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HomeMy WebLinkAboutFLI-08-2016-075764.TIF cArrAwB • Application for Temporary Food Establishment Permit (To be completed for each booth) COUNTY $75.00 Fee Applies Please make check payable to Catawba County Environmental Health North Carolina Mail to Catawba County Environmental Health,PO Box 389,Newton,NC 28658 **All parts of this application must be filled out before turning in** 7 j� Establishment Name 6M Fv L�o �0D c7 F//K'E p T i zz4 FLI-Lf ,)bI -®')5//t'q- Operator/Owner Name j-0,4 A/ 0,e 141-77(16/4- (1 E S 1 V 91 I`6')30 3"iti Mailing Address / 33 CL/gs L Lii/ W /)1O Dews/ 4 L1 A/C ,8117 Telephone (day#) 7/ '1 — 963 - (after hours) 7/ 9(0 3 -/ L 33 Location of Event CLA-,46 OA/r 11/C Name of Event/Festival/Carnival; etc. CL iEni c A 7 DA 2 l= ,2©/4 Dates & Times of Operation FR / S 47 SEAT 3 a " OC7 / 5-re o Pin — //mem Please Indicate Setup Completion Time Fo/DA-y 95"P:T- 3 �y f oo P/11 Signature of applicant: Menu: tach enu or list 1 food items e prepared or served. All foods sold at this Temporary Food Establishment must be prepared and cooked at the permitted site except foods prepared in another establishment permitted under 15A NCAC 1.8A .2659. Food Prepared and Cooked On-Site In the table below, check the procedures for each food which will performed on site in the Temporary Food Establishment. Foods E o o l „, .2 ,= . 0 O oo a� 00 0 "6 E-+ u < U U � � aw f 22-A- /A/6m P4E AE FA ,D,b,„ u9/7r 8,AS RECEIVED AUG 15 2016 C`ATAWW�F3ra COUNTY ENVIRONMENTAL HEALTH Booth sketch: Draw the food booth, identifying and describing all equipment, including handwash facilities, equipment washing facilities, cooking equipment, refrigeration, worktables, storage, hot and cold holding units, water source and storage. Describe the floor, wall and ceiling surfaces of the booth. I I I I I a A.,,, I^ ; 1 , 6 ET-dio --, I 1 I � ! 1 I 1 I t I I I 1 1 I + 1 1 Foods Prepared and Cooked Offsite: , J N 4 ame of Permitted Establishment: NC DENR Establishment ID# Establishment Owner/Manager Establishment Address Establishment telephone# In the table below list all foods prepared in the permitted establishment and check all procedures performed there. Foods `� E x *-8 8 •6 o U U V ° a List sources of all meat, poultry, seafood and shellfish: ,Dtfri4.5 ei.a6 State method of storing and disposing of wastewater: _ WILL /OL 0/A-t2 T,4n/K //4 /eCr'tIL�R '* G�/GL a��� //Yro 4 v -Cr v/S/°aSA� o../ ;5/767. -1 DR riff z, 9,— C,t Vendor Guidelines • Vendor applications are due to the Claremont City Hall on or before September 29th, 2016. • The application & booth fee is $25 made payable to the City of Claremont. This fee is nonrefundable— no exceptions. • Booth spaces are 10ft. x 10ft. If you need more space, you will need to pay an additional $25 for another booth space. • Vendors are responsible for furnishing their own tents, tables, chairs, etc. • Tents must be tethered or weighted down to prevent being blown over by wind. • In the event of inclement weather, no refunds will be issued. • Areas are available for set up on Friday, September 30th at 3:00pm for City Hall parking lot spaces and 5:00pm for Main Street spaces. All areas are available for set up at 7:00am on Saturday, October 1st but must be completely set up by 9:00am. • No vehicles will be allowed in the festival area. Once you unload, your vehicle must be moved to a parking area. Vehicles may re-enter the festival area once the stage show has ended and walking traffic has cleared (11:00pm both nights). • PROHIBITED ITEMS for sell or usage: fireworks (poppers, snap-pops, smoke bombs, etc.), silly string, weapons (swords, knives, guns, etc.). Vendors with these items will be asked to leave the event. • Only food/drink vendors are allowed to sell or give away food and beverages. • Food/drink vendors must obtain a Temporary Food Establishment Permit from the Catawba County Public Health Department. You will need to call the Catawba County Public Health Department to find out necessary requirements (828-465-8270). • The sale of raffle tickets or other fundraising items is not allowed. • Business vendors (Mary Kay, Avon, Thirty-One, Scentsy, Tupperware, etc.) may only have 1 representative at the event. This is a first come, first served basis. (Businesses selling intimacy products are discouraged.) • The City of Claremont reserves the right to remove an item(s)for sell or display that is considered inappropriate. • The City of Claremont reserves the right to accept or refuse vendors. • Requests are not guaranteed, however, we will try our best to honor them. • ..• . . .-. .. .. .. . . .. . . . . . . . .. . .. .. .. 