New Construction Plan Review Application
FOR FOOD, BEVERAGE, AND LODGING ESTABLISHMENTS
Establishment information
Establishment name ____________________________________________________________________
Establishment address __________________________________________________________________
Street City State ZIP
County _________________________________ Business Phone _______________________________
Mark all that apply
Private water Municipal water If private water, unique well # _________________
Private sewer Municipal sewer
Proposed date for start of construction _______ Proposed date for completion of construction ______
Submitter information
Submitter/co. _________________________________________________________________________
First name ______________________________ Last name ____________________________________
Mailing address _______________________________________________________________________
Street City State ZIP
Contact phone ________________ Cell phone _______________ Email _________________________
Owner information (if different from submitter)
Owner/co. ___________________________________________________________________________
First name ______________________________ Last name ____________________________________
Mailing address _______________________________________________________________________
Street City State ZIP
Contact phone ________________ Cell phone _______________ Email _________________________
Contractor/Architect/Engineer information (if different from submitter/owner)
Company name _______________________________________________________________________
First name ______________________________ Last name ____________________________________
Mailing address _______________________________________________________________________
Street City State ZIP
Contact phone ________________ Cell phone _______________ Email _________________________
Public pool or spa only
Is there a swimming pool or spa pool operated for public use on the premises? Yes No
NEW CONSTRUCTION PLAN REVIEW APPLICATION
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Food, beverage and lodging establishment definitions
Category 1 establishment provides one or more of the following:
Pre-packaged food that is served in the package; continental breakfast such as rolls, coffee, juice, milk and cold
cereal; serves beverages; cleans eating, drinking or cooking utensils or is a child care facility licensed under MN
Statutes, 245A.03; a food establishment where the method of food preparation is low-risk as defined by MN
Statutes, 157.20 subd. 2(c).
Category 2 establishment is not a category 1 establishment and is either a food establishment where the method
of food preparation is medium risk as defined by MN Statutes, 157.20 subd. 2 (b); an elementary school or
secondary school as defined in MN Statutes, 120A.05.
Category 3 establishment is not a category 1 or 2 establishment and is either a food establishment where the
method of food preparation is high risk as defined by MN Statutes, 157.20 subd. 2 (a); an establishment where
500 or more meals are prepared each day and served at one or more locations.
Additional food service - a location at a food establishment, other than the primary food preparation and service
area, used to prepare or serve beverages from a bar or prepare food to the public.
HACCP - an annual fee category for a business that performs one or more specialized process that requires an
HACCP plan as required in chapter 31 and MN Rules, chapter 4626.
Individual water - a private water supply other than a community public water supply.
Individual sewer - a private sewage treatment system, which uses subsurface treatment and disposal.
Lodging per unit - the number of guest rooms, cottages, or other rental units of a hotel, motel, lodging
establishment, or resort, or the number of beds in a dormitory.
Plan review fee schedule
The plan review fee is a separate fee from the license fee. After your plan review application has been
reviewed and approved, you will receive a food license application from the Sanitarian noted in your
approval report.
Food and beverage service (food service/restaurant, daycare, school, catering)
Category 1 establishment $400 $ ________
Category 2 establishment $450 $ ________
Category 3 establishment $500 $ ________
Additional food service No. X $250 $ ________
Additional food service (bar) No. X $250 $ ________
HACCP plan review $500 $ ________
Lodging facilities (hotel, motel, board & lodge, youth camp)
Lodging: < 25 rooms $375 $ ________
Lodging: 25 to 99 rooms $400 $ ________
Lodging: 100 or > rooms $500 $ ________
Youth Camp only - No fee
Resorts
Cabins: < 5 $350 $ ________
Cabins: 5 to 9 $400 $ ________
Cabins: 10 or > $450 $ ________
Total plan review fee submitted $ __________
This must be completed in order to review your plan
NEW CONSTRUCTION PLAN REVIEW APPLICATION
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Finish material schedule
Attach additional sheets if needed
Finish material schedule
Room number
Finish area
Walls
Ceilings
Floor/basecove
Example "room 1" Kitchen
FRP/stainless behind
cooking equipment
Smooth vinyl tiles
Quarry tile/quarry tile
cove base
*Mop sink area
*Mop sink areas must have compliant finishes. (enter mop sink information)
What will the wall finish be behind the cooking equipment?
Insulated stainless steel panel Ceramic tile
Floor and base finish of the walk in refrigeration/freezer: (if installing)
Walk in cooler(s) Floor _________________________ Base __________________________
Walk in freezer(s) Floor _________________________ Base __________________________
Walk in keg cooler(s) Floor _________________________ Base __________________________
Commercial water heater model and size (gal): Model _________________________ Size _____________
(Location of water heater must be on the layout)
This must be completed in order to review your plan
NEW CONSTRUCTION PLAN REVIEW APPLICATION
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Equipment schedule
Attach additional sheets if needed
New equipment* - Submit manufacturer specifications sheet for each piece of new equipment.
Used equipment - List used equipment below. Photographs of used equipment suggested.
Equipment schedule
Item number (from
plan)
Qty Note if *new or used Equipment Manufacturer Model
Example "room 1" 1 used Hand-washing sink Company name xx-x
Used or existing equipment will be field approved prior to installation by MDH.
Enter brief description of project
NEW CONSTRUCTION PLAN REVIEW APPLICATION
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Documents required for applying
All 5 pages of this application
Payment for all plan review fees made payable to Minnesota Department of Health
Easily readable layout to scale including:
▪ location of equipment
▪ hand sinks
▪ ware-washing equipment
▪ storage areas
▪ wait stations
▪ bars
▪ janitor areas
Finish and equipment schedule
Intended menu
Manufacturer specifications sheet for each piece of new equipment
Set of elevations and drawings for all custom fabricated equipment
Cabinetry and counter top information
Sleeping room dimensions for lodging establishments
Variance Request
You may apply for a variance (exception) from some parts of Minnesota Rule 4626.
For help filling out this application contact your District Office
Bemidji 218-308-2100
Duluth 218-302-6166
Fergus Falls 218-332-5150
Mankato 507-344-2700
Metro 651-201-4500
Rochester 507-206-2700
St. Cloud 320-223-7300
Submit application/fee to
Make checks payable to Minnesota Department of Health
Notice: The issuance of a dishonored check to this department will require a service charge of $30 per check
pursuant to Minnesota Statutes, Section 604.113, subd. 2.(a). Additional civil penalties may be imposed for
nonpayment.
Minnesota Department of Health
Food, Pools, and Lodging Services Section
PO Box 64975 - Plan Review
St. Paul, Minnesota 55164-0495
health.foodlodging@state.mn.us
651-201-4500
www.health.state.mn.us
09/28/2021
To obtain this information in a different format, call: 651-201-4500. Printed on recycled paper.
