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97-464Council File # l � — � � L '� ordinance # Green Sheet # �S��D � _ ,_ . _ . , RESOLUTION ' CITY OF SAINT PAUL, MINNESOTA Presented By Referred To Committee: Date 1 RESOLVED: That application (ID #62615) for an Auto Body Repair Garage License by Wazd 7effecson DBA 2 Jefferson Auto Repair (Wazd Jefferson, Owner) at 859 University Avenue West be and the same is 3 hereby approved. 4 5 Requested by Department of: 6 Yea Nays Absent 7 B ak� � �� 8 Bostr_T_m Office of License. Snspections and 9 Harrss �� 10 Me ar � EnviroxLmental Protection 11 � �'` 12 T un� � 14 `�' Yl_ �� 15 O � BY _ �� /._( 16 Adopted by Council: Date � 3 � q 17 18 Adoption Certified by Council Secretary Form Approved by Cit ttorney 19 20 (� \ 21 B � � I—�r J\ n 22 y: . By: (�QI�,NLI.�--J �'J �lX �tti 23 Approved by Mayor: Date �{r,J(`17 24 zs �//{� Approved by Mayor for Submission to 26 By: � V council 27 By: °t� —�.c�y �EPARTMENT/OPFICE/CAUNCIL DATEINITIATED GREEN SHEE N_ 35310 LIEP/Licensin -- - -- CONTACTPEFiSON&PHONE ODEPARTMENTDIRECTOR OCT'COUNCIL INRIAlIDA7E Chxistine Rozek 266-4108 "�" �cmnnoanEV �cmc�AK MUST BE ON COUNqL AGENDA BY (MTE) NUYBER FOR a�� DIRECTOR O FlN. 8 MGT. SEFiVICES DIR. ROVnNG ORDER � MpYOH (Ofl ASSISiANn O For hearin : TOTAL # OF SIGNATURE AGES (CLiP ALL LOCATIONS FOR SIGNATUR� ncnoN nEauesreo: Ward Jefferson DBA Jefferson Auto_Repair requests Council approval of its application for an Auto Body Repair Garage located at 859 Unive=sity Avenue West (ID 9i62615). RECOMMENDAT70N5: Approva (A) w Rajec[ (Fl) pERSONAL SERVICE CONTRACTS MU57 ANSWER TME FOLLOWING �UESiIONS: _ PLpNNING COMMI$$ION _ CML SEPVICE COMMISSION �� Hd5 thi5 PersONfifin eV2f WOlked unde( a CoMf2Ci f0� thi5 depaftrnCM? - _ CIBCOMMffTEE YES NO — �� F - 2. Has Mis persoNfirm ever been a cily employee? YES NO _ DISiRiCT COUFiT _ 3. Does Nis person/Firtn ss a skill not normall � posse y possessed by any curreM ciry employee. SUPPORB WHICH CAUNCIL OBJELTIVE? YES NO Explafn all yes answers on separate shcet and attach to green sheet INITIATING PROBIEM, ISSUE, OPPE1RNNffV (Who. Whaz, When, Where, Why): ADVANTAGES IF APPROVED: DISADVANTAGES IF APPROVED: LiVW�6sCt �Q;CY�Y�� 'Sa'u'�iE3r AP� d+l 139? DISADVAMAGES IFNOTAPPROVED: `_._.s -. _ w.. ._,�_.,__,�- _--^° . TOTAL AMOUNT OF TRANSACTION S COST/HEVENUE BUDGETED (CIRCLE ONE) YES NO FUNDIHCa SOURCE ACTIVITY NUMBER FINANCIAL INFORMATION: (EXPLAIN) Greensneet�t 35310 L.I.E.P. REVIEW CHECKLIST Date:3/10/97 � c 1�1-�1.(0`{ in TraCket'? ApP'n Received / ApP'n Processed License ID # 62615 License Type: an Auto Bodv Renair Garage Comp2ny Name: Ward Jefferson DBA: Jefferson Auto Revair Business Addresss: $59 University Avenue West Business Phone: 292-8043 Contact Name/Address: Ward Jefferson, 790 Iglehart, 104 Home Phone: Z22-4023 Date to Council Research: Public Hearing Date: -� Notice Sent to Applicant: � I� � Labels Ordered: District CoUncil #: � � �.� a�o, Notice Sent to Public: `�7�� Ward #: / Department/ Date Inspections Comments Ciry Attorney /�°� ��14 / i � �g. �� Environmental Health � ��' Fire ��2��, �,,� , License s�� d� Lease Received: ��10� !7 �� Police �' � �,]' � - d � Zoning O • F � • �� ✓ � � �� - s�� -rc� �'►�tru. �.0 1�=P�� -�, �p a C� / .� �'� ��t�� CLASS III CITY OF SAII�TT PAUL LICENSE APPLICATIOi�t Office O(Licenx, InSFections znd Em�ironmenizl P;etection �'0 St Pen h Sune?OJ ' Srim AW, Koz�aa S�t4+ (bl� 266Y]9p fu (61.):;.