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Home My WebLink AboutBLD2014-00187 BUILDING PERMIT APPLIION BLD14-00187 Review Type: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT#: BLD14-00187 Received Date: 5/27/2014 SITE ADDRESS: 613 N SANDY SHORE RD CHIMACUM, 98325 OWNER: RANDAL HAUF PHONE: 613 N SANDY SHORE RD CHIMACUM WA 983259731 HAUF SHORT PLAT SUBDIVISION: Block: Lot: PARCEL NUMBER: 801112013 Section: 11 Township: 28 N Range: 01 W CONTRACTOR: SBA NETWORK SERVICES INC PHONE: 815-524-5412 2911 1/S HEWITT AVE STE 2 EVERETT WA 98201 Contractor's License SBANENS891QH Expires 11/7/2015 REPRESENTATIVE: PHONE: PROJECT DESCRIPTION ADDTION OF 3 ANTENNAS& REMOTE RADIO UNITS TO AN EXITING CELL SITE TYPE OF WORK COM SQUARE FOOTAGE: COMMERCIAL: TYPE OF IMP ADD MAIN: INDUSTRIAL: VALUATION 15,000.00 ADD'L: HEAT TYPE: CODE EDITION: 2012 HEAT BASE: HEAT TYPE: OCCUPANCY: UNHEATED: #OF STORIES: OCCUPANCY: OTHER: CONST TYPE: GARAGE: SHORELINE: CONST TYPE: DEC K: 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 $212.00 MEB 05/27/14 148704 Plan Check $137.80 MEB 05/27/14 148704 State Building Code $4.50 MEB 05/27/14 148704 Total: $354.30 \+irlomorlArlo+o\fnrmc\1= RI Il Ann P1,1 rn+ F/4N9f11A Screen: 01 REAL PROPERTY MASTER Mode: INQUJ Auto Roll : OFF Parcel # 000801112013 Geo Cd 280111206211 HAUF SHORT PLAT Nbhd Cd 4330 LOT 1 (TAX 8) SUBJ TO EASE/REST OF RECORD Loc ID * Taxpayer Cd HAUF 2990 HAUF, RANDAL T/P Chg Dt 6/30/2008 * Title Owner T/P Chg Usr SS Tax Code 0211 Status TX TAXABLE Land Use 8100 OSAG Affidavit 108513 Vol/Page / C/U Code A AGRICULTURAL COMPLETE ADDRESS WINDOW Taxpayer HAUF2990 RANDAL HAUF 613 N SANDY SHORE RD CHIMACUM WA 98325-9731 Search Key CMD 7: End of Job co'rs '11 ) UDC • .JEFFERSON COUNTY DEPARTMENT OF COMMUNITY DEVELOPMENT \i,„ .""---, ,, e,21%she Ida t vy e P,,:-? t +rr,-; fl ',NA i 9 3,3?.. 1 `'x* m Ax '.0 ' `ers£;•i wa uslc "r m nit`(lt:'yfir t in tdlr i..a;3c0,3-?9,...;15;:;. r.:,x:ti}..0 r,"+'4. ,.Gm, l )4m(,.' aei C,s:f wa tS'.. B.:i;k iii"P erns is ,"t.yp�arlioP is',Deve op3i'e1 f,.0.0 .t s.t')ey Rt_s i!'W I LOW:i Reno&P,'r?T:ing Watershed St war as,hip Re$OUrce Center Master Permit Application MLA: Project Description(include separate sheets as necessary): 7:? ;.?. S°/47,,:0,1 5.7 a r<. : / ;g i i T_t c.r..: r � 0 "'i t' i l t i� ref Y vv‘,. ? '+t 'a`_ c, y,a"i.%. '> -1,'.. 9• 5...... ,Y 5 ;.1/ ,g,',::,^' :..1,, .fi,i o T. `/ 'I ,�`r Property Size °. x. `k, r Tax Parcel Number' ,�,.. t`� c�.�.. .;,-'^<: � , �� „,. (acres/square feet) Site Address and/or Directions to Property: '.)1:2` 1.,:'4 LP--`r,,,'t.,, „, Xi, ,'>,1 rv.r;,`,r .-,,t! I:: ,, r;,,. ' ,'z 1....') "f;, 7'1 i i +y:,0C'1 i'' (.1:7 1. M..L 'V r.'+. A Property Owner(s)ner(s)of Record: - � = , „ ,y,,),00,,,,:',„: r; y k Telephone-_ ,. , Fax email:-........... Mailing Address t',..I`' it 'L 1 r r rD1 , r- '_j (. C:1 t-f t sv li a�_: 'v�y t i. Applicant/A. nt(if different from owner): `'T -" t..1t:i.,v... M(`t"+Par, '"~)�° `l-i3f1. t eAct C.. ,�,.t y>.� d. .�: kg.‘' Ny i C E.. .rz Telephone=.-._ a ‘'''l 1 t ,x 1 7 7 Fax email' -- 'it"tv�a fir ' ? S',i .:- VIA, Mailing Address 1'74 ,t,j t,a, 'rte c5 t'4 t., r ,: ,a p f,.',..0`t.l ;« 1-2. What kind of Permit?(Check each box that applies d Lot or Road Segregation ' Building 0 Critical Areas Stewardship Plan Demolition C P r emit 0 Variance(Minor,Major or Reasonable Economic Use) O Single Family 0 Garage Attached/Detached 0 Conditional Use(C(a),C(d),or C)** o Manufactured Home 0 Modular 0 Discretionary"CY or Unnamed Use Classification Lid Commercial* 0 Special Use(Essential Pu ** Q Change of Use 0 Boundary Line Adjustment (( r- F.,--. J E o Address 0 Road Approach 0 Short Plat** 6 'v = El Home Business 0 Cottage Industry 0 Binding Site Plan** L,I i II LI Propane 0 Long Plat"* r--) o Sign ❑Planned Rural Residential D vef•.mer ti{PRR )/ mo# iient * o Allowed'Yes'Use Consistency Analysis L Plat Vacation/Alteration** I i' 0 Stormwater Management 0 Shoreline Master Program -+t ion/Permit Revisions** 0 Site Plan Approval Advance Determination(SPAAD)* 0 Shoreline Management Su santia ser wimil t}i ly ' 0 Temporary Use ❑Shoreline Management Va tance,rpr `.coyti ,=l rill x. o Wireless Telecommunication* 0 Comprehensive PlanfUDC/La • * .- . (Y.tit ' ,t• U Forest Practices Act/Release of Six-Year Moratorium ❑Jefferson County Shoreline Master Program Amendment *May require a Pre—Application Conference 0 Tree Vegetation Request **Rer/u/res a Pre-Applice&on 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 Date: ay signing this application form,the owner/agent attests that the information 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 attorneys 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 appiicatrort.that hit or�she wants prior,nelice. g } 1 Signature z-,..., � -.._-.«a__f v Date „,�> />77/j y 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 individt:al,group or agency can file a lawsuit on behalf of an endangered species regarding your action(s)even if you ar . pliant*with the Jefferson County development code.The Applicant acknowledges that he,she or it holds individual and non-lransfera*r ---. ibrlity for ad to and complying with the ESA. The Applicant has read this disctaime and,sii s and dates it below. Signature: / ;,, r! '1. Date: / / ti7/24/21 11 3 • 4E-7,2_.' XG21-7, BUILDER ST ENT The signer of this statement does hereby certify that they are the ers of the parcel referenced herein,that they are not licensed contractors and that they will be assuming the responsibility of the General C ctor for the proposed project. Signature: Date: GENERAL CONTRACTOR OR MANUFACTURED HOME INSTALLER: PHONE: FAX: 513A Nom' MjC - .Nit 3 ( 3/515'2y-59/2. (9/5)324'-iS 9 MAILING ADDRESS: k3b1,4 Z,.+t,t.iyt S,,'7r. P,ornea ile ill_. EMAIL: cilit,et3e sbctsi 4e. Ccvv. CONTRACTOR'S LICENSE 601-/% WAINS NUMBER: J I7/l ri N 5 N S ,9 I (- ..�1 NUMBER ARCHITECT/ENGINEER: �1 PHONE ( ) FAX:( ) MAILING ADDRESS: EMAIL Project Type: Frame Type: Bathrooms: NJ4 Shoreline: Type of Sewage Disposal: ❑ New ❑ Wood Existing: ❑ Sewer ❑ Addition ❑ Steel Proposed: Bank ❑ Community System /J/4 ❑ Alteration/Remodel ❑ Concrete Total: Height: ❑ Individual System ❑ Repair ❑ Masonry SEP Permit# ❑ Demolition ❑ Other: Bedrooms: t 6 i4 Water Supply: Existing: N/ Setback: ❑ Private well ❑ Two Party Type of Heat: J� Proposed: ❑ Public �L,1 A- Total: Name of System: N/A If this is a Commercial Project you must answer the following: -p- ,-i= A7-( j,Aft 'P2 ,..%-A}-(- Number of Parking Spaces: Current: Proposed: Number of ADA Parking Spaces: Number of occupants(includes owners,tenants,employees,etc) Current Proposed IBC Occupancy: IBC Type of construction: Will you have Food Service? Yes / No If this is a Propane Tank and/or Appliance Installation permit,mark all items below that apply: OA Underground Tank Above ground tank Size of Propane Tank: Heat Stove Cook Stove Woodstove Fireplace.nsert rehtO i evotStelleP i knaT retaWtoH I Is this appliance being installed in a Manufactured-/Mobile Home? Yes / No N i4 When applying for a permit to install a propane tank you must also submit a site p an 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 OA EH Bld App Review: 2"0 Floor Heated Consistency Review.Other Heated Base fee: a' , . ...Per nnA Mezzanine Additional Section: pi •vv Heated Basement Plan Check fee: Unheated Basement State Surcharge fee: (.1 1 _ c-0 Other Unheated Pot Water Review fee: Garage/Carport SUBTOTAL a Decks 911/Rd Approach fee: Other TOTAL: $ 1001- 30 Receipt Number: I 46-31014 Cash/Check Number: r` - q ESTIMATED COST(REQUIRED) Date: 1 1 •Fair market value of all labor and materials foundation to finish �1 3-1 `LI r J�- �� Initials: ��^' ` ` 07/24/2013 AP" "No. 1 —'e---b__ L .