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97-147�� Ii��;� Council File # � � � Ordinance # Green Sheet # ` � OF Presented Referred To Committee: Date 7'� i RESQLVED: That application (ID #44108) for an Off Sale Malt License by SuperAmerica Csroup- z Division of A.shland Inc. DBA SuperAmerica #4001 (David Phillippi, Representative) at s 296 East ?th Street be and the same is hereby approved. 4 5 Requested by Department of: 6 Yeas Navs A65ent 7 B a —?- $ � � Office o£ License Tnspections and 9 r Ha r s �— 10 � ar � � Env+rorimental Protection 11 Re t� man 12 Thune � i 3� sostrom 15 16 Adopted by c�ncii: Date `��, _�� 7 q�}�► $y` i� 18 Adoption Certified by Council Secretary ��,��`�',�.� � ,tnr�,�/� 19 Form Approved by City Attorney 20 l ; r� ? 1 Bs' �-___ "� � rr--zZ�—c�...a-�._ � J � �z / By� � s��l�r L�.-�� '3 Approved by Mayor: Date �Jj� J S y- � 4 Approved by Mayor for Submission to 5 �'�� Council 6 BY= �✓�C 1 PAUL, MINNESOTA By: LIEP Christine For hea TOTAL # OF (CLIP ALL LOCATIdNS FOR SIGNATURE) `l`1 �t�� N_ 35387 "-_ " " _ ' . INITIAIJDATE �crtrc��xc _ O FIN. 8 MGT. SEflVICES DiP. o - SuperAmerica Group—Division of Ashland, Inc. DBA SuperAmerica 1P4001 requests Council approval of its application for an Off Sale Malt License at 296 7th Street East (ID #44108). _ PLANNMG COMMISSION _ GMl SEFtV10E COMMISSION _ CIB COMMRSfE _ _ SiAFF _ _ �{S7AICT COUFT _ SUPPORTS WHICH COI/NCIL O&IECfIVE7 PEHSONAL SEHVICE CONTRACTS MUST ANSWER THE FOLLAWING QUESTIONS; 1. Ha5lhis parSONfirm aver worked unGer a coMract for this depaAmeM? - YES NO 2. Has this person/firm ever been a city employee? YES NO 3. Dces this persoNfirm posseSS a skill not nortnally posse55etl by any curzerH ciry employBe4 YES NO Explain ail yes answers on separate shest and attacM to green sAeet j ��, �. � , . c ', � �s aF ►- � , . � � d ��°.y-,x: �� x � T �� J � � �°' lwa"'� fOTAI AMOUNT OF TRANSACTIQN S COSTlREVENUE BUDGETED (CIpCLE ONE) YES NO 'UNDIN6 SOURCE ACTIVITY NUMBER INANCIAL iNFORMATiON: (EXPLAIN) GREEN SHEET O OEPARTMENT OtRECTOR 266-9108 �x �cmnrroar+ev iATE� RO�� R �� BUDGET D1A£CTOF � � �� MAYOH (OR ASSISTANi} Greensheet # 35387 L.I.E.P. REVtEW CHECKLfST Date: 11/26l96 /�� `�y�_ In TraCket? 1WP'n Received / ApP'n Processed License ID # 44108 License 7ype: Off Sa1e Malt Company Name: SuperAmerica Group DBA: Super America-Store �4001 Business Addresss: 296 7th Street East Business Phone: 225-9567 Contact Name/Address: Debra Johnson, 5537 llth Ave S, Home Phone: $ZS-5361 Minneapolis, M13 55417 Date to Councii Research: Public Hearing Date: a �+ Notice Sent to Appiicant: �°� f 2j�� /�� , Notice Sent to Pubfic: f labeis Ordered: ; G�i.J�'7`rTJ��i'1 -1�f{� Dist�ct Council #: I/ Ward Department/ Date inspections Comments City Attorney lZ • 2 •�L ro fi�`� ' Environmental Heaith z.z�P�gb �.� - F��e � � • z_c.� •°! b �7, K - License , 1 .Q.u3 yy � a, P� — Site PIa�+ Reoe�ved:_ ti! Lease Received: � z) � �( � y � �'S � a+.a��-� Police Iz-2 •°�jo O•�• oning �Z.2.�f•4la d��.. $AINi PAUG � AAt1A CLASS III LICENSE APPLICATION TEIIS APPLICATION IS SUB TECl' TO REV[EW BY Tf� PUBLIC Type of License(s) being applied for. PLEASE TYPfi OR PRINT IN INK ��-)`� l SuperMerica Q-oup, a division of Ashland Inc. / CompanyName: _�rlkrerica (�-cxea, a division of Ashland Inc. Cocporafion! Partnecship! Sole Propciecorship If business is incoiporated, give date of incorporation: OCtd�r 22, }g36 Doing Business As: �rPmericd # 400] Business Phone: Z25-9`.