�91Y THIS APPLICA770\' IS SUBJECI' TO REVIEVJ BY TI-IE pL�BLIC PLEASE TYPE OR PRII��I' LN L� K T��pe of License(c) �� p��ed for. Co:poration / Parmership / Sole 1 Company \a�: If business is incorporated, gi��e date of incorporation: Doing Business .4s: Busioess Address: Strcet Addrest Betw�een u�hat cross sveets is the business located? Are the premises now occu ied? _�� '(� '.vlail To Addcess: o Svcet Address Applicant Infoa \'ame and Tide: Fvst Home Address: T}Pe of Business? r� Ciry �—. Iau /}, So-ee A ( V ? �� (� Ciry ^; State Zip Date of Binh: f l l� b^� K1 Place of Birth: m 1 1 I IQYY��{E G � r Home Phone: � Have you ever been convicted of aoy feiony, crime or ��iolation of any ciry ordinance other than traffic? YES _ KO Date of arrest: Rfiere? � Chaz¢e: CoocicGon: ADDRESS !y � h'1 ��-�c�n �� Un� Uer S i�� formerly held, or m�6ave an intere�st in: i__,_ . List the names and residences of three persons of good moral character, lit•ing u•ithin che Twin Cities Metro Area, nof re]ated to the appticant or fmanc3ally ioterested in tl�e premises or business, w•ho may be refeired to as to the applicant's chazacter: s�� c� --��;�� List l�naes w�hich you Have any of the above named licenses ever been revoked? � YES � 1�*O If yes, list the dates and reasons for Are you goiog to opente this business personally? � yES First Tarne Senunce: PHONE NO If not, ufio a�ill operate it? Middie Inivai (Maiden) Last }iomcAddr¢s: Sneu;:ame Ciry State Zip Business Phone: Sute Zip R'hich side of the sveet? `�dd �, dG State Zip Datc of Binh Phone Number -- ^�,�w �. �•'—"�� Are you goine to ha�•e a mana�er or assistant in this business? _ YFS .��0 If the mana�er is not the same az the operator,�., complete the follow�ing information: p� � "l�;( l� ':artie HortK Address: Streei \ame Ciq• Ple2�e list your emplopu�ent history�Or the precious five (�) ��eaz period: List all otBer o�cers of the cocporation: o�c�.x n�rL.E xot.�. NA'.� (Office Held) ADDRESS Iz<t xo�� PAOKE Sute � Date of Birih Zip Phone l�umber 4-91� BUSI:<ESS DA"I"EOF PHO� BIR7�H If business is a parmership, please indude t6e folloW�ing informaUOn for eac6 parmer (uce additional pases if necessar}•): FvSt \ ame HomeAddress: Svee[!:ame First �arne Home Addras: S[rea Tam ti:idLle Initial (\faiden) .'.1id31e Initial Middle Initial (?.Saiden) Ciry (.Maiden) Ciry Ias[ State Last State Date o( Birth Zip Phone Number ' Date of Birth Zip Phonei.umber ML'�`I�'ESO'fA TAX IDEh'I'IF7CAT[O\T h'UMBII2 - Pursuant to the Laws of Minnesota, 1984, Chapter 502, Article 8, Section 2(270.72) (faz Clearaoce; Issvance of Licenses), licensing aut6orities are reqaireA ro provide to the State of Minnesota Commissioner of Revenue, the Minaesota business taz identificatioo oumber and the social securiry number of each license appficant Under tbe Minnesota Govemment Data Fractices Act and tSe Federal Privacy Act of 1974, we aze required to advise you of the folloK�ing regarding the use of the Minnesota Taz Identification Number: - This information may be used to deny the issuance or renewai of your license in the eveot you owe Dtinnesota sa]es, employer's withho]ding or motor vetucle ezcise tazes; - Upon receiving t}us info:mation, the licensing aut6oriry u�ill supply it only to the Minnesota Depa�tmen[ of Reveaue. However, under the Federal Ezchange of Information Agreement, the Department of Revenue may supply tfus information to the Intemal Reveoue Service. Minnesota Taz Ideotification Numbers (Sales & Use Taz \'umber) may be obtained from the Stau of Minnesota, Business Records Department, 10 River Pazk Plaza (612-296-6181). $ocial SecUnty NUmbei: � f�1'�l✓ ��y J 1`7` Minnesota Taz Identification Number: �� 8 b�I-.L , If a Minnesota Taz Identificatioo Number is not requited for the business being operate$ indicate so by placing au "X" in the boz. _„ � __. - - .. . �, �CERTIFICATIO\' OF R'ORKERS' C0�4PE;�SAT10;�T CO��RAGE PL7tSl:�\'I' TO ML\;�'ESOTA ST.4'IUTE 176.182 °� I�'ereby cenify ttiat I, or my company, am in compliance w�i:h che w�orkers' compensation insurance co� erage requiremenu of ;�4innesota ? Stamte 176.182, subdi�•ision 2. I also underctand that pro��isien of falce information in this certification constimtes sufficient gounds for ad��erse action aoainst alllicen<es held, indudinz revocation and suspens�ion�o�f sa lic \ r'ame of Insurance Company: �� G��l `YTEITP, �-?