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HomeMy WebLinkAbout2013-12-31 OPH Ltr to CA Forwarding CUP & Notice of Certification For Recording CITY OF t*' OAK PARK HEIGHTS w 14168 Oak Park Boulevard No • P.O.Box 2007 • Oak Park Heights,MN 55082-2007 • Phone:651/439 4439 • Fax:651/439-0574 December 31, 2013 Mr. Mark Vierling Eckberg, Lammers, Briggs, Wolff&Vierling. P.L.L.P 1809 Northwestern Ave. Stillwater, MN 55082 Re: Conditional Use and Special Home Occupation Permit Sarah Bell—In Home Hair Salon OPH File No.: 2013-11.18 TPC File: 236.05-13.01 Dear Mr. Vierling: Enclosed he ewith for filing with the Washington County Recorder's Office, please find a cop, %f t•e :bove-referenced document. Notice of Certification has been attached. 'eg.ras /rig hnson Ci Administrator .:jah Enclosure Tree City U.S.A. NOTICE OF CERTIFICATION STATE OF MINNESOTA ) COUNTY OF WASHINGTON ) ss. CITY OF OAK PARK HEIGHTS ) I,the undersigned being duly qualified and acting as City Administrator for the City of Oak Park Heights,Minnesota DO HEREBY CERTIFY that I have compared the attached document: Conditional Use Permit Special Home Occupation Permit In Home Hair Salon 13930 55`"St N. with the original thereof on file at the offices of the City of Oak Park Heights, and that the same is a full,true and complete copy of said document within the files of the City of Oak Park Heights. WITNESS my hand and the seal of the City of Oak Park .eigh ,this 31st day of December, 2014. Eric Jo '.n City Ad nistrator CITY OF OAK PARK HEIGHTS CONDITIONAL USE PERMIT SPECIAL HOME OCCUPATION PERMIT iN HOME HAIR SALON 13930-55TH STREET NORTH File No.: 236.05-13.01 Date Issued: December 26,2013 Legal Description: (Washington County Geo.Code: 05.029.20.14.0096) Lot 9 Block 3,River Hills" Owner: Sarah A.Bell fka Sarah A. Chichila 13930 55m St.No Oak Park Heights MN 55082 Applicant: Same Site Address: same Present Zoning District: R-1, Single family District Permitted uses set forth in Ordinance 401 Section 401.15.M I. CONDITIONAL USE PERMIT: To allow an in home hair salon compliant with the provisions for a home occupation within the city code. All uses shall be subject to the following conditions and/or restrictions imposed by the June 22,2010 Resolution of the City Council of the City of Oak Park Heights as follows: 1. Any changes to the structure to accommodate the home occupation shall be compliant with all Building and Fire Code requirements subject to review and approval of the Building Official. 2. Only residents and occupants of 13930 55th Street North shall be allowed to work at the in-home hair salon. 3. The Applicant shall receive and maintain all required state licensing for the business. 4. The Applicant shall provide a sign plan, in compliance with Section 401.15.G of the Zoning Ordinance S [ t L and subject to approval of a sign permit. 5. There shall be no exterior storage of materials as it relates to the business. 6, The home occupation business shall not be conducted between the hours of l0;00 PM and 7;00 AM, 7. The applicant is allowed to sell a limited amount of retail product accessory to the business. 8. The Applicant shall identify the amount of area the salon will occupy in the residence and file a written plan depicting same with the city. III. Reference Attachment: The reports of the City Planner dated December 4,2013 and annexed hereto by reference. IV. Abandonment: Applicant must construct and implement features within the home to accommodate the permit as issued within 12 months from the date of the grant of the permit and council action (See 401.03C.4.a and b). This permit requires continuous use in order to preserve the Conditional Use granted by the City under the terms hereof. Any discontinuation or abandonment of the uses permitted hereunder upon the site for a period of 12 continuous months shall constitute abandonment and void the permit. V. Annual review:Annual review is not imposed as a condition of this permit IN WITNESS WHEREOF,the parties have set forth their hands and seals. CITY OF OAK PARK HEIGHTS Date: 12 -30- 13 BY 101$?. .,,, ,i McComber / ayor Date: 12 ' 30- I3 /d ` . i" .n City Administrator Sarah ,/Bell Date: G. a-► BY a\CIN Q Permit Holder t ¶ t PLANNERS REPORT I , k 3801 Thurston Avenue N, Suite 100 Anoka. MN 66303 Phone:783.231.6840 IIII Facsimile:763.427.0520 TPC@PIanningCo.com MEMORANDUM TO: Eric Johnson FROM: Scott Richards DATE: December 4, 2013 RE: Oak Park Heights—Conditional Use Permit for a Special Occupation Permit to Allow an In-Home Hair Salon t� 3930 55th Street North TPC FILE: 236.05— 13.01 BACKGROUND Sarah Bell has made an application for a Conditional Use Permit (CUP) to allow an in- home hair salon at 13930 551' Street North. The request requires a CUP in that beauty salons are considered a special home occupation. The review of this request is contingent upon a Zoning Ordinance amendment to clarify the language in Section 401.15.M related to home occupations. The property is zoned R-1, Single Family Residential District. EXHIBITS The review is based upon the following submittals: Exhibit 1: Narrative from Sarah Bell Exhibit 2: Application for a Home Occupation Permit Exhibit 3: Salon License Application Exhibit 4: Picture of 13930 55th Street North PROJECT DESCRIPTION The applicant has requested the conditional use permit to open an in-home hair salon. Ms. Bell's narrative indicates the following: "1 am asking if I can apply and get a home occupational permit to open a hair salon business in my home and if traffic volume will be allowed. There will be no more that 1- Page 206 of 254 t