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B12-0355 Restaurant Form
�4 � - 1 � vi�w �ate : I� e �f Establishm�r�t: i�OtJIV7"AIN STAIV �AF�(3 �horte: �'�. Addr�ss of Estabtish�net�t. 193 G�R� �R� �K �RIV� I'hzsnea Fa�, I�arne of Operator (c�wn�a°} : AT7' �QRGI�,�l , KEilItV C IR I'hc�n� : Fr1X: Address of �.lperator (�wner)e � ��� �'�� IL Phone : �70-A76-0125 F�� � 970-476-0137 Name af I,ocal C�n��ct: ATT �OF�GAIV Phone: FAX: Narr�e c�f Cor�tractor. �octcv MouN�a� r� co�sTRUCrion� Gr�ouP phone : 970-476-4458 FAX: 970-4�76-4951 t�ddress of Architect; � 160 SAhITA �E DRIVE Phone : �'f1X : Name ofArchitect: iE6V1F'LE � ROVVR6 DESIG6V, P . C. Phone ; 303-571 -4137 ���; 303-571 -0403 I�ate Constru�tion will begine �E �'� Zo � 2 Date of Plarined 4pening : ���� 2a12 New Establishment: Y�� Remodel ; Y�� �'ype af Estabiis ent �check a11 that appiy}: � Full Service � �c�ffee Shop � �ar _ Iviarket ��'irocer3') Gonvenience Stor� �ish Ivlarket I7eli I4�eat I�tlarket C�terer Concessic�n � School � Spe�ialty Shap �ast F'ood 1VIobile LJnit � C)ther (piease �pecify) : C - 1 Seatrng Capacity (indoor and ��tdoor) : 137 Total Square Fe�t c�f �1�� Establ�s ente 3 , 912 gsf plus 374 �f outdoc�r patio spac� '1's�tat �q�za�°e ��et �fthe �itch�r� Ar�� e 1 , 260 �f I-Ia�� these pl�s be�n s�brnitted c�r dcs ycsu �n�erad �c� s�brr�i� these plans ta other counti�s in the State csf �olorad�? � Y'es � Nc� If yes, �vhich county(s) o If Qperaticsn is Seasonal, L,ist the Afionths of Operatio�o �ear r�und operation ^»"`�� e • � rq I)ay(s) ar�d Hours of Operation: ".� �� � � �- � � 1 ��� °�" � �''` � �° day(s) ho�rs Projected Dail� ivl�irnurn N�tmber of �Ieals to be Served: �� �r�al�fas� � � Lunch 1 ._,: �" °"�� '� Dint��r I�tumb�r �f St��°f (rna�s�u� per shift} : � � � _ _ C - 2 � � � �� ��r� �u ���s � �a�c�s�� � �� us°� � I���.� � E '� C' I'IJL�'E �' E PI ,t�l� EVIE e Lfi�' F` � �'L.ET'E II�tI+'6J 'I`I l�T r��' �+ L,��' Ei�I�+ Al� Pi.d t�PP �AL,. Y o Proposed r�e�c�, rnciudir�g a I�st of foods w�ich �ill r�quire cooling �.fter ecs�king ar�d the method that wb1l b� used fo cool th�se f�ods. 2 . �`ac�lity flo�s� plan. I3ravvn �a scale. 3 . Sp�cification she�ts ��` all cquipr�e�t, including rriake aa�d rri�d�l r�umbers. 4, Shop dr��vings of ali custoan fabricated equiprner�t and cabrnetry. �3rawn ta scale, 5 . Site pla� s�i�wing the Iocatis�n c�f the busir�ess in the building, loc�ti�n �� the buildyn� €�n site ir�cluding apleys, streets and tn� lacati�rs �f atly aautsid� facility (deampsters, dvalk�in units, grease aratercept�rs etc.j . 6e A comp2ete interior #inish scheduleo 1. Mechanical, plumbing and electrical schedu�es. �3rawn to seatee � . W�t�r he�ter specifications, including make and m�dei numbe�°. 9, Locatyon of chernleal and p�rsonal belongings stc�rag�. 1Q. Wat��° suppiy and wastewa�er systegns. C - 3 I. enu A� F��d � nstling t°o��d�r�sd t�a Sub� it I�en� � , Is th��� a �Iaz�rd 1�nal�sis �r�trc�I �ontrol Pair�t ( ���') PI oe�d ��dlin� I�r�c�d�re 1!