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Home My WebLink AboutItem 06 Time Out Tavern Liquor License AGENDA ITEM SUMMARY Meeting Date: 4/19/2021 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 MAD DOG INC, DBA: TIME OUT TAVERN. ACTION REQUESTED: Endorsement of OLCC Liquor License Application for Time Out Tavern, located at 5256 Main St. Springfield, OR 97478. ISSUE STATEMENT: The owner of Mad Dog Inc 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 Mad Dog Inc, DBA: Time Out Tavern is for a Change of Ownership with Full On-Premises and Off-Premises Sales. The license application has been reviewed and approved by the appropriate City Departments. OREGON LIQUOR CONTROL COMMISSION LIQUOR LICENSE APPLICATION 1. Application. Do not include any OLCC fees with your appiication packet (the license fee will be collected at a later time). Application is being made for: License Applied For:CITY AND COUNTY USE ONLY Date application received and/or date stamp: Nsme of City or County: € Brewery 1"' Location Brewery Additional location (2"d) € (3'd) € € Brewery-Public House (BPH) T'location BPH Additional location (2'd) € (3'd) € € Distillery @ FLIII On-Premises. Commercial € Full On-Premises, Caterer Recommends this license be: € Granted € Denied B7: € Full On-Premises, Passenger Carrier € Full On-Premises, Other Public Location € Full On-Premises, For Profit Private Club Date:€ Full On-Premises. Nonorofit Private Club € (irriwpr S;qlpq Privilppp ((igP1 1 " Inr,:itinn - - ' - a a - a - - a - - a a a o a a -5 - 1- - a / - a - - - - ' - ' a Dale application receiOvelCdc: UsE 30NfYl ll gl oateappiicationacceptea:319(g(9( GSP Additional location (2"d) € (3'd) € € Limited On-Premises € Off-Premises € Warehouse LJ Wholesale Malt Beverage & Wine License Action(s): cir>,c,4-nq-% h(pi-iv € Winery l"f Location Winery Additional location (2'd) € (3'd) € (4th) @ (sth) @ 2.ldentifytheapplicant(s)applyingforthelicense(s). ENTITY(example:corporationorLLC)orlNDMDUAL(S)1 applying for the license(s): Mad Dog Inc. App#l:NAMEOFENTITYORINDIVIDUALAPPLICANT App#2:NAMEOFENTITYORINDMDUALAPPLICANT App #3: NAME OF ENTITY OR INDMDUAL APPLICANT App#4: NAME OF ENTITY OR INDMDUALAPPLICANT 3. Trade Name of the Business (Name Customers Will See) Time Out Tavern 4. Business Address (Number and Street Address of the Location that will have the liquorlicense) 5256 Main St. City Springfield County Lane Zip Code 97478 I Read the instructions on page I careftdly. If an is applying for the license, list the name of the e3 as an applicant. If an individual is applying as a sole proprietor (no entity), list the individual as an applicant. OLCC Liquor License Application IRev 9 28 20)Attachment 1, Page 1 of 3 OREGON LIQUOR CONTROL COMMISSION LIQUOR LICENSE APPLICATION 5. Trade Name of the Business (Name Customers Will See) Time Out Tavern 6.DoesthebusinessaddresscurrentlyhaveanOLCCIiquorlicense? iyes aNO 7. Does the business address currently have an OLCC marijuana license? nYES nNO 8. Mailing Address/Pa Box, Number, Street, Rural Route (where the OLCC will send your license certificate, renewal application and other mailings as described in OAR 845-004-0065JlJ.) 38C14 Kathryn Ave Unit A C"y Springfield State Oregon Zip COdeez,i-rs 9. Phone Number of the Business Location 541 746-2148 10. Email Contact for this Applicat.on and for the Business Chris@oregoncreativesolutions.com 11. Contact Person for this Application ' Christopher Craig Phone Number 541-543-3324 Contact Person's Mailing Address (if different) 39285 Upper Camp Creek Rd. City Springfield State Oregon Zip Code 97478 Please note that liquorlicense applications are public records. A copy of the application will be posted on the OLCC website for aperiod of several weeks. ATTESTATION: "READ CAREFULUI AND MAKE SURE YOU UNDERST AND BEFORE SIGNING THIS FORM"" I understand that marijuana is on the licensed premises. This includes marijuana use, consumption, ingestion, inhalation, samples, give-away, sale, etc. I attest that all answers on all forms and documents, and all information provided to the OLCC as a part of this application are true and complete. I affirm that I have read OAR 845-005-0311 and all individuals (so!e proprietors) or entities with an ownership interest (other than waivable ownership interest per OAR 845-005-0311[6]) are listed as license applicants in #2 above. I understand that failure to list an individua) or entity who has an unwaivable ownership interest in the business may result in denial of my license or the 01CC taking action against my license in the event that an undisclosed ownership interest is discovered after license issuance. Applicant(s) Signature * Each individual (sole proprietor) listed as an applicant must sign the application below. * If an applicant is an entity, such as a corporation or LLC, at least one INDMDUAL who is authorized to sign for the entity must sign the application. * Anindividualwiththeauthoritytosignonbehalfoftheapplicant(suchastheapplicant'sattorneyoranindividualwith powerofattorney)maysigntheapplication. Ifanindividualotherthananapplicantsignstheapplication,pleaseprovide written proof of signature authority. Attorneys signing on behalf of applicants may list the state of bar licensure and bar number in lieu of written proof of authority from an applicant. Applicants are still responsible for all information on this form. App #1: [SIGNATURE) Christopher Craig App. #1: (PRINT NAME)App #1: Signature Date Atty. Bar Information (ifapplicable) App. #2: (PRINT NAME)App #2: (SIGNATURE}App #2: Stgnature Date Atty. Bar Information (if applicable) App. #3: (PRINT NAME)App #3: (SIGNATURE)App #3: Signature Date Atty. Bar Information (if applicable) App. #4: (PRINT NAME)App #4: (SIGNATURE)App #4: Signature Date Atty. Barlnformation (ifapplicable) OLCC L:QllOT License Application (Rev. 9.28.201Attachment 1, Page 2 of 3 OREGON LIQUOR CONTROL COMMISSION BUSINESS INFORMATION Please Print or Type ZIP Code: Business Hours: Mondayutol Wednesday to Thursday to 7 Fr'day toW Saturday to Outdoor Area Hours: MOndaY ItO g Tuesday kto8 Wednesday 8 to pr:aay tom Saturday ito4 Seasonal Variations: [] Yes € No If yes, explain: Live Music CrRecorded Music Cl DJ Music CI Dancing CI Nude Entertainers Check all that apply: € Karaoke rdeo Lottery Machines € Social Gaming € Other: The outdoor area is used for: 6od service Hours:lto I hol service Hours: uto 4 The exterior area is adequately viewed and/or supervised by Service Permittees. (Investigator's Initials) I understand if my answers are no% true and compl te, the O!QQ may deny my license application. 1 -800-452-OLCC (6522) www.oregon.gov/olcc (rev72/07) Attachment 1, Page 3 of 3