HomeMy WebLinkAboutLetter to Division of Licensing MN DHS ,._
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CITY of ORONO
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r4 , ititi Municipal Offices
"# ` G Street Address: Mailing Address:
V9$EggOV' 2750 Kelley Parkway P.O. Box 66
�= Orono, MN 55356 Crystal Bay, MN 55323-0066
August 19, 1996
Barb Geistenhaber
Division of Licensing
MN Department of Human Services
444 Lafayette Road
St. Paul, MN 55155
RE: Interagency Request for Inspection
850 Wayzata Boulevard
Dear Barb:
This form came to me from the City of Wayzata. The building at 850 Wayzata Boulevard is in
Orono but has a Wayzata mailing address. I went to the site and conducted a building/fire code
inspection but when I was filling out the form, I realized it was for the "Health Inspector". Orono
does not have a Health Inspector but I signed as the Building Code Inspector and Fire Inspector.
If you have any questions, please call me.
Sincerely,
dp<A,
- Lyle Oman
Building Official
LO/lsv
Enc.
r Telephone (612) 473-7357 • FAX 473-0510
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...> -)..z.,INTERAGENCY REQUEST FOR INSPECTION `� ETURN TO: Division of Licensing
67
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— MN Dept. Human Services
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444 Lafayette Road
A a St. Paul, MN 55155
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TO: ,&t . -f 't • (rState/Local Health Inspector
[ ] Local Building Code Inspector
0,41090 , P) ,3 i/ [ ] State/Local Fire Inspector
.sem 6-3iy
FROM: ,64-4- . '! ' , /' , Licensing Consultant DATE: , -/3 --f6
Prior to issuing a license, verification is required that a facility is in compliance with
appropriate state or local codes for health, building and fire. Please complete the
appropriate section and return to the Licensing Division with any orders attached. A copy
of orders should be provided to the program. //
Name of Facility: /tQeL Proposed Use:��`��' ,1rtfaL
Name of Program: Phone: VS a ya O
Address:
4. -5O u)0-?),e 8 . 4 5 5 i
Stree City Zip
Area to be used: Numbers and Age Ranges of Participants: Facility Plans to
Basement [ ] 6 wks. to 16 mos. Lf serve handicapped:
First [✓f 16 mos. to 2 1/2 yrs. Yes ( ]
Second [ ] 2 1/2 yrs. to 6 yrs. /j No ( ]
Other ( 1 6 yrs. to 12 yrs.
Specify: over 12 yrs. �o
( ] Licensed ( ] Not Licensed [ ] Application left or mailed
[ ] No orders necessary at time of inspection [ ] Major orders issued
( ] Minor orders issued [ ] Major revisions needed before license can be issued
Signature: Date: Comments: Reverse side
BUILDING CODE REQUEST: ( ] Not applicable: facility located .in non-coded area of state
Date of referendum vote removing code requirements:
Signature and Title of Local Official: Date:
An inspection is required for all proposed facilities located in a code area which
involves new construction, major renovating or change in occupancy i.e. any facility not
currently used for the proposed usage.
[J,J Facility meets requirements
( ] Facility does not meet requirements and cannot be occupied until orders are met.
( ] Facility does not meet requirements, but may temporarily be occupied pending
completion of orders until
Signature of Building Code Inspector: 4(\24v.4....._4
Certificate Number: i7i0 Date: 0 - 1Cj -y G Comments: Reverse side
e_o,ittaPPA.9-� -7• k-c- - L/>s ' o
FIRE CODE REQUEST: A fire inspection_ is required for all proposed facilities.
Facilities located in an area of the state under the Uniform Building Code must meet
applicable fire code
requirements. (If both codes address a specific area, the UBC takes precedence over the
fire code. )
Facilities located in an area of the state not under the Uniform Building Code must meet
applicable fire code requirements.
In either instance, the Minnesota Uniform Fire Code applies.
[10_ Facility meets requirements of the fire code
[ ] Facility does not meet requirements of the fire code and cannot be occupied
until orders are met
[ ] Facility does not meet requirements, but may temporarily be occupied pending
completion of orders until
Signature of Fire Inspector: lam' t/✓�� Date: 4(e
Comments: Below
Comments: