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HomeMy WebLinkAbout2014-01-02 WC Recorded Document 3976266 - CUP Receipt:#247061 3976266 USE $46.00 Return E SIMPLIFILE II I I II I I II I I I I 11111 I II 4844 North 300 West Suite 202 Certified Filed and/or recorded on: Provo UT 84604 1/2/2014 4:02 PM 3976266 Office of the County Recorder Washington County,Minnesota Jennifer Wegenius,County Recorder II 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 55th 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 ,In # t. City Ad Imistrator E-RECORDED s„np>>f>>e ID: S9 (0 0-49 co County: Aqmt n /1, 1 6r\. Date /?- r O°1 ^^i 1 CITY OF OAK PARK HEIGHTS CONDITIONAL USE PERMIT SPECIAL HOME OCCUPATION PERMIT IN HOME HAIR SALON 13930?_55111 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 55th 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 and subject to approval of a sign permit. 5. There shall be no exterior storage of materials as it relates to the business. 4, The home occupation business shall not be conducted between the hours of 10:00 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: I 2 -3 d - I 3 4 • ,,,",,_,, By I//•�•, I/G- M. Mc Imber 1i,yor Date: 12 -30- 13 i�Cid 3 B . T c Johnson ity Administrator Sarah A. t ell I Date: 0` al . J By v. Q!✓) '602)2. Permit Holder ' y Yj e r PLANNERS REPORT y ♦ 4 3601 Thurston Avenue N, Suite 100 Anoka. MN 66303 Phone.763.231.5840 I Pi ' C Facsimile:763.427.0520 TPC@Planningco,com MEMORANDUM TO: Eric Johnson FROM: Scott Richards DATE: December 4, 2013 RE: Oak Park Heights—Conditional Use Permit for a Special Permit to Allow an in-Home Hair Salon at 13930 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 55th 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: °l am asking if I can apply and get a home occupational pennit to open business in my home and if traffic volume will be allowed. There will be no more that 1 Page 206 of 254 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 I I f c. 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 clearly 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. 6) 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 t r 9) No home occupation shall be conducted between the hours of 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. 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 care 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 q 1 t 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 property. 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 (i.e., 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 v t t D v 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 p1 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 CITY OF OAK PARK HEIGHTS +DEVELOPMENT APPLICATION J °10 14188 Oak Park Boulevard ¢ej) P.O. Box 2007 Base Fee; 1�O Oak Park Heights,MN 55082 Escrow Amount U R (651)439-4439 Fax: (651)439-0574 Street Location of Property 1393 3 5541 St K. Legal Description of Property Pik) 05.029 =20. It/ = 309(0 )_ • i ' 'Ye.( a ' • * Owner: Name S 1rak 6.e 1 • Address: 17.1c d 5'N'' City: K, kc State: in Zip:lS SOtc '--- Telephone: (Hornell QS1 a- "j usiness) L2S t' I SS`ILOR S (Fax) �. (Other) * Applicant: Name& Lr.yt, L\ -.- Address: • it 5 f _ City: fi,u I State: a) Zip: SC/AA Telephone: (Home)IQ Sl° q -139a(Business) I0Si-' SS-19095 (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 4. Description of Request(s): b • ka' a, ,a. �_. a Ri J O J If a request for planning/zoning action on the subject site or any part thereof has been previously approved, please describe it below: CCS• Owner/Applicant Initials. • Page 213 of 254 • ' r Development Application,Page 2 General Conditions Application Review The undersigned acknowledges that before this request can be considered and/or approved,all required information and fees, including:any 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 al 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 wits 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 and 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 31m of each year, Property Address /343() 65 S. N t' , -&n 6-eiffl Date: Owner Signature n p �►�Ji.1/ ��- 1 ,Q-19 Date: I I ' ( 13 Applicant Signature Page 214 of 254 e. 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.dtyofoakparkheights.com APPLICATION FOR A ROME OCCUPATION PERMIT A p p l i c a n t: S a r 1 . 9 p 11 Pion# tioC " g S S la(7 q s Street Address: Bel god C S+1"_ k. lv City Cam. 4 ; iS m1J zip A's n �a For application property: Street Address: ) 1Q SS i'4'" St city Oa K. Par L 1+6 t h+5 i'1ri k zip ZO f a. Legal Description of the property: IkeSi Gttn4-1 Q t ,a3 arr'-e 3 Cdr 9arapy Zoning Di •ct: . C44 y r id-2 Is the property connected to the City water and sewer system? bt, Yes No Page215of254 (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: 4.5.1 Describe the character of the existing surrounding property: g 3 4,gre- hom.4 tel Who is to be employed in proposed occupation? &1rn k Bill Will any person(s)be employed that does not live at the occupation address listed in this application? Yes 5k No In what part of the structure will the occupation be located? LIU ng r0001 -P a+ all ço & h - 2 Page 216 of 254 I ' r How many customers will be served at one time? J r� What are the intended days and hours of this occupation? IL i ► f 4 l • i; z 14.,1 1 �" V 'a What service will this occupation provide? IA+r Cart" a v nh j t1vi ( a 1-;,n 9 aN po%'they main(d ies . Is off street parking available? Yes No Ifyes,describe location,capacity and type of surface: On ILI 00 -6-e Stree fi ax 0( Z of tANt Will there be a need for street parking? Yes No If yes,how much space will be needed? prothJN not 1 butt jus- - (us-e Mar (rte a tjp . J�4 3 Page 217 of 254 I 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 4t. etzt414141 cyn If yes,please describe the equipment: iC 641,1 .`S . 3r4 o tit)t Brea-e a() 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: M;i. _ ■t 4 O. . 1nti(k-01r How long do you anticipate the occupation be carried on at this address? I & 4 • Ili 4 Page 218 of 254 Es • r How much of an investment in the premise is required for this occupation? T av' not Sum IV 190- T o 5,000-i 0,Oot, d(-e o 1bt'y7 ge Ire If an investment is required,does it include alteration? f Interior •9 Exterior If so,Please describe the required alteration: 13i ck off` res-1W ' 'i 1 bu yi kt 3 raov j - n ; 'TAP d 4 5 t4 (4&a c.:e So 2 teuw 4o .014a� Sf6LR didty awl. 11140 c Sidet04( 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: jM'‘ n-405o A bCritird. u,c COIOI- 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? Y. 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: 10 • \G• 13 USCIAGLIel Signature of Applicant Please Check One: Fee shall be submitted with complete application. New: 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 e e Or FXHIRIT 3 t Board of Cosmetologist Examiners ',j` 2829 University Avenue SE,Suite 710 Shot or Minneapolis,MN 55414 651-201-2742-612-617-2601(fax) www.bceboard.state.mn.us-bce.boardtsstate.mn.js Salon License Application -MAMA COPY OF THE5APHLICATION FAR YOUR RECORDS- THE BCE IS ON A THREE-YEAR LICENSE CYCLL. A LKSNSE CANNOT BE ISSUED FOR MORE THAN THREE YEARS. THIS,YOUR INffiAL LICENSE MAY EXPIRE IN LESS THAN THREE YEARS. Please complete all of the following questions. Failure to have a complete application will resuk Inc 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 pe'rson's or business's kcense Is illegal. The data which you furnish on this application will be used by the BCE to assess your qualifications for l censure.Disclosure of this information is vnlurnay.You ere not lepOy required to provide this data,however if you fall to do so,the BCE may be unable to process this application. Disde re of your Sodal Serenity number is required by Minnesota Statutes 270C.72 and your Sodas Security number may be requested by end Released to the Minnesota Commissioner of Revenue.Den BCE may use your Sodas Security Number for Revenue Recapture as asshoriaed by Minnesota Statutes,Gaaiber 270A.After issuance of a license,all information contained N ties apps,except your Sodel Security Number,vdil be public information pursuant to Minnesota 9atutes,Chapter 13." Pursuers to eminesete Settees Pus ane 609.515 die BCE Is authorised to theme a smite mow of$30.00 for waded tint is retuned for lioniuMdont fields. UrrengratS 094012 Total Fee $243.00 $293.00 if this application is the result of a late renewal l lown Salon Legal Name • Chrorn(1 LOS Sa I on Salon DM Name(DM:Doing Business As) (Ihrprnt. Ln)c .cat or► MN Tax ID,Federal EIN/TIN or 55N(SSN can be used If salon is a sole proprietorship) • ,M= ... Aft o s l iita il'n n r hofr fre.d es, shad lkkplan by bowls and hair wilting stations !f both nail services and waxing(hair removal)services are aged,but not hair core,the salon will need two licenses. The two licenses required