95-1485 Council File # C IS - 0
? ' $ r 1 a
4 Ordinance #
Green Sheet # ,5 fie)
RESOLUTION
CI SAINT PAUL, MINNESOTA 4'
Presented By
Referred To Committee: Date
1 RESOLVED: That application (ID #81841) for an Auto Repair Garage License applied for by
2 Timothy Selix DBA Tim's General Repair (Timothy Selix, Owner) at 411.5
3 Wabasha Street South be and the same is hereby approved.
Absent Requested by Department of:
Blakey Office of License, I n spe ctions and
Guerin
Harris
H Environmental Protection
Megqard
Rettman
Thune 7 � ,
Grimm Lci—.4.A.,-,
• O B y '
Adopted by Council: Date t,.- :-o VMS
Adoption Certified by Council Secretary Form Approved by City Attorney
1161
By: BY:
Approved yor: Date/Z./Z-/ 5
Approved by Mayor for Submission to
Ap Y Y
i / 1 Council
By:
By:
s —‘4s.45
DEPARTMENT/OFFICE/COUNCIL DATE INMATE° GREEN SHEET N_ 3 5 5 4 0 '
LIEP /Licensing
CONTACT PERSON & PHONE DEPARTMENT DIRECTOR ITIALfOATE. ED CITY COUNCIL INITIALlDATE —
Bill Gunther, 266 -9132 ASSIGN El CITY ATTORNEY ❑ CITY CLERK
NUMBER FOR
MUST SE ON COUNCIL AGENDA BY (DATE) ROUTING El BUDGET DIRECTOR ❑ FIN. & MGT. SERVICES DIR.
For hearing: 1217 j Os 5 ORDER MAYOR (OR ASSISTANT)
TOTAL # OF SIGNATURE PAGES (CUP ALL LOCATIONS FOR SIGNATURE)
ACTION REQUESTED:
Timothy Selix DBA Tim's General Repair requests Council approval of its application for
an Auto Repair Garage License at 411.5 Wabasha Street South (ID #81841).
RECOMMENDATIONS: Approve (A) or Reject (R)
PERSONAL SERVICE CONTRACTS MUST ANSWER THE FOLLOWING QUESTIONS:
PLANNING COMMISSION _ CIVIL SERVICE COMMISSION 1. Has this person/firm ever worked under a contract for this department? -
- CIB COMMITTEE YES NO
2. Has this person/firm ever been a dty employes?
— STAFF YES NO
- DISTRICT COURT 3. Does this person/firm possess a skill not normally possessed by any current city employee?
SUPPORTS WHICH COUNCIL OBJECTIVE? YES NO
Explain all yes answers on separate sheet and attach to green sheet
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INMATINO PROBLEM, ISSUE. OPPORTUNITY (Who. What, Whin. Where, Why):
ADVANTAGES IF APPROVED:
Council Research Center
DEC 11 1995
_ � s
DISADVANTAGES IF APPROVED:
DISADVANTAGES IF NOT APPROVED:
TOTAL AMOUNT OF TRANSACTION $ COST/REVENUE BUDGETED (CIRCLE ONE) YES NO
FUNDING SOURCE ACTIVITY NUMBER
FINANCIAL INFORMATION: (EXPLAIN)
1
NOTE: COMPLETE DIRECTIONS ARE 1NcLUOED f THE GREEN SHEET INSTRUCTIONAL
MANUAL AVAILABLE IN THE PURCHASING OFFICE (PHONE NO 29842".6).',
ROUTING ORDER: . ;
Below are correct routings for the five most frequent types of documents:
CONTRACTS (assumes authorized budget exists) COUNCIL RESOLUTION (Amend Budgets/Accept. Grants)
1. Outside Agency 1. Department Director
2. Department Director 2. Budget Director
3. City Attorney 3. City Attorney
4. Mayor (for contracts over $15,000) 4. Mayor /Assistant
5. Human Rights (for contracts over $50,000) 5. City Council
8. Finance and Management Services Director 6. Chief Accountant, Finanoe .and Management Services
7.'" finance Accounting
ADMINISTRATIVE ORDERS (Budget Revision) COUNCIL RESOLUTION (all others, and Ordinances)
1. Activity Manager 1. Department Director
2. Department Accountant 2. City Attorney
3. Department Director 3. Mayor Assistant
4. Budget Director 4. City Council
5. City Clerk
6. Chief Accountant, Finance and Management Services
ADMINISTRATIVE ORDERS (ail others)
1. Department Director
2. City Attorney
3. Finance and Management Services Director
4. City Clerk
TOTAL NUMBER OF SIGNATURE PAGES
Indicate the #of pages on which signatures are required and paperclip or flag
each of these pages.
ACTION REQUESTED
Describe what the project/request seeks to accomplish in either chronologi-
cal order or order of importance, whichever is most appropriate for the
Issue. Do not write complete sentences. Begin each item in your list with
a verb.
RECOMMENDATIONS
Complete if the Issue in question has been presented before any body, public
or private.
SUPPORTS WHICH COUNCIL OBJECTIVE?
Indicate which Council objective(s) your projecthequest supports by listing
the key word(s) (HOUSING, RECREATION. NEIGHBORHOODS, ECONOMIC DEVELOPMENT,
BUDGET, SEWER SEPARATION). (SEE COMPLETE LIST IN INSTRUCTIONAL MANUAL)
PERSONAL SERVICE CONTRACTS:
This information will be used to determine the city's liability for workers compensation claims, taxes and proper civil service hiring rules.
INITIATING PROBLEM, ISSUE. OPPORTUNITY
Explain the situation or conditions that created a need for your project
or request.
ADVANTAGES IF APPROVED
Indicate whether this is simply an annual budget procedure required by law/
charter or whether there are specific ways in which the City of Saint Paul
and its citizens will benefit from this project/action.
DISADVANTAGES IF APPROVED
What negative effects or major changes to existing or past processes might
this project/request produce if It is passed (e.g., traffic delays, noise,
tax Increases or assessments)? To Whom? When? For how long?
DISADVANTAGES IF NOT APPROVED
What will be the negative consequences if the promised action Is not
approved? Inability to deliver service? Continued high traffic, noise,
accident rate? Loss of revenue?
FINANCIAL IMPACT
Although you must tailor the information you provide here to the issue you
are , addressing, in general you must' answer two questkms: How much is it
going to cost? Who is going to pay?
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Greensheet# 35540 L.I.E.P. REVIEW CHECKLIST Date: 11/6/95
In Tracker? App'n Received / App'n Processed
40
License ID # 81841 License Type: Auto Repair Garage
Company Name: Timothy Selix DBA: Tim's General Repair
Business Addresss:4 Wabasha St So. , 55107 Business Phone: 228 -9 554
Contact Name /Address: Tim Selix, 514 Stryker Ave, 107 Home Phone: 227-6170
Date to Council Research:
Public Hearing Date: /2 - . 240 Labels Ordered: n/a
Notice Sent to Applicant: 7/9 District Council #: / 7
Notice Sent to Public: /7 33 z-A-7 Ward #:
Department/ Date Inspections Comments
App'd Date Verified
City Attorney
11 -9
Environmental
Health W. A •
Fire
License cK /X. AI„ 5770 PLOA✓ Site Plan Received:
1 2- / - 7S k Lease Received:
Police 11-2'7- 9 b IVO I CZ3leiti icocl .2&
Zoning
!r - 27 - g,S wiTN co i&r/til
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"'-"' CLASS 111 CITY OF SAINT PAUL go
PAUL LICENSE APPLICATION Office of License, Inspections T'�
and Environmental Protection
350 St Peter St Suitt 300
Saint Paul, Minnesota 55102
MAMA (612) 266 -9090 fax (612) 266 -9124
sernmos• THIS APPLICATION IS SUBJECT TO REVIEW BY THE PUBLIC
PLEASE TYPE OR PRINT IN INK .
Type of License being applied for: /!/TO Rer'
Company Name: 7 S (LN co,edv / e PI,R.
