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BLD2014-00143
°BUILDING PERMIT APPLIGPION BLD14-00143 Review Type: Jefferson County Department of Community Development 621 Sheridan Street Port TOWrisend, WA 98368 PERMIT #: BLD14-00143 ReceivEd Date: 4/23/2014 SITE ADDRESS: 102 DHARMA RD CHIMACUM, 98325 OWNER: RANDAL HAUF RHONE: 613 N SANDY SHORE RD CHIMACUM WA 98325-9731 HAUF.SHORT P AT SUBDIVISION: blocks Lot: PARCEL NUMBER: 801112013 Section: 11 Township: 26 N RRarnie: 01 W CONTRACTOR: TBD PHONE: REPRESENTATIVE: JESSE LONDON PHONE: 206-523-1941 RYKA CONSULTING 918 S HORTON ST#1002 PROJECT DESCRIPTIOt Add (4) Microwave dishes to existing antenna array on existing monopole TYPE OF WORK COM SQUARE FOOTAGE: COMMERCIAL: TYPE OF IMP ADD MAIN: INDUSTRIAL: VALUATION 13,600.00 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 $201.00 MEB 04/23/14 148651 APPROVED Plan Check $130.65 MEB 04/23/14 148651 State Building Code $4.50 MEB 04/23/14 148651 MAY - 2 2014 Total: $336.15 Jefferson County DOD Mich ort. otolfnrmclC DI f1 Ann PIA re-4 Al P fllA gIY%C21SHAwt V/AIOY—W*ONLVAp—S1r1A1 —Yaw OIWmbah— Mr 0/, 2014 — 11*Zom I l; 0 41 z m O i z u • I — — PROPERTY UN 2, .4:.1� _ DHARMA RD. -- 1 9I 1 1 il I CI) _, oQ j 1 • a m �� I m IA 0 Ft .{ r (E) BUILDING r A —� o 0 u' Cl) 0 v - m 5 1 m c1 I m rr E Z UILOIN ir- N W O O •-: �i I g g I f n m m I D I G m m N IO 37 m 27 0 1 L (E) PROPERTY UNE (±700.0') N / 1 zm c � a xi o til pc, 0 1 A N" z� sz I oZ �-1 m co k m61.'N 1p m V ■ v °< � ACC SpT'�dj (v m �� °mC mW 0o Z �� x m c ; - ° to '1T N N =o� Oio ` zc� m ° yx° �•, °�' � gz - v c4i1T10p ooEs .— -14 CU 891 §'� � =• D r � vv w � r k- y� m • 2 X D�Pp��oDey Zoe Nr � co � � " 0 �1 � a C o 4 -i °z � g cC axA10 F°s o` m0 11 1 -I zmm °z j o Z nav a m C �j��c - /.� ° '' x -< T p wt. t a u a` 9� c oQ°m j ��mNnmmgnp �+ �'A _ to yD �25� VAAD-7 �+ /'J ° /771 A O � .1.‹. ,,� W (A zN 1'J\O 0 P2 A A A oil N • •SE72XC213 Beaver Valley Hauf JEFFERSON COUNTY DEPARTMENT OF COMMUNITY DEVELOPMENT fill°11$ 621 Sheridan Street• Port Townsend •Washington 98368 "1 —f 360/379-4450. 3601379-4451 Fax I �� '•t www.co.jefferson.wa.us/commdevelopment Master Permit Application MLA: Project Description(include separate sheets as necessary): Add (4) Microwave dishes to existing antenna array on existing monopole. Tax Parcel Number. 801112013 PropertySize:Lease area =23 0(acresisquare feel Site Address and/or Directions to Property: 100 Dharma Road Chimacum, WA 98325 Property Owner(s)of Record: Randal Hauf Telephone: Fax: email: Mailing Address: 613 N Sandy Shore Road Chimacum, WA 98325 Applican 7.1Z(if different from owner): Jesse London (Ryka Consulting) c/o Sprint Telephone: 206-523-1941 Fax: 206-260-7930 ermajlondon@rykaconsulting.com MailingAddress: 918 S. Horton St. #1002 Seattle, WA 98134 What kind of Permit?(Check each box that applies Building ❑Cdr.= . -=s Stewardship Plan ❑ Demolition Permit ❑Vari •-_ ' Majer or Reasonable Economic Use) ❑Single Family ❑Garage Attached!Detached ❑Con„i∎Ali I '^•, • , • C] ❑ Manufactured Home ❑ Modular ❑Di W . �<�' •t - `� -: 'cation El Commercial* ❑S•,r Line Adjustment v c 4.' ❑ Change of Use ❑B• .. j ❑ Address ❑ Road Approach ❑S tat "* ,-4.0''') , ❑Home Business ❑Cottage Industry ❑ •i •Ifg Site Plan"•- ' ^n; ❑Propane ❑ •ng ** ❑Sign ■ Planned Runt fesidential Develo• - •RRD)/Amendments** ❑Allowed'Yes°Use Consistency Analysis ❑ •lat-VaEa�erattei "`, ❑Stormwater Management ❑Shoreline fogrO Exem�tio •=rmit Revisions** ❑Site Plan Approval Advance Determination(SPAAD)* ❑Shoreline Manage ment.Sifts* al De =,opment** • ❑Temporary Use ❑Shoreline Management Varia ®Wireless Telecommunication* ❑Comprehensive Plan/UDC/Land Use 'istrict 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 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,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- 'de access and right of entry to Jefferson County and its employees,representatives or agents for the sole purpose of application review and any later in=•=• ons. Staffs access and right of entry will be assumed unless the applicant informs the County in writing at the time of the ap• or she wants prior notice. _-. Signature: a�aw Date: The action or actions Applicant will undertake as a result of the Issuance of this permit may negatively impact pon 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 Ac'or"ESA."Jefferson County makes no assurances to the applicant that the actions that will be undertaken because this permit has been ed — violate the ESA. Any individual,group or agency can file a lawsuit on behalf of an endangered species regarding your action(s)eve f you -4 •ce with the Jefferson County development code.The Applicant acknowledges that he,she or It holds individual and r.-•.•• ••'• •r a• _ - - •• •copying with the ESA. The Applicant has read this disgalpter pnft�flips and dates it below. !!!l Si• Date: // � [T/ G:\PennitCenter\###FORMS###\DRD FORMS\Master Permit Application 5-29-08.doc ._ lie • • BUILDER STATEMENT The signer of this statement does hereby certify that they are the Owners of the parcel referenced herein,that they are not licensed contractors and that they will be assuming the responsibility of the General Contractor for the proposed project. Signature: Date: GENERAL CONTRACTOR OR MANUFACTURED HOME INSTALLER: PHONE: FAX: TBD (will notify upon issuance if req. ) ( ) ( ) MAILING ADDRESS: EMAIL: CONTRACTOR'S LICENSE WAINS NUMBER: - NUMBER ARCHITECT/ENGINEER: Cornerstone Engineering, Inc PHONE (425) 487-1732 FAX:( ) MAILINGADDRESS-6928 woociinville-Redmond Rd. 1#211QWJL Project Type: Frame Type: ' Bathrooms: N/A Shoreline: Type of Sewage Disposal: ❑ New 0 Wood Existing: ❑ Sewer N/A ❑ Addition ❑ Steel Proposed: Bank ❑ Community System x Alteration/Remodel ❑ Concrete Total: Height: ❑ Individual System ❑ Repair 0 Masonry 11 A SEP Permit# ❑ Demolition Other. Bedrooms: N/A Water Supply: Tower Existing: Setback: ❑ Private well ❑ Two Party Type of Heat: Proposed: ❑ Public N/A Total: Name of System: If this is a Commercial Protect you must answer the following: Number of Parking Spaces: Current: N/A Proposed: N/A Number of ADA Parking Spaces: N/A Number of occupants(includes owners,tenants,employees,etc) Current N/A Proposed N/A a IBC Occupancy: N/A IBC Type of construction: Te I ecomm. Will you have Food Service? 16:ALF)] If this is a Propane Tank and/or Appliance Installation permit.mark all items below that apply: N/A I Underground Tank I Above ground Tank Size of Propane Tank: I Heat Stove I Cook Stove I Woodstove I Fireplace Insert I Hot Water Tank 1 Pellet Stove I Other Is this appliance being installed in a Manufactured I Mobile Home? Yes / No N/A When applying fora 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. So uare Foota a Current Proceed ` `. 1 ;. ,: t-" k,s,' Main Floor Heated ;,,_ EH Bld App Review: 2"°Floor Heated ' Consistency Review: Other Heated Base fee: Mezzanine ' Additional Section: Heated Basement //i „p `. fee: Unheated Basement � ro 3 , ;r -urchargefee: — I Other Unheated I, , 't,..;;;f •• : er Review fee: Garage/Carport I SUBTOTAL c? Decks - "d Approach fee: Other TOTAL: $ Microwave dish ° Receipt Number: a. CashlCheck Number. ESTIMATED COST(REQUIRED) Date: .Fair market value of all labor and materials foundation to finish $13, 600 Initials: G:\PetmitCenter\###FORMS###\DRD FORMS\Masm Petnut Application 5-29-08.doc JEFFERSON COUNT./ OW NO. •8651 DATE ' Z4-17 / - RECEIVED FROM 6e41.12444 t:59&/11/6-15 I� �4 DESCRIPTION BARS# 2-4- ,'AMOUNT CURRENCY (b4.1441 y//►y , .Y t COIN l(/141/1 / 7°. J i= '. 