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Building 14.0031,0029,0049 Caribou
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Yellow Applicant • (Please type or print and sign at bottom) ADDRESS 1 '' jIH 1.3 S • ZONING (office use) LEGAL DESCRIPTION (office use only) LOT BLOCK ADDITION PIDIMI& (AO •O OWNER. (Name) _Caribou Coffee Cornpany (Phone) 763- 592 -2402 (Address) 3900 Lake Breeze Avenue North, Brooklyn Center, Minnesota 55429 BUILDER (Company Name) Hunter Berg Construction (Phone) 763 -463 -5040 (Contact Name) John Lawyer (Phone) 612 -432 -4881 (Address) 11102 86th Avenue North, Maple Grove, MN 55369 TYPE OF WORK O'New Construction ❑Deck ❑Porch ❑Re- Roofing ❑Re- Siding ❑Lower Level Finish ❑ Fireplace ❑Additihn ❑Alteration ['Utility Connection CODE: ❑I.R.C. ©LB.C. ❑ Misc: Type of Construction: I III IV 1 5 A B 1Z `� 4 -- Occupancy Group: A B E H I R U PROJECT COST /VALUE $ t Division: 1 2 3 5 (excluding land) I hereby certify that I have furnished information on this application which is to the best of my knowledge true and correct. I also certify that I am the owner or authorized agent for the above- mentioned property and that all construction will conform to all existing state and local laws and will proceed in accordance with submitted plans. I am aware that the building official can revoke this mit for . st cause. Furthermore, I hereby agree that the city official or a designee may enter upon the property to perform needed inspect ons. X � \ry Signature Contractor's License No. t o Permit Valuation - - 7 3 67 Park Support Fee # $ Permit Fee • $ /x dt5 — SAC # $ Plan Check Fee 4 $ Water Meter Size 5/8 "; 1 "; $ 4. State Surcharge $ Pressure Reducer $ Penalty $ Sewer /Water Connection Fee # $ Plumbing Permit Fee $ Water Tower Fee # $ Mechanical Permit Fee $ Builder's Deposit $ Sewer & Water Permit Fee $ Other $ Gas Fireplace Permit Fee $ TOTAL DUE $ 14 4 7 z . s This A : cation : co Bu Permit Whe Ap oved Paid / `-tLf 7. c) S --- Receipt No. `7O r," (p / / if _ f Date / • / ° J , / t--f BY - AP.iii /2- '7 3 Buil. ing • f icial Dat. This is to c. $'fy that th ' re.. st the above application and accompanyin doc ments is in accordance with the City Zoning Ordinance and may proceed as requested. This document when sa b the (i , ' y l f ne cons rotes a temporary Certificate of Zo g mpliance and allows construction to commence. Before occupancy, a Certificate of Occupancy must be issued./ j 1 At / l � ' i i ' r 1 (3 lanning Director Date Special Conditions, if any 24 hour notice for all inspections (952) 447 -9850, fax (952) 447 -4245 4646 Dakota Street S.E., Prior Lake, Minnesota 55372 it* • 1 IN „Jot 4. , A. 1 , 4 4 * . ! i r .... A 4 ' < 4 * 4.• . 0, i 6 6 11 • 6 .'111 i i ..ob 4 V. d. kJ. ' V 1 %0 44 1 *6 •CO 8 . 16 • • !ooP Date Rec'd CITY OF PRIOR LAKE PLUMBING PERMIT f _ q Q dej�'NEsc P " w//4-. 3/ 1. slice File PERMIT NO. /4 Z9 2. Gold City 3. Yellow Applicant (Please type or print and sign at bottom) ADDRESS ZONING (office use) CARIBOU COFFEE 16731 HIGHWAY 13 LEGAL DESCRIPTION (office use only) LOT BLOCK ADDITION PID 2 S. 410 (-)61 v (Name) R CARIBOU COFFEE (Phone) 763- 592 -2302 (Address) 3900 LAKEBREEZE AVENUE NORTH, BROOKLYN CENTER, MN 55429 APPLICANT (Name) Commercial Plumbing and Heating, Inc. (Phone) 651- 464 -2988 55025 (Address) 24428 Greenway Avenue Forest Lake (Address) (City) (Zip Code) (Contact Person) Anna Wicks (Phone) 651-464-2988 APPLICANT SIGNATURE DATE k 1 l 1 1 APPLICANT PLEASE COMPLETE BELOW Quantity Type of Fixture Quantity Type of Fixture Bath Tub with or without shower Rough -ins Dishwasher 1 Water Heater 2 Floor Drain Water Softener Lavatory (Bathroom Sink) Stand Pipe (Washing Machine) Laundry Tray (1 or 2 compartment sink Sewage Ejector Shower Stall Backflow Assembly 2 Sinks Backflow Assembly Test Bar Sink Lawn Sprinkler Water Closet (Toilet) Other FEE SCHEDULE Industrial, Commercial & Multi - family 1% of job cost with a $49.50 minimum Residential, New One & Two - Family $149.50 Residential, Additions & Alterations $49.50 The Minnesota Statutes § 326B.148 T ?st $ Building Permit # "SURCHARGE" has been changed for one year effective PLUMBING PERMIT FEE $ (c July 1, 2010, until June 30, 2011. STATE SURCHARGE $ . C,Z.) The minimum surcharge for a "fixed fee" permit TOTAL PERMIT FEE $ is, beginning July 1, 2010 This A lieca ion comes Your Building Permit en pproved Paid ��' ` �` Receip No. 105 1 ( % O ( Date B Building Officia Date 24 hour notice for all inspections (952) 447 -9850, fax (952) 447 -4245 4646 Dakota Street S.E., Prior Lake, Minnesota 55372 t CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd TEMPORARY CERTIFICATE OF ZONING COMPLIANCE x AND UTILITY CONNECTION PERMIT Z /4-- trl - -.._ SO�� I. white File PERMIT NO 4.7 2. Yellow City / 4.. 3 Yellow Applicant (Please type or print and sign at bottom) ADDRESS ZONING (office use) 1L213( \\ tis t3 .i 1--e__ 10 ( . LEGAL DESCRIPTION (office use only) LOT BLOCK ADDITION PID OWNER is (Name) __ Vbv.._ Ca _ (Phone) (Address) ` vra__ BUILDER (Company Name) rillIg:rjt.- equi mein. Rt>ry . (Phone) _ (Contact Name) e tiLA 4 1 4 r4... 4 ,3kd r"CMst (Phone) Co 5/ -• 23 me Q (Address) TYPE OF WORK ❑ New Construction ❑Deck ❑Porch ❑Re- Roofing ❑Re- Siding ❑Lower Level Finish ❑ Fireplace ❑Addition Alteration ❑Utility Connection ,q CODE: DI.R.C. ❑I.B.C. ❑ Misc. Ptsu ,40SI rid^ Type of Construction: I II III IV V A B PROJECT COST /VALUE $ Ztbn Occupancy Group: A B E F HI MR S U Division: 1 2 3 4 5 (excluding land) I hereby certify that I have furnished information on this application which is to the best of my knowledge true and correct. I also certify that I am the owner or authorized agent for the above - mentioned property and that all construction will conform to all existing state and local laws and will proceed in accordance with submitted plans. I am aware that the building official e this for just cause. Furthermore, I hereby agree that the city official or a designee may enter upon the property to perform needed inspections. `- q -e C..