�6� Business Addcess: 296 East lth Street, St Pau2, NN 551�1 SaeetAddress Ciry State Zip Between what cross st�eets is the business located? W}rich side of the street? Are the premises now occupied? Ye5 What Type of Business? COnV2ni2r1C2 Storrretai 1 Sd12S of petr0 pY'odUCt! Mail To Address: �240 W 98th Str2Et 8loattingtari, NN 55431 Sund�"ies, groceries, etc... Street Address City State Zip Applicantlnformalion: Name and Ticie: . David Paul Phillippi Authorized Representative � Fttst T4iddle (Maiden) Last TiOe Home Address: 5537 llth Ave South, Minneapolis, hBJ 55477 Sveet Addeus City State Zip Aate of Birth: 2 Place of Birth: Mirtneapolis, hHV Home Phone: �5-5361 Have you ever been convicted of any felony, crime or violation of any city ordinance other than traffic? YES ! NO X Date of azrest: Chazge: _ Couvicflon: Sentence: List the names and cesidences of three persons of good morai chazacter, living wittrin the Twin Cities Meuo Area, not related to che applicant or financially interested in the premises or business, who may be refened to as to the applicant's chazacter: NA,:;� Robert C. Harctnan Tare Stone Wheze? ADDRESS 54 E Sandralee Drive, St Paul, NN 554]9 Rurai Route 3 Box 47, Fairnnnt, NN 5603] PHONE List licenses which you cunenfly hold formerly held, oi may have an intesest in: __ Several in the City of St Paul, Minneapolis, Cnlden Valley, etc... Have any of the above named licenses evec been revoked? J YES X NO If yes, list the dates and reasons for revocation: Are you going to operate this business personally? _ YES X NO If not, who will operate it? Charl2rle Go1dSChnidt, MdndgeY First Narne Middlelnida) (Maiden) ].ast HomeAddress: SucetName City Stau Zip CITY OkR`SAiNT PAl OfSiCe oE I.iCeJ15G. Sn<Pecbo115 and EnvironmenW ProteGion 3505i PdaSL Sa've 300 $aimPeW.MiurcsUa 55�02 (bi�]b69D90 fas(61n26691]A Datc oi Bir�h Phone Numbec . Q Are you going to have a manager or azsistant in this business? X YFS _ NO Tf the manager is not the 3 complete ihe following infonnation: first Nazne Middk Initial Ias[ � ?i �j� `� O � i� o j � , G�� - " `� �i P ��+' 9 �'? �G .� o, r .y „ ` '�Vy ""p T �A Daua�, � - f \ G' Home Address: Strcet Name City Slsu tip Phone Numbex Please list your employment Sustory for the previous five (5) yeaz period: , ��-�� BusinessJEmpinoyment Address S�erArrerica 1240 W 98th Street, Bloarri on, NN 55431 23 ars List all other officers of the corpocadon: OFFICER TITLE NA.ME (Office Heid) See Attached HOME ADDRESS HOME BUSINESS DATEOF PHOt3E PAONE BIRTH If business is a gartnership, piease include ihe foltowing informaGon for each paztner (use additionaf pages if �xcessary): Middle Initia! HomeAddress: StreetName (Maiden) Last Date of Hinh State Zip Phone Numbe FirstName Middlelnitiai (Maiden) Last DzteoCBicth HomeAddress: SheetNamr Ciry State Zip PhoneNumber MIIVNESOTA TAX IDENTIFICATiON NUMBER - Pursuant to the Laws of Minnesota, 1984, Chapter 502, ARicle 8, Seclion 2(270.72) (Tax Clearaoce; Issuazice of I.icenses), licensing authocities are required to provide to the State of Minnesota Commissioner of Revenue, the Minnesota business tax idenGfication number and We social security number of each license applicant. Under the Minnesota Govemtneat Data Pracfices Act and ffie Federal Privacy Act of 1974, we aze required to advise yoa of the following regazding the use of the Minuesota Tax Idenafication Numbec - This i¢fomiation may be used to deny rhe issuance or renewal of your license in the event you owe Minnesota sales, e�v,?loyer s withholding or motor vehicle excise taxes; - Upon receiving this information, the licetisiag authority will supply it only to the Minnesota Departn�nt of Revenue. However, under ttre Federal &xchange of Infom�ation Agreemeat, the Department of Revenue may supply this information to the intemal Revenue Service. Minnesota Tax Identificafion Numbers (Sales & Use Tax Number) may be obtained from tbe State of Mimesota, Business Records Department, 10 River Pazk Plaza (612-246-6I81). ' Sociat SecuriryNumber: • 469-62-8770 ' , Minnesota Tax Idendfication Number. 1292355 If a Minoesota Taz IdentiFication Number is not required for the business 6eing opetated, indicate so by placing an "X" in the box. � m' �� . :iF WORKERS' COMPENSATION COVERAGE PURSUANT TD MINNESOTA STATUTE 176.182 .,iat I, or my company, azn in compliance wich the workers' compensation insurance coverage requiremenfs of Minnesota o a+f2, subdivision 2. I also understand that provision of false informa6on in this certification constimtes sufficient grounds for y action against all licenses held, including revocation and suspeasion of said licenses. t - 1 yante of Insurance Comgany: IiLSUr"anC2 CCfR)aP1V Of NDY'tft P7�12Y1Cd ��_�� ` Poticy Number: RSCC 42067579 Coveragefrom � Z� 1997 t Dec 31, �997 I have no emp3oyees covered under workers' compensation insurance ANY FALS3FICAT'ION OF ANS�iBI2S 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 informadon contained 6erein is true and cortect to the best of my knowiedge and belief. I hereby state further that I have rueived no money or other consideration, 6y way of loan, gift, contribution, or othenvise, other tUan already dixlosed in tl�e application which I herewith submitted. I aiso understand tbis premise may be inspected hy police, fae, heatth and ocher city oft'iciais at any and ali umes when the business is in operauon. / , _ __ ____!i Signature (REQUIRED for all applications) Date David P. Phillippi, Authroized Representative **Note: If Uris application is FoodlLiquor re3ated, please contact a City of Saint Paul Aeal[h Inspector, Steve Olson (266-9139), to review olans. If any substantial changes to structure are andcipated, please contact a City of Saint Paul Plan Fxaminer at 266-9C107 to agply for building pernrits. If there are any c6aoges to the paziting lot, floor space, or for new operations, please conract a City of Saint Paul Zooiug Inspector at 266-9008. Additional application requirements, please attach: A detailed description of the design, location and square footage of the premises to be licensed (site pIan). T'he following data shoutd be on the siEe plan (Freferabiy on an & L2" x 11" or 81t2" x 14" papu): - Name, address, a� phone number. - The scaie should be stated such as 1" = 20'. ^N should be indicated towazd the top. - Placement of alI perfinent features of the interior of the licensed facility such as seating azeas, kitchens, offices, repair azea, parking, rest rooms, et� - If a request is for an addition or expansion of the licensed facility, indicate both the current area a»d the proposed erzpansioa A copy of your lease agreement or proof of ownership of the property. FOR SPECIFIC APPLICATION REQUIREMENTS, PLEASE SEE REVERSE >>>>. �� Ii��;� Council File # � � � Ordinance # Green Sheet # ` � OF Presented Referred To Committee: Date 7'� i RESQLVED: That application (ID #44108) for an Off Sale Malt License by SuperAmerica Csroup- z Division of A.shland Inc. DBA SuperAmerica #4001 (David Phillippi, Representative) at s 296 East ?th Street be and the same is hereby approved. 4 5 Requested by Department of: 6 Yeas Navs A65ent 7 B a —?- $ � � Office o£ License Tnspections and 9 r Ha r s �— 10 � ar � � Env+rorimental Protection 11 Re t� man 12 Thune � i 3� sostrom 15 16 Adopted by c�ncii: Date `��, _�� 7 q�}�► $y` i� 18 Adoption Certified by Council Secretary ��,��`�',�.� � ,tnr�,�/� 19 Form Approved by City Attorney 20 l ; r� ? 1 Bs' �-___ "� � rr--zZ�—c�...a-�._ � J � �z / By� � s��l�r L�.