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97-434Council File #` ' �j�` i �'E �:� � i �` � � , ti . . .�, < i +; < Presented Sy Referred To Ordinance # � Green Sheet # �-� � RESOLUTION CIN OF SAINT PAUL, MtNNESOTA � Committee: Date i RESOLVED: That application (ID #78902) for a Gas Station, Restaurant-A, Grocery-C, and Cigarette 2 License by Eastem Heights Amoco Inc. DBA Eastern Heights Amoco (Michael Fuhr, 3 President) at 1785 Suburban Avenue be and the same is hereby approved. 4 5 Requested by Department o£: 6 Yeas Nays Absent $ BZa � r Mor1-r Office of License Inspectiona and 9 Harrss � 10 Me�ard � Environmental Protection 11 �.:.�L�lliwc ✓'`� 12 Thune ✓"-� 13 sostrom —�� 14 �� Q �s �,�:.J, 2.� \%9� BY' ��.�`-e: }�-l�ti[/ 16 Adopted by Council: Date 17 ' 18 Adoption Certified by Council Secretary 19 Form Approved by City Attorney 20 t � l 21 BY: G--, � . T'� ��-ra--�..-__ BY: � tliJitGll �Cf � h �t 22 / / 23 Approved by Mayor: Date Y( t a✓� `� y 24 `i /l�� r` T _ ZS Approved by Mayor for Submission to Z6 By: Council 27 Byc G'�_..1._t� �l DEPARTMENT/OFFICFJCOUNCII DATE MRIATED GREEN SHEE N° 3� 3�`� � LIEP/Licensin -- - CONTACTPEFSON & PHONE INITIAVDATE INITiAUDATE ODEPARTMENT�IRECTOR OCffYCAUNCIL Christine Rozek 266-910$ "�'�" Q�T�''�TTOar�v �cma.erm HuuaEa wa MUST BE ON CqUNdL AGENDA BY (DATE� RQ�� BUDGEY DIREGTOfl O FlN. & MGT. SERVICES Dlfl. r' OL hearin : �,3 � ORDER Q MAYOR (OA ASSISTANn Q TOTAL # OF SIGNATURE PAGES (CLIP AI:L IOCATIONS FOR SIGNATURE) ACfiON RE4UESTED: Eastern Heights Amoco Inc. DBA Eastern Heights Amoco requests Council approval of its application for a Gas Station, Restaurant-A, Grocery-C, and Cigarette License located at 1785 Suburban Avenue (ID I�78902). RECOMMENDa710NS: D.ppfove (A) w Reject (R) PERSONAL SERVICE CONTRACTS MUST ANSWEH THE FOLLOWING �UESTIONS: _ PLANNIMG COMMISSIOTI _ CiVIL SERVICE COMMi5310h �� S D�'��'� �r warked under a r,�ntract for this depardnant? � _ CIB COMMI7TEE _ YES IJO _ STAFF _ Z. Has this person�rm ever been a ciry employee? YES NO _ DtS7RiCi cAURi _ 3. Does this persoMfirm possess a skill not normaity possessetl by any current ciry employee? SUPPOFTS WHIGH COUNpL OBJECTIVEI YES NO Explain elt yes enswers on seperete aheet and et[peh to green shcet INRIATING PROBLEM, ISSUE, OPPORTUNRV (Who, What. When, Where, Why): �� dAN Q7 �997 � CtTY ATT � A�VANTAGES IF APPROYED: DiSADYANTAGES IF APPROVED' pR � sv, g ,nd �3'.D'�i � b..e.s'�'��. �. ve..a . .. � . � �kittFi � ,f, I�$ _,..�._.__„.-_____.w�, s� DI5ADVANTAGES IF NOT APPRWED: TOTAL AMOUNT OF iRANSACiION $ COST/REVENUE BUDGETED (CIRCLE ONE) YES NO PUNDING SOURCH ACTIVITY NUMBER FINANCIAL INFOflMATION: (EXPLAIN) \ / ' Greensheet # 35393 L.I.E.P. REVIEW CHECKLIST Date: 12/31/96 / (n Tracket'? App'n Receivea / Apph arocessed �� LicenselD # 789Q2 license Type: Gas Station, Res �rant-A, Grocerv-C, Ci�arette Company Name: Eastern Heiehts Amoco Inc. DBA: Eastern Heights Amoco BusinesS Addresss: 1785 Suburban Avenue, 55109 Business Phone: 735-4282 Contact Name/Address: Michael Fuhr 1899 17th St NW Home Phone: 633-7904 ew Brig ton, 5 112 ��c�o��3�b�i/ z, Date to Council Research: �� Public Hearing Date:_ ' Z� ' �-' Labels Ordered: '��B�g 7 Notice Sent to Applicant: .J � District Council #: J n _� � � Jf�fPt, 'f%t /'� Notice Sent to Public: �/°' �/�/ �� Ward #: 1 DepartmentJ Date lnspeciions Comments City Attorney 3 •�i •9� Z�.� . Environmental Heaith �,Z'�'•Q1� f�.k . Fire 3-z�� • License S�te Plan Received: �o ae��red: — ��1�� o`L Police 3•tt• � �.�. Zoning 3 -2��' � �• � • ._---- SNINT PAUI � A118A CLASS III LICENSE APPLICATION T�IIS APPLICATTON IS SUBJECT TO REVIEW BY THE PUBLIC PLEASE TYPE OR PRINT IN INK Type Company Name: If business is incorpozated, give date of incorporation: Doing Business As: ��i 5�I✓ t. �� S� Business Address ( 7�S _ _ �� 1 ?'