HomeMy WebLinkAboutBLD2014-00316 ILDING PERMITAPPLICATIt BLD14-00316
Review Type:
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT#: BLD14-00316 Received Date: 8/29/2014
SITE ADDRESS: 124 E GO-ONNA DR
QUILCENE, 98376
OWNER: PHONE:
DAVID E WARD
PO BOX 123
QUILCENE WA 98376-0123 9550
SUBDIVISION: Block: Lot: 31
PARCEL NUMBER: 955000031 Section: 27 Township: 26 N Range: 1V1
CONTRACTOR: TBD PHONE: 253-584-6606
REPRESENTATIVE: LYNN CONSULTING INC PHONE: 206-972-1368
17311 135TH AVE NE 425-354-3277
STEA100
PROJECT DESCRIPTIOP Replace 3 existing stand-off arms with 3 proposed sector frames and
add 3 panel antennas,
Add 2 RRG's and 6 junction cylinders, 3 filters and 1 expansion
cabnit
There will be no ground disturbance or grading associated with this
proposal.
TYPE OF WORK COM SQUARE FOOTAGE: COMMERCIAL:
TYPE OF IMP ADD INDUSTRIAL:
VALUATION 10,000.00 MAIN:
CODE EDITION: 2012 ADD'L: HEAT TYPE:
OCCUPANCY: HEAT BASE: HEAT TYPE:
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
State Building Code $4.50 SRE 08/29/14 151399 APPROVED
Permit $168.00 SRE 08/29/14 151399
Plan Check $109.20 SRE 08/29/14 151399 OCT - 9 2014
Total: $281.70 Jefferson County DCD
\\tidemarkldata\forms\F_BLD_App_Bld.rpt 8/29/2014
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October 3, 2014 OCT 6 2014
Anna Bausher, Assistant Planner
Jefferson County Department of Community Development iE E RS&i INTY
621 Sheridan Street DEPT OF COPS°Iti TV a rT ;PSFNT
Port Townsend, WA 98368
RE: Sprint SE63XC005 Coyle/124 Go-Onna Drive, Quilcene/ATC 82927
Dear Anna:
The above referenced project for Sprint was originally submitted to Jefferson County in mid-August.
We have been waiting for the"noise study", as we discussed in emails.
The Acoustical Report, dated September 16, 2014 prepared by SSA Acoustics is enclosed(three
copies). The study concludes that as proposed, the equipment improvements cannot meet the required
45 dBA noise code limit at the nearest receiving property, without proposed/proper mitigation.
The proposed method to achieve the required noise level is installation of a noise barrier around the
equipment (the barrier will also enclose the existing Sprint equipment and help reduce noise from
existing equipment). The top of the barrier will be eight feet(8') above grade, constructed of solid
materials, with sound absorbing materials inside the barrier. The recommendations are specified in the
SSA report.
The results of the noise study in turn created the need for structural analysis of the noise mitigation
and revisions to the engineered construction drawings. Three copies of the additional structural
analysis and three sets of the revised construction drawings are enclosed.
Please review the enclosed materials and let us know if you have any questions or will need additional
information to continue processing this building permit application. We believe the landscaping
requirement portion of the proposal has already been met. Thank you for consideration.
Sinc ely,
ileen Za 41)
Lynx Con g
206 972 1368
Azavales(G,lynxconsulting.org
Enclosures: Three SSA Acoustical Study
Three NW Tower Engineering Structural Analysis for Noise Mitigation Fence
Three sets final construction drawings, revised—stamped and sealed by P.E.
1 1 P a fi e 17311 135th Avenue NE, Suite A-100,Woodinville,WA 98072
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` `i, JEFFERSON COUNTY
DEPARTMENT OF COMMUNITY DEVELOPMENT P
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Date: .� 1L( Time Received: �►,t (5'D/-?‘Pm Mon. Tue. Wed. Thur. Fri.
Date: a- 1 •
BLD: 14- 3 110 Contact Name:
Owner: Contact Number: 360
Address: 1 ).'4 C c c.:, yt00.i,o 206 93 ( I `10 Z
Notes:
Foundation Plumbing Framing Propane Tank Mechanical
Setbacks Under-ground Framing Under ground 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 X
Setbacks Floor
Foundation Wall Address Posted
Block &Tile Ceiling
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LYNX
August 14, 2014
Jefferson County
Department of Community Development
621 Sheridan Street
Port Townsend, WA 98368
RE: Sprint SE63XC005 Coyle/82927—at 124 E Go-Onna Drive, Quilcene, Parcel No. 955000031
Request for land use and building permit review and approval
Dear DCD:
On behalf of Sprint, Lynx Consulting is submitting to Jefferson County a request for zoning and
building permit approval, for modifications to an existing wireless facility located at 124 East Go-
Onna Drive, Quilcene.
The existing facility is a 147'6"tall (AGL) self-support/lattice tower. Specifically, Sprint proposes the
replacement of three existing stand-off arms with three proposed sector frames; and add three panel
antennas, add two RRHs, add six junction cylinders, add three filters and add one expansion cabinet.
The existing Sprint panel antennas have a rad center of 118' AGL. The rad center will remain the
same— 118' AGL following installation of the new sector frame, relocating the three existing and
adding three new panel antennas. The proposed expansion cabinet is being placed behind existing
equipment cabinets and is not increasing the lease or ground footprint area. There will be no ground
disturbance or grading associated with this proposal.
Enclosed please find the following:
• One Master Permit Application
• Three sets of construction drawings (11 x 17")prepared by Lynx Consulting
• Three Structural Analysis Report dated 8/11/2014 prepared by ATC supporting
the proposed antenna modification
• Check in the amount of$528.70 (Land Use fee of$228 and the balance is based upon the
project's valuation of$10,000 per Mary of your office -building permit fee is $300.70)
If you have any questions or need additional information in order to deem this application complete
please call me at 206 972 1368; my email is Azavales(alynxconsulting.org. Thank you for your
consideration.
Sincerely
Aileen Zavales
Lynx Consultin
Enclosures
1 I P a g e 17311 135th Avenue NE, Suite A-100, Woodinville, WA 98072
•
Sally Ellis
From: Sally Ellis
Sent: Friday, August 29, 2014 1:49 PM
To: 'Aileen Zavales'
Subject: RE: Master Permit Application for 2755 Taboo Lake-missing page two
Attachments: StormwaterCalcSheet_2-21-2008.pdf
Importance: High
Aileen,
I am just trying to finally enter the two new permits that you mailed to our office mid August.
You must included 3 additional copies of the Site plan- and fill out a stormwater calculation sheet for each permit.
I have made copies of the site plans for each permit. So not important for these permits-just an FYI for all future
permits.
You must submit the Master Permit Application both pages.
3 copies of Plans with the Structural Engineering and wet stamp.
As well as 3 copies of the Site plan
Complete the Stormwater calculation sheet.
You must have all of this information at the time of submittal.
Please advise if you would like me to send these permits back to your office—or if you can have the stormwater
calculation sheet completed and email or faxed back to my office no later then Tuesday 9/2/14.
Sincerely
Sally L Ellis
Jefferson County Community Development
Permit Technician
621 Sheridan St,
Port Townsend,WA 98368
360-379-4452
sellis @co.jcf£crson.wa.us
From: Aileen Zavales [mailto:Azavales @lynxconsulting.orq]
Sent: Thursday, August 28, 2014 11:21 AM
To: Sally Ellis
Subject: Master Permit Application for 2755 Taboo Lake - missing page two
Hi Sally, and here is complete application for other, also a valuation of$10,000 and contractor TBD. Thanks again for
your help and patience.
Aileen
1
s
Aileen Zavales I Lynx Consulting, Inc.
17311 135th Ave NE,Suite A-100,Woodinville,WA 98072
Cell 206-972-1368 I Fax 425-354-3277 I azavalesPIynxconsulting.org
L1 N Connect to the Future
2
JEFFERSON COUNTY IVO NO. 1 . 23
• DATE 1c/C1l Ly
RECEIVED FROM (' Ile?n - aCtICCs
P� /
BARSk AMOUNT
U ESCPIPTION 1 ?
CURRENCY J • e)c)
COIN p*n 1_ ►a
m
33
n
0
RECEIVED BY S 1 .t TOTAL ___3(4C1
10/9/2014 • Point&Pay-Create Order
Thank you for your payment!
This service has been provided by Jefferson County and Point & Pay, We value your business.
Please keep this receipt for future reference.
You have made a payment to Jefferson County, Jefferson County thanks you for your payment!
Name: Aileen Zavales
Address: 17311 135th Ave NE A-100, Woodinville WA, 98072
Contact: 2069721368
Comments:
Payment ID: 15370267
Date: 10/09/14 02:35 PM
Subtotal: $349.80
Fee: $8.75
Total: $358.55
Method: Credit or Debit Card(******** ***8242)
Item Purchased Transaction Description Account Amount
Real Property Tax JeffersonCtyPrpTxPmt 955000031 $349.80
Signature: Date:
By signing this receipt you agree to the terms and conditions of this service.
You will see two line items on your credit or debit card statement. One line will indicate the amount you paid to
the Jefferson County and will read Je(fersonCtyPrpTxPmt If you have any questions about either of these
charges please call 1-888-891-6064.
Print Receipt Close Window
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pckue -41(1)- -Pi( 6(--n iq -31 (0
D+ eckl T43i toicv ,
h ttps:11cl ient.pointandpay.netlwebportal/partnecdo?method=viewPaymen!Receipt&webSi teld=529&orde rld=15370267 1/1
•
4w$ON 06. Jefferson County Community Development fv# 14-129
621 Sheridan
Port Townsend, WA 98368
"ysy ° (360)385-4450
t ".10 46.-wpwita
• •
J
Name: LYNX ATTN:AILEEN ZAVALES Date: 10/9/2014
Address: 17311 135TH AVE NE SUITE A-100
City: WOODINVILLE State: WA 98072 Case: BLD14-319
Phone: r
r
DATE DESCRIPTION OF SERVICES QTY UNIT PRICE TOTAL
PLAN CHECK 1 137.80 $ 137.80
BLD BASE 1 212.00 $ 212.00
$ -
$
$ -
A SOUND BARRIER FENCE IS REQUIRED FOR THE SCOPE OF
THIS WORK- PLAN CHECK AND BLD BASE FEE'S
BASED OF$15,000 COST OF PROJECT OF FENCE ONLY!
TOTAL: 2 $ 349.80
*****PLEASE PAY FROM INVOICE*****
Submitted By:
Make Check Payable to:
Name: Jodi Adams
Jefferson County Community Development
Title: Office Coordinator 621 Sheridan
Port Townsend,WA 98368
Date: 10/9/2014
• •
Sally Ellis
From: Aileen Zavales <Azavales @lynxconsulting.org>
Sent: Wednesday, October 08, 2014 3:42 PM
To: Sally Ellis
Cc: Anna Bausher
Subject: FW: Sprint SE63XCO05 Coyle/ATC 82927 BP 14 00316
Attachments: SE63XCO05-82927 FedEx Slip.pdf
Hi Sally, I left you a VM as well, here is a pre-paid Fed Ex label for you, in order to send us the approved BP/plans,
etc. This is fed ex ground by the way. I will still need to pay the fees owing on the $15,000 fence, please advise. I will be
in tomorrow (leaving shortly for a doggy emergency vet visit) and I'm in Bellingham on Friday so hopefully we can get
this wrapped prior to close of business by tomorrow(fingers crossed—and toes and eyes too for that matter). Thank
you!!
Aileen Zavales I Lynx Consulting, Inc.
17311 135th Ave NE,Suite A-100, Woodinville,WA 98072
Cell 206-972-1368 ( Fax 425-354-3277 I azavales @lynxconsulting.org
¶`1 LV N X Connect to the Future
'Pt 3 12P
•
1
• .
Sally Ellis
From: Aileen Zavales <Azavales @lynxconsulting.org>
Sent: Wednesday, October 08, 2014 11:27 AM
To: Sally Ellis
Subject: RE: BLD14-00316
It will be Wren Construction out of Everett. Thank you!
Aileen Zavales I Lynx Consulting, Inc.
17311 135th Ave NE,Suite A-100,Woodinville,WA 98072
Cell 206-972-1368 I Fax 425-354-3277 I azavales @lynxconsulting.org
Connect to the Future
From: Sally Ellis [mailto:SEllis @co.jefferson.wa.us]
Sent: Wednesday, October 08, 2014 11:18 AM
To: Aileen Zavales
Subject: RE: BLD14-00316
Thank you- I am sorry if you have already told me- Who will be the contractor for this project?
I will work up the fee and get back to you as soon as I can.
