96-1390 Council File # � � -- ,3�,�
Ordinance #
Green Sheet # S � S
RESOLUTION
CITY OF SAINT PAUL, MINNESOTA 5(�
Presented By
Referred To Committee: Date
i RESOLVED: That application(ID#50636) for an Auto Repair Garage License by Timothy Brown
a DBA R T Automotive (Tim Brown, Owner) at 1054 Payne Avenue be and the same is
3 hereby approved.
4 __________________________________________________________________________________________
5 ________________________________________ Requested by Department of:
6 Y�� Nays Absent
7 B a e,y _�! �
8 Guerin Office of License, Inspections and
9 Harris �
10 Mecrar � Environmental Protection
11 Re tman
12 T une
13 Bostrom ✓
14 =__�_-__-�_-____�____ --
15 ________________ "
16 Adopted by Council: Date ��� _ �, \�q� B�''
17 �
18 Adoption Certified by Council Secretary
19 Form Approved by City Attorney
20 \
21 By: � � ���,..�1� / /
�c��— � By:
22 �
23 Approved by Mayor: Date �/ ��/
24
25 �^- Approved by Mayor for Submission to
26 By:
I (/�,CL Council
27
By:
_ `� 5�-13qn
� DATEINITIATED �REEN SHEET N_ 3 5�9 5
LIEP/Licensin - -
d INITIAL/Dd1TE INITIAUDATE
�DEPARTMENT DiRECT�OR �CT/COUNCIL
Christine Rozek, 266-9108 ��N �CITYATTORNEV �CfTYCLERK
IL BY(OA �� �BUDpET DIRECT�OFi �FIN.l MOT.SERVKK�8 DIN.
For hearia : �) b °RDe" �MAYOR(OR/18813TANT► �
'1'OTAL#E OF SK#NATURE PY�iE8 (CLIP ALL LOCATION8 FOR SIONA7'URE)
IICTION REOUE8TED:
Timothy Brown DBA R T Automotive requests Councii approval of its application for aa Auto
Repair Garage License located at 1054 Payne Avenue (ID �50636) .
'�Ow(A�°��(R) PER80NAL BERYICE CONTRACTS MUST ANSWER TFI@ FOLLOWINQ OUESTION8:
_�V�u�Ix�coAA�nsslo� _civ�sERwce coMwnss�u �. Has mis peraon/(irm e�rer woncsd under a ca+tract tor ehis dep.ranent? -
_GB COAAMITTEE _ YES NO
2. Hes this p�►sONfirm eve�been fl City smployee,�
—$T� — YES NO
—���T�RT — 3. Does this peroonrtirm possea�a�cill not rwrmaNY Pas�d bY e�Y WrreM c�Y smpby�eT
SUPPORT8 WHKSN COUNCIL OBJECTIVE4 YES NO
Explafn ell y�snswKS on ap�rat�sM�t and att�ch to pn�n shest
INITIATII�PROBLEM�ISSI�.OPPORTUNITY(Who.Whet.VMhsn.Whsre�YVhYI:
ADVANTIVOE8IF AP�IED:
DISADVMfTIlGE81F APPROVED:
D18ADVANTIlOEB IF NOT APPROtlED:
+� ��1 C!ltit�l'
OCT 2 8 19�6
_,,.
TOTAL AMOUNT OF TRAMSACTION = COST/REVENU@ BUDGETED(CIRCIff ONE) YES NO
FUNDIHG SOURCE ACTIVITY NUMBER
FlNANCIAL INFORMATION:(EXPLAIN)
Greensheet # 35495 L.I.E.P. REVIEW CHECKLIST Date: 8/9/96 /
In Tracker? App�n Received / npp'n Processed
qC -I 390
License ID # 50636 License Type: Auto Repair Gara�e
Company Name: Timothy Brown DBA: R T Automotive
Business Addresss: 1054 Pavne Avenue Business Phone: 771-4948
Contact Name/Address:Tim Brown, 4838 Grenwich Way N Home Phone: 777-3989
Date to Council Research: Oakdale 55128
Public Hearing Date: 1 � Labels Ordered:
Notice Sent to Applicant: �d � ' �� District Council #:
O G a� J���1
Notice Sent to Public: f 7 / Ward #: �
Department/ Date Inspections Comments
,
City Attorney
�•�• �b c�.� .
Environmental
Health
�.� •
Fire
°I •�'� � o�� '
License Site Plan Received:
Lease Received:
�o�a� �� p � c�
Police
q'•3 •�b D•�:•
Zoning
/l�• 15�°l�o O. � .
. .-----' ,� .:jOC�`3U
CLASS III CITY OF SAINT P.AUL
O(ficc of Liccnsc,lncE,cxtions
LICLNSE APPLICATION and Emironmcntal Pmtcctit�n
��o s�.r�,�,s�.s����ua
S�im Paul.Minnespta }��p�
(61.)266A')40 faa(61:1.td,.91]<
„� � �_���
b
T}ilS APPI_ICA7'10'�' 1S SU�3JECT TO REViFW BY THF PUBLIC
PLEASE T1'PE OR PRINT IN I\K
Type of Licen�e(s)being applied for. /7�/_I�IFePt41����i°
Campany?�'ame: � � r7v]�/`'k�f!�'(°
Corporation/Partnership/Sole Pmprictorchip
If business is i�corporated, �ive date of incorporalion: _��
Doing Business As: _�� 1_��C/l�f'''�DI(� Business Phone: ��l – 7 / �p
Bu�iness Address: _ �d f'/9�'�li� $!/� �p/a(iL !�+/L�' SSl��
Svcc�.Address City S(atc Zip
Beh�•een w�hat cross sveets is the business located? �DOK 4 r7A�tit�//f \4'hich side of the sveet? �it/P$T'
�'�re the prenuses no�v occupied? Y C ] V1'hat T�pe of Business? �Pi¢1� (�i��1�°
�__'n_� -
'�1ail To .Address: _IC7S Y P��C� Afi'� ��i�[� /�'►iv .�`�
Sveet Address City Sute 7_ip
Applicant Information: �
'�'ame and Ti[)c: J//�10� � �vAl��� 4/i►/ ['SL tiPQ`—
First f�4iddlc (A4aidcn) Last Titic
Home Address: yS3� ���i(�� Gi/-1'(" .L�, G��c�1�L.e i"'4�/ 5r���
Svcet Addr�s City State Zip
Date of Birth: c�� /3 ��Sy Place of Binh: �)/C� 1 ��/ Home Phone: �7 J�'�9
Have you ever been com�icted of any felony,crime or violation of any city ordinance other than traffic? �'ES_ NO�
Date of arrest: «'here?
Charge:
Con�•iction: Sentence:
List the names and residences of three persoos of good moral character, living ��ithin the Twin Cities T4etro Area, not related to the
applicant or financially interested in the premises or business,w�ho may be referred to as to the applieant's character:
1�'A.?vIE ADDRESS PHONE
c�eT(.�v�t G-R e�-o� ;- �l s� t"D r�.,.,� �T P��. �,�5��- G.�S�
..L9�� �e,� �� 4�� ��-P 5� APr- ao7
List licenses which you curreotly hold,formerly 6e1d, or ma��have an interest in:
�,��ti-t�
Have any of the abo��e named licenses e��er been revoked? YES �NO If yes,list the dates and reasons for revocation:
Are you going to operate this business personally? �YES NO If not,who will operate it?
First rame Middle lnitial ('.Saiden) Last Date of Birth
}{��Address: Street Kame Cit}' S[ate Zip Phone N�mber
.�.,�,�� _
� ����'�.i
Arc you going to ha�•c a nLZna_cr or ascictari� in t1�is busincss? 1"E:S �'�O If tlie mana�cr is not thc �amc �.� tlie��xrator,p��.�
con�lctc ilic follo��'in� inforn�ation: ��.
. �� ,� ��,�o ,
Frsi:�amc `�tiddlc Initial (`�iaiden) I,ast Da1c of➢irth
H�nx.4ddre��s: Strec�Namc City St�fe 7ip Phone Nurnbcr
Plcase lict your emplo��n�ent histor��for e}ie pre�•ious five (5) �•ear period:
Bucine«/Emplo��nent Address
��_ ' �5 M!SSIDy �O � �t��t'2o �P ��l
List all other officerc of the corporavon:
OFFICER TITLE NOME HO?��fE BUSI\ESS DATE OF
:�'A'�tE (Office Held) ADDRESS PI�OI�E PHO\� BIR7"H
If business is a partnership,gieace include the follo�ing inforn�ation for each partner(use additional pa�es if necescan•):
First lame Middle lnitial (?�1aiden) Last Date o(Binh
Homc.4ddress: Street lame City State Zip Phone Numbcr
First'�anx T2iddle Initial (Tfaiden) last Date of Birth
Home Address: Stneea!�ame City Swte Zip Phone;�umber
1��III�'NESOTA TAX IDENTIFICATIO:�I?�1T1�'IBER-Pursuant to the Lau�s of T4innesota, 1984,Chaptcr 502,Article 8,Seccion 2(270.72)
(Ta�;Clearance;Issuance of Licenses),licensing authorities are required to pro�•ide to the State of Minnesota Comnvssioner of Re��enue,
the A4innesota business tax ideneification number and the social security number of each license applicant.
Under the Minnesoea Govemment Data Practices Act and the Federa] Privacy Act of 1974,we are required to ad��ise you of the fo]lo��ing
regarding the use of the Minnesota Tax Identification Number:
-This infom�ation may be used to deny the issuance or renew•al of your license io the event you owe T4innesota sales,employer's
��ithholding or motor vehicle excise taxes;
-Upon receiving this inforniation,the licensing autt�ority w�il] supply it only to tbe Minnesota Dcpartment of Revenue. However,
under the Federal Exchange of Information Agreement, the Department of Re��e�ue may supply this information to the Intemal
Rc��enue Sec-vice.
1�4inoesota Taz ldentification Numbers (Sales & Use Tax �umber) may be obtained from the State of T4innesota, Business Records
Department, 10 River Park Plaza (612-296-6181).
Social Security Numbcr: � 7 � �(v � �� So
Minncsota Tax Identification;�`umber: �� ��J tl� �
If a Minnesota Taz Identification I�umber is not required for the business being operated, indicate so by placing an "X" in the
box.
t �J`C,_ _y "�'�"._:.:. .
.c?:
"'�'CER,TIFICATIO\' OF\�'ORKERS'CO'�4PE;�SATION CO�'ERAGE PURSUA\T 7'O '�91'�'�ESOT.4 ST.ATUTE 1 iG.l R2
/bereby certif}�that I,or my comp:u���, am in compliance a•ith the N•orkcrs'con�ensation insurance coverage requiremenu of?�9innesota
St��tute ]76.182,sut?di�'ision 2. I�ilso undcrstand that proricion of f:ilsc informition in Qiis ccrtificati�n conctitutcs �ufficicnt�rounds for
advene action against all licen�es held, including re��ocation and suspes�sion of said licenses. , C,
I�'ame of Insurance Company: ��`13 -`O
Policy'�'umber: Co��erage from to
I ha�•e no employees covered under���orkers'compensation insurance_(�
A'�l' FALSIFICATION OF A:�S«'ERS GI�'EN OR AIATERIAL SLTB�tITTED
«'ILL RESliLT I1 DE\IAI.OF THIS APPLICATION
I hereby state that I hare answered all of the preceding questions,and that the inforn�ation contained herein is we and correct to the best
of my l:no�•ledge and belicf. I hereb�•state further that I ha�•e recei��ed no money or other consideration,by u•ay of]oan, �ift,contribution,
or other��ise,other than alread��disclosed in the application w•hich ] hcreN�ith submitted. I also understand ehis premise may be inspected
b��police, fire, health and other cit}�offici:ils at any and all Umes��hen the business is in operation.
_ "_..._. a.��`-��- �r��� y�i� ��
Si€nature (REQliIRED for all applications) Datc
'"'�ote: If this application is Food/Liqoor mlated.plea.ee contact a City of Saint Paul Health Inspector, Ste��e Olson(266-9139), to re�•iew
p]ans.
if any substantial changes to swcture are anticipated,pleace contact a City of Saint Paul Plan Ezaminer at 266-9007 to apply for
bnilding permits.
If there are any changes to the par}:ing lot,floor space,or for new operations,plea.ee contact a City of Saint Paul Zoning Inspector
at 266-9008.
Additional application requirements,please attach:
A detailed description of the design,location and square footage of the premises to be licensed (site plan).
The following data should be on the site plan(preferably on an 8 U2" x 11" or 8 1/2" x 14" paper):
-I�'ame, address, and phone numbcr.
-The sca)e should be stated such as 1"=20'. ^;�should be indicaled toK•ard the top.
-Placement of all pertinent featutes of the interior of the licensed facility such as seating areas,l:ilchens,o�ces,repair
arca, parking,rest rooms,etc.
- If a request is for an addition or ea-pansion of the licensed facility, indicale both the current area and the proposed
capansion
A cop�•of}�our lease agreement or proof of oK•nership oC the property.
FOR SPECIFIC APPLICATION REQUIREME'�`TS, PLEASE SEE RE�'ERSE > > > >