Food Stand Concession Plan Review Checklist

Transcription

1 Food Stand Concession Plan Review Checklist Facility name: This checklist will help you prepare a complete plan review packet. Submit the completed plan review packet and checklist with the required application fee. Incomplete plan review packets will not be accepted. Make a copy of this plan review packet for your records prior to submittal. Plan review fees are non-refundable.. ITEM DESCRIPTION Office Use Only Intake 1 Application Provide complete Food Stand / Mobile Food Unit Plan Review application. 2 Water and sewer adequacy If applicable, provide proof that the facility is connected to an approved water and sewer or septic system. 3 Floor plan Provide a floor plan of the entire facility. Floor plan must show location of all equipment (sinks, refrigeration, cooking, hoods, blenders, countertop appliances, etc.), restrooms, storage areas, etc. Floor plan must be no smaller than ¼ equals 1. 4 Equipment list Provide make and model numbers of all equipment (including countertop appliances). Show location on floor plan. For remodels both new and existing equipment must be shown on the floor plan. Only commercial grade, National Sanitation Foundation (NSF) or equivalent equipment is acceptable. 5 Finish schedule Provide the materials used for all floors, walls, ceilings, counters, and cabinets. 6 Menus Provide a detailed menu of all the food and beverages you will be serving or a list of food and beverages you will be selling. Include condiments, iced beverages and baked goods. Only food and beverages listed may be served. 7 Food sources Provide a list of all food and beverage suppliers. 8 Food preparation steps 9 Commissary agreement letter 10 Restroom agreement letter Provide a description of how menu items will be prepared. Provide a complete commissary agreement letter with a food service establishment permitted in Snohomish County. Hours of operation of the commissary must be the same as the food stand s hours of operation, or the operator of the food stand and his/her employees must have keyed access to the commissary. Provide a complete restroom agreement letter. Restrooms must be located in a commercial building accessible to the public within 200 feet of the Food Stand Concession, and be connected to water and sewer or an approved septic system. 11 Fee Include application fee. I understand I cannot open this food establishment until I have received written approval from this program, obtained all annual operating permits and have been inspected and approved by all applicable city, county and state agencies. Signature/Title Date FoodEstablishmentPlanReviewCheckLIst_EH_10_2017_dlp

2 Food Stand /Mobile Food Vehicle Plan Review Application Application must be completed in full and submitted with fee and the items listed for processing: Reviewed by: (EHS Initials) TYPE OF PLAN REVIEW (Check applicable box) $448 Base fee (2.5 hours) plus $180 per hour for each add l hour (PLU 390) $180 Base fee plus $180 per hour for each add l hour (PLU 311) Food Stand Concession (New) Mobile Food Vehicle (New) Remodel of existing Food Stand Concession or Mobile Food Vehicle or revision of approved plan $180 (PLU 335) Reopen former Food Stand Concession or Mobile Food Vehicle ESTABLISHMENT INFORMATION Name: Site Address: City: OWNER INFORMATION Name: Address: ZIP: Phone: Address: City: State: Zip: CONTACT INFORMATION (if different than owner) Name: Address: Phone: Address: City: State: Zip: COMMISSARY INFORMATION Commissary Name: Local Building Inspection Agency: Commissary Water Supply (check one): Private Well Public Water District: Commissary Sewage Disposal (check one): Onsite Sewage System Sewer Inspection is based upon requirements of WAC Rules & Regulations of the State Board of Health for Food Service Sanitation. Other agency approvals requisite to your operation may include County or City Planning, Building, Plumbing and Fire Departments, Water and Sewer Utilities. Sewer District: OFFICE USE ONLY APPLICANT SIGNATURE DATE FoodStandMobileFoodVehiclePlanReviewAppl_EH_07_17_dlp

