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Home My WebLink AboutMontana Department of Revenue (3) D E C E � W E f ter_a TF Montana Departm of Revenue! y F JUL 2 3 2010 Dan Bucks CITY OF LAUREL Brian Schweitzer Director Governor July 21, 2010 License Type: Montana Domestic Brewery License Number: NEW/97-999-9703-160 Account ID: 6464727-002-DBR Subject: Application for Issuance of a New License Applicant: Fat Jack's Tap Room, LLC —Stephen A. Solberg, Sole Member Location Address: 317 East Main Street, Laurel, Yellowstone County, Montana NEWLY LICENSED PREMISES We need your help to determine if the above applicant and location comply with all laws and ordinances administered by your office. We ask that you please advise us by August 20, 2010, if there is a compliance issue. If we do not hear from you concerning a compliance issue, we will assume the laws and ordinances have been met. We would be happy to provide you with any additional information to determine compliance. It is important for you to understand that local laws are not enforced through the alcoholic beverage licensing process but several factors can influence the issuance of a license: • Compliance with local laws may influence our final decision; and • Notification of a local deficiency will prevent processing of the application until the issue is cleared up at the local level. This is an application for a new premises; a premises not currently licensed for the manufacture, sale, or consumption of malt beverages. Building, health and fire approval will be required before department approval will be considered. I will be happy to assist ypu if you have questions. Please contact me at the address, telephone number or e-mail below. Sinc ly, Shawna M. Chris ianson, Compliance Specialist Department of Revenue Liquor Licensing PO Box 1712 Helena MT 59604-1712 Telephone (406) 444-0712 schristianson(a@mt.gov Encl. Certificate of Service, Floor Plan and Application cc: Department of Labor & Industry revenue.mt.gov A Toll free 1-866-859-2254(in Helena,444-6900) A TDD (406)444-2830 CERTIFICATE OF SERVICE I certify that on this 21 st day of July , 2010, a true and correct copy of the foregoing has been served by placing same in the United States mail, postage prepaid, and addressed as follows: LAUREL CITY COUNCIL PO BOX 10 LAUREL MT 59044 LAUREL CITY ATTORNEY PO BOX 10 LAUREL MT 59044 LAUREL POLICE CHIEF MIKE ATKINSON PO BOX 10 LAUREL MT 59044 LAUREL CITY BUILDING INSPECTOR PO BOX 10 LAUREL MT 59044 YELLOWSTONE COUNTY SANITARIAN BOX 35033 BILLINGS MT 59107 YELLOWSTONE COUNTY TREASURERS OFFICE P O BOX 35010 BILLINGS MT 59107-5010 ADMINISTRATIVE ASSISTANT FIRE PREVENTION AND INVESTIGATION BUREAU 303 NORTH ROBERTS BOX 201415 HELENA MT 59620-1417 Montana DBLA JUN 1 3 Z010 Rev. 09/09 DEPARTMENT OF REVENUE LIQUOR LICENSING Montana Domestic Brewery License Note:Applications for a new license or transfer of location will need approvals from the building, health and fire code officials before we can approve this application. Section 1 -General Information Note:If the name of the applicant is an individual, list the individual s name below. If the name of the applicant is a partnership, limited liability partnership (LLP), corporation, or limited liability corporation (LLC) list the business'name below. Name ofApplicant(s): Fat Jack's Tap Room, LLC FEIN/SSN: 27-1963651 Name of Person Managing the Business: Stephen A. Solberg Assumed Business Name: Fat Jack's Tap Room Contact Person: Stephen A. Solberg Telephone: (406)252-4822 Fax: Cell Phone: (406)860-4004 E-mail Address: sieves@laurelford,net Physical Address of Premises to be Licensed: 317 E. Main Street, Laurel, MT 59044 (Street Address, City, State Zip Code) Mailing Address: 3513 Prestwick Road, Billings, MT 59101 (Street Address, City, State Zip Code) Section 2-Type of Transaction and Fees (This license needs to be renewed on an annual basis by June 301") Please check all the boxes that relate to the type of application you are completing and be sure to include the appropriate fee. ® New License ❑Transfer of Ownership ❑Transfer of Location ❑Corporate Structure Change $500 New License Fee(Annual Fee is $200) Office use Only $100 One-Time Processing Fee(Required for All Transactions) Amount Paid. S Amount Owed: S Neiv License Number: $ 600. Total Amount Enclosed Account Number: Current License No. Montana Domestic Brewery License Application Packet Page 5 of 9 Section 3—Corporate Statement All entities except Sole Proprietors and Individuals please complete the following information for all shareholders, members or partners (please attach additional pages if necessary): Please Print 1 Name: SSN: Stephen A. Solberg 516-62-9127 Address: 3513 Prestwick Road, Billings, MT 59101 Date of Birth: Actual Number of Shares and%of Ownership: March 8, 1949 100% 2 Name: SSN: Address: Date of Birth: Actual Number of Shares and%of Ownership: 3 Name: FSS : Address: Date of Birth: Actual Number of Shares and%of Ownership: 4 Name: SSN: Address: Date of Birth: Actual Number of Shares and% of Ownership: Officers and Directors are: Name Address Title Ste hen A. Solberg Billings, MT 59101 Montana Domestic Brewery License Application Packet Page 6 of 9 Section 4—Ouestions 1. Does any applicant, member, shareholder or partner have ownership interest in a retail liquor license, agency liquor store, beer wholesaler or table wine distributor license in any state or country? ❑ Yes If"yes", please explain: ® No A manufacturer cannot hold any financial ownership or operational control in an agency liquor store, any retail liquor license, beer wholesaler or table wine distributor license. 2. Does any person other than the applicant have financial interest in your business? ❑ Yes If"yes", please list the name, address and give a brief description of the involvement(attach additional paper if necessary): ® No 3. Is the location to be licensed within a zone or area where the sale of alcoholic beverages is not allowed by city or county ordinances? ❑ Yes ® No 4. Do you own or are you purchasing the building proposed for licensing? ❑ Yes If"yes",please send a purchase agreement or current tax bill. ® No If"no",please send a lease agreement. 5. Do you own the furniture, fixtures and equipment used at the location? ® Yes ❑ No If"no", please send a lease or purchase agreement. 6. Is the building complete and ready for use? ❑ Yes ®No If"no", please provide expected date of completion August 1, 2m Montana Domestic Brewery License Application Packet Page 7 of 9 Section 5—Brands(Beer Wholesalers) Any changes in your products need to be sent to the Montana Department of Revenue. (Please attach an additional page if necessary) 1. Brands and sizes of beer to be sold in Montana: Brand Name Percentage of Alcohol by Volume Fat Jack's Un1m own- at this time 2. Licensed Montana Beer Wholesalers that will distribute your products: Name Montana Liquor License No. City/Town None Please be aware that a brewery licensed in the state of Montana selling directly to the consumer the retailer needs to pay the tax on or before the 15`h of the month for beer sold in the previous month and complete Montana tax form (BET). This form can be found on our web page at: http://mt.eov/revenue/forfnsandresources/forms asp Applicant does not intend to provide bottled beer or keg beer. Beer will be sold, served and consumed on the micro-brewery premises. Montana Domestic Brewery License Application Packet Page 8 of 9 Section 6-Declaration and Affidavit This application needs to be signed by all individuals, partners or members. In the case of a corporate applicant, it may be signed by one shareholder or officer with authority to sign. I/We declare under penalty of false swearing that the information provided on this application d its attachm s true, correct, and complete. -/o -( a (�6� S ture D to Printed Name Title Signature Date Printed Name Title Signature Date Printed Name Title Mail completed application as well as all required and applicable documents to: Montana Department of Revenue Liquor Control Division PO Box 1712 Helena,MT 59624-1712 Montana Domestic Brewery License Application Packet Page 9 of 9 APPLICANT: FAT JACK'S ROOM, LLC . r 6 EXISTING FLMR DRAIN f xsnNG EMSE C`D —tw FMW AREA V-WATER (NO NOW AT THIS TIME) RE71 as I � I F I in I 9 i �+ EXIST BIFO ———— E BOSfING UNIT -6' HEATER HRBd R0411 RrrURE FWASE AREA o 0 (NO WORK AT O STORAGE THIS TIME) O O KFLOOR TBVORARY, V-V / I DRAIN WGH STUD WALL, I6' Ko - - O.G.:GB ON TASTING ROOM SIDE ONLY 00 O 21MaS — — ED UNITTM `�-HEATER COOLOZ EGSTM J CaRaTRTOP r (REMATW) I — SERVM =- HIG+-TOP TAP RM AREA TAPS L7 ——————— ——————— I I I I CASUAL TAP RM AREA I 1 I i I I I TAIP I I I i I DaST OH I I 1 EXIST OH 2 1 SLOPE UP fO0 R 1 NEW BREWERY LAYOUT A-1 -a fQ I NEW SRENERY LAYOUT HIGH PLAINS F-+ fif, A R C N I T E C T 8 PACM1 LAURI=L TAP ROOI'1/21001 s arm SO+�.-�� 8 i=RG FAT JACK'S TAP ROOM, LLC Legal Description of Premises: A portion the building and improvements located on the following-described property: Lots 1, 2 and 3, Block 3, of Laurel Realty Subdivision, in the City of Laurel, Yellowstone County, Montana