43"-C N 22et. 00 ~, 1II Pm 331° ' y�co co �s �, c RECEIVED BY TOTAL 5104, I5 Moe, I am prepared to make the fee request for the last Jefferson County site. SE72XC213 I $564.15 I Beaver Valley Hauf I Jefferson County f Thanks, Jesse From: Mary Blain [mailto:mblain @co.jefferson.wa.us] Sent: Tuesday,July 30, 2013 2:39 PM To: Jesse London Subject: RE: Master Permit Application; Fee quote request Jesse, SE72XC213-Beaver Valley Hauf has a permit fee of$564.15, broke down as follows: Base fee:$201.00 Plan Check: $130.65 Consistency Review:$228.00 State:$4.50 And just a reminder like before,a complete building application consists of: • Master Permit Application—signed and completed • Three sets of plans(one must be 11 x 17 to facilitate planning review and copying the other two sets can be larger) o Within the plans there must be current elevations and proposed elevations o Include site plan and leased area • Two sets of structural analysis • Stormwater caic sheet(if the proposal includes any ground equipment or land disturbing activity) • For anything that is stamped by a licensed profession(like a PE)one original wet stamped set must be submitted any others can be copies. • Fees My apologies for taking so long to get these to you. Please let me know if I missed anything,or if you need me to email you other documents so you can complete them...the website can be a little difficult to navigate sometimes. O Thanks! Mary Blain ; L Permit Technician �� I I, J �� Dept of Community Development I J I T. 621 Sheridan St pq Port Townsend,WA 98368 ph: 360-379-4452 Li a fax: 360-379-4451 'CJUNNTY 7 PTO t o �Y 'FI(PM mblain@co.jefferson.wa.us 11W' 5y*( Memo To: Jefferson County From: Jesse London Date: 4/17/2014 Re: Building Permit Application for Sprint SE72XC213 Beaver Valley Huff Enclosed, please find enclosed the building permit application for the above mentioned Sprint Spectrum wireless site(s). Please acknowledge receipt of this package by signing below and faxing (206-260-7930) or emalling to jlondon @rykaconsulting.com. Received by Jefferson County: Signature: Date Recd: Permit # Assigned: APR 2 i 2'71 LLS L JLFi -C CjIJI Sincerely, P P-PI (r',"^f1V-)'DT P' fr'Vi Nq Jesse London Ryka Consulting on behalf of Sprint Spectrum 206523.1941 Ryka Consulting I 919 S. Horton St #1002 Seattle, WA 98134 Memo To: Jefferson County From: Jesse London Re: Permit Submittal Package — Sprint SE72XC213 Beaver Valley Hauf (MW) Hello, Attached are the following documents for the building permit submittal package for 9 9P P 9 Sprint's site located at 735 N Sandy Shore Road: • Master Permit Application • Master Permit Fee and back up documentation • (3) sets of 11 x 17 plans • (2) sets of stamped structural analysis • (1) copy of the Lease between Sprint Spectrum and Verizon Wireless (Managed by American Tower) • Pre-paid postage to return issued Building Permit If you have any questions please feel free to contact me at (206) 523.1941. Sincerely, �, ,a 40 i Jesse 'ins Ryka Consulting osf CO"41b,(, , oUA7y hITV DFiF�Ph1F�T Ryka Consulting 1 918 S. Horton Street Suite 1002 Seattle, WA 98134 • • Site:WA-0817B-Beaver Valley Market: PNW COMMUNICATIONS SITE LEASE AGREEMENT(GROUND) This COMMUNICATIONS SITE LEASE AGREEMENT("Agreement")is dated as of BCD , 2005, by NEXTEL WEST CORP., a Delaware corporation, d/b/a Nextel Communications (" el" or "Tenant") and ROGER L. HAUF and ROBIN L.HAUF, husband and wife("Owner"or"Landlord"). For One Dollar($1.00) paid to Owner, and other good and valuable consideration the receipt and sufficiency of which are hereby acknowledged,the parties hereto agree as follows: 1. Premises. Owner owns a parcel of land ("Land") located in the city of Chimacum, County of Jefferson, State of Washington, commonly known as 735 North Sandy Shore Road, Chimacum,WA 98325(APN: 801112002). The Land is more particularly described in Exhibit A annexed hereto. Subject to the provisions of Paragraph 2 below ("Effective ("Premises"), as may be described generally in Exhibit B annexed hereto. 2. Effective Date/Due Diligence Period. This Agreement shall be effective on the date of full execution hereof ("Effective Date"). Beginning on the Effective Date and continuing until the Term Commencement Date as defined in Paragraph 3 below("Due Diligence Period"), Nextel shall only be permitted to enter the Land for the limited purpose of making appropriate engineering and boundary surveys, inspections, and other reasonably necessary investigations and signal, topographical, geotechnical, structural and environmental tests (collectively, "Investigations and Tests") that Nextel may deem necessary or desirable to determine the physical condition, feasibility and suitability of the Premises. In the event that Nextel determines, during the Due Diligence Period, that the Premises are not appropriate for Nextel's intended use, or if for any other reason, or no reason, Nextel decides not to commence its tenancy of the Premises,then Nextel shall have the right to terminate this Agreement without penalty upon written notice to Owner at any time during the Due Diligence Period and prior to the Term Commencement Date. Owner and Nextel expressly acknowledge and agree that Nextel's access to the Land during this Due Diligence Period shall be solely for the limited purpose of performing the Investigations and Tests, and that Nextel shall not be considered an owner or operator of any portion of the Land, and shall have no ownership or control df any portion of the Land (except as expressly provided in this Paragraph 2), prior to the Term Commencement Date. 3. Term. The term of Nextel's tenancy hereunder shall commence upon the start of construction of the Tenant Facilities (as defined in Paragraph 6 below)or eighteen (18) months following the Effective Date, whichever first occurs ("Term Commencement.Date") and shall terminate on the fifth anniversary of the Term Commencement Date ("Term") unless otherwise terminated as provided herein. Tenant shall have the right to extend the Term for five (5) successive five (5) year periods ("Renewal Terms") on the same terms and conditions as set forth herein. This Agreement shall automatically be extended for each successive Renewal Term unless Tenant notifies Landlord of its intention not to renew prior to commencement of the succeeding Renewal Term. 4. Rent. month ("Rent"). Rent for any fractional month at the beginning or at the end of the Term or Renewal Term shall be prorated. Rent shall be payable to Landlord at 735 North Sandy Shore Road, Chimacum,WA 98325; Attention: Roger L. Hauf. All of Tenant's monetary obligations set forth in this Agreement are conditioned upon Tenant's receipt of an accurate and executed W-9 Form from Landlord. (b) Rent shall be increased on each anniversary of the Term Commencement Date by an amount equal to two percent(2%)of the Rent in effect for the previous year. 5. Use. From and after the Term Commencement Date,the Premises may be used by Tenant for any lawful activity in connection with the provision of communications services, and Tenant shall have the ongoing right to perform such Revised 10/15/2004 • Investigations and Tests as Tenant may deem necessary or desirable. Landlord agrees to cooperate with Tenant, at no out of pocket expense to Landlord, in making application for and obtaining all licenses, permits and any and all other necessary approvals that may be required for Tenant's intended use of the Premises. 