-�� '3 Approved by Mayor: Date �Jj� J S y- � 4 Approved by Mayor for Submission to 5 �'�� Council 6 BY= �✓�C 1 PAUL, MINNESOTA By: LIEP Christine For hea TOTAL # OF (CLIP ALL LOCATIdNS FOR SIGNATURE) `l`1 �t�� N_ 35387 "-_ " " _ ' . INITIAIJDATE �crtrc��xc _ O FIN. 8 MGT. SEflVICES DiP. o - SuperAmerica Group—Division of Ashland, Inc. DBA SuperAmerica 1P4001 requests Council approval of its application for an Off Sale Malt License at 296 7th Street East (ID #44108). _ PLANNMG COMMISSION _ GMl SEFtV10E COMMISSION _ CIB COMMRSfE _ _ SiAFF _ _ �{S7AICT COUFT _ SUPPORTS WHICH COI/NCIL O&IECfIVE7 PEHSONAL SEHVICE CONTRACTS MUST ANSWER THE FOLLAWING QUESTIONS; 1. Ha5lhis parSONfirm aver worked unGer a coMract for this depaAmeM? - YES NO 2. Has this person/firm ever been a city employee? YES NO 3. Dces this persoNfirm posseSS a skill not nortnally posse55etl by any curzerH ciry employBe4 YES NO Explain ail yes answers on separate shest and attacM to green sAeet j ��, �. � , . c ', � �s aF ►- � , . � � d ��°.y-,x: �� x � T �� J � � �°' lwa"'� fOTAI AMOUNT OF TRANSACTIQN S COSTlREVENUE BUDGETED (CIpCLE ONE) YES NO 'UNDIN6 SOURCE ACTIVITY NUMBER INANCIAL iNFORMATiON: (EXPLAIN) GREEN SHEET O OEPARTMENT OtRECTOR 266-9108 �x �cmnrroar+ev iATE� RO�� R �� BUDGET D1A£CTOF � � �� MAYOH (OR ASSISTANi} Greensheet # 35387 L.I.E.P. REVtEW CHECKLfST Date: 11/26l96 /�� `�y�_ In TraCket? 1WP'n Received / ApP'n Processed License ID # 44108 License 7ype: Off Sa1e Malt Company Name: SuperAmerica Group DBA: Super America-Store �4001 Business Addresss: 296 7th Street East Business Phone: 225-9567 Contact Name/Address: Debra Johnson, 5537 llth Ave S, Home Phone: $ZS-5361 Minneapolis, M13 55417 Date to Councii Research: Public Hearing Date: a �+ Notice Sent to Appiicant: �°� f 2j�� /�� , Notice Sent to Pubfic: f labeis Ordered: ; G�i.J�'7`rTJ��i'1 -1�f{� Dist�ct Council #: I/ Ward Department/ Date inspections Comments City Attorney lZ • 2 •�L ro fi�`� ' Environmental Heaith z.z�P�gb �.� - F��e � � • z_c.� •°! b �7, K - License , 1 .Q.u3 yy � a, P� — Site PIa�+ Reoe�ved:_ ti! Lease Received: � z) � �( � y � �'S � a+.a��-� Police Iz-2 •°�jo O•�• oning �Z.2.�f•4la d��.. $AINi PAUG � AAt1A CLASS III LICENSE APPLICATION TEIIS APPLICATION IS SUB TECl' TO REV[EW BY Tf� PUBLIC Type of License(s) being applied for. PLEASE TYPfi OR PRINT IN INK ��-)`� l SuperMerica Q-oup, a division of Ashland Inc. / CompanyName: _�rlkrerica (�-cxea, a division of Ashland Inc. Cocporafion! Partnecship! Sole Propciecorship If business is incoiporated, give date of incorporation: OCtd�r 22, }g36 Doing Business As: �rPmericd # 400] Business Phone: Z25-9`.�6� Business Addcess: 296 East lth Street, St Pau2, NN 551�1 SaeetAddress Ciry State Zip Between what cross st�eets is the business located? W}rich side of the street? Are the premises now occupied? Ye5 What Type of Business? COnV2ni2r1C2 Storrretai 1 Sd12S of petr0 pY'odUCt! Mail To Address: �240 W 98th Str2Et 8loattingtari, NN 55431 Sund�"ies, groceries, etc... Street Address City State Zip Applicantlnformalion: Name and Ticie: . David Paul Phillippi Authorized Representative � Fttst T4iddle (Maiden) Last TiOe Home Address: 5537 llth Ave South, Minneapolis, hBJ 55477 Sveet Addeus City State Zip Aate of Birth: 2 Place of Birth: Mirtneapolis, hHV Home Phone: �5-5361 Have you ever been convicted of any felony, crime or violation of any city ordinance other than traffic? YES ! NO X Date of azrest: Chazge: _ Couvicflon: Sentence: List the names and cesidences of three persons of good morai chazacter, living wittrin the Twin Cities Meuo Area, not related to che applicant or financially interested in the premises or business, who may be refened to as to the applicant's chazacter: NA,:;� Robert C. Harctnan Tare Stone Wheze? ADDRESS 54 E Sandralee Drive, St Paul, NN 554]9 Rurai Route 3 Box 47, Fairnnnt, NN 5603] PHONE List licenses which you cunenfly hold formerly held, oi may have an intesest in: __ Several in the City of St Paul, Minneapolis, Cnlden Valley, etc... Have any of the above named licenses evec been revoked? J YES X NO If yes, list the dates and reasons for revocation: Are you going to operate this business personally? _ YES X NO If not, who will operate it? Charl2rle Go1dSChnidt, MdndgeY First Narne Middlelnida) (Maiden) ].ast HomeAddress: SucetName City Stau Zip CITY OkR`SAiNT PAl OfSiCe oE I.iCeJ15G. Sn<Pecbo115 and EnvironmenW ProteGion 3505i PdaSL Sa've 300 $aimPeW.MiurcsUa 55�02 (bi�]b69D90 fas(61n26691]A Datc oi Bir�h Phone Numbec . Q Are you going to have a manager or azsistant in this business? X YFS _ NO Tf the manager is not the 3 complete ihe following infonnation: first Nazne Middk Initial Ias[ � ?i �j� `� O � i� o j � , G�� - " `� �i P ��+' 9 �'? �G .� o, r .y „ ` '�Vy ""p T �A Daua�, � - f \ G' Home Address: Strcet Name City Slsu tip Phone Numbex Please list your employment Sustory for the previous five (5) yeaz period: , ��-�� BusinessJEmpinoyment Address S�erArrerica 1240 W 98th Street, Bloarri on, NN 55431 23 ars List all other officers of the corpocadon: OFFICER TITLE NA.ME (Office Heid) See Attached HOME ADDRESS HOME BUSINESS DATEOF PHOt3E PAONE BIRTH If business is a gartnership, piease include ihe foltowing informaGon for each paztner (use additionaf pages if �xcessary): Middle Initia! HomeAddress: StreetName (Maiden) Last Date of Hinh State Zip Phone Numbe FirstName Middlelnitiai (Maiden) Last DzteoCBicth HomeAddress: SheetNamr Ciry State Zip PhoneNumber MIIVNESOTA TAX IDENTIFICATiON NUMBER - Pursuant to the Laws of Minnesota, 1984, Chapter 502, ARicle 8, Seclion 2(270.72) (Tax Clearaoce; Issuazice of I.icenses), licensing authocities are required to provide to the State of Minnesota Commissioner of Revenue, the Minnesota business tax idenGfication number and We social security number of each license applicant. Under the Minnesota Govemtneat Data Pracfices Act and ffie Federal Privacy Act of 1974, we aze required to advise yoa of the following regazding the use of the Minuesota Tax Idenafication Numbec - This i¢fomiation may be used to deny rhe issuance or renewal of your license in the event you owe Minnesota sales, e�v,?loyer s withholding or motor vehicle excise taxes; - Upon receiving this information, the licetisiag authority will supply it only to the Minnesota Departn�nt of Revenue. However, under ttre Federal &xchange of Infom�ation Agreemeat, the Department of Revenue may supply this information to the intemal Revenue Service. Minnesota Tax Identificafion Numbers (Sales & Use Tax Number) may be obtained from tbe State of Mimesota, Business Records Department, 10 River Pazk Plaza (612-246-6I81). ' Sociat SecuriryNumber: • 469-62-8770 ' , Minnesota Tax Idendfication Number. 1292355 If a Minoesota Taz IdentiFication Number is not required for the business 6eing opetated, indicate so by placing an "X" in the box. � m' �� . :iF WORKERS' COMPENSATION COVERAGE PURSUANT TD MINNESOTA STATUTE 176.182 .,iat I, or my company, azn in compliance wich the workers' compensation insurance coverage requiremenfs of Minnesota o a+f2, subdivision 2. I also understand that provision of false informa6on in this certification constimtes sufficient grounds for y action against all licenses held, including revocation and suspeasion of said licenses. t - 1 yante of Insurance Comgany: IiLSUr"anC2 CCfR)aP1V Of NDY'tft P7�12Y1Cd ��_�� ` Poticy Number: RSCC 42067579 Coveragefrom � Z� 1997 t Dec 31, �997 I have no emp3oyees covered under workers' compensation insurance ANY FALS3FICAT'ION OF ANS�iBI2S 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 informadon contained 6erein is true and cortect to the best of my knowiedge and belief. I hereby state further that I have rueived no money or other consideration, 6y way of loan, gift, contribution, or othenvise, other tUan already dixlosed in tl�e application which I herewith submitted. I aiso understand tbis premise may be inspected hy police, fae, heatth and ocher city oft'iciais at any and ali umes when the business is in operauon. / , _ __ ____!i Signature (REQUIRED for all applications) Date David