87-1622 WHITE - CITV CLERK
PINK - FINANC�E GITY OF SAINT PALTL Council /1
CANARV - DEPARTMENT t �� //��
BLUE -MAVOR . FI1C NO. �r�
�
cil esolution
Presented By ��
Referred To i� Committee: Date
Out of Committee By Date
RESOLVED: That Application (I.D.#600 0) for a General Repair Garage
License by Old Volks Home nterprises DBA Old Volks Home
at 440 Sibley Street be an the same is hereby approved.
COUNCILMEN Requested by Department of:
Yeas �Dfi�ii► Nays
Nicosia
Rettman In Favor
Scheibel
Sonnen � Against BY
weiaa �OV i 0 1987
wilson
Form pproved y y rney
Adopted by Council: Date
Certified Ya.s by Council Sec ar BY
By
r ���b 1 � �� ppproved by Mayor for Submission to Council
Approve y Mavor: Date
By
PL�.4��,� =��� �<- � �_ i���
, . �����
- ` .N.° 011393 �
�i.v�a..�,�._ ,� �.,.._-� .�;.,�DEPARTMENT - - - - - - -
'°i� :__ ��. _ _, a s - �--� CONTACT NA1�IE � ,.
�k u - S o�(v PHONE
�c�1 i s L �c 7, DA'FE
ASSIGN NUMBER FOR ROUTING ORDER: (See rever a side.)
_ Department Director ,_ Mayor (or Assiatant)
_ Finance and l�ianagement Services Director � City Cler�
_ Budget Director ;Z �._� ,� . .a
t City Attorney _
TOTAL NUMBER OF SIGI�ATURE PAGES: (Clip all locations for signature.)
W T 0 C ? (Purpose/Rationale)
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CO T T U AND P RSONN L
1 l`�
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I C G SO UDG C V C T •
(Mayor's signature not req�ired if under $10 000.)
Tota1 Amount of TransBction: n�� Activity Number: r � L� '
Funding Source: '�`P,-
ATTACHMENTS: (List and number all attachmen s.)
',�.�°�.z`"�
��.��.�-U-,
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�4DM�STRA.TIVE PROCEDURES Y� I�
_Yes _No Rules, Regulations, Proced es. or Budget Amendment required?
_Yes No If yes, are they or timeta e attached?
DEPARTMENT REVIEW CITY ATTORNEY REVIEW
�Yes _No Council resolution required? Rasolution required? _�es �Na
_Yes �No Insursnce required? Insurance sufficient? _Yes _No
_Yes �No Insurance attached?
��: xo� �a oss '����F�? ,
� . .. .v �,.�d.�
The G�EEN SHEET h�s� thrae �18POSES: .
1. to assist in rauting docvments and in securing required signatures;
2. to brief ttie ravieaers af documents on the impacts of appronal;
3. to help ensure that necessary supporting msterials are prepared and, if required,
� attached. .
Providing complete information under the listed headings enables revieaers to make
deciaions on the documents and eliminates folloa-up cantacts that may delay execution.
BeloN is the preferred ROUTING for the five most i4requent tppes of documents:
CONTRACTS (assumes authorized budget exists)
1. Outside Agency 4. Mayor
2. Initiating Department 5. Finance Dir�ector
3. City Attorney 6. Finance Accounting
Note: If a CONTRACT amount is les� than $10,000, the Mayor's signature is not required,
if the department director signs. A contract must alpays be signed by the outside agency
before routing through City offices.
�MiNISTRATIVE ORDER (Budget Revision) ADMINISTRATIVE ORDER (all others)
.1. Activity Manager 1. Initiating Department
2. Department Accountant 2. City Attorney
3. Department Director 3. Mayor/Assistant
4. Budget Diractor 4. City Clerk
5. City Clerk
6. Chief Accountant, Finance and Management Services �
COUNCIL RESQLUTION (Budget Amendment/Grant Acceptance) COUNCIL RESOLIITION (all others)
1. Department Director 1. Department Director
2. Budget Director 2. City Attorney
3. City Attorney 3. Mayor/Assistant
4. Maqor/Assistant 4. City Clerk
5. Chair, Finance, Mgmt. , and Pers. Cte. 5. City Council
6. City Clerk �
7. City Council
8. Chief Accountant, Finance and Management Services
, The COST�BENEFIT. BUDGETARY. AND PEASONNEL IMPACTS heading provides space to explain the
cost/benefit aspects of tha decision. Costs and benefits relate both to City budget
(General Fund and/or Special Funds) and to broader financial impacts (cost to users,
homeowners, or other groups affected bq the action) . The personnel impact is a description
of change or shift of Full-Time Equivalent (FTE) positions.
The ADMINISTRATIVE PROCEDURES section must be completed to indicate whether additional
administrative procedures, including rules, regulations, or resource proposals are
necessary for implementation of an ordinance or resolution. If yes, the procedures or a
timetable for the completion of procedures must be attached.
