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EA184987 - Plumbing - Commercial - Issued Date 06/30/2023 PERMIT City of Eagan ® a Permit Type: Plumbing 3830 Pilot Knob Rd ,®0 ®o®®®® Permit Number: EA184987 Eagan, MN 55122 °®®® ®®®® EAGAN (651)675-5675 11111111111111111111111111111111111111111 www.cityofeagan.com * E R 1 8 4 9 8 7 Date Issued: 6/30/2023 Site Address: 3902 Cedar Grove Pkwy Lot: 011 Block: 01 Addition: Stryker PID:10-72840-01-011 Use: VP Nails * 1 0 — 7 2 8 4 0 — 0 1 — 0 1 1 Description: Sub Type: Commercial Work Type: New Description: PVB 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: $65.00 Contractor: - Applicant - Owner: Gilbert Mechanical Contractors Cbc-Jwf LLC 5251 74th St W %John W Fitzgerald Edina MN 55439 3683 Jeffers Pkwy NW (952)835-3810 Prior Lake MN 55372 This permit shall be null and void if work does not start within 180 days of issuance, or if work is suspended for 180 days or more after started. I hereby acknowledge that I have read this application and state that the information is correct and agree to comply with all applicable State of Minnesota Statutes and City of Eagan Ordinances. Applicant/Permitee: Signature sued B : Signature C Inc 1� c�1 � I For Office Use I Permit#: 0 • •�• ��J� I Permit Fee:EAGA ECEI �o Ma {� s9 op i Staff: I J U G@,p tl 2 9 2023 3830 PILOT KNOB ROAD I EAGAN,MN 55122-1810 I Payment Recvd: Yes _No I (651)675-56751 FAX:(651)675-5694 I I Email:buiidinginspectionsCdlcityofeagan.com By: � Plans _Electronic _Paper I 2023 COMMERCIAL PLUMBING PERMIT APPLICATION ❑ Please submit one set of electronic plans via small Date: 5/12/23 Site Address:3902 Cedar Grove Parkway, Eagan, MN, 55122-1403 Tenant: VP Nails Suite #: Name.. Phone: JBL Companies (Leasa Pratt) 952-882-0884 s" W z Name: Gilbert Mechanical Contractors, LLC License#: PC 769827 Address: 5251 West 74th St City: Edina state: MN Zip; 55439 h952-835-3810 Phone: Email: koneill@gilbertmech.com `' New Construction Addition Modify Space Replacement RepairRebuild Work In Right-Of--Way a Description of work: ) P ) New Install PVB s 16 to pedicure chairs. ,Removed RPZ s 2 Irrigation System(_yes/_no}✓RPZ/_PVB) A �� � x • Rain sensors required on Irrigation systems z • Avg.GPM (2°turbo required unless smeller size allowed by Public Works) ¢ Meter Required–Call Utilities at(651)675-5646 to verity tests passed prior to picking up meter. Domestic:Size&Type Fire. 1 r' rwr Average GPM High demand devices?_Yes No Flushometers_Yes No COMMERCIAL FEES Contract Value$ x:Q'5 $65.00 Permit Fee Minimum 65.00 $65.00 PVB/RPZ Permit(includes State Surcharge) $ Permit Fee Surcharge=Contract Value x$0.0005 $ Surcharge If the project valuation Is over$1 million,please call City for Surcharge $ 65.00 TOTAL FEE The following fees may apply when Installing a new lawn Irrigation system or $ Water Permit connecting a new water service. $ Treatment Plant Contact the City's Engineering Department,(651)675-5646,for required fee amounts. $ Meter Fee $ Radio Read $ State Surcharge =$65.00 TOTAL FEE 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.cftyof—eagan.com/subscObs. CALL BEFORE YOU DIG. Contact Gopher State One Cell at(651)454-0002 or www.gopherstateonecall.orn 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 pian In the case of work which requires a review and approval of plans. xKristin O'Neill x Appl(cant's Printed Name Applicant's Signature n NO �- Water Meter Fees 3/4" $300.00 1" $380.00 $1,380.00 2" $1,600.00 3" $2,000.00 4" $3,500.00 6" $6,500.00 Radio Meter Read $240.00 Additional Information • Radio Meter Reads are required on all new single-family, multi-family and commercial buildings. Boulevard irrigation systems may also require a radio read. • RPZ's must be tested every year and rebuilt every five years. RPZ testing Is submitted directly Online at www.nethydrosoft.com. Please call Hydrosoft customer service at(844)493-7641 or email InfoAhydrocorainc.com. • A minimum permit fee is required per address for the following RPZ's: new, rebuild,repair, &remove. • Water meters include copper horn/strainer,remote wire,and touch-pad meter. • To schedule an inspection of the Inside water line and backflow preventer,call the City of Eagan Building Inspections Division(651)675-5675. • To arrange for water tum-on,call City of Eagan Utilities Department at(651)675-5200. 3830 PILOT KNOB ROAD I EAGAN,MN 55122 (651)675-5675 1 FAX:(651)675-5694 bulldlnolnspectionsCd>citvofeaaan.com If you have a hearing or speech disability,contact us through your preferred telecommunications relay service. Test Status Q Not Tested ❑Q Passed ❑ Failed Facility Name Address Address 2 CEDARVALE BUSINESS CENTER 1 3902 CEDAR GROVE PKWY City State Zip Code EAGAN MN 55122-1403 Type: Size: Meter#: Manufacturer: Model: PVB Wilkins 720A Serial: Permit: ❑ Containment 0 Isolation Q Fire Protection T073417 Location Comments: pedicure chair hot side Added per tester Shut Off Valve 1: Shut Off Valve 2: Line Pressure: Initial Test Date: 0 Closed ❑ Leaked 91 Closed ❑ Leaked 70 04/26/2023 1st Check 2nd Check Relief Valve PVB/SVB Air Inlet PVB/SVB Check Valve Q Closed ❑ Closed ❑ Opened Q Opened Q Held Q Leaked ❑ Leaked ❑ Did Not Open Q Failed Q Failed ❑ Leaked PSID: PSID: PSID: PSID: PSID: 0 0 0 2.5 1.8 Tester/Repair Comments: Tester Name: Testing Company: John Galles I Gilbert Mechanical Contractors Tester Cert#: Gauge Manufacturer: GaugeModel: Gauge Serial#: Calibration Date: 30271 Watts TK-9A 453854 04/05/2019 1st Check 2nd Check Relief Valve PVB/SVB Air Inlet PVB/SVB Check Valve Q Closed ❑ Closed ❑ Opened ❑ Opened ❑ Held Q Leaked ❑ Leaked ❑ Did Not Open ❑ Failed ❑ Failed Q Leaked PSID: PSID: PSID: PSID: PSID: 0 0 0 0 0 Final Test Date: Test Status Q Not Tested 0 Passed Q Failed Facility Name Address Address 2 CEDARVALE BUSINESS CENTER 1 3902 CEDAR GROVE PKWY City State Zip Code EAGAN -� MN 1 155122-1403 Type: Size: Meter#: Manufacturer: Model: PVB �p Wilkins 720A Serial: Permit: Q Containment 0 Isolation Q Fire Protection T073498 Location Comments: Pedicure chair 3 cold feed-added [er tester Shut Off Valve 1: Shut Off Valve 2: Line Pressure: Initial Test Date: 0 Closed Q Leaked 0 Closed Q Leaked 70 04/26/2023 1st Check 2nd Check Relief Valve PVB/SVB Alr Inlet PVB/SVB Check Valve Q Closed Q Closed Q Opened 0 Opened 0 Held Q Leaked Q Leaked Q Did Not Open Q Failed Q Failed Q Leaked PSID: PSID: PSID: PSID: PSID: 0 0 0 1 1.8 1.2 Tester/Repair Comments: Tester Name: Testing Company: John Galles I Gilbert Mechanical Contractors Tester Cert#: Gauge Manufacturer: GaugeModel: Gauge Serial#: Calibration Date: 30271 Watts TK-9A 453854 04/05/2019 1st Check 2nd Check Relief Valve PVB/SVB Air Inlet PVB/SVB Check Valve Q Closed Q Closed Q Opened Q Opened Q Held Q Leaked Q Leaked Q Did Not Open Q Failed Q Falled Q Leaked PSID: PSID: PSID: PSID: PSID: 0 0 0 0 0 Final Test Date: Test Status O Not Tested Q Passed ❑ Failed Facility Name Address Address 2 CEDARVALE BUSINESS CENTER 3902 CEDAR GROVE PKWY City State Zip Code EAGAN MN 55122-1403 Type: Size: Meter#: Manufacturer: Madel: PVB Wilkins —, 720A Serial:rial: Permit: ❑ Containment Q Isolation ❑ Fire Protection T0 Location Comments: Pedicure chair cold-Added per tester Shut Off Valve 1: Shut Off Valve 2: Line Pressure: Initial Test Date: ❑✓ Closed ❑ Leaked © Closed ❑ Leaked 1 70 04/26/2023 1st Check 2nd Check Relief Valve PVB/SVB Air Inlet PVB/SVB Check Valve ❑ Closed ❑ Closed ❑ Opened ❑Q Opened ❑J Held ❑ Leaked ❑ Leaked ❑ Did Not Open O Failed ❑ Failed ❑ Leaked PSID: PSID: PSID: PSID: PSID: 0 0 0 2.5 2 Tester/Repair Comments: Tester Name: Testing Company: John Galles Gilbert Mechanical Contractors Tester Cert#: Gauge Manufacturer: GaugeModel: Gauge Serial#: Calibration Date: 30271 Watts — I TK-9A 453854 04/05/2019 1st Check 2nd Check Relief Valve PVB/SVB Air Inlet PVB/SVB Check Valve ❑ Closed ❑ Closed ❑ Opened ❑ Opened ❑ Held ❑ Leaked ❑ Leaked O Did Not Open ❑ Failed ❑ Failed ❑ Leaked PSID: PSID: PSID: PSID: PSID: 0 0 0 0 0 Final Test Date: Test status Q Not Tested Q Passed Q Failed Facility Name Address Address 2 CEDARVALE BUSINESS CENTER 3902 CEDAR GROVE PKWY City State Zip Code EAGAN MN 1 55122-1403 Type: Size: Meter#: Manufacturer: Model: PVBWilkins � 720A Serial: Permit: Q Containment 2 Isolation Q Fire Protection T074063 Location Comments: Pedicure chair cold-Added per tester Shut Off Valve 1: Shut Off Valve 2: Line Pressure: Initial Test Date: Q Closed Q Leaked R) Closed Q Leaked 1 70 04/26/2023 1st Check 2nd Check Relief Valve PVB/SVB Air Inlet PVB/SVB Check Valve Q Closed Q Closed Q Opened. Q Opened Q Held Q Leaked Q Leaked Q Did Not Open Q Failed Q Failed Q Leaked PSID: PSID: PSID: PSID: PSID: 0 0 0 3 1.4 Tester/Repair Comments: Tester Name: Testing Company: John Galles Gilbert Mechanical Contractors Tester Cert#: Gauge Manufacturer: GaugeModel: Gauge Serial#: Calibration Date: 30271 Watts IF 453854 04/05/2019 1st Check 2nd Check Relief Valve PVB/SVB Air Inlet PVB/SVB Check Valve Q Closed Q Closed Q Opened Q Opened Q Held Q Leaked Q Leaked Q Did Not Open Q Failed Q Failed Q Leaked PSID: PSID: PSID: PSID: PSID: 0 0 0 0 0 Final Test Date: Test status ❑ Not Tested QQ Passed ❑ Failed Facility Name Address Address 2 CEDARVALE BUSINESS CENTER 3902 CEDAR GROVE PKWY City State Zip Code EAGAN MN 1 156122-1403 Type: Size: Meter#: Manufacturer: Model: PVB �p Wilkins 720A Serial: Permit: ❑ Containment (0 Isolation ❑ Fire Protection T073168 Location Comments: Pedicure chair 6 hot feed-Added per tester Shut Off Valve 1: Shut Off Valve 2: Line Pressure: Initial Test Date: 0 Closed ❑ Leaked 2) Closed ❑ Leaked 1 70 04/26/2023 1st Check 2nd Check Relief Valve PVB/SVB Air Inlet PVB/SVB Check Valve ❑ Closed ❑ Closed ❑ Opened dQ Opened QQ Held ❑ Leaked ❑ Leaked ❑ Did Not Open ❑ Failed ❑ Failed ❑ Leaked PSID: PSID: PSID: PSID: PSID: 0 0 0 2 1.2 Tester/Repair Comments: Tester Name: Testing Company: John Galles Gilbert Mechanical Contractors Tester Cert#: Gauge Manufacturer: GaugeModel: Gauge Serial#: Calibration Date: 30271 Watts TK-9A 453854 04/05/2019 1st Check 2nd Check Relief Valve PVB/SVB Air Inlet PVB/SVB Check Valve ❑ Closed Q Closed Q Opened Q Opened Q Held ❑ Leaked ❑ Leaked ❑ Did Not Open ❑ Failed ❑ Failed ❑ Leaked PSID: PSID: PSID: PSID: PSID: 0 j 0 0 0 0 Final Test Date: Test Status ❑ Not Tested ❑Q Passed ❑ Failed Facility Name Address Address 2 CEDARVALE BUSINESS CENTER 3902 CEDAR GROVE PKWY City State Zip Code EAGAN MN 1 55122-1403 Type: Size: Meter#: Manufacturer: Model: PVB �0 Wilkins r 720A Serial: Permit: ❑ Containment © Isolation ❑ Fire Protection T073230 Location Comments: Pedicure chair cold-Added per tester Shut Off Valve 1: Shut Off Valve 2: Line Pressure: Initial Test Date: ❑Q Closed ❑ Leaked ❑J Closed ❑ Leaked 1 70 04/26/2023 1st Check 2nd Check Relief Valve PVB/SVB Alr Inlet PVB/SVB Check Valve ❑ Closed ❑ Closed ❑ Opened Q Opened ❑Q Held ❑ Leaked ❑ Leaked ❑ Did Not