96-963�tl������L
Council File � q`- 9� 3
Ordinance #
Green Sheet # ✓ l�v �
Presented sy
Referred To
RESOLUTION
CITY OF SAINT PAUL, MINNESOTA
Co�ittee: Date
�..s
1 RESOLVED: That applicati,on (ID #39908) for an Auto Repair Garage License by Payne
2 Avenue Radiator � Tire Service DSA Payne Avenue Radiator & Tire Sexvice (Tim
3 Wilson, President) at 933 Payne Avenue be and the same is hereby approved.
4
5 Requested by Department of:
6 Yeas Navs Ab�e ,
7 BZakey � �_
8 Guerin Off'ce of License Inspections and
9 Har_�s Env�ronmental Protection
10 � Me ard � �
11 Re t� man �/
12 Thune
15 Bostrom �
� f
16 Adopted by Council: Date �{ B y ° �� ����
17
18 Adoption Certified by Council Secretary
19 Form Approved by City Attorney
20
21 BY � ` �.�c� - , � -..��,- � . gY . �./ ,��.GC'���0�.,.v�
zz / ?d'�r� � .,
23 Approved by Mayor: Date
24
z5 ��_�� /J� Approved by Mayor for Submission to
26 B �� Council
Y•
27
By:
9 G-9.G3
DEPART}AENT/OFFICE/COUNCIL DATE INITIqTED GREEN SHEE N� 3 5 5 0 8
LIEP Licensin INITIAt1DATE INITIAVDATE
CONTACf PEflSON & PHONE O DEPARTMENt DIPECTOR O CRY COUNCIL
ASSIGN pTYATTORNEY CffYCLEflK
Christine Rozek 266-9108 NUYBERFOR �
MUST BE ON CAUNCIL AGENDA BY (DATE) ROUTING � BUDGET DIRECTO � FIN. & MGT. SERVICES Dlfl.
// � � OAOEA � MAVOfl (ORA$$ISTANT) ❑
For hearin : 7
TOTAL # OF SIGNATUFiE PAGES (CLIP ALL LOCATIONS FOR SIGNATURE)
ACTION flE�UESiED:
Payne Avenue Radiator & Tire Seroice DBA Payne Avenue Radiator & Tire Service request
Council approval of its applicatin for an Auto Repair Garage at 933 Payne Avenue
(ID �135508).
FECOMMEN�ATIONS: Approve (A) or Rajact (R) pER50NAL SERVICE CONTfiACTS MUST ANSWEN THE FOLLOWING DUESTIONS:
_ PLANNING COMMISSION _ CIVIL SER4ICE COMMISSION t Has this persoNfirm ever worketl under a coMracl for fhis departmeM?
_ q8 COMMI77EE YES �NO
_ STAFF Z. Has this perwn/firm ever been a city employee?
— YES NO
_ DISiRIC7 COURT _ 3. Does this personMirm possess a skill not normalry possessed by any curtent city employee?
SUPPORTSWNICHCAUNCILO&IECTIVE7 YES NO
Explain all yes answers on separate sheet antl attach to green sheet
INITIATING PROBLEM, ISSUE, OPPORTUNITV (WM, Whaq When, Where, Why): ���¢��
R��. �
NIAY 24 i996
CI�� �' �� ��,�����
ADVANTAGESIFAPPROVED: . ���� ���
�'a4Dl�43C�
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DISADVANTAGES IFAPPROVED:
m., 3 �
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DISADVANTAGES IPNOTAPPROVED: -�"'�—.__'�""—'-- �.. ^.