Thank you
Sally L Ellis
Jefferson County Community Development
Permit Technician
621 Sheridan St.
Port Townsend,WA 98368
360-379-4452
sellis @co.jefferson.wa.us
From:Aileen Zavales [mailto:Azavales@lynxconsulting.org]
Sent: Wednesday, October 08, 2014 11:11 AM
To:Sally Ellis
Subject: RE: BLD14-00316
Hi Sally, our construction manager just heard back from the contractor on the cost of the fence/noise barrier.
Overall cost will be$15,000. (Materials/equipment$8000 plus labor for$7000). I can pay this fee as soon as you let me
know the amount owing. Hopefully,this is the last issue outstanding on permit approval? Thank you!
Aileen
Aileen Zavales I Lynx Consulting, Inc.
17311 135th Ave NE, Suite A-100,Woodinville,WA 98072
Cell 206-972-1368 I Fax 425-354-3277 I azavales @lynxconsulting.org
LV N X Connect to the Future
1
44,w„SON „, JEJEFFIRON COUNTY
Ny -
w 1 DEPARTMENT OF COMMUNITY DEVELOPMENT
\� 621 Sheridan Street I Port Townsend,WA 98368 I Web:www.co.iefferson.wa.us/communitvdevelopment
9\SHirio” Tel:360.379.44501 Fax:360.379.4451 I Email:dcdOco.iefferson.wa.us
Building Permits&Inspections!Development Consistency Review I Long Range Planning I Watershed Stewardship Resource Center
Master Permit Application MLA:
Project Description(include separate sheets as necessary):
Sprint proposes to modify its antenna equipment on the existing telecommunications tower.The over-all height of the tower will not increase.
Tax Parcel Number: 955000031 Property Size: i 15 (acres/ uare feet)
Site Address and/or Directions to Property:124 East Go-Onna Dr, Quilcene, WA 98376 I .4TE. f?
Towe*operA*„r L#3)(CLY��J ja/1n
Prepyrawner(s)of Record: TWVC.Y PeC4GUUQvC, Cr 7Pr7L7 '-
Telephone: 711-124 L4 Fax: email:
Mailing Address: fD Pros/C/Gn cZ Z uJ / Wdb a/7)1 /4/1-- 0 t$6 j
Applicant/Agent(if different from owner): Lynx Consulting, Ai) 4:1 c/n Sprint
Telephone a0(, k7»31/Y Fax: 4x 3 r,i1 .1"}71 email: Azci Vales<))5,9e—
Mailing Address: 17311 135th Ave NE,Suite A-100,Woodinville,WA 98072 CA3^S ill)i.-am, L
What kind of Permit?(Check each box that applies ❑ Lot or Road Segregation
®Building ❑Critical Areas Stewardship Plan
❑ Demolition Permit ❑Variance(Minor, Major or Reasonable Economic Use)
❑ Single Family ❑ Garage Attached/Detached ❑Conditional Use ern Kra .-,
❑ Manufactured Home ❑ Modular ❑ Discretionary"D p ,ly =n._��- �si do ,
B Commercial* ❑ Special Use(E e tit Put,iic Fe iIitieaj`
❑ Change of Use ❑ Boundary Line '.j :,? 'ent
❑ Address ❑ Road Approach ❑Short Plat*" `. I
❑ Home Business ❑Cottage Industry CI Binding Site Pla "* I AUG 2 9 2014
❑Propane ❑ Long Plat*"' j II
❑Sign ❑ Planned Rural ResidentiaLI- ....-, •::. : - d ents**
❑Allowed"Yes"Use Consistency Analysis ❑ Plat Vacation/AI ration'" JEFFERSON COUNTY
❑Stormwater Management ❑Shoreline Master Prggl'8t1Ti ill . l>7flPertaltr RMPlelons
El Site Plan Approval Advance Determination(SPAAD)* ❑ Shoreline Management Substantial Development*"
❑Temporary Use ❑ Shoreline Management Variance
O Wireless Telecommunication* ❑ Comprehensive Plan/UDC/Land Use District Map Amendment
❑Forest Practices Act/Release of Six-Year Moratorium ❑Jefferson County Shoreline Master Program Amendment
*May require a Pre—Application Conference ❑Tree Vegetation Request
**Requires a Pre-Application Conference
Please identify any other local,state or federal permits required for this proposal, if known:
Lynx Consulting DESIGNATION OF AGENT
I hereby designate y g to act as my agent in matters relating to this application for permit(s).
Tower Operator /
OWNER SIGNATURE : • - �t Date: K 7 I/Se
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 provide access and right of entry to Jefferson County and its employees,representatives or agents for the sole purpose of application
review and any,-qu'red later inspections. Staffs access and right of entry will be assumed unless the applicant informs the County in writing at the
time of the a.p at',n that ,r she wa is prior notice.
Signature: 44' - , , ,A< Date:
The action or actions Appli.iwill 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 you are in compliance with the Jefferson County development code.The Applicant acknowledges that he,she or it holds individual
and non-bran ab a respo ibility fo adhering to and complying with the ESA. The Applicant has read this disclaimer and signs and dates it below.
Signature: Date: 7f 7 LI 1L1
07/24/2013
)21-j Cz Olt by ('U kCr.•fti.c . I 6.1 a-7
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:
GENERALRACTOR OR MANUFACTURED HOME INSTALLER: PHONE: FAX:
( ) ( )
MAILING ADDRESS: EMAIL:
CONTRACTOR'S LICENSE WAINS
NUMBER: NUMBER
ARCHITECT/ENGINEER: PHONE ( ) FAX:( )
MAILING ADDRESS: ' EMAIL
Project Type: Frame Type: Bathrooms: )n Shoreline: Type of Sewage Dispos
New D Wood Existing: Ni/f-- r ❑ Sewer
:1 Addition ❑ Steel Proposed: Ban ❑ Community SysterP
, Alteration/Remodel ❑ Concrete Total: Height: o Individual System
Li Repair ❑ Masonry SEP Permit#
o Demolition 5rOther. Bedrooms: Water Supply:
0 (1 Existing: Setback: 1 Private well U Two Party
Type of` 1 t: Proposed: ❑ Public ��/�ni�.-
N�(- Total: Name of Syst hr5 1'
If this is a Commercial Project you must newer the following:
Number of Parking Spaces: Current: –t . Proposed:'&–)-- Number of ADA Parking Spates:
Number of occupants(i odes owners,tenants,employees,etc) Current Proposed
IBC Occupancy: IBC Type of construction: Will you haverFo_od$et i�?-§ ,111r�/J
If this is a Propane Tank and/or Appliance Installation permit.mar all items below that apply `-" Is- 11J wJ
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 a ,, , '
Is this appliance being installed in a Manufactured I Mobile Home? Yes / No
When applying for a permit to install a propane tank you must also submit a site plan showing all of the buildings,all property
lines, tank location and size,distances from the propane tank to all property lines,buildings and septic system components,
including the reserve area.
Square Footage Current Proposed Forpft .CJ_ae4,Onlyr s. , Amount - =11RevisiOn __
Main Floor Heated EH Bid App Review:
st;r
2n0 Floor Heated 4- Consistency Review:
u
Other Heated :.. .- ,' Base fee: o{✓
Mezzanine "`> Additional Section: , , C1 t)
Heated Basement .- Plan Check fee: 1 °CI . -2 o
Unheated Basement '. L State Surcharge fee: 5-0
Other Unheated -` Pot Water Review fee:
Garage/Carport V:7. SUBTOTAL p� (J•
Decks 911/Rd Approach fee:
Other TOTAL: $
• t `-- Receipt Number:
151399
.- Cash/Check Number •36 5
ESTIMATED COST(REQUIRED) Date: 8' 1�-/ Il—I
•Fair market value of all labor and materials foundation to finish oCi
(1) 61n) Initials: • S�
1,
G:\PemvK:enter\###FORMS###\DIW FORMS\Master Peanit Application 5-29-08.doc
Parcel Details Page 1 of 2
• •
Jefferson County
Home County Info Departments Search
Parcel Number: 955000031 SEARCH
Parcel Number: 955000031 Printer Friendly
Owner Mailing Address:
DAVID E WARD
PO BOX 123
QUILCENE WA98376-0123
Site Address:
124 E GO-ONNA DR
QUILCENE 98376
Section: 27 School District: Quilcene (48)
Qtr Section: SW1/4 Fire Dist: Quilcene (2)
Township: 26N Tax Status: Taxable
Range: 1W Tax Code: 0323
Planning area: South Toandos Peninsula,Coyle Area (9)
Sub Division: 9550 - GO-ONNA BEACH TRACTS #2
Assessor's Land Use Code: 9100 - Vacant Land
Property Description:
GO-ONNA BEACH TR DIV 2 LOT 31
Tax,A/V, Sales, Photos, and
Permit Data Bldg Data Map Parcel Plats &Surveys
Septic Monitoring Info
4-, Jefferson County HOME I COUNTY INFO I DEPARTMENTS I SEARCH
Best viewed with Microsoft Internet Explorer 6.0 or later
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http://www.c o.j efferson.wa.us/assessors/parce Uparce ldetai l.asp?Parcel_NO°95 5 000031 8/29/2014
Parcel Details Page 2 of 2
• a
http://www.coj efferson.wa.us/assessors/parcel/parceldetail.asp?Parcel_NO=955000031 8/29/2014
ill s MOL
RE��ilJcl IN •
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374&'7S OF OFFIC;%,i.R=CJRD R I�rl I N�11L
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P4,4.(Y F.C BOURY
,;E FEkSON Cu. TY AUDITC
3! DEPUTY
•
WM BRINNON 2
FILED FOR RECORD AT REQUEST OF
AND WHEN RECORDED RETURN TO:
U S WEST NewVector Group, Inc.
Attn: Real Estate and Construction Department
3350 161st Ave SE
P. O.Box 91211
Bellevue, WA 98009-9211
MEMORANDUM OF OPTION AND LEASE AGREEMENT
This Memorandum dated this 3rd
RRo tD. Wilson Veda Wilson, H cla SoWJanuery 19 94 by and between
1 Icrcinal'tcr Lessor")and
91211; I3cllevuc, Washin Ion 98 ed Partnershi , 3350 161st Avenue S.E., P.O. Box
and Lease Agreement (hereinafter 921 I (hereinafter -Tenant"), is a record of that Option
anted g CC11enl") between Lessor and Tenant
�e ember 16 1993 , which Agreement includes in part the following terms:
I. )eased Pr n+•a e• The Agreement pertains to real properly which is described in
Exhibit "A" (hereinafter "Properly"),y") which is attached hereto and incorporated herein by this
reference.
2. Term of Agreement and ODtion to
a five- Ext n I. The initial term of the Agreement is for
year(5) period commencing on the date the Option is exercised by Tenant. Tenant has
options to extend the Agreement terns for ]r conseve periods. Tenant may, under certain conditions, elect further extendtthe erm thereof.
3. Successors and ne
,.. ,- The terms, covenants and provisions of the Agreement
extend to and are binding upon the respective executors, administrators, heirs, successors and
assigns of Lessor and Tenant.
4. R2tificatio nn ec. The parties by this Memorandum intend to record a reference
to the Agreement and do hereby ratify and confirm all of the terms and conditions of the
Agreement and do hereby declare that the real property described in Exhibit "A" attached
hereto is in all respects subject to all of the applicable provisions contained in the Agreement.
LESSOR:
Robert D. Wilson & Veda Wilson fENANT:San Juan Cellular Limited Partnership
David Ward and H. Jean Wrrd
s�-�. _
By: U S WMT • = v- tor Group: Inc.
I` a By: er- a ,' r
./1�/pI its: DI - Fr 1... °. .- .
1 1- 't-9'-1
h10Ux1I1, OK —__
9.1-93
O REAL ESTATE
E TAX NotA`.1�, 1+w�l w,�`�,o„ COUNTY T1 L;C?L7Rp1
Eris.. 1\- 15-clla n;iU .EF
I Virhditi P2 rich L. AN ��
S i •
INDIVIDUAL ACKNOWLEDGMENT
STATE OF VL�: � -�
COUNTY OF` iss.
On this day personally appeared before me �,r,� � �t
known to be the individual described in and who execute the within and foregoing , to me
acknowledged that signed the same as n g inttanmdne and
uses and purposes �����'' bee and voluntary act and deed, for the
p poses the mentioned.
GIVEN under my hand and official seal this r"\ day of\ 19 q+.tt.
Y �. s�
Notary Public in and for the State ofv\s,4�, 1
residing at y1
My appointmen expires: ' t "J -
INDIVIDUAL ACKNOWLEDGMENT
STATE OF k,..\,...h. ..e I
COUNTY OF Iss.
On this day personally appeared before me V 1 \ Z\-�
known to be the individual described in and who executed the within and foregoing •to me
acknowledged that signed the same as\ n g inttanmdee and
uses and purposes there mentioned. ��°r"' free and voluntary act and deed, for the
GIVEN under my hand and official Seal this
_n___day°falo,n�� , 19 �l�
Notary Public in and for the State o
residing at (a 1..ae __
My appointmmee t expres: '�
Pa-4rc,a_ L,. Auv.1— 4 6.1r(1y
•
•
•
INDIVIDUAL ACKNOWLEDGMENT
STATE OF `Ze•.ti. .,.ekn..7 — I
COUNTY OF_ Ias.
1
On this day personally appeared before me A�l.tl �1�Arc�
known to be the individual described in and who executed the within and foregoing instrument, and ' to me
acknowledged that Nev. signed the same as Vie}, free and voluntary act and deed, for the
uses end purposes thelenr mentioned.
GIVEN under my hand and official seal this '7 day ot. N..__..�r.N,,
Notary and for the St
residing at(7a ��C�na.
My appointme t expires;?\l_\ -AA. —
INDIVIDUAL ACKNOWLEDGMENT
STATE OF a -:
COUNTY OF Iss'
On this day personally appeared before me R
known to be the individual described in and wh , to me
acknowledged that o executed the within an oluntarg instrument,and
9 �` signed the same as\.��nr free and voluntary act and deed,for the
uses and purposes there mentioned.
GIVEN under my hand and official seal this
- day 19.4:\kk_•
Notary Public in and for the State of\1,)
residing
��---
My ap oin t -vb
r■CIA L. Akuil -1,1,-Y1
•
'r i
III
CORPORATE ACKNOWLEDGMENT
STATE OF
I
155.
COUNTY OF
1 1
On this day of , 19 •efore me personally appeared •
to me know. o be the
,the c. .. ation that executed the within and foregoing instrument,
and acknowledged said instrument to be the re- and voluntary act and deed of said corporation, for the
uses and purposes therein mentioned,a . on oat -tated that was instrument and that the seal affixed, .ny,is the co •orate seal of said corporal on=ed to execute said
IN WITNESS WHEREO,, I have hereunto set my -. d and affixed my official seal the day and year
first above written.
Notary Public in and for the Stare of
residing at
My appointment expires:
`,` P‘
PARTNERSHIP ACKNOWLEDGMENT
STATE OF W
I
COUNTY OF Iss.
\�,J1 E 9 hLi-- - � �� I
M�is,.Y. A gm. d 1�'t"�—, 19 before me personally=—==_�• y appeared
to me known to bete a i.,t,; ,..4112.2 S
of S WEST N . .�►- il�' Ig1IF ∎ s
the partnership that .the general partner of • e•_.... Tai ,
p t at executed the within and foregoing instrument,a • acknowledged said instrument to be
the free and voluntary act and deed of i
oath stated that-• .L said execute said ins the uses and that seal of ix mentioned• and on
was authorized to execute said instrument and that the seal affixed, if any is the
seal of said partnership.
IN WITNESS WHEREOF, I hay nta set my hand (fixed m
first above written. official seal the day and year
'pfUUrpg,
Notary Public i and for �m a� ���s, TA•gF�ai��,
a e State of_WT__ �• e0
residing at_ --- ��
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My appointment exp st.��a-�1n� ,9�n� _
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COPIl e ADD/A V D_.
r,
•
RECORDING REQUESTED 81'
AND WHEN RECORDED RETURN TO:
American Towers,Inc
116 Naotiugton Avenue,11th Floor
Boston,MA. 02116
r'} !' NA
Attn:Site Designation Supplement Coordinator R I k9 L i
(Space above this line for Recorder's use)
MEMORANDUM OF SUBLEASE
This MEMORANDUM OF SUBLEASE, made and entered into as of this JQ2day of
_ A0,20_ by and between SEATTLE SM SA LIMITED PARTNERSHIP
( uble or")'lndAmerican Tower Delaware Corporation. a Delaware corporation
("Sublessee"). ek
I. Pursuant to Site Designation Supplement number OLT/4_,effective_ if,____,
p?JO()_,which is governed by the terms and conditions of that certain Sublease entered into b ween Sublessor,
Sublessee and other parties identified therein on.9Xer`y_/f,p?0OO ,which is incorporated herein by this
reference, Sublessor subleased to Sublessee,and Sublessee subleased from Sublessor,the Subleased Properly(defined
below).
The Commencement Date for the Site Designation Supplement is__ /O_, O C).
2. Notices with respect to the Site Designation Supplement shall be,in addition to the notice address in the
Sublease,directed to:
AirTouch Cellular, Inc.
3350 161st.Avenue SE,M/S 231
Bellevue,W A 98008
Attn:Manager,Site Development
3. The Subleased Property subleased to Sublessee under the Site Designation Supplement is a portion of the
real property commonly known as WA IBRINNON -516 and more specifically described in Schedule 1 attached hereto.
4. In the event of any conflict between this Memorandum of Sublease and the Sublease(and Site Designation
Supplement),the terms of the Sublease(and Site Designation Supplement)shall control.
*Address of Sublessor: **Address of Sublessee:
do AirTouch Communications,Inc. c/o American Towers,Inc.
One California Street,21st Floor 116 Huntington Ave., 11th Floor
San Francisco,CA 94111 Boston,MA 02116
• -._,_ct Vertical Number-516
•
.• COPY.
IN WITNESS WHEREOF,Sublessor and Sublessee have duly executed this
Memorandum of Sublease as of the day and year first above written.
SUBLESSOR: SUBLESSEE:
SEATTLE SMSA LIMITED American Tower Delaware Corporation
PARTNERSHIP,a Delaware a Delaware corporation
limited partnership
By: VODAFONE AIRTOUCH By:
LICENSES,LLC,a general
partner Name: Jonathan R. Black
By: CELLCO PARTNERSHIP,
its so - member / Title: Vice President
By: . :! ( Date:
Name: Gregory Cali:ari Tax ID#: 04-3481371
Title: Attorney-In-Fact
Date: 573(00
Tax ID#: 91-1237252
STATE OF CALIFORNIA )
) SS.
COUNTY OF SAN FRANCISCO )
On May 3,2000,before me, Ruth Biggs,Notary Public,personally appeared Gregory
Caligari,personally known to me to be the person whose name is subscribed to the within
instrument and acknowledged to me that he executed the same in his authorized capacity,
and that by his 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.
guilt 6i994$0.
Ruth Biggs ->r rttrtla0
�. �tontti 12167
Notary Public Notary Ptblc-CoAontb
let% San Rancho,Comely
kti Canm.B V int DaC2421»
Project Vertical# ¶16
•� COPY.
IN WITNESS WHEREOF, Sublessor and Sublessee duly executed this Memorandum of
Sublease as of the day and year above written.
SUBLESSOR: SUBLESSEE:
American Tower Delaware
Corporation, a Delaware corporation
By: By: �
Jo, .th. R. Black
Vi e P esident
Date: J
Tax ID No. Tax ID# 04-34813 1
Project Vertical No. S76
1410 Front Parcel Review • (31.-DI 14 -DU 3t L
Parcel 955000031
Printed: September 4, 2014
Site Address(es):
DAVID E WARD 124 E GO-ONNA DR QUILCENE, WA 98376
PO BOX 123
QUILCENE,WA 98376-0123
Parcel Number: 955000031 S-T-R: 27-26N-1W Total Acreage 1
Legal Description GO-ONNA BEACH TR DIV 2 LOT 31 Land Use: 9100
Flood District: Fire District: 2 Planning Area:
Flood Map(FIRM)Panel No: School District 48 Zoning: 2Q\' 5
COMP PLAN _
DESIGNATION:\�,\ `S
COMMUNITY PLAN: UGA: UGA Trans
[ ] Plot plan states "property line"
[ ] Assessor's Map(Property lines on submitted plot plan must match the property lines as identified on the Assessor's 1/4 map)
[ ] Legal Access to Property OP NO
[ ] Parcel Tags or Scanned Documents YEA,,,, No
[ ] ESA's: Special Reports Nearby YES (NO)
[ ] Designated Ag YES
[ ] Shoreline Designation: YES NO
[ ] Shoreline Slope Stability: YES
Stream Type:YES go
FWHCA: YES al,
Wetlands: YES
Rare Plants:YES
Seismic: YES .6,
Landslide: YES eri
Flood: YES 0
Erosion: YES NO
Aquifer Recharge Area:YES
SIPZ: 41:17-SP At Risk High Risk Coastal
CMZ: o l High Risk Moderate RiskDisconnected CMZ
Stormwater site plan submitted: Yes
[ ] Forest Lands: YES N ) A '
Adjoining Forest Lands: 0 Commercial/ Rural/ Inholding
[ ] Mineral Lands: YES t-)
[ ] Agricultural Lands: YES
[ ] Archaeology: YES •
[ ] No Shooting Zone: Ca. NO (L .�i, I-2, P- I a I ar
[ ] Stormwater: New Impervious Surface IJ,A () Land Disturbing Activity ESA's
Stormwater Req's:Min Req#2 Min Req#1 thru#5 Min Req#1 thru#10 Engineering
[ ] Notice Provisions/Disclosure:Airport YES 0 MRL YES f c Forest Lands YES No
[ ] Landscaping Required: CO No
[ ] Parking Spaces Required NO 2 Other N[/1
f 1 Building Height: 35' UBC Standard Kat
[ ] Impervious Surface coverage percentage: 2S°/(>
Resource Lands&Public: 10% •ural Residential: 25% Rural Industrial) UDC Sec 6.7
Rural Commercial: 60% Area of Building Coverage:60%in Rural Industri ds only
[ ] Total Building(s) Size: N (I
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: 9 Left Side: 5j Right Side: 5 r Rear: h'
Shoreline Setback: N�/
LSHA Setback:
[ ] Road Classification: PO■/7/6-k-{
Road Approach: EXISTING NOT REQ'D RAP
[ ] SEPA Required: YES F IEL
[ ] Flood Certificate: /rA
[ ] Existing Case s) &Condition(s): „ ; 1 • • C i _0_0
Violations: a No _>■ _ l • •• • - ,i.,-1
[ ] Recorded Date of Subdivision AFN ,S' Over 5yrs=UDC
Plat Conditions: <5yrs=Plat Condition plat or Old Ordinance
[ ] Lots/Require Declaration of Restrictiv Covenant YES T� . ubmitted: YES PTO
[ ] UGANo Protest Agreement YES submitted: YES NO
[ ] Site Visit conducted YES 0
[ ] Require Final Zoning Approval S
[ ] ADMIN: Setbacks entered in Permit Plan case et YES
New Parcel Tags entered in Permit Plan N/A YES a „ - •
Special Reports Scanned N/ YES � g !' >.��
Title Notes Updated
Parcel tags found for parcel 955000031
1.) Custom Warning Flag ZON04-00026 Acoustical Report. See Laserfiche or 05/08/2007
MLA04-00241 for full report.
Parcel tags found for parcel 955000031
2.) WSRC Coaching - 2012-02-09, SG 09/05/2013
Other
Parcel tags found for parcel 955000031
3.) WSRC Coaching - 2012-10-29, CZ 11/06/2013
Other
Parcel tags found for parcel 955000031
4.) Customer Assistance CAM 11-00049 15 min CJZ 01/24/2014
Mtg Req
Cases Associated with APN 955000031 Review
Cases Name Type Status Planner
BLD14-00003 WILSON I A Donna Frostholm
Application Received: 1/6/2014 Permit Issued/Case closed: 2/25/2014 Case Finaled:
Modification to existing unmanned cell tower
BLD14-00142 WILSON I A Zoe Ann Lamp
Application Received: 4/23/2014 Permit Issued/Case closed: 5/2/2014 Case Finaled:
Add (1) microwave dish to existing antenna array on existing lattice tower
BLD14-00316 P Anna Bausher
Application Received: 8/29/2014 Permit Issued/Case closed: Case Finaled:
Replace 3 existing stand-off arms with 3 proposed sector frames and add 3 panal antennas,
Add 2 RRG's and 6 junction cylinders, 3 filters and 1 expansion cabnit
There will be no ground disturbance or grading associated with this proposal.
BLD94-00460 US WEST NEWVECTOR GROUF F
Application Received: 7/11/1994 Permit Issued/Case closed: 9/27/1994 Case Finaled: 1/25/1995
150 ft cellular communications tower w/12'x 12' equipment bldg
BLD99-00579 SPRINT SPECTRUM F
Application Received: 8/27/1999 Permit Issued/Case closed: 12/30/1999 Case Finaled: 7/3/2002
minor telecommunications equlpe at 118' level of existing 150'lattice tower
COM96-00008 US WEST NEWVECTOR GROUF F
Application Received: 5/1/1996 Permit Issued/Case closed: Case Finaled: 12/16/1996
Pile driving activity observed on the cleared parcel for most of the day on April 30, 1996.
lltidemarkldata\forms\R_Parcel_CRMLA.rpt 9/4/2014 Page 2 of 4
PRE99-00037 US WEST WIRELESS F J SMITH
Application Received: 8/10/1999 Permi ued/Case closed: 8/27/1999 Casella led:
To co-locate a wireless facility on an existing wireless facility.
