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HomeMy WebLinkAboutBLD2014-00423I OLDING PERMIT APPLICATIM BLD14-00423 Review Type: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT#: BLD14-00423 Received Date: 11/17/2014 SITE ADDRESS: 1219 CENTER RD CHIMACUM, 98325 OWNER: SPRINT/SAMSUNG C/O ANDI SPENCER PHONE: 425-202-0496 8432 154TH AVE. BUILDING C REMOND WA 98052 SUBDIVISION: Block: Lot: T 4+ PARCEL NUMBER: 901231004 Section: 23 Township: 29 N Range: 1■1 CONTRACTOR: TBD PHONE: 253-584-6606 REPRESENTATIVE: PHONE: PROJECT DESCRIPTION CELL TOWER MODIFICATION INSTALL 3 ANTENNAS, 3 RRH'S AND 6 JUNCTION CYLINDERS TO EXISTING TOWER TYPE OF WORK COM SQUARE FOOTAGE: COMMERCIAL: TYPE OF IMP ADD MAIN: INDUSTRIAL: VALUATION 20,000.00 ADD'L: HEAT TYPE: CODE EDITION: 2012 HEAT BASE: HEAT TYPE: OCCUPANCY: UNHEATED: #OF STORIES: OCCUPANCY: OTHER: CONST TYPE: GARAGE: SHORELINE: CONST TYPE: DECK: SETBACK: BANK HEIGHT: SEWAGE DISPOSAL: NUMBER OF EMPLOYEES: WATER SYSTEM: BATHROOMS: Exist: Prop: Total: outing Date: Type Amount Paid By: Date: Receipt: Approved/Date Permit $267.00 SRE 11/17/14 151740 Plan Check $173.55 SRE 11/17/14 151740 APPROVED State Building Code $4.50 SRE 11/17/14 151740 Total: $445.05 DEC 1 ? 2014 Jefferson County DCD \\tidemark\data\forms\F_BLD_App_Bid.rpt 11/17/2014 0 a ono" , g m $ PN i g� � std r vepo go r x '"> e>g z 0 moo F,E fol 2; you say I 1 E, a� I mAZ ,8° 1. ____CENTER ROAD I I— o - --__ -=1------------- w° / J o � — I I I EjEi I I I a ov o /— TAX L0T N0.901233004 I \ m Iz m m m 1 m m_ m >A I % 0 x_=_ _ — r' ap O•t ox F� it of p m _ u ———————————————+ m \v\F n P /ID ;; ,' I NN 1 m I ' I § b -' FROM TOWER C.L. ._ TO PROPERTY _ U / . 'it. ow 5D E.E 2 EA ii IJ I ' C I,_ v ..-.--= L. 1/1111 VI m ° m A - H= -0 2,.., � m m � J m N v e 4 m`1)c ~ m 3 m �a I \ 1 U_, , m m .2 ~ I `L MUTI • . Page 1 of 2 Washington State Department of Labor & Industries MUTI Owner or tradesperson 2626 MIDWEST COURT PETERS, DARRIN M CHAMPAIGN, IL 61822 217-819-3040 Principals PETERS, DARRIN M, PRESIDENT Doing business as MUTI WA UBI No. Business type 603 281 849 Corporation License Verify the contractor's active registration/license/certification (depending on trade)and any past violations. Construction Contractor Active. Meets current requirements. License specialties GENERAL License no. MUTI***869MT Effective—expiration 08/29/2014—08/29/2016 Bond Great American Ins Co $12,000.00 Bond account no. 3835277 Received by L&I Effective date 08/04/2014 07/16/2014 Expiration date Until Canceled Insurance Allied Property&Cas Ins Co $1,000,000.00 Policy no. ACP5906326427 Received by L&I Effective date 08/13/2014 02/01/2014 Expiration date 02/01/2015 Savings No savings accounts during the previous 6 year period. Lawsuits against the bond or savings https://secure.lni.wa.gov/verify/Detail.aspx?UBI=603281849&LIC=MUTI***869MT&SAW= 12/12/2014 MUTI Page 2 of 2 No lawsuits against the bond or save accounts during the previous 6 year pelt L&1 Tax debts No L&I tax debts are recorded for this contractor license during the previous 6 year period, but some debts may be recorded by other agencies. License Violations No license violations during the previous 6 year period. Workers' comp Do you know if the business has employees? If so, verify the business is up-to-date on workers' comp premiums. L&I Account ID Account is current. 320,635-00 Doing business as MUTT Estimated workers reported Quarter 3 of Year 2014"1 to 3 Workers" L&I account representative T1 /FEARAED FEROZE (360)902-4797-Email: FERH235©Ini.wa.gov Workplace safety and health No inspections during the previous 6 year period. ©Washington State Dept.of Labor&industries.Use of this site is subject to the laws of the state of Washington. Access Washington https://secure.lni.wa.gov/verify/Detail.aspx?UBI=603281849&LIC=MUTI***869MT&SAW= 12/12/2014 • • Sally Ellis From: Sally Ellis Sent: Friday, December 12, 2014 12:52 PM To: 'andi.spencer.contractor @crowncastle.com' Subject: BLD14-00423 Parcel#901231004 1219 Center Rd, Chimacum Good afternoon You permit for Sprint/Samsung, 1219 Center Rd in Chimacum,WA is ready to be issued. However before we can issue the permit, You must tell us who the contractor is for this project. Also advise where you wish for us to mail the approved permit, and or if you would prefer to pick it up here in our office. Once you have provided this information I can issue the permit. If you have any questions and or need more information please don't hesitate to contact me. Thank you A te* '1. Sally L Ellis Jefferson County Community Development Permit Technician 621 Sheridan St., Port Townsend,WA 98368 Mon-Thurs 9am-4:30pm,closed from 12-1 Ph: 360-379-4452 Fax: 360-379-4451 sellis@co.jefferson.wa.us http://www.co.jefferson.wa.us Grt-TrAf,:pic- cv / . r\Forhenalisori 111 1211 LI 1 • • Sally Ellis From: Spencer, Andi (Contractor)<Andi.Spencer.Contractor @crowncastle.com> Sent: Friday, December 12, 2014 3:18 PM To: Sally Ellis Subject: RE: BLD14-00423 Parcel#901231004 1219 Center Rd, Chimacum Thanks Sally, Below is our Contractor: Business License#:603.281.849 Contractor's License#: MUTI***869MT Please let me know, if this is approved. After the Permit is issued, should our Carrier decide to change Contractors, I'll provide you with the new Licenses. Thanks so much. Andi Spencer Services Real Estate Specialist-Seattle P:425-202-01711 F:425-202-2771 CROWN CASTLE 8432 154th Avenue North East Building C Redmond,WA 98052 CrownCastle.com From: Sally Ellis [mailto:SEllis @co.jefferson.wa.us] Sent: Friday, December 12, 2014 3:13 PM To: Spencer, Andi (Contractor) Subject: RE: BLD14-00423 Parcel# 901231004 1219 Center Rd, Chimacum Andi You must provide the contractor information. Right now we do not have a contracted listed. If you change contractors...then you can just email that information to me. After you have made that change. Thanks Sally Ellis From:Spencer,Andi(Contractor) [mailto:Andi.Spencer.Contractor(Wcrowncastle.coml Sent: Friday, December 12, 2014 2:55 PM To:Sally Ellis Subject: RE: BLD14-00423 Parcel#901231004 1219 Center Rd,Chimacum Hi Sally, 1 • • Just left you a voicemail. One more question... My Carrier does have a Contractor on hand. If they decide to switch Contractors after Permit Issuance, is there a process in place with the Jurisdiction? I know that you'll need the New Contractor information and license. Is there anything else that needs to be done? Please advise. Thanks so much. Andi Spencer Services Real Estate Specialist-Seattle P:425-202-0171 I F:425-202-2771. CROWN CASTLE 8432 1.54'h Avenue North East Building C Redmond,WA 98052 CrownCastle.com From: Sally Ellis [mailto:SEIIisCaco.jefferson.wa.us] Sent: Friday, December 12, 2014 12:53 PM To: Spencer, Andi (Contractor) Subject: BLD14-00423 Parcel# 901231004 1219 Center Rd, Chimacum Good afternoon You permit for Sprint/Samsung, 1219 Center Rd in Chimacum,WA is ready to be issued. However before we can issue the permit, You must tell us who the contractor is for this project. Also advise where you wish for us to mail the approved permit, and or if you would prefer to pick it up here in our office. Once you have provided this information I can issue the permit. If you have any questions and or need more information please don't hesitate to contact me. Thank you Sally L Ellis Jefferson County Community Development Permit Technician 621 Sheridan St., Port Townsend,WA 98368 Mon-Thurs 9am-4:30pm,closed from 12-1 Ph: 360-379-4452 Fax: 360-379-4451 sellis@co.jefferson.wa.us 2 S http://www.co.jefferson.wa.us This email may contain confidential or privileged material. Use or disclosure of it by anyone other than the recipient is unauthorized. If you are not an intended recipient,please delete this email. This email may contain confidential or privileged material. Use or disclosure of it by anyone other than the recipient is unauthorized. If you are not an intended recipient, please delete this email. 3 N1 '),.,3 .006. JEFFERSON COUNTY DEPARTMENT OF COMMUNITY DEVELOPMENT . , 621 Sheridan Street I Port Townsend,WA 98368(Web:www.co.ieiferson.wa.uslcommunitydevelopment `°NINOS" Tel:360.379.4450 I Fax:360.379.4451 I Email:dcdOco.iefferson.wa.us Building Permits&Inspections I Development Consistency Review I Long Range Planning 1 Watershed Stewardship Resource Center Master Permit Application MLA: Project Description(include separate sheets as necessary): install (3)antennas, (3) RRH's, and(6)junction cylinders. Tax Parcel Number 901231004 Propel �£� i s.square feet) i Site Address and/or Directions to Property: ; i 1219 Center Road Chimacum, WA 98325 � ?i Property Owner(s)of Record: Rayonier Forest Resources I1 NOV 1 7 2014 rl� Telephone:503-684-4004 Fax: email: www.morrisonhe cam Mailing Address: Sol Island Walkway PO Box 728 Fernandina Beach,FL 32035 I I;vTY Applicant/Agent(if different from owner): L 1,,li v I crCrI OPMFNT I Telephone:425-202-0496 Fax: email: tina.hwaangocrowncastie.com Mailing Address: 8432 154th Ave NE Building C Redmond,WA 98052 What kind of Permit?