96-1413 Council Fila # • 3
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° i� '�s � � Ordinance #
�� 1 �. ... tl 6 � l�A
Green Sheet # 3 5 �',�,�
RESOLUTION
CITY OF SAINT PAUL, MINNESOTA p�
Presented By
Referred To Committee: Date
i RESOLVED: That application(ID#27299)for a Dance or Rental Hall License by the Department of
2 Niilitary Affairs, State of Minnesota DBA Maryland Avenue National Guard Armory
s (Gary Bloedel, Military Auditor)at 1530 Maryland Avenue be and the same is hereby
4 approved.
s
6 Requested by Department of:
7 Navs Absent
s a8px
9 Guer�n Office of License, Inspectiona and
1� � — ✓ Environmental Protectfon
12 ✓
13 �
14 __Bostrom �
U ��
16 �`
17 Adopted by Council: Date ' �, _ �-� ���a By'
18
19 Adoption Certified by Council Secretary
20 Form Approved by City Attorney
21
22 By: ''__ gy: -�/ r� ��
23 �`
24 Approved by Mayor: Date
25
26 T - �G ./1��� Approved by Mayor for Submission to
27 By� � � ' � Council
28
By:
.
°I G— 1 �{ �3
LIEP/Licensing �TE INRIA o �REEN SHEET N_ 3�4 6 9
a �oew►ar�enr��N��� �cm couNC�. �Nmwanre
Christine Rozek, 266-9108 ��F� �cm�rroRNer �ciTVC��uc
IL (DA �� �BUDf3ET DIRECTOA �FIN.d MOT.SERVICES DIR.
For hearing: i( (..� °"oan ❑'�"vo�'�°R"as�sTiu�r► ❑
TOTAL#t OF SIONATURE PAGES (CLIP ALL LOCATIONS FOR 81GNATUR�
ACf10N REQUE8TED:
Department of Military Affairs, State of' Minnesota, DBA Maryland Avenue Nationai Guard
Armory requests Gouncil approval of its appli.cation far a Dance or Rental Hall License
_ at 1530 Maryland Avenue East (ID 27299).
RECOMMENDATIONS:Approw(A)a Ry�ct(R) pERSONAL 8ERVICE CONTRACT'S MUST ANSWER THE FOLWWINO�11ESTIQNS:
_PuNWINO c�6M�A�881oN _Clvn.SEavice cOMM188bN t F�ae thia psreonlnrm ever worked und�a c�ltract for ads d.parnl�nt4 -
_���E _ YE3 NO
—�,� _ 2. Has this psrsonlflrm e�ror bssn e City employee,?
YES NO
_DISTRICT COURT _ 3. Doee thiS PerSOn/firm po�sees a aWU r�a normaib a���v�+��•���
8uPPORT8 wMU�1 c�1NCll OBJECnvE9 YES NO
EzplaU dl yea�ntw�►s on�nb�fa�t and�tttch to�n�n shwt
MlIT1A1'INO PROBLEM.ISSUE�OPPORTUNII'Y(YVho.Wh�t.WMn�WMn.WhY1;
.
SEP 3 0 1996
CITY ATTORNEY
������:
DI8ADVANTACiE81F APPAOVED:
DISADVANTAGEB IF NOT APPROVED:
� �� J�
OC i 3 0 1��6
TOTAL AMOUNT OF TRANSACTtON = COST/REYENUE BUDtiETED(CIRCLE ONE) YES NO
FUNDINQ 80URCE ACTIVITY NUMBER
��ir�oatiu►riar:(�un��
Greensheet # 35469 L.�.E.P. REVIEW CHECKLIST Date: 9/23/96 � �y� � l �3
In Tracket'? App'n Received / App'n Processed
License ID # 27299 License Type: Dance or Rental Hall
Company Name: Department of Military Affairs, State of DBA: Maryland Avenue National Guard Armory
Business Addresss: 1530 Maryland Ave E Minnesota Business Phone: 296-6495
Contact Name/Address: Garv Bloedel, 20 w lZth Str. 55155 Home Phone:
Date to Council Research: �� ��
Public Hearing Date: .-+ Labels Ordered:
Notice Sent to Applicant: �� � � District Council #: �
� �
Notice Sent to Public: �� � �"L Ward #:
Department/ Date Inspections Comments
,
City Attorney
1� 1� � �,
Environmental
Health
/1 �y� r
/ 1 � 1
Fire
� }���1..� �����c� '_' G�
License Site Plan Recelved:
Lease Rec�ived:
� � �Z �� �(.
Police
j D I�' �j p. .
Zoning
lo �� �b 0��. :
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CLASS III CITY OF SAINT PAUL
LICENSE APPLICATION Offia of License.����ons
and Em•ironmental Protection
330 Sl Pau S�Sui�e?00
Saiat Psul.►iinnexn !�102
l61�2b64,'`90 fu(612)=66•91 N
�--' q�- 141�
THIS APPLICATIOV IS SUBJECT TO REVIEW BY 7"HE Pt�BLIC
PLEASE TYPE OR PRII�TT IN I\K
'T� of License(s)being applied for: ���'Y �`/ ���'�''1S�P
'Pe
Company�'ame: 1�r Da.r'�w�¢•� o-f �1��I'�'s.r�! ��-�at rs S'f'.i.f� c�-� ��'�h 2 S��p�.
� Corporation/Partnership/Sole Proprietorship
If business is incorporated, gi��e date of incorporation: Pot�,�'�,f Cctw�c.'f'• 7onKt3 �N �
Doing Business As: �'1 , l4✓eh�. . rn��� Business Phone: �`L y�s
Business Addtess: �S3O (�.
W1a.rH �57� Pa.r�.� In�'✓ 3�.5'/0�
Street Address Ciry State Zip
Betv��een w�hat cross streets is the business located? V1'hich side of the street? Se«.
Are the premises now occupied?yrS V�'hat 7 �pe of Business?�1��1� I'�rw�� /0'�a( ��
Mail To Address: l S3 . � � S • � ���0
Saea Address City Scate Zip
Applicant Information: �t� � � 1�'�t��*'r'�( ��7��'r-1 • ,
�S � B�o�'DsL N��l�e��k�.cP�v r
_ Na,,,P and Tide• 0./'vl -
0��� Fust / Tiiddle (Tiaiden) I.ast �de
u Y��� n /
t�� �Home Address: vl� W. lo�'� S�• 57�. l'4�.( �� ' ���
�� Strxt Address Ciry Sute Zip
Date of Birth: Place of Birth: �Phone: �8a'y�/Y7
Have you ever been con��icted of any felony,crime or violation of any ciry ordinance other than traffic? YES_ NO_
Date of arrest: Vi'here?
C6arge:
� Con��iction: Sentence:
List the names and residences of three persons of good moral character, living w�ithin the'fw•in Cities Metro Area, not related to the
applicant or financially interested in the premises or business,who may be referred to as to t6e applicant's c6aracter:
NAME ADDRESS PHONE
List licenses W�hich you cunenQy hold,formerly beld,or may ha��e an interest in:
N an�
Have any of the above named licenses ever been revoked? YES NO !f yes,list the dates and reasons for revocation:
n�� 1 '
Are you going to operaue this business personally? YES �NO If not,w�ho K�ill operate it? �
�h.h(f .�l,�C� �����r4t�/�euWel
First Name 1.iddle Initial (Alaiden) Last Date of B ��
S 3 E. a r � f�-ire s�• a n�� 5S"/b�v a9 -G
Home Address: Stree.t Kame Ciry Sute 7�p Phone Number
Are��ou goine to ha��e a mana�er or assistant in this business? �'ES \O If the manager is not the same as the operator,g'P. �
complete the follov�•ing information:
Frst Tame hiiddle lnitial ('�laidcn) Last Date of B�rth
Home Address: Street Name Ciry• State Zip Phone I�'umber
Please list your emplo��ment history for the previous five(5)pear period: 'Q �• I�17
Business/Emalo��nent ddrec
List all other officers of the corporation:
OFFICER TITirE HOME HO?�4E BUSI'��SS DATE OF
�'A.�'� (Office He)d) ADDRESS PHO?�E PHO\E BIRTH
I If business is a parmership,please include the following information for each par[ner(use additional pages if necessar��):
i
Fvst 1�ame h4iddle Initial (Ttaiden) lact Dau of B�rth
Home Address: Saea Name Ciry State Zip Phone Number
First tiame Middle Initial (Ivltiden) Lazt ' Dau of B�rth
Home Addras: Saeu t�ame Ciry Stace Zip Phone Number
JvIIIvT'ESOTA TAX IDEI�1T�'ICATIO:�I Iv'UMBER-Pursuant to the Laws of Minnesota. 1984,Chapur 502,Article 8.Section 2(270.72)
(Taz Clearance;Issuance of Licenses),licensing authorities are required to provide to the State of Minnesota Commissioner of Revenue.
