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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 ----------------- I 0 I U9W4 Permit#:� I EAGA IV p - I Permit Fee: ECEE Date Received: I 3830 PILOT KNOB ROAD I EAGAN, MN 55122-1810 I I (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, � 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