!! _ Svcct Add+e+e Between what cross streets is the business located7 �! �� Are the premises noH� occu �_ What T}Pe of Business? _ Mai] To Address: l 7 � C i ,�v �? ✓ y�^� ��f s� naa� Applicant Inf'ortna6o �. /j J Name and Tifle: _ _! _' 1 � � °i 9 � Fvrt �ca�u� City �' �/ 1 y< < R U �,�-) c�Ty � �� c� `�,3� CITY OF SAINT PAUL �U of S.iCeilSe. tSISpKiiOnS eC ana &n;ronmrnw r.otec7;on 350 St Pda St Stik 300 Samt Paul, Mm��h 53102 (61�166^0?0 fz�C612)16S9Std r i `�� j r',y �" y �""'� Susiness Phone: Stncc Zip Which side of the street2 S� f� .�s1 s,�w zsp c� � �' �ir'S � � �- -p � Tm� Home Address: / a 1/ � 1 T �� / 7�n/ ifj�✓�� t��• �'1 h �'S�`�- . / Sireet Addrea� Ciry State Zip Date of Bvth: t �� Place of Birth: ,�� • � `' / Home Phone: �� Have you ever been convicted of any felony, crime or violation of any city ordinance other than traffic? YES NO Date of azrest: Where7 Chazge: Con��iction: Sentence: List the names end residences of three persons of good moral character, living a�thin the Twin Cities Metro Area, not related to the applicant or financially interested in ihe premises or business, who may be referred to as to the applicants character p NAME ADDRESS j PH�NE > �T��tv l �,_ ._ t �DO��w.. Inn�_ �.�� 7 � Hace any otthe above named licenses eva 6cen NU li yes, ltst the aates ana reasons ior revocanon: 1211819b r F �^ � - Are you going to operate this business personally? ,1� YES NO If not, afio wili operate it? �, � "; �`�, ° m Fitsl \emt Middie Iniliel (tifeidrn) Last D� of Bviki HomcAddsear. SVwt\ame Citp State Zip Pfionclhumbcr Are gou going to have a manager or assistant in this busines? � YES NO If the manager is not the sazne xs the operator, please complete the following infoimation: �— YYI�> k � f �— 1- �— $`- ,�- 6� �� x��naa,�,,: s,�:a� Please list your emplayment hisiory for the previous five (5) year period: J List all other o�cers of ihe corporation: OFfSCER TITLE HOME NAAhE � (Office Held) ADDRESS �'�1, r �q�/�� i�r:-S ll'g� �7rh /h�.,k �.�b l! J��r �.( 1�,�.� If busines is a partnership, please include the follouing information for each partner (use additional pages if necessary): Nsadt� t�c[�t (Matdrn) � •s y�� s�k ��- �, S� , S� HOME BUSINESS PHOhB PHONE -o S DATE OF BII2TH /G � Lsrt DateolBirth Slate Zip Pho�w N�unbe Last Datc of Birth Home Addrcse: Strce[ l�amc Firrt i�eme Middl< (:�faiden) Home Addrese: Strect Namc Gty Stete Zip P6one Number MII�INESOTA TAX IDENTIFICATION NtTMB£R - Pursuant to Ihe Laws of Minaesota, 1984, Chapter 502, Article 8, Section 2 (270J2) (Tax CSearance; Issusnce of Licenses), licensing authorities aze required to pro��ide to the State of Minnesota Commissioner of Revenue, the Minnesota business tax iden�cation n�unber and the socizl securiry number of each license applicant. Under the Muu�esota Gouernment Data Practices Act and the Federal Privacy Act of 1974, we aze required to advise you of tl�e folloa�ing regarding the use of the Mi�mesota Ta�t Identificalion Number: - This information may be used to deny the issuance or renewal ofyour license in the e��ent you owe Minnesota sales, employers withholding or motor vehicle e�tcise taxes; - Upon receiving this information, the licensing authority will supply it only to the Minnesota Deparhuent of Revenue. However, under the Pederal Exchange of Information Agreement, the Deparhnent of Revenue may supply tlus information to the Intemal Revenue Service. Minnesota Tax 1de�ti5cation Numbe� (Sales & L3se T�t Number) may be obtained from the State of Minnesota, Business Records Department, 10 River Park Plaza (612-296-6 ] S I). � � �� v Social Security Num6er: Mumesota Tax Idrn�cation Number: ,� < _ If a Minnewta Tax ]dent�cation Number is not required for the business being operated, indicate so by placing an "X" in the bor. �,� r�� h'!ti �SIU 72/18J96 .r �_ � ,� ..ERTTFICATION OF tt'ORKERS' COMPENSATION COVERAGE PURSUANT TO MINNESOTA SI ATUl 176.182 � I hereb}' a�rtify that I, or my rampany, azn in compliance «ith the «orkers' compensation insurance coverage requirements of Minnesotz Statute 176.182, subdi� 