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Agenda - City Council - 04/16/2012
s .dio •• southburlington VERMONT AGENDA SOUTH BURLINGTON CITY COUNCIL City Hall 575 Dorset Street SOUTH BURLINGTON, VERMONT Executive Session 5:00 p.m. Monday, April 16, 2012 Consider entering executive session to discuss personnel, contract negotiations and litigation. Regular Meeting 6:00 p.m. Monday, April 16, 2012 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: • ***Approve Minutes from March 26 &April 2, 2012 • ###Sign Disbursements • ### Financial Statements • *** Consider approval of Entertainment permits o ALS Association-September 23, 2012 o Lund Mother's Day Ride- May 13, 2012 5. *** Public Hearing on Amendments to the Land Development Regulation Amendment(Paul Conner, Director of Planning &Zoning). Please note this public hearing has been warned for 6pm or shortly after. 6. Update from Channel 17 (Lauren-Glenn Davitian, Executive Director). 7. ***South Burlington STP 5200(18)-US2 Widening/Sheraton 3rd Lane Project Necessity Hearing (Justin Rabidoux, Public Works Director and Bob Fletcher, City Attorney). Please note this hearing has been warned for 7pm. 8. ###Consider appointment to the Aviation Tech advisory group (Bob Rusten, Deputy City Manager). 9. *** Reconvene as Liquor Control Board to consider 2012-2013 annual liquor licenses: • Bourne's Service Center • Jolley#146 • Jolley# 107 • Koto Restaurant • Klinger's Bread • Champlain Farms • Wooden Spoon Bistro • Moose Lodge# 1618 • Pulcinella's • Simon's Store&Deli • Pizza Putt • Shaw's Supermarket • Shelburne Road Variety • Hannaford Food&Drug • Pauline's Restaurant • Jiffy Mart 10. Other Business. • Any items held from the Consent Agenda. • Other? 11. Consider entering executive session for discussion of personnel matters, litigation and real property matters. 12. Adjournment. Respectfully Submitted: 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. April 16, 2012 City Council Meeting Please Print Name Name Name 1 lathe G0 yav) 18 35 2 M : Lk.-rI" I l 4-,,-,, 19 36 3 ��.4 g, C a.ra,So6 20 37 4 r;r: /tt11�vq 21 38 5 a,,/ -Car, 22 39 6 t )v pi 'BOlgCfik-F 23 40 7 4i74.i 'R 24 41 8 ‘`n franc ct JoKwei 25 42 9 26 43 10 27 44 11 28 45 12 29 46 13 30 47 14 31 48 15 32 49 16 33 50 17 34 51 w y \ . ` y � «Tf : _ � �^ . CITY COUNCIL 26 MARCH 2012 The South Burlington City Council held a regular meeting on Monday, 26 March 2012, at 5:00 p.m., in the Conference Room, City Hall, 575 Dorset St. Members Present: R. Greco, Chair; S. Dooley, P. Engels, P. Mackenzie, H. Riehle Also Present: S. Miller, City Manager; R. Rusten, Deputy City Manager; P. Conner, Director of Planning & Zoning; I. Blanchard, S. Dopp, B. Stuono 1. Agenda Review: No changes were made. 2. Comments & Questions from the Audience not related to agenda items: No issues were raised. 3. Announcements & City Manager's Report: Mr. Miller: Bill #H783 regarding railroad crossings was introduced as a place holder. It relates to individuals who can't get clear title to the access to their properties. The Agency of Transportation would like the railroad to give permanent easements so these people will not have problems selling their homes. There will be a pilot program this year in the area of financial responsibility with 10 to 12 municipalities participating. It will be a good way to improve oversight, etc. Mr. Engels: Met with Debbie Ingram of Vermont Interfaith Action. One thing they concern themselves with is affordable housing. No one had yet talked to her about South Burlington's issues, and she expressed interest in being involved in the city's discussions. Ms. Greco: Attended the Regional Planning Commission meeting in Ms. Dooley's place. The annual transportation prioritization was approved. South Burlington has 4 projects near the top of the list: Staples lane, Market St., U.S. 2 paving, and U.S. 7 from Charlotte to South Burlington. 4. Consent Agenda: There were no items on the Consent Agenda. 5. Discussion of Interim Zoning Studies, Staffing, etc. A. Review of Revised Memo from Paul Conner about Study Groups' Outline B. Studies and Steering Committee Discussion: CITY COUNCL 26 MARCH 2012 PAGE 2 i. ###Update on studies,RFP, etc. ii. ###Review Economic Development, SusAg and Affordable Housing Steering Committees-Consider adopting or giving additional direction to staff and committee leaders C. Staffing considerations - discuss timelines, estimated costs and how Council might address funding Mr. Conner said the only change made from his memo is the addition of a#7 "organizational structure." Regarding the possible steering committee, Mr. Conner said this had been envisioned around the economic development pieces. There could also be a similar group for affordable housing or sustainable agriculture. Mr. Miller cited the need for input from the City Council as to what these committees will be, including studies and staff interaction. Mr. Engels said he would like to keep this as simple and cheap as possible. He also would like not to have too many"layers of bureaucracy" in terms of committees and steering committees, etc. He said that for him, interim zoning is to get the Comprehensive Plan and new Land Development Regulations done as quickly and simply as possible. Ms. Mackenzie said she sees the economic analysis as separate from the others because this is the impact on the community. While this is being done, she felt there will have to be people supporting those doing the economic analysis in order for them to get the information they need. Ms. Riehle said assumed the city will be hiring people well versed in the things that are needed. Ms. Mackenzie said people will need to know where the information is in city documents, what developments are currently pending, and what development was like when the economy was better than it is now. Ms. Dooley said she was not sure that the economic analysis is part of the purpose of interim zoning. Mr. Miller reminded the Council that it is part of the interim zoning by- law that they passed. Mr. Miller said that from the information they have received, the studies will be fairly expensive, without much staff support and less expensive with reliance on a lot of staff support, which, he noted, is not currently available. There will also have to be staff support for the various committees. Mr. Miller estimated the need for 7 or 8 studies, and noted that the city does not control those costs. He stressed that there is nothing cheap about the economic analysis that has been requested. There will also have to be support CITY COUNCIL 26 MARCH 2012 PAGE 3 for the City Council in their review of development applications that come up. With regard to current staffing, Mr. Miller noted that one member of the Planning staff will be going on maternity leave. The department will need at least one other full time person. He reminded the Council that this is why staff had recommended adding one cent to the tax rate, which the Council rejected. Mr. Miller estimated close to $300,000 will be needed for studies and staffing (this includes consultant costs, loss of revenue, legal costs, etc.). Mr. Miller stressed that there is no money in the FY12 or FY13 budgets to cover these costs. He asked the Council if they want to reduce city staff in other areas to pay for this or to look at deficits. He noted that during budget discussions, members said the did not want to cut staff or services. Ms. Dooley said she is particularly interested in what there is about the Land Development Regulations that could be more supportive of affordable housing if the regulations were different. She suggested they might want to look at what is being done out of state as well as in other places in Vermont. She noted that the funding package for affordable housing is very complex. Mr. Miller stressed that the existing planning staff is hardly able to keep up with things now. The Council supported adding a staff person to the Planning Department. They reiterated their intention that there be no cuts in city staff or services. Ms. Dooley said she would be willing to look at the budget to see if there are any possible cuts and also look at possible grants. She suggested use of contingency money or the undesignated reserve. Mr. Rusten said the contingency funds are for unexpected expenses. If the Council had previously discussed an expense, it is not a valid use of contingency money. Mr. Miller thought it might be legitimate if it is for something not in the budget. Ms. Greco said she didn't think it will take a lot of money to do the sustainable agriculture portion as they are talking of using UVM interns and there are many people in the community who are qualified. Mr. Conner asked if the sustainable agriculture group anticipate regulatory as well as non-regulatory things. Ms. Greco said there would be a number of components. One might work on the LDR language; one might work on gardens, education, etc. Mr. Conner said that on the regulatory side, they will need legal input. He also noted that by state statute any regulatory changes must also go to the Planning Commission before the City Council. Mr. Miller said he will put together a job description for the new planning position. He felt they will need someone with a fairly broad skill set. With no staff or budget cuts, CITY COUNCIL 26 MARCH 2012 PAGE 4 there is still no means to pay for this position. Mr. Miller also noted that other departments have already been advised to start the process for hiring staff that has been approved for the FY13 budget so these people can begin in July. Members felt this process should go ahead. Regarding steering committees, Ms. Mackenzie asked to join the existing group looking at Land Development Regulations. She also felt the group should include members of the Planning Commission and Development Review Board. Mr. Miller reminded members that these meetings are subject to the open meeting law and must be held in public with minutes being taken. Ms. Dooley said she would be willing to serve as a liaison to the Affordable Housing group that Jim Knapp is heading. 6. Discuss Rules for Procedure for Council Acting as a Deliberative body for Interim Zoning: Mr. Miller noted he had given members the VLCT model and the Development Review Board's Rules of Procedure. He asked how the Council wants to handle public input. Mr. Conner noted there is a difference between the VLCT and DRB procedures. Those who have a right to testify are considered "interested"parties. Under the VLCT, interested parties have prioritization to testify, and there is limited time for others. Under the DRB interested parties and others are treated equally. Members agreed to use the DRB procedures. Mr. Conner then explained what happens in a de novo hearing when a decision is appealed to the Environmental Board. This process would be the same for a DRB or a City Council decision. Mr. Miller said it would be simpler for staff and applicants if the same procedures are used for the DRB and City Council hearings. Ms. Dooley then moved that for the purposes of Interim Zoning, the City Council adopt the Development Review Board Rules of Procedure and Conflict of Interest Policy dated 20 December 2005. Ms. Riehle seconded. Motion passed unanimously. With regard to staff and legal support, Mr. Miller asked to what extent the Council wants planning staff to be involved (e.g. writing decisions, etc.). He noted that the City Attorney is under a retainer to provide legal advice. CITY COUNCIL 26 MARCH 2012 PAGE 5 Mr. Conner recommended having staff notes prepared in advance. He felt there shouldn't be a draft decision until there is some consensus as to where the Council is heading. Mr. Rusten questioned whether an attorney should be present at Council deliberations. Mr. Miller said he heard that the Council wants the same level of support as the DRB gets. 7. Discuss Rules of Procedure for Council acting as a legislative body (regular Council meetings): Members agreed to postpone this discussion until an April meeting. 8. Schedule Special meeting to set Council priorities (mini-retreat): Mr. Miller noted that Abby Freeman of the VLCT is willing to facilitate this discussion. Members agreed to hold the meeting on 11 April, 4 p.m. with 23 April as a second choice. 9. Discuss possibility for digitizing City Council agenda packets and related materials to reduce paperwork and delivery costs: Mr. Miller explained that this is being done in Montpelier City and to an extent in the Legislature. There is money in the technology budget for this. The cost for year one would be about $12,000. Yearly replacement would cost less than $5,000. People could use their existing laptops, if they are compatible. People could also buy their own machines and have the city put in the appropriate package. Mr. Stuono suggested the DRB might also be interested in doing this. He noted that some members now bring their own technology. Mr. Miller said there is nothing in the budget to support that, but after FY13 it could be looked at. Members were OK with this. Mr. Miller will put a package together in the next few weeks and deal with budget implications. 10. Discuss Use of Social Media to Improve Communications: Ms. Blanchard noted that social media connects with different networks of people. The city now communicates via websites, e-newsletters, Twitter and Front Porch Forum for CITY COUNCIL 26 MARCH 2012 PAGE 6 things such as city news and ways to keep the public in touch. Each department decides what goes on its particular site. Ms. Blanchard showed a sample from several departments. She said the goal is to be sure the people you want to reach are getting the message. Ms. Blanchard also cited the importance of integrating various modes of communication and of measuring success. Current gaps in the system now include: no maintenance schedule, inconsistent style, minimal search engine organization, no ADA accessibility(for the blind), inconsistent integration between communication modes. Mr. Miller said there are no uniform policies or procedures, and there is a lot of outdated, inaccurate content. This is a concern as an increasingly large part of the public is relying on this type of communication. He cited particular importance in instances of disasters such as Tropical Storm Irene. He felt the city needs to do more in this area. Ms. Blanchard will be forming a Tech User Group which will meet in early April to identify internal resources. 10. Other Business: No issues were raised. 11. Executive Session: Ms. Riehle moved that the Council meeting in executive session to discuss personnel, litigation, and real property acquisition and to resume regular session only for the purpose of adjournment. Ms. Mackenzie seconded. Motion passed unanimously. 12. Regular Session: Council returned to regular session. As there was no further business Ms. Riehle moved for Council adjournment. Ms. Greco seconded. Motion passed unanimously. Council adjourned. Clerk CITY COUNCIL 2 APRIL 2012 The South Burlington City Council held a regular meeting on Monday, 2 April 2012, at 6:00 p.m., in the Conference Room, City Hall, 575 Dorset St. Members Present: R. Greco, Chair; S. Dooley, P. Engels, P. Mackenzie, H. Riehle(via telephone) Also Present: S. Miller, City Manager; R. Rusten, Deputy City Manager; G. Maille, M. Young, B. Paquette, T. McCormick, K. Statsir 1. Executive Session: Ms. Dooley moved the Council meet in executive session to discuss personnel, litigation and real property acquisition. Mr. Engels seconded. Motion passed unanimously. Ms. Mackenzie moved the Council exit executive session. Mr. Engels seconded. Motion passed unanimously. Regular Session: 1. Agenda Review: An"other business"item was added after Agenda Item#4. 2. Comments & Questions from the Public not related to Agenda items: Mr. Maille: Asked for an update on issues he had previously raised, including: the status of the Airport noise report, interpretation of the performance standard regarding noise and the Airport, and needed equipment for the Police for noise monitoring. Mr. Young: Noted an article in the Free Press said the"complete streets"project will be from Dorset St. to Kennedy Drive. He said he thought it would be from Hinesburg Rd., not Dorset St. Mr. Miller said the City Council approved the project from Hinesburg Rd. Mr. Paquette: Expressed concern with litter in the city and suggested the city establish and maintain trash and cigarette receptacles at public high traffic locations where there is consistent litter accumulation. Mr. McCormick: Expressed concern with Healthy Living selling food beyond its "sell by"date and changing these dates when they have expired, and also with food such as fresh fish being displayed within 6 feet of a heating unit. He said he"blew the whistle" on them, and they now have charged him with trespassing. CITY COUNCIL 2 APRIL 2012 PAGE 2 3. Announcements and City Manager's Report: Mr. Miller said the inspection of food is the province of the Department of Health. He also noted that individual property owners have the right to work with the police on"no trespassing" issues. In response to Mr. Maille's questions, Mr. Miller noted the City Attorney has said the Police have no authority to regulate noise at the Airport. The City did get the noise data from the study that was done. This will be posted on the city's website. A communication was received from Paul Stabler, the city's CSWD representative regarding organized trash collection. This would organize trash collection so there isn't one carrier picking up in a neighborhood on one day and another on another day, etc. CSWD is willing to do a presentation on this. Members felt they would like a presentation. Ms. Dooley noted this was tried at the state but didn't work out. Mr. Miller advised that a small contract ($1900) will be awarded to Allen& Brooks as part of the TIF presentation. Ms. Dooley: Said that she and Councilor Greco Met with Brenda Torpe and Michael Monte of the Champlain Housing Trust regarding the promotion of affordable housing. She received a copy of a task force report from 1986. Though some of the information is dated, things that municipalities can do are not dated. Champlain Housing is willing to participate in the affordable housing study group. Ms. Mackenzie: Participated with Spectrum Youth Services in a"sleep out." Forty-four business leaders participated and over $80,000 was raised for drug/alcohol rehabilitation for youth on the street. Attended the VLCT seminar regarding open meetings and responding to public records requests. Mr. Engels: Called Carolyn Dwyer to ask why no South Burlington Councilor was invited to the President Obama event. South Burlington Police worked with the Secret Service on this, and city taxpayers paid the bill for it. The City of Burlington was well represented, and South Burlington was again overlooked. Mr. Miller noted that the city's Fire Department and EMT's as well as Public Works people were also involved. The city gets no reimbursement for this. Ms. Mackenzie felt the best way to get their attention is to write to a sitting President, • CITY COUNCIL 2 APRIL 2012 PAGE 3 possibly asking him to send a letter of thanks to the Police and other departments. She added that the Democratic Party organization should also hear about this. Ms. Riehle commented that South Burlington is a"pass through" community and is always challenged. Ms. Dooley felt the city will have more of an identity when there is a City Center. Mr. Young asked if the city can send a bill for additional expenses for presidential visits. He noted this was a fundraiser and over$700,000 was raised. Councilor Greco said she did not want to do this. Mr. Miller said the city can send a bill, but it won't be paid. Councilor Greco stated that she had attended the Planning Commission meeting during which they discussed the Comprehensive Plan and growth issues. 4. Consent Agenda: A. Approve Minutes from March 14 and 19 B. Sign Disbursements C. Consider Approval of Entertainment Permits: 1. Higher Ground-Annual Permit 2. Sheraton Burlington Hotel- Annual Permit 3. Community Bible Church - June 6, 2012 4. National MS Society- August 11-12, 2012 D. Consider authorizing the Fire Department to submit a grant application to VLCT's Equipment Grant program. VLCT annually offers municipalities up to $5,000 to purchase safety related equipment. This year, our Fire Department is requesting funds to assist with the purchase of a "power safety cot"which is designed to be safer for patients and reduce injuries to our EMTs. The total cost of this item is $13,330.26 and the matching funds will come from budgeted funds of$8,330.26 from the FY2012 Fire Department budget. Members removed the Minutes of Higher Ground Annual Permit from the Consent Agenda. Ms. Mackenzie moved to approve the Consent Agenda without the 2 above-mentioned items. Ms. Dooley seconded. Motion passed unanimously. 4a. Other Business: Mr. Engels noted receiving a call from Aaron Gibson about noise issues at the Higher Ground. CITY COUNCIL 2 APRIL 2012 PAGE 4 Mr. Miller noted a few complaints were received from an event held on 28 March of this year. Mr. Statsir of Higher Ground did inform the city of this problem. There have been no other incidents in recent years, and the Police Chief said Higher Ground has been very cooperative. Mr. Miller said he has offered mediation services to address issues. The Police Chief recommends approval of the entertainment permit and liquor license. Mr. Statsir said Higher Ground has been in the city for 7 years and is an active member of the community. He stressed that he takes all feedback very seriously and try to address all issues. City Police frequently drop by and they have a good working relationship with that department. Mr. Statsir noted that like other businesses they are struggling and that when they have shows, other small businesses in the area do well. He also noted that events at Higher Ground raised $1,500,000 for Tropical Storm Irene recovery efforts and also 1,000 pounds of food for the Food Shelter. Mr. Statsir noted that in the incident in question, the performing group brought their own supplemental sound system, and Higher Ground didn't know this would happen. He said they are willing to tell groups not to do this in the future. He added that they kept trying to tell the performers to turn down the equipment that night. Ms. Greco said they received communication from Mr. Gibson who acknowledged that he had"over-reacted." Ms. Dooley then moved to approve Higher Ground's entertainment permit as presented. Ms. Riehle seconded. Motion passed unanimously. In the Minutes of 14 March, it was noted that on p. 6, under Other Business, the word "communities"in the first line should read"neighborhoods." In the Minutes of 19 March, on p. 9, the unidentified audience member was identified as Mr. Palumbo. On p. 2, 3rd paragraph from the bottom, the word"interest"in the first sentence should read "interested." Ms. Riehle moved to approve the Minutes of 14 and 19 March as amended. Mr. Engels seconded. Motion passed unanimously. Mr. Engels suggested the Council meet on Wednesday following the priority-setting session instead of Monday next week so Ms. Riehle can attend. The early session starts at 4 p.m., and members agreed to hold the Council meeting immediately afterwards. Ms. Mackenzie agreed to try to address the "litter" issues raised by Mr. Paquette. Mr. Engels said this should include any costs. Mr. Paquette said he would be willing to join CITY COUNCIL 2 APRIL 2012 PAGE 5 any committee that is formed. 5. Recommendation from the Social Services Committee for Approval of Funding to Local Agencies for FY12: Mr. Rusten reviewed the process for allocation Social Services funding. He noted $39,000 was allocated in FY 11 and $36,000 in FY12. The city received over$41,000 in requests. They first agreed to add no new agencies and then agreed on a funding allocation. Mr. Rusten noted that the committee is uncomfortable with the process and felt that allocation requests should be received before the budgeting is done so the City Council can address any issues. Mr. Miller noted that his concern with changing the process is that it may create an expectation that funding is being expanded and more people may be applying. Mr. Miller also noted that in the past some Council members had opposed the idea of providing this funding at all. Ms. Mackenzie said she loves the idea that the city does this. She recommended that in the 2014 process, there be fund-raising among staff and then have the city match it. Ms. Riehle asked what other communities do. Mr. Miller said in Milton the process is similar to South Burlington. Mr. Rusten said Wilmington is similar to the South Burlington figure and the process is similar to what the committee is recommending. Ms. Dooley then moved to adopt the Social Services Committee recommendation for disbursement of$36,000.00 as presented. Mr. Engels seconded. Motion passed unanimously. 6. Waive first reading of Street Lighting Standard Ordinance; schedule public hearing for 7 May 2012: Mr. Miller noted that in order to specify certain types of lighting in federal and state projects, the city must have this in the ordinance. Mr. Engels moved to waive the first reading of the Street Lighting Standard Ordinance and to schedule a public hearing for 7 May 2012. The motion was amended to change the word"westerly" to "easterly" in the first paragraph. Ms. Mackenzie seconded. Motion passed unanimously. CITY COUNCIL 2 APRIL 2012 PAGE 6 7. Consider Authorizing Re-financing of a Stormwater Mitigation Grant Anticipation Note for $200,000: Mr. Rusten noted that in 2008 the City Council approved a grant for one year in a note that would be renewed. One-third of this note was paid in January. The city then bid out the note and got a reduction in interest. The Merchants Bank has locked in a 1.86% 2- year rate. Mr. Rusten also noted that a note for$580,000 is being paid off early which will save that interest money. Mr. Engels moved to approve the refinancing of the Stormwater Mitigation Grant Anticipation Note as presented. Ms. Mackenzie seconded. Motion passed unanimously. 8. Consider Councilor to Serve as UVM Liaison: Ms. Dooley noted she became liaison 4 years ago. In recent years, issues have been addressed more administratively. She wasn't sure of the need for this position to continue. Mr. Miller agreed this could be handled at the administrative level, and if any issues escalated, the Council could then become involved. Members agreed to this. 9. Liquor Control Board: Ms. Mackenzie moved the Council adjourn and reconvene as Liquor Control Board. Mr. Engels seconded. Motion passed unanimously. Mr. Miller presented annual liquor license renewals from the following: Aviation Deli & Fine Foods Champlain Farms - Exxon Eagles Fraternal Order#793 Champlain Farms Higher Ground Chick Charlie's Holiday Inn Gonzo's Indoor Golf Leisure World, Inc. Green Mountain Suites Hotel M.T. Bellies Deli Short Stop #105 Maplefields Moe's Southwest Grill Olive Garden Price Chopper#228 The Pour House Silver Palace Rotisserie Windjammer Restaurant Sheraton VT Corp Zachary's Pizza Applebee's CITY COUNCIL 2 APRIL 2012 PAGE 7 Councilor Greco asked if there are guidelines for granting liquor licenses and how many police issues such as DUI's were enough to disapprove the application. Mr. Miller said he didn't know that a number was ever capped. Councilor Greco also asked why there was no indication that the police department had seen and approved the applications. Mr. Miller said the police had reviewed all the applications. Mr. Engels said he can't believe the city routinely approves tobacco licenses. Mr. Miller said he would look into both concerns. Mr. Statsir noted that the Police will recommend actions if there is an issue regarding liquor control at a particular place. Ms. Dooley moved to approve the liquor license renewals as presented. Mr. Engels seconded. Motion passed unanimously. 10. Discuss Possible Rules of Procedure and other Regular Expectations for City Council: Mr. Miller suggested that for transparency, there be language as to how to put something on a Council agenda. Mr. Rusten noted that in some communities, Council members are asked if they have anything for the next agenda, and if a majority agrees, it is included in that agenda. Members agreed to stress the confidentiality of executive sessions in the rules. Mr. Miller said it should be made clear that "serial conversations" among members should be discouraged, especially if the intent is to reach a decision. Ms. Dooley expressed concern with"going overboard" in prohibiting conversation among Councilors. Mr. Engels said it gives the public more of an idea on how decisions are made if discussion occurs in public. Regarding contacting city staff, Mr. Miller said Council members should call Mr. Rusten or himself for questions of clarification. Calling members of other departments, however, can result in those people not knowing how to react. Mr. Rusten cautioned against individual Council members tasking the City Manager or Deputy City Manager with work. This should only be done by the entire Council. CITY COUNCIL 2 APRIL 2012 PAGE 8 Members agreed to continue this discussion. As there was no further business to come before the Council, the meeting was adjourned at 8:20 p.m. Clerk die City of South Burlington 40.004 City Clerk's Office Donna Kinville, City Clerk (4:161..) SPECIAL EVENT(EN RTAINMENT) OR CATERING PERMIT C- 1))/ ' FULL NAME OF PERSON, PARTNERSHIP OR CORPORATION: 7=tociU . u) enecird CONTACT PHONE NUMBER OR E-MAIL: am ADDRESS: DATE RECEIVED BY CLERK'S OFFICE: • G*7)/0--- POLICE APPROVED: DATE: r9-8—/z- FIRE APPROVED: DATE: ZONING APPROVED: ( DATE:_Q? RECREATION APPROVED: (/?'J . DATE: 3 .--7' D 1 L--) HIGHWAY/HEALTH DEPT APPROVED: , DATE6 CITY COUNCIL DATE: Henn-) nnn n n A,nr CITY OF SOUTH BURLINGTON ENTERTAINMENT LICENSE APPLICATION Type of Application ❑ Annual Permit I Special Event Permit Date of Application: February 10th, 2012 Name of Establishment: The ALS Association of Northern New England Address of Establishment: The Concord Center, 10 Ferry Street,Suite 309, Concord NH, 03301 Name and Address of Owner: N/A Name and Address of Operator: N/A Complete Description of Show: The Walk to Defeat ALS.This event is a fundraising and community event held at Dorset Park in South Burlington, VT. Entertainment provided for the participants of the walk, which includes a sound system for music and a magician. Date(s) of Show and Hour(s) of Operation: Date(s): Sunday,September 23rd, 2012 Hours(s): 9:30 AM -2:30 PM (Once participants start to head out from the event. Security Provisions: An officer will be on duty. As applicant, I have read and understand the provision of the South Burlington Ordinance Regarding Licensure of Regulation of Circuses, Carnivals and Other Shows. I also understand that only the specific type of entertainment applied for in this license is permitted and that additional types of entertainment will require an additional application. (Amy Coyne) Signature Laura From: Justin Rabidoux Sent: Tuesday, February 28, 2012 9:13 AM To: Laura Subject: Re: ALS walk/ Baseball &softball parade Ok with me On Feb 28, 2012, at 7:05 AM, "Laura" <lkimball(lsburl.com> wrote: > Hello all- > > A Public street application for May 5, 2012 (SB baseball & softball) Trevor I noticed they need Dorset St closed during parade. Are you aware of this? > Entertainment/public street permit for September 23, 2012 (ALS Association) Dorset Park > Any questions, let me know. Thanks > Laura Kimball > Deputy City Clerk > City of South Burlington > 575 Dorset Street > South Burlington, Vt. 05403 > lkimballPsburl.com > <image001.jpg> > <20120228084828060.pdf> 1 Laura From: ray Sent: Tuesday, February 28, 2012 11:45 AM To: Laura Subject: RE: ALS walk/Baseball & softball parade No zoning issues, Ray Belair Administrative Officer City of So. Burlington 802-846-4106 From: Laura Sent: Tuesday, February 28, 2012 9:05 AM To: Trevor Whipple; Doug Brent; Justin Rabidoux; ray; Tom Hubbard Subject: ALS walk/ Baseball &softball parade Hello all- Q A Public street application for May 5, 2012 (SB baseball &softball) Trevor I noticed they need Dorset St closed during parade. Are you aware of this? Entertainment/public street permit for September 23, 2012 (ALS Association) Dorset Park Any questions, let me know. Thanks si a vat/ 4to Laura Kimball Deputy City Clerk City of South Burlington 575 Dorset Street South Burlington, Vt. 05403 IkimballPsburl.com South Burlington City Council Action: 1. Verification of license fee: (See Section 6 or Ordinance) City Manager 2. Verification of approval standards: (See Section 4 of Ordinance) Council Chair 3. Application of License has been approved/disapproved by South Burlington City Council On ,20 4. Special Conditions attached to License (See Section 5 of Ordinance). South Burlington City Council Chair Date Laura From: Tom Hubbard Sent: Tuesday, March 27, 2012 2:43 PM To: Laura Subject: RE: ALS street& Ent permits Thanks Laura, these are all set with me...ALS has been issued our park permit as well for their event. Best, Torn Thomas Hubbard, CPRP Director South Burlington Recreation & Parks Dept. 575 Dorset Street South Burlington, VT 05403 802-846-4108 office 802-846-4101 fax thubbard@sburl.com www.sburlrecdept.com From: Laura Sent: Tuesday, March 27, 2012 12:29 PM To: Tom Hubbard Subject: ALS street& Ent permits Hello Tom- Since these are at Dorset Park, wanted your ok on them. Thanks- Laura von 4fte) Laura Kimball Deputy City Clerk City of South Burlington 575 Dorset Street South Burlington,Vt. 05403 lkimball@sburl.com t �® City of South Burlington $.# . , vg 4 City Clerk's Office Donna Kinville, City Clerk c. � / PECIAL EVENT(ENTERTAINiV1ENT) OR CATERING PERMIT 6---fnt ' ) ,A0 / 3----- FULL NAME OF PERSON, PARTNERSHIP OR COR • GOM -r y )- r, (a rim CONTACT PHONE NUMBER OR E-MAIL: o a ' cz4orpres( ADDRESS: DATE RECEIVED BY CLERK'S OFFICE: . /1' r)/- 4 ‘ sCia---' POLICE APPROVED: DATE: ! / jt _/Z FIRE APPROVED: (63) DATE: ti ZONING APPROVED: 64( DATE: G/"'3 . /a RECREATION APPROVED: /9 1 -, DATE: G) 'g ' "---- HIGHWAY/HEALTH DEPT APPROVED: 044 DATE: ' ) CITY COUNCIL DATE: DATE SENT TO MONTPELIER: CITY OF SOUTH BURLINGTON ENTERTAINMENT LICENSE APPLICATION Type of Application ❑ Annual Permit pedal Event Permit Date of Application: ( _�_a, 3— - [ . Name of Establishment: L V'vi Address of Establishment: 7c C( Q\ Rd ex) r-UA5tcA �` 1 °SYh l Name and Address of Owner: CU Rcui L lk( -P - b � 00 1._. 40(A-et ale ,,,, = (.�� ,� : auu or. Ong et Name and Address of Operator: )'fie GZ,OV I L67 LL_ Complete Descri ti of Show:�t A�ova1 1-L1 � j)4cLQ Date(s) of Show and Hour(s) of Operation: Date(s): ((,�/ / Hours(s): SU/A e Security Provisions: F d < (C e (Jot n,+-e /let S/ [-SA- AA U p-Pi\U s, S f-G Ucvl S0 pc&r+ As applicant, I have read and understand the provision of the South Burlington Ordinance Regarding Licensure of Regulation of Circuses, Carnivals and Other Shows. I also understand that only the specific type of entertainment applied for in this license is permitted and that additional types of entertainment will require an additional application. Signature 2 :.,... . . . 0 0.5 1 2 1 - .'M Iles -."--7 ' CI 2 ! Are:- B U R(i..I NI G T 0 NJ 4,1 31 i EIS r/ il ti„limn) s\N1 j ) 6 , - '''-1P) WIOTHEFFS DAY •rf..-------1, ti. -----.. . . , , RIDE ,,---,,,,...!c r'', C. f' . SOUTH 0 ( \ BURLINGTON i , ., - e; rn I' 1 1, Shelburne f..... . , ? 30-M i le Route _ (---A Bay ...... --......_ , - ---......‘ . .. _ ,,--;.; ( iff';' , N 4 2, rn 1 ....„, 1_, _...• . , ,_.., cn . . --„,-, s , 1 , 3 p 1 , _....,.. - SHELBURNE 2 uri a Ws--- R ' 2 4 , X . ' 1' i ' ' ' 8 t.... 2 2 c' 9 13u.3 RO . ----1P ili)/ ,6, , 7 , 1 Lake Champlain ''-'C' • ..,. ____p. _ ___-,,---T-". 0 re- oS ------ )1.) „. ) ' cb \ irticilutO --------:--------:,.,,,.. ...ill' '.. ."".''''. . '... '''' \ , i \; ii\II lit Q Z 0 --I Z 11 .--' .. ci. i i . .. -. i•-• 2 1 el , $ 1-i NESEURG RD 4410 IND i / „,,,,,$)ve' \ (rock\ EFzR,(RD 1, ... , ti)12011) HOPE•OPPORTUNITY•FAMILY CHARLOTTE Route Map Prod •-.-----" Elevation Profile Feet 7 22 24 6 r 400 5 b 21 0 — 23 30012 9 11 3 1 10 200 8 8 IOU— r.,,,.Chant InfprzArtinn NII irnhpr 1 .1--_''l rcu I HOLT It- 1 II L__ U PROCTOR AV l �j it p p �l a I ci ��-' a x " Be in Mile 0 t is p 9 MAN AV v ____------ End Mile 3.6 b 7LTE PI` v < Ric LU i ; r: 7 _ o High S ` .; CARFF AV" �I NAD� YD--�--- _ MOTHER'S DAY •.' _- BACON^� ot_ JOYDR RIDE _ i r: . .. `-- t, o ? - 0 ) . a + - K" n w ir4 i Mile 0.5 ------------ Family ��r� Family Ride/�:c7.19 (______ P� IIIIIPAD LLI Lv rx HOPE•OPPORTUNITY.FAMILY ( ,,H7 _ u..< LtNDfi ✓ arrell nark ��..� -- —NYVOOD b `.`.� s Ike path? . �-`—�-- 1+ Mile 1.0ii � • -_- i_-....__1._.- 1 '\''' ,+ ER pKWY ~ .. �� OR fjt = L_ __________________LAUREL HILL DR lk (` R. a -� _ 1 ? \\ w / gI 0 /� \ sly \� ,� Mile 1.5 !f '�gTONEHEDG �_��r'BALDWW qua`�!! 1 i > } — OAKHILL ORC. / a. z', =z f tt . APR G 1 0 U :.,.. ,c, Ii. �] � �f p Mile 1.8 $\wee (' 11 "MClNTOSH AV---_ . 1 !'' f 7 _ Sz mansi<; 5 l Park ;� f MOTI N ' p ANDREWS�gU- ��- �—='Route Map Prod ed by X f��--_.----�- o,� r if 1! � �--� N l'4` - E 0 0.05 0.1 0.2 0.3 0.4 O5 �y r Miles S Laura From: Tom Hubbard Sent: Tuesday, April 03, 2012 1:53 PM To: Laura Subject: RE: Lund Mother's day ride Hi Laura— All set with me... Tom Thomas Hubbard, CPRP Director South Burlington Recreation & Parks Dept. 575 Dorset Street South Burlington, VT 05403 802-846-4108 office 802-846-4101 fax thubbard@sburl.com www.sburlrecdept.com From: Laura Sent: Tuesday, April 03, 2012 1:00 PM To: Trevor Whipple; Doug Brent; ray; Justin Rabidoux; Tom Hubbard Subject: Lund Mother's day ride Hello- This event is for May 13, 2012. (street & Entertainment) Let me know if any issues. Laura Doug &Trevor: please note I am still waiting on "ok" for Baseball parade, ALS association (street& ent permit) Doug: Vt cares Thanks for your attention. Laura oto Laura Kimball Deputy City Clerk City of South Burlington 575 Dorset Street South Burlington,Vt. 05403 lkimball@sburl.com 1 Laura From: ray Sent: Tuesday, April 03, 2012 1:06 PM To: Laura Subject: RE: Lund Mother's day ride No zoning issues. Ray Belair Administrative Officer City of So. Burlington 802-846-4106 From: Laura Sent: Tuesday, April 03, 2012 1:00 PM To: Trevor Whipple; Doug Brent; ray; Justin Rabidoux; Tom Hubbard Subject: Lund Mother's day ride Hello- This event is for May 13, 2012. (street& Entertainment) Let me know if any issues. Laura Doug&Trevor: please note I am still waiting on "ok" for Baseball parade,ALS association (street&ent permit) Doug: Vt cares Thanks for your attention. Laura Laura Kimball Deputy City Clerk City of South Burlington 575 Dorset Street South Burlington,Vt. 05403 lkimball@sburl.com 1 La ura From: Justin Rabidoux Sent: Tuesday, April 03, 2012 1:08 PM To: Laura Subject: RE: Lund Mother's day ride Ok with me. From: Laura Sent: Tuesday, April 03, 2012 1:00 PM To: Trevor Whipple; Doug Brent; ray; Justin Rabidoux; Tom Hubbard Subject: Lund Mother's day ride Hello- This event is for May 13, 2012. (street& Entertainment) Let me know if any issues. Laura Doug&Trevor: please note I am still waiting on "ok" for Baseball parade, ALS association (street&ent permit) Doug: Vt cares Thanks for your attention. Laura Laura Kimball Deputy City Clerk City of South Burlington 575 Dorset Street South Burlington,Vt. 05403 Ikimball@sburl.com 1 vi. Al 5 , ,, ' otoit PLANNING & ZONING MEMORANDUM TO: South Burlington City Council & City Manager FROM: Paul Conner, Director of Planning &Zoning Cathyann LaRose, City Planner SUBJECT: Second Reading and consideration of Adoption of Draft Land Development Regulations Amendments DATE: April 16, 2012 City Council meeting The City Council voted in February to warn a public hearing and second reading to consider the enclosed amendments to the City's Land Development Regulations. Following the public hearing, the Council may adopt the Regulations pursuant to state statute. Brief summary and history of the amendments: The amendments consists of revisions to the Table of Uses for the city's residential and institutional zoning districts. These revisions were intended to be a part of a series of amendments adopted by the Council in December but inadvertently left out of the public hearing warning at that time. The Planning Commission therefore warned and held a new public hearing on these amendments, which are now presented to the Council for consideration. Amendments include: • Integration of congregate care, medical offices, social services and general offices into the new Transit Overlay District established in December(enclosed for your reference). Where the Table of Uses lists a use with a"TOD", then that use is only permissible within the portion of that zoning district that lies within the Transit Overlay District. • Removal of the land use entitled "clinic, medical, dental, or optical." It was determined to be a redundant land use category within the table of uses—"medical office" covers all of these. • Reclassification of places of worship to be permitted uses (in accordance with state law). The Commission discussed and developed these amendments during the summer of 2011 and reviewed them as part of their public hearing. The vote to approve was unanimous. Recommendation: staff recommends the City Council hold the public hearing, and, after closure consider adoption of the amendments. Possible motion: I move that the City Council adopt the amendments to the Land Development Regulations, as proposed. 575 Dorset Street South Burlington, VT 05403 tel 802.846.4106 fax 802.846.4101 www.sburl.com 1 i" APPENDIX C USES and DIMENSIONAL STANDARDS C-la Key to Proposed Amendments Proposed additions are hold and underlined; proposed deletion-have a line througw ahem Institutional Residential Southeast Quadrant RESIDENTIAL&INSTITUTIONAL IA(1) PR MU RI R2 R4 R7 R7- R12 LN QCP SEQ- SEQ- SEQ-NR SEQ-VR SEQ- DISTRICTS NC(2) NRP NRT VC(2) Residential Uses Single-family dwelling P P P P PUD PUD P P P P P P P Two-family dwelling PUD P P P PUD P • P P P P P P Multi-family dwelling PUD PUD P PUD PUD 0 C PUD P P Agricultural Uses Horticulture&forestry with on-premise sales Permitted in all districts;3 acre minimum lot size in all districts. Horticulture&forestry,no on-premise sales Permitted in all districts Keeping of livestock on 10 acres or more P P P P P P P P P Single-family dwelling related to agriculture P P P P P P P P P P P P P Additional dwellings for farm employees P P P P P P yik'- P P P P P P Public&Quasi-Public Uses Cemeteries Conditional in all districts Community center PUD P P P C P P P Congregate care,assisted living,or continuum il C C of care facility Cultural facility PUD Educational facility PUD ,' '-, C C C Educational support facilities PUD Funeral homes and mortuaries C C Group home Please see Sec 3.12 for reg "ions. Group quarters PUD Hospice P P Municipal facility C P Parks Permitted in all districts Personal instruction facility I P Place of worship PUD GP 'C P C P IC P GP C P ^ .. _ P Recreation paths Permitted in all districts Social services a i 1 Commercial Uses 1 — — I ! i I Adult use South Burlington Land Development Regulations Draft for City Council Public Hearing 4-16-2012 APPENDIX C USES and DIMENSIONAL STANDARDS C-2a Institutional Residential Southeast Quadrant RESIDENTIAL&INSTITUTIONAL IA(1) PR MU RI R2 R4 R7 R7- R12 LN QCP SEQ- SEQ- SEQ-NR SEQ-VR SEQ- DISTRICTS NC(2) NRP NRT VC(2) Auto&motorcycle and repair, _■■ C accessory use,no fueling pumps Bed and breakfast,min. I acre lot -_C C C C C C C C(3) Family child care home,registered or licensed P P P P P P P P P P P P P P Child care facility,licensed non-residential -___ . , ek��H `��'iaa. 7€ce.- ,, g .,.,. :,.. �:�aa: � , .. ..,.�. ^>�>a� ' .. ate .<'„�.a'E. P :. � �n. �.... +r���:3�s�__ .:.: Commercial greenhouse _■■IIIIIWAh. C-ACC Commercial or public parking facility C C Convenience store<3,000 SF within principal N-PUD __ ■_- structure Financial institution P Golf course _�7 C C C Office,general PUD C C Office,medical . r° ;Tr, 4,,, C Personal or business service,principal use Personal or business service,up to 3,000 SF N-PUDir IV C GFA per any one principal structure = Pet Grooming - _ P Photocopy&printing shops with accessory N-PUD retail w Private providers of public services,including ..4 vehicle storage and maintenance Recreation facility,indoor N-PUD C C C C Recreation facility,outdoor N-PUD C-1- C _C C Research facility or laboratory PUD Restaurant,short order N-PUD C Restaurant,standard N-PUD C C Retail and retail services up to 3,000 SF GFA N-PUD ■■ P C within any one principal structure Retail food estab.<5,000 SF GFA N-PUD __ P C Seasonal Mobile Food Unit __ P Service station w/convenience store __ C Waste transfer stations South Burlington Land Development Regulations •. Draft for City Council Public Hearing 4-16-2012 r, ,n 1041. south , PLANNING & ZONING South Burlington Planning Commission Proposed Land Development Regulation Amendment Report Public Hearing Scheduled for Wednesday, February 8, 2012 In accordance with 24 V.S.A. §4441(c), the South Burlington Planning Commission has prepared the following report regarding the proposed amendment to the city's Land Development Regulations. Brief Description of the Proposed Amendments The South Burlington Planning Commission will hold a public hearing on Wednesday, February 8, 2012 at 7:30 PM in the City Hall Conference Room, 575 Dorset Street, South Burlington, VT to consider the following amendment to the South Burlington Land Development Regulations: 1. Modify table of uses (Appendix C) related to places of worship, and clinics, social services, congregate care, and general and medial offices for consistency with amendments passed in 2011. Findings Concerning the Proposed Amendment The proposed amendments have been carefully considered by the Planning Commission over the course of several meetings for their consistency with the text, goals, and objectives of the City of South Burlington's Comprehensive Plan, last adopted March 9, 2011. The proposed amendments are consistent with the goals and policies of the Comprehensive Plan. Specifically: The following proposed amendments are intended to improve clarity and accuracy within the Regulations. • Elimination of"clinic, medical, dental, or optical" as a redundant and undefined land use category. • Categorization of"places of workshop" as permitted uses, to comply with state law. The following amendments represent adjustments to standards within the Regulations that are consistent with the intent of the regulations, the Comprehensive Plan, State Law, and Federal Law: 575 Dorset Street South Burlington, VT 05403 tel 802.846.4106 fax 802.846.4101 www.sburl.com • Integrate certain transit-supportive land uses (congregate care, social services, general office, medical office) into the City's recently-established Transit Overlay District These amendments are consistent with the goals and policies of the Comprehensive Plan, as described below. The amendments include integration of residential and institutional zoning districts into the recently-established transit overlay district. These amendments are consistent with the Comprehensive Plan goal of encouraging a land use pattern generally consisting of a higher-density, compact urban core and continued investment and growth in existing developed corridors. The remainder of the amendments will provide greater internal consistency within the document and its standards, and greater consistency with State and Federal Law. South Burlington Overlay Districts Effective January 9, 2012 Legend ,I Airport Approach Corndors Traffic In Major Intersections-Zone 1 ^�a High Volume Roadway Segments--Zones 2A,2B,2C a } "' " Balance of Restricted Roads-Zone 3 View Protection Zones / y ' 1 1 DORSET PARK ri -'- J �$"''. 4 S'j= ;. Li HINESBURG RD.-NORTH 4 '1 ( -r- f ,j >•. / 1 , i , HINESBURG RD.-SOUTH J(y ,� I SPEAR ST.-OVERLOOK PARK ' 1 SPEAR ST.-RIDGE '/ \ _I Stormwater Management Overlay District j ` ^ " �J W Stormwater Management Overlay District phi/ �"'•-- Design Review Overlay Districts / DESIGN DISTRICT 1 � t DESIGN DISTRICT 2 X f 1 �„y... '' li,., DESIGN DISTRICT 3 10 �1^".�,. ,,..''� Flood Plain Overlay District t s 1 f f/Y/ t ,'u ,..,r, J7 u. Zone A 100-year Flood Plain 1} $ I il, : 't 1 .�1. i, t�� �' 1 1', -` Tax Parcel boundaries t $ l '� - � L � - tom,°: 0 Water Body 13 y r l V. ,�rJ ��� -n-^-Perennial Stream j t { d t ,,k 'l/ / ' _ --n.- Intermittent Stream t t t F i q �` '"�.Roads 1 k• l�� � I' ',. ' � �""�` �+,, / /Transit Route - �� / Transit Overlay District ! ��i ,> ��� i f +u--'; � 1 i LSD.:! a '•`, t , _LS "ili *fir , e / F r- 'ter. .-.,,,�, s' i r .....• I „� .1 r. -`.' s 4j 0 d f of ' t‘ -- i ‘---,...:1 ,„/....„,,,, 4 r77: 0 1 �M:.# c,.. 1 1 _ Y' - / #4 N E,A, R E �. //' S ` 4 Feet `, , f�i ✓' 0 2,000 4,000 6,000 6 0 0.25 0.5 0.75 1 Miles - Disclaimer; The accuracy of information presented is determined by its sources. Errors and omissions may exist. `' The City of South Burlington is not responsible for these. ~`- Questions of on-the-ground location can beresolved by site inspections and/or surveys by registered surveyors. This map is not sufficient for delineation of features on the gound. This map identifies the presence of features,and may indicate relationships between features, but it is not a replacement for surveyed information or engineering studies. Map updated by H.Shaw using ArcGIS 10.0.All data is in State Plane Coordinate System,NAD 1983. 11,07 \\PW SeMGISData\PlantinglOverlayMap\OverlayMap_ CITY OF SOUTH BURLINGTON CITY COUNCIL US ROUTE 2/WILLISTON ROAD IMPROVEMENT PROJECT CONDEMNATION REPORT This report is prepared and approved by the City of South Burlington City Council, pursuant to the requirements of 19 V.S .A. , Chapter 7 . This report, together with the minutes of the City Council Hearing held 4/16/2012, which minutes are incorporated herein by reference, constitute the report of our doings concerning the condemnation of the lands and interests in land shown and depicted on a set of plans entitled "City of South Burlington, Chittenden County, US2 Improvements Roadway Project (Principal Arterial) " Project Number STP 5200 (18) , dated 4/16/2012 (the "Plans") for purposes of making improvements to US Route 2/Williston Road. NOTICE Statutory Notice was provided in the following manner: 1 . A notice of the City Council' s 4/16/2012 hearing was sent via certified mail, return receipt requested, to the record property owners and mortgage holders of record at least 30 days prior to the hearing. 2 . Notice was sent to the City Development Review Board on or before 3/16/2012 and was posted in the City of South Burlington Clerk' s office on 3/16/2012 . A copy of the Notice of Hearing was published in the The Other Paper, the City' s Official Paper of Record, on 3/29/2012 . NECESSITY During the course of the 4/16/2012 hearing evidence was presented by GARY A. SANTY, PE, Principal, Stantec Consulting Services Inc . JUSTIN RABIDOUX, Public Works Director, City of South Burlington regarding the necessity of the US Route 2/Williston Road 1 Improvement Project and the necessity of acquiring the lands and interests in land to be condemned to enable that project to go forward. No one present at the hearing contested the necessity of the project. DECISION By executing its Condemnation Order, the City Council decided that the public good, necessity, and convenience of the inhabitants of the City of South Burlington requires the construction and installation of the improvements to US Route 2/Williston Road, and further determined that condemnation of property and interests in property shown on the above-referenced Plans was necessary to enable the project to go forward. REPORT, ORDER AND NOTICE The City Council directed that this Report and the companion Order be filed with the South Burlington City Clerk. The Council further directed the City Manager to forward a copy of the companion Order to the owners of the affected properties. 2 Dated at South Burlington, Vermont, this of CITY COUNCIL OF THE CITY OF SOUTH BURLINGTON By: , Chair Its Duly Authorized Agent son11-021 Condemnation FOF Rte 2 widening REA 3 STATE OF VERMONT CHITTENDEN COUNTY, SS. In Re: Condemnation of Lands for ) City of South Burlington US Route 2 Improvements ) City Council Roadway Project ) CONDEMNATION ORDER The South Burlington City Council held a public hearing on the necessity of acquiring certain lands and premises for purposes of making improvements to US Route 2 (a/k/a Williston Road) on 4/16/2012 . Based on the information provided to the City Council at that hearing, the City Council makes the following findings regarding the subject property and enters the order set forth below: FINDINGS OF FACT 1 . The subject property consists of certain lands and interests in land along the northerly and southerly sideline of the US Route 2/Williston Road right-of-way in the City of South Burlington, beginning at the Burlington / South Burlington City line and extending in an easterly direction a distance of 0 .24 miles to the Interstate 89 Exit 14W Interchange. Said land and interests in land is more specifically depicted on a set of plans entitled "City of South Burlington, Chittenden County, US2 Improvements Roadway Project (Principal Arterial) " Project Number STP 5200 (18) , dated 4/16/2012 (the "Plans") . 2 . The City provided statutory notice of its 4/16/2012 hearing by sending written notice by certified mail, return receipt requested, to each affected record property owner and mortgage holder of record at least 30 days prior to the hearing. Copies of said Notice of Public Hearing sent to the interested parties are attached 1 hereto as Exhibit A. A list of the affected properties is attached as Exhibit B. Notice was sent to the City Development Review Board on or before 3/16/2012 and was posted in the City of South Burlington Clerk' s office on 3/16/2012 . A copy of the Notice of Public Hearing was published in the The Other Paper, the City' s Official Paper of Record, on 3/29/2012 . 3. At the 4/16/2012 hearing, the following property owners appeared: [NAME (ORGANIZATION/PROPERTY) ] ; [NAME (ORGANIZATION/PROPERTY) ] ; [NAME (ORGANIZATION/PROPERTY) ]; ; [NAME (ORGANIZATION/PROPERTY)] . 4 . Based upon the testimony of Gary A. Santy, PE, Principal, Stantec Consulting Services Inc. and Justin Rabidoux, Public Works Director, City of South Burlington, we find the following: a. US Route 2/Williston Road is an integral part of the City' s transportation system, providing a vital link between Burlington, South Burlington and Interstate 89 . Area hospitals, colleges and police depend on this roadway to provide necessary public services. b. The current configuration of US Route 2/Williston Road was constructed in 1987, with an anticipated design life span of twenty years. In its present configuration, US Route 2/Williston Road does not adequately provide for the safety and mobility of vehicles, pedestrians, bicycles, and transit through the project area from Spear Street/East Avenue intersection to the western I-89 ramps (northbound off and southbound on ramps) . c. At all times material to this proceeding, the City has had in effect an Official Map adopted pursuant to 24 V.S.A. Section 4421. Exhibit 1 . This map depicts the proposed widening of U.S . Route 2 in the area from 800-868 Williston Road on the north 2 side of Route 2 and 801-861 Williston Road on the south side of Route 2 . The precise stations involved in the Project are show on the Plans] . d. The proposed improvement project, which includes widening US Route 2/Williston Road to six (6) lanes, will achieve the following goals and objectives : (1) the new design will increase vehicular capacity to meet current needs as well as projected traffic needs twenty years into the future; (2) current bicycle and pedestrian facilities will be improved and new facilities will be added; (3) to reduce traffic delays and queues on US Route 2 (Williston Road) ; (4) to reduce the potential for crashes in the project area; (5) to improve pedestrian safety when crossing US Route 2 and the I-89 southbound on-ramp; and (6) to contribute to the increased use of transit services and be compatible with transit strategies as outlined in the US 2 Corridor Transportation Management Plan. e. The Project involves lands currently owned by: 89-2 Realty Company, a Vermont partnership having offices in the City of South Burlington, County of Chittenden and State of Vermont, R.L. Vallee, Inc. , a Vermont corporation, having its principal place of business in the City of St . Albans, County of Franklin and State of Vermont, Timberlake Associates, L.L. P. , a Vermont Limited Liability Partnership, with its principal place of business in the City of South Burlington, County of Chittenden and State of Vermont, FelCor/MM S-4 Hotels (SPE) L.L.C. , a Texas Limited Liability Company with its principal place of business in the City of Irving, County of Dallas, and State of Texas and University of Vermont and State Agricultural College, an instrumentality of the State of Vermont with its principal place of business in the City of Burlington, County of 3 Chittenden and State of Vermont, (collectively, the "Affected Properties")] . Exhibit B. f . Based on "Access Management Program Guidelines" prepared by the Vermont Agency of Transportation, the widening of U.S . Route 2 will necessitate [TAKING/ACQUISITION/Temporary rights and Permanent rights OF property FROM THE AFFECTED PROPERTIES AS DETAILED BELOW BUT WILL NOT AFFECT THEIR ACCESS TO ROUTE 2] . PARCEL AFFECTED ADDRESS AREA REQUIRED AFFECTED STATIONS (Square Feet) 4 813-861 Williston Rd. 1, 857 15+10 . 0 to 21+23 . 0 3 811 Williston Rd. 2, 102 13+50 . 0 to 15+10 . 0 2 801 Williston Rd. 2 , 174 10+66 . 0 to 13+50 . 0 1 800-868 Williston Rd. 26, 181 11+40 . 0 to 15+18 . 5 5 860-870 Williston Rd. 50, 066 14+93 . 0 to 20+56 . 0 Exhibit 1 and testimony of GARY A. SANTY, PE, OF STANTEC CONSULTING SERVICES INC. g. The taking of the lands and interests in land shown of the Plans has no adverse effect on any commercial buildings, condominium units or other structures. Landscaping throughout the project area will be maintained or enhanced. CONCLUSIONS OF LAW 1 . All statutory requirements concerning warning, notification, and conduct of the US Route 2/Williston Road Improvement Project condemnation hearing have been complied with. 2 . The public good, necessity and convenience of the residents of the City of South Burlington requires that the improvements to US Route 2/Williston Road by the City of South Burlington and financed, in part, by the State of Vermont Agency of Transportation and the Federal Highway Administration, be 4 constructed. The property to be condemned is necessary to enable the project to go forward. ORDER WHEREFORE, it is hereby ordered, adjudged and decreed: 1 . That the lands and interests in land shown and depicted as a set of plans entitled "City of South Burlington, Chittenden County, US2 Improvements Roadway Project (Principal Arterial) " Project Number STP 5200 (18) , dated 4/16/2012 and recorded in Map Slides through of the City of South Burlington Land Records (the "Plans") are hereby condemned pursuant to 19 V. S.A. , Chapter 7, for purposes of making improvements to US Route 2/Williston Road. 2 . That the aforementioned right-of-way Plans shall constitute the premises survey required by 19 V.S.A. , Chapter 7. 3 . That within two months of the date of this Order the affected property owners shall remove any fences, timber, wood or trees, which they are requested to in connection with this project. After the expiration of the two months, the City will take possession of the land and rights, remove obstructions therefrom and lay the lands open for construction of the proposed improvements to US Route 2/Williston Road. Dated at South Burlington, Vermont this of CITY COUNCIL OF THE CITY OF SOUTH BURLINGTON By: , Chair Its Duly Authorized Agent son2033 . lit 5 South Burlington STP 5200(18) South Burlington, Vermont EXHIBIT A Notice of Public Hearing Sent to Interested Parties /.. �`ey of 1 0 southburlington PUBLIC WORKS VIA CERTIFIED MAIIJRETURN RECEIPT REQUESTED March 15,2012 University of Vermont and State Agricultural College 106 Morrill Hall 146 University Place Burlington,VT 05405 Re: South Burlington STP 5200(18) US 2 Widening/3`d Lane Project—Parcel 1 Dear Sir or Madam: This letter serves as your official notice for a Necessity Hearing to be held for the referenced project on April 16,2012.The Hearing will be at the South Burlington City Council meeting to be held at 7:00pm at the South Burlington City Hall, 575 Dorset Street, South Burlington,VT 05403. This project has been discussed with each property owner multiple times over the past few years. As a reminder,the Project proposes certain easements be granted from your property to the City for the construction of the project.Attached are two documents outlining the easements required from your property; 1)a set of the Right-of-Way plans showing your property,a listing and a hiellight of each easement and 2)a proposed Warranty Deed of Easement. Please review the attachments and let me know if you have questions. If you would like to meet prior to April 16 to discuss the project,please contact me at 658-7961. Re , f �' Justin bidoux,Director Enclosures 575 Dorset Street South Burlington. VT 05403 tel 802 658 7961 fax 802.658.7976 www.sburl.com Physical Address 104 Landfill Road South Burlington lie tiii `l.. southburlington. PUBLIC WORKS VIA CERTIFIED MAIL/RETURN RECEIPT REQUESTED March 15,2012 University of Vermont Administrative Office 108 Morrill Hall 146 University Place Burlington,VT 05405 Re: South Burlington STP 5200(18) US 2 Widening/3`d Lane Project—Parcel 1 Dear Sir or Madam: This letter serves as your official notice for a Necessity Hearing to be held for the referenced project on April 16,2012.The Hearing will be at the South Burlington City Council meeting to be held at 7:00pm at the South Burlington City Hall, 575 Dorset Street, South Burlington,VT 05403. This project has been discussed with each property owner multiple times over the past few years. As a reminder,the Project proposes certain easements be granted from your property to the City for the construction of the project. Attached are two documents outlining the easements required from your property; 1)a set of the Right-of-Way plans showing your property,a listing and a highlight of each easement and 2)a proposed Warranty Deed of Easement. Please review the attachments and let me know if you have questions.If you would like to meet prior to April 16 to discuss the project,please contact me at 658-7961. Reg ds 1 ustin R idoux,Director Enclosures 575 Dorset Street South Burlington. 1'T 05403 tel 802.658.7961 fax 802.658.7976 www.sburl.com Physical Address• 104 Landfill Road South Burlington iiii 0e pa southburlington PUBLIC WORKS VIA CERTIFIED MAIL/RETURN RECEIPT REQUESTED March 15,2012 Timberlake Associates, LLP 32 San Remo Drive South Burlington,VT 05403 Re: South Burlington SW 5200(18) US 2 Widening/3`d Lane Project—Parcel 2 Dear Sir or Madam: This letter serves as your official notice for a Necessity Hearing to be held for the referenced project on April 16,2012.The Hearing will be at the South Burlington City Council meeting to be held at 7:O0pm at the South Burlington City Hall,575 Dorset Street, South Burlington,VT 05403. This project has been discussed with each property owner multiple times over the past few years. As a reminder,the Project proposes certain easements be granted from your property to the City for the construction of the project.Attached are two documents outlining the easements required from your property; 1) a set of the Right-of-Way plans showing your property, a listing and a highlight of each easement and 2)a proposed Warranty Deed of Easement. Please review the attachments and let me know if you have questions.If you would like to meet prior to April 16 to discuss the project,please contact me at 658-7961. Re ar s, Justin 2idoux,Director Enclosures 575 Dorset Street South Burlington. VT 0541,3 tel 802.658.7961 fax 802.658 7976 www.sburl.com Physical address 104 Landfill Road South Burlington oe,„ southburlington PUBLIC WORKS VIA CERTIFIED MAIL/RETURN RECEIPT REQUESTED March 15,2012 R.L.Vallee,Inc. 280 South Main Street St. Albans, VT 05478 Re: South Burlington STP 5200(18) US 2 Widening/31rd Lane Project—Parcel 3 Dear Sir or Madam: This letter serves as your official notice for a Necessity Hearing to be held for the referenced project on April 16,2012.The Hearing will be at the South Burlington City Council meeting to be held at 7:00pm at the South Burlington City Hall,575 Dorset Street, South Burlington,VT 05403. This project has been discussed with each property owner multiple times over the past few years. As a reminder,the Project proposes certain easements be granted from your property to the City for the construction of the project.Attached are two documents outlining the easements required from your property; 1)a set of the Right-of-Way plans showing your property,a listing and a highlight of each easement and 2)a proposed Warranty Deed of Easement. Please review the attachments and let me know if you have questions.If you would like to meet prior to April 16 to discuss the project,please contact me at 658-7961. Re ards, Justin Rabidoux,Director Enclosures 575 Dorset Street South Burlington, VT 05403 tel 802.658 7961 fax 802.658.7976 www.sburl.com Physical Address 104 Landfill Road South Burlington o 50 southburlin ton PUBLIC WORKS VIA CERTIFIED MAIL/RETURN RECEIPT REQUESTED March 15,2012 89-2 Realty Company do Josh Field 165 E. 72nd Street,#20C New York,NY 10021 Re: South Burlington STP 5200(18) US 2 Widening/3`d Lane Project—Parcel 4 Dear Sir or Madam: This letter serves as your official notice for a Necessity Hearing to be held for the referenced project on April 16,2012. The Hearing will be at the South Burlington City Council meeting to be held at 7:00pm at the South Burlington City Hall, 575 Dorset Street, South Burlington,VT 05403. This project has been discussed with each property owner multiple times over the past few years. As a reminder,the Project proposes certain easements be granted from your property to the City for the construction of the project.Attached are two documents outlining the easements required from your property; 1)a set of the Right-of-Way plans showing your property,a listing and a highlight of each easement and 2)a proposed Warranty Deed of Easement. Please review the attachments and let me know if you have questions.If you would like to meet prior to April 16 to discuss the project,please contact me at 658-7961. Reg s stin Rabidoux,Director Enclosures 575 Dorset Street South Burlington. VT 05403 tel 802.658 7961 fax 802.658.7976 www.sburl.com Physical Address. 104 Landfill Road South Burlington si 4 southburlington PUBLIC WORKS VIA CERTIFIED MAIL/RETURN RECEIPT REQUESTED March 15,2012 89-2 Realty Company c/o Liam Murphy,Esq. Murphy, Sullivan,Kronk 275 College Street Burlington,VT 05401 Re: South Burlington STP 5200(18) US 2 Widening/P Lane Project—Parcel 4 Dear Mr.Murphy: This letter serves as your official notice for a Necessity Hearing to be held for the referenced project on April 16,2012.The Hearing will be at the South Burlington City Council meeting to be held at 7:00pm at the South Burlington City Hall, 575 Dorset Street, South Burlington,VT 05403. This project has been discussed with each property owner multiple times over the past few years. As a reminder,the Project proposes certain easements be granted from your property to the City for the construction of the project.Attached are two documents outlining the easements required from your property; 1)a set of the Right-of-Way plans showing your property, a listing and a highlight of each easement and 2)a proposed Warranty Deed of Easement. Please review the attachments and let me know if you have questions. If you would like to meet prior to April 16 to discuss the project,please contact me at 658-7961. Re , i ustin Rabidoux,Director Enclosures 575 Dorset Street South Burlington. VT 05403 tel 802.658.7961 fax 802.658.7976 www.sburl.com Physical Address. 104 Landfill Road South Burlington 40 n kr* :27,,,....wit southburlington PUBLIC WORKS VIA CERTIFIED MAIL/RETURN RECEIPT REQUESTED March 15, 2012 People's United Bank Two Burlington Square Burlington, VT 05401 Re: South Burlington STP 5200(18) US 2 Widening/3`d Lane Project—Parcels 2&3 Dear Sir or Madam: This letter serves as your official notice for a Necessity Hearing to be held for the referenced project on April 16, 2012. The Hearing will be at the South Burlington City Council meeting to be held at 7:00pm at the South Burlington City Hall, 575 Dorset Street, South Burlington,VT 05403. This project has been discussed with each property owner multiple times over the past few years. As a reminder,the Project proposes certain easements be granted from your property to the City for the construction of the project.Attached are two documents outlining the easements required from your property; 1)a set of the Right-of-Way plans showing your property,a listing and a hi'hlight of each easement and 2)a proposed Warranty Deed of Easement. Please review the attachments and let me know if you have questions. If you would like to meet prior to April 16 to discuss the project,p1eacr contact me at 658-7961. Re , Justin abidoux, Director Enclosures 575 Dorset Street South Butlington, V7 05403 tel 802 658.7961 fax 802 658.7976 www.sburl.com Physical Address' 104 Landfill Road South Butlington 4 o southbur ington PUBLIC WORKS VIA CERTIFIED MAIL/RETURN RECEIPT REQUESTED March 15, 2012 Fortress Credit Corporation c/o Drawbridge Special Opportunities Fund LP 1345 Avenue of the Americas 46th Floor New York,NY 10105 Re: South Burlington STP 5200(18) US 2 Widening/3nt Lane Project—Parcel 5 Dear Sir or Madam: This letter serves as your official notice for a Necessity Hearing to be held for the referenced project on April 16, 2012.The Hearing will be at the South Burlington City Council meeting to be held at 7:00pm at the South Burlington City Hall, 575 Dorset Street, South Burlington,VT 05403. This project has been discussed with each property owner multiple times over the past few years. As a reminder,the Project proposes certain easements be granted from your property to the City for the construction of the project. Attached are two documents outlining the easements required from your property; 1)a set of the Right-of-Way plans showing your property, a listing and a highlight of each easement and 2)a proposed Warranty Deed of Easement. Please review the attachments and let me know if you have questions.If you would like to meet prior to April 16 to discuss the project,please contact me at 658-7961. Rear// , Justin Rabidoux,Director Enclosures 575 Dorset Street South Burlington. YT 05403 tel 802 658 7961 fax 802 658.7f76 www sburl.com Physical Address: 104 Landfill Road South Burlington `.0100% southburlington PUBLIC WORKS VIA CERTIFIED MAIL/RETURN RECEIPT REQUESTED March 15,2012 FelCor/MM S-4 Hotels(SPE)L.L.C. do FelCor Lodging Trust,Inc. 545 E.John Carpenter Freeway, Suite 1300 Irving,TX 75062 Re: South Burlington STP 5200(18) US 2 Widening/3rd Lane Project—Parcel 5 Dear Sir or Madam: This letter serves as your official notice for a Necessity Hearing to be held for the referenced project on April 16,2012.The Hearing will be at the South Burlington City Council meeting to be held at 7:00pm at the South Burlington City Hall,575 Dorset Street, South Burlington,VT 05403. This project has been discussed with each property owner multiple times over the past few years. As a reminder,the Project proposes certain easements be granted from your property to the City for the construction of the project.Attached are two documents outlining the easements required from your property, 1)a set of the Right-of-Way plans showing your property,a listing and a highlight of each easement and 2)a proposed Warranty Deed of Easement. Please review the attachments and let me know if you have questions.If you would like to meet prior to April 16 to discuss the project,please contact me at 658-7961. Re ar s, ustm Rabidoux,Director Enclosures 575 Dorset Street South Burlington. VT 05403 tel 802.658.7961 fax 802.658.7976 www.sburl.com Physical Address. 104 Landfill Road South Burlington South Burlington STP 5200(18) South Burlington, Vermont EXHIBIT B Affected Properties EXHIBIT B AFFECTED PROPERTIES NAME SERVICE ADDRESS MAILING ADDRESS PARCEL NO. (if different) University of Vermont and 106 Morrill Hall 1 State Agricultural College 146 University Place Burlington, VT 05405 Timberlake Associates, LLP 32 San Remo Drive 2 South Burlington, VT 05403 R.L. Vallee, Inc. 280 South Main Street 3 St. Albans, VT 05478 89-2 Realty Company c/o Josh Field 4 165 E. 72nd Street, #20C New York, NY 10021 FelCor/MM S-4 Hotels(SPE) c/o FelCor Lodging Trust, Inc. 5 L.L.C. 545 E. John Carpenter Freeway, Suite 1300 Irving, TX 75062 it, NECESSITY HEARING .,4. US 2 /1-89 EXIT 14 IMPROVEMENTS / ill lb SOUTH BURLINGTON STP 5200(18) � .1 , ,10 \\41.91 ‘2;cf:5. • . v..... - „ ,,, , , , , . ., 1 .. .- - • 1•I QQ \�. •a l I • 1• / al \ I I• 0I• 1 / QZ j I/ x�,} / (...1 'UNIVERSITY OF 0el / VERMONT I Z IS •• i t 1 1 // / 03 1... ; -"ii: p p ZI r ---tea „ 1 . ----� • *N J \ , i ;_, ISHERATON�e, ��__-- - ��i!* * / 4/ I4,0 �� V f STORMWATER TREATMENT` `\ _II I FELCOR�MM S-4 HOTELS (SPE)L.L.C. (� 1 ( "\I i--:. -- 1• • / 4�' \ ♦ t ' ' I I ' co FELCOR LODGING TRUST,LP —`I•�—— I • • • • / / \ • -, 11 I I —_— ( � .—•S a ( I • • e / �� / \ \ ♦ UNIVERSITY OF VERMONT AND 1 I «I a e l O — I / 0 / \ \ STATE AGRICULTURAL COLLEGE , I •1 L---. "( Y i k - / / \ \ 0 ; 1 4 I, 1 i.-7-‘, - r:- ' .- ---7.- : ,-."')IN re I • \ • N. 1, I I4 +' I `�/ .2__,,-- SCe '// STATE OF VERMONT \ s. • \• `��O 0.,,® Q _ p• v, ®• IT0 r 0. i --j 1-- 1. "., . -,.;.i;` -.i.'...1. (Da 0 JOB`, ` 9- ..— ' -_ "-.. -_ .— ... ,. _—— - 4npn•tee - -F TO BURLING •N • ' i o I I� •- - US 2 - WILLISTON ROAD - II T . +w 46• ore ...z.-t4ar _ -_-w--- -is.ter J —'' ON US 2 - MAIN ST. ,,, ,,,,�x -�,a,,.� O LLIST �-•inr-ems - — 9 I _ ;_-- • • .• /, -aTm•c¢q. 4---ki- -'•s--1--1rreglia - iI N-il '1*7?1'rl'p�'rr •e I -r1ifl 11 * •11 CIf1�-fHH�fltjil.Tli Lf1ii' �/ ��� . �\ * , i . _ �"-j o /, ,i I TIMBERLAKE ASSOCIATES,LLP r I 1' /• ��. •\ STATE OF VERMONT /ii I • e O tiIAMPLAIN ( i C , ��Y c=; __-=~-- -=AC__ = .-��- _ LE-- 4*) % \ /i yI • •• FARMS I (MAPLEFIELDSI - ��L-� 89 GOEF FIEALTY LD,JOSH \` \` /i' Q - •L R.L.VALLEE, • • 4O °* \\ VI a. . LEGEND �I STAPLES PLAZAI �• \ \\p\\ IIm4 1 I PROPOSED SIDEWALK �` \\\y\\\ ii� . Q PROPOSED PAVEMENT \\ \\ y' PROPOSED VEGETATED AREA \I \ II • \ \\,0\\ i I 1 1 \ \\ 0 II 1' • EASEMENT AREA0 \\ II ; ---• • \ \\\ \\\ 11 I - R.O.W.TAKE AREA \\ \\ 11 1 sm.— PROPOSED STORM DRAIN \" �� \;, t • ' L. smnlac Coosa PROPERTY LINES L- lin. SSG�nItlnp�vrvkeslnc. •BB B B•PERMANENT TAKE FOR HIGHWAY R.O.W. i • -- :I• South Burlington,vrus.n. ��EXISTING R.O.W. -p- =•---- I ` osao�-zzas 1 APRIL 2012 %mar -mom.:o+�ss' SHEET NUMBER DESCRIPTION CANADA I TITLE SHEET .. j T 2 ROW ALPHA SHEETS !�� "w °ALA {{im: • •rn N' 3 ROW DETAIL SHEETS CITY OF SOUTH BURLINGTON ta,,�� < `, �' ���> 4 7 ROW PLAN SHEETS y 4N. T .,, Mir Stott, of dr s 41", S j INTERCHANGE NEW PORK 11 e� ;_ COUNTY OF CHITTENDEN I ,.. ►��; .00a41l�; State of US2 IMPROVEMENTS rF •-•(r N , NEw HAMPSMRE 1 wn�e ROADWAY PROJECTO —+-E.._f W J/f ) (PRINCIPAL ARTERIAL) ROOJECTN .,a,,,, THIS PROJECT IS LOCATED ON U.S. ROUTE 2 IN THE CITY OF SOUTH BURLINGTON. IT LOCATION MAP > Commonweoith of BEGINS JUST EAST OF THE SPEAR STREET INTERSECTION AT THE BURLINGTON/SOUTH NOT TO SCALE MASSACHUSETTS BURLINGTON CITY LINE AND EXTENDS EASTERLY 1258.50' (0.24 MILES) TO INTERSTATE 89 INTERCHANGE 14. WORK PERFORMED UNDER THIS PROJECT INCLUDES BOX CUT WIDENING, TRAFFIC SIGNALS, OVERHEAD SIGN STRUCTURES, SIDEWALK AND CURB REPLACEMENT, SIGNING, PAVEMENT MARKINGS AND OTHER INCIDENTAL ITEMS. LENGTH OF PROJECT = 0.24 MILES (1258.50 FEET) I- o LINES SHOWN ON THIS PLAN AS EXISTING d PROPERTY LINES (P/L) ARE BELIEVED TO c U.S. ROUTE 2 CONST. STA. 10+43.00 BE ACCURATE BUT SHOULD NOT BE RELIED 0 BEGIN APPROACH CONSTRUCTION UPON FOR PURPOSES UNRELATED TO THE a U.S. ROUTE 2 CONST. STA. 10+91,50 CITY OF SOUTH BURL I NGTON'S ACOU 1 S I T 1 ON z - END APPROACH CON RUCTION z OF LAND AND RIGHTS FOR THIS PROJECT. BEGIN PROJECT STP 5200(18) ii IS- U.S. ROUTE 2 O T TA 24+ R.O.W. PLANS END APPROACH CONSTRUCTION THESE PLANS ARE SUBJECT TO SUCH o \‘‘' ENGINEERING CHANGES A$ MAY BE �I� U.S. ROUTE 2 CONST.1 STA. 23+50.00 REQUIRED BY THE FEDERAL HIGHWAY u i, END PROJECT STP 5200(18) 1-89 SB ADMINISTRATION OR THE DIRECTOR OF BEGIN APPROACH CONSTRUCTION EAST AVENUE OFF RAMP PUBLIC WORKS. OUALITY ASSURANCE PROGRA44(LEVEL j v v s T I I CONSTRUCTION IS TO BE CARRIED ON IN CONVENTIONAL SYMBOLS '�' _ / ACCORDANCE WITH THESE PLANS AND THE Q ' -) STANDARD SPECIFICATIONS FOR cooky"LrE °.*.w.�� TO _ \• b _- _�,'T---- _ ___- - - - TO _ CONSTRUCTION DATED 2006, AS APPROVED TOM LIE �� *...�.. ,DOWNTOWN 1 I U.S. ROUTE 2 WILLISTON BY THE FEDERAL HIGHWAY Loon a oCCEss -o— --0--o�— BURLINGTON I.+r r I I +::__--- I +r s i I .+I s I:+r• ,a„ 2 +„ 2 +00 ADMINISTRAT ION ON JUNE 15, 2006 FOR vonr OF AccEss X -- - -�-- C�.-. �� ^ --. _ _z, __ 19 USE ON THIS PROJECT, INCLUDING ALL FENCE LSE X X X X— — r,•• \/ TERCHANGE 14 SUBSEQUENT REVISIONS AND SUCH REVISED STONE PALL •�• si TRAVELED SAY — 1 SPECIFICATIONS AND SPECIAL PROVISIONS cums0 RAIL n n n o 0 0 ` \�\� AS ARE INCORPORATED IN THESE PLANS. .r RAt ROAD 111111111111111111111111111111111111111111111 SPEAR STREET/ U.S, ROUTE Z CONST. fL STA. 10+66.47 MUNICIPAL PROJECT MANAGER SURVEY LINE I I I 1-89 SB ON RAMP C APPROVED DATE CULVERT EAST TERRACE 62.00' RT. POPER PClE * BEGIN ROW PROJECT TELEPHONE POLE * U.S. ROUTE 2 CONST. fL STA. 21+23.17 CITY REPRESENTATIVE TREES ® {L SURVEYED BY I VSE 58.00' RT. APPROVED DATE coNTROL of AccEss —iii in ///- SURVEYED DATE , 06/2008 & 02/2010 END ROW PROJECT 0Stang PROJECT MANAGER > GREG EDWARDS PROPERTY Lit R O.r.rAItING LINE — y+ DATUM Stantec Consulting Services Inc. SLOPE ROIIrs O e o 0 100 200 55 Green Mountain Drive PROJECT NAME N SOUTH BURLINGTON TOP OF Cut AVERTICAL NAVD 88(CE01D03IFT ��_�-� South e„6Anaton Al U.S.A.05403 PROJECT NUMBER r STF 5200118) TOE OF SLOPE 0 0 0 HORIZONTAL NAD 83(COR596)aFT SCALE Tel.eoz.ea.ozz3 Foe.802.864.0165 ADJUSTMENT LSO SHEET 1 OF 7 SHEETS ALPHABETICAL INDEX SHEET RIGHT OF WAY PLANS GRANTOR SHEET NO PARCEL NO. GRANTOR SHEET No. PARCEL NO. GRANTOR PARCEL No. SHEET NO. UNIVERSITY OF VERMONT AND 4,5,7 1 STATE AGRICULTURAL COLLEGE TIMBERLAKE ASSOCIATES,LLP 4 2 - RL.VALLEE,INC. 4,5 3 89-2 REALTY COMPANY 5,6 4 _ FELCOR/MM S-4 HOTELS(SPE)L.L.C. 5,6,7 5 2 S g' PROJECT NAME, SOUTH BURLINGTON PROJECT NLMIBER, SIP 5200(18) FILE NAME....\Pbt Fflea\ROPARow_ALPHAAgrPLOT DATE' 4/5/2012 PROJECT LEADER' GAE DRAWN BY' STANTEC Stantec DESIGNED BY5 KJR CHECKED BYs GAS RIGHT OF WAY ALPHA SHEET SHEET 2 OF 7 STATE OF OF TT RIGHT O F WAY DETAIL S H E E T AGENCY OF TRANSPORTATION TABLE OF PROPERTY ACQUISITION TABLE OF REVISIONS P NOEL PROPERTY OWNER SNO. BEGINNING STATION ENDING STATION TAKE REMAINDER RIGHT RECORDING DATA REMARKS REVISIONSHEET DESCRIPTION DATE NO. NO. AREA+ AREA* TYPE (T)/(P) AREA* TIRE DATE TOWN/CITY BOOK PAGEMEMIIIIMMilliiiill _ 1 UNIVERSITY OF VERMONT AM) -.-._ 11+40.0 LT 15+18.5 LT I CONST. (T) 10440 sqft CONSTRUCTION EASEMENT 0�_____________:�y3-Y::____7 ____Il_.__ STATE AGRICULTURAL WUE< 11+66.0 LT 12+73.0 LT CONST. (T) TREE PROTECTION FENCE(BF) AT THE DRY SWALE STORMWATER SYSTEM ON LANDS ^___,-,__11+70.0LT -- 15+17.5 LT T_-__ _ SR f ---_-- (Ti 2911 sqR--_---_,-_-.. _ _ _SLOPE CONSTRUCTION__._. -_. OF W PARCELIAND OF FELOOR�PARCEL 5 _ 11+77.0 LT 14+93.0 LT 4293.0 Set ALL R T&I US ROUTE 2 - ----" -- _. V 12+51.0 LT _ INSTALL (P) STREET LIGHT 13+40.0 LT INSTALL (P) OVERHEAD SIGN SUPPORT 13+86.0 LT _ INSTALL (P) STREET LIGHT 14+54.0 LT 15+13.0 LT "- CUL,DIT&DR (P) 6634 sqft DRY SWALE STORMWATER SYSTEM AND STONE LINED DITCH 14+68.0 LT ACCESS (P) _..__.--_... DRY SWALE MAINTENANCE 14+71.0 LT DRIVE (n 20'GRAVEL 14+73.0 LT 14+91.0 LT CUL (P) CULVERT -- _ 14+97.5 LT 15+04.0 LT CONST. (T) 1903 sqft CONSTRUCTION EASEMENT _ 2 TIMBERLAKE ASSOCIATES,UP 10+66.0 RT 13+50.0 RT _ CONST. M 1396 salt CONSTRUCTION EASEMENT -� _ 10+66.5 RT 13+50.0 RT _ SR (T) 778 set SLOPE CONSTRUCTION Eliii _ 11+59.0 RT REMOVE (T) STREET LIGHT -- _ 12+76.0 RT DRIVE (n 24'BITUMINOUS ----- ---- - ----- 13+13.0 RT---------- MINORS ------ - -- -- ------ --_--- --_-__._._._-.--------__ __...._.....13+39.5 RT - DED.&ACC (f).._--- ---- REPLACE OVERHEAD SIGN SUPPORT -. 3 ILL VN113:INC 13+50.0 RT 15+10.0 RT SR (T) 338 set SLOPE CONSTRUCTION -------_------ -----------__. .----13+SOSRT ---- ---IS+30.ORT__. __------ ----- ---. --_.-CONST_ DRIVE CT 1764 sqft -------------- CONSTRUCTION EASEMENT 13+83.0 RT 30'BITUMINOUS ------ ----- 14+82.0 RT - - - --- _--- -.-- DRIVE (T) 30'BITUMINOUS 4 _-, _89-2 REALTY COMPANY go FIELD,7091 __-- ..__..." 15+10.0 RT _-_-- 21+23.0 RT ,_.---. _.-_.CONST. _- iT) _-.1342�t_ --,_-+----__---_--_-- CONSTRUCTION EASEMENT ■ 15+10.0 RT 16+80.5 RT SR (T) 184 sqft CONSTRUCTION --- ' 15+52.0 RT - REMOVE (T) REMOVE TREE M- .� 15+52.0 RT - INSTALL (P) TRAFFIC SIGNAL 1 +5.0 RT INSTALL M) PULL BOX AND WIRING 16+00.0 RT DRIVE (T) SL'BITUMINOUS ■ 17+35.0- RT 17+44.5 RT INSTALL On STREETse set CONSTRUCTION _ 17+39.5 RT T LIGHT 18+19.0 RT 18+39.5 RT SR (T] 39 sgft SLOPE CONSTRUCTION 19+40.0 RT 19+65.0 RT INSTALL (E) 214 sqR SLOPELIGHT CONSTRUCTION == 19+40.0 RT STREET LIGHT 20+75.0 RT 20+98.0 RT r SR (T) 20 sift SLOPE CONSTRUCTION _ IIIII _ - _ 5 FaODR/►4 S4 HOTELS(SEE)LLC 14+93.0 LT 19+99.0 LT _7853_!It_" - SS ROUTE 2II - - ---- - - FELODRLODGING TRUST,LP 14+93.5 LT 20+51.0 LT _ _ SR (T) 33409 sdt ------.. --- SLOPE CONSTRUCTION 14+93.5 LT 15+19.0 LT _ UE (P) UTILITY POLE AND STREET LIGHT METER 11 14+97.5 LT 20+56.0 LT CONST. (T) 5734 sqft CONSTRUCTION EASEMENT 15+04.0 LT 15+18.5 IT CONST. (T) TREE PROTECTION FENCE(BF) 15+03.0 LT 15+38.0 LT CONST. (T) 1850 soft CONSTRUCTION EASEMENT 15+07.O LT 15+28.0 LT DIT&DR (P) 2910sgft I DRY SWALE STORMWATER SYSTEM AND STONE LINED DITCH 15+29.0 LT 15+62.5 LT LANDSCAPE (T) LANDSCAPE CONSTRUCTION _ 15+52.5 LT INSTALL (P) TRAFFIC SIGNAL -- 16+28.0 LT DRIVE (T) 50 -- 16+28.0 LT 19+72.0 LT LANDSCAPE (T) LANDSCAPE CONSTRUCTION NSTRUCTION 16+52.O LT INSTALL `OP _ ---- TRAFFIC SIGNALII 16+58.5 LT 16+78.5 LT INSTALL (P) BUS SHELTER PAD AND VsALKME - -- --- 17+73.0 LT 17+73.0 LT INDSCLL (T) CURD AND PARKING CONSTRUCTION LT 20+42.0 LT LANDSCAPE (T) LANDSCAPE CONSTRUCTION _- 17+85.0 LT REMOVE (T) WALKLii 17+96.0 LT 19+67.0 LT CONST. LT) TREE PROTECTION FENCE(BF) -.18+21.01T -._._.._.-_19+57.0 LT _-.---- --- INSTALL - �-- ------ STREETAININIGH ALL IB+52.0 LT INSTALL11 --19+60.0 LT 19+80.0 LT UE (P) UTILTY PEDESTAL FLUSH MOUNT VAULTIII - MIE 111 IIIII PLAN LEGEND (P) -PERMANENT SCF -SOIL CONTROL FILTER EXISTING RIGHT-OF-WAY -0-0 0 TOE OF SLOPE (T) -TEMPORARY HH -HAND HOLE TAKING WITH ACCESS A .1 DR. -DRAINAGE RIGHT TOP OF CUT SIT. -DITCHING RIGHT SL -STREET LIGHT CH. -CHANNEL RIGHT TAKING WITHOUT ACCESS SR (P) y_ SLOPE RIGHT DRIVE -DRIVE RIGHT CZ - CUL. -CULVERT RIGHT CLEAR ZONE CONST.(T) - CONSTRUCTION RIGHT CET -CLEARING&TRIMMING RIGHT g - F PROPERTY LINE SR -SLOPE RIGHT L LIE -UTILITY EASEMENT PROJECT NAME: SOUTH BURLINGTON i. PROJECT NUMBER: STP 5200(18) FILE NAME:...\ROW\Row_oetafsheet.091 PLOT DATEL 4/5/2012 PROJECT LEADER: GAE DRAWN BY: STANTEC riStafit& DESIGNED BY: K IR CHECKED BY:GAS RIGHT OF WAY DETAIL SHEET 1 SHEET 3 OF 7 EXISTING (PI PERMANENT RIGHT-OF-WAY (Ti i mom — o TEIPORARY .. 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Y[gti0 � �. oTON vERMo 5OU IN 6URL1N NIT LICPTION it \j__� �1�� ABPRET LICENSE �At kk ����r SECOND CLASS AND C IRST, SE s'+B('SNE1 A roWN 1P��~ FULL NAME OF PERSON, PARTNERSHIP, CORPORATION 'nC/ i � D� TRADEN A;�lE DOING BUSINESS AS� ��� `� nor )( ADDRESS ) U , C ABARET SECOND CLASS FIRST CLASS DATE RECEIVED BY CLERK'S OFFICE • South Burlington Police Department Date Chief Trevor S. Whipple South BurlingtonY Fire DepartmenT. �,�t/iz n Date Chief Douglas S. Brent South Burlington Tax Dep tment ' Date Martha Lyons, Deputy Tax Collector Date Sent to Montpelier: 2012 LIQUOR LICENSE RENEWAL APPLICATION 1742-001-SECN-01 SECOND CLASS LICENSE TO SETT 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: Bourne-Meyer, Inc. Doing Business As: Bourne's Service Center Mailing Address: 760 Shelburne Road 760 Shelburne Road South Burlington VT 05403 South Burlington VT 05403 Telephone: (802) 658-6460 PLEASE INCLUDE EMAIL ADDRESS //6ori Description of Premises: Lessor: Grocery store, wood and cement structure, 2000 sq ft., on the first Gary Bourne floor of a building known as Bourne's Service Center, designated as 414 W. Grove Street 760 Shelburne Rd., in City of South Burlington, VT. Middleboro MA Last Enforcement Seminar: 09/17/2011 Fed. ID Number: 03-0319235 Incorporation Date: 03/01/1989 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. Bourne, Rene 116 Lakeview Drive Williston VT 05495 Director 2. Meyer-Bourne, Sharon 116 Lakeview Drive Williston VT 05495 Director 3. Bourne, Gary 414 W. Grove Street Middleboro MA 02346 Stockholder 4. Bourne, Rene 116 Lakeview Drive Williston VT 05495 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 raffic bureau, offense and date In the past year has any director or stockholder of the corporation held any elective or appointive state, county, city, village or town office in Veueait (See VSA, T.7, Ch.9, Sec. 223)? Yes J(. No If yes, please attach the following information: Individii1's name, office and j up( 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 fran 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 cazpliance 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 oninext page STATE OF VERMONT AGENCY OF HUMAN SERVICES STATE BOARD OF HEALTH License to Operate i I.D.# 1 27 7 8 LINK I.D.# CAPACITY: ----- FEE:$ n7 . rd0 LICENSE TYPE: LI4ITE OP RATI Stv EFFECTIVE DATE: 11/O 1/2 0 1 I EXPIRATION DATE: 10/31/2 O 1 2 ESTABLISHMENT NAME&LOCATION: ?.O U R N E S SERVICE CENTER THIS IS UNDER THE PROVISIONS OF-CERTIFY THAT BOVE ESTABLISHMENT IS LICENSED TO TIITLE 18 SECTIONS 4351 4451 VERMONT STATUTESO 760 Q SHE:J R Lf I N R N O ANNOTATED.THIS LICENSE IS VALID PENDING RATIFICATION BY THE VERMONT SOUP-4 :; li(LIi�ST^rN BOARD OF HEALTH. THIS LICENSE IS NOT TRANSFERABLE AND IS VALID ONLY FOR THE LICENSEE LISTED BELOW. LICENSEE NAME&ADDRESS: BOURNE, MEYER INC 769 SHELf;UkNE RO.4 Si)UTH 3UPLINGTON, VT 543??• THIS LICENSE SHALL BE CONSPICUOUSLY POSTED. i. •.•*, • • 2012 LIQUOR LICENSE RENEWAL APPLICATION 1742-001-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 canplete. Dated at ,3t:7 , 5 0-J , in the county of fh1 , and State of /',- tr--e c7"v7/this 794 day of J GldtitI '}� , 67/.2- Signature of authorriZ agent Signature of individual or partners of corporation, canpany, club or association (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 canmissioners 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 Ford, 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 i Approved by Board of Control Coamissioners of e City or o f Ctr Total Membership 645 , 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 2012 TOBACCO LICENSE RENEWAL APPLICATION 1742-001-TOBC-01 TOBACCO LICENSE TO SRLT TOBACCO Page 1 License Year Beginning May1, 2012 endingOptional Fee: $1 0.0 0 of which g g April 30, 2013 $10.0 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: Bourne-Meyer, Inc. Doing Business As: Bourne's Service Center Mailing Address: 760 Shelburne Road 760 Shelburne Road South Burlington VT 05403 South Burlington VT 05403 Telephone: (802) 658-6460 t • � PLEASE INCLUDE EMAIL ADDRESS: rJ )V rr Description of Premises: Lessor: Grocery store, wood and cement structure, 2000 sq ft., on the first Gary Bourne floor of a building known as Bourne's Service Center, designated as 414 W. Grove Street 760 Shelburne Rd., in City of South Burlington, VT. Middleboro NA Last Enforcement Seminar: 09/17/2011 Fed. ID Number: 03-0319235 Incorporation Date: 03/01/1989 Valid Charter?: Yes State of Charter: Vermont Majority of Directors are US Citizens: Y e s ATTACH AN ADDITIONAL SHEET TO THIS APPLICATION NOTING ANY NECESSARY CORRECTIONS OR CHANGES AND UPDATES THAT HAVE OCCURRED DURING THE PAST YEAR. Coipuration Name Address Town/City State Zip Code Director 1. Bourne, Rene 116 Lakeview Drive Williston VT 05495 Director 2. Meyer-Bourne, Sharon 116 Lakeview Drive Williston VT 05495 Director 3. Bourne, Gary 414 W. Grove Street Middleboro MA 02346 Stockholder 4. Bourne, Rene 116 Lakeview Drive Williston VT 05495 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 elec 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 j isdiction ALL APPLICANTS MUST COMPLETE AND SIGN The applicant understands and ayLees 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 in this application is true and canplete. Dated at rJ/e, A W�./1 d/� 4-L; in the county of (ll/4474611 , and State of ///'/-r�this /a/h day of TTQ'AV l,Vf/i , „1 Q/2 Signature of authorized agent Signature of individual or partners of corporation, company, club or association (Title) Are you making this application for the benefit of any other party? Yes 9 No Continued on next page • 2012 TOBACCO LICENSE RENEWAL APPLICATION 1742-001—TOBC—01 TOBACCO LICENSE TO SETT, 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 recatinendation 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 cannissioner 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 o of0. et, D Total Membership ,6 , members present A4 ,v` " . V C, f leNn 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 ca¢missioners 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 4aOf yp�tN.... M, yt,40 ' fr City of South Burlington �'���'i itF 1.� N) 575 DORSET STREET ,/1�t�� `i�#% SOUTH BURLINGTON, VERMONT 05403-6260 ir ‘"iwilmli P.'�ty r„..o 7owN M'R�� FIRST, SECOND CLASS AND CABARET LICENSE APPLICATION FULL NAME OF PERSON, PARTNERSHIP, CORPORATION DOING BUSINESS AS/TRADENAME doi 4 07 •/,C 7g CJ (:,' ADDRESS 9 77 A-elborr- -� . FIRST CLASS SECOND CLASS CABARET DATE RECEIVED BY CLERK'S OFFICE 6�?'I 1 I0 South Burlington Police Department Chief Trevor S. Whipple Date i Sout rlington Fire Department 1L.c 10 in — Chief Douglas S. Brent Date South Burlington Tax Depa tment ,III , Lo r f all«-. Mart a Lyons, Deputy Tax Collector Date Date Sent to Montpelier: k 2012 LIQUOR LICENSE RENEWAL APPLICATION 406-006—SECN-01 SECOND CLASS LICENSE TO SFT,r 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: Jolley, Bruce & Robert/Jolley Associates Doing Business As: Jolley #107 Mailing Address: 977 Shelburne Road P.O. Box 671 South Burlington VT 05403 t5e.Su6l161c eni• Telephone: (802) 864-9654 St. Albans VT 05478-0671 PLEASE INCLUDE EMAIL ADDRESS: smitchell@sbcjolley.corn Description of Premises: Premises: XX Owned Leased Grocery store located in a 1 story steel prefab building, situated on west side of Shelburne Rd. (Rt. 7) and designated as 977 Shelburne Rd. in the City of South Burlington, VT. Last Enforcement Seminar: 11/09/2010 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. Jolley, Bruce 180 Overlake Drive Colchester VT 05446 Has any person 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 XX 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 elective or appointive state, county, city, village or town office in Vermont (See VSA, T.7, Ch.9, Sec. 223)? Yes XX 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 in this application is true and complete. Dated at St. Albans , in the county of Franklin , and State of Vermont i this 18th day of January , 2012 Signature of authorized agent Signature 'victual partn of corporation, company, club or association 4? (Title) Are you making this application for the benefit of any other party? Yes XX No Continued on next page Health License Expiration: 10/31/2012 k 2012 LIQUOR LICENSE RENEWAL APPLICATION 406-006-SECN-01 SECOND CLASS LICENSE TO SF'IX, 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 If Approved by Board of Control Commissioners of it own of _• 'J Total Membership J members present �`� - ) tel 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 406-006-TOBC-01 TOBACCO LICENSE TO SFra, 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 $0.00 is paid to DLC Fee due only if licensee does not have a liquor license Town: 04065 - SOUTH BURLINGTON MISREPRESENTATION OF A MATERIAL FACT ON ANY LICENSE APPLICATION SHALL BE GROUNDS FOR SUSPENSION OR REVOCATION OF THE LICENSE, AFTER NOTICE AND HEARING Applicant: Review all of the information presented on this form, indicating any changes in the spaces provided. Applicant: Jolley, Bruce & Robert/Jolley Associates Doing Business As: Jolley #107 Mailing Address: 977 Shelburne Road P.O. Box 671 South Burlington VT 05403 (So Burlington) Telephone: (802) 864-9654 St._Albans VT 05478-0671 PLEASE INCLUDE EMAIL ADDRESS: smitchell@sbcjoiley.com Description of Premises: Premises: XX Owned _Leased Grocery store located in a 1 story steel prefab building, situated on west side of Shelburne Rd. (Rt. 7) and designated as 977 Shelburne Rd. in the City of South Burlington, VT. Last Enforcement Seminar: 11/09/2010 ATTACH AN ADDITIONAL SHEET TO THIS APPLICATION NOTING ANY NECESSARY CORRECTIONS OR CHANGES AND UPDATES THAT HAVE OCCURRED DURING THE PAST YEAR. Partnership Name Address Town/City State Zip Code Partner 1. Jolley, Bruce 180 Overlake Drive Colchester VT 05446 Has any person been convicted or pleaded guilty to any criminal or motor vehicle offense in any court of law (including traffic tickets by mail) during the last year? Yes XX No If yes, please attach the following information: Individual's name, court/traffic bureau, offense and date In the past year has any person held any elective or appointive state, county, city, village or town office in Vermont (See VSA, T.7, Ch.9, Sec. 223)? Yes XX$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 that the information in this application is true and complete. Dated at St. Albans , in the county of Franklin , and State of Vermont this 18th day of January , 2012 Signature of authorized agent Signature . dividual .r partne / of corporation, company, club or association / r_4411111 Ir (Title) Are you making this application for the benefit of any other party? Yes XX No Continued on next page Health License Expiration: 10/31/2012 2012 TOBACCO LICENSE RENEWAL APPLICATION 406-006-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 e Cit own of p 11 Total Membership 5 , members present C lee-� 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 ��I +„ , City ofSouth Burlington keit City/ C9erk's Office 44 rA.re no �d3Pi Donna Kinville, City Clerk FIRST, SECOND CLASS AND CABARET LICENSE APPLICATION FULL NAME OF PERSON, PARTNERSHIP, CORPORATION DOING BUSINESS AS/ TRADENAME l r 2 " ( or2a/1 ADDRESS -- l v rr 1 f4-. FIRST CLASS SECOND CLASS CABARET DATE RECEIVED BY CLERK'S OFFICE— -�� ;'31 AO 1T— s SO. BURLINGTON POLICE DEPT Chief Trevor S. Whipple Date - SO. URLINGTON FIR .,DEPT ( ) P., y/i/fy Chief Douglas S. Brent Date i SO. BURLINGTON TAX DEPT I I cl,,AA. ,(1,4) 0___ , 1 Marth � Deputy Lyons, De ut T x Collector Y Date sent to Montpelier: F-7F nnrco+ Qtrnn+ cn„+h Rn 1.,,,,n., VT ngnn•7 one Qna Wing d1,,,..,11.,6.A..t..,.1 ....... 20 )( FIRST/SECOND CLASS LIQUOR LICENSE AND TOBACCO APPLICATION License Year: May 1st through April 30th of following year Please file application in duplicate Klinger's Bread Company Print Full Name of Person,Partnership,Corporation,Cluh or LLC Doing Business As--Trade Name Street and street number of premises covered by this application 10 Farrell Street Town or City&Zip Code South Burlington, VT 05403 T 5NfJr 'fla7 Mailing Address(if different from above) Email Address: retail@ klingersbread.com 04)4 j1 a,3rr'1a1.E_or �✓ FIRST CLASS JSECOND CLASS ❑TOBACCO Fee for ANY FIRST class license paid to town/city$100.00/Fee to DLC $100.00 ✓❑ RESTAURANT Fee for ANY SECOND class license paid to town/city$50.00/Fee to DLC $50.00 ❑ HOTEL Fee for TOBACCO ONLY license paid to town/city $10.00 ❑ CABARET ❑ CLUB / TO THE CONTROL COMMISSIONERS OF THE TOWN/CITY OF OI,C'77i u r/,�``jj�1 ,VERMONT Application is hereby made for a license to sell malt and vinous beverages under and in accordance'with "Title 7,Vermont Statutes Annotated, as amended, and certify that all statements, information and answers to questions herein contained are true; and in consideration of such license being granted do promise and agree to comply with all local and state laws; and to comply with all regulations made and promulgated by the Liquor Control Board. Upon hearing,the Liquor Control Board may, in its discretion, suspend or revoke such license whenever it may determine that the law or any regulations of the Liquor Control Board have been violated,or that any statement,information or answers herein contained are false. MISREPRESENTATION OF A MATERIAL FACT ON ANY LICENSE APPLICATION SHALL BE GROUNDS FOR SUSPENSION OR REVOCATION OF THE LICENSE,Al'lER NOTICE AND HEARING. If this premise was previously licensed,please indicate name Klinger's Bread Co. currently holds a second class license I/we are applying as: ❑ INDIVIDUAL I] L.IMI-IED LIABILITY COMPANY • 0 PARTNERSHIP CORPORATION Please fill in name,address,and place of birth of individual,partners,directors or members. I =GAL TAME STREET/CITY/STATE Paid L, nye hie/ 3 i 9 unis - /4w/ d lPo /V �l°//3 ma,/, ZLL_ L Lye' +61 / 2 3 /1i La_�/&lc), 1Il S-r"-, �� y � it r� ,L. / /,n�6ic/ 3i i 13tfr►Ke�4// £r/ • hioi.I /7/6 2ou,S /1'0 Are all of the above citizens of the UNI IED STATES? ✓ Yes El No (Note: Resident Alien is not considered a U.S. Citizen) If naturalized citizen,please complete the following: Name Court where naturalized(City/State/Zip) Date CORPORATE INFORMATION: If you have checked the box marked CORPORATION, please fill out this information for stockholders (attach sheet if necessary). LEGAL NAME STREET/CITY/STATE P. //di oJ 10i r�c/� / �4�f cJCc•^C�' /C�1 i �►2 rz b/�� e Q .-rm.0 QS L.I'�re '77)2 J27 /f' 7J ekes / Date of incorporation Is corporate charter now valid? Lf..eS Corporate Federal Identification Number O Have you registered your corporation and/or trade name with the Town/City Clerk? _and/or Secretary of State? ci�. (as required by VSA Title 1141621,1623&1625). ALL APPLICANTS HAVE ANY OF THE APPLICANTS EVER BEEN CONVIC lED OR PLED GUILTY TO ANY CRIMINAL OR OR VEHICLE Q � jNSE IN ANY COURT OF LAW (INCLUDING TRAFFIC TICKETS BY MAIL) YES (_J NO If yes,please complete the following information: (attached sheet if necessary) Name / Court/Traffiu Offense. Date 7)400 4- / /a kJ'dr% *e-ec -di e /air, �b�e 1��d/R lion ee /)vT— f t '42 .!7u-C/r T7-I A— nie 6 ied c.21 ��°/ L Do any of the an»hcants hold any elective or appointive state,county,city,village/town office in Vermont? (See VSA,T.7,Ch. 9,4223) l YES I J NO If yes,please complete the following information: Name Office Jurisdiction Please give name, title and date attended of manager, director, partner or individual who has attended a Liquor Control Licensee Education Seminar,as required by Education Regulation No.3: NAME: t'ffr'r,eemtr'Z'� TITLE: -t LA2/ ,vas _ DATE: / / (If you have not attended an Education Seminar prior to making application, please contact the liquor Control Investigator in your area regarding this mandatory training) FOR ALL APPLICANTS:DESCRIPTION/I,9 ATION OF EMISES/(Section 4) Description of the premises to be licensed: e 't 1 ' Y_eii/ C'. /o z r/t//_ST• —_ Does applicant own the premises described? If noe'owned,does applicant plicant lease the premises? Lam. If leased,name and address of lessor who holds title to property: /0 7'rcr// Si 1p2P • Please complete and include with your liquor license application Please fill in for Individual,Partners, or Directors Applicant/s Personal Information Legal Name: 1-David / `d, ek/Address: � �u��� // Rd ' 421 ,i Date of Birth 4/-7/W Place of Sirth/2204./ae, Sex fr SS#33 i 341796/ Legal Name: //1xz,-'c/' 4 e_k Address: 3 /4A/!r, Driv{e. le.)i///s Date of Birth 6 7 47 Place of Eirth lu„s(ac, Sex /t 1 SS# �'` —3(F--10-s3/ Legal Name ad` ,e�i / Address:3/9 &, ei- /%Eat �,�erk Date of Birth /"2/ / 3 Place of firth sT Lou, a Sex / SS# Sae yf3$ Legal Name: Address: Date of Birth Place of Birth Sex SS# Legal Name: Address: Date of Birth Place of Birth Sex SS# Legal Name: Address: Date of Birth Place of Birth Sex SS# Stockholder's Personal Information: � dYte fie Legal Name: Address: Date of Birth Place of Birth Sex SS# Legal Name: Address: Date of Birth Place of Birth Sex SS# Legal Name: Address: Date of Birth Place of Birth. Sex SS# Attach additional sheet if necessary 1 • Are you making this application for the benefit of any other party? 1\41 FIRST CLASS APPLICANTS ONLY: No first class license may be issued without the following information. HEALTH LICENSE#: Food /i05"I Lodging (if licensed as a Hotel) VERMONT TAX DEPARTMENT: Meals&Rooms Certificate/Business Account# Business is devoted primarily to: (Circle one) (OOD (restaurant ENTERTAINMENT(cabaret) HOTEL CLUB If you are considering Outside Consumption service on decks, porches, cabanas, etc. you must complete an Outside Consumption Permit. Please request this form from your Town/City or from the Department of Liquor ControL CABARET APPLICANTS ONLY: Applicant hereby certifies that the sale of food shall be less in amount or volume than the sales of alcoholic beverages and the receipts from entertainment and dancing; if at any time this should not be the case, the applicant/licensee shall immediately notify the Department of Liquor Control of this fact. Signature of Individual,Partner,authorized agent of Corporation or LLC member ALL APPLICANTS MUST COMPLETE AND SIGN BELOW The applicant(s)understands and agrees that the Liquor Control Board may obtain criminal history record information from State and Federal repositories prior to acting on this application. I/We hereby certify, under 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 32,43113). In accordance with 21 VSA, 41378 (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. If applicant is applying as an individual: I 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 am in full compliance with a plan to pay any and all child support payable under a support order. (VSA,Title 15,4795). Dated at 7). v✓ in the County of 7 and State of this day of _\ Q yi az ,20 /7--� Corporations/Clubs:Signature of Authorized Agent Individuals/Partners: (All partners must sign) • (Title) 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 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. iI ( 2.;j1.'Y & , ,Vermont, /' I' d Town/City Date APPROVED DISAPPROVED ,I ApprovecUDisapproved by Board of Control Commissioners o e City or. wn(circle one)o •ev�Om...- Total Membership members present 1 City or Town Clerk TOWN OR CITY CLERK SHALL MAIL APPLICATION DIRECTLY TO THE 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 application shall be considered binding except as taken or made at an open public meeting. VSA Title I§312. NOTICE: After local action, all new applications are investigated by the Enforcement and Licensing Division prior to approval/disapproval of the license by the Liquor Control Board. SECTION 5111 AND 5121 OF THE INTERNAL REVENUE CODE OF 1954 REQUIRE EVERY RETAIL DEALER IN ALCOHOLIC BEVERAGES TO FILE A FORM ANNUALLY AND PAY A SPECIAL TAX IN CONNECTION WITH SUCH SALES ACTIVITY. FOR FURTHER INFORMATION,CONTACT: THE BUREAU OF ALCOHOL,TOBACCO&FIREARMS (1 1 B) (513)684-2979 I DEPARTMENT OF THE I REASURY 550 MAIN STREET, CINCINNATI,OH 45202 i „ �® City of South Burlington 44944 City Clerk's Office v°TE Donna Kinville, City Clerk FIRST, SECOND CLASS AND CABARET LICENSE APPLICATION FULL NAME OF PERSON, PARTNERSHIP, CORPORATION IZari 1•-•k ' DOING BUSINESS AS/ TRADENAME 4-- 4)oo&►1 g a i't -ro ADDRESS ,0vo 1 ; ii - a ct FIRST CLASS SECOND CLASS CABARET DATE RECEIVED BY CLERK'S OFFICE--j/ / ard/1 eR22, 4Z/c9-- SO. BURLINGTON POLICE DEPT Chief Trevor S. Whipple Date SO. /BM INGTON FIRE DEPT C ” J 6-L/ Cv/ram l / Chief Douglas S. Brent Date SO. BURLINGTON TAX DEP V • L Mj Jti Mar ha Lyons, Deputy ax Collector Date sent to Montpelier: �7; flnrcnt Ctrr of Cn,,t4, R,rl,nntn„ \!7 n�nn2 ono ona nine 2012 LIQUOR LICENSE RENEWAL APPLICATION 7643-001-1RST-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 $1 0 0.0 0 is paid to town/city $100.00 is paid toDLC 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: Larj LLC Doing Business As: Wooden Spoon Bistro, The Mailing Address: 1210 Williston Road 86 Lafountain Street South Burlington VT 05403 �y Winooski VT 05403 Telephone: (802) 000-0000f4� D C • ,� � PLEASE INCLUDE EMAIL ADDRESS: 7o 1 (ski ik l ' Cpy LL„ I Cia n' ' Description of Premises: Restaurant in the center section of a single story cement block LBJ Enterprises rsr building consisting of approx. 1,500 sq ft of space located on the 105 Appletree Point Rd northern side of Williston Road. Designated as #1210 in the city Burlington VT 05401 of South Burlington, VT Last Enforcement Seminar: 05/23/2011 Filed Articles of Organization: Yes Date Filed: 05/02/2011 Federal ID Number: 45-2975777 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 PAST YEAR. Limited Liability Company Name Address Town/City State Zip Code Member 1. O'Brien, Liza 86 Lafountain Street Winooski VT 05403 Member 2. Raftery, Adam 86 Lafountain Street Winooski VT 05403 Has any person 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 person held any elective or appointive state, county, city, village or town office in Vermont (See VSA, T.7, Ch.9, Sec. 223)? Yes nnX No If yes, please attach the following info tion: Individual's name, office and jurisdiction • Vt, Dept. of Health Food License No.: 10117 Expiration Date: 5 a6 •��' Vt. Dept. of Health Lodging No.: Expiration Date: Vt. Tax Dept. Meals & Rocms Cert./Acct. No.: 440-45297577F-01 Important: Current food and/or lodging license expiration dates are required for license renewal (as applicable) . �j ���n Outside Consumption Permit?: Yes XX No �a��,1 9 -F0 r ✓ `�'v 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 7643-001-1RST-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 eflQ,V I.-►' '',� c�2( 1�, in the county of C ki- 1 C', and State of vA , this �; day of \ 1LJ�.+'C,V\ , 2r:\ pD Signature of authorized agent Signature of individual or partners of corporation, company, club or association -A 3,\T — (Titles"j Are you making this application for the benefit of any other party? Yes 1 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 camanissioners 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 i Approved by }hard of Control Commissioners of City r of , C te/K. Total Membership 5 members present � , ) 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 City of South Burlington eatit.® d City Clerk's Office -1M fib i,3 orE ; Donna Kinville, City Clerk FIRST, SECOND CLASS AND CABARET LICENSE APPLICATION FULL NAME OF PERSON, PARTNERSHIP, CORPORATION DOING BUSINESS AS! TRADENAME ADDRESS I DO Pc-37ord-__,S-I-, FIRST CLASS SECOND CLASS CABARET DATE RECEIVED BY CLERK'S OFFICE rL SO. BURLINGTON POLICE DEPT Chief Trevor S. Whipple Date SO. B -INGTON FIRES DEPT yhab 2- Chief Douglas S. Brent Date SO. BURLINGTON TAX DEPT q/, )i- Mart a Lyons, Deputy T x Collector' Date sent to Montpelier: • � 1 2012 LIQUOR LICENSE RENEWAL APPLICATION 6138-002-1RST-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 $100.00 is paid to DLC Town: 04065 - SOUTH BURLINGTON MISREPRESENTATION OF A MATERIAL FACT ON ANY LICENSE APPLICATION SHALL BE GROUNDS FOR SUSPENSION OR REVOCATION OF THE LICENSE, AFTER NOTICE AND HEARING Applicant: Review all of the information presented on this form, indicating any changes in the spaces provided. Applicant: Pulcinella's LLC Doing Business As: Pulcinella's Mailing Address: 100 Dorset Street 100 Dorset Street South Burlington VT 05403 Sou��hh Burlington VT 05403 Telephone: (802) 863-1000 lLt Pe, ` PLEASE INCLUDE EMAIL ADDRESS: ill_r f$ 44�v c`�1J� .A C O 1/1/4.Js• Description of Premises: Lessor: A restaurant located at 100 Dorset Street approximately 1/10 mile on Century Partners, LLP the left from the intersection of Williston Road and Dorset Street 2 Market Street with 3,300 square feet, located in the City of South Burlington, South Burlington VT 05403 Vermont. Last Enforcement Seminar: 12/05/2009 Filed Articles of Organization: Yes Date Filed: 10/16/2006 Federal ID Number: 20-5720218 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 PAST YEAR. Limited Liability Company Name Address Town/City State Zip Code Member 1. Palmisano, Samuel A. 1265 Dodge Road East Montpelier VT 05651 Member 2. Palmisano, Doreen M. 1265 Dodge Road East Montpelier VT 05651 Member 3. Palmisano, Samuel S. 1-101 Gilbert Square Milton VT 05468 Has any person been convicted or pleaded guilty to any criminal or mot 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 elepi'ive 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.: 812 Expiration Date: ??3131 I Z01 Vt. Dept. of Health Lodging No.: Expiration Date: Vt. Tax Dept. Meals & Rooms Cert./Acct. No.: 440205720218f01 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) Area entails 12 feet deep from front of building, going 27 feet in length of the front of sun windows, on the sidewalk. Area will have seating for no more than 20 people, and will be marked off by a rope chain fence. Roped off area still leaves a five foot passage walk way on the sidewalk. April 1 through November 1 11:30 to 11:30pm. 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. Continued on next page 2012 LIQUOR LICENSE RENEWAL APPLICATION 6138-002-1RST-01 FIRST CLASS RESTAURANT LICENSE TO SELL MALT AND VINOUS BEVERAGES Page 2 I/We have registered the trade name of these premises with the Secr tary of State. I/We hereby cergfy that information in this applicati is true and complete. se Dated at 1" gut(i,keo in the county of Ck,` , and State of VidA.Acv‘i , this day of4 ( , ! o/ Z Signature of authorized agent Signature of individual or partners of co 11.ration, ca n or association (Title) Are you making this application for the benefit of any other party? Yes .0 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 Ii Approved by Board of Control Ccam issioners of e City or �.wn of an(I Total Membership 6 members present ktItest� .hv L�, �= 1 r i{'. -1/4 2- « , ''own 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 _o 4. ® City ©f South Burlington 1 0 � r;� F E[ City Clerk's Office aF 3��'1 Donna Kinville, City Clerk JO Ly ti^ Lam] � . �� • FIRST, SECOND CLASS AND CABARET LICENSE APPLICATION FULL NAME OF PERSON, PARTNERSHIP, CORPORATION DOING BUSINESS AS/ TRADENAME ADDRESS j� 1A2 b6 /A l riii -- I LI�C FIRST CLASS SECOND CLASS CABARET DATE RECEIVED BY CLERK'S OFFICE 4W IO//\.� • SO. BURLINGTON POLICE DEPT Chief Trevor S. Whipple Date SO. INGTON FIRE DEPT ,S414".-* IVA)4- Chief Douglas S. Brent Date SO. BURLINGTON TAX DEPT p is 0-14 LI N/ iO— rt a��ons, D utq Tax Collector al' v��0 • �� Ao ^�iVvAA w1 '� ' '��5 `{e5"v' Date sent to Montpelier: 2012 LIQUOR LICENSE RENEWAL APPLICATION 5617-001-1RST-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: Entertainment Unlimited, LTC Doing Business As: Pizza Putt Mailing Address: 1205 Airport Parkway 1205 Airport Parkway South Burlington VT 05403 South Burlington VT 05403 Telephone: (802) 862-7888 PLEASE INCLUDE EMAIL ADDRESS: G`►TTridn(i( (� j I ZZA 1T1 CO � r Description of Premises: t Premises: XX Owned Leased Restaurant located in a one story steel frame building approximately 2,000 square feet in size on the West side of Airport Parkway and designated as 1205 Airport Parkway, in the City of South Burlington, Vermont. Last Enforcement Seminar: 02/15/2011 Filed Articles of Organization: Yes Date Filed: 11/18/2004 Federal ID Number: 16-1710456 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 PAST YEAR. Limited Liability Company .Name Address Town/City State Zip Code Member 1. Apfel, Jeffrey A. 64 Cherrywood Drive Barre VT 05641 Member 2. Spiter, Elizabeth 20 Bisbee Road Vergennes VT 05491 Member 3. Neri, Anthony Box 913 Midrl7eburY VT 05753 Has any person been convicted or pleaded guilty to any cr 1 or motor vehicle offense in any court of law (including traffic tickets by mail) during the last year? Yes _No TA-Fr'c -r/-CT 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 info tion: Individual's name, office and jurisdiction Vt. Dept. of Health Food License No.: 3920 Expiration Date: ?? Vt. Dept. of Health Lodging No.: Expiration Date: Vt. Tax Dept. Meals & Rooms Cert./Acct. No.: 440-161710456F-01 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 Rnard 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 Anthony Neri / Judicial Bureau / uninspected vehicle/ 2/11/2012 2012 LIQUOR LICENSE RENEWAL APPLICATION 5617-001-1RST-01 FIRST CLASS RESTAURANT LICENSE TO SELL MALT AND VINOUS BEVERAGES Page 2 I/We hereby certify t the information in this application is� true and complete. Dated at SO �uZ , in the county of i 1i-✓d✓\ , and State of 1/-Q this 7(� day of j4/c'ehl , Signature of authorized agent Signature of individual or partners � ration, y, club or association !%"' • e1/27.4 / 6—n (Title) Are you making this application for the benefit of any other party? Yes it 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 most be recorded in town or city before issuance of license. APPROVED DISAPPROVED Approved by Board/rd of Control Commissioners of - e City o, Total Membership €5 , members present Attt` ham- ) C ;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 i o,�JSN 4URLIRCTO,k`f . City of South Burlington /i+. ?��� �� ���) 575 DORSET STREET Sat/10ii~� �Wmet6��� SOUTH BURLINGTON, VERMONT 05403-6260 sy fD 4 70 N M�0.`W FIRST, SECOND CLASS AND CABARET LICENSE APPLICATION FULL NAME OF PERSON, PARTNERSHIP, CORPORATION DOING BUSINESS AS/TRADENAME _-.-1 ? lltrrtL_ far ii4r_ ADDRESS 0- j• Dal �GD 1q2 6 6 ,01/bpr m -4 . FIRST CLASS SECOND CLASS CABARET DATE RECEIVED BY CLERK'S OFFICE 6i 7/1 , c! / 0.010- South Burlington Police Department Chief Trevor S. Whipple Date Sou urlinngtodn'Fire Department Chief Douglas S. Brent Date South Burlington Tax De artment / Z Martha Lyons, Deputy ax Collector Date Date Sent to Montpelier: • • 2012 LIQUOR LICENSE RENEWAL APPLICATION 6118-001-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 $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: Shelburne Road Variety, Tat• Doing Business As: Shelburne Road Variety Mailing Address: 1855 Shelburne Rd. 1855 Shelburne Rd. South Burlington VT 05403 South Burlington VT 05403 Telephone: (802) 658-0332 PLEASE INCLUDE EMAIL ADDRESS: Description of Premises: Lessor: A grocery/convenience store in a one story cement block building Champlain Oil Company, Inc. Lij'Zh(Jeq situated on the west side of Shelburne Town Line and designated South Burlington VT 05403 as 1855 Shellourye Road in th, ity of South Burlington, Vermont. �T S�^,r}kdkroS, ,»rl,�iui it� �� // 4-iv0&Ei4 Gig-TEA /►ry114N*66A it' ) l kit-PL,c'2 Last Enforcement Seminar: 12/17/2009 1a Filed Articles of Organization: Yes Date Eil . 10/25/2006 Federal ID Number: 03-0370543 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 PAST YEAR. Limited Liability Catpany Name Address Town/City State Zip Code Member 1. Cater, Frank Edward 11 Ira Place Milton VT 05468 Has any person been convicted or pleaded guilty to any criminal or r 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, urt/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 No If yes, please attach the following informatr n: 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 Caamissioner 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 v • 2012 LIQUOR LICENSE RENEWAL APPLICATION 6118-001-SECN-01 SECOND CLASS LICENSE TO SELL MALT AND VINOUS BEVERAGES Page 2 I/We herebyhe certify that the information in this application is true and complete. Dated atd OLt` / ea K/•T/CrL`A(in the county ofC rCrlE/VO EIV), and State of UE-P/;4 on2-- this 9...J` ay of ��}/U�t/4l2y/ of�. Signature o authorized agent Signature of individual or partners of ration, , cl a ciation G M&-MI Eft / ' veA (Title) � Are you making this application for the benefit of any other party? Yes 'J\N\\o 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 i •. 4 of 6.3 1; ryas -- Total Membership 6 , members present �Arta� ) 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 ccanaissioners 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 6118-001-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 $10.00 is paid to town/city $0.00 is paid to DLC Fee due only if licensee does not have a liquor license Town: 04065 - SOUTH BURLINGTON MISREPRESENTATION OF A MATERIAL FACT ON .ANY LICENSE APPLICATION SHALL BE GROUNDS FOR SUSPENSION OR REVOCATION OF THE LICENSE, AFTER NOTICE AND HEARING Applicant: Review all of the information presented on this form, indicating any changes in the spaces provided. Applicant: Shelburne Road Variety, Lir Doing Business As: Shelburne Road Variety Mailing Address: 1855 Shelburne Rd. 1855 Shelburne Rd. South Burlington VT 05403 South Burlington VT 05403 Telephone: (802) 658-0332 PLEASE INCLUDE EMAIL ADDRESS: Description of Premises: Lessor: A grocery/convenience store in a one story cement block building Champlain Oil Company, Inc. situated on the west side of Shelburne Town Line and designated South Burlington VT 05403 as 1855 Shelburne Road in the city of South Burlington, Vermont. Last Enforcement Seminar: 12/17/2009 j°L/U11a 0if iii-N Oita r4-C TER.. M4iv$E,E R ,qfV 0 'z', ►Win;&-i2, Filed Articles of Organization: Yes Date Filed: 10/25/2006 Federal ID Number: 03-0370543 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 PAST YEAR. Limited Liability Company Name Address Town/City State Zip Code Member 1. Cater, Frank Edward 11 Ira Place Milton VT 05468 Has any person been convicted or pleaded guilty to any criminal or or 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 e 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 Eloyment 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 complete. f Dated vatSOtifl 121dl�,(_A4g;srdy , in the county ofC' 7E/Z)OE/tf , and State of V & mU/ZJ (_ , this Q�.7 day of4T-J /UCt/ A. , 9 .0 /.09 Signature of authorized agent Signature of individual or partners o ration, c y, club or a c' t' n 147: :oleAf .2!.: t . 41 -r2 e e)0/kela (Title) Are you making this application for the benefit of any other party? Yes No Continued on next page 2012 TOBACCO LICENSE RENEWAL APPLICATION 6118-001-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 .�- o • T91e tN(N Total Membership -- ,�, members present A ,i' �lrt 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 hoard 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 1 11 �® City of South Burlington '� ®® O City Clerk's Office 4 Donna Kinville, City Clerk FIRST, SECOND CLASS AND CABARET LICENSE APPLICATION FULL NAME OF PERSON, PARTNERSHIP, CORPORATION 6/u6 axon— ' r` DOING BUSINESS AS/ TRADENAME 6LJ;Vc S8 -aI)ra► ADDRESS 1. .311- 1 J urr -PJ FIRST CLASS SECOND CLASS CABARET DATE RECEIVED BY CLERK'S OFFICE arch al cRDi� l SO. BURLINGTON POLICE DEPT Chief Trevor S. Whipple Date C.) SO URLINGTON FIRE DEPT Chief Douglas S. Brent Date SO. BURLINGTON TAX DEPT / '- i,,,,;.-1(4,- ,_z___ Martha Lyons, Deputy4çvi llector Date sent to Montpelier: i 2012 LIQUOR LICENSE RENEWAL APPLICATION 6470-001-1RST-01 FIRST CLASS RESTAURANT LICENSE TO SFT,T MALT AND VINOUS BEVERAGES Page 1 Fee: $200.00 of which License Year Beginning May 1, 2012 ending April 30, 2013 $1 0 0.0 0 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: Blue Heron Cafe & Catering, Inc. Doing Business As: Pauline's Cafe and Restaurant Mailing Address: 1834 Shelburne Road 1834 Shelburne Road South Burlington VT 05403 South Burlington VT 05403 Telephone: (802) 862-1081 PLEASE INCLUDE EMAIL ADDRESS: OJJ' b('C&. C (.\ t (�L�1(• k-v Description of Premises: Lessor: Restaurant located in a two story cement block and wood frame Robert Fuller building situated on the east side of Route 7 approximately 400 feet 1834 Shelburne Road north of the Shelburne Town Line, designated as 1834 Shelburne Road, i South Burlington VT 05403 in the City of South Burlington, Vermont. Last Enforcement Seminar: 02/16/2011 Fed. ID Number: 26-1529100 Incorporation Date: 12/06/2007 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. Hoene, David M. 2179 Downingville Road Lincoln VT 05443 Stockholder .2. Hoene, David M. 2179 Downingville Road Lincoln VT 05443 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 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 j sdiction Vt. Dept. of Health Food License No.: 101 Expiration Date: ?? a0 - c30 Vt. Dept. of Health Lodging No.: Expiration Date: Vt. Tax Dept. Meals & Roans Cert./Acct. No.: 440-261529100E-01 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 canpliance 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 chip 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 6470-001-1RST-01 FIRST CLASS RESTAURANT LICENSE TO SELL MALT AND VINOUS BEVERAGES Page 2 I/We hherebycertify that the information in this applicationip is true and camplete. Dated at " 1Li.AVLlf , in the county of QiJ I k1-0,>,)(-\n , and State of \J 0()C- \k` this gO day of r00,1 V__ln , _340_1a Signature of authorized agent Signature of individual or partners of corporation, c , club or association (Title) Are you making this application for the benefit of any other party? Yes XNo 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 can<nissioners will endorse their recatanendation 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 o ,.• . of / •y d 1� u Total Membership 5 , members present '_ W �- � C lei 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 heard 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 04 ���OUNIINOTOk ,.. r City of South Burlington ltia/� lily r���i,�� 575 DORSET STREET rf�'iV `"d% SOUTH BURLINGTON, VERMONT 05403-6260 `'JN`OA TOWN MI/ FIRST, SECOND CLASS AND CABARET LICENSE APPLICATION FULL NAME OF PERSON, PARTNERSHIP, CORPORATION DOING BUSINESS AS/TRADENAME 6D)' - 6' bo aeG ADDRESS MO { _-# _ FIRST CLASS SECOND CLASS CABARET DATE RECEIVED BY CLERK'S OFFICE Z 1 e2D 1 ^ South Burlington Police Department Chief Trevor S. Whipple Date Sou urlington Fire Department Chief Douglas S. Brent Date South Burlington Tax Depar ent v Martha Lyons, Deputy Tax ollector Date Date Sent to Montpelier: 2012 LIQUOR LICENSE RENEWAL APPLICATION 406-025-SECN-01 SECOND CLASS LICENSE TO SELL MALT AND VINOUS BEVERAGES Page 1 Fee: $10 0.00 of which License Year Beginning May 1, 2012 ending April 30, 2013 $5 0.0 0 is paid to town/city $5 0.0 0 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: Jolley, Bruce & Robert/Jolley Associates Doing Business As: Jolley #146 Mailing Address: 1110 Shelburne Road P.O. Box 671 South Burlington VT 05403 St. Albans VT 05478 Telephone: (802) 865-2005 PLEASE INCLUDE EMAIL ADDRESS: smitchell@sbcjolley.com Description of Premises: Lessor: A convenience store located in a single story steel/masonry building James & Deborah Wesson being 3450 square feet in size and located a the southeast corner of Strafford, NH the Intersection of Baldwin Avenue and Shelburne Road in the City of Charlotte Vt South Burlington, Vermont. Last Enforcement Seminar: 05/19/2011 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 C'rrlp Partner 1. Jolley, Bruce 180 Overlake Drive Colchester VT 05446 Has any person 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 XX 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 elective or appointive state, county, city, village or town office in Vermont (See VSA, T.7, Ch.9, Sec. 223)? Yes XXNo If yes, please attach the following information: Individual's name, office and jurisdiction Disclosure of Non-profit Organization?: Yes >a 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 in this application is true and complete. Dated at St. Albans , in the county of Franklin , and State of Vermont this 18th day of January , 2012 Signature of authorized agent Signatu Of in ideal or of corporation, company, club or association (Title) Are you making this application for the benefit of any other party? Yes XXNo Continued on next page Health License Expiration: 05/31/2012 2012 LIQUOR LICENSE RENEWAL APPLICATION 406-025-SECN-01 SECOND CLASS LICENSE TO SELL 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 recammmendation 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 f Approved by Board of Control Commissioners of Ci Town of , Total Membership 6 , members present C.ke-�14`, 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 406-025-TOBC-01 TOBACCO LICENSE TO SELL TOBACCO Page 1 Optional Fee: $1 0.0 0 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: Jolley, Bruce & Robert/Jolley Associates Doing Business As: Jolley #146 Mailing Address: 1110 Shelburne Road P.O. Box 671 South Burlington VT 05403 St. Albans VT 05478 Telephone: (802) I smitchell@sbcolle PLEASE INCLUDEDEEMAMAILL ADDRESS: J y•com Description of Premises: Lessor: A convenience store located in a single story steel/masonry building James & Deborah Wesson being 3450 square feet in size and located a the southeast corner of Strafford, NH the Intersection of Baldwin Avenue and Shelburne Road in the City of Charlotte Vt South Burlington, Vermont. Last Enforcement Seminar: 05/19/2011 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. Jolley, Bruce 180 Overlake Drive Colchester VT 05446 Has any person 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 Xi 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 elective or appointive state, county, city, village or town office in Vermont (See VSA, T.7, Ch.9, Sec. 223)? Yes fNo 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 that the information in this application is true and canplete. Dated at St. Albans , in the county of Franklin , and State of Vermont this 18th day of January 2012 Signature of authorized agent Signature "vidual o. panne s of corporation, company, club or association / 40001 �• r (Title) Are you making this application for the benefit of any other party? Yes MK No Continued on next page Health License Expiration: 05/31/2012 • 2012 TOBACCO LICENSE RENEWAL APPLICATION 406-025-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 mot 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 - . Town o , Total Membership 5 , members present tes C.liett 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 ccnmisrioners shall notify the applicant by letter. No formal action taken by any agency or authority of any town board of selecLmen 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 { jI { 1 ` ®► City of South Burlington O4° City Clerk's Office o°yTE Donna Kinville, City Clerk FIRST, SECOND CLASS AND CABARET LICENSE APPLICATION FULL NAME OF PERSON, PARTNERSHIIP, CORPORATION 1Gk'bat't o sk1 DOING BUSINESS AS/ TRADENAME a Yd ADDRESS r FIRST CLASS SECOND CLASSS12. CABARET DATE RECEIVED BY CLERK'S OFFICE SO. BURLINGTON POLICE DEPT Chief Trevor S. Whipple Date CURLING/TjONNFFTRE DEPT Chief Douglas S. Brent Date SO. BURLINGTON TAX DEPT ' /171/ Mart a Lyons, Deputy ax Collector Date sent to Montpelier: 575 Dorset Street South Btirlinaton.VT 05403 802-846-4105 dkinville@sburl.com 2012 LIQUOR LICENSE RENEWAL APPLICATION 4229-001-1RST-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 $1 0 0.0 0 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: Ichiban Oishii, Incorporated Doing Business As: Koto Restaurant Mailing Address: 792 Shelburne Road 792 Shelburne Road South Burlington VT 05403 South Burlington VT 05403 Telephone: (802) 660-8976 1 PLEASE INCLUDE EMAIL ADDRESS: \i I f ko tO 1I} @ Q(1(��( I (�J m Description of Premises: Lessor: A restaurant approximately 6,000 square feet in size and located in Mountana Handy a one story wood and brick building due south of Pizza Hut on the 75 So. Winooski Avenue eastern side of Route 7 and designated as 792 Shelburne Road in the Burlington Vt city of South Burlington, Vermont. Last Enforcement Seminar: 02/08/2011 Fed. ID Number: 03-0361488 Incorporation Date: 04/12/1999 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. Zhang, Jin Rong 29 Vale Drive South Burlington VT 05403 Director 2. Zhang, Wen Bin 29 Vale Drive South Burlington VT 05403 Stockholder 3. Zhang, Jin Rong 29 Vale Drive South Burlington VT 05403 Stockholder 4. Zhang, Yan Jiao 8 South Peru Plattsburgh NY 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 elective or appointive state, county, city, village or town office in Vermont (See VSA, T.7, 01.9, Sec. 223)? Yes )( No If yes, please attach the following information: Individual's name, office and jurisdiction Vt. Dept. of Health Food License No.: 547 Expiration Date: ?? Vt. Dept. of Health Lodging No.: Expiration Date: Vt. Tax Dept. Meals & Rooms Cert./Acct. No.: 323601 Important: Current food and/or lodging license expiration dates are required for license renewal (as applicable) . Outside Consumption Permit?: Yes X% 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 res pect 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 Name Court/Traffic Bureau Offense Date Jin Rong Zhang State of New York Dept. of Motor Vehicles 6 empire Plaza Albany NY Disobeying a Green Arrow 8/4/2011 Jin Rong Zhang Vermont Judicial Bureau White River Jct. VT Speeding 10/28/2011 2012 LIQUOR LICENSE RENEWAL APPLICATION 4229-001-1RST-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. L'�y , (^ 6 f�t/� n ( ✓1 and State of \fe,(�(n 'L11YV Dated at�,{�,�(�JI� � � I I C��� y, in the county of � '��1�� 1 , this 1;� U day of F(tYOQ,9 , Signature of authorized agent Signature of individual or partners of Corporation, canpany, club or association (Title) ` Are you making this application for the benefit of any other party? Yes X No Upon being satisfied that the conditions precedent to the granting of this license as provided in Title 7 of theVerkaxi t Motes-Annotated -as-amended,-gave 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 shallthereon, before any license may be granted. For the information of the Liquor Control Control Board, all applications of each individual commissioner registering either approval or disapproval. Lease or title mast be recorded in town or city before issuance of license. APPROVED DISAPPROVED Approved by Board of Control Commissioners of e City o, To 6174Sv I/ 1-7 ) ; Own Clerk. Total Membership members present At , 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 cammissioners 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 .® City of South Burlington 41• 44 10 0 City Clerk's Office VQ ® Donna Kinville, City Clerk FIRST, SECOND CLASS AND CABARET LICENSE APPLICATION FULL NAME OF PERSON, PARTNERSHIP, CORPORATION 1 r c DOING BUSINESS AS/ TRADENAME hail a n ) -% . ADDRESS 1 gtt 19% ) /1_11r0,el rd FIRST CLASS SECOND CLASS CABA T )(° CL&°I)—) DATE RECEIVED BY CLERK'S OFFICE �`j- -�-' SO. BURLINGTON POLICE DEPT Chief Trevor S. Whipple Date SO. BURLINGTON FIRE DEPT Q Q �/ y/i4iz Chief Douglas S. Brent Date SO. BURLINGTON TAX DEPT —7q6e-t /t--et -/r_ Martha Lyons, Deputy ax Collector Date sent to Montpelier: i 171 flnrcot Ctroot Cniith Riirlir,ntnn \/T 11FAfl2 9(V).QAR_A9l1G 2012 LIQUOR LICENSE RENEWAL APPLICATION 2396-020—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: Wesco, Inc. Doing Business As: Champlain Farms South Burlington Mailing Address: 'I 1800 Williston Road 32 San Remo Drive South Burlington VT 05403 South Burlington VT 05403-6310 Telephone: (802) 860-5845 PLEASE INCLUDE EMAIL ADDRESS:5QCP WCS a ftri {nS.C D VV\ Description of Premises: Lessor: A convenience store in a one story cement building, approximately Wesco 2100 square feet at the corner of Airport Drive and Williston Road P.O. Box 2287 i designated as 1800 Williston Road in the city of South Burlington South Burlington Vt 05403 Vermont. Last Enforcement Seminar: 11/02/2011 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. Corporation Name Address llthTown/City State Zip Code Director 1. Simendinger, David 14-Hergan-Onve Sex-+ -•VI OSaSa Director 2. Simendinger, William 12 Whiteface Street S Burlington VT 05403 Stockholder 3. Simendinger, David P►s^ox T--05 4i2- Stockholder 4. Simendinger, William 12 Whiteface Street/ S Burlington VT 05403 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? VVVYes 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 elective appointive state, county, city, village or town office in Vermont (See VSA, T.7, Ch.9, Sec. 223)? Yes o If yes, please attach the following information: Individual's name, office and jurisdiction I I 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 fiuut 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, INC. PARivig ''s 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 2396-020-SECN-01 SECOND CLASS LICENSE TO SELL MALT AND VINOUS BEVERAGES Pa,e 2 I/We hereby certify that thej information in this application is true and complete. Dated at .2b ? U` A(\(qk`V Y ` , in the county of )( , , XN , and State of��v\ O A2 this 1 day of v J(s\Q , /AL Signature of authorized agent Signature of individual or partners of co tion, carpany, club or association \A)Q SCO, L Q- (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 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 Town o Q� Total Membership 6 , members present P + C.lgtileN, 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 caanissioners 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 • • III 2012 TOBACCO LICENSE RENEWAL APPLICATION 2396-020-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 $10.00 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 South Burlington Mailing Address: 1800 Williston Road 32 San Remo Drive South Burlington VT 05403 South Burlington VT 05403-6310 Telephone: (802) 860-5845 PLEASE INCLUDE EMAIL ADDRESS: $CeA '@ C'kY C 9, (-U 1'v\ Description of Premises: Lessor: A convenience store in a one story cement building, approximately Wesco 2100 square feet at the corner of Airport Drive and Williston Road P.O. Box 2287 designated as 1800 Williston Road in the city of South Burlington South Brlington Vt 05403 Vermont. Last Enforcement Seminar: 11/02/2011 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. Corporation Name Address Town/City State Zip Code Director 1. Simendinger, David -i5 Hagan Drive e - 'i'W-0Er452 Director 2. Simendinger, William 12 Whiteface Street S Burlington VT 05403 Stockholder 3. Simendinger, David 15 Hach- Dri ==_: VT 06162_ Stockholder 4. Simendinger, William 12 Whiteface Street S Burlington VT 05403 Has any director or stockholder been convicted or pleaded guilty toy criminal or motor vehicle offense in any court of law (including traffic tickets by mail) rinring 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 coLpuration held any electives appointive state, county, city, village or town office in Vermont (See VSA, T.7, Ch.9, Sec. 223)? Yes 1./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. Continued on next page • 2012 TOBACCO LICENSE RENEWAL APPLICATION 2396-020-TOBC-01 TOBACCO LICENSE TO SFTJ TOBACCO Page 2 I/We hereby certify that the information in this application is true and complete. Dated at S2, 1 V►�kVr , in the county of('�\ ;�C,( `[�Q(-\, and State of this 'q day of , 2C)2 Signature of authoriz d agent Signature of individual or partners of corporation, canpany, club or-.soc ion Q,S Co,A a/ (Title) Are you making this application for the benefit of any other party? Yes [ Io 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 . ity o, Tm .f Total Membership 25 , members present ` *�� �^ C.(Gown 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 • „` �� City ©f South Burlington 4W0 ° City Clerk's Office °A p iT Donna Kinville, City Clerk Ao/A lid FIRST, SECOND CLASS AND CABARET LICENSE APPLICATION FULL NAME OF PERSON, PARTNERSHIP, CORPORATION DOING BUSINESS AS/ TRADENAME G° /�D d'� //0/ 1 '')/ADDRESS 1/o /40 iD;I11' a . FIRST CLASS SECOND CLASS CABARET i DATE RECEIVED BY CLERK'S OFFICE r,// IL), aDk9- SO. BURLINGTON POLICE DEPT Chief Trevor S. Whipple Date S . URLINGTO IRE DEPT .(2 .7- Chief Douglas S. Brent / Date SO. BURLINGTON TAX DEPT Abt7-14.0 Mart a Lyons, Deputy T x Collector _ 2////b- Date sent to Montpelier: ' 0 2012 LIQUOR LICENSE RENEWAL APPLICATION -----.565-002-1CLB-01 FIRST CLASS LICENSE FOR CLUB TO SELL MALT AND VINOUS BEVERAGES Page 1 License Year BeginningMay1, 2012 endingApril 30, 2013 Fee: $100.00 ios paich $10 0.0 0 is paid to town/city 00 is paid to DEC Town: 04 65 - SOUTH BURLINGTON MISREPRESENTATION OF A MATERIAL FACT ON ANY LICENSE APPLICATION SHALT,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: Moose, Loyal Order of, Lodge #1618, Inc. Doing Business As: Moose Lodge #1618, Burlington Mailing Address: 1636 Williston Road 1636 Williston Road South Burlington VT 05403 South Burlington VT 05403 Telephone: (802) 655-5192 PLEASE INCLUDE EMAIL ADDRESS: 4c,/7C[; .1 /wet e A!C Description of Premises: Lessor: Club in a single story wood structure situated on the northerly side Irene Hinsdale of Williston Road, designated as #1636 consisting of 3000 sq ft Burlington VT of kitchen, bar and dining/banquet hall in the city of South Burlington, VT Last Enforcement Seminar: 08/17/2011 Fed. ID Number: 03-0187885 Incorporation Date: 09/01/1952 Valid Charter?: Yes State of Charter: Vermont Majority of Directors are US Citizens: Ye s ATTACH AN ADDITIONAL SHEET TO THIS APPLICATION NOTING ANY NECESSARY CORRECTIONS OR CHANGES AND UPDATES THAT HAVE OCCURRED DURING THE PAST YEAR.Sire 07- Corporation Name Address Town/City State Zip Code Director 1. O'Brien,r Timothy- 22'Whttney-"StLeet Winooski -VP _05404 Director 2. Shaw, Normand 63 Bernard Street Winooski VT 05404 Director 3. Bowen, Raymond RR3 Box 4899 Milton VI 05468 Director 4. O'Neal, Jerry 94 Pine Street Winooski VT 05404 Director 5. -Ore,-James, -PO-Box-3285-- -Burlington VT' -VT 05401 Director 6. :Thames,-William -PO-Box 4178-.- _ ..Burlington VT---05406_.. --Box 702 Director 7. ,�Berr3z ,_Allan �(5Kellogg-Rd _..Colchester - VT Has any director or stockholder been convicted or pleaded guilty to any cr 1 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 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 Vt. Dept. of Health Food License No.: 12075 Expiration Date: 04/06/2013 Vt. Dept. of Health Lodging No.: Expiration Date: Vt. Tax Dept. Meals & Rooms Cert./Acct. No.: 440-030187885F-01 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 that he/she must maintain a list of the names and residences of paid up members, a list of club officers, and a list of employees of the club and their annual salaries. These lists must remain on the licensed premises and be available for inspection upon request. The applicant understands and agrees that the Liquor Control Board may obtain criminal history record information from State and Federal record repositories. Continued on next page • Listing of Directors of Burlington Moose Lodge 1618 Wayne Alberts, 59 Allen Road, Grand Isle, VT 05458 Born 01/23/19847 in Burlington, VT Lee Barnett, 56 Lincoln St. #8, Essex Jct. VT 05452 Born 08/08/1965 in Ionia, MI Raymond Bowen, 54 Pattee Hill Road, Milton, VT Born 07/17/1947 in Randolph, VT Mark Heitzinger, 370 Farrell St. #103, So. Burlington, VT Born 12/03/1971 in Bradford,PA Jefferson Howell, 100 West Canal St. #39, Winooski, VT Born 03/09/1982 in Brunswick, ME Jerry O'Neal, 94 Pine St., Winooski,VT Born 01/19/1951 in Connorsville, IN Normand J. Shaw, 63 Bernard St., Winooski, VT Born 02/08/1942 in Laconia,NH SSN 009-26-9696 Theodore J. Shaw, 616 Bean Road, Colchester, VT Born 04/06/1973 in Burlington, VT Ron Wheel, 59 East Allen St., Winooski, VT Born 05/20/1954 in Burlington, VT SSN 009-42-9407 2012 LIQUOR LICENSE RENEWAL APPLICATION 565-002-1CLB-01 FIRST CLASS LICENSE FOR CLUB TO SELL MALT AND VINOUS BEVERAGE'S Page 2 I/ye 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 ocmpliance 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 herebyc� certify that the information in this application is true and complete. Dated at Sae 25i.IJ I-j/ /6 Th,W in the county of C�/f/ A/�IN and State of V t �'rh ",/i , this /[�`.r 'day of A/Y i . , 2,..tv2. Signature of au rized agent Signature of individual or partners corporation cl associa Go V. ieitio.. (Title) Are you making this application for the benefit of any other party? Yes XNo 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 ccuudssioners will endorse their reeamtendaticn on the back of the application and transit it 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 indivich,al camtissioner registering either approval or disapproval. T,acr or title must be recorded in town or city before issuance of license. APPROVED DISAPPROVED Approved by Board of Control Ccmaissioners of - . Town of) r ' Total Membership 5 , members present Attest, '" J `) ,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 camtissioners 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 publicmeeting. VSA T-1,Sec.312 20 2 TOBACCO APPLICATION License Year: May 1st through April 30th of following year Print Full Name of Person,Partnership,Co ration,Club or LLC Ji'fenSL• 1- Ai- 'ft&g4 o/ s..t+ G� %6/6 thit✓, Doingss As-Trade Name /4 O & Lavcia ¢/'18 /el./AI61% AI Street and street number of premises cdwered by this application /o Lt,/LLJS1iw Town or City&Zip Code -o.vej VT' 0.590.5 Telephone Number /y Mailing Address(if different from,hove) Email address TO THE CONTROL COMMISSIONERS OF THE TOWN/CITY OF SO, .91//C4/Ar'7G)/(/ ,VERMONT Application is hereby made for a license to sell tobacco products under and in accordance with Title 7, Vermont Statutes Annotated, as amended, and certify that all statements, information and answers to questions herein contained are true; and in consideration of such license beinggranted dopromi se agreecom ply with all local and state laws; and to � comply with all regulations made and promulgated by the Liquor Control Board. Upon hearing,the Liquor Control Board may, in its discretion, suspend or revoke such license whenever it may determine that the law or any regulations of the Liquor Control Board have been violated,or that any statement,information or answers herein contained are false. MISREPRESENTATION OF A MATERIAL FACT ON ANY LICENSE APPLICATION SHALL BE GROUNDS FOR SUSPENSION OR REVOCATION OF THE LICENSE,AFTER NOTICE AND HEARING. If this premise was previously licensed,please indicate name V— C0/7/34/ y I/we are applying as: INDIVIDUAL LIMITED LIABILITY COMPANY ❑ PARTNERSHIP❑ CORPORATION Please fill in name,address,and place of birth of individual,partners,directors or members. LEGAL NAME STREET/CITY/STATE PLACE OF BIRTH Are all of the above citizens of the UNITED STATES? EZJ Yes No (Note: Resident Alien is not considered a U.S. Citizen) If naturalized citizen,please complete the following: Name Court where naturalized(City/State/Zip) Date Listing of Directors of Burlington Moose Lodge 1618 Wayne Alberts, 59 Allen Road, Grand Isle, VT 05458 Born 01/23/19847 in Burlington, VT Lee Barnett, 56 Lincoln St. #8, Essex Jct. VT 05452 Born 08/08/1965 in Ionia. MI Raymond Bowen, 54 Pailee Hill Road, Milton, VT Born 07/17/1947 in Randolph, VT Mark Heitzinger, 370 Farrell St. #103, So. Burlington, VT Born 12/03/1971 in Bradford, PA Jefferson Howell, 100 West Canal St. #39, Winooski, VT Born 03/09/1982 in Brunswick, ME Jerry O'Neal, 94 Pine St., Winooski, VT Born 01/19/1951 in Connorsville, IN Normand J. Shaw, 63 Bernard St., Winooski, VT Born 02/08/1942 in Laconia, NH SSN 009-26-9696 Theodore J. Shaw, 616 Bean Road, Colchester, VT Born 04/06/1973 in Burlington, VT Ron Wheel, 59 East Allen St., Winooski,VT Born 05/20/1954 in Burlington, VT SSN 009-42-9407 CORPORATE INFORMATION: If you have checked the box marked CORPORATION, please fill out this information for stockholders (attach sheet if necessary). LEGAL NAME STREET/CITY/STATE PLACE OF BIRTH /l//"' Date of incorporation Is corporate charter now valid? Corporate Federal Identification Number Have you registered your corporation and/or trade name with the Town/City Clerk? and/or Secretary of State? (as required by VSA Title 11§1621,1623&1625). Please give name, title and date attended of manager, director, partner or individual who has attended a Liquor Control Licensee Education Seminar,as required by Education Regulation No.3. Please include a copy of your training certificate with this application NAME: 17/1--.0 22e- J, 311A W TITLE: A D7iii,i //4/5'r t !TC►.Z DATE: (If you have not attended an Education Seminar prior to making application,please contact the Liquor Control Investigator in your area regarding this mandatory training.) ALL APPLICANTS MUST COMPLETE AND SIGN BELOW I/We hereby certify, under 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 32,43113). In accordance with 21 VSA, 41378 (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. If applicant is applying as an individual: I 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 am in full compliance with a plan to pay any and all child support payable under a support order. (VSA,Title 15,4795). Dated at SO 1, 'L/,/C ISAJ in the County of CH/'7"-7'4rNPP'AJ' and State of this i0'May of APRIL ,20 /� Corpo ations/Cl : S ture of Author' Agent Individuals/Partners: (All partners must sign) st' Town/City Clerk Signature TOWN OR CITY CLERK SHALL MAIL,FAX or EMAIL COPIES OF APPLICATIONS DIRECTLY TO: DEPARTMENT OF LIQUOR CONTROL,13 GREEN MOUNTAIN DRIVE,MONTPELIER,VT 05602 Fax:(802)828-1031 Email{HYPERLINK"mailto:DLC-Licensing@state.vt.us"} _ ,,.. 4. 4,0 City of South Burlington t City Clerk's Office '41,°EE3 l' Donna Kinville, City Cleric FIRST, SECOND CLASS AND CABARET LICENSE APPLICATION FULL NAME OF PERSON, PARTNERSHIP, CORPORATION ar1el- ' GD _V 1E . fir' ' I Y) : . DOING BUSINESS AS/ TRADENAME 6);rno ri 4-orb 1 6)i ADDRESS (/' 1/0b04'66'-t) T24- 4/149or . FIRST CLASS SECOND CLASS CABARET DATE RECEIVED BY CLERK'S OFFICE 44-) , 1,/ aD ia--/ SO. BURLINGTON POLICE DEPT Chief Trevor S. Whipple Date SO. B INGTON FIRE DEPT ,ems 4l//,/iz Chief Douglas S. Brent Date SO. BURLINGTON TAX DEPT (.,i,,/,4c_. ,A.,‹) . . 01 .,:7.h2--- - Mart a Lyons, Deputy x Collector Date sent to Montpelier: 575 Dorset Street South Burlington.VT 05403 802-846-4105 dkinville@sburl.com • 2012 LIQUOR LICENSE RENEWAL APPLICATION 4312-003—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 DIE 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: Slimain Handy's Convenience Stores, Inc. Doing Business As: Simon's Store & Deli Mailing Address: 974 Shelburne Road 75 South Winooski Avenue South Burlington VT 05403 Burlington VT 05401 • Telephone: (080) 862-8011 PLEASE INCLUDE EMAIL ADDRESS: a .V\nr\(i(i C (1nfh4V1-, Urn Description of Premises: L.) Lessor: Grocery store located in a one story cement and woodframe building Mountaha Handy situated on the east side of Shelburne Road and designated as 974 Burlington Vt Shelburne Road in the city of South Darlington, Vermont. Last Enforcement Seminar: 09/25/2010 Fed. ID Number: 33-1234567 Incorporation Date: 04/06/2000 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. Handy, Joseph 200 Hidden Oaks Drive Colchester VT 05446 Director 2. Handy, Charles 18 Ridgewood Drive Burlington VT 05401 Director 3. Handy, Anthony 4327 Harbor Rd Shelburne VT 05482 Director 4. Handy, Laura 486 Country Lane Colchester VT 05446 Director 5. Handy, Joan 109 Field Green Drive Colchester VT 05446 Stockholder 6. Handy, Joseph 200 Hidden Oaks Drive Colchester VT 05446 Stockholder 7. Handy, Charles 18 Ridgewood Drive Burlington VT 05401 Stockholder 8. Handy, Anthony 4327 Harbor Rd Shelburne VT 05482 Stockholder 9. Handy, Laura 486 Country Lane Colchester VT 05446 Stockholder 10. Handy, Joan 109 Field Green Drive Colchester VT 05446 Has any director or stockholder been convicted or pleaded guilty to any criml or motor vehicle offense in any court of law (including traffic tickets by mail) during the last year? Yes _ 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 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. Continued on next page 2012 LIQUOR LICENSE RENEWAL APPLICATION 4312-003-SECN-01 SECOND CLASS LICENSE TO SFL1, MALT AND VINOUS BEVERAGES Page 2 I/We hereby ,ceertifyt7hat the information in this application is true and complete. Dated at k8Lt f `t-no�� , in the}county of �}1 i a,/ 1 , and State of Vtrm� this 11.0 day o& f n.L��� , Signatur f authori agei Signature of individual or partners f car ration ub or ass iation C571N72 (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 1/1 ' Approved by Board of Control Commissioners of e Cit own e%CAK Total Membership 5 members present ) 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 knard 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 4312-003-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 • Toywn, • 0'4065 - 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: Slimain Handy's Convenience Stores, Inc. Doing Business As: Simon's Store & Deli Mailing Address: 974 Shelburne Road 75 South Winooski Avenue South Burlington VT 05403 Burlington VT 05401 Telephone: i Q ' ��n�� ` PLEASE INCLUDEDE EMAIL ADDRESS: Uom Description of Premises: Lessor: Grocery store located in a one story cement and woodframe building Mountaha Handy situated on the east side of Shelburne Road and designated as 974 Burlington Vt Shelburne Road in the city of South Burlington, Vermont. Last Enforcement Seminar: 09/25/2010 Fed. ID Number: 33-1234567 Incorporation Date: 04/06/2000 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. Handy, Joseph 200 Hidden Oaks Drive Colchester VT 05446 Director 2. Handy, Charles 18 Ridgewood Drive Burlington VT 05401 Director 3. Handy, Anthony 4327 Harbor Rd Shelburne VT 05482 Director 4. Handy, Laura 486 Country Lane Colchester VT 05446 Director 5. Handy, Joan 109 Field Green Drive Colchester VT 05446 Stockholder 6. Handy, Joseph 200 Hidden Oaks Drive Colchester VT 05446 Stockholder 7. Handy, Charles 18 Ridgewood Drive Burlington VT 05401 Stockholder 8. Handy, Anthony 4327 Harbor Rd Shelburne VT 05482 Stockholder 9. Handy, Laura 486 Country Lane Colchester VT 05446 Stockholder 10. Handy, Joan 109 Field Green Drive Colchester VT 05446 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 1/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 elective or appointive state, county, city, village or town office in Vermont (See VSA, T.7, Ch.9, Sec. 223)? Yes 1/ 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 copliance 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 EYbployment and Training. ng. I/We have registered the trade name of these premises with the Secretary of State. Continued on next page 2012 TOBACCO LICENSE RENEWAL APPLICATION 4312-003-TOBC-01 TOBACCO LICENSE TO SEL7 TOBACCO Page 2 I/We hereby certify that the information in this application is true and complete.Dated at (8 u�f �/�(�f`� in the county of �L and State of t b/L M� thisIV_ day of,_ (Ina W(Hy , SignatureA authoriz a ent Signature of individual or partners of corporation, . ,.any, c or associ • DVV/l.Y (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 may be granted. For the information of the Liquor Control Control Board, all applications shall carry the signature of each individual carmissioner 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 Carmissioners o the City wn of o {� Total Membership , members present WC�' C�<<, .,own 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 • City of South Burlington � , t- e City Clerk's Office o "°• Donna Kinville, City Clerk Agi FIRST, SECOND CLASS AND CABARET LICENSE APPLICATION FULL NAME OF PERSON, PARTNERSHIP, CORPORATION L---444,04'14pek (2)(14ir DOING BUSINESS AS/ TRADENAME ra uws -� rf to )ram-- 4 '''(-- ADDRESS ,_ 7A--elboric2: 1 . _ FIRST CLASS ( DCI )LASS CABARET DATE RECEIVED BY CLERK'S OFFICE ,- ) J,5 . SO. BURLINGTON POLICE DEPT Chief Trevor S. Whipple Date SO. Ub / LINGTON FIRE DEPT Chief Douglas S. Brent Date SO. BURLINGTON TAX DEPT CC. ( ./lid �Rii�J i/y<., Martha Lyons, Deputy Tax ollector Date sent to Montpelier: i 2012 LIQUOR LICENSE RENEWAL APPLICATION 3544-019-SECN-01 SECOND CLASS LICENSE TO CET,T. 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: Brockton Corporation Doing Business As: Shaw's Beer & Wine Mailing Address: 570 Shelburne Road B. Nunziato South Burlington VT 05907 150 Pierce Road Ste 200 Telephone: (802) 863-8260 barbra.nunziatbnapgiValu.com PLEASE INCLUDE EMAIL ADDRESS: Description of Premises: Lessor: Grocery store being approximately 73,000 square feet in size, located Heathcote Associates, LP in the grocery shopping plaza on the East side of Shelburne Road, also . PO Box 416027 known as 516 Shelburne Road, in the City of South Burlington, Vermont. Boston MA 02241-6027 I Last Enforcement Seminar: 11/02/2011 Fed. ID Number: 04-3344578 Incorporation Date: 01/01/1997 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 Coda Director 1. Black, John -6- Zsseit-deection _ 0,54` lease s e e Director 2. Marquis, Marcel R. 96 Poor Farm Road Colchester VT 05446 attached. Stockholder 3. Shaw's, Supermarkets 750 West Center Street W. Bridgewater MA 02379 Has any director or stockholder been convicted or pleaded guilty to any cr4pinal or motor vehicle offense in any court of law (including traffic tickets by mail) during'the last year? Yes No If es. please attach the fn]]nwing information: Individual's neme, court/traffic, bureau,_ offense and date In the past year has any director or stockholder of the corporation held any electiyy or appointive state, county, • city, village or town office in Vermont (See VSA, T.7, Ch.9, Sec. 223)? Yes ANo If yes, please attach the following information: Individual's name, office and jurisdiction Disclosure of Non-profit Organization?: Yes )0C 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 camplian.e 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 • • • /U 2012 LIQUOR LICENSE RENEWAL APPLICATION 3544-019—SECN-01 SECOND CLASS LICENSE TO 4F:T,T MALT AND VINOUS BEVERAGES Page 2 I/We hereby certify that the information in this application is true and complete. Dated at_�Ictasca , in the county of DuPage , and State of IL this day of -EJ a o/� Signature of authorised agent Signature of individual or partners •f co ration, .'.:. lub ass 'ation Barbra A. Nunziato/ Assistant Secretary (Title) Are you making this application for the benefit of any other party? Yes X 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 net 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 Town of Total Membership 6 , members present cl 1 t :4 • C.112.41K. , 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 cannissioners 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 ATTACHMENT JOHN BLACK 176 Hayes Avenue South Burlington, VT 05403 2012 TOBACCO LICENSE RENEWAL APPLICATION 3544-019-TOBC-01 TOBACCO LICENSE TO SFTJ, TOBACCO Page 1 Optional Fee: $10.00 of which License Year Beginning May 1, 2012 ending April 30, 2013 $10.00 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: Brockton Corporation Doing Business As: Shaw's Beer & Wine Mailing Address: 570 Shelburne Road B. Nunziato South Burlington VT 05407 150 Pierce Road Ste 200 Telephone: (802) 863-8260 Itasca IL 60143 PLEASE INCLUDE EMAIL ADDRESS: barbra.nunziato@supervalu.com Description of Premises: Lessor: Grocery store being approximately 73,000 square feet in size, located Heathcote Associates, LP in the grocery shopping plaza on the East side of Shelburne Road, also PO Box 416027 known as 516 Shelburne Road, in the City of South Burlington, Vermont. Boston MA 02241-6027 Last Enforcement Seminar: 11/02/2011 Fed. ID Number: 04-3344578 Incorporation Date: 01/01/1997 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 Cod Director 1. Black, John C ESS ]L .1= VT pi4 .P�l e a s e s e e Director 2. Marquis, Marcel R. 96 Poor Farm Road Colchester VT 05446 attached. Stockholder 3. Shaw's, Supermarkets 750 West Center Street W. Bridgewater MA 02379 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 X 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 elective or appointive state, county, city, village or town office in Vermont (See VSA, T.7, Ch.9, Sec. 223)? Yes X 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 canpliance 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 canpliance 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 caspliance 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 caiplete. Dated at Itasca , in the county of DuPage IL , and State of , this , day of • , t:2O/P.-- Signature of author' ed agent Signature of individual or partners 4:firporati ; y, c a ociation Barbra A. Nunzia Assistant Secretary (Title) Are you making this application for the benefit of any other party? Yes )(No Continued on next page ATTACHMENT JOHN BLACK 176 Hayes Avenue South Burlington,VT 05403 ' J 2012 TOBACCO LICENSE RENEWAL APPLICATION 3544-019-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 comissioners 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 of iiallagri ., of, Total Membership 6 , members present 4; p,s `Ck_ + Jv�� >-- ���- -) C �- 4C.OWri 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 1 4 • 4.4;1 City of South Burlington too City Clerk's Office ='JTE 0Efp Donna Kinville, City Clerk FIRST, SECOND CLASS AND CABARET LICENSE APPLICATION FULL NAME OF PERSON, PARTNERSHIP, CORPORATION Wei 14'i —FODG) 1)-P moo. t v ril DOING USINESS AS/ TRADENAME GNU ADDRESS �Jg CIJ'irarnr6(' � QCGI� FIRST CLASS SECOND CLASS CABARET DATE RECEIVED BY CLERK'S OFFICE 2) SO. BURLINGTON POLICE DEPT Chief Trevor S. Whipple Date SO RLINGTON F RE DEPT 9- y'ri(►2/ Chief Douglas S. Brent Date SO. BURLINGTON TAX DEPT —27/ 4_,eq,eL J a e4()—b*C) Si/V/2— P y Mart Ha Lyons, Deputy x Collector Date sent to Montpelier: • 2012 LIQUOR LICENSE RENEWAL APPLICATION 955-003-SECN-01 SECOND CLASS LICENSE TO SETT 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: Martin's Foods of South Burlington, Inc. Doing Business As: Hannaford Food & Drug Superstore Mailing Address: 218 Hannaford Drive 218 Hannaford Drive South Burlington VT 05403 South Burlington VT 05403 Telephone: (802) 658-3496 //�� PLEASE INCLUDE EMAIL ADDRESS: JQ lS o uL� - n tur tcu-fz)r(l• L'. 1. r Description of Premises: Premises: XX Owned Leased A Grocery store in a one story cement and steel structure that is 45,367 square feet in size and designated as 40 Fayette Road situated due southwest of Burger King in the city of South Burlington, Vermont. Last Enforcement Seminar: i7dzm 3/7/2012 (see copy of attached Certificate) Fed. ID Number: 03-0222879 Incorporation Date: 07/24/1969 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.SEE SHEET ATTACHED FOR A COMPLETE Corporation Name Address LIST OF AL R E C T O R S‘t0eFpC nR S. President 1. Campbell, Beth 24 Stonegate Road Cape Elizabeth ME 04107 Secretary 2. Pierson, Douglas C. 175 West Shore Road Grand Isle VT 05458 Director 3. Campbell, Beth 24 Stonegate Road Cape Elizabeth ME 04107 Director 4. Bowne, Garrett D 11 Streamwood Lane Falmouth ME 04105 Director 5. Toner, Lisa 53 Haywood Street Portland ME 04102 Stockholder 6. Hannaford Bros. Co. , P.O. Box 1000 Portland ME 04104 Has any director or stockholder been convicted or pleaded guilty to any crimin51,1 or motor vehicle offense in any court of law (including traffic tickets by mail) during the last year? Yes 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 elective r 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. Continued on next page • 2012-03-07 13:49 HBC8303 8028641726 >> P 2/2 Vermont Department of Liquor Control Certificate of Second Class Seminar Attendance Name (print): A„ Signature: % �1�../ 1. ..0 C. ..�, Date: 1/7 Z. (empires Me ma from eborc die) Investigator's Signature: • Certificate of Second Class miner Attendance Category (circle one): Owner Director Partner Manager Employee Licensee Name: IA c r' (, d/b/a: •.( ) Address: ?__ 0 c. S-- Education Regulation 3-B V.S.A.T•7 §239 • DLC:I OM:I2/07:SC MARTIN'S FOODS OF SOUTH BURLINGTON,INC. (VT) FED ID#: 03-0222879 OFFICERS AND DIRECTORS NAME/TITLF.iSS# IIOMEADDRESS BUSINESS ADDRESS DATE OF BIRTH PLACE OF BIRTH Beth Newlands Campbell 24 Stoaegate Road HANNAFORD BROS.CO. . 03-29-65 Ithaca,NY President&Director Cape Elizabeth,ME 04107 145 Pleasant Hill Road 090-54-7774 Scarborough,ME 04074 Robert J.Schools 17 Prosperity Lane HANNAFORD BROS.CO. 06-24-57 Farmington,ME Vice President Windham,ME 04062 145 Pleasant Hill Road 006-58-4620 Scarborough,ME 04074 Lisa R.Miller 5 Ole Musket Road HANNAFORD BROS.CO. 05-11-61 Glens Falls,NY Vice President Cumberland Foreside,ME 04110 145 Pleasant Hill Road 061-60-3862 Scarborough,ME 04074 Garrett D.Bowne,IV 11 Streamwood Lane HANNAFORD BROS.CO, 10-04-53 Marblehead,MA Treasurer&Director Falmouth,ME 04105 _ 145 Pleasant Hill Road 023-44-4149 Scarborough,ME 04074 Elting H.Smith 75 FieId Road HANNAFORD BROS.CO. 02-19-54 New York,NY Assistant Secretary Cumberland,ME 04021 145 Pleasant Hill Road 113-38-9287 Scarborough,ME 04074 Lisa K Toner 53 Haywood Street HANNAFORD BROS.CO. 04-27-58 Kingsville,TX • Assistant Secretary&Director Portland,ME 04102 145 Pleasant Hill Road 389-66-5742 Scarborough,ME 04074 Patti M.Fletcher 6171 Gold Hill Road FOOD LION,T.1 r 01-19-68 Concord,NC Assistant Treasurer Concord,NC 28025 2110 Executive Drive 244-29-1891 Salisbury,NC 28147 Douglas C.Pierson 175 West Shore Road Pierson,Wadhams,Quinn&Yates 02-11-32 Mount Clair,NJ Secretary&Clerk Grand Isle,VT 05458 253 South Union St .,1 526.42-2541 Burlington,VT 05401 • • • • • • • • • • 09/03/10 2012 LIQUOR LICENSE RENEWAL APPLICATION 955-003-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 and complete. Dated at C7WV I i�/� '�r )) , in the county of G�,� �Q/vAllei 1, and State of V Y Y l O y this /> day of VIVAirt'/I/L.... , �v+� Si ture of au ' ed agent Signature of individual or partners of corp 'on, c , cl or association Martin ' s f So th Burlington, Inc. By: Douglas C. Pierson, Secretary (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 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 Caanissioners of . Towp � /cf ,�✓ Total Membership members present Att st, �� — ) C 44, 1r n 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 955-003-TOBC-01 TCBACCO LICENSE TO SETJ, TOBACCO Page 1 Optional Fee: $10.00 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: Martin's Foods of South Burlington, Inc. Doing Business As: Hannaford Food & Drug Superstore Mailing Address: 218 Hannaford Drive 218 Hannaford Drive South Burlington VT 05403 South Burlington VT 05403 Telephone: (802) 658-3496 PLEASE INCLUDE EMAIL ADDRESS: .1* C�L,e f it'au VNCR ArA .CU v Y) Description of Premises: Premises: XX Owned Leased A Grocery store in a one story cement and steel structure that is 45,367 square feet in size and designated as 40 Fayette Road situated due southwest of Burger King in the city of South Burlington, Vermont. Last Enforcement Seminar:20 3Mx 3/7/2012 (see copy of attached Certificate. ) Fed. ID Number: 03-0222879 Incorporation Date: 07/24/1969 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. SEE SHEET ATTACHED FOR A COMPLETE LIST OF ALL DIRECTORS/OFFICERS. Corporation Name Address Town/City State Zip Code President 1. Campbell, Beth 24 Stonegate Road Cape Elizabeth ME 04107 Secretary 2. Pierson, Douglas C. 175 West Shore Road Grand Isle VT 05458 Director 3. Campbell, Beth 24 Stonegate Road Cape Elizabeth ME 04107 Director 4. Bowne, Garrett D 11 Streamwood Lane Falmouth ME 04105 Director 5. Toner, Lisa 53 Haywood Street Portland ME 04102 Stockholder 6. Hannaford Bros. Co. , P.O. Box 1000 Portland ME 04104 Has any director or stockholder been convicted or pleaded guilty to any crimina 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 elective 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. Continued on next page 2012-03-07 13:49 H8C8303 8028641726 >> P 2/2 Vermont Department.of Liquor Control • Certificate of Second Class Seminar Attendance • Name (print): a�„ ` - M Signature: L �•7 \.`wD C. _ Date: �/-7 1)Z. . • € - ��l1 IwO jpp�IOM ) Investigator's Signature:ga0o /1 Certificate of Second CJase`S'ommar' Atteedance Category(circle one): Owner Director Partner - Manager Employee Licensee Name: C.•c r ',% • • (1 . ^ . • Address; Z R 1-��...,,�.t, " O c. ... Education Regulation 3•B V.S.A.T.7339 DLC:I OM:I2/07:SC • - • MARTIN'S FOODS OF SOUTH BURLINGTON,INC. (VT) FED ID /: 03-0222879 OFFICERS AND DIRECTORS NAME/TITLE/SS# FIOMEADDRESS BUSINESS ADDRESS DATE OF BIRTH PLACE OFBIRTH Beth Newlands Campbell 24 Stonegate Road HANNAFORD BROS.CO. 03-29-65 Ithaca,NY President&Director Cape Elizabeth,ME 04107 145 Pleasant Hill Road 090-54-7774 Scarborough,ME 04074 Robert J.Schools 17 Prosperity Lane HANNAFORD BROS.CO. 06-24-57 Farmington,MB Via President Windham,ME 04062 145 Pleasant Hill Road 006-58-4620 Scarborough,ME 04074 Lisa R.Miller 5 Ole Musket Road HANNAFORD BROS.CO, 05-11-61 Glens Falls,NY Vice President Cumberland Foreside,ME 04110 145 Pleasant Hill Road 061-60-3862 Scarborough,ME 04074 Garrett D.Bovine,IV 11 Streamwood Lane HANNAFORD BROS.CO. 10-04-53 Marblehead,MA Treasurer&Director Falmouth,NLr: 04105 _ 145 Pleasant Hill Road 023-44-4149 Scarborough,ME 04074 Elting H.Smith 75 Field Road HANNAFORD BROS.CO. 02-19-54 New York,NY Assistant Secretary Cumberland,ME 04021 • 145 Pleasant Hill Road • 113-38-9287 Scarborough,ME 04074 Lisa K.Toner 53 Haywood Street. HANNAFORD BROS.CO. 04-27-58 Kingsville,TX • Assistant Secretary&Director Portland,ME 04102 145 Pleasant Bill Road 389-66-5742 Scarborough,ME 04074 Patti M.Fletcher 6171 Gold Hill Road FOOD LION,I JI' 01-19-68 Concord,NC Assistant Treasurer Concord,NC 28025 2110 Executive Drive 244-29-1891 Salisbury,NC 28147 Douglas C.Pierson 175 West Shore Road Pierson,Wadhams,Quinn&Yates 02-11-32 Mount Clair,NJ Secretary&Clerk Grand Isle,VT 05458 253 South Union St • 526-42-2541 Burlington,VT 05401 • • • • 09/03/10 2012 TOBACCO LICENSE RENEWAL APPLICATION 955-003-TOBC-01 TOBACCO LICENSE TO SETT TOBACCO Pace 2 I/We hereby certify that the information in this application is true and complete. / ��n /�, Dated at �r in the county of C� ' tit/� ��, and State of VlvV Y v yv4 , this (c day of 11,�,lC'k—, L)1 — L ©� S'., -tune of au - - -. agent Signature of individual or partners of co •., . on, . cl . or association Martin ' s,.. •f S. . h Burlington, Inc. By: �/ Douglas C. Pierson, Secretary (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 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 tY tt To �, /i i' �� Total Membership 6 members present At ) , 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 seleclimen 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 ; ®0 City of South Burlington o � 0. ,I City Clerk's Office Y OTE °,,,.r`£{t'f .. Donna Kinville, City Clerk FIRST, SECOND CLASS AND CABARET LICENSE APPLICATION FULL NAME OF PERSON, PARTNERSHIP, CORPORATION CDcD as- , 1 1' • DOING BUSINESS AS/ TRADENA�ME � /� r--) C -f y 0 i //D (J ADDRESS Ito , FIRST CLASS SECOND CLASS CABARET DATE RECEIVED BY CLERK'S OFFICE "� . L9 e i SO. BURLINGTON POLICE DEPT Chief Trevor S. Whipple Date (:77SO INGTON FIRE DEPT ' (1--,._/- y72.11-1.- Chief Douglas S. Brent Date SO. BURLINGTON TAX DEPT Wi g r-/4 ifAI -- Mart a Lyons, Deputy ax Collector Date sent to Montpelier: o G7C fln.,,.,+ Q+r...,+ C,,.+L. D...G.,..+.,., VT nEAn`.) On') OAG A1nr .11.:.,.,:11../n1..1....-1 .,...., 2012 LIQUOR LICENSE RENEWAL APPLICATION 316-015-SECN-01 SECCND 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: Coco Mart, Inc. Doing Business As: Jiffy Mart Mailing Address: - 110 Kennedy Drive PO Box 825 South Burlington VT 05403 Claremont NH 03743 Telephone: (802) 865-0143 PLEASE INCLUDE EMAIL ADDRESS: t 1p }-t ec a 1Q nC:A,C C Description of Premises: Lessor: Store located in a wood and brick building approx. 1500 sq. feet in C.D. Cairns Trust size. Located at 110 Kennedy Drive in the City of South Burlington, PO Box 2126 Vermont. So. Burlington VT 05403 Last Enforcement Seminar: 11/02/2011 Fed. ID Number: 03-0323725 Incorporation Date: 03/01/1990 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. Cairns, Charles Box 2307, Lake Rd. Charlotte VT 05445 Director 2: Cairns, Lynn Box 2307, Lake Rd. Charlotte VT 05445 Stockholder 3. Cairns, Bryan Box 2307, Lake Rd. Charlotte VT 05445 Stockholder 4. Cairns, Charles Box 2307, Lake Rd. Charlotte VT 05445 Stockholder 5. Cairns, Lynn Box 2307, Lake Rd. Charlotte VT 05445 Stockholder 6. Cairns, Michael Box 2307, Lake Rd. Charlotte VT 05445 Has any director or stockholder been convicted or pleaded guilty to any cril 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 .JNo 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 2012 LIQUOR LICENSE RENEWAL APPLICATION 316-015—SECN—01 SECOND CLASS LICENSE TO SELL MALT AND VINOUS BEVERAGES =, z 2 I/We hereby certify that the information in this application is true and complete. Dated at .f K 1r1SV i i tQ , in the county of , and State of \Q2(rf1 p(1"{- this 7 daY of % rli Ocy a1Ot a Signature of authorized agent Signature of individual or partners of corporation, company, club or association j ,c1C]1 crictnc>s - (T1-Lle) 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 c ;ssioner 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 7.1iii6f Total Membership , members present A - , ,�d , 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 316-015-TOBC-01 TOBACCO LICENSE TO SF1,T TOBACCO Page 1 Optional Fee: $10.00 of which License Year Beginning May 1, 2012 ending April 30, 2013 $10.00 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: Coco Mart, Inc. Doing Business As: Jiffy Mart Mailing Address: 110 Kennedy Drive PO Box 825 South Burlington VT 05403 Claremont NH 03743 Telephone: (802) 865-0143 PLEASE INCLUDE EMAIL ADDRESS: ._i_tCLiA', '11Cw11Qi����Lam' Description of Premises: Lessor: Store located in a wood and brick building approx. 1500 sq. feet in C.D. Cairns Trust size. Located at 110 Kennedy Drive in the City of South Burlington, PO Box 2126 Vermont. So. Burlington VT 05403 Last Enforcement Seminar: 11/02/2011 Fed. ID Number: 03-0323725 Incorporation Date: 03/01/1990 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. Cairns, Charles Box 2307, Lake Rd. Charlotte VT 05445 Director 2. Cairns, Lynn Box 2307, Lake Rd. Charlotte VT 05445 Stockholder 3. Cairns, Bryan Box 2307, Lake Rd. Charlotte VT 05445 Stockholder 4. Cairns, Charles Box 2307, Lake Rd. Charlotte VT 05445 Stockholder 5. Cairns, Lynn Box 2307, Lake Rd. Charlotte VT 05445 Stockholder 6. Cairns, Michael Box 2307, Lake Rd. Charlotte VT 05445 Has any director or stockholder been convicted or pleaded guilty to any crimi or motor vehicle offense in any court of law (including traffic tickets by mail) during the last year? Yes 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 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 j isdiction 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 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 TOBACCO LICENSE RENEWAL APPLICATION 316-015-TOBC-01 TOBACCO LICENSE TO SF7,1 TOBACCO Page 2 I/We hereby certify that the information in this application is true and complete. Dated at PgcK i r\1��t KI• , in the county of i S C , and State of V ilf m fir)-} 5 this day of �YCJCVCie-'1( Signature of authorized agent Signature of individual or partners of corporation, company, ub r association MCx Qr PC42k itle) Are you making this application for the benefit of any other party? YesVf 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 catmissioners 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 camaissioner 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 41101Pr Town 045J • 4,00 1��t O Total Membership members present ` ►e }. , 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 selecUL n 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