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EA181657 - Plumbing - Commercial - Issued Date 03/10/2023 PERMIT City of Eagan ® , ® ® Permit Type: Plumbing 3830 Pilot Knob Rd ® % Permit Number: EA181657 °®°o ,B mB 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 ype ork 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