96-368��CI�����,� �
Council File 8 3�
ordinance #
Green Sheet # `�����
RESOLUTION
OF SAINT PAUL, MINNESOTA
Presented By
Referred To
Committee: Date
1 RESOLVED: That application (ID #22868) £or an Auto Body Repaix Garage License by KV
2 Auto Body Repairs DBA KV Auto Body Repairs (KOU Vang, Owner) at 930 Duluth
3 Street be and the same is hereby approved.
4
5
6 Y� Navs Absen�
7 BZakev
8 Gizerzn
9 Harri � �/
1� Re t� man
12 T un h e
13 Bostrom
15 � �
16 Adopted by Council: Date �,p.r,�, �p ,\'
17 T
18 Adoption Certified by Council Secretary
19
20 �� 21 By:
22 /
23 Approved by M or: Date `�
24 Aa ��
25
26 By:
27 (
S3
�
Requested by Depaxtment of:
Office of License Inspections and
Environmental Protection
By: �/`� �T �-' I
U
Form Approved by City Attorney
`�/�� o , l� �0.
.
_ V v`
Approved by Mayor for Submission to
Council
By:
9�-3��''�
DEPARTMENT/pFFICE/COUNCIL DATEINRIATED �REEN SHEE N_ - 35275
LIEP/Licensin iNinnvoA - �NmAVOa�
COMACf PER$pN & PNONE O DEPARTbiENT OIRE � CfTV CAIJNCII
Christine Rozek, 266-9108 nsswx �cirvnrrowuev �crrcc�aK
NUMBER FOR
MUST BE ON CpUNC{L pGENDA BY IDATE) qp�ry� O BUDGEf DfFtECTOSi � flN. & fAGS SERV7CE5 iNfi.
For hearing: {.,� � (� ��E OMA'�OR(ORASSISTANT) �
TOTAL # OF SIGNATUflE PAGES (CLIP AL� LOCATIONS FOR SIGNATURE�
ACTION flC-0UESTED:
KV Auto Body Repairs DBA RV Auto Body Repairs requests Council approval of its application
for an Auto Body Repair Garage at 930 Duluth Street (ID 1122868).
RECOMMENOq71pNS: Apprrne (n) « Rejeet{R) pERSONAL SERVICE CONTRACTS MUST ANSWER THE POLLOWING QUESTIONS:
_ PLANNING COAIMISSION _ CIVIL SERVICE COMMISSION �• Has this persoMirm ever worketl untler a conVact for this departmentl -
_ C�B COMMITTEE _ YES NO
_ STAFF 2. Has this personmrm ever been a city employee?
— YES NO
_ DISTRICTCpURT � 3. DOes thi5 pBrSOn/fifm
possess a skill not normally possessed by any current ciry employee?
SUPPOFiTS WHICH CAUNCIL OBJECTIVE7 YES NO
Explain all yes answers on aeperate sheet and attach to green sheet
INITIATING PROBLEM, ISSUE, OPPORTUNITV (WhO. Whet, When, Where. Why): ��: A; �, �;,; �,W „
���'��
FE� 29 1���
.:,��� A�T�R EY
ADVANTAGES If APPROVE�:
DISADVANTAGES IFAPPROVED
DISADVANTAGES �F NOTAPPROVED:
� 4'��`a�,+�� �n.�a..;
i:?. � i fnn.^
TOTAL AMOUNT OP TRANSACTION S COST/AEVENUE BUDGETED (CIRCLE ONE) YES NO
FUNDIfdG SOURCE ACTIVI7Y NUMBEH
FINANCIAL INFORMATION: (EXPLAIN)
Greensneet # 35275 L.I.E.P. REVIEW CHECKLIST �ate: z/2z/96 /
in Trackef? App'n Received ( App'n Processed
qL-36�'
License ID # 22868 license Type: an Auto Body Repair Garage _
COmp2ny Name: � Auto Bod Repairs DBA: RV Auto Body�pairc
Business Addresss: 930 Duluth Street� �� g Business Phone:
Contact Name/Address: Kou Vang 1364 Burr St. 55101 Home Phone: 488-30i 7
Date to Counci! Research�:
Public Hearing Date: "1 1$�9 Zo
Notice Sent to Applicant: ` U/
Labels Ordered: ��,/
DistricT Council #:
=s� m, 3.�' /
Notice Sent to Public: 3 /�� �✓�� Ward #: C D
Department/ Date Inspections Comments
City Attomey �J � Gi la �" �' �
}
�
Environmental Gt N , {� ,
Health �l� 1 �
Fire 3��9 /� � L�. k.--- 1��-7�GA"tllJL�1 oE ��5 , iP"i ,�SC.j� .
n�a N�.r � �� i w�t?z� -
�
License �� �� ��� C7 � Site Plan Received:_
Lease Recefvea:
Police 3�1 /q � O.'�. �
f ` Y
6
zoning �j 5 � �p fl • � •
�
---� .,�.� �g� $ ���� 70 �z�
CLASS III
LICENSE APPLICATION
Type of License(s
Compan}� Name:
If business is incor�
Doing Business As:
Bu;i;;ess Addre;s:
\
date of incorporation:
r�..iv--1
Sveet .4ddress
Behreen w ]�at cross streets is the business located?
Are the premises no�v occupied? _
D4ai1 To Address: �n� e/
Streei ,4ddress
Applicant Inforn
t�'ame and 7'iile:
CITY OF SAINT PAUL
Office of Licrnse, Inspcctions -
and Em•ironmcntal P�o�ettio� � — � � �
+50 St Pan Si Suim iM
S»ntPaui.Afinnaou <5102
(6l?) •_65-4J90 fu (6!?) :fiS9ll4 �
��✓ /�f��'ff C BusinessPhone: I
7tf sT 57 �A-cc �, m r�1 �ssi �z„ I
Ciry State Zip
' S�_ S �llPrll�r �hich side of the street� /U-'$f ��
�" L p ' / S j,
lVhat 7�pe of Busine 1Tl•L717 DDG V ��G.l 1��� f� �LC'�Zt .n�r�
��..i.n!`(' n/{if/.�e!'(" !
City
�
First Middte (Alaiden) Last . I Tiile
Home Address: _ 1� � ���� S j, 5 � . �r�v�. �. /� �! � ,j � Q �
$Veet Addrzss City $Iaie Zip
Date of Binh; �' � d lo � Place of Birth: ��-(� � Home Phone: ��0 � y i�S—.�JG/7
Have you ever been convicted of any feSony, crime or violation of any city ordinance other than traffic? YES _ NO �
Date of anest: Where?
Charoe:
Conviction: Sentence:
List the names and residences of three persons of good moral character, livin� within the Twin Cities Metro Area, not related to the
applicant or financially interested in tl�e premises or business, who may be referred to as to the applicant's character:
Have any of the above named ]icenses ever been revoked? ^ YES ^ NO If yes, list che dates and reasons for revocation:
Are,y9u going to operate this b�u} iness personally? _ YES fN0 If not, who will operate it? ��
Y. nl/ Y. —.... vG �o /�Ad �/? P..�=Z/1 /2
Home Address: Sucet Name
Initiai
Ciry
Lu[ Date of Birth
/ �'toi ���-a�
State Zip Phonc Numbcr
State Zip
. ,._ . . . �.. . .�—���. _
..�.. ___... __"_'_"�. _�...�.._� _ ... � _ .,_�i_,._, �:..,—._.� .�........__. ,.�....._., ��..�.__.._.._...,..-..�.:-�.�.� �:"...:
r \ � THIS APPLICATION IS SUBJECT TO REVIEW BY THE PUBLIC
/�/ PLEASE TYPE OR PRINT IN II�'K
J
List licenses �vhich you currently hold, fonnerly held, or may have an interest in:
Are }�ou goin� to have a manager or assistant in this business?
please comptete the following information:
�;�:c r*�„e
Home Address: SVeet Aame
D9iddle Initial
(Diaiden)
Ciry
�.�����
if the manager is not the same as the oper`�. ,��'
Las[
State Z�P
9 � -3G8'
Date olBirth
Phone Humber
List al1 other officers of the corporation:
OFFICER TITLE HOME HOME BUSINESS DATE OF
NAME (Office Held) ADDRESS PHONE PHONE BIRTH
If business is a partnership, pfease indude the follo�cing infom�at'son for each partner (use additiona] pa�es if necessary):
First i�ame
Home AddreSS: Sveet Name
Name
Home Address: Street i�ame
Dliddle Initial
hliddle Initial
(i.faiden)
City
(hiaiden)
Ciry
Last
State Zip
Lazt
State ZiP
Date of Birth
Phone Numbu
Date of Binh
Phone ldumber
MINNESOTA TAX IDSNTIFICA7ION A't3MBER - Pursuant to the Laws of Minnesota, 1984, Chapter 502, Article S, Section 2
(270.72) (Tax Clearance; Issuance of Licenses), ]icensing 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 Federai Privacy Act of 1974, we are required to advise }�ou of the
followin� regarding the use of the Minnesota Taa Identification Number:
- This infomiation may be used to deny che issuance or renewal of your license in the event you owe Minnesota sales,
employer's �vithholding or motor vehicle eacise taxes;
- Upon receiving this information, the licensin� authority wi}1 supply it only to the Minnesota Department of Re��enue.
Howeve�, undei the Federa! Exchange of Information A�reement, the Department of Revenue may supply this inforznation
to the Intemat Revenue Service.
Minnesota Tax Identification Num se Tax Number) may be obtained from the State of Minnesota, Business Records
Department, 10 River Park Plaza 612-296 `618 ]) '
Social Security Number: ��.3; � �,�C'!�
Minnesota Tax Identification Number: yl
,.__ lf a Minnesola Ta�t ldentitcation umber is not roquired for the business being operated, indicate so by placing an "X" in
thc box.
,.,, ,
Y �� O .
Please ]ist your employment history for the previous five (S) year period:
. SFn49:....�_ �� �� . .�.v6t�ih= ?.Ir'�ftiPA i .�ir'. _ _ .-r.__�— _.. .
� CER�I'IFICATION OF \�/ORKERS' COMPENSATI�'iN C0:'ERAGE PURSUANT TO MINNESQTA STATUTE 176.182
I hereby certify that I, or my company, am in compliance «'ith the workers' compensation insurance covera�e requiremenis of
Minnesota Statute 176.182 subdivision 2. I also understand that provision of false information in tfiis certification constitutes sufficient
grounds for adverse action against ali licenses held, includin� re��ocation and suspension of said licenses.
Name of Insurance Company:
Policy Number: Coverage from�� to
I have no employees covered under �vockers' compensation insurance ��'
ANY FALSIFICATION OF ANS\V£RS GIVEN OR DIATERIAL SUBDIITTED
�YILL RESULT IN DENIAL OF THIS APPLICATION
�G��O
I hereby state that I have ans�i•ered all of the preceding questions, and that the information contained herein is true and correct to the
best of my l:nowled�e and belief. I hereby state further that I have received no money or other consideration, by way of loan, gifr,
contribution, or othern ise, 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 «�hen the business is in operation.
a
for all applications) 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.
]f any substantial changes to structure are anticipated, please contact a City of Saint Pau] Plan Eaaminer at 2b6-9007 to apply
for buildin� permits.
If there are any chan�es to the parkin� lot, floor space, or for new operations, please contact a City of Saint Paul Zonin�
Inspector at 266-9008.
Additionai application mquirements,please attach:
A detailed description of the design, location and square footage of the premises to be licensed (site plan).
The follo�+'ing data should be on the site plan {prefera6ly on an S 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'. ^N should be indicated tofvard, the, top. ,
- Ptacementoi all pertinent features of the interior of the licensed facility such as seating areas, kitchens, oitces, 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.
A copy of your lease agreement or proof of o���nership of the property.
FOR SPECIFIC APPLICATION REQUIREMENTS, PLEASE SEE REVERSE >>>>
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