3 Water and Sewer Adequacy / Food & Community Safety Facility name: Site address: City: State: ZIP: Parcel number: Proposed number of seats: Contact name: Phone: Fax: New construction Remodel/Alteration Expansion of existing restaurant Yes No Yes No Yes No Is the facility connected to a septic system? Are public restrooms available? Is a grease trap required by sewer district or building department? Describe the proposed project: Sewage system Sewer bill or availability letter attached Below completed by official This section should be completed by a Public Sewer System Official, if a sewer bill or availability letter is not provided. Name of system: Sewer utility: The above system will provide service to the facility listed at the above address. System official: Phone: Date: Water system Water bill or availability letter attached Below completed by official This section should be completed by a Public Water System Official, if a water bill or availability letter is not provided. Name of system: State ID number: The above facility is connected has applied The above system will provide service to the facility listed at the above address. System official: Phone: Date: FoodEstablishmentPlanReviewCheckLIst_EH_071817dlp

4 EXAMPLE FLOOR PLAN FOOD STAND CONCESSIONS NOTE: This plan is meant to illustrate health requirements only. 1/4 inch = 1 foot Equipment, finish & plumbing schedules, and menu/haccp details are in the attached pages Handwash sink 5. 2-door undercounter refrigerator 9. Cash Register and stand 2. 5-gallon fresh water tank 6. Storage rack for syrups 10. Storage shelves 3. 6-gallon waste water tank 7. Service shelf / window door milk storage refrigerator 4. Espresso machine 8. Knock box and garbage 12. Counter top and shelving ExampleFloorPlanLimitedGrocery_EH_5_2017_pac

5 Equipment List Facility name: List all food service equipment, including make and model numbers. Examples include, but are not limited to, refrigerators, sinks, stoves, ovens, steam tables, blenders, ice machines, ventilation hoods, and all countertop appliances. If make and model number cannot be found, a picture of the equipment is required. The item numbers on this list must be the same as the item numbers for the equipment on the floor plan. All equipment ID numbers must correspond to location on floor plan. Equipment must be commercial grade and meet American National Standards Institutes (ANSI) standard (NSF, ETL or UL Sanitation listed). Only one item per line. Sample Equipment List ID # Kind of equipment Make Model # 1 Refrigerator 8 x8 walk-in ACME R-789WI 2 Ice machine GAPP IM Rice cooker ACME CR compartment dish wash sink (with 2 drainboards) ACME S-3CWD The equipment list is included on floor plan.

6 Please add a second page if needed. EquipmentList_EH_05_2017_pac

7 Finish Schedule Facility name: Provide the materials used for all floors, walls, coving and ceilings. All bare wood surfaces (doors, trim, counters, shelves, cabinets, etc.) must be painted or sealed. Floors must be constructed of light colored, smooth, easily cleanable, non-absorbent material. Expansion joints, seams, saw cuts and the like in concrete floors in all areas, including customer seating areas, must be filled and sealed so as to provide a smooth and cleanable surface. Coving must be installed at all wall/floor junctions. Walls must be constructed of light colored, smooth, easily cleanable, non-absorbent materials. Provide Fiber Reinforced Plastic (FRP), laminate plastic, tile, or similar waterproof material on wall surfaces behind sinks, dishwashers, food preparation areas, and areas exposed to moisture. Ceilings above the kitchen, lounge, wait and service areas must be constructed of light colored, smooth, easily cleanable, non-absorbent materials. Unsealed and or perforated acoustical ceiling tiles are not allowed. Vinyl covered ceiling tiles such as vinyl rock or other washable surfaces are allowed. All lighting over food preparation, handling and storage areas must have covers or shatterproof bulbs. Sample finish schedule Floors Coving Walls Ceiling Counters Kitchen vinyl tile 6 rubber base FRP painted gypsum board laminate Wait area vinyl tile 4 rubber base painted gypsum board vinyl rock laminate Lounge sealed concrete 4 rubber base varnished wood Armstrong VL tiles granite Dining area carpet 4 rubber base painted gypsum board painted gypsum board n/a Bathrooms ceramic tile ceramic tile painted gypsum board painted gypsum board laminate Shelving Lighting Refrigerators and dry storage: stainless steel wire shelves; liquor storage: varnished wood Bar lights are shatterproof. All kitchen lights have covers. Finish schedule Included on floor plans Floors Coving Walls Ceiling Counters Kitchen Wait area Lounge Dining area Bathrooms Shelving Lighting FoodEstablishmentPlanReviewCheckLIst_EH_06_2017_dlp