6. Facilities; Utilities; Access. (a) Tenant has the right to construct, erect, maintain, test, replace, remove, operate and upgrade on the Premises communications facilities, including without limitation an antenna tower or pole and foundation, utility lines, transmission lines, an air conditioned equipment shelter(s), electronic equipment, transmitting and receiving antennas, microwave dishes, antennas and equipment, a power generator and generator pad, and supporting equipment and structures therefor ("Tenant Facilities"). In connection therewith, Tenant has the right to do all work necessary to prepare, maintain and alter the Premises for Tenant's business operations and to install transmission lines connecting the antennas to the transmitters and receivers. All of Tenant's construction and installation work shall be performed at Tenant's sole cost and expense and in a good and workmanlike manner. Tenant shall hold title to the Tenant Facilities and all of the Tenant Facilities shall remain Tenant's personal property and are not fixtures. Tenant has the right to remove the Tenant Facilities at its sole expense on or before the expiration or earlier termination of this Agreement, and Tenant shall repair any damage to the Premises caused by such removal. Upon the expiration or earlier termination of this Agreement, Tenant shall remove the Tenant Facilities from the Land, but is not required to remove any foundation more than one(1)foot below grade level. (b) Tenant shall pay for the electricity it consumes in its operations at the rate charged by the servicing utility company. Tenant shall have the right to draw electricity and other utilities from the existing utilities on the Land or obtain separate utility service from any utility company that will provide service to the Land. In connection therewith, Landlord hereby grants to the local telephone, power and utility companies (as appropriate) non-exclusive rights to locate, construct, install, operate, maintain, repair, replace, alter, extend, and/or remove cables and lines on, over, under and across a portion of Landlord's Property as necessary or desirable therefor. Landlord agrees to sign such documents or easements, at no cost to Tenant or the utility companies, as may be required by said utility companies to provide such service to the Premises. Any easements necessary for such power or other utilities will be at locations reasonably acceptable to Landlord and the servicing utility company. (c) Tenant, Tenant's employees, agents and contractors shall have access to the Premises without notice to Landlord twenty-four (24) hours a day, seven (7) days a week,at no charge. Landlord grants to Tenant, and Tenant's agents, employees and contractors, a non-exclusive right and easement for pedestrian and vehicular Ingress and egress across the Land, and such right and easement may be described generally in Exhibit B. (d) Landlord shall maintain all access roadways from the nearest public roadway to the Premises in a manner sufficient to allow pedestrian and vehicular access at all times under normal weather conditions. Landlord shall be responsible for maintaining and repairing such roadways, at its sole expense, except for any damage caused by Tenant's use of such roadways. Notwithstanding the foregoing, Tenant may construct an access road to the Premises ("Access Road"), across the Land as more fully described in Exhibit B, if Tenant reasonably determines such Access Road is necessary for Tenant's ingress to and egress from the Premises. Tenant shall be responsible for maintaining and repairing such Access Road until the expiration or earlier termination of this Agreement,at its sole expense, less reasonable wear and tear or loss by casualty or other causes beyond Tenant's reasonable control. Landlord shall be responsible for any damages to the Access Road caused by use of the Access Road by Landlord, or Landlord's agents, employees, licensees, invitees or contractors, and shall be responsible for maintaining and repairing the Access Road from and after the expiration or earlier termination of this Agreement,which costs shall be Landlord's sole responsibility. 7. Interference. (a) Tenant shall operate the Tenant Facilities in compliance with all Federal Communications Commission ("FCC") requirements including those prohibiting interference to communications facilities of Landlord or other lessees or licensees of the Land, provided that the installation and operation of any such facilities predate the installation of the Tenant Facilities. (b) Subsequent to the installation of the Tenant Facilities, Landlord will not, and will not permit its lessees or licensees to, install new equipment on or make any alterations to the Land or property contiguous thereto owned or 2 A:\WA0817 B Lease(red)(ver 2)062305.doc 06/24/2005 i • S controlled by Landlord, if such modifications are likely to cause interference with Tenant's operations. In the event interference occurs, Landlord agrees to use best efforts to eliminate such interference in a reasonable time period. Landlord's failure to comply with this paragraph shall be a material breach of this Agreement. 8. Taxes. If personal property taxes are assessed,Tenant shall pay any portion of such taxes directly attributable to the Tenant Facilities. Landlord shall pay when due all real property taxes, assessments and deferred taxes on the Land. 9. Waiver of Landlord's Lien. (a) Landlord waives any lien rights it may have concerning the Tenant Facilities, all of which are deemed Tenant's personal property and not fixtures, and Tenant has the right to remove the same at any time without Landlord's consent. (b) Landlord acknowledges that Tenant has entered into a financing arrangement including promissory notes and financial and security agreements for the financing of the Tenant Facilities ('Collateral') with a third party financing entity (and may in the future enter into additional financing arrangements with other financing entities). In connection therewith, Landlord (i)consents to the installation of the Collateral; (ii)disclaims any interest in the Collateral, as fixtures or otherwise; and (iii) agrees that the Collateral shall be exempt from execution, foreclosure, sale, levy, attachment, or distress for any Rent due or to become due and that such Collateral may be removed at any time without recourse to legal proceedings. 10. Termination. This Agreement may be terminated without further liability on thirty(30)days prior written notice as follows: (i) by either party upon a default of any covenant or term hereof by the other party, which default is not cured within sixty(60)days of receipt of written notice of default, except that this Agreement shall not be terminated if the default cannot reasonably be cured within such sixty(60)day period and the defaulting party has commenced to cure the default within such sixty (60) day period and diligently pursues the cure to completion; provided that the grace period for any monetary default is ten (10) days from receipt of written notice; or (ii) by Tenant if it does not obtain or maintain any license, permit or other approval necessary for the construction and operation of the Tenant Facilities; or(iii) by Tenant if Tenant is unable to occupy and utilize the Premises due to an action of the FCC, including without limitation, a take back of channels or change in frequencies; or(iv) by Tenant if any environmental report for the Land reveals the presence of any Hazardous Material after the Term Commencement Date;or(v)by Tenant if Tenant determines that the Premises are not appropriate for its operations for economic or technological reasons, including, without limitation, signal interference; or(vi)by Tenant if the Landlord fails to deliver to Tenant an executed memorandum of agreement or non-disturbance and attornment agreement pursuant to Paragraphs 18(g)and(h)below. 