- E72_ C w�ti�soN `OC J - SON COUNTY • x .< DEPARTMENT OF COMMUNITY DEVELOPMENT ysh 621 Sheridan Street I Port Townsend,WA 98368 I Web:www.co.iefferson.wa.us/communitydevelopment Tel:360.379.4450 I Fax:360.379.4451 I Email:dcd q(�.co.iefferson.wa.us Building Permits&Inspections I Development Consistency Review!Long Range Planning I Watershed Stewardship Resource Center Master Permit Application MLA: Project Description(include separate sheets as necessary): 135 AID SPavOy 51/of2E tdd k4-1ofu c4 Sa inte.nvta s AkACC, 'e t-w of-e '('a 6ho UA ki5 " an Sxt5T/x5 CELL__ 517t Tax Parcel Number: ?'O/// aO/ 3 Property Size: /6,0C3$/ (acres/square feet) Site Address and/or Directions to Property: ow-- 1L�4 C )otJro Q). SI'I'IVDy Sfi1a� % • . SBA Communications Corporation q —I 37/-- 470 Davidson Road SBA Pittsburgh, PA 15239 In T+412.515.0111 F+412.515.0119 19 May 2014 -- - sbasite.com .It I ^<, tvit\Y 97 2014 Mary Blain Jefferson County Ty Department of Community Development i , TI EM 621 Sheridan Street Port Townsend, WA 98368 Ms. Blain: Enclosed please find a BP application and a check for$238.46 for modification of an existing telecommunication site located at: 735 N Sandy Shore Road, Chimacum,WA Sprint Reference Number SE72XC213 This project involves the installation of three additional antennas, remote radio heads, filters and junction cylinders plus two new microwave antennas on the existing Sprint array located on an existing monopole. There will be no overall increase in tower height or ground space. If you would be so kind as to return a stamped copy of the enclosed application together with a receipt of the check in the enclosed, stamped return envelope I would sincerely appreciate it as I need to those dMI IMo.,+e 1n- ._-=--ly submittal to Sprint If you have any questions or need any additional information, py r\411-4 /6916.3-9--- Cell Phone: 503-914-8977 or by email at pevans(a)sbasite.con CO � Th s advance for your help. "" \ W�.UL Patrick Evans Property Specialist I I '"18 Screen: 01 40 REAL PROPERTY MASTER Mode: INQUIRY • Auto Roll : OFF Parcel # 000801112013 Geo Cd 280111206211 HAUF SHORT PLAT Nbhd Cd 4330 LOT 1 (TAX 8) SUBJ TO EASE/REST OF RECORD Loc ID * Taxpayer Cd HAUF 2990 HAUF, RANDAL T/P Chg Dt 6/30/2008 * Title Owner T/P Chg Usr SS Tax Code 0211 Status TX TAXABLE Land Use 8100 OSAG Affidavit 108513 Vol/Page / C/U Code A AGRICULTURAL COMPLETE ADDRESS WINDOW Taxpayer HAUF2990 RANDAL HAUF 613 N SANDY SHORE RD CHIMACUM WA 98325-9731 Search Key CMD 6: End Window CMD 7: End of Job SBA NETWORK SERVICES Li Page 1 of 2 0. Washington State Department of Labor & industries SBA NETWORK SERVICES LLC Owner or tradesperson 5900 BROKEN SOUND PKWY NW HUNT,THOMAS P BOCA RATON, FL 33487 561-995-7670 Principals HUNT,THOMAS P, PARTNER/MEMBER STOOPS, JEFFREY A, PARTNER/MEMBER WA UBI No. Business type 602 923 172 Limited Liability Company 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. SBANENS891QH Effective—expiration 11/07/2011-11/07/2015 Bond RLI Ins Co $12,000.00 Bond account no. CMS0276777 Received by L&I Effective date 03/05/2014 05/18/2014 Bond history Insurance _...__.. p Travelers Property Cas Ins Co $900,000.00 Policy no. TJEXGL474M813814 Received by L&I Effective date 04/01/2014 03/15/2014 Expiration date 03/15/2015 Insurance history Savings No savings accounts during the previous 6 year period. https://secure.lni.wa.gov/verify/Detail.aspx?UBI=602923172&LIC=SBANENS891 QH&SAW= 5/30/2014 SBA NETWORK SERVICES LL Page 2 of 2 Lawsuits against the bond or sa s No lawsuits against the bond or savings accounts during the previous 6 yea eriod. 9 g p Y Tax debts No tax debts during the previous 6 year period. License Violations No license violations during the previous 6 year period. IWorkers' comp No active workers' comp accounts during the previous 6 year period. IWorkplace safety and health No inspections during the previous 6 year period. 0.)Washington State Dept.of Labor&industries. Use of this site is subject to the laws of the state of Washington. AM.*Ss taShin tmW https://secure.lni.wa.gov/verify/Detail.aspx?UBI=602923172&LIC=SBANENS891 QH&SAW= 5/30/2014 • Patrick Evans From: Mary Blain <mblain @co jefferson.wa.us> Sent: Thursday,April 17, 2014 9:45 AM To: Patrick Evans Cc: Zoe Ann Lamp;Jodi Adams Subject: RE:Zoning Requirements: 735 N Sandy Shore Road, Chimacum,WA: Sprint Site SE72XC113 Attachments: Checklist.pdf; Masterapp.pdf; StormwaterCalcSheet_2-21-2008.pdf Patrick, For a permit application for additions to an existing cell tower you will need: tjellY4 Master Permit Application (attached) Cr Stormwater Calculation Worksheet(attached) .40 Three sets of engineered plans, including structural calculations Complete Site plan (checklist on second page of"Checklist" attached) Permit fees as follows(based on a $15,000 valuation): Building permit fee: 212 Plans Check: 137.8 Consistency Review: 228 Scanning fee: 19 State fee:4.5 Total: $601.30 Check is the best form of payment, made out to Jefferson County. You are welcome to apply by mail provided all items are included. Incomplete applications will not be accepted. Please let me know if you have additional questions. From: Patrick Evans [mailto:pevans @sbasite.com] Sent: Tuesday, April 15, 2014 1:06 PM To: Zoe Ann Lamp; Jodi Adams; Mary Blain Subject: RE: Zoning Requirements: 735 N Sandy Shore Road, Chimacum, WA: Sprint Site SE72XC113 When either Jodi or Mary email me the required forms,could they also include the fee amount required for submittal of a project with a $15,000 valuation? Patrick Evans �� Property Specialist II � �� II � � �� 503.914.8977+C A!'li 2 7 2014 412.515.0119+ F JEFFERSON COUNTY DEPT.OF COMMUNITY DEVELOPMENT 1 Front Parcel Review Y Parcel 801112013 Printed: July 9, 2014 RANDAL HAUF Site Address(es 613 N SANDY SHORE RD 613 N SANDY SHORE RD CHIMACUI 102 DHARMA RD CHIMACUI. t CHIMACUM,WA 98325-9731 Parcel Number: 801112013 S-T-R: 11-28N-1W TotalAa Legal Description HAUF SHORT PLAT LOT 1 (TAX 8) SUBJ TO EASE/REST Land Use: 8300 OF RECORD Flood District: Fire District: 1 Planning Area: 6 Flood Map(FIRM)Panel No: School District 49 Zoning: COMP PLAN n DESIGNATION: I/``, l r' C COMMUNITY PLAN: UGA: UGA Trans [Vr 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) [ 4}- Legal Access to Property CZ NO [y] Parcel Tags or Scanned Documents YES @) [ r}} ESA's: Special Reports Nearby YES <No 2) [ Designated Ag YES [4-1 Shoreline Designation: YES [L js Shoreline Slo.e Stability: YES T) Stream Typei= "`; NO "y9t .- 46, �, A FWHCA: YES NO Wetlands: YES Rare Plants:YES NO Seismic: YES Qatt Landslide: YES 4Z10, Flood: YES-- Erosion: YES Aquifer Recharge Area:YES TO SIPZ: _JO" At Risk High Risk Coastal CMZ: , o = High Risk Moderate RiskDisconnected CMZ Stormwater site plan submitted: Yes [V] Forest Lands: YES Adjoining Forest Lands: Commercial/ 0G`J Rural/ Inholding [V] Mineral Lands: YES + u� [ } Agricultural Lands: YES [CIO Archaeology: YES NO 01- No Shooting Zone: YES [� Stormwater: New Impervious Surface 6 Land Disturbing Activity ® ESA's Stormwater Req's:M' Req# Min Req#1 thru#5 Min Req#1 thru#10 Engineering W\' Notice Provisions/Disclosure:Airport YES NO MRL YES NO Forest Lands YES NO [— Landscaping Required: Yes " [ Parking Spaces Required` O� 2 Other Building Height: 35' UBC Standard D.-I— Impervious Surface coverage tage: )'�(4 .