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Home My WebLink About952 Sullivan Avenue (2) Town of South Windsor - Health Department Q 1540 Sullivan Ave., South Windsor, CT 06074- Mailing Address 1530 Sullivan Avenue, South Windsor, CT 06074 - Office Address s M�� Phone Number: (860) 337-6173 Fax: (860) 644-1930 SOR•011 Restaurant Establishment Information New Permit❑ Permit Renewal ❑ ***(Please Print Clearly)*** Name of Establishment: Manager's Name: r g Q�b , � Street Address: q S)- v ,vim 14 v City, State, Zip Code: Phone#: g 60 - 6 L-i �-1 S 39 Cell Phone#: Fax#:E-Mail Address: 0_sb L 11401 r o_ Seating Capacity: Please submit latest copy of the Qualified Food Operator/ServSafe certificates to the office. Qualified Food Operator: YES®/NO ❑ (Required for Certificate#: /r Class 3&4) Name: Q� bf n V 4 Date: Testing Organization: �v��.�ro,� 1 /{ Phone#: 10j - �►/J-7j�� E-Mail Address: jho ✓,1'!tz Q S�� 9b,` Alternate Phone#: Designated Alternate 1: ! Designated Alternate2 Restaurant Owner Contact Information Owner's Name: Street Address: City, State, Zip Code: ��^�� C� Lo Phone#: l Fax #: E-Mail Address: h0r Z Cell Phone#: Renovations Were there any renovations made last year? YES❑ NO [� Will there be any renovations? YES❑ NO ❑ If Yes, please list all renovations that were done/to be done: RECEIVED JAN 18 ;�018 Mailing Address to send Food License Renewal Permit to: SOUTH WINDSOR HEALTH DEPT. Name of Restaurant/Company: 141( - Z,x- Attention: A L Address: 1(cJ 1� S City, State, Zip Code: >Co,-,' �- Phone#: �(� ,� - (p _ /. S Restaurant Menu/List of All Items Served/Sold Latest Menu Attached? YES['NO ❑ NOTE**(Must have latest copy on file) Please list all menu items in as much detail as possible or a copy of a menu attached is applicable. Additional Information Please check one only: State Licenses: [Bakery [Liquor Permit j None Water Supply: VPublic _Private Well Wastewater Disposal: (/Public _On-Site _Other(please use space below to explain) Agreement and Signature By submitting this application,I affirm that the facts set forth in it are true and complete. I understand that any false statements or other misrepresentations made on this application may result in immediate shutdown or revocation of my Food Service License for the Town of South Windsor. Applicant Name (Print): Applicant Signature: Date: L 'I Office Use�Only Inspector Name (Print): Inspector Signature: Date: Food Class: 1 ❑ 2 ❑ 3 & 4 ❑ Expiration Date: 2 1 Date Received: Date Approved: A Family Business 952 Sullivan Avenue South Windsor, CT 860-648-1553 Daily Lunch Specials _j 00000, Monday-Saturday 11 AM to 9:00 pm • Sunday 12 Noon to 9:00 pm G ri n d e rS hot or cold Small8" Medium12" GIANTI6" Ham........................7.50....... ......9.50...............13.50 Pizza Genoa Salami.........7.50...............9.50...............13.50 Cooked Salami.......7.50...............9.50...............13.50 Small 10" Med14" Ex.Large 18" Eggplant.................7.50...............9.50...............13.50 Mozzarella............................. 9.25.......12.50.......16.00 Meatball..................7.50...............9.50...............13.50 With any one item.................10.25......13.50.......18.00 Pepperoni...............7.50...............9.50...............13.50 Combination of 2 Items.........11.25......14.50.......19.00 Sausage.................7.50...............9.50...............13.50 Combination of 3 Items.........12.25......15.55 .......20.00 Pepper& Egg.........7.50...............9.50...............13.50 Combination of 4 Items.........13.25......17.25 .......21.00 Meatless.................7.50...............9.50...............13.50 Extra Cheese 1.75 Cappicola...............7.95...............9.95...............14.50 White Garlic also available Pastrami.................7.95...............9.95...............14.50 Extra charge for additional items Chicken Parm.........7.95...............9.95...............14.50 Grilled Chicken.......7.95...............9.95...............14.50 Chicken Cutlet........7.95...............9.95...............14.50 Available Items: Onion, Peppers, Mushrooms, Anchovies, Steak......................7.95..... .........9.95...............14.50 Hamburg, Sausage, Pepperoni, Bacon, Olives, Spinach, Tuna.......................7.95...............9.95...............14.50 Broccoli, Ham, Tomato, Eggplant Turkey....................7.95...............9.95...............14.50 Roast Beef..............7.95...............9.95...............14.50 Veal Parm...............7.95...............9.95...............14.50 Italian......................7.95...............9.95...............14.50 B LT.........................7.95...............9.95...............14.50 Extra Cheese.......... .75...............1.00............... 1.25 Gourmet Pizza Gyro Small 10" Medium 14" Ex Large 18" Gyro Sandwich in a Pita Pocket ................. . 9.50 Meat Lovers..........................13.75......18.25 .......23.75 with fries......................................... 11.75 House Special............... . .....13.75......18.25 .......23.75 Chicken Gyro Sandwich in a Pita Pocket... 9.50 Veggie Special......................13.75......18.25 .......23.75 with fries......................................... 11.75 Greek....................................13.75......18.25 .......23.75 Hawaiian...............................13.75......18.25 .......23.75 Chicken........................... .....13.75......18.25 ......23.75 Calzone Shrimp............................. .....13.75......18.25 .......23.75 Cheese................................... 10.50 Addl. Items$1.25 Ea. Ham, Mushrooms, Pepperoni, Sausage, Broccoli, Meatball Dinners Spaghetti or Ziti with Sauce... .. ....... ....................... 10.00 (served with Soup or Salad, and our Fresh Bread) with Meatballs, Sausage, or Mushrooms...... 11.75 with Meat Sauce........................................... 12.50 Meat or Cheese Ravioli...............................12.75 Baked - Manicotti - or- Stuffed Shells ......12.75 Baked Ziti ....................................................12.75 Seafood Real Veal Parmigiana .................................15.75 ..................14.25 (served with Soup or Salad, Fresh Bread, Fries & Cole Slaw) Baked Lasagna Fried Scallops..................................... ......... 