(Check each box that applies ❑Lot or Road Segregation ElBuilding ❑Critical Areas Stewardship Plan ❑ Demolition Permit ❑Variance(Minor,Major or Reasonable Economic Use) ❑Single Family ❑Garage Attached/Detached ❑Conditional Use(C(a),C(d),or C]" ❑ Manufactured Home ❑ Modular ❑Discretionary SD"or Unnamed Use Classification ❑ Commercial* ❑Special Use(Essential Public Facilities)" ❑ Change of Use ❑Boundary Line Adjustment ❑ Address ❑Road Approach ❑Short Plat** ❑Home Business ❑Cottage Industry ❑Binding Site Plan*" ❑Propane 0 Long Plat** ❑Sign ❑Planned Rural Residential Development(PRRD)iAmendments** ❑Mowed'Yes"Use Consistency Analysis ❑Plat Vacation/Alteration** ❑Stormwater Management ❑Shoreline Master Program Exemption/Permit Revisions** ❑Site Plan Approval Advance Determination(SPAAD)* ❑Shoreline Management Substantial Development** ❑Temporary Use ❑Shoreline Management Variance III Wireless Telecommunication* ❑Comprehensive Plan/UDC/Land Use District Map Amendment ❑Forest Practices Act/Release of Six-Year Moratorium ❑Jefferson County Shoreline Master Program Amendment 'May require a Pre-Application Conference ❑Tree Vegetation Request **Requires a Pre-Application Conference Please identify any other local,state or federal permits required for this proposal,if known: DESIGNATION OF AGENT I hereby designate to act as my agent in matters relating to this application for permit(s). tWNER SIGNATURE 4 _ - IlltA - -14 -/L Date: By signing this application form,the owner/agent attests that the I alien provided herein,and in any attachments,is true and correct to the best of his,her or its knowledge. Any material falsehood or any omission of a material fact made by the owner/agent with respect to this application packet may result in this permit being null and void. I further agree to save,indemnify and hold harmless Jefferson County against all liabilities,judgments,court costs,reasonable attomeVs fees and expenses which may in any way accrue against Jefferson County as a result of or in consequence of the granting of this permit. I further agree to provide access and right of entry to Jefferson County and Its employees,representatives or agents for the sole purpose of application review and any required later inspections. Staffs access and right of entry will be assumed unless the applicant informs the County In writing at the time of the ap 'cation the ors wants prior notice. Iignature: " ----- Date 10/50/2014 The action or actions Applicant will undertake as a result of the issuance of this permit may negatively impact upon one or more threatened or endangered species and could lead to a potential lake'of an endangered species as those terms are defined In the federal law known as the "Endangered Species Act"or'ESA."Jefferson County makes no assurances to the applicant that the actions that will be undertaken because this permit has been issued will not violate the ESA. Any individual,group or agency can file a lawsuit on behalf of an endangered species regarding your action(s)even if you are in compliance with the Jefferson County development code.The Applicant acknowledges that he,she or it holds individual and non-tran rable r-rponsibil •r adhering to and complying with the ESA. The Applicant has read this disclaimer and sig s and dates It below. ignature: / '�E.L i r II_ Date: 10/, 0/2-0 14 07/24/2013 III I BUILDER STATEMENT The signer of this statement does hereby certify that they are the Owners of the parcel referenced h pin, at�tftyy re nrfed at they will be assuming the responsibility of the General Contractor for the proposed project. i ,' L_- '�r'-'-' f j"\4\ Signature: Date: ` i - � i.1l i f) GENERAL CONTRACTOR OR MANUFACTURED HOME INSTALLER: PHONE: • !I NOV 2 ti i TBD (503-694-40041 ( ),�(�j� MAILING ADDRESS: 901 Island Walkway PO Box 728 Femandina Beach.FL 32035 EMAIL: yyyvyy,morrtsonttersl`}fleld:-COr 1_ 1 CONTRACTORS LICENSE WAINS . '--uNlY NUMBER: 8259 NUMBER 5259 __'--L _Vi t) I FLOPMFNT ARCHITECT/ENGINEER: Morrison Hershfield PHONE (503-64.4004 FAX:( ) MAILING ADDRESS: 901 Island Walkway PO Box 728 Fernandina Beach,FL 32035 EMAIL www.morsonhershfield,corn Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal: New _ Wood Existing: : Sewer x Addition l Steel Proposed: Bank Community System Alteration/Remodel _ Concrete Total: Height: _ Individual System Repair : Masonry SEP Permit# I Demolition IT Other: Bedrooms: Water Supply: Existing: Setback: = Private well Two Party Type of Heat: Proposed: _ Public Total: Name of System: It this is a Commercial Proiect you must answer the followina: Number of Parking Spaces: Current 0 Proposed: b Number of aA Parking Spaces:0 Number of occupants(includes owners,tenants,employees,etc) Current 0 Proposed 0 IBC Occupancy: U IBC Type of construction: V-B Will you have Food Service? Yes / No If this Is a Propane Tank and/or Appliance installation permit,mark all items below that apply: Underground Tank Above ground tank Size of Propane Tank: Heat Stove Cook Stove Woodstove Fireplace.nsert rehtO I evotS telleP I knaT retaW toH I Is this appliance beina installed in a Manufactured I Mobile Home? Yes / No When applying for a permit to install a propane tank you must also submit a site plan showing all of the buildings,all property lines,tank location and size,distances from the propane tank to all property lines,buildings and septic system components, including the reserve area. Square Footage Current Proposed For Office Use Only Amount Revision Main Floor Heated EH Bld App Review: ra Floor Heated Consistency Review Ikab-°° Other Heated Base fee: 44 Mezzanine Additional Section: () , v v Heated Basement Plan Check fee: 1-3 , 5---- Unheated Basement State Surcharge fee: b Other Unheated ' Pot Water Review fee: Garage/Carport SUBTOTAL Decks 911/Rd Approach fee: Other TOTAL: $ Receipt Number: 'ti, 14 Cash/Check Number: UC e.2/ ESTIMATED COST(REQUIRED) Date: \V 1 I t A •Fair market value of all labor and materials foundation to finish 1 $20,000 Initials: 4e „ 1)7/24/21)13 • • 44r.c„'s°N V JEFFERSON COUNTY ; i -�`' ., DEPARTMENT OF COMMUNITY DEVELOPMENT NOV` 621 Sheridan Street • Port Townsend •Washington 98368 360/379-4450 • 360/379-4451 Fax CdTY 'atN http://www.co.jefferson.wa.us/commdevelopment/ 1' r"EIOPP,ENT Stormwater Calculation Worksheet GFr; 2.,� MLA# PROJECT/APPLICANT NAME: 82.40891 1 C W-YY- DETERMINING STORMWATER MANAGEMENT REQUIREMENTS: This stormwater calculation worksheet should be completed first to classify the proposal as"small,""medium,"or"large." The size determines whether a Stormwater Site Plan is required in conjunction with a stand-alone stormwater management permit application, building permit application, or other land use approval application that involves stormwater review. The basic information will also be helpful for completing a Stormwater Site Plan, if required. ��,,l!�� PARCEL SIZE(I.E.,SITE) Size of parcel '1 .04` acres An acre contains 43,560 square feet. Multiply the acreage by this figure. Size of parcel in square feet 5 (lM/A) sq/ft C,u, oV1- Land-disturbing activity is any activity that results in movement of earth, or a change in the existing soil cover(both vegetative and non-vegetative) and/or the existing soil topography. Land disturbing activities include, but are not limited to clearing, grading, filling, excavation, and compaction associated with stabilization of structures and road construction. Native vegetation is vegetation comprised on plant species, other than noxious weeds,that are indigenous to the coastal region of the Pacific Northwest and which reasonably could have been expected to naturally occur on the site. Examples include species such as Douglas fir,western hemlock,western red cedar, alder, big-leaf maple, and vine maple; shrubs such as willow,elderberry,salmonberry, and salal; herbaceous plants such as sword fern, foam flower,and fireweed. LAND DISTURBING ACTIVITY,CONVERSION OF NATIVE VEGETATION,AND VOLUME OF CUT/FILL Calculate the total area to be cleared, graded,filled, Answer the following two questions related to excavated, and/or compacted for proposed development conversion of native vegetation: project. Include in this calculation the area to be cleared for: Does the project convert%acres or more of Construction site for structures 1, --a. /ft native vegetation to lawn or landscaped areas? Drainfield, septic tank,etc. sq/ft Circle: Yes No Well, utilities,etc. sq/ft Does the project convert 2'/z acres or more of native vegetation to pasture? Driveway, parking, roads, etc. sq/ft Circle: Yes No Lawn, landscaping,etc. sq/ft Other compacted surface, etc. sq/ft Indicate Total Volumes of Proposed: Total Land Disturbance sq/ft Cut Fill (cu/yd) [over] stormwater calc worksheet—REV.11/1/2013 1 • S • Impervious surface is a hard surface that either prevents or retards the entry of water into the soil mantle as under natural conditions prior to development. A hard surface area which causes water to run off the surface in grea •• - ' '-s or at an increased rate of flow from the flow present under natural conditions prior to development. Common impervious jarfac nGpgg, r- • •- -• • oaf tops, walkways, patios, driveways, parking lots or storage areas, concrete or asphalt pavi d,l grja'vel cods; kkid � - -ri:Is, and oiled, macadam or other surfaces which similarly impede the natural infiltration of stormwater. -- --, STORMWATER CALULATIONS–IMPERVIOUS SURFACE NC a I ] '7,11,/, I f NEW EXISTING , ,w iY Structures(all roof area) sq/ft Structures(all roof area), IN ri/c 1-I npR ft Sidewalks sq/ft Sidewalks sq/ft Patios sq/ft Patios sq/ft Solid Decks sq/ft Solid Decks sq/ft (without infiltration below) (without infiltration below) Driveway, parking, roads, etc sq/ft Driveway, parking, roads,etc`,. sq/ft Other sq/ft Other -ice oa o� 1 OO sq/ft Total New sq/ft Total Existing 11(000 sq/ft TOTAL NEW+TOTAL EXISTING* 1)1000 sq/ft `This amount will be used to check total lot coverage. The following questions will help determine whether the proposed project is considered development or redevelopment. No c ,ylGte to (Arptt yjI DEVELOPMENT v.REDEVELOPMENT 0.0025 s�ce. �JJ Di Vide the total existinq impervious surface above by the size of the parcel and convert to a percentage: Does the site have 35%or more of existinq impervious surface? Circle: Yes No FURTHER INSTRUCTIONS: If the answer is yes, the proposal is considered redevelopment and the attached Figure 2 should be used to determine the applicable Minimum Requirements. If the answer is no, the proposal is considered new development and the attached Figure 1 should be used. At this juncture, the applicant should refer to the applicable Flow Chart to determine the Minimum Requirements for stormwater management. DCD staff will help verify the classification of the project and the