CITY OF PARK RIDGE 505 BUTLER PLACE PARK RIDGE, IL 60068 TEL: 847/ 318-5291 FAX: 847/ 318-6411 TDD:847/ 318-5252 URL:http://www.parkridge.us Food Service Establishment Plan Review Form THE FOLLOWING INFORMATION MUST BE INCLUDED FOR PLAN REVIEW TO BEGIN: Complete set of food service plans; including the equipment lay-out, equipment list, plumbing plan and finish schedule Plan review application form Menu, or list of menu items Establishment Name Address Owner (Corporate Headquarters) Phone( ) - Address City/State Zip Project Contact Address Phone( ) - City State Zip Fax( ) - Architect Address Phone( ) - City State Zip Fax( ) - Contractor Address Phone( ) - City State Zip Fax( ) - Signature of Owner or Authorized Agent Signature: Date / / Print Signature: Date / / OUR MISSION: THE CITY OF PARK RIDGE IS COMMITTED TO PROVIDING EXCELLENCE IN CITY SERVICES IN ORDER TO UPHOLD A HIGH QUALITY OF LIFE, SO OUR COMMUNITY REMAINS A WONDERFUL PLACE TO LIVE AND WORK.
II. Refrigeration Have you made provisions for refrigeration and freezer storage Yes No Are you installing a buffet or salad bar Yes No Have you designed the type of refrigeration needed for: Cooling large quantities of food (Blast Chiller) Yes No Marinating food products (Walk-in Cooler) Yes No Cooling of hot foods (Walk-in Cooler) Yes No Refrigerating large quantities of food (Walk-in Cooler) Yes No Working supplies of food at various stations (Reach-in Cooler) Yes No Display of food products (Display Case) Yes No Customer Self Service (Display Case, Pop Coolers) Yes No III. Storage Facility Specify the type of shelving units that will be provided in the following areas: Dry Areas Manufacturer Finish Refrigerated Areas Manufacture Finish Food Service Dry Storage Requirements [25% of the total foodservice area] *Wall shelves, under shelves, cabinet shelves or tiers not to be included in final calculations Calculate: Total food service area= sq. ft. (wall-wall) Determine total dry storage required: Food Service Area x.25= sq. ft. (wall-wall) Enter the amount of proposed dry storage area: sq. ft. (wall-wall) Additional dry storage area needed to comply sq. ft. (wall-wall) Have you indicated the storage location for dry storage? Yes No Have you indicated a storage area for your cleaning supplies that is separate from food storage areas and food service operations? Yes No Have you specified a heavy-duty-mop-rack capable of holding wet mops? above the mop basin Yes No Are you using firewood as a fuel source for cooking equipment? Yes No If yes, specify the location of firewood storage
IV. Employee Areas, Restrooms, & Hand Washing Sinks Employee Area Have you shown the location for personal belongings storage on plans? Yes No Indicate type of storage: Coat hooks Coat rack Lockers Other Restrooms Have you provided the number of toilets/facilities as required by the Illinois? State Plumbing code and verified with the local Sanitary District or Building Department? Yes No Is a mechanical exhaust fan provided in each restroom? Yes No Have you specified garbage containers with lids, sanitary containers? Yes No Hand Washing Sinks How many hand washing sinks are you providing? Are the locations of these hand sinks visible and accessible? Yes No Do your plans indicated that all hand washing sinks will be supplied with dispensed soap and paper towels? Yes No V. Plumbing Either the Building Department or the local Sanitary District requires a grease interceptor. Indicate unit(s) specifications: Manufacturer: Model #: Capacity: gallons Size of Inlet/Outlet: inches How will it be installed? Outdoors Indoors-Recessed Is the location of this unit on the plans? Yes No Are all pre-fabricated floor basin janitorial sinks indicated on the plans? Yes No
Potable Water Backflow Protection is required on the following pieces of equipment. Check those that apply Chemical mixing system(s) Pre-rinse sprayer(s) Dishwashing machine(s) Carbonator(s) Water faucets with hose bib attachments Hose reel unit(s) Other Indirect Open site Waste Connections are required on the following pieces of equipment. Check those that apply Refrigerator/freezer condensation line(s) Steam table(s) Ice maker/ice bin(s) Three-compartment sink-food Food preparation sink(s) Three-compartment sink-bar Dipper well(s) Dishwashing machine(s)* Salad bar(s) Soda dispenser(s) Steam kettle Buffet condensate Walk-in refrigerator drain(s) Espresso/Cappuccino *Dishwashing machines must by-pass the grease trap Other VI. Sanitizing Equipment and Facilities Hot Water System Specify the water heater storage capacity in gallons Specify the water heater recover rate GPH F, if mechanical (Chemical or hot water) sanitizing is being proposed Manual Utensil Washing Have you specified a standard food service three-compartment sink? With two integral drain boards? Yes No Is your largest item able to be submerged into the three-compartment sink? Yes No Do you have a clean-in-place procedure for stationary equipment? (If yes, attach proposal) Have you provided additional space for storage of clean utensils? If yes, where? Yes No Yes No
