Fillable Tree And Landscape Permit Application (City of Golden Valley)

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Tree And Landscape Permit Application (City of Golden Valley)

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BROWSE CITY OF GOLDEN VALLEY (MN) FORMS

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q Part 1. Permit Application
q Part 2. Tree Inventory Worksheet
q Part 3. Tree Mitigation Worksheet
q Part 4. Replacement Requirement Worksheet
q Part 5. Minimum Landscape Requirements Worksheet
q Part 6. Tree & Landscape Plan
q Part 7. Security Deposit Worksheet
Enginnering Sta
763-593-8030
Assistant Forester
Tim Teynor
763-593-3976
tteynor@goldenvalleymn.gov
http://www.goldenvalleymn.gov/code/index.php
Click “City Code,” then search “Tree and Landscape.”
Physical Development Department | 7800 Golden Valley Road, Golden Valley, MN 55427-4588
763-593-8030 | 763-593-3988 (fax) | TTY: 763-593-3968
www.goldenvalleymn.gov | publicworksdept@goldenvalleymn.gov
Checklist
TREE & LANDSCAPE
PERMIT APPLICATION PACKET
Applicants must complete the entire packet, ll in all applicable areas,
and submit with permit fee before application will be reviewed.
Contact Information
City Code Chapter 111
Tree & Landscape Permits are required for all new construction projects, for projects that increase the building footprint by 100 percent in single-family
residential (R1 and R2) zoning districts, and for projects that increase impervious areas by 10 percent in all other zoning districts. Multi-lot or two-phase
development projects may require additional permits. Note: It may take up to a minimum of 15 business days to review a complete application.
Property address/location
Description of project
Applicant
Address City State Zip
Phone Cell phone Email
Property owner (if dierent than above)
Address City State Zip
Phone Cell phone Email
I have read and understand all applicable information included in this application packet. I certify that the information supplied in this application is correct.
If granted this permit, I agree to comply with all regulations, limitations, and conditions that apply to Golden Valley’s tree and landscape plan ordinance.
Individual(s) representing the City of Golden Valley have the legal authority to bind the applicant to all terms, conditions, and provisions contained herein.
Applicant’s signature Printed name Date
Physical Development Department | 7800 Golden Valley Road, Golden Valley, MN 55427-4588
763-593-8030 | 763-593-3988 (fax) | TTY: 763-593-3968
www.goldenvalleymn.gov | publicworksdept@goldenvalleymn.gov
Tree & Landscape
PERMIT APPLICATION
continued
Staff Use Only
Date applied: _________________________________ Application complete: Yes No Permit: Approved Denied
Single Family Residential: $150 Security amount: $_____________ Total: $_____________
All Other Projects: $400 Security amount: $_____________ Total: $_____________
Paid: Yes No Invoiced Paid: Yes No Type _____________
_______________________________________________________ ______________________
City Engineer Signature Date
click to sign
signature
click to edit
Tree Inventory
Identify the Signicant (S) and Legacy (L) trees by ID number, species, size, and type (S or L) and show their locations on the survey or inventory map
(see example below). Signicant Trees: (6 inches diameter or greater for hardwoods such as oak, maple, walnut, birch, black cherry, honey locust,
basswood, hackberry; 12 inches diameter or greater for softwoods such as cottonwood, poplar, aspen, ash, box elder, willow, silver maple, elm; 4 inches
diameter or greater for conifers). Legacy Trees: (30 inches diameter or greater for hardwoods and 24 inches diameter or greater for conifers). If the site
has no Significant or Legacy Trees, skip the Tree Inventory and Tree Mitigation sections.
ID# Species Size Type
Tree Mitigation (complete this section to determine if mitigation is required)
1. Total number of Signicant and Legacy trees on site
_________
2. Multiply by: 15% residential development
20% phase one of a two-phase development
30% commercial development
x ________
3. Number of tree removals allowed before mitigation is
required (round down to the next whole number)
= ________
4. Number of Signicant and Legacy tree removals neces-
sary to complete the project
___________
If line 4 is greater than line 3, mitigation is required.
Mitigation not required: Move on to Minimum Landscape Re-
quirements section.
Mitigation required: Complete Tree Mitigation and Replacement
Requirement sections before moving on to Minimum Landscape
Requirements section
5. Number of Signicant tree removals from
line 4
__________
6. Subtract allowable removals from line 3
– ________
7. Total number of trees needed to mitigate
(use this number to complete Replace-
ment Requirement section)
= ________
continued
Total number of Signicant and Legacy trees on site: ___________________
ID# Species Size Type
Physical Development Department | 7800 Golden Valley Road, Golden Valley, MN 55427-4588
763-593-8030 | 763-593-3988 (fax) | TTY: 763-593-3968
www.goldenvalleymn.gov | publicworksdept@goldenvalleymn.gov
ID# Species Size Type
ID# Species Size Type
1 Maple 14" S
EXAMPLE:
continued
Tree Replacement Options (Pick One Category)
Identify Trees To Mitigate
(start with large trees rst)
Category A
Deciduous (4" diameter)
Conifers (at least 12' high )
Category B
Deciduous (2.5" diameter)
Conifers (at least 6' high )
Category C
Deciduous (1.5"diameter)
Conifers (at least 4' high )
Legacy Trees
(see Tree Inventory section for denition) ________
x 3 ______ x 6 ______ x 12 ______
Hardwoods 21"–29" diameter ________ x 2 ______ x 4 ______ x 8 ______
Softwoods greater than 24" diameter ________ x 2 ______ x 4 ______ x 8 ______
Conifers 19"–24" diameter ________ x 2 ______ x 4 ______ x 8 ______
Hardwoods 6"–20" diameter ________ x 1 ______ x 2 ______ x 4 ______
Softwoods 12"–24" diameter ________ x 1 ______ x 2 ______ x 4 ______
Conifers 4"–18" diameter ________ x 1 ______ x 2 ______ x 4 ______
Total
__________
(should match line 7 on Tree Mitigation section)
__________ __________ __________
Permit holder will plant _________ Category A, _________ Category B, and/or _________ Category C trees to meet mitigation requirements.
Physical Development Department | 7800 Golden Valley Road, Golden Valley, MN 55427-4588
763-593-8030 | 763-593-3988 (fax) | TTY: 763-593-3968
www.goldenvalleymn.gov | publicworksdept@goldenvalleymn.gov
Replacement Requirement (if mitigation is necessary)
Minimum Landscape Requirements (complete this section to calculate minimum landscape standards for the property)
Zoning District
Single-Family Residential (R-1 or R-2): New construc-
tion or 100 percent increase in building footprint of
principle structure requires a minimum planting of three
trees (one of which must be located in the front yard),
and a minimum combined planting of ve shrubs and
perennials.
Industrial/Light Industrial: New construc-
tion or 10 percent increase in impervious
surface requires a minimum planting of one
tree per 50 linear feet of perimeter abutting
or adjacent to street frontage, residential
property, or regional trail and a minimum
combined planting of one shrub or peren-
nial per ve linear feet of same perimeter.
All Other (Multi-Family Residential, Mixed
Use, Oce, Commercial, Institutional): New
construction or 10 percent increase in imper-
vious surface requires a minimum planting of
one tree per 50 linear feet of perimeter and a
minimum combined planting of one shrub or
perennial per ve linear feet of perimeter.
Trees
Existing: _________ (total) _________(front yard)
_________ (rear/side yards)
To be Planted: _________ (total) _________(front yard)
_________ (rear/side yards)
Shrubs/Perennials
Existing: _________ (total) _________(front yard)
_________ (rear/side yards)
To be Planted: _________ (total) _________ (front yard)
_________ (rear/side yards)
_________ Total perimeter length
÷ 50 = _________ (number of trees to plant
and/or preserve)
÷ 5 = _________ (number of shrubs/
perennials to plant
and/or preserve)
__________ Total perimeter length
÷ 50 = __________ (number of trees to plant
and/or preserve)
÷ 5 = __________ (number of shrubs/
perennials to plant and/or
preserve)
Tree & Landscape Plan
(Attach plan that identies Signicant and Legacy trees, tree protection measures, and all new landscape plantings (if applicable).
Financial Security Deposit (ll in only those items that apply to your project)
Note: Security will be held for one year following City inspection and acceptance of completed project. Contractor must notify City sta when
landscape installation is completed so the one-year warranty period can be recorded.
Tree Mitigation
Number of Category B* trees required for mitigation _______ x $450/tree =
*If choosing to plant Category A or C trees, provide number of equivalent Category B trees for this calculation.
$______________
Minimum Landscape Requirements
Number of trees (if not covered by mitigation above) ________x $450/tree =
Number of shrubs _______ x $40/shrub (in No. 5 container or larger) =
Number of perennials _______ x $20/perennial (in No. 2 container or larger) =
Number of acres native vegetation seeding _______ x $3,500/acre =
$______________
$______________
$______________
$______________
Tree Protection
Estimated cost of tree protection (fencing, other)
$______________
Subtotal (add lines above) $______________
x 125%
Total Financial Security $______________
Physical Development Department | 7800 Golden Valley Road, Golden Valley, MN 55427-4588
763-593-8030 | 763-593-3988 (fax) | TTY: 763-593-3968
www.goldenvalleymn.gov | publicworksdept@goldenvalleymn.gov
4/19
This document is available in alternate formats upon a 72-hour request. Please call 763-593-8006 (TTY: 763-593-3968) to
make a request. Examples of alternate formats may include large print, electronic, Braille, audiocassette, etc.
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Tree And Landscape Permit Application (City of Golden Valley)

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Completed 14 July 2020

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