application requirements. For proponents of "small" projects who must comply only with Minimum Requirement #2—Construction Stormwater Pollution Prevention—an additional submittal is not required. The proponent is responsible for employing the 12 Elements to control erosion and prevent sediment and other pollutants from leaving the site during the construction phase of the project. Pick up the Construction Stormwater Pollution Prevention (SWPP) Best Management Practices (BMPs) Packet. Proponents of"medium" projects—those that must meet only Minimum Requirements #1 through #5—and for "large" projects—those that must meet all 10 Minimum Requirements—are required to submit a Stormwater Site Plan. DCD has prepared a submittal template of a Stormwater Site Plan, principally for rural residential projects. Complete the template in the Stormwater Site Plan Instructions and Submittal Template or prepare a Stormwater Site Plan using the step-by-step guidance in the Stormwater Management Manual. APPLICANT SIGNATURE By signing the Stormwater Calculation Worksheet, I as the applicant/owner attest that the information provided herein is true and correct to the best of my knowledge. I also certify that this application is being made with the full knowledge and consent of all owners^of�the affected ,,roperty. ,♦/ 11/OCo/20 19- (LANDOWNER OR AUT VIZED REPRESENTATIVE SIGNATURE) (DATE) � stormwater calc worksheet—REV.11/1/2013 2 o I —I u !' � .. o 3 ¢ rewa FF Y•'', C a s� ^ QE.te r m op o o• ' �� h W H W m H? /N w e I !i! LIIII_JJ! z F 3 w o I a = �3 z o N U�w 4 _ zo o - Ald3d08d 01 g w w N '1'0 213M01 1106J' 4 7-7 -- 11111111 / a y / a I/ / 4� o / N N _ N= = N n I I %` I _J I ° N�N� o Lt' N :: !J r— q � s I a oa aai3�—===1 I_. I I gm n IR1) 1 LL ....1 } L I G ', b l' i ` 2c, go% —o LI_ i _ 3z_ al= 2 I 0 Norma z rc s asa a f!� 22Y yi_i a6 0 O S Fp.p 2 -g ,Ni H 2 y Dy p!" c17' ° ° g N Pg. 13 .Er1,19 o X mD oZ Z Dmnc z z°z 0 1 N' O Z m 0�o i-mm 2z •0Z0 trio 1 m°Z N2 0 m I 0 A Fi 1 � u :. t, ' 1 r_z I L J Ord M X 17 Z m 0 w co PJZPZ C) 00 0O 01 CENTER CO M o I-- _ : - __ ROAD — �-1---- — _°X oy °x D - -i--- IV r- T _ W oXI o _, L o _N� CA J X o 0 Z O N N I r f I O Z I Z N O O O Z 0 O 0 TAX LOT N0. 901233004 1 m m 17 o m m — O \\ Z x oy my m °x -- ymp Nr6 O - Z WOO • 0 O v N. 0 rTi X O Z 0 � cn Z muOC> 0 Oo N A Z CO (-,4 r m Z X m JO R O � \ m��.17 t0 0 a' Z y m o -{r p 0 0 Z xl m m O 1 o m rzi c c 0 O J �D S m (.17 / v 70 0 M 4 I / m m CO CO °0 0 791'5° i? °_ FROM TOWER C.L. mx °x N TO PROPERTY r d Iz oz v W NZ OZ w -0_. Z o o O I m= �J mK Co O. o � �m D O ;I. N.Z 2 (n J.� W K 'Y.'m Z 0 o Oao 3 II) 0 0 pig U y - W 8 O � /� o ��o . O O N a (1, A z V • x-. 0 ONT m ��m -4.0. D p �mz !n 3 y 2 ri 0) A A c_-_,) ci oNo o z\ c xv\ z o cw O co r OO ' T m A I '�Oo Cf co ir 1 x y m RI cn o D 000 aaco .O NS r ��m a A°oc op�' A m = >m a cn xi 2 o r Z Z L • • Op Front Parcel Review . ) iL►-o )2'S Parcel 901231004 Printed: December 3, 2014 TIMBERLANDS HOLDING COMPANY Site Address(es): 1 1901 ISLAND WALKWAY 1219 CENTER RD CHIMACUM, WA 98325 1 FERNANDINA BEACH, FL 32034-4732 Parcel Number: 901231004 S-T-R: 23-29N-1W Total Acreage 240 Legal Description S23 T29 R1W SW NE, SE1/4(LS W1/2 W1/2 W1/2 NW Land Use: 8800 SE)TX 4, TAX l0(LS TX12) Flood District: Fire District: 0 Planning Area: 6 Flood Map(FIRM)Panel No: School District 49 Zoning: (j1 r— COMP PLAN n\ DESIGNATION: (f COMMUNITY PLAN: UGA: UGA Trans [ ] Plot plan states "property line" [ ] Assessor's Map (Property lines on submitted plot plan must match the property lines as identified on the Assessor's 1/4 map) [ ] Legal Access to Property YES NO [ ] Parcel Tags or Scanned Documents YES 0 [ ] ESA's: Special Reports arby YES (NO`) [ ] Designated Ag YES NO [ ] Shoreline Designation: YES NO [ ] Shoreline S1ose,Stability: YES Stream Typo 0 � ,,, ti > %�` — i i- - � ., or FWHCA: NO . ` il � ....11. . '. -._- �' , /, Wetlands: YES f Rare Plants:YES f Seismic: _ Landslide: YES J..�A�4� " ii_s� - /1.6 A 4 __,. .i / ,. . Flood: YE d Erosion: ES NO L.� ,` - k 0 , - ° — ►'- I �cri_ Aquifer Rec arge Are..YES NO SL * cjv e: ---0 k „,,,,,,,,...„i, SIPZ: no At Ris High Risk Coastal l� CMZ: no : High Risk Moderate 'iskDisconnected CMZ Stormwater site ...= submitted: Ye' o [ ] Forest Land 410, NO -- 4.".5r ■ Adjoining Forest Lands: cam( A.. Commercial/ CA--(3-(Sural/ ,r=— ,dInholding [ ] Mineral Lands: YES VA. e [ ] Agricultural Lands: S NO k-f --� i A 1-— _ 0-4-4 At _�. 49 [ ] Archaeology: YES �10 ) 10 [ ] No Shooting Zone: YES 0 [ ] Stormwater: New Impervious Surface 0 Land Disturbing Activity 6 ESA's Stormwater Req's:Min Req#2 Min Req#1 thru • Min Req#1 thru#10 Engineerin: [ ] Notice Provisions/Disci• re:Airport YES NO MRL YES Forest Lands YES NO [ ] Landscaping Require• No ap , lifAir [ ] Parking Spaces Requir-• • 2 Other r ) Building Height: 35' UBC Standard [ ] Impervious Surface coverage rcentage: Resource Lands&Public: 10%lip Rural Residential: 25% Rural Indust> er UDC Sec 6.7 WIARural Commercial: 60% Area of Building Coverage:60%in Rural Indust 1 Lands only Total Building (s) Size: RVC:20,000 SF CC: 5,000 SF NC: 7,500 SF GC: 10,000 SF All others:subject to septic&water constraints/None specified NASetbacks: Front: Left Side: Right Side: Rear: Shoreline Setback: pl LSHA Setback: d [ ] Road Classificati n: Road Approach: EXISTING NOT REQ'IRAP • [ ] SEPA Required: YES EXEMPT tin AC. j ci"-1 -- 11 - 3' 0 V ( 7 S) 6 c Ci J [ ] Flood Certificate: [ ] Existing Case(s)& 'tion(s): :,') 9!i 12.2_�ii A Violations: Yes No [ ] Recorded Date of Subdivis'on: �,PI AFN Over 5yrs=UDC Plat Conditions: , /' <5yrs=Plat Conditions on plat or Old Ordinance Lots/Require Declaration of Restrictive Covenant YES NO, submitted: YES NO ,. ,4 [ UGA No Protest Agreement YE. 0, submitted: YES NO [ ] Site Visit conducted YES NO [ ] Require Final Zoning Approval S [ ] ADMIN: Setbacks entered in Permit Plan ca "4 YES New Parcel Tags entered i it Plan ', ES Special Reports Scanned N/A YES Title Notes Updated Parcel tags found for parcel 901231004 1.) 6yr Mor. on FPA2611860 application approved on 7/22/12. Moratorium 07/24/2012 Non-Forest Permits expires 7/22/18.JCC18.20.160(5)(b) "Mandatory six year development moratorium. For six years after the date of the application the county shall deny any and all applications for permits and approvals, including building permits and subdivision approvals, relating to or for non forestry uses of land subject to the application. Parcel tags found for parcel 901231004 2.) 6yr Mor. on FPA2611961 application approved on 8/22/12. Moratorium 08/27/2012 Non-Forest Permits expires 8/22/18.JCC18.20.160(5)(b) "Mandatory six year development moratorium. For six years after the date of the application the county shall deny any and all applications for permits and approvals, including building permits and subdivision approvals, relating to or for non forestry uses of land subject to the application. Parcel tags found for parcel 901231004 3.) WSRC Coaching - 2011-11-16, SG 08/27/2013 Other Cases Associated with APN 901231004 Review Cases Name Type Status Planner BLD01-00070 A N E FORESTS PUGET SOON[ F Application Received: 2/1/2001 Permit Issued/Case closed: 2/1/2001 Case Finaled: 2/20/2001 Propane Tank BLD12-00414 SMARTLINK S Lisa Keller Application Received: 12/26/2012 Permit Issued/Case closed: 12/27/2012 Case Finaled: MODIFICATION TO CELL I UWEIl - INSTALL 3 PANEL ANTENNAS, 1 MIGHOWAVE ANTENNA,2 EQUIPMENT CABINETS & REMOVE 6 PANEL ANTENNAS AND 3 EQUIPMENT CABINETS BLD14-00423 C/O ANDI SPENCER I P Tim Woolett Application Received: 11/17/2014 Permit Issued/Case closed: Case Finaled: CELL TOWER MODIFICATION INSTALL 3 ANTENNAS, 3 RRH'S AND 6 JUNCTION CYLINDERS TO EXISTING TOWER \\tidemark\data\forms\R_Parcel_CRMLA.rpt 12/3/2014 Page 2 of 4 CAM14-00409 RAYMOND M Colleen Zmolek Application Received: 7/23/2014 Per ssued/Case closed: 7/23/2014 Ca inaled: cell tower co-locate CAM14-00579 WILEY NA M Joel Peterson Application Received: 10/23/2014 Permit Issued/Case closed: 10/24/2014 Case Finaled: Proposed expansion of compound area by 600 s.f./co-locate? FPA2611860 RAYONIER FOREST RESOURCE F Application Received: 6/27/2012 Permit Issued/Case closed: 7/22/2012 Case Finaled: 7/24/2012 Five culvert removals and six culvert installations. FPA2611961 RAYONIER FOREST RESOURCE F Application Received: 8/27/2012 Permit Issued/Case closed: 8/22/2012 Case Finaled: 8/27/2012 39.1-acre timber harvest and 225 feet of road construction. M LA01-00379 BLD01-00400 MLA01-00379 A N E FOREST OF PUGET SOU! I F J SMITH Application Received: 7/10/2001 Permit Issued/Case closed: 8/1/2001 Case Finaled: 12/12/2001 CO LOCATION OF COMMUNICATIONS FACILITY ON EXISTING I OWEN MLA02-00253 BLD02-00259 MLA02-00253 CINGULAR WIRELESS II F J SMITH Application Received: 5/2/2002 Permit Issued/Case closed: 11/15/2002 Case Finaled: 5/2/2003 CO LOCATION WITH 15' EX I ENSION ZONO2-00073 MLA02-00253 A N E FORESTS PUGET SOUNE II F J SMITH Application Received: 6/14/2002 Permit Issued/Case closed: 8/13/2003 Case Finaled: 8/13/2003 EXTEND EXISTING 145-F00 1 TOWER BY ADDING A 15' EXT NEW TOWER HEIGH I WILL BE 160-FEET. A NEW ANTENNAARRAY WILL BE COLOCATED ON THE TOWER. LIGHTING OF THE TOWER MAY BE REQUIRED BY THE F.A.A. M LA05-00635 BLD05-00682 MLA05-00635 CINGULAR WIRELESS I F David Wayne Johnson Application Received: 10/28/2005 Permit Issued/Case closed: 1/18/2006 Case Finaled: 8/8/2006 REPLACE 6 EXISTING AN I ENNAS &ADD 2 NEW RADIO EQUIPMEN I CABINETS MLA08-00319 BLD08-00287 MLA08-00319 CINGULAR WIRELESS LLC I F Zoe Ann Lamp Application Received: 6/27/2008 Permit Issued/Case closed: 8/13/2008 Case Finaled: 10/6/2009 ADDING 3 ANTENNAS AND 2 EQUIPMENT CABINETS TO EXISTING TOWER WITHIN AN EXISTING LEASED AREA MLA11-00209 BLD11-00268 MLA11-00209 AT&T I C Zoe Ann Lamp Application Received: 9/29/2011 Permit Issued/Case closed: 10/26/2011 Case Finaled: REPLACE 1 MICROWAVE DISH - PERMIT CANCELLED DUE