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97-201p��NOt�o - aIa�I9� 9 7 _ � Council File ¢` ` I � �� °� j�'. R�`_ p� 4 r` t L..= t A . �' . . � . . _, Presented By Referred To RESOLUTION CITY OF SAINT PAUL, MINNESOTA ordinance # Green Sheet # ✓��/ �� Committes: Date i RESOLVED: That application (ID #24311) for an Auto Repair Cmrage License by the Asian Auto z Tech DBA Asian Auto Tech (Xong Vang, President) at 874 Maryland Avenue East be 3 and the same is hereby approved with the following conditions: 1. Parking for customers and employees shall be arranged on the lot as shown on the site plan. No more than 18 vehicles shall be parked out doors on the lot. 2. The licensee is responsible for managing the number of customer vehicles to that which may be repaired and returned to their owners in the shortest period. Only customer vehicles and personal vehicles of the licensee may be parked on the lot. This condition is intended to prohibit long term storage of vehicles on the lot. 3. All vehicles parked outdoors on the lot must be completely assembled with no parts missing. Vehicle salvage is not permitted. 4. Vehicle parts, tires, oil or similar items may not be stored outdoors. 5. No repair of vehicles may occur on the exterior of the lot or in the public right-of-way. 6. The existing wood screen fence must be restored along the west and south property lines, by July l, 1997. An inspection of the property revealed the remnants of a wood fence at this location. Screen fencing to obscure the parking and business activity from the adjacent homes is a requirement of City Ordinance, Chapter 62.104(12). The licensee aRrees to extend the fence as far out toward the sidewalk 4 a5 will n�vio a e e i v s co e an raf��c rPnn�r� 5 Requested by Department of: 6 Yea Navs Absent 7 B a�Tce � $ Of£ice of License. Insgections aiid 9 Harris � 10 � ar � Environmental Protection 11 Re t� man 12 Thune _� � � 13 Bostrom /� 15 �+�..ir' � � Ej- 16 Adopted by Council: Date � � B Y 0 17 18 Adoption Certified by Council Secretary Form Approved by City Attorney 19 20 21 By: 22 � 1a.. " w�.� b gp; ��9...s�.et� � cc.l 23 Approved by Mayor: Date �/7 �- � 24 � 2 �� Approved by Mayor for Submission to 26 $y. � �y Council 27 By: 97-a,o� DEPARTMENTlOFFICFJCOUNCIL DATEINfrIATED GREEN SHEE N� 35391 LIEP/Licensin — - — CANTACT PEflSON 8 PHONE INRIAVOATE INRIAUDATE � DEPARiMENTDIRECTOR � CRYCAUNCIL Chxistine Rozek, 266-9108 "u��" OcmaTroaNev �cmc�aK MUST BE ON COUNCIL AGENDA BV (DATE) MUYBER FON ❑ BUDGET DIRECTOR � FIN. & MGT. SERVICES DIR. XOVfING r'OI hearin : Z. R� ORDER aMpypp(ORASSISTANn � TOTAL # OF SIGNATURE PA ES (CLIP ALL LOCATIONS FOR SIGNATUHE) ACTION HE�UESTED: Asian Auto Tech DBA Asian Auto Tech requests Council approval of its application for an Auto Repair Garage License located a[ 874 Marylarid Avenue East (ID 4k24311). PECOMMENDA710NS: Approve (A) or Hejed (P) pERSONAL SERVICE CONTHACTS MUST ANSWER TNE FOLLOWING QUESTIONS: _ PLANNING COMMISSION _ CIVIL SERVICE COMMISSION 1. Has ihis personlfirm eve� worked under a contrac[ for this departmBM? - _CIBCOMMfTTEE _ YES 'NO — �� F _ 2. Has ihis personffirm ever been a city employee? YES NO _ DISTRICi COUR7 _ 3. Does this person/Firm possess a skill not normally passessed by any curtent ciry employee? SUPPORTS WHICH COUNCIL O&IECTIVET YES NO Expla�� ell yes answers on separate shcet antl attech to green sheet INITIATING PROBLEM, ISSUE, OPPORTUNIN (Who, Whe[. When, WhBre. Why): ADVANTAfiESIFAPPROVED: DISADVANTAGES IFAPPROVED: � ','tr:�.;:9 �'='sei^,°��rq;CC ...°�Z?7 U, ' ' a. � ;-, �, 9iJW� ....,.a a7 0 • DISADVANTAGES IF NOTAPPROVED: � _„A TOTAL AMOUNT OF 7pANSACTION S COSTlREVENUE BUDGETED (CIHCLE ON� VES NO PUNDING SOUFiCE NC7IVITV NUMBER FINANCIAL INFORMATION: (EXPLAIN) CITY OF SAIN°T PAUL Norm Coleman, Mayo� 7anuary 6, 1997 OFFICE OF LICENSE, INSPECTIONS AND I/'�j� DI EN V IRONMENTAL YRO'1BCTTON RobertKeaaler, DireeYOr LICENSEAND Teiephone:612-266-9090 INSPFCTIQNS Facsimlk:612•266-9t24 330Sr. PeterStreet Suite 300 SairtlPauLMinrwsota SSf02 I agree to the foliowing conditions being placed on the Auto Repair Garage License at 874 MaryIand Avenue East as follows: 1. Parking for customers and employees sha11 be arranged on the iot as shown on the site plan. No more than 18 vehicles shail be parked out doors on the lot. 2. The licensee is responsi6le for managing the numDer of customer vehictes to that whie#� may be repaired and returned to therr owners in the shortest period. tJn1y austomer v€hietes and personal vehicies of the lieense� may' he parked oa the #ot. This eonditaon is intended to prohibit long term storage of vehicles'on the tot. 3. All vehicles parked outdoors on the lot must be con�pletely assembled wi:h no parts missing. Vehicle safvage is not permitted. 4. Vehicle parts, tires, oil or s'rmitar items may not be stored autdoors. S. No repair of vehicies may occur on the exterior of the lot or in the public right-of- way. 6, The existing wood screen fence must be resYOred along the west and south property tines, by Iuly l, I937, An inspection of the property revealed the remnants afa wood fence ai this tocation. Screen fencing to obscure the parking and business acYivity frorn the adjacent homes is a requirement of City Ordinance, Chapter 62.104(12). - Xiong Vang, President �l �'/� i - Date Greensheet # 35391 in Trackec'?_1�� .I.E.P, REVIEW CHECKLIST Date: 12/27/96 � 1WP'n F�ceived / ApP'n Procesced License ID # 24311 license Type: an Auto Revair Gara�e Company Name: Asian Auto Tech DBA: Asian Auto Tech Business Addresss: 874 Maryland Avenue East Business Phone: n/a Contact Name/Address: Xion� VanQ, 709 Rent St 1F1, 103 Home Phone: 487-b063 Date tq Council Research: l�� 2� �'�it�� `�� Pubtic Hearinq Date: �� Z- � � R� Labets Ordered: ��% Notiee Sent ta Appiicant: Districi Counci! #: —� Notice SeM to City Attorney Ward #: {,P Date Inspections Comments � Environmeniai Heaith Fire �'.7.`1�. �•�•�� ( �r ,K License ��2� �,� Police 1 �� Zoning r F/��' v ��2g��- � �.�. w �--a s�e wan Reo� I.ea� Recxiv CLASS III L�ENSE APPLICATION }( ✓ 1 � \ / � � t """ � �, � THIS APPLICATION IS StTBJECT TO REVIEW BY TF� PUBLIC PLEASE TYPE OR PRINI' IN II�TK Business Phone: ��t� �-`;lZ� � i� �) /� f�, � �-7 �} of License(s} being applied for: =41 � E � t-P' .LY(.�'7`fl �(y }��. % Y �GI �� G('f'� S . � � ! . `�"' ` � � � s Company Name: _ f75 /f} i� �} t,f i:� T�G_ j-J CorporaGon / Pmficrsbip / solc Propriams6ip Lf business is incorporated, give date of incorporation: Doing Business As: A-LF 1° �.� i 1Z Busiz�ess Addresc 3� i �f � • /Z9,+�:'?'L SlreetAddreu Bet�3 een what cross streets is the business located� Are ihe premises nou occupied /� VTha Mail To Address: ��_ �� /!� / . �-r Strcet Addresa Applicant Infoimation: Nazne and Tifle: �� tr!" -�T. CiTy /C7�� CITY OF SAII�TT PAUL os� orLS�, �r�oa� and Env'monmttrtal Protection 350 St Pna SC Sititc300 So-.^r•P+u7,Mbcicoa 35102 (611)26F� fu{6l2)=cF413S Staze Zip (�✓'fi�J ! C ( E'�i Fssat Yv&d , � dle � c (.Maidca) Iast Tit2e Home Address: �� L�T �.�-1 �' ) cS ) _ ��}j�� tJ � � /2 � Strsu Addresa CiTy Ststc Zip Date of Birth: � '"- Ls�,� Place of Birth: �'�� > Home Phone: �t� �`�d �� Have you ever been convict� of any felo�, crime or ��iolaTion of any cet�� ordinance other than traffia? YES NO ` Dafe of a¢st: i�Y�7X� WhereY Chazge: _ Con�icuon: Senteace: List the names and residences of three persoas of good maral character, living within the Twin Cities Metro Area, not related to ihe a or financially interesEed in the premises or business, who may be referred to as to the applicanYs character: NAME AI3DRESS �� _SI�I�' PHONE %%b''S � Hat�e.any of the above named licenses ever been revoked7 YES �_ NO If yes, list the dates and reasons for r 12/ City , Siete Zip ��e-�'Yl.� �'ti`�„_ �� y��t DG7�} tiVhicb side of the street9 <�� -. r�r' � TypeofBusiness�? .��1`O /�� / � 1"�}L�` � ��J °� � � / d S Lisi licenses which you cuirenUy hold, fozmerly held, or may have an inierest in: Are you going to operate this bnsiness personally? � YES � NO If not, u•ho will operate ifl waai� �� ,v;am) E� Date of Birch HomeAdd`ess: Shuctiemc City Stafe Tsp Phonel�5mm Are }'on going to ha��e amanager or assistant in this business? YES � NO If the manager is not the same ss tbe oper please complete the following information: � First?<ame (A3aidm) I,est Dati of Binb Home Addreas: SYttet tiame City Statc Zip Phonc;.'umber Please list your employment history for the przvious &ve (5) year period: BusinesslEmplormrnt ess S ;z �I�Z��nC'�� lc��J � ;v�><'.G y r'i ��-z.�°i C iiU� " " " /i L �/ l� SI .�f�UL ,,/l.� ti '�((� � 1L( �"2�+C_tl-I_ 1.�`1= I'{� tYi�/EL� ��r .�.oSt�'v� �ir ��f rt.� bt1G� �� t��s�r=�, tN�- I �9S Ur�itlE�s>��i+� ��v List all other officers af she corparation: OFFICER TITLE NAME (Office Held} HOME ADDRESS HOME BUSII�TESS DATE OF PHONE PHONE B1RTH If business is a parhiership, please inciude the foIIou information for each partrier (tue additional gages if neczssary): i Cil�/s X i� UC�- i�� Fixat tiamc Svfiddle I¢itiil (Maidcn) � Lsst �r �A��. � �c4 i� - % S�, Deu of Bir7h naa�: semm,e� c�ry s�.�e z;y t�ho� �.umx� Fast \ame :vliddle Initia! (!.3aidrn) Last Date of B�� fiomcAddress: Stmt?:ame City Stait .Zip PhoneN MINNESOTA TAX IDENTIFICATFON NiJMBER - Pursuant to the Laws of Minnesota,l9$4, Chapter 502, Article 8, Section 2(2 (fae Cie�ce; Issuance of Licenses}, licensing authorities are required To provide to the Stste of Minnesota Commissioner of Rec�Pn Minnesota business taY identificatioa nnmber and the sociat security number of esch license applicant Under the Minnesota Government I}ata Practices Act aad the Federat Privacy Act of 1474, we are required to edvise you of the f� regarding the use of the Minnesota Tax IdeniiScation Number: - This informa6on may be cued to deny the issvance or renewal of your license in the event you oH�e Minnesota sales, W�thholding or motor vehicle excise ta�ces; - I3pon receiving this information, the licensing autbority u�ill supply it onty to the Minnesota Department of Revenue. � under the Federat Exchange of Infrnmafion Agreement, the Department of Revenue may supply this information to +� Revrnue SenZCe. lvfinnesota Tax Identi5cation Numbeis (Sales & Use Tax Number) may l�e obtained from the State of 2�nnesota, Business Records � 1 Q Riaer Yark Plaza (612-296-6181). Soeial Securiry Number. /�/' 3 L �""�� / � Minnesota Tax Identification Numher: _ If a Minnesota Tax Identification Number is not required for the business being operated, indicate so b�• piacing an "� 12/' . . `T 7-a-o/ CERTIFICATIOAT OF F�'ORKERS' CO?dPENSATION COVERAGE PURSUANT TO 1vIINNNESOTA STANTE 176.182 T hereb}' certifi that I, or mti� company, am in complia�me uzth the workers' compensation insuance coaerage requirements of Minnesota Statute 176.? 82, subdivision 2. T aLo undecst�d that proiision of false infom'iaton in tlus ceitificatian consstutes sufficient grounds for adveise action against all licenses held, iacluding recocation and suspension of said licenses. �Tamz of Insuance Co:npanc: Polic}' Num�: Coverage from to T ha� e no e�aptot�ezs core: ed undzr n orl:ers campensation insurance �(II��ITIALS) Ai�Y FALS�ICATION OF AIV'SWERS GIVEN OR MATERIAL SUBh'lI1"I'E➢ WII,L RESULT IN DENfAL OI' TfIIS APPLICA'�IOft I hereby state that I ba��e ansu ered a11 of the preceding questions, and that the infom2ation contained herein is true and cosect to the best of my Imow�iedge and batie£ I hereby state fiuther that I have received no money or othet consideraGon, bp way of loan, gift, contribution, or otheruise, other than already disclosed in the applicafion uiuch I herew�ith submiifEd. I aiso understand this premise m�� be inspe�ted bg police, fire, health and other city offtcials at any aud atl times when ihe business is in operation. We eill accepi payment bp eash, check (made gacable to City of Saint Pau� or credit card (M1C or Visa). IFPAYINGBYCXEDITGSRDPLEASECQMPLETETHEFOLLON'INGA'FORMATION: �MasterCazd � Visa BKPIItATION DATE: � � � � ACCOUNTNUMB$R: � � � � � � � � � � � � � � � for aIt Dace '�'Note: If tlus applica6on is Food/Liquoz related, pfease contact a City of Saint Paul Aealth Inspector, Steve Olsos. `:r C6-9139), Yo r� plans. If any substanEial changes to structure are anticipafed, please contact a City of Saint Paut Plan Examiner si "'60-9007 to a7 building pamiu. If thc�e are aa}• changes to the pazkzng lot, floor space, ot for necv operations, please contact a CiTy• of Sast P�nrl 'oning L 266-9008. Ail applications mquire the toiloaing documenfs. Please aYtach tIiese documents when submftfing �•au� �pp13c� 1. A detailed description of tfie desigq location and square footage of the pzemises to be licensed (site plan}. The folloK�ing data should be on ihe site plan (prefera6ly on an$ 12" x 1 I" oz 8 I t2" x I4" papes): - Name, adc3ress, and phone number. - The scale should be sfated such as 1" = 26'. ^N should be indicated toward the top. - Placetnent of all pertinent features of the interior of tbe licensed facility sucL as seating areas, l�icbens, af��es parlang, rest rooms, etc. - If a request is for an additiou oz ex�pansion of the licensed faciliry, indicate both the current azea and the ��iopos 2. A copy of yow lease ageement or proof of ou�nership of the property. SPECI�IC LICENSE APPLIC�TTOiYS REQLTIItE ADDTTIONAL Il!'FORMATION. LEASE SEE REVERSE FOR DETAILS >>>> If appt� for, q`1-26 Cabaret adutt, please attach a�ritten proof that each emplo}•ee is at Ieast 18 yeacs old Con��ersarion/Rap partor adult, please attach u�itten proof that each employee is at least 18 years old £ntertsinment, please specify class A, B, or C ficense; obtain and attach signatures of approti�al from 40% of }�ouc neighbors u�7thin 3� feex of the e,�ablishment This licevse must be applied for in conjunction a�tt� a Liquor, Wine, Malt On Sate or RwtaUDance Hall licea,e. Fireatws, pleaze attach a lettet tviih the follorting infotmation: state if selling or oniy repaiiing, Federal Firearms License Number, ripe of Aimed Sen discharge (Honorable, Geberai, Bad Conduct, Undesirable, Dishonorable, or no milttary sen�ice• (N�TE: Establishment must be cammercially zoned.) _ Game room, please prrnide the followting infonnation: name of machine end list price. {NOTE: A Pool Hall licc�nse is required if there are any pool tables in ihe establishment) HealtkJSporta clu6 adult, piease attsch written proaf that each empioyce is at least 18 years old Liquor offion sale, refer to attaci�ed liquor application Lock opening ser+ices, please att�ch a list of all emplopces (aith hame address snd telephone number) K�o u�i13 be doing the lock opeaing sen2ce; attach S]0,000 Swety Bond. hfassage center, please attach a detail�d descripuon of the sen�ices being proc�ided. hSassage center aduit, p3ease attach kTitten groof that each employee is at least 18 years old. Massage praciitioner, please anach a cop5� of letterfar appmt�al from Health; proof of insurance coverage of SI,000,000 00 each gen� liabilii�� and professional liabitity kith che Ci1y� of Ssint Paul named as an addstianal insured, and a 30 day notice of cancellation; a le from your empioc�r to vetify empio}ment uith a license massage ce�ter. Motorc�ele dealer, piease include State of Minnesata 17eater Number. Iie+� motor vehiele dealer, please inciude State of Minnesota peater Number. Padrmg bthnmp Please inciuc� the mmmber ofPa�onB SPeces, and attach plans containing a general desc:iption of tte security � at the lothmnp, a site plan shoutin� driaecra}s of the ptoposed lat and the legal description of the property {ttus requirement neces if no site plan is cuirendp on file}. Attach a cover letter describing yaur plans to comply with the lighting and painting requir Pavra6mker, please attacfi $S,Od0.00 Surery Bond Second hand dealer-motor vehicie, p} �clude State of 2�nnesota Deatez Number. � Second hand deater-motor vehicle parts, please attach S5,000.00 Surery Band. Steam room/bat6 house adult, please att,ach written pra�f that each emp}oyee is at least 18 years old Theater adutt, please attach written proof that each employee is at least 18 years oid p��NOt�o - aIa�I9� 9 7 _ � Council File ¢` ` I � �� °� j�'. R�`_ p� 4 r` t L..= t A . �' . . � . . _, Presented By Referred To RESOLUTION CITY OF SAINT PAUL, MINNESOTA ordinance # Green Sheet # ✓��/ �� Committes: Date i RESOLVED: That application (ID #24311) for an Auto Repair Cmrage License by the Asian Auto z Tech DBA Asian Auto Tech (Xong Vang, President) at 874 Maryland Avenue East be 3 and the same is hereby approved with the following conditions: 1. Parking for customers and employees shall be arranged on the lot as shown on the site plan. No more than 18 vehicles shall be parked out doors on the lot. 2. The licensee is responsible for managing the number of customer vehicles to that which may be repaired and returned to their owners in the shortest period. Only customer vehicles and personal vehicles of the licensee may be parked on the lot. This condition is intended to prohibit long term storage of vehicles on the lot. 3. All vehicles parked outdoors on the lot must be completely assembled with no parts missing. Vehicle salvage is not permitted. 4. Vehicle parts, tires, oil or similar items may not be stored outdoors. 5. No repair of vehicles may occur on the exterior of the lot or in the public right-of-way. 6. The existing wood screen fence must be restored along the west and south property lines, by July l, 1997. An inspection of the property revealed the remnants of a wood fence at this location. Screen fencing to obscure the parking and business activity from the adjacent homes is a requirement of City Ordinance, Chapter 62.104(12). The licensee aRrees to extend the fence as far out toward the sidewalk 4 a5 will n�vio a e e i v s co e an raf��c rPnn�r� 5 Requested by Department of: 6 Yea Navs Absent 7 B a�Tce � $ Of£ice of License. Insgections aiid 9 Harris � 10 � ar � Environmental Protection 11 Re t� man 12 Thune _� � � 13 Bostrom /� 15 �+�..ir' � � Ej- 16 Adopted by Council: Date � � B Y 0 17 18 Adoption Certified by Council Secretary Form Approved by City Attorney 19 20 21 By: 22 � 1a.. " w�.