ZON99-00033 US WEST WIRELESS F J SMITH
Application Received: 8/27/1999 Permit Issued/Case closed: 12/9/1999 Case Finaled: 1/7/2002
To co-locate a wireless communication facility on an existing 150 teet high telecommunications tower.
CAM14-00049 WILSON NA M Colleen Zmolek
Application Received: 1/23/2014 Permit Issued/Case closed: 1/23/2014 Case Finaled:
ZONING? PROCESS I KEPACL EXISTING CELL TOWER
COM00-00054 WILSON F
Application Received: 3/11/2002 Permit Issued/Case closed: Case Finaled: 5/6/2002
Tower and generator without proper EPA approval? Disel generator is running 24 hours a day next to complaintants
house.
IZA94-00040 US WEST NEWVECTOR GROUF F
Application Received: 6/28/1994 Permit Issued/Case closed: 9/19/1994 Case Finaled: 5/6/2002
to construct a cellular communications facility on a vacant residential lot located on East Go-Onna Dr on the loandos
Peninsula. The site will contain a 150 ft steel self-supporting !attic towner and a 12 ft x 12 ft pre-fabricated equipment
building containing radios which control the cellular telephone system.
M LA02-00174
BLD02-00187 MLA02-00174 WILSON &VEDA WILSON I F J SMITH
Application Received: 4/5/2002 Permit Issued/Case closed: 5/10/2002 Case Finaled: 5/8/2008
12 ft. by 12 ft. ADDITION I0 EXIS TING COMMERCIAL EQUIPMENT SHELI ER SERVING WIRELESS
COMMUNICATION FACILITIES
M LA04-00241
BLD04-00283 MLA04-00241 WILSON II F Stacie Hoskins
Application Received: 4/30/2004 Permit Issued/Case closed: 6/10/2005 Case Finaled: 5/8/2008
CO-LOCATION ON EXIS I ING WIRELESS TELECOMMUNICATION FAGILI I YAND EQUIPMEN I BUILDING
PRJ04-00112 MLA04-00241 WILSON P
Application Received: 5/3/2004 Permit Issued/Case closed: Case Finaled:
Co-locate additional antennas & equipment to(e)WCF
ZON04-00026 MLA04-00241 T-MOBILE -VOICESTREAM PC II F Stacie Hoskins
Application Received: 5/3/2004 Permit Issued/Case closed: 6/7/2005 Case Finaled: 8/31/2011
T-Mobile USA, dba VoiceStreamPUS III, Corporation proposes to co-locate onto an existing wireless
telecommunication facility. The proposed facility would consist of a 3-sector array with 2 antennas per sector, for a
total of 6 antennas mounted on the existing tower. Associated ground equipment is proposed near the base of the
tower within the existing fenced communication equipment compound. The original tower was permitted by Jefferson
County in 1994 (IZA94-00040).
MLA07-00085
BLD07-00072 MLA07-00085 VERIZON WIRELESS II F Zoe Ann Lamp
Application Received: 2/23/2007 Permit Issued/Case closed: 6/19/2007 Case Finaled: 8/7/2008
REMOVE 2 EXISTING AN I ENNAS &ADD 12 ANTENNAS TO LATTICE TOWER
PRJ07-00032 MLA07-00085 WILSON P
Application Received: 3/1/2007 Permit Issued/Case closed: Case Finaled:
REMOVE 2 EXISTING AN I ENNAS &ADD 12 ANTENNAS TO LATTICE TOWER
ZON07-00017 MLA07-00085 VERIZON WIRELESS II A Zoe Ann Lamp
Application Received: 2/23/2007 Permit Issued/Case closed: 6/19/2007 Case Finaled:
Verizon Wireless proposes to remove two (2)existing omni antennas and add twelve (12) panel antennas to the
existing lattice telecommunications tower located at 124 E. Go-onna Dr., Quilcene. The proposal does not include new
ground equipment. The antennas and mounts will be painted to match the existing structure. The proposed antennas
will be lower than the existing antennas. The original tower was permitted by Jefferson County in 1994 (IZA94-00040).
This proposal requires a Type II Conditional Administrative Use permit with public notice. State and local agencies
have been asked to review and comment on the proposal.
Review under the State Environmental Policy Act(SEPA) is required per WAC 197-11-800(25).
M LA12-00233
BLD12-00333 MLA12-00233 VERIZON WIRELESS I F Zoe Ann Lamp
Application Received: 10/22/2012 Permit Issued/Case closed: 12/26/2012 Case Finaled: 1/2/2014
Building Permit with SEHA: the proposal is to install a new four(4)toot diameter microwave dish at a height of 127
feet(antenna centerline)on an existing 147' 6" lattice tower. The subject parcel is zoned Rural Residential 1:5 and the
size of the new microwave dish is over the size for a microcell as defined in SEPA under WAC 197-11-800(25). As a
result, the proposal required review under the State Environmental Policy Act.
M LA12-00234
\\tidemark\data\forms\RParcel_CRMLA.rpt 9/4/2014 Page 3 of 4
BLD12-00334 MLA12-00234 VERIZON WIRELESS I F Lisa Keller
Application Received: 10/22/2012 Perm/Rued/Case closed: 11/6/2012 Case led: 4/16/2013
REPLACE 6 PANEL AN I ENNAS ON EXISTING TOWER
PRE06-00057 REALCOM ASSOCIATES F Zoe Ann Lamp
Application Received: 11/21/2006 Permit Issued/Case closed: 12/5/2006 Case Finaled:
Modify existing facility by removing two existing omni antennas and adding three sectors consisting of four panel
antennas eeach(total of twelve panel antennas)on an existing wireless telecommunication tower.
lltidemarkldata lforms\R_Parcel_CRMLA.rpt 9/4/2014 Page 4 of 4
f�,rne�
BL06
!UILDING1EIFVHTAPPLICASN Review Type:
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368 �G"'�`r "11' Th'd
7Y>! ZL4r`i 7 iv.1j
PERMIT #: BLD14-00316 Received Date: 8/29/2014
SITE ADDRESS: 124 E GO-ONNA DR
QUILCENE, 98376
OWNER: PHONE:
DAVID E WARD
PO BOX 123
QUILCENE WA 98376-0123 9550
SUBDIVISION: Block: Lot: 31
PARCEL NUMBER: 955000031 Section: 27 Township: 26 N Range: 1\
CONTRACTOR: TBD PHONE: 253-584-6606
REPRESENTATIVE: LYNN CONSULTING INC PHONE: 206-972-1368
17311 135TH AVE NE 425-354-3277
STEA100
PROJECT DESCRIPTIOI+ Replace 3 existing stand-off arms with 3 proposed sector frames and
add 3 panal antennas,
Add 2 RRG's and 6 junction cylinders, 3 filters and 1 expansion
cabnit
There will be no ground disturbance or grading associated with this
proposal.
TYPE OF WORK COM SQUARE FOOTAGE: COMMERCIAL:
TYPE OF IMP ADD MAIN: INDUSTRIAL:
VALUATION 10,000.00 ADD'L: HEAT TYPE:
CODE EDITION: 2012 HEAT BASE: HEAT TYPE:
OCCUPANCY: UNHEATED: #OF STORIES:
OCCUPANCY: OTHER:
CONST TYPE: GARAGE: SHORELINE:
CONST TYPE: DECK: SETBACK:
BANK HEIGHT:
SEWAGE DISPOSAL: NUMBER OF EMPLOYEES:
WATER SYSTEM:
BATHROOMS:
Exist:
Prop:
Total:
Routing Date:
Type Amount Paid By: Date: Receipt: Approved/Date
State Building Code $4.50 SRE 08/29/14 151399
Permit $168.00 SRE 08/29/14 151399
Plan Check $109.20 SRE 08/29/14 151399
Total: $281.70
\\tidemark\data\forms\F_BLD_App_Bld.rpt 8/29/2014
IA i
«<4' `ue, JEFFERSON COUNTY
ti,
{ DEPARTMENT OF COMMUNITY DEVELOPMENT
4_ , 621 Sheridan Street I Port Townsend,WA 983681 Web:www.co.jefferson.wa.uslcommunitvdevelooment
1'sK1Noc Tel: 360.379.44501 Fax:360.379.4451 j Email:dcd(rD.co.jefferson.wa.us
Building Permits &Inspections I Development Consistency Review I Long Range Planning I Watershed Stewardship Resource Center
Master Permit Application MLA:
Project Description(include separate sheets as necessary):
Sprint proposes to modify its antenna equipment on the existing telecommunications tower.The over-all height of the tower will not increase.
Tax Parcel Number: 955000031 Property Size: a 5 (acres/ uare feet)
Site Address and/or Directions to Property: East Go-Onna Dr, Quilcene,WA 98376 ,4.1Z i?r}
�5.€1.13),,C4.) ,arn H
Tower nrrator
Prepertyawaer(s)of Record: 7OYYG►" le/e6VQYC, v J
Telephone: 7 1- I Z -4 Fax: email: 1
Mailing Address: /0 p,-e 'a&n a ( W/ u m r M it o f )i l �
Applicant/Agent(if different from owner): Lynx c nstlting,,4-Ile , c/n Sprint
Telephone aD(,r 4773 tai/h) Fax: &OS 3514 l'}"71 email: A-Ze.Vei/e. 's)Jp9r
Mailing Address: 17311 135th Ave NE,Suite A-100,Woodinville,WA 98072 r.,61--Lc i;111.-f_r L±
What kind of Permit?(Check each box that applies ❑Lot or Road Segregation
RIBuilding ❑ Critical Areas Stewardship Plan
❑ Demolition Permit ❑Variance(Minor, Major or Reasonable Economic Use)
❑Single Family ❑Garage Attached/Detached ❑Conditional Use[C(a), C(d),or C]*"
❑ Manufactured Home ❑ Modular ❑ Discretionary"D"or Unnamed Use Classification
8 Commercial* ❑ Special Use(Essential Public Facilities)*"
❑ Change of Use ❑ Boundary Line Adjustment
❑ Address ❑ Road Approach ❑Short Plat**
❑Home Business ❑Cottage Industry ❑Binding Site Plan**
❑Propane ❑ Long Plat'"'
❑Sign ❑Planned Rural Residential Development(PRRD)/Amendments**
El Allowed"Yes"Use Consistency Analysis ❑Plat Vacation/Alteration"
❑Stormwater Management ❑Shoreline Master Program Exemption/Permit Revisions**
❑Site Plan Approval Advance Determination(SPAAD)* ❑Shoreline Management Substantial Development'"
❑Temporary Use ❑Shoreline Management Variance
9 Wireless Telecommunication* ❑Comprehensive Plan/UDC/Land Use District Map Amendment
❑ Forest Practices Act/Release of Six-Year Moratorium ❑Jefferson County Shoreline Master Program Amendment
*May require a Pre–Application Conference ❑Tree Vegetation Request
**Requires a Pre-Application Conference
Please identify any other local,state or federal permits required for this proposal, if known:
Lynx Consultin DESIGNATION OF AGENT
nx
I hereby designate y g to act as my agent in matters relating to this application for permit(s).
Tower Operator , �?
OWNER SIGNATURE C C "- . S"r.-- i t."ZYLS--4Y Date: ?/ 7/ /7
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 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 .uired later inspections. Staffs access and right of entry will be assumed unless the applicant informs the County in writing at the
time of the app; ati.n that •r she wa is prior notice.
Signature: • i .A' Date: L
The action or actions Appli..• 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' you are in compliance with the Jefferson County development code.The Applicant acknowledges that he,she or it holds individual
and non-tram ab- respo ibility fo adhering to and complying with the ESA. The Applicant has read this disc) imer and signs and dates it below.
Date: ' -1 Li `/LI
Signature: �I _ -
07/24/2013
121-i 6-4 -vvi .1-r- (4,u k /./w! . � q a-7
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 OR MANUFACTURED HOME INSTALLER: PHONE: FAX:
( ) ( )
MAILING ADDRESS: EMAIL:
CONTRACTOR'S LICENSE WAINS
NUMBER: NUMBER
ARCHITECT/ENGINEER: PHONE ( ) Fax( )
MAILING ADDRESS: ' EMAIL
Project Type: Frame Type: Bathrooms: ` : Shoreline: Type of Sewage Dispose
❑ New j Wood Existing: N ili �/�. 0 Sewer
❑ dition ❑ Steel Proposed: Ban / ' 0 Community SysterV
Alteration/Remodel 0 Concrete Total: Height: 0 Individual System
❑ Repair 0 Masonry SEP Permit#
❑ Demolition Other: Bedrooms: Water Supply:
Mkt lir r i Existing: Setback: ❑ Private well 0 Two Party
Type ofl� t: 1'`^� Proposed: 0 Public fnnnq�/rAy
/" )� Total: Name ofSysti15�t1''
If this is a Commercial Protect You must nswer the followin
Number of Parking Spaces: Current: 1 Proposet Number of ADA Parking Sgabes:
Number of occupants(}Dudes owners,tenants,employees,etc) Current Proposed �J�
IBC Occupancy: V IBC Type of construction: 'V j-)'41 Will you have Food Service? Yes / No
If this is a Propane Tank and/or Appliance Installation permit,mars all items below that apply:
1 Underground Tank i Above ground Tank Size of Propane Tank:
I Heat Stove 1 Cook Stove 1 Woodstove 1 Fireplace Insert I Hot Water Tank 1 Pellet Stove 1 Other
Is this appliance being installed in a Manufactured 1 Mobile Home? Yes / No
When applying for a permit to install a propane tank you must also submit a site plan showing all of the buildings,all property
lines,tank location and size,distances from the propane tank to all property lines,buildings and septic system components,
including the reserve area.
Square Footage Current Proposed For.`,Office UseOnly, Amount E1evision _>•
Main Floor Heated _ EH Bld App Review: ,C-
2n4 Floor Heated ',-;--",----/--- Consistency Review: (.. ;
Other Heated Base fee: �c . vU
Cl
Mezzanine :-Additional Section: V •, 0&
Heated Basement Plan Check fee: 1 n r . -2 o
Unheated Basement -': State Surcharge fee: SG
Other Unheated Pot Water Review fee:
Garage/Carport SUBTOTAL n , -__, o
Decks 911/Rd Approach fee:
Other TOTAL $ – ^I— am�-�)—
�`l(v(t,V . L lri t
«,- Receipt Number r• ■ ',-(1
Cash/Check Number: 7
ESTIMATED COST(REQUIRED) Date: / I1.-1
.Fair market value of all labor and materials foundation to finish !
( 6-1(x) Initials:
1 VII t.
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O)
October 3, 2014 1 OCT (;�;?
li I
Anna Bausher, Assistant Planner j--- J
Jefferson County Department of Community Development EFT: " TY
DEPT OF CO r< I�r Iry --"?°rENT
621 Sheridan Street
Port Townsend, WA 98368
RE: Sprint SE63XC005 Coyle/124 Go-Onna Drive, Quilcene/ATC 82927
Dear Anna:
The above referenced project for Sprint was originally submitted to Jefferson County in mid-August.
We have been waiting for the"noise study", as we discussed in emails.
The Acoustical Report, dated September 16, 2014 prepared by SSA Acoustics is enclosed(three
copies). The study concludes that as proposed, the equipment improvements cannot meet the required
45 dBA noise code limit at the nearest receiving property, without proposed/proper mitigation.
The proposed method to achieve the required noise level is installation of a noise barrier around the
equipment(the barrier will also enclose the existing Sprint equipment and help reduce noise from
existing equipment). The top of the barrier will be eight feet (8') above grade, constructed of solid
materials,with sound absorbing materials inside the barrier. The recommendations are specified in the
SSA report.
The results of the noise study in turn created the need for structural analysis of the noise mitigation
and revisions to the engineered construction drawings. Three copies of the additional structural
analysis and three sets of the revised construction drawings are enclosed.
Please review the enclosed materials and let us know if you have any questions or will need additional
information to continue processing this building permit application. We believe the landscaping
requirement portion of the proposal has already been met. Thank you for consideration.
Sine el jy,
ileen Za
•
Lynx Con . g
206 972 1368
Azavales@lynxconsulting.org
Enclosures: Three SSA Acoustical Study
Three NW Tower Engineering Structural Analysis for Noise Mitigation Fence
Three sets final construction drawings, revised—stamped and sealed by P.E.
1 1 P a e 17311 135`h Avenue NE, Suite A-100, Woodinville, WA 98072
SSA acoustics L_D - 31 (40
smwan•at Allaoua•Burt•Ma®rack,n 1V
CEME
September 16, 2014 D
Bert White OCT — 6 ?�'a
Lynx Consulting, Inc. �� `' 1
17311 135th Ave NE, Suite A-100,
Woodinville, WA 98072 JEFFERSON COuNTY
1 '�'r,%,''! nngF^l
DEPT.OF CO,_,_..MIIN_—:-_.._r
Re: Acoustical Report— Sprint SE63XC005 Coyle (1 ` O I t/
Site: 124 E Go-Onna Drive, Quilcene, WA 98376 C� 'y,1 l
Dear Bert,
This report presents a noise survey performed in the immediate vicinity of the proposed
Sprint telecommunications facility at 124 E Go-Onna Drive in Quilcene, WA. This noise survey
extends from the proposed equipment to the nearest properties. The purpose of this report is to
document the existing conditions and the impacts of the acoustical changes due to the
proposed equipment.
Code Requirements
The site is located within the Jefferson County zoning jurisdiction in a RR-5 Rural Residential
zoning district. The nearest receiving properties are also within a Rural Residential district.
The proposed new equipment includes (3) new antennas and (3) new Sprint RRH units and (1)
expansion cabinet. The equipment support cabinet is the only proposed noise-generating
source and the cabinet is expected to run 24 hours a day.
Under Jefferson County Code Chapter 18.42 Personal Wireless Service Facilities, noise
generated by a wireless facility shall not exceed the maximum environmental noise levels set
forth in Chapter 173-60 WAC as it is now in effect or hereafter amended. According to WAC
173-60-040, noise from equipment on a Class A EDNA (Residential) property is limited as
follows:
Class A EDNA Receiver: Noise is limited to 55 dBA during daytime hours. During nighttime,
defined as the hours between 10 p.m. and 7 a.m., maximum sound levels are reduced by 10
dBA for receiving properties within Class A EDNA's.
Since the support cabinet is expected to operate 24 hours a day, it must meet the 45 dBA
nighttime limit.
Proposed new Equipment
The proposed new equipment includes (3) new antennas and (3) new Sprint RRH units and (1)
expansion cabinet. The equipment support cabinet is expected to run 24 hours a day.
SSA Acoustics, LLP
222 Etruria Street, Ste 100, Seattle, Washington 98109
t. 206.839.0819 f. 206.839.0824
• •
Sprint
SE63XC005 COYLE
Predicted Equipment Sound Levels
24-Hour Operation Equipment
The proposed equipment includes one Sprint MMBS cabinet.
The following table presents a summary of the equipment data according to the manufacturer:
Cabinet Description QTY Sound Level, dBA @ 5' (1.5 M)
Samsung MMBS Equipment Cabinet 1 66
To predict equipment noise levels at the receiving properties, this survey used the methods
established by AHRI Standard 275. Application factors such as location, height, and reflective
surfaces are accounted for in predicting the sound level at the nearest receivers.
The proposed equipment is to be located adjacent to existing equipment within the compound.
The nearest receiving property is approximately 5 feet south of the equipment location. The
predicted sound level at the nearest property is shown in Table 1 below.
Table 1
Application Factors and Predicted Noise Levels
Proposed New Equipment
Line Application Factor South
1 Sound Pressure Level at 5 ft. (dBA), Lpl 66
2 Distance Factor(DF) -0
Inverse-Square Law(Free Field): DF = 20log (d1/d2) (5 ft)
3 New Equipment Sound Pressure Level at Receiver, Lpr 66
(Add lines 1 and 2)
As shown in Table 2, the sound level from the proposed equipment cabinets will not meet the 45
dBA noise code limit at the nearest receiving property.
Please refer to the noise mitigation section for the noise control requirements for the equipment
to meet code.
FE, c L L ;'
IL OCT - 62` 14 If
1
JEFFERSON COUNTY
, DEPT.OFCOP:1r�AITYtiFVmUFh+,rr'T.
Page 2
• •
Sprint
SE63XC005 COYLE
Noise Mitigation
The noise level from the equipment cabinets needs to be reduced by 21 dB for the equipment to
meet code at the south property line. In order to reduce noise levels effectively, a noise barrier
must be installed as follows:
Noise Barrier
o Install a noise barrier around the equipment as indicated by the bold lines in figure 2.
Note that the barrier also encloses the existing Sprint equipment so it can be accessed
and additionally will help reduce noise from the existing equipment.
o The top of the noise barrier shall be at 8'-0" above grade.
o Construct the noise barrier with a solid material that has a surface mass of at least 2.5
lbs/sq ft. The following are common barrier materials that meet this requirement:
o 3/4-inch exterior grade plywood
o 16-gauge sheet metal
o 1/2" Fiber Cement board (HardiPanel or HardiBacker Vertical Siding)
o Install sound absorbing material (NRC 0.8) inside of the barrier between 1'-0" to 7'-0"
above grade. Recommended products for this application include minimum 1" thick F-
Sorb, 1" Thick Stratocell Whisper or Soundseal QFA-11. These products are available
from Forrest Sound, contact Doug Bixel (425) 646-9703.
o A general detail for the barrier is presented in the following figure.
(1) LAYER 3/4" PLYWOOD OR
(1) LAYER OF 16 GAUGE SHEET
1 METAL OR A CONTINUOUS MATERIAL
W/ A MASS OF 2.5 LB/SF OR
GREATER
LOP BARRIER MATERIAL SHALL BE
CONTINUOUS. ALL GAPS OR JOINTS 11PCIEOVE )
SHALL BE SEALED W/ ACOUSTICAL EQUIP, a , CAULKING
SIDE
RECEIVER EXTERIOR GRADE SOUND ABSORBING
+� SIDE MATERIAL, APPLIED TO SIDE OF OCT ����
"LAN BARRIER FACING EQUIPMENT
JEFFERSON COUNTY
FRAMING PER STRUCTURAL DEPT OF COMMUNITY DEtiIFLOPME IT
REQUIREMENTS
MAXIMUM OF 1" GAP
ALLOWED FOR DRAINAGE
80_TT0M_
NOTE: MATERIALS SUCH AS SIDING
CAN BE ADDED TO THE OUTSIDE OF
THE BARRIER FOR AESTHETIC
—I I 1=III- I I=II- PURPOSES, BUT MAY NOT SUBSTITUTE
-"I I III—I l 1-111_i FOR REQUIRED BARRIER MATERIALS
SUCH AS PLYWOOD OR SHEET METAL.
NOISE BARRIER DETAIL
Figure 1: Noise Barrier General Detail
Page 3
• •
Sprint
SE63XC005 COYLE
PRCO;IN25 Li na.. �i .
_ ( T I �i Li I 11
Lx ST,NC SrRINT
PROPOSED SPRINT PAD MOUNTED n — NOISE BARRIER
EXPANSION CABINET yy
PROPOSED SPRINT 4.-0-mr-0•
CONCRETE EWIPMEAR PAD -. —I
i-6• SNG SPRINT
AOLE ,RAY R"Si■
11.
Figure 2: Noise Barrier Plan
Table 2
Application Factors and Predicted Noise Levels
With Mitigation
Line Application Factor South
1 Sound Pressure Level at 5 ft. (dBA), Lp1 66
2 Noise Barrier Reduction -21
3 Distance Factor(DF) -0
Inverse-Square Law(Free Field): DF = 20log (d1/d2) (5 ft)
4 New Equipment Sound Pressure Level at Receiver, Lpr 44
(Add lines 1 and 2)
As shown in the table above, the equipment cabinets will meet the 45 dBA nighttime code limit
with noise mitigation installed.
Please contact us if you have any questions or require further information.
Sincerely,
SSA Acoustics, LLP
Alan Burt, P.E.
ASSOCIATE PARTNER D f E 0 V/ I� ,
_ 6 1 (---1
a on- 1
IFFERSGN COIINTY
DEPT OF COMM UN'TV F19OPMFAT
Page 4
• •
�� N coa. JEFFERSON COUNTY
kkri, DEPARTMENT OF COMMUNITY DEVELOPMENT
4 , . 621 Sheridan Street • Port Townsend •Washington 98368
s-3,& 4•0 360/379-4450. 360/379-4451 Fax
http://www.co.jefferson.wa.us/commdevelopmenV
. - 1) I s 2)1 6tt Crivrvti
Stormwater Calculation Worksheet ,9' If���
"ALA fF PROJECT/APPLICANT NAME: 1,1-1-1 .� "/ ' 6'1‘tYlf..ei
DETERMINING STORMWATER MANAGEMENT REQUIREMENTS:This stormwater calculation worksheet should be completed first
to classify the proposal as"small,""medium,'or"large." The size determines whether a Stormwater Site Plan is required in conjunction
with a stand-alone stormwater management permit application, building permit application, or other land use approval application that
involves stormwater review, The basic information will also be helpful for completing a Stormwater Site Plan,if required.