TONON:1719INT UNDER AMNESTY PROG MLA12-00025 BLD12-00042 MLA12-00025 AT&T I S David Wayne Johnson Application Received: 2/13/2012 Permit Issued/Case closed: 11/21/2012 Case Finaled: ADD 4' MICROWAVE DISH ON EXISTING TOWER & NEW CABTNEYONEXISTING SLAB M LA12-00195 BLD12-00272 MLA12-00195 AT&T MOBILITY I F David Wayne Johnson Application Received: 8/30/2012 Permit Issued/Case closed: 9/24/2012 Case Finaled: 4/16/2013 ADD (3) NEW PANEL ANTENNAS &ADD CABINET ON EXISTING CONCRETE PAD BLD00-00359 VOICE STREAM WIRELESS F Application Received: 6/2/2000 Permit Issued/Case closed: 11/17/2000 Case Finaled: 2/20/2001 VOICE STREAM WIRELESS TOWER PRE99-00050 VOICE STREAM WIRELESS F M GREWELL Application Received: 9/9/1999 Permit Issued/Case closed: 10/5/1999 Case Finaled: Voice Stream Wireless proposes to construct a 150' lattice tower to support a three-sector antenna array with (3) antennas per sector(9 antennas total). Voice Stream may elect to mount two microwave dishe antennas (1 @ 4' diameter& 1 @ 8' diameter) onto the tower in the future. \\tidemark\data\forms\R_Parcel_CRMLA.rpt 12/3/2014 Page 3 of 4 ZON99-00057 VOICE STREAM WIRELESS F J SMITH Application Received: 12/20/1999 Per ssued/Case closed: 10/6/2000 Ca inaled: 7/26/2001 Voice Stream Wireless proposes to construct a 150' lattice tower to support a three-sector antenna array with (3) antennas per sector(9 antennas total). Voice Stream may elect to mount two microwave dishe antennas (1 @ 4' diameter& 1 @ 8' diameter) onto the tower in the future. The tower will be located within a 40-ft. by 40-ft.lease area along with a small radio equipment cabinet to be placed on a concrete pad. Emergency power to this equipment will be provided via a Backup Battery System. A second concrete pad will also be constructed for placement of a portable generator in the event the BBS capacity is reached. This lower power minor communications facility will transmit and receive signals for digital wireless (PCS)communications. \\tidemark\data\forms\R_Parcel_CRMLA.rpt 12/3/2014 Page 4 of 4 �UILDING PERMIT APPLICA N B 0423 Ree view view Type: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT#: BLD14-00423 Received Date: 11/17/2014 SITE ADDRESS: 1219 CENTER RD CHIMACUM, 98325 OWNER: SPRINT/SAMSUNG CIO ANDI SPENCER PHONE: 425-202-0496 8432 154TH AVE. BUILDING C REMOND WA 98052 SUBDIVISION: Block: Lot: T 4+ PARCEL NUMBER: 901231004 Section: 23 Township: 29 N Range: 1V1 CONTRACTOR: TBD PHONE: 253-584-6606 REPRESENTATIVE: PHONE: PROJECT DESCRIPTION CELL TOWER MODIFICATION INSTALL 3 ANTENNAS, 3 RRH'S AND 6 JUNCTION CYLINDERS TO EXISTING TOWER TYPE OF WORK COM SQUARE FOOTAGE: COMMERCIAL: TYPE OF IMP ADD MAIN: INDUSTRIAL: VALUATION 20,000.00 ADD,L. HEAT TYPE CODE EDITION: 2012 HEAT BASE: HEAT TYPE: OCCUPANCY: UNHEATED: #OF STORIES: OCCUPANCY: OTHER: CONST TYPE: GARAGE: SHORELINE: CONST TYPE: DECK: SETBACK: BANK HEIGHT: SEWAGE DISPOSAL: NUMBER OF EMPLOYEES: WATER SYSTEM: BATHROOMS: Exist: Prop: Total: Routing Date: Type Amount Paid By: Date: Receipt: Approved/Date Permit $267.00 SRE 11/17/14 151740 Plan Check $173.55 SRE 11/17/14 151740 State Building Code $4.50 SRE 11/17/14 151740 Total: $445.05 \\tidemark\data\forms\F_BLD_App_Bld.rpt 11/17/2014 III i` _ � 44' °OO JEFFERSON COUNTY 4. � DEPARTMENT OF COMMUNITY DEVELOPMENT 2 621 Sheridan Street I Port Townsend,WA 98368 I Web:www.co.Jefferson.wa.us/communitydevelopment 4SxjNO.O° Tel:360.379.4450 I Fax:360.379.4451 I Email:dcdf4co.jefferson.wa.us Building Permits&Inspections I Development Consistency Review I Long Range Planning I Watershed Stewardship Resource Center Master Permit Application MLA: Project Description(include separate sheets as necessary): Install (3)antennas, (3) RRH's, and(6)junction cylinders. _ Tax Parcel Number: 901231004 Property Size I- \ r= .• s square feet) Site Address and/or Directions to Property: . 1219 Center Road Chimacum, WA 98325 Ai�R�r f34�1�j , i Property Owner(s)of Record: Ra onier Forest Resources I Telephone:503-684-4004 Fax: email: www.morrisonher• -.. m Mailing Address: 901 Island Walkway PO Box 728 Fernandina Beach,FL 32035 ^/ Applicant/Agent(if different from owner): nr"fPT Telephone:425-202-0496 Fax: email: tina.hwang) crownCastle.com Mailing Address: 8432 154th Ave NE Building C Redmond,WA 98052 What kind of Permit?(Check each box that applies ❑Lot or Road Segregation i lBuilding ❑Critical Areas Stewardship Plan ❑ Demolition Permit ❑Variance(Minor,Major or Reasonable Economic Use) ❑Single Family ❑Garage Attached 1 Detached ❑Conditional Use[C(a),C(d),or C]** ❑ Manufactured Home ❑ Modular ❑Discretionary"D"or Unnamed Use Classification ❑ Commercial* ❑Special Use(Essential Public Facilities)** ❑ Change of Use ❑Boundary Line Adjustment ❑ Address ❑Road Approach ❑Short Plat*" ❑Home Business ❑Cottage Industry ❑Binding Site Plan*" ❑Propane ❑Long Plat** ❑Sign ❑Planned Rural Residential Development(PRRD)/Amendments** ❑Allowed"Yes"Use Consistency Analysis ❑Plat Vacation/Alteration ❑Stormwater Management ❑Shoreline Master Program Exemption/Permit Revisions*"` ❑Site Plan Approval Advance Determination(SPAAD)* ❑Shoreline Management Substantial Development** ❑Temporary Use ❑Shoreline Management Variance ®Wireless Telecommunication* ❑Comprehensive Plan/UDC/Land Use District Map Amendment ❑Forest Practices Act/Release of Six-Year Moratorium ❑Jefferson County Shoreline Master Program Amendment *May require a Pre—Application Conference ❑Tree Vegetation Request **Requires a Pre-Application Conference Please identify any other local,state or federal permits required for this proposal,if known: DESIGNATION OF AGENT I hereby designate to act as my agent in matters relating to this application for permit(s). �( _ ` OWNER SIGNATURE f1 10,E ecf i.. /I -/L I Date: By signing this application form,the owner/agent attests that the i ation provided herein,and in any attachments,is true and correct to the best of his,her or its knowledge. Any material falsehood or any omission of a material fact made by the owner/agent with respect to this application packet may result in this permit being null and void. I further agree to save,indemnify and hold harmless Jefferson County against all liabilities,judgments,court costs,reasonable attorney's fees and expenses which may in any way accrue against Jefferson County as a result of or in consequence of the granting of this permit. I further agree to provide access and right of entry to Jefferson County and Its employees,representatives or agents for the sole purpose of application review and any required later inspections. Staffs access and right of entry will be assumed unless the applicant informs the County in writing at the time of the ap ication th the or s -wants prior notice. ignature: t _ Date: i 0/30/gO 14 • The action or actions Applicant will undertake as a result of the issuance of this permit may negatively impact upon one or more threatened or endangered species and could lead to a potential"take"of an endangered species as those terms are defined In the federal law known as the "Endangered Species Act°or"ESA."Jefferson County makes no assurances to the applicant that the actions that will be undertaken because this permit has been issued will not violate the ESA. Any individual,group or agency can file a lawsuit on behalf of an endangered species regarding your action(s)even if you are in compliance with the Jefferson County development code.The Applicant acknowledges that he,she or it holds individual and non-tran ��rabll-e��re//ponslbilit for adhering to and complying with the ESA. The Applicant has read this disclaimer and slg s and dates It below. tignature:+� ✓ ��st ..e_._.----------- Date: 10/ O/20 /4 JJ o7/2412013 • • BUILDER STATEMENT The signer of this statement does hereby certify that they are the Owners of the parcel referenced herein,that they are n iticen ed contractors_ at I� they will be assuming the responsibility of the General Contractor for the proposed project. 1� j Signature: Date: 1; , 1 GENERAL CONTRACTOR OR MANUFACTURED HOME INSTALLER: PHONE: if AS1' TBD (503-614-4004 ( ) ,( f l MAILING ADDRESS: 901 Island Walkway PO Box 728 Fernandina Beach.FL 32035 EMAIL: www.morrisonhershield.com.-e__,j`—J CONTRACTORS LICENSE WAINS 8259 / NUMBER: 8259 NUMBER _ ___ +!Y:" ,-„T ARCHITECT/ENGINEER: Morrison Hershfield PHONE (503-6)34-4004 FAX:( ) MAILING ADDRESS: 901 Island Walkway PO Box 728 Fernandina Beach.FL 32035 EMAIL www.morrisonhershCeld corn Project Type: Frame Type: ( Bathrooms: Shoreline: 1 Type of Sewage Disposal: New = Wood Existing: f Sewer X Addition x Steel Proposed: Bank Community System Alteration/Remodel Concrete Total: Height: Individual System Repair : Masonry SEP Permit# Demolition = Other: Bedrooms: Water Supply: Existing: Setback: = Private well Two Party Type of Heat: Proposed: _. Public Total: Name of System: If this is a Commercial Project you must answer the following: Number of Parking Spaces: Current: 0 Proposed: ° Number of ADA Parking Spaces:0 Number of occupants(includes owners,tenants,employees,etc) Current 0 Proposed 0 IBC Occupancy: U IBC Type of construction: V-B Will you have Food Service? Yes / No YPe y If this is a Propane Tank and/or Appliance Installation permit,mark all items below that apply: Underground Tank Above ground tank Size of Propane Tank: Heat Stove Cook Stove Woodstove Fireplace.nsert rehtO I evotS telleP i knaT retaW toH i Is this appliance being installed in a Manufactured I Mobile Home? Yes / No When applying for a permit to Install a propane tank you must also submit a site plan showing all of the buildings,all property lines,tank location and size,distances from the propane tank to all property lines,buildings and septic system components, including the reserve area. Square Footage Current Proposed For Office Use Only Amount Revision Main Floor Heated I EH Bid App Review: 2' Floor Heated Consistency Review (�, f� CJ•c3 Other Heated Base fee: Mezzanine Additional Section: l c, v U Heated Basement Plan Check fee: R-3 ,� Unheated Basement State Surcharge fee: i Est Other Unheated Pot Water Review fee: Garage/Carport SUBTOTAL Uri 1 0 \ Decks 911/Rd Approach fee: Other TOTAL: $ Receipt Number: j V_).4 I'� Cash/Check Number: 1 k,`1 ESTIMATED COST(REQUIRED) Date: •Fair market value of all labor and materials foundation to finish l`\l I . )4 $20,000 Initials: , q. 07/24;2013 • • w4i , co�� JEFFERSON COUNTY ti DEPARTMENT OF COMMUNITY DEVELOPMENT - k, 621 Sheridan Street • Port Townsend • Washington 98368 ,qs � ,O 360/379-4450 • 360/379-4451 Fax �tiNG` http://www.co.jefferson.wa.uslcommdevelopment/ Stormwater Calculation Worksheet G rt 2., MLA# PROJECT/APPLICANT NAME: 8 Z.