HomeMy WebLinkAboutFSE Application 100 Evergreen Way Dec 22 16, 09:58a Burtons Grill 8604324717 p.1
,to*N =`'�� Town of South Windsor -- Health Department RECEIVED
co
1540 Sullivan Ave., South Windsor, CT 06074—Mailing Address
' 1530 Sullivan Avenue, South Windsor, CT 06074—Office Address DEC Z
�. Phone Number: (860) 337-6173 Fax: (860) 644-19
�4sox•c°'' 30 �(k�TH WINDSQ,t
Restaurant Establishment Information .11EALTH DEPT
New Permit❑ Permit Renewal ❑
` (Plea se Print Clearly).*4-
Name of Establishment: i
Gn I I
Manager's Name:
i .. ... ... _ _. ._...__ _--/� _ __ 0 n. L��I ce
C�...E Addrnt
City, State, Zip -
Phone#: f
� 3 - ! Cell Phone#:
j _..... . _ .. _....
f E-Mail Address. I
l(�C4I-6ce�. , r��) Cuing Capacity: I -1 i
Please submit latest copy of the Qualified Food op ator/serv5afe certificates-
- -- - - to the office.
Qualified Food Operator: YES NO ❑ (Reautred for irti6te# I 1
-- --- . .. Name: .) - - •_� __�_.- Q
j G
Testing Organization:-� -5�
- .� Phone.#:
E-Maif Address: - _ --
- --- -•••- -•• -••—--- -_ Alternate Piione#: I
Designated Alternate is
-- Designated Altemate2 : ( i
Restaurant Owner Contact Information
Owner's Name: _
Street Address 300 ►'1 c-I5J -
1 � .City, State, Zip Code: ! /
-- - .._
_11 v0,r� f` A
Phone#: .
Fax #: .. i
_ E-Mail Address:
qc.r�z]-�q r►I -hone#
Renovations V
Were there any renovations made last year? YES ❑ No
----- - _ _ Will there be any renovations? YES_❑ No
If Yes, please list all renovations ❑
� _ _
f that were done,/to be done:
i
i
f
i f
I
Mailing Address to send Food License Renewal Permit to:
I
Name of Restaurant/Company: -
Attention: ; �
..- _ y►1 tj GtLse
Address• I
City, State, Zip Code: - _-
5 G C 7
Phone#: i s7��.._.. .._ ._.. ..
t
-- - . . o -c,/3Z-�/..�.��
s
Dec 22 16, 09:59a Burtons Grill 8604324717
tow„ p.2
`q Town of South Windsor — Health Department
o ; 1540 Sullivan Ave., South Windsor CT 06074— Mailing Address
�. 1530 Sullivan Avenue, South Windsor, CT 06074—Office Address
4, Phone Number: (860) 337-6173 Fax: (860) 644-1930
8p Q,C p.
Res•tauran;; MeaujUst of All TLeMs Served/Solcl
Latest Menu Attached? YES �;KNO ❑
Please list all menu items in as much detail as possible _:: a co -r, ~ -'
.,
-- p� of a menu attached is applicable.
I�
f
f�dditiorial 1nPorr-rratiur�
Please check one only:
State Licenses: ❑ Bakery Liquor Permit
❑ None
Water Supply:
Public _ Private Well
Wastewater Disposal: �ublic
_ On-Site Other (please use space below to explain)
I
,ygreeni2rai.G:�a,d Sic�raacvr.;.p _—.._
By submitting this application, I affirm chat the facts set forth in it are true and complete.I understard that any false
statements or other misrepresentations made on --h s application may result in immediate shutdown or revocation of my Food
Service License for the Town of South Windsor.
Applicant Name (Print):— —
I GC
Applicant Signature:
Date: -7_Z Z_
CffliCe Use onl'j
rDate
or Name (Print):
r Signature:
Date:
ss: 1 ❑ 2 L 3 ❑ 4 [�
ceived: Expiration Date:
Date Approved:
• ;;ra, .. ,.�..., :� h:Pl• ....Via•' ,:Irto+�: .1.,I
i
ti
N
CERTIFICATIONco
ao
ervSnf
SALVATORE GAROFALO
for successfully cornpleling the standards set forth for the ServSofe3 Food Protection Manager Certificotiore Exarninalipn,
which is accredited by the American Notional Standards Insfitute (ANSI)-Conference for Food Protection(CFP).