PARCEL,SIZE(I.E.,SITE
Size of parcel . 1D acres An acre contains 43,560 square feet. Multiply the acreage by this figure.
Size of parcel in square feet : ) r 0 y 30 sq/ft
Land-disturbing activity is any activity that results in movement of earth, or a change in the existing soil cover (both vegetative and
non-vegetative) and/or the existing soil topography. Land disturbing activities include, but are not limited to clearing, grading, filling,
excavation,and compaction associated with stabilization of structures and road construction.
Native vegetation is vegetation comprised on plant species, other than noxious weeds,that are indigenous to the coastal region of the
Pacific Northwest and which reasonably could have been expected to naturally occur on the site. Examples include species such as
Douglas fir,western hemlock,western red cedar,alder,big-leaf maple,and vine maple; shrubs such as willow,elderberry,salmonberry,
and salal;herbaceous plants such as sword fern,foam flower,and fireweed.
LAND DISTURBING ACTIVITY,CONVERSION OF NATIVE VEGETATION,AND VOLUME OF CUT/FILL
Calculate the total area to be cleared,graded,filled, Answer the following two questions related to
excavated,and/or compacted for proposed development conversion of native vegetation:
project. Include in this calculation the a ea to be cleared for:
Does the project convert V.acres or more of
Construction site for structures i'\) )4.* sq/ft native vegetation to lawn or landscaped areas?
Drainfield,septic tank,etc. 4;:i2.- sq/ft Circle: Yes No
Well,utilities,etc. sq/ft Does the project convert 2'/z acres or more of
native vegetation to pasture?
Driveway, parking, roads,etc. sq/ft /�'
Circle: Yes Mo /
Lawn,landscaping, etc. sq/ft t_,f
jV
Other compacted surface,etc. / Indicate, 1 sq/ft � '-Y4 Volumes of Proposed:
Total Land Disturbance N sq/ft Cut LTY Fill t 't tr u/yd)
[over]
srormwetor cdc worksheet—REV.2/2312000 7
• •
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) sglft 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 sq/ft Total Existing sq/ft
TOTAL NEW+TOTAL EXISTING* C/ 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 existing impervious surface? Circle: Yes No
FURTHER INSTRUCTIONS: If the answer is yes, the proposal is considered redevelopment and the attached Figure 2 should be
used to determine the applicable Minimum Requirements. If the answer is no,the proposal is considered new development and the
attached Figure 1 should be used. At this juncture, the applicant should refer to the applicable Flow Chart to determine the Minimum
Requirements for stormwater management. DCD staff will help verify the classification of the project and the application requirements.
For proponents of "small" projects who must comply only with Minimum Requirement #2—Construction Stormwater Pollution
Prevention—an additional submittal is not required. The proponent is responsible for employing the 12 Elements to control erosion and
prevent sediment and other pollutants from leaving the site during the construction phase of the project. Pick up the Construction
Stormwater Pollution Prevention (SWPP) Best Management Practices (BMPs) Packet. Proponents of"medium" projects—those
that must meet only Minimum Requirements #1 through #5—and for "large" projects—those that must meet all 10 Minimum
Requirements—we required to submit a Stormwater Site Plan. DCD has prepared a submittal template of a Stormwater Site Plan,
principally for rural residential projects. Complete the template in the Stormwater Site Plan Instructions and Submittal Template or
prepare a Stormwater Site Plan using the step-by-step guidance in the Stormwater Management Manual.
APPLICANT SIGNATURE
By signing the Stormwater Calculation Worksheet, I as the applicant/owner attest that the information provided herein is true and
correct to the best of my knowledge. I also certify that this application is being made with the full knowledge and consent of all
owners of he affected property.
D
(LAND NER OR AUTHOR! REPRESENTATIVE SIGNATURE) (DATE)
:e-:':-"17-774; 9 t��. fie.. � �X�rr a}M°+ m � _��� �Y� ,� �" 14a I'
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SHEET OF
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GO-ONNA BEACH TRACTS D/V/S/ON 2
S/TUATE /N SS'r-N%2-S.W.%,SEC.27 T26N,R/W, W M.
JEFFERSON COUNTY WASH.
MAY,/968 GEORGE ROATS
�f��CAT/ON urn rwfrrrr•IAN/tN w
rrrs
rortard, PAIR.
YYDn Au nd by those presents that USTIS Y.SOIEfmT,•starring.an,as his PROTECTIVE COVENANTS
generate estate,owner i°fee Maple of the land hereby platted,hereby declares Chi. 1. All lots in this plat shall ha need for residential,camping,or recreational
plat and dedicates to the use or the public forever all trots,One...and places ..V.}vrposee..V.w
shown no the plat and the e thereof for any and all public warps...not Ineon.0.tant
with the use thereof for public highway purple..,also the right to make all n.m•saary 2. No permanent structure or building shell be constructed on any lot,tract or parcel
•lopes for cute and fill,upon the lots and blocks Mom on this plat is the readable of this plat door than 20 feet to the margin of any etnet or road. Ws lot, tract or
original grading of all streets,menu.,and place.shown hereon. Also,the right portion of a lot or tract of thin plat shall be divided and old,or reald,or ownership
to drain all strata over and across any lot cr lots Men water sight take a natural changed er transferred dwrby the omenhip of any portion of Chi°rplot Mull he Las
comae after tan street or streets are graded. 111 lets,tracts or parcels of land than 20,000 square feet or less than 70 feet is width at the building aet back line,.
embraced i.thin plat are subject to and shall be in Cmforaity with JOtferoo County
Con os rvgtlatipa. 3. so lot shall be used or maintained ae a dumping ground for rubbish,trash,garbage
r otter w&i..
In prOs.ae whereof we has henueto sat our hands and male Chia /age o
dny of (/.�/� 19g,a.o. 4. No poultry,livestock or animals of say ther than rouse pets shall M kept
0 or maintained on any part of the platted lot•.
5. No building,shed or garage shall M comtrueted within 2D feet of the street right-
// C of-wed or within 5 feat of the lot side or back lines.
WARnS k. CH000PT
6. Easements within 5 teat of all lot lines are hereby reserved for drainage,water
ACKNOWLEDGMENT ante.pipes, sewage pipe., atom suers and utilities,including right of aintenanc•.
state offgashington)e, 7. Ho mziem or offensive activity°hell be carried on upon any lot,nor shall
y° ..r,� thing be drew thence which may he or become an a-rwce or nuisance to the Com.aut�
761e is to certify that on the 3.e, day of wrf S. any outdoor fireplace,barbecue or the like shall be eon:trusted and maintained
19f4 0.0.,Wore r,the undersigned,a Votary Pantie in and fo •Staid of in accordance lath the specifications and oNmarda of the Dated State.leraot^y iw.
Washington duly coa°k.siooed and sore,personally appeared MIAMI Y.SCn0411S27, to
a kmo to S.the indiwiduel deorited in and who executed the tangoing Instrument 9. The cost of construction,Lpo.eant and/or main.--n'e of•oo .aity water
and acknowledged to r that he sighed and meled the.ace as his tree and voluntary meta,electricity,parks and recreational area within the area appurtc.et to the said
act and deed for the um.s and porno..Mersin mentioned. described real property and within the area defined and d.asribed L cit.plat of"CO-
MM
q trod and ads the and BEACH TRACTS DIVISION 2•and the plat of.00-0YYA BRACM TIMCLS^,shall he paid by
In witness whereof,1 have hereunto set day year first all noes of property within the aforesaid plate, am,as Y/he
above written. designated by the developer.of N.aforesaid and addition., or by prime corpora-
tiro.subJut to governmental regulation..
10. Be shack or unsightly buildings shall he.rented on the maid described reel prop.
Not Pnh1 c'So end f the State° arty. All etnetar.e shall he completed a to easterner app..r n.. including finished
°ing at painting,within twenty-four(24)wathe from the date Of Ooaenoernt of construction.
Yea C••hirer expires
11. All garbage and now container,shall be kept In an are concealed from wpbs
view.
T EASURER`S CERTIFICATE 12. All oar or septic eynt.0 must be properly iaet.ued.d alntaiad aeeooi°g to
regulation.on masted or hereinafter pawed by any goo.rime°tal authority having Jarie-
I Treasurer of Jefferson County,Washington, diction over the said described real property.
heresy e rt fy tams on the above property an paid up to end including the
year of44f A.D. 13. The breaeb of any of the ten
against the persona°omitting the breach by up other lepconstitute
r Or punheaer of of
real property
in the area described Within the plat.of Q1_0051A BEACH TRACTS 51013I01 2e mod•00OHW•
�AY_L�.t/V�le✓sG+cw BEACH TRACTS`.
J.fferod G6 uuty,Treseunr 14. Each lot sonar shall have one aizty-fifth share of the Commit,Beach o described
bales,
Community Bach--That portion of co-mermen.tot 2,Section 27,To...Min 26 North,Hangs 1
APPROVALS Rat,W.Y.,Jeff-anon county.Washington described o toile..:
Beginning at the Soutb.eet corner of said geeti0n 27;thane.S 90946'37^E 2617.26
fit foot to the South quarter corner of said Motion 27;theme Y 1°13.27^Y 663.86 feet;thaw
Approved by a this 3-day of Jane 19, A.D. $811,447r56a S 1007.17 teat; th.nce g 2 930,00"S 974-65 feet; Name c0otlnuing
Y 2°30'00.1 555.05 feet;thence$87°Z7'QOe S 721.23 feet to the balanced Coverneat Mend-
er line of good Canal.end the Iran Point Of Beginning;them.Y 57029'00^•30 feet;th—.
Y yW 150 foot;Menge S 87927'005 Y 30 feet to said Mender 11a; thaw slog mid mauler
•
S 6.33.16m C 139.20 font; thence•34956r1449 14.03 feet to the True feint d'3540011,0.
t.afuet+ f W TOC2711611 WITH Second Clue Tidelotl.fronting.
Coat,!salaams
Yaw lot oa.r shall ham right of Ingress and Berme over the.rieting•ua.rood eat of
this plat to said Camaiy Beech.
Approved by the Board of County Co.saion.re this.^1 dq of Jun" 15. rho well site is located m lot end rev or septic meta Se prracted wised.
1900. •.0. 100 feat of the w1.1.
e.
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Board of County,.. eli,eere
ATTEST:
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Board id o County comdesioa.rre
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SHEET.,OF ..
G�-ONN,4 BEACH TRACTS D/I//5/ON 2
SITUATE IN S72—N72—SW. %,SEC.27, T26N, R/W, W.M
JEFFERSON COUNTY WASHe
SCALE:I°c 100' MAY, /966 GEORGE ROATS
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'MIS PLAT OF•u0-0050 BEACH TRACTS DIVISION 2^ portion of the
+�•• -ar< - comprises 7,T
i • — y 0 h Smith half of the North lull at eridin,t quarter of Section 27,2emeE1P 26 North,
e 5 z k Q 4 Range 1 Soot of the M l eette Yeritl u,described ea follows:
J
%r N V q 0 h of said S at the southwest corner of said Section 27;to the alma the weal.
VUteM Z h line of said Section 27,North 1°33.00"But 1376.25 feet to the 5outheart 0 9� p I corner of the South half of the North half of the sonthweet quarter or Raid
2O sr O Z Section 27,the True Point of Beginning;thence continuing along North 1 33.00•
o i East 663.12 feet to the Northwest corner of the South half of the North half of
.r3454 ± • 4t, x 6 the s°of too quarter of Section 27;thence the 8e°49•54"quarter along the North 27
4 line of the South half of the North half of the southwest quarter Section 27
1273.64 feet;Warms
LM 0 South 1°10.35"West 3E11,73 feet;Thence North outh 88049.25.Meat
------- 0 635.00 feet M antould lint of tM hence le vine.Sd Ce LMnee South 1°1Ot35•BoeL 60 feet aloha Rata cSouth iee theme]saal.7 eeee eta the M South eBof 1.6.•
t Go.ON ISEnA.0 NLest 650.00 feet; thence South 1°10.35^Nast 301.74 feet to the south line of the ea Sovtb hLLf 11 Lhe Norm Halt)e LM 9a 93.16 quarto a Trio Fe 27i f es01 LLoeg k'e•.e•V.w .°a-. t a w.+eew eeltl SOOth lino lbrth 86°49.556 Meet 129316 feat to tM Tree saint of Beaimtna,
'+.(a-.v e.. " 4 r Except the right of may of the Chanty Road;
SECTION-5116-DIVISION situate in the Bounty of Jefferson,state of Washington.•
SECTION 27 + ei
"o� ENGINEER'S CERTIF/CATS
• VICINITY MAP I hereby Certify that this plat of"CO_ONNA BEACH TRAITS DIVISION 2^is bawd
SEPALS 1.s•MllLs wen an actual saadivieion of Section 27 Ton0hip 26 North,Range 1 Weft,W.Y.,
RECORDING CERTIFICATE that the distances and Soar...of end..or. ...°m there...M,....1y and w
000usants have teen stated on the ground.
