EA180725 - Plumbing - Commercial - Issued Date 12/20/2022 PERMIT
City of Eagan , , Permit Type: Plumbing
3830 Pilot Knob Rd Permit Number: EA180725
GAN
Eagan,MN 55122 EA
(651)675-5675
11111111111111111111111111111111111111111111111
www.cityofeagan.com * E R 1 8 0 7 2 5 *
Date Issued: 12/20/2022
Site Address: 2620 Eagan Woods Dr
Lot: 1 Block: 1 Addition: Eagan Woods Office Park 3rd
PID: 10-22552-01-010
Use: Summit Orthopedics * 1 0 — 2 2 5 5 2 — 0 1 — 0 1 0
Description:
Sub Type: Commercial
Work Type: Replace
Description: RPZ
Meter Size Meter Tae Manufacturer Serial Number Remote Number Line Size
Comments:
Fee Summary: PL-RPZ/PVB/Lawn Irrigation $59.00 0801.4087
Surcharge-Fixed $1.00 9001.2195
Total: $60.00
Contractor: - Applicant - Owner:
Gilbert Mechanical Contractors Hsre 2620 Eagan Mob LLC
5251 74th St W %Harrison Street Real Estate
Edina MN 55439 444 Lake St W Ste 2100
(952)835-3810 Chicago IL 60606
This permit shall be null and void if work does not start within 180 days of issuance,or if work is suspended for 180 days or more after
started.
I hereby acknowledge that I have read this application and state that the information is correct and agree to comply with all applicable State
of Minnesota Statutes and City of Eagan Ordinances.
Applicant/Permitee: Signature ssued B :Signature
For Office Use I
------
I
I Permit#: 19 O T ZS j
EAGAN 1
EV Permit Fee: I
Date Received: I
3830 PILOT KNOB ROAD I EAGAN, MN 55122-1810 I I
(651)675-56751 TDD:(651)454-85351 FAX:(651)675-5694 I gthg;
buiidinginspections(acitvofeagan.com I_________________;
CROSS CONNECTION CONTROL PROGRAM INSPECTIONS
PERMIT APPLICATION
Date: 12/14/22 Site Address: 2620 Eagan Woods Dr.
Tenant: Summit Orthopedics Suite#:
Pr0�1@I�f
Owner Name: Summit Orthopedics Phone: 612-393-3184
Name: Gilbert Mechanical Contractors, LLC License#: PC 769827
Contractor Address: 5251 West 74th St City: Edina state: MN zip: 55439
Phone: 952-835-3810 Email: koneill@gilbertmech.com
_New _Replacement _Repair ✓Rebuild
.'Type of'Vyork
Description of work: Complete rebuild RPZ, serial#58358.
S#288393
COMMERCIAL
_Irrigation System(_Yes/Ve no) RP2/_PVB)
Permit Type • Rain sensors required on Irrigation systems
• Avg.GPM (2"turbo required unless smaller size allowed by Public works)
Avg.GPM High demand devices?_Yes_No Flushometers Yes_No
Permit Fee$60.00
You may subscribe to receive an electronic notification from the City of proposed ordinances by signing up for an email update on the City's website at
www.citvofeaaan.comisubscribe.
CALL BEFORE YOU DIG. Call Gopher State One Call at(651)454-0002 for protection against underground utility damage.
hereby acknowledge that this information is complete and accurate;that the work will be in conformance with the ordinances and codes of the City of Eagan;that
understand this Is not a permit,but only an application for a permit,and work Is not to start without a permit;that the work will be In accordance with the approved
plan In the case of work which requires a review and approval of plans.
x Kristin O'Neill X f
Applicant's Printed Name Atollcant's gnature
I to
Test Status Q Not Tested Q Passed Q Failed
Facility Name Address Address 2
SUMMIT ORTHOPEDICS 2620 EAGAN WOODS DR
City State Zip Code
rEAGAN —� MN 55121
Type: Size: Meter#: Manufacturer: Model:
RPBP O � -1 Watts 919
Serial: Permit:
Q Containment Q Isolation Q Fire Protection
58358
Location Comments:
Serves sterilizer, located in sterilizer room on 3rd floor rm 3091
Shut Off Valve 1: Shut Off Valve 2: Line Pressure: Initial Test Date:
Q Closed Q Leaked (0 Closed Q Leaked 0 10/05/2022
1st Check 2nd Check Relief Valve PVB/SVB Air Inlet PVB/SVB Check Valve
Q Closed Q Closed Q Opened Q Opened Q Held
Leaked Q Leaked 0 Did Not Open Q Failed Q Failed
Q Leaked
PSID: PSID: PSID: PSID: PSID:
0 0 0 0 0
Tester/Repair Comments:
Tester Name: Testing Company:
Kenneth Thunder Gilbert Mechanical Contractors
Tester Cert#: Gauge Manufacturer. GaugeModel: Gauge Serial#: Calibration Date:
31412 — 1 Watts TK-9A 0122858 07/16/2019
1st Check 2nd Check Relief Valve PVB/SVB Air Inlet PVB/SVB Check Valve
2 Closed Q Closed Opened Q Opened Q Held
Q Leaked Q Leaked Q Did Not Open Q Failed Q Failed
Q Leaked
PSID: PSID: PSID: PSID: PSID:
7.6 6.8 3 0 0
Final Test Date:
10/05/2022