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INTERAGENCY R�QUEST FOR BUILDING INSPECTIONS
<br /> To: RETURN TO:
<br /> Building Inspector Division of Licensing �
<br /> City Addiction, Intervention,Recovery MN Department of Human Services
<br /> Resources of Minnesota PO Box 64242
<br /> 2389 Blaine Ave,PO Box 21 St. Paul, MN 55164-0242
<br /> Navarre,MN 55392 FAX: (651)439-7673
<br /> Prior to issuing a license, verification is required that a facility is in compliance with appropriate state oF local
<br /> building codes. An inspection is required for all proposed facilities located in a code area which involves new
<br /> construction, major renovating, ar change in occupancy{i.e. any facility not currentiy used for the proposed
<br /> usage,) Please comp{ete 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: Addiction, 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 /> Name/phone 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 ta serve handicapped individuals? Unknown�at this time
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<br /> BUILDING CODE REQUEST:
<br /> [ ] Not applicable: facility located in a non-coded area bf state.
<br /> Signature of Local OfFicial: � � � Date: `�-�� ' �y�I
<br /> Title: ������r�rr� rJ Y� Li,r� l,
<br /> The facility is located in a code area ' , ' , �e�ese��a�sy-+:e.
<br /> [�`j Facility meets requirements
<br /> [ ] Facility does not meet requirements and cannot be occupied until ordars are met
<br /> [ ] Facility does not meet requirements, but may temporarily be occupied untif (date)
<br /> pending completion of orders.
<br /> Signature of Building Code Inspector:
<br /> DATE ''1�'�7" ��N Certificate Number: (2 8�
<br /> Comments:
<br />
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