96-649ORI�I�;�AL
Council File # q�. - G y�
ordinance #
Green Sheet # �'
Presented By
Referred To
Committee: Date
1 RESOLVED: That application (ID �590541 £or an Auto Repair Garaqe and Gas Station
2 License by David Kaufman DBA Rice & Larpenteur 66 (David Kaufman, Owner) at
3 1675 Rice Street be and the same is hereby approved.
4
`' Requested by Department of:
6 Yeas Nays Absent
7 B a e ,y �
8 Guerzn Off' e of T' ens Inspections and
9 Harris
10 Mega� — 7 Fnv'rorLmental P otect'on
11 _�ettman �^
12 T un�e — �
13 Bostrom �- ,/�
15 BY . �� /"I �i�
16 Adopted by Council: Date �-- \� � V L
17
18 Adoption Ce=tified by Council Secretary
19 Form Approved by City Attorney
20 ^ ` �` l�
21 By: 1 .��, ¢�+�s��.A�� gp: _, ,�,.��
22 /� - --
23 Approved by Mayor: Date l"(4 �
24 z ��� =
25 �/ Approved by Mayor for Submission to
26 By: (� Council
27
RESOLUTION
OF SAINT PAUL, MI
ESOTA
�
By:
9,` - G 4.q
DPARTMENT/OFFICFJCOUNC�L DATEINRIATED GREEN SHEE N� 35291 '
LIEP/Licensing INITIAVDATE INRIAUDATE
CANTACT PERSON & PHONE � DEPARTMENT DIRECTOfl � CffY COUNCIL
Christine Rozek, 266-9108 ��w" OCITYATfORNEV OCITYCLERK
MUST BE ON CAUNCIL AGENDA BY (DATE) pp��qG� O BUDGET O�RECTOR O FIN. & MGT. SERVICES Dlq.
r'OT hearing: FQ �Z Cf (o �p��p OMAVOR(ORASSISTANn O
TOTAL # OF SIGNATURE PAGES (CLIP ALL LOCATIONS FOR SIGNATURE)
ncTwti aEOUES��:
David Raufman DBA Rice & Larpenteur requests Council approval of its application for an
Auto Repair Garage and Gas Station License at 1675 Rice Street (ID �/59054).
RECOMMENOA7loNS: Approve (A) or Rejac[ (R) PEFiSONAL SEHVICE CONTRACTS MUST ANSWER THE FOL40WING �UESTIONS:
_ PLANNING CAMMISSION _ CIVIL SERVICE COMMISSION �� Has Nis person/fittn ever worketl under a contrac[ for this tlepartment?
_ ct8 COMMtT7EE YES NO
� STq� — 2. Has this personrtrm evet been a city employee?
— YES NO
_ DISiRICT COURT � 3. Does this person/firm possess a skill no[ nortnally possessetl by any current ciry employee?
SUPPOFiTS WHICH COUNCIL O&IECTIVE9 YES NO
Explain all yes enswers on separate sheet and attach to green sheet
INITIATING PROBLEM, iSSUE, OPPORTUNITY (Who. Whflt, When. Whare. Why�.
� �� ��
r i :
;����'
APR 1 g t996
�. � �; `� ��� � ��
ADVANTAGES IF APPROVED:
DISA�VANTAGES IF APPROVED:
���t?� ���� ���6
��� � � ���
-�°`� .