TOTAL AMOUNT OP 7RANSACTION S COST/HEVENUE BUDGETED (CIRCLE ONE) YES NO
FUNDIIdG SOURCE ACTIVITY NUMeER
FINANCIAL INFORMATION: (EXPLAIN)
Greensheet # 355os L.I.E.P. REVIEW CHECKLIST Date: 5/zo/96 / 9�' 9(.'.3
In Trackel'? App'n Received / App'n Processed
License ID # 39908 License Type: an Auto Renair Ga*agP
COmpany Name:Pavne Avenue Radiator & Tire Service DBA: cam —
Business Addresss: 933 Payne Avenue Business Phone: 771-3445
Contact Name/Address: Tim Wilson,
Pubiic Hearing Date: � 9 Labels Ordered: /V�
Notice Sent to Applicant: �� District Council #: �
�� �
� -.� - � --
Notice Sent to Public: � /�'��� Ward #: �
Department/ Date Inspeciions Comments
City Attorney
�o•�� �O O � K� '
Environmental
Health
��.�
Fire
� � Ji
License �� P�a^ ������—
6a v Lease Fteceived:
� I2�fI �(o
Police
( D-Y�.-
Zoning
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CLASS III cz� oF sa�rrr ra
LICENSE APPLICATION O�ce of Licen�e, Inspections
and Enevonmentai Roiection
�C 350 S� Pev Si Sun<l00
�T� � Saim Paul, Mioasda 55102
� (61�]b69p90 fu(6ll)36F9126
Q
OT
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� THIS APPLICATION IS SUBJECI' TO REVIFW BY THE PIIBLIC
ti
4 , y�
Type of Lice'�Se(s) being applied for. �;
�` 31 �, OD
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ca��, x�: ��f-Y�/� �/�N v� l�i�'�iJ2..'�` �2 � s���'c �
Coipomtion! ParinushiQ / Sole Proprietorsh�p q
If business is incorporated, give date of incorporation: ��' � %�i
Doing Business As: �/ Business Phone: 7�� .3`f�/, �
Business Address: 93✓� P/)'�� 6� /! "b� ,y� �j,st�� /�'//(� S��/p/
Street Address City Sute Zip
C�l ,� `�e�.k �
Between wnat cross streeis is the business loca[ed? V�%hich side of the st�eet? W�/
Are [he premises now occupied?,� What Type of Business�
Mail To Addcess: `, .5.3 'Y y'"; v N irs
Street Address
Appticant Informationc �� �+
Name and Ti4e: ��p/ l/y _ J
PLEASE TYPE OR PRIh�I' ,N L�i K
City
�i ���
Zip
l�c+v.
Fast �
��✓ � �
Strcet Addrus / Ciry S // Zip
Date of Birth: � �. Place of Birth: - / Home Phone; ( ���
Aave you ever been convicted of any felony, crime or violation of any city otdinance othet than 7affic? YES _ A'O
Date of azrest:
Charge: _
Convictioo:
Where?
Senteuce:
List the names and residences of tiuee persons of goo3 vne.�� characte*, livir.a wit?ain tbe Twin Ci[ies Metro Area, not rela[ed to the
applicant ot 5nancially interested in the premises or busiuess, who may be referred to as to the applicanPs chazacter.
NAT�
. _,
ADDRESS
�
Have any of the above named licenses ever been revoked? ^ YES _ NO If yes, li;t the dates and reasons for revocation:
Are you going to operate this busic�ess personally?
Frst Name
Home Address: Street Name
Middle Initial
Y�S _ NO If not, who will operate it?
cM�a�,� c.az�
City
State
Date of Birth
Zip Phone
��" •�----.,,.
a going to have a manager or assistant in this business?
,lete fo information: �
� l GI.�4.r/ (T
. Na /' Middle
,—�
Addras: Street Name
City
, Piease Sist your employment history for the pievious five (5} }�eaz period:
� Business/Emolovment Address
t�tJ
�
List all other ofFicers of the corporation:
OFFICER / TITLE
NAME 1/ (Office Held
/�i���„�-1 �2�.✓,�,,H/ !/. �
C2.�ss,�.,1 V,
If the manager is not the same as the operator, please `3
�
„+�ki�i-�
HOME
PHONE
State
Date of Birth
Zip Phone Number
S�
BUSINESS
PHONE
If business is a pazmership, please include the following informaGon for each pazmer (use additional pages if nuessary):
First Narne
Middle Ini[ial
Home Address: Street
Frst Nune
Middle Initiai
(Maiden)
City
(Maiden)
Last
State
Iast
DATE OF
BIRTH
Date of Birth
Phone Number
Daze of Binh
Home Address: Strcet Name Ciry Slatc Zip Phone Number
MINNFSOTA TAX IDENT'IFICATION NUMBER - Pursuant to the T.aws of Minnesota, 1984, Chapter 502, Acticle 8, Section 2(270.72)
(Tax Ciearance; Issuance of Licenses), licensing autt�orities aze required to provide to the State of Minnesota Commissioner of Revenue,
the Minneso[a business taz identification number and the social security number of each license applicaut.