`t� � p � � J �� / i Policy;�'umber. � �� '�_� Coceragefrem�_to "`� 14 I hace oo employees covered under a�orkers' compensation iburance � . A\Y FAISIFICATIO:Q OF A\SR`ERS GI�'EI� OR'�tATERIAl SLB:�IITTED R'II,L RESULT L\ DE\IAL OF THIS r�PPLICATiO.\' I hereby state that I have ansu�ered all of the preceding quesuons, and that the informavon contained herein is tcue and corrut to the best of my kno�•ledge aod belief. I hereby state furthu tl�at I ha� e received no money or ottier consideration, by w�ay of ]oan, gift, contribution, or otberwise, other tban already disclosed in the application a hic6 I herew•itb submitted. I also understaad t}ris premise may be inspected by police, fue, Lealth and other city officials at any and all times u�hen the business is in operation. "*:�ote: If itris application is Food/L.iquor retafed pleue contact a Ciry of Saint Paul Healch Inspector, Ste��e Olson (266-9139), to re�iew plans. If aoy substanual changes to strvcuue are anticipate3, please contact a Ciry of Saint Paul Plan Ezaminer at 26G4007 to apply for buildiog pecmits. If tl�ere are any changes to the paz}:iog ]ot, floor spa: e, or for new opencions, p]ease contact a City of Saint Paul Zoning Inspector az 266-9008. Additional application requirements, please attach: A detailed description of the design, location and square footage of the premises to be licensed (site plan). The folloKing data should be on the site plan (preCerably on an 81/2" x 11" or 81l2" x 14" paper): - I�ame, address, and phone number. - The scale should be stated such u 1" = 20'. ^\ should be indicated towazd the Wp. - Ptacement of al! pertinent features of the interior of fhe licensed facility such as seating areas, ldtchens, oft'ices, repair area, parldng, rest rooms, etc - If a reqvest is for an addition or ezpansion of the licensed facility, indicate both the current area and the proposed ea A copy of your lease agreement or proof of oknership ot the property. FOR SPECIFTC APPLICATION REQUIREA1Eh'TS, PLEASE SEE REVERSE >>>> Council File # l � — � � L '� ordinance # Green Sheet # �S��D � _ ,_ . _ . , RESOLUTION ' CITY OF SAINT PAUL, MINNESOTA Presented By Referred To Committee: Date 1 RESOLVED: That application (ID #62615) for an Auto Body Repair Garage License by Wazd 7effecson DBA 2 Jefferson Auto Repair (Wazd Jefferson, Owner) at 859 University Avenue West be and the same is 3 hereby approved. 4 5 Requested by Department of: 6 Yea Nays Absent 7 B ak� � �� 8 Bostr_T_m Office of License. Snspections and 9 Harrss �� 10 Me ar � EnviroxLmental Protection 11 � �'` 12 T un� � 14 `�' Yl_ �� 15 O � BY _ �� /._( 16 Adopted by Council: Date � 3 � q 17 18 Adoption Certified by Council Secretary Form Approved by Cit ttorney 19 20 (� \ 21 B � � I—�r J\ n 22 y: . By: (�QI�,NLI.�--J �'J �lX �tti 23 Approved by Mayor: Date �{r,J(`17 24 zs �//{� Approved by Mayor for Submission to 26 By: � V council 27 By: °t� —�.c�y �EPARTMENT/OPFICE/CAUNCIL DATEINITIATED GREEN SHEE N_ 35310 LIEP/Licensin -- - -- CONTACTPEFiSON&PHONE ODEPARTMENTDIRECTOR OCT'COUNCIL INRIAlIDA7E Chxistine Rozek 266-4108 "�" �cmnnoanEV �cmc�AK MUST BE ON COUNqL AGENDA BY (MTE) NUYBER FOR a�� DIRECTOR O FlN. 8 MGT. SEFiVICES DIR. ROVnNG ORDER � MpYOH (Ofl ASSISiANn O For hearin : TOTAL # OF SIGNATURE AGES (CLiP ALL LOCATIONS FOR SIGNATUR� ncnoN nEauesreo: Ward Jefferson DBA Jefferson Auto_Repair requests Council approval of its application for an Auto Body Repair Garage located at 859 Unive=sity Avenue West (ID 9i62615). RECOMMENDAT70N5: Approva (A) w Rajec[ (Fl) pERSONAL SERVICE CONTRACTS MU57 ANSWER TME FOLLOWING �UESiIONS: _ PLpNNING COMMI$$ION _ CML SEPVICE COMMISSION �� Hd5 thi5 PersONfifin eV2f WOlked unde( a CoMf2Ci f0� thi5 depaftrnCM? - _ CIBCOMMffTEE YES NO — �� F - 2. Has Mis persoNfirm ever been a cily employee? YES NO _ DISiRiCT COUFiT _ 3. Does Nis person/Firtn ss a skill not normall � posse y possessed by any curreM ciry employee. SUPPORB WHICH CAUNCIL OBJELTIVE? YES NO Explafn all yes answers on separate shcet and attach to green sheet INITIATING PROBIEM, ISSUE, OPPE1RNNffV (Who. Whaz, When, Where, Why): ADVANTAGES IF APPROVED: DISADVANTAGES IF APPROVED: LiVW�6sCt �Q;CY�Y�� 'Sa'u'�iE3r AP� d+l 139? DISADVAMAGES IFNOTAPPROVED: `_._.s -. _ w.. ._,�_.,__,�- _--^° . TOTAL AMOUNT OF TRANSACTION S COST/HEVENUE BUDGETED (CIRCLE ONE) YES NO FUNDIHCa SOURCE ACTIVITY NUMBER FINANCIAL INFORMATION: (EXPLAIN) Greensneet�t 35310 L.I.E.P. REVIEW CHECKLIST Date:3/10/97 � c 1�1-�1.(0`{ in TraCket'? ApP'n Received / ApP'n Processed License ID # 62615 License Type: an Auto Bodv Renair Garage Comp2ny Name: Ward Jefferson DBA: Jefferson Auto Revair Business Addresss: $59 University Avenue West Business Phone: 292-8043 Contact Name/Address: Ward Jefferson, 790 Iglehart, 104 Home Phone: Z22-4023 Date to Council Research: Public Hearing Date: -� Notice Sent to Applicant: � I� � Labels Ordered: District CoUncil #: � � �.� a�o, Notice Sent to Public: `�7�� Ward #: / Department/ Date Inspections Comments Ciry Attorney /�°� ��14 / i � �g. �� Environmental Health � ��' Fire ��2��, �,,� , License s�� d� Lease Received: ��10� !7 �� Police �' � �,]' � - d � Zoning O • F � • �� ✓ � � �� - s�� -rc� �'►�tru. �.0 1�=P�� -�, �p a C� / .� �'� ��t�� CLASS III CITY OF SAII�TT PAUL LICENSE APPLICATIOi�t Office O(Licenx, InSFections znd Em�ironmenizl P;etection �'0 St Pen h Sune?OJ ' Srim AW, Koz�aa S�t4+ (bl� 266Y]9p fu (61.):;.�91Y THIS APPLICA770\' IS SUBJECI' TO REVIEVJ BY TI-IE pL�BLIC PLEASE TYPE OR PRII��I' LN L� K T��pe of License(c) �� p��ed for. Co:poration / Parmership / Sole 1 Company \a�: If business is incorporated, gi��e date of incorporation: Doing Business .4s: Busioess Address: Strcet Addrest Betw�een u�hat cross sveets is the business located? Are the premises now occu ied? _�� '(� '.vlail To Addcess: o Svcet Address Applicant Infoa \'ame and Tide: Fvst Home Address: T}Pe of Business? r� Ciry �—. Iau /}, So-ee A ( V ? �� (� Ciry ^; State Zip Date of Binh: f l l� b^� K1 Place of Birth: m 1 1 I IQYY��{E G � r Home Phone: � Have you ever been convicted of aoy feiony, crime or ��iolation of any ciry ordinance other than traffic? YES _ KO Date of arrest: Rfiere? � Chaz¢e: CoocicGon: ADDRESS !y � h'1 ��-�c�n �� Un� Uer S i�� formerly held, or m�6ave an intere�st in: i__,_ . List the names and residences of three persons of good moral character, lit•ing u•ithin che Twin Cities Metro Area, nof re]ated to the appticant or fmanc3ally ioterested in tl�e premises or business, w•ho may be refeired to as to the applicant's chazacter: s�� c� --��;�� List l�naes w�hich you Have any of the above named licenses ever been revoked? � YES � 1�*O If yes, list the dates and reasons for Are you goiog to opente this business personally? � yES First Tarne Senunce: PHONE NO If not, ufio a�ill operate it? Middie Inivai (Maiden) Last }iomcAddr¢s: Sneu;:ame Ciry State Zip Business Phone: Sute Zip R'hich side of the sveet? `�dd �, dG State Zip Datc of Binh Phone Number -- ^�,�w �. �•'—"�� Are you goine to ha�•e a mana�er or assistant in this business? _ YFS .