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FOSTER CARE HOME INSPECTION REQUEST

By Bernard Palmer,2014-05-06 02:11
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FOSTER CARE HOME INSPECTION REQUEST

     HOME INSPECTION

    REQUEST

    INSTRUCTIONS

General Notes:

    ? Use this application for any residential inspection request. DO NOT use this form for

    commercial building inspection requests.

    ? This completed form can be mailed, faxed, or emailed to Howard County Department of Fire

    and Rescue Services (see page 2).

Proposed Use:

    ? Indicate the intended occupancy classification and total number of persons if applicable. This

    will let the inspector know the necessary inspection requirements.

Section A:

    ? This section must be completed by the agency requesting an inspection for adoption or foster

    care.

Section B:

    ? This is information on the home to be inspected. Please note any special instructions or

    additional information.

Section C:

    ? Indicate if this is an initial or renewal inspection for foster care only. Indicate the deadline for

    the inspection. Please note that a minimum of 14 working days are required to schedule the

    inspection.

    ? You will receive a invoice for an inspection fee of $75.00 for all initial inspections and $50.00 for

    all renewal inspections.

    ? If any violations are noted, a re-inspection may be necessary.

    ? The resident will receive two copies of the inspection report. It will be the homeowner’s

    responsibility to forward a copy to the requesting agency.

    ? Do not call the Fire Marshal’s office. Once your check has cleared, the Fire Marshal’s office will

    call to make an appointment for the inspection.

Bottom Section:

    ? If applicable, this section will be completed by the case worker for foster care.

     HOME INSPECTION REQUEST

To: Howard County Department of Fire & Rescue

     ATTN: Office of the Fire Marshal Phone: 410-313-6040

     6751 Columbia Gateway Drive Fax: 410-313-6066

     Columbia, MD 21046-2164 Email: rkelly@howardcountymd.gov

    Proposed Child Foster Care for _____ person(s) Adult Foster Care for _____ person(s) Use

     Adoption ______ person(s) Home Safety Inspection __________

* NOTE: You will receive an invoice for an inspection fee of $75.00 for all initial inspections and $50.00 for all renewal

    inspections. Once your check has cleared The Fire Marshal’s office will call to make an appointment for the inspection.

Section A: Requesting Agency for Foster Care or Adoption Inspection

    Name of Requestor: Date of Request:

    Requesting Agency: E-Mail of Agency:

Agency Address:

    City/Town: Zip Code:

Agency Telephone Number: Agency Fax Number:

Section B: Residence

Resident(s):

Address:

    City/Town: Zip Code: County:

    Home Phone: Work Phone: Other Phone: (specify, cell, etc.)

Special Instructions:

Section C: Inspection Type

    Initial Inspection _____ Renewal Inspection _____ Due Date ____________________

_______ Home approved _______ Violations noted on attached Inspection sheet

Signature of Inspector: ________________________ ID# _________ Date: _____________

I certify the violations as noted on the attached inspection sheet have been corrected.

Signature of Case Worker: _________________________ Date: ___________

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