97-890Council Eile # �— �q�
OR(G1NAL
Ordinance #
Green Sheet # J �/ ��
RESOLUTION `
CITY OF SAWT PAU6
Presented
Referred To
i
2
3
Committee: Date
RESOLVED: That application (ID #71� for a Restaurant-B and Cabaret-A License by Black Beaz Crossings
LTD DBA Black Bear Crossings (David Glass, President) at 831 Como Avenue be and the same
is hereby approved.
4
5 _ r—,�„—� Requested by Department of:
6 Ye
7 B� �
8 Bostrom
9 Harrs s _]�
10 Me� �
il orM__ t�n _ �
12 � Thun � �
13 Collins �
14
15
16 Adopted by Council:
17
18 Adoption Certified by
19
20
21 By'
22
23 Approved by Mayo
Date
Date
24 / `
2 5 `'.���2�����^'Y
26 By:
27
Office of License InsDections and
Environmental Protection
� B l_�-�.�.��:- �- rl. � ,!./
Form Approved by City Attorney
Approved by Mayor £or Submission to
Council
BY=
`�'1-�`i�
DEfMpiA1ENTAFFlCFJCOUNCIL DATEINITIATED GREEN SHEE � � � � �
LIEP/Licensin INITIAUDAiE INITIAWATE
CONTACf PERSON & PHONE O DEPARTMENT DIRECTOR O qTY COUNCIL
Christine Rozek 266- 10 A��GN �CIT'ATTORNEV aCfiYCLERK
NUNBERFOfl
MUST BE ON CAUNCIL AGENDA BY (�ATEj ROUTING � BUDGEf DIRECTOR O FIN. & MGT. SERVICES UIR.
OflDER � MAYOR (OR ASSISTAN'n O
Eor hearin :
TOTAL # OF SIGNATURE PAGES (CLIP ALL LOCATIONS FOR SIGNATURE)
ACTION P.EQUESTED:
Black Bear Crossings LTD DBA Black Bear Crossings requests Council approval of its
application for a Restaurant-B and Cabaret-A License lcoated at 831 Cono Avenue (ID I171223).
PECOMMENDATIONS: Approve (A) or Reject (R) pERSONAL SERVICE CONTRACTS MUST ANSWER THE FOLLOWING QUESTIONS:
_ PLANNING CAMMISSION _ CIVIL SERVICE CAMMISSION �� Has th15 pe1'SOn/Firtn eVBf WOfked UntlEr a ContfdCt fof th�5 departmeM?
_CIBCAMMITTEE _ VES NO
2. Has this person/firm ever been a ciry employee?
_ SiAFF — YES NO
_ DIS7iiICT COUR7 — 3. Does this personRirm possess a skill not normally possessed by any curceni ciry employee?
SUQPORTS WHICH COUNCIlO&IECTIVE? YES NO
Explain all yes answers on separete sheet and atteeh to green sheet
INITIATING PROBLEM, ISSUE, OPGORTUNiN (Who, What. When, Where. Why):
ADVANTAGESIFAPPROVED:
DISAOVANTAGES IFAPPROVED
DISADVANTAGES IF NOTAPPROVED�
RE�Et'�'F�
c�� � �� �u� a
JU� � � '19�7 J{3 g i997
COLUNS
TOTAL AMOUNT 6F TRANSACTION $ COSTlREVENUE eU0GE7E0 (CIRCLE ONE) YES NO
FUNDIfdG SOURCE ACTIVITV NUMBER
fINANCIAL IkFORFnAT10P!' (EXPLAIN)
Greensheet # 37971 L.I.E.P. REVIEW CHECKLfST Date: 7/3/97 / q� ����
In Tracker? App'n Received / app'n arocessed
license ID # 71223 License Type: Restaurant-B and Cabaret-A
Company Name: Black Bear Crossings LTD _ DBA:Black Bear Crossines
Business Addresss: 831 Como Avenue Business Phone: 488-2327
Contact Name/Address: David Glass, 800 ArlinQton AveW. Nome Phone: 489-6560
Date to Council
Pubiic Hearing Date:
Notice Sent to Applicant:
Notice Sent to Pubiic:
�r�%����y�3�����
Labels Ordered: �7/7 �
District Council #:
Ward #: �
Department/ Date Inspections Comments
City Attorney
�Ig���
Environmental
Heaith
�.�.aj�.., � � .
Fire
� . '�- . � �" p I � .
License �te P�an aeceived:
Lease Received:
�- g-�� a �
Police
�—� —�� ��
Zoning
�•��� �,� �
q�l��90
Company 13ame.
1'� �/ I �
.v
y�� ���
Corporation/Pazti:tship/SolePropric[orzhip -J
If busir.ess is incorporated, �ice date of inco:porztion: A�t_. !;. 1`� � G
Doing Business As: Business Phone: S�,Y� v�3Z 7
Business Address: 4.�s72 �" M� �{'V� S�' �7' w � I /yfR•� S �7 p.j
s� naa� ctp� smm z;p
Between what cross streets is the business located? �✓��Ncf '� i f a mn ' V.'bich side of the stzet? � 4 J�
Are the premises no�c occupied? .� S What Type of Business? G�'•���� cr��
Mail To Address: -
Applicant Infon
i��ame and Title:
Home Address:
I'��
CITY OF S9I?�'T PAiJI,
o�� o: L;�:�:, �.�a�
znd Ea�iron_-::r�tzl Pto;e: ion
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('_viaiden)
sir�et Addass ✓ Ciry sis4 zip
Da*.e of Birth: ���"�� Place of Birth: /'7P �3 Home Phone: yd'J` (y J� a
y
Have you ever bzen con�•icted of anp felony, crime or violation of an} city ordinance oftier than traTnc % Y tS i`dv^ �'
Date ofarrest: VJhere?
Charge:
Com�iclion: Sentence:
List the names and residences of three persons of good moral character, living within the Ttt�in Cities Metro Area, not related to the applicant
or financially interested in thz premises or business, who may be referred to as to the appiicant`s character:
NAME ADDRESS PHONE
�{ /�cJJC��.�/ /�oa �Ni�IP/Si�y � � � 3l0 (P�J 73Jy
�22�i1 �.��J�t'i✓ �t�q f/�c�orc� S�r�4�--' S�GoY Ce�2- �000
J
List licenses N$ich } ou curre�ndy hold formerly held, or may ha��e an interest in:
Ha�•e any of the abo�•e nazned licenses ever been revoked? YES
cLass zil
LICENSE APPLICATION
��i ���r�
TFLS APPLICATION IS SUBJECT TO REVL� BY TI:E PUBLIC
PLEASE TYPE OR PRINT I?�T i1�K
s�c�K � � o yL
NO If yzs, list the dates and reasons for re��ocalion:
'�.
`�
P.rz you going to operaie flvs business personall} '�- YES
Fsst \r�e
'.�liddic Initial
(�:xiden)
G�'
YES
?3ooe sddress: SL-ee:\cvc
Are } ou goine to ha� e a man2Qa or usistant in Lhis b�siness?
pleasse completz the follon�i*:s informalion:
First \'ame
Homc Add.�css: StreR \cve
Cin
Sixte Z�P
Dze o`, Birtn
P'r,aae \v�ber
�: �
List zil other officers of the corporation:
OFFICER TITLE HOME
N� � (Offiee Held) ADDRESS
`YA2vRl�K 1✓if�lPV-l�lY�_i �d��:.n�,
NO if not, mho N�iA operate ii? , ��—�'D�
I-%s� De[c of 9irtF�
S+s[e Zip pion:\wpber
/ �
� I�rO ff the manager is not Lnz szme zs the op:; 2to,,
L ast
HO;vIE
PHO:�TE
��.1
BUSI:vESS
PHO;�TE
G�i (+�. G �
If business is a par�ership, please include ihe follou�ing infonnation for each partner (use additional pages if necessan):
Fuat \ame
Hame Add�ess: Sfreet �ame
Fintl�ame
!vtiddle Initisl
Home Address: Stru-.[ \ame
(\1aid--n)
Gty
(Vlnidrn)
c�n-
Lsat
State Zip
I.ast
s�u Zp
DATE OF
BIRTH
�� %% Sd'! '
�/3 �.
Dete ofBirth
Phone ::umber
Dste of Buth
Phone �umber
MIIv'NESOTA TAX IDE?�TTffICATION I�TUMSER - Pursuant to the Iaws of Minnesota, 1984, Chapter 502, Article 8, Seclion 2(270.72)
(Tax Clearance; Issuance of Licenses), licensing authorities aze required to provide to the State of Minnesota Commissioner of Revenue, the
Minnesota business tax identification number and the social security number of each license applicant.
Under the Minnesota Govemmrnt Data PracUces Act and the Federal Pm•acy Act of 1974, we are required to advise you of thz following
regazding the use of the Minnesota Tax Ident�calion Number:
- This information may be used to deny the issuance or renewal of your license in the event you o�;�e Minnesota sales, employer's
k�thholding or motor vehicle excise tates;
- Upon receiving this information the licensing authorin' uill suppl}' it only to the Minnesota Department of Revenue. Hon•e� er,
under the Federal Eachange of Information Ageement, the Departrnent of Revenue may suppl}' this infonnation to the Intemal
Re��enue Senice.
Minnesota Ta� Identification Numbers (Sales & Use Tax IvTtunber) ma}' be obtained frnm the State of Minnesota, Business Records Department,
10 Ri��er Park Plaza (612-296-6181).
Social Security Number: `f'7 S' S$ �"S 3�� Minnesota Tax Identification Number: C� D��o ��� Z �
If a Minnesota Tax Identification Number is not requued for the business being operated, indicate so b}' placmg an"X" in the boz
\tiddle Inilirl (�riden)
2/18.'97
Please list } our emplo}ment tustory for the previous fi�>e (5) } zz period:
CERTIFICAT;ON OF WORKERS' CO?J3ENSATION COVERAGE PURSUANT IO MINATESOTA STANTE 176.182 �� ��� Q
I hereby cec'�fi that i, or m} compan}� am in compliance « the norkers' compensation insu*ance co�•erage reauiremznts of Minnesota Stztute
1 i6.182, subdi� 2. I also nndzrs thzt p;o�7sion offalse uu`ormatioa in Uus cerufication constitutes suu groands for adeersz action
2EcLT15I 3I� I1G."RSZS t'eld, L*1C]ll�L'1Q :z��ocztion and suspension of szid licznses.
\arne of Ins:rznce Compan}'.
'x't�
Po! icy Nu.*r,ber: _� a! v o t o g I� � a Co��erage from 11/� �'7 ry S� to ��7 �' ��i
1`a�.e no emplrn co��eted unde; n�o:kr, s compensation u�s.irznce (I\'iTL�4L. �
A!\'Y FALSIFICATIO'� OF A_�'SWERS GIVEN OR MATERIAL SUBhiIITED
WII,L RESliLT Lti DElZ�.L OF THIS APPLICATION
1 hereby state that I have ansu ered a11 of thz preceding que�uons, and that the informatioa contained herein is true and correct to the best of
m� knowledge and belief. I herebt' state fwther that I have receiaed no money or othzr consideration, b} �;'a}• of loan, �ift, contribution, or
oLheruise, oLhc:r than already disclo� in the wplicarion uhich I herew�th submitted I also undzrstand this przmise ma} be inspected b}' police,
fire, health and other cih� officizls at any a�d all times u�hen the business is in operztion.
�i
all epplicatioas) Date
We Rill accept pa} ment b)' cash, check (made payabie to City of Sfaint�ul) or cmdit card (M/C or Visa).
IF PAYlNG BY CREDIT CARD PLEASE COMPLETE THE FOLLOWlNG INFORMATIOK �'..?asterCard � Visa
EXPLRAI ION DATE: ACCOUIJT NUMBER:
❑[�/�❑ ❑0�❑ ❑C7�❑ ❑[��❑ ❑�0❑
\ame of
for all
*"Note: If this application is Food/Liquor related, please contact a City of Saint Pau] Hezith Inspector, Ste� e Olson (266-97 39), to re� iew
plans.
1f any substanUal chanees to structure are anucipated, please contact a Cit}' of Saint Paul Plan Exzminer at 256-9007 to apply for
buiiding permits.
Ifthere are any changes to the parking ]ot, floor space, or for new operations, please contact a Crty of Saint Paul Zoning Inspector at
266-9008.
All applications require the follo»ing documents. Plesse attach these documents when submitting �our application:
1. A detailed description of the desigq location and square footage of the premises to be licensed (site plan).
The following data should be on the site plan (preferablp on an 8 1/2" a I 1" or 8 I/2" x? 4" paper):
- Nazne, address, and phone number.
- The sca]e should be stated such as 1"= 20'. ^ N should be indicated tow the top.
- Placement of a11 pertinent fzatures of the interior of the licensed facilit} such as seating areas, kitchens, offices, repair azea,
parking, rest rooms, etc.
- If a request is for an addioon or expansion of the licensed facility, indicate both the current area and the proposed e�pansion.
2. A copy of }�our lease agreement or proof of ounership of the property.
SPECIFIC LICEl�'SE APPLICATIONS REQLTIl2E ADDTTIOn'AL Ih�'ORMATIO�'.
PLEASE SEE REVERSE FOR DETAILS >>>>
z: � s�9�
Council Eile # �— �q�
OR(G1NAL
Ordinance #
Green Sheet # J �/ ��
RESOLUTION `
CITY OF SAWT PAU6
Presented
Referred To
i
2
3
Committee: Date
RESOLVED: That application (ID #71� for a Restaurant-B and Cabaret-A License by Black Beaz Crossings
LTD DBA Black Bear Crossings (David Glass, President) at 831 Como Avenue be and the same
is hereby approved.
4
5 _ r—,�„—� Requested by Department of:
6 Ye
7 B� �
8 Bostrom
9 Harrs s _]�
10 Me� �
il orM__ t�n _ �
12 � Thun � �
13 Collins �
14
15
16 Adopted by Council:
17
18 Adoption Certified by
19
20
21 By'
22
23 Approved by Mayo
Date
Date
24 / `
2 5 `'.���2�����^'Y
26 By:
27
Office of License InsDections and
Environmental Protection
� B l_�-�.�.��:- �- rl. � ,!./
Form Approved by City Attorney
Approved by Mayor £or Submission to
Council
BY=
`�'1-�`i�
DEfMpiA1ENTAFFlCFJCOUNCIL DATEINITIATED GREEN SHEE � � � � �
LIEP/Licensin INITIAUDAiE INITIAWATE
CONTACf PERSON & PHONE O DEPARTMENT DIRECTOR O qTY COUNCIL
Christine Rozek 266- 10 A��GN �CIT'ATTORNEV aCfiYCLERK
NUNBERFOfl
MUST BE ON CAUNCIL AGENDA BY (�ATEj ROUTING � BUDGEf DIRECTOR O FIN. & MGT. SERVICES UIR.
OflDER � MAYOR (OR ASSISTAN'n O
Eor hearin :
TOTAL # OF SIGNATURE PAGES (CLIP ALL LOCATIONS FOR SIGNATURE)
ACTION P.EQUESTED:
Black Bear Crossings LTD DBA Black Bear Crossings requests Council approval of its
application for a Restaurant-B and Cabaret-A License lcoated at 831 Cono Avenue (ID I171223).
