EA181657 - Plumbing - Commercial - Issued Date 03/10/2023 PERMIT
City of Eagan ® , ® ® Permit Type: Plumbing
3830 Pilot Knob Rd ® % Permit Number: EA181657
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Eagan,MN 55122 4®•• EAUjoCkN
(651)675-5675
www.cityofeagan.com * E R 1 8 1 6 S 7
Date Issued: 3/10/2023
Site Address: 2620 Eagan Woods Dr
Lot: 1 Block: l Addition: Eagan Woods Office Park 3rd
PID:10-22552-01-010
Use: Summit Orthopedics * 1 0 — 2 2 S S 2 — 0 1 — 0 1 0
Description:
Sub Type: Commercial
Work Type: Alteration
Description: RPZ
Meter Size Meter Tune Manufacturer Serial Number Remote Number Line Size
Comments:
Fee Summary: PL-RPZ/PVB/Lawn Irrigation $64.00 0801.4087
Surcharge-Fixed $1.00 9001.2195
Total: $65.00
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
®e® ® r `0 I Permit#:EAGAN i b
iPermit Fee:. I
Date Received: 01 j
3830 PILOT KNOB ROAD I EAGAN,MN 55122-1810 I I
(651)675-5675 1 FAX:(651)675-5694 � Staff: �
buildinginspection oityofeagan.cam ----------------
CROSS CONNECTION CONTROL PROGRAM INSPECTIONS
PERMIT APPLICATION
Date: 3/3/23 Site Address: 2620 Eagan Woods Dr
Tenant: Summit Orthopedics suite#:
Pr°petty
Summit Orthopedics, Kristen Hedin 651-287-8204
Ow"o Name: Phone:
Name: Gilbert Mechanical Contractors, LLC assns®#: PC769827
Contractor Address: 5251 West 74th St city: Edina states MN zip: 55439
Phone: 612-267-7742 Email: koneill@gilbertmech.com
_New _Replacement ✓ Repair —Rebuild
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Description of work: Installed new#1, #2 checks and relief for RPZ, serial #08398.
Tof
W
COMMERCIAL
Irrigation System yes/✓no)(V RPZ/_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$65.00
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.citvof®aoan.com/subscribe.
CALL BEFORE YOU DIG. Contact Gopher State One Call at(651)454-0002 or www.gopherstateonscall.org for protection against underground utility
damage. Contact Gopher State One Call 48 hours before you Intend to dig to receive locates of underground utilities.
I 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 I 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.
XKristin O'Neill x
Applicant's Printed Name Applicant's Signature
Test Status Q Not Tested Q✓ Passed Q Failed
Facility Name Address Address 2
SUMMIT ORTHOPEDICS 2620 EAGAN WOODS DR
City State Zip Code
EAGAN IMN 155121
Type: Size: Meter#: Manufacturer: Model:
RPBP 0.5 I ,Watts
Serial: Permit:
Q Containment 2 isolation Q Fire Protection
08398
Location Comments:
Serves Sonic Washer,located in decontamination room on 3rd floor rm#3083.
Shut Off Valve 1: Shut Off Valve 2: Line Pressure: Initial Test Date:
® Closed Q Leaked QJ Closed Q Leaked L.�= 02/08/2023
let Check 2nd Check Relief Valve PVB/SVB Air Inlet PVB/SVB Check Valve
Q Closed Q Closed Q Opened Q Opened Q Held
QQ Leaked QQ Leaked ® Did Not Open Q Failed Q Failed
Q Leaked
PSID: PSID: PSID: PSID: PSID:
0 0 0 0
Tester/Repair Comments:
Complete Rebuild 2/8/23
Tester Name: Testing Company:
John Galles Gilbert Mechanical Contractors
Tester Cert#. Gauge Manufacturer: GaugeModel: Gauge Serial#: Calibration Date:
130271 Watts TK-9A 453854 04/05/2019
1st Check 2nd Check Relief Valve PVB/SVB Air Inlet PVB/SVB Check Valve
® Closed ® Closed ® Opened Q Opened Q Held
Q Leaked Q Leaked Q Did Not Open Q Failed Q Failed
Q Leaked
PSID: PSID: ((PSID:4--] rPSID: {PSID:
14 11 � L�� L_0�
Final Test Date:
02/08/2023