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Page 2 <br /> Building Code Request (continued) <br /> ( ) Facility meets requirements building code requirements <br /> ()C) Facilit does not meet requirements and cannot be occupied until orders are met <br /> Fi r I';<.L-cJ /4 1!_rmoPet-/cove c®.+ Ii/Wc—€ <br /> ( ) Facility does not meet requirements, but may temporarily be occupied until <br /> (date), pending� completion of orders. <br /> Signature of Building Inspector: i,�o COA-vv t y\. , Phone# 45Z-Z`i9- 462.5"Certificate Number: 12$O a Date: 14- 2-'1 - 6 S <br /> a <br /> Fire Code Request: A fire inspection under the Minnesota Uniform Fire Code is <br /> required for all proposed facilities. The facility must be inspected within 12 months before initial <br /> licensure. The Commissioner of DHS must not grant a license until written approval of <br /> compliance with the MN Uniform Fire Code has been received from the fire marshal with <br /> jurisdiction. <br /> ( ) Facility meets requirements of the fire code <br /> (V) Facility does not meet requirements of the fire code and cannot be occupied <br /> until orders are met sss-c ,,ore A-io"Je <br /> ( ) Facility does not meet requirements, but may temporarily be occupied until <br /> (date), pending completion of orders. <br /> Signature of Fire Inspector: A (6(1 (eyes , Phone# (' 2 -'I%c 2 30') <br /> Agency Name: OP 0Am r 11nA,n6fna4 , Date: e-1-z4 -a S <br /> Comments: <br /> When the inspection is completed, mail or fax this form to: <br /> Minnesota Department of Human Services <br /> Division of Licensing <br /> 444 Lafayette Road <br /> St. Paul, MN 55155-3842 <br /> Fax number: (651) 297-1490 <br /> Updated: 2-26-04 <br />