PECOMMENDATIONS: Approve (A) or Reject (R) pERSONAL SERVICE CONTRACTS MUST ANSWER THE FOLLOWING QUESTIONS:
_ PLANNING CAMMISSION _ CIVIL SERVICE CAMMISSION �� Has th15 pe1'SOn/Firtn eVBf WOfked UntlEr a ContfdCt fof th�5 departmeM?
_CIBCAMMITTEE _ VES NO
2. Has this person/firm ever been a ciry employee?
_ SiAFF — YES NO
_ DIS7iiICT COUR7 — 3. Does this personRirm possess a skill not normally possessed by any curceni ciry employee?
SUQPORTS WHICH COUNCIlO&IECTIVE? YES NO
Explain all yes answers on separete sheet and atteeh to green sheet
INITIATING PROBLEM, ISSUE, OPGORTUNiN (Who, What. When, Where. Why):
ADVANTAGESIFAPPROVED:
DISAOVANTAGES IFAPPROVED
DISADVANTAGES IF NOTAPPROVED�
RE�Et'�'F�
c�� � �� �u� a
JU� � � '19�7 J{3 g i997
COLUNS
TOTAL AMOUNT 6F TRANSACTION $ COSTlREVENUE eU0GE7E0 (CIRCLE ONE) YES NO
FUNDIfdG SOURCE ACTIVITV NUMBER
fINANCIAL IkFORFnAT10P!' (EXPLAIN)
Greensheet # 37971 L.I.E.P. REVIEW CHECKLfST Date: 7/3/97 / q� ����
In Tracker? App'n Received / app'n arocessed
license ID # 71223 License Type: Restaurant-B and Cabaret-A
Company Name: Black Bear Crossings LTD _ DBA:Black Bear Crossines
Business Addresss: 831 Como Avenue Business Phone: 488-2327
Contact Name/Address: David Glass, 800 ArlinQton AveW. Nome Phone: 489-6560
Date to Council
Pubiic Hearing Date:
Notice Sent to Applicant:
Notice Sent to Pubiic:
�r�%����y�3�����
Labels Ordered: �7/7 �
District Council #:
Ward #: �
Department/ Date Inspections Comments
City Attorney
�Ig���
Environmental
Heaith
�.�.aj�.., � � .
Fire
� . '�- . � �" p I � .
License �te P�an aeceived:
Lease Received:
�- g-�� a �
Police
�—� —�� ��
Zoning
�•��� �,� �
q�l��90
Company 13ame.
1'� �/ I �
.v
y�� ���
Corporation/Pazti:tship/SolePropric[orzhip -J
If busir.ess is incorporated, �ice date of inco:porztion: A�t_. !;. 1`� � G
Doing Business As: Business Phone: S�,Y� v�3Z 7
Business Address: 4.�s72 �" M� �{'V� S�' �7' w � I /yfR•� S �7 p.j
s� naa� ctp� smm z;p
Between what cross streets is the business located? �✓��Ncf '� i f a mn ' V.'bich side of the stzet? � 4 J�
Are the premises no�c occupied? .� S What Type of Business? G�'•���� cr��
Mail To Address: -
Applicant Infon
i��ame and Title:
Home Address:
I'��
CITY OF S9I?�'T PAiJI,
o�� o: L;�:�:, �.�a�
znd Ea�iron_-::r�tzl Pto;e: ion
�z� s: ?-.� sc s__ �
Sz^.. �E'�� .Vi.'::�C:2 SS'.O�
(0ll)1669:5'� !n (e3]) i6S�:..
S
S �� 7J. �
S `t"�� ' �
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s�te z�
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1%4 Title
svttc ,saa,�
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Furi !�iiddlc
��'O f7�'�in G''C�,'� �ti-e_ �'i-%
ccn
('_viaiden)
sir�et Addass ✓ Ciry sis4 zip
Da*.e of Birth: ���"�� Place of Birth: /'7P �3 Home Phone: yd'J` (y J� a
y
Have you ever bzen con�•icted of anp felony, crime or violation of an} city ordinance oftier than traTnc % Y tS i`dv^ �'
Date ofarrest: VJhere?
Charge:
Com�iclion: Sentence:
List the names and residences of three persons of good moral character, living within the Ttt�in Cities Metro Area, not related to the applicant
or financially interested in thz premises or business, who may be referred to as to the appiicant`s character:
NAME ADDRESS PHONE
�{ /�cJJC��.�/ /�oa �Ni�IP/Si�y � � � 3l0 (P�J 73Jy
�22�i1 �.��J�t'i✓ �t�q f/�c�orc� S�r�4�--' S�GoY Ce�2- �000
J
List licenses N$ich } ou curre�ndy hold formerly held, or may ha��e an interest in:
Ha�•e any of the abo�•e nazned licenses ever been revoked? YES
cLass zil
LICENSE APPLICATION
��i ���r�
TFLS APPLICATION IS SUBJECT TO REVL� BY TI:E PUBLIC
PLEASE TYPE OR PRINT I?�T i1�K
s�c�K � � o yL
NO If yzs, list the dates and reasons for re��ocalion:
'�.
