EA185604 - Plumbing - Commercial - Issued Date 07/31/2023 PERMIT
City of Eagan a , , a Permit Type: Plumbing
3830 Pilot Knob Rd Permit Number: EA185604
Eagan, MN 55122 EAGAN
(651)675-5675 1111111111111 IN 11111111111111111111111111111 IN
www.cityofeagan.com * E R 1 8 5 6 0 4
Date Issued: 7/31/2023
Site Address: 2620 Eagan Woods Dr
Lot: 1 Block: 1 Addition: Eagan Woods Office Park 3rd
PID:10-22552-01-010 1111111111
Use: Summit Orthopedics * 1 D — Z 2 5 S Z — 0 1 — 0 1 0
Description:
Sub Type: Commercial
Work Type: Rebuild
Description: RPZ
Meter Size Meter Tyne 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 sued B : Signature
For Office Us
-----------------
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Permit#:� I
EAGA
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p - I Permit Fee:
ECEE
Date Received: I
3830 PILOT KNOB ROAD I EAGAN, MN 55122-1810 I
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(651)675-5675 1 FAX:(651)675-5694 1 Staff;
build Ing InspectionsCcDcltyofeaoan.com5 -----------------�
BY:
CROSS CONNECTION CONTROL PROGRAM INSPECTIONS
PERMIT APPLICATION
Date: 7/25/23 Site Address: 2620 Eagan Woods Dr
Tenant: Summit Orthopedics site#:
Name: Summit Orthopedics Phone: 651-287-8204
Name: Gilbert Mechanical Contractors, LLC License#: PC 769827
Address: 5251 West 74th St city; Edina State: MN Zip: 55439
Phone: 952-835-3810 Email: koneill@gilbertmech.com
_New _Replacement _Repair ✓ Rebuild
Description of work: Rebuild (4) RPZ's, serial #'s 0815, 08069, 08075 & 08064.
COMMERCIAL
_Irrigation System(_yes/✓no)(_RPZ/_PVB)
• 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.citvofeaaan.comisubscrl be.
CALL BEFORE YOU DIG. Contact Gopher State One Call at(651)454-0002 or www.aomherstateonecall.ora 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 plan
XKristin O'Neill X (jbi,
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Applicant's Printed Name Aillipli6anildSIgnature
Test Status 0 Not Tested DQ Passed 0 Failed
Facility Name Address Address 2
SUMMIT ORTHOPEDICS 2620 EAGAN WOODS DR F
City State Zip Code
EAGAN MN 55121
Type: Size: Meter#: Manufacturer: Model:
RPBP 0.5 Watts 919 —�
Serial: Permit:
08015 0 Containment Q Isolation 0 Fire Protection
Location Comments:
RPZ, serial 408015 serves washer/disinfector in 3rd floor clean room#3092.
Shut Off Valve 1: Shut Off Valve 2: Line Pressure: Initial Test Date:
0 Closed 0 Leaked Q Closed 0 Leaked 70 05/10/2023
1st Check 2nd Check Relief Valve PVB/SVB Air Inlet PVB/SVB Check Valve
Closed Q Closed Q 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
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 -
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:
9 7 4 0 0
Final Test Date:
07/12/2023
Test Status 0 Not Tested OQ Passed 0 Failed
Facility Name Address Address 2
SUMMIT ORTHOPEDICS 2620 EAGAN WOODS DR
City State Zip Code
EAGAN MN I 55121
Type: Size: Meter#: Manufacturer: Model:
RPBP 0.5 Watts —� 919
Serial: Permit:
0 Containment 0 Isolation 0 Fire Protection
08064
Location Comments:
Serves washer/disinfector, located in clean room on 3rd floor rm#3092.
Shut Off Valve 1: Shut Off Valve 2: Line Pressure: Initial Test Date:
0 Closed 0 Leaked (0 Closed 0 Leaked 1 70 1 05/10/2023
1st Check 2nd Check Relief Valve PVB/SVB Air Inlet PVB/SVB Check Valve
0 Closed 0 Closed 0 Opened 0 Opened 0 Held
Leaked Q Leaked 2 Did Not Open 0 Failed 0 Failed
0 Leaked
PSID: PSID: PSID: PSID: PSID:
0 0 0 0 0
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
Q Closed OJ 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:
12 9 4 0 0
Final Test Date:
07/12/2023
Test Status Q Not Tested QJ Passed Q Failed
Facility Name Address Address 2
SUMMIT ORTHOPEDICS 2620 EAGAN WOODS DR
City State Zip Code
EAGAN MN_,
55121
Type: Size: Meter#: Manufacturer: Model:
RPBP 0.5 Watts —� 919 —�
Serial: Permit:
Q Containment QJ Isolation Q Fire Protection
08057
Location Comments:
RPZ serves washer/disinfectors in clean room on 3rd floor Rm#3092.
Shut Off Valve 1: Shut Off Valve 2: Line Pressure: Initial Test Date:
O✓ Closed Q Leaked R Closed Q Leaked 1 70 05/10/2023
1 st Check 2nd Check Relief Valve PVB/SVB Air Inlet PVB/SVB Check Valve
Q Closed Q Closed Q Opened Q Opened Q Held
Ga Leaked QJ 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:
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
QJ Closed QJ Closed QJ Opened Q Opened Q Held
Q Leaked Q Leaked Q Did Not Open Q Failed Q Failed
Q Leaked
PSID: PSID: PSID: PSID: PSID:
12 9 5 —0 0
Final Test Date:
07/12/2023