Food Establishments Application

Transcription

1 Fd Establishments Applicatin Carsn City The infrmatin in this package is t guide the wner r builder thrugh the submittal and apprval prcedures when btaining a permit t perate a Fd Establishment in Carsn City. A fd establishment means any place, structure, premises, vehicle r vessel, r any part theref, in which any fd intended fr ultimate human cnsumptin is manufactured r prepared by any manner r means whatever, r in which any fd is sld, ffered r displayed fr sale r served per NRS The design f all fd establishments must be designed with all applicable cdes, including but nt limited t the: Nevada Administrative Cde 446 and the Unifrm Plumbing Cde. Dcumentatin that must be submitted fr review: Applicatin fr a Fd Establishment Wrksheet fllwing this page and a prpsed menu. The fllwing may be requested at the time f review: Manufacturer specificatin sheets fr each piece f equipment shwn n the plan. Site plan shwing the lcatin f the building, lcatin f building n site, including alleys, streets and lcatin f any utside facilities (ex: dumpsters, patis, walkways). Plan drawn t scale f facility shwing lcatin f equipment, plumbing, electrical services and mechanical ventilatin. Regulatins fr fd establishments: Nevada Revised Statutes & Nevada Administrative Cde (NAC) 446, which can be fund n the web at Carsn City Municipal Cde, Chapter 9, which can be fund the web at Required Inspectins: The Public Health Reginal Partnership (PHRP) will perfrm inspectins f all new, remdeled and cnverted facilities. Please call PHRP t schedule appintment fr inspectin. Inspectins must be scheduled at least twenty-fur (24) hurs in advance. Required Licenses: In Carsn City, new businesses and expansins t existing businesses will require that all applicable fees assciated with the nature f the establishment be paid befre a permit is issued. Please cntact Carsn City Business License at 108 Prctr Street, Carsn City, NV. Phne: (775) The permit is issued upn a passing final inspectin and the annual fee is billed. Nte: Fr questins regarding Grease Interceptrs in Carsn City, please call Carsn City Envirnmental Cntrl at (775)

2 Fd Establishment Wrksheet TYPE OF ESTABLISHMENT: (Check as many as apply) Bar Bttled Water Plant Catering Child Care Center Church Fast Fd Restaurant Htel/Casin Multiple Fd Facility Restaurant Restaurant & Bar Retail Grcery Schl Whlesale Distributr Catering Truck Cnvenience Stre Fd Facility Resrt Cmplex Retail Fd Prducer Schl Cafeteria TYPE OF ESTABLISHMENT New Establishment Existing Establishment (Change) ESTABLISHMENT INFORMATION OLD NAME (fr existing/changes) NEW NAME: NAME OF OWNER MAILING ADDRESS BUSINESS ADDRESS PRIMARY PHONE # SECONDARY PHONE # If applicable please list NAME OF CONTRACTOR MAILING ADDRESS PRIMARY PHONE # SECONDARY PHONE # APPLICABLE LICENSE # NAME OF ARCHITECT/ENGINEER FIRM NAME OF PRIMARY CONTACT MAILING ADDRESS PRIMARY PHONE # SECONDARY PHONE #

3 PROJECTED DATE FOR START OF CONSTRUCTION: PROJECTED DATE FOR COMPLETION OF PROJECT: TYPE OF SERVICE: (check as many as apply) Sit-dwn meals Take Out Caterer Delivery Mbile HOURS OF OPERATION: SUNDAY MONDAY TUESDAY WEDNESDAY NUMBER OF SEATS THURSDAY FRIDAY SATURDAY TOTAL SQ FT OF FACILITY APPROXIMATE MAXIMUM NUMBER OF MEALS TO BE SERVED: BREAKFAST LUNCH DINNER FOOD PREPARATION REVIEW FOOD SUPPLIES: THE PROJECTED FREQUENCIES OF DELIVERIES FOR (days between deliveries) Frzen fds Refrigerated fds Dry gds SPACE ALLOCATED FOR STORAGE (in cubic feet) Frzen fds Refrigerated fds Dry gds CHECK THE CATEGORIES OF FOODS TO BE HANDLED, PREPARED AND SERVED CATEGORY YES NO Meats, pultry, fish, eggs Cld prcessed fds: salads, sandwiches, vegetables Ht prcessed fds: sups, stews, rice, ndles, gravy, chwder Bakery gds: pies, custards, cream fillings & tppings Prepackaged, nn-ptentially hazardus items : THAWING OF POTENTIALLY HAZARDOUS FOODS THAWING METHOD YES NO Refrigeratin Under running 70 degrees F Micrwave (as part f cking prcess) Cked frm frzen

