Bismarck-Burleigh Public Health
500 E Front Avenue, Bismarck, ND 58504
701-355-3400 Fax: 701-221-6883 Email: bbph@bismarcknd.gov
FOOD LICENSE APPLICATION
Business Name: Business Phone #:
Business Address:
City: State:
Zip:
Mailing Address:
City: State:
Zip:
Owner’s Name: Owner’s Phone #:
Owner’s Email: Applicant’s email:
Applicant’s Name & Title: Applicant’s Phone #:
As the Applicant/Licensee, I am (check which best applies): Projected Opening Date:
Starting a new business in a new structure (New business)
Starting a new business in an existing structure (New business)
Taking over an existing business (New owner) Name of existing business:
Food License Category that best describes your operation (see categories on 2
nd
page):
Total square footage (of areas used for food preparation, storage, display and customer seating):
Will your food establishment have exposed (unscreened) outer openings (i.e.: retractable doors, etc.): Yes No
Floor plans, equipment list and an anticipated menu must be submitted with this application for all new businesses:
(Note: Submission of floor plans, equipment list and anticipated menu is not required for new owners of an existing business if there will be
no remodeling, no relocating of equipment and no menu changes.)
Floor plans must be drawn to scale and show the proposed layout, arrangement, mechanical plans, and construction materials of
work areas, and proposed fixed equipment and facilities.
Equipment list that includes the types and models of all equipment (including sinks) that will be used for food service.
(Note: equipment and multi-use utensils shall comply with applicable National Sanitation Foundation standards or their equivalent).
Anticipated Menu that list all foods that will be offered to the public and identifies:
o
Foods that will be served raw or undercooked for which a consumer advisory is required
o
Foods that will be made from scratch as opposed to those that are received in ready to eat form
o
Foods that will go through a cook and cool process.
o
Foods that food go through a specialized process (i.e.: smoking as method of food preservation, curing, fermenting, reduced
oxygen packaging - aka vacuum packing, sprouting, processing and packaging juice, canning or adding components/additives
to TSC foods to render shelf stable.
Construction and/or remodeling can occur only after the applicant has been notified that their submitted plans have been approved.
Upon receiving application materials, a plan review will be conducted. Electronic copies are preferred and can be emailed to
asattler@bismarcknd.gov Plan reviews can take up to 10 days. The applicant will be notified when the plan review is completed and the
license fee
amount, which can then be paid. The applicant must schedule
a pre-operational inspection with Bismarck/Burleigh Public
Health after construction is complete, all equipment is installed and functional and the final cleaning has occurred. Upon passing
the pre-
operational inspection a food license will be issued.
With my signature, I agree to operate the above named food establishment in accordance with Bismarck’s Food Code and understand that
failing to do so can result in the suspension or revocation of the establishment’s food license. I understand that any changes to my
submitted plans and specifications must be pre-approved by Bismarck’s Environmental Health Division and that unauthorized changes
may result in the revocation of my license application.
License Holder’s Name (Print)
License Holder’s Signature: Date:
FOR OFFICE USE ONLY:
Date Recvd:
Assigned EHS:
click to sign
signature
click to edit
*A TSC food is a food that is perishable & requires time or temperature control for safety purposes
Submit Application to:
Bismarck-Burleigh Public Health
Environmental Health Division
500 E Front Ave, Bismarck, ND 58504
701-355-3400 Fax: 701-221-6883 Email: bbph@bismarcknd.gov
Food License Categories
Description
Food Establishment Level 1
Food establishments that prepare and sell only non-time/temperature control for
safety (TCS*) foods. Food establishments that store, display and sell only
commercially processed, pre-packaged TSC foods requiring cold holding. Food
establishments that re-heat only commercially processed, TSC foods for hot
holding or immediate service. No cooling of TSC (i.e.: no leftovers that were
previously cooked or reheated). No cooking of raw animal foods (i.e.: meats, eggs,
etc.) at the facility.
Examples may include some gas station and variety store operations, coffee
shops heating milk products only, bakeries, and vending machines/micro marts.
Food Establishment Level 2
Food establishments that primarily serve a limited menu including items that are
prepared, cooked, and served immediately. Service may involve hot and/or cold
holding of TCS foods after preparation or cooking. Complex preparation of TCS
foods requiring cooking, cooling, and reheating for hot holding is limited to only
one or two TCS foods.
Examples may include convenience store operations serving a limited menu, meat
markets, schools not serving a highly susceptible population, fast food restaurant
operations, pizza delivery, bar/taverns serving a limited menu, coffee shops
serving a limited menu, and hotel continental breakfast services.
Food Establishment Level 3
Food establishments that primarily serve an extensive menu that involved handling
of raw ingredients. Food establishments that prepare and serve complex food
processes including cooking, cooling, and reheating for hot holding and involve
several TCS foods. A variety of processes require hot and cold holding of TCS
food. Food establishments that conduct specialized processes that require a
HACCP plan (i.e.: smoking as method of food preservation, curing, fermenting,
reduced oxygen packaging (aka vacuum packing), sprouting, processing and
packaging juice, canning or adding components/additives to TSC foods to render
shelf stable.
Examples may include full service restaurants, catering operations, retail grocery
store operations including delicatessens, and large convenience store/truck stop
operations.
Institution Type 1
Schools, childcare facilities, fraternal clubs and non-profit organizations
Institution Type 2
Hospitals, assisted living facilities and nursing homes
Mobile Food Unit
Food truck, food trailer or pushcart
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