DISADVANTAGES IF NOTAPPROVED:
TOTAL AMOUNT OF iflANSACTION $ COST/REVENUE BUDGETED (CIRCLE ONE) YES NO
FUNDIIdG SOURCE ACTIVITY NUMBER
FINANCIAL INFOFiMATION: (EXPLAIN)
Greensneet# 35291 L.I.E.P. REVIEW CHECKLIST Date: 4-17-96 /�L—Ly,q
in Tracker? App'n Received / npp'n Process d
License ID # 59054 LiCense Type: Auto Repair GaraQe and Gas Station
Comp3ny NBme: David Raufman DBA:Rice & Larpenteur 66
Business Addresss: 1675 Rice Street Business Phone: 489-4150
Contact Name/Address: David Raufman, 6740 29th St. N Home Phone: 770-1290
Oakdale, 55128
Date to Council Research:
Public Hearing Date: � I
Notice Sent to Applicant:
Labels Ordered:_____1 � � ,
� T--
District Council #: �P
. . �� ��
Notice Sent to Public: ✓ �`' Ward #: �
Department/ Date Inspections Comments
City Attorney � •23 • 9 � o. � •
Environmental `~ ' � ' N '�` '
Health
Fire L.f . 2 J� " I� �� �' � A �
License c� /� C`�j'(,�-: �e��� �ed e �
���� ��
Paice �• 2 3 •�{ (o �, � '
Zoning � ' 23 •� �O �. � -
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LICENSE APPLICATION
CITY OF SAIl3T PA
OKce o( Licenu, Inspections
and Enaironmental Proiection
3505i Puu S�. Svne 300
$diM Paui. �finM•w $5102
(F12) 2G6-9090 faz (612)=66-912d
THIS APPLICATION IS SUBJECI' TO REVIEW BY THE PUBLIC
PLEASE TYPE OR PRINT IN IA'K
Type of License(s) being applied for: "' ��^,,
rt �
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rnr�,.^..^.` /�' <..x � /��t�/'�M .L^{t+�
CorporationlPMnetship SolePm�
If business is incorpora[ed, give date uf incQr�oca[ion:
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DoingBusinessAs: S�ra.��.: s�«��e�� -�av Ke�cz„^ _ BusinessPhone:��a� `I`5 �l�`��S�Z'
BusinessAddress: /l�S ./L'. R�ce S/ St� r�i�..l /'/'1.1 S�7/ 7
Svice[ Address City State Zip
Between what cross streets is the business located? t��-,ta.��.+� A::� d. `.i�vlo� �' (:�Y..=�Which side of the street? t�-r5 ��}
Are the premises now occupied? � What Type of Business? �c'�vP
Mail To Address: � E 7 S� N� �; �e -S�� � 1 /'�.o s371 �
Sveet Address City Slale Zip
Appticant tnforcnation:
I�ame and Title: �•,••; , �L :��^- � 1 a � �e`L � �h C�v � (`�c.�,nL !'
Frst Middie (Maiden) Last Title
HomeAddress: ( Jti(D „LiC4-�� �}- 1�J �jcs"t���a1P t�`1n ;i:.i125'
Svcet Address City SSate Zip
Aate of Binh: �-' /G- L S Place of Birth: ,�� �.0 1 Hou� Phone: 7 7C -!o2''>C.7
Have you ever been convicted of any felony, crime or violation of any city ordinance oiher than traffic? YES ^ NO �
Bate o; a,�est:
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 £mancially interested in the premises or business, who may be referred to as to the applicant's cUaracter:
NAME ADDRESS - PHONE
,,.�f) c. r` /'�L !/7c'. S r P. � �� I a7�jth S{�� N l5:,.✓.ia 1: .N n 27; - C'L�/S
���y�ro?
Have any of the above named licenses ever been revoked? _ YES � NO If yes, list the dates and reasons for revocation:
Are you going ro operate this business personally? � YFS _ A'O If no[, who will operate it?
Frs[ Name
Ho�nc A�idres5: Sveet t�ame
Middle Initial
City
Last
Sizte Zip
Date of Birth
Phoix Number
r�,.. , r..ya' a >f>.n r
.,...,. , - ., . �,.,._ � .. <.<. ._.. - s :a,., .,.-. _ , ,:,,
_ . ,_.. . , . _�....,�,- <
List licer�ses which you cuirenUy hold, formerly held, or may have an interes[ in:
Are you going to have a mana�er or assistzni in ihis business?
complete [he followin� infomiation: � �
Frs[
xo� naa�s: so-�, xa�
�YE� _I�O
e5��
�4iddle Initial (Maiden) �
��1�t�►� ��
Gry
F � �
��-C�xj���
If the manager is not tl�e sanie as e operator, p1eaF"'� -� 3�
"� <
� ` �r /,_� _
Last � Date of Birth
a�� � �� ss�� �7 T��-���>
Sute
Please list yoar employment history for the previous five (5) }�eaz period:
Business/E�lovment Addre
l-�caYv�'; � 5��;�t�'S i
List all oLher officcrs of the corporation:
OFFiCER TITLE HOME
NA1JE (Office Held) ADDRESS
If business �s a pazcnership, please include the fo]lowing information for each paztnei (use additionaV pages if necessary):
Frst Name
Home Address: Street Name
Frst Name
Home Addrus: Street Name
�E'
HOD4E BUSINESS
PHONE PHONE
Phone Number
�
�
DATE OF
BIRTH
Mibdle Snitiai
Cicy
(Maiden)
City
LaSI
State
Las[
Staie
Date of Birth
Zip Phone Number
Date of Binh
Zip Phone Number
MI�'IQESOTA TAX TDENI'TFICATION NUMBER - Pursuane to thP Laws of Mienesecz. L 34, Chapsr 502, ;r'uc'se �, Se:.tion Z(270.7��
(Tar. Cleazance; Issuance of Licenses),licensing authorities are requ'ued to provide to the State of Minneso[a Cominissioner of Reve�ue,
the Minnesota busicess tax identification rmmber and the social security number of each license applican[.
