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97-584Council File # , S�y ordinance # Green Sheet # �� , � RESOLUTION SAINT PAUL, MINNESOTA Presented By 1 RESOLVED: That application (ID #22876) for a Liquor On Sale-B, Sunday On Sale Liquor, Entertaiament B, 2 Restaurant-B, and Cigarette License by Grand American Restawant Compazry DBA The Wild 3 Onion (Joseph Schaefer, President) at 788 Grand Avenue be and the same is hereby approved. 4 5 Requeated by Department of: 6 Yeas Navs Absent 7 a a� 8 Bostrom Off+'ce of License. Inspections and 9 Harris - 10 Me a� • Environmental Protect�on 12 T vn � 14 �� ''-�,. �i � n n 15 B 1�Ah�a�L�tR.I TT ''"`l� 16 Adppted by Council: Date L °`� - 17 18 Adoption Ceztified by Council Se etary 19 Form Approved by City Attorney 20 21 BY � �� a- .�:�v�.� `�/ r J� a..0�-v�s 22 // / BY� �fsQ�i��-GGL '� 23 Approved by Mayor: Date �1 �2C ��" � 24 25 Approved by Mayor for Submission to 26 BY. -�'__i�� Council 27 By: _ _ �,�t-sg�{ oePaatenErrrroF�+c�courica� on� u�mn'cEO �� 3 5 312 LIEP Li�ensln GREEN SHEE _ _ . _ _ CONTACT PERSON 8 PHONE INRIAVDATE INITIA4IDATE O DEPARTMENi DIRECTOR O CRY CAUNCIL i tine Rozek 266-9108 "��" � cmnrroaNer � anc�nK MUST BE ON COUNCIL AGENOA 8Y (��1 N ❑�� pIRECTO ' O FIN. A MGi SERYICES Dl43. � a sl �� ORDER O MpYOR (OR ASSISfANn ❑ TOTAL # OF SIGNATURE PAGES (CLIP ALL LOCA710NS FOR SIGNATURE) pCiION REQUESTED: • Grand American Restaurant Company DBA Grand American Restaurant Company requests Council approval on its application for a Liquor On Sale-B, Sunday On Sale Liquox, Entertainment-B, Restaurant-B, and Cigarette License at 788 Grand Avenue (ID 4�22876). qECAMMEwDA510NS: App�we (A) rn Aajact (p) pERSONAL SERVICE CONTRACTS MUST ANSWER THE POLLOWING QUESTIONS: _ _ PIANNNlG COMMISSION _ CfVIL SEAVICE CAMMISSION t. H&S ihi5 per50n/fvm eV2r worked untler a COMIeCt for this dep3rtm8M? � _ CIB COMMfi7EE _ �'ES NO _ STAFF ' _ 2. Has ihi5 perSOnAirm ever been a c�ty employee? VES NO � DISTRICi CAUR7 — 3. Does this person/Firm possess a skill not nortnally possessetl by any curreM ciry employee? SUPPOATS WNfCH COUtiCiL OBJECi7VE1 YES P10 , Explain ell yes anawers on seperate sheet and attach to green sheet INITIATING PROBLEM, ISSUE, OPP4lRNNITY (VJiw. What. When, YMere, Why): �RE��I��l�� o �� C�TY A�'TORNEY A�VANTAGESIFAPPROVED: � DISADVANTAGES IFAPPROVED: G� �',.3�°^aq� �i�z�*SP AFR 21 1�� --__.—_,. DISADVAPfTAGES IF NOT APPROVED: • TOTAL AMOUNT OF iRANSACTION S COST/REVENUE BUDOETED (CIRCLE ONE) YES NO FUNDIHG SOUACE ACTIYITY NUMBER FINANCIAL INFOflMAT10N: (EXPLAIN) Council File # ordinance ,$ Green Sheet ,# �`�`�" :� �� E�-. / Presented By Referred To i RESOLVED: z 3 4 5 6 7 8 B a e�� - 9 Bostrom 10 Harris _ 11 � Me a _ 12 Re t� man 13 Thane 14 15 - 16 17 Adopted by Coun il 18 19 Adoption Cer,ified 20 � 21 / zz sy: j 23 24 Approved by Mayor: 25 26 l 2� By: 28 PAUL, MINNESOTA Committee;/ Date ��-s�`1 That application (ID #22876) for a Liquor On Sale-B, Sunday Sale Liquor, Entertainment-B, Restaurant-B, and Cigazette License by Grand American urant Company DBA Grand American Restaurant Company (Joseph Schaefer, Presid t) at 788 Grand Avenue be and the same is hereby approved Requested by Department of: • - - t - s-� •a- � —�ii—� - .� �uui - �--,��-�- . Date B y' � � by Council Secretary Date For[n Approved by City Attorney B �� Approved by Mayor for Submission to Council By: Greensheet # 35312 In Tracker? License ID # 2287b Company L.I.E.P. REVIEW CHECKLIST Date:3-18-97 L�`� � App'n Received / App'n Processed License staurant-B, Cigarette License oanv A: cama Business Addresss: 788 Grand Avenue Business Phone: �r19-4772 Contact Name/Address: Josenh Schaefer. 1889 xunter Lane HOme PhonB: 686-6803 Date to Council Pubfic Hearing Notice Sent to a/ Labels Ordered: � - 17 - � � Distcict Council #: 1 �� 'yac ia[i a.a Notice Sent to Public: �� Ward #: ,� DepartmentJ Date inspections Comments Ciry Attorney 3•Z�-•9� �•� Environmental Health � • /�f •9a- o•-� . Fire �`2� g�- �•K License Site Plan Received:, Lease Received: �F�l � f �� Police 3�2� 9 � �.�- . Zoning �• 2� •`��- D.� • �-s CLASS ITI LICENSE APPLICATION o ueY PLEASE TYPE OR PRINP IN R�K Type of License(s) beiag applied for: ��q 4 er - O �ic2�t CITY OF SAINT PAUL ofi;« urLice�uq Insvec��ons ana Ea.�ronsnanat Protect��n 350 SL Pelc SC Swfe 300 SainiPeW,llmnecv 55102 (617)I669�U fix(b1�2669134 Res�'a�ra,nf (6� ' tsa f�i4•, /2.s�afs S GN�I✓' rQ�N !ft �✓it ' ��453 � .S �u �a Oh Sa�p ��o.o✓ $ � Company Nazne: u ra n a - H+..� z,� � c� y _ Corporation / PaMenhip / Sole Proprietaship If business is incorporated, give date of incorporation: X Doing Business As: Business Address: Business SireetAddnsa � Oh �ir4h(� b¢-Ffr4pyjCity V ' Slete Zip THIS APPLICATION IS SUBSECT TO REVIEW BY TIIE PUBLIC Betw�een u�hat cross streets is the business located7 f� ✓ e ti a� h� G r e� f v Which side of the street? a w�" �i Are the premises now occupied7 �ec What Type of Business? �J4+ e 5�44.nn �, � �� v oa s�u � o a �+ra �� Mail To Address: 6 0S Sq�-c �� ff �'rc l2 ,/�f ��o'f v ye�.��'S __ Mh • SS// � Strcel Address Applicaut Information: 2vTame and TiUe: J n o.H Fi�t Home Address: � �S _ J� (Meidat) �irt � F�Fb .^n -7-9 City State Zip .�q/ry�Q,N Sec. Lsst Title DateofBirth: /�• `1- yFl PlaceofSirth:l+�Nnea !"1y • Hzve you ever been com�icted of any felony, crime or violalion of any city ordinance other than traffic. Daie of arrest: Chazge: _ Convictiou: Sentence: � 51ete Zip HomePhone:(�O/� ' g�$� 7 YES _ NO Lisl the names and tesidences of three persons of good moral character, living within the Twin Cities MeVO Area, not related to the applicant or financially interested in the premises or business, who may be referred to as to the applicanYs character: NAME ADDRESS PHONE ��1 /'ie�� 3oNovc( Cr'vc% 2�/..Narf�oaks Ma. SS�17 yr�y Boh�;a- I✓,Ik=wS l�s� kq+vl �/. �Por��•/�e M�, sS'/i3 �ISf9- (. c.r✓Y We�f��e�„� I?S M l}�e. So. . Go(ri.e.. Vs�fe,,. 1�1.,.SSY.�b SY�-93ss6 List licenses which you currently hold, foimerly he3d, or may have an a�terest in: Have any ot thb above nazned licenses evec bcen revoked7 YES _�_ NO Ifyes, list the dates and reasons for revocation: Where? 2/18/97 Aze you going to operate tlus busin ss personally? � YES NO 0�4�it¢v ' e�Rn� 7 'te5f'a�..v4ht C :.yddle HrnxAddrda: Street\ame Are }rou going to hai•e a manager ar_assistant in this business? please complete ihe following information: X 7�1�0�,�-� S. I,� IG-L! �cr.� _ t.