2. I also understand that provision of false infmmation in this cert�cation constitutes sufficient grounds for ad�•erse action against alS licenses held, inc3nding revocation and suspension of said ]icenses. Iv'ame of Insurance C f'Y')f`�J r`t ti �aG+nOt �. s`�27� �n.. g PolicyNumber: /-} C — WCC70�J 7U� ' � Coveragefrom�=to �� r / � I have no emplo} corered under v.rorkers' compensation insurance (INITIALS) ANY FAISIFICATION OF AI�SWEI2S GIVEN OR MATERIAL SUBMTTTED WII,L RESULT IN D£N7AL OF TIIIS APPLICATION I hereby state that I ha��e answered all of the preceding questions, and that the infoTmation contained herein is tcue and conect to the best of my kno�•ledge and belief. I hereby state fiuther that I have received no money or other considecation, by w•ay of loan, gift, contribution, or otheiwise, other than already disclosed in the application which I berewith submitted I also understand this premise may be inspected by police, fue, health and other city officizis at a�� and alI times when the business is ia operation. /�-.�1 � (� (REQUIRED for all applications) Date We eill accept pa}�ment b}' cash, check (made pa�•able to City of Saint Pau� or credit card (M/C or Visa). IFP � MasterCazd O Visa EXPIRA7ION DATE: � � � � ot L�KK�I�L�rWul_2�.:� � � � � � � � � � � � � � � � � ""Note: ff Uus application is Food/Liquor related, please contact a Ciry of Saint Paui Health Inspector, Steve Olson (266-9139), to re��ew plans. If any substantial changes to structure ue anticipated, please contact a City of Saint Pau1 Plan Examiner at 266-9Q�7 to apply for building penniu. If there are auy changes to the parking lot, floor space, or for new operations, p3ease contsct a City of Saini Paul Zoning Inspector at 266-9008. AU applications require the following documents. Please a#ach these documents R•hen submitting Soar application: 1. A detailed description of the design, location and square footage of tl�e premises to be licensed (site pian), T6e follov.zng data should be on the site plan (preferably on an 8 I f2" x I I" or S 1/2" x I4" paper}: - Name, address, and phone nutnber. - The scale should be stated such as 1" = 20'. ^N sbould be indicated toward the top. - Placement of all pertinent features of the interior of tl�e licen.sed facility such as seating areas, kitchens, offices, repair area, parking, rese rooms, etc. - If a reques[ is for an addifion or erpansion of the licenseci facility, indicate both the ciurent area and the proposed erpansion. 2. A copy ofyour ]ease agreemrnt or proof of owmership of the property. SPECIFIC LICENSE APPLICATIONS REQUIRE AIIDTTIONAL INFOIiMATIOY. PLEASE SEE REVERSE FOR DETAII.S >>>> ]2JI8196 Council File #` ' �j�` i �'E �:� � i �` � � , ti . . .�, < i +; < Presented Sy Referred To Ordinance # � Green Sheet # �-� � RESOLUTION CIN OF SAINT PAUL, MtNNESOTA � Committee: Date i RESOLVED: That application (ID #78902) for a Gas Station, Restaurant-A, Grocery-C, and Cigarette 2 License by Eastem Heights Amoco Inc. DBA Eastern Heights Amoco (Michael Fuhr, 3 President) at 1785 Suburban Avenue be and the same is hereby approved. 4 5 Requested by Department o£: 6 Yeas Nays Absent $ BZa � r Mor1-r Office of License Inspectiona and 9 Harrss � 10 Me�ard � Environmental Protection 11 �.:.�L�lliwc ✓'`� 12 Thune ✓"-� 13 sostrom —�� 14 �� Q �s �,�:.J, 2.� \%9� BY' ��.�`-e: }�-l�ti[/ 16 Adopted by Council: Date 17 ' 18 Adoption Certified by Council Secretary 19 Form Approved by City Attorney 20 t � l 21 BY: G--, � . T'� ��-ra--�..