14.25 Eggplant Parmigiana...................................14.25 Clam Strips................................................... 12.50 Chicken Parmigiana....................................14.25 Fried Shrimp................................................. 14.25 Shrimp Parmigiana......................................14.25 Stuffed Eggplant..........................................14.25 Fish & Chips................................................. 12.50 Seafood Platter......................... ................... 19.75 Kids Menu Club Sandwiches Turkey .......................................................... 12.50 RoastBeef.................................................... 12.50 Pasta and Meatballs.......................................7.50 Tuna ............................................................. 12.50 Chicken Tenders w/Fries.............................7.50 Chicken Club................................................ 12.50 Ravioli (Meat or Cheese) 7.95 Ham.............................................................. 12.50 Includes Fries and Cole Slaw Wraps Beverages Turkey Club.................................................. 10.25 Soda.............. . .......................................................1.50 Philly Steak................................................... 10.25 Soda Pitcher.. .......................................................5.60 Chicken Cutlet............................................. 10.25 Coffeeor Tea............................................................1.20 Ham and Cheese........................................ 10.25 Milk............... ............................................................1.50 Italian........................................................... 10.25 ,1 Tuna Melt Wrap............................................ 10.25 SalaUS (served with fresh bread) Add French Fries to wraps ................................. 2.00 Dinner Salad .. ...........................3.75 Side Orders Extra Dressing............................1.25 French Fries ................................................. 4.50 OnionRings.................................................. 4.75 Reg. Large Meatballs...................................................... 5.25 TossedSalad.............................7.50 ..................... 9.50 Sausage ....................................................... 5.25 Antipasto....................................9.95 .....................11.95 Garlic Bread ................................................. 3.80 Chef Salad .................................9.95 .....................11.95 Garlic Bread w/Cheese................................. 5.75 Greek..........................................9.95 .....................11.95 Tuna9.95 11.95........................................... .................... Grilled Chicken...........................9.95 ..................... 11.95 Appetizers Fried Mozzarella - our own! ................... ..... 9.50 Chicken Wings (10) ..................................... 10.50 SOUPS Ask for the soup of the day (Seasonal) Chicken Wings (15) . ................................. 12.75 Cup............................................................................3.25 Jalapeno Poppers (Mild)............................... 9.50 Bowl. ......................................................................5.25 Chicken Tenders .......................................... 9.50 Buffalo Tenders............................................ 9.75 EXAM FORM NO. 4377 rSew'r'vS.ajW CERTIFICATE NO. 6083396 SeivSafea T. BOBBY MOUTTA for successfully completing the standards set forth by the National Restaurant Association Educational Foundation for the ServSafe®Food Protection Manager Certification Examination, which is accredited by the American National Standards Institute (ANSI)—Conference for Food Protection (CFP). 9/8/2008 DATE OF EXAMINATION 9/8/2013 is DATE OF EXPIRATION Local laws apply.Check with your local regulatory agency for recertification requirements. all NATIONAL #0655 - - - - - RESTAURANT Mary M Adolf ASSOCIATION National Restaurant Association President&COO, Products and Services Division S 0 L U T 1 0 N S rm EDUCATIONAL FOUNDATION National Restaurant Association Solutions 02008 National Restaurant Association Educational Foundation.All rights reserved ServSafe•and the ServSafe logo are registered trademarks of the National Restaurant Association Educational Foundation, and used under license by National Restaurant Association Solutions,LLC,a wholly owned subsidiary of the National Restaurant Association. This document cannot be reproduced or altered 0706VOI v0808 - - . r � .- - � i r - � - ., .. esEXAM FORM NO. 4377 CERTIFICATE NO. 6083396 SetvSafe Certificaboon TO BOBBY MOUTTA for successfully completing the standards set forth by the National Restaurant Association Educational Foundation for the ServSafe®Food Protection Manager Certification Examination, which is accredited by the American National Standards Institute (ANSI)—Conference for Food Protection (CFP). 9/8/2008 DATE OF EXAMINATION 9/8/2013 DATE OF EXPIRATION Local laws apply.Check with your local regulatory agency for recertification requirements. American National S andards In . and the C rotect to , #0655 NATIONAL RESTAURANT National Restaurant Association Mary M.Adolf ASSOCIATION Presid-m &COO,Products and Services Division EDUCATIONAL FOUNDATION National Restaurant Association Solutions S 0 L U T 1 0 N S Tm National Restaurant Association Educational Foundation.All rights reserved ServSafem and the ServSafe logo are registered trademarks of the National Restaurant Association Educational Foundation, and used under license by National Restaurant Association Solutions,LLC,a wholly owned subsidiary of the National Restaurant Association. This document cannot be reproduced or altered. U7060701 v.0808 1 1 ■ 1 L6NN -NN: NNI ME �2 err � 1 •-_�� • � �rtir �%� p r Oil A 4: � y 1 L ■ No ■~OMVAIW No 1 ■ � .1 ■ 1 *IP r- . 1 ■ J