4.17 4.17
Liquor Authority—Waiver of 30 Day Notification—Nichols—Blue Moose—11-16-15
RESOLUTION AUTHORIZING WAIVER OF 30 DAY NOTIFICATION
REQUIRED BY NEW YORK STATE LIQUOR AUTHORITY IN
CONNECTION WITH THE BLUE MOOSE TAVERN AND RESTAURANT
RESOLUTION NO.: ,2014
INTRODUCED BY:
WHO MOVED ITS ADOPTION
SECONDED BY:
WHEREAS, Daniel and Ellen Nichols (Owners) own and operate the Blue Moose Tavern
and Restaurant located at 1300 State Route 9, Queensbury,New York,and
WHEREAS, the Owners have applied for a renewal of liquor license and have requested
that the Town of Queensbury waive the 30-day notification required by the New York State Liquor
Authority(NYS)in an effort to expedite such renewal,and
WHEREAS, the Town Board wishes to authorize the Town Clerk to notify the Owners
and/or NYS that the Town Board has waived the 30 day notification period before the Owners'
liquor license is issued and/or renewed,
NOW,THEREFORE,BE IT
RESOLVED, that the Queensbury Town Board hereby authorizes and directs the Town
Clerk to notify the applicants, Daniel and Ellen Nichols, owners of The Blue Moose Tavern and
Restaurant, to then notify the New York State Liquor Authority that the Town waives the 30 day
notification period before the liquor license is issued/renewed to Daniel and Ellen Nichols and that
the Town Board has no objection to such license, and
BE IT FURTHER,
RESOLVED, that the Town Board further authorizes and directs the Town Supervisor,
and/or Town Clerk to take any actions necessary to effectuate the terms of this Resolution.
Duly adopted this 16t day of November, 2015 by the following vote:
AYES :
NOES :
ABSENT:
rev 10/23/13 OFFICE USE ONLY 49
r ' Original ,;_) Amended Date
State of New York Standardized NOTICE FORM for Providing 30-Day Advanced Notice to a
Executive Department Local Municipality or Co •• . oard
Division of Alcoholic Beverage Control
V' '
State Liquor Authority - ' " `"��
N, de► t
1. Date Notice was Sent:(mm/dd/yyyy) it/'(9 V / // .9-D o J �;f" r ia`t`0 �`
2. Select the type of Application that will be filed with the Authority for an On-Premises Alcoholic Beverage •.ense NOV 1 6 2015 L_ f
New Application Renewal Alteration Corporate Change QUEENSBURY �•
CLERK'S OFFICE
This 30-Day Advance Notice is Being Provided to the Clerk of the following Local Municipality or Comm ,Board ``\
3. Name of Municipality or Community Board 7�u� I �5'
l� & &IJQCk S l3 Up' , -
Applicant/Licensee Information
4. License Serial Number,if not New Application: 'a 1 S'' 6 j, Expiration Date,if not New Application: �a 2 1,t-
5. Applicant or Licensee 4/ _ ` 4 .: 1t q ,,
6. Trade Name(if any): Q i LAf ti44 cye Ta-q,,t4 T E-61. - ac,
7. Street Address of Establishment: 13 8 0 SiLlz Re Q f-e. f. City,Town or Village: (r,ijc-C C Co /- "r ,NY Zip Code: `A,3(a-
9. Business Telephone Number of Applicant/Licensee: rj ?- 7 ( / -4s- Zr
10. Business Fax Number of Applicant/Licensee:
11. Buisness E-mail of Applicant/Licensee: p$_ to w to a wp id (r1 et-, / , C 0 ('ll
For New applicants,provide description below using all information known to date.
For Alteration applicants,attach complete description and diagram of proposed alteration(s).
For Current Licensees,set forth approved Method of Operation only.
Do Not Use This Form to Change Your Method of Operation.
12. Type(s)of Alcohol sold or to be sold: ("X"One) ❑ Beer Only L Wine&Beer Onlyiquor,Wine&Beer
Restaurant(Sale of food primarily; Tavern/Cocktail Lounge/Adult Venue/Bar(Alcohol
13. Extent of Food Service:("X"One) .Full food menu;Kitchen run by chef) sales primarily;Meets legal minimum food
availability requirements)
❑ Recorded Music ►!A ive Music H Disc Jockey Juke Box ❑ Karaoke Bar L Stage Shows
L Patron Dancin• small scale) H Cabaret,Night u (Large Scale Dance Club) ❑ Catering Facility
14. Type of Establishment: H Capacity of 600 or more patrons L Topless Entertainment [Restaurant L Hotel
("X"all that apply)
H Recreational Facility(Sports FacilityNessel) H Club(e.g.Golf Club/Fraternal Org.) ❑ Bed&Breakfast
❑ Seasonal Establishment
15. Licensed Outdoor Area: I I None IX Patio or Deck L Rooftop L Garden/Grounds I 1 Freestanding Covered Structure
("X"all that apply) I I Sidewalk Cafe L Other(specify):
Page 1 1 flintfortfe, I
A
rev 10/23/13 OFFICE USE ONLY 49
i • Original Amended Date
State of New York Standardized NOTICE FORM for Providing 30-Day Advanced Notice to a
Executive Department Local Municipality or Community Board
Division of Alcoholic Beverage Control
State Liquor Authority (Page 2 of 2 of Form)
16. List the floor(s)of the building that the establishment is located on: rise- Flt 6V 1- 4ectG 0 ko
✓
17. List the room number(s)the establishment is located in within the
building,if appropriate:
18. Is the premises located with 500 feet of three or more on-premises liquor establishments? L Yes No
19. Will the license holder or a manger be physically present within the establishment during all hours of operation?4j Yes H No
20. Does the applicant or licensee own the building in which the establishment is located?("X"One) [ Yes(If Yes SKIP 21-24) ` No
Owner of the Building in Which the Licensed Establishment is Located
21. Building Owner's Full Name: 1 T, iJ (,44- lo/', f-t l �-. N , 6 22. Building Owner's Street Address: 3Z j 3 e s 1'60 , r;.- -'
23. City,Town or Village: Q v ct p liPp A t State: JU,ka 2 Zip Code: ``).'i ).ti
li
Attorney Representing the Applicant in A Connection with the Applicant's License Application Noted as Above for the
Establishment Identified in this Notice
25. Attorney's Full Name: v, 13QL t � YYYYUUUU , ,Z►1 �
d , V r !-
� '
26. Attorney's Street Address: 3 tt S,
27. City,Town or Village: 6 C,,,ei,—,1 r(pet„ State: Ai y Zip Code: t")., 6
28. Business Telephone Number of Attorney: tJ is- —2 It,f— &y `7
29. Business Email Address of Attorney: � p--0141, e V V ems:li o 1,i , htl-
I am the applicant or hold the license or am a principal of the legal entity that holds or is applying for the license. Representations
in this form are in conformity with representations made in submitted documents relied upon by the Authority when
granting the license. I understand that representations made in this form will also be relied upon,and that false representations
may result in disapproval of the application or revocation of the license.
By my signature,I affirm-under Penalty of Perjury-that the representations made in this form are true.
,I � % '
30.Printed Name: D Cam` i{ (G1 4 Gl Title ��
Signature: X t W
CA_____
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