-__ BY: � tliJitGll �Cf � h �t 22 / / 23 Approved by Mayor: Date Y( t a✓� `� y 24 `i /l�� r` T _ ZS Approved by Mayor for Submission to Z6 By: Council 27 Byc G'�_..1._t� �l DEPARTMENT/OFFICFJCOUNCII DATE MRIATED GREEN SHEE N° 3� 3�`� � LIEP/Licensin -- - CONTACTPEFSON & PHONE INITIAVDATE INITiAUDATE ODEPARTMENT�IRECTOR OCffYCAUNCIL Christine Rozek 266-910$ "�'�" Q�T�''�TTOar�v �cma.erm HuuaEa wa MUST BE ON CqUNdL AGENDA BY (DATE� RQ�� BUDGEY DIREGTOfl O FlN. & MGT. SERVICES Dlfl. r' OL hearin : �,3 � ORDER Q MAYOR (OA ASSISTANn Q TOTAL # OF SIGNATURE PAGES (CLIP AI:L IOCATIONS FOR SIGNATURE) ACfiON RE4UESTED: Eastern Heights Amoco Inc. DBA Eastern Heights Amoco requests Council approval of its application for a Gas Station, Restaurant-A, Grocery-C, and Cigarette License located at 1785 Suburban Avenue (ID I�78902). RECOMMENDa710NS: D.ppfove (A) w Reject (R) PERSONAL SERVICE CONTRACTS MUST ANSWEH THE FOLLOWING �UESTIONS: _ PLANNIMG COMMISSIOTI _ CiVIL SERVICE COMMi5310h �� S D�'��'� �r warked under a r,�ntract for this depardnant? � _ CIB COMMI7TEE _ YES IJO _ STAFF _ Z. Has this person�rm ever been a ciry employee? YES NO _ DtS7RiCi cAURi _ 3. Does this persoMfirm possess a skill not normaity possessetl by any current ciry employee? SUPPOFTS WHIGH COUNpL OBJECTIVEI YES NO Explain elt yes enswers on seperete aheet and et[peh to green shcet INRIATING PROBLEM, ISSUE, OPPORTUNRV (Who, What. When, Where, Why): �� dAN Q7 �997 � CtTY ATT � A�VANTAGES IF APPROYED: DiSADYANTAGES IF APPROVED' pR � sv, g ,nd �3'.D'�i � b..e.s'�'��. �. ve..a . .. � . � �kittFi � ,f, I�$ _,..�._.__„.-_____.w�, s� DI5ADVANTAGES IF NOT APPRWED: TOTAL AMOUNT OF iRANSACiION $ COST/REVENUE BUDGETED (CIRCLE ONE) YES NO PUNDING SOURCH ACTIVITY NUMBER FINANCIAL INFOflMATION: (EXPLAIN) \ / ' Greensheet # 35393 L.I.E.P. REVIEW CHECKLIST Date: 12/31/96 / (n Tracket'? App'n Receivea / Apph arocessed �� LicenselD # 789Q2 license Type: Gas Station, Res �rant-A, Grocerv-C, Ci�arette Company Name: Eastern Heiehts Amoco Inc. DBA: Eastern Heights Amoco BusinesS Addresss: 1785 Suburban Avenue, 55109 Business Phone: 735-4282 Contact Name/Address: Michael Fuhr 1899 17th St NW Home Phone: 633-7904 ew Brig ton, 5 112 ��c�o��3�b�i/ z, Date to Council Research: �� Public Hearing Date:_ ' Z� ' �-' Labels Ordered: '��B�g 7 Notice Sent to Applicant: .J � District Council #: J n _� � � Jf�fPt, 'f%t /'� Notice Sent to Public: �/°' �/�/ �� Ward #: 1 DepartmentJ Date lnspeciions Comments City Attorney 3 •�i •9� Z�.� . Environmental Heaith �,Z'�'•Q1� f�.k . Fire 3-z�� • License S�te Plan Received: �o ae��red: — ��1�� o`L Police 3•tt• � �.�. Zoning 3 -2��' � �• � • ._---- SNINT PAUI � A118A CLASS III LICENSE APPLICATION T�IIS APPLICATTON IS SUBJECT TO REVIEW BY THE PUBLIC PLEASE TYPE OR PRINT IN INK Type Company Name: If business is incorpozated, give date of incorporation: Doing Business As: ��i 5�I✓ t. �� S� Business Address ( 7�S _ _ �� 1 ?'!! _ Svcct Add+e+e Between what cross streets is the business located7 �! �� Are the premises noH� occu �_ What T}Pe of Business? _ Mai] To Address: l 7 � C i ,�v �? ✓ y�^� ��f s� naa� Applicant Inf'ortna6o �. /j J Name and Tifle: _ _! _' 1 � � °i 9 � Fvrt �ca�u� City �' �/ 1 y< < R U �,�-) c�Ty � �� c� `�,3� CITY OF SAINT PAUL �U of S.iCeilSe. tSISpKiiOnS eC ana &n;ronmrnw r.otec7;on 350 St Pda St Stik 300 Samt Paul, Mm��h 53102 (61�166^0?0 fz�C612)16S9Std r i `�� j r',y �" y �""'� Susiness Phone: Stncc Zip Which side of the street2 S� f� .�s1 s,�w zsp c� � �' �ir'S � � �- -p � Tm� Home Address: / a 1/ � 1 T �� / 7�n/ ifj�✓�� t��• �'1 h �'S�`�- . / Sireet Addrea� Ciry State Zip Date of Bvth: t �� Place of Birth: ,�� • � `' / Home Phone: �� Have you ever been convicted of any felony, crime or violation of any city ordinance other than traffic? YES NO Date of azrest: Where7 Chazge: Con��iction: Sentence: List the names end residences of three persons of good moral character, living a�thin the Twin Cities Metro Area, not related to the applicant or financially interested in ihe premises or business, who may be referred to as to the applicants character p NAME ADDRESS j PH�NE > �T��tv l �,_ ._ t �DO��w.. Inn�_ �.