any, shall be made pursuant to Section 17 of the Massachusetts General taws Chapter 40A, and shall be filed within 20 days of filing of this decision in the office of the City Clerk. Pursuant to the Massachusetts General Laws Chapter 40A, Section 11, the Variance or Special Pemut granted herein shall not take effect until a copy of the decision bearing the certificate of the City Clerk has been filed with the Essex South Registry of Deeds. j Good ell 5�. J -/,3-0y Commonwealth of Massachusetts City of Salem C Board of Health 120 Washington Street, 4th Floor Kimberley Driscoll Mayor SALEM, MA 01970 Food/Retail Establishment Permit DATE PRINTED: 03/20/2008 ESTABLISHMENT NAME: File Number: BHF -2008-000007 LOCATED AT: Witch City Roasters 3 Goodell Street SALEM MA 01970 SALEM, MA 01970 Permit Type Permit No. Permit Issued Permit Expires Fee Restrictions / Notes RETAIL FOOD BHP -2008-0428 Mar 20, 2008 Dec 31, 2008 $70.00 Total Fees: $70.00 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 1 of 1 Commonwealth of Massachusetts City of Salem Board of Health 120 Washington Street, 4th Floor SALEM, MA 01970 Food/Retail Establishment Perinit DATE PRINTED: 03/20/2008 ESTABLISHMENT NAME: File Number: BHF -2008-000007 LOCATEl,1 AT: C IGtnbetiey Ddsw11 Mayor Witch City Roasters 3 Goodell Sheet SALEM MA 01970 SALEM, MA 01970 Permit Type Permit No. Permit Issued Permit Expires Fee Restrictions / Notes RETAIL FOOD BHP -2008-0428 Mar 20, 2008 Dec 31, 2008 570.00 PERMIT EXPIRES Total Fees: $70.00 :r 31, 2008 This Permit is not transferable and must be reissued upon change of ownership or location. The permit must be posted in a prominent location in the Establishment In accordance with the state Sanitary Code, beofre any revonatious, improvements, or.�uipment changes are made, all plans for such must be submitted to and approved by the Salem Beard of Health- PaRe.I of 1 KIMBERLEY DRISCOLL . MAYOR JOANNE SCOTT, HEALTH AGENT CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH 120 WASHINGTON STREET, 4'm FLOOR TEL. (978) 741-1800 FAX (978) 745-0343 )S=(tzz)SALEM. COM 2008 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT NAME OF ESTABLISHMENT hll!TC4 C-ITY Pj45-;;'1fW5- /n/C TEL # 9 2gL,Zc, S 42> j ADDRESS OF ESTABLISHMENT 3 6<inn le --GL 5—/ 9674 I14 FAX # MAILING ADDRESS (if different) EMAIL -Business': (��NOur%�SO���✓/iCI{C/7/sltt�Q� c✓iiG/.1eiTY�o�1S"�r6cs c OWNER'S NAME TEL # 9 %ff % 6� ADDRESS 3 C-00i76-e-ry S%� S W ©�%d 9 STREET CITY STATE ZIP CERTIFIED FOOD MANAGER'S NAMES) CERTIFICATE#(S) (Required in an establishment where potentially hazardous food is prepared) EMERGENCY RESPONSE PERSON --DW'-,,- HOME TEL # 17.6 74 5_%m [7�_ DAYS OF OPERATION 1 Monday Tuesday Wednesday Thursday Friday Saturday Sunda HOURS OF OPERATION Please write in fine of day. (For example 11 an -11 pm) TYPE OF ESTABLISHMENT FEE (check only) RETAIL STORE YES NO less than 1000sq.ft._$ 70 1000-10,000sq.ft. =$280 more than 10,000sq.ft. =$420 RESTAURANT YES NO (Outdoor Stationary Food Cart $210) - "--'-'-'---------------- BEDIBREAKFAST/ YES NO CHILDCARE SERVICES------------------------------------------------------- ADDITIONAL PERMITS MAKE (notjust serve) ICE CREAM, YOGURT/SOFT SERVE TOBACCO VENDOR ALL NON-PROFIT (such as church kitchens) --------------------------------------- --------- less than 25 seats =$140 25-99 seats =$280 more than 99 seats =$420 ------------------------------------------------- $100 YES NO $25 YES NO $135 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 su�fr1i nitt be submitted to and approved by the Salem Board of Health. ursuant t MGL pter 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 turns and ai tate tales required under the law. J 3// 31aLf o? 6 /C3.6-000 Date Social Security or Federal Identification Number -------------'-----------------------------------------_ ----------------------------- Revised 4/24/07 FOODAP2008.adm -- .___------------------- CheckH R Date 5