`�
P.rz you going to operaie flvs business personall} '�- YES
Fsst \r�e
'.�liddic Initial
(�:xiden)
G�'
YES
?3ooe sddress: SL-ee:\cvc
Are } ou goine to ha� e a man2Qa or usistant in Lhis b�siness?
pleasse completz the follon�i*:s informalion:
First \'ame
Homc Add.�css: StreR \cve
Cin
Sixte Z�P
Dze o`, Birtn
P'r,aae \v�ber
�: �
List zil other officers of the corporation:
OFFICER TITLE HOME
N� � (Offiee Held) ADDRESS
`YA2vRl�K 1✓if�lPV-l�lY�_i �d��:.n�,
NO if not, mho N�iA operate ii? , ��—�'D�
I-%s� De[c of 9irtF�
S+s[e Zip pion:\wpber
/ �
� I�rO ff the manager is not Lnz szme zs the op:; 2to,,
L ast
HO;vIE
PHO:�TE
��.1
BUSI:vESS
PHO;�TE
G�i (+�. G �
If business is a par�ership, please include ihe follou�ing infonnation for each partner (use additional pages if necessan):
Fuat \ame
Hame Add�ess: Sfreet �ame
Fintl�ame
!vtiddle Initisl
Home Address: Stru-.[ \ame
(\1aid--n)
Gty
(Vlnidrn)
c�n-
Lsat
State Zip
I.ast
s�u Zp
DATE OF
BIRTH
�� %% Sd'! '
�/3 �.
Dete ofBirth
Phone ::umber
Dste of Buth
Phone �umber
MIIv'NESOTA TAX IDE?�TTffICATION I�TUMSER - Pursuant to the Iaws of Minnesota, 1984, Chapter 502, Article 8, Seclion 2(270.72)
(Tax Clearance; Issuance of Licenses), licensing authorities aze required to provide to the State of Minnesota Commissioner of Revenue, the
Minnesota business tax identification number and the social security number of each license applicant.
Under the Minnesota Govemmrnt Data PracUces Act and the Federal Pm•acy Act of 1974, we are required to advise you of thz following
regazding the use of the Minnesota Tax Ident�calion Number:
- This information may be used to deny the issuance or renewal of your license in the event you o�;�e Minnesota sales, employer's
k�thholding or motor vehicle excise tates;
- Upon receiving this information the licensing authorin' uill suppl}' it only to the Minnesota Department of Revenue. Hon•e� er,
under the Federal Eachange of Information Ageement, the Departrnent of Revenue may suppl}' this infonnation to the Intemal
Re��enue Senice.
Minnesota Ta� Identification Numbers (Sales & Use Tax IvTtunber) ma}' be obtained frnm the State of Minnesota, Business Records Department,
10 Ri��er Park Plaza (612-296-6181).
Social Security Number: `f'7 S' S$ �"S 3�� Minnesota Tax Identification Number: C� D��o ��� Z �
If a Minnesota Tax Identification Number is not requued for the business being operated, indicate so b}' placmg an"X" in the boz
\tiddle Inilirl (�riden)
2/18.'97
Please list } our emplo}ment tustory for the previous fi�>e (5) } zz period:
CERTIFICAT;ON OF WORKERS' CO?J3ENSATION COVERAGE PURSUANT IO MINATESOTA STANTE 176.182 �� ��� Q
I hereby cec'�fi that i, or m} compan}� am in compliance « the norkers' compensation insu*ance co�•erage reauiremznts of Minnesota Stztute
1 i6.182, subdi� 2. I also nndzrs thzt p;o�7sion offalse uu`ormatioa in Uus cerufication constitutes suu groands for adeersz action
2EcLT15I 3I� I1G."RSZS t'eld, L*1C]ll�L'1Q :z��ocztion and suspension of szid licznses.
\arne of Ins:rznce Compan}'.
'x't�
Po! icy Nu.*r,ber: _� a! v o t o g I� � a Co��erage from 11/� �'7 ry S� to ��7 �' ��i
1`a�.e no emplrn co��eted unde; n�o:kr, s compensation u�s.irznce (I\'iTL�4L. �
A!\'Y FALSIFICATIO'� OF A_�'SWERS GIVEN OR MATERIAL SUBhiIITED
WII,L RESliLT Lti DElZ�.L OF THIS APPLICATION
1 hereby state that I have ansu ered a11 of thz preceding que�uons, and that the informatioa contained herein is true and correct to the best of
m� knowledge and belief. I herebt' state fwther that I have receiaed no money or othzr consideration, b} �;'a}• of loan, �ift, contribution, or
oLheruise, oLhc:r than already disclo� in the wplicarion uhich I herew�th submitted I also undzrstand this przmise ma} be inspected b}' police,
fire, health and other cih� officizls at any a�d all times u�hen the business is in operztion.
�i
all epplicatioas) Date
We Rill accept pa} ment b)' cash, check (made payabie to City of Sfaint�ul) or cmdit card (M/C or Visa).
IF PAYlNG BY CREDIT CARD PLEASE COMPLETE THE FOLLOWlNG INFORMATIOK �'..?asterCard � Visa
EXPLRAI ION DATE: ACCOUIJT NUMBER:
❑[�/�❑ ❑0�❑ ❑C7�❑ ❑[��❑ ❑�0❑
\ame of
for all
*"Note: If this application is Food/Liquor related, please contact a City of Saint Pau] Hezith Inspector, Ste� e Olson (266-97 39), to re� iew
plans.
1f any substanUal chanees to structure are anucipated, please contact a Cit}' of Saint Paul Plan Exzminer at 256-9007 to apply for
buiiding permits.
Ifthere are any changes to the parking ]ot, floor space, or for new operations, please contact a Crty of Saint Paul Zoning Inspector at
266-9008.
All applications require the follo»ing documents. Plesse attach these documents when submitting �our application:
1. A detailed description of the desigq location and square footage of the premises to be licensed (site plan).
The following data should be on the site plan (preferablp on an 8 1/2" a I 1" or 8 I/2" x? 4" paper):
- Nazne, address, and phone number.
- The sca]e should be stated such as 1"= 20'. ^ N should be indicated tow the top.
- Placement of a11 pertinent fzatures of the interior of the licensed facilit} such as seating areas, kitchens, offices, repair azea,
parking, rest rooms, etc.
- If a request is for an addioon or expansion of the licensed facility, indicate both the current area and the proposed e�pansion.
2. A copy of }�our lease agreement or proof of ounership of the property.
SPECIFIC LICEl�'SE APPLICATIONS REQLTIl2E ADDTTIOn'AL Ih�'ORMATIO�'.
PLEASE SEE REVERSE FOR DETAILS >>>>
z: � s�9�
Council Eile # �— �q�
OR(G1NAL
Ordinance #
Green Sheet # J �/ ��
RESOLUTION `
CITY OF SAWT PAU6
Presented
Referred To
i
2
3
Committee: Date
RESOLVED: That application (ID #71� for a Restaurant-B and Cabaret-A License by Black Beaz Crossings
LTD DBA Black Bear Crossings (David Glass, President) at 831 Como Avenue be and the same
is hereby approved.
4
5 _ r—,�„—� Requested by Department of:
6 Ye
7 B� �
8 Bostrom
9 Harrs s _]�
10 Me� �
il orM__ t�n _ �
12 � Thun � �
13 Collins �
14
15
16 Adopted by Council:
17
18 Adoption Certified by
19
20
21 By'
22
23 Approved by Mayo
Date
Date
24 / `
2 5 `'.���2�����^'Y
26 By:
27
Office of License InsDections and
Environmental Protection
� B l_�-�.�.��:- �- rl. � ,!./
Form Approved by City Attorney
Approved by Mayor £or Submission to
Council
BY=
`�'1-�`i�
DEfMpiA1ENTAFFlCFJCOUNCIL DATEINITIATED GREEN SHEE � � � � �
LIEP/Licensin INITIAUDAiE INITIAWATE
CONTACf PERSON & PHONE O DEPARTMENT DIRECTOR O qTY COUNCIL
Christine Rozek 266- 10 A��GN �CIT'ATTORNEV aCfiYCLERK
NUNBERFOfl
MUST BE ON CAUNCIL AGENDA BY (�ATEj ROUTING � BUDGEf DIRECTOR O FIN. & MGT. SERVICES UIR.
OflDER � MAYOR (OR ASSISTAN'n O
Eor hearin :
TOTAL # OF SIGNATURE PAGES (CLIP ALL LOCATIONS FOR SIGNATURE)
ACTION P.EQUESTED:
Black Bear Crossings LTD DBA Black Bear Crossings requests Council approval of its
application for a Restaurant-B and Cabaret-A License lcoated at 831 Cono Avenue (ID I171223).
PECOMMENDATIONS: Approve (A) or Reject (R) pERSONAL SERVICE CONTRACTS MUST ANSWER THE FOLLOWING QUESTIONS:
_ PLANNING CAMMISSION _ CIVIL SERVICE CAMMISSION �� Has th15 pe1'SOn/Firtn eVBf WOfked UntlEr a ContfdCt fof th�5 departmeM?
_CIBCAMMITTEE _ VES NO
2. Has this person/firm ever been a ciry employee?
_ SiAFF — YES NO
_ DIS7iiICT COUR7 — 3. Does this personRirm possess a skill not normally possessed by any curceni ciry employee?
SUQPORTS WHICH COUNCIlO&IECTIVE? YES NO
Explain all yes answers on separete sheet and atteeh to green sheet
INITIATING PROBLEM, ISSUE, OPGORTUNiN (Who, What. When, Where. Why):
ADVANTAGESIFAPPROVED:
DISAOVANTAGES IFAPPROVED
DISADVANTAGES IF NOTAPPROVED�
RE�Et'�'F�
c�� � �� �u� a
JU� � � '19�7 J{3 g i997
COLUNS
TOTAL AMOUNT 6F TRANSACTION $ COSTlREVENUE eU0GE7E0 (CIRCLE ONE) YES NO
FUNDIfdG SOURCE ACTIVITV NUMBER
fINANCIAL IkFORFnAT10P!' (EXPLAIN)
Greensheet # 37971 L.I.E.P. REVIEW CHECKLfST Date: 7/3/97 / q� ����
In Tracker? App'n Received / app'n arocessed
license ID # 71223 License Type: Restaurant-B and Cabaret-A
Company Name: Black Bear Crossings LTD _ DBA:Black Bear Crossines
Business Addresss: 831 Como Avenue Business Phone: 488-2327
Contact Name/Address: David Glass, 800 ArlinQton AveW. Nome Phone: 489-6560
Date to Council
Pubiic Hearing Date:
Notice Sent to Applicant:
Notice Sent to Pubiic:
�r�%����y�3�����
Labels Ordered: �7/7 �
District Council #:
Ward #: �
Department/ Date Inspections Comments
City Attorney
�Ig���
Environmental
Heaith
�.�.aj�.., � � .
Fire
� . '�- . � �" p I � .
License �te P�an aeceived:
Lease Received:
�- g-�� a �
Police
�—� —�� ��
Zoning
�•��� �,� �
q�l��90
Company 13ame.
1'� �/ I �
.v
y�� ���
Corporation/Pazti:tship/SolePropric[orzhip -J
If busir.ess is incorporated, �ice date of inco:porztion: A�t_. !;. 1`� � G
Doing Business As: Business Phone: S�,Y� v�3Z 7
Business Address: 4.�s72 �" M� �{'V� S�' �7' w � I /yfR•� S �7 p.j
s� naa� ctp� smm z;p
Between what cross streets is the business located? �✓��Ncf '� i f a mn ' V.'bich side of the stzet? � 4 J�
Are the premises no�c occupied? .� S What Type of Business? G�'•���� cr��
Mail To Address: -
Applicant Infon
i��ame and Title:
Home Address:
I'��
CITY OF S9I?�'T PAiJI,
o�� o: L;�:�:, �.�a�
znd Ea�iron_-::r�tzl Pto;e: ion
�z� s: ?-.� sc s__ �
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(0ll)1669:5'� !n (e3]) i6S�:..
S
S �� 7J. �
S `t"�� ' �
S
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s�te z�
`7�i�� S i llz -�'�
1%4 Title
svttc ,saa,�
J���y:<( .ic�M�� C1
Furi !�iiddlc
��'O f7�'�in G''C�,'� �ti-e_ �'i-%
ccn
('_viaiden)
sir�et Addass ✓ Ciry sis4 zip
Da*.e of Birth: ���"�� Place of Birth: /'7P �3 Home Phone: yd'J` (y J� a
y
Have you ever bzen con�•icted of anp felony, crime or violation of an} city ordinance oftier than traTnc % Y tS i`dv^ �'
Date ofarrest: VJhere?
Charge:
Com�iclion: Sentence:
List the names and residences of three persons of good moral character, living within the Ttt�in Cities Metro Area, not related to the applicant
or financially interested in thz premises or business, who may be referred to as to the appiicant`s character:
NAME ADDRESS PHONE
�{ /�cJJC��.�/ /�oa �Ni�IP/Si�y � � � 3l0 (P�J 73Jy
�22�i1 �.��J�t'i✓ �t�q f/�c�orc� S�r�4�--' S�GoY Ce�2- �000
J
List licenses N$ich } ou curre�ndy hold formerly held, or may ha��e an interest in:
Ha�•e any of the abo�•e nazned licenses ever been revoked? YES
cLass zil
LICENSE APPLICATION
��i ���r�
TFLS APPLICATION IS SUBJECT TO REVL� BY TI:E PUBLIC
PLEASE TYPE OR PRINT I?�T i1�K
s�c�K � � o yL
NO If yzs, list the dates and reasons for re��ocalion:
'�.
`�
P.rz you going to operaie flvs business personall} '�- YES
Fsst \r�e
'.�liddic Initial
(�:xiden)
G�'
YES
?3ooe sddress: SL-ee:\cvc
Are } ou goine to ha� e a man2Qa or usistant in Lhis b�siness?
pleasse completz the follon�i*:s informalion:
First \'ame
Homc Add.�css: StreR \cve
Cin
Sixte Z�P
Dze o`, Birtn
P'r,aae \v�ber
�: �
List zil other officers of the corporation:
OFFICER TITLE HOME
N� � (Offiee Held) ADDRESS
`YA2vRl�K 1✓if�lPV-l�lY�_i �d��:.n�,
NO if not, mho N�iA operate ii? , ��—�'D�
I-%s� De[c of 9irtF�
S+s[e Zip pion:\wpber
/ �
� I�rO ff the manager is not Lnz szme zs the op:; 2to,,
L ast
HO;vIE
PHO:�TE
��.1
BUSI:vESS
PHO;�TE
G�i (+�. G �
If business is a par�ership, please include ihe follou�ing infonnation for each partner (use additional pages if necessan):
Fuat \ame
Hame Add�ess: Sfreet �ame
Fintl�ame
!vtiddle Initisl
Home Address: Stru-.[ \ame
(\1aid--n)
Gty
(Vlnidrn)
c�n-
Lsat
State Zip
I.ast
s�u Zp
DATE OF
BIRTH
�� %% Sd'! '
�/3 �.
Dete ofBirth
Phone ::umber
Dste of Buth
Phone �umber
MIIv'NESOTA TAX IDE?�TTffICATION I�TUMSER - Pursuant to the Iaws of Minnesota, 1984, Chapter 502, Article 8, Seclion 2(270.72)
(Tax Clearance; Issuance of Licenses), licensing authorities aze required to provide to the State of Minnesota Commissioner of Revenue, the
Minnesota business tax identification number and the social security number of each license applicant.
Under the Minnesota Govemmrnt Data PracUces Act and the Federal Pm•acy Act of 1974, we are required to advise you of thz following
regazding the use of the Minnesota Tax Ident�calion Number:
- This information may be used to deny the issuance or renewal of your license in the event you o�;�e Minnesota sales, employer's
k�thholding or motor vehicle excise tates;
- Upon receiving this information the licensing authorin' uill suppl}' it only to the Minnesota Department of Revenue. Hon•e� er,
under the Federal Eachange of Information Ageement, the Departrnent of Revenue may suppl}' this infonnation to the Intemal
Re��enue Senice.
Minnesota Ta� Identification Numbers (Sales & Use Tax IvTtunber) ma}' be obtained frnm the State of Minnesota, Business Records Department,
10 Ri��er Park Plaza (612-296-6181).
Social Security Number: `f'7 S' S$ �"S 3�� Minnesota Tax Identification Number: C� D��o ��� Z �
If a Minnesota Tax Identification Number is not requued for the business being operated, indicate so b}' placmg an"X" in the boz
\tiddle Inilirl (�riden)
2/18.'97
Please list } our emplo}ment tustory for the previous fi�>e (5) } zz period:
CERTIFICAT;ON OF WORKERS' CO?J3ENSATION COVERAGE PURSUANT IO MINATESOTA STANTE 176.182 �� ��� Q
I hereby cec'�fi that i, or m} compan}� am in compliance « the norkers' compensation insu*ance co�•erage reauiremznts of Minnesota Stztute
1 i6.182, subdi� 2. I also nndzrs thzt p;o�7sion offalse uu`ormatioa in Uus cerufication constitutes suu groands for adeersz action
2EcLT15I 3I� I1G."RSZS t'eld, L*1C]ll�L'1Q :z��ocztion and suspension of szid licznses.
\arne of Ins:rznce Compan}'.
'x't�
Po! icy Nu.*r,ber: _� a! v o t o g I� � a Co��erage from 11/� �'7 ry S� to ��7 �' ��i
1`a�.e no emplrn co��eted unde; n�o:kr, s compensation u�s.irznce (I\'iTL�4L. �
A!\'Y FALSIFICATIO'� OF A_�'SWERS GIVEN OR MATERIAL SUBhiIITED
WII,L RESliLT Lti DElZ�.L OF THIS APPLICATION
1 hereby state that I have ansu ered a11 of thz preceding que�uons, and that the informatioa contained herein is true and correct to the best of
m� knowledge and belief. I herebt' state fwther that I have receiaed no money or othzr consideration, b} �;'a}• of loan, �ift, contribution, or
oLheruise, oLhc:r than already disclo� in the wplicarion uhich I herew�th submitted I also undzrstand this przmise ma} be inspected b}' police,
fire, health and other cih� officizls at any a�d all times u�hen the business is in operztion.
�i
all epplicatioas) Date
We Rill accept pa} ment b)' cash, check (made payabie to City of Sfaint�ul) or cmdit card (M/C or Visa).
IF PAYlNG BY CREDIT CARD PLEASE COMPLETE THE FOLLOWlNG INFORMATIOK �'..?asterCard � Visa
EXPLRAI ION DATE: ACCOUIJT NUMBER:
❑[�/�❑ ❑0�❑ ❑C7�❑ ❑[��❑ ❑�0❑
\ame of
for all
*"Note: If this application is Food/Liquor related, please contact a City of Saint Pau] Hezith Inspector, Ste� e Olson (266-97 39), to re� iew
plans.
1f any substanUal chanees to structure are anucipated, please contact a Cit}' of Saint Paul Plan Exzminer at 256-9007 to apply for
buiiding permits.
Ifthere are any changes to the parking ]ot, floor space, or for new operations, please contact a Crty of Saint Paul Zoning Inspector at
266-9008.
All applications require the follo»ing documents. Plesse attach these documents when submitting �our application:
1. A detailed description of the desigq location and square footage of the premises to be licensed (site plan).
The following data should be on the site plan (preferablp on an 8 1/2" a I 1" or 8 I/2" x? 4" paper):
- Nazne, address, and phone number.
- The sca]e should be stated such as 1"= 20'. ^ N should be indicated tow the top.
- Placement of a11 pertinent fzatures of the interior of the licensed facilit} such as seating areas, kitchens, offices, repair azea,
parking, rest rooms, etc.
- If a request is for an addioon or expansion of the licensed facility, indicate both the current area and the proposed e�pansion.
2. A copy of }�our lease agreement or proof of ounership of the property.
SPECIFIC LICEl�'SE APPLICATIONS REQLTIl2E ADDTTIOn'AL Ih�'ORMATIO�'.
PLEASE SEE REVERSE FOR DETAILS >>>>
z: � s�9