we a manl turist salon license and an Sian salon license.' $fl mitwo facts�,i the*sme the nth oil EPCosmetology Salon (Care of hair,nails,and skin) CDManicurist 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: Check/MO/Receipt Number: Amount Paid: Application Number: License Number: Date Processed: Page 221 of 254 • Check one of the foilowinE alp nswer any onal gum lrjyer Been Li ed Sebn Previous Salon License Number Previous Salon Name Previous Salon Address Previous Salon Owner C)usousassumatata Current Salon license Number Expiration Date cf Salon License C::,)Oka Mamba Previous Salon License Number Previous Salon Name Previous Salon Address agamitaistumsbanga Previous Salon License Number Check Tvoe of Business Structure []Business Trust is limited liability Company CDCorporation [J limited Liability Partnership T1General Partnership [j Limited Partnership OSoie Proprietor Other Business Structure: CDSole Member ilC Page 2 of 12 Page 222 of 254 • P •• r l (Find ownership type,any items with a chedonaric are required for that type.) Dawn swam Poga age sera USW 2neig on Om Completed Application(Signed& 1-12 / / f Notarized) it 8I Application Fee 1 1 r I MN Tax ID,Federal Tax ID(TIN or EIN)or 1 j j aI� Soda!Securfty Number Y e Cie of Assumed Name(Copy) Attachment s i 1 j / 'A Certificate of Assumed Name must be filed If the name of the business is different than the full name of the owner(s)of the business. This requirement applies to all forms of business organizations. Articles of Incorporation/Organization Attachment t j •y 1/ Or Current Manger(Name,License Number 4,12 &S , athure Zoning Official Signature 4-5 Cete of Occupancy(Signed)and Attachment INIBIUMMUI Buildi Permits if=. , r We Co Professional Liability insurance Certificate 6, Attachment Workers Compensation For Employees 6-7, 1 ✓ 1 1 r Attachment Disclosure of Owners Form 7 a/! 1 j f Floor Plan(Use Correct Codes) 8-9 f� i ! 1 1 Owner&Manager Acknowledgements 11-12 Y✓ Copy of Completed Application(for you) - j 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 ((aiesuse.taxpstate.mn.us I www.taxes.state.mn.us) Department of Labor and Industry 651-284-5005 • Workers Compensation www•dlimn.aov 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 htto://www.posftiveivminnesota.com Assistance) I Page 3 of 12 Page 223 of 254 • . • Additional Annlication Information Salon Name(Complete Again) Salon Legal Name(Complete Again) 11 • • ei einr 00'1 • • • (0 Owner First and Last Name or Corporation Name SarCLk co a Salon Address 13g d 5 S .4 J City State Zip Code Oat .0 t— A E o ta. Salon Phone Number County of Salon Location 1- • S- t.J20• WaiSh i<s Email Address and Web Address Salon Manager Last Name Salon Manager First Name • .Sarain Salon Manager MN License Number Salon Manager License Type of Manager License /� Expiration Date Cosmetologist l l l 0o cr / 30/a01 0 Esthetician Please check the following days the salon is open: • Monde a Tuesda e Wednesd • Thursda • Frida Saturda 0 Sunda Is this salon open by appointment only? Is this salon in a Residence? ('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 ` ": ;lo�! - O! St t Tctif ,f�� x V,r' t.ry ;,.�«F ''i s,r .r • + ' ti i.a jd fx s. x+p c rsa' l c '1.tT ,AO :� r�* K,' a - ...MFed � a rrr} "40%3 juuildina and Zoning Cpmnllance 1. Check the appropriate box below. 2. Obtain signature In appropriate section and attach required documentation. 11Compiete section A if you select the following: The building in which this salon is located is new construction. Complete section A below. jComplete 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. Complete section C if 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 • B + rl• 4 �£, �;4 �,yr�,�xj,s?���'�.v�toye ?w t � “:' ec" Jfiyi 4 3 t , � ,r' s=:f a '•t The building in which this salon is located is new construction. 1. Applicant must attadi 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 sigrwtwe 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 A :-$ t. 7 +: -41: Z 'Ny 1.14 The building in which this salon is located is en 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 Offidal that salon Is in compliance with zoning ordinances,or obtain signature below: Salon address inspected and meets zoning compliance Signature of Zoning Title Date 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 Information Failure to complete this section results in a delay of licensors. The most common reason the BCE returns applications is because the certificate of Insurance is not submitted or is incorrect. Professional Liability Insurance(Required for 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 DBA 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 ComQenfatian insurance Answer the following 2 questions to determine if Workers Compensation is required. 1. Will this salon employ individuals? [Jes(complete WC Insurance) a)No 2. Wilt this salon have one independent contractors with MN Manager Licenses? Yes No(complete WC Insurance) (Workers Compensation Continued on Next Page) Page 6 of 12 Page 226 of 254 • , e A , r • a S 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 sufficient;the BCE must also have a copy of the certificate(s)as described above. Name of Workers Comp Insurance Company Policy Number(Workers Comp) ' Disdosureyf Conpnanv Owners.Partners.Officers An applicant fora 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 LLt:: Provide the name and address of all elected Officers,Directors,Governors,Members, Shareholders owning 10%or more of company stock,and any Maragers/Employees with authority to eerttse control in poky or management of the company if any owner or partner is silos business gnats,you must complete tilt ham to disclose the t atbudnonrl*v went. Last Name First Name Middle Initial Residential Address Primary Telephone Number 1 °1M S S.'^ c 62S 1—`ASS—1,1209•S Title as Owner,General Partner,Limited Pa* er,motor) ton Last Name First Name Middle Initial Residential Address Primary Telephone Number City state Zip Code Title(Such as Owner,General Partner,Limited Partner,Muted This form may be photocopied if additional forms are needed Page 7 of 12 Page 227 of 254 F. t A I f ■ • • + C Codes To Be Used and Listed on Floor Plan (on the next page) % Chair(Any Style) )4. Cabinet(Supplies) Sink I. Table(All Styles) jShampoo Bowl J. Hot Water Heater D. Pedicure Spa ire Dispensary Area L Work Stations Counter/Cabinets ,k( Restrooms fCovered Container(Soiled Towels) M. Entrance/Exit j( Cabinet(Clean Linens) D00 vf!!J0000 0 ( o ) 0 H E E 0 ( D ) ILI Ill N 0 D M WaithArea I�nicune/kdioiiRaom 0 M r.-3-; G G F F UI6I.6IGIGI El E ....., THIS IS AN Q E E EXAMPLE E VUArea - 0 6 LA IF Iii II M 000 0 E H Shirt9p00A/es E "'H 000 1 - 1 H 1 0 Dispensary ylf Esthetician A A A 0 al 0 Em 1:3 Room 13 Page 8 of 12 Page 228 of 254 • a. R ' G + -S 1►fi , Lk ti �� S inMgip tot OF SAWN 0)11r001n Lo x Sat on _ �, Melee any Rte,eastroom and Supply weer Total Floor Space (from salon floor plan below) ��3'7asquarofeet which wet�orthesalon floorspace: a"SIG R�ptionArea=►93 sq a,refeet Total Deductions(from calculation at Right) — square feet Restroom Area 1_square Supply Area• squtrefeet Total Work Space(TodgoorSpaoe alas TM L)edacaons) = square feet Total Deductions c square feet Prepare a diagram of the salon floor plan following the example on page 8: • rinfungni used for regulated servio.ratan have a dnk for shampoo bowl). • The dispensary must also have a sink. • Each room must be labeled as what it is used 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 pdnls/formal drawings with appropriate codes and labels(n uet etIN complete above deductions). Each square below represents 5 feet by 5 feet. If your salon is large than 50 feet by 50 feed,attach additional pages to show complete floor plan- �� r Ai Illb& ,s_^ ?) £ It csoa- r�, �"1 b4 1: s Sit ; 1 WeAktr II Ia gyrrom Oife A-n l IN10u0 3\lamkoo +h-cAcaseni r j ,i. r--- —1 1 / '� 1te5k-r'oon-) I S 4''2 -!i t ionck ,. . slice *-{sz, - Lars d S,1 On 1 J . a '-c-e# to t O.-€ Page 9 of 12 l4 t U e..t.A- 10 l'I 01 4t1 `1 tic .e5 d-e.e,p 4§ge vJf '�Gt W 5. le A t I Sakallionariationithaft Owning A Salon 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,dvil 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. -Renew Online! o Your salon license will expire on the anniversary of your three-year license period. If you fall 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 mall renewal notices to each licensee,but it is your ob tlon to renew liga 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. Neer Charure • if you change your manager,you must notify the Board immediately. Nome rue • Complete the Name Change Form within 60 days of the change. Owner/Business StructurrChanery • Complete an Initial Salon Application within 60 days of the change. Mdress Chenee • if.your salon moves locations,you must complete and submit 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. Cosmetoloev Laws and Rules • Copies of Cosmetology Laws and Rules are available from the Minnesota Bookstore at 651-297-3000 or www.Ieg.state.mn.us. Page 10 of 12 Page 230 of 254 i ■ • • a C t s 9d Salon Manager Ack��ledgemgpts and C. fic ation of Aoolicant 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. f1S) (initials of at least 1 owner) B. We acknowledge that it is our responsibility to have a fire extinguisher available in our salon and employees will be made aware of where this is located. Si3 (Initials of at least 1 owner) C. We acknowledge that it is our responsibility to have a.ftrst aid kit In our salon and employees will be made aware of where this is located. 426).46 (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. 4:20/3 (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. (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. (IV) (Initials of at least 1 owner) H. We acknowledge that there is a waste receptade 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 1 .1 1 e imhanAlanagarltslon • 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,including 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. If i 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. 131OC) Ls ()1J30 / DON Salon Manager License Number Salon pager Expiration Date SarctleN Salon Manager Printed Name I \ i-i 13 Salon Manger Signature Date I 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. .4 ce OQ _ 1 l 17' �3 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 (If there are more than 2 owners,attach additional pages) Page 12of12 Page 232 of 254 ',I A __ 4, 1) 1 , Certificate of Insurance UM,.n, This certifies that © State Farm Fire and Casualty Company,Blooniigton.Binds ■ State Farm General Insurance Company,sioomi gton.II cols ■ State Farm Flre and Casualty Company,Aurora,Ontario �.a�.a • State Farm Florida Insurance Company,wader Haven,Florida • Stab Farm Lloyds,Dales,Texas insures the policyholder for the coverages indicated below: Policyholder Sarah Bell Address dpericyresder 1900 County Rd D E,Maplewood MN 55109 Location of operations • Description of operations Sarah Bell The policies listed below have been issued to the policyholder for the policy periods shown.The insurance described in these policies* subject to all the teens,exclusions,and conditions of those policies.The fluffs of liability shown may have been reduced by any paid claims. Policy reriod Limits of liability , Policy Number Type of Insurance Effective Date I Expiration Date (at beginning of policy period) Comprehensive ; BODILY INJURY AND 93-BR-G197-5 F Business Liability 07-06-2013.�L 07-062014 PROPERTY DAMAGE This insurance itaudes: • Products-Completed Operations ------- © Contractual Liability Each Occurrence $ 1,000,000.00 • • Personal Injury General Aggregate $ 2,000,000.00 • Advertising injury • Product-Completed S 2,000,000.00 ■ Operations Aggregate ' Policy Period BODILY INJURY AND PROPERTY DAMAGE Policy Number EXCESS UABIUTY Effective Date Expiration Date (Combined Single Limit) ! ❑Umtualla Each Occurrence $ o Other I Aggregate $ Policy Period Effective Date I Expiration Date Part I- Workers Compensation-Statutory Workers'Compensation { Part II-Employers Liability and Employers Liability r Each Accident $ Disease-Each Employee $ ( Disease-Pokey Limit $ Policy Number Policy ineriod Units of Liability I licy Type of insurance _ Effective Date 's Expiration Date (at beginning of policy period) i .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 POUCY DESCRIBED HEREIN. Name and Address of Ceriifrcation Holder If any of the described policies are canceled before Minnesota Board of Cosmetologist Examiners their expiation date,State Forme wr7 try to mall a 2821 University Aim Ste 710 written notice to the certificate holder days Minneapolis,MN 55414 before cancellation.if we fail to mail such notioe,no abrogation or liability wB be imposed -, State Farm or Its agents or' - -ntatives. 071021/3 The Date Am Agent Name -"""' Telephone Number(651)735-4193 IAgenrs Code&amp Code 23 7S Page 233 of 254 AFC 10131280 106399-10 0e,262069 • I a e '. e • II , k , 1 rYHIBIT- 4 . - L L i . .:=9 i . '. • .:- 9 - , 1 . ' .!/..'?. ..., r.' El I 11l:.■.:ill I . ,/•... Sill A - - i'. 1 I I i 1. ,. 1 .: , ...,. . ., , • ,, \ . . .. :, ! 41 , '. ' , iI- =-- .- • -.,, , . i •• ' l'-,1 i9 ' - ui 1 _ j nilini ., . . . . \.., .;';!, ■ ,:::■i'l ir---- - I J . . r I . .. .,, ',•