� b gp; ��9...s�.et� � cc.l 23 Approved by Mayor: Date �/7 �- � 24 � 2 �� Approved by Mayor for Submission to 26 $y. � �y Council 27 By: 97-a,o� DEPARTMENTlOFFICFJCOUNCIL DATEINfrIATED GREEN SHEE N� 35391 LIEP/Licensin — - — CANTACT PEflSON 8 PHONE INRIAVOATE INRIAUDATE � DEPARiMENTDIRECTOR � CRYCAUNCIL Chxistine Rozek, 266-9108 "u��" OcmaTroaNev �cmc�aK MUST BE ON COUNCIL AGENDA BV (DATE) MUYBER FON ❑ BUDGET DIRECTOR � FIN. & MGT. SERVICES DIR. XOVfING r'OI hearin : Z. R� ORDER aMpypp(ORASSISTANn � TOTAL # OF SIGNATURE PA ES (CLIP ALL LOCATIONS FOR SIGNATUHE) ACTION HE�UESTED: Asian Auto Tech DBA Asian Auto Tech requests Council approval of its application for an Auto Repair Garage License located a[ 874 Marylarid Avenue East (ID 4k24311). PECOMMENDA710NS: Approve (A) or Hejed (P) pERSONAL SERVICE CONTHACTS MUST ANSWER TNE FOLLOWING QUESTIONS: _ PLANNING COMMISSION _ CIVIL SERVICE COMMISSION 1. Has ihis personlfirm eve� worked under a contrac[ for this departmBM? - _CIBCOMMfTTEE _ YES 'NO — �� F _ 2. Has ihis personffirm ever been a city employee? YES NO _ DISTRICi COUR7 _ 3. Does this person/Firm possess a skill not normally passessed by any curtent ciry employee? SUPPORTS WHICH COUNCIL O&IECTIVET YES NO Expla�� ell yes answers on separate shcet antl attech to green sheet INITIATING PROBLEM, ISSUE, OPPORTUNIN (Who, Whe[. When, WhBre. Why): ADVANTAfiESIFAPPROVED: DISADVANTAGES IFAPPROVED: � ','tr:�.;:9 �'='sei^,°��rq;CC ...°�Z?7 U, ' ' a. � ;-, �, 9iJW� ....,.a a7 0 • DISADVANTAGES IF NOTAPPROVED: � _„A TOTAL AMOUNT OF 7pANSACTION S COSTlREVENUE BUDGETED (CIHCLE ON� VES NO PUNDING SOUFiCE NC7IVITV NUMBER FINANCIAL INFORMATION: (EXPLAIN) CITY OF SAIN°T PAUL Norm Coleman, Mayo� 7anuary 6, 1997 OFFICE OF LICENSE, INSPECTIONS AND I/'�j� DI EN V IRONMENTAL YRO'1BCTTON RobertKeaaler, DireeYOr LICENSEAND Teiephone:612-266-9090 INSPFCTIQNS Facsimlk:612•266-9t24 330Sr. PeterStreet Suite 300 SairtlPauLMinrwsota SSf02 I agree to the foliowing conditions being placed on the Auto Repair Garage License at 874 MaryIand Avenue East as follows: 1. Parking for customers and employees sha11 be arranged on the iot as shown on the site plan. No more than 18 vehicles shail be parked out doors on the lot. 2. The licensee is responsi6le for managing the numDer of customer vehictes to that whie#� may be repaired and returned to therr owners in the shortest period. tJn1y austomer v€hietes and personal vehicies of the lieense� may' he parked oa the #ot. This eonditaon is intended to prohibit long term storage of vehicles'on the tot. 3. All vehicles parked outdoors on the lot must be con�pletely assembled wi:h no parts missing. Vehicle safvage is not permitted. 4. Vehicle parts, tires, oil or s'rmitar items may not be stored autdoors. S. No repair of vehicies may occur on the exterior of the lot or in the public right-of- way. 6, The existing wood screen fence must be resYOred along the west and south property tines, by Iuly l, I937, An inspection of the property revealed the remnants afa wood fence ai this tocation. Screen fencing to obscure the parking and business acYivity frorn the adjacent homes is a requirement of City Ordinance, Chapter 62.104(12). - Xiong Vang, President �l �'/� i - Date Greensheet # 35391 in Trackec'?_1�� .I.E.P, REVIEW CHECKLIST Date: 12/27/96 � 1WP'n F�ceived / ApP'n Procesced License ID # 24311 license Type: an Auto Revair Gara�e Company Name: Asian Auto Tech DBA: Asian Auto Tech Business Addresss: 874 Maryland Avenue East Business Phone: n/a Contact Name/Address: Xion� VanQ, 709 Rent St 1F1, 103 Home Phone: 487-b063 Date tq Council Research: l�� 2� �'�it�� `�� Pubtic Hearinq Date: �� Z- � � R� Labets Ordered: ��% Notiee Sent ta Appiicant: Districi Counci! #: —� Notice SeM to City Attorney Ward #: {,P Date Inspections Comments � Environmeniai Heaith Fire �'.7.`1�. �•�•�� ( �r ,K License ��2� �,� Police 1 �� Zoning r F/��' v ��2g��- � �.�. w �--a s�e wan Reo� I.ea� Recxiv CLASS III L�ENSE APPLICATION }( ✓ 1 � \ / � � t """ � �, � THIS APPLICATION IS StTBJECT TO REVIEW BY TF� PUBLIC PLEASE TYPE OR PRINI' IN II�TK Business Phone: ��t� �-`;lZ� � i� �) /� f�, � �-7 �} of License(s} being applied for: =41 � E � t-P' .LY(.�'7`fl �(y }��. % Y �GI �� G('f'� S . � � ! . `�"' ` � � � s Company Name: _ f75 /f} i� �} t,f i:� T�G_ j-J CorporaGon / Pmficrsbip / solc Propriams6ip Lf business is incorporated, give date of incorporation: Doing Business As: A-LF 1° �.� i 1Z Busiz�ess Addresc 3� i �f � • /Z9,+�:'?'L SlreetAddreu Bet�3 een what cross streets is the business located� Are ihe premises nou occupied /� VTha Mail To Address: ��_ �� /!� / . �-r Strcet Addresa Applicant Infoimation: Nazne and Tifle: �� tr!" -�T. CiTy /C7�� CITY OF SAII�TT PAUL os� orLS�, �r�oa� and Env'monmttrtal Protection 350 St Pna SC Sititc300 So-.^r•P+u7,Mbcicoa 35102 (611)26F� fu{6l2)=cF413S Staze Zip (�✓'fi�J ! C ( E'�i Fssat Yv&d , � dle � c (.Maidca) Iast Tit2e Home Address: �� L�T �.�-1 �' ) cS ) _ ��}j�� tJ � � /2 � Strsu Addresa CiTy Ststc Zip Date of Birth: � '"- Ls�,� Place of Birth: �'�� > Home Phone: �t� �`�d �� Have you ever been convict� of any felo�, crime or ��iolaTion of any cet�� ordinance other than traffia? YES NO ` Dafe of a¢st: i�Y�7X� WhereY Chazge: _ Con�icuon: Senteace: List the names and residences of three persoas of good maral character, living within the Twin Cities Metro Area, not related to ihe a or financially interesEed in the premises or business, who may be referred to as to the applicanYs character: NAME AI3DRESS �� _SI�I�' PHONE %%b''S � Hat�e.any of the above named licenses ever been revoked7 YES �_ NO If yes, list the dates and reasons for r 12/ City , Siete Zip ��e-�'Yl.� �'ti`�„_ �� y��t DG7�} tiVhicb side of the street9 <�� -. r�r' � TypeofBusiness�? .