96-1344 Council File # � �� `y
��� �) E � O `�'*°� f� ¢
� " ° ` � •^` a e , � Ordinance #
Green Sheet # ���/
RESOLUTION
CITY OF SAINT PAUL, MINNESOTA �p
Presented By
Referred To Committee: Date
i RESOLVED: That application(ID#21520) for a Wine On Sa1e License by 128 Cafe Inc. DBA 128
a Cafe (Brian Bowman, President) at 128 Cleveland Avenue North be and the same is
s hereby approved with the following conditions:
l. The floor space at the southeast corner of basement not be used
for food or beverage service.
2. Business hours are limited to 7:00 a.m. to 10:00 p.m.
4
5 Requested by Department of:
6 Y�e _ Nays Absent
8 Guerin 1- v
9 r's ,i Office of License, Insnections and
10 Me ar ✓ Environmental Protection
11 e t n �
12 T une ✓
13 Bostrom �
15 � � �
16 Adopted by Counci • ate / G BY'
17
18 Adoption Cer ified by Co n il retary
19 Form Approved by City Attorney
20 ��
21 By: By: ��
22
23 Approved by Mayo . Date � �
24
25 � ,` Approved by Mayor for Submission to
26 By: �(� Council
27
By:
RG•�� �Iy
IL DATE INRIATED �REEN SHEET N_ 3 5 4 9 9
LIEP Licensin - - - - -
� �'DEPARI"MENTDIRECTORN���� �CITYCOUNCIL �mA��
� 1 O8 �N �CITY ATTORNEY �CITY CLERK
(DA ��� �BUDOET OIFiECTOR �FlN.S MC�T.8LRVICEB DIR.
1Q��3�7� �� �MA1fOR(OH A�18TANn �
TOTAL#E OF SICiNATURE PAtiE8 (CLIP ALL LOCAYION8 FOR SIQNATUR�
AC710N REGUESTED:
128 Cafe Inc. DBA 12$ Cafe requests Council approval of its application for a Wine On Sala
License ].ocated at 128 Cleveland Avenue North (ID #21520).
REf�MM1ENDAt►ONB:Approvs{A}a qeJ�ct(Fq PER80NAL�EpViCE CONTq,ACTS MUST AN8INER THE FOLLOWINO QUESTiONB:
_PW�Na�i�NSaION , _...r cnn�BeRVice coA�A�K�N t Nas tnis personnirm ever worksd undsr a cwnaect tor thfa a�peransrH9
_CIS COMAAI7'TEE _ YE8 NO
2. Has this psrson/ti►m e�ror bssn a cNy empiopee4
—�� — YES NO
_D18TRIC'i COURT _ s. Does this prrsonRirm posasss a akiil not normalb Pos�ssed bY anY d+►►eM dlY�mplo�ns?
SUPPOR78 wMICH COUNCII OB�CrnE7 YES NO
Expteln all ya�nriwn on«p�rst�shut a�d�tt�eh to�n�M�t
p�rr�x+�EM.�ssu�,ow�ruNm lwno,v�na,wn�,wnK..wnr►:
AdVANTAGE8IF APPROVED:
DISADVANTAOEB�APPHOVEO:
�O�IiiC� R��e�tCh C�ntet
SEP 12 19J6
ois�wv�rrr�o�s�nor,uPVAOVEC: --
rY;�;
TOTAL AMOUNT OF TRANSACTION = COST/REVBNUE BUD�iETED(GRCLE ONE) YES NO
FUNOiNO SONRCE ACTIVITY NUMBER
FINAMCIAI INFORMATION:(EXPLAIN)
s.�_._ _, . ;� /,�, c}
f . y
CITY OF SAINT P U��
CLASS III .
LICENSE APPLICATION Office of License,Inspcctions
and Environmenlal Protection
3t0 SL Pacr St.Suiic.1p0
Saint Paul,Minnexrna 55102
(612)266�9090 fa:(612)2G6•9121
W�
THIS APPLICATION IS SUBJECT TO REVIEW BY THE PUBLtC
PLEASE TYPE OR PRINT IN INK
Type of License(s)being applied for: ��^L Un `=���- •� �
Company Name: ��-� C°`�� �^<...