Corporation / Partnership / Sole Proprietorship
If business is incorporated, give date of incorporation: /" 0
Doing Business As: ' "TO tt7" 'c,1,'/ C Business Phone- 0242 ? --755
Business Address: 5 7.2 wet, 4.5i 0... Sr 5 TVA, Z ,y, / ,"N 5J7D7
Street Address City State Zip
Between what cross streets is the business located? Co* co/el/ iMea$42 Which side of the street? )5
Are the premises now occupied? Yes' What Type of Business? fi "re eel"
Mail To Address: V// Xd w aAaS/ 5T, / L AG 'Aw sszo
Street Address City State Zip
Applicant Information:
Name and Title: riir>e A(7 LF vieeN sn/, % DG✓/1'
First Middle (Maiden) Last Title
Home Address: S` /t -� S7 Y ./ /1Ue 57/Le/ ,a, ;,./ti .6S /o7
Street Address City State Zip
Date of Birth: o2. 0102- 6 / Place of Birth: Afftr ',''e e ,(1.AV Home Phone: 222
Are you a citizen of the United States? Native? Naturalized?
If you are not a U.S. citizen, you must have work authorization from the U.S. Immigration & Naturalization Service. .
Have you ever been convicted of any felony, crime or violation of any city ordinance other than traffic? YES NO f/
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 fmancially interested in the premises or business, who may be referred to as to the applicant's character:
NAME ADDRESS PHONE
Ro c/ x' 4 .yQ o e 1, 4 -('
w ..Cg, „d «.4e_ . ir:
a ��z eu . � ��,.,,-,,o
List licenses which you curre tly hold, formerly held, or may have an interest in:
Acxe f .,
Have any of the above named licenses ever been revoked? _ YES CI0 If yes, list the dates and reasons for revocation:
Are you going to operate this business personally? v YES NO If not, who will operate it?
First Name Middle Initial (Maiden) Last Date of Birth
7777,41 Y 4 o 1 d 'e v - � Z '1C ;Z -z z - 6 l
Home Address: Street Name City State Zip Phone Number
.67V .4 ' Al.? -.11.1/44ii r
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4
Are you gc ng to have a manager or assistant in this business? YES NO If the manager is not the same as the operator, Gs».
please complete the following information:
First Name Middle Initial (Maiden) Last Date of Birth
Home Address: Street Name City State Zip Phone Number 1
Please list your employment history for the previous five (5) year period:
Business/Emnlovment Address
'd,.,- R«Q I / 6 o7 err, '/f
List all other officers of the corporation:
OFFICER TITLE HOME HOME BUSINESS DATE OF
NAME (Office Held) ADDRESS PHONE PHONE BIRTH
If business is a partnership, please include the following information for each partner (use additional pages if necessary):
First Name Middle Initial (Maiden) Last Date of Birth
Home Address: Street Name City State Zip Phone Number
First Name Middle Initial (Maiden) Last Date of Birth
Home Address: Street Name City State Zip Phone Number
MINNESOTA TAX IDENTIFICATION 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 Government Data Practices Act and the Federal Privacy Act of 1974, we are required to advise you of the
following regarding the use of the Minnesota Tax Identification Number.
- This information may be used to deny the 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 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 Tax Identification Numbers (Sales & Use Tax Number) may be obtained from the State of Minnesota, Business Records
Department, 10 River Park Plaza (612 - 296 - 6181).
Social Security Number. V7 / FA - 75
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Minnesota Tax Identification Number.
If a Minnesota Tax Identification Number is not required for the business being operated, indicate so by placing an "X" in
the box. .
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FE RTIFIOATION OF WORKERS' COMPENSATION COVERAGE PURSUANT TO MINNESOTA STATUTE 176.182
reby certify that I, or my company, am in compliance with the workers' compensation insurance coverage requirements of
nesota Statute 176.182, subdivision 2. I also understand that provision of false information in this certification constitutes sufficient unds for adverse action against all licenses held, including revocation and suspension of said licenses.
Name of Insurance Company:
Policy Number: Coverage from to
I have no employees covered under workers' compensation insurance
ANY FALSIFICATION OF ANSWERS GIVEN OR MATERIAL SUBMITTED
WILL RESULT IN DENIAL OF THIS APPLICATION
I hereby 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 have received no money or other consideration, by way of loan, gift,
contribution, or otherwise, other than already disclosed in the application which I herewith submitted.
1/ 6 - ?5
Signature (REQUIRED for all ap 'cations) Date
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Attach to this application:
1) 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 1/2" x 11" or 8 1/2" x 14" paper):
- Name, address, and phone number.
- The scale should be stated such as 1" = 20'. AN 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 area, parking, rest rooms, etc.
- If a request is for an addition or expansion of the licensed facility, indicate both the current area and the
proposed expansion.
2) A copy of your lease agreement or proof of ownership of the property.
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