11. Destruction or Condemnation. If the Premises or Tenant Facilities are damaged, destroyed, condemned or transferred in lieu of condemnation, Tenant may elect to terminate this Agreement as of the date of the damage, destruction, condemnation or transfer in lieu of condemnation by giving notice to Landlord no more than forty-five (45) days following the date of such damage, destruction, condemnation or transfer in lieu of condemnation. If Tenant chooses not to terminate this Agreement, Rent shall be reduced or abated in proportion to the actual reduction or abatement of use of the Premises. 12. Insurance. (a) Tenant, at Tenant's sole cost and expense, shall procure and maintain commercial general liability ('CGL") insurance covering bodily injury and property damage with a combined single limit of at least One Million and 00/100 Dollars ($1,000,000.00) per occurrence. Subject to the standard exclusions and limitations of CGL policies, such insurance shall insure, on an occurrence basis,against all liability of Tenant, its employees and agents arising out of or in connection with Tenant's use of the Premises, all as provided for herein. Within thirty (30) days following the Effective Date, Tenant shall provide Landlord with a certificate of insurance ('COI') evidencing the coverage required by this Paragraph 12. Alternatively, Tenant shall have the option of providing Landlord with evidence of such coverage electronically by providing to Landlord a Uniform Resource Locator ("URL") Link to access Tenant's memorandum of insurance("MOP)website in order for Landlord to review the coverage required by this Paragraph 12. 3 MWA0817 B Lease(red)(ver 2)062305.doc 06/24/2005 • 13. Liability and Indemnity. Landlord and Tenant shall each indemnify, defend and hold the other harmless from and against all claims, losses, liabilities, damages, costs, and expenses(including reasonable attorneys' and consultants' fees, costs and expenses) (collectively"Losses") arising from the indemnifying party's breach of any term or condition of this Agreement or from the negligence or willful misconduct of the indemnifying party or its agents, employees or contractors in or about the Land. The duties described in this Paragraph 13 shall apply as of the Effective Date of this Agreement and survive the termination of this Agreement. 14. Assignment and Subletting. Tenant may not sublet or license the Premises or any portion thereof without the prior written consent of Landlord,which consent shall not be unreasonably withheld, conditioned or delayed. Tenant may assign this Agreement, which assignment shall be evidenced by written notice thereof to Landlord within a reasonable period of time thereafter. Upon assignment, Tenant shall be relieved of all future performance, liabilities, and obligations under this Agreement, provided that the assignee assumes all of Tenant's obligations herein. Landlord may assign this Agreement,which assignment may be evidenced by written notice to Tenant within a reasonable period of time thereafter, provided that the assignee assumes all of Landlord's obligations herein, including but not limited to, those set forth in Paragraph 9("Waiver of Landlord's Lien')above. This Agreement shall run with the Land and shall be binding upon and inure to the benefit of the parties, their respective successors, personal representatives, heirs and assigns. Notwithstanding anything to the contrary contained in this Agreement,Tenant may assign, mortgage, pledge, hypothecate or otherwise transfer without notice or consent its interest in this Agreement to any financing entity, or agent on behalf of any financing entity to whom Tenant (i) has obligations for borrowed money or in respect of guaranties thereof, (ii) has obligations evidenced by bonds, debentures, notes or similar instruments, or(iii) has obligations under or with respect to letters of credit, bankers acceptances and similar facilities or in respect of guaranties thereof. 15. Warranty of Title and Quiet Enjoyment. Landlord warrants that: (i) Landlord owns the Land in fee simple, has rights of access thereto from the nearest public roadway, which Tenant is legally permitted to use, and the Land and access rights are free and clear of all liens, encumbrances and restrictions except those of record as of the Effective Date; and(ii) Landlord covenants and agrees with Tenant that Tenant may peacefully and quietly enjoy the Premises and such access thereto, provided that Tenant is not in default hereunder after notice and expiration of all cure periods. 16. Repairs. Tenant shall repair any damage to the Premises or Land caused by the negligence or willful misconduct of Tenant. Except as set forth in Paragraph 6(a) above, upon expiration or termination hereof, Tenant shall repair the Premises to substantially the condition in which it existed upon start of construction, reasonable wear and tear and loss by casualty or other causes beyond Tenant's reasonable control excepted. 17. Hazardous Material. (a) As of the Effective Date of this Agreement: (1) Tenant hereby represents and warrants that it shall not use,generate, handle, store or dispose of any Hazardous Material in, on, under, upon or affecting the Land in violation of any Environmental Law(as defined below), and (2) Landlord hereby represents and warrants that(i)it has no knowledge of the presence of any Hazardous Material located in, on, under, upon or affecting the Land in violation of any Environmental Law; (ii) no notice has been received by or on behalf of Landlord from, and Landlord has no knowledge that notice has been given to any predecessor owner or operator of the Land by, any governmental entity or any person or entity claiming any violation of, or requiring compliance with any Environmental Law for any environmental damage(or the presence of any Hazardous Material) in, on, under, upon or affecting the Land; and (iii) it will not permit itself or any third party to use, generate, handle, store or dispose of any Hazardous Material in, on, under, upon, or affecting the Land in violation of any Environmental Law. (b) Without limiting Paragraph 13, Landlord and Tenant shall each indemnify, defend and hold the other harmless from and against all Losses (specifically including, without limitation, attorneys', engineers', consultants' and experts'fees, costs and expenses) arising from (i) any breach of any representation or warranty made in this Paragraph 17 by such party; and/or(ii) environmental conditions or noncompliance with any Environmental Law(as defined below) that result, in the case of Tenant, from operations in or about the Land by Tenant or Tenant's agents, employees or contractors, and in the case of Landlord,from the ownership or control of, or operations in or about, the Land by Landlord 4 A:\WA0817 B Lease(red)(ver 2)062305.doc 06/24/2005 or Landlord's predecessors in interest, and their respective agents, employees, contractors, tenants, guests or other parties.The provisions of this Paragraph 17 shall apply as of the Effective Date of this Agreement and survive termination of this Agreement. (c) "Hazardous Material' means any solid, gaseous or liquid wastes (including hazardous wastes), regulated substances, pollutants or contaminants or terms of similar import, as such terms are defined in any Environmental