— CY1 S 1-2.1-04 4 Signature Contractor's License No. Date • Permit Valuation *DO „ Park Support Fee # $ Permit Fee $ /1 c SAC # $ Plan Check Fee - $ /--- 2.-C- .- Water Meter . Size 5/8 "; 1 "; $ State Surcharge $ S-i) Pressure Reducer $ Penalty $ Sewer /Water Connection Fee # $ Plumbing Permit Fee $ Water Tower Fee # $ Mechanical Permit Fee $ Builder's Deposit $ Sewer & Water Permit Fee $ Other $ Gas Fireplace Permit Fee $ TOTAL DUE $ 4- /. 75 This • plic tion : comes Yo Building Permit When Approved Paid 4 ( , � / Re ipt No. 70 7 ( ( 2 / Date (. Z(.{.I(-(' B / %h. /72 71 F 130ildiniOftic y a te This is to certify that the request in the above application and accompanying documents is in accordance with the City Zoning Ordinance and may proceed as requested. This document when signed by the City Planner constitutes a temporary Certificate of Zoning compliance and allows construction to commence. Before occupancy, a Certificate of Occupancy must be issued. p� I _ n f74(60 Vert € n t 4( Ce)c er�v Planning Director Date Special Conditions, if any 24 hour notice for all inspections (952) 447 -9850, fax (952) 447 -4245 16200 Eagle Creek Avenue Prior Lake, MN 55372 �` . o* YRig# # 6 121 White - Building ,��, Canary - Engineering Pink - Planning BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST NAME OF APPLICANT ' 4 dJ 1 . APPLICATION RECEIVED 12- • 3 - The Building, Engineering, and Planning Departments have reviewed the building permit application for construction activity which is proposed at: /6 » Al /3 z- ro.s p�) ,, Accepted ' Accepted With Corrections Denied / ir. _.. t t'7 t3 Reviewed By: Date: Comments: '� / C � 'L— G� / s ! "The issuance or granting of a permit or approval of plans, specifications and computations shall not be construed to be a permit for, or an approval of, any violation of any of the provisions of this code or of any other ordinance of the jurisdiction. Permits presuming to give authority to violate or cancel the provisions of this code or other ordinances of the jurisdiction shall not be valid." .- O PRI04 c7 � White - Building Canary - Engineering 4 'M 1 ES O ` t Pink - Planning BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST NAME OF APPLICANT / �v� 1 i 6262L 6 eWs7 M , APPLICATION RECEIVED 1 Z . 3 - 13 The Building, Engineering, and Planning Departments have reviewed the building permit application for construction activity which is proposed at: / 1 , Or-AVA-1 l3 (2 t7 Accepted ✓ Accepted With Corrections Denied Reviewed By: Date: / f 7 5 Comments: / . - LA-A/ 4 " cr` A5- = ,. t irr" / 11 ` 41 - 4 At. / If A /i ..� - : CO,, s Tc7rv&J /Vew R6 2.o- OPW7t//.../ c s "The issuance or granting of a permit or approval of plans, specifications and computations shall not be construed to be a permit for, or an approval of, any violation of any of the provisions of this code or of any other ordinance of the jurisdiction. Permits presuming to give authority to violate or cancel the provisions of this code or other ordinances of the jurisdiction shall not be valid." ii, LETTER OF TRANSMITTAL WILKUS December 2, 2013 ARCHITECTS, PA To: Dan Rogness City of Prior Lake 4646 Dakota Street SE Prior Lake, MN 55372 Project: Caribou Coffee — Lund's Via: UPS From: Jim Sultany MICHAEL J. WILKUS ARCHITECT 11487 Valley View Road Eden Prairie, MN 55344 QUANTITY DESCRIPTION 2 Signed and sealed drawings 1 Application for Plan Review COMMENTS Lund's will be remodeling the entire space and will be submitting for a AC Determination for the entire store. Once the General Contractor is selected, they Michael J. Wilkus will sign the application and provide the project valuation. A r c h i t e c t If you have any questions please contact me at (952) 941 -8660. . VA vprT ry 11487 Valley View Road cc: Minnesota Department of Health Z . o"'` 06 in oe 6.0 vlir) Department of Labor & Industry (Plumbing Review) Eden Prairie, A3innesola 55344 i s ph. 952. 941. 8660 fx 952.941 2755 443 Lafayette Road N. 1 N ESOTA DEPARTMENT OF (651) 284 -5005 St. Paul, Minnesota 55155 1 -800- DIAL -DLI w ww.dli.mn.gov L 1 ABOR at NDU TR TTY: (651) 297 -4198 Division of Construction Codes and Licensing REPORT ON PLANS Plans and specifications on plumbing: Caribou Coffee Company, 16731 Highway 13 S, Prior Lake, Scott County, Minnesota, Plan No. PLB 1312 -00039 OWNERSHIP: Caribou Coffee Co, 3900 Lakebreeze Avenue N, Brooklyn Center, MN 55429 SUBMITTER(S): Wilkus Architects Inc., 11487 Valley View Road, Eden Prairie, MN 55344 Plans Dated: December 2, 2013 Date Received: December 3, 2013 Date Reviewed: December 9, 2013 SCOPE: This review is limited to the design of this particular project only insofar as the provisions of the Minnesota Plumbing Code, as amended, apply, and does not cover the water supply or sewerage system to which this plumbing system is connected. The review is based upon the supposition that the data on which the design is based are correct, and that necessary legal authority has been obtained to construct the project. The responsibility for the design of structural features and the efficiency of equipment must be taken by the project designer. Approval is contingent upon satisfactory disposition of any requirements included in this report. Special care should be taken to insure that the material and installation of the plumbing system are in accordance with the provisions of the Minnesota Plumbing Code. A copy of the approved plans, specifications, and this Report on Plans must be retained at the project location for future reference. INSPECTIONS: All plumbing installations must be tested and inspected in accordance with the requirements of the Minnesota Plumbing Code. As specified in Minnesota Rules, part 4715.2830, no plumbing work may be covered prior to completing the required tests and inspections. Provisions must be made for applying an air test at the time of the roughing -in inspection as outlined in Minnesota Rules, part 4715.2820, subpart 2, of the code. A manometer test, as specified in Minnesota Rules, part 4715.2820, subpart 3, is required at the time of the finished plumbing inspection. It is the responsibility of the contractor /installer to notify the Minnesota Department of Labor and Industry when an installation for a state contract job, Minnesota Department of Health licensed healthcare facility, or project in an area where there is no local administrative authority is ready for an inspection and test. To schedule inspections, contact the state plumbing standards representative for your region. For your regional inspector's contact information, visit our website at http: / /www.dli .mn.gov /CCLD /CCLDContactus.asp REQUIREMENT(S): 1. All plumbing shall be installed in accordance with the Minnesota Plumbing Code (see Minnesota Rules, part 4715.0320). 2. The maximum permissible distance between a 3 -inch floor sink trap (P -7) and its vent is 6 feet (see Minnesota Rules, part 4715.2620, subpart 4). 3. Verify that the existing waste and vent pipes are sized to accommodate the added fixtures (see Minnesota Rules, part 4715.2310 and part 4715.2520). This information can be provided to you in alternative formats (Braille, large print or audio). An Equal Opportunity Employer Caribou Coffee Company Plumbing Plan No. PLB1312 -00039 Page 2 4. The specifications indicate the use of CPVC pipe for the water distribution system. Assume a limiting velocity of 5 feet per second for iron pipe size (IPS) CPVC and 8 feet per second for copper tube size (CTS) CPVC, verify that the existing water distribution pipes are sized to accommodate the added fixtures (see Minnesota Rules, part 4715.3800). 5. Verify a 3 -inch minimum vent stack, continuous in size from base to terminal, is provided for every sanitary building sewer (see Minnesota Rules, part 4715.2520, subpart 1). This stack should be the most remote from the location where the building drain leaves the building. 6. Reduced pressure zone backflow preventers are permitted when periodic testing is done by a trained backflow preventer tester acceptable to the administrative authority. Testing intervals shall not exceed one year, and records must be kept. All devices must be tested after initial installation and overhauled at least once every five years. New installations must be at least 12 inches, but not more than 6 feet, above the finished floor or ground level. 7. Water heaters, including their controls and valves, must be installed so that they are capable of being reached safely and quickly for inspection, repair, or replacement without requiring the use of tools or the removal of obstacles, panels, or similar obstructions (see Minnesota Rules, part 4715.2240). 8. Equipment used for heating water or storing hot water shall be protected by approved safety devices in accordance with Minnesota Rules, part 4715.2210 and part 4715.2230. 9. A full -way valve must be provided on the cold water supply line to the water heater (see Minnesota Rules, part 4715.1800). 10. Pot or scullery sinks must be provided with waste outlets not less than 2 inches in diameter (see Minnesota Rules, part 4715.1390, subpart 1). 11. A single 2 -inch trap and waste may serve the three- compartment sink if the trap is located not more than 30 inches from each compartment outlet (see Minnesota Rules, part 4715.0900). Locating the trap beneath the center compartment will meet this requirement in most instances. 12. The chemical/soap dispensing system must be provided with backflow prevention in accordance with ASSE 1055. Exception: an atmospheric vacuum breaker integrally mounted on a faucet that is connected to a chemical/soap dispenser must be protected against back pressure by the installation of a pressure bleeding device and a backflow preventer complying with ASSE 1052. The backflow preventer must be installed on the side outlet of the pressure bleeding device. A wye connector that has an integral shutoff may not be connected to a faucet that has an integral atmospheric vacuum breaker (see Minnesota Rules, part 4715.2165). 13. The reverse osmosis system must discharge into the drainage system through an air gap (see Minnesota Rules, part 471 5.1570). The receptor must be individually vented. 14. Water supply connections to fixtures or equipment which have inlets below the spill line must be provided with an air gap or approved backflow preventer (see Minnesota Rules, part 4715.2000). Caribou Coffee Company Plumbing Plan No. PLB 1312 -00039 Page 3 15. Indirect waste pipes from appliances, devices, or equipment not regularly classed as plumbing fixtures, but which are equipped with drainage outlets, must be trapped, but the traps need not be vented. The waste pipe must be at least 3/4 inches in size, but not less than the size of the outlet or tail piece of the equipment served (see Minnesota Rules, part 4715.1510). 16. It is recommended that a cleanout be provided where new waste and vent piping connects with existing plumbing to facilitate required testing of the new installation. 