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97-54Council File � � Ordinance # Green Sheet � �✓ � � Presented By _"P + Referred To RESOLUTION C1TY OF SAINT PAUL, MINNESOTA ',\� ti Committee: Date i 2 3 RESOLVED: That application (ID #40236) £or an Off Sale Malt, Grocery-C, Gas Station, and Cigarette License by Chong Vang DAB Sunny Muri Market & Gas (Chong Vang, Owner) at 1530 Sherwood Avenue be and the same is hereby a�proved. 4 5 Requested by Department of: 6 Yeas. Navs sen 7 B a e ,y' ' ' 8 �n r� 9 � Harr.z � � 10 �M��e �a_�rd 11 Re t� man � 12 Thune � 13 Bostrom � is � � 16 Adopted by Council: Date .'�.a 17 18 Adoption Certified by Council Secretary 19 20 21 BYc -._., �- . ��_�„_ . 22 23 Approved by Mayor: Date Z� � 24 ZS `� � 26 By: 27 Office of License. Inspections and Environmental Protection B ��'�� fl ,��u-� Form Approved by City Attorney By: �/v7 4livt,G�i— �\J � Approved by Mayor for Submission to Council By: DEPMTMENf/OFFICHCOUNCIL DATEINRIATED GREEN SHEE N� 353 LIEP JLicensin INRIAWATE INIiIAWA CAN7ACf PEASON R PHONE O pEpp{iTMEM DIRECTOR O CfTV CAUNCIL Christine Rozek 266-9108 "u'�" OCfTVATfQRNEY �❑CT'CLEqK MUST BE ON CAUNpL AGENDA 8Y (DAT� NUMBER FOR a�� DIflECfOR a FlN. & MGT. SEFVICES DIR. Q ROUTIN6 For hearin : � aa 1 � oEp O� ( � p �� TOTAL # OF SIGNATURE PAGES (CLIp ALL IOCATIONS POR SIGNATURE) � aanoN nEOU�o: Chong Vang DBA Sunny Mini Market & Gas requests Council approval of its application for an Off Sale Malt, Grocery-C, Gas Station, and Cigarette License located at 1530 Sherwood Avenue <ID /640236). RECOMMENDwiloNS: Approva (A) or neject (R) pEHSONAL SERVICE CONTRACTS MUST ANSWER 7XE FOILOWING �UESTIONS: _ PLANNING COMMISSION _ CIVIL SERNCE COMM�SSION �� Has this personlfirm ever worked untler a contrect for this tleparfinent? - _ CIB COMMR7EE _ 1'ES NO _ SiAFF _ 2. 47as ihis personffirm ever been a city employae? YES NO _ Dis7AIC7 COUHi _ 3. Does Mis persoMirm possess a sltill not normalry possessetl by any current city empfoyee? SUPPORTSWHICHCOUNCILOHJEGTiVE9 YES NO Explatn ali yes answers on separete sheet and attaeh to grean sheet INITtATING PROBLEM. ISSUE, OPPORTUNITV (VJtw, NTat, When, Where, Why): R�C�� NOV 2� 1996 C1TY ATT4RNEY ADVANTAGES IFAPPROVED: DISA�VANTAGES IFAPPROVED: ��:..,.r: :°.,. �,.Yt§ f�-l� � � 1:��.7� v ��,, ��,, DISADVANTAGES IF NO7 APPAWED: - TOTAL AMOUNT OF TRANSACTION $ COST/REVENUE BUDGETED (CIRCLE ONE) YES NO FUNDING SOURCE ACTIVITV NUMBER FINANCIAL INFORMATION: (EXPLAIN) (�eensheet # 35384 In Tracker? License ID # 40236 L.I.E.P. REVIEW CHECKLIST Date: 11/14/96 � APP'n Hec:eived / APP'n Processed �,� License Type: Off Sale Malt, Grocery-C, Gas Station. Cigar ta r�a Company Name: Chong Vang DBA: Sunny Mini Market & Gas BusineSS Addresss: 1530 Sherwood Avenue Business Phone: 774-6400 Contact Name/Address: Chong VAng, 721 Sackson St �11, 101 Home Phone: 310-0109 Date to Council Research: Public Hearing Date: � 2 � Notice Sent to Aoolicant: ��/�7�6 Labels Ordered: ��a District Council #: r�C 94/a`, Notice Sent to Public: ��G� �"/ G� Ward #: ( r /1 Department/ Date Inspections Comments City Attorney izzy�� 05� . Environmenial Health 12• 2y �i� f�� - Fire (2•Z�•°l�o p� License Site Plan Received:_ � ��vli „_ _ �`/ . j�� Lease Received: - �.� �.iyw, !�. - a H- 9k ,�,:�.,-, _ rru� Ch a�v�,� N-- '��'�`r 0 � Jc� Police 12 �2�� fJ �{� . Zoning 1 `�� T;�pe CLASS III LICENSE APPLICATION THIS APPLICA7'IOV IS SUBJECT TO REVIE�V BY Tf� PL�BLIC PLEASE TYPE OR PRINT IN L� K Company Tamne: / Sole Propriuorship Strcet Addrus Ciry State Zip Betu�een w�hat cross sveeu is the business ]ocated? Which side of tbe street? /t.� Are tl�e premices now occupied? � A'hat Type of Business? / I C1�-- MailToAddress: �S �J1� Sji�✓'�GP {nd?P /�-E-�. ��'f-�GL-[•�Q �l/�J SS/O�p $veet Address City Stam Zip ApplicantInforma6on: ' . � `�atne and Title: C_'_ Fvst �'� Middle / (Pfaidrn) -` Iatt � Title Home Address �� l �J(� C �.56'� .�T 7� � �7 '�L1 Lt � ��/lf S� � StrxtAddress Ciry Sute Zip � Date of Birch: L D`S � Place of Birth: L-GA—U S Home P600e: c� /�' d��I Have you evet been conricted of any felony, crime or �7olation of any city ordinance other than traffic? YES � NO�, Date of azrest: Charge: _ Convicuon: Senunce: List the names and residences of three persons of good moral chazacter, living wittun the Twin Cities Metro Area, not related to the applicant or financially interested in the premises or business, who may be referred to as to the applicaofs chazacter: NAME � ADDRESS G1 S`� CITY OF SAII�'T PAUL Office o( Licrnse, Inspations and Em•ironmental Proteaion 1<0 A Pea St Suim?00 Saim hW. Nineesah !�12' (61771bbA'SV (u/6II)'_(d-9t2� �a�� PHO:�B List licenses which you currendy ho]d,�foimerly 6eld, or may have an interest in: Hace any of tLe above named licenses evu beeo revoked? _ YES � ATO If yes, list the dates and reasons for revocation: Are you going to opente / �f C � first I�arne , Homc Addrest: Strcet Tame Vd6ere? YES� N�O not, who " operate it? d �K �VI�V va�� l� �� —r' r Ciry State � �/ o� � �y� �, Date of Binh C //� - 7 � �,L-kY`z� 7�p Phone Number �� If business is incorporated, give date of incorporation: Doing Busioess As: Business Phone: '77 �- ��/ Buciness Address: �5�� Sy( � �` - VC ��- >Y- 11 L M/V �-�d.F� . . . . . Ci .o° � A:� you goine to ha�•e a mana�er or asictant in this business? � YES _ 10 If ihe manager is not the same az the operator, p1.. � h� � comple�e.t�e following infoimation: < _ _ � _ , Fcst HomeAddras: Strea�xme �fiddle Ci.y Please list your emplo�ment history for the pre��ious five (�) }•eaz period: Businecs/Err�lgement ,,, Address �tt Date of Binh Sute Zip PFwnet:umber List all other officers of the corpontion: OFFfCEK TTTI,E HOME '�'A'.'� (Oftice Held) ADDRESS HO'�� BUSI:�'ESS DATE OF PHO\ PHO\� BIRTH lf business is a pazmership, please include the following ioformation for each partner (use additional pages if nuessar�'): Fast \arne Hoire Addras: Saea':arne Fvst!:ame Home Addrus: Stred S:ame 14iddle lr�uai Middit Inivai (Maiden) Ciry (Maiden) Ciry l,ast Siate lau Slate Date ot Hinh Zip Phone Number � Dace ot Birth Zip Phoce Number M4\7�'ESOTA TAX IDENTTFiCATiO� I�'CtIvIBER - Pucsuant to the L,aws of Minnesota, 1984, Chapter 502, Article S, Section 2(270.72) (Tax Cleacance; Issuance of Licenses), licensing authorities are required W ptovide to the State of MImesota Commissioner of Revenue, the Mimesota business caz idenaficadoo number and the socia! security number of each license applicant Under the Minnesota Govemment Dafa Practices Act and tLe Federal Privacy pct of 1974, we are required ro advise you of the foliowing regazding tbe use of t6e Minnesota Tax Identification A�umbet: - Tfus infocma600 may be used to deny the issuance or renewai of your license in t6e event you ov.�e h4innesota sales, employei s withholding or motor vehicle excise tazes; - Upon receiving this infoimation, ihe licensing authority will supply it only to t6e Minnesota Depaztment of Revenue. However, under the Federal Ezchange of Information Agreement, the Department of Revenue may supply this informa6on to the Intemal Revence Service. Minnesota Taz Identification Numbers (Sales & Use Tax \'umber) may be obtained from the Stau of Minuesota, Business Recocds Department, ]0 River Pazk Plaza (612-296-6181). Social Security Number. ��C� - J� 0'� C�.SS Minnesota Taz Identifica6on Number: � � � � _ If a Minnesota Taz Idenrification A'umber is not mqu'ued for the business being operated, indicate so by placing au "X" in the boz. ;o�_ ::�,,.:,;-� .. ,-,_ .:- �:-,..-� .