P. Phillippi, Authroized Representative **Note: If Uris application is FoodlLiquor re3ated, please contact a City of Saint Paul Aeal[h Inspector, Steve Olson (266-9139), to review olans. If any substantial changes to structure are andcipated, please contact a City of Saint Paul Plan Fxaminer at 266-9C107 to agply for building pernrits. If there are any c6aoges to the paziting lot, floor space, or for new operations, please conract a City of Saint Paul Zooiug Inspector at 266-9008. Additional application requirements, please attach: A detailed description of the design, location and square footage of the premises to be licensed (site pIan). T'he following data shoutd be on the siEe plan (Freferabiy on an & L2" x 11" or 81t2" x 14" papu): - Name, address, a� phone number. - The scaie should be stated such as 1" = 20'. ^N should be indicated towazd the top. - Placement of alI perfinent features of the interior of the licensed facility such as seating azeas, kitchens, offices, repair azea, parking, rest rooms, et� - If a request is for an addition or expansion of the licensed facility, indicate both the current area a»d the proposed erzpansioa A copy of your lease agreement or proof of ownership of the property. FOR SPECIFIC APPLICATION REQUIREMENTS, PLEASE SEE REVERSE >>>>. �� Ii��;� Council File # � � � Ordinance # Green Sheet # ` � OF Presented Referred To Committee: Date 7'� i RESQLVED: That application (ID #44108) for an Off Sale Malt License by SuperAmerica Csroup- z Division of A.shland Inc. DBA SuperAmerica #4001 (David Phillippi, Representative) at s 296 East ?th Street be and the same is hereby approved. 4 5 Requested by Department of: 6 Yeas Navs A65ent 7 B a —?- $ � � Office o£ License Tnspections and 9 r Ha r s �— 10 � ar � � Env+rorimental Protection 11 Re t� man 12 Thune � i 3� sostrom 15 16 Adopted by c�ncii: Date `��, _�� 7 q�}�► $y` i� 18 Adoption Certified by Council Secretary ��,��`�',�.� � ,tnr�,�/� 19 Form Approved by City Attorney 20 l ; r� ? 1 Bs' �-___ "� � rr--zZ�—c�...a-�._ � J � �z / By� � s��l�r L�.-�� '3 Approved by Mayor: Date �Jj� J S y- � 4 Approved by Mayor for Submission to 5 �'�� Council 6 BY= �✓�C 1 PAUL, MINNESOTA By: LIEP Christine For hea TOTAL # OF (CLIP ALL LOCATIdNS FOR SIGNATURE) `l`1 �t�� N_ 35387 "-_ " " _ ' . INITIAIJDATE �crtrc��xc _ O FIN. 8 MGT. SEflVICES DiP. o - SuperAmerica Group—Division of Ashland, Inc. DBA SuperAmerica 1P4001 requests Council approval of its application for an Off Sale Malt License at 296 7th Street East (ID #44108). _ PLANNMG COMMISSION _ GMl SEFtV10E COMMISSION _ CIB COMMRSfE _ _ SiAFF _ _ �{S7AICT COUFT _ SUPPORTS WHICH COI/NCIL O&IECfIVE7 PEHSONAL SEHVICE CONTRACTS MUST ANSWER THE FOLLAWING QUESTIONS; 1. Ha5lhis parSONfirm aver worked unGer a coMract for this depaAmeM? - YES NO 2. Has this person/firm ever been a city employee? YES NO 3. Dces this persoNfirm posseSS a skill not nortnally posse55etl by any curzerH ciry employBe4 YES NO Explain ail yes answers on separate shest and attacM to green sAeet j ��, �. � , . c ', � �s aF ►- � , . � � d ��°.y-,x: �� x � T �� J � � �°' lwa"'� fOTAI AMOUNT OF TRANSACTIQN S COSTlREVENUE BUDGETED (CIpCLE ONE) YES NO 'UNDIN6 SOURCE ACTIVITY NUMBER INANCIAL iNFORMATiON: (EXPLAIN) GREEN SHEET O OEPARTMENT OtRECTOR 266-9108 �x �cmnrroar+ev iATE� RO�� R �� BUDGET D1A£CTOF � � �� MAYOH (OR ASSISTANi} Greensheet # 35387 L.I.E.P. REVtEW CHECKLfST Date: 11/26l96 /�� `�y�_ In TraCket? 1WP'n Received / ApP'n Processed License ID # 44108 License 7ype: Off Sa1e Malt Company Name: SuperAmerica Group DBA: Super America-Store �4001 Business Addresss: 296 7th Street East Business Phone: 225-9567 Contact Name/Address: Debra Johnson, 5537 llth Ave S, Home Phone: $ZS-5361 Minneapolis, M13 55417 Date to Councii Research: Public Hearing Date: a �+ Notice Sent to Appiicant: �°� f 2j�� /�� , Notice Sent to Pubfic: f labeis Ordered: ; G�i.J�'7`rTJ��i'1 -1�f{� Dist�ct Council #: I/ Ward Department/ Date inspections Comments City Attorney lZ • 2 •�L ro fi�`� ' Environmental Heaith z.z�P�gb �.