%�an�al that describes pr�paratio�, cooling9 r�heatir�g, cooking csf foods aa�d t�e har�dli�sg c�f Ieftovers? � Yes _ No If yes, please subrri�t �vith plans, Co I,ist th� f�ods that wi�l be prepared �ore than 12 h��r°s rn advance of service. �� �-� ��`��?�-�'�� ���� . I3, List the foads ar�d descrabe the rnethods of ho�r hot foods wb11 be cooled �0 41 °F' �S°�) or b�l�w. ��; ��.������,�, �� � �� � � ��� � ` �� � �� � � 3 `� E. List the fomds arid describe th� rriethads of how foods will b� rap�dly reheated t� a65°� ('74°�) ar ab��e. �,� �€„���,� ��w M �, � � � W �.��� �._� � � �€.�� �'���,°�. � �. List the f�ods and indicate ho�r hot fo�ds �vil� be held at 135°F {57°�� or above, �°��a�- r- � � �� �a I-���✓ �ri11 froz�r� foods be tha�ved? � ` � . ` �� � �� � �� � ����- � � _ � �� � e� �".� ��� �II. Will raw meats, paul�ry, and sea#`ood be stored/d�spiayed r� the same refrigerator(s} and freezer(s) with �ooked, ready-ta-eat fo�ds? � �'es Na � _` � :�'���' �'��� �- �' ��� * I. Indicate the total numb�r of refrigeration and freezer units: ,�' � i��� J. �U�il catering be conduc�ed? � �'es No K. �ill food be tratispmrted or delivered to another Iocation? � �es No If yes, what equipment wzll be prov7ded to maantarr� food at proper temperatures during transport? ���.� L . �ill the produce used washed �n the establishment� �r `viil all praduce be received pre� �rashed: " �°.,�° �.°T"".,�"�°° �� N1. Will vacuum packag�n� be conducted in the establishment? � Yes I'�o If yes, please provrde the r°equired I-�ACCI' I'lan for �ach �at�gory of food to be vac��zm p�ckaged. C - 4 �Im I$"aeiti F'l�a�r Ia� » A. S�brrait F'toor Pl�n Drawn To Scalee � . Fl�c�r �'lan ivl�zst In�fl�de Lo��tic�n ar�d Identificat�c�n af` .A11 Eq�zip�nen� �d �r�as Ira�l�ading: 1 . Sir�ks - �� I-�andsink(s� b� �I�getable/Food Preparatiort Sinls(s) c} LTtilatyll�Iop Sitik(s� d} Uuin� Sirak�s) e) t�T�revvashir�g Sink(s} f} Other 2. �ait Station(s) 3 . T'oilet Fac�lit�es 4. I)rylF�od Stc�rage Area(s) § . Employee �reak/L,ocker Area(s} 6 , Chemicai Storage t� rea(s) 7. �ater �-Ieater Locat��n 8 . �aa° Service t�rea(s� 9. Indo�r/C>utdoor Seating 10. (Jutdoor ��okingf�ar Area(s� 11 . I,ocation Of I,aLandry Fa�ility 12 . tZecycle/I7amag� etu�-ned C7oods L,aeatian 13 . I,ocation t�f AIl Fl��r Sr�ks and �taor I3ra�rs� 14. �reas� Intercept�r/Greas� Trap 15 . Ice �ir�siic� Ivlael�is�es 16a 3�apper Wells 17. Ghe�raicai IJ�spensir�g �Jr�its C - 5 I�Io E �i� �nt Sp��af���ti�n� a t�. S�6mit equ�pm�nt sp�cafcatic�n sheets, inciud�ng r�aake and rnodei r�umbers �f the �quipment. If �he specificaticsra she�t l�sts anor� th� c�r�e piece o�` eq�iprr����, flde�ati�`y �he speci�c equipment to b� �sed, If there is n� specif�ca�ior� si�eet availabie, the equiprrzen� vui1P onl� be aecept�d �pcs� a f�eld flr�specti�n t� detern�ine i� it rs��ets co�tr�ercial design criteria. � . Subtr�it shop drawin�s of �11 ver�t�la�ion hoods. I7ravvr� to scale. C. Scaba�it