17. Materials used for water distribution piping must comply with the standards specified in Minnesota Rules, part 4715.0520. 18. Materials used for drain, waste, and vent systems must comply with the standards specified in Minnesota Rules, part 4715.0570 through part 4715.0600. 19. Solder and flux for potable water systems shall contain less than 0.2 percent lead. Solder other than 95 -5 tin antimony or 96 -4 tin silver must be approved by the administrative authority prior to use. Joints must include noncorrosive paste -type flux complying with ASTM B813 -00. 20. PVC solvent weld joints must include a primer of contrasting color to the pipe and cement (see Minnesota Rules, part 4715.0810, subpart 2). 21. Valves shall be installed permitting the water supply to each room or individual fixture to be shut off without disrupting any other portion of the building (see Minnesota Rules, part 4715.1800, subpart 6). NOTE(S): 1. The scope of this project consists of the remodeling of an existing building. Installation shall include an RO filter, a water heater, floor drains, a floor sink, a three - compartment sink, a counter sink, a hand sink, a dipper well, a dump sink, a mop sink, and potable water connections to beverage equipment. 2. This facility will be served by existing municipal sanitary sewer and municipal water service. 3. This plan review is for the plumbing systems only and does not pertain to the licensing requirements for the facility. Additional plans, information and fee may be required by the licensing authority for review. Changes to the plumbing system may be required as a result. Revised plumbing plans showing any significant changes to the plumbing system must be submitted to and approved by this office prior to installation. Authorization for construction in accordance with the approved plans may be withdrawn if construction is not undertaken within a period of two years. The fact that the plans have been approved does not necessarily mean that recommendations or requirements for change will not be made at some later time when changed conditions, additional information, or advanced knowledge make improvements necessary. Caribou Coffee Company Plumbing Plan No. PLB 1312 -00039 Page 4 Approved: Bob Johnson Public Health Engineer Plumbing Plan Review and Inspections Unit 651/284 -5183 cc: Wilkus Architects Inc. Caribou Coffee Co Dunham Associates Inc. City of Prior Lake Building Official MDH EHS Via E -Mail File Jan. 28, 2014 12:21PM No. 0062 P. 2,. gig ui =ter Aviv* 1 i . cv 9529412755 WIL_MS ARCHITEM rr+uc 01 / bs. 443 la►f4yetto Road N. MINNESO'T'A DEPARTMENT OF . (BS9) 284.5005 St. Paul, Minnesota 80988 9.800•DiAI.•D1,I www.dli.mn.gov . LABOR I tU�*'T TTY: 051)29741n Division of Construction Codes and Licensing E PORT QN_ PLANS Plans and apeoifiicatfons on plumbing: Caribou Coffee Company, 16731 klighway 13 5, Prior Lake, Scott County Mibme_aota„ Plan No. PLB1312 -Q0039 4 11- . 003 1 • '14:121a riD OWNERSI -fl : Caribou Coffee Co, 3900 Lakebreeze Avenue N, Brooklyn Center, MN 55429 C SUBMiTTER(S): WiUtu$ Architects Inc., 11487 Wiley View Roae1; Eden Prairie, MN 55344 Z Plans Dated: December 2, 2013 :.: uTL:e ;1 P.A. . Date Received: December 3;2013 Date Reviewed: December 9, 2013 . SCOPE: This raeview is limited to tbo design of this particular project only insofar as the proviefons dike Minnesota Piumblttg Code, as amended, apply, and does not cover the water supply or sewerage system to which this plumbing system is connected. The review is based upon the supposition that the data on which the design is based are correct, and that meanly legal authority has been obtained to eoustruct the project. The responsibility for the design of structural features and the efficiency of equipment rnu t be taken by the project designer: Approiral is contingent upon satisfactory disposition of any requirements included in this report. Special care should be taper to insure that the material and installation of the plumbing system are in accordance with the provisions of the lviiu iesata Plumbing Code. A copy of the approved plans, specifications, and this Report on Plans must be retained at the project location for Attar* reference. INSPECTIONS: Ail plumbing installations must be tested and inspected in accordance wig the requirements of the Minnesota Plumbing Code. As specified in Minnesota Rules, part 4715.2830, no plumbing work maybe covered prior to coMpledng the required tote end inspections. Provisions must be made for applylog an air test at thodale ado roughing- ln•inspectiou as outlined in 1Mannesotn Rules, part 4715.2820, subpart 2, ofthe code. A manometer b°.,st, as specified in Minnesota Rules, part 4715.2820, subpart 3, is required at the time ofthe finished plumbing impeotion, It is the responsibility ofthe contractor/Installer to ttotii+ the Minnesota Department of Labor and Industry -w ten - an - installatoon fox -trstate aontrant7ob; l innesota ntit o tti 1�"WAhcare . facility, or_pwject. n an. area where there is no loot' administrative autb.orrity is nerdy for an inspection and tom. To • •- • schedule inspections, contact the state plumbing standards representative for your region. For your regional inspector's contact information, visit our website at http://www.dli.mn.gov/CCLD/CCLcr-ontactus.asp REQ I ENT(S): 1. All plumbing shall be installed in accordance with the Minnesota Plumbing Code (gee Minnesota Ruieo, part 4115.0320). 2. The maximum permissible distance between a -3 -incb floor sink trap (P-7) and its vent is 6 feet (see . Minnesota Rules, part 4715,2620, subpart 4). • 3. Verify that the existing waste and vent pipes are sized to accommodate the added fixtures (see Minnesota Rules, part 4715.2310 and part 4715.2520), This information can be provided to you hi alteroethtire formats (BraNa.large pdnt or audio). An Equal Op ortuniry dnpioyer Jan. 28. 20141.12 : 22PM952 94 12755 WILKUS ARCHITECTS No. 0062 P. 3. 02 /ErPO • . r . ' 7 Caribou Ctdii'�ee Company Plumbing Pfen No. PU3131240039 Page 2 4. Tbo.specifications Indicate the use of C,,PVC pips for the water distribution system. Assume a limiting velocity of S feet per second for iron pipe size UPS) CPVC and 8 theft per second for copper tube size (CTS) CPVt.,, vet that the existing water distribution pipes are sired to accommodate the added'fixtures (see Minnesota Rules, part 4715.3800). 5. Verify a 3-inch minimum vent stack, continuous in size from base to terminal, is provided for every sanitary building sewer (sea Minnesota Rule, part 4715.2520, subpart 1). This stack should be the most remote from the location were the building din leaves the building, 6. Reduced pressure zone backflow prevent is are permitted when periodic testing Is done by a trained beckkf low preventer tester acceptable to the administrative authority. Testing intervals shall not exceed one year, oiud records must be kepi tall deyMcg . inufit be tested aRet.inhtial. installation arid -overt .Ie a least- -... • - once - Wei) , five years. New installations must be at least 12 inches, but not more than 6 fbet, above the finished floor or ground levet. 7. Water heaters, including their controls and valves, must be installed so that they are capable of being reached safely and quickly for inspection, repair, or replacement without requiring the use of tools or the removal of obstacles, panels, or similar obstructions (see Minnesota Rules, least 4715.2240). 8. Equipment used for heating water or storing hot water shall, be protected by approved safety devices itt accordance with Minnesota Rules, part 4715.2210 and part 4715.2230. 9. A ll way valve must be provided on the cord water supply line to the water heater (sea Minnesota Rules, part 4715.1800). • 10. Pot or scullery sinks must be provided with waste outlets not Tees than 2 Incites its dlat nete r (see Minnesota Rules, part 4715.1.390, subpart 1). 11. A sint,Ie 2-inch trap and waste may serve the three compartment sink if the trap is located not more than 30 inches from each compartment outlet (see Minnesota Rules, part 4715.0900). Locating the trap beneath the center compartment will meets requirement in most instances. 1 e-chemieslfsasp- dispensing-syste n- must- be-ptevided- with- backftaw -preyentiorritraccordanoe:with ASSE 1445,--Rxeeptient•ett-atmespherivmenumbreaker Attegraily mounted on &faucet that is conne ted.tc a chemical/soap dispenser must be protected against back pressure by the installation of a pressure bleeding device and a backflow preventer complying with ASSE 1052. The backflow reventermust be installed on tbo side outlet of the pressure bleeding device, A wye connector that has an integral shutoff may not be connected to a faucet that has an integral atmospheric vacuum breaker (see Minnesota Ratios, part 471S.216S). • 13. Tits reverse osmosis system most di charge into the drainage system through an air gap (see Minnesota Rules, part 4715.1570). The receptor must be individually vented. 14. Wafer supply connections to fixtures or equipment which have inlets below die spilt line must be provided with an air gap or approved beokfltow preventer (see Minnesota Rules, part 4715.2000). Jan. 28. 20141.12 :22PM 9529412759 WYiKu At2 iYr cTS No. 0062 P. 4_ 02fiprD • -, Caribou Coffee Company Plumbing Plan No K8131240039 Page 3 15. Indirect waste pipes from appliances, devices, or equipment not regularly classed as plumbing fixtures, but which are equipped with drainage 4utiet; must h trapped, but the traps need not be vented. The waste pipe must by at yeast 3/4 inches in size, but not less than the size of the outlet or tailpiece of the equipment served (see Minnesota Rules, part 4715.1510). 16. ft is recommended that a cleanout be provided where new waste and vent piping connects with existing plumbing to faollitate required testing of the new installation. 17. Materials used for water distribution piping must comply with the standards specified in Minnesota Rules, part 4 715,0520. 18. Materials used for drain, waste, and vent systems moist comply with the standards specified in Ivlinneeota Rules, part 4715.0570 through part 471'5.0600. 19. Solder and flux for potable water systems shall contain less than 0,2 percent load. Solder other than 95 -5 tin antinio:ny or 96-4 tiff silver must be approved by the administrative authority prior to use. roaittA must include noncorrosive paste -type flux complying with .ASTM. B813 - 00. 20. PVC solvent weld joints must include a primer gf'contrasting color to the pipe and cement (sec Minnesota Rules, pert 4715,0810, subpart 2). 21. Valves shall be Installed permitting tho water suppl to each room or individual fixtare to be shut off without disrupting any other portion of the building (see lvtinnesota Rules, part 471 5. ] 800, subpart 6). NOTE(S): 1. The scope of this project consists of the remodeling ©fan existing building. Installation stall include an RO filter, a. water heater, fQQt drains, a floor sank, a three-compartment sink, a counter sink, a hand sink, a dipper well, a clump sink, a mop sink, and potable water connections to beverage equipment. 2. This facility will h served by existing municipal sanitary sewer and municipal water service. 3. This plan review is for the plumbing systems only and does not pertain to the licensing requirements for the thcility. Addittcnal plans, -u format1en- and -Peer may be•requtted bytire l censing antlRr ty for review. Changes to the plumbing system may be required as a ,esult, Revised plumbing plans showing any significant changes to the plumbing system must be submitted to and approved by this office prior to installation. Authorization for construction in accordance with the approved plans maybe withdrawn if construction is not undertaken within a period of two years- The fact that the plans have been approved does not necessarily mean that recommendations or requirements tar change will not be trade at Some later tunic when changed conditions, additional information, or advanced knowledge make improvements necessary_ Jan. 28. 2014112:22PM 5529412755 Caribou Coffee Company WILKUS ARCHITECTS No. 0062 P. 5E Elibp.AU . .. .-...,,,..-.- _ PIUM WO Plan No. FL131312-00039 Pogo 4 App 'roved; ir / . Bob ohnson Public Health Engineer . . ?bombing Plan Review and Inspections Unit 651/284.5133 . eo: Wilkus Arehiteetsine.. . Caribou Coffee Co Dunham Msociates Inc. . . .. ...,,.,, .. . . •. 4 ., 01 . _City ofPrforTsake thril - ' - . . • MDH IEPIS Via B-Mail ' Filo . . • . .. ..— , . . . .. . •,... . . . ....,. ., _ „ . . . . • 1 Twi ' • . ---- • • • . • ••'& ' ' ' ' - •--7- • • ' . hol ' . ' ta S'i t Y02705 119: tithorato • IN • . n CRY Waterainic Laboratory Test Report -! . : .* : • innes --°• T • • • • Wisconsln-State:Laboratov :ON 10 ' • Client; • Commercial Plumbing Report Number: 14-02532 Twin City Water Clinic Inc. sample collection Date: oz/13/14 617 13th Avenue South Address: 24428 Greenway Ave Sample Collection Time: 1300 Hopkins, MN 55343 Forest Lake,MN 55025 Sample Receipt Date: 02/14/14 Phone: (952)935-3556 Report Issue Date: 02/17/14 Fax: (952)935-5077 • Laboratory i : Abalyto : Client ID Parameter • • • : Sample Pie!): ' Sample Analysii ' : • • Test . ; . • .. . S ample ID ' : " " :.• ''' ' ' '' ' ..- ' ' . ' ' ' : pito • ..: lime. , . 'Date ' ' Tiiiie... ' ; ReitiiiS'•' Units' ----: • . : 14-01532 Conform Drinking Water, 02/14/14 11153 Absent _ Nitrate Drinking Water m g/I Arsenic Drinking Water PM — Lead Drinking Water WI Drinking Water , Drinking Water k Drining Water ' • ' • . X NosamPles were 5ulico4railed;pr the above t6st result(a) • Weil 1415 'kith"?' designation ivere producidby,a itibcontracted .. Sample pt: Caribou Coffee la boraiy..., ; " ' . ' " . ' : ' ' ' [La bOratori name' . : - • . • - " Well Adr: 16731 Hwy 13 Prior Lake,MN . addre4; iv0ti ilablDii]. • • • ! . 'The sUbContracted ' j faimra tory maintains MDH Cel tWo fielci(i) of testing Owner: performed. : ' ; • : : . i ; • : ' : : • • : Owner Adr: Sample Conditions: Sample Temperature: 18°C Discussion: Note: : • . • • .. Approved methods used In arialy*iithesamples :: • . ' . . . listed above have the fallowing reporting levels: : ' • Maximum Contaminanelevels: • . ; : : . .. . • : . : , . . .. . • • .. SK4922211:-.CalliorM, 1 cfullOOrn1:- : • : ; • . • : • c 5 1 ml . . ; . : • ' ' ! ! . : : . • • • Nitrogen 10.0 mg/I . .. • • . 51\44500D - : 1 91trate . 19itrolgen,iDrngt I • • • • - . : Arsenic 10.0 ug / I . .. . .. - .• . Sio31.1.30 Arsen10.01.t Lg./ I ' : . . 1: ' ' • • . . .. . . . Lead, 15.0 pg/ I , • . . .. .. . • - ' ' : SM33113e - Leas:10'm / i . • ' . • • . • • • . .. . .. . . . ' • • • . • • • . _ • . .. /1 62, Sample Collected by: X Client TCWC Approved By: 011l Van Arsdale Alan Senechal Laboratory Manager Senior Analyst , .... . . , . . .. The results llstad:in:thli•repdit'apply•only to the above listed sarnPlis. All Milne quality as;suranCa. procedures were followed, tunless otherwise noted. Thii,analyticul report Must be reported in it Ontirety. Alt mathOdS: are *tined by thii of Health, .unle*ss otherwise noted.. TCIND Rev 1.2 Page 1 of 3 MINNESOTA MDH DEPARTMENT oFHEALTH Protecting, maintaining and improving the health of all Minnesotans January 22, 2014 Caribou Coffee Company 3900 Lake Breeze Ave N Brooklyn Center, Minnesota 55429 Dear Ladies and Gentlemen: Subject: Caribou Coffee, 16731 Highway 13, Suite 101, Prior Lake, Scott County, Minnesota, Project No. 140323 Thank you for submitting your plans for remodel to the Minnesota Department of Health (MDH). We are enclosing a copy of our report covering the review of information submitted for the above - designated project. This review does not constitute approval of your project. This report indicates specific items to be corrected prior to approval and inspection of your project. Please pay close attention to the bolded items as these indicate corrections to be made. Failure to implement these corrections may result in nonapproval of your project and delays in opening or operating. Please contact me at least two weeks prior to completion of your project to arrange for a preoperational inspection and approval of your project. If additional fees are needed or this is a new licensee, a license application has been included. Please fill out the application and return along with fees prior to making an appointment for an inspection. A preoperational inspection cannot be conducted until a license application is submitted with the appropriate fees to MDH. Please submit application and fees to: Minnesota Department of Health Environmental Health Services Section 625 Robert Street North, P.O. Box 64495 St. Paul, Minnesota 55164 -0495 If you have any questions, please contact me at 507- 344 -2724 or at matthew.finkenbiner @state.mn.us. Sincerely, d tg vt " Matt Finkenbiner, R.S. Environmental Health, FPLS Plan Review Mankato District Office 12 Civic Center Plaza, Suite 2105 Mankato, Minnesota 56001 -3752 MRF:smp Enclosures CC: Hunter Berg Construction Marijke Schwarz