� - F��e � � • z_c.� •°! b �7, K - License , 1 .Q.u3 yy � a, P� — Site PIa�+ Reoe�ved:_ ti! Lease Received: � z) � �( � y � �'S � a+.a��-� Police Iz-2 •°�jo O•�• oning �Z.2.�f•4la d��.. $AINi PAUG � AAt1A CLASS III LICENSE APPLICATION TEIIS APPLICATION IS SUB TECl' TO REV[EW BY Tf� PUBLIC Type of License(s) being applied for. PLEASE TYPfi OR PRINT IN INK ��-)`� l SuperMerica Q-oup, a division of Ashland Inc. / CompanyName: _�rlkrerica (�-cxea, a division of Ashland Inc. Cocporafion! Partnecship! Sole Propciecorship If business is incoiporated, give date of incorporation: OCtd�r 22, }g36 Doing Business As: �rPmericd # 400] Business Phone: Z25-9`.�6� Business Addcess: 296 East lth Street, St Pau2, NN 551�1 SaeetAddress Ciry State Zip Between what cross st�eets is the business located? W}rich side of the street? Are the premises now occupied? Ye5 What Type of Business? COnV2ni2r1C2 Storrretai 1 Sd12S of petr0 pY'odUCt! Mail To Address: �240 W 98th Str2Et 8loattingtari, NN 55431 Sund�"ies, groceries, etc... Street Address City State Zip Applicantlnformalion: Name and Ticie: . David Paul Phillippi Authorized Representative � Fttst T4iddle (Maiden) Last TiOe Home Address: 5537 llth Ave South, Minneapolis, hBJ 55477 Sveet Addeus City State Zip Aate of Birth: 2 Place of Birth: Mirtneapolis, hHV Home Phone: �5-5361 Have you ever been convicted of any felony, crime or violation of any city ordinance other than traffic? YES ! NO X Date of azrest: Chazge: _ Couvicflon: Sentence: List the names and cesidences of three persons of good morai chazacter, living wittrin the Twin Cities Meuo Area, not related to che applicant or financially interested in the premises or business, who may be refened to as to the applicant's chazacter: NA,:;� Robert C. Harctnan Tare Stone Wheze? ADDRESS 54 E Sandralee Drive, St Paul, NN 554]9 Rurai Route 3 Box 47, Fairnnnt, NN 5603] PHONE List licenses which you cunenfly hold formerly held, oi may have an intesest in: __ Several in the City of St Paul, Minneapolis, Cnlden Valley, etc... Have any of the above named licenses evec been revoked? J YES X NO If yes, list the dates and reasons for revocation: Are you going to operate this business personally? _ YES X NO If not, who will operate it? Charl2rle Go1dSChnidt, MdndgeY First Narne Middlelnida) (Maiden) ].ast HomeAddress: SucetName City Stau Zip CITY OkR`SAiNT PAl OfSiCe oE I.iCeJ15G. Sn<Pecbo115 and EnvironmenW ProteGion 3505i PdaSL Sa've 300 $aimPeW.MiurcsUa 55�02 (bi�]b69D90 fas(61n26691]A Datc oi Bir�h Phone Numbec . Q Are you going to have a manager or azsistant in this business? X YFS _ NO Tf the manager is not the 3 complete ihe following infonnation: first Nazne Middk Initial Ias[ � ?i �j� `� O � i� o j � , G�� - " `� �i P ��+' 9 �'? �G .� o, r .y „ ` '�Vy ""p T �A Daua�, � - f \ G' Home Address: Strcet Name City Slsu tip Phone Numbex Please list your employment Sustory for the previous five (5) yeaz period: , ��-�� BusinessJEmpinoyment Address S�erArrerica 1240 W 98th Street, Bloarri on, NN 55431 23 ars List all other officers of the corpocadon: OFFICER TITLE NA.ME (Office Heid) See Attached HOME ADDRESS HOME BUSINESS DATEOF PHOt3E PAONE BIRTH If business is a gartnership, piease include ihe foltowing informaGon for each paztner (use additionaf pages if �xcessary): Middle Initia! HomeAddress: StreetName (Maiden) Last Date of Hinh State Zip Phone Numbe FirstName Middlelnitiai (Maiden) Last DzteoCBicth HomeAddress: SheetNamr Ciry State Zip PhoneNumber MIIVNESOTA TAX IDENTIFICATiON NUMBER - Pursuant to the Laws of Minnesota, 1984, Chapter 502, ARicle 