s�r�p dr�dvings �f �11 ��s�orn fabr�cated equipmea�t ar4c� cabinetr;�o I�ravv� to s��1�. I�. Submit the follos�ring �vater heater inforniati�n: (See Agpendi� I� for criteria �n caicuflating adequate amaunts �� hot �vater) l . Ivlake : Ivlodel Numb�r: 2 . BTLT/I�ilowatt IZating: 3 . R�coveay Rate, 100°F rise, at sea level: C - 6 E. 5�brnit i�stal�ation specifa�ati�snsa LTse the fotlos�ing ch�rt tca ir�d�cat� equipm�nt spac��g a�d e�evat�on; wh�cla equipn�er�t wil� b� placed on legs andJor easters, qazack dbsconrtects (etc.): Inst�lla��on e��ocl� Eqetig� ��t Ins�a�la�aon I,ist �t A� A�ja���t Flomr� �'�li E ua me�t Ec�ui�rtaent li�ake and I�Ic��e� � � `°d � �' � a' � �'' ro o � � � � '� `�- � � � � O � °� o � � � �° �, � � � � � � � � � � �. � �, o � � �° � °� � � °� � � � � n n � �. � � � � � � � � � � � � � � � � � � � � .�"�'�`"' ` ,. � � ���� �� �° .� ��;. � C - 7 F. �ub��t tY�� follavving war�w�sh�ng anfarrr�ati��: 1 . l�[ TE1I, � Ir��iude the fa�lo��a�g for ail w�e�ashing s' sm (K�tchen, ISishrc�orr�, � �r, etc.) a� Size �f e�ch sink �ompar�rnent: ,,� . ,, � L,�ngth: � ��� �«Tidth: � ' -�� � I7�pth: � '� L,engthe ��_ �idth: ���'� l��pth: � ���. �- -----��---- I,er�g�ha `' ` �_ VVidth: �,�°�''� I�epth: �� b) Size �f aIl soiled and c�ean dragn bssa�d(s�/dryir�� racks : � �,� ��dth: _��� I�e�th: :�� � �_���. Length: � �'� ���t I,�ngth: ;� _ �idth: ,�`�� Depthe I,�ngth: Width ° Depth: � l.. � � ' � ..#; � �`'�� � � � � � �` �� . �� � �v.�, c) I're-Rir�se I 5pray Hose Provided: � yes no 2 . NIECIIEINI�AL : a} 1Vlake ar�d model nurribers of waredvvashing machine(s) : Il � F "' ��"� � _d �'"�, b) I�eat or chemical sanitizatimna _ �� �� � �� � c� Bc�oster I-�eater: 1 . Make �ttd Ivl�d�l N2zrr�ber: 2 , I�ecc�very Rate, 40°F Rase, at sea 1ev�t : 3 . I)astanc� fresrr� th� �Iarewashing 1�tlach�nee � C - � d) Manufactur�r' s h�t �rater requirerrpent (galPcans per hour}: �,�`' � e} S�ze c�f a1fl drarn baardsJdrying racks (length and �v�dth) : � � .�' � „ ,. '"'� ! ��"�" � ��` �� � Pre-�nse t Spray I-��ase Frc�v�d�do Yes I�o g} Saak Si�k i'��v�ded� �es I�o G. Csaa°ba�e I3ispc�sal�: Yes �c� If yes, Indicat� L�catic�n(s) � H. IZefrz�eratia reezer Capaci�i�s - Compiet� tt�� fc�llow�ng t�b3e : 'I°�'PE I+' IT1�tI'T # OF LTI�TIT'S °I'O'TAIJ P �IDE �IT IC F'EE�' �alk-in I�efrigerati�n � � rt � � Reach-in I�efriger�tian � � � $ Walk-in Preezer ,��f � � � I�each-i�a Fr�ezer j �" �� � �Iast Chiller � � � � � � Retarl I�isplay � � �� � ��� � I. Dis�layed Food Iteans : 1 . B�zlk Po�ci Items: �es . I�ia lf y�s, subinit eq�ipment specifications for food binse Include venda� pr�vided equipment. 