��1`O /�� / � 1"�}L�` � ��J °� � � / d S Lisi licenses which you cuirenUy hold, fozmerly held, or may have an inierest in: Are you going to operate this bnsiness personally? � YES � NO If not, u•ho will operate ifl waai� �� ,v;am) E� Date of Birch HomeAdd`ess: Shuctiemc City Stafe Tsp Phonel�5mm Are }'on going to ha��e amanager or assistant in this business? YES � NO If the manager is not the same ss tbe oper please complete the following information: � First?<ame (A3aidm) I,est Dati of Binb Home Addreas: SYttet tiame City Statc Zip Phonc;.'umber Please list your employment history for the przvious &ve (5) year period: BusinesslEmplormrnt ess S ;z �I�Z��nC'�� lc��J � ;v�><'.G y r'i ��-z.�°i C iiU� " " " /i L �/ l� SI .�f�UL ,,/l.� ti '�((� � 1L( �"2�+C_tl-I_ 1.�`1= I'{� tYi�/EL� ��r .�.oSt�'v� �ir ��f rt.� bt1G� �� t��s�r=�, tN�- I �9S Ur�itlE�s>��i+� ��v List all other officers af she corparation: OFFICER TITLE NAME (Office Held} HOME ADDRESS HOME BUSII�TESS DATE OF PHONE PHONE B1RTH If business is a parhiership, please inciude the foIIou information for each partrier (tue additional gages if neczssary): i Cil�/s X i� UC�- i�� Fixat tiamc Svfiddle I¢itiil (Maidcn) � Lsst �r �A��. � �c4 i� - % S�, Deu of Bir7h naa�: semm,e� c�ry s�.�e z;y t�ho� �.umx� Fast \ame :vliddle Initia! (!.3aidrn) Last Date of B�� fiomcAddress: Stmt?:ame City Stait .Zip PhoneN MINNESOTA TAX IDENTIFICATFON NiJMBER - Pursuant to the Laws of Minnesota,l9$4, Chapter 502, Article 8, Section 2(2 (fae Cie�ce; Issuance of Licenses}, licensing authorities are required To provide to the Stste of Minnesota Commissioner of Rec�Pn Minnesota business taY identificatioa nnmber and the sociat security number of esch license applicant Under the Minnesota Government I}ata Practices Act aad the Federat Privacy Act of 1474, we are required to edvise you of the f� regarding the use of the Minnesota Tax IdeniiScation Number: - This informa6on may be cued to deny the issvance or renewal of your license in the event you oH�e Minnesota sales, W�thholding or motor vehicle excise ta�ces; - I3pon receiving this information, the licensing autbority u�ill supply it onty to the Minnesota Department of Revenue. � under the Federat Exchange of Infrnmafion Agreement, the Department of Revenue may supply this information to +� Revrnue SenZCe. lvfinnesota Tax Identi5cation Numbeis (Sales & Use Tax Number) may l�e obtained from the State of 2�nnesota, Business Records � 1 Q Riaer Yark Plaza (612-296-6181). Soeial Securiry Number. /�/' 3 L �""�� / � Minnesota Tax Identification Numher: _ If a Minnesota Tax Identification Number is not required for the business being operated, indicate so b�• piacing an "� 12/' . . `T 7-a-o/ CERTIFICATIOAT OF F�'ORKERS' CO?dPENSATION COVERAGE PURSUANT TO 1vIINNNESOTA STANTE 176.182 T hereb}' certifi that I, or mti� company, am in complia�me uzth the workers' compensation insuance coaerage requirements of Minnesota Statute 176.? 82, subdivision 2. T aLo undecst�d that proiision of false infom'iaton in tlus ceitificatian consstutes sufficient grounds for adveise action against all licenses held, iacluding recocation and suspension of said licenses. �Tamz of Insuance Co:npanc: Polic}' Num�: Coverage from to T ha� e no e�aptot�ezs core: ed undzr n orl:ers campensation insurance �(II��ITIALS) Ai�Y FALS�ICATION OF AIV'SWERS GIVEN OR MATERIAL SUBh'lI1"I'E➢ WII,L RESULT IN DENfAL OI' TfIIS APPLICA'�IOft I hereby state that I ba��e ansu ered a11 of the preceding questions, and that the infom2ation contained herein is true and cosect to the best of my Imow�iedge and batie£ I hereby state fiuther that I have received no money or othet consideraGon, bp way of loan, gift, contribution, or otheruise, other than already disclosed in the applicafion uiuch I herew�ith submiifEd. I aiso understand this premise m�� be inspe�ted bg police, fire, health and other city offtcials at any aud atl times when ihe business is in operation. We eill accepi payment bp eash, check (made gacable to City of Saint Pau� or credit card (M1C or Visa). IFPAYINGBYCXEDITGSRDPLEASECQMPLETETHEFOLLON'INGA'FORMATION: �MasterCazd � Visa BKPIItATION DATE: � � � � ACCOUNTNUMB$R: � � � � � � � � � � � � � � � for aIt Dace '�'Note: If tlus applica6on is Food/Liquoz related, pfease contact a City of Saint Paul Aealth Inspector, Steve Olsos. `:r C6-9139), Yo r� plans. If any substanEial changes to structure are anticipafed, please contact a City of Saint Paut Plan Examiner si "'60-9007 to a7 building pamiu. If thc�e are aa}• changes to the pazkzng lot, floor space, ot for necv operations, please contact a CiTy• of Sast P�nrl 'oning L 266-9008. Ail applications mquire the toiloaing documenfs. Please aYtach tIiese documents when submftfing �•au� �pp13c� 1. A detailed description of tfie desigq location and square footage of the pzemises to be licensed (site plan}. The folloK�ing data should be on ihe site plan (prefera6ly on an$ 12" x 1 I" oz 8 I t2" x I4" papes): - Name, adc3ress, and phone number. - The scale should be sfated such as 1" = 26'. ^N should be indicated toward the top. - Placetnent of all pertinent features of the interior of tbe licensed facility sucL as seating areas, l�icbens, af��es parlang, rest rooms, etc. - If a request is for an additiou oz ex�pansion of the licensed faciliry, indicate both the current azea and the ��iopos 2. A copy of yow lease ageement or proof of ou�nership of the property. SPECI�IC LICENSE APPLIC�TTOiYS REQLTIItE ADDTTIONAL Il!'FORMATION. LEASE SEE REVERSE FOR DETAILS >>>> If appt� for, q`1-26 Cabaret adutt, please attach a�ritten proof that each emplo}•ee is at Ieast 18 yeacs old Con��ersarion/Rap partor adult, please attach u�itten proof that each employee is at least 18 years old £ntertsinment, please specify class A, B, or C ficense; obtain and attach signatures of approti�al from 40% of }�ouc neighbors u�7thin 3� feex of the e,�ablishment This licevse must be applied for in conjunction a�tt� a Liquor, Wine, Malt On Sate or RwtaUDance Hall licea,e. Fireatws, pleaze attach a lettet tviih the follorting infotmation: state if selling or oniy repaiiing, Federal Firearms License Number, ripe of Aimed Sen discharge (Honorable, Geberai, Bad Conduct, Undesirable, Dishonorable, or