Law, and shall include, without limitation, any petroleum.or petroleum products or by-products,flammable explosives, radioactive materials, asbestos in any form, polychlorinated biphenyls and any other substance or material which constitutes a threat to health, safety, property or the environment or which has been or is in the future determined by any governmental entity to be prohibited, limited or regulated by any Environmental Law. (d) "Environmental Law"means any and all present or future federal, state or local laws, rules, regulations, codes, ordinances, or by-laws, and any judicial or administrative interpretations thereof, including orders, decrees, judgments, rulings, directives or notices of violation,that create duties, obligations or liabilities with respect to: (i) human health; or(ii)environmental pollution, impairment or disruption, including, without limitation, laws governing the existence, use, storage, treatment, discharge, release, containment, transportation, generation, manufacture, refinement, handling, production, disposal, or management of any Hazardous Material, or otherwise regulating or providing for the protection of the environment. 18. Miscellaneous. (a) This Agreement constitutes the entire agreement and understanding between the parties, and supersedes all offers, negotiations and other agreements concerning the subject matter contained herein. Any amendments to this Agreement must be in writing and executed by both parties. (b) Both parties represent and warrant that their use of the Land and their real and personal property located thereon is in compliance with all applicable, valid and enforceable statutes, laws, ordinances and regulations of any competent government authority. (c) If any provision of this Agreement is invalid or unenforceable with respect to any party, the remainder of this Agreement or the application of such provision to persons other than those as to whom it is held Invalid or unenforceable, shall not be affected and each provision of this Agreement shall be valid and enforceable to the fullest extent permitted by law. (d) This Agreement shall be binding on and inure to the benefit of the successors and permitted assignees of the respective parties. (e) Any notice or demand required to be given herein shall be made by certified or registered mail, return receipt requested,or reliable overnight courier to the address of the respective parties set forth below: Landlord: Tenant: Roger and Robin Hauf Nextel West Corp. 735 North Sandy Shore Road 1255 Treat Blvd.Suite 800 Chimacum,WA 98325 Walnut Creek,CA 94597-7982 Attn: Roger L.Hauf Attn: Property Services Phone:(360)732-4326 Phone:(800)275-9084 With a copy to: Nextel Communications, Inc. 2001 Edmund Halley Drive Reston,VA 20191-3436 5 A:1WA0817 B Lease(red)(vex 2)062305.doc 0624/2005 , • • • { Attn: Contracts Manager-Legal Landlord or Tenant may from time to time designate any other address for this purpose by written notice to the other party.All notices hereunder shall be deemed received upon actual receipt or refusal to accept delivery. (f) This Agreement shall be governed by the laws of the State of Washington. (g) Landlord agrees to execute and deliver to Tenant a Memorandum of Agreement in the form annexed hereto as Exhibit C and acknowledges that such Memorandum of Agreement will be recorded by Tenant in the official records of the County where the Land is located. • (h) In the event the Land is encumbered by a mortgage or deed of trust, Landlord agrees to obtain and deliver to Tenant an executed and acknowledged non-disturbance and attornment instrument for each such mortgage or deed of trust in a recordable form reasonably acceptable to both parties. (I) Landlord agrees to fully cooperate with Tenant (including obtaining and/or executing necessary documentation)to clear any outstanding title issues that could adversely affect Tenant's interest in the Premises created by this Agreement (j) In any case where the approval or consent of one party hereto is required, requested or otherwise to be given under this Agreement,such party shall not unreasonably delay or withhold its approval or consent. (k) Each of the parties hereto represent and warrant that they have the right, power, legal capacity and authority to enter into and perform their respective obligations under this Agreement. (I) Both parties took part in the negotiation of this Agreement and agree that legal concepts intended to construe the Agreement against the drafter will not apply against either party. (m) In the event of any breach or default by either party, the other party shall be entitled to all rights and remedies provided for in this Agreement and/or available at law, in equity, by statute or otherwise, all of which rights and remedies shall be cumulative(and not exclusive). (n) The captions and headings in this Agreement are for convenience only and in no way define,-limit or describe the scope or intent of any provision of this Agreement. (o) All Recitals set forth above, and all Riders and Exhibits annexed hereto, form material parts of this Agreement and are hereby incorporated herein by this reference. (p) This Agreement may be executed in duplicate counterparts,each of which shall be deemed an original. 19. Supplier Diversity. Nextel is committed to equal employment and vendor diversity.As part of this commitment, it is the policy of Nextel that small business concerns, veteran-owned small business concerns, HUBZone small business concerns, women-owned small business concerns, small disadvantaged business concerns (including 8(a) business concerns) and historically black colleges and universities and minority institutions ("Diverse Suppliers,"as further defined below)shall have the maximum practicable opportunity to participate in performance of contracting between Nextel and its vendors. The term "Diverse Supplier(s)"shall mean and be defined as set forth in Federal Acquisition Regulation Part 19 and 13 C.F.R. Part 121. In addition, "Historically black colleges and universities," as included in the definition of"Diverse Suppliers" for purposes of this Agreement, shall mean and include institutions determined by the Secretary of Education to meet the requirements of 34 C.F.R. Section 608.2;any nonprofit research institution that was an integral part of such a college or university before November 14, 1986; and "Minority institutions," as included, in the definition of "Diverse Suppliers" for purposes of this Agreement, shall mean institutions meeting the requirements of Section 1046(3) of the Higher Education Act of 1965 (20 U.S.C. §1135d-5(3)); and also Hispanic-serving institutions as defined in Section 316(b)(1) of such Act (20 U.S.C. §1059c(b)(1)). Landlord shall confirm in the space below whether or not Landlord reasonably believes it qualifies as a Diverse Supplier. • ***SIGNATURES ON FOLLOWING PAGE*** 6 A:1WA0817 B Lease(red)(ver 2)062305.doc 06/242005 S IN WITNESS WHEREOF,the parties have executed this Agreement as of the date of the last signature below. LANDLORD: TENANT: ROGER L. HAUF and ROBIN L. HAUF, NEXTEL WEST CORP., husband and wife a Delaware corporation, d/b/a Nextel Communications By' By: Name: Roger L.Haut L Name: Mary Murdoch II Title: Owner // Title: Director of Site Development,NorCal/PNW • Date: /2rD/4405/ Date: 6o'e�o"og Tax ID.: f-33— �7 Z `�°�i 7 _ By: Name Robin L. Hauf- Title: Owner Date: 6 _ AR-- OS Tax I.D.: 65--33' Diverse Supplier. YES NO ***ALL SIGNATURES MUST BE ACKNOWLEDGED*** ***ACKNOWLEDGEMENTS ON FOLLOWING PAGE*** 7 A:\WA0817 B Lease(red)(ver 2)062305.doc 0624/2005 STATE OF Washington COUNTY OF h On 3k.di , before me, Gt.