Filed for sword aL the request of ,_ -ee fe.el..af on
;[awes,,. 3 19 A.B.at o t al;utee peat o•OE Ro
//////"''O AM O 11006 and recorded in Velum�ef Plats,pages 43.. , .�• e. [��c�.� � i N
Hamrsa of Iefferam Cm. 100911
y'Ye0h�'On. Civil Engineer and Land Surveyor
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FOR INFORMATIONAL PURPOSES ONLY-
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efferson County does not attest to the accuracy of the data contained herein and makes no warranty with respect to its
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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
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FOR INFORMATIONAL PURPOSES ONLY-
Jefferson County does not attest to the accuracy of the data contained herein and makes no warranty with respect to its
correctness or validity. Data contained in this map is limited by the method and accuracy of its collection.Thu Sep 04
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FOR INFORMATIONAL PURPOSES ONLY-
Jefferson County does not attest to the accuracy of the data contained herein and makes no warranty with respect to its
correctness or validity. Data contained in this map is limited by the method and accuracy of its collection.Thu Sep 04
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VOL r OFFIC RSCRD RIGINAL 374875 RECr-
139k AU6 29 ?4 12 59
?k Y E. a.EOURY
FERSON Cc;yTY AUDITCR
5■ DEPUTY
•
•
WA1 BRINNGN 2
•
FILED FOR RECORD AT REQUEST OF
AND WHEN RECORDED RETURN TO:
U S WEST NeveVector Group, Inc.
Attn: Real Estate and Construction:Department
xnm•
30 !61st Ave SE P ant
P. O. Box 91211
Bellevue, WA 98009.9211
MENtoRANDuni UFOPTION AND LEASE AUItEE11lEN'I'
This Memorandum dated this 3rd Clay of January
'
Robe Wilson & Veda Wilson, Husband g Wye 19 94
by and between
,—
ibreinaflcr "Lessor")and
L'm'ted partnerahi
91211; I3cllcvue, Washin 3350 161st Avenue S.
gton 98009.9211 (hereinafter "Tenant"), is a record of hat Option
ox
and Lease Agreement (hereinafter "Agreement") between Lessor and Tenant
elated December 16 1993
which Agreement includes in part the following terms:
I. I.easetl Pr mist
--�,. The Agreement pertains to real properly which is described in
Exhibit "A" (hereinafter "pro
reference. lerty") which is attached herein and incorporated herein by this
2. Term�fement and Option 1
a five- car 5 Extend, The initial term of the Agreement is for
Y (-) period commencing on the date the Option is exercised by Tenant. Tenant has
options to extend the Agreement term for 4ur five-year(5)
periods. Tenant may, under certain conditions, elect to extend tthe term thereof.
3. SSSgessors and A i n . The terns, covenants and provisions of the Agreement
extend to and are binding upon the respective executors, administrators, heirs, successors and
assigns of Lessor and Tenant.
4. Ratification of Lea
to the Agreement and The parties by this Memorandum intend to record a reference
Agreement and t nd do hereby y and confine all of the terms and conditions of the
hereby declare that the real property described in Exhibit "A"
attached
hereto is in all respects subject to all of the applicable provisions contained in die
LESSOR: Agreement.
Robert D. Wilson & vela Wilson TfiNAN'I';
David Ward And H. San Juan Cellular Limited partnership
,n Jean Wdrd g
-;-�', 1C1� r _
By: U S WES_T1et+V- tor Group, Inc.
L�,t '�J By: - era,! a , r
Its: DirectorFF� ':'.•.' .. -
I- 1-9`.1 _
Mnt1M1]1. PATE —`--
9.1.9)
= t�
SALES REAL ESTATE
ottsk..� v3- o
COUNT?.T max, i,°C�t)rRP1
E''f'P'• \\- t5-glo , 3'i.En, U:EF
IN
Pelfrrcta L. 114 tJ i I Itenc/19
Ow ' •
INDIVIDUAL ACKNOWLEDGMENT
STATE OF\yam_\ _ 1
COUNTY OF Iss.
4 v p.r I
•
On this day personally appeared before me \ A. Xv1 �rys
known to be the individual described in and who execute the within and foregoing instrument, and , to me
acknowledged that\-‘,,. signed the same as\h,��„-0 free and voluntary act and deed, for the
uses and purposes therein mentioned.
GIVEN under my hand and official seal this ^A day of. 19 CI',
Notary Public in and for the State of\V\s,wr M
residing at �.:),.._.
My appointmen expires: ' � -—
--
.
INDIVIDUAL ACKNOWLEDGMENT
STATE OF 1\S.1u.S,;,ra,.-F,,,,,1 I
Its.
COUNTY OF I
On this day personally appeared before me\11114.....\1,......S.4.1.
known to be the individual described in and who executed the within and foregoing instrument,and to me
acknowledged that signed the same as
uses and purposes there mentioned. �',°� free and voluntary act and deed, for the
GIVEN under my hand and official seal this
--_n_-day o . 19 kA,
Notary Public in and for the State o
residing at - t5
My appointment expires:__S\—.113..91. ..
Pa_41-rcia L. /auu l — !4 6 0 dIj
•
•
•
•
• 4011 • •
INDIVIDUAL ACKNOWLEDGMENT
STATE OF
COUNTY OF Iss.
ssz5„
On this day personally appeared before me a \.33?‘_rA
known to be the individual described In and who executed the within and foregoing , to me
acknowledged that h. signed the same as �� n g inttrnmdne and
NN.., e r Tree and voluntary act and deed, for the
uses and purposes the mentioned.
GIVEN under my hand and official seal this '■ day of
•
Notary Public in aor the State f>
residing atc� a,S,ca ", '''<
My appointme th expires: vs.- _9M
INDIVIDUAL ACKNOWLEDGMENT
STATE OF
COUNTY OF )ss.
On this day personally appeared before me
known to be the individual described in and who executed the within an oi� , to me
acknowledged that �ti signed the same as n g instrument,and
uses and t free free and voluntary act and deed, for the
purposes theret mentioned.
GIVEN under my hand and official seal this day .`
o� 19_a1r`�.•
. - • — ,11e...:'M...
Notary Public in and for the State ofVZ,,o
residing
M ap
My poin cv
Mintme t expve5: k
MA'r, e,a. L. auu,l -44.4'11
•
A' 111/ 0
CORPORATE ACKNOWLEDGMENT
•
STATE OF
COUNTY OF Iss.
1 ,
On this day of 19__ , •afore me personally appeared •
to me know• o be the
•the co .• ation that executed the within and fore oin
and acknowledged said instrument to be lb. re. and voluntary act and deed of said corporation,g g instrument,
uses and purposes therein mentioned, a • on oat -tated that cut for the
Instrument and that the seal affixed, -ny, is the co •orate seal of said corporation authorized to execute said
IN WITNESS WHEREO-, I have hereunto set my - d and affixed my official seal the day and year
first above written.
Notary Public in and Ion ti Stare of
residing at
My appointment expires:
11111` A PARTNERSHIP ACKNOWLEDGMENT
STATE OF 1
I
COUNTY OF Iss.
t1 I
0 th. do_> `day of ,9c'1Li
o-v,,,¢, before _ personally appeared
to me known to be the it, P • e . •ns
of SUJest N ., ?rj
• the general partner of _ "� '
the partnership that executed the within and foregoing instrument, a !--" � to be
the free and volu ry act and deed of said partnership, for the uses and purposesgtherein dmentioned, and on I`
oath stated that was authorized to execute said instrument and that the seal affixed, if an
seal of said partnership,
. y, is the
IN WITNESS WHEREOF, I hav
first above written. nta set my hand a (fixed m official hcial seal the day arid year
C .;) .,,,,,nrT .........,
Notary Public' and for
e State of � . tom.
residing at - ____ •� oN O 6�
My appninerneni exp .s: �+ .;:r NOTARY•p; S.
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COPY ; ADD/AIVID
RECORDING REQDESTEDBr
AND WHEN RECORDED RETURN TO:
American Towers,In c.
116 Huntington Avenue,Mb Floor
Boston,MA. 02116
Attn:Site Designation Supplement Coordinator 0 R l el , I
(Space above this line for Recorder's use)
MEMORANDUM OF SUBLEASE
This MEMORANDUM OF SUBLEASE, made and entered into as of this I .day of
og?lLP___ by and between SEATTLE SMSA LIMITED PARTNERSHIP
(" ubles or")lndAmerican Tower Delaware Corporation, a Delaware corporation
("Sublessee").4#
I• Pursuant to Site Designation Supplement number/ _,effective_
ta7_04(2_,which is governed by the terms and conditions of that certain Sublease entered i to b ween Sublessor,
Sublessee and other parties identified therein on{�Qd.Kllr�yf ,,2?0OO ,which is incorporated herein by this
reference. Sublessor subleased to Sublessee,and Sublessee ubleased from Sublessor,the Subleased Property (defined
below).
The Commencement Date for the Site Designation Supplement is__ f _, 212..d
2. Notices with respect to the Site Designation Supplement shall be,in addition to the notice address in the
Sublease,directed to:
AirTouch Cellular, Inc.
3350 161st.Avenue SE,M/S 231
Bellevue,WA 98008
Attn:Manager,Site Development
3. The Subleased Property subleased to Sublessee under the Site Designation Supplement is a portion of the
real property commonly known as WA IBRINNON -516 and more specifically described in Schedule 1 attached hereto.
4. In the event of any conflict between this Memorandum of Sublease and the Sublease (and Site Designation
Supplement),the terms of the Sublease(and Site Designation Supplement)shall control.
•
*Address of Sublessor: **Address of Sublessee:
c/o AirTouch Communications, Inc. c%American Towers,Inc.
One California Street,21st Floor 116 Huntington Ave., 1 lth Floor
San Francisco,CA 94111 Boston, MA 02116
.._,-ct Vertical Number-516
COPY
IN WITNESS WHEREOF, Sublessor and Sublessee have duly executed this
Memorandum of Sublease as of the day and year first above written.
SUBLESSOR: SUBLESSEE:
SEATTLE SMSA LIMITED American Tower Delaware Corporation
PARTNERSHIP,a Delaware a Delaware corporation
limited partnership
By: VODAFONE AIRTOUCH By:
LICENSES,LLC,a general
partner Name: Jonathan R. Black
By: CELLCO PARTNERSHIP,
its so - member / Title: Vice President
By: ./ ( Date:
Name: Gregory Cali:ari Tax ID#: 04-3481371
Title: Attorney-In-Fact
Date: 5(3(00
Tax ID#: 91-1237252
STATE OF CALIFORNIA )
) SS.
COUNTY OF SAN FRANCISCO )
On May 3,2000, before me, Ruth Biggs,Notary Public,personally appeared Gregory
Caligari, personally known to me to be the person whose name is subscribed to the within
instrument and acknowledged to me that he executed the same in his authorized capacity,
and that by his 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.
kcal_ 619,10.
Ruth Biggs - RUTH BIGGS
Notary Public r0 Cwmbran Public O^ /1+ lltomb
1!ff Son Francisco County
Project Vertical# �6
COP YIP
IN WITNESS WHEREOF, Sublessor and Sublessee duly executed this Memorandum of
Sublease as of the day and year above written.
SUBLESSOR: SUBLESSEE:
American Tower Delaware
Corporation, a Delaware corporation
By: By: ' .
Jo,ath• R. Black
Vi e P esident
Date: Date: 3
1
Tax ID No. Tax ID# 04-34813
•
Project Vertical No. ,_5-76
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JEFFERSON COUNTY
tis7"'--- -=';'\2 DEPARTMENT OF COMMUNITY
",1 DEVELOPMENT
;,,' « + 621 Sheridan Street, Port Townsend,WA 98368 Web:www.co.iefferson.wa.uslcommunitydevelopment
rf I L Tel:360.379.4450 I Fax:360.379.4451 I Email:dcdna,co.iefferson.wa.us
SquareONE Resource Center I Building Permits&Inspections I Development Review Long Range Planning
September 8, 2014
LYNN CONSULTING INC
17311 135TH AVE NE
STEA100
RE: SITE ADDRESS: 124 E GO-ONNA DR
CASE#: BLD14-00316
Dear LYNX CONSULTING INC:
The Department of Community Development is in the process of reviewing your application. The
following information is needed to continue review of your project.
All wireless communication facilities must submit a landscaping plan for the equipment enclosure in
residential districts. Please submit a revised site plan that indicates the existing vegetation or
landscaping outside of the security fence that conceals or screens the existing and proposed
facilities. Also, noise generated by a wireless facility shall not exceed the maximum environmental
noise levels set forth in Chapter 173-60 WAC. Please submit noise generation data for the noise
that will be generated by the equipment associated with the proposed expansion cabinet.
