Fill - Free fillable 7022 Rental License Application Packet (City of Burnsville) PDF form

100 Civic Center Parkway | Burnsville, Minnesota 55337-3817

952-895-4400 | rental@burnsvillemn.gov | www.burnsvillemn.gov/property

Below is a list of Rental License Standards that owners/managers are asked to agree to as part of their

rental license.

I understand that by owning property in Burnsville, I am operating in a residential zone of the city.

I understand my rental license must be renewed annually.

I understand City Code, Chapter 28, regarding rental licensing, and understand I am subject to the requirements

contained therein.

I understand the rental property must pass a rental property inspection conducted by a City Housing Inspector, and

must maintain the property in accordance with City Codes.

I understand I must screen all potential tenants by using a written rental application, which contains sufficient

information to conduct a criminal background check.

I must use a written lease for all tenants.

In addition to a written lease, I understand I must also issue a Crime Free/Drug Free Housing lease addendum as

required by the Ordinance.

I understand my rental license is not transferrable.

I understand my rental license must be renewed annually.

I understand the “Kari Koskinen Manager Background Check Act” M.S. 299C.66 to 299C.71 and that I am

required to complete a background check on anyone that is defined as a “manager” according to the

statute. This applies to and includes leasing agents, maintenance personnel, etc.

For multi-family rentals: The license holder or manager has attended or is scheduled to attend a City of Burnsville

multi-housing training. This training is put on annually. All managers are required to attend once every three

years. Additional repeated training is optional and recommended.

I understand the efforts of the Burnsville Fire Department in regard to multi-unit housing fire prevention,

and will supply to all new tenants information regarding fire prevention efforts.

I understand the City Manager may deny or not renew a license and the City Council may revoke or suspend a

license for failure to address any tenant or property issues. Failure to abide by the above requirements is

grounds for penalties which may include license non-renewal, suspension, revocation, and fines.

Government data practices act Tennessen warning: The data you supply on this form will be used to process the license you are applying for. You are not legally required to provide this data,

but we may not be able to process the license without it. The data will constitute a public record if and when the license is granted.

Is this property licensed by a state agency? Please see Ordinance 3-28-5: EXCEPTION (B) Yes No

All multi-unit complexes must attach a detailed list with the individual building addresses and unit numbers to be licensed.

RENTAL PROPERTY LOCATION

CityStreet address _________________ State ______ Zip Code __________________________________ __________

PROPERTY DESCRIPTION

Single family

Townhome

Duplex

Multi-family structure (Apts./Condos) # of units ________

# of buildings__________

Manufactured Home

Licenses will commence – and are renewed annually – in the quarter in which the application is received.

First quarter runs from April 1 to March 31 the following year

Second quarter runs from July1 to June 30 the following year

Third quarter runs from Oct. 1 to Sept. 30 the following year

Fourth quarter runs from Jan. 1 to Dec. 31 the following year

RENEWALS SHOULD BE SENT TO

License Process: Fill out this application completely and enclose the appropriate license fee. (All fees and a link to rental standards are listed on the

reverse side of this application).

Failure to enclose the proper fee and complete the MN Workers Compensation and Tax Id page, will result in the

application being

returned to you and delay the processing of your rental business license.

 Do not email the application



Email rental@burnsvillemn.gov to schedule a rental inspection. Rental inspections are required every three years

 If paying by check, make payable to the City of Burnsville

Sign, date and return the completed application to Burnsville

City Hall, 100 Civic Center Parkway, Burnsville, MN 55337.

I understand that it is my responsibility to submit all required fees and obtain all necessary approvals prior to licensing. I acknowledge that I am the owner of

record or agent for this property and am authorized to sign this application.

By signing this application I am acknowledging and agreeing to uphold the rental

standards as

part of my rental license. All information is correct and accurate to the best of my knowledge.

Applicant name _____________________________________________________________________________________________

First Middle L

ast

Signature Date _____________________________

S C □ Rental License Region Inspection Scheduled _FOR CITY USE ONLY: Amount/Ck# _________ ____________

7/25/2018 Rental License Mailed /emailed Passed Inspection Provisional License Mailed _________ ______________

Owner

Property manager

PROPERTY OWNER INFORMATION

Business name (if applicable) __________________________

Owner name _______________________________________

Owner address______________________________________

City_____________________ State _______ Zip _________

Cell Owner phone ________________ __________________

Owner email*_______________________________________

*Email addresses are optional. This information may be considered public record

and may be made available upon request.

PROPERTY MANAGER/CARETAKER INFORMATION:

The agent named below is authorized to make or order repairs and/or

service to the building, to provide required services necessary to protect

the health, safety and welfare of the occupants or is able to contact the

person so authorized.