- . ;,. . . . CERTIFICATIOV OF VVORKERS' C0:�4PENSA7ION C0�'ERAGE PtRSUA\'I' TO MINA'ESOTA STATUTE 176.182 \ I hereby cenify that I, or my company, azn in compliance w'ith the workets compensation insurance co��eraoe requiremenu of Minnesota Surote 176.IS2, subdi��ision 2. I also understand tbat provision of false information in this certification constitutes su�cient grounds for ad��ese action agaiost all licenses he1d, including revocation� susp of �aid licenses. �"` � �`azne of Insurance Company: ��,P/7/ � ol.-U /''CQILJL- N-� S ^/, �� t° �a 7 Policy Vumber: � Coeerage from I ha��e no employees co��ered under u�orkers compensation iaurance A2rY FAISIFICATION OF A.\SR'ERS GI�'E\ OR'�SATERIAL SGB\'IITTED R`II,L RESULT I\ DE.\'IAL OF THIS APPLICATION I hereby state thaz I 6ave answered all of the preceding questions, and that the informapon contained herein is true and correct to the best of my lcoowledge and belief. I hereby state fiutber that I hace received no money or other consideration, by u�ay of loan, gifr, contribuuon, or o[herwise, otbet than already disclosed in the application a�lvch I herewith submitted. I also understand tUis premise may be inspected by police, fue, health and ot6et ciq� o�cia]s at any and all fimes w•hen the business is in operation. ///3� Signature tiIltED for all appli�tions) Date '*Note: If this application is Food/L,iquor relate� pleue conta; t a Ciry of Saint Paul Healtli Inspector, Steve Olson (266-9139), to review plans. If any substantial changes to swcnue are anticipated, please contaci a City of Saint Paul Plan Ezaminer at 266-9007 w apply for buildiag permits. If there are any changes to the pazking lot, floor space, or for new operarions, please contact a City of Saint Paul Zoning Inspector at266-9008. Additional apptication requirements, please attach: A detailed desviption of the design, location and square footage o[ the premises to be licensed (site plan). The Collowing data should be on the sife ptan (preferably on an 81/2" x 11" or 81l2" s 14" paper): - Name, address, and phone number. - 7'he scaie should be stated such u 1" _?A'. ^N should be indicated towazd the top. - Placement oI all pertinent features of the interior ot the licensed facility such as seating areu, kitchens, oftices, repair area, parlcing, rest rootns, etc - If a request 3s for an addition or expansion of the Gcensed facility, indinte both the current area and the praposed expansion A copy of your fease agreement or proo[ oC orrnership of the propecty. FOR SPECIFIC APPLICATION REQUIREAIE:�'TS, PLEASE SEE REVERSE >>>> Council File � � Ordinance # Green Sheet � �✓ � � Presented By _"P + Referred To RESOLUTION C1TY OF SAINT PAUL, MINNESOTA ',\� ti Committee: Date i 2 3 RESOLVED: That application (ID #40236) £or an Off Sale Malt, Grocery-C, Gas Station, and Cigarette License by Chong Vang DAB Sunny Muri Market & Gas (Chong Vang, Owner) at 1530 Sherwood Avenue be and the same is hereby a�proved. 4 5 Requested by Department of: 6 Yeas. Navs sen 7 B a e ,y' ' ' 8 �n r� 9 � Harr.z � � 10 �M��e �a_�rd 11 Re t� man � 12 Thune � 13 Bostrom � is � � 16 Adopted by Council: Date .'�.a 17 18 Adoption Certified by Council Secretary 19 20 21 BYc -._., �- . ��_�„_ . 22 23 Approved by Mayor: Date Z� � 24 ZS `� � 26 By: 27 Office of License. Inspections and Environmental Protection B ��'�� fl ,��u-� Form Approved by City Attorney By: �/v7 4livt,G�i— �\J � Approved by Mayor for Submission to Council By: DEPMTMENf/OFFICHCOUNCIL DATEINRIATED GREEN SHEE N� 353 LIEP JLicensin INRIAWATE INIiIAWA CAN7ACf PEASON R PHONE O pEpp{iTMEM DIRECTOR O CfTV CAUNCIL Christine Rozek 266-9108 "u'�" OCfTVATfQRNEY �❑CT'CLEqK MUST BE ON CAUNpL AGENDA 8Y (DAT� NUMBER FOR a�� DIflECfOR a FlN. & MGT. SEFVICES DIR. Q ROUTIN6 For hearin : � aa 1 � oEp O� ( � p �� TOTAL # OF SIGNATURE PAGES (CLIp ALL IOCATIONS POR SIGNATURE) � aanoN nEOU�o: Chong Vang DBA Sunny Mini Market & Gas requests Council approval of its application for an Off Sale Malt, Grocery-C, Gas Station, and Cigarette License located at 1530 Sherwood Avenue <ID /640236). RECOMMENDwiloNS: Approva (A) or neject (R) pEHSONAL SERVICE CONTRACTS MUST ANSWER 7XE FOILOWING �UESTIONS: _ PLANNING COMMISSION _ CIVIL SERNCE COMM�SSION �� Has this personlfirm ever worked untler a contrect for this tleparfinent? - _ CIB COMMR7EE _ 1'ES NO _ SiAFF _ 2. 47as ihis personffirm ever been a city employae? YES NO _ Dis7AIC7 COUHi _ 3. Does Mis persoMirm possess a sltill not normalry possessetl by any current city empfoyee? SUPPORTSWHICHCOUNCILOHJEGTiVE9 YES NO Explatn ali yes answers on separete sheet and attaeh to grean sheet INITtATING PROBLEM. ISSUE, OPPORTUNITV (VJtw, NTat, When, Where, Why): R�C�� NOV 2� 1996 C1TY ATT4RNEY ADVANTAGES IFAPPROVED: DISA�VANTAGES IFAPPROVED: ��:..,.r: :°.,. �,.Yt§ f�-l� � � 1:��.7� v ��,, ��,, DISADVANTAGES IF NO7 APPAWED: - TOTAL AMOUNT OF TRANSACTION $ COST/REVENUE BUDGETED (CIRCLE ONE) YES NO FUNDING SOURCE ACTIVITV NUMBER FINANCIAL INFORMATION: (EXPLAIN) (�eensheet # 35384 In Tracker? License ID # 40236 L.I.E.P. REVIEW CHECKLIST Date: 11/14/96 � APP'n Hec:eived / APP'n Processed �,� License Type: Off Sale Malt, Grocery-C, Gas Station. Cigar ta r�a Company Name: Chong Vang DBA: Sunny Mini Market & Gas BusineSS Addresss: 1530 Sherwood Avenue Business Phone: 774-6400 Contact Name/Address: Chong VAng, 721 Sackson St �11, 101 Home Phone: 310-0109 Date to Council Research: Public Hearing Date: � 2 � Notice Sent to Aoolicant: ��/�7�6 Labels Ordered: ��a District Council #: r�C 94/a`, Notice Sent to Public: ��G� �"/ G� Ward #: ( r /1 Department/ Date Inspections Comments City Attorney izzy�� 05� . Environmenial Health 12• 2y �i� f�� - Fire (2•Z�•°l�o p� License Site Plan Received:_ � ��vli „_ _ �`/ . j�� Lease Received: - �.� �.iyw, !�. - a H- 9k ,�,:�.,-, _ rru� Ch a�v�,� N-- '��'�`r 0 � Jc� Police 12 �2�� fJ �{� . Zoning 1 `�� T;�pe CLASS III LICENSE APPLICATION THIS APPLICA7'IOV IS SUBJECT TO REVIE�V BY Tf� PL�BLIC PLEASE TYPE OR PRINT IN L� K Company Tamne: / Sole Propriuorship Strcet Addrus Ciry State Zip Betu�een w�hat cross sveeu is the business ]ocated? Which side of tbe street? /t.� Are tl�e premices now occupied? � A'hat Type of Business? / I C1�-- MailToAddress: �S �J1� Sji�✓'�GP {nd?P /�-E-�. ��'f-�GL-[•�Q �l/�J SS/O�p $veet Address City Stam Zip ApplicantInforma6on: ' . � `�atne and Title: C_'_ Fvst �'� Middle / (Pfaidrn) -` Iatt � Title Home Address �� l �J(� C �.56'� .�T 7� � �7 '�L1 Lt � ��/lf S� � StrxtAddress Ciry Sute Zip � Date of Birch: L D`S � Place of Birth: L-GA—U S Home P600e: c� /�' d��I Have you evet been conricted of any felony, crime or �7olation of any city ordinance other than traffic? YES � NO�, Date of azrest: Charge: _ Convicuon: Senunce: List the names and residences of three persons of good moral chazacter, living wittun the Twin Cities Metro Area, not related to the applicant or financially interested in the premises or business, who may be referred to as to the applicaofs chazacter: NAME � ADDRESS G1 S`� CITY OF SAII�'T PAUL Office o( Licrnse, Inspations and Em•ironmental Proteaion 1<0 A Pea St Suim?00 Saim hW. Nineesah !