� Sic Resource Lands&Public: 10% Ural Residential: 25% Rural Industria UDC Sec 6.7 Rural Commercial: 60% Area of Building Coverage:60%in Rural Industria ds only [L}— Total Building(s) Size: l e.,‹n etrp,A /4,0 0 5 4; 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 [` ] Setbacks: Front: Left Side: Right Side: Rear: Shoreline Setback: LSHA Setback: [IX Road Classificati s : � 0 2?el Road Approach: '4fflt NOT REQ'D RAP [i.-1- SEPA Required: YES r'1vl T [ .,. Flood Certificate: At [ Existing Case(s)& dition(s): Violations: Yes Z] Recorded Date of Subdivision: AFN Over 5yrs=UDC Plat Conditions: <5yrs=Plat Conditions on plat or Old Ordinance [V] Lots/Require Declaration of Restrictive Covenant YES NO, submitted: YES NO pc'] UGA No Protest Agreement YS-..,,NO, submitted: YES NO [')j Site Visit conducted YES O jc] Require Final Zoning Approval YES b< ADMIN: Setbacks entered in Permit Plan cast /A YES New Parcel Tags enterer in Permit Plan YES Special Reports Scanned ,tu YES No parcel tags found for parcel Cases Associated with APN 801112013 Cases Name Review Type Status Planner BLD14-00143 HAUF I A Application Received: 4/23/2014 Permit Issued/Case closed: 5/2/2014 Case Finaled: Add (4)Microwave dishes to existing antenna array on existing monopole BLD14-00187 HAUF P Application Received: 5/27/2014 Permit Issued/Case closed: Case Finaled: ADDTION OF 3 ANTENNAS &REMOTE RADIO UNITS TO AN EXITING CELL SITE CAM14-00227 EVANS NA M Application Received: 4/15/2014 Permit Issued/Case closed: 4/15/2014 Case Finaled: COLOCATION OF THREE NEW ANTENNAS AND REMOTE RADIO DS- MLA05-00239 BLD05-00363 MLA05-00239 HAUF F D JOHNSON Application Received: 6/3/2005 Permit Issued/Case closed: 10/24/2005 Case Finaled: 6/10/2008 INSTALLATION OF 15(717ONOPOLE ZON05-00025 MLA05-00239 HAUF III A S HOSKINS Application Received: 4/21/2005 Permit Issued/Case closed: 10/24/2005 Case Finaled: A Conditional Use Permit(CUP)to construct a 150-foot monopole and associated components within a proposed 40'x 40'compound area. A 6-foot fence and a 15-foot natural buffer are proposed to surround the compound. SEP07-00158 HAUF F Application Received: 5/17/2007 Permit Issued/Case closed: 8/4/2007 Case Finaled: 2/6/2008 lot 1 Less Tax 8 \\tidemark\data\forms\R_Parcel_CRMLA.rpt 7/9/2014 Page 2 of 2 BUILDING PERMIT APPLICATION B Review Type: Review Type: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT#: BLD14-00187 Received Date: 5/27/2014 SITE ADDRESS: 613 N SANDY SHORE RD CHIMACUM, 98325 OWNER: RANDAL HAUF PHONE: 613 N SANDY SHORE RD CHIMACUM WA 983259731 HAUF SHORT PLAT SUBDIVISION: Block: Lot: PARCEL NUMBER: 801112013 Section: 11 Township: 28 N Range: 01 W CONTRACTOR: SBA NETWORK SERVICES INC PHONE: 815-524-5412 2911 1/S HEWITT AVE STE 2 EVERETT WA 98201 Contractor's License SBANENS89IQH Expires 11/7/2015 REPRESENTATIVE: PHONE: PROJECT DESCRIPTION ADDTION OF 3 ANTENNAS& REMOTE RADIO UNITS TO AN EXITING CELL SITE TYPE OF WORK COM SQUARE FOOTAGE: COMMERCIAL: TYPE OF IMP ADD MAIN: INDUSTRIAL: VALUATION 15,000.00 ADD'L: HEAT TYPE: CODE EDITION: 2012 HEAT BASE: HEAT TYPE: OCCUPANCY: OCCUPANCY: UNHEATED: #OF STORIES: CONST TYPE: OTHER: SHORELINE: CONST TYPE: GARAGE: SETBACK: DECK: BANK HEIGHT: SEWAGE DISPOSAL: NUMBER OF EMPLOYEES: WATER SYSTEM: BATHROOMS: Exist: Prop: Total: Routing Date: Type Amount Paid By: Date: Receipt: Approved/Date Permit $212.00 MEB 05/27/14 148704 Plan Check $137.80 MEB 05/27/14 148704 State Building Code $4.50 MEB 05/27/14 148704 Total: $354.30 \\firinmer1Ar4ofo1fnrmc\F RI Il Ann PIA rnt ranpla 4A A 6 • fr" r, iL, - - .; DEPARTMENT OF COMMUNITY DEVELOPMENT r , .ent s' j ;.2". h t{1 ?'f .-.� 1 i':.G 3 �.nrr p :c n�;5�?:t N o(Jt=Ct . F�.:�£ita P�.p.:., ... ....,,.i ... i5 1LL,•r.4..)_.r...4 3 i 1 ;_<1...:? e i:e _..,... 15s a:/d.r:t Permit,3 4.,,spe c t t�fr.rr�! ti' ��` to:,lcy R.,_.re.w?i t_';i,pct.',1E;P.awii,h;kfte(a''€u Stewardship i?e'St?i.Cx.°C.4;11i0r Master Permit Application MLA: Project Description(include separate sheets as necessary): 7_?. t(;, f:Iir; ;ti` 5 3 ',:> 't L.Oi4lcfi...' Cam, ,,)Cii\1C91$[.`7 Ar\r '•. i: '-v1 4'}*a 42.:IrtCY . i,A _ce. } (_,_ .... Tax Parcel Number: ''',.?:!:-.:V/j Lc)/ 3 Property Size: :' r i i r itt'rr,,,,_, (acres/square feet) Site Address and/or Directions to Property: 7)1.: t '4 ',,P".';f.i )v . '•?)Ir. .y N- -i .E A wy- , 'i,. , - . tr(`r NA t,,t::' > - _-.-') __ .. .t r rt,. Property Owner(s)of Record '7 (\ E _ va rrti: Telephone: Fax: erpeil-- Mailing Address: ;•i r t-. '� Fi1,4 s .a,Hr.<'t. i 4 `. t-i i iv)el.(4.,,✓ij, U ,._i ' i Applicant/A nt(if different froth owner): "--PikT L'X..K E' r*,,-'•;,_ ?t\ t i r r ,; , .v i C t:. 1 Telephone: ')4.-'-', i tt t 7 7 Fax m s Mailing Address € "' { 1 -`--� _ _f x ,x t'k;j'i'�'�.‹.c:vv‘ email: z.. � <- w e"? .�_..� i 7 ``t $fc,'i 't`'.t f.i i-�.,).'�'�.'...-t k 3>{`-r 4i ti;. .r l":,'., r- 1 1 e'"f ' What kind of Permit?(Check each box that applies ❑Lot or Road Segregation ' t8uilding 0 Critical Areas Stewardship Plan O Demolition Permit 0 Variance(Minor,Major or Reasonable Economic Use) 0 Single Family 0 Garage Attached/Detached 0 Conditional Use(C(a),C(d),or Cl** O Manufactured Home 0 Modular o Discretionary"D'or Unnamed Use Classification tz Commercial* 0 Special Use(Essential Publio Facilities)** © Change of Use 0 Boundary Line Adjustment! r" r" ( 8 �/E O Address 0 Road Approach 0 Short Plat** 1 1{ i c' ��°-. ►` U V L! 0 Home Business 0 Cottage industry 0 Binding Site Plan** 0 0 Si npane 0 Long Plat** im) ,S7 r.?.7 g ❑Planned Rural Residential D el merA(i?pR2)/RmOrld>rten ' 0 Allowed°Yes'Use Consistency Analysis 0 Plat Vacation/Alteration** 1 i ' 1' 7 0 Stormwater Management g 0 Shoreline Master Program .'• ion/Permit Revisions'* :I Site Plan Approval Advance Determination(SPAAD)• 0 Shoreline Management Su tantia pe F.J Temporary Use ❑Shoreline Management Va lance-1,17. D.rvf: 0 Wireless Telecommunication* 0 Comprehensive Plan/UDC/L. . . '. i ',.riy t i 't"rcki 0 Forest Practices Act/Release of Six-Year Moratorium ❑Jefferson County Shoreline Master Program Amendment *May require a Pre-Application Conference 0 Tree Vegetation Request M **Requires et Pre-Applicetion Conference Please identify any other local,state or federal permits required for this proposal,if known: DESIGNATION OF AGENT --a I hereby designate to act as my agent in matters relating to this application for permit(s). OWNER SIGNATURE Date: By signing this application form,the owner/agent attests that the information 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,indemnity and hold harmless Jefferson County against all liabilities,judgments,court costs,reasonable attorney's foes 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 appiicalior,tttat'te or she wants priot netice. Signature 1 I I Date: • 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 ar-Iiilil • pliance with the Jefferson County development code.The Applicant acknowledges that he.she or it holds individual and non-iransfera.: ibitity for ad to and complying with the ESA. The Applicant has read this disclaims and s' sand dates it below. Signature: r')l%.4----It _. Rate: O� /� Ali 07/24/2013 0 SE 7)XC-21 m BUILDER ST ENT The signer of this statement does hereby certify that they are the ers of the parcel referenced herein,that they are not licensed contractors and that they will be assuming the responsibility of the General C_p ctor for the proposed project. Signature: �' Date: GENERAL CONTRACTOR OR MANUFACTURED HOME INSTALLER: PHONE: FAX: 513Pt WA" WO ay- .‘it Lt.