Request For Fire Inspection
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1
2Request for Fire Inspection or Reinspection
State Fire Marshal’s Office
Approved local fire department
445 Minnesota St.
St. Paul, MN 55101-5145
651-201-7200
Date of request: _______________________
APPLICANT’S NAME:
COUNTY:
ADDRESS:
CITY:
ZIP CODE:
HOME PHONE NUMBER:
CELL PHONE NUMBER:
WORK PHONE NUMBER:
EMAIL ADDRESS:
REQUESTING AGENCY:
E-MAIL ADDRESS OF AGENCY LICENSOR:
REQUESTOR’S NAME:
PHONE NUMBER:
Proposed use:
Family Child Care, Class ________
Adult Foster Care for ________________ persons
Group Family Child Care, Class________
Community Residential Setting for _________persons
Child Foster Care for ________ persons
Family Adult Day Services ((R-3 inspection required)
Reason for request:
Inspection required because:
Mobile home-
Capacity of more than 10 - FCC
FCC/(CFC-only if manufactured prior to 6/15/76)
Care in the basement-FCC
Capacity of 4 or more – CFC
Free standing solid fuel heating appliance
Mixed-occupancy building
(i.e., attached garage-FCC)
(wood, corn, etc. stoves) –FCC/CFC
(CFC- only if hazard identified)
Per rule or statute requirement (AFC/FADS/CRS)
Multiple dwelling building
(i.e., apartment building-FCC)
(CFC- only if hazard identified)
FC sleeping in room 50% or more below ground level - CFC
Reasonable cause by the agency
______________________________________________________
(explain in detail)
_______________________________________________________________________________________________
Existing use:
Areas to be used:
NOTE:
For rental property,
Single family residence
Basement
written, signed permission from
Multiple dwelling building
First floor
the landlord/owner to inspect
the entire building must be
Duplex
Second Floor
attached to this request.
Townhome
Third floor and above
Apartment with three or more units
Church building
Other building explain: __________________________________________________________________________
A detailed inspection report is required and must be attached. A copy should be sent to the Licensor noted above.
July 2016
page 1
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Parent category: Business