�am�v�;sd , HameAdd`ens: Sheet:�ame (Slaiaen) c�^ �°�-a N � �$ rv� s a�� oU City Please list your emplo}went history for the pre�rious five (5) yeaz period; Business/Emplovment Address �dS/ S,' [� SEatc u�c� �� ,.. it? �w� fh o�kew 6 �'' Dar<ursinh \ �SS//8' ��la)dSS6-6$o3 � Zip Phone\umbcr NO If the manager is not the sazne as the operator, I,ssc Sta4 `9 :��-/��' Date of Buth � � S n7� /��7��5�73 Zip Phone \imbcr e �. / � /�w. Mey�v� S/18' ( 1991 fi„ra-Se,�f� i _ � /�1H .SSS'o� � � 19 9 3� �v ese�,f � � List all other officers of the corporation: OFFICER TITLE HOME HOME BUSINESS DATE OF NAME (Office Held) ADDRESS PH01dE PHONE BIRTH Jd��l� Sc(�ae�e� Pres. ls'�5 � ��-�✓ �4Ne (6«�6��-b�o3 G/?)95/-n/6o 6 '��5v If busine� is a partnership, piease include the folloµing information for each partner (use additional pages if necessary): Fintl�eme Middlelnitial (Maidrn) Laat DatcoCHiM Home Ad�esa: Strat I�ame City Siste Zip Phonc 2lumba' Middle Initiet (�faidrn) Laa Date � 1-Iome Add�see: Stmt 2�ame � City SUte Zip Phone ISumber MINNESOTA TAX II?ENTIFICA7ION NUMBER - Pursuant to the Laa�s of Minnesota, 1984, Chapter 502, Article 8, Section 2(270J2) (Ta� Clearance; Issuance of Licenses), licensing authorities are required to provide to the State of Minnesota Commissioner of Revenue, the Minnesota business ta�c identification nwnber and the socia] security number of each ]icense applicanL Under tbe Minnesots Govemment Data Praclices Act and the Federal Privacy Act of 1974, we are required to advise you of the following regarding the use of the Minnesota Tax Ident�cation Number: - This infotmation may be used to deny the issuance or renewal of your license in the event you ow�e Minnesota sales, employer s withholding or motor vehicle excise taxes; - L7pon receiving this informatioq the licensing authority wiIl supply it only to the Minnesota Department of Revenue. However, under the Fe3eral Exchange of Information A�eement, the Departmrnt of Revenue may supp3y t}ris infoimation to the Intemal Revenue Sen7ce, Mumesots Tax Identi5cation Numbers (SaIes & Use Tax Number) may be obtained fiom the State of Minnesota, Business Records Departmen; 10 Ri��ec Park Plaza (612-296-6181 }. 5ocial Security Number: j 'I �`1 .S ff - S$ 6 C � Ivlinnesota rax Identification Number: Y I r I �( n ��_ _ If a Minnesota Tax Identification Number is not required for the business being operated, indicate so by placing an"X" in the box. 2l7 8'97 '�CER;IFICATION OF WORKERS' COMPENSA7ION COVEI2AGE PURSUANT TO MINNESOTA STATUTE 176.182 I `"1 �`� 0� �' I hereb}� certif} that I, or m}• compazry, arn in compliance u7th the �vorkers' wmpensation inswance cocerage requirements of Minnesota Statute /' 776 subdi�ision 2. I also understand that pro�ision of falx information in ihis ceRification constitutes s�cient grounds for ad�•erse action agamst all licenses held, including recocation and suspension of said licenses. Name of Insurance C,ompany: Polic� Number: - Co�� j e� from I ha��e no emplo}'ees cocered under urorkers compensation insurance� �� (R�TITIALS) ANY FALSIFICATION OF ANSWERS GNEN OR MATERIAL SUBMITTED W ILL RESULT IN DENL4L OF THIS APPtICATION 1 hereby state that I have ansa ered all of the preceding questions, and that the information contained herein is U and correct to the best of my knowledge and belief. I hereby state further that I have receiced no money or other consideration, by u ay of loan, gift, contributiott, or othernise, other than already disclosed in the appGcation w�hich I hereaith submitted I also understand this premise may be inspected by police, fire, heallh and other cit}• officials at any and all times u-hen the business is in operation. � Signature -17-9� Datc for all applications) We aill accept payment bc cash, c6eck (made payable to Cit�• of Saint Paun or credit card (MIC or V isa). IFPAYINGBYCREDITCARDPLEASECOMPLETETHEFOLLON'INGItVFOItb1ATION: �MasterCard � Visa EXPIRATION DATE: ACCOUNT NUMBER: ❑�/L7❑ ❑��❑ ❑00❑ ❑C1[�❑ ❑C]C7❑ of Cardholder *•Note: ]f this application is Foodll,iquor related, please contact a City of Saint Paul Health tnspector, Steve Olson (266-9139), to review plans. ff any substantial changes to sWcture are anticipated, please contact a City of Saint Paul Plan Erazniner at 266-9007 to apply for building pemvu. Ifthere are azry• changes to the puking lot, floor space, or for new operations, please contact a City of Saint Paul Zoning Inspector at 266-9008. All appGcations require t6e followiag documents. Please attach these documents afien submitting your application: 1. A detailed description of the design, location and square footage of the premises to be licensed (site plan). The following data should be on the site plan (preferably on an 8 1/2" x 11" or 8 I/2" x 14" paperj: - Neme, address, and phone number. -'3'he scale should be stated such as t" = 20`. ^N should be indicated towazd the top. - Placement of aIl pertinent features of the interior of the licensed faciliTy such as seating azeas, kitchens, offices, repaic azea, parking, rest rooms, etc. - Tf a request is for an addiGon or eapansion of the licensed facility, indicate both the current azea and the proposed eapansion. 2. A copy of your lease agreemrnt or proof of oNmerslup of the property. SPECIFIC LICENSE APPLICATIONS REQITIRE ADDTTIONAL INFORNiATION. PLEASE SEE REVERSE FQR DETAILS >>>> zn sr�� .� CLASS III LICENSE APPLTCATION PLEASE TYPE OR PRINl' IN INK T}pe of License(s) being applied for: Company Neme: Corporation / Paztnetsttip! Sok Proprietonirip If 6usiness is Doing Business As: Business Address: ( CITY OF SAINT PAUL �ce of Licrnsq Inspec[ions and Emvomnrntal Proteclion 3511 SL Pet¢ St Surtc 300 5�[P�v�\fymescu SSlU2 (613)1669090 fax(61])366913< give date of incorporation: rn/�-�L. —� ' % 7 > � �2 ! A/ Business Phone: �/ Z - C ��- �I7�z �I �i5�(�cr h��r�r�b�zf�� l wy_ �ct?u�crt� /-�� ,�N� ss�r�' Ben+�een what cross streets is the business located? Are the premises now occupied7 � Wha Mai] To Address: ApplicantInfomiation: / // C � /�� / Nazne and Title: _ �6 � �C P �7 �� /�`�-�� (� � J(�/%/"J('l� c/L ��.f"S (� , � (Maiden) I,ait Title `� Home Address: � t �(3 � ��1 R/ ( �-l2 �/Q/U '�f G�t n,��a�Ti�- �/bIS ��'J �.5 �� f� s,n�c naa� ct�y sm�� zsp � Date of Birth: — �S C) Place of Birth: S�• ./�U L hi ( N'v Home Phon�e: / �71 Z '�� 3 Ha��e you e�•er been com•icted of any felony, crime or ti�olation of azry city ordinance other than traffic? YES �% NO �' Date of arrest; ��T tL �ll rJ Vlhere� C1,a�ge: ��h. -Q/a l�in1 f� n n� i�z � nzL�� r>,� f!'-1 b G/a-T� ,� n1 Com�clion: Sentence: Lisi the narnes and residences of ttuce persons of good moral chazacter, ]iving within the Twin Cities Metro Area, not related to the applicant or financially interested in the premises or business, who may be refe[red to as to the applicanPs character: I��ui� ADDRESS Have any of ihe above named licenses ever been PHONE YES �_ NO If yes, list the dates and reasons for revocation: 2/18t97 so-ae naa� c�ry smm z�p List li s which you c�urendy hold, forcnerly held, or a�ave an interest'vt: L��lo2_ �—tc-�,cJCr� .��i�,rr.�rin�,cr�/l��,t�S�>' THIS APPLICATION 1S SUBJECT TO REVIEW BY TF� PUBLIC , �w � �� A:e pou going to operate this business personally? YES NO ff no� ��ho will operate it7 G� �—$ �� - First Name \tiddic Initiil (\fnidrn) 1.ut Dete of B'vih � �3 N � If business is a parhtiership, please include the following infoimation For each partnet (use additional pages if necessary): F'urt 7�ame Middle Ltitial , (Mniden) Leat Date olBirth NomeA�drsss: St�mtN�e Fi�st7�ame � 9� Home Addreer. Street Middic Initinl City @7ai8rn) c�Ty 8ate Zip I.aa Stete Zip Phone Number Dau of SirtF� �IO�IC MINI�IESOTA TAX IDENI IFICATION NUMBER - Pursuant to the Laws of Minneso[� 1984, Chapter 502, Article 8, Section 2(270.72) (Tar Ctearance; Issuance of Licenses), licensing authorities are required to provide ro the State of Minnesota Comtnissioner of Revenue, the Minnesota business tax identification number and the social securiry number of each license applicant. Under the Minnesota Goveaunent Data Practices Act and the Federal Privacy Act of 1974, we are required to advise you of the following regazding the use of the Minnesota Tax Identification Number: - This information may be used to deny the issuance or renewal of yow license in the event you owe Minnesota sales, emptoyei s witUholding or motor vehicle excise taxes; - Upon receiving this information, the licensing authority will supply it only to the Mim�esota Department of Revenue. However, under the Federal Exchange of Information Agreement, the Departrnrnt of Revrnue may supply this informalion to the Intemal Revenve Sen�ice. Minnesota Ta�c Identification Numbers (Sales & iJse Tax Number) may be obtained 5om the State of Minnesota, Business Records Departrnent, 10 River Park Plaza (612-296-6181). Sociat S�uciry Number: � 7�`S � D 9/ O Minnesota Tax Identification Number: �f l� l�� C � G� _ If a Minnesote Tax Idrnt�cation Number is not required for the business being operated, indicate so by placing an "X" in the box. 2l18J97 Home Add�ec Stcect \ame Cih• / Sfatc Zip Phone N�unber Are }'ou going to ha��e a manzger or.assistant in this business7 ✓ YES NO ff the manager is not the sazne as the operator, please complete the following information: , Please list your emplo}ment history for the previous five (5) }�eaz period: List all other officers of the cocporation: OFFICER TITLE HOME HOME BUSINESS AATE OF NAMR (nffice Heldl A17DRESS PHONE PHONE BIRTH �� CERTIFICATION OF WORKERS' COMPENSATION CO VERAGE PURSUAN'C IO MINNESOTA STANTE 176.182 ' 1 � s o� I hereby certify that I, or my company, am in compliance with the �corkers' compensation insurance coverage requirements of Minnesota Statute ] 76. ] 82, subdi�RSion 2. I also understand that pro�ision of false infrnmation in this certitication constitutes sufficient grounds for ad�•erse action against al] licenses held, including revocalion and suspension of said licenses. Nazne of Insurance Company: Policy Number: Coverage from to I have no emplocees co��ered under workers compensation insurance (II3ITIALS) ANY FALSIFICATION OF ANSR'ERS GIVEN OR MATERL�L SUBMITTED WILL RESULT IN DENIAL OF TFIIS APPLICATION I hereby state that I have az�swered all of the preceding questions, and that the information contained herein is we and correct to ihe best of my knowledge and belief. I hereby state fwther ihat I have received no money or other consideratioq by way of loan, gift, conh or othenvise, ot6er than already disc]osed in the application w�hich I herewith submitted I also understand this premise may be inspected by police, fire, health and other ciry officials at any and all times when the busines is in operation. Signature (�QUIItEb for a11 We ni[I accept pa}�ment 6�• cas6, check (made payable to City of Saint Pauij or credit card (M/C or Visa). �=�?" F � Datc IF PAYTNG BY CREDIT CAftD PLEASE COMPLETE THF FOLLO N'ING INFORMATION: � MasierCard � Visa EXPII2ATION DATE: � � � � ACCOUNtNUMBER: � � � � � � � � � � � � � � � � I Da[e ""Note: If this application is Food/Liquor related, please contact a City of Saint Paul Health Inspector, Steve Olsou (266-9139), to re��ew plans. If any substantial changes to strvcture are anticipated, please contact a Ciry of 5aint Paul Plan Examiner at 266-9007 to applp for building pertnits. If there are any changes to the pazking lot, floor space, or for new operations, please contact a City of Saint Paul Zoning Inspector at 266-9008. Atl applications require the foliowing documents. Please attach these documents w'hen submitting ?�our application: 1. A detailed descriplion of the desigq localion and square footage of the premises to be licensed (site plan). The fotlowing data should be on the site plan (preferably on an 8 I/Z" x 11" or 8 1/Z" x 14" paper): - Name, address, and phone number. - The scale should be stated such as 1" = 20'. ^N should be indicated towazd the top. - Placement of all petinent features of the interior of the licensed facility such as seating areas, kitchrns, offices, repair area, pazking, resi rooms, ete. - Tf a request is for an addition or expansion of the licensed faciliry, indicate both the currrnt area and the proposed expansion. 2. A wpy of your lease agreement or proof of owrership of the properiy. SPECIFIC LICENSE APPLICATIONS REQUIItE ADDTTIONAL INFORMATION. PLEASE SEE REVERSE FOR DETAILS >>>> 2/18797 Council File # , S�y ordinance # Green Sheet # �� , � RESOLUTION SAINT PAUL, MINNESOTA Presented By 1 RESOLVED: That application (ID #22876) for a Liquor On Sale-B, Sunday On Sale Liquor, Entertaiament B, 2 Restaurant-B, and Cigarette License by Grand American Restawant Compazry DBA The Wild 3 Onion (Joseph Schaefer, President) at 788 Grand Avenue be and the same is hereby approved. 4 5 Requeated by Department of: 6 Yeas Navs Absent 7 a a� 8 Bostrom Off+'ce of License. Inspections and 9 Harris - 10 Me a� • Environmental Protect�on 12 T vn � 14 �� ''-�,. �i � n n 15 B 1�Ah�a�L�tR.I TT ''"`l� 16 Adppted by Council: Date L °`� - 17 18 Adoption Ceztified by Council Se etary 19 Form Approved by City Attorney 20 21 BY � �� a- .�:�v�.� `�/ r J� a..0�-v�s 22 // / BY� �fsQ�i��-GGL '� 23 Approved by Mayor: Date �1 �2C ��" � 24 25 Approved by Mayor for Submission to 26 BY. -�'__i�� Council 27 By: _ _ �,�t-sg�{ oePaatenErrrroF�+c�courica� on� u�mn'cEO �� 3 5 312 LIEP Li�ensln GREEN SHEE _ _ . _ _ CONTACT PERSON 8 PHONE INRIAVDATE INITIA4IDATE O DEPARTMENi DIRECTOR O CRY CAUNCIL i tine Rozek 266-9108 "��" � cmnrroaNer � anc�nK MUST BE ON COUNCIL AGENOA 8Y (��1 N ❑�� pIRECTO ' O FIN. A MGi SERYICES Dl43. � a sl �� ORDER O MpYOR (OR ASSISfANn ❑ TOTAL # OF SIGNATURE PAGES (CLIP ALL LOCA710NS FOR SIGNATURE) pCiION REQUESTED: • Grand American Restaurant Company DBA Grand American Restaurant Company requests Council approval on its application for a Liquor On Sale-B, Sunday On Sale Liquox, Entertainment-B, Restaurant-B, and Cigarette License at 788 Grand Avenue (ID 4�22876). qECAMMEwDA510NS: App�we (A) rn Aajact (p) pERSONAL SERVICE CONTRACTS MUST ANSWER THE POLLOWING QUESTIONS: _ _ PIANNNlG COMMISSION _ CfVIL SEAVICE CAMMISSION t. H&S ihi5 per50n/fvm eV2r worked untler a COMIeCt for this dep3rtm8M? � _ CIB COMMfi7EE _ �'ES NO _ STAFF ' _ 2. Has ihi5 perSOnAirm ever been a c�ty employee? VES NO � DISTRICi CAUR7 — 3. Does this person/Firm possess a skill not nortnally possessetl by any curreM ciry employee? SUPPOATS WNfCH COUtiCiL OBJECi7VE1 YES P10 , Explain ell yes anawers on seperate sheet and attach to green sheet INITIATING PROBLEM, ISSUE, OPP4lRNNITY (VJiw. What. When, YMere, Why): �RE��I��l�� o �� C�TY A�'TORNEY A�VANTAGESIFAPPROVED: � DISADVANTAGES IFAPPROVED: G� �',.3�°^aq� �i�z�*SP AFR 21 1�� --__.—_,. DISADVAPfTAGES IF NOT APPROVED: • TOTAL AMOUNT OF iRANSACTION S COST/REVENUE BUDOETED (CIRCLE ONE) YES NO FUNDIHG SOUACE ACTIYITY NUMBER FINANCIAL INFOflMAT10N: (EXPLAIN) Council File # ordinance ,$ Green Sheet ,# �`�`�" :� �� E�-. / Presented By Referred To i RESOLVED: z 3 4 5 6 7 8 B a e�� - 9 Bostrom 10 Harris _ 11 � Me a _ 12 Re t� man 13 Thane 14 15 - 16 17 Adopted by Coun il 18 19 Adoption Cer,ified 20 � 21 / zz sy: j 23 24 Approved by Mayor: 25 26 l 2� By: 28 PAUL, MINNESOTA Committee;/ Date ��-s�`1 That application (ID #22876) for a Liquor On Sale-B, Sunday Sale Liquor, Entertainment-B, Restaurant-B, and Cigazette License by Grand American urant Company DBA Grand American Restaurant Company (Joseph Schaefer, Presid t) at 788 Grand Avenue be and the same is hereby approved Requested by Department of: • - - t - s-� •a- � —�ii—� - .� �uui - �--,��-�- . Date B y' � � by Council Secretary Date For[n Approved by City Attorney B �� Approved by Mayor for Submission to Council By: Greensheet # 35312 In Tracker? License ID # 2287b Company L.I.E.P. REVIEW CHECKLIST Date:3-18-97 L�`� � App'n Received / App'n Processed License staurant-B, Cigarette License oanv A: cama Business Addresss: 788 Grand Avenue Business Phone: �r19-4772 Contact Name/Address: Josenh Schaefer. 1889 xunter Lane HOme PhonB: 686-6803 Date to Council Pubfic Hearing Notice Sent to a/ Labels Ordered: � - 17 - � � Distcict Council #: 1 �� 'yac ia[i a.a Notice Sent to Public: �� Ward #: ,� DepartmentJ Date inspections Comments Ciry Attorney 3•Z�-•9� �•� Environmental Health � • /�f •9a- o•-� . Fire �`2� g�- �•K License Site Plan Received:, Lease Received: �F�l � f �� Police 3�2� 9 � �.�- . Zoning �• 2� •`��- D.� • �-s CLASS ITI LICENSE APPLICATION o ueY PLEASE TYPE OR PRINP IN R�K Type of License(s) beiag applied for: ��q 4 er - O �ic2�t CITY OF SAINT PAUL ofi;« urLice�uq Insvec��ons ana Ea.�ronsnanat Protect��n 350 SL Pelc SC Swfe 300 SainiPeW,llmnecv 55102 (617)I669�U fix(b1�2669134 Res�'a�ra,nf (6� ' tsa f�i4•, /2.s�afs S GN�I✓' rQ�N !ft �✓it ' ��453 � .S �u �a Oh Sa�p ��o.o✓ $ � Company Nazne: u ra n a - H+..� z,� � c� y _ Corporation / PaMenhip / Sole Proprietaship If business is incorporated, give date of incorporation: X Doing Business As: Business Address: Business SireetAddnsa � Oh �ir4h(� b¢-Ffr4pyjCity V ' Slete Zip THIS APPLICATION IS SUBSECT TO REVIEW BY TIIE PUBLIC Betw�een u�hat cross streets is the business located7 f� ✓ e ti a� h� G r e� f v Which side of the street? a w�" �i Are the premises now occupied7 �ec What Type of Business? �J4+ e 5�44.nn �, � �� v oa s�u � o a �+ra �� Mail To Address: 6 0S Sq�-c �� ff �'rc l2 ,/�f ��o'f v ye�.��'S __ Mh • SS// � Strcel Address Applicaut Information: 2vTame and TiUe: J n o.H Fi�t Home Address: � �S _ J� (Meidat) �irt � F�Fb .^n -7-9 City State Zip .�q/ry�Q,N Sec. Lsst Title DateofBirth: /�• `1- yFl PlaceofSirth:l+�Nnea !"1y • Hzve you ever been com�icted of any felony, crime or violalion of any city ordinance other than traffic. Daie of arrest: Chazge: _ Convictiou: Sentence: � 51ete Zip HomePhone:(�O/� ' g�$� 7 YES _ NO Lisl the names and tesidences of three persons of good moral character, living within the Twin Cities MeVO Area, not related to the applicant or financially interested in the premises or business, who may be referred to as to the applicanYs character: NAME ADDRESS PHONE ��1 /'ie�� 3oNovc( Cr'vc% 2�/..Narf�oaks Ma. SS�17 yr�y Boh�;a- I✓,Ik=wS l�s� kq+vl �/. �Por��•/�e M�, sS'/i3 �ISf9- (. c.r✓Y We�f��e�„� I?S M l}�e. So. . Go(ri.e.. Vs�fe,,. 1�1.,.SSY.�b SY�-93ss6 List licenses which you currently hold, foimerly he3d, or may have an a�terest in: Have any ot thb above nazned licenses evec bcen revoked7 YES _�_ NO Ifyes, list the dates and reasons for revocation: Where? 2/18/97 Aze you going to operate tlus busin ss personally? � YES NO 0�4�it¢v ' e�Rn� 7 'te5f'a�..v4ht C :.yddle HrnxAddrda: Street\ame Are }rou going to hai•e a manager ar_assistant in this business? please complete ihe following information: X 7�1�0�,�-� S. I,� IG-L! �cr.� _ t.�am�v�;sd , HameAdd`ens: Sheet:�ame (Slaiaen) c�^ �°�-a N � �$ rv� s a�� oU City Please list your emplo}went history for the pre�rious five (5) yeaz period; Business/Emplovment Address �dS/ S,' [� SEatc u�c� �� ,.. it? �w� fh o�kew 6 �'' Dar<ursinh \ �SS//8' ��la)dSS6-6$o3 � Zip Phone\umbcr NO If the manager is not the sazne as the operator, I,ssc Sta4 `9 :��-/��' Date of Buth � � S n7� /��7��5�73 Zip Phone \imbcr e �. / � /�w. Mey�v� S/18' ( 1991 fi„ra-Se,�f� i _ � /�1H .SSS'o� � � 19 9 3� �v ese�,f � � List all other officers of the corporation: OFFICER TITLE HOME HOME BUSINESS DATE OF NAME (Office Held) ADDRESS PH01dE PHONE BIRTH Jd��l� Sc(�ae�e� Pres. ls'�5 � ��-�✓ �4Ne (6«�6��-b�o3 G/?)95/-n/6o 6 '��5v If busine� is a partnership, piease include the folloµing information for each partner (use additional pages if necessary): Fintl�eme Middlelnitial (Maidrn) Laat DatcoCHiM Home Ad�esa: Strat I�ame City Siste Zip Phonc 2lumba' Middle Initiet (�faidrn) Laa Date � 1-Iome Add�see: Stmt 2�ame � City SUte Zip Phone ISumber MINNESOTA TAX II?ENTIFICA7ION NUMBER - Pursuant to the Laa�s of Minnesota, 1984, Chapter 502, Article 8, Section 2(270J2) (Ta� Clearance; Issuance of Licenses), licensing authorities are required to provide to the State of Minnesota Commissioner of Revenue, the Minnesota business ta�c identification nwnber and the socia] security number of each ]icense applicanL Under tbe Minnesots Govemment Data Praclices Act and the Federal Privacy Act of 1974, we are required to advise you of the following regarding the use of the Minnesota Tax Ident�cation Number: - This infotmation may be used to deny the issuance or renewal of your license in the event you ow�e Minnesota sales, employer s withholding or motor vehicle excise taxes; - L7pon receiving this informatioq the licensing authority wiIl supply it only to the Minnesota Department of Revenue. However, under the Fe3eral Exchange of Information A�eement, the Departmrnt of Revenue may supp3y t}ris infoimation to the Intemal Revenue Sen7ce, Mumesots Tax Identi5cation Numbers (SaIes & Use Tax Number) may be obtained fiom the State of Minnesota, Business Records Departmen; 10 Ri��ec Park Plaza (612-296-6181 }. 5ocial Security Number: j 'I �`1 .S ff - S$ 6 C � Ivlinnesota rax Identification Number: Y I r I �( n ��_ _ If a Minnesota Tax Identification Number is not required for the business being operated, indicate so by placing an"X" in the box. 2l7 8'97 '�CER;IFICATION OF WORKERS' COMPENSA7ION COVEI2AGE PURSUANT TO MINNESOTA STATUTE 176.182 I `"1 �`� 0� �' I hereb}� certif} that I, or m}• compazry, arn in compliance u7th the �vorkers' wmpensation inswance cocerage requirements of Minnesota Statute /' 776 subdi�ision 2. I also understand that pro�ision of falx information in ihis ceRification constitutes s�cient grounds for ad�•erse action agamst all licenses held, including recocation and suspension of said licenses. Name of Insurance C,ompany: Polic� Number: - Co�� j e� from I ha��e no emplo}'ees cocered under urorkers compensation insurance� �� (R�TITIALS) ANY FALSIFICATION OF ANSWERS GNEN OR MATERIAL SUBMITTED W ILL RESULT IN DENL4L OF THIS APPtICATION 1 hereby state that I have ansa ered all of the preceding questions, and that the information contained herein is U and correct to the best of my knowledge and belief. I hereby state further that I have receiced no money or other consideration, by u ay of loan, gift, contributiott, or othernise, other than already disclosed in the appGcation w�hich I hereaith submitted I also understand this premise may be inspected by police, fire, heallh and other cit}• officials at any and all times u-hen the business is in operation. � Signature -17-9� Datc for all applications) We aill accept payment bc cash, c6eck (made payable to Cit�• of Saint Paun or credit card (MIC or V isa). IFPAYINGBYCREDITCARDPLEASECOMPLETETHEFOLLON'INGItVFOItb1ATION: �MasterCard � Visa EXPIRATION DATE: ACCOUNT NUMBER: ❑�/L7❑ ❑��❑ ❑00❑ ❑C1[�❑ ❑C]C7❑ of Cardholder *•Note: ]f this application is Foodll,iquor related, please contact a City of Saint Paul Health tnspector, Steve Olson (266-9139), to review plans. ff any substantial changes to sWcture are anticipated, please contact a City of Saint Paul Plan Erazniner at 266-9007 to apply for building pemvu. Ifthere are azry• changes to the puking lot, floor space, or for new operations, please contact a City of Saint Paul Zoning Inspector at 266-9008. All appGcations require t6e followiag documents. Please attach these documents afien submitting your application: 1. A detailed description of the design, location and square footage of the premises to be licensed (site plan). The following data should be on the site plan (preferably on an 8 1/2" x 11" or 8 I/2" x 14" paperj: - Neme, address, and phone number. -'3'he scale should be stated such as t" = 20`. ^N should be indicated towazd the top. - Placement of aIl pertinent features of the interior of the licensed faciliTy such as seating azeas, kitchens, offices, repaic azea, parking, rest rooms, etc. - Tf a request is for an addiGon or eapansion of the licensed facility, indicate both the current azea and the proposed eapansion. 2. A copy of your lease agreemrnt or proof of oNmerslup of the property. SPECIFIC LICENSE APPLICATIONS REQITIRE ADDTTIONAL INFORNiATION. PLEASE SEE REVERSE FQR DETAILS >>>> zn sr�� .� CLASS III LICENSE APPLTCATION PLEASE TYPE OR PRINl' IN INK T}pe of License(s) being applied for: Company Neme: Corporation / Paztnetsttip! Sok Proprietonirip If 6usiness is Doing Business As: Business Address: ( CITY OF SAINT PAUL �ce of Licrnsq Inspec[ions and Emvomnrntal Proteclion 3511 SL Pet¢ St Surtc 300 5�[P�v�\fymescu SSlU2 (613)1669090 fax(61])366913< give date of incorporation: rn/�-�L. —� ' % 7 > � �2 ! A/ Business Phone: �/ Z - C ��- �I7�z �I �i5�(�cr h��r�r�b�zf�� l wy_ �ct?u�crt� /-�� ,�N� ss�r�' Ben+�een what cross streets is the business located? Are the premises now occupied7 � Wha Mai] To Address: ApplicantInfomiation: / // C � /�� / Nazne and Title: _ �6 � �C P �7 �� /�`�-�� (� � J(�/%/"J('l� c/L ��.f"S (� , � (Maiden) I,ait Title `� Home Address: � t �(3 � ��1 R/ ( �-l2 �/Q/U '�f G�t n,��a�Ti�- �/bIS ��'J �.5 �� f� s,n�c naa� ct�y sm�� zsp � Date of Birth: — �S C) Place of Birth: S�• ./�U L hi ( N'v Home Phon�e: / �71 Z '�� 3 Ha��e you e�•er been com•icted of any felony, crime or ti�olation of azry city ordinance other than traffic? YES �% NO �' Date of arrest; ��T tL �ll rJ Vlhere� C1,a�ge: ��h. -Q/a l�in1 f� n n� i�z � nzL�� r>,� f!'-1 b G/a-T� ,� n1 Com�clion: Sentence: Lisi the narnes and residences of ttuce persons of good moral chazacter, ]iving within the Twin Cities Metro Area, not related to the applicant or financially interested in the premises or business, who may be refe[red to as to the applicanPs character: I��ui� ADDRESS Have any of ihe above named licenses ever been PHONE YES �_ NO If yes, list the dates and reasons for revocation: 2/18t97 so-ae naa� c�ry smm z�p List li s which you c�urendy hold, forcnerly held, or a�ave an interest'vt: L��lo2_ �—tc-�,cJCr� .��i�,rr.�rin�,cr�/l��,t�S�>' THIS APPLICATION 1S SUBJECT TO REVIEW BY TF� PUBLIC , �w � �� A:e pou going to operate this business personally? YES NO ff no� ��ho will operate it7 G� �—$ �� - First Name \tiddic Initiil (\fnidrn) 1.ut Dete of B'vih � �3 N � If business is a parhtiership, please include the following infoimation For each partnet (use additional pages if necessary): F'urt 7�ame Middle Ltitial , (Mniden) Leat Date olBirth NomeA�drsss: St�mtN�e Fi�st7�ame � 9� Home Addreer. Street Middic Initinl City @7ai8rn) c�Ty 8ate Zip I.aa Stete Zip Phone Number Dau of SirtF� �IO�IC MINI�IESOTA TAX IDENI IFICATION NUMBER - Pursuant to the Laws of Minneso[� 1984, Chapter 502, Article 8, Section 2(270.72) (Tar Ctearance; Issuance of Licenses), licensing authorities are required to provide ro the State of Minnesota Comtnissioner of Revenue, the Minnesota business tax identification number and the social securiry number of each license applicant. Under the Minnesota Goveaunent Data Practices Act and the Federal Privacy Act of 1974, we are required to advise you of the following regazding the use of the Minnesota Tax Identification Number: - This information may be used to deny the issuance or renewal of yow license in the event you owe Minnesota sales, emptoyei s witUholding or motor vehicle excise taxes; - Upon receiving this information, the licensing authority will supply it only to the Mim�esota Department of Revenue. However, under the Federal Exchange of Information Agreement, the Departrnrnt of Revrnue may supply this informalion to the Intemal Revenve Sen�ice. Minnesota Ta�c Identification Numbers (Sales & iJse Tax Number) may be obtained 5om the State of Minnesota, Business Records Departrnent, 10 River Park Plaza (612-296-6181). Sociat S�uciry Number: � 7�`S � D 9/ O Minnesota Tax Identification Number: �f l� l�� C � G� _ If a Minnesote Tax Idrnt�cation Number is not required for the business being operated, indicate so by placing an "X" in the box. 2l18J97 Home Add�ec Stcect \ame Cih• / Sfatc Zip Phone N�unber Are }'ou going to ha��e a manzger or.assistant in this business7 ✓ YES NO ff the manager is not the sazne as the operator, please complete the following information: , Please list your emplo}ment history for the previous five (5) }�eaz period: List all other officers of the cocporation: OFFICER TITLE HOME HOME BUSINESS AATE OF NAMR (nffice Heldl A17DRESS PHONE PHONE BIRTH �� CERTIFICATION OF WORKERS' COMPENSATION CO VERAGE PURSUAN'C IO MINNESOTA STANTE 176.182 ' 1 � s o� I hereby certify that I, or my company, am in compliance with the �corkers' compensation insurance coverage requirements of Minnesota Statute ] 76. ] 82, subdi�RSion 2. I also understand that pro�ision of false infrnmation in this certitication constitutes sufficient grounds for ad�•erse action against al] licenses held, including revocalion and suspension of said licenses. Nazne of Insurance Company: Policy Number: Coverage from to I have no emplocees co��ered under workers compensation insurance (II3ITIALS) ANY FALSIFICATION OF ANSR'ERS GIVEN OR MATERL�L SUBMITTED WILL RESULT IN DENIAL OF TFIIS APPLICATION I hereby state that I have az�swered all of the preceding questions, and that the information contained herein is we and correct to ihe best of my knowledge and belief. I hereby state fwther ihat I have received no money or other consideratioq by way of loan, gift, conh or othenvise, ot6er than already disc]osed in the application w�hich I herewith submitted I also understand this premise may be inspected by police, fire, health and other ciry officials at any and all times when the busines is in operation. Signature (�QUIItEb for a11 We ni[I accept pa}�ment 6�• cas6, check (made payable to City of Saint Pauij or credit card (M/C or Visa). �=�?" F � Datc IF PAYTNG BY CREDIT CAftD PLEASE COMPLETE THF FOLLO N'ING INFORMATION: � MasierCard � Visa EXPII2ATION DATE: � � � � ACCOUNtNUMBER: � � � � � � � � � � � � � � � � I Da[e ""Note: If this application is Food/Liquor related, please contact a City of Saint Paul Health Inspector, Steve Olsou (266-9139), to re��ew plans. If any substantial changes to strvcture are anticipated, please contact a Ciry of 5aint Paul Plan Examiner at 266-9007 to applp for building pertnits. If there are any changes to the pazking lot, floor space, or for new operations, please contact a City of Saint Paul Zoning Inspector at 266-9008. Atl applications require the foliowing documents. Please attach these documents w'hen submitting ?�our application: 1. A detailed descriplion of the desigq localion and square footage of the premises to be licensed (site plan). The fotlowing data should be on the site plan (preferably on an 8 I/Z" x 11" or 8 1/Z" x 14" paper): - Name, address, and phone number. - The scale should be stated such as 1" = 20'. ^N should be indicated towazd the top. - Placement of all petinent features of the interior of the licensed facility such as seating areas, kitchrns, offices, repair area, pazking, resi rooms, ete. - Tf a request is for an addition or expansion of the licensed faciliry, indicate both the currrnt area and the proposed expansion. 2. A wpy of your lease agreement or proof of owrership of the properiy. SPECIFIC LICENSE APPLICATIONS REQUIItE ADDTTIONAL INFORMATION. PLEASE SEE REVERSE FOR DETAILS >>>> 2/18797 Council File # , S�y ordinance # Green Sheet # �� , � RESOLUTION SAINT PAUL, MINNESOTA Presented By 1 RESOLVED: That application (ID #22876) for a Liquor On Sale-B, Sunday On Sale Liquor, Entertaiament B, 2 Restaurant-B, and Cigarette License by Grand American Restawant Compazry DBA The Wild 3 Onion (Joseph Schaefer, President) at 788 Grand Avenue be and the same is hereby approved. 4 5 Requeated by Department of: 6 Yeas Navs Absent 7 a a� 8 Bostrom Off+'ce of License. Inspections and 9 Harris - 10 Me a� • Environmental Protect�on 12 T vn � 14 �� ''-�,. �i � n n 15 B 1�Ah�a�L�tR.I TT ''"`l� 16 Adppted by Council: Date L °`� - 17 18 Adoption Ceztified by Council Se etary 19 Form Approved by City Attorney 20 21 BY � �� a- .�:�v�.� `�/ r J� a..0�-v�s 22 // / BY� �fsQ�i��-GGL '� 23 Approved by Mayor: Date �1 �2C ��" � 24 25 Approved by Mayor for Submission to 26 BY. -�'__i�� Council 27 By: _ _ �,�t-sg�{ oePaatenErrrroF�+c�courica� on� u�mn'cEO �� 3 5 312 LIEP Li�ensln GREEN SHEE _ _ . _ _ CONTACT PERSON 8 PHONE INRIAVDATE INITIA4IDATE O DEPARTMENi DIRECTOR O CRY CAUNCIL i tine Rozek 266-9108 "��" � cmnrroaNer � anc�nK MUST BE ON COUNCIL AGENOA 8Y (��1 N ❑�� pIRECTO ' O FIN. A MGi SERYICES Dl43. � a sl �� ORDER O MpYOR (OR ASSISfANn ❑ TOTAL # OF SIGNATURE PAGES (CLIP ALL LOCA710NS FOR SIGNATURE) pCiION REQUESTED: • Grand American Restaurant Company DBA Grand American Restaurant Company requests Council approval on its application for a Liquor On Sale-B, Sunday On Sale Liquox, Entertainment-B, Restaurant-B, and Cigarette License at 788 Grand Avenue (ID 4�22876). qECAMMEwDA510NS: App�we (A) rn Aajact (p) pERSONAL SERVICE CONTRACTS MUST ANSWER THE POLLOWING QUESTIONS: _ _ PIANNNlG COMMISSION _ CfVIL SEAVICE CAMMISSION t. H&S ihi5 per50n/fvm eV2r worked untler a COMIeCt for this dep3rtm8M? � _ CIB COMMfi7EE _ �'ES NO _ STAFF ' _ 2. Has ihi5 perSOnAirm ever been a c�ty employee? VES NO � DISTRICi CAUR7 — 3. Does this person/Firm possess a skill not nortnally possessetl by any curreM ciry employee? SUPPOATS WNfCH COUtiCiL OBJECi7VE1 YES P10 , Explain ell yes anawers on seperate sheet and attach to green sheet INITIATING PROBLEM, ISSUE, OPP4lRNNITY (VJiw. What. When, YMere, Why): �RE��I��l�� o �� C�TY A�'TORNEY A�VANTAGESIFAPPROVED: � DISADVANTAGES IFAPPROVED: G� �',.3�°^aq� �i�z�*SP AFR 21 1�� --__.—_,. DISADVAPfTAGES IF NOT APPROVED: • TOTAL AMOUNT OF iRANSACTION S COST/REVENUE BUDOETED (CIRCLE ONE) YES NO FUNDIHG SOUACE ACTIYITY NUMBER FINANCIAL INFOflMAT10N: (EXPLAIN) Council File # ordinance ,$ Green Sheet ,# �`�`�" :� �� E�-. / Presented By Referred To i RESOLVED: z 3 4 5 6 7 8 B a e�� - 9 Bostrom 10 Harris _ 11 � Me a _ 12 Re t� man 13 Thane 14 15 - 16 17 Adopted by Coun il 18 19 Adoption Cer,ified 20 � 21 / zz sy: j 23 24 Approved by Mayor: 25 26 l 2� By: 28 PAUL, MINNESOTA Committee;/ Date ��-s�`1 That application (ID #22876) for a Liquor On Sale-B, Sunday Sale Liquor, Entertainment-B, Restaurant-B, and Cigazette License by Grand American urant Company DBA Grand American Restaurant Company (Joseph Schaefer, Presid t) at 788 Grand Avenue be and the same is hereby approved Requested by Department of: • - - t - s-� •a- � —�ii—� - .� �uui - �--,��-�- . Date B y' � � by Council Secretary Date For[n Approved by City Attorney B �� Approved by Mayor for Submission to Council By: Greensheet # 35312 In Tracker? License ID # 2287b Company L.I.E.P. REVIEW CHECKLIST Date:3-18-97 L�`� � App'n Received / App'n Processed License staurant-B, Cigarette License oanv A: cama Business Addresss: 788 Grand Avenue Business Phone: �r19-4772 Contact Name/Address: Josenh Schaefer. 1889 xunter Lane HOme PhonB: 686-6803 Date to Council Pubfic Hearing Notice Sent to a/ Labels Ordered: � - 17 - � � Distcict Council #: 1 �� 'yac ia[i a.a Notice Sent to Public: �� Ward #: ,� DepartmentJ Date inspections Comments Ciry Attorney 3•Z�-•9� �•� Environmental Health � • /�f •9a- o•-� . Fire �`2� g�- �•K License Site Plan Received:, Lease Received: �F�l � f �� Police 3�2� 9 � �.�- . Zoning �• 2� •`��- D.� • �-s CLASS ITI LICENSE APPLICATION o ueY PLEASE TYPE OR PRINP IN R�K Type of License(s) beiag applied for: ��q 4 er - O �ic2�t CITY OF SAINT PAUL ofi;« urLice�uq Insvec��ons ana Ea.�ronsnanat Protect��n 350 SL Pelc SC Swfe 300 SainiPeW,llmnecv 55102 (617)I669�U fix(b1�2669134 Res�'a�ra,nf (6� ' tsa f�i4•, /2.s�afs S GN�I✓' rQ�N !ft �✓it ' ��453 � .S �u �a Oh Sa�p ��o.o✓ $ � Company Nazne: u ra n a - H+..� z,� � c� y _ Corporation / PaMenhip / Sole Proprietaship If business is incorporated, give date of incorporation: X Doing Business As: Business Address: Business SireetAddnsa � Oh �ir4h(� b¢-Ffr4pyjCity V ' Slete Zip THIS APPLICATION IS SUBSECT TO REVIEW BY TIIE PUBLIC Betw�een u�hat cross streets is the business located7 f� ✓ e ti a� h� G r e� f v Which side of the street? a w�" �i Are the premises now occupied7 �ec What Type of Business? �J4+ e 5�44.nn �, � �� v oa s�u � o a �+ra �� Mail To Address: 6 0S Sq�-c �� ff �'rc l2 ,/�f ��o'f v ye�.��'S __ Mh • SS// � Strcel Address Applicaut Information: 2vTame and TiUe: J n o.H Fi�t Home Address: � �S _ J� (Meidat) �irt � F�Fb .^n -7-9 City State Zip .�q/ry�Q,N Sec. Lsst Title DateofBirth: /�• `1- yFl PlaceofSirth:l+�Nnea !"1y • Hzve you ever been com�icted of any felony, crime or violalion of any city ordinance other than traffic. Daie of arrest: Chazge: _ Convictiou: Sentence: � 51ete Zip HomePhone:(�O/� ' g�$� 7 YES _ NO Lisl the names and tesidences of three persons of good moral character, living within the Twin Cities MeVO Area, not related to the applicant or financially interested in the premises or business, who may be referred to as to the applicanYs character: NAME ADDRESS PHONE ��1 /'ie�� 3oNovc( Cr'vc% 2�/..Narf�oaks Ma. SS�17 yr�y Boh�;a- I✓,Ik=wS l�s� kq+vl �/. �Por��•/�e M�, sS'/i3 �ISf9- (. c.r✓Y We�f��e�„� I?S M l}�e. So. . Go(ri.e.. Vs�fe,,. 1�1.,.SSY.�b SY�-93ss6 List licenses which you currently hold, foimerly he3d, or may have an a�terest in: Have any ot thb above nazned licenses evec bcen revoked7 YES _�_ NO Ifyes, list the dates and reasons for revocation: Where? 2/18/97 Aze you going to operate tlus busin ss personally? � YES NO 0�4�it¢v ' e�Rn� 7 'te5f'a�..v4ht C :.yddle HrnxAddrda: Street\ame Are }rou going to hai•e a manager ar_assistant in this business? please complete ihe following information: X 7�1�0�,�-� S. I,� IG-L! �cr.� _ t.�am�v�;sd , HameAdd`ens: Sheet:�ame (Slaiaen) c�^ �°�-a N � �$ rv� s a�� oU City Please list your emplo}went history for the pre�rious five (5) yeaz period; Business/Emplovment Address �dS/ S,' [� SEatc u�c� �� ,.. it? �w� fh o�kew 6 �'' Dar<ursinh \ �SS//8' ��la)dSS6-6$o3 � Zip Phone\umbcr NO If the manager is not the sazne as the operator, I,ssc Sta4 `9 :��-/��' Date of Buth � � S n7� /��7��5�73 Zip Phone \imbcr e �. / � /�w. Mey�v� S/18' ( 1991 fi„ra-Se,�f� i _ � /�1H .SSS'o� � � 19 9 3� �v ese�,f � � List all other officers of the corporation: OFFICER TITLE HOME HOME BUSINESS DATE OF NAME (Office Held) ADDRESS PH01dE PHONE BIRTH Jd��l� Sc(�ae�e� Pres. ls'�5 � ��-�✓ �4Ne (6«�6��-b�o3 G/?)95/-n/6o 6 '��5v If busine� is a partnership, piease include the folloµing information for each partner (use additional pages if necessary): Fintl�eme Middlelnitial (Maidrn) Laat DatcoCHiM Home Ad�esa: Strat I�ame City Siste Zip Phonc 2lumba' Middle Initiet (�faidrn) Laa Date � 1-Iome Add�see: Stmt 2�ame � City SUte Zip Phone ISumber MINNESOTA TAX II?ENTIFICA7ION NUMBER - Pursuant to the Laa�s of Minnesota, 1984, Chapter 502, Article 8, Section 2(270J2) (Ta� Clearance; Issuance of Licenses), licensing authorities are required to provide to the State of Minnesota Commissioner of Revenue, the Minnesota business ta�c identification nwnber and the socia] security number of each ]icense applicanL Under tbe Minnesots Govemment Data Praclices Act and the Federal Privacy Act of 1974, we are required to advise you of the following regarding the use of the Minnesota Tax Ident�cation Number: - This infotmation may be used to deny the issuance or renewal of your license in the event you ow�e Minnesota sales, employer s withholding or motor vehicle excise taxes; - L7pon receiving this informatioq the licensing authority wiIl supply it only to the Minnesota Department of Revenue. However, under the Fe3eral Exchange of Information A�eement, the Departmrnt of Revenue may supp3y t}ris infoimation to the Intemal Revenue Sen7ce, Mumesots Tax Identi5cation Numbers (SaIes & Use Tax Number) may be obtained fiom the State of Minnesota, Business Records Departmen; 10 Ri��ec Park Plaza (612-296-6181 }. 5ocial Security Number: j 'I �`1 .S ff - S$ 6 C � Ivlinnesota rax Identification Number: Y I r I �( n ��_ _ If a Minnesota Tax Identification Number is not required for the business being operated, indicate so by placing an"X" in the box. 2l7 8'97 '�CER;IFICATION OF WORKERS' COMPENSA7ION COVEI2AGE PURSUANT TO MINNESOTA STATUTE 176.182 I `"1 �`� 0� �' I hereb}� certif} that I, or m}• compazry, arn in compliance u7th the �vorkers' wmpensation inswance cocerage requirements of Minnesota Statute /' 776 subdi�ision 2. I also understand that pro�ision of falx information in ihis ceRification constitutes s�cient grounds for ad�•erse action agamst all licenses held, including recocation and suspension of said licenses. Name of Insurance C,ompany: Polic� Number: - Co�� j e� from I ha��e no emplo}'ees cocered under urorkers compensation insurance� �� (R�TITIALS) ANY FALSIFICATION OF ANSWERS GNEN OR MATERIAL SUBMITTED W ILL RESULT IN DENL4L OF THIS APPtICATION 1 hereby state that I have ansa ered all of the preceding questions, and that the information contained herein is U and correct to the best of my knowledge and belief. I hereby state further that I have receiced no money or other consideration, by u ay of loan, gift, contributiott, or othernise, other than already disclosed in the appGcation w�hich I hereaith submitted I also understand this premise may be inspected by police, fire, heallh and other cit}• officials at any and all times u-hen the business is in operation. � Signature -17-9� Datc for all applications) We aill accept payment bc cash, c6eck (made payable to Cit�• of Saint Paun or credit card (MIC or V isa). IFPAYINGBYCREDITCARDPLEASECOMPLETETHEFOLLON'INGItVFOItb1ATION: �MasterCard � Visa EXPIRATION DATE: ACCOUNT NUMBER: ❑�/L7❑ ❑��❑ ❑00❑ ❑C1[�❑ ❑C]C7❑ of Cardholder *•Note: ]f this application is Foodll,iquor related, please contact a City of Saint Paul Health tnspector, Steve Olson (266-9139), to review plans. ff any substantial changes to sWcture are anticipated, please contact a City of Saint Paul Plan Erazniner at 266-9007 to apply for building pemvu. Ifthere are azry• changes to the puking lot, floor space, or for new operations, please contact a City of Saint Paul Zoning Inspector at 266-9008. All appGcations require t6e followiag documents. Please attach these documents afien submitting your application: 1. A detailed description of the design, location and square footage of the premises to be licensed (site plan). The following data should be on the site plan (preferably on an 8 1/2" x 11" or 8 I/2" x 14" paperj: - Neme, address, and phone number. -'3'he scale should be stated such as t" = 20`. ^N should be indicated towazd the top. - Placement of aIl pertinent features of the interior of the licensed faciliTy such as seating azeas, kitchens, offices, repaic azea, parking, rest rooms, etc. - Tf a request is for an addiGon or eapansion of the licensed facility, indicate both the current azea and the proposed eapansion. 2. A copy of your lease agreemrnt or proof of oNmerslup of the property. SPECIFIC LICENSE APPLICATIONS REQITIRE ADDTTIONAL INFORNiATION. PLEASE SEE REVERSE FQR DETAILS >>>> zn sr�� .