96-79Council File � � — .��
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Referred To
Ordinance �
Green Sheet # �����
CITY OF
RESOLUTION
41NT PAUL, MINNESOTA
Committee: Date
1 RESOLVED: That application (ID #46929) for a Cigarette, Grocery-C, and Gas Station
2 License applied £or by Totem Foods, Inc. DBA Total Station #2 (Sikander Dar,
3 Pxesident) at 1170 Arcade Street be and the same is hereby approved.
1—i�1 „L___� Requested by Department of:
Office of License, Inspections and
Environmental Protection
Adopted by cauncil:
Adoption Certi£ied by
By:
Appx
By:
✓
Secretary
Form Approved by City Attorney
B � �. f �gl�
Approved by Mayor for Submission to
Council
By:
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By: C�� �-r�,2�� �
LIEP
Gunther, 266-9132
For hearing: �
TOTAL # OF SIG!lATURE
9`-?q
GREEN SHEET N° 35255
IN/TIAVDATE INRIAL/DATE
�EPAiiTMENT �IRECTOR a CRY COUNqL
CITY ATTOANEY O CtTY GLERK
BUIX'aET OIREC10fl � GIN. & MGT. SERVICES DIR.
MAYOF (OR ASSISTpNn �
(CLtP ALL LOCATIONS FOR
�a€�F'vo�Tnc. DB9 Total Station �l2 requests Council approval of its application £or a
Gas Statian, Grocery-C, and Gigarette License af 1170 Axcade Street (ID 46929).
_ PLANNiNG COMMISSION _ CNN. SERVECE
� dB COMMRTEE _
_ STAFF _
_ D15TAICT OpUpT _
SUPPORTS WHICN COUNCIL O&IECTNE7
ADVANTAGES
PERSONAL SERVICE CONTRACTS MUST ANSWER THE FOLLOWING QUESTIONS:
1. Has mis perso�rm ever worked under a contract Por Mis department? �
YES IJO
2. Has this parsonRircn ever been a city employee?
YES NO
3. Does Mis person/firm possess a skill not normally possessetl by any current ciry employee?
YES NO
Explain ell yes answsrs on separate sheet and atteeh to green sheet
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iOTALAMOUN70FTHANSAC710N S
COST/REVENUE BUDGE7ED (CIRCLE ONE) YES NO
�UNDIRG SOURCE ACTIVITY
'INANCIAL INFORMATIOM (EXPlA1N)
Greensheet # ss255 L.I.E.P. REVIEW CHECKLIST �ate: �z1�r+l9s !� 4 '� q
In Trackef? twp'n aecorved / apa Processed
License iD # 46929 Ucense Type: Gas Station Grocerv-C and GiQarette
Comp3ny Name: Totem Foods Inc. DBA: Total Station 9i2
Business
Phone: 93�-0506
Date to Council Research:
Pubiic Hearing Date: �- 2 `� - �
Notice Sent to Applicant:
Notice Sent to Public: ______ ��� 3 '�� '
Labets Ordered: �/
District Council #: --/
Ward #: U
Department/ Date Inspeetions Comments
Cfty Attorney 1 ��-- g � ��
Envlronmental
Heaith
l -�-YG 6l<
F��6
J — 5 - $� ��
License Siie Plan Received:_
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Police
1- �"- � 6 6�
Zoning
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CLASS III
LICENSE APPLICATION
CITY OF SAIi3T PAl
Officc of License, Inspeaions
and Em•ironmenta{ Protettion
35o St Pc.v 5c Svlu io0
SzimPmL�mao�a 55102
(6L+) ]66.9p90 fa (6121 �66-9124
THIS APPLICATION IS SUBJECT TO REVIEW BY THE PUBLIC
PLEASE TYPE OR PRINT IN IhTIC
Type of License(s}
Company A'ame: _
applied for: �' .� t Cj �`� �1 S�'/t 7! on
Corporatio� I Parmenhip 1 Sole Proprietorship
]f business is incorporated, give date of incorporation: �� /���
� Doin� Business As: �O"�/a (� S I Ii�7t E� fto� Business Phone:
BusinessAddress: ���'fl ��R-Ar� �f1'ILEtT � !11l�4' SC'
SVeet Address Ciry State Zip
Between what cross streets is the business located? Which side of the street?
Are the premises now occupied? ��'Jhat T�pe of Business? � A5 STPr7�o�v
Mail To Address: ��n3.� �--� H i� �6 �Y F GC�L �-1�Fj !'S i2c+� �j`<{a(
Sueet Address City State Zip
Applicant Information; �
Name and Tit]e: �(KA1YDii%- ��-'l $�' �� �k.$s�acc-.�r
First Middle (Maiden) Lut Tiilt
HomeAddress: �n�f�'t6 �'IISTlLAC� C�1 .�_���rv /�213!/L%� !� SS3�Ib
Street Address Ciry Statc �� �- Zip �
Date of Birth: �—��' -" 4-�f Place of Birth: ICA-�Rci+-i YAr�c �a,,� Home Phone: �}3'3 —OSU�
Have you ever been convicted of any felony, crime or violation of any city ordinance other than traffic? YES NO'_�t
Date of arrest: Where?
