88-2016 . . � � ������
UIVISION OF LICENSE AND PERMIT ADMINISTRATION DATE / Gj
INTERDF.PARTMFNTAL REVIEW CHECKLIST Appn rocessed/Received by
Lic Enf Aud
�' I �
ApplicantT� �Q��,�I��,`,,,,� �y� , Home Address �..� �i l (S �v��•
Rusiness Iv'ame �('j� Home Phone �{��"'�'�
Business Address s(9� W • �o�.� I[,��..�Type of License(s) �lti �-�., ��
4"_-T
Business Phone � � �' C �,�ftr4� �,�_�r � (`�1�L!' . (�11T�. ,
y=T
Public Hearing Date � �Io�License I.D. 4� � ���(� B
at 9:00 a.m. in the Council Cham ers,
3rd floor City Hall and Cou thouse State Tax I.D. �C �j 3 ��`Z��
I�.� �� ���) �/�
llate Nutice Sent; Dealer �� YI �
to Applicant —
I'ederal Fi.rearms 4� I� (�
Public Hearing
DATE II�'SPECTIUN
REVIEW VERFIED (COMPUTER) CUMMENTS
Approved Not A roved
�
Bldg I & D +
�0� 5- �
Health Divn. �
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Fire Dept. j � �
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Police Dept. (� I I
13
License Divn. l �
ib� � � K
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City Attorney � �
l� a ,
Date Received:
Site Plan �� ��
To Council Research Z (,F
Lease or Letter ate
f rom Landlord ��I �
CURRENT INFORMATION NEW INFORMATION
Current Corporation Name: New Corporation Name:
Current DBA: New DBA:
Current Officers: Insurance:
Bond:
Workers Compensation:
New Officers:
Stockholders:
.�L__-:.aS� �. � " tl_ ' 7[�: �•..'tfi��1��'{� .. i� -r�-....� se � -• .s. - ' . _.. '.... -, .� r . _.
. .. .y::.. . - . .��'.�:� ^a['�i-i'Y'.w'Qq-.+.P.. .•�
. • � � City of Saint Paul � ������.,J�
Department of Finance and Management Services
' . License and Pennit Division
� . ������
, . .. � ' � 203 CRy Ha11
- St. Paul,Minnesota 55102-298-5056
- APPLICATION FOR UCENSE
�-�.CASN CHECK CLASS NO. ,�;e,�F , New Renew . . ., � _ -_ - . _ .
r � � � � ' � � . " : .
. • Date 1�
"' � Code No. Title of Ltcense . . : - From 19��0 �—� 1�
_ . +
• 1� �Gx��l�C/�e, �:�
.' ^ � Appllean7ComPany Nam� ,
` 100
;:.. � 9 � °� �J ,��e.. .
100 - Business Name
,:. , •
� . :.� ,00 � �. C��
..� — ;- - . . BuslnnsAddnss �_-���/" _ 'S„5, ��O
�. to0 �
_ / .��� ��• ��
100 Mail to Address Phone No.
.
100 Q�
� ManaqeHOw •Nam� ' rJ�_
100 7
/� •�°�'`f
.
100 � �anayeHGwne►-HamAddresa Phon�No.
��.'_:� 4pgg Application Fee - . . ' - " �
2. 50 :
o-t R eived he Sum of 100 ' �G�^� �� � �/�• ��3��
Li2�'-G�/ � • -�_ManaqerlOwnar.c�c�.siace a no co�
100 �<+�'- ,.;Total . 100 �: .^: : .. .. '
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. :.
. .
, , . . .
Y�. . ' , '. - ,. ' . ` �-i� � -
�f' . .. ��. � � . � ••• ' �
:;�Licenae Inspector By: �qnatu�e of App�icant
_ _+
r'C�nd� . . _ � � � ' . . � � � .
. ..' .. �. ,{' . -. .�. . .
� , ' Company Name . Policy No. Expiration Oate
= (RSUf3�C@' . . .
-" . Compaey Nam� PoHCy Na Eupintion Oate
Y`Mtnnesota State Identlfication No. �����7d � Social Security No
: s:,� .
:�;. . .. . . . , .
� :� Vehicte Information: �
� S�ri�l Numb�r st� umb�r
� .
Other �
�;;�. THiS IS A RECEIPT FOR APPLICATION
THIS iS NOT A LICENSE TO OPERATE Your application tor Ilcense wili either be granted or reiected sub�eet to the provisio�a oi the zoning �-
ordinance and compietton of the inspections by the Hoalth, Fire,Zoniny andlor Licenss Inspectoro.
$15.00 CHARGfi FOR ALL RETURNED CHECKS
,��,� 9-� 8`� rnp
� � . � - ��ao��
, - , .
, CITY OF ST. PAUL
DEPARTI�AT � FIl�ARCE APD MABAG��"g�RU3C�S
LIC�lQSE ARD P�EtMIT DIYI:IOl�' : ':=:��
,
Theae ststement torms are iasued in d�plicste. Plcase aaseer all qnestions !tii],�y aad
com�plctely. This applfcstioa ia thoroug�ly c�cked. Any fal�ification �rill be csuse
for deaial.
Date Septesnber 8, lg 88
1. Applicatiou tor G c rv Gas Station License (yfaas�) (permi,t)
2. Hame o! a li cant ��
�P �a t / / �� ./1 FV'A/l Z rG. )
3. If applicsnt is/haa bean a mnrried female, list maidea nam�
4. Date of birth 7/13/5 5 Age 3 3 pince of bir�h A 11 e qan, �Iz
5. Are you a citizen of the United Statee yes Nsti�+e _ Aaturalized _
6. Are you a reg3stered voter ves Where North�ille, M.?
?. Home sddresa 116 8 8 Tho rnhi 11 Rd. Hame telephane 612 942-6244
A. Present business addreas 814 8 P i 11 s bury Ave, S Busiaess te
— lephme 612 881-4483
9. Including your present busineas/employmeat, v�at bnsiaess/ea�loyment bave yon
folloved for the past tive years,
Business/F}Rplaymeat Addresa
Total Petroleum, Inc. P.O. F3ox 500 Denver, CO 80201
10. Married yes It ans�rer is jrea", liat name and addzess ot apause
Patricia J. Mast 11688 Thornhill Road Eden Prairie, :�V 55344
II. !�tave you ever been arrested for an ot2'ense that has resu].ted in a coQViction!No
I! ans�rer is "yes", list dates of arrests, wl�ere, chargea, coirv�ictioas and
sentences.
• Date of arrest 19__ Where
r
CAAI?CE
CONVZCZ'ION �
Date o: arrest I9 Where
CHARGr
CDNV IC"�'iQi+ 5���
12. List the names and addresses (it married, name o! spanse also) of all peraona, �
cox�orations, partnerships, associations or organizationa wt�ich in a�r vUr have:
a. A mortgage interest in the l.icenaed premise, �
,
b. A security interest in tbe licensed premises, licenae, or lbraishings of the
licensed prtmise, / __
c. A prv�issory note for ltiulds loaned for the aperation o! th� licensed premise
or the pnrchase ot'the license, �!�24`-�t� �
d. Financially contzibut�d to the purchase of the premise or the license it-
self /12(�t,� /
e. Ar�y other interest eitl�er direct or indirect, either financial or otherwise
�
in the licensed premise or the license itaelf,
_��'�c.�.-�
Attach a copy hereto of aay and all decwnents nferred to in this aftidsvit.
. Lease Attached
1?. Give namea aad a�ddresses oP tyre persona, resideats of St. Psul, Mianesats, who
can give intormation concerning you.
RAI� AD�FSS
Ja�res P . Hill 1707 Tavlor, St. Paul, NIlV 55104
Scott Fisher 812 - 17th St., Newport, �I 55055
Z4. Addreas ot premises for �+hich License or Permit is made 568 W MaYyland
Addreas 568 W yiarvland, �t. F3u1, tM1 55117 Zoae claasificatio�
15. Betxeen what croas streets Kent & Danforth Whi=h side of street South Side
16. Na�e under xhich this busineas wrill be conducted Total
I7. Business telepho�e n�ber 612/489-9939
lQ. Attach to this application, a detailed description of the design, location, aad
square Pootage of the pre�ises to be licensed Concrete Block 420 sq. ft.
�9. �re oremises now occupied yes What business gas/c-store H� long
. . �. � � ���°��
. 20: , List license w!lich you currently hold, or former�y held, or mepr have an intere
in
NtP�20US
y
2I. Have arry of the licenses listed by you in No. 20 ever beea xvoked. Yes_
N� �Y_. If ansver is "yes��, list dstes aad reasona:
22. Do you have aa interest of ar�r type ia arLy other businesa oz busiaess premiaea.
I; ariswer is "yes", list business, busineae address aad telrptione �tumber.�
No
23. If business is incorporated, give dete of incorporation 2/6 19 36
and at�ach capy of Articles of Incorporation and miautes of firat meetiag.
2�. List all officers of the corporation giving their names, office held, h�e
address, and home and buainesa telephone numbers:
3Q3/?99-6601
Philippe Dunoyer, President - 2000 E 12th Ave., Denver, 00 80206 303/291-2085
. 3d3/771-2571
C. Gary Jones, Vice President - 5927 E Jamison Lane, Enalewood, CO 80112 303/2°1-2862
303/799-0?'93
Larrv C. Ross. Secretarv - 8749 E Otero Cr., EnQlewood, C�0 80112 303/291-2145
�
303/690-6137
R�nd Leeks, Treasurer - 14656 E Grand Ave., Aurora, CO 80115 303/291-2079
25. If business is partnership, list partner(s) addreas and telephone a�bers:
Name Address � Ztie1.Ao.
-
_
26. Ia there a�rone else wiio will have an interest in this buainess ox� premiaes?
Ir answer is "yes", give name, home addreas, teltphoc�e m�bers and in ahst
manner is their i�.erest: No �
27. Are you goin�; to operate this business personal�y �_ it not, vho xill vperate
it: P.O. Box SQO
Aame Total Petroleuan, Inc. Hane address Denver, �0 80i01 �1,�}03/291-2000
. � •
Are y�u going to have a Mana�er or assistaat in this business? It ansver is '
"yes", give naam and home address and home telrphone mimber:
1184 Mackubin #106
Name Robert Ristaw Home addressSt. Paul,''NIl�i 55117 T�e1.No612/489-4317
29. Has a�yone yau have named in ques�ions 22 thrau�h 25 ever been arrested? If
answer is "yes", list aame of person, dates ot arrest, vhere, cha.•ges, com�ic-
tions as�d sentence . No
30. I � understand this premise msy be in-
spected by t pol e, fire, health and other city ofiicisls at ar�r aad aLL
times When the business is in operation.
State of A+linnesota) �
��V�)SS
Couaty of &a�sey )
�Gc,t,c1 • G7,���¢� being first du�y srorn, deposes aad says upan
oath tha he h ad the �'oregoing statement bearing his si�ature and 1maKS the
conten�s thereo , aad that the same is true oP his mrn l�ovledge except as to those �
matters therein stated upon information and belief aad as to those matters he be-
lievts ttiem to be true.
Subscribed ar�d ss+orn to beloxe me
�j �i�/ Signa Applicant
this �_dey of lQ OD
������� �J�G�� MARLENE J.WALSTEN
,���
, NOTARY PUBLIC-MINNES07
Notary Public County, Minnesota �� DAKOTA COUNTY
�G�9c'''""`'� ires Feb.24.1991
MY Commias�on F.xP
'�y co�ission expirea
/
: ����: _
�„� . � _ . : �„�..�,� �� F�E�N
� , �, � ���'T �o. Q�02�4
��� : �����,
' r Christine Rozek � �� � �.M�►�� �3-c�«�
��°: � so�,o — �*� �C�;inci l `Resear�h
F i�ar��.& ., . ;. 298-5 56 .. . , o�: �":��. — : �
: � _ _ , . : .
, ; : _ '
Applic�tion `�or a Gas Sta+�ion to 3 Pumps l.icense:, 3 Add�tior�aal �t�nps
and an Original Container; License.
Notificatio.n Date: 12-5-88 t�earing Date: 12-2o-s8 �
:
,�o�c�ov�.w a�c�� ��:
a�a►wr�o co�+wroeioH. ; Gvic:sr�vicE�ori ; o��w o�rE art : vsr w+or�►�. >
, (
�ow+o oa.�.�o�+ �o a�s�oa.e�o � _
BfAFF. � . �. . GMIiTB1��N i � � CAMPLE7E AS i3 � � AqDL MF0.ADDED+ . � RETD 70 OONTA�'f. �. .
. . � � . �; � _ . . � _'f+OR ADD'C 11'IFO. . _FEE08110K ADOED t..
� �-D�C�4E7CENCL ... . � . � . . � _ � . . ' �
. .. *EXPUN�TION: . . ..
� � BUPPOrtf�MMICli COINCL 0l,I�CTIVE4 � . - � � � . -� . � � �� � . . . - . .
- �L�7.�J�[.�.w Q i
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_ �
: Total Petroleum Inc: DBA 'Tota1 requests Councij appr al of its application
' �� ; :for t�e.:�tao��:l'icenses at 568 W. Maryland. ` `
� : . �
;..
�
, :
. .:.�.+a�tc�arue.n.w. ' �ar. < . . 4 :; ; ; . �
All f�es a�d :application have been subm�tted� A11 required depar�+ts -
Zoning, H��1-th, Fi re,� Po�i ce and Li censa:n #�ave given tlae�r ap�rovai .
_ 9`
! ,
; _
,
„- .;c�c,�s:tw�r.we.g.,�,a so w�: _ . .: �
..
. . i
If Council ap�roval is g�ve�, Tota� Petroleum Inc. wi�1 ape�^ate th� ' � �
business at 56S W. Maryl�rtd. ' :
, . E � .,.
; - ,-_;.
: - ;, � ;; - - �
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��w►n�.:. �, , rnos , ao�s , _ !
C�unc � E�e����:.���;� �Y;�ter ,
, . . . a:,
,;
. . . _ �'� (� ��88 �. _
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NOTE: This station was previously operated `
,
3
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, _ .
'�.eok.rwe� ; :
_ ; ,
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�;t�RY .R�CAQA�A?10M/�lM�li'�Pi A1.S: " s-' �
STAIfFt10LDERS,(L�9t) P08fIlON t+,—.�) 'i �MIILL TES11FY4(Y!N),>. HI►710qALE(S�mnri�Win Mqmow�ls)
/
� '�MtsvVa� ��P�� ��. � � . F1R3T YEAR(Stmt Date). � - . '�ND VEl1A NOTE3: .- .
t.
OPERATNO OIIDGETc �
REVENUES(�ENERATED
. � 1, � ....................:...................._ ..a.... , ,
. � . , ,
EXAEN$ES:
. = . -
Salariea/Fri�e Benefi�........................................................ _ . _
E4��t�............... .:.�..... .:...... .:...::i ......... . � .
, _ . , . ..
�PP�g.............. ... .. ... ... ..... ,
Corriracds for Service............. ........ , . . :
Other _
.
PROFi7'(1�) ................................................................................ , , _ , . :
FUNDIfIfi 80URCE FOR ANY L08S(Name end Amount)
CAPITAL iMPROVEMENT BtlDOET: �
DESKK�iN COSTS '
_ ACQINSITION OOS7'S
>:- , .,
CANSTRUCIId�I COSTS ....._.........................................................
;
TflTAL......................:.........................................
souACE oF Funowci p�arne�d anounc>
�aCT oN euna�:
AMQUMT CURREMiLY QUD6ETED......:.......:........................:::....
.,,, .. . .
AIAOUtiT IN EXCESS OF CURRENT BUDOET ... _ . , ., _. ,: ,.
SOURCE OF AI�UNT QMfR 8l1DQET........................................ ` ' - .''..-
- PROPERTY TAXE$Pa�111ER/4TED iLOST) ......... �
MAPLEIAENTA7TON RESPON�BILITY: .
�pr�t�� av�on FuN�n�
BUDOET ACTNITY N R 8 TITLE ` ' ACTIVITY MANAGER `
lIOW PERFOiiMANCE WILL BE MEASURED?:
MiOORAM 08JEC71VE3: PROGRAY II�ICATORS • 1ST YR. 2MD YR:
EYALUAiION RESPO�N.RY: , . . . . .
PERSOr� oEPr. _ wioNE No. REPORT TD CO(�ICiL dF oArE .
F/NiT pIGRTERLY