�12' (61771bbA'SV (u/6II)'_(d-9t2� �a�� PHO:�B List licenses which you currendy ho]d,�foimerly 6eld, or may have an interest in: Hace any of tLe above named licenses evu beeo revoked? _ YES � ATO If yes, list the dates and reasons for revocation: Are you going to opente / �f C � first I�arne , Homc Addrest: Strcet Tame Vd6ere? YES� N�O not, who " operate it? d �K �VI�V va�� l� �� —r' r Ciry State � �/ o� � �y� �, Date of Binh C //� - 7 � �,L-kY`z� 7�p Phone Number �� If business is incorporated, give date of incorporation: Doing Busioess As: Business Phone: '77 �- ��/ Buciness Address: �5�� Sy( � �` - VC ��- >Y- 11 L M/V �-�d.F� . . . . . Ci .o° � A:� you goine to ha�•e a mana�er or asictant in this business? � YES _ 10 If ihe manager is not the same az the operator, p1.. � h� � comple�e.t�e following infoimation: < _ _ � _ , Fcst HomeAddras: Strea�xme �fiddle Ci.y Please list your emplo�ment history for the pre��ious five (�) }•eaz period: Businecs/Err�lgement ,,, Address �tt Date of Binh Sute Zip PFwnet:umber List all other officers of the corpontion: OFFfCEK TTTI,E HOME '�'A'.'� (Oftice Held) ADDRESS HO'�� BUSI:�'ESS DATE OF PHO\ PHO\� BIRTH lf business is a pazmership, please include the following ioformation for each partner (use additional pages if nuessar�'): Fast \arne Hoire Addras: Saea':arne Fvst!:ame Home Addrus: Stred S:ame 14iddle lr�uai Middit Inivai (Maiden) Ciry (Maiden) Ciry l,ast Siate lau Slate Date ot Hinh Zip Phone Number � Dace ot Birth Zip Phoce Number M4\7�'ESOTA TAX IDENTTFiCATiO� I�'CtIvIBER - Pucsuant to the L,aws of Minnesota, 1984, Chapter 502, Article S, Section 2(270.72) (Tax Cleacance; Issuance of Licenses), licensing authorities are required W ptovide to the State of MImesota Commissioner of Revenue, the Mimesota business caz idenaficadoo number and the socia! security number of each license applicant Under the Minnesota Govemment Dafa Practices Act and tLe Federal Privacy pct of 1974, we are required ro advise you of the foliowing regazding tbe use of t6e Minnesota Tax Identification A�umbet: - Tfus infocma600 may be used to deny the issuance or renewai of your license in t6e event you ov.�e h4innesota sales, employei s withholding or motor vehicle excise tazes; - Upon receiving this infoimation, ihe licensing authority will supply it only to t6e Minnesota Depaztment of Revenue. However, under the Federal Ezchange of Information Agreement, the Department of Revenue may supply this informa6on to the Intemal Revence Service. Minnesota Taz Identification Numbers (Sales & Use Tax \'umber) may be obtained from the Stau of Minuesota, Business Recocds Department, ]0 River Pazk Plaza (612-296-6181). Social Security Number. ��C� - J� 0'� C�.SS Minnesota Taz Identifica6on Number: � � � � _ If a Minnesota Taz Idenrification A'umber is not mqu'ued for the business being operated, indicate so by placing au "X" in the boz. ;o�_ ::�,,.:,;-� .. ,-,_ .:- �:-,..-� .- . ;,. . . . CERTIFICATIOV OF VVORKERS' C0:�4PENSA7ION C0�'ERAGE PtRSUA\'I' TO MINA'ESOTA STATUTE 176.182 \ I hereby cenify that I, or my company, azn in compliance w'ith the workets compensation insurance co��eraoe requiremenu of Minnesota Surote 176.IS2, subdi��ision 2. I also understand tbat provision of false information in this certification constitutes su�cient grounds for ad��ese action agaiost all licenses he1d, including revocation� susp of �aid licenses. �"` � �`azne of Insurance Company: ��,P/7/ � ol.-U /''CQILJL- N-� S ^/, �� t° �a 7 Policy Vumber: � Coeerage from I ha��e no employees co��ered under u�orkers compensation iaurance A2rY FAISIFICATION OF A.\SR'ERS GI�'E\ OR'�SATERIAL SGB\'IITTED R`II,L RESULT I\ DE.\'IAL OF THIS APPLICATION I hereby state thaz I 6ave answered all of the preceding questions, and that the informapon contained herein is true and correct to the best of my lcoowledge and belief. I hereby state fiutber that I hace received no money or other consideration, by u�ay of loan, gifr, contribuuon, or o[herwise, otbet than already disclosed in the application a�lvch I herewith submitted. I also understand tUis premise may be inspected by police, fue, health and ot6et ciq� o�cia]s at any and all fimes w•hen the business is in operation. ///3� Signature tiIltED for all appli�tions) Date '*Note: If this application is Food/L,iquor relate� pleue conta; t a Ciry of Saint Paul Healtli Inspector, Steve Olson (266-9139), to review plans. If any substantial changes to swcnue are anticipated, please contaci a City of Saint Paul Plan Ezaminer at 266-9007 w apply for buildiag permits. If there are any changes to the pazking lot, floor space, or for new operarions, please contact a City of Saint Paul Zoning Inspector at266-9008. Additional apptication requirements, please attach: A detailed desviption of the design, location and square footage o[ the premises to be licensed (site plan). The Collowing data should be on the sife ptan (preferably on an 81/2" x 11" or 81l2" s 14" paper): - Name, address, and phone number. - 7'he scaie should be stated such u 1" _?A'. ^N should be indicated towazd the top. - Placement oI all pertinent features of the interior ot the licensed facility such as seating areu, kitchens, oftices, repair area, parlcing, rest rootns, etc - If a request 3s for an addition or expansion of the Gcensed facility, indinte both the current area and the praposed expansion A copy of your fease agreement or proo[ oC orrnership of the propecty. FOR SPECIFIC APPLICATION REQUIREAIE:�'TS, PLEASE SEE REVERSE >>>> Council File � � Ordinance # Green Sheet � �✓ � � Presented By _"P + Referred To RESOLUTION C1TY OF SAINT PAUL, MINNESOTA ',\� ti Committee: Date i 2 3 RESOLVED: That application (ID #40236) £or an Off Sale Malt, Grocery-C, Gas Station, and Cigarette License by Chong Vang DAB Sunny Muri Market & Gas (Chong Vang, Owner) at 1530 Sherwood Avenue be and the same is hereby a�proved. 4 5 Requested by Department of: 6 Yeas. Navs sen 7 B a e ,y' ' ' 8 �n r� 9 � Harr.z � � 10 �M��e �a_�rd 11 Re t� man � 12 Thune � 13 Bostrom � is � � 16 Adopted by Council: Date .'�.a 17 18 Adoption Certified by Council Secretary 19 20 21 BYc -._., �- . ��_�„_ . 22 23 Approved by Mayor: Date Z� � 24 ZS `� � 26 By: 27 Office of License. Inspections and Environmental Protection B ��'�� fl ,��u-� Form Approved by City Attorney By: �/v7 4livt,G�i— �\J � Approved by Mayor for Submission to Council By: DEPMTMENf/OFFICHCOUNCIL DATEINRIATED GREEN SHEE N� 353 LIEP JLicensin INRIAWATE INIiIAWA CAN7ACf PEASON R PHONE O pEpp{iTMEM DIRECTOR O CfTV CAUNCIL Christine Rozek 266-9108 "u'�" OCfTVATfQRNEY �❑CT'CLEqK MUST BE ON CAUNpL AGENDA 8Y (DAT� NUMBER FOR a�� DIflECfOR a FlN. & MGT. SEFVICES DIR. Q ROUTIN6 For hearin : � aa 1 � oEp O� ( � p �� TOTAL # OF SIGNATURE PAGES (CLIp ALL IOCATIONS POR SIGNATURE) � aanoN nEOU�o: Chong Vang DBA Sunny Mini Market & Gas requests Council approval of its application for an Off Sale Malt, Grocery-C, Gas Station, and Cigarette License located at 1530 Sherwood Avenue <ID /640236). RECOMMENDwiloNS: Approva (A) or neject (R) pEHSONAL SERVICE CONTRACTS MUST ANSWER 7XE FOILOWING �UESTIONS: _ PLANNING COMMISSION _ CIVIL SERNCE COMM�SSION �� Has this personlfirm ever worked untler a contrect for this tleparfinent? - _ CIB COMMR7EE _ 1'ES NO _ SiAFF _ 2. 47as ihis personffirm ever been a city employae? YES NO _ Dis7AIC7 COUHi _ 3. Does Mis persoMirm possess a sltill not normalry possessetl by any current city empfoyee? SUPPORTSWHICHCOUNCILOHJEGTiVE9 YES NO Explatn ali yes answers on separete sheet and attaeh to grean sheet INITtATING PROBLEM. ISSUE, OPPORTUNITV (VJtw, NTat, When, Where, Why): R�C�� NOV 2� 1996 C1TY ATT4RNEY ADVANTAGES IFAPPROVED: DISA�VANTAGES IFAPPROVED: ��:..,.r: :°.,. �,.Yt§ f�-l� � � 1:��.7� v ��,, ��,, DISADVANTAGES IF NO7 APPAWED: - TOTAL AMOUNT OF TRANSACTION $ COST/REVENUE BUDGETED (CIRCLE ONE) YES NO FUNDING SOURCE ACTIVITV NUMBER FINANCIAL INFORMATION: (EXPLAIN) (�eensheet # 35384 In Tracker? License ID # 40236 L.I.E.P. REVIEW CHECKLIST Date: 11/14/96 � APP'n Hec:eived / APP'n Processed �,� License Type: Off Sale Malt, Grocery-C, Gas Station. Cigar ta r�a Company Name: Chong Vang DBA: Sunny Mini Market & Gas BusineSS Addresss: 1530 Sherwood Avenue Business Phone: 774-6400 Contact Name/Address: Chong VAng, 721 Sackson St �11, 101 Home Phone: 310-0109 Date to Council Research: Public Hearing Date: � 2 � Notice Sent to Aoolicant: ��/�7�6 Labels Ordered: ��a District Council #: r�C 94/a`, Notice Sent to Public: ��G� �"/ G� Ward #: ( r /1 Department/ Date Inspections Comments City Attorney izzy�� 05� . Environmenial Health 12• 2y �i� f�� - Fire (2•Z�•°l�o p� License Site Plan Received:_ � ��vli „_ _ �`/ . j�� Lease Received: - �.� �.iyw, !�. - a H- 9k ,�,:�.,-, _ rru� Ch a�v�,� N-- '��'�`r 0 � Jc� Police 12 �2�� fJ �{� . Zoning 1 `�� T;�pe CLASS III LICENSE APPLICATION THIS APPLICA7'IOV IS SUBJECT TO REVIE�V BY Tf� PL�BLIC PLEASE TYPE OR PRINT IN L� K Company Tamne: / Sole Propriuorship Strcet Addrus Ciry State Zip Betu�een w�hat cross sveeu is the business ]ocated? Which side of tbe street? /t.� Are tl�e premices now occupied? � A'hat Type of Business? / I C1�-- MailToAddress: �S �J1� Sji�✓'�GP {nd?P /�-E-�. ��'f-�GL-[•�Q �l/�J SS/O�p $veet Address City Stam Zip ApplicantInforma6on: ' . � `�atne and Title: C_'_ Fvst �'� Middle / (Pfaidrn) -` Iatt � Title Home Address �� l �J(� C �.56'� .�T 7� � �7 '�L1 Lt � ��/lf S� � StrxtAddress Ciry Sute Zip � Date of Birch: L D`S � Place of Birth: L-GA—U S Home P600e: c� /�' d��I Have you evet been conricted of any felony, crime or �7olation of any city ordinance other than traffic? YES � NO�, Date of azrest: Charge: _ Convicuon: Senunce: List the names and residences of three persons of good moral chazacter, living wittun the Twin Cities Metro Area, not related to the applicant or financially interested in the premises or business, who may be referred to as to the applicaofs chazacter: NAME � ADDRESS G1 S`� CITY OF SAII�'T PAUL Office o( Licrnse, Inspations and Em•ironmental Proteaion 1<0 A Pea St Suim?00 Saim hW. Nineesah !�12' (61771bbA'SV (u/6II)'_(d-9t2� �a�� PHO:�B List licenses which you currendy ho]d,�foimerly 6eld, or may have an interest in: Hace any of tLe above named licenses evu beeo revoked? _ YES � ATO If yes, list the dates and reasons for revocation: Are you going to opente / �f C � first I�arne , Homc Addrest: Strcet Tame Vd6ere? YES� N�O not, who " operate it? d �K �VI�V va�� l� �� —r' r Ciry State � �/ o� � �y� �, Date of Binh C //� - 7 � �,L-kY`z� 7�p Phone Number �� If business is incorporated, give date of incorporation: Doing Busioess As: Business Phone: '77 �- ��/ Buciness Address: �5�� Sy( � �` - VC ��- >Y- 11 L M/V �-�d.F� . . . . . Ci .o° � A:� you goine to ha�•e a mana�er or asictant in this business? � YES _ 10 If ihe manager is not the same az the operator, p1.. � h� � comple�e.t�e following infoimation: < _ _ � _ , Fcst HomeAddras: Strea�xme �fiddle Ci.y Please list your emplo�ment history for the pre��ious five (�) }•eaz period: Businecs/Err�lgement ,,, Address �tt Date of Binh Sute Zip PFwnet:umber List all other officers of the corpontion: OFFfCEK TTTI,E HOME '�'A'.'� (Oftice Held) ADDRESS HO'�� BUSI:�'ESS DATE OF PHO\ PHO\� BIRTH lf business is a pazmership, please include the following ioformation for each partner (use additional pages if nuessar�'): Fast \arne Hoire Addras: Saea':arne Fvst!:ame Home Addrus: Stred S:ame 14iddle lr�uai Middit Inivai (Maiden) Ciry (Maiden) Ciry l,ast Siate lau Slate Date ot Hinh Zip Phone Number � Dace ot Birth Zip Phoce Number M4\7�'ESOTA TAX IDENTTFiCATiO� I�'CtIvIBER - Pucsuant to the L,aws of Minnesota, 1984, Chapter 502, Article S, Section 2(270.72) (Tax Cleacance; Issuance of Licenses), licensing authorities are required W ptovide to the State of MImesota Commissioner of Revenue, the Mimesota business caz idenaficadoo number and the socia! security number of each license applicant Under the Minnesota Govemment Dafa Practices Act and tLe Federal Privacy pct of 1974, we are required ro advise you of the foliowing regazding tbe use of t6e Minnesota Tax Identification A�umbet: - Tfus infocma600 may be used to deny the issuance or renewai of your license in t6e event you ov.