4 HOT AND COLD HOLDING: 1. Hw will ht ptentially hazardus fds (PHFs) be maintained at F r abve during hlding fr service? Indicate type and number f ht hlding units. 2. Hw will cld ptentially hazardus fds (PHFs) be maintained at 41 0 F r belw during hlding fr service? Indicate type and number f cld hlding units. COOLING: Please indicate by checking the apprpriate bxes hw PHFs will be cled t 41 0 F within 4 hurs. COOLING METHOD Shallw Pans Ice Baths Reduce vlume/size Rapid Chill THICK MEATS THIN MEATS THIN SOUPS/GRAVY THICK SOUP/GRAVY RICE/NOODLES FINISH SCHEDULE: Applicant must indicate which material (ex: quarry tile, stainless steel, fiberglass reinfrced plastic (FRP), etc, will be used in the fllwing areas.) (as per NAC : surfaces must be light-clred, smth, nn- absrbent, durable, and easy t clean ). Nte: If clearly stated n prfessinally prepared plans submitted with this applicatin, yu need nt repeat it here. AREA FLOOR COVING WALL CEILING Kitchen Bar Fd Strage Strage Tilet Rms Dressing Rms Garbage/Refuse Mp Sink Dishwashing Walk-in Refrigeratrs/Freezers * Please nte clr fr each item listed.

5 PLUMBING CONNECTIONS: Indicate which type f cnnectins these items have t the sewer: air gap, air break r internal trap. Nte: If clearly stated n prfessinally prepared plans submitted with this applicatin, yu need nt repeat it here. AREA TYPE OF CONNECTIONS Mp Sink Hand wash Sink 3-Cmpartment Sink 2-Cmpartment Sink 1-Cmpartment Sink (ex: Fd Preparatin Sink r Dump Sink) Dishwasher Refrigeratin Cndensatin/Drain Lines Ice Machines Ice Strage Bin Steam Tables Dipper Wells Beverage Dispenser

6 DISHWASHING FACILITES (check as many as apply): 3-Cmpartment Sink with integrated drain bards Dishwasher High Temperature Bster Heater Chemical Sdium Hypchlrite (Chlrine bleach) Quaternary Ammnium Idine HAND WASHING, TOILET FACILITIES Is there a hand washing sink in each fd preparatin and dishwashing area? D all hand washing sinks, including thse in restrms have a mixing valve r cmbinatin faucet? Is ht and cld running water under pressure available at each hand sink? D self-dsing metering faucets prvide a flw f water fr at least twenty (20) secnds withut the need t reactivate the faucet? Is sap dispenser available at all hand washing sinks? Are fingernail scrub brushes available at all hand washing sinks? Are hand-drying facilities available at all hand washing sinks (ex: paper twels, air blwer, etc.)? Are all tilet rm drs self-clsing? Are all tilet rms equipped with adequate ventilatin? YES NO N/A STATEMENT I hereby certify that the abve infrmatin is crrect, and I fully understand that any deviatin frm the abve apprval withut prir permissin frm this Health Regulatry Office may nullify this apprval. Apprval f these plans and specificatins by this Health Regulatry Authrity DOES NOT indicate cmpliance with any ther cde, law r regulatin that may be required by federal, state r lcal agency. It further DOES NOT cnstitute endrsement r acceptance f the cmpleted establishment, including but nt limited t the structure r equipment. A pre-pening inspectin f the establishment with the equipment will be necessary t determine if it cmplies with the State f Nevada and/r Carsn City Municipal Cdes as applicable gverning fd service establishments. Signature(s): Date: