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HomeMy WebLinkAboutEHPR-9-10-7241.TIF 72#1 v)A . Catawba County Environmental Health it U- t 1. Contact Information for Plan Review ' 100A Southwest Boulevard, Newton, NC 28658 �8 (828) 465 -8270 phone (828) 465 -8276 fax FLI Case # PLN Case# Property Location Property ID# * 37 /6 - cf x,/ Street Address * d5a0 14kc h y 70 Ni c �c� r , D vaca City * R∎c,IcsNr Zip * a•Klno Business Name: * Rye Gu � S 13u -e r S 1,A, Mailing Address * 15Do �, h 7O Address 2 City * HI Ow/ Zip * a -(ko,D Phone Owner Name C h r, 5 k- - e_ r C Owner Mailing Address Roc) ►Pc I p i S Pc Crnt Physical Mailing Address City 1'1'voureSv,112 , nL Zip Phone Isr,) c l - -)( e3a- Architect 50.kr-a, ' I`v (Straw n xr ca� Contact Address 15 florl ' r 'Park a Address 2 �a ,1c1� � Sy i 1e DOC) City Zip Phone "77o G [ 1 — 5 q I (o Contractor Contact Address Address 2 City Zip Phone Contact Information Sheet and a fee required to begin plan review process. See fee schedule Complete and return Food Esta)ish- ent Appli . o` * Required field Applicant Signature 1 _ Date Vieo v) 5)--i" - 2 • , Catawba County Public Health Department Division of Environmental Health <7 FOOD ESTABLISHMENT PLAN REVIEW APPLICATION For submission with full set of signed and sealed plans produced by an architect or engineer. Type of Construction: NEW 1C REMODEL CONVERSION County in which Located: CCA CAW a Name of Establishment: U Q G e \ 13(1 r9- n, rC\ S Establishment's Address: ►' k10k■a,.`1 70 City: F{YCtorl y'1( Zip Code: a861 Owner's Current Physical - 1(7 - 1 - C C hY\ c,E , ,LQ 51 Mailing Address: City: I (0 0 � f vl-p `sic` Thoc teSu Ikzip Code: . Phone if available: (FS1v ) — ( 54:1 - n934 Fax: ( ) — ( - ) *********************.***** r.*********************** r.*****,. .* ******** *is* * *? :***r.***** * x: **r. I have submitted plans /application to the following: (Please note date, phone number and contact person on application line) Plumbing Contact Person S have o a r r \` k>) Pfa- 0 Phone Number ( 770) — ((o I °( - 5c) I (.P ) Electrical Contact Person c . , „ 1 _ 5(, 329 - 557 Phone Number (770) - Sc11(1 Building Contact Person S k0 , -w 1 l - e (o c Phone Number ( — ((D19 - 5 %(/) Hours of Operation Sun tIa- ;OF Mon 11 fU� Tue l( /Op Wed t( -(Up Thu 11w lOh Fri ila Sat 1k-10r Number of Seats Number of Staff 7 - 5 rsii;t vlaximum per shift) Facility Total Sq. Ft. a(DOG Projected Number of Meals to be Served: (Approximate number) Breakfast Lunch lScD Dinner 130 Projected Start Date of Construction /a 5 / /C) Projected Completion Date of Project 11 /1c/0 1 Type of Service (Check all that apply) Sit Down Meals (/ Take Out Caterer Mobile Food Unit Push Cart Limited Food Service Temporary Food Stand Single Service Utensil Only Multi -Use Utensil Service Only Both Multi -Use and Single Service Utensils Other Please Enclose the Following Documents • Proposed menu items (including seasonal variations in the menu). • Manufacturer specification sheets for each piece of equipment shown on plans. • Site plan showing location of business in building, location of building on site including alleys, streets and location of any outside facility (dumpster, walk -ins, etc.). • Plan of facility drawn to scale showing location of equipment, plumbing, electrical service and mechanical ventilation, including location of all electrical panels. 2 ITEMS TO BE ADDRESSED 1. Information plans should include; the proposed menu, seating capacity, projected daily meal volume for food service operation. 2. Adequate rapid cooling including ice baths and refrigeration, and hot - holding facilities for potentially hazardous food (PHF) should be clearly designated on the plan. 3. When menu dictates, separate food preparation sinks should be labeled and located to preclude contamination and cross - contamination of raw and ready to eat foods. 4. Auxiliary areas such as storage rooms, garbage rooms. toilets, basements and /or cellars used for storage or food preparation should be represented on the plan. 5. Insure that all food service /kitchen equipment is National Sanitation Foundation International (NSF) listed, Underwriters Laboratories Inc., Classified for Sanitation or if not NSF or UL listed /classified, be constructed to meet NSF standards as specified according to 15A NCAC 18A .2600, Rule .2617 paragraph (d). 6. As specified according to 15A NCAC 18A .2600, Rule .2632 "Storage Spaces ". All items stored in rooms where food or single- service items are stored shall be at least 12 in. (30.48 cm.) above the floor when placed on stationary storage units or 6 in. (15.24 cm.) above the floor when placed on portable storage units or otherwise arranged so as to permit thorough cleaning. 7. Acceptable materials for walls, ceilings and coved juncture bases in food preparation, handling and storage areas include quarry tile, ceramic tile, sealed concrete, commercial linoleum, fiberglass reinforced panels, stainless steel, wall board painted with washable, nonabsorbent paint, vinyl coated ceiling tiles: brick, cinder blocks, slag blocks, or concrete blocks, if used, must be glazed, tiled, plastered or filled so as to provide a smooth surface. If plans specify the use of a material not on this list, include a sample of the material for evaluation. 3 . ® BURGERS and FRIES Mooresville, NC 654 River Hwy Mooresville, NC 28117 Tel: 704 - 799.7500 OPEN 7 DAYS A WEEK! 11AM - 10PM -- ORDER ONLINE @ FIVEGUYS.COM BURGERS 100% FRESH BEEF -- NO FILLERS OR PRESERVATIVES HAMBURGER $4.49 LITTLE HAMBURGER $3.39 CHEESEBURGER $5.19 LITTLE CHEESEBURGER $3.79 BACON BURGER $ 5.29 LITTLE BACON BURGER $ 3.99 BACON CHEESEBURGER $ 5.89 LITTLE BACON CHEESEBURGER $4.39 DOGS SANDWICHES KOSHER STYLE HOT DOG $3.19 VEGGIE SANDWICH $2.89 CHEESE DOG $ 3.79 CHEESE VEGGIE SANDWICH $3.09 BACON DOG $3.79 GRILLED CHEESE $2.89 BACON CHEESE DOG $ 3.99 FRIES DRINKS FIVE GUYS STYLE or CAJUN STYLE REGULAR $ 1.79 REGULAR $2.59 LARGE $1.99 LARGE $4.39 BOTTLED WATER $1.79 Cooked in pure, no cholesterol, (� �^ /,u,�eZ tasty peanut oil ! ALL TOPPINGS FREE MAYO LETTUCE PICKLES TOMATOES GRILLED ONIONS GRILLED MUSHROOMS KETCHUP MUSTARD RELISH ON O`.) JAL AFENO FE r'F K CGRE EN FE Fr'E L A SAUCE EAK -E Q SAUCE HO r SAUCE (EVERYTHING or ALL THE WAY receives only toppings In black) • ZAGAT Survey rated - `01 thru `10 Rated #1 Burger for Lunch In NYC Time Out New York '08 Voted Best Bargain (Cheap Eats) `00 thru `07 "Fine dining of hamburgers" Washington Magazine The State (Columbia, SC) '05 "Reader's Choice" #1 Hamburger `99 thru `08 Voted Best French Fries - `09 Washingtonian Magazine Colorado Springs Gazette "The Best $5 Burger a Man Can Eat" Voted Best Burger GQ Magazine '09 Gulfshore Life (FL) '09 Voted Favorite Place to Buy a Burger Winner Best of the New Lancaster Newspapers (PA) '09 The Boston Globe Magazine '09 Best Burger "appealing made -to -order burgers" University Daily Kansan '08 Star - Telegram.com (TX) D8 Reminder. Consuming raw or undercooked poultry, meat, eggs, shellfish or seafood may increase your risk of foodborne illness. For more area locations go to www.fiveguys.com © 2010 Five Guys Enterprises, LLC FOOD PREPARATION REVIEW Check categories of Potentially Hazardous Food (PHF) to be handled prepared and served. CATEGORY Yes No Thin meats, poultry, fish, eggs (hamburgers, chicken breast, fish filet, etc.) Thick meats, whole poultry (whole roasts, pork, chicken, meat loaf, etc.) Hot processed foods (soups, stews, chowders, casseroles) Bakery goods (pies, custards, creams) �( Other: — re► -�Gh F cs) PLEASE CHECK Box FOR THE FOLLOWING QUESTIONS FOOD SUPPLIES 1. Are all food supplies from inspected and approved sources? Yes No COLD STORAGE 2. Are adequate and approved freezer and refrigeration available to store frozen foods at 0 F and below, and refrigerated foods at 45 F (7 C) and below? Yes ,`( No Provide the method used to calculate cold storage requirements: 'k 6,1c P 6vt,„rJr_ Provide total footage of space dedicated to walk -in cold storage 7'q `x i0/‘ 7` i' Provide total footage of space dedicated to reach -in cold storage 5? '' 3)'y 4," 4 - -1 - 3) n `Xi CI�a F be. y1 S a ( ad 3. Will raw meats, poultry and seafood be stored in the same refrigerators and - freeze with JJ �wf' cooked /ready -to -eat foods? Yes NI No If yes, how will cross - contamination be prevented? Rc nA -e w si 1\ be SltreCt on O S l te \2 ) r\ • , Pr at . UCH 4. Does each refrigerator /frerhave a thermometer? Yes \. No Number of refrigeration units:2 Number of freezer units: ,AWIN (i Please indicate by checking the appropriate box how PHF (potentially hazardous food) in each category will be thawed. More than one method may apply. Thawing Process Thick Meats Thin Meats Fish Seafood Poultry Products Baked Goods Refrigeration Running Water less than 70 (21 Cooked Frozen (indicate wt. lbs.) Microwave Other (describe): l // 4 COOKING PROCESS Item #1 - Will food product thermometers (0 — 212 F) be used to measure final cooking /reheating temperatures of PHF (potentially hazardous food)? Yes No Minimum cooking time and temperature of product utilizing convection and conduction heating equipment: Product Time & Temperature Product Time & Temperature Beef roast 130 F (121 min) Comminuted meats 155 F (15 sec) Seafood 145 F (15 sec) Poultry 165 F (15 sec) Port 155 F (15 sec) Other PHF 145 F (15 sec) Eggs 145 F (15 sec) * reheating PHF 165 F (15 sec) Item #2 - Hot Holding How will hot PHF (potentially hazardous food) be maintained at 140 F (60 C) or above during holding for service? Indicate type and number of hot holding units. n? HO kdic1� un �S - 1. f�-y (�ll��.� S nb'7,r —1/0i L� k-eat- ICNAtVS L i» dayS{ J 1 peke tir ft grAtec\ rnvs) t oni 5 W, +h .e,-r - 1'L5 2,? 5 9" A�1,11 wy - Item #3 - Cold Holding How will cold PHF (potentially hazardous food) be maintained at 45 F (7 C) or above during holding for service? Indicate type and number of hot holding units. ` Clsef _\ r4seS h e `r tA) 5 ri \ O (' c t c\ htkckcci C r S' A Sl-Ci 1,1--■ ■S (0 kAck" -p1-c iAii., () I7 ( r /A"' 4 .) Item #4 - Cooling Please indicate by checking the appropriate box how PHF (potentially hazardous food) will be cooled to 45 F (7 C) within 6 hours (140 F to 70 F in 2 hours and 70 F to 45 F in 4 hours). Cooling Process Thick Meats Thin Meats Fish Seafood Poultry Products Baked Goods Shallow Pans Ice Baths Rapid Chill Other (describe): -? i , 'f geee. are_ t \ ec- �a re c u rn- * Wrn11' .l r, CocleK"-- P - -e Q. chew -c .y. .,- •a1�C�t ) - I r, t c e 1-h C nVrtica- h 91-- 11 5 FOOD PREPARATION 1. Please list cate:ories of food prepared more than 12 hours in advance of service. ••• - i re vr\ G w • - au r\ r - ' 11 . • a. e • . rcz,- pa`I41 C-s bar-.er. Ivyar CA c 1 v aAV a 2. Will disposable gloves and /or utensils and /or food grade paper be used to minimize handling of ready -to -eat foods? Yes )( No 3. Is there an established policy to exclude or restrict food workers who are sick or have infected cuts and lesions? Yes j( No Please describe procedure: 3 i cX_ r C -er5 tea nur r r ‘,-►v�. C 5 or\ !-.av, clS rnu he coL,ereck with (CJCrcc hC,r\d ('n \(l yoieS cnlcfrl. 1r , � e cct VOCUr4 S ca 1r Ike q 4riLel ._ , e - C e-e- IS r\C ■ - 'rj 4JC �k 4. How will cooking equipment, cutting boards, counter tops and other food contact surfaces which cannot be submerged in sinks or put through a dishwash r be cleaned and sanitized? Please describe procedure: 6 , 11 s l ��ec�r- d ( )5 ; y-, J1d (debt( t c r: 11 6 nosh � ✓ G►e (Aft,r.r�` cJJ■ 1 Srtr, , ►Zcf SuIt, rr■ C'hrAr py/C1 0c± L A l rv•..c 6 0,-( CAT- v I r 5. How will ingredients for cold ready -to -eat foods such as tuna, mayonnaise and eggs for salads and sandwiches be pre - chilled before mixed and /or assembled? /A 6 THE FOLLOWING 4 QUESTIONS DEAL WITH FOOD PREPARATION PROCEDURES FOR FACILITIES. Food preparation procedures are needed to obtain information on how the food is prepared and to help determine that adequate facilities are available. The food preparation procedures should include types of food prepared, time of day and equipment used for service in the facility. (Attached is Food Item Preparation Worksheet Supplement for additional food items prepared in the facility.) If your company has food preparation procedures already developed, these can be submitted as part of the plan review approval process. 1. Produce Preparation Procedures a. Will produce be washed or rinsed prior to use? Yes `4. No b. Is there an approved location used for washing or rinsing produce? Yes " No c. Will it be used for other operations? Yes No( Please indicate location of produce washing equipment and describe the procedures. Include time of day and frequency for washing or rinsing the roduce at this location: i roc\ t)(-<_ S cr,l Q ( i g y-\ C1 0k (7 ro U ff. si - T r - o tVCe (`7 f rej>CA r.c)r ) 5 t J 2 k G ek e i r ' r.r rl ckl5h (AI S1 \ti t4. Sf /t�L Please describe the produce preparation procedures and indicate location of equipment to support this operation. The preparation procedure should include dishes (proposed menu items) in which the produce will be used, and should include tirve of day and frequency of preparation for the produce at this location: l�aa�y r pros∎ C< 1 5 ,ic st & 4 51 /WA o&r \d4errcA Cov ere d lcAketi c Ca rjorel 5 r\ `l-1 y�G��C to rooter F ckre srr i 1 Yzt( r-e f •-, ye_ r r_Sl c-ers Cvf(e COY (A) c,- • 5 S c r . k z csa Q rivk W I k 1 11- Ncrz 1-41 t1 PS 2. Seafood Preparation Procedures a. Will seafood be washed or rinsed prior to use? Yes No b. Is there an approved location used for washing r °insin se od? Yes No c. Will it be used for other operations? Yes No Please indicate location of seafood washing equi men and describe the procedures. Include time of day and frequency for washing or rinsing the seafood at this location: 7 i Please describe the seafood preparation procedures and indicate location of equipment to support this operation. The preparation procedure should include dishes (proposed menu items) in which the seafood will be used, and should include time of day and frequency of preparation for the seafood at this location: 3. Poultry Preparation Procedures a. Will poultry be washed or rinsed prior to use? Yes No b. Is there an approved location used for shing r r' sing poultry? Yes No c. Will it be used for other operations? Yes No Please indicate location of poultry wash ng quip nd describe the procedures. Include time of day and frequency for washing or rinsing th sea ood at t is ocation: Please describe the poultry preparation procedures and indicate location of equipment to support this operation. The preparation procedure should include dishes (proposed menu items) in which the poultry will be used, and should include time of day and frequency of preparation for the poultry at this location: 4. Pork and /or Red Meat Preparation Procedures a. Will pork and red meats be washed or rinsed prior to use? Yes No X,____ b. Is there an approved location used for washing or rinsing pork and red meats? Yes No c. Will it be used for other operations? Yes No Please indicate location of seafood washing equipment and describe the procedures. Include time of day and frequency for washing or rinsing the seafood at this location: Please describe the pork and red meats preparation procedures and indicate location of equipment to support this operation. The preparation procedure should include dishes (proposed menu items) in which the pork and red meats will be used, and should include time of day and frequency of preparation for the pork and red meats at this location: ( 1 1, G w,XlV rr— �e^ 1 \ 1 e-, 00- - r ` C p pe ' c-� c„, \\../ 'i h ' � - �.L rr,ri rrl i r., t rr C v� I t A� ` be c... c IN C y S m r.s �t� � e {-� o� }l �a�e r d- �� C d vere� 16 1s t �.S 1 ''l W �� ' i n c o yl c r 5 t. 'f Q y r ,,d /"..f-e _ k..) c1-■i q c. N i 2 ( 8 DESIGN INFORMATION I. DRY GOODS STORAGE 1. Is appropriate dry good storage space provided for based upon menu, meals and frequency of deliveries? Yes y No Provide information on the frequency of deliveries and the expected gross volume that is to be delivered each time. I - Dr CfrAS Cu'r t C t�e rcct U v,-zi n n-LUv V■ nr cFe r tiJ j-r e b cdc-c SO 6c\"■ P r(ct 5 1 f -(r v (_ K-- II. WATER SUPPLY 1. Please check one: Is water supply Community? Yes No y Municipal? Yes ( No If the Water supply is other than a Municipal supply, it will be required to be registered with Public Water Supply. 2. If water supply is from a Community Water Supply system is it registered and approved as public water supply? Yes No If yes, please attach copy of written approval and /or permit. 3. Is ice made on premises or purchased commercially? Yes No Please specify: p' 1 re ;-,-, SC 5 If made on premised than specification for the ice machine will need to be provided. Describe provision for ice scoop storage: ro c -e Scdc? n-eec(cc\. k-e 'f S C\ \, r\sRd frc,v.. Co SC c C III DUMPSTER 4. Will a dumpster be used? Yes No N/A Number Size Fr quency of Pickup Contractor Service: 5. Will the dumpster be cleaned on site? Yes No '( If the dumpster is to be cleaned on site, then the waster water from the cleaning operation will be required to be discharged to the sanitary sewer system. 6. Is the dumpster to be cleaned by an off site contracted cleaning service? Yes T No 9 If yes, please provide name and address of the firm contracted for this service. Name: Mailing Address: City: State: Zip Code: Telephone: ( ) -(- ) Fax: ( ) -( - ) 7. Will a compactor be used? Yes No N/A Number Size Frequency of P ckup Contractor Service: 8. Will the compactor be cleaned on site? Yes No N/A If the compactor is to be cleaned on site, then the waste water from the cleaning operation will be required to be discharged to the sanitary sewer system. 9. Is the compactor to be cleaned by an off site contracted cleaning service? Yes No If yes, please provide name and address of the firm contracted for this service. Name: Mailing Address: City: State: Zip Code: Telephone: ( ) -( - ) Fax: ( ) -( - ) 10. Describe surface and location where dumpster /c mpactor /cans are to be stored: 11. Will trash containers be stored outside? Yes No If yes, please describe location: ��KI -C._ p c. OO }rc,�St� r-cct j 12. Type and location of waste cooking grease storage receptacle: v - c T +1 S b� r� e A ofk 41SiSt 7�t 13. Is there an area to store recycled containers? Yes No )(- Describe: 14. Location and size of grease trap: o 1 S, c k . r) - C &v S k r T rx e\ 15O p cu l orS 10 X. SEWAGE DISPOSAL 1. Is building connected to a municipal sewer? Yes No 2. If no, is private disposal system approved? Yes No Pending If yes, please attach a copy of the written approval and /or permit. XI. GENERAL 1. Are insecticides /rodenticides if used stored separately from cleaning and sanitizing agents? Indicate location: Yes ) No 2. Are all cleaning materials and toxicants stored away from food preparation /storage areas? This includes items used on premises, retail sales and personal medications. Yes 1. No Please Describe Location: 'Dr,/ Sic �l��l► /e 3. Are all containers of toxic /cleaning material including sanitizing spray bottles clearly labeled? Yes No 4. Are laundry facilities located on premises? Yes No 7( If yes, what will be laundered? 5. Is a laundry dryer available? Yes No If yes, please describe location: 6. Location of clean linen storage: ar ` s{- ) ,- Sly \ve 7. Location of dirty linen storage: iv. r V,e 10j **************************************************** **** *>;***r.************** ***i: r. * *** STATEMENT: I hereby certify that the above information is correct, and I fully understand that any deviation from the above without prior approv. from this Health Regulatory Office may nullify this approval. 7 i Signature(s) Owner(s) or Responsible Representative(s) Date: /c1/0 11 FOOD PREPARATION WORKSHEET SUPPLEMENT Food Item: Will the food item be washed or rinsed prior to use? If yes please indicate location of equipment and describe the washing procedures. Include time of day and frequency for washing or rinsing the product at this location: Location of equipment: Time of day and frequency: Procedure used to wash or rinse food item: Please describe the preparation procedures for the food items described above and indicate location of equipment to support this operation. The preparation procedure should include dishes in which the product will be used, and should include time of day and frequency of preparation for the food item at this location: Location and type of equipment of equipment: Time of day and frequency: Food item preparation procedures: 12 V -POS - Transaction Receipt Page 1 of 1 . Transaction Receipt , Catawba County, NC Catawba County Permit Center 100 A SW Blvd Newton , NC 28658 828 - 4658404 09/09/2010 02:21 PM Catawba090910142007202Smi 37652528 cbpr -9 -10 -7240 & ehpr -9 -10 -7241 FIVE GUYS BUGERS AND FRIES SAME 1 N/A STEINER/CHRISTINE 160 polpis rd mooresville nc 28117 * * * * * * * * * ** *3370 Authorization and Capture Amount: $210.00 Cardmember acknowledges receipt of goods and /or services in the amount of the total shown hereon and agrees to perform the obligations set forth by the cardmember's agreement with the issuer. Signature click here to continue. https : / /www. ve locitypayment. com/admin/catawbacountync /vpos /942 /transactions /receipt/ ?... 9/9/2010 �A �' CATAWBA COUNTY, NC \ �� 100 -A South West Blvd PLAN RECEIPT a Newton, NC 28658 aPA • (828)465 - 8399 Thursday, September 9, 2010 1842 sM k www.catawbacountync.gov Plan Case: EHPR -9 -10 -7241 Invoice Number: INV -9 -10- 266820 Environmental Health Plan Review Invoice Date: 09/09/2010 Site Address: 1520 SE HWY 70, Hickory, NC APPLICANT OWNER CONTRACTOR FIVE GUYS BURGERS AND FRIES COUNTY WIDE INSURANCE AGENCY 1520 SE HWY 70 INC HICKORY NC 28602- PO BOX 730 CLAREMONT NC 28610 -0730 Fee Name Fee Amount Food and Lodging Review Fee Fixed $200.00 Total Fees Due: $200.00 PAYMENTS PAYER: CHRIS STEINER Date Pay Type Check Number Amount Paid Chang( 09/09/2010 Credit Card -1 $200.00 $0.00 Total Paid: $200.00 • Total Due: $0.00 plan rcccipt 09/09/2010 14:23