��0 If the mana�er is not the same az the operator,�., complete the follow�ing information: p� � "l�;( l� ':artie HortK Address: Streei \ame Ciq• Ple2�e list your emplopu�ent history�Or the precious five (�) ��eaz period: List all otBer o�cers of the cocporation: o�c�.x n�rL.E xot.�. NA'.� (Office Held) ADDRESS Iz<t xo�� PAOKE Sute � Date of Birih Zip Phone l�umber 4-91� BUSI:<ESS DA"I"EOF PHO� BIR7�H If business is a parmership, please indude t6e folloW�ing informaUOn for eac6 parmer (uce additional pases if necessar}•): FvSt \ ame HomeAddress: Svee[!:ame First �arne Home Addras: S[rea Tam ti:idLle Initial (\faiden) .'.1id31e Initial Middle Initial (?.Saiden) Ciry (.Maiden) Ciry Ias[ State Last State Date o( Birth Zip Phone Number ' Date of Birth Zip Phonei.umber ML'�`I�'ESO'fA TAX IDEh'I'IF7CAT[O\T h'UMBII2 - Pursuant to the Laws of Minnesota, 1984, Chapter 502, Article 8, Section 2(270.72) (faz Clearaoce; Issvance of Licenses), licensing aut6orities are reqaireA ro provide to the State of Minnesota Commissioner of Revenue, the Minaesota business taz identificatioo oumber and the social securiry number of each license appficant Under tbe Minnesota Govemment Data Fractices Act and tSe Federal Privacy Act of 1974, we aze required to advise you of the folloK�ing regarding the use of the Minnesota Taz Identification Number: - This information may be used to deny the issuance or renewai of your license in the eveot you owe Dtinnesota sa]es, employer's withho]ding or motor vetucle ezcise tazes; - Upon receiving t}us info:mation, the licensing aut6oriry u�ill supply it only to the Minnesota Depa�tmen[ of Reveaue. However, under the Federal Ezchange of Information Agreement, the Department of Revenue may supply tfus information to the Intemal Reveoue Service. Minnesota Taz Ideotification Numbers (Sales & Use Taz \'umber) may be obtained from the Stau of Minnesota, Business Records Department, 10 River Pazk Plaza (612-296-6181). $ocial SecUnty NUmbei: � f�1'�l✓ ��y J 1`7` Minnesota Taz Identification Number: �� 8 b�I-.L , If a Minnesota Taz Identificatioo Number is not requited for the business being operate$ indicate so by placing au "X" in the boz. _„ � __. - - .. . �, �CERTIFICATIO\' OF R'ORKERS' C0�4PE;�SAT10;�T CO��RAGE PL7tSl:�\'I' TO ML\;�'ESOTA ST.4'IUTE 176.182 °� I�'ereby cenify ttiat I, or my company, am in compliance w�i:h che w�orkers' compensation insurance co� erage requiremenu of ;�4innesota ? Stamte 176.182, subdi�•ision 2. I also underctand that pro��isien of falce information in this certification constimtes sufficient gounds for ad��erse action aoainst alllicen<es held, indudinz revocation and suspens�ion�o�f sa lic \ r'ame of Insurance Company: �� G��l `YTEITP, �-?`t� � p � � J �� / i Policy;�'umber. � �� '�_� Coceragefrem�_to "`� 14 I hace oo employees covered under a�orkers' compensation iburance � . A\Y FAISIFICATIO:Q OF A\SR`ERS GI�'EI� OR'�tATERIAl SLB:�IITTED R'II,L RESULT L\ DE\IAL OF THIS r�PPLICATiO.