no milttary sen�ice• (N�TE: Establishment must be cammercially zoned.) _ Game room, please prrnide the followting infonnation: name of machine end list price. {NOTE: A Pool Hall licc�nse is required if there are any pool tables in ihe establishment) HealtkJSporta clu6 adult, piease attsch written proaf that each empioyce is at least 18 years old Liquor offion sale, refer to attaci�ed liquor application Lock opening ser+ices, please att�ch a list of all emplopces (aith hame address snd telephone number) K�o u�i13 be doing the lock opeaing sen2ce; attach S]0,000 Swety Bond. hfassage center, please attach a detail�d descripuon of the sen�ices being proc�ided. hSassage center aduit, p3ease attach kTitten groof that each employee is at least 18 years old. Massage praciitioner, please anach a cop5� of letterfar appmt�al from Health; proof of insurance coverage of SI,000,000 00 each gen� liabilii�� and professional liabitity kith che Ci1y� of Ssint Paul named as an addstianal insured, and a 30 day notice of cancellation; a le from your empioc�r to vetify empio}ment uith a license massage ce�ter. Motorc�ele dealer, piease include State of Minnesata 17eater Number. Iie+� motor vehiele dealer, please inciude State of Minnesota peater Number. Padrmg bthnmp Please inciuc� the mmmber ofPa�onB SPeces, and attach plans containing a general desc:iption of tte security � at the lothmnp, a site plan shoutin� driaecra}s of the ptoposed lat and the legal description of the property {ttus requirement neces if no site plan is cuirendp on file}. Attach a cover letter describing yaur plans to comply with the lighting and painting requir Pavra6mker, please attacfi $S,Od0.00 Surery Bond Second hand dealer-motor vehicie, p} �clude State of 2�nnesota Deatez Number. � Second hand deater-motor vehicle parts, please attach S5,000.00 Surery Band. Steam room/bat6 house adult, please att,ach written pra�f that each emp}oyee is at least 18 years old Theater adutt, please attach written proof that each employee is at least 18 years oid p��NOt�o - aIa�I9� 9 7 _ � Council File ¢` ` I � �� °� j�'. R�`_ p� 4 r` t L..= t A . �' . . � . . _, Presented By Referred To RESOLUTION CITY OF SAINT PAUL, MINNESOTA ordinance # Green Sheet # ✓��/ �� Committes: Date i RESOLVED: That application (ID #24311) for an Auto Repair Cmrage License by the Asian Auto z Tech DBA Asian Auto Tech (Xong Vang, President) at 874 Maryland Avenue East be 3 and the same is hereby approved with the following conditions: 1. Parking for customers and employees shall be arranged on the lot as shown on the site plan. No more than 18 vehicles shall be parked out doors on the lot. 2. The licensee is responsible for managing the number of customer vehicles to that which may be repaired and returned to their owners in the shortest period. Only customer vehicles and personal vehicles of the licensee may be parked on the lot. This condition is intended to prohibit long term storage of vehicles on the lot. 3. All vehicles parked outdoors on the lot must be completely assembled with no parts missing. Vehicle salvage is not permitted. 4. Vehicle parts, tires, oil or similar items may not be stored outdoors. 5. No repair of vehicles may occur on the exterior of the lot or in the public right-of-way. 6. The existing wood screen fence must be restored along the west and south property lines, by July l, 1997. An inspection of the property revealed the remnants of a wood fence at this location. Screen fencing to obscure the parking and business activity from the adjacent homes is a requirement of City Ordinance, Chapter 62.104(12). The licensee aRrees to extend the fence as far out toward the sidewalk 4 a5 will n�vio a e e i v s co e an raf��c rPnn�r� 5 Requested by Department of: 6 Yea Navs Absent 7 B a�Tce � $ Of£ice of License. Insgections aiid 9 Harris � 10 � ar � Environmental Protection 11 Re t� man 12 Thune _� � � 13 Bostrom /� 15 �+�..ir' � � Ej- 16 Adopted by Council: Date � � B Y 0 17 18 Adoption Certified by Council Secretary Form Approved by City Attorney 19 20 21 By: 22 � 1a.. " w�.� b gp; ��9...s�.et� � cc.l 23 Approved by Mayor: Date �/7 �- � 24 � 2 �� Approved by Mayor for Submission to 26 $y. � �y Council 27 By: 97-a,o� DEPARTMENTlOFFICFJCOUNCIL DATEINfrIATED GREEN SHEE N� 35391 LIEP/Licensin — - — CANTACT PEflSON 8 PHONE INRIAVOATE INRIAUDATE � DEPARiMENTDIRECTOR � CRYCAUNCIL Chxistine Rozek, 266-9108 "u��" OcmaTroaNev �cmc�aK MUST BE ON COUNCIL AGENDA BV (DATE) MUYBER FON ❑ BUDGET DIRECTOR � FIN. & MGT. SERVICES DIR. XOVfING r'OI hearin : Z. R� ORDER aMpypp(ORASSISTANn � TOTAL # OF SIGNATURE PA ES (CLIP ALL LOCATIONS FOR SIGNATUHE) ACTION HE�UESTED: Asian Auto Tech DBA Asian Auto Tech requests Council approval of its application for an Auto Repair Garage License located a[ 874 Marylarid Avenue East (ID 4k24311). PECOMMENDA710NS: Approve (A) or Hejed (P) pERSONAL SERVICE CONTHACTS MUST ANSWER TNE FOLLOWING QUESTIONS: _ PLANNING COMMISSION _ CIVIL SERVICE COMMISSION 1. Has ihis personlfirm eve� worked under a contrac[ for this departmBM? - _CIBCOMMfTTEE _ YES 'NO — �� F _ 2. Has ihis personffirm ever been a city employee? YES NO _ DISTRICi COUR7 _ 3. Does this person/Firm possess a skill not normally passessed by any curtent ciry employee? SUPPORTS WHICH COUNCIL O&IECTIVET YES NO Expla�� ell yes answers on separate shcet antl attech to green sheet INITIATING PROBLEM, ISSUE, OPPORTUNIN (Who, Whe[. When, WhBre. Why): ADVANTAfiESIFAPPROVED: DISADVANTAGES IFAPPROVED: � ','tr:�.;:9 �'='sei^,°��rq;CC ...