Mechanical Utensil Washing If not applicable proceed to next section Are you installing a dishwashing machine? Yes No If yes, Manufacturer Model# Dishwashing machine demand of rinse water GPH @ 20 PSI flow pressure Have you included a soiled-dish table? Yes No Have you included a pre-rinse sink? Yes No Have you included a clean-dish table? Yes No Did you provide mechanical ventilation at dishwashing machine? Yes No Provide and indicate the location for your clean utensil and dish storage? Chemical Sanitizing Machine If not applicable, proceed to next section Are you providing a sanitizing machine? Yes No Have you provided an audible and visual alarm warning for sanitizer? Yes No Have you provided a location for air drying utensils after being washed? Yes No If yes, where Hot Water Sanitizing Machine If not applicable, proceed to next section Are you installing a hot water sanitizing machine? Yes No If yes, Manufacturer (Booster Heater) Model# Booster Heater recovery rate: GPH @ F Have you provided for a temperature gauge before booster heater? Yes No VII. Lighting Are your food preparation and utensil-washing areas lighted according To specifications? Yes No Are your food rooms lighted according to specifications? Yes No Have you provided dimmer switches or on/off switches in bar areas? Yes No Have you supplied fluorescent lights with vapor-proof fixtures or additional Incandescent light kits for your walk-in refrigerator and freezer? Yes No Are all of your light fixtures shielded with protective tubes and end caps? Yes No
VIII. Laundry Facility If not applicable to proceed to the next section Do you have a washer? If yes, a dryer is also required. Yes No Is a door provided to separate the laundry area from the food service area? Yes No Is shelving provided to keep clean linens stored separately from soiled linens? Yes No IX. Insect & Rodent Control Are all the vents covered with screening? Yes No All the voids and gaps around utility lines, pipes etc. sealed? Yes No Are openable windows properly screened? Yes No Do you have a: Drive thru window Carry out window Walk-up window The type(s) of protection provided for those windows: Semi-automatic bump pad Electronic opener Air curtain w/micro switch Spring-loaded screen The type(s) of protection for your delivery and entrance doors: Self-closing device Threshold Threshold sweep Weather stripping If you have a garage-style delivery door, have you provided an air curtain? Yes No If yes, Manufacturer Model # X. Garbage and Refuse Disposal The type of disposal provided: Dumpster Compactor Recycling Container Exterior grease container Interior grease container Type of surface provided for storage of disposal containers: Concrete pad Machine-laid asphalt See Zoning Ordinance for all requirements of refuse enclosures.
XI. Room Finish Schedule Specific brand names and colors for materials should be specified whenever possible to ensure acceptability Dark shades such as black will not be permitted Room Or Area Floor Floor Base Or Cove Walls Ceiling Food Preparation Cook Lines Utensil Washing Food Storage Liquor Storage Walk-In Refrigerator/Freezer Janitorial Station Waitress Areas Bar Restrooms Buffet and Salad Bars
XII. Exhaust Hood Ventilation For Cook line Establishment Name City Mechanical Engineer Phone Fax Determine Exhaust Hood Type (Refer to Section C): Check types that apply: Factory Engineered System: Custom Built* Wall Canopy Island Canopy Review the Construction Needs and Criteria Check List (Refer to Section I) The following are required-check to verify: Type I Hood Type II Hood List all equipment to be installed under the hood on the next page, one form per hood. Exhaust hood design and installation meets or exceeds the specifications that are required. Hood and components are NSF approved or fabricated in compliance with NSF Basic Criteria C-2. Exhaust system will have a minimum of 50 FPM capture velocity at cooking surface. No exposed horizontal piping on any portion of the hood in front of the filter bank. Point where the air is exhausted shall not be within ten feet of any air intake into the building. No insulation installed in the interior of the ductwork. * If custom built system please complete the section below. Otherwise skip to the next page. Determine Exhaust Hood Size and Performance (Refer to Section D): Formula: Total Length and Depth of Equipment inches x inches Total Length & Depth of Wall/Canopy Hood (including 12 front & side overhangs) W ft. x L ft.= ft 2 x 100 CFM/ ft 2 = CFM Total Length & Depth of Island/Canopy Hood (including 12 front & side overhangs) W ft. x L ft.= ft 2 x 150 CFM/ ft 2 = CFM Total Length of Non-Canopy Hood Determining Exhaust Duct(s) Needs (Refer to section E): Number: Formula (Using Square or Rectangular Duct Work): L x W = inches 2 144= ft. 2 = ft. 2 CFM ft. 2 = (1500-2200 FPM Range) Determining Exhaust Filter Needs (Refer to Section F) Number: Total Length of Filter Bank inches Determining Make-Up Air Needs (Refer to Section H) L ft. x 300 CFM/ft.= CFM Size: Type: Total CFM of make-up air to be supplied Described method of introducing make-up air into area
LIST ALL EQUIPMENT WHICH WILL BE LOCATED UNDER THE HOOD Exhaust Hood: (one form per hood) Equipment # Equipment Description Length Depth TOTALS The following support information should accompany this form: Performance specifications for the exhaust fan(s) and the filters, shop drawings of the exhaust hood & ductwork cleaning schedule. This approval in no way constitutes or implies a guarantee to the proper functioning of any oral components and/or design factors of this system. All systems are subject to a smoke test.
XIII. EQUIPMENT LIST All food Service Equipment must be commercial/nsf or meet recognized equivalent Model # s are required if a statement is not noted on the plans referencing compliance with the National Sanitation Foundation (NSF) or recognized equivalent standards. All equipment including small wares will be considered new unless specified as used (U) Existing (E) equipment must meet the same standards and specifications as required of new equipment Method of Equipment Installation Information provided here must be identical to the information found on the blueprints ITEM # EQUIPMENT LIST NEW EXISTING USED MANUFACTURER MODEL NUMBER NSF APPROVED MOVABLE ON CASTERS SPACED ON LEGS CP&D Health 12/07 OUR MISSION: THE CITY OF PARK RIDGE IS COMMITTED TO PROVIDING EXCELLENCE IN CITY SERVICES IN ORDER TO UPHOLD A HIGH QUALITY OF LIFE, SO OUR COMMUNITY REMAINS A WONDERFUL PLACE TO LIVE AND WORK.