&$9 I fl W,LWAj-V‘YY\ DETERMINING STORMWATER MANAGEMENT REQUIREMENTS: This stormwater calculation worksheet should be completed first to classify the proposal as"small,""medium," or"large." The size determines whether a Stormwater Site Plan is required in conjunction with a stand-alone stormwater management permit application, building permit application, or other land use approval application that involves stormwater review. The basic information will also be helpful for completing a Stormwater Site Plan, if required. PARCEL SIZE(I.E.,SITE) Size of parcel hi •� acres r / An acre contains 43,560 square feet. Multiply the acreage by this figure. Size of parcel in square feet 5 `f/ ) sq/ft Land-disturbing activity is any activity that results in movement of earth, or a change in the existing soil cover(both vegetative and non-vegetative) and/or the existing soil topography. Land disturbing activities include, but are not limited to clearing, grading, filling, excavation, and compaction associated with stabilization of structures and road construction. Native vegetation is vegetation comprised on plant species, other than noxious weeds,that are indigenous to the coastal region of the Pacific Northwest and which reasonably could have been expected to naturally occur on the site. Examples include species such as Douglas fir,western hemlock,western red cedar, alder, big-leaf maple, and vine maple; shrubs such as willow,elderberry,salmonberry, and salal; herbaceous plants such as sword fern, foam flower, and fireweed. LAND DISTURBING ACTIVITY,CONVERSION OF NATIVE VEGETATION,AND VOLUME OF CUT/FILL Calculate the total area to be cleared, graded,filled, Answer the following two questions related to excavated, and/or compacted for proposed development conversion of native vegetation: project. Include in this calculation the area to be cleared for: Does the project convert%acres or more of Construction site for structures �,�3 t /ft native vegetation to lawn or landscaped areas? Drainfield,septic tank,etc. sq/ft Circle: Yes No Well, utilities,etc. sq/ft Does the project convert 2%acres or more of native vegetation to pasture? Driveway,parking, roads, etc. sq/ft Circle: Yes No Lawn, landscaping, etc. sq/ft Other compacted surface, etc. sq/ft Indicate Total Volumes of Proposed: Total Land Disturbance sq/ft Cut Fill (cu/yd) [over] stormwater calc worksheet-REV.11/1/2013 1 • • Impervious surface is a hard surface that either prevents or retards the entry of water into the soil mantle as under natural conditions prior to development. A hard surface area which causes water to run off the surface in greater quantitigs or at an increased rate of flow from the flow present under natural conditions prior to development. Common impervious surfaces include,-burar not-lirnited..tct.coof tops, walkways, patios, driveways, parking lots or storage areas, concrete or asphalt paving, gravel roads, packed earthe-6 packed earthen rnateripls, and oiled, macadam or other surfaces which similarly impede the natural infiltration of stormwater. = ' STORMWATER CALULATIONS-IMPERVIOUS SURFACE 1 wr: NEW EXISTING - 1 Structures(all roof area) sq/ft Structures(all roof area) q/ft v Sidewalks sq/ft Sidewalks sq/ft Patios sq/ft Patios sq/ft Solid Decks sq/ft Solid Decks sq/ft (without infiltration below) (without infiltration below) Driveway, parking, roads, etc sq/ft Driveway, parking, roads,etc sq/ft Other sq/ft Other "10%-"-'0 �0� I,000 sq/ft Total New sglft Total Existing 1 I CP00 sq/ft TOTAL NEW+TOTAL EXISTING* I,( sq/ft *This amount will be used to check total lot coverage. The following questions will help determine whether the proposed project is considered development or redevelopment. So G� lIT 'r ( rorotu1I DEVELOPMENT v.REDEVELOPMENT O.00Z�j Di is de the total existing impervious surface above by the size of the parcel and convert to a percentage: % Does the site have 35%or more of existing impervious surface? Circle: Yes No FURTHER INSTRUCTIONS: If the answer is yes, the proposal is considered redevelopment and the attached Figure 2 should be used to determine the applicable Minimum Requirements. If the answer is no, the proposal is considered new development and the attached Figure 1 should be used. At this juncture, the applicant should refer to the applicable Flow Chart to determine the Minimum Requirements for stormwater management. DCD staff will help verify the classification of the project and the application requirements. For proponents of "small" projects who must comply only with Minimum Requirement #2—Construction Stormwater Pollution Prevention—an additional submittal is not required. The proponent is responsible for employing the 12 Elements to control erosion and prevent sediment and other pollutants from leaving the site during the construction phase of the project. Pick up the Construction Stormwater Pollution Prevention (SWPP) Best Management Practices (BMPs) Packet. Proponents of"medium" projects—those that must meet only Minimum Requirements #1 through #5—and for "large" projects—those that must meet all 10 Minimum Requirements—are required to submit a Stormwater Site Plan. DCD has prepared a submittal template of a Stormwater Site Plan, principally for rural residential projects. Complete the template in the Stormwater Site Plan Instructions and Submittal Template or prepare a Stormwater Site Plan using the step-by-step guidance in the Stormwater Management Manual. APPLICANT SIGNATURE By signing the Stormwater Calculation Worksheet, I as the applicant/owner attest that the information provided herein is true and correct to the best of my knowledge. I also certify that this application is being made with the full knowledge and consent of all owners of the affected 0 roperty. il,7-61:' ,i/ 11/0(o A2014 (LANDOWNER OR AUT r•IZED REPRESENTATIVE SIGNATURE) (DATE) G ¢• .v 88 s a.ee "i x r .. i .q s n S ..'` r ry'.,.: r :-; mp,, 7.77- "s a;;7,7�"['-,e - 5 r -,. 4a if z .il"l..ux ,,, +i�� o ,,, 8, b F :' ` 3�.`g:: ,Tri,,`,,,,- 7 N N 'i P,, ", 4 f t§--- 3 ,?i -' � `, ,�`�'�' +'�� '�s _ �`^w v�+,�" '� �. a�_,. r n .fir .ry,R'�,��'��a� �s<w r + s,o �' '�' z stormwater calc worksheet—REV.11/1/2013 2 0 • 3< W � 'R' W H E Y- = w E wF ( g o O17 ow 1 ..IC El t4i%1 N2 i 'If – >— g W O'° W D W rcm ZQ •� W p3LL m WK �a m °mom 10m Q V a:w3 g J i //�� ` Z x d o �,,,.� . 6 ppom g o°" 19,.. 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Cn n n 0 U (7 (7 D D DD- m m r r ..(A D m CO -1 � 0) N 70 U1 ab Z aDO [r ° 3 fD 0 y � t /") n n m rn =v V N AP ! 1 my Cfl o m , .- D m DX Wm m K=-3 �� _ n, m m n o O o rn 4 7 J � O x -. � m 3m m rN- Z v _ O m 1 T mi , o m - >o I0 DZ c 14."rn Z ° > ' r-f• •v < a g z yx� ZI . ooR` � ?.D m D � m A m C m o °0° �°,� x -< 2 fn N N ,,,No 3 p \i z Q ° N Q �w n p ) A o A ° 'AA rum o o m 11 p Z z o V a r Z�� v f _ a • • CROWN Crown Castle 8432154th Avenue NE CASTLE Building C,2nd Floor Redmond,WA 98052 November 6, 2014 r r� Jefferson County Department of Community Development 7 I J Attn: Sally Ellis—Permit Technician 621 Sheridan Street 1 Port Townsend,WA 98368 RE: Wireless Communication Facility located at 1219 Center Road,Seattle,WA 98325 Crown Site#826841/Crown Site Name: PT CHIMACUM/ANE Sprint ID SE54XC069 Sprint PCS is in the process of a national update and modernization of its wireless service. The project requires adding antennas and remote radio heads to its existing antenna array. Sprint has applied to make such changes at the above referenced Wireless Communication Facility operated by Crown Castle. THE HEIGHT OF THE EXISTING TOWER WILL NOT BE INCREASED, NOR WILL THE FOOTPRINT OF THE EXISTING EQUIPMENT COMPOUND BE CHANGED. Sprint proposes to modify an existing unmanned Wireless Communication Facility as follows: • Install (3) new panel antennas • Install (3) new remote radio heads(RRH's) • Install (1) new filter • Install (6) new junction cylinders The Foundation for a Wireless World. CrownCastle.com • • Parcel: 901231004 All work will take place on the existing 160'Self Support Tower. The value of construction is estimated to be $20,000. No new landscaping is proposed. Itemized list of submittal documents: • Cover letter • 3 sets of site plans, stamped and signed by a Washington-registered engineer • Storm Calculation Worksheet • Email Correspondence with Mary Blain • 1 Permit Application Form–with Landlord Memorandum of Lease Agreement(attached) Sincerely, ma- Andi Spencer Services Real Estate Specialist r r Office: (425)202-0171 - 1 Email: Andi.Spencer.Contractor @CrownCastle.com 7 II J ' UN(Y " _Cu '1,01NITY I)FJrP OPM17-N;1T The Foundation for a Wireless World. CrownCastle.com a • • Spencer, Andi (Contractor) , Sally Ellis <SEllis cojefferson.wa.us> From: y @ � Sent: Tuesday, November 04, 2014 3:52 PM To: Spencer,Andi (Contractor) Subject: Parcel#901231004 1219 Center Rd Chimacum WA New permit Attachments: stormwater calc worksheet.pdf; incomplete application.pdf Dear Andi Good afternoon, As we discussed on the phone this afternoon, attached the Storm Water Calculation worksheet, and the incomplete master permit application. Please fill out I have attac p p pp and return these forms with 3 copies of a site plan. into system until these forms are completed and returned to our office. I can't process this application and enter to ou r s Y p p pp If we do not receive these forms by 11/14/14, I will have to send the incomplete application back to you. If you have any questions or need more information please feel free to contact me. Thank you and have a wonderful day! Sincerely Sally L Ellis Jefferson County Community Development ET' Permit Technician ! {, Li:_ �, ` R1 621 Sheridan St.,Port Townsend,WA 98368 1 I Mon-Thurs gam-4:30 p m,closed from 12-1 Ph: 360-379-4452 Fax: 360-379-4451 � 7 I f sellis@co.jefferson.wa.us http://www.co.jefferson.wa.us , " co„ t$ v Q 1 r I • • From: M a ry Blain To: pesmet.Shauna(Contractor). Subject: RE: BU#826841/App ID#250192-Pt.Chimacum/ANE Date: Tuesday,June 24,2014 9:26:12 AM Attachments: imaoe001.onq Fees for a project with a valuation of$20,000 are as follows: Base fee: 267 Plan Check: 173.55 Consistency Review: 228 Scanning Fee: 19 State fee: 4.50 Total:692.05 You are welcome to send a check(made out to Jefferson County)with the required documents to our office for application. Please let me know if you have questions. Mary Blain Plans Examiner I ,': I' <\/ err', Dept of Community Development , 621 Sheridan St Port Townsend,WA 98368 j/ I ph: 360-379-4461 _/ + fax:360-379-4451 ) mblain @co.jefferson.wa.us t'��?