1-3896517 5185
.._CERTIFICATE NUMBER EXAM FORM NUMBER
7/20/20,16 7/20/2021
DATE OF EXAMINATION DATE OF E),:?.RATION
Local lows apply.CIi K with your"regulatory Q9ency for recertification requil,_, nts.
,Ln
(D
(n
C �
C)
m
Shernton Brown
Cu 0 SVP, Notional Restaurant Association Solutions '
�q 90655
rn rr�
0 In vcrordinre..;•h hte.�/ime labalr CwNeition T006 �'•�T^�'C
Reak#ion ADM N 068.2013
lRegtlalion�.2 Sk.ldod A121.
C'1015 fVob�not Roburml(A»o6efon
N NO`'onol Restauvtl AslooanorJlfl end rlte°re dmhY+ � of �,d A�°fd i+e Se�n.Sa�.I�yo we rodaro.ts of the t`dWEF. 1.I j�F�::
1F4�unmY connot be reprodtuai or obcvc ar#�
(D v.1401
0 ceww a v4h 9�alions ut 175 W Chicago,rt.6060d w Sems*(e®rmbvroN.0T
c _ todaon Blvd.Ste I500,
i
iJ
'lbt h". 'Jt :.M r•:' a 'tit; _. ;.r
.. ln , It , "1 •,ol ..
r.n
ervSafe
Cq
co
'T
C>
ao
CERTIFICATION
(0
ROVINSON VIVAR
for successfully cornplefing the standards set forth for d,e ServSafea Food Protection Manager Certification Examination,
which is accredited fry Ike American Nalionul Standards Institute(ANSI)—Conference for Food Protection(CFP).
13896528 5191
CERTIFICATE NUMBER EXAM FORM NUMBER
7/20/2016 7/20/2021
DATE OF EXAMINATION DATE OF EXPIRATION
Lord lass apply.aea Wilk your local regulatory ov,cy for recerlifteation requirements.
co
r
C
O
Sherman Brown
m r
.5VP,.National Restaurant Associallan Solutions
#UGS5
P -A' :
rnaQa •dd,nr�imKrfi«red.m,onZoos.a.�ru►a,luxtHos:�ei�lm,a,t�„3s, �dQda3� r ��
O �2015 tloliond Re+bwvtdkl of 1r hlda d Aerateant A..amcnd l�SrwS�(e 6po me Iledert+vks d iM N2/EF. 0'
t•td'oadRe>tlgbtinl.4�o4d'�id ��
(�' �6xuaww mmasEr .or
'1" t;l l:d Or]fit. '9^.^.'�." dlllt,Mt• r1401
(,lp, Cam-w uyh gk1e4ieal d 175 W Jodxu,DW.Ste 1$00,Chit w.IL 6Mi or
1 4414-
N
N
U
m
0
EXAM FORM NO. 4935
CERTIFICATE NO. 11056248
ry( feo
I
CERTIFICATION
TO RQRYN WALLACE
for successfully completing the standards set forth for the ServSafe'Food Protection Manager Certification Examination,
which Is accredited by the American National Standards Institute(ANSI)-Conference for Food Protection(CFP).
05/14/2014
DATE OF EXAMINATION
05/14/2019
DATE OF EXPIRATION
Local laws apply.Check with your local regulatory agency for recertification requirements.
Sherman Brown
p SVP,National Restaurant Association Solutions
#0655
c02014 National Restaurant Association Educational Foundation(NRAFF).All rights reserved ScrvSafe is a registered trademark of the NRAEF,usod under license by National Restaurant Association Solutions,L.L.C.
The logo appearing next to ServSafe is a trademark of the National Restaurant Associetlon.
This document cannot be reproduced or altered.
140U002 v1401
<<eab
National Rcpistry or Food Safety professionals
CERTIFIED FOOD SAFETY ivlAI"AGER
NATHAN E HOEMY
�.4 ERYIPIF�
7680 Unhreree.WVd
Site 550,• W: CcrriGcate Na?ASQ4662
��g,N328{9 Issue Date:Novembx
xoae'(8OOS 446i1257
Lepaaron Date:Pimembcrl,2017
cae(�0.7)352.8834'
tiRF^aP_ 'Wr' '
11t17; On Premise S9N.: XXX_ X_X)=
}ss_ed: 2/23120/5 Expires: 2l1012q*
IDS 3924810 D.O.B.: *Uxxo)=
NATHAN E HOLMY
1500 Main St ' '
Springfield, MA 01115-1000 .
