NEW YORK STATE LIQUOR AUTHORITY APPLICATION for PERMISSION TO MAKE ALTERATIONS SECTION 99D (A.B.C.) CONTENTS • Instructions for completing forms • Application Forms DIRECTIONS FOR COMPLETING THIS LICENSE APPLICATION • Must be TYPED or PRINTED. (In blue or black ink) • Complete applicable forms FULLY. • Follow instructions carefully. S.L.A. ZONE OFFICES: ZONE 1 State Liquor Authority 317 Lenox Ave. New York, New York 10027 Telephone: 212-961-8385 ZONE 2 State Liquor Authority Alfred E. Smith Building 80 So. Swan Street, Suite 900 Albany, New York 12210-8002 Telephone: 518-474-7604 ZONE 3 State Liquor Authority Iskalo Electric Tower Building 535 Washington Street, Suite 303 Buffalo, New York 14203 Telephone: 716-847-3035 Agency Website address: www.abc.state.ny.us SLA FORM: L.B.-28 (10/10) American LegalNet, Inc. www.FormsWorkFlow.com WHERE DO I MAIL MY APPLICATION? The State Liquor Authority maintains three Zone Offices. Mail your application to the office that supports the county where you will establish your business. ZONE 1 State Liquor Authority 317 Lenox Ave. New York, NY 10027 Phone #(212) 961-8385 Fax #(212) 961-8283 ZONE 2 State Liquor Authority 80 S. Swan Street Suite 900 Albany, NY 12210-8002 Phone #(518) 474-3114 Fax #(518) 473-2286 ZONE 3 State Liquor Authority 535 Washington St. Buffalo, NY 14203 Phone #(716) 847-3035 Fax #(716) 847-3435 Bronx Albany Allegany Kings Clinton Broome New York Columbia Cattaraugus Queens Delaware Cayuga Richmond Dutchess Chautauqua Essex Chemung Franklin Chenango Fulton Cortland Greene Erie Hamilton Genesee Herkimer Livingston Jefferson Monroe Lewis Niagara Madison Ontario Montgomery Orleans Nassau Schuyler Oneida Seneca Onondaga Steuben Orange Tioga Oswego Tompkins Otsego Wayne Putnam Wyoming Rensselaer Yates Rockland St. Lawrence Saratoga Schenectady Schoharie Suffolk Sullivan Ulster Warren Washington Westchester American LegalNet, Inc. www.FormsWorkFlow.com -36 ALTERATION STATE OF NEW YORK LIQUOR AUTHORITY APPLICATION FOR PERMISSION TO MAKE ALTERATIONS THIS APPLICATION MUST BE FILED WITH THE APPROPRIATE ZONE OFFICE OF THE STATE LIQUOR AUTHORITY IN WHICH THE LICENSED PREMISES ARE SITUATED. This application must be accompanied by the following: 1. Plan or diagram on paper not more than 8 1/2" x 11" in size, showing the present layout of the premises. 2. Plan or diagram on paper not more than 8 1/2" x 11" in size, showing the proposed alterations. 3. If changes to the front of the premises are proposed, an elevation or diagram on paper not more than 8 1/2" x 11" in size of the proposed front of the premises. If desired, the front elevation plan may be incorporated on the plan showing the proposed alterations. 4. Submission of financial documentation proving the availability of the funds listed under Estimated Cost of Alteration that may include but are not limited to three (3) consecutive months worth of bank statements from checking or savings accounts showing the availability of the funds at the time that they were expended. The bank statements must show the name of the bank, account number and the name and address of account holder. Proof of financial documentation may also include any loan agreements as stated in the Source of Funds Used to Pay for Alterations. 5. Proof of Notice to the Municipality/Community Board, by means of the State Liquor Authority’s form, submitted to the Municipality/Community Board via Certified Return Receipt at least 30 days before filing the Alteration Application. Proof of Notice is a copy of the completed Form as well as the original return receipt. The notice form is available on our website at www.abc.state.ny.us. 6. Photos of the area to be altered as it appears when filing the Alteration Application. 7. Submission of an updated establishment questionnaire if there are any substantial alterations to the licensed premises or if an outside area or an additional bar is being added to the licensed premises. The establishment questionnaire may be found in the retail application on our website at www.abc.state.ny.us. 8. If application the submission of a building permit or café permit or a letter from the municipality waiving this requirement. NO FEE IS REQUIRED. CHECK ONE Substantial Alteration: Any enlargement or reduction of a licensed premises. Any physical change to the exterior, that involves the creation or relocation of any window or door, and any interior change of physical structure. Any change in size or location of a bar or dining and kitchen facilities. Minor Alteration: One costing and valued at less than ten thousand dollars, which does not affect the material character or physical structure that existed at the time of licensing. The licensee named below hereby requests the permission of the Liquor Authority for the Alteration of the licensed premises set forth below. Full Name of Applicant-Licensee Trade Name or other designation License Serial No: Street address of premises Post Office address, City, Town or Village-Zip Code of premises (if different) City, Town or Village-Zip Code County Telephone No. E-Mail Address (if available) Estimated Cost of Alteration: Source of Funds Used to Pay for Alterations: 1. List proposed alterations: (Describe all changes fully. If more space is needed, attach additional sheets). American LegalNet, Inc. www.FormsWorkFlow.com LB-28 (10/10) 2 (a) State whether additional space is being added or eliminated.___________________________________________________________ (b) If added, give size, location and use of space. ______________________________________________________________________ (c) Is a building permit required in your location (City, Town, Village)? ____________________________________________________ (Answer "Yes" or " No") If answer is yes, give permit number and issuing municipality as well as submit a copy of the permit: ___________________________ (Number ) (City, Town, Village) (d) If additional space is added, give name of landlord & terms of lease, if applicable _______________________________________ Alcoholic beverages may not be kept or sold in any added space until the Alteration is approved. 3. Will any entrance or exit of premises as altered be within 200' of the entrance to a school, church or synagogue or other place of worship? 3. ________________________________________ (Answer "Yes" or "No") 4. (a) State whether there is a change in address. (If the address of the premise has changed since the last application, submit a written explanation or letter from the Post Office as well as an Endorsement Application to amend the address). 4. (a) _____________________________________ (Answer "Yes" or "No") (b) If so, give eliminated address and/or additional address. (b) ____________________________________ (Eliminated Address) ______________________________________ (Additional Address) TO BE ANSWERED BY ON-PREMISES LICENSEE ONLY 5. Seating Capacity at tables Present _______________ Proposed ______________ Total Length of Bar _______________ ______________ This permission, as granted herein, is VOID if not completed in 90 days unless the time is extended by this Authority. Such request must be made in writing. There may be no deviation from the items approved herein without written permission of this Authority. THE FOLLOWING CERTIFICATION MUST BE SIGNED AND DATED BY SOLE PROPRIETOR AND EACH MEMBER OF PARTNERSHIP The undersigned, each for himself, certifies that he is the applicant above named; that he knows the contents of the above application and the statements contained therein and the same are true of his own knowledge. The undersigned also certifies that they will meet all local code requirements of the municipality in which the premises is located and obtain any necessary permits required of him in order to perform the alteration within the boundaries of the law. DATED__________________________________ _____________________________________________ _____________________________________________ _____________________________________________ (Signature of sole proprietor or of each partner) THIS CERTIFICATION TO BE SIGNED AND DATED BY A CORPORATION _______________________________________________________, certifies that he is ___________________________________________________________ (Title) of the above named applicant corporation; that he knows the contents of the above application and the statements and answers therein; that the same are true of his knowledge; that he has been authorized, by order of the Board of Directors of said applicant corporation to make the statements and answers in this application in behalf of said applicant corporation with the same force and effect as if said corporation made such statements and answers itself. The undersigned also certifies that they will meet all local code requirements of the municipality in which the premises is located and obtain any necessary permits required of him in order to perform the alteration within the boundaries of the law. DATED____________________________________ ______________________________________________ (Signature of authorized officer) ENTRY RECORD (To be made by State Liquor Authority) Zone: ____________ County: __________________ Serial: ______________________ Class:______________ Deposit Date: _____________ Slip No:______ Audited By: _______________________________ ACTION BY LIQUOR AUTHORITY : APPROVED _____________ DISAPPROVED _______________ BY__________________ DATE:________________ LB-28 (10/10) American LegalNet, Inc. www.FormsWorkFlow.com STATE OF NEW YORK Standardized ALTERATION APPLICATION NOTICE FORM DIVISION OF ALCOHOLIC BEVERAGE CONTROL in connection with the submission to the State Liquor Authority of the Application for Permission to Make Alterations for the Establishment Identified in this Notice STATE LIQUOR AUTHORITY 1. for Providing a 30-Day Advance Notice to a Local Municipality or Community Board EXECUTIVE DEPARTMENT Date the Original copy of this Notice was Mailed to the Local Municipality or Community Board: 2 0 THIS 30-DAY ADVANCE NOTICE IS BEING MAILED TO THE CLERK OF THE FOLLOWING LOCAL MUNICIPALITY OR COMMUNITY BOARD: . 2 3. 4. 5. Name of the Local Municipality or Community Board: Street Address of Local Municipality or Community Board: City, Town or Village: NY Zip Code: Telephone Number of Clerk of Local Municipality or Community Board: - - APPLICANT INFORMATION Applicant’s Full Name as it Appears on the License Certificate: License Serial No. 6. Street Address of Premises City, Town or Village-Zip Code County Telephone No. 7. 8. Type(s) of Alcohol Currently Sold under the License: (“X” one) Beer Only Wine and Beer Only Liquor, Wine and Beer PROPOSED CHANGES/ALTERATIONS Check One Substantial Alteration: Any enlargement or contraction of a licensed premises. Any physical changes to the exterior, that involves the creation or 9. relocation of any window or door, and any interior changes of physical structure. Any change in size or location of bar, or dining and kitchen facilities. or Minor Alteration: One costing and valued at less than ten thousand dollars, which does not affect the material character or physical structure that existed at the time of licensing. Where will the Alteration be confined to? 10. 11. If interior, will the Occupancy change? Yes or No Interior If Exterior, do you plan on utilizing outdoor areas? Yes or No Exterior If Yes, which outdoor area? Check One Rooftop Is a Building Permit required for this type of Alteration? Yes or No Interior and Exterior Patio or Deck Freestanding Covered Structure Garden/Grounds Other If so, has permit been applied for? Yes or No 12. Will any entrance or exit of premises as altered be within 200’ of the entrance to a school, church or synagogue or other place of worship? Yes or No Will there be a change of address upon completion of Alterations? Yes or No Are there any known limitations by the County or Municipality for this type of Alteration? Yes or No 13. Is so, what are they? 14. ATTORNEY OR REPRESENTATIVE REPRESENTING THE APPLICANT IN CONNECTION WITH THE APPLICANT’S ALTERATION APPLICATION FOR THE ESTABLISHMENT IDENTIFIED IN THIS NOTICE Attorney’s Full Name is: 15. Attorney’s Street Address: City, Town or Village: Business Telephone Number: 16. I am the Person who holds the license or I am a Principal of the Legal Entity that will hold the License. Representations in this form are in full conformity with representations made in documents that have been submitted (or documents that will be submitted) to the State Liquor Authority and relied upon by the Authority. I understand that representations made in this form will also be relied upon by the Authority and that false representations in any document submitted to the Authority may result in revocation of any license that may be issued. By my signature, I affirm-under Penalty of Perjury-that the representations made in this form are true. Printed Name Title Signature American LegalNet, Inc. www.FormsWorkFlow.com ALTERATIONS TO LICENSED PREMISES  INSTRUCTIONS FOR SUBMITTING APPLICATIONS SEC. 99-d (A.B.C. Law) Except as hereinafter provided, no licensee shall make any physical change or alter a licensed premises without applying to and receiving permission from the State Liquor Authority. 1. Before any SUBSTANTIAL ALTERATION to a licensed premises may be undertaken by or on the behalf of any licensee except a Farm Winery, the licensee shall apply to the State Liquor Authority for permission to do so. A substantial alteration shall include any enlargement or contraction of a licensed premises; (A) Any physical change to the exterior of the licensed premises that involves the creation or relocation of any window or door, or reduces the visibility that existed at the time of licensing. (B) Any physical changes in the interior that materially affect the character of the premises or physical structure that existed at the time of licensing. (C) In the case of establishments licensed for On- Premises Consumption: Any enlargement or reduction of the dining or kitchen facilities or any change in the size or location of any bar from which alcoholic beverages are served shall be deemed a substantial alteration. 2. MINOR ALTERATION: Shall be deemed to be one costing and valued at less than ten thousand dollars, which does not affect the material character or physical structure that existed at the time of licensing. Before commencing work on the alteration the licensee must request permission to effect such minor alteration and shall submit an affidavit, in person or by certified mail – return receipt requested, on forms prescribed by the Authority that includes, but is not limited to: (A) A description of the proposed alteration. (B) The cost and value of the alteration, and (C) The source of the monies used to pay for the alteration. After receiving the affidavit, the State Liquor Authority will have twenty days to review the proposed alteration. If there is any objection, the Authority will notify the licensee by certified mail. If no objection is made within the twenty days after reviewing the necessary forms, it shall be deemed that permission has been granted. Work may commence on the alteration if no objection is received by the twenty-fifth day after filing. 3. COST OF ALTERATION: for the purpose of the Alcohol Beverage Control Law, the cost of the alteration shall be the total sum spent to complete the proposed alteration, excluding professional fees. SLA Form LB-28 revised (10/10) American LegalNet, Inc. www.FormsWorkFlow.com