96-571Council File � Q L_ S � 1
Ordinance #
Green Sheet # �V
RESOLUTION
CITY OF SAINT PAUL, MINNESOTA
Presented By
Referred To
Committee: Date
1 RESOLVED: That application (ID #35925) for a Restaurant-8 and On Sale Malt (3.2)
2 License by Hearthside, Inc. DBA Hearthside Pizza (Michael Wert, President) at
3 1641 Rice Street be and the same is hereby approved.
4
`' Requested by Department of:
6 Yea Nays Absent
7 BZa�y �
8 Gueri�_ ✓ Office of License Inspections and
9 Harris ✓
10 Mec�ard ✓ Environmental Protection _ __
11 Rettman ✓
12 Thune �
13 Bostrom ✓
15
16 Adopted by Council: Date � B Y'
17
18 Ado tion Certified b Council Secretar
l� � f��
19
p Y y Form Approved by City Attorney
20 ^ /J/
21 By: �� .� . 1� ���� � G/ (Nl4' q/° ��
22 r � [/ �Y'
23 Approved by Mayor: Date �pJ��l�6
24
25 �� .��"�' Approved by Mayor for Submission to
26 By: Council
27
By:
GREEN SHEET
Christine Rozek, 266-910$
For Hearing:
TOTAL # OF SIGNATURE
O DEPARTMENT DIFEGIUR
E3 p� Q cm anor�Nev
�� � BU�GET DIqEGTOR
iR � MAYON lOR ASSISTANT)
ALL lOCAT10NS FOR SIGNATURE)
INI7IAUDATE
CIN COUNqL
cm c�aK
F1N, & MGL SERViGES DIP.
Hearthside, Inc. DBA Hearthside Pizza requests Council approval for an On Sale Malt (3.2)
and Restaurant-B License at 1641 Rice Street (ID "�135925.
_ PLANNMG COMMIS510N _ CIVIL SERYIGE
_ C18 COMtdITTEE _
_ STAFf _
_ DISTRICiCOURT _
SUPPORTS WHICH COUNCIL O&IECTIVE?
PERSONAL SERVIGE CONTRACTS MUST ANSWER THE FOLIOWING QUE5T10NS:
7. Ftas this persnnlfi�m aver worked urtder a cnntract for this departmeM? �
YES NO
2. Has this personlfirm ever 6een a city Bmp�oyee?
YES NO
3. Does this personR'�rm possess a skdi rrot normally possessed by any curteM city empbyee?
YES NO
Explein e11 yes answers on separota sheet antl amch m green sheet
�
qc.- sn�
N_ 35283
6c��i6��a�� 6`:��i�ffix� �$71t��
S:af����i �,�� �l���
TOTAL AMOUNT OF iRANSACTION $
COSUREVENUE BUDGETED (CiRCLE ONE)
YES NO
FUNDItdG SOURCE ACTIVITY NUMBEH
FMIANCIAL INFORMATION: (E%PlA1N)
Gree�sheet # 35283
In Tracke(?__ t�
L.I.E.P. REVIEW CNECKLIST Date: 4/I/96 �
9 c- s�t 1
APP�n Received / kPP�n Processed
License ID # 35925 Ucense Type: Restaurant—B On Sale Mal t(� �)
COmpBny Nam2: Hearthside TnC _ DBA: Haarthsid P�� a
Business Addresss: 1641 Rice Street Susiness Phone: 488-0569
Coniact Name/Address: Michael Wert, 195 wheelock Pkwv, ll7 Home Phone: �88-82n3
Date to Councif Research: _,
Pubiic Hearing
Notice Sent to
Notice Sent to
Department/
Ciry Attorney
Environmentai
Heaith
Fire
Police
/ 1 2 Labels �rdered:
� ,� ��_ District CounCii #: tP
�l /�J �� y � jyj ���� a�aga3�s��3
"l�/��n__ ---- �r ' Ward #:
Date Inspections
Comments
�� � .
a�
�{•�'`�!�
c-}, 2� -�'? lo
y23•9�,
���� g�
�. 2 � -R(�
4• �
�. �
��
!
Site Wan Rec�
Lsgge FteGeiv
Zoning ' y ' 2 � ' 1 � � 6� ` �"
CJ '
.�
O ��
�
CLASS III
LICENSE APPLICATION
q�.=s�+�
CITY OF SAINT PAUL
Office of License. Inspections
and Envi�onmentai Protection
350St Pnv SL Suiie,iCO
SsimPaW.Mwasaa 55102
{6in266909� lu(fi12J366�912d
THIS APPLICATfON IS SUBJEGT TO REVIEW BY TE� PUBLIC
PLEASE lYPE OR PRINT IN INK
Type of License{s) being applied for:
CompanyName: N�Lf2T�S.�DE� TNG..� —
Corporation 1 Pamiership / Sok Proprietorahip
If business is i�orporated give date af iocorpon6vn:
Doing Business As
Business Address:
Betwexn what cross streets is t6e business located? W�iee�x.� I�kwf� >f ��pp�' '�'ch side of the street? LV�?.ST
�T
Are the premises now occupied? �/� S What Type of Business? _ Re S�,a rn�Qrtn� �"
Mail To Address: �6 yJ l�� ce sT S�". P��/ /�'/n�. 5SI/
StrcetAddcess City Sute � Zi�
Applicant Tnfotmation: /
Name and Title: ��QE( t�. �E/t'r I"R2
Fust Middle (Maiden} Last TiU
Home Address: � 95 C.�). Cwl�.o e �oc �c pkW � , S'I�rF'/�a � /'YIN s
/ SV�t Addcess City SUte
Date of Sirth: �ei�. 2�� �q�2 Place of Bizth: .S�T ��u. I Home Phoae: �/���
Have you ever been convicted of any felony, crime or vialation of any city ordivance other than traf6c? YES _ NO X
Date of axrest:
Charge: _
Conviction:
Sentence;
List the names and residences of three persons of good moral chazacter, living withio the Twin Cities Metca Area, not rel
agpiicant or 5nancia[ly interested in tF�e premises or business, who may be referred to as to the applicanYs chazacter:
`' ADDIZESS
:E 119 S�. So �
a ss
List ticenses which you cuirently hold, formecly he1d, or may have an interest in:
„
Have any of the above nazned licenses ever been revoked? _ 1'ES � IQQ If yes, list ihe dates and reasons for
Are you going to operate this business petsonalty? � YFS _ NO If not, who will operate it?
PH�
first Namt Middle fniGat (Maiden) I.asc
Addrets: SueUName
Where?
City
Zip
Streei Address Ciry Sute Zip
-""—�-r-v' . ^-. . . . . . . � �� � �
U
Are you going to have a manager or a�sistant in this business? _ YES � NO ff the manager is not the same as tF�e operator, ptem_
complete the followiBg informalion: „_, a� � 5�{
— t \
Arst Name
HomeAddress: StreetName
Middie
{Maiden) Last
Dafe of Binh
State ' Zip Phwrc Numbes
,�1�2 /n'J.v. S�S�1/^�
City
Please list your employment lilstory for the pceviaus five (5) yeaz period:
BusinesslEmployment Address
C'i • C,�� '�l S O t.,3 6 �
Nepa�s, Q (,'zeA IG��/r ,1:,.n cr �'�
List all other office�s of the corporaaon:
OFFICER �TITLE HOME HdME BUSINESS DATE OF
NAME t/(Office Held) ADDRESS PHONE PHONE BtRTH
�hR�s G�I�,�T 7'�eS /�S �. W�ee%c� t°kw;- (d��)y��8zo� a�2-�801 1/-7-6
ff husiness is a pazmership, please include the foilowing information for each partner (use additional pages if necessary):
Prst Name
Middte IniUal
(Maiden}
Last
Date oF B
Home Addres:: SVee[ Name City State Zip Phane N�
Frst Nsme Middle Iniva! (Maiden) Iast Date e�
Ho�Adtltess: StreetName City SUte Zip Pho�
MIlVNESOTA TAX IDENTiFICATTON NUMBER - Pursuant to the Laws of Minc�esota, 1984, Chapter 502, Articte $, Section
('f'ax Clearaoce; Issuance of Licenses), licensing authorities aze required to pro��ide to t6e State of Mincesota Commissiooer o�
the Minnesota business tax identification number and the sacial security number of each Iicense applicant.
Under the Mincesota Govemmeai Data Practices Act and t6e Federal Privacy Act of 1974, we aze required to advise you of t�
regazding the use of t6e Minnesota Tax Identification Numher:
- This infornsation may be used to deny ihe issuance or renewai of your licec:se in the eveot }rou owe Min�esota sat�
withhoiding or motor vehicle excise taees;
- Upon receiving tlils infomSation, rhe licensing authority will supply it only to ihe Minnesota Deparfit�ent of Reve^
under the Federal Exchange of Information Agreement, the Department of Revenue may supply this information
Revenue Service.
Minnesata Tax Identification Nambecs (Sales 8c Use Tax Number} may be obtained from the State of Minnesota, $�
Depaxtment, 10 River Pazk Piaza {612-296-6181).
Sociat Securiry Numbec / �-�"�� "7.ZSS
Minnesota Tac Identi6cafion Numbec:
` If a Minnesota Taz Iden�ca6on Number is not required for the husiness being operated, indicate so by p�
box.
�� ro � � `�`���
CERTiFiCATION OF WORKERS' COMPENSATION CdVERAGE PURSUANT Td MINNESOTA STATUTE 176.182
� I hereby certify that I, or my company, am in compliance wich the u�orkers compensation insurance coverage requirements of Minnesota
Statute 176.182, subdivision 2. I also understand tUat prorision of false information in this certification consdtutes sufficient grounds for
� adverse acGon against all licenses 6eld, including revocarion and suspension of said licenses.
Name of Insurance Company.
Policy Number: Coverage from to
I have no emptoyees co1�ered under workers compensaiion insucance
ANY FALS7FICATION OF A2�'SR*ERS GIVEN OR MATERL4L SUBD'IITTED
WILL RESULT IN DENIAL OF THIS APPI,iCATION
I hereby state that I 6ave answered all of t6e preceding questions, and that the infortnat[aa contained herein is true and cocrect to the best
of my knowledge and belief. I hereby state furthar that I have received no money or other consideration, by way of 2oan, gift, contribuflon,
or otherwise, other than atready disclosed in the application which I herewitt� submitted. I also understand tltis premise may be inspected�
by police, fire, 6ealth and other city officials at any and alI cimes when t6e busioess is in operaHon.
�.�-'�/ � � ' /`" �
Signature (REQ(fHtE�for all applicazions) Dat�
*"Note: If this application is Food(t.iqaor retateA, please contact a City of Saint Paul Health Iospector, Steve Olson (266-4139)> t
plaos.
If any substantial changes to sftucWre are auticipated, please contact a City of Saint Paul Plan Fxaminer at 26b-9007 t�
building pernrits.
If there aze any changes to the pazking lot, fIoor space, or for new opecauoas, please contact a City of Saint Paui Zoni�
at266-900$.
Additional application requirements, please attach:
A deta3led description of the design, location and square foofage of fhe premises to be licensed (site p1
The following data shoutd be an the site ptan (preferahly on an 8 712" x i 3" or 8 IfL" x 14" paper};
- Name, address, and phone number.
- The scate should be stated such as 1" = 20'. ^N should be indicated toward tLe top.
- Placement of all pertinent features of the interior of the licensed facitity such as seating areas, kitch
area, parking, rest rooms, etc.
• If a mquest is for an addifion or expansion af the licensed facitiky, indicate 6oth the current aze
expansion.
A copy of your )ease agreement or groof of ownership of the property.
�� n���ICATION REQUIREMENTS, PLEASE SEE REVERSE »>
II