�� 7 � Hace any otthe above named licenses eva 6cen NU li yes, ltst the aates ana reasons ior revocanon: 1211819b r F �^ � - Are you going to operate this business personally? ,1� YES NO If not, afio wili operate it? �, � "; �`�, ° m Fitsl \emt Middie Iniliel (tifeidrn) Last D� of Bviki HomcAddsear. SVwt\ame Citp State Zip Pfionclhumbcr Are gou going to have a manager or assistant in this busines? � YES NO If the manager is not the sazne xs the operator, please complete the following infoimation: �— YYI�> k � f �— 1- �— $`- ,�- 6� �� x��naa,�,,: s,�:a� Please list your emplayment hisiory for the previous five (5) year period: J List all other o�cers of ihe corporation: OFfSCER TITLE HOME NAAhE � (Office Held) ADDRESS �'�1, r �q�/�� i�r:-S ll'g� �7rh /h�.,k �.�b l! J��r �.( 1�,�.� If busines is a partnership, please include the follouing information for each partner (use additional pages if necessary): Nsadt� t�c[�t (Matdrn) � •s y�� s�k ��- �, S� , S� HOME BUSINESS PHOhB PHONE -o S DATE OF BII2TH /G � Lsrt DateolBirth Slate Zip Pho�w N�unbe Last Datc of Birth Home Addrcse: Strce[ l�amc Firrt i�eme Middl< (:�faiden) Home Addrese: Strect Namc Gty Stete Zip P6one Number MII�INESOTA TAX IDENTIFICATION NtTMB£R - Pursuant to Ihe Laws of Minaesota, 1984, Chapter 502, Article 8, Section 2 (270J2) (Tax CSearance; Issusnce of Licenses), licensing authorities aze required to pro��ide to the State of Minnesota Commissioner of Revenue, the Minnesota business tax iden�cation n�unber and the socizl securiry number of each license applicant. Under the Muu�esota Gouernment Data Practices Act and the Federal Privacy Act of 1974, we aze required to advise you of tl�e folloa�ing regarding the use of the Mi�mesota Ta�t Identificalion Number: - This information may be used to deny the issuance or renewal ofyour license in the e��ent you owe Minnesota sales, employers withholding or motor vehicle e�tcise taxes; - Upon receiving this information, the licensing authority will supply it only to the Minnesota Deparhuent of Revenue. However, under the Pederal Exchange of Information Agreement, the Deparhnent of Revenue may supply tlus information to the Intemal Revenue Service. Minnesota Tax 1de�ti5cation Numbe� (Sales & L3se T�t Number) may be obtained from the State of Minnesota, Business Records Department, 10 River Park Plaza (612-296-6 ] S I). � � �� v Social Security Num6er: Mumesota Tax Idrn�cation Number: ,� < _ If a Minnewta Tax ]dent�cation Number is not required for the business being operated, indicate so by placing an "X" in the bor. �,� r�� h'!ti �SIU 72/18J96 .r �_ � ,� ..ERTTFICATION OF tt'ORKERS' COMPENSATION COVERAGE PURSUANT TO MINNESOTA SI ATUl 176.182 � I hereb}' a�rtify that I, or my rampany, azn in compliance «ith the «orkers' compensation insurance coverage requirements of Minnesotz Statute 176.182, subdi� 2. I also understand that provision of false infmmation in this cert�cation constitutes sufficient grounds for ad�•erse action against alS licenses held, inc3nding revocation and suspension of said ]icenses. Iv'ame of Insurance C f'Y')f`�J r`t ti �aG+nOt �. s`�27� �n.. g PolicyNumber: /-} C — WCC70�J 7U� ' � Coveragefrom�=to �� r / � I have no emplo} corered under v.rorkers' compensation insurance (INITIALS) ANY FAISIFICATION OF AI�SWEI2S GIVEN OR MATERIAL SUBMTTTED WII,L RESULT IN D£N7AL OF TIIIS APPLICATION I hereby state that I ha��e answered all of the preceding questions, and that the infoTmation contained herein is tcue and conect to the best of my kno�•ledge and belief. I hereby state fiuther that I have received no money or other considecation, by w•ay of loan, gift, contribution, or otheiwise, other than already disclosed in the application which I berewith submitted I also understand this premise may be inspected by police, fue, health and other city officizis at a�� and alI times when the business is ia operation. /�-.�1 � (� (REQUIRED for all applications) Date We eill accept pa}�ment b}' cash, check (made pa�•able to City of Saint Pau� or credit card (M/C or Visa). IFP � MasterCazd O Visa EXPIRA7ION DATE: � � � � ot L�KK�I�L�rWul_2�.:� � � � � � � � � � � � � � � � � ""Note: ff Uus application is Food/Liquor related, please contact a Ciry of Saint Paui Health Inspector, Steve Olson (266-9139), to re��ew plans. If any substantial changes to structure ue anticipated, please contact a City of Saint Pau1 Plan Examiner at 266-9Q�7 to apply for building penniu. If there are auy changes to the parking lot, floor space, or for new operations, p3ease contsct a City of Saini Paul Zoning Inspector at 266-9008. AU applications require the following documents. Please a#ach these documents R•hen submitting Soar application: 1. A detailed description of the design, location and square footage of tl�e premises to be licensed (site pian), T6e follov.zng data should be on the site plan (preferably on an 8 I f2" x I I" or S 1/2" x I4" paper}: - Name, address, and phone nutnber. - The scale should be stated such as 1" = 20'. ^N sbould be indicated toward the top. - Placement of all pertinent features of the interior of tl�e licen.sed facility such as seating areas, kitchens, offices, repair area, parking, rese rooms, etc. - If a reques[ is for an addifion or erpansion of the licenseci facility, indicate both the ciurent area and the proposed erpansion. 2. A copy ofyour ]ease agreemrnt or proof of owmership of the property. SPECIFIC LICENSE APPLICATIONS REQUIRE AIIDTTIONAL INFOIiMATIOY. PLEASE SEE REVERSE FOR DETAII.S >>>> ]2JI8196 Council File #` ' �j�` i �'E �:� � i �` � � , ti . . .�, < i +; < Presented Sy Referred To Ordinance # � Green Sheet # �-� � RESOLUTION CIN OF SAINT PAUL, MtNNESOTA � Committee: Date i RESOLVED: That application (ID #78902) for a Gas Station, Restaurant-A, Grocery-C, and Cigarette 2 License by Eastem Heights Amoco Inc. DBA Eastern Heights Amoco (Michael Fuhr, 3 President) at 1785 Suburban Avenue be and the same is hereby approved. 4 5 Requested by Department o£: 6 Yeas Nays Absent $ BZa � r Mor1-r Office of License Inspectiona and 9 Harrss � 10 Me�ard � Environmental Protection 11 �.:.�L�lliwc ✓'`� 12 Thune ✓"-� 13 sostrom —�� 14 �� Q �s �,�:.J, 2.� \%9� BY' ��.�`-e: }�-l�ti[/ 16 Adopted by Council: Date 17 ' 18 Adoption Certified by Council Secretary 19 Form Approved by City Attorney 20 t � l 21 BY: G--, � . T'� ��-ra--�..-__ BY: � tliJitGll �Cf � h �t 22 / / 23 Approved by Mayor: Date Y( t a✓� `� y 24 `i /l�� r` T _ ZS Approved by Mayor for Submission to Z6 By: Council 27 Byc G'�_..1._t� �l DEPARTMENT/OFFICFJCOUNCII DATE MRIATED GREEN SHEE N° 3� 3�`� � LIEP/Licensin -- - CONTACTPEFSON & PHONE INITIAVDATE INITiAUDATE ODEPARTMENT�IRECTOR OCffYCAUNCIL Christine Rozek 266-910$ "�'�" Q�T�''�TTOar�v �cma.erm HuuaEa wa MUST BE ON CqUNdL AGENDA BY (DATE� RQ�� BUDGEY DIREGTOfl O FlN. & MGT. SERVICES Dlfl. r' OL hearin : �,3 � ORDER Q MAYOR (OA ASSISTANn Q TOTAL # OF SIGNATURE PAGES (CLIP AI:L IOCATIONS FOR SIGNATURE) ACfiON RE4UESTED: Eastern Heights Amoco Inc. DBA Eastern Heights Amoco requests Council approval of its application for a Gas Station, Restaurant-A, Grocery-C, and Cigarette License located at 1785 Suburban Avenue (ID I�78902). RECOMMENDa710NS: D.ppfove (A) w Reject (R) PERSONAL SERVICE CONTRACTS MUST ANSWEH THE FOLLOWING �UESTIONS: _ PLANNIMG COMMISSIOTI _ CiVIL SERVICE COMMi5310h �� S D�'��'� �r warked under a r,�ntract for this depardnant? � _ CIB COMMI7TEE _ YES IJO _ STAFF _ Z. Has this person�rm ever been a ciry employee? YES NO _ DtS7RiCi cAURi _ 3. Does this persoMfirm possess a skill not normaity possessetl by any current ciry employee? SUPPOFTS WHIGH COUNpL OBJECTIVEI YES NO Explain elt yes enswers on seperete aheet and et[peh to green shcet INRIATING PROBLEM, ISSUE, OPPORTUNRV (Who, What. When, Where, Why): �� dAN Q7 �997 � CtTY ATT � A�VANTAGES IF APPROYED: DiSADYANTAGES IF APPROVED' pR � sv, g ,nd �3'.D'�i � b..e.s'�'��. �. ve..a . .. � . � �kittFi � ,f, I�$ _,..�._.__„.