-5 ( isls24 .sue/2_ (9/51-52`i-9389 MAILING ADDRESS: `3N gy.vf°(rye%5-P'Dr. f_GT IA i(Q . i EMAIL: ct_tik e.,,50 cJ 1 IC. CGt/t/l CONTRACTOR'S LICENSE Fjpyyi(, WAINS NUMBER: SBA I V NEM5139l :t.4 NUMBER ARCHITECT/ENGINEER: PHONE ( ) FAX:( ) MAILING ADDRESS: EMAIL Project Type: Frame Type: Bathrooms: N/-1, Shoreline: Type of Sewage Disposal: ❑ New D. Wood Existing: ❑ Sewer ❑ Addition ❑ Steel Proposed: Bank ❑ Community System 11A C Alteration/Remodel 111 Concrete Total: Height: C Individual System / • Repair ❑ Masonry SEP Permit# ❑ Demolition ❑ Other. Bedrooms: 1 1)1\ Water Supply: Existing: N Setback: ❑ Private well ❑ Two Party Type of Heat: , + O/ Proposed: Total: ❑ Public Name of System: N/A If this is a Commercial Proiect you must answer the following: NO C=FiMJ -QorIA %--- Number of Parking Spaces: Current: Proposed: Number of ADA Parking Spaces: Number of occupants(includes owners,tenants,employees,etc) Current Proposed IBC Occupancy: IBC Type of construction: Will you have Food Service? Yes / No If this is a Propane Tank and/or Appliance Installation permit,mark all items below that apply: (J/A, Underground Tank Above ground tank Size of Propane Tank: Heat Stove Cook Stove Woodstove Fireplace.nsert rehtO I evotS telleP I knaT retaWtoH I Is this appliance being installed in a Manufactured/Mobile Home? Yes / No (0 Q 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 N ¢i n EH Bld App Review: 2"O Floor Heated Consistency Review: Other Heated Base fee: a -Pe+-p-,,a Mezzanine Additional Section: lei •tJv Heated Basement Plan Check fee: ' J- v° Unheated Basement State Surcharge fee: q i co Other Unheated Pot Water Review fee: `T Garage/Carport SUBTOTAL V Decks 911/Rd Approach fee: Other TOTAL: $ ■ \. 30 Receipt Number: 14 U Cash/Check Number: /467--.. -L�•, ESTIMATED COST(REQUIRED) Date: � •Fair market value of all labor and materials foundation to finish 9 2 ,' l 1`"r /5/ Initials: c c 07/24/2013 , , Ili) 11111 N II JEFFERSON COUNTY i ,.,,,,\ It `�+ DEPARTMENT OF COMMUNITY DEVELOPMENT 621 Sheridan Street• Port Townsend•Washington 98368 •.. 360/379-4450 •360/379-4451 Fax http://www.cojefferson.wa.us/commdevelopment/ II!, Stormwater Calculation Worksheet MLA# PROJECT/APPLICANT NAME: 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) tiW i1(acult) Size of parcel acres An acre contains 43,560 square feet. Multiply the acreage by this figure. Size of parcel in square feet L/NKIPOW P3 sq/ft 1,, !c e_ a4rems,- Ilc,C 3F, 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 3/4 acres or more of Construction site for structures ♦o mint native vegetation to lawn or landscaped areas? Drainfield,septic tank,etc. 4r0 sq/ft Cirde: Yes No Well,utilities,etc. 10 sq/ft Does the project convert 2%acres or more of native vegetation to pasture? Driveway, parking,roads,etc. 1j sq/ft Circle: Yes No Lawn,landscaping,etc. IV sq/ft Other compacted surface,etc. 00 sq/ft Indicate Total Volumes of Proposed: Total Land Disturbance 0 sq/ft Cut 40 Fill 4 (cu/vd).. ._. I— tNI n [over] �U 572777/7-1/ ri-1 27201 It stormwater calk worksheet—REV.2/20/2008 JEFFERSON COUNTY DEPT.OF COMMUNITY DEVELOP2EM 411. 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 quantities or at an increased rate of flow from the flow present under natural conditions prior to development. Common impervious surfaces include, but are not limited to roof tops,walkways, patios,driveways, parking lots or storage areas, concrete or asphalt paving, gravel roads, packed earthen materials, and oiled,macadam or other surfaces which similarly impede the natural infiltration of stormwater. STORMWATER CALULATIONS–IMPERVIOUS SURFACE NEW EXISTING Structures(all roof area) sq/ft Structures(all roof area) sq/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 sq/ft Total New 11100 sq/ft Total Existing sq/ft TOTAL NEW+TOTAL EXISTING* 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. DEVELOPMENT v.REDEVELOPMENT Divide 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 xistin I 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 Stonnwater 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 property. 40.1,, Ar 1/.r. 09/"/ LANDOWNER OR AUTHOR ZED REPRESENTATIVE SIGNATURE) 0 M t(DATE) I stormwater calc worksheet—REV.2J20l2008 2 1Ei r ERJN COUNTY DEPT.Or COMMUNITY DEVELOPMENT Map Output • Page 1 of 2 ArcIMS HTML Viewer Map 801112007 84111 82i 110i 8(111 +1 801112011 12001 8f?11S24Q4 lownsommomumw 801112012 801112008 801112013 h. .1; r1 1200180111,++. J + 11200;1 VI Maps pragickt by Jefersoi Cory http://gisserver/servlet/com.esri.esrimap.Esrimap?ServiceName=ovmap&ClientVersion=4.0... 7/9/2014 Map Output • Page 2 of 2 Legend Selected Features ivt JC_Roadla Parcels*! — County ZOIHng MPR-8F Taos Rural Pusidantad 1:8 Rural RuadanUal 1:10 Rowel Rasakastad 1:20 illl•R-tingle randy ■ MPRAltdiffunly MPR.Rashrt Carnplai Parks and Rrdantaee ■ MPRwt]pam Spain ■ Rural Foust ■ Carnma®i Faust Farad ■ MPR-YgaCrar ■ AP 1:28 ■ Rutal Waage Cam ■ Rasounaa eased kid. .0 LOA inchrsolvili MFR-Reuaation Watt*Mgmt LYC ■ e_ ■ ■ Craearoada41C ■ AL 1:20 EUt+A4Jdpa a Camrnaraid UGA-MlobretLight Industrial UGA4I , 1 UGA4IOR UGA UGA.LOR UGA=Y9dtat Oriented Caaamara al MPRAIRN " MRI O CONTINTiNall Fa u& 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. Wed Jul 09 15:21:20 2014 http://gisserver/servlet/com.esri.esrimap.Esrimap?ServiceName=ovmap&ClientVersion=4.0... 7/9/2014 Map Output II IP Page 1 of 1 ArcIMS HTML Viewer Map III ' ,,tt t ,.v ,F t a41ti r tr VIIIIIIreTIA Legend 0 Selected Features atlttt20t2 JC_Roads .#- . I i Parcels+) #-, ; , 2013 Aerial Photos 1'4; n11 Sha.c1 t20d180111; . ` '' €..;111200 IN of t Maps Rxemtlad cry Jeteettal Carty Celt*Senecas GIS 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. Wed Jul 09 15:19:25 2014 http://gisserver/servlet/com.esri.esrimap.Esrimap?ServiceName=ovmap&ClientVersion=4.0... 7/9/2014 • Jefferson County Building Division Permit Number: BLD14-00187 Applicant: HAUF 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 3rd party final inspection lanning Approval A final inspection will not be scheduled until all of 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 • BUILDING PERMIT • Jefferson County Department of Community Development 621 Sheridan Street, Port Townsend, WA 98368 (360)379-4450 FAX (360)379-4451 PERMIT#: BLD14-00187 Received Date: 5/27/2014 SITE ADDRESS: 613 N SANDY SHORE RD Issue Date 7/16/2014 CHIMACUM, 98325 Expiration Date 7/16/2015 OWNER: RANDAL HAUF PHONE: 613 N SANDY SHORE RD CHIMACUM WA 983259731 SUBDIVISION: Block: Lot: PARCEL NUMBER: 801112013 Section: 11 Township: 28 N Range: 1V1 CONTRACTOR: SBA NETWORK SERVICES INC PHONE: 815-524-5412 2911 1/S HEWITT AVE STE 2 EVERETT WA 98201 Contractor's License SBANENS891QH Expires 11/7/2015 PROJECT DESCRIPTION: ADDTION OF 3 ANTENNAS & REMOTE RADIO UNITS TO AN EXITING CELL SITE TYPE OF WORK COM SQUARE FOOTAGE: COMMERCIAL: TYPE OF IMP ADD INDUSTRIAL: VALUATION 15,000.00 MAIN: CODE EDITION: 2012 ADD'L: HEAT TYPE: OCCUPANCY: HEAT BASE: HEAT TYPE: OCCUPANCY: UNHEATED: #OF STORIES: OTHER: CONST TYPE: SHORELINE: CONST TYPE: GARAGE. SETBACK: BANK HEIGHT: SEWAGE DISPOSAL: WATER SYSTEM: Type Amount Paid By: Date: Receipt: BATHROOMS: Permit $212.00 MEB 05/27/14 148704 Exist: Plan Check $137.80 MEB 05/27/14 148704 Prop: State Building Code $4.50 MEB 05/27/14 148704 Total: Total: $354.30 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 • • CONDITIONS for Building Permit# :BLD14-00187 1.) The project shall adhere to the Best Management Practices (BMPs)to control stormwater, erosion and sediment during construction. BMPs shall address permanent measures to stabilize soil exposed during construction, and in the design and operation of stormwater and drainage control systems. 