�NT� From: Desmet, Shauna (Contractor) [mailto:Shauna.Desmet.contractor @crowncastle.com] Sent: Monday, June 23, 2014 9:03 AM To: Mary Blain; #dcd Subject: RE: BU#826841/App ID#250192-Pt. Chimacum/ANE Thanks, Mary. The valuation is$20,000. From: Mary Blain [mailto:mblainCa�co jefferson.wa.us] �� Sent: Monday,June 23, 2014 8:15 AM To: Desmet, Shauna (Contractor); #dcd Subject: RE: BU#826841/App ID#250192-Pt. Chimacum/ANE A complete application will have the following: • • -Master Permit Application form, with signatures,contractor info etc -Stormwater calculation worksheet -Three sets of engineered plans(on at least 11x17) -Three copies of the site plan (on NO bigger than 11x17) -Fees (based on valuation of the project) If you'll send the valuation of the project, I can send you a fee list. All our forms can be found on our website at http://www.co.jefferson.wa.us/commdevelopment/PermitForms.htm Please let me know if you have additional questions. III Mary Blain Plans Examiner I Dept of Community Development �r I (� 621 Sheridan St Port Townsend,WA 98368 ), ph: 360-379-4461 fax: 360-379-4451 , ukiY mblainPco.jefferson.wa.us .` JIh(DfVEt�p^'rail From: Desmet, Shauna (Contractor) [mailto:Shauna.Desmet.contractorCacrowncastle.com] Sent: Friday,June 20, 2014 3:59 PM To: #dcd Subject: BU#826841/App ID#250192-Pt. Chimacum/ANE Hi Mary, My name is Shauna DeSmet and I'm looking to find out the Building permitting requirements for our customer Sprint.This is an existing wireless facility (cell tower) located at 1219 Center Rd. Chimacum,WA 98325 that will be adding three new antennas. Can you confirm requirements listed below and give me any info needed. -BP Application (need electronic copy for files) -How many sets of CD's/and can we submit 11x17? -Is separate zoning required? -Fees -Turnaround time for review and approval (approx.) -Please itemize any other documents needed for a complete submittal package -NIER -Structural Analysis �► • -LOA Any and all information will help me with my research of the permitting requirements. Thanks, SHAUNA DESMET Real Estate Specialist T: 425-202-0202 I M. 425-223-2062 Email: shauna.desmet.contactor @crowncastle.com CROWN CASTLE 8432 154th Ave NE Bldg C Redmond, WA 98052 all% CROWN v CASTLE This email may contain confidential or privileged material. Use or disclosure of it by anyone other than the recipient is unauthorized. If you are not an intended recipient,please delete this email. This email may contain confidential or privileged material. Use or disclosure of it by anyone other than the recipient is unauthorized. If you are not an intended recipient,please delete this email. r \-\%7 L 1 i I. • • 7 ! E nr Parcel: 901231004 ,� � All work will take place on the existing 160'Self Support Tower. The value of construction is estimated to be$20,000. No new landscaping is proposed. Itemized list of submittal documents: • Cover letter • 3 sets of construction drawings, stamped and signed by a Washington-registered engineer • 3 sets of site plans, stamped and signed by a Washington-registered engineer • 3 sets of structural calculations, stamped and signed by a Washington-registered engineer • 1 Permit Application Form Sincerely, Andi Spencer Services Real Estate Specialist Office: (425)202-0171 Email: Andi.Spencer.Contractor @CrownCastle.com The Foundation for a Wireless World. CrownCastle.com • • CROWN Crown Castle 8432154th Avenue NE am%,• CASTLE Building C,2nd Floor Redmond,WA 98052 October 30, 2014 -)_ Jefferson County Department of Community Development ■ J i t NOV I-73 2(114 Attn: Mary Blain—Plans Examiner 1 ,L E`, 621 Sheridan Street i t ft, 0a'I i iyTY Port Townsend,WA 98368 `__ of [` ° t�Y'it!'fis flNT 4 RE: Wireless Communication Facility located at 1219 Center Road,Seattle,WA 98325 Crown Site#826841/Crown Site Name: PT CHIMACUM/ANE Sprint ID SE54XC069 Sprint PCS is in the process of a national update and modernization of its wireless service. The project requires adding antennas and remote radio heads to its existing antenna array. Sprint has applied to make such changes at the above referenced Wireless Communication Facility operated by Crown Castle. THE HEIGHT OF THE EXISTING TOWER WILL NOT BE INCREASED, NOR WILL THE FOOTPRINT OF THE EXISTING EQUIPMENT COMPOUND BE CHANGED. Sprint proposes to modify an existing unmanned Wireless Communication Facility as follows: • Install (3) new panel antennas • Install (3) new remote radio heads(RRH's) • Install (1) new filter • Install (6)new junction cylinders The Foundation for a Wireless World. CrownCastle.com ' • • EXHIBIT D Memorandum of Lease and Option To the Site Lease with Option dated 3— I S' ,between ANE Forests of Puget Sound Inc.,as Landlord,and VoiceStream PCS BTA I Corporation,as agent for Cook Inlet/VoiceStream PV/SS PCS,L.P., as Tenant. Memorandum of Lease and Option,with cover sheet,notary page(s)and Exhibit A. Document Attached • [ '7 _ "Y NOV 1 7 ?014 0P"OPCT Site Number. SE-6101 Site Name: Chimacum Market Seattle Exoansion D-1 0 • • Return Address: VoiceStream PCS BTA I Corporation, as agent for Cook Inlet/VoiceStream PV/SS PCS,L.P. 19807 North Creek Parkway,Suite 101 Bothell,Washington 98011 Attention: PCS Lease Administrator MEMORANDUM OF LEASE AND OPTION Grantor: ANE Forests of Puget Sound Inc. Grantee: VoiceStream PCS BTA I Corporation, as agent for Cook Inlet/VoiceStream PV/SS PCS,L.P. Legal Description: PTNS NE&SE 23-29-1W Complete legal description is on page D-4 of document. Assessor's Property Tax Parcel Account Number(s): 901231004 Site Number: SE-6101 Site Name: Chimacum Market Seattle Expansion D-2 • S After recording,please return to: VoiceStream PCS BTA I Corporation, as agent for Cook Inlet/VoiceStream PV/SS PCS,L.P. 19807 North Creek Parkway,Suite 101 Bothell,Washington 98011 Attention: PCS Lease Administrator Site Identification: SE-6101-Chimacum Market: Seattle Expansion Memorandum of Lease and Option Between ANE Forests of Puget Sound Inc.("Landlord") and VoiceStream PCS BTA I Corporation,as agent for Cook Inlet/VoiceStream PV/SS PCS,LP.("Tenant") A Site Lease with Option ("Lease") dated as of t' IA1 C) (S .?,L—by and between ANE Forests of Puget Sound Inc.("Landlord") and VoiceStream PCS BTA I Corporation, as agent for Cook Inlet/ VoiceStream PV/SS PCS,L.P.("Tenant")was made regarding the following premises: See attached Exhibit A. Subject Lease is for a term of six(6)years and will commence on the date as set forth in the Lease(the "Commencement Date")and shall terminate at midnight on the last day of the month in which the 5th anniversary of the Commencement Date shall have occurred. Tenant shall have the right to extend this Lease for three(3)additional three-year terms. IN WITNESS WHEREOF,the parties hereto have respectively executed this memorandum on the /S day of fat ,199_ TENANT: VoiceStream PCS ETA I Corporation, Lk NDLOI1D: •' agent or oo �'-'y _.-VoiceStream PV/SS PCS, L.P. By: Its: 1 /xee... , i< LANDLORD: ANE Forests of Puget Sound Inc. TerthefF: Cook Inlet/ c�S ,Imo. By: .0 �f' Its: ,Gloaeil- Site Number: SE-6101 Site Name: Chimacum Market: Seattle Expansion D-3 l 3 • S , i f [Notary block for Corporation,Partnership,Limited Liability Company] STATE OF aterd ) o )ss. COUNTY OF ) I certify that I know or have satisfactory evidence that Sort) twia rk is the person who appeared before me,and said person acknowledged that hefshe signed this instrument,on oath stated that .helshe was authorized to execute the instrument and acknowledged it as far es t den T of ANE Forests of Pueet Sound Inc.to be the free and voluntary act of such party for the uses and purposes mentioned in the instrument. Dated: 4123 o o Notary Public tt �> OFFICIALSE L Print Name J1or4J 3. / erson # C DEBORAH J.PIERSON My commission expires S I bin NOTARY PUBLIC-OREGON !cam COMMISSION NO 062227 MY COMMISSION EXPIRES MAY 10,20C 1 (Use this space for notary stamp/seal) STATE OF WASHINGTON ) �/i p � )ss. COUNTY OF 'h V( r_ ) • I certify that I know or have satisfactory evidence that T IAI J C1 is the person whoa ed before me, and said person acknowledged that h e signed this instrument,on oa stated that 'she was #uthorized to execute the instrument and acknowledged it as the )(t°.Cl t f tVt—-lo e. ,i of VoiceStream PCS BTA I Corporation,as agent for Cook Inlet /VoiceStream PV/SS PCS,L.P.,to be the free and voluntary act of such party for the uses and purposes mentioned in the instrument. /�,> Dated: 3- v v . ENT �, Notary Public •o�\\lit EYo•o ¢Q Melinda S. Felon n Print Name ttOTARy My commission expires - 12- 03 ,y mimic "../.7.);.