HomeMy WebLinkAboutBusiness License Application 1988-8-1
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CITY OF SPRINGFIELD
APPLICATION FOR
SPECIAL COMMUNITY EVENT LICENSE
1. PLEASE PROVIDE THE FOLLOWING INFORMATION REGARDING THE SPONSOR AND EACH OF THE
INDIVIDUALS RESPONSIBLE FOR ORGANIZING THE EVENT:
NAME(St LOCAL ADDRESS LOCAL PHONE
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2. EVENT FOR WHICH LICENSE IS SOUGHT u.Jir1L ~.ro~(17i.Sh~
EVENT DATE(S) f\W1 l2,t.h. /qXX ' '
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3. IS'SPONSOR A NOT-FOR-PROFIT TAX EXEMPT ENTITY? ~O'
4. PLEASE PROVIDE THE FOLLOWING SPECIFIC INFORMATION REGARDING EACH OF THE ACTIVITIES
ANTICIPATED TO OCCUR AS PART OF THE EVENT (Attach Additional Pages if Necessary)
. ACTIVITY . LOCATION. DATE(St TIME(St
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5. PLEASE PROVIDE A CLEAR STATEMENT OF THE SPECIFIC REASONS YOU BELIEVE THE EVENT WILL
SIGNIFICANTLY CONTRIBUTE TO AND BENEFIT THE SPRINGFIELD COMMUNITY (Attach Additional
Pages If Necessary)
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6. PLEASE PROVIDE A CLEAR STATEMENT OF THE OPPORTUNITIES' FOR CITY-WIDE CITIZEN PARTICI-
PATION IN THE EVENT:
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7. HAS LIABILITY INSURANCE BEEN OBTAINED FOR THE EVENT? YES ~NO. IF SO.
PLEASE INDICATE:
FACE AMOUNT OF THE POLICY
POLICY HOLDER(S)
ADDITIONAL INSUREDS
8. WILL THE EVENT INCLUDE:
A CARNIVAL: YES V- NO
A CIRCUS: YES V NO
IF SO. PLEASE INDICATE THE DATE(S) AND LOCATION(S) FOR EACH
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APPLICATION SHOULD JCEIVED N~T LESS THAN 10 DAYS PRIOR TO EVEN~
OREGON LIQUOR CONTROL COMMISSION
APPLICATION AND AUTHORITY TO OPERATE
APPLICATION IS MADE FOR:
- Special Dispenser - $25.00 No. of Days
. Special Event Winery - $10.00-1- No. of Days
Note: Fee must be paid by CHECK or MONEY ORDER only
PLEASE TYPE OR PRINT FIRMLY USING BALL POINT PEN
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1. Applicant: VIVIANA & SF.RraO CERVI-SKINNER
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2. Trade Name: S. C. S. CELLARS I
3. Mailing Address: 514 CANDY LANE. ROSEBURG. OR.
4. Person(s) Responsible at Event: r.F.NF. MI"F'\TRll
;(< 5. Date(s) and Hours of Event(s): AVfrlA~T ,~: 12:00 Or-
6. Type of Event: WINE COOLER TASTING
7. Event Address' 555 W. CENTENNIAL. SPRINGFIELD. OR
;4t 8. Above location is Within City Limits Outside City Limits
9. Boundaries of Event. INSIDE STORE-FOOD VALUE STORE
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Phone....6..1..3-141 q ,
, License Type
Phone 459 -480~
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10. Method of supervision to insure compliance with liquor laws: CHECK ID' s
11. Expected Attendance: 300
12. I/We understand that a false or misleading answer to any of the foregoing questions may subject this
application to denial. I/We certify that all Information submitted is complete and correct to the best of
my/our know~e9ge. / 0 / ... ," 'I ~i
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~ 13.' AUTHORIZATION BY PROPERTY OWNER/OPERATOR CONTROLLING PROPERTY
I own/control the property where this event Is to be held. This application meets with my approval.
( ; Owner or Agent:
.' Name /1fA~ u). ,,({~I / ~ ./
" Authorized Signature ~t6....,,/ ~r( U'L-~?
Phone 7~/-~/~ 7
Date e/cJI/e6 .
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~ 14. RECOMMENDATION OF CITY POLICY DEPARTMENT/COUNTY SHERIFF'S OFFICE
, Recommendation: Grant. Deny, ' I' ' " , ' ! ii
Police Agency
Authorized Signature Date
If recommendation is refused, please indicate grounds for refusal by letter.
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15. THIS AUTHORITY IS NOT VALID UNLESS SIGNED BY AN OLCC REPRESENTATIVE
License is Granted~" Recommend Refuse_Date Issued;' .;'"
By .Titlp
RESTRICTIONS Fee Pain
.Date Issued' I
Receipt #
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AUG 05 REc'a
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M E M 0 RAN DUM
CITY OF SPRINGFIELD
August 5, 1988
TO: Karen Evansr Police Dept.
Rebecca Hollenbeck, Fire and Life Safety
~indie, Harmon, Plannin~"DepartrTlent,;:;
FROM: Melanie Dawson, Admini~t~ative'-'ser~ices /,}{P1
SUBJECT: APPLICATION FOR SPECIAL COMMUNITY EVENT BY S.C.S. CELLARS
Attached is an application for special community event license by S.C.S.
Cellars (Viviana & Sergio Cervi-Skinner). I am sending a copy to all
departments to inform them as soon as possible about the requested'
special event license.
Please sign on the bottom of the second page and indicate any concerns
or conditions you may have. Please return to me as soon as possible.
Attachments