2.) The site plan as submitted with the cell tower antennas&radio units application on 5/27/2014 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 July 9, 2014 shall be resubmitted for review and approval by Jefferson County Department of Community Development. 3.) jmp \\tidemark\data\forms\F_BLD_Permit_BIdg.rpt 7/16/2014 , v K K z o • m o q 2 2 N D n n M to PROP.,gRTY LINE(#Fi48,01 tHARNIA ROA I . • 11,1 r + m o nv Z m Ln°z o L .1 0 r o z � i I m°Z Z m Iv m cc o c CO 6 CO o 0 m. 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Z WO 177 °> � co�m °�° j ....1 x' O S m m z 0 o rZ , ■ • �aa 4 1 • Sally Ellis From: Fisher, Renee<rfisher @northskycomm.com> Sent: Wednesday, December 03, 2014 2:50 PM To: Sally Ellis Cc: Michael Coulter; Lori Bloom; Nathan Shaffer; Ethon Dolph Subject: BLD14-187 Hello, Sally. Per our conversation in reference to the building permit indicated above, we will be the Contractor doing the work for SBA Network Services. Here is our information you requested: Name-North Sky Communications Address - 11818 SE Mill Plain Blvd, Suite 410, Vancouver, WA 98684 Phone Number- 503-783-5834 WA License#-NORTHSCOO5D3 Please let me know if you need anything more from me. Thank you. Renee Fisher North Sky Communications, inc. 503-783-5834 10860 SW Clutter Rd.Sherwood, Or. 97140 rfisherna.northskycomm.com the 4k.r2r- kL✓ C U VVt t S L ix12 Co ccAc r y s c1 be icEed .+ Ferivu= 1 "2-/S/ t 1 NORTH SKY COMMUNICATIONS INC Page 1 of 4 CjiWashington State Department of Labor & industries NORTH SKY COMMUNICATIONS INC Owner or tradesperson 11818 SE MILL PLAIN BLVD KUENZI, ROD VANCOUVER, WA 98684 360-254-6920 Principals CLARK County KUENZI, ROD, PRESIDENT JOHNSON, MARK A, VICE PRESIDENT KINSEY, DALE E, VICE PRESIDENT XANTHOS, JOHN A, VICE PRESIDENT VILSOET, RICHARD B, SECRETARY DEFERRARI, HARRY ANDREW, TREASURER NIELSEN, STEVEN E, DIRECTOR CORPORATION SERVICE COMPANY, AGENT GORDON, DANA, VICE PRESIDENT (End: 08/01/2013) HADDOX, JAMES, SECRETARY (End: 08/01/2013) GRINDSTAFF, NICK, TREASURER (End: 08/01/2013) Doing business as NORTH SKY COMMUNICATIONS INC WA UBI No. Business type 601 973 572 Corporation License Verify the contractor's active registration/license/certification (depending on trade)and any past violations. Electrical Contractor Active. Meets current requirements. License specialties TELECOMMUNICATIONS License no. NORTHSC958NE Effective—expiration 08110/2005—08/14/2015 Designated administrator Dolph, Ethon A Active. Meets current requirements. https://secure.ini.wa.gov/verify/Detail.aspx?UBI=601973572&LIC=NORTHSC958NE&SAW= 12/5/2014 NORTH SKY COMMUNICATIONS INC Page 2 of 4 License type License no. Electrical Administrator DOLPHEA894L8 Bond Liberty Mutual Ins Co $4,000.00 Bond account no. 016055979 Received by L&I Effective date 08/01/2013 08/10/2013 Expiration date Until Canceled Bond history Insurance Liberty Mutual Fire Insurance $5,000,000.00 Policy no. TB2631004260014 Received by L&l Effective date 07/14/2014 07/31/2014 Expiration date 07/31/2015 Insurance history Savings No savings accounts during the previous 6 year period. 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. This company has multiple workers'comp accounts. Active accounts L&I Account ID Self Insured. 706,176-00 This business is certified to cover its own workers'comp costs. No premiums due. Doing business as DYCOM INDUSTRIES INC Estimated workers reported N/A L&l account representative (360)902-4817 Track this contractor al} IWorkplace safety and health Check for any past safety and health violations found on jobsites this business was responsible for. https://secure.lni.wa.gov/verify/Detail.aspx?UBI=601973572&LIC=NORTHSC958NE&SAW= 12/5/2014 NORTH SKY COMMUNICATIONS INC Page 3 of 4 Citation issue date ' 07126/2012 No violations Inspection no. 316308766 Location Daisy and 4th St NE Soap Lake,WA 98851 Citation issue date 03/15/2012 No violations Inspection no. 315897157 Location 630 E Clark Connell,WA 99326 Citation issue date 02/06/2012 No violations Inspection no. 315748533 Location 6521 Rd 17 NW Basin City,WA 99343 Citation issue date 11/14/2011 No violations Inspection no. 315575019 Location Sunset and Valda West Richland,WA 98601 Citation issue date 11/03/2011 No violations Inspection no. 315573485 Location 3189 Ivan Morse Rd Manson,WA 98831 Citation issue date 09/21/2011 No violations Inspection no. 315177659 Location https://secure.lni.wa.gov/verify/Detail.aspx?UBI=601973572&LIC=NORTHSC958NE&SAW= 12/5/2014 NORTH SKY COMMUNICATIONS INC Page 4 of 4 Steilacoom Rd and Duterrow Lacey,WA 98317 Citation issue date 03/16/2011 No violations Inspection no. 314752304 Location Badger and Leslie Kennewick,WA 99336 Citation issue date 07/21/2010 No violations Inspection no. 314481177 Location Mile post 36, Hwy 503 Woodland,WA 98674 Citation issue date 06/28/2010 No violations Inspection no. 314476524 Location J street and 27th Tacoma,WA 98402 Citation issue date 11/18/2009 No violations Inspection no. 313820052 Location Hoyt and Hewitt Ave Everett,WA 98045 ©Washington State Dept.of Labor&Industries.Use of this site is subject to the laws of the state of Washington. Access Whtngton ° x^,:yn!}itef.f`sa`itiric,3t Wae''-_Fn https://secure.lni.wa.gov/verify/Detail.aspx?UBI=601973572&LIC=NORTHSC958NE&SAW= 12/5/2014 FDH APPROVED By James Sheets at 4:26 pm, Apr 117, 2014 FDH Engineering,Inc.,6521 Meridien Drive Raleigh,NC 27616,Ph.919.755.1012 Structural Analysis for SBA Network Services, Inc. 149'Monopole Tower(150'AGL) SBA Site Name: Beaver Valley SBA Site ID:WA40442-T-01 Sprint Site ID:SE72XC213 Sprint Site Name:WA0817-Phase 2-Beaver Valley Hauf FDH Project Number 1463F04400 Analysis Results Tower Components 20.8% Sufficient Foundation 20.8% Sufficient 0:1 N k of QI Prepared By: O . a Reviewed By: 14- Kevin C. Diaz, EIT JONAL' ' John W. Kelly III, SE Project Engineer WA SE License No.45021 B&T Engineering, Inc.(918)587-4630 FDH Engineering,Inc. 1717 S. Boulder 6521 Meridien Drive Suite 300 Raleigh, NC 27616 Tulsa, OK 74119 E C E II V/ E (919)755-1012 B+T G R P 918-587-4630 info @fdh-inc.com 0(2 7 2014 JEFFERSON COUNTY April 15, 2014 DEPT.OF COMMUNITY DEVELOPMENT Prepared pursuan o - 2-G Structural Standard for Antenna Supporting Structures and Antennas and 2012 International Building Code Document No.ENG-RPT-501S Revision Date:06/17/11 Structural Analysis Report SBA Network Services,Inc. SBA Site ID:WA40442-T-01 April 15,2014 TABLE OF CONTENTS EXECUTIVE SUMMARY 3 Conclusions 3 Recommendations 3 APPURTENANCE LISTING 4 RESULTS 5 GENERAL COMMENTS 6 LIMITATIONS 6 APPENDIX 7 Document No.ENG-RPT-501 S Revision Date:06/17/11 2 Structural Analysis Report SBA Network Services,Inc. SBA Site ID:WA40442-T-01 April 15,2014 EXECUTIVE SUMMARY At the request of SBA Network Services, Inc., FDH Engineering, Inc. performed a structural analysis of the monopole located in Chimacum, WA to determine whether the tower is structurally adequate to support both the existing and proposed loads pursuant to the Structural Standard for Antenna Supporting Structures and Antennas, ANSI/TIA-222-G and 2012 International Code (IBC). Information pertaining to the existing/proposed antenna loading, current tower geometry, geotechnical data,foundation dimensions, and member sizes was obtained from: ❑ Sabre Communications Corporation(Job No. 06-06047)Structural Design Report dated June 6, 2005 ❑ LSI Adapt, Inc. (Project No.WA05-12374-GEO)Geotechnical Engineering Evaluation dated May 10,2005 ❑ SBA Network Services, Inc. This analysis has been performed