°�Z?7 U, ' ' a. � ;-, �, 9iJW� ....,.a a7 0 • DISADVANTAGES IF NOTAPPROVED: � _„A TOTAL AMOUNT OF 7pANSACTION S COSTlREVENUE BUDGETED (CIHCLE ON� VES NO PUNDING SOUFiCE NC7IVITV NUMBER FINANCIAL INFORMATION: (EXPLAIN) CITY OF SAIN°T PAUL Norm Coleman, Mayo� 7anuary 6, 1997 OFFICE OF LICENSE, INSPECTIONS AND I/'�j� DI EN V IRONMENTAL YRO'1BCTTON RobertKeaaler, DireeYOr LICENSEAND Teiephone:612-266-9090 INSPFCTIQNS Facsimlk:612•266-9t24 330Sr. PeterStreet Suite 300 SairtlPauLMinrwsota SSf02 I agree to the foliowing conditions being placed on the Auto Repair Garage License at 874 MaryIand Avenue East as follows: 1. Parking for customers and employees sha11 be arranged on the iot as shown on the site plan. No more than 18 vehicles shail be parked out doors on the lot. 2. The licensee is responsi6le for managing the numDer of customer vehictes to that whie#� may be repaired and returned to therr owners in the shortest period. tJn1y austomer v€hietes and personal vehicies of the lieense� may' he parked oa the #ot. This eonditaon is intended to prohibit long term storage of vehicles'on the tot. 3. All vehicles parked outdoors on the lot must be con�pletely assembled wi:h no parts missing. Vehicle safvage is not permitted. 4. Vehicle parts, tires, oil or s'rmitar items may not be stored autdoors. S. No repair of vehicies may occur on the exterior of the lot or in the public right-of- way. 6, The existing wood screen fence must be resYOred along the west and south property tines, by Iuly l, I937, An inspection of the property revealed the remnants afa wood fence ai this tocation. Screen fencing to obscure the parking and business acYivity frorn the adjacent homes is a requirement of City Ordinance, Chapter 62.104(12). - Xiong Vang, President �l �'/� i - Date Greensheet # 35391 in Trackec'?_1�� .I.E.P, REVIEW CHECKLIST Date: 12/27/96 � 1WP'n F�ceived / ApP'n Procesced License ID # 24311 license Type: an Auto Revair Gara�e Company Name: Asian Auto Tech DBA: Asian Auto Tech Business Addresss: 874 Maryland Avenue East Business Phone: n/a Contact Name/Address: Xion� VanQ, 709 Rent St 1F1, 103 Home Phone: 487-b063 Date tq Council Research: l�� 2� �'�it�� `�� Pubtic Hearinq Date: �� Z- � � R� Labets Ordered: ��% Notiee Sent ta Appiicant: Districi Counci! #: —� Notice SeM to City Attorney Ward #: {,P Date Inspections Comments � Environmeniai Heaith Fire �'.7.`1�. �•�•�� ( �r ,K License ��2� �,� Police 1 �� Zoning r F/��' v ��2g��- � �.�. w �--a s�e wan Reo� I.ea� Recxiv CLASS III L�ENSE APPLICATION }( ✓ 1 � \ / � � t """ � �, � THIS APPLICATION IS StTBJECT TO REVIEW BY TF� PUBLIC PLEASE TYPE OR PRINI' IN II�TK Business Phone: ��t� �-`;lZ� � i� �) /� f�, � �-7 �} of License(s} being applied for: =41 � E � t-P' .LY(.�'7`fl �(y }��. % Y �GI �� G('f'� S . � � ! . `�"' ` � � � s Company Name: _ f75 /f} i� �} t,f i:� T�G_ j-J CorporaGon / Pmficrsbip / solc Propriams6ip Lf business is incorporated, give date of incorporation: Doing Business As: A-LF 1° �.� i 1Z Busiz�ess Addresc 3� i �f � • /Z9,+�:'?'L SlreetAddreu Bet�3 een what cross streets is the business located� Are ihe premises nou occupied /� VTha Mail To Address: ��_ �� /!� / . �-r Strcet Addresa Applicant Infoimation: Nazne and Tifle: �� tr!" -�T. CiTy /C7�� CITY OF SAII�TT PAUL os� orLS�, �r�oa� and Env'monmttrtal Protection 350 St Pna SC Sititc300 So-.^r•P+u7,Mbcicoa 35102 (611)26F� fu{6l2)=cF413S Staze Zip (�✓'fi�J ! C ( E'�i Fssat Yv&d , � dle � c (.Maidca) Iast Tit2e Home Address: �� L�T �.�-1 �' ) cS ) _ ��}j�� tJ � � /2 � Strsu Addresa CiTy Ststc Zip Date of Birth: � '"- Ls�,� Place of Birth: �'�� > Home Phone: �t� �`�d �� Have you ever been convict� of any felo�, crime or ��iolaTion of any cet�� ordinance other than traffia? YES NO ` Dafe of a¢st: i�Y�7X� WhereY Chazge: _ Con�icuon: Senteace: List the names and residences of three persoas of good maral character, living within the Twin Cities Metro Area, not related to ihe a or financially interesEed in the premises or business, who may be referred to as to the applicanYs character: NAME AI3DRESS �� _SI�I�' PHONE %%b''S � Hat�e.any of the above named licenses ever been revoked7 YES �_ NO If yes, list the dates and reasons for r 12/ City , Siete Zip ��e-�'Yl.� �'ti`�„_ �� y��t DG7�} tiVhicb side of the street9 <�� -. r�r' � TypeofBusiness�? .��1`O /�� / � 1"�}L�` � ��J °� � � / d S Lisi licenses which you cuirenUy hold, fozmerly held, or may have an inierest in: Are you going to operate this bnsiness personally? � YES � NO If not, u•ho will operate ifl waai� �� ,v;am) E� Date of Birch HomeAdd`ess: Shuctiemc City Stafe Tsp Phonel�5mm Are }'on going to ha��e amanager or assistant in this business? YES � NO If the manager is not the same ss tbe oper please complete the following information: � First?<ame (A3aidm) I,est Dati of Binb Home Addreas: SYttet tiame City Statc Zip Phonc;.'umber Please list your employment history for the przvious &ve (5) year period: BusinesslEmplormrnt ess S ;z �I�Z��nC'�� lc��J � ;v�><'.G y r'i ��-z.�°i C iiU� " " " /i L �/ l� SI .�f�UL ,,/l.� ti '�((� � 1L( �"2�+C_tl-I_ 1.�`1= I'{� tYi�/EL� ��r .�.oSt�'v� �ir ��f rt.� bt1G� �� t��s�r=�, tN�- I �9S Ur�itlE�s>��i+� ��v List all other officers af she corparation: OFFICER TITLE NAME (Office Held} HOME ADDRESS HOME BUSII�TESS DATE OF PHONE PHONE B1RTH If business is a parhiership, please inciude the foIIou information for each partrier (tue additional gages if neczssary): i Cil�/s X i� UC�- i�� Fixat tiamc Svfiddle I¢itiil (Maidcn) � Lsst �r �A��. � �c4 i� - % S�, Deu of Bir7h naa�: semm,e� c�ry s�.�e z;y t�ho� �.umx� Fast \ame :vliddle Initia! (!.3aidrn) Last Date of B�� fiomcAddress: Stmt?:ame City Stait .Zip PhoneN MINNESOTA TAX IDENTIFICATFON NiJMBER - Pursuant to the Laws of Minnesota,l9$4, Chapter 502, Article 8, Section 2(2 (fae Cie�ce; Issuance of Licenses}, licensing authorities are required To provide to the Stste of Minnesota Commissioner of Rec�Pn Minnesota business taY identificatioa nnmber and the sociat security number of esch license applicant Under the Minnesota Government I}ata Practices Act aad the Federat Privacy Act of 1474, we are required to edvise you of the f� regarding the use of the Minnesota Tax IdeniiScation Number: - This informa6on may be cued to deny the issvance or renewal of your license in the event you oH�e Minnesota sales, W�thholding or motor vehicle excise ta�ces; - I3pon receiving this information, the licensing autbority u�ill supply it onty to the Minnesota Department of Revenue. � under the Federat Exchange of Infrnmafion Agreement, the Department of Revenue may supply this information to +� Revrnue SenZCe. lvfinnesota Tax Identi5cation Numbeis (Sales & Use Tax Number) may l�e obtained from the State of 2�nnesota, Business Records � 1 Q Riaer Yark Plaza (612-296-6181). Soeial Securiry Number. /�/' 3 L �""�� / � Minnesota Tax Identification Numher: _ If a Minnesota Tax Identification Number is not required for the business being operated, indicate so b�• piacing an "� 12/' . . `T 7-a-o/ CERTIFICATIOAT OF F�'ORKERS' CO?dPENSATION COVERAGE PURSUANT TO 1vIINNNESOTA STANTE 176.182 T hereb}' certifi that I, or mti� company, am in complia�me uzth the workers' compensation insuance coaerage requirements of Minnesota Statute 176.? 