Application Date:

Check box for all individuals to receive copies of Health Department Plan Review Letters and other correspondence.

Date construction is to start:

Date of planned opening:

Establishment Information

Name of Establishment: Phone: Street Address: Cell: City: Fax: State/Zip: Email:

Business/Ownership Information

Individual(s) or Corporate Name: Phone: Street Address: Cell: City: Fax: State/Zip: Email:

Contact Information

Name of Primary Contact: Phone: Street Address: Cell: City: Fax: State/Zip: Email: Name of Architect: Phone: Street Address: Cell: City: Fax: State/Zip: Email: Name of Contractor: Phone: Street Address: Cell: City: Fax: State/Zip: Email:

Environmental Health

Retail/Wholesale Food

Plan Review Application

Questions? Contact Kerwin Nance at Kerwin.Nance@denvergov.org.

www.denvergov.org/PHI Revised April 19, 2017 Department of Environmental Health

201 W. Colfax Ave., Dept. 205, Denver, CO 80202 Phone: 720-865-2832

Page 1 of 16

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Indicate number of seats in each area:

Indoor: Outdoor:

Below is a checklist of required information needed to complete the plan review. Please ensure all information is included.

*Lack of complete information will delay review and plan approval.*Facility Floor Plan/Equipment Layout Site Plan (pg. 11)

Equipment Specifications (pg. 5) Chemical and Personal Storage (pg. 11)

Menu / Product List (pg. 11) Fixtures Requiring Hot Water

Plans and Sched ules Plumb./ Elect./ Mech. Plans and Sched. (pg. 10)

Type of Retail Food Establishment (Check all that apply.) Full Service Restaurant Bar Fast Food Coffee Shop

Market (Grocery) School Food Program

Deli Catering Operation

Fish Market Concession

Meat Market Manufacturer with Retail Sales Convenience Store Marijuana Dispensary/ Retailer Specialty Shop Marijuana Infused Product (MIP)

Animal Concept Facility Other:

Square Footage and Area Location *If the establishment is in a multi-story structure, indicate on which floor the area is located.

Please indicate square footage in each area Square Feet (ft2) *Floor

Total Square Feet of the Establishment Total Square Feet of the Kitchen Area

Square Feet of the Food Preparation and Dishwashing Area(s) Square Feet of Food/Beverage Storage Area(s)

Square Feet of Retail Sales Area (Markets)

What type of project is this?

Please describe scope of construction work.

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I. FACILITY FLOOR PLAN/EQUIPMENT LAYOUT:A. Submit floor plans drawn to scale that include the location and identification of all

equipment, plumbing fixtures and storage areas that may apply to the establishment.Check all that apply.

Days and Hours of OperationIndicate hours below in the following format: 8am to 8pm

Days Sunday Monday Tuesday Wednesday Thursday Friday SaturdayHours Hours

For seasonal operations, please circle all that apply

Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sept

Add additional information (if necessary):

Projected daily maximum number of meals to be served per shift, where applicable. Breakfast Lunch Dinner

Maximum number of staff per shift, where applicable. Breakfast Lunch Dinner

Floor Plan/ Equipment Layout Hand sink(s) Dry Storage Area(s) Chemical Dispensing Unit(s) Food Preparation Sink(s)

Ice Bins/Ice Machines Ventilation Hoods(s)

Utility Mop Sink(s) Wait Stations Chemical Storage Areas

Dump Sink(s) Bar Service Area(s) Recycled/Damaged/Returned Goods Dish machine Water Heater

Location(s) Personal Storage Area(s)

3-Compartment Sink(s) Indoor/Outdoor Seating Dipper Wells

Toilet Facilities Outdoor Cooking/ Bar/ Patio

Grease Interceptor/ Grease Trap

Floor Sinks/ Floor Drains

Buffet Lines Laundry Facility Locations

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Provide or use the finish schedule in Table 1 below to indicate interior finishes for each area within the establishment.

Table 1

ROOM FINISH SCHEDULE

Room Name Or Number

Floors Wall Finishes Ceiling

Finish Material Type of Base North East South West Material Finish

Example: Kitchen

Quarry Tile Quarry Tile FRP FRP FRP Stainless Vinyl Acoustical Tile Smooth

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I. EQUIPMENT SPECIFICATIONS:A. Submit equipment specification sheets, including make and model numbers. All equipment

shall be of commercial design. If the specification sheet lists more than one piece ofequipment, identify the specific equipment to be used.

B. Provide information on refrigeration/freezer capacities and hot food holding units bycompleting Table 2 and Table 3 below.

(Table 2) (Table 3)

C. Bulk and self-service food:

1. Will bulk food items such as candy, trail mix, etc. be sold in a retail manner to the

public?

If yes, please submit equipment specifications for bulk food bins.

2. Will self-service foods (e.g., buffets and salad bars) be provided?

If yes, please submit equipment specifications for food shields and/or sneeze guards.

D. Please provide installation information for all equipment in Table 4 on next page.

Refrigeration Capacities

Type of Unit # of Units Total Cubic Feet

Walk in Refrigerator

Walk in Freezer

Reach-in Cooler

Open Top Sandwich Cooler

Reach-in Freezer

Blast Chiller

Retail Display

Other:

Hot Food Holding Units TYPE OF UNIT # of Units

Steam Tables

Hot Box

Cook & Hold Units

Other:

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(Table 4)

Equipment Installation List

Installation Method

Floor- Mounted

Counter/

Table-Mounted ID

# on

Plan

Equipment Make/Model

New

(N) /

Used (U)

Plumbing

Required Yes /

No

Casters

Legs: 6”

Sealed In

Place

Portable

Legs: 4”

Complete the following table to indicate method of equipment installation or attach an equipment schedule, including display units. *Note: Under "Installation Method," check all that apply.

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II. PLUMBING PLANS AND SCHEDULES:A. Submit a plumbing plan that indicates location and specifications of the following:

1. Floor sinks and floor drains2. Restrooms, toilets, urinals and hand washing sinks3. Grease trap, grease interceptor, or solids interceptor, if required by the local building,

water or sanitation authority4. Hose bibs and hose reels, if applicable5. Laundry facilities, if applicable6. Showers, if applicable

B. Complete Table 5 below for all plumbing fixtures and equipment in which food will beplaced that will drain to sewer. Indicate if fixtures or equipment will be indirectly drained(e.g., floor sink or air gap), directly connected to the sewer, and/or what method ofbackflow prevention will be used, if applicable. If additional equipment is provided, pleasespecify in the table below.

(Table 5)

Note: Approved backflow protection must be supplied on all fixtures and equipment with submerged inlets. Vacuum breakers must be installed on water inlet lines for dishwashing machines, garbage disposals, and hose bibs. Continuous pressure backflow protection devices must be installed on water lines where a valve or shut off is located between the backflow device and the inlet to the fixture/equipment, such as hose reels.

ID # Fixture or Equipment Indirect/Direct Drainage

Method of Backflow Prevention

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C. Is a dedicated food preparation sink provided?

If yes, please attach a specification sheet for the sink(s) and provide the followinginformation.

a. Is more than one food preparation sink provided?

If yes, are they indirectly drained?

(Table 6)

ID# on Plans Length of Drain board Dimensions (Inches) of compartments of sinks (LxWxD)

D. Is a garbage disposal provided?

If yes, please indicate the location(s).

E. Food/beverages will be primarily served on:

F. Indicate the locations of drink dump sink(s) installed in areas where soiled drinkingglasses are emptied and staged for ware washing:

G. Complete Table 7 and Table 8 for ware washing:Will alternate equipment or methods be used in place of traditional drain boards?

If yes, indicate the methods that will be used and provide specification sheets:

Food Preparation Sink Information

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1. Manual - Include the size of each compartment (length x width x depth) of the warewashing sinks, soiled and clean drain board length, and whether or not a pre-rinsespray hose will be installed for each ware washing area, including bars.

(Table 7)

Note: An indirectly drained 3-compartment sink is required in all new or extensively remodeled facilities. Ware washing sinks must be large enough to accommodate the largest piece of equipment or utensils used. **Drain boards for primary ware washing sinks must be 24’ or greater. Bar sinks require a minimum of 18’ drain boards. If these dimensions are not met, an approved alternative method must be used.

2. Mechanical - Provide make and model numbers and attach specification sheets for eachwarewashing machine. Please indicate if the machine(s) is heat or chemical sanitizing.Indicate soiled and clean drainboard length, whether or not a pre-rinse spray hose willbe used, utensil soak sink dimensions and water usage in gallons per hour (GPH).

(Table 8)

a. Is a booster heater provided?If yes, please complete Table 9 below:

(Table 9)

ID or Code on Plans

Length (“) of Soiled

Drainboard Dimensions (“) of Sink Compartments (LxWxD)

Length (“) of Clean

Drainboard

Pre-Rinse Sprayer Yes/No

Mechanical Warewashing Information

Make Model # Heat/Chemical Sanitizing

Drainboard Length (“)

Pre-Rinse Yes/No

Utensil Soak Sink Dimensions (“) (LxWxD)

Make Model # kW/BTU Rating Distance from Machine (ft)

/Water Usage

(Racks per hour) x

(Gal. per rack)

Booster Heater Information

Manual Warewashing Information

*Bar 3Comp. Sink

*Conveyor Dishmachine

*Conveyor Dishmachine

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H. Indicate type of water heater or heating systems servicing the facility.

I. Provide the following water heater information in Table 10, Table 11 or Table 12 , whereapplicable. (Please attach specification sheets.)

If more than one water heater is servicing the facility, please indicate the number of heating systems and which plumbing fixtures each heater or system will service.

Specify multiple heating system combinations:

(Table 10)

(Table 11)

(Table 12)

*Note: For instantaneous/tankless systems when a dishmachine is used, a properly sized storage tank (minimum 20 gallons), recirculation line, and an aqua stat (water thermostat) must be installed. For facilities with high-temperature dishwashing machines, use 100F rise. For all other facilities, use 80F rise. If flow rate in GPM is not provided, contact the manufacturer to obtain the information.

III. MECHANICAL PLANS AND SCHEDULES:A. Provide plans and schedules that indicate the location and specifications of ventilation

hoods and restroom exhaust fans. The ventilation schedule shall include exhaust capacities(CFMs) for all hoods and exhaust fans, including ventilation systems in restrooms. Indicatethe volume of outside air each roof top and make up air unit will supply into the building.

Make/ Model# Recovery Rate @ 100F Rise KW/BTU Rating

Make/ Model# Recovery Rate @ 100F Rise KW/BTU Rating

Make/ Model# Manufacturer Max. Flow Rate (GPM)

Flow Rate (GPM) @ 80°F

Flow Rate (GPM) @ 100°F rise

Storage Tank Capacity (Gallons), if applicable

Standard Tank Type Heater

Heat Reclaim System

Instantaneous/Tankless Systems (Gallons per Minute or GPM)Please indicate which required degree rise will be used in the flow rate column: 80F or 100F.

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IV. SITE PLAN:A. Submit a site plan which includes the following:

1. Refuse enclosure(s) and trash compactor(s)2. Outside walk-in cooler(s)/freezer(s)3. Outside storage area(s)

V.CHEMICAL AND PERSONAL STORAGE:

A. Submit the proposed locations of chemical and employee personal item storage areas.

VI. PLUMBING FIXTURESProvide the number of plumbing fixtures requiring hot water in Table 13 below. This information will be used to determine hot water demand within the facility and sizing criteria for the water heater.

Table 13: Number of Plumbing Fixtures Requiring Hot Water

Plumbing Fixture Requiring Hot Water

Number of Fixtures throughout facility

Menu and Food Handling Procedures A. Please submit menu(s) or detailed product list, such as breakfast, lunch and dinner menus.

B. If SOPs (Standard Operating Procedures) or Food Handling Procedure Manuals thatdescribe food preparation procedures are available, please submit with plans andverify that questions C-M (below and on next two pages) are addressed. If not,please provide responses in the corresponding sections.

C. Will vacuum packaging/reduced oxygen packaging or specialized processes as defined inSection 3-606 and 3-607 of the Denver Retail Food Establishment Rules and Regulations be conducted?

3 comp sink(Alternate) 3 comp sink

2 comp sinkUtensil soak sink

Dish machineConveyor pre-rinse

Clothes washer (9-12 lbs.)Clothes washer (16 lbs.)

Hand op pre-rinseHand sinks including restrooms

Mop sinkGarbage can washer

ShowerHose bib

Preparation Sinks

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If yes, please provide specifications sheets for the equipment that will be used and a copy of the required HACCP plan for each category of food to be processed in this manner.

D. Will potentially hazardous foods be rapidly cooled to 41ºF (5ºC) or below?

E. What method will be used to rapidly cool potentially hazardous foods? Indicate all thatapply.

Specify other methods:

List the foods that will require rapid cooling. Include foods that are made from scratch such as soups, sauces, potato salad, pastas, chili, noodles, roasts, casseroles, sausages, yogurts, etc.:

F. Will potentially hazardous foods be reheated and then held hot before being served?

If yes, please explain how they will be rapidly reheated to above 165ºF (74ºC) within 2 hours. (Reference 3-504 Reheating in the Denver Retail Food Establishment Rules and Regulations .)

1. List the equipment that will be used for reheating:

G. Indicate how frozen foods will be thawed. (Reference 3-601 Thawing in the Denver Retail Food Establishment Rules and Regulations.)

Specify other methods:

H. Will raw meats, poultry, or seafood be stored/displayed in the same refrigerator(s) and

freezer(s) with cooked, ready-to-eat foods?

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I. Will catering be conducted?

J. Will food be transported or delivered to another location?

a. If yes, please list the equipment that will be used to maintain food at propertemperatures during transport.

K. Will a salad bar, buffet line, omelet station, sauté station, carving station, beverage bar or customer self service areas be operated?

L. Will produce be washed?

M. If not, will produce be received commercially pre-washed?If yes, please provide additional documentation verifying the source of the produce (an invoice stating produce is pre-washed, written statement from distributor, etc.).

N. Will the establishment prepare foods that will be sold wholesale?If yes, please visit www.colorado.gov/pacific/cdphe/food-regulations and click on

"Wholesale food."

O. Will marijuana infused products be manufactured, stored, or sold?a. If yes, please provide a separate list of edible products that will be manufactured and

sold.

P. Will marijuana extraction processes be used to produce marijuana concentrate?

Q. What will the marijuana extraction products be used for?

R. Will marijuana extraction products be sold wholesale to other MIP kitchens for edibles?

If no, please provide a written signed statement verifying that all extraction products are meant for non-edible products and will be properly labeled.

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S. Please provide description of tasks conducted in each room associated with foodpreparation, dishwashing, and manufacturing and packaging.

T. Will there be table service provided in the outside seating area or patio?1. If so, please indicate size of patio area in square ft.

U. Will dogs or pets be allowed in outside dining area or patio?

Plumbing Fixture

Water Usage (GPM)

Number of Fixtures

Water Demand Flow Rate in (GPM)

3-compartment sink* 23-compartment sink (Bar) 2Utensil soak sink or 1-compartment sink 1Dishwashing Machine 4Dishwasing machine conveyor pre-rinse 2Clothes washer 2Hand operated pre-rinse sprayer 2Food preparation sink 1Hand washing sinks 0.5Mop/Utility sinks 2Garbage can washer 1Showers 1Hose bib used for cleaning 5

Altitude Adjustment ElevationAdjustment FactorNumber of heating units required (80F rise)Number of heating units required (100F rise)

Tankless Heater Calculation

Flow Rate (GPM @ 80F rise)Flow Rate (GPM @ 100F rise)Manufacturer's Max. Flow Rate

*Use spec sheet rating, or 0.75 if spec sheet is not available.* Please note that plans will not be approved if recovery rate of the water heating system @ 100F rise does not

meet or exceed Total Water Demand for required fixtures. Additional information required for heating systems not meeting these requirements.

Total Water Demand (GPM) required

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Water Usage

to

to

Efficiency rating of hot water heater (**0.75 - 0.90)

Total water (gph) required by all fixtures

Electric Water Heater

Gas Water Heater

BTU RatingAllowable Range

Kilowatt ratingAllowable Range

Max. Hourly Hot Water Usage

Adjustment FactorMax Hourly

Requirement (GPH)

**Use spec sheet rating, or 0.75 if spec sheet is not available.** Please note that plans will not be approved if recovery rate of the water heating system @ 100F rise does not meet or exceed

Max. Hourly Water Usage for required fixtures. Additional information required for heating systems not meeting these requirements.

Standard Tank Hot Water Calculation

3-Comp.Alternate 3-Comp.

2-Comp.Utensil Soak

Width (in)Length(in) Depth (in)

# of Fixtures

Fixture

Water Usage (GPH)Plumbing Fixture

3-comp sink(Alternate) 3-comp sink

2 comp sinkUtensil soak sink

Dish machineConveyor pre-rinse

Clothes washer (9-12 lbs.) Clothes washer (16 lbs.)

Hand op pre-rinseHand sinks including restrooms

Mop sinkGarbage can washer

ShowerHose bib

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