SUPPORTING MATERIALS. In the ATTACHMENTS section, identify all attachments. If the Green
Sheet is �ell done, no letter of transmittal need be included (unless signing such a letter
is one of the requested.actions).
Note: If an agreement rsquires evidence of insurance/co-insurance, a Certificate of
Ins�rance should be one of .the attachments at titne:of .routing. ;
No e: Actions �hich require City Council resolutions include contractual relationships
with other governmental units; collective bargaining contracts; purchase, sale, or lease of
land; issuance of bonds by City; eminent domain; assumption of liability by City, or
granting by �City of indemnification; agreements �rith state or faderal government under
which they are providing funding; budget amendments.
, � , (�-�-,����
rc DIVISION OF LICENSE AND PERMIT ADMINISTRAT ON DATE �.SS"1 /��
INTERDF.PARTMFNTAL REVIEW GHECKLIST Appn Processed/Received by
Lic Enf Aud
Applicant ��� Uc�l1LS �,�_, �,,,�.e�p Home Address j�Z � �� ,�� �-�
�� �� �_�.c�-o c73 g
Business IvTame ����;l ����� -�vt_� Home Phone �a(� - a�73�
Business Address ��� Type of License(s) C��.�,,�,�,_Q,_��,� LA 1�yr�,,`�_
Business Phone �ZZ- �I i 1 �/kv� •
Public Hearing Date License I.D. 4� ���QQ�
at 9:00 a.m. in the Council Chambers,
3rd floor City Hall and Courthouse State Tax I.D. �� ?j�� ��5 GJ
llate nTOtice Sent; ��� Q Dealer �l n `A�
to Applicant ��'� �`�� �
Federal Fj_rearms �� � (�-
Public Hearing
D�1TE INSPECTIO
REVIEW VERFIED (COMPUT R) COMMENTS
Approved Not A roved
�
Bldg I & D �v I +
� (�
�
Health Divn. '
I
� _ (�.� .
�
Fire Dept. i �
� � �/�� �
I (
Police Dept. I
License Divn. 101 �
�� � � �
City Attorney �
f
Date Received:
Site Plan
To Council Research �(� l i � � �� �J
�ease or Letter Date
rom Landlord
/ r�e,�,-> O l {<5�t`3
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. �.. . �,.,..�-. -., . . - .. _ r .. . . � . . .. . .-- .-.... .- . . .. . . . .
� ..
CURRENT INFORMATION NEW INFORMATION
Ctirrent Corporation Name: New Gorporation Name:
Current DBA: New DBA:
Current Officers: Insurance:
Bond:
Workers Compensation:
New Officers:
Stockholders:
- -.�----y�; - ��=�y'/���
,; -� c�^% eF T. Dh�L
��a�aaT � r�cE r�raxAC�.►�r s�rtcFs
LICENSE AND DIVISIJN
These statement °or..,s are issued in d�aglic te. Please ansuer sli questions Ptil.�y and
completely. T!:is appl?cation is thoroug checked. Any Palsification will be cause
Por denial. .
�ate � - (� 19 �
1. Application •.°or � � ` -..���,�� ,�A (License) (Permit)
2. Name oP applicant �p v�"� 1'
, If ap�l�csnt is/has been a married °e le, list ma.iden nHiaC
!+. Date ot birth � l - 3Cj - � Age Place oP birtt� S� ��Jl�.�
i
5. Are yvu a c?tizen of the United Siates v�s Rative � Aaturalized
�. Are you a registered voter ��_ Where L! U(� ( �r : (�1 �
'. Home address � I �-�-�� Home telephone 4 �o�0?1�
A. ?resent business address �� �j�' � 3usiaeas teltphone G���
9. Including yoi:r oresent business/emol n�, what business�employme� have you
fo?lo�+�ed for the past Pive years.
9usiness/Fa,ployment Address
m� �-4-U O 51 �L�� �� �1 ��tL.
Z0. Married � Zf ans�er is "yes", list sme and address o! spouse
� � G I+ T �U rn� a�A�
:I. ?iave you eve� been arrested Por an o£Pe se that has resulted in s comrictioa?��
It ansz+er is ",yes", list dates of arres s, vtiere, ct�arges, convictiona and
sentences.
iJa.te o.* a:rest 19 Wh re
CFiEtiP.GE
CONVT_C"IOl�' SF�ITENC'E
�te �° a:�rest i9 �ther "
C?�.RGr
C�IVVI�:""_�:' SE�:ICC''�'
. ���7���
12. List the na►aes an; a3cresses !i.° ied, narae oP spouse also) of a.IZ per�sons,
Corporat:ons, ��•*aerships, assoc ations or org�nizatfons Which in ar.y �ray have:
T�14(.)1(.� Kx�PAU�
a. A mor*�age interest in the Li eased pre:cise, (�'}(�.Q�'� {��.'3��/.ky�
G f�ec.0 s�
b. A security interest in the i� 2r,sed premises, license, or Purnishings of the
licensed premise, � .
c. A pr�issory note for funds aned tor the aperstion of the licensed oremise
or tbe purchase oP �he licen e,
3. �'�nancial'_y contributed to t e purchase of the oremise or the license it-
sel_° —
e. P.ny otner interest either di ect or indi:ect, e:ther °inancial or otherrrise
i
in the licensea premise or t e license itself, — �
=.�tac�: a copy hereto oP any arid a11 d ;,^:ments rePerred to in t:�is affidavit.