--(ca,14otary Public, personally appeared Roger L. Hauf, personally known to me (or proved to me on the basis of satisfactory evidence) to be the person whose name is subscribed to the within instrument and acknowledged to me that they executed the same in their authorized capacity, and that by their signature on the instrument, the person, or the entity upon behalf of which the person acted, executed the instrument. B�a1°7FWSA N00fr*R, WITNES my h-r'd officials 0 '.4 0 ••00.fxo•.,! s` /• / • i , (SE ) ,01"AR •t*1 . Notar Pub y'11�•;`�Amo,400' FS My commission expires: �b 9rFOF�VPS� , aa34100- STATE OF Washington COUNTY OF Iid4E �� �/J� • On 1j it� before me, �' ��tt� +�— ,� Notary Public, personally appeared Robin L. Hauf, personally known to me (or proved to me o e basis of satisfactory evidence) to be the person whose name is subscribed to the within instrument and ackno edged to me that they executed the same in their authorized capacity, and that by their signature on the instrument, the person, or the entity upon behalf of which the person acted, executed the instrument. WITNESS y hay. . •' 0 cial sea tor,ffilmioN ' Notalubi • o ,' �,oTAR r My commission expires: — *; '� a of wns�� 8 A:\WA0817 B Lease(red)(ver 2)062305.doc 06/24/2005 • • • EXHIBIT A DESCRIPTION OF LAND to the Agreement dated , 2005, by and between ROGER L. HAUF and ROBIN L. HAUF, husband and wife as Landlord, and NEXTEL WEST CORP., a Delaware corporation, d/b/a Nextel Communications, as Tenant. The Land is described and/or depicted as follows(metes and bounds description): APN:801112002 LEGAL DESSCRIPTLON That portion, of the Northwest 1/4 and the Northeast 1/4 of the Southwest 1/4 of Section 11, Township 28 North, Range 1 West, W.M. , described as follows, to wit: From a 4" post designated as the 1/4 corner between Sections 10 and 11 in said Township and Range, run thence East along the North line of the Northwest 1/4 of the Southwest 1/4 of said Section 3.1, 330.0 feet to the E P0� OP BEGINNING; thence turning on a 90 angle and running North 1650.0 feet; thence turning on a 90' angle and running East 1856.0 feet; thence turning on a 90° angle and running South 1815.0 feet; thence turning on a 90 angle and running West 866.0 feet to intersect the East line of the Northwest 1/4 of the Southwest 1/4 of said Section 11; thence North along said East line, 165.0 feet; thence West along the North line of the Northwest 1/4 of the Southwest 1/4 of said Section 11, 990.0 feet to the TRUE POINT OF BEGINNING; EXCEPTING THEREFROM the right of way of the existing county road; ALSO EXCEPTING THERFrFROM the following described Parcels A through F: PARCEL A: The South 550 feet of the West 396 feet of the above described parcel. PARCEL B: The North 550 feet of the South 1100 feet of the West 396 feet of the above described parcel. PARCEL C: The North 550 feet of the South 1650 feet of the West 396 feet of the above described parcel. PARCEL Dr The North 447.53 feet of the East 486.67 feet of the West 8B2.67 feet of the above described parcel. PARCEL E: The. North 447.53 feet of the East 486.67 feet of the West 1369.34 feet of the above described parcel. PARCEL F: The North 447.53 feet of the Ease 486.66 feet of the West 1856.01 feet of the above described. parcel. Situate in the County of Jefferson, State of Washington. • • EXHIBIT B DESCRIPTION OF PREMISES to the Agreement dated , 2005, by and between ROGER L. HAUF and ROBIN L. HAUF, husband and wife as Landlord, and Nextel West Corp.,a Delaware corporation, dlb/a Nextel Communications,as Tenant The Premises are described and/or depicted as follows: 1 ; Property Lines Proper Lines t— 130' Setback North (P) 15'wide Nextel Access easement over (P)gravel road err (approx 150' from 1.____....* Dharma Road to Lease i'" Area) (P)5'wide Nextel (E)Power (P)Nextel utilities easement 130' Setback Pole Approx.40'x power/telco(approx. 40'Lease Area 150'from(E)pole to Lease Area) (P) 15'Wide Nextel access easement cross existing ���((( 735 North Sandy Shore Road, gravel road(Dharma Chimacum,WA 98325 I I Rd.)to Public right- APN: 801112002 of-way 130' Setback (E)House North Sandy Shore Road Public right-of-way "Not to Scale" Notes:. 1. Tenant may replace this Exhibit with a survey of the Premises once Tenant receives it. 2. The Premises shall be setback from the Land's boundaries as required by the applicable governmental authorities. 3. The access road's width will be the width required by the applicable governmental authorities, including police and fire departments. 4. Without in any way limiting Paragraph 6 (or Tenants right to make future changes), Tenant intends to initially install up to twelve (12) antennas, fifteen (15) coaxial cables and three GPS signal units and connections. The type, number, mounting positions and locations of antennas and transmission lines are illustrative only. The actual types, numbers,mounting positions and locations may vary from what is shown above. 5. The locations of any utility easements are illustrative only. The actual locations will be determined by the servicing utility company in compliance with all local laws and regulations. • . • EXHIBIT C to the Agreement dated , 2005, by and between ROGER L. HAUF and ROBIN L. HAUF, husband and wife, as Landlord, and NEXTEL WEST CORP., a Delaware corporation, d/b/a Nextel Communications, as Tenant. RECORDED AT REQUEST OF,AND WHEN RECORDED RETURN TO: Nextel West Corp. 1255 Treat Blvd.Suite 800 Walnut Creek,CA 9597-7982 Attn: Property Services MEMORANDUM OF AGREEMENT WA0817B Beaver Valley 11,28 1W TAX 1(LESS`TAX 2-7) APN:801112002 This MEMORANDUM OF AGREEMENT iS entered into on , 2005, by ROGER L. HAUF and ROBIN L. HAUF, husband and wife, with an address at 735 North Sandy Shore Road, Chimacum, WA 98325 (hereinafter referred to as "Owner" or "Landlord') and NEXTEL WEST CORP., a Delaware corporation, d/b/a Nextel Communications, with an office at 1255 Treat Blvd. Suite 800, Walnut Creek, CA 94597 (hereinafter referred to as "Nextel"or°Tenant°). 1. Landlord and Nextel entered into a Communications Site Lease Agreement ("Agreement") dated as of , 2005, effective upon full execution of the parties ("Effective Date") for the purpose of Nextel undertaking certain Investigations and Tests and, upon finding the Land appropriate, for the purpose of installing, operating and maintaining a communications facility and other improvements. All of the foregoing is set forth in the Agreement. 2. The term of Nextel's tenancy under the Agreement is for five (5) years commencing on [commercial operation/the start of construction]of the Tenant Facilities or eighteen (18)months following the Effective Date,whichever first occurs ("Term Commencement Date"), and terminating on the fifth anniversary of the Term Commencement Date with five(5)successive five(5)year options to renew. 3. The Land that is the subject of the Agreement is described in Exhibit A annexed hereto. The portion of the Land being leased to Tenant and all necessary access and utility easements (the °Premises") are set forth in the Agreement. In witness whereof,the parties have executed this Memorandum of Agreement as of the day and year first written above. LANDLORD: TENANT: ROGER L. HAUF and ROBIN L. HAUF, NEXTEL WEST CORP., husband and wife a Delaware corporation, d/b/a Nextel Communications By: EXHIBIT ONLY—DO NOT EXECUTE By: EXHIBIT ONLY—DO NOT EXECUTE Name: Name: Title: Title: Date: Date: • • STATE OF COUNTY OF On , before me, , Notary Public, personally appeared Roger L. Hauf, personally known to me (or proved to me on the basis of satisfactory evidence) to be the person whose name is subscribed to the within instrument and acknowledged to me that they executed the same in their authorized capacity, and that by their signature on the instrument, the person, or the entity upon behalf of which the person acted, executed the instrument. WITNESS my hand and official seal. (SEAL) Notary Public • My commission expires: STATE OF COUNTY OF On , before me, , Notary Public, personally appeared Robin L. Had, personally known to me (or proved to me on the basis of satisfactory evidence) to be the person whose name is subscribed to the within instrument and acknowledged to me that they executed the same in their authorized capacity, and that by their signature on the instrument, the person, or the entity upon behalf of which the person acted, executed the instrument. • WITNESS my hand and official seal. (SEAL) Notary Public My commission expires: • • STATE OF COUNTY OF On , before me, , Notary Public, personally appeared Mary Murdoch, personally known to me (or proved to me on the basis of satisfactory evidence) to be the person whose name is subscribed to the within instrument and acknowledged to me that they executed the same in their authorized capacity, and that by their signature on the instrument, the person, or the entity upon behalf of which the person acted, executed the instrument. WITNESS my hand and official seal. (SEAL) Notary Public My commission expires: • s ., Front Parcel Review • BUD I �-f q--3 - Parcel 801112013 Printed: May 1, 2014 RANDAL HAUF Site Address(es): 613 N SANDY SHORE RD 613 N SANDY SHORE RD CHIMACUM, WA 98325 102 DHARMA RD CHIMACUM, WA 98325 CHIMACUM, WA 983259731 Parcel Number: 801112013 S-T-R: 11-28N-01W Total Acreage 10 Legal Description HAUF SHORT PLAT LOT 1 (TAX 8) SUBJ TO EASE/REST Land Use: 8100 OF RECORD Flood District: lanning Area: Flood Map(FIRM)Panel No: oning: COMP PLAN v DESIGNATION: ((JJ COMMUNITY PLAN: I - I [ ] Plot plan states "property line" , 41 0 _ [ ] Assessor's Map (Property lines on /� �51� :nti ed ,n , e Ass or's 1/4 map) [ ] Legal Access to Property YES (�tJ f 1 i [ ] Parcel Tags or Scanned Docu p,colfr:ipinn)[ ] ESA's: Special Reports Nearb nI �IIU AM [ ] Designated Ag YES NO /v d �j ■ ‘. [ ] Shoreline Designation: YES / y fi [ ] Shoreline Slope Stability: YE: — Sr r��J I vi Stream Type:YES NO FWHC'A: YES NO Wetlands: YES NO - . Mania ' _ICE■ Rare Plants:YES NO Ilikrik & Laill=ffraW Seismic: YES NO q . 1 V ( � Landslide: YES NO A,* At lk Flood: YES NO r \VIMBWA11111 Erosion: YES NO Iii W IV_ Aquifer Recharge Area:YES NO SIPZ: none At Risk High Risk Coastal CMZ: none High Risk Moderate RiskDisconnected CMZ Stormwater site plan sub •' ted: YesNo [ ] Forest Lands: YES • Adjoining Forest , ds: Commercial/ Rural/ Inholding [ ] Mineral Lands: YES NO [ ] Agricultural .nds: YES NO [ ] Archaeolo YES NO [ ] No Shoo ng Zone: YES NO [ ] Sto water: New Impervious Surface Land Disturbing Activity ESA's Stormwater Req's:Min Req#2 Min Req#1 thru#5 Min Req#1_t I.._:_-= - - - - [ ] Notice Provisions/Disclosure:Airport YES NO M' S NO Forest Lands YES NO [ ] Landscaping Required: Yes No [ ] Parking Spaces Required NO 2 Other l 1 Building Height: 35' UBC Standard I P ah sl_Lived ct Le, ktA. ___ _ _ _ [ ] Impervious Surface coverage percentage: Resource Lands&Public: 10% ivural Residential: 25% Rural Industrialair UDC Sec 6.7 Rural Commercial: 60% Area of Building Coverage:60%in Rural IndustrAillinds 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 [ ] Setbacks: Front: Left Side: Right Side: Rear: Shoreline Setback: LSHA Setback: [ ] Road Classification: Road Approach: EXISTING NOT REQ'D RAP [ ] SEPA Required: YES EXEMPT [ ] Flood Certificate: [ ] Existing Case(s) & Condition(s): Violations: Yes No [ ] Recorded Date of Subdivision: 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 [ ] UGA No Protest Agreement YES NO, submitted: YES NO [ ] Site Visit conducted YES NO [ ] Require Final Zoning Approval YES NO [ ] ADMIN: Setbacks entered in Permit Plan case N/A YES New Parcel Tags entered in Permit Plan N/A YES Special Reports Scanned N/A YES No parcel tags found for parcel Cases Associated with APN 801112013 Cases Name Review Tyre Status Planner BLD14-00143 HAUF P Application Received: 4/23/2014 Permit Issued/Case closed: Case Finaled: Add (4) Microwave dishes—fo existing antenna array on existing monopole 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 HEADS M LA05-00239 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 150' MONOPOLE 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. SFPO7-00158 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 5/1/2014 Page 2 of 2 GILDING PERMIT APPLICAT BRLD1e 001443 1 Jefferson County Department of Community beveioprfie f 621 Sheridan Street PortTownsefid,WA 98168 PERMIT#: BLD14-00143 Received Otite 4/23/2014 SITE ADDRESS: 102 DHARMA RD CHIMACUM, 98325 OWNER: RANDAL HAUF oHONt 613 N SANDY SHORE RD CHIMACUM WA 98325-9731 HAUF SHORT PLAT SUBDIVISION: Block: 'Lot: PARCEL NUMBER: 801112013 Section: 11 Township: 28 N Rang : tf w CONTRACTOR: TBD PHONE: REPRESENTATIVE: JESSE LONDON PHONE: 206-523-1941 RYKA CONSULTING 918 S HORTON ST#1002 PROJECT DESCRIPTIOF Add (4) Microwave dishes to existing antenna array on existing monopole TYPE OF WORK COM SQUARE FOOTAGE: COMMERCIAL: TYPE OF IMP ADD MAIN: INDUSTRIAL: VALUATION 13,600.00 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 $201.00 MEB 04/23/14 148651 Plan Check $130.65 MEB 04/23/14 148651 State Building Code $4.50 MEB 04/23/14 148651 Total: $336.15 11fIrInMnAe1e1A1nlinrn+ekC QI n Ann RId rn1 AvrziOMB • •' N. 72XC213 Beaver Valley Hauf COQ JEFFERSON DEPARTMENT OF COMCOUNTY MUNITY DEVELOPMENT 621 Sheridan Street• Port Townsend •Washington 98368 6 LA i N q -i cis .y 360/379-4450 . 360/379-4451 Fax J - ,�p www.co.jefferson.wa.us/commdevelopment Master Permit Application MLA: Project Description(include separate sheets as necessary): Add (4) Microwave dishes to existing antenna array on existing monopole. Tax Parcel Number. 801112013 property size:Lease area =230(acresisquare reel Site Address and/or Directions to Property: 100 Dharma Road Chimacum, WA 98325 Property Owner(a)of Record: Randal Hauf Telephone: Fax email: Mailing Address: 613 N Sandy Shore Road Chimacum, WA 98325 Appiica ' (if different from owner): Jesse London (Ryka Consulting) c/o Sprint Telephone: 2 0 6-52 3-1941 Fax 206-260-7930 email.london @rykaconsulting.com Mailing Address: 918 S. Horton St. #1002 Seattle, WA 98134 What kind of Permit?(Check each box that applies Building ❑C'' . •:.== Stewardship Plan ❑ Demolition Permit ❑Vari= i . or Reasonable Economic Use) ❑Single Family ❑Garage Attached/Detached ❑Con H• t •' C]" ❑ Manufactured Home ❑ Modular ❑Di •�- ' - . - ;'fication I Commercial• ❑S. ( I. �c r!' F_ k ❑ Change of Use ❑B•ft .r Line Adjustment ❑ Address ❑Road Approach ❑8 7 ' t"" 4,0,. ❑Home Business ❑Cottage Industry ❑ r i •Ir1g Site Plan'"' Vin., ❑Propane ❑ ong Pfat� ❑Sign ■ Plant)ed Rural_ esidential Develo• (•RRDyAmendments"" ❑Allowed`Yes"Use Consistency Analysis ❑ •8tif �'ia`t(c j,; ❑Stonnwater Management ❑Shoreline r i cem ion/P=unit Revisions"" ❑Site Plan Approval Advance Determination(SPAAD)" ❑Shoreline Mana of Dev,opment"" ❑Temporary Use ❑Shoreline Management Vana ®Wireless Telecommunication" ❑Comprehensive Plan/UDC/Land Use iistrict Map Amendment ❑Forest Practices Act/Release of Six-Year Moratorium ❑Jefferson County Shoreline Master Program Amendment *May require a The—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 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,indemnify and hold harmless Jefferson County against all liabi sties,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 - ide access and right of entry to Jefferson County and its employees,representatives or agents for the sole purpose of application review and any_d later in=..