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Collects owner/operator details, person in charge, legal address, contact information, and the list of events requiring permits with dates and operating hours. Requires food item and preparation details, including storage and hot/cold handling, plus worker insurance compliance documentation and operator signature. Includes office-use fields and an event-site readiness checklist covering water, electrical capacity, waste handling, handwashing, toilets, dishwashing, lighting, and food safety training requirements.",{"@graph":69,"@context":122},[70,84,105],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":35,"@type":76,"position":81},"https://docshare.wps.com/document/healthcare/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/application-for-permits-to-operate-temporary-food-service-cattaraugus-county-health-department-section-a-e/495818/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/application-for-permits-to-operate-temporary-food-service-cattaraugus-county-health-department-section-a-e/495818.png","ImageObject",300,407,{"name":92,"@type":93},"Aria Callaghan","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-11-10","2026-10-02",true,{"@type":102,"interactionType":103,"userInteractionCount":52},"InteractionCounter",{"@type":104},"ViewAction",{"@type":106,"mainEntity":107},"FAQPage",[108,114,118],{"name":109,"@type":110,"acceptedAnswer":111},"What information is collected in Section A for the owner or operator?","Question",{"text":112,"@type":113},"Section A requests owner/operator details including operating corporation, person in charge, legal address, contact information (phone and email), and identification information such as SSN or EIN.","Answer",{"name":115,"@type":110,"acceptedAnswer":116},"What does Section B require applicants to list?",{"text":117,"@type":113},"Applicants must list all events that need permits, including the event/location address, operation name, and dates/hours of operation.",{"name":119,"@type":110,"acceptedAnswer":120},"What worker-related insurance documentation is required in Section D?",{"text":121,"@type":113},"Section D requires proof of workers’ compensation and disability insurance coverage, either by providing specified insurance forms showing coverage or, when not provided, an exemption-attestation form.","https://schema.org",{"og:url":83,"og:type":124,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":126,"canonical":83},"index,follow",{"doc_id":128,"site_id":62},495818,1791317201,{"code":4,"msg":5,"data":131},{"doc_id":128,"user_id":132,"nickname":92,"user_avatar":133,"doc_module":4,"category_id":34,"category_name":35,"doc_title":65,"doc_description":67,"doc_content":134,"file_id":135,"file_url":136,"file_type":137,"file_size":138,"view_count":52,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":44,"language":139,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":140,"faqs":141,"seo_title":142,"seo_description":67,"update_tm":143,"read_time":144,"preview_page_count":4},962084926284,"https://ap-avatar.wpscdn.com/davatar_29158cc5080c5b710cf443261637dec0","Application for Permit(s) to Operate Temporary Food Service Cattaraugus County Health Department  \nSection A: Owner/Operator Information  \nPermit Application Information  \nOperating Corporation    \nPerson in Charge  First   M. I.   Last   \nLegal Address  \nCity,State,Zip  \n| SSN EIN (Circle One) | Number |  |\n| --- | --- | --- |\n\nTotal Fee:  \nSSN or EIN Number  \nOther Name(s) to print on Permit:   Phone    \nE-mail address   Home Cell Other (Circle One)  \n\n| Section B: Please list all Events for which Permits are needed. |\n| --- |\n| Event/Location Address Operation Name Dates/Hours of Operation\u003Cbr>|\n| Section C: FOODS (Please attach additional foods served info for each event listed, if different) |\n\n\n| Name of Food | Supplier of Ingredients | Where and How food will be prepared and served, How kept Hot/Cold |\n| --- | --- | --- |\n|  |  |  |\n|  |  |  |\n|  |  |  |\n\nWill all food preparation be at the concession? Yes No  \nIf not, please describe:  \nFOR OFFICE USE ONLY  \nPage 1 of 2 DOH-3965TF (8/98)(rev 3/09)  \nApplication for Permit(s) to Operate Temporary Food Service Cattaraugus County Health Department  \n\n| Section D: Workers' Compensation and Disability Insurance |\n| --- |\n| Submit copies of the