in accordance with the 2012 International Building Code based upon an ultimate 3-second gust wind speed of 110 mph converted to a nominal 3-second gust wind speed of 85 mph per section 1609.3.1 as required for use in the TIA-222-G standard per Exception#5 of Section 1609.1.1. Exposure Category B with topographic category 1, Risk Category II,and Spectral Response Accelerations of SS= 1.277 and Si=0.519 were used in this analysis. Conclusions With the existing and proposed antennas from Sprint in place (see Table 1), the tower meets the requirements of the ANSI/TIA-222-G standard and 2012 IBC provided the Recommendations listed below are satisfied. Furthermore, provided the foundation was designed and constructed to support the original design reactions (see Sabre Job No. 06-06047), the foundation should have the necessary capacity to support both the proposed and existing loading. For a more detailed description of the analysis of the tower,see the Results section of this report. Our structural analysis has been performed assuming all information provided to FDH Engineering, Inc. is accurate (i.e., the steel data, tower layout, existing antenna loading, and proposed antenna loading) and that the tower has been properly erected and maintained per the original design drawings. Recommendations To ensure the requirements of the ANSI/TIA-222-G standard and 2012 IBC are met with the existing and proposed loading in place,we have the following recommendations: 1. The proposed feed lines should be installed inside the pole's shaft. 2. RRH/RRU Stipulation: The proposed equipment may be installed in any configuration as determined by the client. Document No.ENG-RPT-501 S Revision Date:06/17/11 3 Structural Analysis Report SBA Network Services,Inc. SBA Site ID:WA40442-T-01 April 15,2014 APPURTENANCE LISTING The proposed and existing antennas with their corresponding cables/coax lines are shown in Table 1. If the actual layout determined in the field deviates from the layout, FDH Engineering, Inc. should be contacted to perform a revised analysis. Table 1 -Appurtenance Loading Existing Loading: Antenna Mount Elevation Description Feed Lines Carrier Elevation Mount Type (ft) (ft) (2)RFS APXVRR13-C-A20 (1)Andrew HBXX-9014DS-VTM (3)Samsung RRH-P4 RRHs (3)Samsung RRH-C2A RRHs 150 (3)1-1/4" (3)Samsung RRH C2A Filters Hybrid S Sprint 149 (2)Horizon Compact 18HY50EFC066V00 ODUs p (3)T-Arms (1)Andrew VHLP2-18 Dish (4)1/2" 1 Andrew VHLP2-11 Dish 144 (2)Horizon Compact 18HY50EFC066V00 ODUs 2 Andrew VHLP1-23 Dishes 1.Feed lines installed inside the pole's shaft unless otherwise noted. Proposed Loading: Antenna Mount Elevation Description Feed Lines Carrier Elevation Mount Type (ft) (ft) (2)RFS APXVRRI3-C-A20 (1)Andrew HBXX-9014DS-VTM (3)KMW ET-X-WM-18-65-8P (3)Samsung RRH-P4 RRHs (3)Samsung RRH-C2A RRHs (3)Samsung RRU 2.5 LTE V3 10K RRUs 150 (3)Samsung RRH C2A Filters (3)1-1/4" (2)Horizon Compact 18HY50EFC066V00 ODUs Hybrid Sprint 149 (3)T-Arms (3)Amphenol Power Junctions (4)1/2" (3)Amphenol fiber Optic Junctions (1)RF Filter (1)Andrew VHLP2-18 Dish 1 Andrew VHLP2-11 Dish 144 (2)Horizon Compact 18HY50EFC066V00 ODUs 2 Andrew VHLP1-23 Dishes Document No.ENG-RPT-501S Revision Date:06/17/11 4 Structural Analysis Report SBA Network Services,Inc. SBA Site ID:WA40442-T-01 April 15,2014 RESULTS The following yield strength of steel for individual members was used for analysis: Table 2-Material Strength Member Type Yield Strength Tower Shaft Sections 65 ksi Base Plate 60 ksi Anchor Bolts 75 ksi Table 3 displays the summary of the ratio (as a percentage)of force in the member to their capacities. Values greater than 100% indicate locations where the maximum force in the member exceeds its capacity. Note: Capacities up to 105% are considered acceptable. Table 4 displays the maximum foundation reactions. Table 5 displays the maximum antenna rotations at service wind speeds(dishes only). If the assumptions outlined in this report differ from actual field conditions, FDH Engineering, Inc. should be contacted to perform a revised analysis. Furthermore, as no information pertaining to the allowable twist and sway requirements for the existing or proposed appurtenances was provided,deflection and rotation were not taken into consideration when performing this analysis. See the Appendix for detailed modeling information Table 3-Summary of Working Percentage of Structural Components Section Elevation Component Pass No. ft Type Size o Capacity Fail L1 150-98.25 Pole TP30.33x14.5x0.25 20.8 Pass L2 98.25-48.5 Pole TP45.04x28.6829x0.3125 20.6 Pass L3 48.5-1 Pole TP58.94x42.657x0.375 19.5 Pass Anchor Bolts 16 2.25"0 w/BC=66" 18.9 Pass Base Plate PL 64"SQ.x 2.75"Thick 16.7 Pass Table 4-Maximum Base Reactions Current Analysis Base Reactions (ANSI/TIA-222-G)* Original Design Seismic Load Wind Load (TIA/EIA-222-E) Axial** — 28 k 36 k Shear** 4 k*** 11 k 34 k Moment --- 1,015 k-ft 3,607 k-ft *Current analysis reactions are within an allowable factor of 1.35 per the ANSI/TIA-222-G standard when the original design reactions are based on an allowable stress design. *'Per our experience with foundations of similar type,the axial and shear loading should not control the foundation analysis. **"Seismic shear does not control this analysis. Table 5-Maximum Antenna Rotations at Service Wind Speeds(Dishes Only) Centerline Elevation(ft) Antenna Tilt(deg)* Twist(deg)" 150 (1)Andrew VHLP2-18 Dish 0.6483 0.0052 1 Andrew VHLP2-11 Dish 144 2 Andrew VHLP1-23 Dishes 0.6121 0.0045 *Allowable tilt and twist values to be reviewed by the carrier. Document No.ENG-RPT-501 S Revision Date:06/17/11 5 Structural Analysis Report SBA Network Services,Inc. SBA Site ID:WA40442-T-01 April 15,2014 GENERAL COMMENTS This engineering analysis is based upon the theoretical capacity of the structure. It is not a condition assessment of the tower and its foundation. It is the responsibility of SBA Network Services, Inc. to verify that the tower modeled and analyzed is the correct structure (with accurate antenna loading information) modeled. If there are substantial modifications to be made or the assumptions made in this analysis are not accurate, FDH Engineering, Inc. should be notified immediately to perform a revised analysis. LIMITATIONS All opinions and conclusions are considered accurate to a reasonable degree of engineering certainty based upon the evidence available at the time of this report. All opinions and conclusions are subject to revision based upon receipt of new or additional/updated information. All services are provided exercising a level of care and diligence equivalent to the standard and care of our profession. No other warranty or guarantee, expressed or implied, is offered. Our services are confidential in nature and we will not release this report to any other party without the client's consent. The use of this engineering work is limited to the express purpose for which it was commissioned and it may not be reused, copied, or distributed for any other purpose without the written consent of FDH Engineering, Inc. Document No.ENG-RPT-501S Revision Date:06/17/11 6 Structural Analysis Report SBA Network Services,Inc. SBA Site ID:WA40442-T-01 April 15,2014 APPENDIX Document No.ENG-RPT-5015 Revision Date:06/17/11 7 • • 1500ft 17 • DESIGNED APPURTENANCE LOADING 4 TYPE 1 ELEVATION TYPE 1 ELEVATION Lightning Rod 150 :Compact 18HY50EFC066V00 !149 j ! _.. APXVRR13-GA20 wl Mount Pipe 149 Compact 18HY50EFC066V00 149 APXVRR13-C-A20 w/Mount Pipe 149 Compact 18HY5OEFC066V00 149 HBXX-9014DS-VTM w/Mount Pipe 149 'Compact 18HY5OEFC066V00 149 ET-X-WM-18-65-8P w/Mount Pipe 149 Power Junction 149 ET-X-WM-18-65-8P w/Mount Pipe 149 Power Junction 149 ET-X-WM-18-65-8P w/Mount Pipe 149 Power Junction 149 4 RRH-P4 149 Fiber Optic Junction 149 o o RRH-P4 149 Fiber Optic Junction 149 - ' m N • b m of ill RRH-P4 ..... 