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Minnesota Department of Labor and Industry <br />Construction Codes and Licensing Division <br />Plumbing Plan Review <br />443 Lafayette Road North St. Paul, MN 55155 <br />Phone: (651) 284-5063 <br />www.dli.mn.gov <br />DEPARTMENT OF <br />LABOR AND INDUSTRY <br />Plumbing Plan Review Agreement Application <br />Under Minnesota Statutes, section 326B.43, subd. 2, the commissioner of the Department of Labor and Industry (DLI) may enter into an <br />agreement with a municipality, in which the municipality agrees to perform plan review and specifications of plumbing systems in their <br />jurisdiction subject to statutory requirements. Certain types of plans must still be submitted to DLI. <br />To request a formal plumbing plan review agreement, this application and all requested documents must be completed and submitted to: <br />Judv.Tachenv(&state.mn.us. Incomplete application will be rejected. <br />1. MUNICIPALITY INFORMATION <br />MUNICIPALITY NAME <br />DATE <br />City of Mounds View <br />09-11-2023 <br />ADDRESS <br />EMAIL <br />2401 Mounds View Boulevard <br />brian.beeman@moundsviewmn.org <br />CITY <br />STATE <br />IP CODE <br />PHONE <br />Mounds View <br />MN <br />�55112 <br />763-717-4024 <br />BUILDING OFFICIAL NAME <br />Nick Henly <br />MAILING ADDRESS PHONE <br />2401 Mounds View Boulevard 763-717-4024 <br />CITY STATE ZIP CODE E-MAIL <br />Mounds View �MN 55112 nick.henly@moundsviewmn.org <br />APPROVED PLUMBING PLAN REVIEWER(S). If reviewer is contracted through a private company, check here Mand submit contract for review. <br />NAME LICENSE # E-MAIL/PHONE <br />Joseph Gohman PM067457 joe@rumrivercc.com/763-331-7722 <br />NAME LICENSE # E-MAIL/PHONE <br />1 2. REQUIRED DOCUMENTS THAT MUST BE ADOPTED BY ORDINANCES <br />Submit copies of following relevant ordinances: <br />1. The ordinance in which the municipality adopts the Minnesota Plumbing Code. <br />(Adoption of the Minnesota State Building Code by ordinance includes adoption of the Minnesota Plumbing Code, Chapter 4714.) <br />2. The ordinance that requires plumbing plans and specifications to be submitted, reviewed, and approved by the municipality. The ordinance must <br />clearly state exceptions for projects listed in Minnesota Statutes, section 32613.43 subd. 2(n) as listed below as those must be submitted to DLI for <br />plan review. Plumbing plans and specifications for the following projects shall be submitted to DLI for plan review. <br />a) State -licensed facilities (as defined in section 32613.103, subd. 13). <br />b) Public buildings (as defined in section 32613.103, subd. 11). <br />c) Projects of a special nature for which department review is requested by either the municipality or the state. <br />3. The ordinance that authorizes the municipality to perform plumbing inspections required by the Minnesota Plumbing Code. (Plumbing inspections, <br />testing, and permits are subject to Minn. Rules, part 1300.0215, subparts I through 5.) <br />4. The ordinance that authorizes the municipality to administer and enforce the Minnesota Plumbing Code in accordance with Minnesota Statutes, <br />section 32613.121. (Enforcing the Minnesota State Building Code by ordinance automatically includes and requires enforcement of the Minnesota <br />Plumbing Code) <br />of the above required ordinances must be submitted with this application to be considered. <br />Page 112 <br />