HomeMy WebLinkAbout2015-02-23-Meeting Agenda
Public Service Committee Meeting Commission Chamber- 2/23/2015- 1:00 PM
PUBLIC SERVICES
1. New Application: A. N. 15 - 05: A request by Michael Thomas
Evertsen for an on premise consumption Liquor, Beer & Wine
license to be used in connection with Forty-One, Inc. D/B/A
Tin Lizzy's Taqueria Cantina located at 2821 Washington Rd.
There will be Sunday sales. District 7. Super District 10.
Attachments
2. New Application: A. N. 15 - 06: A request by Ok Pun Kartye
for a retail package Liquor, Beer & Wine license to be used in
connection with OK Wine & Spirits located at 2811 Tobacco
Rd. There will be Sunday Sales. District 4. Super District 9.
Attachments
3. New Application: A. N. 15 - 07: A request by Richard Kellogg
for an on premise consumption Liquor, Beer & Wine license to
be used in connection with The Touch of Class located at 3156
Wrightsboro Rd. There will be Dance. District 2. Super
District 9.
Attachments
4. New Application: A. N. 15 - 08: A request by Eric Kinlaw for
an on premise consumption Liquor, Beer & Wine license as
well as a retail package Beer & Wine to be used in connection
with The Hive located 215 Tenth St. There will be Sunday
Sales. District 1. Super District 9.
Attachments
5. New Ownership Application: A. N. 15 - 09: A request by
Hemant K. Patel for a retail package Beer & Wine license to
be used in connection with Ja Ho Market located at 1770
Kissingbower Rd. Therer will be Sunday Sales. District 2.
Super District 9.
Attachments
6. New Ownership Application: A. N. 15 - 10: A request by
Shena Brewer for an on premise consumption Liquor, Beer &
Wine license to be used in connection with Wheeler Tavern
located at 3664 Wheeler Rd. There will be Dance. District 3.
Super District 10.
Attachments
www.augustaga.gov
7. New Ownership Application: A. N. 15 - 11: A request by
Ritaben Patel for a retail package Beer & Wine License to be
used in connection with Super Express #7 located at 1901
Gordon Hwy. District 5. Super District 9.
Attachments
8. Discussion: A request by Henry Todd Schafer for a Sunday
Sales license to be used in connection with Abel Brown
located at 491 Highland Ave Ste B. There will be Sunday
Sales. District 7. Super District 10.
Attachments
9. Discussion: A request by Faulkner Warlick for a Sunday Sales
license to be used in connection with Finch & Fifth located at
379 Highland Ave. There will be Sunday Sales. District 7.
Super District 10.
Attachments
10. Discussion: A request by Marva Renee Little for a Therapeutic
Massage Operators License to be used in connection with
Marva's Relaxing Bodywork located at 6070 Reynolds Circle,
Grovetown, Ga 30813. (massage outcall) District 1 thru 8.
Super District 9 & 10.
Attachments
11. Discussion: A request by the RCSO for a hearing to consider
the possible Probation, Suspension or Revocation of the
alcohol license and business license held by Ralph H. Dillman
Jr for Ralph's Five Pines Lounge, Inc. located at 2301 Gordon
Hwy for violating the controlled substance law. District 3.
Super District 10. (Referred from February 9 Public Services
Committee)
Attachments
12. Motion to approve the minutes of the Public Services
Committee held on February 9, 2015.
Attachments
Public Service Committee Meeting
2/23/2015 1:00 PM
Alcohol Application
Department:Planning & Development
Caption:New Application: A. N. 15 - 05: A request by Michael Thomas
Evertsen for an on premise consumption Liquor, Beer & Wine
license to be used in connection with Forty-One, Inc. D/B/A Tin
Lizzy's Taqueria Cantina located at 2821 Washington Rd. There
will be Sunday sales. District 7. Super District 10.
Background:This is the former location of Roadrunner Cafe.
Analysis:The applicant meets the requirements of the City of Augusta's
Alcohol Ordinance.
Financial Impact:The applicant will pay a fee of $5445.00.
Alternatives:
Recommendation:Planning & Development recommends approval. The RCSO
recommends approval.
Funds are Available
in the Following
Accounts:
REVIEWED AND APPROVED BY:
Finance.
Law.
Administrator.
Clerk of Commission
Cover Memo
Item # 1
Augusta-Richmond C ounty
1815 Marvin Griffin Road
Augusta, GA 30906
ALCOHOL BEVERAGE APPLICATION
l.
2.
aJ.
4.
5.
Alcohol Number
Name of Business Fortv-One, lnc. d/b/a Tin Lizzy's Taqueria Cantina
Business Address 2821 Washington Road
City Auousta State GA Zip 30909
Business Phone (404-) 822.3849 Home Phone ( 678 ) 849.7922
Applicant Name and Address: Michael Thomas Evertsen
100 Hampton Walk
Marietta. GA 30067
Applicant Social Security #D.o.B. Zlpnl-1-999-
If Application is a transfer, list previous Applicant:
Road Runner Cafe
Year 2015 Alcohol AccountNumber /Oti' l{o
6.
7.
8.
9.
Business Location: Map & Parcel 0120065010 Zoning C3
Location Manager(s)TBD - Michael Evertsen and Andrew McKoski
for ooenino.
10. Is Applicant an American Citizen or Alien lawfully admitted for permanent residency?(X)Yes ( ) No
OWNERSHIP INFORMATION
Corporation (if applicable): Date Chartered: 81112002
Mailing Address:
Name of Business Forty-One, lnc. d/b/a Tin Lizzy's Taqueria Cantina
ll.
12.
Attention
Address
CitylStatelZip
Michael Evertsen
2030 Powers Ferry Road, SE, Suite 460
Atlanta, GA 30339
13.
14.
Ownership Type:
Corporate Name:
(X)Corporation ( )PartnershipForty-One, lnc.
( ) Individual
T ist name and other required information for each person having interest in this business.
Name Position SSNO #Address I Interest
Michael Evertsen Owner I 100 Hampton Walk, Marietta, 30067 30%
John Piemonte Owner 1805 Buckhead Ln, Atlanta, 30324 25o/.
Chris Hadermann Owner 3954 Sheldon Dr, Atlanta,30342 25o/<
Andrew McKoski Owner 502 Hascall Road, Atlanta, 30309 20ol
15.What type of business will
(X) Restaurant (
( ) Package Store (
you operate in this location?( ) Convenience Store) Lounge
) Other:
Total License Fee: 5 5445 + 120 app fee
Prorated License Fee: (After July 1 ONLY) $
16.Have you ever applied for an Alcohol Beverage License before:Not in Augusta-Richmond
If so, give year of application and its disposition:
License Information Liouor Beer Wine Dance Sundav Sales
Retail Packase Dealer
Consumption on Premises X X x X
Wholesale
17.
alcoholic beverages? (X) Yes ( ) No If so, please initial.
Are you familiar with Georgia and Augusta-Richmond County laws reg4
Attachment number 1 \nPage 1 of 2
Item # 1
18.AAach a passport-size photograph
(front view) taken within two y"ars.
Write name on back of the dealer
submitting the license application.
Has any liquor business in which you hold, or have held, any financial inLterest, or areemployed, or have been employed, ever been cited for any violation of the rules andregulations of Richmond County or the State Revenue Commission relatirrLg to the saleand distribution of distilled spirits? ( ) yes (X ) No
19.
If yes, give full details:
20.Have you ever been arrested, or held bV F
List owner or owners of building and property.
lffalter W. Lyon - 318 Coffee Ave S., Douglas, GA 31533
authorities, for any violation of any Federal, State, County or Municipal law, regulationor ordinance? (Do not include traffrc violations, with the exception of any iff.rr..,pertaining to alcohol or drugs.) All other charges must be included, "r"r if they aredismissed. ( )Yes (x)No
If yes, give reason charged or held, date and place where charged and its disposition.
21.
22.
23.
Listthenameandotherrequiredinformationforeachperson,fi,m@
any interest in the business.
See #14
If a new application, attach a surveyor's plat and state the straight line distan"e fro- the
property line of school, church, library, or public recreation area to the wall of the
building where alcohol beverages are sold.
A.) Church
B.) Library
C.) Schoolnla nla
D.) Public Recreation
State of Georgia, Augusta-Richmond County,I, Michael Thomas Evertsen
Do solemnly swear, subject to the penalties of false swearing, that the statements and
answers made by me as the applj in the forgoing alcoholic beverage application are
true-
25.I hereby certiff that Mich Evertsen is personally known to be,
nla nla
24.
that he/she signed hislher name to
knew and understood all statements
The Board of Commissioners on the day of
(Approved, Disapproved) the forgoing application.
the foregoing application stating to me that he/she
and answers made herein, and, under oath acfually
administered by me, has sworn that said statements and answers are true.This (p aay of 4r-,b , in the V"u, Xp ii- .
*lPl-.?tvst,-giomi,
'rsdl,ltiv6irib6ff#orsFOR OFFICE USE ONLY
Department
Recommendation
Alcohol Insoector
Administrator Date
in the year
Attachment number 1 \nPage 2 of 2
Item # 1
Public Service Committee Meeting
2/23/2015 1:00 PM
Alcohol Application
Department:Planning & Development
Caption:New Application: A. N. 15 - 06: A request by Ok Pun Kartye for a
retail package Liquor, Beer & Wine license to be used in
connection with OK Wine & Spirits located at 2811 Tobacco Rd.
There will be Sunday Sales. District 4. Super District 9.
Background:This is a new location.
Analysis:The applicant meets the requirements of the City Of Augusta's
Alcohol Ordinance.
Financial Impact:The applicant will pay a fee of $4660.00.
Alternatives:
Recommendation:Planning & Development recommends approval. The RCSO
recommends approval.
Funds are Available
in the Following
Accounts:
REVIEWED AND APPROVED BY:
Finance.
Law.
Administrator.
Clerk of Commission
Cover Memo
Item # 2
Alcohol Number
l. Name of Business
2. Business Address
3. City
4. Business5. Applicant Name and Address:
Applicant Social Security #
If Application is a frqnsfer, list previous Applicant:
Augusta-Ricirmonrl C ountY
l8l5 Ivlarvin Griffin Road
Augusta, GA 30906
ALCOHOL BEVERAGE APPLICATION
Year'Alcohol Account Nrrmber hl6:: 11
# Phone(!&) %o r|il.e
Z,AI
D.o.B. t7 - t5 - nr+6.$
$Business Location: Map & Parcel Zoning
Location Manager(s)
11.
12.
10. Is Applicant an Americaq0r=@or Alien lawfully admitted for permanent residency?
({Yes ( )No
OWNERSIilP INFORMATION
Corporation(ifapplicable): DateChartered: t-lc- {*lO *70?2
Mailing Address:
Name of Btisiness
Attention
Address
CrtylStatelZip
Corporate Name: Lf-C
List name and other required information for each person having interest in this business.
15.What type of business will you operate in this location?( ) Restaurant(/) Package Store ( ) Other:
( ) Lounge ( ) Convenience Store
Total License Fee: $
Prorated License Fee: (After July I ONLY) $
Have you ever applied for an Alcohol Beverage License before: fE9
If so, give year of application and its disposition: *oD7/ ao 4W
alcoholic beverages? (p Yes ( ) No If so, please initial. 0k
-
13.
14.
16.
( ) Individual
Name Position SSNO#Address Interest
F\,<- kkL-fJ=-0t,flEP-E}*lz.|lLNT-kkffi&"fi I O0 e/n
Lisensb Information Liquor Eleer Wine Dance Sundav Sales
Retail Packase Dealer x x x v
Consumption on Premises
lVholesale
17.
Attachment number 1 \nPage 1 of 2
Item # 2
18.Attach a passport-size photograph
(front view) taken wilhin two years.
Write name on back of the dealer
submitting the license application.
19. Has any liquor business in which you hold, or have held, any financial interest, or are
employed, or have been employed, ever been cited for any violation of the rules and
regulations of Richmond County or the State Revenue Commission relating to the sale
and distribution of distilled spirits? (X) Yes ( ) No
If yes, give tull details: UAIFR ArtF .cN,E
20.Have you ever been arrested, or held by Federal, State, or other law-enftrrcement
authorities, for any violation of any Federal, State, County or lvlunicipal law, regulation
or ordinance? (Do not include fiaffrc violations, with the exception of any offenses
pertaining to alcohol or dnrgs.) All other charges must be included, even if they are
dismissed. ( )Yes (pNo ,,
If yes, give reason charged or held, date and place where charged and its dispositlon.
'{,21.
22.List the name and cther required inforrnation for each person, firm or corporation having
any interest in the business.
0K_ ?ut cttot 4frPTyT=
23. If a neW application,.dffach a surveyor?s plat and staie the straight line distance from the
property iine of school, church, librry, or public recreation area to the wall of the
A.) Church b>o H - C.) School )-ll7
Public R.ecreation
YF
Do solemnly swear, subject to the,penalties of false
answers made by rire as the applicant in the f,orgoing alcoholic beverage application are
true.
I hereby certifu that qr< f xWe . - - - is personally known to be,
that heishe signed hisArer name to the tbregolng application stating to me that he/she
knew and understood all statements and answers made herein, and, under
administered by me, has swnrn that said statements and answers are
This &?t day of ---:, in the ]rear
lc
FOR OFFICE TJSE ONI,Y
I Department I App..,'.,*i'D.ni'Coiiun.:nts
*t_..-.-*-
The Board oiCommissioners or:. the -:---- dai; of'
(Approved, Disapprcved) the forgoing applicat.ir:n.
B.) Library Z i4 t',lr D.)
State of Georgia; Augusta-Richmond County,I,24.
25.
I
I
--LI
List owner or owners of building and property.
Recommendaticn
Alcohol Inspgqt_ol
Administrator Date
in the year
Attachment number 1 \nPage 2 of 2
Item # 2
Public Service Committee Meeting
2/23/2015 1:00 PM
Alcohol Application
Department:Planning & Development
Caption:New Application: A. N. 15 - 07: A request by Richard Kellogg for
an on premise consumption Liquor, Beer & Wine license to be
used in connection with The Touch of Class located at 3156
Wrightsboro Rd. There will be Dance. District 2. Super District 9.
Background:This is the former location of Cloud Nine Bar & Grill.
Analysis:The applicant meets the requirements of the City of Augusta's
Alcohol Ordinance.
Financial Impact:The applicant will pay a fee of $4781.00.
Alternatives:
Recommendation:Planning & Development recommends approval. The RCSO
recommends approval.
Funds are Available
in the Following
Accounts:
REVIEWED AND APPROVED BY:
Finance.
Law.
Administrator.
Clerk of Commission
Cover Memo
Item # 3
Augusta-Richmonrl C ounty
18l5 Marvin Griffin Road
Augusta, GA 30906
ALCOHOL BEVER.AGE AT'PLICATION
Year Alcohol Account Number
l.
2.
aJ.
4.
5.
Alcohol Number
Name of Business
iness Address
Applicant Social Security #
If Application is a transfer, list previous Applicant:
4o(? LB
4?d-4o3"
o.n. 2/q/, <46.
7.
8.
9.
10.
Business Location: Map
Location Manager(s)
W*l"lti:*t"an citizen or Alien lawtully admitted for permanent residency?
OWNTERSHIP INFORMATION
Corporation (if applicable): Date Chartered:
Mailing Address:
Name of Bdsiness
Attention
Address
City/StatelZip
Ownership Type:
Corporate Name:
( ) Partnership (' ) Individual
List name and other required information for eaih person having irt"r.rt ip thir b,oin"rr.
15.What type of business will you operate in this location?
(,x) Restaurant (,,{ Lounge ( ) Convenience Store( )PackageStore ( )Other:
Total License Fee: $
Prorated License Fee: (After July 1 ONLY) $--
familiar wi Augusta-Richmond County laws regard
11.
12.
13.
14.
16.Have you ever applied for an Alcohol Beverage License before: 4" "lf_so, give year of app-lication and its disposition:
License Information
t7.
alcoholic beverages?( )No If so, please initial.
Attachment number 1 \nPage 1 of 2
Item # 3
18. Attach a passport-size photograph
(front view) taken rvithin two years.
Write name on back of the dealer
submitting the license application.
19. Has any liquor business in which you hold, or have held, any financial interest, or are
employed, or have been employed, ever been cited for any violation of the rules and
regulations of Richmond County or the State Reve11rc Commission relating to the sale
and distribution of distilled spirits? ( ) Yes |rTNoIf yes, give full details:
20.Have you ever been arrested, or held by Federal, State, or other law-enforcement
authorities, for any violation of any Federal, State, County or Municipal law, regulation
or ordinance? (Do not include traffic violations, with the exception of any offenses
pertaining to alcohol or drugs.).-A{f other charges must be included, even if they are
dismissed. ( )Yes UrTNoIf yes, give reason charged -or held, date and place where charged and its disposition.
22. List the name and other required inforrnation for each person, firm or corporation.having
any interest in,the business.
If a neW applicatiori, dttacha surve,vor?s plat and state the straight line distance liom the
properiy iine bf school, church, iil:rary, or public resreation area to the wall of the
building where alcohol beverages are sold.
C.) School
2t.
23.
A.) Church
B.) Library D.)
24.State of Georgia, Augusta-Richmond County, I,
Do solemnly swear, subject to the,penalties of false swearing, that the s ts and
answers made by me as the agplicapt i ic beverage ication are
true.
icant25. I hereby certifr is perGofially known to be,
that he/she signed his/her name to the ication stating to me that he/she
knew and understood all statements and answers made herein, and, under oath
administered bv me. htnis C/ ?fday'of
wom that said statements and answers are true.
Public
FOR OFFICE IISE ONLY
The Board of Commissioners on the --- day of ;
(Approved, Disapproved) the forgoing application.
/-x
Administrator Date
in tl-re year
Attachment number 1 \nPage 2 of 2
Item # 3
Public Service Committee Meeting
2/23/2015 1:00 PM
Alcohol Application
Department:Planning & Development
Caption:New Application: A. N. 15 - 08: A request by Eric Kinlaw for an
on premise consumption Liquor, Beer & Wine license as well as
a retail package Beer & Wine to be used in connection with
The Hive located 215 Tenth St. There will be Sunday Sales.
District 1. Super District 9.
Background:This is a new location.
Analysis:The applicant meets the requirements of the City of Augusta's
Alcohol Ordinance.
Financial Impact:The applicant will pay a fee of $7320.00.
Alternatives:
Recommendation:Planning & Development recommends approval. The RCSO
recommends approval.
Funds are Available
in the Following
Accounts:
REVIEWED AND APPROVED BY:
Finance.
Law.
Administrator.
Clerk of Commission
Cover Memo
Item # 4
Augusta-Richmond County
18l5 Marvin Griffin Road
Augusta, GA 30906
ALCOHOL BEVERAGE APPLICATION
Year' Alcohol Account Ntrmber
l.
2.
3.
4.
5.
Alcohol Number
Name of Business
Business Address
Applicant Social Security #
If Application is a transfer, list previous Applicant:
6.
7.
D.O.B. d?to41414
State
Home Phone (?0b )
t0.
8.
9.
11.
12.
13.
14.
Business Location: Map & Parcel Zoning
Location Manager(s)
Is .{,pplicant an American Citizen or Alien lawfully admitted for permanent residency?
lyJves ( ) No
OWI\iERSIilP INFORMATION
Corporation (if applicable): Date Chartered:
Attention
Address
CitylStatelZip
Ownership Type:
Corporate Name:
()
List name and other required information for each person having interest in this business.
15. Wllt type of business will you operate in this location?
(/)Restaurant ()Lounge ().ConvenienceStore
( )PackageStore ( )Other:
Total License Fee: $
Prorated License Fee: (After July I ONLY) $
16.Have you ever applied for an Alcohol Beverage License before: K' -
If so, give y"* of upplication and its disposition: ?OOt - Cmt* l;cnu,tu
Mailing Address:
Name of Business -11,{ \Lto- G.ral,t\r- 9r.-
Augusta-Richmond County laws regardinq the sale of
alcoholic beverages? qr) Ves ( ) No lf so, please initial. 4!+-
) Individual
Name Position SSNO #Address lnterestInr- t{"^L.^r 1o-Olnlncr F'11 Cavloll,'a$4.qno
Il.rlsh, lZi'.\av (n -O,ol.ncr .It9r "T?.'-Y'i-?,'TYl SDYoKyttrrcr&'rAao'l
17.
Attachment number 1 \nPage 1 of 2
Item # 4
18.Attach a passport-size photograph
(front view) taken rvithin two years.
Write name on back of the dealer
submitting the license application.
If yes, give full details: _
Have you ever been arrested, or held by Federal, State, or other law-enfbrcement
authorities, for any vioiation of any Federal, State, County or Municipal law, regulation
or ordinance? (Do not include trafric violations, with the exception of any offenses
pertaining to alcohol or drugs.) All other charges must be included, even if they are
dismissed. ( ) Yes (y-{ No
If yes, give reason charged or held, date and place where charged and its disposition.
1 ,..{
19.
20.
Has any liquor business in which you hold, or have held, any financial interest, or are
employed, or have been employed, ever been cited for any violation of the iules and
regulations of Richmond County or the State ReTenue Comrnission relating to the sale
and distribution of distilled spirits? ( ) Yes (lt No
21.List owner or owner! of building and property"
t-)at\a,w.r^^ 0^*.rn,
23.
22. a
any interest in,the ,business. :
If a nerv application,.attach a srerveyol'ts plat and sta'te the straight line distance from the
property linerof school, church,library, or- public recreaticn'area to the wall of the
A.) Church
B.) Library
C.) School
D.)Public Rbcreation
24. State of Georgi4 Augusta-Richmond County, I,
Do solemnly swear, subject to the pehal lse swearing, that the statements and
answers made by me hs the applicant in alcoholic beverage application are
tnre.
I hereby certifu that
SignaturetcAD is personally known to be,
that he/she signed his/her name to the foregoing application stating to me that helshe
knew and understood all statements and answers made herein, and, under oath acfually
Nctary Public
FOR OTFICE USE ONLY
Alcohol trn
Sheriff
The Board oiCornrnissioners on the -j ,-- day of .
(Approved, Disapproved) the forgoing application.
25.
,ddministratcr Date
in tt-re year
Attachment number 1 \nPage 2 of 2
Item # 4
Public Service Committee Meeting
2/23/2015 1:00 PM
Alcohol Application
Department:Planning & Development
Caption:New Ownership Application: A. N. 15 - 09: A request by Hemant
K. Patel for a retail package Beer & Wine license to be used in
connection with Ja Ho Market located at 1770 Kissingbower
Rd. Therer will be Sunday Sales. District 2. Super District 9.
Background:This is a new ownership application. Formerly in the name of
Kirktikaben Patel.
Analysis:The applicant meets the requirements of the City of Augusta's
Alcohol Ordinance.
Financial Impact:The applicant will pay a fee of $1330.00.
Alternatives:
Recommendation:Planning & Development recommends approval. The RCSO
recommends approval.
Funds are Available
in the Following
Accounts:
REVIEWED AND APPROVED BY:
Finance.
Law.
Administrator.
Clerk of Commission
Cover Memo
Item # 5
Alcohol Number
Name of Business
Business Address
City
Applicant Social Security #
If Application is a trqnsfer, list previous Applicant:
Augusta-Idchmond C ounty
1815 Ivlarvin Griffin ]load
Augusta, GA 30905
ALCOHOL BEVF]RAGE APPLICATIO}\
State efi
Year Alcohol Account Number t t-' I 4 q
t+o KEt.
2.
3.
4.
5.
t-qqo4wl
k i.es i,'!^
6.
7.
8.
9.
10.
13.
14.
Business Location: Map & Parcel Zoning
Location Manager(s)
American Citizen or Alien lawfully admitted for permanent residency?
No
OWI\ERSIilP INFORMATION
Corporation (if applicable): Date Chartered:
Mailing Address:
Name of Business dfA H0 h4 RRH Pf
Attention
Address
CitylStatelZip
Ownership Type:( ) Partnership ( ) tndividual
Corporate Name: 9EDJ\ 11L 20 l2- LL?-
List name and other required information for each person having interest in this business.
15.What type of business will you operate in this location?( ) Restaurant ( ) Lounge l,fionvenience Store( )PackageStore ( )Other:
Total License Fee: $
Prorated License Fee: (After July I ONLY) $
16.Have you ever applied for an Alcohol Beverage License before:Au
If so, give year of application and its disposition:
Is Applicant an
1,zf?es ( )
I l.
12.
era
Name Position SSNO #Address lnterest'l-le*.,^"nl P^Jd C\\sh\ tory-,?rq.hK <<P,-iwgLci',\c
| 4!rrsus.,b". rJ .2osr<r
50 \'
trle"rqi"Lt Ztal CJ Ui9e"Y -92i,w- c .Cr'-imLooce 5ol,
License Information Liquor Beer Wine Dance Sunda'y Sales
Retail Packase Dealer L/'
Consumption on Premises
Wholesale
Are you familiar with Georgla and Augusta-Richmond County laws regarding$e sale of
alcoholic beverages? (-Yfes ( ) No [f so, please initial. \t'r\17.
Attachment number 1 \nPage 1 of 2
Item # 5
18. Attach a passport-size photogrrph
(front vievr) taken rvithin two year.
Write name on back of the dealer
submitting the license application.
19. Has any liquor business in which you hold, or have held, any financial interest, or are
etnployed, or have been employed, ever been cited for any violation of the rules and
regulations of Richmond County or the State Revenue Commission relating to the sale
and distribution of distilled spiriis? ( ) Yes tfuoIf yes, give fulldetails:
20.Have you ever been arrested, or held by Federal, State, or other law-enfbrcement
authorities, for any violation of any Federal, State, CounE or Municipal law, regulation
or ordinance? (Do not include traffic violations, with ttre exception of any offenses
pertaining to alcohol or drugs) All other charges must be included, even if they are
dismissed. ( )Yes frN,If yes, give reason charged or held, date and place where charged and its disposition.
2t.List owner or owners of building and property./.t'r . flrJd
22. Ltst tt* **",
any interesi in,the business.
73. If a neW application, dfiaeh a surveyor?s plat and state the straight line distance from the
property line bf school, church, library, or puirlic resreation area to the wall of the
A.) Church
B.) Library
C.) School
D.) Fublic R.ecreation
24.State of Georgia, Augusta-Richmond County,I,
Do solemnly swear, subject to the penalties of false swearing, that the staterrLents and
answers made by me hs the applicant in the 'forgoing alcoholic beverage application are
true.
25. I hereby certif,i that is personally known to be,
that he/she signed his/her name to the foregoing application stating to me that helshe
knew and understood all statements and answers made herein, and, under oath actually
administered by me, has swom that said statements and answers are true.
This lf, day of in the year ,la'a"-.
Department Approve Comments
The Board oiCommissioners on iit*: .--... -.,ja;v of ---- -- .-- -.---, in tlre year
(Approved, Disapprcved) the forgoing app[ication.
ll f)';dApplicant Signature'
Date
FOR OF'FICE USE ONLY
Adririnistrator
Attachment number 1 \nPage 2 of 2
Item # 5
Public Service Committee Meeting
2/23/2015 1:00 PM
Alcohol Application
Department:Planning & Development
Caption:New Ownership Application: A. N. 15 - 10: A request by Shena
Brewer for an on premise consumption Liquor, Beer & Wine
license to be used in connection with Wheeler Tavern located at
3664 Wheeler Rd. There will be Dance. District 3. Super District
10.
Background:This is a new ownership application. Formerly in the name of
George V. Raley.
Analysis:The applicant meets the requirements of the City of Augusta's
Alcohol Ordinance.
Financial Impact:The applicant will pay a fee of $4778.00.
Alternatives:
Recommendation:Planning & Development recommends approval. The RCSO
recommends approval.
Funds are Available
in the Following
Accounts:
REVIEWED AND APPROVED BY:
Finance.
Law.
Administrator.
Clerk of Commission
Cover Memo
Item # 6
Augusta-Richmond C ounty
1815 Marvin Griffin Road
Augusta, GA 30906
ALCOHOL BEVERAGE AFPLICATION
Year' _ Alcohol Account Number
1.
2.
3.
4.
5.
Alcohol Number
Corporate Name:
Citylstatelzip t
Ownership Type: Q/) Corporation
Name of Business
Business Phone
State
Home
Applicant Name and
Applicant Social Security # D.O.B.
If Application is a hqnsfer, list previous Applicant:
Busiiress Location:
Location Manager(s)
ls ,!aplicant an American Citizen or Alien lawfully admitted for permanent residency?\7fv"' ( ) No
OWITERSTilP INFORMA
Mailing Address:
Name of Business
Attention
Address
l,'t/
(fi
Business
cilv
-
6.
7.
8.
9.
10.
I l.
12.
13.
14.
( ) Ifrdividual
List name and other required information for each person having interest in this business.
15.What type of business will you operate in this location?( ) Restaurant( ) Package Store
Total License Fee: $
Prorated License Fee: (After July 1 ONLY) $
( )Lounge ( )ConvgnienceStoreg7f other: Hdiftt tf n+ / R 2
16. Have you ever applied for an Alcohol Beverage License before: /V0
Sundav Sales
Consumption on Premrses
17.Are you familiar with Georyia and Augusta-Richmond Countl'laws
alcoholic beverages? (r,fnes ( ) No If so, please init
sale of
Attachment number 1 \nPage 1 of 2
Item # 6
18.Attach a passport-size photograph
(front view) taken rvithin two years.
Write name on back of the dealer
submitting the license application.
19.Has any liquor business in which you hold, or have held, any financial interest, or are
employed, or have been employed, ever been cited for any violation of the rules and
regulations of Richmond County or the State Revenue Commission relating to the sale
and distribution of distilled spirits? ( ) Yes V1*olf yes, give full details:
20.Have you ever been arrested, or held by Federal, State, or other law-enftrrcement
authorities, for any vioiation of any Federal, Siate, County or Municipal law, regulation
or ordinance? (Do not include traffic violations, with ttre exception of any offenses
pertaining to alcohol or drugsr), All other charges must be included, even if they are
dismissed. ( )Yes WNoIf yes, give reason charged br held, date and place where charged and its disposition.
List the name and other required information for each person, firm or corporation having
any in,the business.
23. If a neW applicatiort, dttach a surveyor?s plat and state the straight line distance from the
property tine bf school,. church, library, or public recreation area to the wall of the
A.) Church
B.) Library
C.) School
24.State of Georgia, Augusta-Richmond County,I,
Do solemnly sweal, subject to the puralties ng, thaf the statements and
answers made by me as the. appli ic beverage application are
true.
21.
D.)lc
25.
n r AppllqpPSigfnahlFe
lherebycertiff tnat lWlll\-brUdy is personally knowrr ro be,
that he/she signed his/her name to the foregoing application stating to me that he/she
knew and understood all statements and answers made herein, and, under oath actually
administered by me, has swom that said statements and answers are true.rnis &r'lfiday of .)ayuOvr4 , in the year Qot1
rst owner or ow of building and property
FOR OFFICE USE ONLY
Recommendation
Approve Deny Comrnents
Alcohol Insoector
Sheriff
Fire I
The Board oiCommissioners on the day of
(Approved, Disapproved) the forgoing application.
Administrator Date
in the year
Attachment number 1 \nPage 2 of 2
Item # 6
Public Service Committee Meeting
2/23/2015 1:00 PM
Alcohol Application
Department:Planning & Development
Caption:New Ownership Application: A. N. 15 - 11: A request by Ritaben
Patel for a retail package Beer & Wine License to be used in
connection with Super Express #7 located at 1901 Gordon Hwy.
District 5. Super District 9.
Background:This is a new ownership application. Formerly in the name of
Hemaliben Patel.
Analysis:The applicant meets the requirements of the City of Augusta's
Alcohol Ordinance.
Financial Impact:The applicant will pay a fee of $1330.00.
Alternatives:
Recommendation:Planning & Development recommends approval. The RCSO
recommends approval.
Funds are Available
in the Following
Accounts:
REVIEWED AND APPROVED BY:
Finance.
Law.
Administrator.
Clerk of Commission
Cover Memo
Item # 7
Alcohol Number
Augusta-Richmond County
IB i5 Marvin Griffin Road
Augusta, GA 30906
AI,COEOL tsE\TERAGE .A.PPLICATION
Year _- Alcohol Account Number
L Name of Business SUPER EXPRESS IT72. Business Address 13. ciry AUGUST State4. Business phone (.-)5. Applicant Name and Address:
6.
7.
8.
9.
r0
Applicanr Social Securiry #
If Application is a transfer, f irt p.*Auiappf i.u,,r
D.o.B 10/30/7s
Business Location, MaiTTIiJ ZoningLocation Manager(s)
itJYJi"^'l"l ffitt'"* citizen or AIien lawtullv admitred for permanent reside,cy?
ll corporation(ir^ppri.?bffi*:ffi,H"RMArroN12. Mailing Address:
NameofBusiness SUpER EXpRESS #7Attention : tr'
13.
14.
OwnershipType: (XCo
co.porut"Num., 'Gunu oensran, r,r,E nto ( ) Inaividual--
List name and other required tnto ffi
Address
Cit\t/State/Zip
Total License Fee: $
Prorated License Fee:
i3**4fi?R?9 ---
(After July I ONLY) $
( ) Restaurant ( ) Lounge fi ) Convenience Store( ) PackageStore ( ) Other:
r6.Have you ever applied for an Alcohol Beverage License before:If so' give{'f "t'od$8fl"'ffts*fltb"fJ61t,
-
YES
-_
f"^I:,l riii' * *llh .c:o:gi, ana eu@
15. What type of business will you operate in this location?
alcohotic u.r.rug"ri (l .f.; -"i j"r.i;"'"-^'""'"'lr"#J,1?r:1:ilTTff rr, "
Attachment number 1 \nPage 1 of 2
Item # 7
18.Attach a passport-size photograph
(front view) taken within two years.
Write name on back of the dealer
submitting the license application.
Has any liquor business in which you hold, or have held, any financial interest, or
employed, or have been employed, ever been cited for any violation of the rules
regulations of Richmond county or the State Revenue commission relating to the
and distribution of distilled spirits? ( ) Yes [ ) No
If yes, give tull details:
20.Have you ever been arrested, or held by Federal, State, or other law-enfor..*t
authorities, for any violation of any Federal, state, county or Municipal law, regulation
or ordinance? (Do not include traffic violations, with the exception of any ofrenses
t9.
and
sale
pertaining to alcohol or drugs.) All other charges must be included, even if they aredismissed. (;) Yes / ) No
Ifyes, give reas6n charged or held, date and place where charged and its disposition.
' Z c' i \ *-< s',,tf gr. i:lt*'y {.t2 -
-
23.
21.
22.
List owner or owners of building and properfy.
S-r!)2)P t- t?)Tt4
List the name and other required information for each person, firm or corporation havin[
any interest in the business.
If a new application, attach a surveyor's plat and state the straight line distance frc,m the
theproperty line of school, church, library, or public recreation area to the wall of
building where alcohol beverages are sold,
A.) Church C.) School
Eo solemnly swear, subject to the penalties of false swearing, that
answers made by me as the applicant in the forgoing alcoholic
true.
B.) Library D.) Public Recreation24. State of Georgia, Augusta-Richmond County, I; RITABEN PATEtr--._---
the statements and
age application are
Applicant Signature25. I hereby certify that RITABEN PATEL is personally known to be,
that he/she signed his/her name to the foregoing application stating to me that he/she
knew and understood all statements and answers made herein, and, under oath actually
administered by me, has sworn that said statements and answers are true.riris I Q -oay of J finug-r q . in the year 3ol-( .
NotarYPubtic
Columbia Cormty, Cieorgia
Connission er6ret June l7' 20irFOR OFFTCE USE ONLY
The Board of Commissioners on the
-
day of
(Appioved, Disapproved) the forgoing application.
Administrator Date
in the year __
Attachment number 1 \nPage 2 of 2
Item # 7
Public Service Committee Meeting
2/23/2015 1:00 PM
Alcohol Application
Department:Planning & Development
Caption:Discussion: A request by Henry Todd Schafer for a Sunday Sales
license to be used in connection with Abel Brown located at 491
Highland Ave Ste B. There will be Sunday Sales. District 7. Super
District 10.
Background:This is a new request.
Analysis:The applicant meets the requirements of the City of Augusta's
Alcohol Ordinance
Financial Impact:The applicant will pay a fee of $1330.00.
Alternatives:
Recommendation:Planning & Development recommends approval. The RCSO
recommends approval.
Funds are Available
in the Following
Accounts:
REVIEWED AND APPROVED BY:
Finance.
Law.
Administrator.
Clerk of Commission
Cover Memo
Item # 8
;a//- /1//
STATE OF GEORGIA
AUGUSTA.RICHMOND COUNTY
Personally appeared before the undersigned an officer duly authorizedby law to administer
trilr; hrst duly sworn, deposed and says on oath as
t. I am the applicant and/or hold of an Alcoholic Beverage License from Augusta Richmond
Count.
The license for which is for an eating establishment known as
At least 50% of its total annual gross food and Beverage sales are from the sale of prepared
meals or food.
This affrdavit is made for the pu{pose of being used by Augusta Richmond County, Georgia
to authorize the sale of distilled spirits, malt beverages, or wine, for consumption only, on the
premise of said establishment, on Sundays between the hours of 12:30 P.M. and 2:00 A.M.
Sworn and subscrilpd .{.\
Before me this O#auv of __!_(I4_.1011
No tary Pu'" *m%5*Hl&H,ffi1$S,ilYb:ff{H"
NOTICE: The above affidavit is given under oath. Any person convicted of false swearing
shall be punished by a fine of not more than $1,000.00 or by imprisonment for not less than one
or more than five years, or both under Georgia Law.
The Augusta-Richmond County Wine, Beer and Whiskey regulations provides the follow: "any
untrue or misleading information contained in, or material omission left out of an original,
renewal or transfer application for a license here under shall be cause for the denial thereof, and
if any license has been granted under such circumstances, same shall be subject to Revocation.
I am applying for and/or hold,
1J.
4.
-ffi{5*HleH,ffil}:s,ilYa:rg"
Attachment number 1 \nPage 1 of 1
Item # 8
Public Service Committee Meeting
2/23/2015 1:00 PM
Alcohol Application
Department:Planning & Development
Caption:Discussion: A request by Faulkner Warlick for a Sunday Sales
license to be used in connection with Finch & Fifth located at 379
Highland Ave. There will be Sunday Sales. District 7. Super
District 10.
Background:This is a new request.
Analysis:The applicant meets the requirements of the City of Augusta's
Alcohol Ordinance.
Financial Impact:The applicant will pay a fee of $1330.00.
Alternatives:
Recommendation:Planning & Development recommends approval. The RCSO
recommends approval.
Funds are Available
in the Following
Accounts:
REVIEWED AND APPROVED BY:
Finance.
Law.
Administrator.
Clerk of Commission
Cover Memo
Item # 9
Jan, 6, 2015 5:02PM surrev center pharmacv
I
N0,3242 P, 2
itz/3* 9rz
3.
4
STATE OF GEORGIA
AUGUSTA-RICHMOND C OUNTY
an officer duly authorized by law to administer
first duly sworn, deposed and says on oath as
1. I am the applicant aud/sr hold of an Alcoholic Beverage License from Augusta Richmond
Count.
2. The license folw[iqhlam applying for and/or hold, is for ur eating establishmeut known as
At least 50% ofits total annual gross food and Beverage sales are from the sale ofprepared
meals or food.
This affidavit is made for the purpose of being used by Augr:sta Richmond County, Georgia
to authorize the sale of distilled spirits, rnalt beverages, or wine, for consumption only, on lhepremise of said establishment, on Sr:odays betvveen the hours of 12:30 P.M. and 2:00 A.M.
Swom and subscribed
Beforemethis 6 daVof $,urrrr*t ,2019
Notary Public
NOTICE: The above afEdavit is given of fslse swearing
shallbe punished by a fine of not more than $1,000.00 or by impdsonment for not less than one
or more than five years, or bottr uuder Georgia Law.
The Augusa-Richmond County Wine, Beer and Whiskey regulations provides the follow: "any
uttrue or misleading information contained in, or material omission left out of an original,
renewal or transfer application for a license here under shall be cause for the deuial thereof, and
if any license has been grantcd under such cilsrrmshgqes, satne shall be subject to Revocation.
Attachment number 1 \nPage 1 of 1
Item # 9
Public Service Committee Meeting
2/23/2015 1:00 PM
Therapeutic Massage Operators License
Department:Planning & Development
Caption:Discussion: A request by Marva Renee Little for a Therapeutic
Massage Operators License to be used in connection with Marva's
Relaxing Bodywork located at 6070 Reynolds Circle, Grovetown,
Ga 30813. (massage outcall) District 1 thru 8. Super District 9 &
10.
Background:This is a license for therapeutic massage done on a outcall basis.
Analysis:The applicant meets the requirements of the City of Augusta's
Ordinance regulating Therapeutic Massage
Financial Impact:The applicant will pay a fee of $140.00.
Alternatives:
Recommendation:Planning & Development recommends approval. The RCSO
recommends approval.
Funds are Available
in the Following
Accounts:
REVIEWED AND APPROVED BY:
Finance.
Law.
Administrator.
Clerk of Commission
Cover Memo
Item # 10
fi!>T>.Df c n cxo(o "(o*EEP5:J ox ii
9jor: N,uo?l:6ro e )rY-o 3i'No oN,'. (O ){=J O..J;P N^ oo x-N={:)6<.t- r36ry9aaoou^!v
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Attachment number 1 \nPage 1 of 4
Item # 10
r)
2)
5)
6)
Full Name of Applicant:
Home Address:
AUGUS'I'A ruCHMUNI.l CUUN'I Y
PERSONNEL STATEMENT
1815 MARVIN GRIFFIN ROAD
AUGUSTA GA 30906
or GED: V.r{No
L(\/D r Tou.J \ llf+ AXt3
-DateofBirth:&A:3) retephone #, -l DloL{bl bLDD,SS#: '- r -- -r--
High SchoolDiploma: Yes l/No
4) Trade name of Business of which personnel statement is a part of:
e)Place of Birth:
Naturalized:
Business Address:
Business Telephone:
7) Positionof ApplicantinBusiness: O( ^ fS-f-
use by applicant:names used in former marriages, alias, stagename, and or
nickn:'qes
Date, Place and Court:
(L,
Citizen()yes ( )no
Certification No:
l0) Martial Status: (ffirried ()Divorced ( ) Separated( ) Widowed ( ) Single( )
l1) If manied, divorced, gn rri
Full name of spouse:JC hfiQJ
I 2) Applicants: Height:Weight:
Color Hair:
Give most recent
Attachment number 1 \nPage 2 of 4
Item # 10
Fffi#FES$I#ftI &t LICEfiISIh*G
fif;ORGIA SECRETARY OF 5T'ATF SftiAru F. KEMP
Licensee Details
Licensee Information
: ilhrya Renee Little otrnen
6070 ReynoHs Cirde
Grovetoun GA30E13
him anv Source Lieense Inform ation
#: MfO1o288 ProEadont +fm; rvpe: iliassage Therapist
SecondarY:
Acfive lssued: 1l'1312015 Erpiresi $13112016
Renewal Da!e:
: Application [filrrro*
Associated Licenses
t$hfonration
Public Board Orders
see sec{lon Board Orders
OtherDocuments
Other Docurents
Data curent as d January 14,2O1511:N:2.
This uebsite is to be used as a prinnry sour@ vertftcation for licenses issued by tre Professional Liensing Boards.
Paper rrerifications are available for a fee. Pbase contact the Professional Licensing Boards at 47&207.2.4y'i0.
Attachment number 1 \nPage 3 of 4
Item # 10
Oeeulmtional Tax Cerfifteate
Date Issued
ut6t20ts Nrmber 5773
Marva's Rela;ing Bodywork
HOME OCCI]PATION LICENSE
6070 Reynolds Circle
IVlarva's Rel a:ring Bodywork
6070 Reynolds Circle
Grovetown, GA 30813
yt5t2ol5
Date Expires
12BlD,015
Issued to:
Classification Type:
Physical Location:
Mailing Address:NOTFYIHSOFFICE G
ANV q{ANGE N LOCAIIoD.I
OR OWI.IERSHIP
Year Established:
THE ABOVE |.IAMED lS At THORIED TO D O BUSI I.IESS I N THE CIIY OF GROI/EIOWI{ AtlD oPROVrSr0i6 ALTCITYORDNAI.ICES.
NON.TRANSTERRABLE
COMMERCIAL BUSINESS MUST POST IN A CONSPICUOUS PLACE
NON-FDGD LOCATION IVIUST KEEP IN POSSESSION
I
Attachment number 1 \nPage 4 of 4
Item # 10
Public Service Committee Meeting
2/23/2015 1:00 PM
Alcohol License Hearing
Department:Planning & Development
Caption:Discussion: A request by the RCSO for a hearing to consider the
possible Probation, Suspension or Revocation of the alcohol
license and business license held by Ralph H. Dillman Jr for
Ralph's Five Pines Lounge, Inc. located at 2301 Gordon Hwy for
violating the controlled substance law. District 3. Super District
10. (Referred from February 9 Public Services Committee)
Background:A large quanity of marijuana was found inside the location
and management nor ownership can or will explain how it got
there.
Analysis:This would be a violation of the City of Augusta's Alcohol
Ordinance.
Financial Impact:none
Alternatives:
Recommendation:Planning & Development recommends revocation. The RCSO
recommends revocation.
Funds are Available
in the Following
Accounts:
REVIEWED AND APPROVED BY:
Cover Memo
Item # 11
Attachment number 1 \nPage 1 of 1
Item # 11
Public Service Committee Meeting
2/23/2015 1:00 PM
Minutes
Department:Clerk of Commission
Caption:Motion to approve the minutes of the Public Services Committee
held on February 9, 2015.
Background:
Analysis:
Financial Impact:
Alternatives:
Recommendation:
Funds are Available
in the Following
Accounts:
REVIEWED AND APPROVED BY:
Cover Memo
Item # 12
Attachment number 1 \nPage 1 of 4
Item # 12
Attachment number 1 \nPage 2 of 4
Item # 12
Attachment number 1 \nPage 3 of 4
Item # 12
Attachment number 1 \nPage 4 of 4
Item # 12