Corporation/Partnership/Sole Proprie�orship
If business is incorporated, give date of incorporacion: �t`��
Doing Business As: 17� rsCt; Business Phone: ��Z� �`�S'y tZ¢
Business Address: �Z-`�� Uev��«��� F��e N �1.1��.�� MU SSIU��
Street Address City Stale Zip
Between what cross streets is the business located? �-.c.tv���1 Which side of the street? G`'�"'a
Are the premises now occupied? v�� What Type of Business?�°`�'�``�'
�
Mail To Address: IZ��, r\2,v1�;n�� �x l��. S�� r<<�I P�OJ 55��`�{
Sveet Addte.a City State Zip
Applicant Information: l�
1`Tame and Ti[le: �i ,�"� 1� �0�'l7 J�^�-� �'�`>
First Middlc (Maiden) Last Title
Home Address: �1��� (�1��r;,1�,�� � . �, ���� M�) SSlO S
Svect Address City Statc Zip
Date of Birth: � -�s-' �� � Place of Birth: S� � ��� Home Phone: �Q��'��3 �
Have you ever been convicted of any felony,crime or violation of any city ordinance other than traffic? YES_ NOx
Date of arrest: Where?
Charge:
Conviction: Sentence:
List the names and residences of three persons of good moral character, living within the Twin Cities Metro Area, not related to the
applicant or financially interested in the premises or business,who may be referred to as to the applicant's character:
NAME ADDRESS PHONE
�_zt U��rk-� `�i 7 O ;J�.rlor-,�.r <=-`�- ����4'0 S L-�
(��,f,�, �v�.�-: � ��, ;�s� �' ��.��� A� y�—�ti��
��,.,L �,�,,, �v�t (�,.�kc�, �4, 6�U�S�t3
List licenses which you currently hold,formerly held,or may have an interest in:
���tJ�c
Have any of the above named licenses ever been revoked? YES � NO If yes,list the dates and reasons for revocation:
Are you going to operate this business personally? X YFS NO If not,who will operate it?
iirst Name Middle Initial (Maiden) Last Date of Birlh
Homc Address: Svect Name Ciry State Zip Phone Number
' �� c,�
' 4 �� ..
Are you going to ha��e a manager or assistant in U�is business? YES �NO If the manager is not the same�e d�e operator,ples�V �,� JvQ
complete the following informalion: ~'r �� e
� ��- I 34y� �a
Frst Name Middle Initial (Maiden) Last Date of Birth
}iome Address: Svcet Name Ciry Sute 7_ip Phone Number
Please]ist your cmployment history for the previous five(5) year period:
Business/Em�lo�nnent Address
��]��, C)� �pr��tt��s (L'-IE' C,RCV.ca f�c 5��aJl 1'yUJ ��e�v�;l W����ispr-,.
�
C,l\, C.� �p�1 pt Ar,,,I-,c.� . -
List all other officers of the corporation:
OFFICER T[TLE HOME HOME BUSINESS DATE OF
NAME (Office Held) ADDRESS PHONE PHONE BIRTH
1Ji�l�-l!1 ,/�V�`J1'��\ }�('�c) 1��:1() ��V�i.���� b`�'���� !�b�� � ��Z �6yS-�I�Z4� �-�.�"� �
'�' �" � �i13� �t��'� l�.k, J. E��Z•7z+'3f�`IS b`z'645-yiLL ��`Z�•� �
t,���- oh1� ;f �-�� .
If business is a partnership,please include the following information for each partner(use addiUOnal pages if necessary):
Frst Name 1�7iddlc Initi�l (Maidcn) Iast Datc of Birth
Home Address: Street Name City State 7_ip Phone Number
First Name Middle Initial (Maiden) Last Date of B�rth
Home Address: Svicet Name City State Zip Phone Number
MINNESOTA TAX IDENT'IFICATION NUMBER-Pursuant to the Laws of Minnesota, 1984,Chapter 502,Article 8,Section 2(270.72)
(Tax Clearance;Issuance of Licenses),licensing authorities are required to provide to the State of Minnesota Commissioner of Revenue,
the Minnesota business tax identification number and the social security number of each license applicant.
