HomeMy WebLinkAboutItem 05 Flashback Grill Liquor License AGENDA ITEM SUMMARY Meeting Date: 2/3/2020
Meeting Type: Regular Meeting Staff Contact/Dept.: Robin Holman - DPW Staff Phone No: 541-726-3662
Estimated Time: Consent Calendar S P R I N G F I E L D C I T Y C O U N C I L Council Goals: Mandate
ITEM TITLE: LIQUOR LICENSE APPLICATION FOR A CHANGE OF OWNERSHIP FOR
FLASHBACK FAMILY GRILL LLC, DBA: FLASHBACK GRILL.
ACTION REQUESTED: Endorsement of OLCC Liquor License Application for Flashback Grill, located at 4229 Main Street Springfield, OR 97478.
ISSUE STATEMENT: The owner of Flashback Family Grill LLC has requested the City Council to endorse its OLCC Liquor License Application.
ATTACHMENTS: Attachment 1: OLCC Liquor License Application.
DISCUSSION/ FINANCIAL IMPACT:
The license endorsement for Flashback Family Grill LLC, DBA: Flashback Grill is for a Change of Ownership with Full On-Premises Sales. The license application has been reviewed and approved by the appropriate City Departments.
ffi OREGON LIQUOR CONTROL COMMISSION
LIQUOR LICENSE APPUCATION
1. Application. Do not include any OLCC fees with your application packet (the license fee will be collected at a later
time). Application is being made for:
2. ldentify the applicant(s) applying for the license(s). ENTITY (example: corporation or LLC) or INDIVIDUAL(S) applying
ror-the license(s): FbshbecL le,.,r i[,., Gn't(, LILI r' '#rt
License ied For:
Brewery 1't Location
CIWAND COUNW USE ONIY
Date application received and/or date stamp:
Name of City or County:
Recommends this license be:
E Granted n Denied
By:
Date:
n Brewery 2nd Location
tr Brewery 3'd Location!Brewery-Public House l't location
tr Brewery-Public House 2nd location
tr Brewery-Public House 3'd location
tr Distillery
tr Full On-Premises, Commercial
tr Full On-Premises, Caterer
tr Full On-Premises, Passenger Carrier
tr Fullon-Premise For Profit Private Club
Full On-Premises, Nonprofit Private Club
tr Grower Sales Privilege 1-'t location
tr Grower Sales Privilege 2nd location
tr Grower Sales Privilege 3'd location otcc usE oNtY
Date application received:
to
By:
Lice Action(s)
clo
tr Limited On-Premises
n Off-Premises
tr Off-Premises with Fuel Pumps
tr Warehouse
! Wholesale Malt Beverage & Wine
tr Winery 1't Location
tr Winery 2nd Location
tr Winery 3'd Location
(Applicant #1)(Applicant #2)
(Applicant #3)(Applicant #4)
3. Trade Name of the Business (Name Customers WillSee)
Floshlr'.oq G'itl
4. Business Address (Number and Street Address of the Location that will have the liquor license)
tlzzq illi,r, st
S *nol,lJ
City County
htil(
Zip Code
qru76
OLCC l-iquor License Application (Rev. 4.5.19)Attachment 1, Page 1 of 4
OREGON LIQUOR CONTROL COMMISSION
LIQUOR LICENSE APPLICATION
5. Trade Name of the Business (Name Customers Will See)
f[othbov G,il(
6. Does the business address currently have an OLCC liquor license?ffives il*o
7. Does the business address currently have an OLCC marijuana license? flVeS E*O
8. Mailing Address/PO Box, Number, Street, Rural Route (where the OLCC will send your mail)
AUq ptuir 5t
Spri^aAd/
City State
03 ?lvt6
Zip Code
9. Phcine ru0fnber of the Business Location
c z7l
S'1( -72L -,
10. Email Contact for this Application
f lt",r. - fu,h*02@ q4,v il, Cou
11. Contact Person for this Application
f Lr;rlooh- Atl.,,. R*/,ta
ilt{one Number
qaIZIlrs og0
Contict Perso d's Ma i li ng Add ressl if d iffe rent)
lvtbl D s+
City
.br,"aL"lol }i7
State Zip Code
?tyt7
Please note that liquor license applications are public records. A copy of the application will be posted on the OLCC
website for a period of several weeks.
I understand that marijuana (such as use, consumption, ingestion, inhalation, samples, give-away, sale, etc.) is prohibited on
the licensed premises.
I attest that all answers on all forms, documents, and information provided to the OLCC are true and complete.
Appl icant Signature(sl
o Each individual person listed as an applicant must sign the application.o lf an applicant is an entity, such as a corporation or LLC, at least one person who is authorized to sign for the entity
must sign the application.. A person with the authority to sign on behalf of the applicant (such as the applicant's attorney or a person with
power of attorney) may sign the application. lf a person other than an applicant signs the application, please
provide authority
(Applicant #2)
(Applicant#3)(Applicant #4)
OLCC Liquor License Application (Rev. 4.6.19)Attachment 1, Page 2 of 4
OREGON LIQUOR CONTROL COMMISSION
LItMITED LIABILITY CON/PANY QUESTIONNAIRE
Please Print or Type
LLC Name:11[l Year Filed : TslQ
Trade Name (dba): f(qshbov A;Jt
Business Location Address: c1224 ttlta\a Sl-
City:*rirr"eicbt ZIP Code: glqb
List Members of LLC:
1. Cl,'stoot.t A BpL*
Percentage of Membership lnterest:
oo?"
ry,%
(managing r{rember)
Jo",*. l!,2.
3.
4.
5.
6.
(members)
(Note: lf any LLC member is another legal entity, that entity must also complete an LLC, Limited
Partnership or Corporafion Questionnaire. lf the LLC has officers, please list them on a separate
sheef of paper with their titles.)
I understand that if my answers are not true and complete, the OLCC may deny my license application.
Date: tolt/n
1-800-452-OLCC (65221
(title)
sig
www.olcc.state.or.us (rev.8/11)
Server Education Desisnee , ( hn+bpt'rd k . boehq DoB
Attachment 1, Page 3 of 4
OREGON LIQUOR CONTROL COMMISSION
BUSI NESS I N FORIVIATION
Please Print or Type
Applicant Name (t Phone: >ll'1Et@- (trll
Trade Name (dba): Flqshtcooc G..t(
Business Location Address: c{zzq nu.r^ sl.
City ZIP Code: 4lqtb
DAYS AND HOURS OF OPERATION
Business Hours:
Sunday 7no^ 1o 'l:oo e*.,Monday (i.3pA^ to lo,rF-
Tuesday L'30 prn to g:00 Pn
Wednesday biSoAr to 9:ooPp.
Thursday ' ?.'3,rA," to QEE-Fridav [30 A* b qtv p$
Saturday WoAr to1it?r
Outdoor Area Hours
Sunday -?A
Monday U"bk
Tuesday
Wednesday
Thursday
Friday
Saturday
to
to
to
to
to
to
to
---------:--rL
I
I
It
NO Aleoho I S,env ic,e, A*b4de/
The outdoor area is used for:
q?flroooservice Hours: JA to QP
tr Alcohol service Hours:to
!(Enclosed, how Ol>n@
The exterior area is adequately viewed and/or
supervised by Service Permittees.
(lnvestigator's lnitials)
tr
E
tr
tr
tr
Live Music
Recorded Music
DJ Music
Dancing
Nude Entertainers
Restaurant:
Lounge:
Banquet:
I understand if my answers
Check all that apply:
E Karaoke
E Coin-operated Games
E viO"o Lottery Machines
EI sociat Gaming
E PootTables
E ot"r,
Outdoor:
Other (explain)&0 - bac{L
Total Seating: _
Sunday
Monday
Tuesday
Wednesday
Thursday
Friday
to
to
to
to
to
to
1-800-452-OLCC (65221
wtwil.oregon.gov/olcc
OLCC USE ONLY
lnvestigator Verified Seating:_(Y) _(N)
lnvestigator lnitials:_
l-'l e*a'
complete, the OLGC may deny my license application.
ENTERTAINMENT DAYS & HOURS OF LIVE OR DJ MUSIC
SEATING COUNT
Applicant Sig 9"L. to /zz/ tl
(rev. 12/07)
Seasonal Variations: E Yes tr No lf yes, explain:
Attachment 1, Page 4 of 4