2 . F�od Shields - 5ubmit the type and location (If cttstcsrt� design, please stzbmit shop drawings} : _ _ � � �''�� � � C - 9 e P E ISES; Ao S�zbmit site plan which ��cludes the follc�wi�ag: IZefuse Er�closures, Cornpact�rs9 O�ztsid� Walk-ir� Cooler�s)/Freezer(s), L�scatia�n of �I�ter Supply, Se�vage L3isposal �ystern, C�r�ase Inter�ept�r, Ail�ys, Stre�ts, F'arkar�� and tJ�ts�d� Storage Areas . � . Water Supply and �Iaste�rater Sys�ems : 1 , Water S�pply : a} �ornmunity/�ubli� : I�i � of 3�istrict� b) I�on-�or�rri�zn�tyl�ravate : P'VdSI� # ; c) ��11 : Spring: If it is a �v�ll, indicate �h� depth: I�Ieth�d of i)isir�fectPOn: 2 . Sewage I�isposalo a) Maznicipall�ublic . Naanc of D�strict: b� Indiv�duai Sewage I3flsposal Systeria �ISI�S). � - 10 � � � .: °o .� _ �`!"; � b � � .-a � v � � � � � J . � � m � � �° O e� m � � f� IW— � � � — m � Q � � � } � O � � p � z � � O � °� � � o � o � � � � � � � � � � � � � � � ... � (t3 � � � � � � W � cn w O � � � °� °� z � o o.. b � vs y � g OC � � � � t�° �+ U3 c� U3 � � o � S � O � � � � Z � � � � � � � � � � ,� � � U3 � O J � � � w � 4 � � � � � � .� � � � � .� � o � � °� � W C7 W tJ u� � � `o � O i— p i— p � .� v, � � � � � � ' � � � � � � G3 � � .� "c3 U � � a� O � t�J � � � � � � L!J ..-, � c � � � � � � � `� � .� °� � � � � � � � � � e� � � � � �, o � � �—,° F�a � � � .'� � aa � � � r�n � � €�, o � W = L!1 � � � � � � � � � � � � � � � � � � � � t— � � � v � � � � � � �} � p (� CA3 VI� �cl�a�ai�alp P�umtaia�g, ��ci El��tric�l �ch�da�fle�e Ae F'lumbin�; � , S�b�it the lcsc�ti�n af �it �I��r si �d f�caor d��insa 2 . List a�l the equip�sen� t�aat wili be ins�alled �vith �n ind�rect �vaste pipe. 3 . S�brrait the iocatian �f all hose bibbs . 4 . Submzt the number an� location of all torlet fixYures (Incl�ding handsir9ks, uri�als, argd ava�er closets�. � . Sub�nit the locatior� c��' the grease tra�s or intercept�r. C. S�brnit the tn��, rnod�l and locagi�n of all �h�mi��� disp�nsir�� unit(s}. 7 . IJse the f�ll�su�ing �hart to list the iocation of a11 back�lo�r preventior� devices, includ��g �11 ve�dor suppli�d �ternse �+ ITIP'1VIEl�t'I° °I°E r�L �+ �L°I'E r�L I' 'I'EC'TI lv P O'I°E'C'I'IOl�t _ �arewashpng 1Vlachines i�ilater �Jash I�oods ��� � � Cher�icalInjection � � , Tow�rs � �oda StaYions � �c�ffee Urns � Ice Makers �.. �Y�3�1�Y ��IIS g �� � � �.` . 1 �� W1t�4 �w� � � � �1'�-T1TY �'�a �ISp8Y1S81" ��.. �O�? SI11�C "'` � �"� �Iase Bibb(s) � � �j � R�el I,ines � � � � C - 12 E ITI �+ NT° �°�+ AL. EX'TE r�I., P 'I'EC�'I l� P T°ECTI N Stearrg I�ettl� Faucets �3. Nl�ch�ical : 1 . Sub�it a eoanpl�te v�ntil��ion schedu�e ancl�ding ��aust �apaciti�s (cubic feet p�r razinute rati�ags) f�r a11 hoods and the location ar�d capa�ity af all make-up air diffusers. 2. If the vent�latic�n hc�ods are iJL listed fc�r Iow�r ai� fl�svs, subrnit the infoa�rnatior� l�cated �n the rr�anufacturer' s LTL listing card. 3 . �nclude ventilat��n systems an r�stroams. C. Ele�tricalm 1 . Submit the locat��n and typ� of �igllt fix�ures througfliout th� faciirtyq i�cluding the fixt�ares in �alk-in r�frigeration/fi°�ez�r un�ts. 2. 5ubmit the type of bulbs andlor shielding for each type of �ight fixture, �vvher� r�quired. 3 . I�dicate the location of transforrners and ele�trical pan�is af iocated in ti�� food pr�parat�onl f�csd st�rage areas. C - 13