8 Food Sources Facility name: List all food and beverage suppliers you use. Please check the boxes of the common suppliers you use and add the name and phone number of any of your suppliers that are not already listed. This list is provided for informational purposes only and for the convenience of the user. This should not be taken as an endorsement by the Snohomish Health District. This is not a complete list of available suppliers. Look in the Yellow Pages or similar references for additional suppliers. Name of supplier Phone number Boyd s Coffee Cash N Carry (Everett) Charlie s Produce Coke Costco (Everett) Costco Business Center (Lynnwood) Food Services of America Franz Bakery Pepsi Restaurant Depot (Woodinville) Sam s Club Sunfood Trading Sysco FoodEstablishmentPlanReviewFoodSources_EH_05_2017_pac

9 Commissary Agreement I own both the business requiring and the business providing commissary services and as such no commissary agreement is necessary. This agreement between the commissary owner and the vendor signifies that both parties agree to the vendor s access to and use of the services identified below. Snohomish Health District (SHD) will not recognize any transfer of this agreement to food service facilities or persons not specifically identified in this agreement Food Service Establishment (FSE) requiring commissary support to qualify for a Permit to Operate Name of FSE: Vendor (FSE owner): Mailing address: Phone number(s): Business days & hours: The following services will be provided by the commissary: Approved water supply Yes No Handwashing sink Yes No Approved waste water disposal Yes No Food preparation sink for vegetables Yes No Garbage disposal Yes No Food preparation sink for raw meats Yes No Dry storage for food and single service Yes No Approved 3-compartment sink Yes No Refrigeration space cubic feet Yes No Approved restroom Yes No Freezer space cubic feet Yes No Entrance key for after-hours access Yes No Ice in pounds per day lbs. Yes No I verify the information provided in this agreement is accurate and we are responsible to comply with the Washington State Food Code (WAC ) and will allow access for inspection during business hours for either business. Commissary name: Commissary address: Business hours: Commissary owner s name: Commissary phone: Printed name of Commissary Owner Signature of Commissary Owner Date Printed name of Food Service Establishment Owner Signature of Food Service Establishment Owner Date CommissaryAgreement_EH_05_2017_pac 3020 Rucker Avenue, Suite 104 Everett, WA fax: tel:

10 Restroom Agreement Letter Date: Food Safety Program Snohomish Health District 3020 Rucker Ave., Suite 104 Everett, WA Restroom letter for: Name of Food Stand Concession or Mobile Food Vehicle I, have an agreement with Owner name of restroom facility Owner name of Food Stand/Mobile giving and his/her employees the right to use the restrooms Name of Food Stand/Mobile at Name and address of restroom facility The hours that I allow the restroom to be used are: These hours are during my normal operating hours. These hours are outside my normal operating hours. I have provided afterhours access. This agreement begins I am not responsible for any actions of Date Name of Food Stand/Mobile outside of my establishment and may terminate my agreement with Name of Food Stand/Mobile for Reason for termination of restroom agreement I understand that Snohomish Health District has the right to inspect the restroom while the restroom is in operation. I will notify Snohomish Health District at such time as the agreement is terminated. Signed: Restroom Owner Date: (Consult your attorney before signing any legal document) FoodEstablishmentPlanReviewRestroomAgreement_EH_05_2017_pac 3020 Rucker Avenue, Suite 104 Everett, WA fax: tel: