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Home My Public Portal About080_010_2014 Agenda Request-Alcohol-Entertainment License-Tybee Island Fish Camp MAYOR CITY MANAGER ' Jason Buelterman r Diane Schleicher CITY COUNCIL CLERK.OF COUNCIL Wanda Doyle, Mayor Pro Tern Janet LeViner Bill Garnett 1 Paul Wolff / CITY ATTORNEY Rob Callahan Edward M.Hughes Monty Parks Barry Brown CITY OF TYBEE ISLAND City Council Agenda Item Request Agenda Item Requests and supporting documentation must be submitted to the Clerk of Council by 4:00PM on the Thursday prior to the next scheduled Council meeting. If this form is received after the deadline,the item will be listed on the next scheduled agenda. Council Meeting Date for Request: April 10, 2014 Item: Alcohol and Entertainment License Request: Liquor/Beer/Wine/Sunday Sales- Entertainment Explanation: Full service restaurant and bar: YummSchumm, LLC DBA Tybee Island Fish Camp 106 South Cam.bell Ave (In location of former Jitterbug Cafe) Budget Line Item Number(if applicable): Paper Work: X Attached* Audio/Video Presentation** * Electronic submissions are requested but not required. Please email to ilevinerA,citvoftvbee.org. ** Audio/video presentations must be submitted to the IT department at City Hall by 4:00PM on the Thursday prior to the scheduled meeting. Submitted by: Sharon S. Shaver Phone/Email:472-5072 I sshaver@cityoftybee.org Comments: Date given to Clerk of Council April 3,2014 .0.Box 2749—4 03 Butler Avenue,Tybee Island,Georgia 31328-2749 (866)786-4573—FAX(866)786-5832 www.cityoftybee.org �A1�, CITY OF TYBEE ISLAND 1.1-' "`,,,, ALCOHOL LICENSE APPLICATION Application is hereby made for a license to do business within the City of Tybee Island as a dealer in alcoholic beverages as indicated below: LICENSE CLASSIFICATION FEE CHECK Notice: The applicant Retail Beer/Wine—Package Sales Only,Consumption on Premises Prohibited $ 350 for a license shall be a citizen of the United Retail Beer/Wine—Sale by Drink for Consumption on Premises Only 575 States, a resident of Retail Liquor—Sale by Package Only,Consumption on Premises Prohibited 850 Chatham County, and Retail Liquor—Sale by Drink for Consumption on Premises Only 1,250 t,/" owner of the business Retail Liquor—Sale by Package&Drink both in One Building under One Ownership 2,000 or if a corporation, Sunday Sales,Sale by Drink for Consumption on Premises Only 150 ✓ partnership or other Sunday Sales-Package Sales Only 50 legal entity is the Wholesale Beer 765 owner, a substantial Wholesale Liquor 1,500 and major stockholder Wholesale Wine 150 or the applicant may be Distiller,Brewer,or Manufacturer of Alcoholic Beverages 300 the manager of the Special Event—Public or Private Property-Beer,Wine(no current license)per event 50 business charged with Special Event—Public or Private Property-Beer,Wine(no current license)3 days 100 the regular operation of Special Event—Public or Private Property-Beer,Wine(holding current license)per event 10 said business on the Special Event—Business Property—Beer,Wine, Liquor(no current license)per event 50 premises for which the Special Event—Business Property—Beer,Wine, Liquor(no current license)3 days 100 license is issued. Special Event—Business Property—Beer,Wine, Liquor(holding current license)per event 10 Business Name Location 1 Nil Q_ L o� Mailing Address Lf � Phone ( . -2- S03 l a in ��, .f 114- 1 Email ►' i er'4 Q 1.. ast} 'ii. Y1.ift` 'I� 3 Names and Home Addresses of Owners, Partners or Corporate Officers with Ten Percent(10%)Interest in Business Names(attach additional pages if necessary) Date of Birth Home Addresses City,State,Zip Social Security# t °CI NC S Air4 • (fi r ..:e't a.,64'g4 31e If special event,date(s)of event Is business incorporated? 'ICS State of Incorporation Date Incorporated _ Names of landlord of the business location J TA` 1'O Address Phone �J®'..›.-7t/0 .S'7 M7 What other business is conducted at this location? Has application been made for required State and Federal Licenses? ` e Has applicant,any person connected with,or any person having an interest in this business: a ever been convicted of any violation of law other than for a traffic violation? 7 :7 o ever served time in prison or other correctional institution? N'O o ever had an alcohol beverage license suspended or revoked at any time in any location? (if answer is yes,give details) 7'f9g61 /1 1 . )COO Y.9"---.c w s€ O 4711414 J'ct.,Qtt4C it . SE el. 11.13 If this application is for RENEWAL of an existing license,enter License Number of existing license If business is an eating establishment,are SUNDAY sales of alcoholic beverages contemplated? [ `'�, d If yes,submit additional affidavit. ALL OF THE FOREGOING INFORMATION IS HEREBY GIVEN AND ALL OF THE FOREGOING STATEMENTS ARE HEREBY MADE ON OATH WILLFULLY,KNOWINGLY, D ABSOLUTELY,AND THE SAME IS AND ARE HEREBY SWORN TO ME TO BE TRUE UNDER PENALTY OF LAW. a Applicant Signature r Date 3_ `J 1 — /4 Approval Signature Date _ city Manager Swor .• iljubscribed bef• • m• l' 5 1 day of N1• t, zoning /•4 I Police 4` z i'i1'r-�, k �f v.4 --__ City Council No as •u,•llic SHARON S.SHAVER Notary Public,Chatham County, GA My Commission Expires Dec. 5, 2015 c*►t3 � , CITY OF TYBEE ISLAND Fee $50 i ENTERTAINMENT LICENSE APPLICATION s, `be penalty fa a \�",. . renewal payment made . ,s' Chapter 34, Article VII, Entertainment Licenses after March 31. 41FVMMStAitiMAit 1.1.4:, alb(a Business Name --ire t 9409 IF Chi Business Location 10 b 4 C...44.4.e l% - , Mailing Address . ® .NC gii r • re f e ISL, (IA. 2,132-5 Business Phone Other Phone Emai Federal ID#4 L„_. .0.bigc/ -7 State Sales Tax ID# NAICS Code Business Type(circle one) Sole Proprietor Partnership Corporation Agpo Non-Profit Other: Names and home addresses of Owners, Partners or Corporate Officers Name Home Address City, State,Zip Title Ki eri SC4{4 tA Nir-4 1 tif0 t t S 4'4 , - -f a c i k1 t 3/3 4$' &do tg A . The nature of any and all commercial acttiyities conducted at the location: Proposed hours of operation: ' 7�- ►Jr44 6i fliJJ , - Describe any efforts to mitigate impacts on neighbors or occupants of nearby properties: Contact information for the designated manager or contact person available twenty-four hours a day for any operational issues. The license holder must notify the City of Tybee Island immediately of any change to this designated contact information. Narn Physical A ress ' Phone s � I 1'4 9 J�5 !WC. _T ? +C 21 c .q Z.. y 7'/ Has this business or anyone connected with this business been cited or charged with any violation of Georgia Law,Federal Law, Local Ordinance or any Rule or Regulation of the State Revenu?Commissioner or any Rule or Regulation of the City or County within the past 12 months? (circle one) �� r NO (If YES, list details below) ��--nPi3'1 i?v4-r . M1:::•o L"W tst tr./ is 43 i# LOwt. vE-1J L Oily t. '..s:Z.. .l7 Applicant Signature Date 7a'3�. Printed Name ktA2TI s � P rvi Received by Date ROUTE APPROVE or DENY SIGNATURE DATE RECOMMENDED RESTRICT1ONS/CONDITIONS City Manager Planning&Zoning Mgr. Police Chief Fire Chief Mayor/City Council Date of consideration: Approved with restrictions or conditions: Reason for denial: Date mailed to applicant: 403 Butler Avenue, P.O. Box 2749, Tybee Island, Georgia 31328-2749 (912) 786-4573 FAX (912) 786-5832 www.cityoftybee.org CONSENT FORM is required for ALL alcohol license applications. CONSENT FORM I HEREBY AUTHORIZE THE TYBEE ISLAND POLICE DEPARTMENT TO REQUEST ANY CRIMINAL BACKGROUND HISTORY RECORD INFORMATION PERTAINING TO ME WHICH MAY BE IN THE FILES OF ANY STATE OR LOCAL CRIMINAL JUSTICE AGENCY. BE IT FURTHER UNDERSTOOD THAT THE PURPOSE OF OBTAINING THIS INFORMATION IS TO SATISFY THE REQUIREMENTS SET FORTH BY THE MAYOR AND COUNCIL OF THE CITY OF TYBEE ISLAND,REGARDING AN ALCOHOL BEVERAGE LICENSE APPLICATION. ji,4_14 , , FULL NAME(PRINT) SEX I CE / DATE OF BIRTH ESADD RES SOCIA_SECURITY NUMBER v. t 1470 1 J�7 sIGNA�[UR DATE CITY STATE,ZIP / C-460//k114 4)r ,,4.Ach The ACKNOWLEDGEMENT is required for all LIQUOR BY THE DRINK alcohol license applications. ACKNOWLEDGEMENT I declare knowl-•2e and understanding of Municipal Code Section 58-80: There is levied an excise tax on the sale of distilled spirits +y the • ink in the amount of three percent of the charge to the public for the beverage. s/./ SIGNATUR' DATE The AFFIDAVIT is required if SUNDAY SALES of alcohol for consumption on premises are contemplated. Food and beverage sales records prepared by a CPA are required to be furnished to the City upon request. STATE OF GEORGIA COUNTY OF CHATHAM CM'OF TYBEE ISLAND AFFIDAVIT I, Via--1-):C r/t.r /t. , do hereby make this affidavit to be part of my application for an alcohol beverage license in the City of Tybee Island to sell distilled spirits, malt beverages and/or wine for the consumption on the premises in my eating establishment on Sunday. Said establishment is located at tv S, L ezEL ,,. — ,Tybee Island, Georgia. I am the D r . of the establishment known as - 100 I hereby further state that at least fifty percent (50%) of the total annual gross food and beverage sales are derived from the ale of prepared meals or food. SIGNATURE DATE Approved Denied .. Chief of Police PILIMIS Date