82, subdivision 2. T aLo undecst�d that proiision of false infom'iaton in tlus ceitificatian consstutes sufficient grounds for adveise action against all licenses held, iacluding recocation and suspension of said licenses. �Tamz of Insuance Co:npanc: Polic}' Num�: Coverage from to T ha� e no e�aptot�ezs core: ed undzr n orl:ers campensation insurance �(II��ITIALS) Ai�Y FALS�ICATION OF AIV'SWERS GIVEN OR MATERIAL SUBh'lI1"I'E➢ WII,L RESULT IN DENfAL OI' TfIIS APPLICA'�IOft I hereby state that I ba��e ansu ered a11 of the preceding questions, and that the infom2ation contained herein is true and cosect to the best of my Imow�iedge and batie£ I hereby state fiuther that I have received no money or othet consideraGon, bp way of loan, gift, contribution, or otheruise, other than already disclosed in the applicafion uiuch I herew�ith submiifEd. I aiso understand this premise m�� be inspe�ted bg police, fire, health and other city offtcials at any aud atl times when ihe business is in operation. We eill accepi payment bp eash, check (made gacable to City of Saint Pau� or credit card (M1C or Visa). IFPAYINGBYCXEDITGSRDPLEASECQMPLETETHEFOLLON'INGA'FORMATION: �MasterCazd � Visa BKPIItATION DATE: � � � � ACCOUNTNUMB$R: � � � � � � � � � � � � � � � for aIt Dace '�'Note: If tlus applica6on is Food/Liquoz related, pfease contact a City of Saint Paul Aealth Inspector, Steve Olsos. `:r C6-9139), Yo r� plans. If any substanEial changes to structure are anticipafed, please contact a City of Saint Paut Plan Examiner si "'60-9007 to a7 building pamiu. If thc�e are aa}• changes to the pazkzng lot, floor space, ot for necv operations, please contact a CiTy• of Sast P�nrl 'oning L 266-9008. Ail applications mquire the toiloaing documenfs. Please aYtach tIiese documents when submftfing �•au� �pp13c� 1. A detailed description of tfie desigq location and square footage of the pzemises to be licensed (site plan}. The folloK�ing data should be on ihe site plan (prefera6ly on an$ 12" x 1 I" oz 8 I t2" x I4" papes): - Name, adc3ress, and phone number. - The scale should be sfated such as 1" = 26'. ^N should be indicated toward the top. - Placetnent of all pertinent features of the interior of tbe licensed facility sucL as seating areas, l�icbens, af��es parlang, rest rooms, etc. - If a request is for an additiou oz ex�pansion of the licensed faciliry, indicate both the current azea and the ��iopos 2. A copy of yow lease ageement or proof of ou�nership of the property. SPECI�IC LICENSE APPLIC�TTOiYS REQLTIItE ADDTTIONAL Il!'FORMATION. LEASE SEE REVERSE FOR DETAILS >>>> If appt� for, q`1-26 Cabaret adutt, please attach a�ritten proof that each emplo}•ee is at Ieast 18 yeacs old Con��ersarion/Rap partor adult, please attach u�itten proof that each employee is at least 18 years old £ntertsinment, please specify class A, B, or C ficense; obtain and attach signatures of approti�al from 40% of }�ouc neighbors u�7thin 3� feex of the e,�ablishment This licevse must be applied for in conjunction a�tt� a Liquor, Wine, Malt On Sate or RwtaUDance Hall licea,e. Fireatws, pleaze attach a lettet tviih the follorting infotmation: state if selling or oniy repaiiing, Federal Firearms License Number, ripe of Aimed Sen discharge (Honorable, Geberai, Bad Conduct, Undesirable, Dishonorable, or no milttary sen�ice• (N�TE: Establishment must be cammercially zoned.) _ Game room, please prrnide the followting infonnation: name of machine end list price. {NOTE: A Pool Hall licc�nse is required if there are any pool tables in ihe establishment) HealtkJSporta clu6 adult, piease attsch written proaf that each empioyce is at least 18 years old Liquor offion sale, refer to attaci�ed liquor application Lock opening ser+ices, please att�ch a list of all emplopces (aith hame address snd telephone number) K�o u�i13 be doing the lock opeaing sen2ce; attach S]0,000 Swety Bond. hfassage center, please attach a detail�d descripuon of the sen�ices being proc�ided. hSassage center aduit, p3ease attach kTitten groof that each employee is at least 18 years old. Massage praciitioner, please anach a cop5� of letterfar appmt�al from Health; proof of insurance coverage of SI,000,000 00 each gen� liabilii�� and professional liabitity kith che Ci1y� of Ssint Paul named as an addstianal insured, and a 30 day notice of cancellation; a le from your empioc�r to vetify empio}ment uith a license massage ce�ter. Motorc�ele dealer, piease include State of Minnesata 17eater Number. Iie+� motor vehiele dealer, please inciude State of Minnesota peater Number. Padrmg bthnmp Please inciuc� the mmmber ofPa�onB SPeces, and attach plans containing a general desc:iption of tte security � at the lothmnp, a site plan shoutin� driaecra}s of the ptoposed lat and the legal description of the property {ttus requirement neces if no site plan is cuirendp on file}. Attach a cover letter describing yaur plans to comply with the lighting and painting requir Pavra6mker, please attacfi $S,Od0.00 Surery Bond Second hand dealer-motor vehicie, p} �clude State of 2�nnesota Deatez Number. � Second hand deater-motor vehicle parts, please attach S5,000.00 Surery Band. Steam room/bat6 house adult, please att,ach written pra�f that each emp}oyee is at least 18 years old Theater adutt, please attach written proof that each employee is at least 18 years oid