<(k9108 (Use this space for notary stamp/seal) Site Number. SE-6101 Site Name: Chimacum Market: Seattle Expansion 11111 • EXHIBIT A Legal Description To the Memorandum of Lease and Option dated 3—IC—00 between ANE Forests of Puget Sound Inc., as Landlord, and VoiceStream PCS BTA I Corporation, as agent for Cook Inlet/VoiceStream PV/SS PCS,L.P.,as Tenant. The Property is legally described as follows: EXHIBIT A LEGAL DESCRIPTION FOR:CTC- 35427 PARCEL 1: TBE SOUTHWEST QUARTER OF TEE NORTHEAST QUARTER, THE NORTHEAST QUARTER OF THE SOUTHEAST QUARTER, THE SOUTH HALF OP THE SOUTHEAST QUARTER, AND THE EAST SEVEN-EIGHTS (7/8) OF THE NORTHWEST QUARTER OF THE SOUTHEAST QUARTER IN SECTION 23, TOWNSHIP 29 NORTH, RANGE 1 WEST, W.M., IN JEFFERSON COUNTY, WASHINGTON. • PARCEL.2. THAT PORTION OF THE NORTH RALF OF THE NORTHEAST QUARTER OF SECTION 23, TOWNSHIP 29 NORTH, RANGE 1 WEST, W.M., JEFFERSON COUNTY, WASHINGTON, AND DESCRIBED AS FOLLOWS: • BEGINNING AT A POINT ON THE NORTH LINE OF SAID SECTION 23 WHICH POINT IS • NORTH 89°45'55" EAST 316.66 FEET FROM THE NORTH QUARTER SECTION CORNER OF SAID SECTION 23, AND IS LOCATED AT THE NORTHWEST CORNER OF THE EAST HALF OF THE WEST HALF OF THE NORTHWEST QUARTER OF THE NORTHEAST QUARTER OF SAID SECTION 23; THENCE FROM SAID POINT OF BEGINNING SOUTH 1°01'31" WEST, ALONG THE WEST LINE OF SAID EAST HALF OF THE WEST HALF OF THE NORTHWEST QUARTER OF THE NORTHEAST QUARTER, A DISTANCE OF 1315.28 FEET TO THE SOUTHWEST CORNER THEREOF; THENCE NORTE 89°26'27" EAST, ALONG THE SOUTH LINE OF THE NORTH HALF OF THE NORTHEAST QUARTER OF SAID SECTION 23, A DISANCE OF 1522.20 FEET, MORE OR LESS, TO THE POINT OF INTERSECTION WITH THE SOUTHWESTERLY LINE OF.THE RIGHT OF WAY OF THE "TOREELSON COUNTY ROAD°, WHICH POINT OF INTERSECTION IS SOUTH 89°26'27" WEST 713.76 FEET FROM THE SOUTHEAST CORNER OF TEE NORTHEAST QUARTER OF THE NORTHEAST QUARTER OF SAID SECTION 23; THENCE FROM SAID POINT OF INTERSECTION NORTH 53°30'25" WEST, ALONG THE SOUTHWESTERLY LINE OF SAID COUNTY ROAD RIGHT OF WAY, A DISTANCE OF 116.30 FEET; THENCE LEAVING SAID SOUTHWESTERLY RIGHT OF WAY LINE AND CONTINUING NORTH 88°49.06" WEST 79.05 FEET; THENCE NORTH 43°53'28" WEST 207.14 FEET; THENCE NORTH 40°12.59" WEST 114.59 FEET; THENCE NORTH 49°36.47" WEST 239.63 FEET; THENCE NORTH 72°55'51" WEST 120.44 FEET; THENCE NORTH 38°24'20" WEST 358.93 FEET; THENCE NORTH 18°22'25" WEST 402.83 FEET; THENCE NORTH 32°05'28" EAST 76.99 FEET, MORE OR LESS, TO A POINT ON THE SOUTHWESTERLY LINE OF THE RIGHT OF WAY OF AFORESAID "TORRELSON COUNTY ROAD"; THENCE NORTE 30 008'30" WEST, ALONG THE SOUTHWESTERLY LINE OF SAID COUNTY ROAD RIGHT OF WAY, A DISTANCE OF 86.87 FEET TO TEE POINT OF INTERSECTION WITH THE NORTH LINE OF SAID SECTION 23; THENCE SOUTH 89°45'55" WEST, ALONG THE NORTH LINE OF SAID SECTION 23, A DISTANCE OF 949.95 FEET TO THE POINT OF BEGINNING; EXCEPT °TORXELSON COUNTY ROAD" RIGHT OF WAY; ALSO EXCEPT THE FOLLOWING DESCRIBED PROPERTY: BEGINNING AT A POINT ON THE SOUTHERLY LINE OF THE NORTHEAST QUARTER OF THE NORTHEAST QUARTER OF SAID SECTION 23, WHICH POINT BEARS NORTH 89°26'27" EAST 572.06 FEET FROM THE SOUTHWEST CORNER OF SAID SUBDIVISION; THENCE NORTH 53°30'25" WEST 116.30 FEET; THENCE NORTH 88°49'06" WEST 79.05 FEET; THENCE (Continued) V,+197 Site Number: SE-6101 Site Name: Chimacum Market: Seattle Expansion D-4 • EXHIBIT A continued Legal Description Page 2 NORTH 43°53'28" WEST 207.14 FEET; THENCE NORTH 40°12'59" WEST 114.59 FEET; THENCE NORTH 49°36'47" WEST 239.63 FEET; THENCE NORTH 72°55'51" WEST 120.44 FEET TO THE TRUE POINT OF BEGINNING, SAID POINT BEING MARRED BY AN IRON ROD; THENCE SOUTH 49°28'40" WEST 144.99 FEET TO AN IRON ROD; THENCE NORTH 42°49'20" WEST 263.22 FEET TO AN IRON ROAD; THENCE NORTH 49°50'40" EAST 75.59 FEET TO AN IRON ROAD; THENCE NORTH 48°54'40" EAST 89.63 FEET TO AN. IRON ROAD; THENCE SOUTH 38°24'20" EAST 263.78 FEET, MORE OR LESS, TO THE TRUE.POINT OF BEGINNING. PARCEL 3: THAT PORTION OF THE NORTH HALF OF THE NORTHEAST QUARTER, SECTION 23, TOWNSHIP 29 NORTH, RANGE 1 WEST, W.M., IN JEFFERSON COUNTY, WASHINGTON, DESCRIBED AS FOLLOWS: BEGINNING AT A POINT WHICH BEARS NORTH 89°26'27" EAST 572.06 FEET AND NORTH 53°30'25" WEST 116.30 FEET FROM THE SOUTHWEST CORNER OF THE NORTHEAST QUARTER OF THE NORTHEAST QUARTER OF SAID SECTION 23, SAID POINT BEING IN COMMON WITH THE SOUTHERLY EDGE OF THE""TORKELSON="COUNTY ROAD"; THENCE NORTH 88°49'06" WEST 79.05 FEET; THENCE NORTH 43°53'28" WEST 81.64 FEET TO AN IRON ROD; THENCE NORTH 01°46'35" EAST 80.56 FEET TO THE SOUTHERLY EDGE OF SAID COUNTY ROAD; THENCE SOUTH 44°19'55" EAST ALONG SAID SOUTHERLY EDGE 191.16 FEET, MORE OR LESS,.TO THE POINT OF BEGINNING. PARCEL 4: THAT PORTION OF THE SOUTHEAST QUARTER OF THE NORTHEAST QUARTER OF SECTION 23, TOWNSHIP 29 NORTH, RANGE 1 WEST, W.M., IN JEFFERSON COUNTY, WASHINGTON, DESCRIBED AS FOLLOWS: BEGINNING AT THE NORTHWEST CORNER OF SAID SOUTHEAST QUARTER OF THE NORTHEAST QUARTER OF SAID SECTION 23; THENCE SOUTH 1320 FEET, MORE OR LESS, TO THE SOUTHWEST CORNER OF SAID SUBDIVISION; THENCE EAST 1320 FEET, MORE OR LESS, TO THE SOUTHEAST CORNER OF SAID SUBDIVISION; THENCE NORTHWESTERLY TO A POINT ON THE NORTH LINE OF SAID SUBDIVISION WHICH IS 891 FEET WEST FROM THE NORTHEAST CORNER OF SAID SUBDIVISION; THENCE WEST 429 FEET, MORE OR LESS, TO THE POINT OF BEGINNING. ALL SITUATE IN COUNTY OF JEFFERSON, STATE OF WASHINGTON. • Site Number. SE-6101 Site Name: Chimacum Market Seattle Expansion D-5 • S - 1 ORIGINAL CONSENT TO SUBLEASE AND AGREEMENT DATED: JUNE 15 ,2001 BY: VOICESTREAM PV/SS PCS,L.P., a Delaware Limited Partnership formerly Voicestream PCS BTAI Corporation a Delaware Corporation formerly agent for Cook Inlet/VoiceStream PV/SS PCS,L.P., a Delaware limited partnership TENANT AND: SPRINT SPECTRUM LP, a Delaware limited partnership SUBTENANT AND ANE FORESTS OF PUGET SOUND INC., a Washington corporation LANDLORD Landlord owns lands in Jefferson County,Washington(the"Property"),and is party to a Site Lease with Option dated March 15,2000 with Tenant(the"Site Lease"). Tenant has exercised the option to enter in a lease and has constructed a transmission tower for wireless signals on the leased Property. Tenant wishes to sublet on a nonexclusive basis to Subtenant so that Subtenant shall have the right to place antennas on the tower and have access thereto for maintenance and inspection. NOW,THEREFORE,the parties agree as follows: 1. Consent to Subletting. Landlord consents to Tenant subletting to Subtenant the right to install twelve(12)antennas on the tower located on the Property,plus the right to a nonexclusive use of the access road and gate,such use to be in common with Tenant. This consent is conditioned upon Tenant and Subtenant complying with all of the provisions of this Agreement. 2. Rent. As of the effective date of the subletting,the rent under the Site Lease will increase to the sum of$1,350 per month for the balance of the initial term of the Site Lease,subject to increases upon renewal as provided in paragraph 5 of the Site Lease. The sublease will automatically renew in the same manner as the Site Lease is renewed. 3. Certificate of Insurance. Subtenant shall provide to Landlord at the address set forth below proof that Subtenant is carrying insurance as required by the Site Lease,which insurance shall name Landlord as an additional insured as specified in paragraph 10 of the Site Lease and paragraph 9 of the Addendum to Site Lease. 4. Waiver of Subrogation. The provisions of paragraph 10(b)of the Site Lease regarding waiver of subrogation shall apply as between Subtenant and Landlord and as between Subtenant and Tenant. • .5. Further Subletting. Subtenant shall not further sublet or assign its rights without the consent of Landlord,nor 1411 Subtenant or Tenant grant to any other party the right to use the access road. This consent relates to this transaction only and does not waive Landlord's right to consent to further subletting or assignment by either Tenant or Subtenant. 1 Ponlnd1-20'6303.1 0010060-00004 06/11/01 4:15 p.m. S • �tr0/14/LUU1 1(:1:7 kA . 4Za3116I4: ) ( 1®004 II 6. Landlord's Attorneys'Fees. Tenant shall pay Landlord's attorneys'fees incurred in connection with the negotiation and preparation of this Agreement,not to exceed$3,500. An invoice will be provided at such time as this Agreement has been signed by all parties. 7. Effective Date. This Agreement shall be effective upon receipt by Landlord of a fully signed copy of this Agreement,together with a copy of the sublease agreement between Tenant and Subtenant(not including any master lease document),the proof of insurance and payment of attorneys' fees. The increased rent shall be prorated as of the effective date. 8. Notices.. The address for notices to Landlord and Tenant shall be as provided in the Site Lease. Subtenant's address for notices is as follows: Sprint Spectrum LP 4683 Chabot Drive Pleasanton CA 94588 Phone: 925.468.7800 Fax: 925.468.7350 IN WITNESS WID3R.EOF,the parties have executed this Agreement as of the date first written above. TENANT: VOICESTREAM PV/SS PCS LP By: +.✓ ..,,, Printed Name: ( kvty n 41.+n n retie)en Title: W4.4.44-e.r'- Etter VP SUBTENANT: SPRINT SPECTRUM LP � + 4 By. Print ante: George Ghantous Title:Director,Site Development LANDLORD: ANE FORESTS OF PI.UGET SOUND INC. ,;. /, ` By: l►`�' ' ((II Printed Name: • iiI •(( Title: a�Ge c a es-f' 4.9..e.A, 1 2 -- OW11/01 4:15 p.m. . . • • ( • ) Fiscal Authorization Policy SPRI.VT PCS ATTACHMENT C TEMPORARY DELEGATION OF APPROVAL AUTHORITY T: V? Cor.t-oUe:- PCS • • Atli, 7 LI 11 VA •-• (1110,- Na. e chint.Typ4, in accordance with Spr.r.:.PCS Financial Policy,paragraph 9.1,do hereby delegate m focal approval authority to: A 1.0 qi_a(Altti\I UAW' EplaYpe Name Title fsr:he following de :r..