1?. Give names and addresses of t:�o persons, residerrts oP St. Paul, Minnesota, w�io
can give infarastion concerning you.
PiAME ADDRFSS
s��� cia`� �t�2�u�oc..r- �
�mo��� �n �
!�. Address o_° premises Por xhi,ch icense or Pe�it is made
Acdress 4�0 �l�-E� 5T r �p�.�� R1� ?one classi°ication rJ S
'_5. 3etween What cwoss streets �- ��� �Thich side of street��,�,1
i6. �a�e under Which this business will oe conducted ()�jJ vd LKS M1rY1�
?^. 9+isiness telephone munber o� �� � �
1?, Attach to this applicat'_on, a etailed descrigtion of the 3esign, location, and
sauare °ootage oP the pre*nises to be Iicensed �(��� SC1 ���
--� `1'�t.t O► � t cn . u�
'?. �re �remi ses noW occ��ied what b�.siness(.�(.O V�.KS (-�im E N��' �on� ��_��O
` -,:.f' � C��/��
' ' � 20. List license w+:ich you cu_Trently h ld, vr Ponaer�,r held, or may have an intere
� � in �
�l C �1�St�' � � T � i
_ '- � U
21. Have any of the licenses listed by ou in No. 20 ever been revoked. Yes
No �_, If ansxer is "yes��, lis dates sad readona:
?_2. TJo you have an interest oY ar�y type in arly o�her busiaess or business premises. ��
I:' answer is "yes", list business, usiness address and telephoae number.
??. I.° business is incorporated, give d te oP incorooration G_�_ 19 $�'J
and attach caoy oP Articles of Inca oration and mirnttes oP first meeting.
2�. List a11 oP��cers of the corporatio giving their names, oPfice beld, htme
address, and home and business tele hone numbers:
� 1�pl�J � �= —
�Y1�1e1 F �K1'11�p�►� `�
I SI
_�i ��E . N�,iC� �so
��� -�il� ya� - � �
25. If business is oartnership, list pa er(s) address and telephcne a�bers:
Name � dress �1.Ao.
26. Zs there arlyone else vho will have n interest fn this business or premiaes? ��
If answer is "yes", give name, home address, telephone nu�bers and in rr�at
manner is their intarest:
27. Are yvu goinR to operate this busine s peraonal�y� ii not, xho vill aperate
i lI•
R� Home address 1`e1.Ro.
' ------------- AGENDA ITE __________------------------____ ��/��Z
ID#: [349 ] DATE REC: (10/15/87] AGE DA DATE: [00/00/00] ITEM #� [ ]
SUBJECT: [GENERAL REPAIR GARAGE LICENSE - 0 VOLKS HOME - 440 SIBLEY ]
STAFF ASSIGNED: [NONE � SIG:[RET MAN ] OUT-[X] TO CLERK [00/00/00]
ORIGINATOR:[LICENSE DIV. ] ONTACT:[SCHWEINLER - 5056 ]
ACTION:[ ]
[ ]
C.F.# [ ] ORD.# [ ] FILE COMPLETE="X" [ ]
� � � � � � � � � � �
FILE INFO: [RESOLUTION/CHECKLIST/APPLICATIO ]
C ]
C ]
I
� � � L�!=�7���a-
.ax�e you going to 'r.ave a !�an�er or aistant in this business� IvP aaswer is
��yes", give na�e an� ho:ae address an home telephone number:
Name ome address Te1.No.
29• Ha.s ariy�ne you have named in questio s 22 �hrou�h 25 ever been arrested?��
ans.+er is ��yes", list name oP person dates oP arrest, where, charges, convic-
tions and sentence
3�. I � �'(� 'r����N understand this pre�nise m�y be in-
spected by the police, �ire, health nd other city oPficials at a�r and a11.
times wnen the business =s �n aoerat on.
State of �tinnesota)
)SS
��ounty of Ratnsey ) � /�
Signature oP Agolicant
being first du�y sworn, deposes and says upon
oath that he has *ead the °�regoing state. nt bearing his signatuse and ?mows the
conter.ts therec.°, and that the same is t e of his own knowledge except as to those
�a�ters thereir. stated upon informati�n a d belieP and as to those. matters he be-
lieves them to be true.
Subscribed and svorn ta bePoze me
Signature of Appiicant,
this day of la �
� ` c){_�a:on �<uao
�r --�—
�: NOTA6Y PU6LIC-).;I�?'NESOTA�
ar`r ?ublic, ?asasey C�unty, Minnes�tg �, Rar�s:�r Co�r�Tv
f/� y:
Mv commission expires $-1Q_9?
'�y co�nission expires �/a —y�� •
���