96-310Council File # �..�•�Q
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ordinance #
Green Sheet ,� 3 ��5( i�
MINNESOTA
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Presented By
Referred To
COmmittee: Date
1 RESOLVED: That application (ID #19207) for a Liquor On Sale-A, Sunday On Sale Liquor,
2 Entertainment-C, and Restaurant-B License applied for by CRM Trade Center,
3 Inc. DBA Hearthrob Cafe (James Domoracki, President) at 30 8th Street East be
4 and the same is hereby approved.
�.--��--��� Requested by Department of:
Adoption Certified by Council Secretary
By:
Appr
By:
Office of License, InsDections and ---
Environmental Protection
B (���C,� �
Form Approved by City Attorney
B �� � • ; r��/ys
Approved by Mayor for Submission to
Council
By:
Adopted by Council: Date �v\ �� t�.q`��
9G-3�b
�EPARTMENT/OFFICFJCOUNCIL �ATEINITIATED GREEN SHEE �O 35256
LZEP/Licensin INITIAVDATE INITIAL/DATE
CANTACT PERSON 8 PHONE O DC4AF�MENT DIRECTOR � CRY COUNCIL
Bill Gunther, 266-9132 A�GN �CfiYATfOFiNEY OCRYGLERK
XUYBEN FOp � BUDCaEf DIRECTOfl � FIN. & MGT. SERVICES OIfl.
MUST BE ON COUNCIL AGENDA BY (DATE) ROVfING
? I. I� ONOEP a MpYOR (OR ASSISTANi) O
For hearin : at
TOTAL # OF SIGNATURE PAGES (CLIP ALL LOCATIONS FOR SIGNATUR�
ACiION fiEDUE5TED:
CRM Trade Center, Inc. DBA Hearthrob Cafe requests Council approval of its application for
a Liquor On Sale-A, Sunday On Sale Liquor, Entertainment-B, and Restaurant-B License
at 30 8th Street East (ID 4119207).
pECOMMENDA71oNS: Approve (A1 w Reject (R) pERSONAL SERVICE CONTRACTS MUST ANSWER THE FOLLOWING QUESTIONS:
__ PLANNING COMMISSION _ CIVIL SERVICE CAMMISSION �� H35 thi5 pCfSO�rtn eVef WOIKetl �ndef d COnVdC[ fOf thls dapartmeM? - �
_ CIB COMMfREE _ YES �NO
_ STAFF 2. Has this person�rm ever bee� a ciry employee?
— YES NO
� OIS7RICT CAUR7 _ 3. Does this pereon/firm possess a skill not normally possessed by any curteM ciry employee?
SUPPORTS WMICH COUNCIL O&IECTIVE7 YES NO
Explain eli yes answers on separate sheet and attach to green sheet
INITIATINCa PROBLEM, ISSUE.OPPOR7UNITV (Who. Whet WhBn, Where, Why):
ADVANTAGESIFAPPROVED:
DISADVANTAGES IFAPPROVED:
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DISADVANTAGES IF NOT APPFOVED:
TOTAL AMOUNT OFTRANSACTION S COS7/REVENUE BUDGETED (CIRCLE ONE) YES NO
FUNDING SOURCE NCTIVITY NUMBER
FINANCIAL INFORMATION: (EXPLr11N)
Greensneet # 35256 L.I.E.P. REVIEW CHECKLIST Date: 12/14/95 /��. '� � 0
In Tracker? app'n rteceived / app'n �rocessed
License ID # 19207 License Type: Lia-On Sale-A Sundav On Sale Liq En �mm �-
Company Name: CRM Trade Center, Inc Restaurant-�BA. gearthrob Cafe
Business Addresss: 30 8th Street East Business Phone: 224-2783
Contact Name/Address: James Domoracki, Pres Home Phone: 559-9113
4265 Lanewood Ln, Plymouth 55446
Date to Council Research: ,
Pubiic Hearing
Notice Sent to
Notice Sent to
Department/
City Attorney
Environmental
Health
Fi�e
Lice�se
Police
,���(, 37-�
33�
Date Inspections
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1 "� Z ``�
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3-5 •`�t�
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Labels Ordered: /"/T�
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District Councii #: �7
Ward
Comments
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Site Plan Received:
�. K. �� ���� S • Lease Received:
1`4�pS L �7i�� �C.-��'T''t8�11"j"'
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Zoning
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CLASS III
LICENSE APPLICATION
�1
CITY OF SAI�NT P 3L
O�ce oC License, Inspections
and Environmrntal Protection
350 Sc Pac St Suim i00
SainxPaul,Afinnaou 55101
(612)+_649090 fac(612)'66913d
THIS APPLICATION IS SUBJECT TO REVIEW BY THE PUBLIC
PLEASE TYPE OR PRINT IN INK
Type of License(s) bein� applied for: i-/Ol/O� p.c/ SAL�
Company Name: Ci2l77 7•E��D� G�ir/7�,P �/UG .�B4 y�•0.� C/,���
Corporanon / Paztnership / Sole Proprietorship
If business is incorporated, give date of incorporation:
Doin� Business As: .�/EA.E7 7�� �'.Q Business Phone:
Business Address:
SVeet Address � �� QQ Ciry I $Wte Zip
Between what cross streets is the business located? 7�'S .y /i✓!� ��S/� Which side of the street? E•C�17
Are the premises now occupied� ��..5 What Type of Business� �S,,qd,eq,✓/
Mail To Address: �ry� J� 7��- /-�� �-. —� �r
Sveet Address — C��
%B72C0/ G��1�+Z� �j- ✓.�✓tJ' �YS' y s�are z�
Applicant Information:
Name and Title: _,;/yrrl� — — ,� {',Z�id�/7 v
mo,e,ac% �
Fast M�ddSe (Maidcn) Lazt Title
Home Address:
Date of Binh:
/�ZIoS� �,ni✓Ec%ab .�.✓ /�lvinnvT�, /yJ-✓ SSf'S��
SUeel Address CiTy Stale Zip
�,�/3��/b Place of Birth: /l7iLW . •(�/� L. Home Phone: 3 S'r/ 9//3
Have you ever been convicted of any felony, crime or violation of any city ordinance other than traffic?
Date of arrest:
Charge: _
Conviction:
Where?
Sentence:
YES _ NO �
List the names and residences of three persons of good mora] character, livin� within the Twin Cities Metro Area, not re]ated to the
applicant or financially interested in the premises or business, who may be referred to as to the applicanYs character:
NAME ADDRESS ' PHONE
�.o�c ,�1,�i �o �.ss� ���,� s�/�.�L �n� z9�-� z�i
__/ 7Limrm�68�./ .�oX ?Q Z- �i�4.�/�gssF�c/ /yl�/ y7'f d7J�
i „ -
List licenses which you wnently hold, formerly held, or may have an interest in:
�o�em -�2Ly /-, � t� 1 �Gpvo L,'cE.✓s � i.r./ .s;
�
2.
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 YES _ NO ]f not, who wi11 operate it?
First Namc Middle Initiai
(Maidcn)
l.act
Home Address: Sveet Namc Ciry Statc Zip
Date of Binh
Phone Number
�u going to have a mana�er or assistant in this business? �YES
complete the following infocmatian:
G�
r�,,�
NO If the mana�er is not the same as the operator,
�/3o/6Z �
Fint Name Middle Ini[ial (D9aiden) Las[ Date of Birih
/9i9 �s.'L��2 r��// �40 �iay i=.r�G4� �� s�%zz �SZ-.s7Zc
Home Address: Stree[ Narne City State Zip Phone Number
Please list your employment history for the previous Fve (5} year period:
Business/Emolovment Address
r' ONNO 1 SS E�/�- �E57Av.2A�•/7 ll7R �/,4GE inE�� i�f C
i o ao //�4v z.a7.g .C3 � �� # Z`�J /�'7iw.✓c 7o.�.E�. Y�'J�/ S S3 0�
� -
List all other officers of the corporation:
OFFICER TITLE HOME HOME BUSINESS DATE OF
NAME (Office Held) ADDRESS PHONE PHONE BIRTH
— J' omv/La�' �2�• �/ZG! .�UE�a 569�9// ,S'ZS-/49Z �o /3�g6
J��,mo�7h /�l
If business is a partnership, please include the following infom�ation for each partner (use additional pa�es if necessary):
First Name
Middle Initial
HomeAddress: $VeetName
Fint Name
Middk fnitial
Home Address: Sveet Name
(Maiden)
City
(Maiden)
City
Last
$tatc Zip
Lut
State Zip
Date of Birlh
Phone Number
Date of Binh
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), licensin� 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 are required to advise you of the
following regarding the use of the Minnesota "Iax 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 withholdina or motor vehicle excise taxes;
- Upon receiving this information, the licensin� 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 inforznation
to the intemal 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: c39Z— �/2—OO� �
Minnesota Tax Identification Number: �lr/1JL1Cd ��
��
If a Minnesota Tax Identification Number is not required for the business being operated, indicate so by placing an "X" in
the box.
TIFICATION OF WORKERS' COMPENSATION COVERAGE PURSUANT TO MINNESOTA STAT(lTE 176.182
hereby certify that I, or my company, am in compliance with the workers' compensation insurance coverage requirements of
Minnesota Statute 176.182, subdivision 2. 1 also understand that provision of false information in this certification constitutes su�cient
� grounds for adverse action against all licenses held, including revocation and suspension of said licenses. ����`�
Name of Insurance Company: fJ-!�I✓��� �/�-
Po]icy Number. Covera�e from to
I have no employees covered under workers' compensation insurance
ANY FALSIFICATION OF ANSNERS 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. I also understand this premise
may be inspected by police, fire, health and other city officials at any and all times when the business is in operation.
for all applications)
�9r
Date
*'�Note: If this application is Food/Liquor 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 Pau] Plan Examiner at 266-9007 to apply
for buildin� permits.
If there are any changes to the parking lot, floor space, or for new operations, please contact a City of Saint Paul Zonin�
Inspector at 266-9008.
Additionai application requirements, please attach:
A detailed description of the design, location and square foatage 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 S I/2" x 14" paper):
- Name, address, and phone number.
- The scale should be stated such as 1" = 20'. ^N should be indicated toward the top.
- Piacement of all pertinentfeatures 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
eapansion.
A copy of your lease agrecment or proof of ownership of the property.
FOR SPECIFIC APPLICATION REQUIREMENTS, PLEASE SEE REVERSE >>>>