, the Minnesota business taz identification number and t6e social security number of each license applicanG
Under the Minnesota Govemment Data Practices Act and the Federal Priracy Act of 1974,we aze required to ad��ise you of the following
regarding the use of t6e Minnesota Taz Tdentification T'umber:
-This infocmation may be used to deny the issuance or reoewal of your license in the event you ow�e Ttinnesota sales,employer s
withholding or motor vehicle excise tazes;
-Upon receiving this information,the licensing authoriry will supply it only to the Minnesota Departn�ent of Revenue. However,
under the Federal Ezchange of Infom�ation Agreeuxnt,the Department of Revenue may supply this information to the Intemal
Revenue Service.
Minnesota Tax Identification Numbers (Sales & Use'Taz T'umber) may be obtained from the State of Minnesota, Business Records
Department, 10 River Pazk Plaza(612-296-6181).
Social Security Number:
Minnesota Taz Identification Number: �
.7,� If a Minoesota'Taz Identification Number is not required for the business being operated,indicate so by placing an"X" in the
boz.
� _
, ' t CERTIFICATIO\OF V�'ORKERS'CO:�'iPENSATION CO�'ERAGE PURSUA.\7'7'O T1II�l�'ESOTA STATUTE 176.182
� 1 hereby certify that I,or my company,am in compliance With the w�orl:ers'compensation insurance co�•erage requirements of?�4innesota
Statute 176.182,subdivision 2. I also understand that pra��ision of false information in this ceRification constitutes su�cient grounds for
ad�•erse action against all licenses held,including revocation and suspeasion of said licenses. �
\ame of Insurance Company: J+'l.� �vK,fKrGd/ � S�� e� �/LI�kv1 PSO l ` •I y `�
--T—�--
Policy Number: Co��erage from to
I ha�•e no employees co��ered under��orkers'compensation insurance •
A�Y FALSffICATIO:�OF A1SR'ERS GI�'EN OR:�1ATERIAL SLB�IITTED
�i'ILL RESULT IN DE\IAL OF THIS APPLICATION
I hereby state that I have answered all of t6e preceding questions,and that the information contained herein is true and correct to the best
� of my know�ledge and belief. I hereby state fiutber that I ha�•e recei��ed no money or other consideration,by u�ay of loan,gift,contribution,
or otherwise,other thaa already disclosed in the application a•hich I bere��it6 submitted. I also understand this premise may be inspected
b�•police,fire,health and othec cit}�officials at any and all times When the business is in operation.
�3 ��
~ gnature(REQ D for all applications) ate
�� � l,�S
�
"*'�ote: If this application is Food/I_iquor related,please contact a City of Saint Paul Heaith Inspector,Ste�•e Olson(266-9139),to review
plans.
If any substantial changes w strvcture are aoticipaud,pleau coatact a City of Saint Paul Plan Examiner at 266-9007 to apply for
building perauts.
If tbere are aoy changes to the paz�:ing lot,floor space,or for new operations,please contact a City of Saint Paul Zoning Inspector
at 266-9008.
Additional appUcatfon requirements,please attach:
A detailed description of the design,location and square footage of the premises to be licensed(site plan).
The totlo�ring data should be on the site plan(preferably on an 81/2"x 11"or 81l2"x 14"paper):
-Name,addtess,and phone number.
-The scale should be stated such as 1"=20'. ^N should be indlcated toward the top.
-Placement of all pertinent teatures of the interior of the licensed tacitity such as scating areas,idtchens,offices,repair
area,parking,rest rooms,etc.
- It a request is for an additjon or expansion of the licensed facilitp, indicate both the current area and the proposed
expansion
A cop.y of}•our lease a.greement or proof of o�•ncrship of the property.
FOR SPECIFIC APPLICATION REQUIREAZENTS, PLEASE SEE REVERSE >>> >