� CLASS III LICENSE APPLTCATION PLEASE TYPE OR PRINl' IN INK T}pe of License(s) being applied for: Company Neme: Corporation / Paztnetsttip! Sok Proprietonirip If 6usiness is Doing Business As: Business Address: ( CITY OF SAINT PAUL �ce of Licrnsq Inspec[ions and Emvomnrntal Proteclion 3511 SL Pet¢ St Surtc 300 5�[P�v�\fymescu SSlU2 (613)1669090 fax(61])366913< give date of incorporation: rn/�-�L. —� ' % 7 > � �2 ! A/ Business Phone: �/ Z - C ��- �I7�z �I �i5�(�cr h��r�r�b�zf�� l wy_ �ct?u�crt� /-�� ,�N� ss�r�' Ben+�een what cross streets is the business located? Are the premises now occupied7 � Wha Mai] To Address: ApplicantInfomiation: / // C � /�� / Nazne and Title: _ �6 � �C P �7 �� /�`�-�� (� � J(�/%/"J('l� c/L ��.f"S (� , � (Maiden) I,ait Title `� Home Address: � t �(3 � ��1 R/ ( �-l2 �/Q/U '�f G�t n,��a�Ti�- �/bIS ��'J �.5 �� f� s,n�c naa� ct�y sm�� zsp � Date of Birth: — �S C) Place of Birth: S�• ./�U L hi ( N'v Home Phon�e: / �71 Z '�� 3 Ha��e you e�•er been com•icted of any felony, crime or ti�olation of azry city ordinance other than traffic? YES �% NO �' Date of arrest; ��T tL �ll rJ Vlhere� C1,a�ge: ��h. -Q/a l�in1 f� n n� i�z � nzL�� r>,� f!'-1 b G/a-T� ,� n1 Com�clion: Sentence: Lisi the narnes and residences of ttuce persons of good moral chazacter, ]iving within the Twin Cities Metro Area, not related to the applicant or financially interested in the premises or business, who may be refe[red to as to the applicanPs character: I��ui� ADDRESS Have any of ihe above named licenses ever been PHONE YES �_ NO If yes, list the dates and reasons for revocation: 2/18t97 so-ae naa� c�ry smm z�p List li s which you c�urendy hold, forcnerly held, or a�ave an interest'vt: L��lo2_ �—tc-�,cJCr� .��i�,rr.�rin�,cr�/l��,t�S�>' THIS APPLICATION 1S SUBJECT TO REVIEW BY TF� PUBLIC , �w � �� A:e pou going to operate this business personally? YES NO ff no� ��ho will operate it7 G� �—$ �� - First Name \tiddic Initiil (\fnidrn) 1.ut Dete of B'vih � �3 N � If business is a parhtiership, please include the following infoimation For each partnet (use additional pages if necessary): F'urt 7�ame Middle Ltitial , (Mniden) Leat Date olBirth NomeA�drsss: St�mtN�e Fi�st7�ame � 9� Home Addreer. Street Middic Initinl City @7ai8rn) c�Ty 8ate Zip I.aa Stete Zip Phone Number Dau of SirtF� �IO�IC MINI�IESOTA TAX IDENI IFICATION NUMBER - Pursuant to the Laws of Minneso[� 1984, Chapter 502, Article 8, Section 2(270.72) (Tar Ctearance; Issuance of Licenses), licensing authorities are required to provide ro the State of Minnesota Comtnissioner of Revenue, the Minnesota business tax identification number and the social securiry number of each license applicant. Under the Minnesota Goveaunent Data Practices Act and the Federal Privacy Act of 1974, we are required to advise you of the following regazding the use of the Minnesota Tax Identification Number: - This information may be used to deny the issuance or renewal of yow license in the event you owe Minnesota sales, emptoyei s witUholding or motor vehicle excise taxes; - Upon receiving this information, the licensing authority will supply it only to the Mim�esota Department of Revenue. However, under the Federal Exchange of Information Agreement, the Departrnrnt of Revrnue may supply this informalion to the Intemal Revenve Sen�ice. Minnesota Ta�c Identification Numbers (Sales & iJse Tax Number) may be obtained 5om the State of Minnesota, Business Records Departrnent, 10 River Park Plaza (612-296-6181). Sociat S�uciry Number: � 7�`S � D 9/ O Minnesota Tax Identification Number: �f l� l�� C � G� _ If a Minnesote Tax Idrnt�cation Number is not required for the business being operated, indicate so by placing an "X" in the box. 2l18J97 Home Add�ec Stcect \ame Cih• / Sfatc Zip Phone N�unber Are }'ou going to ha��e a manzger or.assistant in this business7 ✓ YES NO ff the manager is not the sazne as the operator, please complete the following information: , Please list your emplo}ment history for the previous five (5) }�eaz period: List all other officers of the cocporation: OFFICER TITLE HOME HOME BUSINESS AATE OF NAMR (nffice Heldl A17DRESS PHONE PHONE BIRTH �� CERTIFICATION OF WORKERS' COMPENSATION CO VERAGE PURSUAN'C IO MINNESOTA STANTE 176.182 ' 1 � s o� I hereby certify that I, or my company, am in compliance with the �corkers' compensation insurance coverage requirements of Minnesota Statute ] 76. ] 82, subdi�RSion 2. I also understand that pro�ision of false infrnmation in this certitication constitutes sufficient grounds for ad�•erse action against al] licenses held, including revocalion and suspension of said licenses. Nazne of Insurance Company: Policy Number: Coverage from to I have no emplocees co��ered under workers compensation insurance (II3ITIALS) ANY FALSIFICATION OF ANSR'ERS GIVEN OR MATERL�L SUBMITTED WILL RESULT IN DENIAL OF TFIIS APPLICATION I hereby state that I have az�swered all of the preceding questions, and that the information contained herein is we and correct to ihe best of my knowledge and belief. I hereby state fwther ihat I have received no money or other consideratioq by way of loan, gift, conh or othenvise, ot6er than already disc]osed in the application w�hich I herewith submitted I also understand this premise may be inspected by police, fire, health and other ciry officials at any and all times when the busines is in operation. Signature (�QUIItEb for a11 We ni[I accept pa}�ment 6�• cas6, check (made payable to City of Saint Pauij or credit card (M/C or Visa). �=�?" F � Datc IF PAYTNG BY CREDIT CAftD PLEASE COMPLETE THF FOLLO N'ING INFORMATION: � MasierCard � Visa EXPII2ATION DATE: � � � � ACCOUNtNUMBER: � � � � � � � � � � � � � � � � I Da[e ""Note: If this application is Food/Liquor related, please contact a City of Saint Paul Health Inspector, Steve Olsou (266-9139), to re��ew plans. If any substantial changes to strvcture are anticipated, please contact a Ciry of 5aint Paul Plan Examiner at 266-9007 to applp for building pertnits. If there are any changes to the pazking lot, floor space, or for new operations, please contact a City of Saint Paul Zoning Inspector at 266-9008. Atl applications require the foliowing documents. Please attach these documents w'hen submitting ?�our application: 1. A detailed descriplion of the desigq localion and square footage of the premises to be licensed (site plan). The fotlowing data should be on the site plan (preferably on an 8 I/Z" x 11" or 8 1/Z" x 14" paper): - Name, address, and phone number. - The scale should be stated such as 1" = 20'. ^N should be indicated towazd the top. - Placement of all petinent features of the interior of the licensed facility such as seating areas, kitchrns, offices, repair area, pazking, resi rooms, ete. - Tf a request is for an addition or expansion of the licensed faciliry, indicate both the currrnt area and the proposed expansion. 2. A wpy of your lease agreement or proof of owrership of the properiy. SPECIFIC LICENSE APPLICATIONS REQUIItE ADDTTIONAL INFORMATION. PLEASE SEE REVERSE FOR DETAILS >>>> 2/18797