Under the Minnesota Govemment Data Practices Act and the Federal Privacy Act of 1974,we aze required to advise yon of the following
regarding the use of the Minnesota Tax Identification Number:
-This informaUon may be used to deny the issuance or renewal of your license in the event you owe Min�esota sales,employer's
withholding or motor vehicle excise taxes;
-Upon receiving this informaUon,the liccnsing authority will supply it only to the Minnesota Department of Revenue. However,
under the Federal Exchange of Information Agreement,the Department of Revenue may supply this information to the Internal
Revenue Service.
Minnesota Taz Identificalion Numbers (Sales & Use Tax Numbcr) may be obtained from the State of Minnesota, Business Records
Department, 10 River Park Plaza(612-296-6181).
Social Security Number: ���'� 7 z ?'��� �'
Minnesota Tax ldentificaeion Number:
If a Minnesota Taz Identification Number is not required for the business being operated, indicate so by placing an "X" in the
box.
�AP� �`_i�4y
°ERTIFICATION OF WORKERS'COMPENSATION COVERAGE P[JRSUANT TO MWNESOTA STATUTE 176.18
9 I hercby certify that I,or my company,am in compliance with the workers'compensation insurance coverage requirements of Minnesoca
� Statute 176.182,sutxiivision 2. I also understand that provision of false information in this certification constitutes sufficient grounds for
, adverse action against all licenses held, including revocation and suspension of said licenses.
Name of Insurance Company: `�n'��"'� �`� ��� �.-������`'
Policy Numbcr: �� �`��yU � ��� � Coverage from "t'�g-�lO to ����'Q�
I have no employees covered under workers'compen5ation insurance
ANY FAISIF'ICATION OF ANS�'VERS GIVEN OR MATERIAL SUBA'IITTED
�i'ILL RESULT IN DENIAL OF THIS APPLICATION
I hereby state that I have answered all of che preceding questions,and that the information contained herein is true and correct to the best
of my knowledge and belief. I hereby state further that I have received no money or other consideratio�,by way of loan,gift,contribution,
or otherwise,other than already disclosed in the application which I herewith submitted. I also understand this premise may be inspected
by police, ftre,health and other city officials at any and all Umes whe�the business is in opera[ion.
�..�-��� J`��
%�_--- � �--_- �-(S-���
Signature(REQUIRED for all applications) Date
**Note: If this application is Food/I.iquor related,please contact a City of Saint Paul Health Inspector,Steve Olson(266-9139),to review
plans.
If any substantial changes to structure are anticipated,please contact a City of Saint Paul Plan Exanuner at 266-9007 to apply for
building pernvts.
If there are any changes to the parking lot,floor space,or for new operations,please 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).
7'he following data should t�e on the site plan(preferably on an 8 1/2" x 11"or 8 1/2" x 14"paper):
-Name,address,and phone numbcr.
-The scale should be stated such as 1"=20'. ^N should be indicated toward the top.
-Placement of all pertinent features of the interior of the licensed facility such as seating areas,kitchens,offices,repair
arca,parking,rest rooms,etc
- If a request is for an addition or ex-pansion of the licensed facility, indicate both the current area and the proposed
expansion.
A copy of}•our leasc agreement or proof of ownership of thc property.
FOR SPECIFIC APPLICATION REQUIREMENTS, PLEASE SEE REVERSE >>>>
Greensheet # 35499 L.I.E.P. REVIEW CHECKLIST Date: 8/19/96 /
In Tracker? App�n Received / App'n Processed
`1C.-1� 4y
L(cense ID # 21520 License Type: Wine On Sale
Company Name: 128 Cafe Inc. DBA: 128 Cafe
Business Addresss: 128 Cleveland Avenue North Business Phone: 645-4128
Contact Name/Address: Brian Bowman, 1138 Churchill, 103 Home Phone: 487-5282
�����,�����D��/ � .
Date to Council Research: 7 ��
Public Hearing Date: 2 �O Labels Ordered: /`� ���
Notice Sent to Applicant: � District Council #: I ✓
3� �td
Notice Sent to Public: '"/�� �'�� Ward #:
Department/ Date Inspections Comments
�
City Attorney
g �ZS��c� o�� .
Environmental
Health
8. 2.8• °c 10 O. �,
Fire
8•28•910 v. b�, . '--�l�l� � I�1�`T�41�
License Site Plan Received:
l.ease Recetved:
Police
�•�� �� •
Zoning
� 3D •��o C>�C. �1.�1{`f�J C'�`�iY��