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96-1071 ' . � � Council File # ' �O� I f� ^ � �-j �t � � �/�(o Ordinance # � �l Green Sheet # ��0 RESOLUTION CITY OF SAINT PAUL, MINNESOTA Presented By �� Referred To Committee: Date F�Z�-�o, i RESOLVED: That application (ID #24003) for a Cigarette, Restaurant-B, Entertainment-B, Sunday a On Sale Liquor, and Li uor On Sale-A License by Moose's Lockeroom LLC DBA 3 Moose's Lockeroom(��. " laylon, CEO) at 1177 Clarence Street be and the same is 4 hereby approved with the following conditions: 5 6 1. The existing parking arrangement may continue as long as it remains compliant � with the encroachment permit issued by Public Works. e 9 2. Subject to final approval by Fire and Environmental Health before opening. io ii ia __________________________________________________________________________________________ 13 ______________—_____________-________= Requested by Department of: 14 Yeas Nays nt 15 B a 16 Guer� � Office of License. Ins�ections and 17 H rr 18 Mecrar ✓ Environmental Protection 19 Re� man ✓ 20 T une � 21 Bostrom i3 ___________________�__-_—�_-__=1=___ 24 Adopted by Council: Date �a.8''�� By� 25 26 Adoption Certified by Council Secretary 2� Form Approved by City Attorney 28 � � 2 9 By: �a � . -a —� . .� /� 30 � BY: K.X 31 Approved by Mayor: Date � �� 32 33 �]�� Approved by Mayor for Submission to 34 By: �G Council 35 By: , .V IL DATE I I ATE O ��• �� I LIEPJLicensin �REEN SHEET _N_ 3�4 8 0 a (�oEq►�r o�cron�mwou►rE �cir�couwci� �"m�� Christine Rozek 266-9108 "�0N ❑cirrnrra�Nev �cmc�RK IL ( TE) �� BUO(iET OIRECTOR �FIN.6 MfiT.BERVICEB pIR. AAIIY�T(�i A8St8TANT► F r h arin : �� ❑ � TOTAL#F OF 8KiNANRE PAOH$ (CLIP ALL LOCATIQNS FOR SIIiNATURE) ACfl�l REGUESTED: Moose�'��ckeroom LLC DBA Moose's Lockeroom requeets Council agproval of its application for a Cigarette, Restaurant-B, Entertainment-B, �unday On Sale Liquor, and Liquor On Sale-A License at 1177 Clarence Street (ID �24003). REOOMMENDATION8:Appov�(A)a Rysct(R) PERSONAL SERVICE CONTRACT8 MUST AN8WER TFtE FOLIAWINi#QN�TIONS: _PLANNMN#COMMISBION _CIVIL 8EIivICE 001AMISSION 1. Hes this psraon!}irm sver wpHced undsr a oonhact for 1hb depardnent� - _��E _ YES NO 2. Hts ihis p�rsoNtirtn sve►been s aty smployee9 —��F — YES NO _D18TRK:f f�URT _ S. Doss this ps►son/Nrm posssse a skNl not rrormeMy P�d bY a�Y arrent dly ert�ployas? BuPPORTB wNK:F1 OouNCIL OBJECTIVE? YES NO Explsin all yq en�wKS on Npanb sM�t�nd�tt�eh to OrNn tMK u�m�r�o�oe��,�ssue.o�ontuNmr cw�w.wna.wn.�,wns�e,w�+r): � RECEIVED �UL 25 1996 . CITY ATT�RNEY ADVANTAQEB IF APPAOVfD: q18ADVANTAOES IF APPFiONED: � D18ADVANTIU�EB IF NOT APP�ED: T,OTAL AMOUNT OF TRANSACTION S COST/REYENUE BUDOETED(CIRCIff ONH) YES NO RUNDING 80URCE ACTIVtTY NUMBER FlNANCIAL INFOqMAT�N:(EXPLAIN) Greensheet # 35480 L.I.E.P. REVIEW CHECKLIST �ate: 7/11/96 / � �.� ��, � In TraCket? App'n Received / App'n Processed �Q�� License ID # 24003 License Type: Cigarette, Rest.-B, Entertainment-B, Sunday On Sale Company Name: Moose's Lockeroom LLC Liquor, and L��or On Sale-A Moose's Lockeroom Business Addresss: 1177 Clarence St. Business Phone: 774-8725 Contact Name/Address: Mark Na lon Home Phone: �-��9�,�� D� Date to Council Research: �/� � � Public Hearing Date: Labels Ordered: � Notice Sent to Applicant: District Council #: OI Notice Sent to Public: Ward #: (� Department/ Date Inspections Comments , City Attorney 8• 5 •°� lo c�.� . Environmental Health g. � .�,(o d.ir. . A� � '� ' �� • ��o Fire 8�2�•�!o 141P�'�II�D S��' '� �"1 ld�C.� 41 `� . �icense �A stte Plan Received: � � � • �-,�-ryy� ?CZ�,�}� )'YIMso�' l.ease Received• 8 /�' ��-�-t� �-�.yIV W � �►'h[J ..� - l.1 Police ��1, 'Z- � t� 8• 5 •�lo �• � . Zoning 8 • z�-• Qb d,� . CLASS III CITY OF SAINT PAUL LICENSE APPLICATION Offict of License,i�,��tio� and Environmental Protection 350 Sc Pau St.Sui¢300 Saint Paul,Minnesda 55102 (612)2669090 taz(612)��?4 � � � O� � THIS APPLICATIOV IS SUBJECT TO REVIEW BY THE PLTBLIC PLEASE TYPE OR PRINT L�1 L1K Type of License(s)being applied for: I I C! Il�S� G/Gf , P f��• Company\'ame: m CGS�-�� (.�c-l��OD/►') L L C'� Corpontion/Parmership/Sole Proprietorship " If business is incorporated, give date of incorporation: Doing Business As: � / �� L/�Q;L�/�,)L+L Business Phone: �,7 7 ' ��5 Business Address: �/ 7 � C� /4k��C' S% /-��- /1�1/J' �~/d� Sveet Address City State Zip Betvveen what cross streeu is the business located? G�-►4QtN<<= v�' �S t, Which side of the street? �� ( Are the premises now occupied?_ `� � V�'hat Type of Business? Mail To Address: � � � 7 GL�1-�C I`iC.0 5 i�f�v L ►�N 5.��UO SvePt Address City State Zip Applicant Information: � �'ame and Tide: " c..Ci �� First Ttiddle (Maiden) Last Tide Home Address: �� / ) �///� ' �. // �� Saxt Address City State Z�P Date of Birth: Place of Birth: �_� .. Home Phone: � Have you ever been c nvic of any felony,crime or violation of any ciry ordinance other than traffic? YES_ NO� Date of azrest: Where? Chazge: � 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: I�TAME ADDRESS PHONE /�g� �'�►� �=m,an/ List licenses which you curtendy hold,formerly held,or may have an interest in: 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? YFS NO If not,who will operate it? First Name Middle Initial ('viaiden) Last Date of Birch Home Address: Strcet Name City State Zip Phone Number Are}�ou going to ha��e a manager or assistant in this business? %�,YES I�O If the manager is not the same as the operator,please complete the folloy�ng information: STC l�L� �! • UovN .� ` ' � Frst�ame �liddle Initial (�4aiden) Last Date of Binh f l",�� c� r-�- S� ��L .�rl�� S�'i � 7��f �4�-( Home Address: Street:�ame Ciry State Z�p Phone\'umber Please list your emplo��ment history for the previous five(5)}ear period: ` y" 1�� f�'/ Business/Emplo��ment Address � — � - �-�2 S �-�;c�L �� 4 / /�'/�,r f�r c= �' List all other officers of the corporation: OFFICER TTTLE HO:vIE HOME BliSI'.�'ESS DATE OF NA1ViE (Office Held) ADDRESS PHO�'E PH01� BIKTH �r.�r iC /�,�fWGc;/t/ C.C_� ��S`7.S– C> pi tY��G(��2 �'�� 7�/–�1�� Cc��°(o Z` �(L`VC �r� .�c rI�JS I k'�S �� LN�r t�� e�Qri� �T��5'U %/°0?7-.5� If business is a parmership,please include the follov��ing information for each partner(use additional paEes if necessary): First\ame Middle Initial (T4aiden) Last Date of Birth Home Address: Stree�'�ame Ciry State Zip Phone Vumber First'�ame Middle Inival (Maiden) Last Dau of Birth Home Address: Saset Kame Ciry State Trp Phone Number ?�ZINT'ESOTA TAX IDE.'�'TIFTCATI0:�1 T�TMBER-Pursuant to the Laws of Minnesota, 1984,Chapter 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?vlinnesota business taz identification number and tbe social security number of each license applicant. Under the Minnesota Govemment Data Practices Act and tbe Federal Privacy Act of 1974,we are required to advise you of tbe following regarding the use of the Minnesota Tax Identification 1�Tumber. -This information may be used to deny tbe issuance or renewal of your license in the event you owe Minnesota sales,employer s withholding or motor vehicle excise taxes; -Upon receiving this information,the licensing authoriry will supply it only to the Minnesota Depazunent of Revenue. However, under the Federal Ezchange of Information Agreement,the Department of Revenue may supply this information to the Intemal Revenue Service. Minnesota Taz Identification Numbers (Sales & Use Taz :�'umber) may be obtained from the State of Minnesota, Business Records Department, 10 River Pazk Plaza(612-296-6181). Social Securiry T'umber: Minnesota Taz Identification Number: � � If a Minnesota Taz Identification�'umber is not required for the business being operated,indicate so by placing an"X"in the boz. CERTIFIC�TIO\QF Vt'ORKERS'C0�4PENSATION CO�"ERAGE PURSU/�'�"T TO MII�TNESOTA STATUTE 176.182 I hereby certify tbat I,or my company,am in compliance w�ith the workers'com�ensation insurance co��erage requ'uemenu of Minnesota Stawte 176.182,subdi��ision 2. I also understand that provision of false information in this cert�cation constitutes su�cient grounds for ad��erse action against all licenses held,including revocation and suspension of said licenses. Name of Insurance Company: � Policy:�'umber: Coverage from to I have no employees covered under w�orkers'compensation insurance Q r � 1�S'� 1 -��o � � Y A:�'Y FALSffICATION OF A\S«�RS GIVEN OR'.1iATERIAL SLB:�ZITTED �'��,L RESULT L'�DE\ZAL OF THIS APPLICATION I bereby state that I have answered all of the 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 ha��e received no money or other consideration,by v��ay of loan,gift,contribution, or otherwise,other than already disclosed in t6e application v,•hich I herewith submitted: I also understand ttus premise may be inspected by police,fire,health and other city officials at any and all times when the business is in operation. i� - ''''`� ` � -� �� I� Signature(REQUIRED for all applications) Date *"`Note: If this application is Food/Liquor related,please contact a City of Saint Paul Health Inspector�Steve�Ol�so,�(266-9139),to review plans. If any substantial changes to savcture are anticipated,please contact a Ciry of Saint Paui Plan Ezaminer at 266-9007 to apply for building permiu. If there are any changes to the parking lot,floor space,or for new operations,please contact a Ciry of Saint Paul Zonin Ins tor 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 folloK3ng data should be on the site plan(greferably on an 8 U2" x 11"or 81/2"x 14"paper): -Name,address,and phone number. -The scale should be stated such as 1"=20'.^h'should be indicated towazd the top. -Placement of all pertinent features of the interior of the licensed facility such as seating areas,idtchens,offjces,repair area,garlang,rest rooms,eta - If a request is for an addition or e�pansion of the licensed facility, indicate both the current area and the proposed expansion A copy of your lease agreement or proof of ownership of the property. FOR SPECIFIC APPLICATION REQUIREMENTS, PLEASE SEE REVERSE >>>>