HomeMy WebLinkAboutAgenda - City Council - 04/11/2012 •
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AGENDA
SOUTH BURLINGTON CITY COUNCIL
City Hall
575 Dorset Street
SOUTH BURLINGTON, VERMONT
Mini-Retreat 4:00pm-7:OOpm (ending time is estimated) Wednesday, April 11, 2012
City Council Priority Setting- Mini Retreat and Workshop, facilitated by Steve Jeffrey, VLCT
Regular Meeting 7:00pm (estimated - begins immediately following Mini-Retreat)
1. Agenda Review: Additions, deletions or changes in order of agenda items.
2. Comments and questions from the public (not related to the agenda).
3. Announcements and City Manager's Report.
4. Consent Agenda: Nothing at this time.
5. ### Presentation from CSWD on Organized Trash Collection (Paul Stabler, South
Burlington CSWD Representative).
6. *** Condo Energy Efficiency Project contract award (Paul Conner, Planning and Zoning
Director).
7. Update on Interim RFP, Staffing, Committees (Councilors and Staff).
8. ***Reconvene as Liquor Control Board for consideration of license applications.
• Champlain Farms
• Cheese Traders
• Independent Brewers (Magic Hat)
• Outback Steakhouse
• U Save Beverage
9. Continue to discuss possible Rules of Procedure and Other Regular Expectations for City
Council (Councilors and Staff).
10. Other Business.
a. Any items held from the Consent Agenda.
b. Other?
11. Consider entering executive session for discussion of personnel matters, litigation and real
property matters.
Respectfully Submitte :
Sanford I. Miller, City Manager
*** Attachments Included
### Attachments Sent Separately or Previously
South Burlington City Council Meeting Participation Guidelines
The City Council Chair is presenting these guidelines for public participation and attendance at City Council meetings
in an effort to insure that everyone has a chance to be heard and meetings function as smoothly as possible.
1. Please raise your hand to be recognized to speak. The Chair will make every effort to recognize the public in the
order in which hands are raised.
2. Once recognized by the Chair, please identify yourself to Council.
3. If the Council has suggested time limits, please respect them. Time limits will be used when they can aid in
making sure everyone is heard and sufficient time is available for Council to conduct business items.
4. In order for City Councilors and other members of the audience to hear speakers' remarks,side conversations
between audience members should be kept to an absolute minimum. The hallway outside the Community Room
is available should people wish to chat more fully.
5. Please address the Chair. Please do not address other audience members or staff or presenters and please do
not interrupt others when they are speaking.
6. Make every effort not to repeat the points made by others.
7. The Chair will make reasonable efforts to allow everyone who is interested in participating to speak once before
speakers address the Council for a second time.
8. Council desires to be as open and informal as possible within the construct that the Council meeting is an
opportunity for Councilors to discuss,debate and decide upon policy matters. Council meetings are not"town
meetings". To this end, after the public has had the opportunity to make comments,the Chair may ask that
discussion be among Councilors.
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southburlington
VERMONT
WARNING
SOUTH BURLINGTON CITY COUNCIL
SOUTH BURLINGTON, VERMONT
Not An Official Public Meeting 1:15 p.m. Monday, April 16, 2012
DARE Graduation at Chamberlin School Gym/Cafeteria: A majority of City Council may (or may
not) be in attendance to honor the DARE graduates and program participants. Councilors will
not discuss any City business nor will they take any action.
Not An Official Public Meeting 1:35 p.m. Tuesday, May 1, 2012
DARE Graduation at Orchard School Cafeteria: A majority of City Council may (or may not) be
in attendance to honor the DARE graduates and program participants. Councilors will not
discuss any City business nor will they take any action.
Respectfully Submitted:
Sanford I. Miller, City Manager
41
south. . t i
PLANNING & ZONING
MEMORANDUM
TO: South Burlington City Council & City Manager
FROM: Paul Conner, Director of Planning &Zoning
SUBJECT: Condominium Energy Efficiency Request for Proposals
DATE: April 11, 2012 City Council meeting
In February the City issued an RFP for a consultant to work with condominium associations in
the community on energy efficiency programs. The selected consultant will prepare a "how to
toolbox" to help navigate the particular challenges faced by multi owners in a single building or
association.
The project is funded through a Federal Energy Block Grant, via the Chittenden County
Regional Planning Commission. The total grant is for $46,500, with a 10%local in-kind match
required. In its application for the grant, the city envisioned the match being met through a
combination of staff and volunteer time, with no cost outlay to the city.
We received three responses to the RFP, from Shelter Analytics, Perkins Smith, and Chip
Patullo. Staff reviewed the proposals separately in accordance with the RFP standards, as did a
representative from Vermont Gas, a partner in the project.
The proposal led by Shelter Analytics was the top staff choice and was supported by Vermont
Gas. Staff has followed up with four of their references and received positive reports from each.
An important note: Both the Shelter Analytics and Perkins Smith proposals included a team
member who presently serves on the city's Energy Committee. The Shelter Analytics team
member contacted staff prior to the submission of the proposal and provided the statement listed
below. There does not appear to be any city conflict of interest policy that would preclude this
member from serving on a consulting team. Shelter Analytics has advised us that if we have any
concerns about this team member, they would like the opportunity to re-organize.
Staff recommendation: Staff recommends that the City Council authorize the City Manager to
make final negotiations with the intent to award Shelter Analytics as the consultant for the
project. The Council may, further, discuss the presence of a team member from the Energy
Committee and should determine whether the consultant team as organized is acceptable or
whether changes to the team are required.
575 Dorset Street South Burlington, VT 05403 tel 802.846.4106 fax 802.846.4101
www.sburl.com
1 City of South Burlington
40 / City Clerk's Office
VOTE Donna Kinville, City Clerk
FIRST, SECOND CLASS AND CABARET LICENSE APPLICATION
FULL NAME OF PERSON, PARTNERSHIP, CORPORATION
, Inc ,
DOING BUSINESS AS/ TRADENAME
C\nQ lo1Y\ a'ad'7 0 ^d vJ
6/ /1/0
ADDRESS
) ) /s____Loii))):4Dr rJ ,
FIRST CLASS SECOND CLASS CABARET
DATE RECEIVED BY CLERK'S OFFICE ,:Q'3 ---,7J D) '
SO. BURLINGTON POLICE DEPT
Chief Trevor S. Whipple Date
SO BURLINGTON FIRE DEPT-)
-flf- 9/1 /14,..
Chief Douglas S. Brent Date
SO. BURLINGTON TAX DEPT
Gam: 02-
-
Mart a Lyons, Deput Tax Collector
Date sent to Montpelier:
i
2012 LIQUOR LICENSE RENEWAL APPLICATION 2396-030-SECN-01
SECOND CLASS LICENSE TO SFTT, MALT AND VINOUS BEVERAGES Page 1
Fee: $100.00 of which
License Year Beginning May 1, 2012 ending April 30, 2013 $50.00 is paid to town/city
$50.00 is paid to DEC
Town: 04065 - SOUTH BURLINGTON
MISREPRESENTATION OF A MATERIAL FACT ON ANY LICENSE APPLICATION SHALL BE GROUNDS
FOR SUSPENSION OR REVOCATION OF THE LICENSE, AFTER NOTICE AND HEARING
Applicant: Review all of the information presented on this form, indicating any changes in the spaces provided.
Applicant: Wesco, Inc.
Doing Business As:
Champlain Farms Mailing Address:
1118 Williston Road • 32 San Remo Drive
South Burlington VT 05403 South Burlington VT 05403-6310
Telephone: 2) I -C
PLEASE INCLUDEDE EMAMAILL ADDRESS:� P,�PC0c'V\(,a'�nP�C�.i mJC , C6rn
Description of Premises: Lessor:
Store located within a wood constructed building being approximately Wesco, Inc.
2,200 square feet in size, designated as 1118 Williston Road, in the South Burlington VT 05403
City of South Burlington, Vermont.
Last Enforcement Seminar: 10/05/2011 �`
Fed. ID Number: 03-0273319 Incorporation Date: 09/21/1979 Valid Charter?: Yes State of Charter: Vermo � Q
i/tit'..-:11-)
Majority of Directors are US Citizens: Yes
ATTACH AN ADDITIONAL SHEET TO THIS APPLICATION NOTING ANY NECESSARY CORRECTIONS 0 CHANGES
AND UPDATES THAT HAVE OCCURRED DURING THE PAST/EARQQ� �^�ID/�A �J1.1/��
Corporation Name Addres�`'' y Town/City State Zip Code
Director 1. Simendinger, David Limon VT 05452
Director 2. Simendinger, William 12 Whiteface Street S Burlington VT 05403
Stockholder 3. Simendinger, David 16 Hagaw Driuc.. Pre. , VT 05452
Stockholder 4. Simendinger, William �� Whiteface Street� ���Burlington VT 05403
Has any director or stockholder been convicted or 1 ty to nal or tor vehicle offense in any court
of law (including traffic tickets by mail) during the last year? ("Yes No
If yes, please attach the following information: Individual's name, court/traffic bureau, offense and date
In the past year has any director or stockholder of the cor&ration held any electivy or appointive state, county,
city, village or town office in Vermont (See VSA, T.7, Ch.9, Sec. 223)? Yes V No
If yes, please attach the following information: Individual's name, office and jurisdiction
Disclosure of Non-profit Organization?: Yes XX No
ALL APPLICANTS MUST COMPLETE AND SIGN
The applicant understands and agrees that the Liquor Control Board may obtain criminal history record information from
State and Federal record repositories.
I/We hereby certify, under the pains and penalties of perjury, that I/We are in good standing with respect to or in full
compliance with a plan approved by the Commissioner of Taxes to pay any and all taxes due the State of Vermont as of the date
of this application. (VSA, Title 32, Section 3113)
I/We hereby certify that I/We are not under an obligation to pay child support or that I/We are in good standing with
respect to child support or are in full compliance with a plan to pay any and all child support payable under a support
order. (VSA, Title 15, Section 795)
In accordance with 21 VSA, Section 1378(b), I/We certify, under pains and penalties of perjury, that I/We are in good
standing with respect to or in full compliance with a plan to pay any and all contributions or payments in lieu of
contributions due to the Department of Employment and Training.
I/We have registered the trade name of these premises with the Secretary of State.
Continued on next page
Health License Expires
/ /2012
WESCO,
PARIVIS
2012 Liquor/Tobacco License Renewal
Change of Address:
David Simendinger
88 Calloway Dr
Williston, VT 05495
Traffic Tickets:
William Simendinger
Connecticut Superior Court
Speeding
05/11/2011
William Simendinger
State of New Hampshire, Sullivan County
Newport District Court
Speeding
05/20/2011
2012 LIQUOR LICENSE RENEWAL APPLICATION 2396-030—SECN-01
SECOND CLASS LICENSE TO SELL MALT AND VINOUS BEVERAGES Page 2
I/We hereby certify that the information in this application is true and complete.
Dated at •1/U►�` , in the county of \ , and State of \1 Q,{�VV\.M\,
this `�C day of S\�q 1�JM 0 ,
Signature of authorize agent Signature of individual or partners
of corpgration( company, cl associa io
11
W Q,`EJ\\ I 12,5\
(Title)
Are you making this application for the benefit of any other party? Yes V No
Upon being satisfied that the conditions precedent to the granting of this license as provided in Title 7 of the Vermont
Statutes Annotated, as amended, have been fully met by the applicant, the commissioners will endorse their recommendation on -
the back of the applications and transmit both copies to the Liquor Control Board for suitable action thereon, before any
license may be granted. For the information of the Liquor Control Control Board, all applications shall carry the signature
of each individual commissioner registering either approval or disapproval. Lease or title must be recorded in town or city
before issuance of license.
APPROVED DISAPPROVED
Approved by Board of Control Commissioners of th it of '/ :..
Total Membership 5 members present �r� C.tees �Town Clerk
TOWN OR CITY CLERK SHALL MAIL APPROVED RENEWAL DIRECTLY TO:
DEPARTMENT OF LIQUOR CONTROL
13 GREEN MOUNTAIN DRIVE
MONTPELIER, VT 05602
If application is disapproved, local control commissioners shall notify the applicant by letter.
No formal action taken by any agency or authority of any town board of selectmen or city board of aldermen on a first or
second class license application shall be considered binding except as taken or made at an open public meeting. VSA T-1,Sec.312
2012 TOBACCO LICENSE RENEWAL APPLICATION 2396-030-TOBC-01
TOBACCO LICENSE TO SELL TOBACCO Page 1
Optional Fee: $10.00 of which
License Year Beginning May 1, 2012 ending April 30, 2013 $1 0.0 0 is paid to town/city
$0.00 is paid to DLC
Fee due only if licensee does not have a liquor license
Town: 04065 - SOUTH BURLINGTON
MISREPRESENTATION OF A MATERIAL FACT ON ANY LICENSE APPLICATION SHALL BE GROUNDS
FOR SUSPENSION OR REVOCATION OF THE LICENSE, AFTER NOTICE AND HEARING
Applicant: Review all of the information presented on this form, indicating any changes in the spaces provided.
Applicant: Wesco, Inc.
Doing Business As:
Champlain Farms Mailing Address:
1118 Williston Road 32 San Remo Drive
South Burlington VT 05403 South Burlington VT 05403-6310
Telephone: (802) 863-6611 p r p (�
PLEASE INCLUDE EMAIL ADDRESS: C.LC. �CQ\GAV\1'Q,YV�/\5.(D �
Description of Premises: ` Lessor:
Store located within a wood constructed building being approximately Wesco, Inc.
2,200 square feet in size, designated as 1118 Williston Road, in the South Burlington VT 05403
City of South Burlington, Vermont.
Last Enforcement Seminar: 10/05/2011
Fed. ID Number: 03-0273319 Incorporation Date: 09/21/1979 Valid Charter?: Yes State of Charter: Vermont
Majority of Directors are US Citizens: Yes
ATTACH AN ADDITIONAL SHEET TO THIS APPLICATION NOTING ANY NECESSARY CORRECTIONS OR CHANGES
AND UPDATES THAT HAVE OCCURRED DURING THE PAST YEAR.,�J,�^
Corporation Name Address �'^' / Town/City State Zip Code
Director 1. Simendinger, David }� E000s f 95444.
Director 2. Simendinger, William 12 Whiteface Street S Burlington VT 05403
Stockholder 3. Simendinger, David lb Hagan Hrize. C000x GE)152
Stockholder 4. Simendinger, William 12 Whiteface S reet Burlington VT 05403
Has any director or stockholder been convicted or pleaded guil' o y criminal or motor vehicle offense in any court
of law (including traffic tickets by mail) during the last year? Yes No
If yes, please attach the following information: Individual's name, court/traffic bureau, offense and date
In the past year has any director or stockholder of the corporation held any electi e or appointive state, county,
city, village or town office in Vermont (See VSA, T.7, Ch.9, Sec. 223)? Yes No
If yes, please attach the following information: Individual's name, office and jurisdiction
ALL APPLICANTS MUST COMPLETE AND SIGN
The applicant understands and agrees that the Liquor Control Board may obtain criminal history record information from
State and Federal record repositories.
I/We hereby certify, under the pains and penalties of perjury, that I/We are in good standing with respect to or in full
compliance with a plan approved by the Coimiissioner of Taxes to pay any and all taxes due the State of Vermont as of the date
of this application. (VSA, Title 32, Section 3113)
I/We hereby certify that I/We are not under an obligation to pay child support or that I/We are in good standing with
respect to child support or are in full compliance with a plan to pay any and all child support payable under a support
order. (VSA, Title 15, Section 795)
In accordance with 21 VSA, Section 1378(b), I/We certify, under pains and penalties of perjury, that I/We are in good
standing with respect to or in full compliance with a plan to pay any and all contributions or payments in lieu of
contributions due to the Department of Employment and Training.
I/We have registered the trade name of these premises with the Secretary of State.
I/We hereby certify that the information in this application is true and cotplete.
Dated at , in the county of tl , and State of Vefyv .QV\,"1
this ,q day of 0-0
Signature of authorized agent Signature of individual or partners
of corporation, company, ub or sociation
Are you making this application for the benefit of any other party? Yes
Continued on next page
• 2012 TOBACCO LICENSE RENEWAL APPLICATION 2396-030-TOBC-01
TOBACCO LICENSE TO SRT,T TOBACCO Page 2
Upon being satisfied that the conditions precedent to the granting of this license as provided in Title 7 of the Vermont
Statutes Annotated, as amended, have been fully met by the applicant, the commissioners will endorse their recaumendation on
the back of the applications and transmit both copies to the Liquor Control Board for suitable action thereon, before any
license may be granted. For the information of the Liquor Control Control Board, all applications shall carry the signature
of each individual ca:missioner registering either approval or disapproval. Lease or title must be recorded in town or city
before issuance of license.
APPROVED DISAPPROVED
Approved by Board of Control Commissioners of City or Town of j7.
Total Membership 6 members present Att t ll day, Town Clerk
TOWN OR CITY CLERK SHALL MAIL APPROVED RENEWAL DIRECTLY TO:
DEPARTMENT OF LIQUOR CONTROL
13 GREEN MOUNTAIN DRIVE
MONTPELIER, VT 05602
•
If application is disapproved, local control commissioners shall notify the applicant by letter.
No formal action taken by any agency or authority of any town board of selectmen or city board of aldermen on a tobacco
license application shall be considered binding except as taken or made at an open public meeting. VSA T-1,Sec.312
•
Sps3TN Yf yuFIortcro, ?*4J
City of South Burlington
�,/+�`�� �hli 575 DORSET STREET
S•�i�arf`f� ��, SOUTH BURLINGTON, VERMONT 05403-6260
fir
e`SNF.A TOWN M1R,,,,y+ IRST, SECOND CLASS AND CABARET LICENSE APPLICATION
FULL NAME OF PERSON, PARTNERSHIP, CORPORATION
y !) ) tic ,
DOING BUSINESS AS/TRADENAME
(h/ ' ---fraArs
ADDRESS
/1 go w;i //:4D/A-6Si •
FIRST CLASS SECOND CLASS CABARET
DATE RECEIVED BY CLERK'S OFFICE iti , /7, ac9
South Burlington Police Department 7-
Q/
Chief Trevor S. Whipple Date
South rliQ1'V
ngton Fire Department
ilz.//lZ
Chief Douglas S. Brent Date
South Burlington Tax Department
-Z ,4 1 f'711z
Martha Lyons, Deputy Tax Collector Date
Date Sent to
Montpelier:
2012 LIQUOR LICENSE RENEWAL APPLICATION 6320-001-SECN-01
SECOND CLASS LICENSE TO SFTJ MALT AND VINOUS BEVERAGES Page 1
Fee: $100.00 of which
License Year Beginning May 1, 2012 ending April 30, 2013 $50.00 is paid to town/city
$50.00 is paid to DLC
Town: 04065 - SOUTH BURLINGTON
MISREPRESENTATION OF A MATERIAL FACT ON ANY LICENSE APPLICATION SHALL BE GROUNDS
FOR SUSPENSION OR REVOCATION OF THE LICENSE, AFTER NOTICE AND HEARING
Applicant: Review all of the information presented on this form, indicating any changes in the spaces provided.
Applicant: Maro, Inc.
Doing Business As: ,
Cheese Traders Mailing Address:
1186 Williston Road 1186 Williston Road
Suite 200 Suite 200
South Burlington VT 05403 South Burlington VT 05403 pz
Telephone: (80DE2) 863-01 : j_11 ^^r' 12.10490.
Q�PLEASE INCLUDE EMAIL ADDRESS: �V`.�' 1/ p, �L/1-
Description of Premises: r Lessor:
Store utilizing the basement and first floor of a one story wood Charles & Janet Perkins
framed building occupying approximately 8,000 square feet and Burlington VT 05401
located on the North side of Williston Road, designated as 1186
Williston Road Suite 200, in the City of South Burlington, Vernwut.
Test Enforcement Seminar: 03/14/2011
Fed. ID Number: 20-8847353 Incorporation Date: 04/13/2007 Valid Charter?: Yes State of Charter: Vermont
Majority of Directors are US Citizens: Yes
ATTACH AN ADDITIONAL SHEET TO THIS APPLICATION NOTING ANY NECESSARY CORRECTIONS OR CHANGES
AND UPDATES THAT HAVE OCCURRED DURING THE PAST YEAR.
Corporation Name Address Town/City State Zip Code
Director 1. Bachofen, Robert H. 260 Village Glen Manchester 05254
Director 2. Bachofen, Luz Marina 260 Village Glen Manchester Ufpg 05254
Director 3. Alexander, Charles P.O. 247 Manahcctcr Con*.wr� ��',�,,�tly I' 45254 o 1.f L
Director 4. Alfaro-Alexander, Ana Maria P.O. Box�354 jg$/'7 Pl nel.c i CetrL, �1A`•' VT 9525Fi.p5if
Director 5. Samuelson, Matthew P.O. Box 1091 Manchester VT 05255
Stockholder 6. Bachofen, Robert H. 260 Village Glen Manchester VT 05254
Stockholder 7. Bachofen, Luz Marina 260 Village Glen Manchester VT 05254
Has any director or stockholder been convicted or pleaded guilty to any criminal or motor vehicle offense in any court
of law (including traffic tickets by mail) during the last year? Yes ,/ No
If yes, please attach the following information: Individual's name, court/traffic bureau, offense and date
In the past year has any director or stockholder of the corporation held any electiv9 or appointive state, county,
city, village or town office in Vent (See VSA, T.7, Ch.9, Sec. 223)? Yes °/ No
If yes, please attach the following information: Individual's name, office and jurisdiction
Disclosure of Non-profit Organization?: Yes XX No
ALL APPLICANTS MUST COMPLETE AND SIGN
The applicant understands and agrees that the Liquor Control Board may obtain criminal history record information from
State and Federal record repositories.
I/We hereby certify, under the pains and penalties of perjury, that I/We are in good standing with respect to or in full
compliance with a plan approved by the Commissioner of Taxes to pay any and all taxes due the State of Vermont as of the date
of this application. (VSA, Title 32, Section 3113)
I/We hereby certify that I/We are not under an obligation to pay child support or that I/We are in good standing with
respect'to child support or are in full caspliance with a plan to pay any and all child support payable under a support
order. (VSA, Title 15, Section 795)
In accordance with 21 VSA, Section 1378(b), I/We certify, under pains and penalties of perjury, that I/We are in good
standing with respect to or in full compliance with a plan to pay any and all contributions or payments in lieu of
contributions due to the Department of Employment and Training.
I/We have registered the trade name of these premises with the Secretary of State.
Continued on next page
Y
2012 LIQUOR LICENSE RENEWAL APPLICATION 6320-001—SECN—01
SECOND CLASS LICENSE TO SET,L MALT AND VINOUS BEVERAGES Page 2
I/We hereby certify that the information in this application is true and complete.Dated at a�17h. `/I{{,��PJLJ , in the county of_a,,L___•_ffekete , and State of f/ 1 this 0 day of Ck , _9 Q,-fcQ-
Signat e of authorized agent Signature of individual or partners
of co ation, company, club or association
P,eLfr ; / ► dew
(Ti e)
Are you making this application for the benefit of any other party? Yes YNO
Upon being satisfied that the conditions precedent to the granting of this license as provided in Title 7 of the Vermont
Statutes Annotated, as amended, have been fully met by the applicant, the commissioners will endorse their recommendation on
the back of the applications and transmit both copies to the Liquor Control Board for suitable action thereon, before any
license may be granted. For the information of the Liquor Control Control Board, all applications shall carry the signature
of each individual commissioner registering either approval or disapproval. Lease or title must be recorded in town or city
before issuance of license.
APPROVED DISAPPROVED
Approved by Board of Control Commissioners of e City o Towl o Go Vd IL
fill
Total Membership `� members present Attest, — � c, �Vl
Town Clerk
TOWN OR CITY CLERK SHALL MAIL APPROVED RENEWAL DIRECTLY TO:
DEPARTMENT OF LIQUOR CONTROL
13 GREEN MOUNTAIN DRIVE
MONTPELIER, VT 05602
If application is disapproved, local control commissioners shall notify the applicant by letter.
No formal action taken by any agency or authority of any town board of selectmen or city board of aldermen on a first or
second class license application shall be considered binding except as taken or made at an open public meeting. VSA T-1,Sec.312
•
„0c .0 Cityof South Burlington
.®® ;. City Clerk's Office
"°”DpED Donna Kinville, City Clerk
d •
FIRST, SECOND CLASS AND CABARET LICENSE APPLICATION
FULL NAME OF PERSON, PARTNERSHIP, CORPORATION
r C-P
DOING BUSINESS AS/ T EN
‘-- /7Y)146)1
ADDRESS 42aCLO
felr14-k4-4,- elEr______ir,J - ,)/
FIRST CLASS SECOND CLASS CABARET
DATE RECEIVED BY CLERK'S OFFICE- 4 12)�---�
SO. BURLINGTON POLICE DEPT
Chief Trevor S. Whipple Date
SO.(
O. ERLINGTON FIRE DEPT
Li eI2, 41/21 2-
Chia Douglas S. Brent Date
SO. BURLINGTON TAX DEPT
Z2-1/K) 17/-2//, -
Mart a Lyons, Deputy Ta,6::d(a_ x'Collector
Date sent to Montpelier:
i
4
2012 LIQUOR LICENSE RENEWAL APPLICATION 6858-002-SECN-01
SECOND CLASS LICENSE TO SELL MALT AND VINOUS BEVERAGES Page 1
Fee: $100.00 of which
License Year Beginning May 1, 2012 ending April 30, 2013 $5 0.0 0 is paid to town/city
$50.00 is paid to DLC
Town: 04065 - SOUTH BURLINGTON
MISREPRESENTATION OF A MATERIAL FACT ON ANY LICENSE APPLICATION SHALL BE GROUNDS
FOR SUSPENSION OR REVOCATION OF THE LICENSE, AFTER NOTICE AND HEARING
Applicant: Review all of the information presented on this form, indicating any changes in the spaces provided.
Applicant: Independent Brewers United Corporation
Doing Business As:
Independant Brewers United Corporation (2nd) Mailing Address:
5 Bartlett Bay Road 5 Bartlett Bay Road
S. Burlington VT 05403 ���!� S.� Burlington
fVTT(075403 'gyp
Telephone: DE EMAIL2739 y�'^q'L 1 F 5 RDQ 4Q&���J
PLEASE INCLUDE ADDRESS: A
Description of Premises: Lessor:
Store in a steel building consisting of approx. 4,300 square feet Antonio B & Rita M Pomerleau
located on/within a manufacturing facility located on the north side S. Burlington VT
of Bartlett Bay Road. Designated as #5, 1/10 of a mile west of the
intersection of Rte 7 in the city of South Burlington, VT
Last Enforcement Seminar: 01/26/2010
Fed. ID Number: 91-1258355 Incorporation Date: 03/27/1984 Valid Charter?: Yes State of Charter: Washington
Majority of Directors are US Citizens: Yes
ATTACH AN ADDITIONAL SHEET TO THIS APPLICATION NOTING ANY NECESSARY CORRECTIONS OR CHANGES
AND UPDATES THAT HAVE OCCURRED DURING THE PAST YEAR.
Corporation Name Address Town/City State Zip Code
Director 1. Palmer, Raquel V 151 West 17th Street 11G New York NY 10011
Director 2. Madden, Kevin M 305 W 13th St Apt 4H New York NY 10014
Director 3. Lozyniak, Richard 18 Broms Grove Hill Pittsford NY 14534
Director 4. Saputo, Randy 403 Coastal View Drive Wchster NY 14580
Director 5. Pendegraft, James 16 Redbrick Road Orchard Park NY 14127
Stockholder 6. Independent Brewers , United I 431 Pine Street Suite g-14 Burlington VT 05401
Has any director or stockholder been convicted or pleaded guilty �Q/��y criminal or motor vehicle offense in any court
of law (including traffic tickets by mail) during the last year? /\Yes No
If yes, please attach the following information: Individual's name court/traffic bureau, offense and date
In the past year has any director or stockholder of the corporation held any electiv or appointive state, county,
city, village or town office in Vermont (See VSA, T.7, Ch.9, Sec. 223)? Yes )4No
If yes, please attach the following information: Individual's name, office and jurisdiction
Disclosure of Non-profit Organization?: Yes XX No
ALL APPLICANTS MUST COMPLETE AND SIGN
The applicant understands and agrees that the Liquor Control Board may obtain criminal history record information from
State and Federal record repositories.
I/We hereby certify, under the pains and penalties of perjury, that I/We are in good standing with respect to or in full
compliance with a plan approved by the Commissioner of Taxes to pay any and all taxes due the State of Vermont as of the date
of this application. (VSA, Title 32, Section 3113)
I/We hereby certify that I/We are not under an obligation to pay child support or that I/We are in good standing with
respect to child support or are in full compliance with a plan to pay any and all child support payable under a support
order. (VSA, Title 15, Section 795)
In accordance with 21 VSA, Section 1378(b), I/We certify, under pains and penalties of perjury, that I/We are in good
standing with respect to or in full compliance with a plan to pay any and all contributions or payments in lieu of
contributions due to the Department of Employment and Training.
I/We have registered the trade name of these premises with the Secretary of State.
Continued on next page
Rider to the 2012 Renewal Application:
Please make the following changes to the directors within our company,
Remove Randy Saputo and add in Daniel Harrington-Chief Financial Officer
Daniel's home address is 45 Turning Leaf Drive, Pittsford, NY 14534
In regards to the question, if any director pleaded guilty to a motor vehicle offense in any court of law:
YES
James Pendegraft-Town of West Seneca, NY Town Court on 09/06/2011, guilty to a parking ticket.
•
2012 LIQUOR LICENSE RENEWAL APPLICATION 6858-002-SECN-01
SECOND CLASS LICENSE TO SELL MALT AND VINOUS BEVERAGES Pace 2
I/We hereby certify+ that the information in this application is true and complete.
Dated at �y 'V , in the�county of �n , and State of U 2.L y o( U. .
this ,�l day of MQrth , l/)f
Si f autho ized agent Signature of individual or partners
of co rate , club or association
-3-0j0Q2. RPs -
i CQ r(e J C�4 \
v
(Title)
Are you making this application for the benefit of any other party? Yes r No
Upon being satisfied that the conditions precedent to the granting of this license as provided in Title 7 of the Vermont
Statutes Annotated, as amended, have been fully met by the applicant, the commissioners will endorse their recommendation on
the back of the applications and transmit both copies to the Liquor Control Board for suitable action thereon, before any
license may be granted. For the information of the Liquor Control Control Board, all applications shall carry the signature
of each individual commissioner registering either approval or disapproval. Lease or title must be recorded in town or city
before issuance of license.
APPROVED DISAPPROVED
Approved by Board of Control Commissioners of . City or . of(; . r /11
(4)11--
Total Membership members present A4t--} _ , C.to Clerk
TOWN OR CITY CLERK SHALL MAIL APPROVED RENEWAL DIRECTLY TO:
DEPARTMENT OF LIQUOR CONTROL
13 GREEN MOUNTAIN DRIVE
MONTPELIER, VT 05602
If application is disapproved, local control commissioners shall notify the applicant by letter.
No formal action taken by any agency or authority of any town hoard of selectmen or city board of aldermen on a first or
second class license application shall be considered binding except as taken or made at an open public meeting. VSA T-1,Sec.312
•
2012 TOBACCO LICENSE RENEWAL APPLICATION 6858-002-TOBC-01
TOBACCO LICENSE TO SFT,T TOBACCO Page 1
Optional Fee: $1 0.0 0 of which
License Year Beginning May 1, 2012 ending April 30, 2013
$10.00 is paid
to town/city
$0.00 is paid to DID
Fee due only if licensee does not have a liquor license
Town: 04065 - SOUTH BURLINGTON
MISREPRESENTATION OF A MATERIAL FACT ON ANY LICENSE APPLICATION SHALL BE GROUNDS
FOR SUSPENSION OR REVOCATION OF THE LICENSE, AFTER NOTICE AND HEARING
Applicant: Review all of the information presented on this form, indicating any changes in the spaces provided.
Applicant: Independent Brewers United Corporation
Doing Business As:
Independant Brewers United Corporation (2nd) Mailing Address:
5 Bartlett Bay Road 5 Bartlett-Bay Road
S. Burlington VT 05403 S. Burlington VT 05403
Telephone: DE I /}0(4 / �, „ e ce()ecl Can
PLEASE INCLUDE EMAIL ADDRESS: t _ .]I V`�.)fi 71�!✓f
Description of Premises: Lessor:
Store in a steel building consisting of approx. 4,300 square feet Antonio B & Rita M Pomerleau
located on/within a manufacturing facility located on the north side S. Burlington VT
of Bartlett Bay Road. Designated as #5, 1/10 of a mile west of the
intersection of Rte 7 in the city of South Burlington, VT
Last Enforcement Seminar: 01/26/2010
Fed. ID Number: 91-1258355 Incorporation Date: 03/27/1984 Valid Charter?: Yes State of Charter: Washington
Majority of Directors are US Citizens: Yes
ATTACH AN ADDITIONAL SHEET TO THIS APPLICATION NOTING ANY NECESSARY CORRECTIONS OR CHANGES
AND UPDATES THAT HAVE OCCURRED DURING THE PAST YEAR.
Corporation Name Address Town/City State Zip Code
Director 1. Palmer, Raquel V 151 West 17th Street 11G New York NY 10011
Director 2. Madden, Kevin M 305 W 13th St Apt 9H New York NY 10014
Director 3. Lozyniak, Richard 18 Brous Grove Hill Pittsford NY 14534
Director 4. Saputo, Randy 403 Coastal View Drive Webster NY 14580
Director 5. Pendegraft, Jags 16 Redbrick Road Orchard Park NY 14127
Stockholder 6. Independent Brewers , United I 431 Pine Street Suite g-14 Burlington VT 05401
Has any director or stockholder been convicted or pleaded guilty to any criminal or motor vehicle offense in any court
of law (including traffic tickets by mail) during the last year? Yes No
If yes, please attach the following information: Individual's , court/traffic bureau, offense and date
In the past year has any director or stockholder of the coiporation held any elective or appointive state, county,
city, village or town office in Vermont (See VSA, T.7, Ch.9, Sec. 223)? Yes )(No
If yes, please attach the following information: Individual's name, office and jurisdiction
ALL APPLICANTS MUST COMPLETE AND SIGN
The applicant understands and agrees that the Liquor Control Board may obtain criminal history record information from
State and Federal record repositories.
I/We hereby certify, under the pains and penalties of perjury, that I/We are in good standing with respect to or in full
ca pliance with a plan approved by the Commissioner of Taxes to pay any and all taxes due the State of Vermont as of the date
of this application. (VSA, Title 32, Section 3113)
I/We hereby certify that I/We are not under an obligation to pay child support or that I/We are in good standing with
respect to child support or are in full compliance with a plan to pay any and all child support payable under a support
order. (VSA, Title 15, Section 795)
In accordance with 21 VSA, Section 1378(b), I/We certify, under pains and penalties of perjury, that I/We are in good
standing with respect to or in full ca pliance with a plan to pay any and all contributions or payments in lieu of
contributions due to the Department of Employment and Training.
I/We have registered the trade name of these premises with the Secretary of State.
Continued on next page
2012 TOBACCO LICENSE RENEWAL APPLICATION 6858-002-TOBC-01
TOBACCO LICENSE TO SELL TOBACCO Page 2
I/We hereby certify that the information in this application is true and complete.
Dated at V L} Q/(j , in the county of fEr l(__ , and State of +v evV \() f
this day of
Signa o orized agent Signature of individual or partners
of rporati , c y, club or association
Vico Pces�c '
(Title)
Are you making this application for the benefit of any other party? Yes No
Upon being satisfied that the conditions precedent to the granting of this license as provided in Title 7 of the Vermont
Statutes Annotated, as amended, have been fully met by the applicant, the commissioners will endorse their recommendation on
the back of the applications and transmit both copies to the Liquor Control Board for suitable action thereon, before any
license maybe granted. For the information of the Liquor Control Control Board, all applications shall carry the signature
of each individual commissioner registering either approval or disapproval. Lease or title must be recorded in town or city
before issuance of license.
APPROVED DISAPPROVED
-
Approved by Board of Control Commissioners of the City or . J,. IJIM / Its
Total Membership members present At 1 , Town Clerk
TOWN OR CITY CLERK SHALL MAIL APPROVED RENEWAL DIRECTLY TO:
DEPARTMENT OF LIQUOR CONTROL
13 GREEN MOUNTAIN DRIVE
MONTPELIER, VT 05602
If application is disapproved, local control commissioners shall notify the applicant by letter.
No formal action taken by any agency or authority of any town board of selectmen or city board of aldermen on a tobacco
license application shall be considered binding except as taken or made at an open public meeting. VSA T-1,Sec.312
m® City of South Burlington
40�® 0 City Clerk's Office
von 04. ;:} Donna Kinville, City Clerk
L •
FIRST, SECOND CLASS AND CABARET LICENSE APPLICATION
FULL NNA"ME OF PERSON, PARTNERSHIP, CORPORATION
DOING BUSINESS AS/ TRADENAME
Mar D' -rizzat----
ADDRESS
00/ 1//J o ,
FIRST CLASS SECOND CLASS CABARET
DATE RECEIVED BY CLERK'S OFFICE ',. 7, o2D 1 O
SO. BURLINGTON POLICE DEPT
Chief Trevor S. Whipple Date
SO. B INGTON FI K DEPT
Chief o uglas S. Brent Brent Ifil'il‘L"
Date
SO. BURLINGTON TAX DEPT
art a Lyons, Deputy ax Collector
Date sent to Montpelier:
2012 LIQUOR LICENSE RENEWAL APPLICATION 4369-001-1RST-01
FIRST CLASS RESTAURANT LICENSE TO SELL MALT AND VINOUS BEVERAGES Page 1
Fee: $200.00 of which
License Year Beginning May 1, 2012 ending April 30, 2013 $100.00 is paid to town/city
$100.00 is paid to DLC
Town: 04065 - SOUTH BURLINGTON
MISREPRESENTATION OF A MATERIAL FACT ON ANY LICENSE APPLICATION SHALL BE GROUNDS
FOR SUSPENSION OR REVOCATION OF THE LICENSE, AFTER NOTICE AND HEARING
Applicant: Review all of the information presented on this form, indicating any changes in the spaces provided.
Applicant: Team McGrath, Incorporated
Doing Business As:
Marco's Pizza Mailing Address:
1301 Williston Road 1301 Williston Road
South Burlington VT 05403 South Burlington VT 05403
Telephone: (802) 658-5858
PLEASE INCLUDE EMAIL ADDRESS:
Description of Premises: Lessor:
A restaurant located in a one story brick building approximately Pcmerleau to Sean McGrath
2200 square feet in size and located in the city of South Burlington College Street
Vermont. Burlington Vt
Last Enforcement Seminar: 10/25/2011
Fed. ID Number: 03-0358950 Incorporation Date: 10/27/1998 Valid Charter?: Yes State of Charter: Vermont
Majority of Directors are US Citizens: Yes
ATTACH AN ADDITIONAL SHEET TO THIS APPLICATION NOTING ANY NECESSARY CORRECTIONS OR CHANGES
AND UPDATES THAT HAVE OCCURRED DURING THE PAST YEAR.
Corporation Name Address Town/City State Zip Code
Director 1. Mrf,'rath, Sean 3 Butler Drive South Burlington VT 05403
Director 2. McGrath, Brendan 10 Dairy Lane South Burlington VT 05403
Stockholder 3. McGrath, Sean 3 Butler Drive South,Burlington VT 05403
Has any director or stockholder been.convicted or pleaded guilty to any crinu or mo veh
icle tor offense in any court
o#,law (including traffic tickets by^'mail), during the last year? « Yes o""
If yes, please attach the following information: Individual's name, court/traffic bureau, ffense and date
In the past year has any director or stockholder of the corporation held any electiv or appointive state, county,
city, village or town office in Vermont (See VSA, T.7, Ch.9, Sec. 223)? Yes No
If yes, please attach the following information: Individual's name, office and jurisdiction
Vt. Dept. of Health Food License No.: 1184 Expiration Date: ??
Vt. Dept. of Health Lodging No.: Expiration Date:
Vt. Tax Dept. Meals & Roans Cert./Acct. No.: 176301
Important: Current food and/or lodging license expiration dates are required for
license renewal (as applicable) .
Outside Consumption Permit?: Yes XX No
Disclosure of Non-profit Organization?: Yes XX No
ALL APPLICANTS MUST COMPLETE AND SIGN
The applicant understands and agrees that the Liquor Control Board may obtain criminal history record information from
State and Federal record repositories.
I/We hereby certify, under the pains and penalties of perjury, that I/We are in good standing with respect to or in full
compliance with a plan approved by the Commissioner of Taxes to pay any and all taxes due the State of Vermont as of the date
of this application. (VSA, Title 32, Section 3113)
I/We hereby certify that I/We are not under an obligation to pay child support or that I/We are in good standing with
respect to child support or are in full compliance with a plan to pay any and all child support payable under a support
order. (VSA, Title 15, Section 795)
In accordance with 21 VSA, Section 1378(b), I/We certify, under pains and penalties of perjury, that I/We are in good
standing with respect to or in full compliance with a plan to pay any and all contributions or payments in lieu of
contributions due to the Department of Employment and Training.
I/We have registered the trade name of these premises with the Secretary of State.
Continued on next page
•
2012 LIQUOR LICENSE RENEWAL APPLICATION 4369-001-1RST-01
FIRST CLASS RESTAURANT LICENSE TO SELL MALT AND VINOUS BEVERAGES Page 2
I/We hereby certify that the information in this application is true and complete.
Dated at 1o1/Z[Cc , in the county of 61.1 , and State of \J-1
this )7 day of cc() , ZP I Z
Signature of auth d ent Signature of individual or partners
of corporati , c , club or sociation
•
60-h P. M °C->r z'fi" Cp r )
(Title)
Are you making this application for the benefit of any other party? Yes No
Upon being satisfied that the conditions precedent to the granting of this license as provided in Title 7 of the Vermont
Statutes Annotated, as amended, have been fully met by the applicant, the commissioners will endorse their reccumendation on
the back of the applications and transmit both copies to the Liquor Control Board for suitable action thereon, before any
license may be granted. For the information of the Liquor Control Control Board, all applications shall carry the signature
of each individual commissioner registering either approval or disapproval. Lease or title must be recorded in town or city
before issuance of license.
APPROVED DISAPPROVED
Approved by Board of Control Conmdssioners ., the City ors .f J) '�• (/ /i 1 ( ,!Jrj �
Total Membership 5 , members present Attest, , Town Clerk
TOWN OR CITY CLERK SHALL MAIL APPROVED RENEWAL DIRECTLY TO:
DEPARTMENT OF LIQUOR CONTROL
13 GREEN MOUNTAIN DRIVE
MONTPELIER, VT 05602
If application is disapproved, local control commissioners shall notify the applicant by letter.
No formal action taken by any agency or authority of any town board of selectmen or city board of aldermen on a first or
second class license application shall be considered binding except as taken or made at an open public meeting. VSA T-1,Sec.312
4+ rb City of South Burlington
ko , � �
City Clerk's Office
°"° = Donna Kinville, City Clerk
FIRST, SECOND CLASS AND CABARET LICENSE APPLICATION
FULL NAME OF PERSON, PARTNERSHIP, CORPORATION
OsSlitrILGc.
DOING BUSINESS AS/ TRADENAME
17
ADDRESS
l� D DEG ( -k
FIRST CLASS SECOND CLASS CABARET
DATE RECEIVED BY CLERK'S OFFICE 3 r ! O 10
SO. BURLINGTON POLICE DEPT
Chief Trevor S. Whipple Date
SO. U LINGTON FIRE DEPT
t ,M
Chief Douglas S. Brent 1 Date
SO. BURLINGTON TAX DEPT
---7"451e/-4/ 'SiLe 1(1/
Martha Lyons, Deputy ax Collector
Date sent to Montpelier:
• r
•
2012 LIQUOR LICENSE RENEWAL APPLICATION 4362-001-1RST-01
FIRST CLASS RESTAURANT LICENSE TO SELL MALT AND VINOUS BEVERAGES Page 1
Fee: $200.00 of which
License Year Beginning May 1, 2012 ending April 30, 2013
100.00 is paid to town/city
$100.00 is paid to DLC
Town: 04065 - SOUTH BURLINGTON
MISREPRESENTATION OF A MATERIAL FACT ON ANY LICENSE APPLICATION SHALL BE GROUNDS
FOR SUSPENSION OR REVOCATION OF THE LICENSE, AFTER NOTICE AND HEARING
Applicant: Review all of the information presented on this form, indicating any changes in the spaces provided.
Applicant: OSSIVT, LLC
Doing Business As:
Outback Steakhouse Mailing Address:
150 Dorset Street 2202 N West Shore Blvd
South Burlington VT 05403 5th Floor attn Licenses
Telephone: (802) 862-0003 TampaAL 3361E74
PLEASE INCLUDE EMAIL ADDRESS: //L C/lie1•/y,Q1/n f)-!
Description of Premises: Lessor:
A restaurant approximately 6500 square feet in size and located in a Dorset Square Associates
one story steel and cement structure located in the Blue Mall and 1350 Shelburne Road
designated as 150 Dorset Street in the city of South Burlington, Vt. Suite 200
So. Burlington Vt 05403
Last Enforcement Seminar: 01/09/2010
Filed Articles of Organization: Yes Date Filed: 06/05/2000 Federal ID Number: 03-0367169
Majority of Members are US Citizens: Yes
ATTACH AN ADDITIONAL SHEET TO THIS APPLICATION NOTING ANY NECESSARY CORRECTIONS OR CHANGES
AND UPDATES THAT HAVE OCCURRED DURING THE AST YEAR.
N i L fl f J— 6I J •7i,3,0-04
Limited Liability
Company Name � ess Town/City State Zip Code
O0*2.h Sept �euf< f�Qnr /� . 7
Member 1. Outback/Emp;re ,a n-e ' S.• Tampa FL 33604' ,
Member 2. GormangIV Old Plump Roo Jericho VT 05465
Member 3. Go haie Le ge Road Burlington VT 05465
� CV-for-4-L. L�0
Has any person been convicted or pleaded guilty to any criminal or moto vehicle offense in any court of law
(including traffic tickets by mail) during the last year? Yes No
If yes, please attach the following information: Individual's name, court/traffic bureau, offense and date
In the past year has'any person held any el ive or appointive state, county, city, village or town office in Vermont
(See VSA, T.7, Ch.9, Sec. 223)? Yes a No
If yes, please attach the following information: Individual's name, office and jurisdiction
Vt. Dept. of Health Food License No.: 12421 Expiration Date: ??
Vt. Dept. of Health Lodging No.: Expiration Date:
Vt. Tax Dept. Meals & Rooms Cert./Acct. No.: 2233601
Important: Current food and/or lodging license expiration dates are required for
license renewal (as applicable) .
Outside Consumption Permit?: XX Yes No
Are there any changes to this Outside Consumption area?: _Yes No (If yes, attach necessary information)
Front porch completely enclosed by rail to the left and right of
front entrance. 12 p.m. to 12 p.m. June 6 to closing date.
Disclosure of Non-profit Organization?: Yes XX No
ALL APPLICANTS MUST COMPLETE AND SIGN
The applicant understands and agrees that the Liquor Control Board may obtain criminal history record information from
State and Federal record repositories.
I/We hereby certify, under the pains and penalties of perjury, that I/We are in good standing with respect to or in full
compliance with a plan approved by the Commissioner of Taxes to pay any and all taxes due the State of Vermont as of the date
of this application. (VSA, Title 32, Section 3113)
I/We hereby certify that I/We are not under an obligation to pay child support or that I/We are in good standing with
respect to child support or are in full compliance with a plan to pay any and all child support payable under a support
order. (VSA, Title 15, Section 795)
In accordance with 21 VSA, Section 1378(b), I/We certify, under pains and penalties of perjury, that I/We are in good
standing with respect to or in full compliance with a plan to pay any and all contributions or payments in lieu of
contributions due to the Department of Employment and Training.
I/We have registered the trade name of these premises with the Secretary of State.
Continued on next page
*y/ i 6v/ b) /Se( Cci 7 '
2012 LIQUOR LICENSE RENEWAL APPLICATION 4362-001-1RST-01
FIRST CLASS RESTAURANT LICENSE TO SELL MALT AND VINOUS BEVERAGES Page 2
I/We hereby certify that the information in this application is true and complete.
2202 N.W¢c�Shnra.8t►lt h 4L 1�1 1't- t,-
Dated at 'rgyvN ea, (. (o Q 7 in the county of r �, 6 YJCr O l(G h, and State of `;
this 2.41 day of 1'itO rtAI 41,t( , 2_4N 2
Signature o authorized agent Signature of individual or partners
of corporation, y, club or association
‘3 !
o h i k
e c cl. P eG
(Ti e)
Are you making this application for the benefit of any other party? Yes ✓No
Upon being satisfied that the conditions precedent to the granting of this license as provided in Title 7 of the Vermont
Statutes Annotated, as amended, have been fully met by the applicant, the commissioners will endorse their recommendation on
the back of the applications and transmit both copies to the Liquor Control Board for suitable action thereon, before any
license may be granted. For the information of the Liquor Control Control Board, all applications shall carry the signature
of each individual ccumissioner registering either approval or disapproval. Lease or title must be recorded in town or city
before issuance of license.
APPROVED DISAPPROVED
Approved by Board of Control Commissioners of e City or 'own of D. U rif
•
Total Membership 6 , members present test, e`�keil(L. , Town Clerk
TOWN OR CITY CLERK SHALL MAIL APPROVED RENEWAL DIRECTLY TO:
DEPARTMENT OF LIQUOR CONTROL
13 GREEN MOUNTAIN DRIVE
MONTPELIER, VT 05602
If application is disapproved, local control commissioners shall notify the applicant by letter.
No formal action taken by any agency or authority of any town board of selectmen or city board of aldermen on a first or
second class license application shall be considered binding except as taken or made at an open public meeting. VSA T-1,Sec.312
• '0. ® City of South Burlington
� �® 0 City Clerk's Office
vo.e . Donna Kinville, City Clerk
FIRST, SECOND CLASS AND CABARET LICENSE APPLICATION
FULL NAME OF PERSON, PARTNERSHIP, CORPORATION
DOING BUSINESS AS/ TRADENAME
6' )0'
ADDRESS
) P.A -1)0%ii&Dr1 -0 .
FIRST CLASS / SECOND CLASS CABARET
DATE RECEIVED BY CLERK'S OFFICE + j� , OJ ^
SO. BURLINGTON POLICE DEPT
Chief Trevor S. Whipple Date
SO. 5 LINGTON FIRE DEPT
-e ill I/4/1/2-
Chief Douglas S. Brent Date
SO. BURLINGTON TAX DEPT
—LE)1__.g—
Martha Lyons, Depu y Tax Collector j
1
Date sent to Montpelier:
2012 LIQUOR LICENSE RENEWAL APPLICATION 3919-001-SECN-01
SECOND CLASS LICENSE TO SELL MALT AND VINOUS BEVERAGES Page 1
Fee: $100.00 of which
License Year Beginning May 1, 2012 ending April 30, 2013 $50.00 is paid to town/city
$50.00 is paid to DLC
Town: 04065 - SOUTH BURLINGTON
MISREPRESENTATION OF A MATERIAL FACT. ON ANY LICENSE APPLICATION SHALL BE GROUNDS
FOR SUSPENSION OR REVOCATION OF THE LICENSE, AFTER NOTICE AND HEARING
Applicant: Review all of the information presented on this form, indicating any changes in the spaces provided.
Applicant: Bushway, Richard & Karen
Doing Business As:
U Save Beverage Mailing Address:
1302 Williston Raod 1302 Williston Road
South Burlington VT 05403 South Burlington VT 05403
Telephone: DE EMAIL
Q1 Q 2 i ti t petce.PLEASE INCLUDE EMAIL ADDRESS: (�'� r LXJ 1'
Description of Premises: Lessor:
A beverage and variety store in a one story building on the northerly Champlain Oil Co.
side of Williston Road due west of the Mobil station, designated as Dorset Street
1302 Williston Road in the City of South Burlington, Vermont. South Burlington VT 05403
Last Enforcement Seminar: 02/03/2010
ATTACH AN ADDITIONAL SHEET TO THIS APPLICATION NOTING ANY NECESSARY CORRECTIONS OR CHANGES
AND UPDATES THAT HAVE OCCURRED DURING THE PAST YEAR.
Partnership Name Address Town/City State Zip Code
Partner 1. Bushway, Richard 50 Barrett Street South Burlington VT 05403
Partner 2. Bushway, Karen 50 Barrett Street South Burlington VT 05403
Has any person been convicted or pleaded guilty to any criminal or ngtor vehicle offense in any court of law
(including traffic tickets by mail) during the last year? Yes %( No
If yes, please attach the following information: Individual's name, court/traffic bureau, offense and date
In the past year has any person held any el¢ctive or appointive state, county, city, village or town office in Vermont
(See VSA, T.7, Ch.9, Sec. 223)? Yes )( No
If yes, please attach the following information: Individual's name, office and jurisdiction
Disclosure of Non-profit Organization?: Yes XX No
ALL APPLICANTS MUST COMPLETE AND SIGN
The applicant understands and agrees that the Liquor Control Board may obtain criminal history record information from
State and Federal record repositories.
I/We hereby certify, under the pains and penalties of perjury, that I/We are in good standing with respect to or in full
compliance with a plan approved by the Commissioner of Taxes to pay any and all taxes due the State of Vermont as of the date
of this application. (VSA, Title 32, Section 3113)
I/We hereby certify that I/We are not under an obligation to pay child support or that I/We are in good standing with
respect to child support or are in full compliance with a plan to pay any and all child support payable under a support
order. (VSA, Title 15, Section 795)
In accordance with 21 VSA, Section 1378(b), I/We certify, under pains and penalties of perjury, that I/We are in good
standing with respect to or in full compliance with a plan to pay any and all contributions or payments in lieu of
contributions due to the Department of Employment and Training.
I/We have registered the trade name of these premises with the Secretary of State.
I/We hereby certify that the information jn this application is true and complete.
Dated 1.67/2-t-a (3 o. s�.} fn the county of T t , and State of � '�" '
this 6., day of FL'-) , 2 E /Z
Signat e^`of authorized a ent Si ture of in 'vidual or partners
r....rat' n companey, club association A
D�,�.J r'Y- 6 ��!/
•
644,.ve z !r/�LtK
(Title)
Are you making this application for the benefit of any other party? Yes No
Continued on next page
•
2012 LIQUOR LICENSE RENEWAL APPLICATION 3919-001-SECN-01
SECOND CLASS LICENSE TO CET,T MALT AND VINOUS BEVERAGES Page 2
Upon being satisfied that the conditions precedent to the granting of this license as provided in Title 7 of the Vermont
Statutes Annotated, as amended, have been fully met by the applicant, the commissioners will endorse their recommendation on
the back of the applications and transmit both copies to the Liquor Control Board for suitable action thereon, before any
license may be granted. For the information of the Liquor Control Control Board, all applications shall carry the signature
of each individual commissioner registering either approval or disapproval. Lease or title must be recorded in town or city
before issuance of license.
APPROVED DISAPPROVED
1
Approved by Board of Control Commissioners o City o of
Total Membership 5 , members present , O`C•._ etedtwn Clerk
TOWN OR CITY CLERK SHALL MAIL APPROVED RENEWAL DIRECTLY TO:
DEPARTMENT OF LIQUOR CONTROL
13 GREEN MOUNTAIN DRIVE
MONTPELIER, VT 05602
If application is disapproved, local control commissioners shall notify the applicant by letter.
No formal action taken by any agency or authority of any town board of selectmen or city board of aldermen on a first or
second class license application shall be considered binding except as taken or made at an open public meeting. VSA T-1,Sec.312
I
I
•
2012 TOBACCO LICENSE RENEWAL APPLICATION 3919-001-TOBC-01
TOBACCO LICENSE TO SFT,T, TOBACCO Page 1
Optional Fee: $10.0 0 of which
License Year Beginning May 1, 2012 ending April 30, 2013
$10.00 is paid to town/city
$0.0 0 is paid to DLC
Fee due only if licensee does not have a liquor license
Town: 04065 - SOUTH BURLINGTON
MISREPRESENTATION OF A MATERIAL FACT ON ANY-LICENSE APPLICATION SHALL BE GROUNDS
FOR SUSPENSION OR REVOCATION OF THE LICENSE, AFTER NOTICE AND HEARING
Applicant: Review all of the information presented on this form, indicating any changes in the spaces provided.
Applicant: Bushway, Richard & Karen
Doing Business As:
U Save Beverage Mailing Address:
1302 Williston Raod 1302 Williston Road
South Burlington VT 05403 South Burlington VT 05403
Telephone: (802) 862-2907.
PLEASE INCLUDE EMAIL ADDRESS:
Description of Premises: Lessor:
A beverage and variety store in a one story building on the northerly Champlain Oil Co.
side of Williston Road due west of the Mobil station, designated as Dorset Street
1302 Williston Road in the City of South Burlington, Vermont. South Burlington VT 05403
..sue
Last Enforcement Seminar: 02/03/2010
ATTACH AN ADDITIONAL SHEET TO THIS APPLICATION NOTING ANY NECESSARY CORRECTIONS OR CHANGES
AND UPDATES THAT HAVE OCCURRED DURING THE PAST YEAR.
Partnership Name Address Town/City State Zip Code
Partner 1. Bushway, Richard 50 Barrett Street South Burlington VT 05403
Partner 2. Bushway, Karen 50 Barrett Street South Burlington VT 05403
Has any person been convicted or pleaded guilty to any criminal or rygtor vehicle offense in any court of law
(including traffic tickets by mail) during the last year? Yes Y No
If yes, please attach the following information: Individual's name, court/traffic bureau, offense and date
In the past year has any person held any �Ye ctive or appointive state, county, city, village or town office in Vermont
(See VSA, T.7, Ch.9, Sec. 223)? Yes ,) No
If yes, please attach the following information: Individual's name, office and jurisdiction
ALL APPLICANTS MUST COMPLETE AND SIGN
The applicant understands and agrees that the Liquor Control Board may obtain criminal history record information from
State and Federal record repositories.
I/We hereby certify, under the pains and penalties of perjury, that I/We are in good standing with respect to or in full
compliance with a plan approved by the Commissioner of Taxes to pay any and all taxes due the State of Vermont as of the date
of this application. (VSA, Title 32, Section 3113)
I/We hereby certify that I/We are not under an obligation to pay child support or that I/We are in good standing with
respect to child support or are in full compliance with a plan to pay any and all child support payable under a support
order. (VSA, Title 15, Section 795)
In accordance with 21 VSA, Section 1378(b), I/We certify, under pains and penalties of perjury, that I/We are in good
standing with respect to or in full compliance with a plan to pay any and all contributions or payments in lieu of
contributions due to the Department of Employment and Training.
I/We have registered the trade name of these premises with the Secretary of State.
I/We hereby certify d that the inform o in tfhi.s application is true and complete.
Dated at 13 O 2- //IV=( (',/ ' ,Sin`the county of L.-- J°�6'J , and State of
this day of Fe-lo , 2r,rZ
'gnature of auth.+.zed agent Signature of individual or partners
of ration, c. ��/club or association / 9
#(11/i/t/I,
efe
(Title)
Are you making this application for the benefit of any other party? Yes o
Continued on next page
•
2012 TOBACCO LICENSE RENEWAL APPLICATION 3919-001-TOBC-01
TOBACCO LICENSE TO SELL TOBACCO Page 2
Upon being satisfied that the conditions precedent to the granting of this license as provided in Title 7 of the Vermont
Statutes Annotated, as amended, have been fully met by the applicant, the commissioners will endorse their recommendation on
the back of the applications and transmit both copies to the Liquor Control Board for suitable action thereon, before any
license may be granted. For the information of the Liquor Control Control Board, all applications shall carry the signature
of each individual commissioner registering either approval or disapproval. Lease or title must be recorded in town or city
before issuance of license.
APPROVED DISAPPROVED
Approved by Board of Control Commissioners of JIMMP - • 50, f
Total Membership 5 , members present Att g , ` a • C 44611 Clerk
TOWN OR CITY CLERK SHALL MAIL APPROVED RENEWAL DIRECTLY TO:
DEPARTMENT OF LIQUOR CONTROL
13 GREEN MOUNTAIN DRIVE
MONTPELIER, VT 05602
If application is disapproved, local control commissioners shall notify the applicant by letter.
No formal action taken by any agency or authority of any town board of selectmen or city board of aldermen on a tobacco
license application shall be considered binding except as taken or made at an open public meeting. VSA T-1,Sec.312
•
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