For service visit us online at ww.w.9ettlps_c0m
.Lisa Noveffi,39831
Dec 2216, 10:01 a Buttons Grill 8604324717
p.10
ServSafe
CERTIFICATION
COREY STEINKE
far is,CLQ C�(3li t og the standards 5d fodh for+-Scrvbaroe Foos�d prvlesion Mosn fic Exominction,
'- by American Na►iorsal Standard gOr C., olion
s In9itule(ANSI}{o„(��for Food Prow or,((. P)
-'_12620143 5071
.CERTIFICATE--NUMBER
EXAM FORM NUMBER
7/28/2015 7/28/2020
DATE OF EXAMINATION
load laws cppy.clwck with ycw loci re8"icrorY°8�Y 6r raccrt Fcc-n r»quATE OF xierncr%,PIRAT I O N
5VP,NcSoncl Readuscul Asse lation SeiUltanl
ODS55
..ra.r,k,;zaps,�„s,�nrNoeazoi� � O
':wf aei Ro�arati ;cC„ {�,d t�Pen+1T.Sudad wy�.
n'-nxs Brs`�y wxserm od ti eR C4;A�.Il r�r�wrGd read f.r Sw3a{,wo as nmc...b.,f d.Nt�Ef
G'aA�ad
TMdeo.eMrm v6. J"P'a•rt+ba.ie.Ir,.fbar �,nn,� O
I�tQ7o?I '� . beiw�J.
V.1401
_ ... - ' Go.+alan riA wd�mad l75 w.r„dear.6bJ Sre lino,
.- `��ryv.IL.UMOn a krv5de9rew.,ani�y
Dec 22 16, 09:59a Burtons Grill 8604324717 p.3
rn
BUFFALO CHICKEN DIP
grilled chicken,blue cheese,cheddar,
corn tortilla chips...12.95
SIGNATURE WINGS
memphls dry rubbed or maple sriracha sauce,
pickled vegetab.e slaw..13.95
SPINACH &ARTICHOKE FRITTERS
romesco sauce,whipped goat cheese...11.95
PHILLY SPRING ROLLS
tender sirloin,onions,provolone,americon cheese,
crispy onion strings,spicy ketchup...12.95
FIRECRACKER SHRIMP
crispy rice n000les,american style kimchi...13,95
TUNA POKE'
avocado,pineoppie,toasted pine nuns,wosobl cream,
SOY sauce,lotus chips,cucumber solod...14.95
POINT JUDITH CALAMARI
cherry peppers,tartar souce...13.9.5
TODAY'S SOUP
fres,ily prepared
MEDITERRANEAN
cucumbers.grope fornafoes, rj ppers,rec .ions,
feta,mixed olives,oregano vinaigret`o..,6,9b 0,95
SUPERFOOD
qulnoa,baby spinach,dried cranberries,grope.omatoes,
OvOCadc.shaved brussels sprouts,fetes,
lemon vinalgrefte...7.95/T'.95
COBS
romaine hearts,grape tomatoes,b,ue cheese,
red o!-,Icns,applewood smoked bacon,chopped egg,
avocado,buttermilk ranch dressing...7.95111.95
CAESAR
romaine hearts,croutons,parmesan,
white anchovies on request...5-95/8.95
HOUSE
romoine,neorts,iceberg, cucumbers,grape tomatoes,
peppers,applewood smoked bacon,blue cheese,
mustard vinalgrette...6.95/10.95
ROASTED BEET
goat cheese,Prllled sweet onions,candled walnuts,
Dec 22 16,09:59a Buttons Grill 8604324717 p.4
171
MEDITERRANEAN CHICKEN RISOTTO
pan served Chicken,artichoke iearts,roasted tomctoes,
spinoch, basil,feta. lemon butter sauce, pesic...15.95/22 95
PAN ROASTED CHICKEN
all natural statler chicken breast.qulnoo,
citrus fennel and orugwa salad,carrot butter sauce...19.95
CHESHIRE PORK CHOP"
heritage form center cut bone-In pork chop.
roasted red peppers,herbed parmesan.
mashed potatoes, brussels sprouts..23.95
SHORT RIBS
aged certified argus beef.mashed potatoes,
red wine Jus,horserodisr cream.
brussels sprouts...17.95/26.95
CRAB CRUSTED HADDOCK
Icelandic haddock,super lump blue crab stuffing,
herbed Jasmine rice,rainbow carrots.