�e h4innesota sales, employei s withholding or motor vehicle excise tazes; - Upon receiving this infoimation, ihe licensing authority will supply it only to t6e Minnesota Depaztment of Revenue. However, under the Federal Ezchange of Information Agreement, the Department of Revenue may supply this informa6on to the Intemal Revence Service. Minnesota Taz Identification Numbers (Sales & Use Tax \'umber) may be obtained from the Stau of Minuesota, Business Recocds Department, ]0 River Pazk Plaza (612-296-6181). Social Security Number. ��C� - J� 0'� C�.SS Minnesota Taz Identifica6on Number: � � � � _ If a Minnesota Taz Idenrification A'umber is not mqu'ued for the business being operated, indicate so by placing au "X" in the boz. ;o�_ ::�,,.:,;-� .. ,-,_ .:- �:-,..-� .- . ;,. . . . CERTIFICATIOV OF VVORKERS' C0:�4PENSA7ION C0�'ERAGE PtRSUA\'I' TO MINA'ESOTA STATUTE 176.182 \ I hereby cenify that I, or my company, azn in compliance w'ith the workets compensation insurance co��eraoe requiremenu of Minnesota Surote 176.IS2, subdi��ision 2. I also understand tbat provision of false information in this certification constitutes su�cient grounds for ad��ese action agaiost all licenses he1d, including revocation� susp of �aid licenses. �"` � �`azne of Insurance Company: ��,P/7/ � ol.-U /''CQILJL- N-� S ^/, �� t° �a 7 Policy Vumber: � Coeerage from I ha��e no employees co��ered under u�orkers compensation iaurance A2rY FAISIFICATION OF A.\SR'ERS GI�'E\ OR'�SATERIAL SGB\'IITTED R`II,L RESULT I\ DE.\'IAL OF THIS APPLICATION I hereby state thaz I 6ave answered all of the preceding questions, and that the informapon contained herein is true and correct to the best of my lcoowledge and belief. I hereby state fiutber that I hace received no money or other consideration, by u�ay of loan, gifr, contribuuon, or o[herwise, otbet than already disclosed in the application a�lvch I herewith submitted. I also understand tUis premise may be inspected by police, fue, health and ot6et ciq� o�cia]s at any and all fimes w•hen the business is in operation. ///3� Signature tiIltED for all appli�tions) Date '*Note: If this application is Food/L,iquor relate� pleue conta; t a Ciry of Saint Paul Healtli Inspector, Steve Olson (266-9139), to review plans. If any substantial changes to swcnue are anticipated, please contaci a City of Saint Paul Plan Ezaminer at 266-9007 w apply for buildiag permits. If there are any changes to the pazking lot, floor space, or for new operarions, please contact a City of Saint Paul Zoning Inspector at266-9008. Additional apptication requirements, please attach: A detailed desviption of the design, location and square footage o[ the premises to be licensed (site plan). The Collowing data should be on the sife ptan (preferably on an 81/2" x 11" or 81l2" s 14" paper): - Name, address, and phone number. - 7'he scaie should be stated such u 1" _?A'. ^N should be indicated towazd the top. - Placement oI all pertinent features of the interior ot the licensed facility such as seating areu, kitchens, oftices, repair area, parlcing, rest rootns, etc - If a request 3s for an addition or expansion of the Gcensed facility, indinte both the current area and the praposed expansion A copy of your fease agreement or proo[ oC orrnership of the propecty. FOR SPECIFIC APPLICATION REQUIREAIE:�'TS, PLEASE SEE REVERSE >>>>