-..ions. Stall's access and right of entry will be assumed unless the applicant informs the County in writing at the time of the app . = or she wants prior notice. Signature: 4�� Date: The action or actions Applicant will undertake as a result of the issuance of this permit may negatively Impact n 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' ed ' ., violate the ESA. Any individual,group or agency can file a lawsuit on behalf of an endangered species regarding your action(s)eve are in •0 ce with the Jefferson County development code.The Applicant acknowledges that he,she or it holds individual and •. •...-'.' r a. _ - _.,. .copying with the ESA. The Applicant has read this dise(e' e sigps and dates it below. S.• attire: � � (7/ Date: G:\PermitCenter\###FORMS###\DRD FORMS\Master Permit Application 5-29-08.doc • • BUILDER STATEMENT The signer of this statement does hereby certify that they are the Owners of the parcel referenced herein,that they are not licensed contractors and that they will be assuming the responsibility of the General Contractor for the proposed project. Signature: Date: GENERAL CONTRACTOR OR MANUFACTURED HOME INSTALLER: PHONE: FAx: TBD (will notify upon issuance if req. ) ( ) ( ) MAILING ADDRESS: EMAIL: CONTRACTORS LICENSE WAINS NUMBER: NUMBER ARCHrrECT/ENGINEER: Cornerstone Engineering, Inc PHONE (425) 487-1732FAx:( ) MAILINGADDRESS3-6928 wooainville-Reamona Ra. 1#21(EMAIL Project Type: Frame Type: Bathrooms: N/A Shoreline: Type of Sewage Disposal: ❑ New ❑ Wood Existing: ❑ Sewer N/A ❑ Addition ❑ Steel Proposed: Bank ❑ Community System Alteration/Remodel ❑ Concrete Total: Height: ❑ Individual System ❑ Repair ❑ Masonry N SEP Permit# ❑ Demolition pf Other: Bedrooms: N/A Water Supply: Tower Existing Setback: ❑ Private well ❑ Two Party Type of Heat Proposed: ❑ Public N/A Total: Name of System: If this is a Commercial Prolect you must answer the following: Number of Parking Spaces: Current: N/A Proposed: N/A Number of ADA Parking Spaces: N/A Number of occupants Smcludes owners,tenants,employees,etc) Current N/A proposed N/A IBC Occupancy: N/A IBC Type of construction:_Te l ecomm. Will you have Food Service? Yes / If this is a Propane Tank and/or Appliance Installation permit mark all items below that apply: N/A 1 Underground Tank I Above ground Tank Size of Propane Tank: 1 Heat Stove 1 Cook Stove 1 Woodstove 1 Fireplace Insert 1 Hot Water Tank 1 Pellet Stove 1 Other Is this appliance being installed in a Manufactured/Mobile Home? Yes / No N/A 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. S•uare Foote e Current Pro•osed :' Main Floor Heated EH Bid App Review: 2' Floor Heated Consistency Review: Other Heated Base fee: Mezzanine 1( Additional Section: Heated Basement Unheated Basement 111 Other Unheated ©f � Garage/Carport SUBTOTAL Decks 21+t9 K • Approach fee: Other TOTAL: $ Microwave dish -, Receipt Number: x t Cash/Check Number. ESTIMATED COST(REQUIRED) Date: .Fair market value of all labor and materials foundation to finish $13, 600 Initials: • G:\PumitCenter\###DORMS###\DRD FORMS\Master Permit Application 5-29-08.doc Mary Blain From: Jesse London [jlondon @rykaconsulting.com] Sent: Wednesday, May 28, 2014 10:50 AM To: Mary Blain Subject: BLD14-00143 Follow Up Flag: Follow up Flag Status: Flagged Hi Mary, Our contractor has discovered that they cannot execute the work permitted by building permit number BLD14-00143, because the site is red carded by WISHA(Washington's OSHA). No people or equipment can be added to the tower until structural corrections are made. I wasn't notified that there was any problem with the structural calculations,as the permit was approved.Would you know what the issues are here and what it would take to start work on this project? Thanks for your help. Jesse London 10, 206.523.1941 Office 425.327.6833 Ceti 206.260.7930 Fax jlondon @rykaconsulting.com 918 South Horton Street Suite 1002, Seattle, WA 98134 in 1 AO14— 11-3 dialKrazan FIELD BAssociates,; nc. REPORT NO.: 15074DFR051815-JM aeotec finical Engineering•Environmental Engineering Conatnuction Testing and Inspection DATE: 5/18/2015 CONTRACTOR MUTT PROJECT#. 10615074 PERMIT#: PROJECT: SE72%C213 BEAVE VALLEY INSPECTOR: Juan Martinez LOCATION: 100 DHARMA RD JURISDICTION: CHIMICUM WA KA P.M.: WEATHER CLEAR TEMP: 72° I arrived at this site and made the following observations: South Elevation® 150'a antennae(new)has been installed.This antenna is securely fastened.At the height of 143' 6"a M/W antennae has been installed and is securely fastened to the down pipe with U-bobs.Cable routing is internal and appears to be secured and routed properly. MMBS cabinet installed and functioning. These observations were conducted at ground level using a OLYMPUS XRT RANGE FINDER(6x).All workmanship conforms to the required local and state regulations. Reviewed By. iv C� ASTM Test p: Equipment/Asset Number(s): To the best of my knowledge,the above WAS performed In accordance with the approved plans,specifications end regulatory requirements. Superintendent/Representative: Technician: e v p„*, 41 Y9i1 iapYi Offices Serving the Western United States Lynnwood(425)485-5519•Poulsbo(360)598-2126•Puyallup(253)939-2500 /ARYFiddMmwt R°ririoeS Effective 01/13/2013 :BM alaatnY sap**.seado*..ma.dm le1.ptrpaa a ereevlfr]Yee.arWonsewa}aaYd0.nce.e.neme4rn1a Mgmt■tis..t■smw la.eoadlello�b.ra deamebrrerer fl*c.TH.Yeaaeb Y.4s1 bra 1.501eda1w.ea4dRlY war.orimmd.r ammo.paAllybohdr Armin las*amain YV lrt4r.'11•11,:ai BUILDING PERMIT Jefferson County Department of Community Development 621 Sheridan Street, Port Townsend, WA 98368 (360)379-4450 FAX (360)379-4451 PERMIT#: BLD14-00143 Received Date: 4/23/2014 SITE ADDRESS: 102 DHARMA RD Issue Date 5/2/2014 CHIMACUM, 98325 Expiration Date 5/2/2015 OWNER: RANDAL HAUF PHONE: 613 N SANDY SHORE RD CHIMACUM WA 98325-9731 HAUF SHORT PLAT SUBDIVISION: Block: Lot: PARCEL NUMBER: 801112013 Section: 11 Township: 28 N Range: 01 W CONTRACTOR: TBD PHONE: PROJECT DESCRIPTION: Add (4) Microwave dishes to existing antenna array on existing monopole TYPE OF WORK COM SQUARE FOOTAGE: COMMERCIAL: TYPE OF IMP ADD MAIN: INDUSTRIAL: VALUATION 13,600.00 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 $201.00 MEB 04/23/14 148651 Exist: Plan Check $130.65 MEB 04/23/14 148651 Prop: State Building Code $4.50 MEB 04/23/14 148651 Total: Total: $336.15 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 Jefferson County Building Division Permit Number: BLD14-00143 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 days 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,photographs submitted at time of installation are acceptable. meb 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 • • CONDITIONS for Building Permit# :BLD14-00143 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 on April 23, 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 May 1, 2014 shall be resubmitted for review and approval by Jefferson County Department of Community Development. 3.) This approval is for a adding four microwave dishes to an existing wireless facility 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.) zal \\tidemark\data\forms\F_BLD_Permit_Bldg.rpt 5/2/2014