Smith, Minnesota Department of Health Dan Disrud, Minnesota Department of Health Mr. Marty Schmitz, Zoning Administrator Mr. Robert Hutchins, Building Official Mr. Al Frechette, Env. Hlth. & Bldg. Insp. Mngr., Building Official General Information: 651- 201 -5000 • Toll-free: 888-345-0823 • TTY: 651-201-5797 • www.health.state.mn.us An equal opportunity employer MINNESOTA DEPARTMENT OF HEALTH Division of Environmental Health REPORT ON PLANS Plans and specifications on New Food: Caribou Coffee, Project No. 140323 Location: 16731 Highway 13, Suite 101, Prior Lake, MN 55372, Scott County Date Approved: January 22, 2014 Date Received: December 3, 2013 Submitted by: Caribou Coffee Company, 3900 Lake Breeze Ave N, Brooklyn Center, MN 55429, (763) 592 -2402 Hunter Berg Construction, 11102 86th Ave N, Maple Grove, MN 55369, (763) 463 -5040 Ownership: No owner found Scope of Project: Construction of a new coffee kiosk within an existing Lund's grocery store. Lund's Bakery will provide baked goods for sale at the coffee kiosk. No food is permitted in the establishment until approval frorn the Health Authority is given. Approved Finish Schedule Finish Area Walls: Ceiling: Floor & Basecove: Service: Stainless steel Semi -gloss painted Quarry tile with sheetrock integral quarry tile basecove Dry storage: Semi -gloss painted Smooth vinyl tile Quarry tile with sheetrock/FRP at integral quarry tile mop sink basecove Construction Specifics: Pay particular attention to the bolded items You are responsible for all aspects of the Minnesota Food Code. This code is available at http: / /www.health. state. mn. us /divs /eh/food/code /index.html. 1. Equipment Standards — General Requirements: Food and beverage equipment shall meet the applicable standards for one of the following: • National Sanitation Foundation (NSF). • Edison Testing Laboratories (ETL) to NSF Standards. • Underwriters Laboratory (UL) to NSF standards. • Canadian Standards Association (CSA) to NSF Standards. Equipment shall bear the NSF or equivalent sticker and manufacturer information. Specification information from manufacturer for the following item(s) or equipment was not supplied for review. The Sanitarian/Plan Reviewer doing the opening inspection will follow up to ensure that equipment meets applicable standards. Caribou Coffee New Food 140323 Page 2 Not Approved • Three compartment sink • Stainless steel back service counter with integral dumpsink Wood is prohibited within a foodservice area. Wood doors or frames, wood shelving, wood cabinets and wood windows are not allowed. All custom fabricated equipment shall meet NSF International or equivalent standards and bear a sticker indicating the equipment meets the standard. Custom Equipment Manufacturer Stainless steel equipment Mocorp Inc 2. Food Service Equipment: Table - mounted equipment that is not easily movable shall be sealed to the table or elevated on four (4) inch NSF legs. All floor mounted equipment shall be elevated on six (6) inch NSF legs or casters. Provide approved equipment for the dispensing of single service items. 3. Food contact surfaces: Primary food contact surfaces (tables and counters) shall be of stainless steel construction in compliance with NSF Standard No. 2 or equivalent. Plastic laminate surfaces are not acceptable for food contact and food preparation surfaces. 4. Cabinetry: Cabinetry located within a foodservice area: Service area. All service cabinets shall be protected with plastic laminate or equivalent to Standard No. 35 covering all exposed surfaces. The cabinets installed on this project will be constructed of: Plastic laminate. The approved countertop finish on the cabinetry is: Plastic laminate, stainless steel and solid surface. Enclosed hollow base cabinets are not allowed. Cabinets shall be on a solid raised masonry base (four inch) or six (6) inch NSF legs or heavy duty castors. The cabinets will be installed on 6 inch stainless steel legs. Laminate shall not be used on surfaces subject to intentional, expected or reasonable direct food contact. Non -food contact surfaces of equipment that are exposed to splash, spillage or frequent cleaning shall be constructed of a corrosion- resistant, nonabsorbent and smooth material. Caribou Coffee New Food 140323 Page 3 Not Approved Exposed wood surfaces on cabinets and under counter tops shall be covered to provide a smooth and easily cleanable surface. Cutouts in millwork shall be made and sealed by the fabricator. Exposed wood is not permitted in cut out areas. 5. Refrigeration: Enough equipment for cooling and cold holding shall be provided. Equipment should be sufficient in number and capacity to meet the needs of the establishment. 6. Three - Compartment Sink: A three - compartment sink with dual integral drain boards will be provided. Sink bowls shall be adequately sized for the largest utensil to be washed in the three- compartment sink. Approved racks, shelves or dish tables for storing soiled equipment and utensils; and air drying clean equipment and utensils have been provided. Soap and chemical dispensers attached to the faucet of a three - compartment sink must be installed according to Minnesota Plumbing Code Chapter 4715 and have appropriate backflow prevention. 7. Hand Sink: NSF International or equivalent hand sink will be provided in the following areas: Back service counter Install a right splashguard at the hand sink. • Adjacent dump sink provided with left and right splashguards. Each handwashing sink shall be provided with hot and cold water through a mixing valve or combination faucet. Self- closing or metering faucet shall be designed to provide a flow of water for at least 15 seconds without the need to reactivate the faucet. 8. Dump Sink: A dump sink has been provided at the back service counter. Dump sinks are used when operation produce excess beverage waste that needs to be dumped. Operations such as, bars with mixed drinks, ice, blender drinks, coffee drinks, smoothies or espresso areas may require a dump sink. Caribou Coffee New Food 140323 Page 4 Not Approved A three compartment sink, food preparation sink or handwashing sink must not be used as a dump sink. 9. Storage Area: Location: Approved racks, dry storage room. Provide an adequate amount of storage space for supplies necessary for the operation. Approved (NSF or equivalent) shelving will be provided to maintain food items, single- service items and equipment six (6) inches above the floor surfaces. Designate an appropriate chemical storage space separate from food products, single- service items and food equipment. 10. Walls: • Kiosk food shields shall be a minimum of 60" tall. Plan will be modified to meet this requirement per email dated 1/9/14. 11. Floors: Floors in kitchens, bars, other rooms where food is stored, prepared or washed, employee dressing or locker rooms, toilet rooms and janitorial rooms shall be smooth, non - absorbent, durable and easily cleanable. Epoxy or polyurethane base grout shall be utilized. Where a wall meets the floor it must be properly coved within any foodservice area. A four inch integral base cove shall be installed at all floor /wall junctions. CORRECT METHOD r ' INCORRECT METHOD I r rr ill .. ..- . ..„ .a - • L.. issommumi _:_, valavina A Non -slip tile may not be located underneath equipment. Caribou Coffee New Food 140323 Page 5 Not Approved 12. Janitorial Area: Janitorial areas shall have FRP, ceramic tile or equivalent, stainless steel or cleanable block walls in the splash area. Provide vacuum breakers at all threaded hose bibs. No wye adapters. Chemical or detergent dispensers shall provide appropriate backflow prevention devices. 13. Plumbing: All plumbing plans shall be approved by the Minnesota Department of Labor and Industry (DOLI) or delegated agent. For information on submittal contact Department of Labor and Industry at 651- 284 -5067 or visit their website at http: / /www.dli.mn.gov /CCLD /Plumbing.asp. A plumbing plan approval letter has not been received at this time. Provide at opening inspection evidence that the plumbing system has been inspected and approval given by the local building official or a representative from the Department of Labor and Industry (DOLI). A separate on -site inspection will be conducted by the Minnesota Department of Labor and Industry plumbing inspector or delegated agent to determine compliance with the Minnesota Plumbing Code. All plumbing equipment shall be installed in accordance with the Minnesota Plumbing Code for a commercial establishment. All pipe chases that pass through walls shall be tightly sealed and covered. All utility pipes shall be enclosed in walls or ceiling. Utility lines must not be placed on the floor and must be installed at least 6" off the floor. Wye adapters are not permitted. Indirect waste pipes shall not discharge into hand sinks, prep sinks or three - compartment sinks. Telltale drains are required for food service sinks (3 compartment, food preparation and dump sinks) or as required during the plumbing plan review. All hot water generating equipment (water heaters) shall be of adequate capacity to meet the needs of the anticipated demand of the establishment. 14. Lighting: Food preparation areas in which food or beverages are prepared, utensils are washed shall provide a minimum of 50 foot - candles of shielded light measured 30 inches above the floor. Food and utensil storage rooms, toilets, locker rooms, dressing rooms shall be provided with at least 30 foot candles of shielded light measured at 30 inches above the floor. Caribou Coffee New Food 140323 Page 6 Not Approved 15. Employee Lockers, Restrooms and Break areas: Lockers or other suitable facilities shall be provided for the orderly storage of employee's clothing and other possessions. 16. Other Code Requirements: For information on the Minnesota Clean Indoor Air Act (MCIAA) contact 651- 201 -4601 or visit their website at http: / /www.health.state.mn.us /divs /eh/air. Contact MN Electrical Licensing & Inspection at 651- 284 -5026 or visit their website at http: / /www.dli.mn.gov /CCLD /Electrical.asp for information on electrical requirements and the name of the electrical inspector in your area. Sincerely, Matt Finkenbiner, R.S. Environmental Health, FPLS Plan Review Mankato District Office 12 Civic Center Plaza, Suite 2105 Mankato, Minnesota 56001 -3752 PRIOR LAKE DEPARTMENT OF BUILDING AND INSPECTION INSPECTION RECORD SITE ADDRESS NATURE OF WORK G%� USE OF BUILDING PERMIT NO. — DAT ISSUED A 4- CONTRACTOR •— - =�'_' ! --- �.•,�.�.,� HONE ; y � INSTALL EROSIO CONRTOL AND MAINTAIN CLEAN STREETS AT ALL TIMES INSPECTOR DATE N (Prior To Backfill) DER PLACE NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED ROUGH - INS FRAMING i tv /14 INSULATION ELECTRICAL PLUMBING )1 'TO '$= 1ZU Ni 1 Zt ( 4 _F GAS LINE AIR TEST ittweeNR&TARDER F�2 ` �2Es�/ ( i Ire 14 COVER NO WORK UNTIL THE ABOVE HAS BEEN SI D flifklaSEWA9W AWE 1 1 FINALS IOR TO SODDING) BUILDING ' ELECTRICAL PLUMBING DO NOT OCCUPY UNTIL ABOVE HAS BEEN SIGNED NOTICE This card must be posted near an electrical service cabinet prior to rough -in inspections and maintained until all inspections have been approved. On buildings and additions where no service cabinet is available, card shall be placed near main entrance. FOR ALL INSPECTIONS (952) 447 -9850