If you have any questions regarding this information, you can contact me by phone at 360.379.4454
or by email at abausher @co.jefferson.wa.us
Please submit the above information to the Department of Community Development within 90 days
of the date of this letter which would be 12/7/2014. As required by Jefferson County Code, JCC
18.40.110(3) and (6), if the information is not submitted or additional time to submit the required
information within the ninety (90) calendar day period is not requested, the application would be
considered abandoned and therefore withdrawn and application fees will be forfeited. Jefferson
County Code provides that the Department of Community Development shall not be responsible for
notifying the applicant of an impending expiration, thus any further notification would not be
forthcoming.
Sincerely,
al/la MaaJice4
Department of Community Development Staff
c: File
•
\\tidemark\data\forms\F MLT_Addlnfo_Requst.rpt 9/8/2014
•
V LYNX
August 14, 2014
Jefferson County
Department of Community Development
621 Sheridan Street
Port Townsend, WA 98368
RE: Sprint SE63XC005 Coyle/82927— at 124 E Go-Onna Drive, Quilcene, Parcel No. 955000031
Request for land use and building permit review and approval
Dear DCD:
On behalf of Sprint, Lynx Consulting is submitting to Jefferson County a request for zoning and
building permit approval, for modifications to an existing wireless facility located at 124 East Go-
Onna Drive, Quilcene.
The existing facility is a 147'6"tall (AGL) self-support/lattice tower. Specifically, Sprint proposes the
replacement of three existing stand-off arms with three proposed sector frames; and add three panel
antennas, add two RRHs, add six junction cylinders, add three filters and add one expansion cabinet.
The existing Sprint panel antennas have a rad center of 118' AGL. The rad center will remain the
same— 118' AGL following installation of the new sector frame, relocating the three existing and
adding three new panel antennas. The proposed expansion cabinet is being placed behind existing
equipment cabinets and is not increasing the lease or ground footprint area. There will be no ground
disturbance or grading associated with this proposal.
Enclosed please find the following:
• One Master Permit Application
• Three sets of construction drawings (11 x 17")prepared by Lynx Consulting
• Three Structural Analysis Report dated 8/11/2014 prepared by ATC supporting
the proposed antenna modification
• Check in the amount of$528.70 (Land Use fee of$228 and the balance is based upon the
project's valuation of$10,000 per Mary of your office - building permit fee is $300.70)
If you have any questions or need additional information in order to deem this application complete
please call me at 206 972 1368; my email is Azavales(rlynxconsulting.org. Thank you for your
consideration.
Sincerely
Aileen Zavales
Lynx Consultin
Enclosures
I m a g e 17311 135th Avenue NE, Suite A-100, Woodinville, WA 98072
(44--) ,z JEFFERSON COUNTY
DEPARTMENT OF CO
ti � COMMUNITY DEVELOPMENT
t_, ... . ,.s. 621 Sheridan Street• Port Townsend •Washington 98368
1,9 /I,O 360/379-4450. 360/379.4451 Fax
http://www.corjefferson.wa.us/commdevelopment/
- ' 1)- 1 IVi 60 G ti
Stormwater Calculation Worksheet
MLA# PROJECT/APPLICANT NAME �?� (( „•// 1
DETERMINING STORMWATER MANAGEMENT REQUIREMENTS: This stormwater calculation worksheet should be completed first
to classify the proposal as"small,""medium,"or large." The size determines whether a Stormwater Site Plan is required in conjunction
with a stand-alone stormwater management permit application, building permit application, or other land use approval application that
involves stormwater review. The basic information will also be helpful for completing a Stormwater Site Plan,if required.
PARCEL SIZE(I.E.,SITE
Size of parcel . i, acres 1r An acre contains 43,560 square feet. Multiply the acreage by this figure.
Size of parcel in square feet .3 ./ r7 730 sq/ft
Land-disturbing activity is any activity that results in movement of earth, or a change in the existing soil cover(both vegetative and
non-vegetative) and/or the existing soil topography. Land disturbing activities include, but are not limited to clearing, grading, filling,
excavation,and compaction associated with stabilization of structures and road construction.
Native vegetation is vegetation comprised on plant species, other than noxious weeds,that are indigenous to the coastal region of the
Pacific Northwest and which reasonably could have been expected to naturally occur on the site. Examples include species such as
Douglas fir,western hemlock,western red cedar,alder,big-leaf maple,and vine maple; shrubs such as willow,elderberry,salmonberry,
and salal;herbaceous plants such as sword fern,foam flower,and fireweed.
LAND DISTURBING ACTIVITY,CONVERSION OF NATIVE VEGETATION,AND VOLUME OF CUT/FILL
Calculate the total area to be cleared,graded,filled, Answer the following two questions related to
excavated,and/or compacted for proposed development conversion of native vegetation:
project. Include in this calculation the area to be cleared for:
fit/ ,rL Does the project convert'/,acres or more of
Construction site for structures l r sq/ft native vegetation to lawn or landscaped areas?
Drainfield,septic tank,etc. "" sq/ft Circle: Yes No
Well,utilities,etc. sq/ft Does the project convert 2'/ acres or more of
•tJ native vegetation to pasture?
Driveway,parking, roads,etc. sq/ft
IP
Circle: Yes
Lawn,landscaping,etc. sq/ft
Other compacted surface,etc. sq/ft Indicate Total Volumes of Proposed:
/
Total Land Disturbance _XJ sq/ft Cut o--t4 Fill 11 tr ulyd)
[over)
slormwator talc worksheet-REV 2202006 1
Impervious surface is a hard surface that either prevents or retards the entry of water into the soil mantle as under natural conditions
prior to development. A hard surface area which causes water to run off the surface in greater 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) q
Driveway,parking, roads,etc sq/ft Driveway, parking, roads,etc sq/ft
Other sq/ft Other sq/ft
Total New 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 existing impervious surface? Circle: Yes No
FURTHER INSTRUCTIONS: If the answer is yes, the proposal is considered redevelopment and the attached Figure 2 should be
used to determine the applicable Minimum Requirements. If the answer is no, the proposal is considered new development and the
attached Figure 1 should be used. At this juncture, the applicant should refer to the applicable Flow Chart to determine the Minimum
Requirements for stormwater management. DCD staff will help verify the classification of the project and the application requirements.
For proponents of "small" projects who must comply only with Minimum Requirement #2—Construction Stormwater Pollution
Prevention—an additional submittal is not required. The proponent is responsible for employing the 12 Elements to control erosion and
prevent sediment and other pollutants from leaving the site during the construction phase of the project. Pick up the Construction
Stormwater Pollution Prevention (SWPP) Best Management Practices (BMPs) Packet. Proponents of"medium" projects—those
that must meet only Minimum Requirements #1 through #5--and for "large" projects—those that must meet all 10 Minimum
Requirements—are required to submit a Stormwater Site Plan. DCD has prepared a submittal template of a Stormwater Site Plan,
principally for rural residential projects. Complete the template in the Stormwater Site Plan Instructions and Submittal Template or
prepare a Stormwater Site Plan using the step-by-step guidance in the Stormwater Management Manual,
APPLICANT SIGNATURE
By signing the Stormwater Calculation Worksheet, I as the applicant/owner attest that the information provided herein is true and
correct to the best of my knowledge, I also certify that this application is being made with the full knowledge and consent of all
owners of he affected properly
(LAND ER OR AUrHQF2IZ D REPRESENTATIVE SIGNATURE) (DATE)
c1 V—�, f w it r , .ems
�is� d y :si4" 4s 5a s' z, �' f a �{�"� ,€`�. � .x`+ �+.a ,y
:, 't 01•fit
stermwa!er cal<worksheet-REV.21202008
2
• •
HE..ALTH 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: BLD14-00316
Applicant: LYNX CONSULTING INC
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
Post Holes
Framing
Miscellaneous ‘ //7/)S-- 9, 8'fence
Miscellaneous ( third party verification required
lanning Approval
A final inspection will not be scheduled until the following are completed and signed off by the applicable Department:
• Building Permit Conditions are met • Septic Permit Final/Complete for any building containing plumbing
• Land Use Conditions met and signed off • Public Works Permit Final(where applicable)
FINAL INSPECTION 4—?El FINAL INSP CTION UST BE APPROVED PRIOR TO BUILDING BEING OCCUPIED
THIS PERMIT IS VALID FOR ONE YEAR
• •
CONDITIONS for Building Permit# :BLD14-00316
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.) This approval is for a Modification of an Existing Cell Tower 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.
3.) The revised site plan as submitted with the building application on October 6, 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 October 7, 2014 shall be resubmitted
for review and approval by Jefferson County Department of Community Development.
4.) Noise generated by the wireless telecommunication facility shall not exceed the maximum
environmental noise levels established in Chapter 173-60, Washington Administrative
Code, as it is now in effect or in effect or hereafter amended. In the event the applicant
adds an emergency generator in the future, the applicant shall notify Jefferson County and
provide noise generation data for the installed generator. All noise emitting equipment that
cannot in any way operate below the maximum permitted noise level shall be housed in a
sound-attenuating structure, unless otherwise stipulated in the project approval. The
applicant may be required to submit sound attenuation plans for review and approval by
the department.
5.) For all towers and related equipment enclosures located in commercial and residential
districts, or a agricultural land, the applicant shall prepare a landscaping plan for review
and approval. Landscaping shall be placed outside the security fence and shall consist of
fast growing vegetation with a minimum planted height of six feet, placed so as to form a
solid hedge within two years of planting. Existing vegetation shall be preserved to ensure
that the tower and related equipment are adequately screened and concealed The County
may require a supplemental planting plan prior to issuance of a Certificate of Compliance.
In lieu of compliance with this requirement, the applicant may apply for a variance
pursuant to Section 18.42.120 Variances.
6.) The applicant shall comply with the recommendations of th acoustical report prepared by
SSA Acoustics dated September 16, 2014 including construction of a eight(8)foot high
noise barrier fence.
According to the report, "The top of the noise barrier shall be at 8'-0" above grade.
Construct the noise barrier with a solid material that has a surface mass of at least 2.5
lbs/sq ft. The following are common barrier materials that meet this requirement: 3/4-inch
exterior grade plywood, 16-gauge sheet metal, 1/2" Fiber Cement board (HardiPanel or
Hardibacker Vertical Siding). Install sound absorbing material (NRC 0.8) inside of the
barrier between 1'-0"to 7'-0"above grade. Recommended products for this application
include minimum 1"thick F-Sorb, 1"Thick Stratocell Whisper or Soundseal QFA-11.
These products are available from Forrest Sound, contact Doug Bixal (425) 646-9703.
7.) The proposal meets JCC 18.42.020(2)(d)which exempts the following from the provisions
of the Chanpter 18.42 JCC.
Emergency or routine repairs, reconstruction, or routine maintenance of previously
approved facilities, or replacement of transmitters, antennas, or other components of
previously approved facilities which do not create a change in visual impact.
8.) AWB
\\tidemark\data\forms\F_BLD_Permit_BIdg.rpt 10/9/2014
• •
BUILDING PERMIT
Jefferson County Department of Community Development
621 Sheridan Street, Port Townsend, WA 98368
(360)379-4450 FAX (360)379-4451
PERMIT#: BLD14-00316 Received Date: 8/29/2014
SITE ADDRESS: 124 E GO-ONNA DR Issue Date 10/9/2014
QUILCENE, 98376 Expiration Date 10/9/2015
OWNER: PHONE:
9550
SUBDIVISION: Block: Lot: 31
PARCEL NUMBER: 955000031 Section: 27 Township: 26 N : 1V)
CONTRACTOR: WREN CONSTRUCTION INC PHONE: (425) 252-1282
DAVID SMITH/ROD CRAWFORD
1410 80TH ST SW STE A
EVERETT WA 98203
Contractor's License WRENCI*013B6 Expires 1/26/2016
PROJECT DESCRIPTION: Replace 3 existing stand-off arms with 3 proposed sector frames and add 3
panal antennas,
Add 2 RRG's and 6 junction cylinders, 3 filters and 1 expansion cabnit
ALSO TO INCLUDE A SOUND BARRIER FENCE 5X18
There will be no ground disturbance or grading associated with this
proposal.
TYPE OF WORK COM SQUARE FOOTAGE: COMMERCIAL:
TYPE OF IMP ADD INDUSTRIAL:
VALUATION 10,000.00 MAIN:
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: State Building Code $4.50 SRE 08/29/14 151399
Exist: Permit $168.00 SRE 08/29/14 151399
Prop: Plan Check $109.20 SRE 08/29/14 151399
Total: Permit $212.00 SRE 10/09/14 151623
NUMBER OF EMPLOYEES: Plan Check $137.80 SRE 10/09/14 151623
Total: $631.50
Directions to Site: