97-692Council File � 9'1- Gq a,
ordinance #
Green Sheet # � � � ��
i
2
3
�_ , .
Presented By
Referred To
RESOLUTION
AINT PAUL, MINNESOTA
Committee: Date
3�
RESOLVED: That application (ID #€11429) for a Wine On Sale and On Sale Malt (Sirong Beer) License by D&
D of Minnesota Inc. DBA Famous Dave's BBQ Shack (Mark Payne, CFO) at 1902 7th Street West
be and the same is hereby approved.
4
5 Requested by Department of:
6 Yeas Nays Absent
7 B2a e.� �
8 Bostrom Off� o License ZnsQPCtions and
9 Hartis �
10 M� Fnv�ronmental Protect�on
13 Morton —�` � �
14
15 �� By: �/�[.(..n� ��.L.��
16 Adopted by Council: Date t �
17
18 Adoption Certified by Council Secretary
19 Form Approved by City Attorney
20 � .._.� j �� su�i
21 Bye
22 � r f+ 0!„ it�! ��- � � � —
23 Approved by ors Date U
24
25 " Approved by Mayor for Submission to
26 BY: _ _ Council
27
By:
Q.'1- C°I�.
DEPARiMENTAFFlCE/COUNGIL DATE INITIATED J � � °4 �
LIEP/Licensing GREEN SHEE �
CONTACTPERSON & PHONE � OEPARTil,ENTDfRECTORNITIAVDATE O qNCOUNCIL �NITIALIDATE
Christine Rozek, 266-9108 ���N �CIiYATfORNEY aCITVCLERK
NUMBEFFOF
MUST BE ON COUNdL AGENDA BY (�ATE) pOU(ING � BUOGET OIRECT� O FIN.B MGT. SERVICES �IR.
For hearin : �,j �� ORDEN OMAYOR(OflASSISTANn �
TOTAL # OP SIGNATURE PAGES (CLIP ALL LOCATIONS FOR SIGNATURE)
ACTION REQUESTED:
D& D of Minnesota Inc. DBA Famous Dave`s BBQ Shack requests Council approval of its
application for a Wine On Sale and 6n Sale Malt {Strong Beex) located at 1902 7th St. W.
(ID 1111929).
AECOMMENDATIONS: Approve (A) ar Re�ect (R) pERSONAL SERVICE CONTRACTS MUST ANSWER TNE FOLLOWING �UESTIONS:
_ PLANNINCa COMMISSION _ CIVIL SERVICE COMMISSION i. Has this person/firm ever worketl untler a contract for this tlepartment?
_ CIB COMMRTEE _ YES NO
_ S7AFF 2. Has this person/firm ever been a ciry employee?
— YES NO
_ oISTRICT COUa7 _ 3. Does this perwn/firm possess a Skill not normally possessed by any current city employee?
SUPPORTS WHICH COUNCIL OBJECTIVE? VES NO
Explain all yes answers on separate sheet anE attach to green sheet
INITIATING PROBLEM, ISSUE, OPPORTUNITY (Who, What, When, Whare. Why):
ADVANTAGESIFAPPROVEO:
DISADVANTAGES IF APPROVED.
�'* � �Fi ,^"-„_,:.
- • ,...._;ta,k �:.';.:".:'`S
r,, 4' u � -fi � ('� ']
.�
�dit'=lo� e .� �v,7!
DISADVANTAGES IF NOTAPPROVE��
TO7pL AMOUNT OF TRANSACTION $ COS7/REVENUE BUDGETED (CIHCLE ONE) YES NO
FUNDIIdG SOURCE ACTIVITY NUMBER
FINANCIALINFORFAATION:(EXPLAIN)
Greensneet# 37940 L.I.E.P. REVIEW CHECKLIST Date: 3/28/97 /�
In TraCkel'? App n Received / App'n Processed
LiCense ID # 11929 License Type: Wine On Sale and On Sale Ma� t fStronv RaP,-L
COmpBny Nartte: D& D of Minnesota Inc. DBA: Famous Dave's BBO Shack
Business Addresss: 1902 7th Street West Business Phone: 557-5798
Contact Name/Address: M�rk Payne, 8860 Flesher Circle Home Phone: 934-4705
Eden Prairie 55437 a �,� � j � ��i��6fD %
Date to Council Research: // r o�� .;>
Public Hearing Date: Labels Orde��d:�� 7��I���
Notice Serrt to Appiicant: � 7 District Council #: .�
Notice Sent to
���� ���E
Ward #: �
Departmeni/
City Attomey
Date
�f • 2 I
Environmentai
Health
y 2 I
Fire
2I
License
'��Z �� ��
Police
`I � � f • i T
Comments
N�
stte F�an Recetved:_
Lease Received: .. _
orv
'�
�• 2�
-,
CLASS III
LICENSE APPLICATION
0 ��?i� - -�Jt21 �� � 1 � 1 c � �
THIS APPLICATION IS SLJBJECT TO REVIEW BY TfiE PUBLIC
PLEASE TYPE OR PRINT IN INK
applied for:
�.� � � �' ��.} i f�1V.� 1 : ;�I .�.(f ��/ J . . ,
CITY OF SAINT PAUL
oa;« otU�rnu, Insp«rions ,}
and Em�iromnemat Protection �
3d5CPetttStS�uh300 �A��
Sa-nt Ru� MvmooG SSIC] - r
(oI�3669p90 (u<61Z)2669t2d
S�
S� � �
S � 3� L� '
S
Y CompanyName: �"` � 4� t�� 'M�rJiJtS�TP ���.�C_�
f Ca+poration / PutnQa6ip / Sole Proptie[orship
If business is incorporated, gi��e date of incorporation: �' ��'Q6
Doing Business As: �a�. `� �AV� �-+ 133C3 Sh�'PL�' Basiness Phone: 5"'�? ^`37 �1�
BusinessAddress: \'i..ZUO Z� . D� -.T Q�Va. �2���� �vhR� Y��� 1AtvJ S'�"�1y1
(ZG�ty�y Q,P,wT +ftroet qddRV ` ... ' Ciry Stete Zip
\`�o� ��St ��- �T.�wv�
Between w• at cross str ts ts t�e asmess ]ocated7 �'ttr� `E L��� Wfrich side of the street? So��k
Are the premises now occupied? �O What Type of Busitiess?