I V 1 2 customers at a time. I will offer hair services and some product retail items to my clientele. The name of my salon will be ChromaLox. ChromaLox will be in a portion of my residence where all standards and codes will be met by both the City and State." The salon will be located in the living room of the structure. Within the state license materials, a diagram is included that shows the plan for the salon. She notes that there would be one to two customers at a time and would be open Monday to Saturday with hours between 8:00 AM to 9:00 PM. There is a three stall garage with a large driveway for parking. She has indicated that she may add a separate entrance and sidewalk if required. The changes to the structure will require a building permit. ISSUES ANALYSIS Comprehensive Plan: The property is designated as low density residential in the Comprehensive Land Use Map. The request for a Special Home Occupation is consistent with the Comprehensive Plan policies related to low density land use. Zoning: The property Is zoned R-1 Single Family Residential District. Section 401.15.M addresses home occupations. A hair salon would require a Conditional Use Permit in that it qualifies under the criteria of a Special Home Occupation. Currently this section of the Ordinance does not allow persons to come to a residence for services offered by a home occupation business. This is an issue within the wording of the Ordinance that was not the original intent. Special Home Occupations are set up to require the public hearing and the CUP in order to consider allowing a limited number of customers to come to the residence. A public hearing has been scheduled to make the necessary Ordinance change. That hearing will be conducted prior to the hearing for the CUP. Please see the separate memo on this issue. The criteria for reviewing home occupation requests are as follows: 3. Requirement General Provisions. All home occupations shall comply with the following general provisions and according to definition, the applicable requirement provisions. a. General Provisions. 1) No home occupation shall produce light, glare, noise, odor, vibration, smoke, dust, heat, or hazardous or toxic material shall not be produced, stored, or kept on the premises that will in any way have an objectionable effect upon adjacent or nearby property. 2 Page 207 of 254 1 Comment: The hair salon should not create any issues such as those listed above. 2) No equipment shall be used in the home occupation which will create electrical interference to surrounding properties. Comment: The equipment should not create any issues with electrical interference. 3) Any home occupation shall be dearly incidental and secondary to the residential use of the premises, should not change the residential character thereof, and shall result in no incompatibility or disturbance to the surrounding residential uses. Comment: The hair salon will be secondary to the residential use. There will be no change to the residential character of the neighborhood. 4) No home occupation shall require internal or external alterations or involve construction features not customarily found in dwellings except where required to comply with local and state fire and police recommendations. Comment: The dwelling changes proposed are consistent with the single family design of the structure. 5) There shall be no exterior storage of equipment or materials used in the home occupation, except personal automobiles used in the home occupation may be parked on the site. Comment: There will be no exterior storage of equipment and materials. B) The home occupation shall meet all applicable fire and building codes. Comment: The home occupation will be required to meet all fire and building codes. 12 7) All signing and Informational or visual communication devices shall be in compliance with Section 401.15.G of this Ordinance. Comment: The applicant shall provide sign plan that will be consistent with the Ordinance and subject to approval of City Staff. 8) All home occupations shall comply with the provisions of the City Code. Comment: The hair salon will be required to comply with City Code. 3 Page 208 of 254 r r Y 9) No home occupation shall be conducted between the hours of Pa 10:00 pm. and 7:00 am. unless said occupation is contained entirely within the principal building, excluding attached garage space, and will not require any on-street parking facilities. Comment: The proposed hours are 8:00 AM to 9:00 PM. 10) No commodity shall be sold on the premises. Comment: The applicant has proposed selling a limited amount of product. The Planning Commission and City Council should comment. 11) Not over twenty-five (25)percent of any one story can be used for a home occupation. Comment: The total amount of area that the salon will occupy is about 200 square feet. The applicant should identify the size of the portion of house that the salon will be located. c. Requirements-Special Home Occupation. 1) No person other than a resident shall conduct the home occupation. Comment The applicant which is a resident of the home will be the only person doing the home occupation. i 2) Special home occupations shall be limited to only those activities of a non-residential nature which are specified as allowed by state statute or regulation such as day cam group nursery or which comply with Sections a and b above, but are conducted entirely within the principal building, attached garage space, or detached accessory building. Comment: The salon is regulated by the state. The salon business will be done entirely within the building. 3) Special home occupations may be allowed to accommodate their parking demand through utilization of on-street parking. In such cases where on-street parking facilities are necessary, however, the City Council shall maintain the right to establish the maximum number when and where changing conditions require additional review. Comment: There is adequate room in the driveway to accommodate the one to two customers that may be at the salon at any one time. 4 Page 209 of 254 • , • Conditional Use Permit Criteria: The conditional use permit criteria, found in Section 401.03.A.7 of the Zoning Ordinance, are found as follows: 1. Relationship to the specific policies and provisions of the municipal comprehensive plan. 2. The conformity with present and future land uses in the area. 3. The environmental issues and geographic area involved. 4. Whether the use will tend to or actually depreciate the area in which it Is proposed. 5. The impact on character of the surrounding area. 6. The demonstrated need for such use. 7. Traffic generation by the use in relation to capabilities of streets serving the properly. 8. The impact upon existing public services and facilities Including parks, schools, streets, and utilities, and the City's service capacity. 9. The proposed use's conformity with all performance standards contained herein (Le., parking, loading, noise, etc.). Comment: Most of the issues listed above have been adequately addressed in previous review. The Planning Commission and City Council should consider the overall neighborhood impact to determine If there are any issues in this area. There are other similar home occupation hair salons In Oak Park Heights that have not created issues for the neighborhood. CONCLUSION/RECOMMENDATION Upon review of the request for the Conditional Use Permits, City staff would recommend the Conditional Use Permit to allow an in-home hair salon at 13930 55th Street North with the following conditions: 1. Any changes to the structure to accommodate the home occupation shall be compliant with all Building and Fire Code requirements subject to review and approval of the Building Official. 2. Only residents of 13930 55th Street North shall be allowed to work at the in-home hair salon. 3. The Applicant shall receive and maintain all required state licensing for the business. 4. The Applicant shall provide a sign plan, in compliance with Section 401.15.G of the Zoning Ordinance and subject to approval of a sign permit. 5. There shall be no exterior storage of materials as it relates to the business. 5 Page 210 of 254 6. The home occupation business shall not be conducted between the hours of 10:00 PM and 7:00 AM. 7. The Planning Commission and City Council should comment on the request to sell products related to the home occupation business. 8. The Applicant shall identify the amount of area the salon will occupy in the residence. 6 Page 211 of 254 , EXHIBIT 1 City of Oak Park Heights, I am asking if I can apply and get a home occupational permit to open a hair salon business in my home and if traffic volume will be allowed.There will be no more than 1-2 customers at a time.I will offer hair services,and some product retail items to my clientele.The name of my salon will be ChromaLox.ChromaLox will be in a portion of my residence where all standards and codes will be met by both city and state. Thank you, Sarah Bell 13930 55th St N Oak Park Heights,MN 55082 651-955-6095 Page 212 of 254 --,=, EXHIBIT 2 t- 1 CITY OF OAK PARK HEIGHTS o DEVELOPMENT APPLICATION 1 S .1406 14168 Oak Park Boulevard (1-6) P.O. Box 2007 Base Fee; *1 00 , Oak Park Heights,MN 55082 Escrow Amount U Pt. (851)439-4439 Fax (851)439-0574 Street Location of Property 1 393 d 5& 5+ t Legal Description of Property Pt iJ G 5.0Z9 •20. 1 q , 00 9(o _--,_/1_'e& g:j e4' - s Oi r4 d n . * Owner: Name - SelrOAA be k k . IV 1 , Address: 1)q 0 5 -1-1-.‘ 'r` ` ' City:-Oa„ (hSri h+s state: (rN Zip:SSOica' Telephone: (Home). - eiusiness) Las l'9SS'-le.pq 5 (Fax) —. (Other) * Applicant: Name$OJ ,.\..._.___._. _W Address:,., 93 D 5S " `t N _ _ t City: - r State: Ma_ Zip: SSC)R-r Telephone: (Home)(9S'l^ ip.-1392(Dusiness).�g o95 (Fax) ... �._ (Other) Type of Request(s) Zoning District Amendment X Home Occupation Conditional Use Permit Site Plan Review Variance: Single Family Residential PUD: Amendment Variance: Other Residential/Commercial/industrial PUD: Concept Plan Subdivision PUD: General Plan - Subdivision:Minor - 'Street Vacation , Comprehensive Plan Amendment City Financial Assistance .>F Description of Request(s): 0 ,,' A ,L Ala a AI _ r If a request for planning/zoning action on the subject site or any part thereof has been previously approved,please describe it below: i l U) Owner/Applicant Initials i Page 213 of 254 I Development Application,Page 2 General Conditions Applicattion Review The undersigned acknowledges that before this request can be considered and/or approved,all required information and fees, Includingcny deposits,must be paid to the City. An incomplete application will be returned to the applicant. The application approval process commences and an application is considered complete when all required information and fees are submitted appropriately to the City Professional Fee Responsibility; It is the understanding of the undersigned that d City incurred professional fees and expenses associated with the processing of this request(s)will be promptly paid upon receipt.. If payment is not received from the applicant,the property owner acknowledges and'agrees to be responsible for the unpaid fee balance either by direct payment or a special assessment against the property. Applicants wiO be billed on a monthly basis for Planning, Engineering, Legal and Community Development fees as they are accrued. it is understood that interest will be charged on the account at the maximum rate allowed by the Fair Credit Act if It becomes thirty(30)days past due. Failure to pay administrative arid processing fees In a timely manner may result in denial of the application. All fees must be paid at the time of application and shall be paid prior to the issuance of a building permit. The undersigned applicant further acknowledges and consents that all unpaid fees owing the City of Oak Park Heights shall be treated as unpaid utility fees and may be certified for collection as with delinquent utility billings and may be assessed against the subject real property if unpaid by October 31 of each year, Property Address /3g30 55 ' St- Ai C910SQ V; 2 Date: ' ` P 1 3 Owner Signature � -� A/ig`�-I/1 Date: 1 +-i • (3 Applicant Signature Page 214 of 254 ♦ I I City of Oak Park Heights 14168 Oak Park Blvd. Box 2007 Oak Park Heights,MN 55082 Phone(651)439-4439 —Fax(651)439-0574 www.cltyofoakparkhclghts,cam APPLICATION FOR A HOME OCCUPATION PERMIT Applicant: SO...na.h A , %-t9 k‘ Phone# tP S t - q S S-6 0 9 S Street Address: BO(g0 S S-+". City r to Zip g'S n CA, For application property: Street Address: )3 1S0 SS H" St A City QR K. par'L f �'1' M 14 Zip o/re Legal Description of the property: KeSlaen#1 0.l • A3 CA.Cre 3 Cetr ar g � Zoning Di 'ct: ( , SiNwa'L+Q.. came me l y r 1'0(4 KY-7'4 II Is the property connected to the City water and sewer system? b( Yes No Page 215 of 254 (If additional space is needed to adequately answer the following,please accurately number and answer the responses on the back of these sheets.) Describe the home occupation(type of home business)being proposed: 44 o�n Describe the character of the existing surrounding property: g3 , r .rtcH&1 h- v re S; e.y�-r- ary & . Who is to be employed in proposed occupation? &r& - Bk\ Will any person(s)be employed that does not live at the occupation address listed in this application? Yes 5c No In what part of the structure will the occupation be located? 0/19 roo1/1 i- Q r all SSA hF 2 Page 216 of 254 How many customers will be served at one time? What are the intended days and hours of this occupation? oviaj &1-4-u,r d.a t-l-eyna n3 What service will this occupation provide? }fair Q4.( and m t a j r a_ t u-)611-iO3 an o& po ',w 9 main (cures II Is off street parking available? Yes 7 No If yes,describe location,capacity and type of surface: 0104 On -144-e S - e fi air\Il. dfut'wtLI of l eLkAft kof 1-e _pair kc--- Will there be a need for street parking? V( Yes No If yes,how much space will be needed? pco1zutL1 not { b u ff ju c - ;i C LtS_e ., Mar fry Ot Cg• 3 Page 217 of 254 . Will the occupation require the use of an accessory building? Yes No If yes,please justify the need of an accessory building and describe the facility: Will the home occupation require or involve any equipment not normally found in a dwelling unit? Yes _No 044 14 pr-\ If yes,please describe the equipment: kr Ste k-o-n Will the occupation involve over-the-counter sale of merchandise produced off the premises? Yes No If yes,please describe the merchandise to be sold: ../ ' 1. ' ► •;i. r/ s1 0 How long do you anticipate the occupation be carried on at this address? Os font QS \je . h .ere . 4 Page 218 of 254 . . How much of an investment in the premise is required for this occupation? I awl not SuN' 14� but I � n4 )ut.esSI'l 5%DM-1 o Ooc LA-f tio� inn o 1 b�'rl e Ire&lid- C 4-VIA-VI Co _+ L 4- If an investment is required,does it include alteration? Interior .Exterior If so,Please describe the required alteration: Zt4A $I®c 441 res et.ii-. q I * bu yi h.€ 3 roavAS z t a.. rid S-�e -e. r311)OV C1J4,1 intj ((..0 otecaeti Are other governmental licenses or permits required to legally conduct business in this occupation? Yes No If yes please list the licenses and/or permits below: 'Minn-'5Q -'l fwd 0.c COST-9100 The City reserves the right upon issuing any home occupation permit to inspect the premises in which the occupation is being conducted to insure compliance with the provisions of Zoning Ordinance 401.15.M"Home Occupations." May the City inspect the premise during the application process? 'X Yes No If no,please explain: 5 Page 219 of 254 Is there any additional information regarding this application that the City should be aware of concerning the occupation? By signing this application,I declare that I have read all applicable City Ordinances. I affirm that all information provided to the City of Oak Park Heights on this application, or as a part thereof,is true and accurate to the best of my knowledge. Date: o • UIS2Akici frW Signature of Applicant Please Check One: Fee shall be submitted with complete application. XNew: Special Home Occupation —Fee: $100 (Ordinances 401.03 &401.15.M) New: Permitted Home Occupation -Fee: $25 (Ordinance 401.15.M) Home Occupation Renewal(Annual) —Fee: $ 15 6 Page 220 of 254 • . FXHIBIT 3 Q Board of Cosmetologist Examiners 2829 University Avenue SE,Suite 710 Minneapolis,MN 55414 651-201-2742-612-617-2601(fax) www.bceboardstate.mn,us-bce.board @state.mn ps Salon License Application -MAKEA COPY OF 11*T5APPUCA1JOf4 MR YOUR RECOR S- THE BCE IS ON A THREE-YEAR LICENSE CYCLE.A LICENSE CANNOT BE ISSUED FOR MORE THAN THREE YEARS. THUS,YOUR INITIAL UCENSE MAY EXPIRE IN IFSS THAN THREE YEARS. Please complete all of the following questions. Failure to have a complete application will result in a delay of your Salon Licensure as the application will be returned. A Salon License does not transfer when a salon is sold or moved. Owning and operating a salon under another person's or business's license is illegal. "The data whidn you furnish on this application will be used by the BCE to assess your qualifications for icensure.Disdosu re of this information is voluntary.You are not iegeky required to ode this data,however if you fall to do so,the BCE may be unable to process this application. Disclosure of your Social SeunRy number is required by Minnesota Statutes 2700.72 and your Soda!Security number may be requested by and Released to the Minnesota Commissioner of Revenue.Then BCE may use your Social Security Number for Revenue Recapture as authorized by Minnesota Statutes,Chapter 270A.After issuance of a license,an l nformadsn contained In this applation,except your Soda!Security Number,will be public Information pursuant to Minnesota Statutes.Chapter 13." Pursuant to Manna*Steals MAU and 609.516 the BCE Is authoriaadto these a service Charge of$30.00 for any check that Is retuned far ncsl &lent finds. lignatjaS 094012 Total Fee $243.00 $293.00 if this application is the result of a late renewal Initial Salon In Salon Legal Name ChrornaLo' Sat �v Salon DBA Name(DBA:Doing Business As) ChrOm LO alor, MN Tax ID,Federal EiN/TiN or SSN(SSN can be used if salon is a sole proprietorship) tb o .<r,. s l s%the salon m r'Iuiir core s is w t n ifleet plu n b r`sJ poe bowls and hair cutting stations If both nail services and waxing(hair removal)services are offered,but not hair care,the salon will need two licenses. The two licenses required we a manicurist salon license and an est hetician salon license. Stihalft two applitertions tOgetber h the Wine time adui all ,. i QCosmetology Salon (Care of hair,nails,and skin) L-3 Manicurist Salon (Care of nails,does not include the removal of hair by waxing) Esthetician Salon (Care of skin,including waxing) For Office Use Only: Staff Initials: Chedc/MO/Receipt Number: Amount Paid:_ Application Number: License Number: Date Processed: Page 221 of 254 Check one of the followjng and answer any additional gpgstions= I><I fikwiligritiftuaggaidigiag Chants of Ownership(Currently Licensed$alogl Previous Salon License Number Previous Salon Name Previous Salon Address Previous Salon Owner Late Renewal AtmIllation Current Salon License Number Expiration Date of Salon License Salon Relontion Previous Salon License Number Previous Salon Name Previous Salon Address business Structure Chance Previous Salon License Number Check Time of Business Structure )Business Trust is Limited Liability Company 1:f Corporation Limited Liability Partnership OGeneral Partnership Limited Partnership []Sole Proprietor Other Business Structure: • L)Sole Member LLC Page 2 of 12 Page 222 of 254 Salon Aoolicatlnn f.]hedsfisr(Find ownership type,any items with a checkmark are required for that type.) Document Name Paeetsl Mg General LLP Con oration Ohm .1. Completed Application(Signed& 1-12 ta/ f Notarized Application Fee 1 MN Tax ID,Federal Tax ID(TiN or EIN)or 1 Sodas -• Number Certificate of Assumed Name(Copy) Attachment •A Certificate of Assumed Name must be filed if the name of the business is different than the full name of the owners)of the business. This requirement applies to all forms of business organizations. Articles of Incorporation/Organization Attachment / / (OM) P Current Manger(Name,License Number 4,12 fi ✓ ✓ r or &Signature) Zoning Official Signature 4-5 ./ If ✓j 1 Or Certificate of Occupancy(Signed)and Attachment !J 1 Building Permits if applicable(Copy) �+ Professional Liability Insurance Certificate 6, I I / j I Attachment Workers Compensation For Employees 6-7, I I ✓ ✓ Attachment 1/ hm Disclosure of Owners Form 7 C y / Floor Plan(Use Correct Codes) 8-9 if j f I Owner&Manager Acknowledgements 11-12 I/ IC ti 1 Copy of Completed Application(for you) -- I, ✓ ! Department Name Contact Information Secretary of State 651-296-2803 or 1-877-551-6767 • Assumed Name www.sos.state.mn.us • Articles of incorporation/Organization Department of Revenue 651-296-6181 or 1-800-657-3777 • MN Tax ID Number (plesuse.taxxstate.mn.us/www.taxes.state.mn.us) Department of Labor and Industry 651-284-5005 • Workers Compensation www.dli.mn.eov Zoning Official Contact city or county offices in which your salon will be located to get more information. Department of Treasury 800-829-0115 Positively Minnesota(Small Business Owner htta://www.positivelvminnesota.com Assistance) Page 3 of 12 Page 223 of 254 Additional Aooiication information Salon Name(Complete Again) Salon Legal Name(Complete Again) _Chrom .Lox. &thin CO(r .i O 1 Sal o r� Owner First and Last Name or Corporation Name Sa.rCLk 18'e Li Salon Address 1-693 0 5 S44-) S4 0 Oty State Zip Code 00X-- Qa�r I4e. le �tJ ESo ti-a. Salon Phone Number County of Salon Location U2S1-9S5- Wo sh in5Fa vi Email Address and Web Address Nr6W1C6 01Sc OfOP c 1 - rc rr Salon Manager Last Name Salon Manager First Name f e,l t SSa ram Salon Manager MN License Number Salon Manager License Type of Manager License Expiration Date Cosmetologist ' 13 00 01 / 30f at:li 0 0Esthetdam Please check the following days the salon is open: 94/Monday A-Tuesday Wednesday f 'Thursday 9 Friday gi Saturday 0 Sunday Is this salon open by appointment only? Is this salon in a Residence? c)Yes O No If Yes,list one day per month salon is open: /" Yes O No Total Number of Practitioners Working in Salon Total Square Feet of Salon , ' i l{j QO: StAA y r Y 4 -� -f Y SV�F-av�aN^ -J �.i _ .h� t � 7 , 1 .. ... t ''.' ,N,13. ?' _ .. .• _ :. "''.. �� 4f. try 4, c„.,'". . r t rt, :,T ,r t 1. e VP' 9 ' . Ar' �'� ..,1':. '4 .?� C . . 'g ... , ,"r.7� a , ' i„. ., r ' ;. ' - - , . '. $uldina and Zoning Comollance 1. Check the appropriate box below. 2. Obtain signature in appropriate section and attach required documentation. I Complete section A If you select the following: The building in which this salon is located is new construction. Complete section A below. iComplete section B if you select the following: The building in which this salon is located is an existing building. The Applicant has made improvements or changes to the salon which require building permits and zoning approval.Complete section B below. LiComplete section Cif you select the following: The building in which this salon is located is an existing building. No Building Permits or Zoning Approval was required by the City or County in which this salon is located.Complete section C below. Page 4 of 12 Page 224 of 254 _•i-,':,';4;..-- , . r 4. ♦` . 'Y' ,ra 4.;f..4-4,','0'',0:1.1.:,::...: l '. Jy4 Lxa-e%,.,i;::. 1.7,i tl 4. Y E a. ''t, vj 'r-:=. ',a; kjt is p 4 rl' xx 1° • S 3 7 ('r ie'�� 2[`.-}fir ayi'`r° �„��3� 1 �,� `�'� ,t_ 't��t�*'.i,. �c1a�- l,v "��1i��.. � 3+141. tom,, tYc c z.lei'it ss :,i;;t y..41 /, n i t o i l k3. *7•' .ntuit;. 4 ,,4_T .Y:k.i;,S i a1+ y. 4 The building In which this salon is located Is new construction. 1 L Applicant must attach a copy of the signed,dated Certificate of Occupancy issued by the City or County In which the building is located. 2. Applicant must attach statement from Zoning Official that salon is in compliance with zoning ordinances,or obtain signature below: Salon address inspected and meets zoning compliance Signature of Zoning Official Title Date Print Name of Zoning Official City or County Name Telephone Number C �b ^ �h a" , � f ;la Yr.�✓ f r rr.t .. l � The building in which this salon is located is an existing building. The Applicant has made improvements or changes to the salon which requires building permits and zoning approval. 1. Applicant must attach a copy of the Building Permits Issued by the City or County in which the building is located. 2. Applicant must attach statement from Zoning Official that salon is In compliance with zoning ordinances,or obtain signature below: Salon address inspected and meets zoning compliance Signature of Zoning Title Date - I Print Name of Zoning Official City or County Name Telephone Number The building in which this salon is located is an existing building. No Building Permits or Zoning Approval was required by the City or County in which this salon is located. Obtain signature below: Salon address inspected and meets zoning compliance Signature of Zoning Official Title Date Print Name of Zoning Official City or County Name Telephone Number Page 5 of 12 Page 225 of 254 Insurance Infiormation Failure to complete this section results in a delay of licensure. The most common reason the BCE returns applications is because the certificate of insurance is not submitted or is incorrect. II Professional Liability Insurance(Required fur All Salons)—General Liability will not be accepted -Professional Liability insurance covers "workmanship"of licensee where General Liability does not- Read Carefully: 1. Attach a Certificate of insurance to the Application that indicates: • Certificate Must Show: o $25,000 coverage/each claim o $50,000 coverage/each policy per operator o Must state"Professional Liability Insurance" • Certificate Holder Must Be: o Minnesota Board of Cosmetologist Examiners,2829 University Ave SE,Suite 710, Minneapolis,MN 55414. • Name of insured must be the owner and DM of the salon and assigned to the salon's address. Completing the Name and Policy Number is not sufficient;the BCE must also have a copy of the certificate(s)as described above. Name of Insurance Company Policy Number(Professional Liability) • Workers Compensation Insurance Answer the following 2 questions to determine if Workers Compensation is required. 1. Will this salon employ individuals? L.....Jyes(complete WC Insurance) CO No 2. Will this salon have only Independent contractors with MN Manager Licenses? CZ) Yes ID No(complete WC Insurance) (Workers Compensation Continued on Next Page) Page 6 of 12 Page 226 of 254 Workers Compensation insurance(Required for All Salons Employing individuals) Required documentation to be submitted to the BCE • Certificate Must Show: o Workers Compensation Coverage • Certificate Holder Must Be: o Minnesota Board of Cosmetologist Examiners,2829 University Ave SE,Suite 710, Minneapolis, MN 55414. Contact the Minnesota Department of Labor and Industry Regarding workers compensation questions at 651- 284-5005. Completing the Name and Policy Number is not suffident;the BCE must also have a copy of the certificate(s)as described above. Name of Workers Comp Insurance Company Policy Number(Workers Comp) • DirdiaillESAMIMIRML2t0 ners.Partners.Off cers An appllcantfor a Salon license must include the following Information: • individual Proprietor: Provide the name and address of the Owner • Partnership Provide the name and address of all General Partners and limited Partners • Corporation or KC Provide the name and address of all elected Officers,Directors,Govemors,Members, Shareholders owning 10%or more of company stock,and any Managers/Employees with authority to exercise control In policy or management of the company if any owner or partner is alto a business entity,you most complete this force to disclose the of that business entity as welt Lasjtt Name First Name Middle Initial k7"(? Sarc ' Residential Address Primary Telephone Number 1Y160 S S' '^ S — NJ Lo51-IsS-62.09.S L R4v (.- W-( 1'L sta t T i \ ZIP code log c - Title as Owner,General Partner,limited r,Director) gokon • Last Name ' First Name Middle Initial Residential Address Primary Telephone Number City State Zip Code Title(Such as Owner General Partner,Limited Partner,Director) This form may be photocopied if additional forms are needed Page 7 of 12 Page 227 of 254 Codes To Be Used and Listed on Floor Plan (on the next page) % Chair(Any Style) y!. Cabinet(Supplies) Sink i. Table(All Styles) f• Shampoo Bowl 1. Hot Water Heater D. Pedicure Spa Dispensary Area C Work Stations Counter/Cabinets ,e Restrooms Covered Container(Soiled Towels) M. Entrance/Exit Cabinet(Clean linens) U 0 0 VIO 0 0 0 0 0 o 0 HHH 1 Q © p1 O 16,\ © 4 0 0 OD WaltingArea Mankure/Pedkaat Roan 0 _ M IGIGIGIGI Vii 0 VOIGIGIGJGIO I IMMO M '`�, THIS IS AN 0 E EXAM P LE E IL�t1+0o�11! :1E Q V I V Hair Station �. Area . E 410 4 '... H VL Z � /..,. H K Shampoo Area E H i 0 0 0 TDiSP.nWYv E Roam etician H I A A r61-717171 r Page 8 of 12 Page 228 of 254 L. ,S Sa!o!Floor p0 p ' (' 0 Mrs Lam] X Sat on �� NAME� � V) Total Floor Space (from salon floor plan below) I' 3'71 feat ° any R Oa' floor"ocmead 'PMew P � erhldi we mrt odthe salon a m � Reception Area• squarefeet Total Deductions(from calculation at Right) — square feet Restroom Area square het Supply Area • squerefeet Total Work Space(FbialRxeSpece mho TotalDrtfrsons) = square feet Total Deductions= square feet Prepare a diagram of the salon floor plan following the example on page 8: • Whim used for regulated services ggiailigtaggi(or shampoo bowl). • The dispensary must also have a shit. • Each room must be labeled as what it is wed for. • All codes from page 8 are required to be used(excluding possibly the pedicure spa and/or shampoo bowl). • You may instead submit blue ptints/formal drawings with appropriate codes and labels(muat sill complete above deductions). Each square below represents 5 feet by 5 feet. If your salon is larger than 50 feet by 50 fee,stitch additional pages to show complete floor plan. 0• b 1 l 'r MarMI __ " _ " 1111.10011� tr N �'o Ill trec)c\A l5 tOC&t( 00•1 aftfn o l`n fril,"v?"Ilierilii•-- ) 104,10 -4,0„0„, 9e5 ow) is • ion A-12111 ,1 3 ,41 .",..r_,,_ ,_,...._ ,,,, . _______ ..... ,ton 1 '> G. a €4 LoZ 6-e Page 9of12 14t U. --,t-e., - 1 o tin 7 i C .e S Pl f.e f sege v v-w k sic Sajoijjematilianagbift NallIZA o Salons are limited to offer cosmetology-related services to the type of license held. If a salon is found to offer services that fall under the BCE Regulation and are not licensed to offer those services,the Salon can be assessed civil penalties up to$2,000 per violation found. o A salon must have a current designated manager with a current salon manager license. o The salon must ensure all practitioners working in the salon are currently licensed. If a salon is found to have unlicensed or expired practitioners,civil penalties of up to$2,000 per violation may be assessed,to the salon manager and owner or loss of licensure may result o The current salon license,salon manager license,and all licenses of employees and independent contractors must be posted conspicuously at the salon. o The salon must post a notice regarding availability of inspection records. Amnia -Renew Online! o Your salon license will expire on the anniversary of your three-year license period. If you fail to renew on or before that date,you will be considered expired and not eligible to offer services. Additional renewal fees will apply if you fail to renew on time. The Board makes every effort to mail renewal notices to each licensee,but it is your obligation to renew your license on time whether you receive a notice or not. o Failure to renew the salon license within 30 days of expiration date would require the submittal of a new salon application. Manager atar • If you change your manager,you must notify the Board Immediately. Name-- • Complete the Name Change Form within 60 days of the change. Owner/Business Structure Change • Complete an Initial Salon Application within 60 days of the change. Address Change • if.your salon moves locations,you must ,Y complete and submit P an entirely new Salon Application and complete all the requirements for a new salon. Online License Verification • To verify the license status of persons performing services at your salon,use the Online License Verification at www.bceboard.state.mn.us. Cosmetology Laws and Rules • Copies of Cosmetology Laws and Rules are available from the Minnesota Bookstore at 651-297-3000 or www.leg.state.mn.us. Page 10 of 12 Page 230 of 254 •1,. 1 r '. ." ' 1 u 1. : LM.lam ri'. : 11 11!- i.' ,• 1111..1_ •. • • • It Owner Adcnowledunztnb Section A. We acknowledge that it is our responsibility to have a copy of the laws and rules in our salon and employees will be made aware of where this is located. 43?) (Initials of at least 1 owner) B. We acknowledge that ft is our responsibility to have a fire extinguisher available in our salon and employees will be made aware of where this is located. CvJ� (Initials of at least 1 owner) C. We acknowledge that it is our responsibility to have a first aid kit in our salon and employees will be made aware of where this is located. V?) (Initials of at least 1 owner) D. We acknowledge that a Dispensary Area must be inaccessible to the public and has a sink. This means either a locked cabinet or a door leading Into a dispensary room that must be dosed at all times. 4:243• (Initials of at least 1 owner) E. We acknowledge that a city code official has signed off on the Building and Zoning Compliance section on page 5. (Initials of at least 1 owner) F. We acknowledge that a Certificate of Professional Liability insurance is attached to this application and meets the requirements on page 6 and the BCE is the certificate holder. 143 (Initials of at least 1 owner) G. We acknowledge that if Workers Compensation Insurance is required,it is attached to this application and meets the requirements on pages 6-7 and the BCE is the certificate holder. qe) (Initials of at least 1 owner) H. We acknowledge that there is a waste receptacle at each station. (Initials of at least 1 owner) I. We have reviewed salon requirements in MN Statute 155A and MN Rule 2105.0350 through 2105.0390 and meet all the requirements. (Initials of at least 1 owner) Page 11 of 12 Page 231 of 254 L 1 Ealianlimumasinfed I,the licensed salon manager for the salon listed in this application,certify that I will be the licensed salon manager and I am the responsible party of this salon. These responsibilities include,but are not limited to: A. Ensuring the salon license is current. B. Ensuring all employees/independent contractors that are providing licensed services are in fact currently licensed,induding myself. A minimum fine of$150.00 per practitioner can be assessed to you,the manager,if individuals in the salon you are managing are found working on an expired license. C. Ensuring all equipment is in proper working condition,and that all sanitation and safety requirements are met. D. Ensuring the salon complies with all sanitation requirements and requirements of Minnesota Rules 2105.0350 through 2105.0390. E. On the days I am not working or on a break,I may appoint,but am not required to appoint another licensed salon manager as responsible while I am absent. They assume the responsibilities listed here. F. RI leave this salon or quit managing,I will notify the Board of this,so I am no longer listed as responsible for this salon's compliance with Minnesota laws and rules. 113100 ( 9i3O ( DONS Salon Manager License Number Salon anger Expiration Date Sara.an P-e1 Salon Manager Printed Name l \ • t- 1 • 13 Salon Manger Signature Date t]wnerlsLAReliratlon Certification I certify that the information submitted within this application is true and correct. I also certify that this document has not been altered or changed in any manner from the form adopted by the Board of Cosmetologist Examiners. ‘&21anetiol ewQ 11 . 1 . 1 Signature of Owner#1 Date Subscribed and sworn to before me: This day of ,20 My Commission Expires: Signature of Notary Notary Seal Signature of Owner#2 Date Subscribed and sworn to before me: This day of ,20 My Commission Expires: Signature of Notary Notary Seal Of there are more than 2 owners,attach additional pages) Page 12 of 12 Page 232 of 254 C . I f. 1 1 {"' I. Certificate of Insurance i MU coin This certMes that State Farm Fire and Casualty Company,Bloomington.Minces alb State Farm General Durance Company,Bloconington.Snots State Farm Fire and Casually ammo State Farm Fiodda Insurance Company,Aurora.Ovnrto State Farm Lloyds,Dallas,Tags Company,Wader Haven.F�rida insures the fotowing polcyhdder for the coverages indicated below: Policyholder Sarah Bell Address of PolicyNxfdder 1900 County Rd D E,Maplewood MN 55109 Location of operations Oeon of operations Sarah Bell The policies listed below have been issued to the policyholder for the policy periods shown.The insurance described m these policies is subject to ar the terms,exclusions,and conditions of those policies.The limes of liability shown may have been reduced by any paid claims. Policy Period Untits of Liability Policy Number Type of insurance L07.O0.2013L07.0540l4 ffective Date # :,on Date (at beginning of policy period) CemPrehensive 1 BODILY INJURY AND 93-BR-Q197-6 F Business Liabilly PROPERTY DAMAGE This insurenoe Includes: : PP��Operations Each Occurrence $ 1,000,000.00 • � Aggregate $ 2,000„000.00 • Product-Completed s 2,000,000.00 • OPerldione Aggregate Policy Period BODILY INJURY AND PROPERTY DAMAGE Policy Number EXCESS UABIUTY Effective Dale i Expiration elate (Combined Single Limit) ❑Umbrella ! Each Occurrence $ Other I Aggregate $ Policy;period Effective Date I Expiration Date Part I- Workers Compensation-Statutory Workers'Compensation # Part II-Employers Liability and Employers Liability ! Each Accident $ I Disease-Each Employee $ Disease-Policy Limit $ Policy Period Limits of Liability Policy Number Type of Insurance Effective Date : Expiration Date (at beginning of policy period) . I THE CERTIFICATE OF INSURANCE IS NOT A CONTRACT OF INSURANCE AND NEITHER AFFIRMATIVELY NOR NEGATIVELY AMENDS,EXTENDS OR ALTERS THE COVERAGE APPROVED BY ANY POLICY DESCRIBED HEREIN. Name and Address of Certification Holder If any of the described policies are canceled before Minnesota Board of Cosmetologist Examiners their expiration date,State Farmswi try to mall a 2829 Linty/malty Ave,Ste 710 notice to the certificate holder days Minneapolis,MN 55414 before carbon.tf we fail to mail such notice,no obligation or 6abiMy vall be imposed •. State Farm or its agents or - - -natives. 07102/13 Tide - Dale Agent Name -- Telephone Number(651)735-4193 I Igpatrs Code Stamp Agent Cafe 33-7363 AFo code Page 233 of 254 imam 106399_1D 0326,2009 ... , • . • ,_____. , rYHIBIT. 4 . , A i . 1 . : I ..Yit';i.:-'''": eAlt, - 1 _ ...., , . . - ..., ..,, ,.. . .. ,... .._ -.. •• • • • • • ,_.: ,.1 • ;,: , ,•, • •'•; •• • • , .•• • • • .' 46 77.,:':•-.•' ':' I '• ,... 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