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' -liaiR4v/IfitFt irka:ZE 0,-;-.01,---1 ,-z , , 2i , j ifi I, Vendor Application Name: Joii i 6R /n--4/6/e4 JONES Organization:EiVIUCIo 6--hot) hED4 Address: /33 (C/_, �6= e,c-S/41 City: i910aa;C=Sf,L1_ State:iVC Zip Code: g// 7 Phone: 21 9 - 963 -/3-33 Vendor Description Please select which type of vending and write a brief description below. Craft: S. Food: /7/22/1-- , Art: Commercial: Education: Other: **Please fill out the back of this form if you have electrical needs. D Number of booths: x $25.00 = SO (cash or check only) I, JO. IJ -O/4 ( S have read and understand the Vendor Guidelines for Claremont Daze and agree to uphold them. I understand that if I (or anyone in the group I am representing fails to follow these guidelines, I will forfeit my booth space, application fee and admittance to future events. For office use only: Date received: By: Cash Amount: Check Amount/Number: • Electrical Needs • Number of plug-ins: i' • Need water: yes X no • Type of appliance(s): J5-- I C7�g r9 TO i • Number of amps per appliance: 1/a Extension Cord Information Extension Cords 1. Grounded tools require a three wire extension cord. 7. Make sure the extension cord is properly wired ? I Double Insulated tools can use either end in good electrical condition. Always replace a two or three wire extension cord. a damaged extension cord or have it repaired by a qualified electrician before using it, 2. As the distance from the supply outlet increases, > you must use a heavier gauge extension cord. 8. Protect the extension cords from sharp objects, (— Using extension cords with inadequately sized excessive heat,and damp or wet areas. u. wire causes a serious drop in voltage,resulting " ! in loss of power and possible tool damage. TABLE A: RECOMMENDED MINIMUM WIRE �Vdj • (See Table A.on page 7") GAUGE FOR EXTENSION CORDS 1201240 VOLT 3. The smaller the gauge number of the wire,the NAMEPLATE EXTENSION CORD greater the capacity of the cord. For example, AMPERES LENGTH . a 14 gauge cord can carry a higher current full load)t ) Z5' 50' 75' 1 148" 150'_ than a 16 gauge cord. (See Table A.) 0_2.0 18 18 18 18 16 4. When using more than one extension cord to make 2.1—3,4 18 18 18 16 14 • • up the total length,make sure each cord contains at 3.5--5.0 18 18 16 14 12 least the minimum wire size required. (See Table A") 5.1—7.0 18 16 14 12 12 5. If you are using one extension cord for more 7.1—12.0 18 14 12 10 - than one tool,add the nameplate amperes 12.1-16.0 14 12 10 - and use the sum to determine the required minimum cord size. (See Table A.) - 16.1—20.0 12 10 `Based on limiting the line voltage drop to five volts at • 6. If you are using an extension cord outdoors,make 160%of the rated amperes. sure it is marked with the suffix"W-A"("W1i'in Canada)to indicate it is acceptable for outdoor use. 4;;=T.§'• } EnFuego Wood Fired Pizza Serving pizzas hot out of the mobile wood fired oven. Each pizza takes approximately 90 seconds to cook in this wood fired oven. The area will be covered by a tent. The oven sits behind the tent, with the edge of the tent coming right up to the opening of oven. The ground will be covered by beautiful lush green grass(indoor/outdoor carpeting!) There is a sink built in to the trailer with a small electric heater for heating the water. This will be used for washing hands. The only utensil used will be a pizza cutter which will be cleaned with a health department approved sanitizer. The prep table (picture enclosed)is the top of the refrigeration unit. This unit is specifically made for the use of preparing foods with multiple toppings. Our fully cooked toppings are stored in the bins on top of the unit for ease of preparation. Food will be kept cold by the refrigeration unit and be served straight out of the oven sizzling HOT. Our pizzas will be handed directly to the person who ordered it. There is a photo of the pizza being prepared, one of the pizza coming out of the oven,and one of the pizza being sliced, and one of the owner/operator. If you need additional information, please do not hesitate to give us a call. John and Patty Jones En Fuego Wood Fired Pizza 112 Cypress Bay Washington, NC 27889 720-339-0000 719-963-1233 En Fuego Wood Fired Pizza Pizzas Pepperoni Pizza $8 Pepperoni and cheese Sausage Pizza $8 Sausage and cheese Kids Just Cheese $5 Cheese and sauce Breakfast Pizza $8 Sausage, egg, cheddar cheese with a white sauce Buffalo Chicken $8 Chicken, red onions, cheddar cheese with hot sauce Sodas and water $1 All ingredients sourced from Sams Club. All precooked. Transported in coolers with ice,then stored in refrigerated pizza prep table on site. (-1413A- Cp CATAWBA COUNTY 100A SOUTHWEST BLVD ryt NEWTON,NORTH CAROLINA 28658 RECEIPT yi PHON E: 828.465.8399 U . �� Tuesday,August 16, 2016 /842 SM nc. y g www.catawbacount ov 1 PAYOR: En Fuego Wood Fired Pizza, LLC En Fuego Wood Fired Pizza, LLC PAYMENTS TRANSACTION NUMBER: TRC-784616-16-08-2016 PAYMENT DATE : 08/16/2016 PAYMENT TYPE: Check 12086 received by mail INVOICE NUMBER FEE NAME FEE AMOUNT 08-16-331645 Temporary Food Establishment $75.00 Fee TOTAL PAYMENTS : $75.00 FLI-08-2016-075764 CASE TYPE: Food& Lodging Institutions WORK CLASS: 73 -Temporary Food Establish] SITE ADDRESS: 3288 E MAIN ST, CLAREMONT NC 28610 Applicant EN FUEGO WOOD FIRED PIZZA, LLC, 112 CYPRESS BAY, WASHINGTON NC 27889 B:7199631233 **NO PEOPLESOFTACCOUNTASSIGNED ** receipt 08/16/2016 10:31 Page 1 of I