"Application for Public Market Permit" - Nova Scotia, Canada

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Application for Public Market Permit
Nova Scotia Environment, Inspection, Compliance and Enforcement Division
Part A
The information contained in this application may be subject to public release. Please note: This permit is not
transferable to any person/business or market.
1 Give contact Information
(This will be used as return mailing address information.)
Contact name:
Business name:
Mailing address:
Prov.
Postal code:
Telephone:
Cell:
Fax:
Email address:
Registered business number:
N S
(To register a business, please visit Service Nova Scotia at
http://novascotia.ca/sns/access/business/ready-register-business.asp
2 Give market details
(For more information on guidelines for public markets, visit our website at
http://novascotia.ca/nse/food-protection/forms.asp
• Per the Guidelines for Public Markets, permits are for NO LONGER than two days at any individual market.
Name of Market
Location (address including civic number)
Day(s) of the Week
3 Specify type of permit *
(check ONE)
TYPE OF MARKET
INSPECTION/PERMIT FEES
FEE (per person) + HST(15%) =
TOTAL
Public Market (Schedule A Vendor)
$38.70
+
$ 5.81
=
$44.51
Public Market (Organizer) – go to #7
$ 0.00
+
$ 0.00
=
$ 0.00
*
Please note: a separate application form and fee for each market location is required.
DESCRIPTIONS
SCHEDULE A VENDOR:
A vendor who sells potentially hazardous food products. Examples include: meat, fish, poultry, eggs, fruit and vegetable juices
processed on-site, dairy products and potentially hazardous dessert products.
MARKET ORGANIZER:
The individual responsible for allowing vendors to set up in association with the market, thus responsible for excluding a
vendor from the event.
FORM B MUST BE COMPLETED (page 2)
January 2018
1 of 2
Application for Public Market Permit
Nova Scotia Environment, Inspection, Compliance and Enforcement Division
Part A
The information contained in this application may be subject to public release. Please note: This permit is not
transferable to any person/business or market.
1 Give contact Information
(This will be used as return mailing address information.)
Contact name:
Business name:
Mailing address:
Prov.
Postal code:
Telephone:
Cell:
Fax:
Email address:
Registered business number:
N S
(To register a business, please visit Service Nova Scotia at
http://novascotia.ca/sns/access/business/ready-register-business.asp
2 Give market details
(For more information on guidelines for public markets, visit our website at
http://novascotia.ca/nse/food-protection/forms.asp
• Per the Guidelines for Public Markets, permits are for NO LONGER than two days at any individual market.
Name of Market
Location (address including civic number)
Day(s) of the Week
3 Specify type of permit *
(check ONE)
TYPE OF MARKET
INSPECTION/PERMIT FEES
FEE (per person) + HST(15%) =
TOTAL
Public Market (Schedule A Vendor)
$38.70
+
$ 5.81
=
$44.51
Public Market (Organizer) – go to #7
$ 0.00
+
$ 0.00
=
$ 0.00
*
Please note: a separate application form and fee for each market location is required.
DESCRIPTIONS
SCHEDULE A VENDOR:
A vendor who sells potentially hazardous food products. Examples include: meat, fish, poultry, eggs, fruit and vegetable juices
processed on-site, dairy products and potentially hazardous dessert products.
MARKET ORGANIZER:
The individual responsible for allowing vendors to set up in association with the market, thus responsible for excluding a
vendor from the event.
FORM B MUST BE COMPLETED (page 2)
January 2018
1 of 2
Application for Public Market Permit
Nova Scotia Environment, Inspection, Compliance and Enforcement Division
Part B
4 Give menu details
(List on back of application if necessary)
What food(s) will be sold?
Where and by whom will foods be prepared?
5 Describe equipment to be used at site
Cooking
Refrigeration
Hot Holding
Food Storage
Will prepared foods be transported to site?
Yes
No If yes, How?
How will utensils be washed?
6 Describe facilities
Booth / structure from which food will be served:
Roof
Sides
Floor
Describe what hand washing is available at booth
7 Toilet and hand washing
(Organizers ONLY)
Number of toilets available:
Foodhandlers use
Public use
Is hand washing available?
Yes
No Describe:
Portable toilets? Name of Contractor:
Is there a maintenance contract?
Yes
No
8 Foodhandler awareness
Has person in charge of booth or any workers attended a Department sponsored course of instruction for foodhandlers?
Person in charge:
Yes
No
Workers:
Yes
No
Please provide names and dates of attendance (list on back of application if necessary)
9 Sign application
Signature of Applicant
Date
10 Enclose payment
(cheque or money order ONLY – no debit, credit or cash -
Payable to “Minister of Finance”)
11 Return completed form with payment to
Nova Scotia Environment, Inspection, Compliance and Enforcement Division
Questions?
36 Inglis Place, Truro, NS B2N 4B4
Call toll-free 855-893-5309 or 902-893-5311(Truro)
January 2018
2 of 2
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