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INTERAGENCY R�QUEST FOR BUILDING INSPECTIOfdS
<br /> To: RETURN TO:
<br /> Building Inspector Division of Licensing
<br /> City Addiction, Interventian,Recovery MN Department of Human Services
<br /> Resources of Minnesota PO Box 64242
<br /> 2389 Blaine Ave,PO Box 21 St. Paul, MN 55164-Q242
<br /> Navane,MN 55392 FAX: (651)439-7673
<br /> Prior to issuing a license, verification is required that a facility is in compliance with appropriate state or local
<br /> building oodes. An inspection is required for all proposed facilities located in a code area which involves new
<br /> construction, major renovating, or change in occupancy{i.e. any facility not currendy used for the proposed
<br /> usage,} Please complete the information requested and retum to the Licensing Division with any orders
<br /> attached. A copy of orders should also be provided to the program.
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<br /> PROGRAM INFORMATION
<br /> Date:April 7, 2014
<br /> Name/address of facility: Addic#ion, Intervention, Recovery Resources of Minnesota, 2389
<br /> Blaine Ave, PO Box 21, Navarre, MN 55392
<br /> Proposed use: To provide chemical dependency treatment services
<br /> Namelphone number of contact person: Mary Ellen Mackenna McNutt at 612-720-3470
<br /> Area of facility to be used: Unknown at this time
<br /> Numbers and age ranges of participants:Ages 18—75 years old, both genders
<br /> Does the facility plan to serve handicapped individuais? Unknown�at this time
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<br /> � BUILDING CODE REQUEST:
<br /> [ ) Not applicable: facility located in a non-coded area of state.
<br /> Signature of Locai Official: � Date:
<br /> Title:
<br /> The facility is located in a code area and has new construction, major renovating, or change in occupancy i.e.
<br /> any facility not currently used for the proposed usage.
<br /> [ ] Facility meets requirements
<br /> [ ] Facility does not meet requirements and cannot be occupied until�rders are met
<br /> [ ] Facility does not meet requirements, but may temporarily be axupied untif (date)
<br /> pending completion of orders.
<br /> Signature of 8uilding Code Inspector:
<br /> DATE Certificate Number.
<br /> Comments:
<br />
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