8, Seclion 2(270.72) (Tax Clearaoce; Issuazice of I.icenses), licensing authocities are required to provide to the State of Minnesota Commissioner of Revenue, the Minnesota business tax idenGfication number and We social security number of each license applicant. Under the Minnesota Govemtneat Data Pracfices Act and ffie Federal Privacy Act of 1974, we aze required to advise yoa of the following regazding the use of the Minuesota Tax Idenafication Numbec - This i¢fomiation may be used to deny rhe issuance or renewal of your license in the event you owe Minnesota sales, e�v,?loyer s withholding or motor vehicle excise taxes; - Upon receiving this information, the licetisiag authority will supply it only to the Minnesota Departn�nt of Revenue. However, under ttre Federal &xchange of Infom�ation Agreemeat, the Department of Revenue may supply this information to the intemal Revenue Service. Minnesota Tax Identificafion Numbers (Sales & Use Tax Number) may be obtained from tbe State of Mimesota, Business Records Department, 10 River Pazk Plaza (612-246-6I81). ' Sociat SecuriryNumber: • 469-62-8770 ' , Minnesota Tax Idendfication Number. 1292355 If a Minoesota Taz IdentiFication Number is not required for the business 6eing opetated, indicate so by placing an "X" in the box. � m' �� . :iF WORKERS' COMPENSATION COVERAGE PURSUANT TD MINNESOTA STATUTE 176.182 .,iat I, or my company, azn in compliance wich the workers' compensation insurance coverage requiremenfs of Minnesota o a+f2, subdivision 2. I also understand that provision of false informa6on in this certification constimtes sufficient grounds for y action against all licenses held, including revocation and suspeasion of said licenses. t - 1 yante of Insurance Comgany: IiLSUr"anC2 CCfR)aP1V Of NDY'tft P7�12Y1Cd ��_�� ` Poticy Number: RSCC 42067579 Coveragefrom � Z� 1997 t Dec 31, �997 I have no emp3oyees covered under workers' compensation insurance ANY FALS3FICAT'ION OF ANS�iBI2S 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 informadon contained 6erein is true and cortect to the best of my knowiedge and belief. I hereby state further that I have rueived no money or other consideration, 6y way of loan, gift, contribution, or othenvise, other tUan already dixlosed in tl�e application which I herewith submitted. I aiso understand tbis premise may be inspected hy police, fae, heatth and ocher city oft'iciais at any and ali umes when the business is in operauon. / , _ __ ____!i Signature (REQUIRED for all applications) Date David P. Phillippi, Authroized Representative **Note: If Uris application is FoodlLiquor re3ated, please contact a City of Saint Paul Aeal[h Inspector, Steve Olson (266-9139), to review olans. If any substantial changes to structure are andcipated, please contact a City of Saint Paul Plan Fxaminer at 266-9C107 to agply for building pernrits. If there are any c6aoges to the paziting lot, floor space, or for new operations, please conract a City of Saint Paul Zooiug Inspector at 266-9008. Additional application requirements, please attach: A detailed description of the design, location and square footage of the premises to be licensed (site pIan). T'he following data shoutd be on the siEe plan (Freferabiy on an & L2" x 11" or 81t2" x 14" papu): - Name, address, a� phone number. - The scaie should be stated such as 1" = 20'. ^N should be indicated towazd the top. - Placement of alI perfinent features of the interior of the licensed facility such as seating azeas, kitchens, offices, repair azea, parking, rest rooms, et� - If a request is for an addition or expansion of the licensed facility, indicate both the current area a»d the proposed erzpansioa A copy of your lease agreement or proof of ownership of the property. FOR SPECIFIC APPLICATION REQUIREMENTS, PLEASE SEE REVERSE >>>>.