Property Mgmt. Company _____________________________

Attn _______________________________________________

Address ____________________________________________

City ____________________ State ________ Zip _________

Phone ___________________ Cell ____________________

Email:______________________________________________

Emergency 24-hour contact number ______________________

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The rental license standards and online instructions can be found at this link at www.burnsvillemn.gov/rental.

Assistance or paper copies may be requested by emailing rental@burnsvillemn.gov or by calling 952-895-

4440.

It is the responsibility of the owner or owner’s agent to renew the rental license on or before the due date.

Failure to obtain a rental license or allowing the license to expire can result in a citation and fine of up to

$1000.

License exemptions can be located at www.burnsvillemn.gov/citycode in City Code 3-28-5.

License fees are not refundable or transferable.

Please email our office at

rental@burnsvillemn.gov

to schedule a rental inspection. Inspections must occur during

regular business hours. State law requires that you notify tenants in advance of upcoming inspections.

If there are items noted during the inspection that are not in compliance with City ordinances, they shall be

corrected prior to the issuance of the business license. It is the responsibility of the owner or owner’s agent to

schedule all re-inspections.

Additional inspections beyond the re-inspection may be charged at an additional $185. This is a separate fee

and is not applied toward your license fee. After the property has been determined to be in compliance with

City ordinances the license will be issued. Some correction may require a building permit. Please call 952-895-

4444 to verify building ordinance requirements.

The City of Burnsville provides general information, updates and notices via email subscription. Sign up to

receive notices at www.burnsvillemn.gov/subscribe. This includes notifications of any proposed

ordinances at

least 10 days before the City Council conducts a final vote on the proposed ordinance. (M.S. 415.19)

INDIVIDUAL HOMEOWNER FEES

MULTI-FAMILY STRUCTURE COMPLEX OWNERS:

Rental conversion fee (new or over $500

one year since expiration)

Single family home

Manufactured home not owned by park $175

Townhome, Condominium

Townhome in association

Duplex per unit rented

Multi-family dwellings $160/building and $15/per unit

(apartments, independent, coop, assisted living)

Multi-family townhome $100/building and $15/per unit

(entire building owned by same owner)

Manufactured home park $ 285 plus $60/ per unit

(owned by the park)

Annual fire inspection $160 (per building)

Inspection Fee $185 (per building)

Late fees

Submitted 15-29 days after due date 25% of license base fee

Submitted 30-45 days after due date 50% of license base fee

Submitted 45 days after due date 100% of license base

This form must be submitted with the Rental License application

LICENSE APPLICANT:

Pursuant to *Minnesota Statute 270C.72 Tax Clearance: Issuance of Licenses, the licensing authority is required to

provide to the Minnesota Commissioner of Revenue your Minnesota business tax identification number and the Social

Security number of each license applicant.

Under the Minnesota Government Data Practices Act and the Federal Privacy Act of 1974, we are required to advise

you of the following regarding the use of this information:

1. This information may be used to deny the issuance, renewal or transfer of your license in the event you owe the

Minnesota Department of Revenue delinquent taxes, penalties or interest.

2. Upon receiving this information, the licensing authority will supply it only to the Minnesota Department of

Revenue. However, under the Federal Exchange of Information Agreement the Department of Revenue

may supply this information to the Internal Revenue Service.

3. Failure to supply this information may jeopardize or delay the processing of your licensing issuance or

renewal application.

Please supply the following information and return along with your application to the agency issuing the license.

Do not return to the Department of Revenue.

Name of Applicant: _________________________________________________________________________

Type of Business:

____________________________________________________________________________

*Provide a social security number; or a Minnesota Tax ID; or Federal Tax ID Number. Only one tax ID number is required.

Sole Proprietors only: Partnerships, LLCs, Corporations:

Social Security Number: ______________________ Minnesota Tax ID Number: __________________________

Federal Tax ID Number: ____________________________

Applicant full Name: __________________________________________________________________________

(Print Name) First Middle Last

Applicant Signature: _________________________________________________ Date: _________________

If a Minnesota Tax Identification Number is not required, please explain below.

2018 Minnesota Statutes

270C.72 TAX CLEARANCE; ISSUANCE OF LICENSES. Subd. 4. Licensing authority; duties.

Licensing authority; duties. All licensing authorities must require the applicant to provide the applicant's Social Security number or individual taxpayer identification

number and Minnesota business identification number, as applicable, on all license applications. Upon request of the commissioner, the licensing authority must

provide the commissioner with a list of all applicants, including the name, address, business name and address, and Social Security number or individual taxpayer

identification number and business identification number, as applicable, of each applicant. The commissioner may request from a licensing authority a list of the

applicants no more than once each calendar year.

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LIC 04 (11/16)

Certificate of Compliance

Minnesota Workers’ Compensation Law

This form must be completed by the business license applicant.

Print in ink or type

Minnesota Statutes § 176.182 requires every state and local licensing agency to withhold the issuance or renewal of a license or

permit to operate a business in Minnesota until the applicant presents acceptable evidence of compliance with the workers'

compensation insurance coverage requirement of Minn. Stat. chapter 176. If the required information is not provided or is falsely

stated, it shall result in a $2,000 penalty assessed against the applicant by the commissioner of the Department of Labor and Industry.

A valid workers’ compensation policy must be kept in effect at all times by employers as required by law.

License or certificate number (if applicable)

Business telephone number

Alternate telephone number

Business name (Provide the legal name of the business entity. If the business is a sole proprietor or partnership, provide the owner’s

name(s), for example John Doe, or John Doe and Jane Doe.)

DBA (“doing business as” or “also known as” an assumed name), if applicable

Business address (must be physical street address, no P.O. boxes)

City

State

ZIP code

County

Email address

You must complete number 1 or 2 below.

Note: You must resubmit this form to the authority issuing your license if any of the information you have provided changes.

1. I have a workers’ compensation insurance policy.

Insurance company name (not the insurance agent)

Policy number

Effective date

Expiration date

I am self-insured for workers’ compensation. (Attach a copy of the authorization to self-insure from the Minnesota

Department of Commerce; see www.mn.gov/commerce/industries/insurance/licensing/self-insurance.)

2. I am not required to have workers’ compensation insurance because:

I only use independent contractors and do not have employees. (See Minn. Stat. § 176.043 for trucking and messenger

courier industries; Minn. Stat. § 181.723, subd. 4, for building construction; and Minnesota Rules chapter 5224 for other

industries.)

I do not use independent contractors and have no employees. (See Minn. Stat. § 176.011, subd. 9, for the definition

of an employee.)

I use independent contractors and I have employees who are not required to be covered by the workers’

compensation law. (Explain below.)

I only have employees who are not required to be covered by the workers’ compensation law. (Explain below.) (See

Minn. Stat. § 176.041 for a list of excluded employees.)

Explain why your employees are not required to be covered

I certify the information provided on this form is accurate and complete. If I am signing on behalf of a business, I certify I am

authorized to sign on behalf of the business.

Print name

Applicant signature (required)

Title

Date

If you have questions about completing this form or to request this form in Braille, large print or audio, call (651) 284-5032 or

1-800-342-5354.

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Burnsville Fire would like to welcome you to your new residence. We are providing the following

information to give you an awareness of fire safety and to remind you that you are not the only

person living in the building. Other residents are counting on you to be safety-conscious and

prevent fires.

Most multi-housing building fires that have occurred in Burnsville were due to human error due to

careless smoking, cooking, and/or candles.

We are asking you to do what we have asked current residents to do, please watch a 12 minute

fire safety video created by Burnsville Fire and to follow these important tips. You can do your

part to make your living community a safe and enjoyable experience.

Links to the video:

Keep the Burn out of Burnsville [English - Full] http://youtu.be/elWZ7LsSXBQ

Keep the Burn out of Burnsville [Spanish - Full]: http://youtu.be/9oSw2G84p98

Keep the Burn out of Burnsville [Russian - Full]: http://youtu.be/P9Vh-FJDsbI

Keep the Burn out of Burnsville [Somali - Full]: http://youtu.be/1yTHek-8IyY

Important Safety Guidelines:

• If you smoke, use a noncombustible ashtray such as a “Butt Bucket” or Aluminum

pop can.

• Do Not use a planter, potted plant or any combustible container to discard smoking

materials

• Never leave candles unattended

• Test smoke detectors once a month and change the batteries (if applicable) twice a year

• Report any suspected arson to the Police or Fire Department

• Store flammables and combustibles in approved areas only

• Learn and follow City Ordinances and fire laws for grilling

• Never leave a kitchen unattended while cooking

• Research and purchase a stovetop fire suppression canister for your cooking hood

• It is recommended to purchase Renter Insurance to protect your property

If you have any other questions, please contact the Burnsville Fire Department at 952-895-4570

or www.burnsvillemn.gov/fire.

Rental Inspection Checklist

Single and Multi- Units | Interior

Reviewing rental units for compliance with this list could save from costly re-inspections. Rental units include

apartments, condos, manufactured home parks and single-family homes for rent.

This list contains common violations. It is not intended to be a comprehensive list of all violations that could occur.

Ceiling

Free of water damage, cracks and peeling

Electrical

All outlets and switch plate covers present and

secured

Wiring is concealed

Free of temporary wiring/extension cords

Electrical panel and/or electrical room labeled and

accessible? (three foot clearance to panel and inspection sticker)

Floors

Floors free of holes, cracks and tripping hazards

Water-tight surfaces in bathrooms and kitchens

Food Storage/Preparation

Cabinet doors, drawers and hardware in good

condition

Kitchen is sanitary

Furnace/Air Conditioner

Heating appliances and air conditioners operable

with secure gaskets and handles

Controls/thermostats easily accessible

Refrigerator

Refrigerator operable with secure gaskets and

handles

Sink/Wash Basin

Sinks and wash basins are cleanable; have

water-tight surfaces that are free of chips, cracks

and leaks

 Nopresenceofexiblepiping

Smoke/Carbon Monoxide Detectors

Working smoke detectors installed in each

bedroom, adjacent hallways and on each level

Working carbon monoxide (CO) detector are within

10 feet of bedrooms where required

Stove/Range/Oven

Burners and oven elements are operable

Door gaskets are in good condition

Adjacent countertops are below stovetop cooking

surfaces

Environment

Free of signs of rodent or pest infestation

Tubs/Showers/Toilets

 Surfacesaroundtub,shower,oorandtoiletare

washable and water-tight

 Plumbingxturesareoperatingproperly

Ventilation

Bathroom |Operable bath fans if there is no

bathroom window

Kitchen | Mechanical fans or windows open freely

Dryer | Vented through rigid metal or other

 approvedexiblematerials,securedatjointswith

metal tape

Dryer | Directly vented to the outside

Walls

Walls free of holes or water damage

Windows/Patio Doors

Windows open, close and latch freely

Doors open, close and latch freely

Windows and doors free from leaks, cracks and

peeling paint

Screens on all windows and doors

Exits and Pathways

Exits and pathways are clear, maintained and

usable

Stairs and Guardrails

Carpeting on stairs is secure

Handrails are present and secure

Water Heater

Water heater is free of leaks and rust

A metal drip pipe is in place within 18 inches of the

ground

Vented properly

Turn page over for:

• Single and Multi- Units | Exterior

• Multi-Family | Interior Common Areas

• Multi-Family | Exterior Common Areas

Combustible Storage

Combustible materials (i.e. paint, gasoline, etc.)

are stored properly

Address

Building address is visible from street

Individual numbers in the address are at least four

inches tall

Building Exterior/Yard Maintenance

Roof and siding in good condition

Sidewalks and steps maintained

Yard/landscaping maintained (mowed or plowed)

and free of junk and debris

Painted surfaces are free of chipping/peeling

Decks

Guardrails present on any decking over 30 inches

from ground

Decks free of grills, where applicable

Decks structurally sound (no holes, no rotting)

Vehicles/Outdoor Storage

Yard and exterior free of prohibited items

All vehicles parked on the property are operable,

licensed and properly parked

Emergency Contacts and Fire Department Key Box

Up-to-date emergency contact numbers

Fire Department box contains all necessary keys

Fire Extinguisher

Fire extinguishers are visible, accessible with valid

inspection dates

Extinguisher cases are free of broken or chipped

glass

Fire Safety Features

 Emergencylights,exitsignsandredoorsare 

maintained and operable

Stairs and Guardrails

Carpeting on stairs is secure

Handrails are present and secure

Pool Chemicals

Pool chemicals stored properly

Dumpsters

Dumpsters are located away from building and

wall openings

Fire Lanes

Fire lanes are posted and well maintained

Hydrants and Sprinklers

Hydrants and sprinkler systems are well

maintained

Utility Meter

Utility meters are protected from potential vehicle

damage

Garbage/Recycling

A garbage and recycling service is in place

Containers are stored in approved enclosures

Laundry Rooms

Laundry rooms maintained and properly ventilated

All surfaces are water-tight

Pool Chemicals

Pool chemicals stored properly

Single and Multi- Units | Exterior

Multi-Family | Interior Common Areas

Multi-Family | Exterior Common Areas

Contact Information

City of Burnsville

100 Civic Center Parkway

Burnsville, MN 55337-3817

952-895-4400

Rental License & Code Enforcement

100 Civic Center Parkway

Burnsville, MN 55337-3817

952-895-4440

Fire Department Administration

952-895-4570

Police Department Administration

952-895-4600

For more information visit

www.burnsvillemn.gov/property

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