-_____.w�, s� DI5ADVANTAGES IF NOT APPRWED: TOTAL AMOUNT OF iRANSACiION $ COST/REVENUE BUDGETED (CIRCLE ONE) YES NO PUNDING SOURCH ACTIVITY NUMBER FINANCIAL INFOflMATION: (EXPLAIN) \ / ' Greensheet # 35393 L.I.E.P. REVIEW CHECKLIST Date: 12/31/96 / (n Tracket'? App'n Receivea / Apph arocessed �� LicenselD # 789Q2 license Type: Gas Station, Res �rant-A, Grocerv-C, Ci�arette Company Name: Eastern Heiehts Amoco Inc. DBA: Eastern Heights Amoco BusinesS Addresss: 1785 Suburban Avenue, 55109 Business Phone: 735-4282 Contact Name/Address: Michael Fuhr 1899 17th St NW Home Phone: 633-7904 ew Brig ton, 5 112 ��c�o��3�b�i/ z, Date to Council Research: �� Public Hearing Date:_ ' Z� ' �-' Labels Ordered: '��B�g 7 Notice Sent to Applicant: .J � District Council #: J n _� � � Jf�fPt, 'f%t /'� Notice Sent to Public: �/°' �/�/ �� Ward #: 1 DepartmentJ Date lnspeciions Comments City Attorney 3 •�i •9� Z�.� . Environmental Heaith �,Z'�'•Q1� f�.k . Fire 3-z�� • License S�te Plan Received: �o ae��red: — ��1�� o`L Police 3•tt• � �.�. Zoning 3 -2��' � �• � • ._---- SNINT PAUI � A118A CLASS III LICENSE APPLICATION T�IIS APPLICATTON IS SUBJECT TO REVIEW BY THE PUBLIC PLEASE TYPE OR PRINT IN INK Type Company Name: If business is incorpozated, give date of incorporation: Doing Business As: ��i 5�I✓ t. �� S� Business Address ( 7�S _ _ �� 1 ?'!! _ Svcct Add+e+e Between what cross streets is the business located7 �! �� Are the premises noH� occu �_ What T}Pe of Business? _ Mai] To Address: l 7 � C i ,�v �? ✓ y�^� ��f s� naa� Applicant Inf'ortna6o �. /j J Name and Tifle: _ _! _' 1 � � °i 9 � Fvrt �ca�u� City �' �/ 1 y< < R U �,�-) c�Ty � �� c� `�,3� CITY OF SAINT PAUL �U of S.iCeilSe. tSISpKiiOnS eC ana &n;ronmrnw r.otec7;on 350 St Pda St Stik 300 Samt Paul, Mm��h 53102 (61�166^0?0 fz�C612)16S9Std r i `�� j r',y �" y �""'� Susiness Phone: Stncc Zip Which side of the street2 S� f� .�s1 s,�w zsp c� � �' �ir'S � � �- -p � Tm� Home Address: / a 1/ � 1 T �� / 7�n/ ifj�✓�� t��• �'1 h �'S�`�- . / Sireet Addrea� Ciry State Zip Date of Bvth: t �� Place of Birth: ,�� • � `' / Home Phone: �� Have you ever been convicted of any felony, crime or violation of any city ordinance other than traffic? YES NO Date of azrest: Where7 Chazge: Con��iction: Sentence: List the names end residences of three persons of good moral character, living a�thin the Twin Cities Metro Area, not related to the applicant or financially interested in ihe premises or business, who may be referred to as to the applicants character p NAME ADDRESS j PH�NE > �T��tv l �,_ ._ t �DO��w.. Inn�_ �.�� 7 � Hace any otthe above named licenses eva 6cen NU li yes, ltst the aates ana reasons ior revocanon: 1211819b r F �^ � - Are you going to operate this business personally? ,1� YES NO If not, afio wili operate it? �, � "; �`�, ° m Fitsl \emt Middie Iniliel (tifeidrn) Last D� of Bviki HomcAddsear. SVwt\ame Citp State Zip Pfionclhumbcr Are gou going to have a manager or assistant in this busines? � YES NO If the manager is not the sazne xs the operator, please complete the following infoimation: �— YYI�> k � f �— 1- �— $`- ,�- 6� �� x��naa,�,,: s,�:a� Please list your emplayment hisiory for the previous five (5) year period: J List all other o�cers of ihe corporation: OFfSCER TITLE HOME NAAhE � (Office Held) ADDRESS �'�1, r �q�/�� i�r:-S ll'g� �7rh /h�.,k �.�b l! J��r �.( 1�,�.� If busines is a partnership, please include the follouing information for each partner (use additional pages if necessary): Nsadt� t�c[�t (Matdrn) � •s y�� s�k ��- �, S� , S� HOME BUSINESS PHOhB PHONE -o S DATE OF BII2TH /G � Lsrt DateolBirth Slate Zip Pho�w N�unbe Last Datc of Birth Home Addrcse: Strce[ l�amc Firrt i�eme Middl< (:�faiden) Home Addrese: Strect Namc Gty Stete Zip P6one Number MII�INESOTA TAX IDENTIFICATION NtTMB£R - Pursuant to Ihe Laws of Minaesota, 1984, Chapter 502, Article 8, Section 2 (270J2) (Tax CSearance; Issusnce of Licenses), licensing authorities aze required to pro��ide to the State of Minnesota Commissioner of Revenue, the Minnesota business tax iden�cation n�unber and the socizl securiry number of each license applicant. Under the Muu�esota Gouernment Data Practices Act and the Federal Privacy Act of 1974, we aze required to advise you of tl�e folloa�ing regarding the use of the Mi�mesota Ta�t Identificalion Number: - This information may be used to deny the issuance or renewal ofyour license in the e��ent you owe Minnesota sales, employers withholding or motor vehicle e�tcise taxes; - Upon receiving this information, the licensing authority will supply it only to the Minnesota Deparhuent of Revenue. However, under the Pederal Exchange of Information Agreement, the Deparhnent of Revenue may supply tlus information to the Intemal Revenue Service. Minnesota Tax 1de�ti5cation Numbe� (Sales & L3se T�t Number) may be obtained from the State of Minnesota, Business Records Department, 10 River Park Plaza (612-296-6 ] S I). � � �� v Social Security Num6er: Mumesota Tax Idrn�cation Number: ,� < _ If a Minnewta Tax ]dent�cation Number is not required for the business being operated, indicate so by placing an "X" in the bor. �,� r�� h'!ti �SIU 72/18J96 .r �_ � ,� ..ERTTFICATION OF tt'ORKERS' COMPENSATION COVERAGE PURSUANT TO MINNESOTA SI ATUl 176.182 � I hereb}' a�rtify that I, or my rampany, azn in compliance «ith the «orkers' compensation insurance coverage requirements of Minnesotz Statute 176.182, subdi� 2. I also understand that provision of false infmmation in this cert�cation constitutes sufficient grounds for ad�•erse action against alS licenses held, inc3nding revocation and suspension of said ]icenses. Iv'ame of Insurance C f'Y')f`�J r`t ti �aG+nOt �. s`�27� �n.. g PolicyNumber: /-} C — WCC70�J 7U� ' � Coveragefrom�=to �� r / � I have no emplo} corered under v.rorkers' compensation insurance (INITIALS) ANY FAISIFICATION OF AI�SWEI2S GIVEN OR MATERIAL SUBMTTTED WII,L RESULT IN D£N7AL OF TIIIS APPLICATION I hereby state that I ha��e answered all of the preceding questions, and that the infoTmation contained herein is tcue and conect to the best of my kno�•ledge and belief. I hereby state fiuther that I have received no money or other considecation, by w•ay of loan, gift, contribution, or otheiwise, other than already disclosed in the application which I berewith submitted I also understand this premise may be inspected by police, fue, health and other city officizis at a�� and alI times when the business is ia operation. /�-.�1 � (� (REQUIRED for all applications) Date We eill accept pa}�ment b}' cash, check (made pa�•able to City of Saint Pau� or credit card (M/C or Visa). IFP � MasterCazd O Visa EXPIRA7ION DATE: � � � � ot L�KK�I�L�rWul_2�.:� � � � � � � � � � � � � � � � � ""Note: ff Uus application is Food/Liquor related, please contact a Ciry of Saint Paui Health Inspector, Steve Olson (266-9139), to re��ew plans. If any substantial changes to structure ue anticipated, please contact a City of Saint Pau1 Plan Examiner at 266-9Q�7 to apply for building penniu. If there are auy changes to the parking lot, floor space, or for new operations, p3ease contsct a City of Saini Paul Zoning Inspector at 266-9008. AU applications require the following documents. Please a#ach these documents R•hen submitting Soar application: 1. A detailed description of the design, location and square footage of tl�e premises to be licensed (site pian), T6e follov.zng data should be on the site plan (preferably on an 8 I f2" x I I" or S 1/2" x I4" paper}: - Name, address, and phone nutnber. - The scale should be stated such as 1" = 20'. ^N sbould be indicated toward the top. - Placement of all pertinent features of the interior of tl�e licen.sed facility such as seating areas, kitchens, offices, repair area, parking, rese rooms, etc. - If a reques[ is for an addifion or erpansion of the licenseci facility, indicate both the ciurent area and the proposed erpansion. 2. A copy ofyour ]ease agreemrnt or proof of owmership of the property. SPECIFIC LICENSE APPLICATIONS REQUIRE AIIDTTIONAL INFOIiMATIOY. PLEASE SEE REVERSE FOR DETAII.S >>>> ]2JI8196