149 Fiber Optic Junction 149 '' o ' 4 ,°„ RRH-C2A 149 RF Filter 149 ......... ____. ___. RRH-C2A 149 (3)T-Arms _... 149 149 (1)Pipe Mount 149 • RRU 2.5LTEV3 10K __. 149 (1)Pipe Mount ....... 149.. ....__ RRU 2.5LTEV3 10K 149 VHLP2-18 149 RRU 2.5LTEV3 10K---- — 149 VHLP2-11 149 RRH C2A Filter 149 VHLP1-23 149 RRH C2A Filter 149 VHLP1-23 149 RRH C2A Filter 149 MATERIAL STRENGTH 98.3 ft GRADE Fy Fu t GRADE I Fy 1 Fu A572-65 65 ksi 80 ksi 1 I TOWER DESIGN NOTES 1. Tower is located in Jefferson County,Washington. il 2. Tower designed for Exposure B to the TIA-222-G Standard. 3. Tower designed for a 85 mph basic wind in accordance with the TIA-222-G Standard. 4. Tower is also designed for a 30 mph basic wind with 0.25 in ice.Ice is considered to increase in thickness with height. 5. Deflections are based upon a 60 mph wind. 6. Tower Structure Class II. S 7. Topographic Category 1 with Crest Height of 0.00 ft h. a a . i 0 8. TOWER RATING:20.8% in CO a in eo ',. g r CO. 0 Q V O N '4 p � I l II 48.5 ft I ALL REACTIONS ARE FACTORED • AXIAL g I 32 K m "ten 2 O I SHEAR MOMENT V 1 K f J 124 kip-ft TORQUE 0 kip-ft 30 mph WIND-0.2500 in ICE AXIAL ii 1 28K SHEAR' MOMENT 11 K j f 1015 kip-ft 1.0 ft �. _ N TORQUE 1 kip-ft a s REACTIONS-85 mph WIND +r o 2! y c Y 5 c E t n m 'y FDH Engineering,Inc. Job'Beaver Valley, WA40442-A-01 FDH 6521 Meridien Drive Project:1463F04400 Raleigh, North Carolina 27616 Client: SBA Network Services,Inc. Drawn by:KDiaz App'd: Tower Analysis Phone:(919)755-1012 Code: TIA-222-G Date:04/15/14 Scale: N FAX:(919)755-1031 Path:-- m,—- ---n &M tl- — Dag No. Job Page ower Beaver Valley, WA40442-A-01 1 of 4 FDH Engineering,Inc. Project Date 6521 Meridien Drive 1463F04400 14:59:31 04/15/14 Raleigh,North Carolina 27616 Client Designed by Phone:(919)755-1012 SBA Network Services, Inc. KDiaz FAX:(919)755-1031 Load Combinations Comb. Description No. 1 Dead Only 2 1.2 Dead+1.6 Wind O deg-No Ice 3 0.9 Dead+1.6 Wind 0 deg-No Ice 4 1.2 Dead+1.6 Wind 30 deg-No Ice 5 0.9 Dead+1.6 Wind 30 deg-No Ice 6 1.2 Dead+1.6 Wind 60 deg-No Ice 7 0.9 Dead+1.6 Wind 60 deg-No Ice 8 1.2 Dead+1.6 Wind 90 deg-No Ice 9 0.9 Dead+1.6 Wind 90 deg-No Ice 10 1.2 Dead+1.6 Wind 120 deg-No Ice 11 0.9 Dead+1.6 Wind 120 deg-No Ice 12 1.2 Dead+1.6 Wind 150 deg-No Ice 13 0.9 Dead+1.6 Wind 150 deg-No Ice 14 1.2 Dead+1.6 Wind 180 deg-No Ice 15 0.9 Dead+1.6 Wind 180 deg-No Ice 16 1.2 Dead+1.6 Wind 210 deg-No Ice 17 0.9 Dead+1.6 Wind 210 deg-No Ice 18 1.2 Dead+1.6 Wind 240 deg-No Ice 19 0.9 Dead+1.6 Wind 240 deg-No Ice 20 1.2 Dead+1.6 Wind 270 deg-No Ice 21 0.9 Dead+1.6 Wind 270 deg-No Ice 22 1.2 Dead+1.6 Wind 300 deg-No Ice 23 0.9 Dead+1.6 Wind 300 deg-No Ice 24 1.2 Dead+1.6 Wind 330 deg-No Ice 25 0.9 Dead+1.6 Wind 330 deg-No Ice 26 1.2 Dead+1.0 Ice+1.0 Temp 27 1.2 Dead+1.0 Wind 0 deg+1.0 Ice+1.0 Temp 28 1.2 Dead+1.0 Wind 30 deg+1.0 Ice+1.0 Temp 29 1.2 Dead+1.0 Wind 60 deg+1.0 Ice+1.0 Temp 30 1.2 Dead+1.0 Wind 90 deg+1.0 Ice+1.0 Temp 31 1.2 Dead+1.0 Wind 120 deg+1.0 Ice+1.0 Temp 32 1.2 Dead+1.0 Wind 150 deg+1.0 Ice+1.0 Temp 33 1.2 Dead+1.0 Wind 180 deg+1.0 Ice+1.0 Temp 34 1.2 Dead+1.0 Wind 210 deg+1.0 Ice+1.0 Temp 35 1.2 Dead+1.0 Wind 240 deg+1.0 Ice+1.0 Temp 36 1.2 Dead+1.0 Wind 270 deg+1.0 Ice+1.0 Temp 37 1.2 Dead+1.0 Wind 300 deg+1.0 Ice+1.0 Temp 38 1.2 Dead+1.0 Wind 330 deg+1.0 Ice+1.0 Temp 39 Dead+Wind 0 deg-Service 40 Dead+Wind 30 deg-Service 41 Dead+Wind 60 deg-Service 42 Dead+Wind 90 deg-Service 43 Dead+Wind 120 deg-Service 44 Dead+Wind 150 deg-Service 45 Dead+Wind 180 deg-Service 46 Dead+Wind 210 deg-Service 47 Dead+Wind 240 deg-Service 48 Dead+Wind 270 deg-Service 49 Dead+Wind 300 deg-Service 50 Dead+Wind 330 deg-Service Maximum Tower Deflections -Service Wind' Job Page n x Tower Beaver Valley, WA40442-A-01 2 of 4 FDH Engineering,Inc. Project Date 6521 Meridien Drive 1463F04400 14:59:31 04/15/14 Raleigh,North Carolina 27616 Client Designed by Phone:(919)755-1012 SBA Network Services, Inc. FAX:(919)755-1031 KDiaz Section Elevation Horz. Gov. Tilt Twist No. Deflection Load ft in Comb. Ll 150-98.25 8.762 44 0.6483 0.0052 L2 102-48.5 3.464 44 0.3701 0.0008 L3 54.25-1 0.860 44 0.1536 0.0002 Critical Deflections a nd Radius of Curvature - Service Wind Elevation Appurtenance Gov. Deflection Tilt Twist Radius of Load Curvature ft Comb. in ft 150.00 VHLP2-18 44 8.762 0.6483 0.0052 73991 149.00 APXVRRI3-C-A20 w/Mount Pipe 44 8.639 0.6423 0.0051 73991 144.00 VHLPI-23 44 8.026 0.6121 0.0045 61659 Maximum Tower Deflections - Design Wind Section Elevation Horz. Gov. Tilt Twist No. Deflection Load ft in Comb. ° Ll 150-98.25 31.526 12 2.3291 0.0185 L2 102-48.5 12.469 12 1.3324 0.0028 L3 54.25-1 3.094 12 0.5528 0.0007 Critical Deflections and Radius of Curvature - Design Wind Elevation Appurtenance Gov. Deflection Tilt Twist Radius of Load Curvature ft Comb. in ft 150.00 VHLP2-18 12 31.526 2.3291 0.0185 20636 149.00 APXVRR13-C-A20 w/Mount Pipe 12 31.084 2.3076 0.0181 20636 144.00 VHLP1-23 12 28.879 2.1998 0.0161 17196 Compression Checks 1 Pole Design Data Section Elevation Size L L„ Kl/r A P. 4IP„ Ratio No. P„ ft ft ft in2 K K gyp„ Ll 150-98.25(1) TP30.33x14.5x0.25 51.75 0.00 0.0 22.9583 -5.78 1638.66 0.004 L2 98.25-48.5(2) TP45.04x28.6829x0.3125 53.50 0.00 0.0 42.6204 -13.25 2869.19 0.005 L3 48.5-1(3) TP58.94x42.657x0.375 53.25 0.00 0.0 69.7070 -27.59 4450.19 0.006 • � � Job Page Beaver Valley, WA40442-A-01 3 of 4 FDH Engineering,Inc. Project Date 6521 Meridien Drive 1463F04400 14:59:31 04/15/14 Raleigh,North Carolina 27616 Client Designed by Phone:(919)755-1012 SBA Network Services, Inc. KDiaz FAX:(919)755-1031 Pole Bending Design Data Section Elevation Size M x OM„„ Ratio M y OMny Ratio No. M„ MY ft kip ft kip ft 4Mx kip ft kip ft 4M,, Ll 150-98.25(1) TP30.33x14.5x0.25 199.00 974.17 0.204 0.00 974.17 0.000 L2 98.25-48.5(2) TP45.04x28.6829x0.3125 510.11 2536.68 0.201 0.00 2536.68 0.000 L3 48.5-1(3) TP58.94x42.657x0.375 1014.99 5367.07 0.189 0.00 5367.07 0.000 Pole Shear Design Data I Section Elevation Size Actual r1V Ratio Actual OT„ Ratio No. V V„ T„ T ft K K 'V kip ft kip ft 4T Ll 150-98.25(1) TP30.33x14.5x0.25 5.23 819.33 0.006 0.53 1950.73 0.000 L2 98.25-48.5(2) TP45.04x28.6829x0.3125 7.89 1434.60 0.005 0.53 5079.57 0.000 L3 48.5-1(3) TP58.94x42.657x0.375 11.13 2225.09 0.005 0.53 10747.25 0.000 Pole Interaction Design Data Section Elevation Ratio Ratio Ratio Ratio Ratio Comb. Allow. Criteria No. P„ M„„ M, V„ T Stress Stress ft oPn rpM„x omny 4.V 4)T Ratio Ratio Ll 150-98.25(1) 0.004 0.204 0.000 0.006 0.000 0.208 1.000 4.82 1/ V J� L2 98.25-48.5(2) 0.005 0.201 0.000 0.005 0.000 0.206 1.000 4.8.2 y V L3 48.5-1(3) 0.006 0.189 0.000 0.005 0.000 0.195 1.000 4.8.2 V V Section Capacity Table Section Elevation Component Size Critical P 0P„u„w % Pass No. ft Type Element K K Capacity Fail Ll 150-98.25 Pole TP30.33x14.5x0.25 1 -5.78 1638.66 20.8 Pass L2 98.25-48.5 Pole TP45.04x28.6829x0.3125 2 -13.25 2869.19 20.6 Pass L3 48.5-1 Pole TP58.94x42.657x0.375 3 -27.59 4450.19 19.5 Pass Summary Pole(L1) 20.8 Pass RATING= 20.8 Pass Job Page t Tower Beaver Valley, WA40442-A-01 4 of 4 FDH Engineering,Inc. Project Date 6521 Meridien Drive 1463F04400 14:59:31 04/15/14 Raleigh,North Carolina 27616 Client Designed by Phone:(919)755-1012 SBA Network Services, Inc. ( FAX:(919)755-1031 KDiaz Program Version 6.1.4.1-12/17/2013 File://fdh-irvine/FDH-Irvine/Projects/2014 Effective-Client Jobs/SBANET_SBA Network Services, Inc/WA/WA40442-T_Beaver Valley-WA/1463FO4400/Analysis/WindBeaver Valley,WA40442-A.eri Square, Stiffened / Unstiffened Base Plate, Any Rod Material - Rev. F /G Assumptions: 1)Rod groups at corners. Total#rods divisible by 4. Maximum total#of rods=48(12 per Corner). 2)Rod Spacing=Straight Center-to-Center distance between any(2)adjacent rods(same corner) 3)Clear space between bottom of leveling nut and top of concrete not exceeding(1)*(Rod Diameter) Site Data Base Reactions BU#: TIA Revision: G Site Name: Factored Moment, Mu: 1015 ft-kips App#: Factored Axial, Pu: 28 kips Anchor Rod Data Factored Shear,Vu: 11 kips Eta Factor, n 0.5 TIA G(Fig.4-4) Qty: 16 Diam: 2.25 in Anchor Rod Results Rod Material: A615-J TIA G--> Max Rod (Cu+Vu/n): 49.3 Kips Yield, Fy: 75 ksi Axial Design Strength, cD*Fu*Anet: 260.0 Kips Strength, Fu: 100 ksi Anchor Rod Stress Ratio: 18.9% Pass Bolt Circle: 66 in Plate Data Base Plate Results Flexural Check PL Ref. Data W=Side: 64 in Base Plate Stress: 9.0 ksi Yield Line(in): Thick: 2.75 in PL Design Bending Strength, (1)*Fy: 54.0 ksi 31.57 Grade: 60 ksi Base Plate Stress Ratio: 16.7% Pass Max PL Length: Clip Distance: 0 l in 31.57 N/A-Unstiffened Stiffener Data(Welding at both sides) Stiffener Results Configuration: Unstiffened Horizontal Weld : N/A Weld Type: ** Vertical Weld: N/A Groove Depth: in** Plate Flex+Shear,fb/Fb+(fv/Fv)^2: N/A Groove Angle: degrees Plate Tension+Shear,ft/Ft+(fv/Fv)^2: N/A Fillet H.Weld: <--Disregard Plate Comp. (AISC Bracket): N/A Fillet V.Weld: in Pole Results Width: in Pole Punching Shear Check: N/A Height: in Moo PL Length Thick: in Y;e,d Line Notch: in a Aoeh°rs 5t ^ 5t t= BASE PL Grade: ksi Qty 4 p .14 NESS Weld str.: ksi ^n`h°r. TYP. Clear Space �� nssuMEO iN°r"oo �4T10N between \411-1 , 31-* Stiffeners at —_ B.C. in \ at put Clear Space 8 C for Single - Anchor Case Pole Data 9� Ai Pole w� DIAM D Diam: 58.94 in Anehor SPoe ng same As Thick: 0.375 in r Stlffener Spacing Excep{ for S�gnle Corner Grade: 65 ksi Anchor (inpat clear spore) #of Sides: 18 "0"IF Round Stress Increase Factor ASD ASIF: 1 1333; 1 **Note:for complete joint penetration groove welds the groove depth must be exactly 1/2 the stiffener thickness for calculation purposes Analysis date:4/15/2014 Monopole Analysis per 2012 IBC Project#: 1463F04400 Site Name: Beaver Valley Site ID: WA40442-T j3rnrr1 TNX], �al,Wt= 28.0 kips• lea',V 11.0 kips degrees minutes seconds Site La#itud§= 47 k 55 59.16 • 47.9331 degrees 5 e bbngitg0.0= 122 46 31..08 -122.7753 degrees ., Mass or f tens xe a "sties= Na (Table 2-9) Ground 0000rt4 5 *0 Yes V044s0 II. (Table 2-1) gitiffille§110MMESERA.10111.1.1.11[111111,11 INS leg $ aSS= :PH Stiff Soil (Table 2-11) w 5pe0tral respse acceleration short perk ,Ss= 1.277 pe��response accelera#ion 1 s period,Si= 0'•.519 ,L�SGS Seismic Too er Height tA :4),Hi 149.0 ft In 9 Ce F` ;tt}t`,I 1.0 (Table 2-3) III Acceleration-based site co f nt,Fa 1.0 (Table 2-12) :1111•1131 1 HO Velocity-based Site coe ici ent:4 ..! 1.5 (Table 2-13) Design a al response ac lera ioa short period,S0s= 0.851 (2.7.6) IMO Design spe€tral respons *o§ojeration 1,s: riod,Sn1-' 0.519 (2.7.6) j. alaa`Ced 0.568 (2.7.7.1) 'l base Seismic She.,ar,V _ 13.2 kips Appurtenance Wei t t top 3 s cture ,W„_' 2.1 kips Average Moment of lnertit la = 9234.3 in4 Fundamental j requency,,F1= 0.439 (2.7.11.2) Ffrelat-edunable.S1= 0.228 (2.7.8.1) .; al is 0.152 (2.7.7.1) Minimum C5= 0.037 (2.7.7.1) Minimum ;wren S1�0 =!.75 0.000 (2.7.7.1) c Fins=' 0.152 Alternative Base Seismic Shear,V.=; 3.5 kips Full seismic analysis is required by 2012 IBC for all sites. CCISeismic 2.0.07 Page 1 Analysis Date:4/15/2014 150.0 ft 9 !i DESIGNED APPURTENANCE LOADING i ' TYPE i ELEVATION TYPE 1 ELEVATION Seismic Discrete Force 1 152 Seismic Section Force 9 77 • F,.. Seismic Discrete Force 2 150 Seismic Linear Force 8 76 Seismic Discrete Force 3 149 Seismic Section Force 1067 Seismic Linear Force 1 1455 Seismic Linear Force 9 66 • r. Seismic Section Force 1 145 Seismic Section Force 11 57 Seismic Discrete Force 4 144 Seismic Linear Force 10 56 o _ o Seismic Linear Force 2 136 Seismic Section Force 12 50.25 m n Lo S 0 Seismic Section Force 2 135 Seismic Section Force 13 49.25 _.•c fO 4 o ' Seismic Linear Force 3 126 Seismic Linear Force 11 46 Seismic Section Force 3 125 Seismic Section Force 14 39.25 Seismic Linear Force 4 116 ---- Seismic Linear Force 12 36 Seismic Section Force 4 115 Seismic Section Force 15 29.25 Seismic Linear Force 5 106 Seismic Linear Force 13 26 Seismic Section Force 5 105 Seismic Section Force 16 19.25 Seismic Section Force 6 99.125 Seismic Linear Force 14 16 Seismic Section Force 7 97 Seismic Section Force 17 9.25 Seismic Linear Force 6 96 Seismic Linear Force 15 6.... Seismic Section Force 8 87 Seismic Section Force 18 2.625 rl Seismic Linear Force 7 !86 • fil 98.3 ft MATERIAL STRENGTH 1 GRADE Fy Fu 1 GRADE 1 Fy 1 Fu A572-65 65 ksi 80 ksi TOWER DESIGN NOTES 1. Tower is located in Jefferson County,Washington. 2. Tower designed for Exposure B to the TIA-222-G Standard. 3. Tower designed for a 85 mph basic wind in accordance with the TIA-222-G Standard. 4. Tower is also designed for a 30 mph basic wind with 0.25 in ice.Ice is considered to increase in thickness with height. 5. Deflections are based upon a 60 mph wind. P A W o O 6. Tower Structure Class II. 7. Topographic Category 1 with Crest Height of 0.00 ft N co 1 - 8 Q 0 8. TOWER RATING:13.6% G N '4 - I 11 48.5 ft ALL REACTIONS ARE FACTORED o o AXIAL o °r m v. O. 29K o SHEAR MOMENT 0 K ( V i 0 kip-ft I'' 30 mph WIND-0.2500 in ICE AXIAL 28 K I SHEAR MOMENT 4 K ( 467 kip-ft J L 1.o ft � 11 R REACTIONS-85 mph WIND a .. E. ° e Y c 0 m 3 c d a m v t e 'I J z iE y 12 m c.1 FDH Engineering,Inc. Job:Beaver Valley, WA40442-A-01 FOH 6521 Meridien Drive Project:1463F04400 Raleigh, North Carolina 27616 O11ent: SBA Network Services,Inc.Drawn by:KDiaZAPP'd Tower Analysis Phone:(919)755-1012 Code: TIA-222-G Date'04/15/14 Scale: N FAX:(919)755-1031 Path:—..<,a...,_----.._..—....m. .._.....:..wm...�.-..._.,Dwg No. FOUNDATION REACTION COMPARISON REACTIONS PER DESIGN *FACTORED CURRENT ANCHOR REACTIONS DESIGN REACTION % CAPACITY REACTIONS AXIAL(kips) 36.0 48.6 28.0 57.6% SHEAR(kips) 34.0 45.9 11.0 24.0% MOMENT(kip-ft) 3607.0 4869.5 1015.0 20.8% Design loads from: Sabre Job No. 06-06047 Although the axial and shear capacity is at 57.6% &24.0%, the moment reaction is the governing criteria for a monopole drilled shaft foundation. Therefore, the overall capacity for this foundation is 20.8% *Design loads were multiplied by 1.35 for comparison as allowed by TIA-222-G, Section 15.5.1. ■ 0 m O W D li n� mNUI Ono 7:1 x-w ' m I to xm xD -0 o D c) N m N O N >o i o > will ! 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AO C C m mf InN EE w �� 00 m Z8 m o x, °2-,JEFFERSON COUNTY SHiNG.CO� DEPARTMENT OF COMMUNITY DEVELOPMENT Date: t',,-gTime Received: 9.'tt r&pm Mon. Tue. Wed. 4WD Fri. Date: BLD: t=E' 1 - !g? Contact Name: Owner: Contact Number: 360 Address: (0, i3 JS st- K .. 206 Notes: '7 07 LtJ ?9 30 Foundation Plumbing Framing Propane Tank Mechanical Setbacks Under-ground Framing Underground Furance Footing Rough In Air Seal Above ground Gas Stemwall Hydronic Exterior shear Exterior lines Oil Straps Hot Water Htr Interior shear Interior lines Ducts Post Hole Ventilation Appliance Underfloor Gas/Wood stove Man-Homes Insulation Final Inspection ` - Setbacks Floor Foundation Wall Address Posted Block &Tile Ceiling