lemon butter souee...I6.95i24.95•
FRESH CATCH RISOTTO'
bronzed fish, roasted carrots,snap peas
lemon but-e•sauce...6oz,9oz Mk-S
SALMON ROMESCO'
bronzed gu;-,of rtialne salmon, romesco sauce
herbed jasmine rics.rainbow ccrrcts,
citrus fenrel slow..,16.95/24.95
MARKET CATCH-
simph•prepared grilled or bronzed,
herbed Jasmine rice,rainbow carrots...6ozi9oz Mkt S
CRAB CAKES
supa:r lump blue crab,pl, clea vegetable slow,
mustard sauce,fresh cut french fries...15.95/24.95
LOBSTER SHRIMP PASTA
fresh to'noroes,snap peas.parmesan.
fettuccine,tomato cream sauce. 18.95,27.95
_Y
Our chefs select the most tender,well marbled cut of block
angus beef from mld-western family fa•ms.
our steaks are e)pertly aged for a minimum of 21 days.
FILET MIGNON
center out aged beef,mashed potatoes,brussels sprouts,
1`13G)steakhouse butter
{medium well&well filets will be served as two meddllons)
6 oz...2Z95 9 oz...34.95
Dec 22 16,09:59a Burtons Grill 8604324717 p.5
CLASSIC CHEESE BURGER-
hand packed certified angus beef,choice of cheese,
griddled bun,fresh cut french fries. .13,95
add saut&ed crirnini musi)rcorr•Is, caramelzed re anions
:1nd aPPlewood smoked ba•co.� 1.95/.95 each
,B) MAXX BURGER"
hand Packed certified angus beef,omer r r, ,,heese,
sh•reddec lettuce,tomato,house made pickles.b_.i fu i,special sauce,
crispy onion strings,griddled bun,fresh cut french fries...14.95
MAPLE CHICKEN
grilled chicken,apPlewood smoked bacon,caramelized red onions,
arugula,cranberry,maple dijonnaise,griddled clabotta,fresh cut french fries...13.95
TURKEY AVOCADO
smoked turkey breast',avoCoao,sumach,tornato,
lerron atoll,roar bread,cucu-nDer saloc...13.95
SHORT RIB GRILLED CHFFSF
braised csrtffied angus beef short W ,pickled->ni.: r s,maple srlracha,
vermont cheddar,griddled clobatto,red wine jus,
fresh cut French fries...17.95
REUBEN
certified angus comed beef,sauerkraut,imported swiss,
russlan dressing,griddled marble rye,fresh cut french fries...14.95
FISH SANDWICH
fr'ed haddock. pickled onion,house made fried pickles,
srlracha,tartar sauce,griddled bun,fresh cut french fries...13.95
SALMON BURGER
tzatziki,sliced eng ish cucumber,arugula,red onion,
noan bread,cucumber salad...13.95
STREET TACOS
bronzed fish,tomato jalaperio relish,shaved napa cabbage,
guacamole, bojo sauce,arugula salad...14.95
(suba-�ture sv�eei Po-;a'o fries .95?
Dec 22 16,Og:5ga Burtons Grill
8604324717 p 6
RISOTTO PROVEN4�:AL
artichoke hearts, roosted Yoatoes,
spinach. basil, fofa, maliveS lemcn bu►ter sauce,
pesto...13.95;17.95
GARDEN ROSA
roasted mushrooms.fresh to snap peas
fettuccine, tornfc cream sauce..matoes,snap
i a
Qshaved brussels sproutUI eOArQOWL
nberriroasted beets&carrots,snreaded cheddar,es
candled w
alnuts,
aole diJonn0lse._.,6.95
BLACK BEAN BURGER
lemon aloli, shredded lettuce, guacamoje
tomoto Jala;Def)o relish,
griddled bun, fresh cut french flies-12,95
(con;oios eg.)
FRESH CUT FRENCH FRIES ..6
GARLIC PARMESAN FRIES...8
SWEET POTATO FRITES-8
ONION STRINGS-6
LOADED MASHED POTATOES...6
ROASTED MUSHROOMS AND RED ONIONS,,,3/6
the perfec-acccm.,-,an r ent wish o r steaks
MUSHROOM RISOTTO..,6
CREAMED SPINACH...6
BACON BRUSSELS SPROUTS...6
our award wlnn:n KEY LIME PIE
9 and hand crafted version of the florida classic
two creamy layers surrounded by a groncia crust,
-_-- — topped with fresh whioped crearn_10