-..ent(s): Depart=ent Na—ber,$) • • • This delegation is effe:::ve for the period 1, k Ok ;-.1e I I z; • (not to exceed 30 days. and is necessary due to . (reason:e.g. absence. va.cazion etc.) / • — i•• to/ • it I S:gn.a:ure of person ri:etiang t o2porary elegatton Date /i• S:g .aute 2 of persr,n wse authonty is being delegate l: • Date A copy of this cornp:e:ed form should accompan. all individual financial con:mitments or expenditure documentation approved under the aboce temporary delegation. 1 • S 19/86/2 081 17:55 8045 SIDE 02102 • • VVY.YVY '1 VYY • CONSENT RESOLUTION OF ANE FORESTS OF PYJGET SOUND INC. The undersigned,being the sole stockholder and director of ANE Forests of Puget Sound Inc. ("A "),hereby authorizes Assistant Secretary David P.Miller to enter into an agreement consenting to allow VoiceSneam PV/SS PCS,L.P.("VoiceStream")to sublet to Sprint Spectrum LP the right to place twelve(12) antennas on the radio transmission tower located on the Site Lease from ANE to VoiceStrear s in Jefferson County,Washington. The consent document shall provide that the rent under the Site Lease to Voicestream shall increase from 5900 per month to 51,350 per month. EXECUTED as of this 15th day of June,2001, Sam Nymark,President, Sole Stockholder and Director of ANE Forests of Puget Sound Inc. Ao mind I-207621L9.1 0410060.00004 Map Output • • Page 1 of 1 ,, .-Avot'l',:-.S.., ,1' tRi~.. i.,,,,,oigi;4, ' iiinrial'i'' ArcIMS HTML Viewer Ma ' .., 4. . ., .....r:,,..;,,,,,,tyil,, ,,,,,4iir,k: !*z J yam, z X, r,‘ ,:s ..ri, , �,; =r ��� '''''' I, ,--1.- 0 8oloomd Foadroa,,,..,,. t, ° � 4 f Township ilrwa # w / MajorRoada " aMF {Y ' Pa_ e �, lOM militia i-7-0 ' € , . .' . .1:, 4 ' , r,iow....iiirtito,,, „it- �- 4. it,,el I 111E �rey 1dc�.rycxser,cxs -, FOR INFORMATIONAL PURPOSES ONLY- efferson County does not attest to the accuracy of the data contained herein and makes no warranty with respect to its orrectness or validity. 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Mataral R�iaao Farago- FOR INFORMATIONAL PURPOSES ONLY- efferson County does not attest to the accuracy of the data contained herein and makes no warranty with respect to its orrectness or validity. Data contained in this map is limited by the method and accuracy of its collection.Thu Dec 11 13:58:25 2014 http://gisserver/servlet/com.esri.esrimap.Esrimap?ServiceName=ovmap&ClientVersion=... 12/11/2014 Map Output • • Page 1 of 1 ArcIMS HTML Viewer Ma• rl 4, ,,wo 1 -1 N1„. �y � .I t 1- ,' I , -7— .,,,,,,;,, /A ii , 1 Tik _ 1---- -ii IN 1 ? r-----,4-__ 4 E9 —� c) Selected Features i-- �- ' I.r �. — _I 'c'-- _ O - -___ f r Township Lines -, �-Ii �. _�a .w Major Roads 'r .._ ■ �' I�t' L Parcds�l i ► �ls,L' Critical Aquifer Recharge g s r_- Areas 1 ' 1 I L::-I- i 1 1 im #�_�- .i_u - ,- o �� Y _ ( $t' ,. ,,___N ,! 1. SMIPA s LINK i 1 r r — li__ i ■M v b /cots CIS ::::C p.-Hi 11 f r�'_. 1 FOR INFORMATIONAL PURPOSES ONLY- Jefferson County does not attest to the accuracy of the data contained herein and makes no warranty with respect to its correctness or validity. Data contained in this map is limited by the method and accuracy of its collection.Thu Dec 11 13:57:56 2014 http://gisserver/servlet/com.esri.esrimap.Esrimap?ServiceName=ovmap&ClientVersion=... 12/11/2014 Map Output • • Page 1 of 1 ArcIMS Viewer Map r ilr I a,�I r , ;a- ' �. 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E■; u |�. . i"I a.i§ V§ .�,�E2 §< § §« K / §2§|� ■■ t$ « $/16® | | k ,,,W%�Le ) §,,o.k= ! g� !§�£ , - . :2§§w 9_ | B§P§k}};K0,|; g !E/§) 0 ! ■k&§2|!§■!K; | road Page 1 of 1 • ADDRESS INFORMATION FOR 1219 CENTER RD ROAD NUMBER:C931507 ROAD NAME:CENTER RD ADDRESS:1219 APT: REAL MILE POST:1.24 LT APPLICANT:VOICE STREAM WIRELESS ADDRESS CREATION DATE:07/10/00 PARCEL:901231004 LEGAL:CELLULAR TOWER GRID:E-9-E FIRE DIST:1 ZIP:98325 POSTAL DISTRICT:CHIMACUM PLANNING AREA:6 VOTING DIST:301 CEMETERY DIST:- HOSPITAL DIST: SCHOOL DIST:49 WATER DIST: SITE LONGITUDE: SITE LATITUDE: SITE COORDINATE TYPE: ACCESS LONGITUDE: ACCESS LATITUDE: MODIFY DELETE ADDRESS NAME SEARCH REPORTS http://isserver/Address/RoadAddressDetail.asp?ROAD_NUMBER=C931507&ADDRES... 12/11/2014 • Jefferson County Building Division Permit Number: BLD14-00423 Applicant: C/O ANDI SPENCER BUILDING PERMIT INSPECTION APPROVALS Applicable Code: 2012 International Building Codes To schedule inspections, call (360)379-4455 no later than 3:00PM the day before the inspection is needed. Requests received after 3:00 PM will not be scheduled for the next day's inspections. ELECTRICAL PERMITS are issued by the Washington State Department of Labor& Industries. The electrical permit must be signed off by the State Inspector prior to the County's Framing Inspection Inspection Item Date Approval Signature Notes Miscellaneous third party inspection A final inspection will not be scheduled until the following are completed and signed off by the applicable Department: • Building Permit Conditions are met • Septic Permit Final/Complete for any building containing plumbing • Land Use Conditions met and signed off • Public Works Permit Final(where applicable) FINAL INSPECTION FINAL INSPECTION MUST BE APPROVED PRIOR TO BUILDING BEING OCCUPIED THIS PERMIT IS VALID FOR ONE YEAR i CONDITIONS for Building Permit# :BLD14-00423 1.) Jefferson County has determined that the use of real property for agriculture and forestry operations is a high priority and favored use in the county. The county will not consider to be a nuisance those inconveniences or discomforts arising from such operations, if such operations are consistent with commonly accepted best management practices in compliance with local, state, and federal laws. If your real property includes or is within five hundred (500)feet of real property designated as Rural Residential 1:10 or 1:20, Rural Industrial, Rural Commercial, Agriculture, or Forestry, you may be subject to inconveniences or discomforts arising from such farming and forestry operations, including but not limited to noise, tree removal, odors,flies, fumes, dust, smoke, the operation of farm and forestry machinery during any 24-hour period, the storage and disposal or manure, and the application of permitted fertilizers and permitted pesticides. One or more of these inconveniences may occur as a result of agricultural and forestry operations which are in conformance with existing laws and regulations. 2.) The site plan as submitted with the building application for modification to an existing wireless tower on November 17,2014 has been reviewed for consistency under the UDC, and has been approved by Jefferson County Department of Community Development. Any modifications, changes, and/or additions to the stamped, approved site plan dated December 11, 2014 shall be resubmitted for review and approval by Jefferson County Department of Community Development. 3.) This approval is for a modification to an existing wireless tower only. Any future permits on this site are subject to review for consistency with applicable codes and ordinances and does not preclude review and conditions which may be placed on future permits. 4.) The proposal meets JCC 18.42.020(2)(d)which exempts the following from the provisions of the Chapter 18.42, JCC: Emergency or routine repairs, reconstruction, or routine maintenance of previously approved facilities, or replacements of transmitters, antennas, or other components of previously approved facilities which do not create a change in visual impact; 5.) AWB \\tidemark\data\forms\F_BLD_Permit_BIdg.rpt 12/12/2014 • BUILDING PERMIT Jefferson County Department of Community Development 621 Sheridan Street, Port Townsend, WA 98368 (360)379-4450 FAX(360)379-4451 PERMIT#: BLD14-00423 Received Date: 11/17/2014 SITE ADDRESS: 1219 CENTER RD Issue Date 12/12/2014 CHIMACUM, 98325 Expiration Date 12/12/2015 OWNER: SPRINT/SAMSUNG C/O ANDI SPENCER PHONE: 425-202-0496 8432 154TH AVE. BUILDING C REMOND WA 98052 SUBDIVISION: Block: Lot: T 4+ PARCEL NUMBER: 901231004 Section: 23 Township: 29 N Range: 1V1 CONTRACTOR: PETERS, DARRIN PHONE: 253-584-6606 2626 MIDWEST COURT CHAPAIGN IL 91822 Contractor's License Expires 2/15/2015 PROJECT DESCRIPTION: CELL TOWER MODIFICATION INSTALL 3 ANTENNAS, 3 RRH'S AND 6 JUNCTION CYLINDERS TO EXISTING TOWER TYPE OF WORK COM SQUARE FOOTAGE: COMMERCIAL: TYPE OF IMP ADD MAIN: INDUSTRIAL: VALUATION 20,000.00 ADD'L: HEAT TYPE: CODE EDITION: 2012 HEAT BASE: HEAT TYPE: OCCUPANCY: UNHEATED: #OF STORIES: OCCUPANCY: OTHER: CONST TYPE: GARAGE: SHORELINE: CONST TYPE: DECK: SETBACK: BANK HEIGHT: SEWAGE DISPOSAL: WATER SYSTEM: Type Amount Paid By: Date: Receipt: BATHROOMS: Permit $267.00 SRE 11/17/14 151740 Exist: Plan Check $173.55 SRE 11/17/14 151740 Prop: State Building Code $4.50 SRE 11/17/14 151740 Total: Total: $445.05 NUMBER OF EMPLOYEES: Directions to Site: HEALTH DEPARTMENT AND PUBLIC WORKS APPROVAL REQUIRED PRIOR TO FINAL INSPECTION THIS PERMIT IS VALID FOR ONE YEAR OR IT MUST BE PROPERLY RENEWED BUILDING INSPECTION HOT-LINE 379-4455. Request must be received by 3pm the day before the inspection is needed. Office Hours 9:00 am -4:30 pm MONDAY- THURSDAY HOT LINE AVAILABLE 24 HOURS A DAY SPECIAL CONDITIONS APPLY-SEE ATTATCHED MAIM 11044 I MAIM 11044 I ( .\ }.�® � \� / _ �: « � � k w .- . ��� \\ . � '\y.� :��� /&� �\ �� <�� » ;���� \� \\ � � �. ^�� � � �\: ��� 4� - J-1- 2.-01'5 11 - ►1 ' ILI \� lk MAX-I.- tot, i � ��� \ /, `� �' f��� `��\ �� , �:���� �� N �::' ' � o. —_ r-' � 4 �� d u �� 1,71 IUM low M, 4,6 l � y �, � � � i.� � �� �;s y,�^ '_`b�j � r ��1� �.��,�s � • � _.^ � $ ry, G, d..k' l irt'^l j�ah. _ - s� !P��� _ � � �' '4'�' ' �t'. r �. ..v � �� ,� ' �k v.: .4 .. �. �' 4Fk + . t' ti� � a �. `, _ I✓' .. ��. r /� Y �' "air '�3Y e :.. � , �� �:t� . r � 'f � � M'� ��' ;, �� � � JF� ��® .;s � ° � ��0 � o ,ter` -- �� �� 1A I, J _ III I� qtr 6 t '� I9 '\ ��� �.',J, �'Y � ���� � ,� , "�,� �`( ��,C;�pl I �„ � �, �� ':W �` , V ! '.� ��t �tia .ill I A " R 1 il r 9h'a �y Q I� oj�` 1� ►1'°. r.. . QM. y`"` 1 n 1. 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