Open ❑ Failed ❑ Failed ❑ Leaked PSID: PSID: PSID: PSID: PSID: 0 0 0 2.5 1.2 Tester/Repair Comments: Tester Name: Testing Company: John Galles Gilbert Mechanical Contractors Tester Cert#: Gauge Manufacturer: GaugeModel: Gauge Serial#: Calibration Date: 30271 WattsK-9A 453854 04/05/2019 T 1st Check 2nd Check Relief Valve PVB/SVB Air Inlet PVB/SVB Check Valve ❑ Closed ❑ Closed ❑ Opened ❑ Opened ❑ Held ❑ Leaked ❑ Leaked ❑ Did Not Open ❑ Failed ❑ Failed ❑ Leaked PSID: PSID: PSID: PSID: PSID: 0 0 0 0 0 Final Test Date: Test Status Q Not Tested QQ Passed ❑ Failed Facility Name Address Address 2 CEDARVALE BUSINESS CENTER 3902 CEDAR GROVE PKWY City State Zip Code EAGAN I MN 55122-1403 Type: Size: Meter#: Manufacturer: Model: PVBWilkins 720A Serial: Permit: ❑ Containment Q✓ Isolation ❑ Fire Protection T073549 Location Comments: pedicure chair cold-Added per tester Shut Off Valve 1: Shut Off Valve 2: Line Pressure: Initial Test Date: Q✓ Closed Q Leaked QQ Closed ❑ Leaked 1 70 04/26/2023 1st Check 2nd Check Relief Valve PVB/SVB Air Inlet PVB/SVB Check Valve ❑ Closed Q Closed ❑ Opened Q Opened ./Q Held ❑ Leaked ❑ Leaked Q Did Not Open ❑ Failed ❑ Failed ❑ Leaked PSID: PSID: PSID: PSID: PSID: 0 0 0 3 1.5 Tester/Repair Comments: Tester Name: Testing Company: John Galles Gilbert Mechanical Contractors Tester Cart#: Gauge Manufacturer: GaugeModel: Gauge Serial#: Calibration Date: 30271 Watts 1 TK-9A 453854 04/05/2019 1st Check 2nd Check Relief Valve PVB/SVB Air Inlet PVB/SVB Check Valve ❑ Closed Q Closed ❑ Opened Q Opened ❑ Held ❑ Leaked ❑ Leaked Q Did Not Open ❑ Failed ❑ Failed ❑ Leaked PSID: PSID: PSID: PSID: PSID: 0 0 0 0 0 Final Test Date: Test Status Q Not Tested Q Passed Q Failed Facility Name Address Address 2 CEDARVALE BUSINESS CENTER 3902 CEDAR GROVE PKWY - Clay State Zip Code EAGAN MN 55122-1403 Type: Size: Meter#: Manufacturer: Madel: PVB Wiiklns 720A Serial: Permit: Q Containment QJ Isolation Q Fire Protection T073173 Location Comments: Pedicure chair hot-added per tester Shut Off Valve 1: Shut Off Valve 2: Line Pressure: Initial Test Date: 0 Closed Q Leaked (0 Closed Q Leaked 1 70 04/26/2023 1st Check 2nd Check Relief Valve PVB/SVB Air Inlet PVB/SVB Check Valve Q Closed Q Closed Q Opened JQ Opened QQ Held Q Leaked Q Leaked Q Did Not Open Q Failed Q Failed Q Leaked PSID: PSID: PSID: PSID: PSID: 0 0 0 2.5 1.5 Tester/Repair Comments: Tester Name: Testing Company: John Galles Gilbert Mechanical Contractors Tester Cert#: Gauge Manufacturer: GaugeModel: Gauge Serial#: Calibration Date: 30271 Watts TK-9A 453854 04/05/2019 1st Check 2nd Check Relief Valve PVB/SVB Air Inlet PVB/SVB Check Valve Q Closed Q Closed Q Opened Q Opened Q Held Q Leaked Q Leaked Q Did Not Open Q Failed Q Failed Q Leaked PSID: PSID: PSID: PSID: PSID: 0 0 0 0 0 Final Test Date: Test Status ❑ Not Tested QQ Passed Q Failed Facility Name Address Address 2 CEDARVALE BUSINESS CENTER 3902 CEDAR GROVE PKWY City State Zip Code EAGAN MN 55122-1403 Type: Size: Meter#: Manufacturer: Model: PVB O Wilkins 720A Serial: permit: Q Containment Q✓ Isolation Q Fire Protection T073196 Location Comments: Pedicure chair 7 hot feed-Added per tester Shut Off Valve 1: Shut Off Valve 2: Line Pressure: Initial Test Date: Ga Closed ❑ Leaked 0 Closed Q Leaked 1 70 04/26/2023 1st Check 2nd Check Relief Valve PVB/SVB Air Inlet PVB/SVB Check Valve Q Closed Q Closed Q Opened Q Opened QQ Held Q Leaked ❑ Leaked O Did Not Open Q Failed Q Failed ❑ Leaked PSID: PSID: PSID: PSID: PSID: 0 0 0 2.5 1.5 Tester/Repair Comments: Tester Name: Testing Company: Chad Paetznick Gilbert Mechanical Contractors Tester Cert#: Gauge Manufacturer: GaugeModel: Gauge Serial#: Calibration Date: 46511watts tk-9a 0080618 1111/03/2020 1st Check 2nd Check Relief Valve PVB/SVB Air Inlet PVB/SVB Check Valve Q Closed Q Closed Q Opened Q Opened Q Held Q Leaked Q Leaked ❑ Did Not Open Q Failed Q Failed 0 Leaked PSID: PSID: PSID: PSID: PSID: 0 j 0 0 0 0 Final Test Date: Test status ❑ Not Tested 0 Passed ❑ Failed Facility Name Address Address 2 CEDARVALE BUSINESS CENTER 3902 CEDAR GROVE PKWY City State Zip Code EAGAN MN 55122-1403 Type: Size: Meter#: Manufacturer: Model: PVB �p Wilkins 720A Serial: permit: Q Containment 0 Isolation ❑ Fire Protection T074116 Location Comments: Pedicure chair hot Added per tester Shut Off Valve 1: Shut Off Valve 2: Line Pressure: Initial Test Date: 0 Closed Q Leaked 0 Closed Q Leaked 1 70 04126/2023 1st Check 2nd Check Relief Valve PVB/SVB Air Inlet PVB/SVB Check Valve ❑ Closed ❑ Closed ❑ Opened 0 Opened 0 Held Q Leaked Q Leaked Q Did Not Open ❑ Failed ❑ Failed 0 Leaked PSID: PSID: PSID: PSID: PSID: 0 0 0 2.5 1.2 Tester/Repair Comments: Tester Name: Testing Company: John Galles Gilbert Mechanical Contractors Tester Cert#: Gauge Manufacturer: GaugeModel: Gauge Serial#: Calibration Date: 30271 Watts TK-9A 453854 04/05/2019 1st Check 2nd Check Relief Valve PVB/SVB Air Inlet PVB/SVB Check Valve Q Closed Q Closed ❑ Opened Q Opened ❑ Held ❑ Leaked ❑ Leaked Q Did Not Open Q Failed ❑ Failed Q Leaked PSID: PSID: PSID: PSID: PSID: 0 0 0 0 0 Final Test Date: Test Status ❑ Not Tested QQ Passed Q Failed Facility Name Address Address 2 CEDARVALE BUSINESS CENTER 3902 CEDAR GROVE PKWY City State Zip Code EAGAN M N 55122-1403 Type: Size: Meter#: Manufacturer: Model: PVB Wilkins 720A Serial: Permit: Q Containment Q✓ Isolation Q Fire Protection T073202 Location Comments: Pedicure chair 3 hot side pvb-Added per tester Shut Off Valve 1: Shut Off Valve 2: Line Pressure: Initial Test Date: Closed Q Leaked (0 Closed Q Leaked 1 70 04/26/2023 1st Check 2nd Check Relief Valve PVB/SVB Air Inlet PVB/SVB Check Valve Q Closed Q Closed Q Opened QQ Opened dQ Held ❑ Leaked Q Leaked Q Did Not Open Q Failed Q Failed ❑ Leaked PSID: PSID: PSID: PSID; PSID: 0 0 �0� 2 1 1.2 Tester/Repair Comments: Tester Name: Testing Company: John Galles Gilbert Mechanical Contractors Tester Cert#: Gauge Manufacturer: GaugeModel: Gauge Serial#: Calibration Date: 30271 Watts TK-9A 453854 04/05/2019 list 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 Q Did Not Open Q Failed Q Failed ❑ Leaked PSID: PSID: PSID: PSID: PSID: 0 0 0 0 0 Final Test Date: Test Status Q Not Tested pQ Passed Q Failed Fadilty Name Address Address 2 CEDARVALE BUSINESS CENTER 3902 CEDAR GROVE PKWY City State Zip Code EAGAN MN 55122-1403 Type: Size: Meter#: Manufacturer: Model: PVB Wilkins r 720A Serial: Permit: Q Containment 0 Isolation Q Fire Protection T073502 Location Comments: Pedicure chair 2 cold feed-Added per tester Shut Off Valve 1: Shut Off Valve 2: Line Pressure: Initial Test Date: 0 Closed ❑ Leaked (0 Closed ❑ Leaked 1 70 04/26/2023 1st Check 2nd Check Relief Valve PVB/SVB Air Inlet PVB/SVB Check Valve Q Closed ❑ Closed ❑ Opened Q Opened Q Held ❑ Leaked Q Leaked Q Did Not Open ❑ Failed Q Failed ❑ Leaked PSID: PSID: PSID: PSID: PSID: 0 0 0 2.5 1.5 Tester/Repair Comments Tester Name: Testing Company: John Galles Gilbert Mechanical Contractors Tester Cert#: Gauge Manufacturer: GaugeModel: Gauge Serial#: Calibration Date: 30271 Watts I TK-9A 453854 04/05/2019 list Check 2nd Check Relief Valve PVB/SVB Air Inlet PVB/SVB Check Valve ❑ Closed ❑ Closed ❑ Opened ❑ Opened ❑ Held ❑ Leaked ❑ Leaked Q Did Not Open ❑ Failed Q Failed ❑ Leaked PSID: PSID: PSID: PSID: PSID: 0 0 0 0 0 Final Test Date: Test Status 0 Not Tested OQ Passed 0 Failed Facility Name Address Address 2 CEDARVALE BUSINESS CENTER 3902 CEDAR GROVE PKWY City State Zip Code EAGAN MN I 55122-1403 Type: Size: Meter#: Manufacturer: Model: PVB Wilkins 720A Serial: Permit: • 0 Containment 0 Isolation 0 Fire Protection T073708 Location Comments: Pedicure chair#2 Hot water feed-Added per tester Shut Off Valve 1: Shut Off Valve 2: Line Pressure: Initial Test Date: 0 Closed 0 Leaked (0 Closed 0 Leaked 1 70 04/26/2023 1st Check 2nd Check Relief Valve PVB/SVB Air Inlet PVB/SVB Check Valve 0 Closed 0 Closed 0 Opened 2 Opened 0✓ Held 0 Leaked 0 Leaked 0 Did Not Open 0 Failed 0 Failed 0 Leaked PSID: PSID: PSID: PSID: PSID: 0 0 1 0 2.2 1.5 Tester/Repair Comments: Tester Name: Testing Company: John Galles Gilbert Mechanical Contractors Tester Cert#: Gauge Manufacturer: GaugeModel: Gauge Serial#: Calibration Date: 30271 WattsK-9A 45 T 3854 04/05/2019 1st Check 2nd Check Relief Valve PVB/SVB Air Inlet PVB/SVB Check Valve 0 Closed 0 Closed 0 Opened 0 Opened 0 Held 0 Leaked 0 Leaked 0 Did Not Open 0 Failed 0 Failed 0 Leaked PSID: PSID: PSID: PSID: PSID: 0 0 0 0 0 Final Test Date: Test Status Q Not Tested (0 Passed Q Failed Facility Name Address Address 2 CEDARVALE BUSINESS CENTER 3902 CEDAR GROVE PKWY City State Zip Code EAGAN MN 1 55122-1403 Type: Size: Meter#: Manufacturer: Model: PVB WILKIN 720A Serial: Permit: Q Containment QJ Isolation Q Fire Protection T073079 Location Comments: Pedicure chair hot-Added per tester Shut Off Valve 1: Shut Off Valve 2: Line Pressure: Initial Test Date: Q✓ Closed Q Leaked 91 Closed Q Leaked 70 04/26/2023 1st Check 2nd Check Relief Valve PVB/SVB Air Inlet PVB/SVB Check Valve Q Closed Q Closed Q Opened Q✓ Opened QQ Held Q Leaked Q Leaked Q Did Not Open Q Failed Q Failed Q Leaked PSID: PSID: PSID: PSID: PSID: 0 0 0 2.5 2 Tester/Repair Comments: Tester Name: Testing Company: John Galles Gilbert Mechanical Contractors Tester Cert#: Gauge Manufacturer: GaugeModel: Gauge Serial#: Calibration Date: 30271 Watts TK-9A 453854 04/05/2019 11 1st Check 2nd Check Relief Valve PVB/SVB Air Inlet PVB/SVB Check Valve Q Closed Q Closed Q Opened Q Opened Q Held Q Leaked Q Leaked Q Did Not Open Q Failed Q Failed Q Leaked PSID: PSID: PSID: PSID: PSID: 0 0 0 0 0 Final Test Date: Test Status ❑ Not Tested Q Passed ❑ Failed Facility Name Address Address 2 CEDARVALE BUSINESS CENTER 3902 CEDAR GROVE PKWY City State Zip Code EAGAN MN 55122-1403 Type: Size: Meter#: Manufacturer: Model: PVB �0 Wilkins 720A Serial: Permit: ❑ Containment ❑J Isolation Q Fire Protection T073457 Location Comments: Pedicure chair 6 cold feed-added per tester Shut Off Valve 1: Shut Off Valve 2: Line Pressure: Initial Test Date: Q Closed ❑ Leaked ❑✓ Closed ❑ Leaked 1 70 04/26/2023 1st Check 2nd Check Relief Valve PVB/SVB Air Inlet PVB/SVB Check Valve ❑ Closed ❑ Closed ❑ Opened Q Opened ❑Q Held ❑ Leaked Q Leaked ❑ Did Not Open ❑ Failed Q Failed ❑ Leaked PSID: PSID: PSID: PSID: PSID: 0 0 0 2.5 1.2 Tester/Repair Comments: Tester Name: Testing Company: John Galles Gilbert Mechanical Contractors Tester Cert#: Gauge Manufacturer: GaugeModel: Gauge Serial#: Calibration Date: 30271 Watts TK-9A 453854 04/05/2019 list Check 2nd Check Relief Valve PVB/SVB Air Inlet PVB/SVB Check Valve Q Closed Q Closed ❑ Opened ❑ Opened Q Held ❑ Leaked Q Leaked Q Did Not Open ❑ Failed ❑ Failed Q Leaked PSID: PSID: PSID: PSID: PSID: 0 0 0 0 -o - Final Test Date: Test Status 0 Not Tested 0 Passed 0 Failed Facility Name Address Address 2 CEDARVALE BUSINESS CENTER 3902 CEDAR GROVE PKWY City State Zip Code EAGAN MN 55122-1403 Type: Size: Meter#: Manufacturer: Model: PVB �0 Wilkins 720A Serial: Permit: Serial: 0 Containment 0 Isolation 0 Fire Protection Location Comments: Pedicure chair 7 cold feed-added per tester Shut Off Valve 1: Shut Off Valve 2: Line Pressure: Initial Test Date: Q Closed 0 Leaked 0 Closed 0 Leaked 1 70 04/26/2023 1st Check 2nd Check Relief Valve PVB/SVB Air Inlet PVB/SVB Check Valve 0 Closed 0 Closed 0 Opened 0 Opened 0 Held 0 Leaked 0 Leaked 0 Did Not Open 0 Failed 0 Failed 0 Leaked PSID: PSID: PSID: PSID: PSID: 0 0 0 2.5 1.4 Tester/Repair Comments: Tester Name: Testing Company: Chad Paetznlck Gllbert Mechanical Contractors Tester Cert#: Gauge Manufacturer: GaugeModel: Gauge Serial#: Calibration Date: 46511 watts tk-9a 0080618 11/03/2020 1st Check 2nd Check Relief Valve PVB/SVB Air Inlet PVB/SVB Check Valve 0 Closed 0 Closed 0 Opened 0 Opened 0 Held 0 Leaked 0 Leaked 0 Did Not Open 0 Failed 0 Failed 0 Leaked PSID: PSID: PSID: PSID: PSID: 0 0 0 0 0 Final Test Date: GILBERT REGULATED BACKFLOW ASSEMBLY (RBA) FORM)TEST REPORT }' job Address 3902 Cedar Grove Pky, Eagan, MN, 55122-1403 Job Name VP Nails job Number 23-5583-40 Contractor Name: Tester Name: Gilbert Mechancial Contractors G Chad Paetznick Contractor Address: Tester Certification#: 5251 W 74th Street, Edina', MN 55439 BF065907 Contractor License#: Test Equipment Manufacturer: 058808-PM N/A Contractor Phone#: Test Equipment Model#: 952-835-3810 N/A Test Equipment Serial#: N/A Testing Equipment Calibration Date: N/A Backflow Assembly Detail Information(Check One:) G Reduce Pressure Principal or Pressure Principal Fire Protection Type of Work(Check One) G Remove Manufacturer: System Serviced: Apollo Hot Water Feed To Salon Chairs Model# Location In Bldg RPLF4A Janitors Room Serial# Floor# 905310 Main Level Size(Inches) Room # 3/4" Janitors Room REGULATED BACKFLOW ASSEMBLY (RBA) FORM/TEST REPORT cont. ------------------------------------------------------------------------------------------------------------------------------------------------------- Reduced Pressure Principal or Reduced Pressure Detector Fire Protection(RP)-TEST RESULTS Check Valve#2 (Closed Tight) Shutoff Valve#2 (Closed Tight) Check Valve#1 Initial Test O No @)No O No (Closed Tight) Final Test 0 No 0 No No (Closed Tight) Reduced Pressure Principal or Reduced Pressure Detector Fire Protection(RP)-TEST RESULTS Continued Check Valve Pressure Differential Relief Check Valve Static Line #1 Valve #2 Pressure InklalTest-Pressure Drop Across 0 0 0 0 psid Final Test-Pressure Drop Across 0 0 0 0 _ psid Initial Test-Opened At psid Final Test-O pened At psid Lbs. TEST RESULTS: 65 FAIL Double Check Valve or Double Check Detector Fire Protection Double Check Valve or Double Check Detector Fire Protection (DC)-TEST RESULTS (DC)-TEST RESULTS continued Check Check Shutoff Check Valve Check Valve Shutoff Valve Valve#1 Valve#2 Valve#2 #1 #2 #2 Initial Test-Closed Initial Test Tight psid Final Test Closed Final Test Tight psid Pressure Vacuum Breaker(PVB)or Spill Resistant Vacuum Pressure Vacuum Breaker(PVB) or Spill Resistant Vacuum Breaker(SRVB)-TEST RESULTS Breaker(SRVB)TEST RESULTS continued Air Inlet Valve- Check Valve- Shutoff#2- Air Inlet Check Failed to Open Closed Tight Closed Tight Valve Valve Initial InkialTest-Opened at psid Test Final Test-Opened at psid Final Initial Test-Pressure Drop Across Test Check Valve#1 psid Final Test-Pressure Drop Across Check Valve#1 psid Describe parts and repairs when needed: REMOVED THE APOLLO RPZ FROM SERVICE, NO LONGER NEEDED. Tester's Signature: Date: 04/26/2023 ALBERT REGULATED BACKFLOW ASSEMBLY (RBA)FORM/TEST REPORT Job Address 3902 Cedar Grove Pky, Eagan, MN, 55122-1403 Job Name VP Nails Job Number 23-5583-40 Contractor Name: Tester Name: Gilbert Mechanclal Contractors G Chad Paetznick' Contractor Address: Tester Certification#: 5251 W 74th Street, Edina, MN 55439 BF065907 Contractor License#: Test Equipment Manufacturer: 058808-PM N/A Contractor Phone#: Test Equipment Model#: 952-835-3810 N/A Test Equipment Serial#: N/A Testing Equipment Calibration Date:' N/A Backflow Assembly Detail Information(Check One:) G Reduce Pressure Principal or Pressure Principal Fire Protection Type of Work(Check One) G Remove Manufacturer: System Serviced: Apollo Cold water feed to salon chairs Model# Location In Bldg RPLF4A Janitors Room Serial# Floor# 808595 Main Level Size(Inches) Room# 3/4" Janitors Room REGULATED BACKFLOW ASSEMBLY (RBA) FORM/TEST REPORT cont. ------------------------------------------------------------------------------------------------------------------------------------------------------- Reduced Pressure Principal or Reduced Pressure Detector Fire Protection(RP)-TEST RESULTS Check Valve#2(Closed Tight) Shutoff Valve#2 (Closed Tight) Check Valve#1 Initial Test *No O No No (Closed Tight) Final Test OO No O No O No (Closed Tight) Reduced Pressure Principal or Reduced Pressure Detector Fire Protection (RP)-TEST RESULTS.Continued , Check Valve Pressure Differential Relief Check Valve Static Line #1 Valve #2 Pressure Initial Test'Pressure Drop Across 0 0 0 0 psid Final Test-Pressure Drop Across 0 0 0 0 psid Initial Test-Opened At psid Final Test-Opened At psid Lbs. TEST RESULTS: 65 FAIL Double Check Valve or Double Check Detector Fire Protection Double Check Valve or Double Check Detector Fire Protection (DC)-TEST RESULTS (DC)-TEST RESULTS continued Check Check Shutoff Check Valve Check Valve. Shutoff Valve Valve#1 Valve#2 Valve#2 #1 #2 #2 Initial Test-Closed Initial Test Tight psid Final Test Closed Final Test Tight psid Pressure Vacuum Breaker(PVB)or Spill Resistant Vacuum Pressure Vacuum Breaker(PVB)or Spill Resistant Vacuum Breaker(SRVB)TEST RESULTS Breaker(SRVB)TEST RESULTS continued Air Inlet Valve- Check Valve- Shutoff#2- Air Inlet Check Failed to Open Closed Tight Closed Tight Valve Valve Initial Initial Test-Opened at psid Test Final Test-Opened at psid Final Initial Test-Pressure Drop Across Test Check Valve#1 psid Final Test-Pressure Drop Across Check Valve#1 psid Describe parts and repairs when needed: Rmoved the Apollo rpz from service Tester's Signature: Date: 04/26/2023 CITY OF EAGAN MANDATORY INSPECTION OF BACKFLOW PREVENTER Test Reduced Pressure Zone Backflow Preventer Unit ID (Account #) I PROPERTY I ADDRESS [ CONTACT PERSON I PHONE # BACKFLOW PREVENTER INFORMATION Type Assembly Serial Number Model Size Manufacturer Do S?'uo i Z. Responsible Company Phone # Date of Last Rebuild Next Scheduled Rebuild Device Location I Device Serves What System pan vcc-F D " BACKFLOW PREVENTER ASSEMBY TEST Check Valve 1 O Leaked (vTC�Iosed Tight Check Valve 2 () Leaked ( sed Tight Press Diff Across Check Valve #1 , Z PSI Press Diff Across Check Valve #2 PSI Press Diff Relief Open PSI Describe Repairs I hereby certify the forgoing data to be correct and that the tested device is functioning within the limits of the standards. Firm Name: Northland Mechanical Contractors, Inc. Address: 9001 Science Center Drive License Number 059225-PM New Hope, Minnesota 55428 Test By:�% j M Printed Name: Mike Calverley nt New Install ( ) Test ( ) Rebuild Certification #: BF708175 Date Tested: 2-1 S' / 2, Zth ( ) Replaced Unit PLUMBING PERMIT IS REQUIRED FOR ALL REPAIRS AND REBUILDS Date Copy to City