Mail To Address: lqfl2 W�SZ — 1� S'LY ��=T ST �Avt_- U`t��J SS1\�
Strut Add.�ese City S�nte Zip
AppGcant Information: �,�
Name and Tide: Srp� V— '{�L� �J � �q� N G L�b
Ficrt �liddic ('.�Se�drn) L%st Title
HomeAddress: �Y�(�0 �LE�WW .e.� C'.\�7 �t �C�Br-'��2f�., �M+J 5`�'�i37
so-«cnaar� C;ry s�m z;p
Date of Birth: 4 3 Place of Birth:�t � u.�i
Haee you ever been com•icted of any felony, crime or violation of any cit}� ordinance other than vaffic.
Date of arrest:
Chazge: _
Comiction:
Where9
Sentrnce:
Home Phone:�3� ��(�1D.i
� YES NO �
Listthe zsames and residences of three persons of good moral character, living within che Twtin Cities Metro Psea, not related to the applicant
or financially interesied in the premises or busiaess, who may be referred to as to the applicanYs character:
NAME ADDRESS PHONE
S�rcvc C��AC��. '�'�...��, �.���•rr�,�� �ati� iti��`�Vb�e'to�$��� 3��-ysb�
'�a`� � r��2�u= st�-. >���o,�.�,� c,-��ybi-`tc�C.�1 �s���42�
�1���- C2i �t� '�L��h nLTll�,p� \ �(�� `��Z> �IOSI ���
List licenses w'hich you currendy hold, formerly Leld, or may have an interest in:
Hai•e any of the above named icenses ecer bcen [evoked7 YES NO If yes, list the dates and reasons fot revocalion:
2'18.'97
—"_ ,_.-�+�,., . "J
Are you going to operaie this business personall}? YES ✓ NO If no� u•ho wlll operate it? ��- 1
h.t �z To 3� a.�e � 69?�
F'uri\amo ASiddlc Initial (�Saidcn) l,nsc Dam of Sirth
x�� nem� sc�a ��
Clh'
Are you going to have a maz�ager orassistant in ttris business? '� YES
please complete the following infoanation:
Ficstl�ame IvGddlelnitisl (\laiden)
Homc Addrac Street \ume City
Please list your emplo}ment history for the pre�ious five (5) }'ear period:
Stnlc Zip Phone'.�'umber
NO If the manager is not the sazne as the operator,
Lsst
Stnm
Detc of Birth
Phone::�bcz
: �. •..-
�`.' � • � t�' 1► a► �= u
. � ` . � �_. � � a�r. .�.
• A c.., •
List all other officers of the corporation:
OPfICER TITLE HOME
NAME (Office Held) � ADDRESS �.
HOME BUSINESS DATE OF
�� PH023E PHONE BIRIH
erc
�'
If btuiness is a partnershiQ, please include the following information for each partner (use additional pages if necessary):
Furt \ame Middie Initid (�Saidcn) Lmt Da�e of Birth
Home Addrev: StRCt Neme City S�ete Z�p Phon� ��mbcr
Fint\eme Middlelnitisl (�faidrn) Lnct DateofBirth
_
HomcAdc4n+: SUect:vnme City Stetc Zip Phonel�umbcr
MIIJNESOTA TAX IDENTIFICATION 1VIJMBER - Pursuant to the Law�s of MSnnesot� 1984, Chapter 502, Ariicle 8, Section 2(270.72)
(Tar Clearaace; Issuance of Licenses), liceusing aut6orities are required to pro��de to the State of Minnesota Commissioner of Revenue, the
Minnesota business taa identification number and the social security number of each license applicant
Under the Minnesota GovernmenY Data Practices Act and the Federal Privacy Act of 1974, we are required to advise you of the fol]owing
regarding the use of the Minnesota Tax Identi5cation Number:
- This information may be used to deny the issuance or reneu�al of your license in the event you owe Minnesota sales, employer s
withholding or motor vehicie excise taxes;
- Upon receiving ttris infomiation, the licensing authoriry w�ill supply it only to the Minnesota Departinent of Revenue. However,
under the Federal Exchange of Information Agreement, the Department of Revenue may supply this informalion to the Intemal
Revenue Service.
M'vmesota T�c 7d�ti5cstion Numbeis (Sales & Use Tar Number) may be obtained from the State of Minnesota, Business Records Departrnent,
10 River Park Plaza (672-296-6181).
Socia] SecuriTy Number:
Minnesota Tax Idrntification Number: I��S yy�n
If a Minnesote TaY Identification Number is not requised for the business being operated, indicate so by placing an"X" in the bor.
2.�18.'97
� .��� q� -G92
CERTIfICATION OF WORKERS' COMPENSATION COVFRAGE�PURSUANT TO MINNESO?A STAN�IE 1�6.182
I hzreby c�..rtif} that I, or m} company, am in compliance with the �3 orkecs' compensation insurance cocerage requiremrnts of Minnesota Statute
176.182, subdivisian 2. I aLso understand that provision of faLse infrnmation in this certi5cation wns$tutes sufficient gounds for adcerse action
against ai1 licenses held, including reeocation and suspension of said licenses.
NarzofInsuranceCompany:l��cti ��.-�2 �1t�T�r�iU.� �+�i5u2�+tJCS�
Polin ��3�31'�'i(�''�-[b Coveragefrom �-15'96 to �`iS"
I hzce no emplrn-ees co� ered under w orkers compensalion insurance (INiTIALS)
ANY FALSIFICATION OF ANSWERS GIVEN OR MATERIAL SUBMTITED
WILL RESULT IN DE1�7AL OF THIS APPLICATION
I hereby state that I have answered all of the preceding questions, and that the information contaioed herein is true and correct to the best of
my laowledge ac�d belief. I hereby state fiuther that I have received no money or oiher wnsideration, by �cay of loan, gift, contribution, or
othern other than already disclosed in the application which I baewith submiUed I also underssand this premise mag be inspected by police,
fue, heatth and other cin� officials at anV and all times when the business is in operation.
We wif] accept pa�ment by cash, c6eck (made payabSe to Citp of Saint Fau� or cmdii card {M/C or Visa).
IF PAYlNG BYCREDIT CARD PLEASE COMPLETE THE FOLLOi3'ING INFORMATION: � MasterCazd � Visa
EXPII2ATION DATE: ACCOUNf NCTMBER:
��/�❑ ❑C7❑❑ ❑�[.�❑ ❑C�❑(� ❑O[�❑
of CuA�otdrr
Date
*"Note: If this application is Food/Liquor relate� please contact a City of Saint Paul Health Inspector, Ste��e Olson (266-9139), to re��ew
plans.
ff any substanlial changes to sWcture aze anticipated, please contact a City of Saint Paul Plan Exazniver at 266-9007 to apply for
building prnnits.
If there are a� changes to the parking lot, floor space, or for new operatioas, please contact a City of Saint Paul Zoning Inspector at
266-4008.
All applications require the folloning documents. Please attach t6ese documents when submitting }'our appGcation:
1. A detailed description of the design, location and square footage of ttie premises to be licensed (site plan).
The following data should be on the site plan (preferably on an 8 12" x 11 ° or 8 1/2" x 14" paper):
- Nazne, address, and phone number.
- The scale should be stated such as 1" = 20'. ^N shouid be indicated tow�azd the top.
- Placement of all pertinent features of the interior of the licensed facility such as seating areu, kitchrns, offices, repair azea,
pazking, rest rooms, etc.
- If a tequest is for an addition or expansion of tt�e licensed facility, indicate both the current area and the proposed expansion.
2. A copy of your lease agreement or proof of ownership of the property.
SPECIFIC LICENSE APPLICATIONS REQUIRE AAATTIONAL IlV'FORMATION.
PLEASE SEE REVERSE FOR DETAII,S >>>>
Council File � 9'1- Gq a,
ordinance #
Green Sheet # � � � ��
i
2
3
�_ , .
Presented By
Referred To
RESOLUTION
AINT PAUL, MINNESOTA
Committee: Date
3�
RESOLVED: That application (ID #€11429) for a Wine On Sale and On Sale Malt (Sirong Beer) License by D&
D of Minnesota Inc. DBA Famous Dave's BBQ Shack (Mark Payne, CFO) at 1902 7th Street West
be and the same is hereby approved.
4
5 Requested by Department of:
6 Yeas Nays Absent
7 B2a e.� �
8 Bostrom Off� o License ZnsQPCtions and
9 Hartis �
10 M� Fnv�ronmental Protect�on
13 Morton —�` � �
14
15 �� By: �/�[.(..n� ��.L.��
16 Adopted by Council: Date t �
17
18 Adoption Certified by Council Secretary
19 Form Approved by City Attorney
20 � .._.� j �� su�i
21 Bye
22 � r f+ 0!„ it�! ��- � � � —
23 Approved by ors Date U
24
25 " Approved by Mayor for Submission to
26 BY: _ _ Council
27
By:
Q.'1- C°I�.
DEPARiMENTAFFlCE/COUNGIL DATE INITIATED J � � °4 �
LIEP/Licensing GREEN SHEE �
CONTACTPERSON & PHONE � OEPARTil,ENTDfRECTORNITIAVDATE O qNCOUNCIL �NITIALIDATE
Christine Rozek, 266-9108 ���N �CIiYATfORNEY aCITVCLERK
NUMBEFFOF
MUST BE ON COUNdL AGENDA BY (�ATE) pOU(ING � BUOGET OIRECT� O FIN.B MGT. SERVICES �IR.
For hearin : �,j �� ORDEN OMAYOR(OflASSISTANn �
TOTAL # OP SIGNATURE PAGES (CLIP ALL LOCATIONS FOR SIGNATURE)
ACTION REQUESTED:
D& D of Minnesota Inc. DBA Famous Dave`s BBQ Shack requests Council approval of its
application for a Wine On Sale and 6n Sale Malt {Strong Beex) located at 1902 7th St. W.
(ID 1111929).
AECOMMENDATIONS: Approve (A) ar Re�ect (R) pERSONAL SERVICE CONTRACTS MUST ANSWER TNE FOLLOWING �UESTIONS:
_ PLANNINCa COMMISSION _ CIVIL SERVICE COMMISSION i. Has this person/firm ever worketl untler a contract for this tlepartment?
_ CIB COMMRTEE _ YES NO
_ S7AFF 2. Has this person/firm ever been a ciry employee?
— YES NO
_ oISTRICT COUa7 _ 3. Does this perwn/firm possess a Skill not normally possessed by any current city employee?
SUPPORTS WHICH COUNCIL OBJECTIVE? VES NO
Explain all yes answers on separate sheet anE attach to green sheet
INITIATING PROBLEM, ISSUE, OPPORTUNITY (Who, What, When, Whare. Why):
ADVANTAGESIFAPPROVEO:
DISADVANTAGES IF APPROVED.
�'* � �Fi ,^"-„_,:.
- • ,...._;ta,k �:.';.:".:'`S
r,, 4' u � -fi � ('� ']
.�
�dit'=lo� e .� �v,7!
DISADVANTAGES IF NOTAPPROVE��
TO7pL AMOUNT OF TRANSACTION $ COS7/REVENUE BUDGETED (CIHCLE ONE) YES NO
FUNDIIdG SOURCE ACTIVITY NUMBER
FINANCIALINFORFAATION:(EXPLAIN)
Greensneet# 37940 L.I.E.P. REVIEW CHECKLIST Date: 3/28/97 /�
In TraCkel'? App n Received / App'n Processed
LiCense ID # 11929 License Type: Wine On Sale and On Sale Ma� t fStronv RaP,-L
COmpBny Nartte: D& D of Minnesota Inc. DBA: Famous Dave's BBO Shack
Business Addresss: 1902 7th Street West Business Phone: 557-5798
Contact Name/Address: M�rk Payne, 8860 Flesher Circle Home Phone: 934-4705
Eden Prairie 55437 a �,� � j � ��i��6fD %
Date to Council Research: // r o�� .;>
Public Hearing Date: Labels Orde��d:�� 7��I���
Notice Serrt to Appiicant: � 7 District Council #: .�
Notice Sent to
���� ���E
Ward #: �
Departmeni/
City Attomey
Date
�f • 2 I
Environmentai
Health
y 2 I
Fire
2I
License
'��Z �� ��
Police
`I � � f • i T
Comments
N�
stte F�an Recetved:_
Lease Received: .. _
orv
'�
�• 2�
-,
CLASS III
LICENSE APPLICATION
0 ��?i� - -�Jt21 �� � 1 � 1 c � �
THIS APPLICATION IS SLJBJECT TO REVIEW BY TfiE PUBLIC
PLEASE TYPE OR PRINT IN INK
applied for:
�.� � � �' ��.} i f�1V.� 1 : ;�I .�.(f ��/ J . . ,
CITY OF SAINT PAUL
oa;« otU�rnu, Insp«rions ,}
and Em�iromnemat Protection �
3d5CPetttStS�uh300 �A��
Sa-nt Ru� MvmooG SSIC] - r
(oI�3669p90 (u<61Z)2669t2d
S�
S� � �
S � 3� L� '
S
Y CompanyName: �"` � 4� t�� 'M�rJiJtS�TP ���.�C_�
f Ca+poration / PutnQa6ip / Sole Proptie[orship
If business is incorporated, gi��e date of incorporation: �' ��'Q6
Doing Business As: �a�. `� �AV� �-+ 133C3 Sh�'PL�' Basiness Phone: 5"'�? ^`37 �1�
BusinessAddress: \'i..ZUO Z� . D� -.T Q�Va. �2���� �vhR� Y��� 1AtvJ S'�"�1y1
(ZG�ty�y Q,P,wT +ftroet qddRV ` ... ' Ciry Stete Zip
\`�o� ��St ��- �T.�wv�
Between w• at cross str ts ts t�e asmess ]ocated7 �'ttr� `E L��� Wfrich side of the street? So��k
Are the premises now occupied? �O What Type of Busitiess?
Mail To Address: lqfl2 W�SZ — 1� S'LY ��=T ST �Avt_- U`t��J SS1\�
Strut Add.�ese City S�nte Zip
AppGcant Information: �,�
Name and Tide: Srp� V— '{�L� �J � �q� N G L�b
Ficrt �liddic ('.�Se�drn) L%st Title
HomeAddress: �Y�(�0 �LE�WW .e.� C'.\�7 �t �C�Br-'��2f�., �M+J 5`�'�i37
so-«cnaar� C;ry s�m z;p
Date of Birth: 4 3 Place of Birth:�t � u.�i
Haee you ever been com•icted of any felony, crime or violation of any cit}� ordinance other than vaffic.
Date of arrest:
Chazge: _
Comiction:
Where9
Sentrnce:
Home Phone:�3� ��(�1D.i
� YES NO �
Listthe zsames and residences of three persons of good moral character, living within che Twtin Cities Metro Psea, not related to the applicant
or financially interesied in the premises or busiaess, who may be referred to as to the applicanYs character:
NAME ADDRESS PHONE
S�rcvc C��AC��. '�'�...��, �.���•rr�,�� �ati� iti��`�Vb�e'to�$��� 3��-ysb�
'�a`� � r��2�u= st�-. >���o,�.�,� c,-��ybi-`tc�C.�1 �s���42�
�1���- C2i �t� '�L��h nLTll�,p� \ �(�� `��Z> �IOSI ���
List licenses w'hich you currendy hold, formerly Leld, or may have an interest in:
Hai•e any of the above named icenses ecer bcen [evoked7 YES NO If yes, list the dates and reasons fot revocalion:
2'18.'97
—"_ ,_.-�+�,., . "J
Are you going to operaie this business personall}? YES ✓ NO If no� u•ho wlll operate it? ��- 1
h.t �z To 3� a.�e � 69?�
F'uri\amo ASiddlc Initial (�Saidcn) l,nsc Dam of Sirth
x�� nem� sc�a ��
Clh'
Are you going to have a maz�ager orassistant in ttris business? '� YES
please complete the following infoanation:
Ficstl�ame IvGddlelnitisl (\laiden)
Homc Addrac Street \ume City
Please list your emplo}ment history for the pre�ious five (5) }'ear period:
Stnlc Zip Phone'.�'umber
NO If the manager is not the sazne as the operator,
Lsst
Stnm
Detc of Birth
Phone::�bcz
: �. •..-
�`.' � • � t�' 1► a► �= u
. � ` . � �_. � � a�r. .�.
• A c.., •
List all other officers of the corporation:
OPfICER TITLE HOME
NAME (Office Held) � ADDRESS �.
HOME BUSINESS DATE OF
�� PH023E PHONE BIRIH
erc
�'
If btuiness is a partnershiQ, please include the following information for each partner (use additional pages if necessary):
Furt \ame Middie Initid (�Saidcn) Lmt Da�e of Birth
Home Addrev: StRCt Neme City S�ete Z�p Phon� ��mbcr
Fint\eme Middlelnitisl (�faidrn) Lnct DateofBirth
_
HomcAdc4n+: SUect:vnme City Stetc Zip Phonel�umbcr
MIIJNESOTA TAX IDENTIFICATION 1VIJMBER - Pursuant to the Law�s of MSnnesot� 1984, Chapter 502, Ariicle 8, Section 2(270.72)
(Tar Clearaace; Issuance of Licenses), liceusing aut6orities are required to pro��de to the State of Minnesota Commissioner of Revenue, the
Minnesota business taa identification number and the social security number of each license applicant
Under the Minnesota GovernmenY Data Practices Act and the Federal Privacy Act of 1974, we are required to advise you of the fol]owing
regarding the use of the Minnesota Tax Identi5cation Number:
- This information may be used to deny the issuance or reneu�al of your license in the event you owe Minnesota sales, employer s
withholding or motor vehicie excise taxes;
- Upon receiving ttris infomiation, the licensing authoriry w�ill supply it only to the Minnesota Departinent of Revenue. However,
under the Federal Exchange of Information Agreement, the Department of Revenue may supply this informalion to the Intemal
Revenue Service.
M'vmesota T�c 7d�ti5cstion Numbeis (Sales & Use Tar Number) may be obtained from the State of Minnesota, Business Records Departrnent,
10 River Park Plaza (672-296-6181).
Socia] SecuriTy Number:
Minnesota Tax Idrntification Number: I��S yy�n
If a Minnesote TaY Identification Number is not requised for the business being operated, indicate so by placing an"X" in the bor.
2.�18.'97
� .��� q� -G92
CERTIfICATION OF WORKERS' COMPENSATION COVFRAGE�PURSUANT TO MINNESO?A STAN�IE 1�6.182
I hzreby c�..rtif} that I, or m} company, am in compliance with the �3 orkecs' compensation insurance cocerage requiremrnts of Minnesota Statute
176.182, subdivisian 2. I aLso understand that provision of faLse infrnmation in this certi5cation wns$tutes sufficient gounds for adcerse action
against ai1 licenses held, including reeocation and suspension of said licenses.
NarzofInsuranceCompany:l��cti ��.-�2 �1t�T�r�iU.� �+�i5u2�+tJCS�
Polin ��3�31'�'i(�''�-[b Coveragefrom �-15'96 to �`iS"
I hzce no emplrn-ees co� ered under w orkers compensalion insurance (INiTIALS)
ANY FALSIFICATION OF ANSWERS GIVEN OR MATERIAL SUBMTITED
WILL RESULT IN DE1�7AL OF THIS APPLICATION
I hereby state that I have answered all of the preceding questions, and that the information contaioed herein is true and correct to the best of
my laowledge ac�d belief. I hereby state fiuther that I have received no money or oiher wnsideration, by �cay of loan, gift, contribution, or
othern other than already disclosed in the application which I baewith submiUed I also underssand this premise mag be inspected by police,
fue, heatth and other cin� officials at anV and all times when the business is in operation.
We wif] accept pa�ment by cash, c6eck (made payabSe to Citp of Saint Fau� or cmdii card {M/C or Visa).
IF PAYlNG BYCREDIT CARD PLEASE COMPLETE THE FOLLOi3'ING INFORMATION: � MasterCazd � Visa
EXPII2ATION DATE: ACCOUNf NCTMBER:
��/�❑ ❑C7❑❑ ❑�[.�❑ ❑C�❑(� ❑O[�❑
of CuA�otdrr
Date
*"Note: If this application is Food/Liquor relate� please contact a City of Saint Paul Health Inspector, Ste��e Olson (266-9139), to re��ew
plans.
ff any substanlial changes to sWcture aze anticipated, please contact a City of Saint Paul Plan Exazniver at 266-9007 to apply for
building prnnits.
If there are a� changes to the parking lot, floor space, or for new operatioas, please contact a City of Saint Paul Zoning Inspector at
266-4008.
All applications require the folloning documents. Please attach t6ese documents when submitting }'our appGcation:
1. A detailed description of the design, location and square footage of ttie premises to be licensed (site plan).
The following data should be on the site plan (preferably on an 8 12" x 11 ° or 8 1/2" x 14" paper):
- Nazne, address, and phone number.
- The scale should be stated such as 1" = 20'. ^N shouid be indicated tow�azd the top.
- Placement of all pertinent features of the interior of the licensed facility such as seating areu, kitchrns, offices, repair azea,
pazking, rest rooms, etc.
- If a tequest is for an addition or expansion of tt�e licensed facility, indicate both the current area and the proposed expansion.
2. A copy of your lease agreement or proof of ownership of the property.
SPECIFIC LICENSE APPLICATIONS REQUIRE AAATTIONAL IlV'FORMATION.
PLEASE SEE REVERSE FOR DETAII,S >>>>
Council File � 9'1- Gq a,
ordinance #
Green Sheet # � � � ��
i
2
3
�_ , .
Presented By
Referred To
RESOLUTION
AINT PAUL, MINNESOTA
Committee: Date
3�
RESOLVED: That application (ID #€11429) for a Wine On Sale and On Sale Malt (Sirong Beer) License by D&
D of Minnesota Inc. DBA Famous Dave's BBQ Shack (Mark Payne, CFO) at 1902 7th Street West
be and the same is hereby approved.
4
5 Requested by Department of:
6 Yeas Nays Absent
7 B2a e.� �
8 Bostrom Off� o License ZnsQPCtions and
9 Hartis �
10 M� Fnv�ronmental Protect�on
13 Morton —�` � �
14
15 �� By: �/�[.(..n� ��.L.��
16 Adopted by Council: Date t �
17
18 Adoption Certified by Council Secretary
19 Form Approved by City Attorney
20 � .._.� j �� su�i
21 Bye
22 � r f+ 0!„ it�! ��- � � � —
23 Approved by ors Date U
24
25 " Approved by Mayor for Submission to
26 BY: _ _ Council
27
By:
Q.'1- C°I�.
DEPARiMENTAFFlCE/COUNGIL DATE INITIATED J � � °4 �
LIEP/Licensing GREEN SHEE �
CONTACTPERSON & PHONE � OEPARTil,ENTDfRECTORNITIAVDATE O qNCOUNCIL �NITIALIDATE
Christine Rozek, 266-9108 ���N �CIiYATfORNEY aCITVCLERK
NUMBEFFOF
MUST BE ON COUNdL AGENDA BY (�ATE) pOU(ING � BUOGET OIRECT� O FIN.B MGT. SERVICES �IR.
For hearin : �,j �� ORDEN OMAYOR(OflASSISTANn �
TOTAL # OP SIGNATURE PAGES (CLIP ALL LOCATIONS FOR SIGNATURE)
ACTION REQUESTED:
D& D of Minnesota Inc. DBA Famous Dave`s BBQ Shack requests Council approval of its
application for a Wine On Sale and 6n Sale Malt {Strong Beex) located at 1902 7th St. W.
(ID 1111929).
AECOMMENDATIONS: Approve (A) ar Re�ect (R) pERSONAL SERVICE CONTRACTS MUST ANSWER TNE FOLLOWING �UESTIONS:
_ PLANNINCa COMMISSION _ CIVIL SERVICE COMMISSION i. Has this person/firm ever worketl untler a contract for this tlepartment?
_ CIB COMMRTEE _ YES NO
_ S7AFF 2. Has this person/firm ever been a ciry employee?
— YES NO
_ oISTRICT COUa7 _ 3. Does this perwn/firm possess a Skill not normally possessed by any current city employee?
SUPPORTS WHICH COUNCIL OBJECTIVE? VES NO
Explain all yes answers on separate sheet anE attach to green sheet
INITIATING PROBLEM, ISSUE, OPPORTUNITY (Who, What, When, Whare. Why):
ADVANTAGESIFAPPROVEO:
DISADVANTAGES IF APPROVED.
�'* � �Fi ,^"-„_,:.
- • ,...._;ta,k �:.';.:".:'`S
r,, 4' u � -fi � ('� ']
.�
�dit'=lo� e .� �v,7!
DISADVANTAGES IF NOTAPPROVE��
TO7pL AMOUNT OF TRANSACTION $ COS7/REVENUE BUDGETED (CIHCLE ONE) YES NO
FUNDIIdG SOURCE ACTIVITY NUMBER
FINANCIALINFORFAATION:(EXPLAIN)
Greensneet# 37940 L.I.E.P. REVIEW CHECKLIST Date: 3/28/97 /�
In TraCkel'? App n Received / App'n Processed
LiCense ID # 11929 License Type: Wine On Sale and On Sale Ma� t fStronv RaP,-L
COmpBny Nartte: D& D of Minnesota Inc. DBA: Famous Dave's BBO Shack
Business Addresss: 1902 7th Street West Business Phone: 557-5798
Contact Name/Address: M�rk Payne, 8860 Flesher Circle Home Phone: 934-4705
Eden Prairie 55437 a �,� � j � ��i��6fD %
Date to Council Research: // r o�� .;>
Public Hearing Date: Labels Orde��d:�� 7��I���
Notice Serrt to Appiicant: � 7 District Council #: .�
Notice Sent to
���� ���E
Ward #: �
Departmeni/
City Attomey
Date
�f • 2 I
Environmentai
Health
y 2 I
Fire
2I
License
'��Z �� ��
Police
`I � � f • i T
Comments
N�
stte F�an Recetved:_
Lease Received: .. _
orv
'�
�• 2�
-,
CLASS III
LICENSE APPLICATION
0 ��?i� - -�Jt21 �� � 1 � 1 c � �
THIS APPLICATION IS SLJBJECT TO REVIEW BY TfiE PUBLIC
PLEASE TYPE OR PRINT IN INK
applied for:
�.� � � �' ��.} i f�1V.� 1 : ;�I .�.(f ��/ J . . ,
CITY OF SAINT PAUL
oa;« otU�rnu, Insp«rions ,}
and Em�iromnemat Protection �
3d5CPetttStS�uh300 �A��
Sa-nt Ru� MvmooG SSIC] - r
(oI�3669p90 (u<61Z)2669t2d
S�
S� � �
S � 3� L� '
S
Y CompanyName: �"` � 4� t�� 'M�rJiJtS�TP ���.�C_�
f Ca+poration / PutnQa6ip / Sole Proptie[orship
If business is incorporated, gi��e date of incorporation: �' ��'Q6
Doing Business As: �a�. `� �AV� �-+ 133C3 Sh�'PL�' Basiness Phone: 5"'�? ^`37 �1�
BusinessAddress: \'i..ZUO Z� . D� -.T Q�Va. �2���� �vhR� Y��� 1AtvJ S'�"�1y1
(ZG�ty�y Q,P,wT +ftroet qddRV ` ... ' Ciry Stete Zip
\`�o� ��St ��- �T.�wv�
Between w• at cross str ts ts t�e asmess ]ocated7 �'ttr� `E L��� Wfrich side of the street? So��k
Are the premises now occupied? �O What Type of Busitiess?
Mail To Address: lqfl2 W�SZ — 1� S'LY ��=T ST �Avt_- U`t��J SS1\�
Strut Add.�ese City S�nte Zip
AppGcant Information: �,�
Name and Tide: Srp� V— '{�L� �J � �q� N G L�b
Ficrt �liddic ('.�Se�drn) L%st Title
HomeAddress: �Y�(�0 �LE�WW .e.� C'.\�7 �t �C�Br-'��2f�., �M+J 5`�'�i37
so-«cnaar� C;ry s�m z;p
Date of Birth: 4 3 Place of Birth:�t � u.�i
Haee you ever been com•icted of any felony, crime or violation of any cit}� ordinance other than vaffic.
Date of arrest:
Chazge: _
Comiction:
Where9
Sentrnce:
Home Phone:�3� ��(�1D.i
� YES NO �
Listthe zsames and residences of three persons of good moral character, living within che Twtin Cities Metro Psea, not related to the applicant
or financially interesied in the premises or busiaess, who may be referred to as to the applicanYs character:
NAME ADDRESS PHONE
S�rcvc C��AC��. '�'�...��, �.���•rr�,�� �ati� iti��`�Vb�e'to�$��� 3��-ysb�
'�a`� � r��2�u= st�-. >���o,�.�,� c,-��ybi-`tc�C.�1 �s���42�
�1���- C2i �t� '�L��h nLTll�,p� \ �(�� `��Z> �IOSI ���
List licenses w'hich you currendy hold, formerly Leld, or may have an interest in:
Hai•e any of the above named icenses ecer bcen [evoked7 YES NO If yes, list the dates and reasons fot revocalion:
2'18.'97
—"_ ,_.-�+�,., . "J
Are you going to operaie this business personall}? YES ✓ NO If no� u•ho wlll operate it? ��- 1
h.t �z To 3� a.�e � 69?�
F'uri\amo ASiddlc Initial (�Saidcn) l,nsc Dam of Sirth
x�� nem� sc�a ��
Clh'
Are you going to have a maz�ager orassistant in ttris business? '� YES
please complete the following infoanation:
Ficstl�ame IvGddlelnitisl (\laiden)
Homc Addrac Street \ume City
Please list your emplo}ment history for the pre�ious five (5) }'ear period:
Stnlc Zip Phone'.�'umber
NO If the manager is not the sazne as the operator,
Lsst
Stnm
Detc of Birth
Phone::�bcz
: �. •..-
�`.' � • � t�' 1► a► �= u
. � ` . � �_. � � a�r. .�.
• A c.., •
List all other officers of the corporation:
OPfICER TITLE HOME
NAME (Office Held) � ADDRESS �.
HOME BUSINESS DATE OF
�� PH023E PHONE BIRIH
erc
�'
If btuiness is a partnershiQ, please include the following information for each partner (use additional pages if necessary):
Furt \ame Middie Initid (�Saidcn) Lmt Da�e of Birth
Home Addrev: StRCt Neme City S�ete Z�p Phon� ��mbcr
Fint\eme Middlelnitisl (�faidrn) Lnct DateofBirth
_
HomcAdc4n+: SUect:vnme City Stetc Zip Phonel�umbcr
MIIJNESOTA TAX IDENTIFICATION 1VIJMBER - Pursuant to the Law�s of MSnnesot� 1984, Chapter 502, Ariicle 8, Section 2(270.72)
(Tar Clearaace; Issuance of Licenses), liceusing aut6orities are required to pro��de to the State of Minnesota Commissioner of Revenue, the
Minnesota business taa identification number and the social security number of each license applicant
Under the Minnesota GovernmenY Data Practices Act and the Federal Privacy Act of 1974, we are required to advise you of the fol]owing
regarding the use of the Minnesota Tax Identi5cation Number:
- This information may be used to deny the issuance or reneu�al of your license in the event you owe Minnesota sales, employer s
withholding or motor vehicie excise taxes;
- Upon receiving ttris infomiation, the licensing authoriry w�ill supply it only to the Minnesota Departinent of Revenue. However,
under the Federal Exchange of Information Agreement, the Department of Revenue may supply this informalion to the Intemal
Revenue Service.
M'vmesota T�c 7d�ti5cstion Numbeis (Sales & Use Tar Number) may be obtained from the State of Minnesota, Business Records Departrnent,
10 River Park Plaza (672-296-6181).
Socia] SecuriTy Number:
Minnesota Tax Idrntification Number: I��S yy�n
If a Minnesote TaY Identification Number is not requised for the business being operated, indicate so by placing an"X" in the bor.
2.�18.'97
� .��� q� -G92
CERTIfICATION OF WORKERS' COMPENSATION COVFRAGE�PURSUANT TO MINNESO?A STAN�IE 1�6.182
I hzreby c�..rtif} that I, or m} company, am in compliance with the �3 orkecs' compensation insurance cocerage requiremrnts of Minnesota Statute
176.182, subdivisian 2. I aLso understand that provision of faLse infrnmation in this certi5cation wns$tutes sufficient gounds for adcerse action
against ai1 licenses held, including reeocation and suspension of said licenses.
NarzofInsuranceCompany:l��cti ��.-�2 �1t�T�r�iU.� �+�i5u2�+tJCS�
Polin ��3�31'�'i(�''�-[b Coveragefrom �-15'96 to �`iS"
I hzce no emplrn-ees co� ered under w orkers compensalion insurance (INiTIALS)
ANY FALSIFICATION OF ANSWERS GIVEN OR MATERIAL SUBMTITED
WILL RESULT IN DE1�7AL OF THIS APPLICATION
I hereby state that I have answered all of the preceding questions, and that the information contaioed herein is true and correct to the best of
my laowledge ac�d belief. I hereby state fiuther that I have received no money or oiher wnsideration, by �cay of loan, gift, contribution, or
othern other than already disclosed in the application which I baewith submiUed I also underssand this premise mag be inspected by police,
fue, heatth and other cin� officials at anV and all times when the business is in operation.
We wif] accept pa�ment by cash, c6eck (made payabSe to Citp of Saint Fau� or cmdii card {M/C or Visa).
IF PAYlNG BYCREDIT CARD PLEASE COMPLETE THE FOLLOi3'ING INFORMATION: � MasterCazd � Visa
EXPII2ATION DATE: ACCOUNf NCTMBER:
��/�❑ ❑C7❑❑ ❑�[.�❑ ❑C�❑(� ❑O[�❑
of CuA�otdrr
Date
*"Note: If this application is Food/Liquor relate� please contact a City of Saint Paul Health Inspector, Ste��e Olson (266-9139), to re��ew
plans.
ff any substanlial changes to sWcture aze anticipated, please contact a City of Saint Paul Plan Exazniver at 266-9007 to apply for
building prnnits.
If there are a� changes to the parking lot, floor space, or for new operatioas, please contact a City of Saint Paul Zoning Inspector at
266-4008.
All applications require the folloning documents. Please attach t6ese documents when submitting }'our appGcation:
1. A detailed description of the design, location and square footage of ttie premises to be licensed (site plan).
The following data should be on the site plan (preferably on an 8 12" x 11 ° or 8 1/2" x 14" paper):
- Nazne, address, and phone number.
- The scale should be stated such as 1" = 20'. ^N shouid be indicated tow�azd the top.
- Placement of all pertinent features of the interior of the licensed facility such as seating areu, kitchrns, offices, repair azea,
pazking, rest rooms, etc.
- If a tequest is for an addition or expansion of tt�e licensed facility, indicate both the current area and the proposed expansion.
2. A copy of your lease agreement or proof of ownership of the property.
SPECIFIC LICENSE APPLICATIONS REQUIRE AAATTIONAL IlV'FORMATION.
PLEASE SEE REVERSE FOR DETAII,S >>>>