Under the Minnesota Govemment Da[a Practices Act ar�d the Federal Privacy Act of 1974, we aze reguired to advise you of the following
regarding the use of the DlinnesotaTax IdentificaGon Number:
- This infoanation may be used ro deny the issuance or renewai of your license in the event you owe Minnesota sales, employer s
witt�holding or motoc vehicle excise taxes;
- Upon receiving this information, ihe licensing authority will supply it only [o the Minnesota Department of Revenue. However,
undet the Federal Exchange of Infoanation Agreement, the Depariment of Revenue may supply this inforcnation to the Intemal
Revenue Ser�•ice.
Minnesota Tax Identification Numbers (Sales & Use Tax Number) may be obtained from ihe State of Minnesota, Business Records
Depanment, 10 River Park Plaza (612-296-6181).
Social Sewrity Number: `i E%�( � i 4 `�ttC-._3
Minnesota Tax Identificauon Number: t�� � r �_S�
_ If a Minnesota Tar. Tdenti5cation Number is not requued for [he business being operated, indicate so by p]acing an "X" in the
box.
�� �� ER7IFICATION OF w'ORKGRS' COSIPENSATION COVERAGE PURSUANT TO MINNESOTA STATUTE 17G.182
I hereby ceRify tl�at I, or my company, am in compliance with the workers compensation insurance coverage tequirements of Minnesota
Statute 176.182, subdivision 2. I also understand that provision of false informaUOn in this certification constiwtes sufFcient grounds for
, adverse action against all licenses held, including revocation and suspension of said licenses. A
Name of Insurance Company: :� � lZ �< <- �= y /� y h� l,hl � 5/ �/��T �' �7 5
Policy Number: �' �� ��( �' 9 L % l '- � Coverage from �� �� % � �to
I ha��e no employees covered under workers' compensation insurance
AN�P FALSIFICATION OF ANS�i'ERS GIVEN OR 114ATERIAL SUBD4ITTED
�4'ILL RESULT IN DENIAL OF TIIIS APPLICATION
, - `% S
�
l heieby state [hat t nave answereci ai] of cne preceefir.g que,[iens, an3 thai u�e inCurmation cuntnined �eiein is true ar3 cm;cct to the best
of my knowledge and belief. I hereby state funher that I ha��e received no money or other consideration, by way of loa*�, giII, cOnL^�bntion.
or othenvise, other Ihan already disclosed in the application which I herewith submitted. I also understand [his premise may be inspected
by police, fire, heallh and other city officials at any and all times when the business is in operation.
for
-/'.
Date
**Note: If this application is Food/Liquoc related, please contact a City of Sain[ Paul Health Inspector, Ste��e Olson (266-9139), to review
plans.
If any substantial changes to structure are anticipated, please cootac[ a City of Saint Paul Plan Examiner a[ 266-9007 to apply for
building permits.
If there are any cha�ges to tlie pazkiug lot, floor space, or for new operations, please contact a City of Saint Paul Zoni�g Inspecror
at266-9008.
Additional application requirements, please attach:
A de[ailed description of the design, location and square footage of the premises to be licensed (site plan).
The following dafa should be on the site plan (prefera6ly on an S U2" x 11" or 8 I/2" x 14" paper):
- Name, address, and phone number.
- The scale should be stated such as 1" = 20'. ^N shoutd be indicated toward the top.
- Placement of a[I pertinent features of the interior of the licensed facility such as seating areas, kitchens, o�ces, repair
area, parking, rest rooms, etc
- If a request is for an addition or e�cpansion of the licensed facility, indicate both the current area and the proposed
expansion.
A copy of your lease agreement or prQOf of ownership of the property.
FOR SPECIFIC APPLICATION REQUIREMENTS, PLEASE SEE REVERSE >>>>.
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