Under the Minnesota Govemment Data Fracuces Act and the Federal Priva.y.4ct ef 1974, we aze reauired to advise you of the fo3lowing
regacding the use of the Minnesota Tax Idenafication Number:
- This information may be used to deny the issuance or renewal of your license in the event you owe Minnesota sales, employer s
withholding or motor vehicle excise taxes; T
- Upon receiving tiils ic�formauon, the licensiog authority will supply it only to the Minnesota Deparnnent of Revenue. However,
under the Federal Exchange of Information Agreement, the Department of Revenue may supply tlus information to the Intemal
Revenue Service.
Minnesota Tax Tdentification Numbers (Sales & Use Taz Number) may be obtained from the State of Minnesota, Business Records
Department, 10 Ttiver Park Plaza (612-296-6181).
SceialSecurityNumber: �/ �/ —
Minnesota Tax Identifica6on Number: ��� 7a�
_ If a Minnesota Taz Identification Number is oot requ'ued for [he business being operated, indicate so by placing an "X" in the
box.
�YES _NO
HOME
5 �AL3n v�,
.
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�
,.f1�ICATION OF WORKERS' COMPENSATION CC`'�:.AGE PURSUANT' TO MINA'ESOT.4 STATUTE 176182 Gl(� �9`'3
Ihereby cer[ify tfiat I, or my company, am in compliance with the workers' compensation insurance coverage requiremen[5 of Minnesota
Stam[e 176.182, subdivision 2. I also understand that provision of false information in this certification constitutes sufficient grounds for
adverse action against all licenses held, including revocation and suspens�ion �of said licenses. , � f
Name of Iasurance ompany: S1i"'�� TZl/�� ����'O'r�'' ��U�/
Policy Number: �i��i 11� h Coverage from to
I have no employees covered under workers' compensation iacurance
ANY FALSIFICATION OF ANSSi'ERS GIVEN OR MATERIAL SUBMITTED
WII,L 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 tcue aod coirect to the best
of my knowledge and belief. I hereby state further that T have received no money or other consideration, by way of loan, gift, contribution,
or otherwise, otLer than already disclosed +� the applicazion �chich I herewith subnritted. I also understand llus premise may be inspected
by police, fire, health and other city officials at aoy and all times when the business is in operation.
—' {o�-<• S l� 9�
�� Sigpa�'��(REQUIItED for all applications) ' Date
**Note: If this application is Foodll.iquor relatrd, please cootact a City of Saint Paul Health Inspector, Steve Olson (266-9139), to review
plans.
If any substanrial changes ro structure are aaticipated, please contut a Ciry of Saint Paul Plan Exanuner at 266-9007 to appiy for
building pemuts.
If there are any changes to the pazking lot, flooc space, or for new operations, please contact a City of Saint Paul Zoning Inspector
at266-9008.
Additional application requirements, p(ease attach:
A detailed descripfion of the design� location and square footage of the premises to be licensed (site plan).
The following data shouid be on the site plan (preferably on an 8 ll2" z 11" or 81/2" z 14" paper):
- Name, address, and phone number.
- The scale should be sfated such as 1" = 20'. ^N should be indicated toward the top.
- Placement of all perGnent features of the interior of the licensed facility svch as seating areas, kitchens, offices, repair
azea, parldng, rest rooms, etc
- If a request is for an additian or e�cpansion of the licensed facility, indicate both the current area and the proposed
expansion �
A copy of your tease agreement or proof of ownership of the property.
FOIi SPECIFIC APPLICATION REQUIREIVIENTS, PLEASE SEE REVERSE >>>>,
_ . �. . .. ..:. _;.,:',�-":