following documentation with the application to document compliance with the Worker's Compensation Law:\u003Cbr>A. Workers Compensation and Disability Insurance Coverage is PROVIDED\u003Cbr>Workers Compensation\u003Cbr>Form C-105 .2 – Certificate of Worker's Compensation Insurance OR\u003Cbr>Form U-26 .3 – Certificate of Workers' Compensation Insurance OR\u003Cbr>Form SI-12 – Certificate of Workers' Compensation Self-Insurance OR\u003Cbr>GSI – 105.2 – Certificate of Participation in Workers' Compensation Group Self-Insurance\u003Cbr>AND\u003Cbr>Disability Benefits\u003Cbr>DB-120 .1-Certificate of Disability Benefits OR\u003Cbr>Form DB-155 – Certificate of Disability Benefits Self-Insurance\u003Cbr>B. Workers Compensation and Disability Insurance Coverage is NOT PROVIDED\u003Cbr>Form CE-200 – Certificate of Attestation of Exemption from NYS Workers' Compensation and/or Disability Benefits Coverage |\n\nPlease return completed application to:  \nCattaraugus County Department of Health Environmental Health Division  \n1 Leo Moss Dr.  \nOlean NY 14760  \n(716) 373-8050  \nSection E: Signature of Individual Operator or Authorized Official (Entire section must be completed by all applicants.)   \nFailure to completely fill out and sign this form may delay issuance of your permit to operate. Operation without a valid permit is a violation of the State Sanitary Code. False statements made on this application are punishable under the penal law.  \nSignature   Print Name  Title   Date    \nFOR OFFICE USE ONLY  \nPermit issuance recommended?  \nYes  \nNo  \nNumber of Permits Issued  \nConditions of approval    \nSignature   Title   Date    \nPage 2 of 2 DOH-3965TF (8/98)(rev 3/09)  \nPlease review each item below and check the boxes indicating that you have everything necessary for your temporary food service operation.  \nTemporary Food Service Setup  \nPotable water for cooking/cleaning will be supplied from a municipal water supply or other Health Department approved source. Ice used for food/drinks and storage will be made with potable water, or purchased from a retail ice supplier.  \nNote: If your event organizer does not provide potable water hook-ups for your food service operation, you are responsible for providing potable water to meet you operation’s needs.  \nPlease coordinate with your event organizer and plan accordingly.  \nElectrical capacity at the event will be sufficient to run all food service equipment throughout the event.  \nNote: If your event organizer does not provide enough amperage to power your equipment without triggering breakers, you must provide a generator to meet your operation’s needs.  \nPlease coordinate with your event organizer and plan accordingly.  \nAll garbage and wastewater generated during the food service operation will be handled in a sanitary manner. Garbage will be kept in cans or ","cbCairW5B9cBBF5m","https://ap.wps.com/l/cbCairW5B9cBBF5m","pdf",740953,"English","# Section A: Owner/Operator Information\n## Permit Application Information\n# Section B: Events for Which Permits Are Needed\n# Section C: Foods (Names, preparation, and hot/cold handling)\n# Section D: Workers' Compensation and Disability Insurance\n# Section E: Signature and Office-Use Review\n# Temporary Food Service Setup Checklist\n## Water, electrical capacity, garbage/wastewater\n## Handwashing, toilets, dishwashing, lighting\n# Food Handling During the Event","[{\"question\":\"What information is collected in Section A for the owner or operator?\",\"answer\":\"Section A requests owner/operator details including operating corporation, person in charge, legal address, contact information (phone and email), and identification information such as SSN or EIN.\"},{\"question\":\"What does Section B require applicants to list?\",\"answer\":\"Applicants must list all events that need permits, including the event/location address, operation name, and dates/hours of operation.\"},{\"question\":\"What worker-related insurance documentation is required in Section D?\",\"answer\":\"Section D requires proof of workers’ compensation and disability insurance coverage, either by providing specified insurance forms showing coverage or, when not provided, an exemption-attestation form.\"}]","Application for Permit(s) to Operate Temporary Food Service - Cattaraugus County Health Department - Section A-E | PDF",1790922432,23]