�...,
Chazge:
Conviction: Sentence: ' - ` '
List the names and residences of three persons of good mozal character, livin� within the Twin Cities Metro Area, not re3ated to the
applicant or financially interested in the premises or business, ivho may be refened to as to the applicant's character:
NAM �� � t n ADDRESS PHONE
:T�u,�t i.� 6�35 Jv�t7/i,�rt Lrt�s_ PLz/uc,cu-Ct-J'S44t - �- .S�fd'�3��rn
L-"
List licenses which you currently hold, formerly held, or may have an inter in:
C-,n,Y;.»,� �F�Q CrU. / Sc�' K- �LL`C� dL��i�j
Have any of the above named licenses ever been revoked� _ YES ✓NO If yes,
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ry� S3'�/U�%'
r ,�
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Are you going to operate this business personally? �YES _, NQ lf not, who will i
(Maiden) .-
City
Are you going to have a mana�er or assistant in this business? _ YES �NO If the mana�er is not the same as the opera4or, ��
please complete the followin� information: . a 6 ���1
� (
Frst \�ame Middie
Home Address: Sveet Name
(.'�lziden)
CIN
Date of Birth
Phone Number
List all other officers of the corporation:
OFFICER TITLE HOME HOME BUSIlQESS DATE OF
I�'AME (Office Held) ADDRESS PHONE s334S� PHOI�'E BIRTH
C'�C.r�rcflt`../L !� �R-� P4.¢.uze�..�.f ��(rrF� t�,rs �' P 93�-erc� s��-YE� L(
7�,�r1� :k�,f7a�rv V-P faa-�: li�fk�.,�� a'3o-oaEP SYV-�5'6v /e -�F9 "�
If business is a partnership, please include the followin� information for each partner (use additional pages if necessary):
Fint 2�'azne
Aliddle [nitial
Home Addres5:
First Name
Middle Ini[ial
Home Address: Sveet Name
(T7aiden)
Ciry
(Maiden)
Ciry
Date of Birth
Phone Number
Date of Birth
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 Government Data Practices Act and the Federal Privacy Act of 1974, we are required to advise you of the
following re�ardin� 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,
emp3oyer's withholding or motor vehic3e excise taxes;
- Upon receiving this information, the ]icensing authority wil] supply it only to the Minnesota Department of Revenue.
However, under the Federal Exchange of Information A�reement, the Department of Revenue may suppiy this in£ormation
to the Intemal Revenue Service.
Minnesota Ta� Identification Numbers (Sales & Use Tax Num6er) may be obtained from the State of Minnesota, Business Records
Department, 10 Rivet Park Plaza (612-296-6181).
Social Security Number: (.{'��-' � -�� 3�
Minnesota Tax Identifrcation Number: ��� b 3
'_:.___ If a Minnesota Tax Jdentification Number is not
the box.
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I.ast
State Z;p
Last
State Zip
Last
Stste Zip
opented, indicate so by p]acing an "X" in
BusinesslEmnlovment Address
9 c.—'t q
� CERTIFICATION OF WORKERS' COMPENSATION COVERAGE PURSUANT TO MIATIESOTA STATUTE 176.182
I hereby certify that I, or my company, am in compliance with the �vorkers' compensation insurance covera�e requirements of
Minnesota Statute 176.182, subd'avision 2. I also understand that provision of false information in this certification constitutes sufficient
�ounds for adverse action a�ainst all licenses he]d, including revocation and suspension of said ]icenses.
Name of Insurance Company: .S7l�'7� �e n�� !K K�u t�-L 1NS4R.efi��*?
Po]icy Number. ��_� 3�• ao 1 Covera�e from i f—�_ ��;
compensation insurance
ANY FALSIFICATION OF AnSR'ERS GIVEN OR MATERIAL SUBMITTED
�VILL RESIILT IN DENIAL OF THIS APPLICATIOlY
I hereby state that I have answered all oF the preceding questions, and that the information contained herein is hve and conect to the
best of my kno�vledge and belief. I hereby state further that I have received no money or other consideration, by way of 3oan, 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 officia]s at any and all times when the business is in operation.
(REQUIRED for all appiications)
�
Date
'•Note: If this application is Pood/Liquor related, please contact a City of Saint Paul Heahh Inspector, Steve Olson (266-9li9), to
review plans.
If any substantial chan�ea to structure aze anticipated, please contact a City of Saint Paul Plan Eaaminer at 266-9007 to apply
for building permits.
If there are any chan�es to the parking ]ot, floor space, or for new operations, please contact a City of Saint Paul Zoning
Inspector at 266-9008,
Additional apglication requirements, please attach;
A detailed description of the design, focation and square footage of the premises to be licensed (site p]an). ,
The following data should 6e on fhe site plan {preferabfy on an 8 1(2" x 11" or S 1/2" x 14" paper):
- Name, address, and phone number.
- The sca3e should be stated such as i" = 20'. ^N should be indicated toward the top.
- Placementof all pertinent features of the interior of the licensed facifity such as seating areas, kitchens, offices, regair
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
expansioo.
A copy of your lease agreement or proof of ownership of the property.
FOR SPECIFIC APPLICATIOI� REQUIREMENTS, PLEASE SEE REVERSE >>>