\' I hereby state that I have ansu�ered all of the preceding quesuons, and that the informavon contained herein is tcue and corrut to the best of my kno�•ledge aod belief. I hereby state furthu tl�at I ha� e received no money or ottier consideration, by w�ay of ]oan, gift, contribution, or otberwise, other tban already disclosed in the application a hic6 I herew•itb submitted. I also understaad t}ris premise may be inspected by police, fue, Lealth and other city officials at any and all times u�hen the business is in operation. "*:�ote: If itris application is Food/L.iquor retafed pleue contact a Ciry of Saint Paul Healch Inspector, Ste��e Olson (266-9139), to re�iew plans. If aoy substanual changes to strvcuue are anticipate3, please contact a Ciry of Saint Paul Plan Ezaminer at 26G4007 to apply for buildiog pecmits. If tl�ere are any changes to the paz}:iog ]ot, floor spa: e, or for new opencions, p]ease contact a City of Saint Paul Zoning Inspector az 266-9008. Additional application requirements, please attach: A detailed description of the design, location and square footage of the premises to be licensed (site plan). The folloKing data should be on the site plan (preCerably on an 81/2" x 11" or 81l2" x 14" paper): - I�ame, address, and phone number. - The scale should be stated such u 1" = 20'. ^\ should be indicated towazd the Wp. - Ptacement of al! pertinent features of the interior of fhe licensed facility such as seating areas, ldtchens, oft'ices, repair area, parldng, rest rooms, etc - If a reqvest is for an addition or ezpansion of the licensed facility, indicate both the current area and the proposed ea A copy of your lease agreement or proof of oknership ot the property. FOR SPECIFTC APPLICATION REQUIREA1Eh'TS, PLEASE SEE REVERSE >>>> Council File # l � — � � L '� ordinance # Green Sheet # �S��D � _ ,_ . _ . , RESOLUTION ' CITY OF SAINT PAUL, MINNESOTA Presented By Referred To Committee: Date 1 RESOLVED: That application (ID #62615) for an Auto Body Repair Garage License by Wazd 7effecson DBA 2 Jefferson Auto Repair (Wazd Jefferson, Owner) at 859 University Avenue West be and the same is 3 hereby approved. 4 5 Requested by Department of: 6 Yea Nays Absent 7 B ak� � �� 8 Bostr_T_m Office of License. Snspections and 9 Harrss �� 10 Me ar � EnviroxLmental Protection 11 � �'` 12 T un� � 14 `�' Yl_ �� 15 O � BY _ �� /._( 16 Adopted by Council: Date � 3 � q 17 18 Adoption Certified by Council Secretary Form Approved by Cit ttorney 19 20 (� \ 21 B � � I—�r J\ n 22 y: . By: (�QI�,NLI.�--J �'J �lX �tti 23 Approved by Mayor: Date �{r,J(`17 24 zs �//{� Approved by Mayor for Submission to 26 By: � V council 27 By: °t� —�.c�y �EPARTMENT/OPFICE/CAUNCIL DATEINITIATED GREEN SHEE N_ 35310 LIEP/Licensin -- - -- CONTACTPEFiSON&PHONE ODEPARTMENTDIRECTOR OCT'COUNCIL INRIAlIDA7E Chxistine Rozek 266-4108 "�" �cmnnoanEV �cmc�AK MUST BE ON COUNqL AGENDA BY (MTE) NUYBER FOR a�� DIRECTOR O FlN. 8 MGT. SEFiVICES DIR. ROVnNG ORDER � MpYOH (Ofl ASSISiANn O For hearin : TOTAL # OF SIGNATURE AGES (CLiP ALL LOCATIONS FOR SIGNATUR� ncnoN nEauesreo: Ward Jefferson DBA Jefferson Auto_Repair requests Council approval of its application for an Auto Body Repair Garage located at 859 Unive=sity Avenue West (ID 9i62615). RECOMMENDAT70N5: Approva (A) w Rajec[ (Fl) pERSONAL SERVICE CONTRACTS MU57 ANSWER TME FOLLOWING �UESiIONS: _ PLpNNING COMMI$$ION _ CML SEPVICE COMMISSION �� Hd5 thi5 PersONfifin eV2f WOlked unde( a CoMf2Ci f0� thi5 depaftrnCM? - _ CIBCOMMffTEE YES NO — �� F - 2. Has Mis persoNfirm ever been a cily employee? YES NO _ DISiRiCT COUFiT _ 3. Does Nis person/Firtn ss a skill not normall � posse y possessed by any curreM ciry employee. SUPPORB WHICH CAUNCIL OBJELTIVE? YES NO Explafn all yes answers on separate shcet and attach to green sheet INITIATING PROBIEM, ISSUE, OPPE1RNNffV (Who. Whaz, When, Where, Why): ADVANTAGES IF APPROVED: DISADVANTAGES IF APPROVED: LiVW�6sCt �Q;CY�Y�� 'Sa'u'�iE3r AP� d+l 139? DISADVAMAGES IFNOTAPPROVED: `_._.s -. _ w.. ._,�_.,__,�- _--^° . TOTAL AMOUNT OF TRANSACTION S COST/HEVENUE BUDGETED (CIRCLE ONE) YES NO FUNDIHCa SOURCE ACTIVITY NUMBER FINANCIAL INFORMATION: (EXPLAIN) Greensneet�t 35310 L.I.E.P. REVIEW CHECKLIST Date:3/10/97 � c 1�1-�1.(0`{ in TraCket'? ApP'n Received / ApP'n Processed License ID # 62615 License Type: an Auto Bodv Renair Garage Comp2ny Name: Ward Jefferson DBA: Jefferson Auto Revair Business Addresss: $59 University Avenue West Business Phone: 292-8043 Contact Name/Address: Ward Jefferson, 790 Iglehart, 104 Home Phone: Z22-4023 Date to Council Research: Public Hearing Date: -� Notice Sent to Applicant: � I� � Labels Ordered: District CoUncil #: � � �.� a�o, Notice Sent to Public: `�7�� Ward #: / Department/ Date Inspections Comments Ciry Attorney /�°� ��14 / i � �g. �� Environmental Health � ��' Fire ��2��, �,,� , License s�� d� Lease Received: ��10� !7 �� Police �' � �,]' � - d � Zoning O • F � • �� ✓ � � �� - s�� -rc� �'►�tru. �.0 1�=P�� -�, �p a C� / .� �'� ��t�� CLASS III CITY OF SAII�TT PAUL LICENSE APPLICATIOi�t Office O(Licenx, InSFections znd Em�ironmenizl P;etection �'0 St Pen h Sune?OJ ' Srim AW, Koz�aa S�t4+ (bl� 266Y]9p fu (61.):;.�91Y THIS APPLICA770\' IS SUBJECI' TO REVIEVJ BY TI-IE pL�BLIC PLEASE TYPE OR PRII��I' LN L� K T��pe of License(c) �� p��ed for. Co:poration / Parmership / Sole 1 Company \a�: If business is incorporated, gi��e date of incorporation: Doing Business .4s: Busioess Address: Strcet Addrest Betw�een u�hat cross sveets is the business located? Are the premises now occu ied? _�� '(� '.vlail To Addcess: o Svcet Address Applicant Infoa \'ame and Tide: Fvst Home Address: T}Pe of Business? r� Ciry �—. Iau /}, So-ee A ( V ? �� (� Ciry ^; State Zip Date of Binh: f l l� b^� K1 Place of Birth: m 1 1 I IQYY��{E G � r Home Phone: � Have you ever been convicted of aoy feiony, crime or ��iolation of any ciry ordinance other than traffic? YES _ KO Date of arrest: Rfiere? � Chaz¢e: CoocicGon: ADDRESS !y � h'1 ��-�c�n �� Un� Uer S i�� formerly held, or m�6ave an intere�st in: i__,_ . List the names and residences of three persons of good moral character, lit•ing u•ithin che Twin Cities Metro Area, nof re]ated to the appticant or fmanc3ally ioterested in tl�e premises or business, w•ho may be refeired to as to the applicant's chazacter: s�� c� --��;�� List l�naes w�hich you Have any of the above named licenses ever been revoked? � YES � 1�*O If yes, list the dates and reasons for Are you goiog to opente this business personally? � yES First Tarne Senunce: PHONE NO If not, ufio a�ill operate it? Middie Inivai (Maiden) Last }iomcAddr¢s: Sneu;:ame Ciry State Zip Business Phone: Sute Zip R'hich side of the sveet? `�dd �, dG State Zip Datc of Binh Phone Number -- ^�,�w �. �•'—"�� Are you goine to ha�•e a mana�er or assistant in this business? _ YFS .��0 If the mana�er is not the same az the operator,�., complete the follow�ing information: p� � "l�;( l� ':artie HortK Address: Streei \ame Ciq• Ple2�e list your emplopu�ent history�Or the precious five (�) ��eaz period: List all otBer o�cers of the cocporation: o�c�.x n�rL.E xot.�. NA'.� (Office Held) ADDRESS Iz<t xo�� PAOKE Sute � Date of Birih Zip Phone l�umber 4-91� BUSI:<ESS DA"I"EOF PHO� BIR7�H If business is a parmership, please indude t6e folloW�ing informaUOn for eac6 parmer (uce additional pases if necessar}•): FvSt \ ame HomeAddress: Svee[!:ame First �arne Home Addras: S[rea Tam ti:idLle Initial (\faiden) .'.1id31e Initial Middle Initial (?.Saiden) Ciry (.Maiden) Ciry Ias[ State Last State Date o( Birth Zip Phone Number ' Date of Birth Zip Phonei.umber ML'�`I�'ESO'fA TAX IDEh'I'IF7CAT[O\T h'UMBII2 - Pursuant to the Laws of Minnesota, 1984, Chapter 502, Article 8, Section 2(270.72) (faz Clearaoce; Issvance of Licenses), licensing aut6orities are reqaireA ro provide to the State of Minnesota Commissioner of Revenue, the Minaesota business taz identificatioo oumber and the social securiry number of each license appficant Under tbe Minnesota Govemment Data Fractices Act and tSe Federal Privacy Act of 1974, we aze required to advise you of the folloK�ing regarding the use of the Minnesota Taz Identification Number: - This information may be used to deny the issuance or renewai of your license in the eveot you owe Dtinnesota sa]es, employer's withho]ding or motor vetucle ezcise tazes; - Upon receiving t}us info:mation, the licensing aut6oriry u�ill supply it only to the Minnesota Depa�tmen[ of Reveaue. However, under the Federal Ezchange of Information Agreement, the Department of Revenue may supply tfus information to the Intemal Reveoue Service. Minnesota Taz Ideotification Numbers (Sales & Use Taz \'umber) may be obtained from the Stau of Minnesota, Business Records Department, 10 River Pazk Plaza (612-296-6181). $ocial SecUnty NUmbei: � f�1'�l✓ ��y J 1`7` Minnesota Taz Identification Number: �� 8 b�I-.L , If a Minnesota Taz Identificatioo Number is not requited for the business being operate$ indicate so by placing au "X" in the boz. _„ � __. - - .. . �, �CERTIFICATIO\' OF R'ORKERS' C0�4PE;�SAT10;�T CO��RAGE PL7tSl:�\'I' TO ML\;�'ESOTA ST.4'IUTE 176.182 °� I�'ereby cenify ttiat I, or my company, am in compliance w�i:h che w�orkers' compensation insurance co� erage requiremenu of ;�4innesota ? Stamte 176.182, subdi�•ision 2. I also underctand that pro��isien of falce information in this certification constimtes sufficient gounds for ad��erse action aoainst alllicen<es held, indudinz revocation and suspens�ion�o�f sa lic \ r'ame of Insurance Company: �� G��l `YTEITP, �-?`t� � p � � J �� / i Policy;�'umber. � �� '�_� Coceragefrem�_to "`� 14 I hace oo employees covered under a�orkers' compensation iburance � . A\Y FAISIFICATIO:Q OF A\SR`ERS GI�'EI� OR'�tATERIAl SLB:�IITTED R'II,L RESULT L\ DE\IAL OF THIS r�PPLICATiO.\' I hereby state that I have ansu�ered all of the preceding quesuons, and that the informavon contained herein is tcue and corrut to the best of my kno�•ledge aod belief. I hereby state furthu tl�at I ha� e received no money or ottier consideration, by w�ay of ]oan, gift, contribution, or otberwise, other tban already disclosed in the application a hic6 I herew•itb submitted. I also understaad t}ris premise may be inspected by police, fue, Lealth and other city officials at any and all times u�hen the business is in operation. "*:�ote: If itris application is Food/L.iquor retafed pleue contact a Ciry of Saint Paul Healch Inspector, Ste��e Olson (266-9139), to re�iew plans. If aoy substanual changes to strvcuue are anticipate3, please contact a Ciry of Saint Paul Plan Ezaminer at 26G4007 to apply for buildiog pecmits. If tl�ere are any changes to the paz}:iog ]ot, floor spa: e, or for new opencions, p]ease contact a City of Saint Paul Zoning Inspector az 266-9008. Additional application requirements, please attach: A detailed description of the design, location and square footage of the premises to be licensed (site plan). The folloKing data should be on the site plan (preCerably on an 81/2" x 11" or 81l2" x 14" paper): - I�ame, address, and phone number. - The scale should be stated such u 1" = 20'. ^\ should be indicated towazd the Wp. - Ptacement of al! pertinent features of the interior of fhe licensed facility such as seating areas, ldtchens, oft'ices, repair area, parldng, rest rooms, etc - If a reqvest is for an addition or ezpansion of the licensed facility, indicate both the current area and the proposed ea A copy of your lease agreement or proof of oknership ot the property. FOR SPECIFTC APPLICATION REQUIREA1Eh'TS, PLEASE SEE REVERSE >>>>