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Home My WebLink AboutBLD2015-00234 - CELL TOWER MOD • BUILDING PERMIT Jefferson County Department of Community Development 621 Sheridan Street, Port Townsend, WA 98368 (360)379-4450 FAX (360)379-4451 PERMIT#: BLD15-00234 Received Date: 7/9/2015 SITE ADDRESS: 2805 LARSON LAKE RD Issue Date 7/21/2015 CHIMACUM, 98325 Expiration Date 7/21/2016 OWNER: T-MOBILE WEST LLC CROWN CASTLE PHONE: 206-336-2881 1505 WESTLAKE AVE N#800 SEATTLE WA 98109 SUBDIVISION: Block: Lot: PARCEL NUMBER: 801122002 Section: 12 Township: 28 N Range: 1V1 CONTRACTOR: APPLE ROBERT PHONE: 866-545-1782 1825 PONCE DE LEON BLVD CORAL GABLES FL 33134 Contractor's License BRUBAAJ868QF Expires 4/10/2016 PROJECT DESCRIPTION: REPLACE 3 ANTENNAS, REMOVE 3 TMA'S INSTALL, 3 FRLB RADIOS, 2 FXFC, 1 FXFC, 1 FBBC, 1FSMR AND 1 ESMB. REVISION SUBMITTED TO ADD RELOCATE 1 EXISTING MICROWAVE- 1 NEW MICROWAVE - REMOVE 1 EXISITNG PLATFORM- INSTALL 3 NEW ANTENNA MOUNTS. TYPE OF WORK COM SQUARE FOOTAGE: COMMERCIAL: TYPE OF IMP ALT MAIN: INDUSTRIAL: VALUATION 45,000.00 ADD'L: HEAT TYPE: CODE EDITION: 2012 HEAT BASE: HEAT TYPE: OCCUPANCY: U-1 UNHEATED: #OF STORIES: OCCUPANCY: OTHER: CONST TYPE: GARAGE: SHORELINE: CONST TYPE: SETBACK: DECK: BANK HEIGHT: SEWAGE DISPOSAL: WATER SYSTEM: Type Amount Paid By: Date: Receipt: BATHROOMS: Permit $532.00 SRE 07/09/15 156236 Exist: Plan Check $345.80 SRE 07/09/15 156236 Prop: Consistency Review $234.00 SRE 07/09/15 156236 Total: Scanning Fee $19.50 SRE 07/09/15 156236 NUMBER OF EMPLOYEES: State Building Code $4.50 SRE 07/09/15 156236 Plan Check $85.00 SRE 03/09/16 162672 Consistency Review $85.00 SRE 03/09/16 162672 Total: $1,305.80 Directions to Site: HEALTH DEPARTMENT AND PUBLIC WORKS APPROVAL REQUIRED PRIOR TO FINAL INSPECTION THIS PERMIT IS VALID FOR ONE YEAR OR IT MUST BE PROPERLY RENEWED BUILDING INSPECTION HOT-LINE 379-4455. Request must be received by 3pm the day before the inspection is needed. Final Inspections require 24 hour notice. Office Hours 9:00 am -4:30 pm MONDAY- THURSDAY HOT LINE AVAILABLE 24 HOURS A DAY • BUILDING PERMIT Jefferson County Department of Community Development 621 Sheridan Street, Port Townsend, WA 98368 (360)379-4450 FAX (360)379-4451 PERMIT#: BLD15-00234 Received Date: 7/9/2015 SITE ADDRESS: 2805 LARSON LAKE RD Issue Date 7/21/2015 CHIMACUM, 98325 Expiration Date 7/21/2016 OWNER: T-MOBILE WEST LLC CROWN CASTLE PHONE: 206-336-2881 1505 WESTLAKE AVE N #800 SEATTLE WA 98109 SUBDIVISION: Block: Lot: PARCEL NUMBER: 801122002 Section: 12 Township: 28 N Range: 1'v CONTRACTOR: APPLE ROBERT PHONE: 866-545-1782 1825 PONCE DE LEON BLVD CORAL GABLES FL 33134 Contractor's License BRUBAAJ868QF Expires 4/10/2016 PROJECT DESCRIPTION: REPLACE 3 ANTENNAS, REMOVE 3 TMA'S INSTALL, 3 FRLB RADIOS, 2 FXFC, 1 FXFC, 1 FBBC, 1 FSMR AND 1 ESMB. TYPE OF WORK COM SQUARE FOOTAGE: COMMERCIAL: TYPE OF IMP ALT MAIN: INDUSTRIAL: VALUATION 45,000.00 ADD'L: HEAT TYPE: CODE EDITION: 2012 OCCUPANCY: HEAT BASE: HEAT TYPE: OCCUPANCY: UNHEATED: #OF STORIES: CONST TYPE: OTHER: SHORELINE: CONST TYPE: GARAGE: SETBACK: DECK: BANK HEIGHT: SEWAGE DISPOSAL: WATER SYSTEM: Type Amount Paid By: Date: Receipt: BATHROOMS: Permit $532.00 SRE 07/09/15 156236 Exist: Plan Check $345.80 SRE 07/09/15 156236 Prop: State Building Code $4.50 SRE 07/09/15 156236 Total: Total: $882.30 NUMBER OF EMPLOYEES: Directions to Site: HEALTH DEPARTMENT AND PUBLIC WORKS APPROVAL REQUIRED PRIOR TO FINAL INSPECTION THIS PERMIT IS VALID FOR ONE YEAR OR IT MUST BE PROPERLY RENEWED BUILDING INSPECTION HOT-LINE 379-4455. Request must be received by 3pm the day before the inspection is needed. Office Hours 9:00 am -4:30 pm MONDAY- THURSDAY HOT LINE AVAILABLE 24 HOURS A DAY • • SPECIAL CONDITIONS APPLY- SEE ATTATCHED Jefferson County Building Division Permit Number: BLD15-00234 Applicant: CROWN CASTLE BUILDING PERMIT INSPECTION APPROVALS Applicable Code: 2012 International Building Codes To schedule inspections, call (360)379-4455 no later than 3:00PM the day before the inspection is needed. Requests received after 3:00 PM will not be scheduled for the next day's inspections. ELECTRICAL PERMITS are issued by the Washington State Department of Labor& Industries. The electrical permit must be signed off by the State Inspector prior to the County's Framing Inspection Inspection Item Date Approval Signature Notes Miscellaneous third party inspection letter to verify built to plan 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 FINAL INSPECTION MUST BE APPROVED PRIOR TO BUILDING BEING OCCUPIED THIS PERMIT IS VALID FOR ONE YEAR • • CONDITIONS for Building Permit# :BLD15-00234 1.) The proposal meets JCC18.42.020(2)(d)which exempts the following from the provisions of the Chapter 18.42 JCC. Emergency or routine repairs, reconstruction, or routine maintenance of previously approved facilities, or replacement of transmitters, antennas, or other components of previously approved facilities which do not create a change in visual impact. 2.) 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. 3.) The approval granted July 14, 2015 was to replace three antennas, remove 3 TMA's, install 3 FRLB radios, 2FXFC, 1 FXMF, and 1 FBBC, 1 FSMR and 1 ESMB. This revision approval is to relocate one existing microwave, add one new microwave, remove one existing platform and install three new antenna mounts only. Any future permits on this site are subject to review for consistency with applicable codes and ordinances and does not preclude review and conditions which may be placed on future permits. 4.) The revised site plan as submitted with the cell tower modification application on March 7, 2016 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 revised site plan dated MArch 23, 2016 shall be resubmitted for review and approval by Jefferson County Department of Community Development. 5.) EDB 6.) The installed permitted equipment will be compliant with Jefferson County Code 18.42.090 (g). T-Mobile will be responsible for not exceeding the maximum environmnetal noise levels set forth in WAC Chapter 173-60. \\tidemark\data\forms\F_BLD_Permit_Bldg.rpt 3/24/2016 • • SPECIAL CONDITIONS APPLY- SEE ATTATCHED Jefferson County Building Division Permit Number: BLD15-00234 Applicant: CROWN CASTLE BUILDING PERMIT INSPECTION APPROVALS Applicable Code: 2012 International Building Codes To schedule inspections, call (360)379-4455 no later than 3:00PM the day before the inspection is needed. Requests received after 3:00 PM will not be scheduled for the next day's inspections. ELECTRICAL PERMITS are issued by the Washington State Department of Labor& Industries. The electrical permit must be signed off by the State Inspector prior to the County's Framing Inspection Inspection Item Date Approval Signature Notes Miscellaneous third party inspection letter to verify built to plan lanning Approval A final inspect-ion will not be scheduled until the following are completed and signed off by the applicable Department: • Building Permit Conditions are met • Septic Permit Final/Complete for any building containing plumbing • Land Use Conditions met and signed off • Public Works Permit Final(where applicable) FINAL INSPECTION FINAL INSPECTION MUST BE APPROVED PRIOR TO BUILDING BEING OCCUPIED THIS PERMIT IS VALID FOR ONE YEAR IKra..zar1 & Associates Page 1 of 2 , Inc_ Field Geotechnical Engineering• Environmental Engineering Report NO.: 10616254DFR2102017DW Construction Testing and Inspection DATE: 2/10/2017 Set Count: CONTRACTOR: SAC Wireless PROJECT#: 10616254 PERMIT#: BLD15-00234 PROJECT: SE06102B PT HWY 19(Beaver VLY) INSPECTOR: David Wright LOCATION: 2805 Larson Lake Rd,Port Ludlow JURISDICTION: Jefferson County KA P.M.: Wes Mahan WEATHER: Rainy TEMP:42°F Krazan&Associates,Inc.inspector arrived onsite to perform visual inspection of tower attachments. I used a scope and tripod to view the bolting on attachments from ground level.Attachments inspected include: • New T-Mobile BHLP2-18 Microwave • Relocated Existing T-mobile VHLP1-23 MicrowaveC10857011DP • New T-Mobile Sabre 12'HD V-Boom Mounts(1 per sector) • New T-Mobile Commscope LNX-6515DS-AIM Antennas(1 per sector) Photographs were taken of each attachment that was inspected,and samples are included below. All bolting appeared to have been installed in general conformance with design specifications. 5—?`")"14 Mt 11 Lk4 JUL 0 3 UV E� F �ON COUNT'Da) Offices Serving the Western United States Lynnwood (425)485-5519 •Poulsbo (360) 598-2126 •Puyallup (253) 939-2500 The information provided on this report is prepared for the exclusive use of the client.This report may not be reproduced in any format without the written permission of the client and Krazan&Associates.This report indicates our inspectors observation and testing results based on site conditions and contractor activities.This information is subject to review prior to final submittal.By signing this report,our inspector does not accept responsibility for validity of results.The same information has been provided by others on site. Page 2 of 2 azari & Associates, Inc. Field Geotechnical Engineering•Environmental Engineering Report NO.:10616254DFR2102017DW Construction Testing and Inspection Sample Photos NI, 1 r� . ... %0 I 44, i A 4,, , 14, , ., ,, 4,,,,..„ p., t .„,...,„.„ .., , .: .., .,,, Sector A Antenna New Microwave I Reviewed B REVIEWED STM Test#: Asset Number(s): y\iB Tim Casey at 14:41 pm,Feb 17,2017 To the best of my knowledge,the above WAS performed in accordance with the approved plans,specifications and regulatory requirements. Superintendent/Representative: Technician: L /....---"K---1-".ar: ///(//// // ' '1-7CIW:CP174.1„i141 (:), it" Jul03Z17 Offices Serving the Western United States Lynnwood (425) 485-5519 • Poulsbo (j� ;� 651.11411-1P I) 939-2500 The information provided on this report is prepared for the exclusive use of the client.This report may not be reproduced in any format without the written permission of the client and IGazan&Associates.This report indicates our inspectors observation and testing results based on site conditions and contractor activities.This information is subject to review prior to final submittal.By signing this report.our inspector does not accept responsibility for validity of results.The same infocma[ion haireen provided by others on site. Jordan Cawyer From: Jordan Cawyer Sent: Wednesday,June 28, 2017 8:09 AM To: 'tinahwang@crowncastle.com' Subject: BLD15-00234 - T mobile Good Morning! We received your inspection request for today, June 28th, 2017, however all that is needed is a letter from a third party inspector. Once we receive this letter we can final your permit. Let us know if you have any questions! Sincerely, Jordan Cawyer Jefferson County Community Development Administrative Clerk 621 Sheridan St.,Port Townsend, WA 98368 Mon-Thurs 9am -4:30pm, closed from 12-1 Ph: 360-379-4450 Fax: 360-379-4451 jcawyer(a,co jefferson.wa.us 1 s �je DEPARTMENT OF COMMUNITY DEVELOPMENT 621 Sheridan Street,Port Townsend,WA 98368 Tel:360.379.4450 Fax:360.379.4451 , Web:www.co.Jefferson.wa.us/communitydevelopment 1St/I N��‘�' E-mail:dcd@co.jefferson.wa.us T-MOBILE WEST LLC CROWN CASTLE 1505 WESTLAKE AVE N #800 SEATTLE WA 98109 (01 a/ �- RE: PERMIT RENEWAL (First Notice) SITE ADDRESS: 2805 LARSON LAKE RD PERMIT#: BLD15-00234 PARCEL: 801122002 DATE EXPIRES: 7/21/2017 PROJECT DESCRIPTION: Replace 3 antennas, remove 3 TMA'S install, 3 FRLB radios, 2 FXFC, 1 FXFC, 1 FBBC, 1FSMR and 1 ESMB. Revision- relocate 1 existing microwave- 1 new microwave- Remove 1 existing platform- Install 3 new antenna mounts. According to our records, your building permit will expire on 7/21/2017 and has not yet passed final inspection. Please either schedule a final inspection prior to expiration or submit a renewal payment in the amount of$270 to 621 Sheridan St., Port Townsend, WA 98368 prior to expiration. You are welcome to make a payment online at: http://www.co.jefferson.wa.us/commdevelopment/Credit%20Card.htm To schedule an inspection, please contact our inspection hotline at 360-379-4455 and have your approved permit and plans available on-site. If you have any questions about your permit, you can contact our office at 379-4450 between 9:00 a.m. and 4:30 p.m. Monday through Thursday. Thank you, Community Development Permit Technician 360-379-4450 dcd@co.jefferson.wa.us SITE ADDRESS: 2805 LARSON LAKE RD PERMIT#: BLD15-00234 PARCEL: 801122002 DATE EXPIRES: 7/21/2017 PAYMENT ENCLOSED: $270 \\tidemark\data\forms\F_BLD_REN_NOTICE 1_BTCH.rpt i Cryy"t j --0 2e �;..,,t „. DEVELOPMENT COMMUNITY B I ` �;�� DEPARTMENT OF �Joh "' 621 Sheridan Street,Port Townsend,WA 98368 Tel:360.379.4450 I Fax:360.379.4451 .4Web:www.co.Jefferson.wa.us/communitpdevelopment s/,f ci\ E-mail:dcdaco.jefferson.wa.us T-MOBILE WEST LLC CROWN CASTLE 1505 WESTLAKE AVE N #800 SEATTLE WA 98109 RE: PERMIT RENEWAL (Second Notice) SITE ADDRESS: 2805 LARSON LAKE RD PERMIT#: BLD15-00234 PARCEL: 801122002 DATE EXPIRES: 7/21/2017 PROJECT DESCRIPTION: Replace 3 antennas, remove 3 TMA'S install, 3 FRLB radios, 2 FXFC, 1 FXFC, 1 FBBC, 1FSMR and 1 ESMB. Revision- relocate 1 existing microwave- 1 new microwave- Remove 1 existing platform- Install 3 new antenna mounts. According to our records, your building permit will expire on 7/21/2017 and has not yet passed final inspection. Please either schedule a final inspection prior to expiration or submit a renewal payment in the amount of$270 to 621 Sheridan St., Port Townsend, WA 98368 prior to expiration. You are welcome to make a payment online at: http://www.co.jefferson.wa.us/commdevelopment/Credit%20Card.htm To schedule an inspection, please contact our inspection hotline at 360-379-4455 and have your approved permit and plans available on-site. If you have any questions about your permit, you can contact our office at 379-4450 between 9:00 a.m. and 4:30 p.m. Monday through Thursday. Thank you, Community Development Permit Technician 360-379-4450 dcd@co.jefferson.wa.us SITE ADDRESS: 2805 LARSON LAKE RD PERMIT#: BLD15-00234 PARCEL: 801122002 DATE EXPIRES: 7/21/2017 PAYMENT ENCLOSED: $270 \\tidemark\data\forms\F_BLD_REN_NOTICE2_BTCH.rpt CROWN! Srown Castle 1505 Westlake Avenue North,Suite 800 v CASTLE Seattle, WA 98109 March 2,2016 ItriVISZT) Jefferson County 7,016 Attn: Dept.of Community Development O6 621 Sheridan Street t,l,t,v%R5DN COUNTY DL/ Port Townsend,WA 98368 RE: Request to revise Permit#BLD 15-00234 Crown Site 826842/Crown Site NamePT Hwy 19(Beaver Vly) T-Mobile Site ID SE06102B Crown Castle on behalf of T-Mobile West LLC would like to request a revision to Building Permit#BLD 15-00234 issued 7/21/2015 to make changes to Transmission Equipment on a telecommunications Tower located at 2805 Larson Lake Road,Port Ludlow in County of Jefferson,WA. T-Mobile now wishes to amend that permit to include an additional Microwave and to replace the antenna mount. Permit#BLD 15-00234 granted permission to: • Replace(3)antennas,remove(3)TMAs,install(3)FRLB radios,(2)FXFC,(1)FXMF,(1)FBBC, T-Mobile would like to revise that permit to include: • Relocate(1)existing Microwave • Install(1)new Microwave • Remove(1)existing Platform • Install(3)new antenna mounts There will be no changes to ground space or the ground equipment. Itemized list of submittal documents: • Narrative • Stamped and sealed final Construction Drawings(including Site Plan)with revision items highlighted • Stamped and sealed Structural Analysis report Please let us know if you have any questions or concerns. Sincerely, Tina Hwang Real Estate Project Manager I Office: 206-336-2881 I Email:Tina.Hwang@CrownCastle.com ?sf>. V'y Plait% f S•� c72ce� i"� II0Z�: Zoe �a� REV S •�� dri*- 140 4 l Iry I The Foundation for a Wireless World. CrownCastle.com �� • 0 Sally Ellis From: Sally Ellis Sent: Monday, July 20, 2015 1:08 PM To: 'Hwang, Tina' Subject: FW: bId15-00234 ready to issue Hey Tina The permit that was received on 7/9/15 for 2805 Larson Lake Rd, Chimacum Is also ready to issue, once we received the contractor's information from you! BLD15-00234, Once you have determined whom the Contractor will be if you would be so kind to provide-contractors name, address and license number- I will then issue the permit and mail it to you attention. thanks Ziir ''''''t IR Sally L Ellis Jefferson County Community Development Permit Technician 621 Sheridan St., Port Townsend,WA 98368 Mon-Thurs 9am -4:30pm, closed from 12-1 Ph: 360-379-4452 Fax: 360-379-4451 sellis@co.jefferson.wa.us http://www.co.jefferson.wa.us From: Emma Bolin Sent: Monday,July 20, 2015 8:17 AM To:Sally Ellis Subject: RE: bId15-00234 ready to issue It looks like it's good to go once you can determine the contractor. Emma Bolin Assistant Planner Phone 360-379-4484 From: Sally Ellis Sent: Friday,July 17, 2015 4:52 PM To: Emma Bolin Subject: FW: bId15-00234 ready to issue Please take a look and see if this is ready to be issued, Thanks 1 �N �� 0 0 4, _.,_._ Sally L Ellis Jefferson County Community Development Permit Technician 621 Sheridan St., Port Townsend,WA 98368 Mon-Thurs 9am-4:30pm, closed from 12-1 Ph: 360-379-4452 Fax: 360-379-4451 sellis@co.jefferson.wa.us http://www.co.jefferson.wa.us From: Mary Blain Sent: Friday,July 17, 2015 4:41 PM To:Sally Ellis Subject: bld15-00234 ready to issue Once contractor is chosen. Also, "Upfront review" is not signed off, but "Consistency review" is ?? Mary Blain Plans Examiner I Dept of Community Development 621 Sheridan St Port Townsend,WA 98368 ph: 360-379-4461 fax: 360-379-4451 mblain@co.j efferson.wa.us All e-mail sent to this address has been received by the Jefferson County e-mail system and is therefore subject to the Public Records Act,a state law found at RCW 42.56.Under the Public Records law the County must release this e-mail and its contents to any person who asks to obtain a copy(or for inspection)of this e-mail unless it is also exempt from production to the requester according to state law, including RCW 42.56 and other state laws. 2 Horne Jnicio en Espanol Contact Search L&I . A-Z Index Help My Secure TM Safety Claims&Insurance Workplace Rights Trades&Licensing Washington State Department of � Labor & Industries MASTEC NETWORK SOLUTIONS INC Owner or tradesperson 1825 Ponce De Leon Boulevard APPLE,ROBERT E CORAL GABLES,FL33134 866-545-1782 Principals APPLE,ROBERT E,PRESIDENT DE CARDENAS,ALBERTO I,VICE PRESIDENT PITA,GEORGE L,TREASURER CORPORATE CREATIONS NETWRK INC,AGENT WA UBI No. Business type 603 235 974 Corporation License Verify the contractors active registration/license/certification(depending on trade)and any past violations. Electrical Contractor Active. Meets current requirements. License specialties GENERAL License no. MASTENS863JS Effective—expiration 04/10/2014—04/10/2016 Designated administrator Brubach,Anthony J Active. Meets current requirements. License type License no. Electrical Administrator BRUBAAJ868QF Bond ..........._.. Travelers Cas and Surety Co of America $4,000.00 Bond account no. 106063550 Received by L&I Effective date 04/10/2014 03/31/2014 Expiration date Until Canceled Savings No savings accounts during the previous 6 year period. License Violations .........................................._.... No license violations during the previous 6 year period. Workers' comp No active workers'comp accounts during the previous 6 year period. • Workplace safety and health No inspections during the previous 6 year period. 5 Washington State Dept.of Labor&Endo stries,Use of this site is subject to the laws of the state of Washington. IIII • Sally Ellis From: Hwang, Tina <Tina.Hwang@crowncastle.com> Sent: Monday, July 20, 2015 1:20 PM To: Sally Ellis Subject: RE: bId15-00234 ready to issue (826842) Attachments: MasTec- UBI=603235974&LIC.pdf; 826842 FedEx for BP-2805 Larson Lake Road.pdf Hi, Sally, the GC for the Building Permit for 2805 Larson Lake Road will also be MasTec. Thanks, Tina TINA HWANG Real Estate Project Manager,Seattle District T: (206)336-2881 I M: (253)653-1640 CROWN CASTLE 1505 Westlake Ave N., Suite 800, Seattle,WA 98109 CrownCastle.com How was my service? Please send your comments to my manager, Veronica Sayer at:veronica.sayer@crowncastle.com From: Sally Ellis [mailto:SEllis@co.jefferson.wa.us] Sent: Monday, July 20, 2015 1:09 PM To: Hwang, Tina Subject: FW: b1d15-00234 ready to issue Hey Tina The permit that was received on 7/9/15 for 2805 Larson Lake Rd, Chimacum Is also ready to issue, once we received the contractor's information from you! BLD15-00234, Once you have determined whom the Contractor will be if you would be so kind to provide-contractors name, address and license number- I will then issue the permit and mail it to you attention. thanks E� (Iff.:,,,, , �.yr Sally L Ellis Jefferson County Community Development Permit Technician 621 Sheridan St., Port Townsend,WA 98368 Mon-Thurs 9am -4:30pm, closed from 12-1 Ph: 360-379-4452 Fax: 360-379-4451 sellis@co.jefferson.wa.us http://www.co.jefferson.wa.us 1 From: Emma Bolin Sent: Monday,July 20, 2015 8:17 AM To: Sally Ellis Subject: RE: bId15-00234 ready to issue It looks like it's good to go once you can determine the contractor. Emma Bolin Assistant Planner Phone 360-379-4484 From:Sally Ellis Sent: Friday,July 17, 2015 4:52 PM To: Emma Bolin Subject: FW: bId15-00234 ready to issue Please take a look and see if this is ready to be issued, Thanks 4( to , t <-„.:1,„2„ , Sally L Ellis Jefferson County Community Development Permit Technician 621 Sheridan St., Port Townsend,WA 98368 Mon-Thurs 9am-4:30pm, closed from 12-1 Ph: 360-379-4452 Fax: 360-379-4451 sellis@co.jefferson.wa.us http://www.co.jefferson.wa.us From: Mary Blain Sent: Friday,July 17, 2015 4:41 PM To:Sally Ellis Subject: bId15-00234 ready to issue Once contractor is chosen. Also, "Upfront review" is not signed off, but "Consistency review" is ?? Mary Blain Plans Examiner I Dept of Community Development 621 Sheridan St Port Townsend,WA 98368 ph: 360-379-4461 fax: 360-379-4451 mblain@co.jefferson.wa.us 2 All e-mail sent to this address has been received by the Jefferson County e-mail sysl and is therefore subject to the Public Records Act,a state law found at RCW 42.56.Under the Public Records law the County must release this e-mail and its contents to any person who asks to obtain a copy(or for inspection)of this e-mail unless it is also exempt from production to the requester according to state law, including RCW 42.56 and other state laws. This email may contain confidential or privileged material. Use or disclosure of it by anyone other than the recipient is unauthorized. If you are not an intended recipient,please delete this email. 3 • CROlNN Crown Castle CASTLE 1505 Westlake Avenue North,Suite 800 Seattle, WA 98109 July 7,2015 Jefferson County Attn: Dept.of Community Development 621 Sheridan Street Port Townsend,WA 98368 RE: Eligible Facilities Request to modify equipment on a communications Tower Crown Site 826842/Crown Site NamePT Hwy 19(Beaver Vly) T-Mobile Site ID SE06102B Crown Castle on behalf of T-Mobile West LLC is submitting the attached Eligible Facilities Request application to add, remove,modify,or replace Transmission Equipment on a telecommunications Tower located at 2805 Larson Lake Road,Port Ludlow,in County of Jefferson,WA. Section 6409 of the Middle Class Tax Relief and Job Creation Act of 2012,commonly known as the"Spectrum Act" (Pub.Law No.112-96,126 Stat 156),mandates that state and local governments"may not deny,and shall approve,any eligible facilities request for a modification of an existing wireless tower or base station that does not substantially change the physical dimensions of such tower or base station." Under federal law,an Eligible Facilities Request is deemed granted sixty(6o)days after a complete application is filed with a local jurisdiction. T-Mobile proposes to modify an existing unmanned Wireless Communication Facility as follows: • Replace(3)antennas,remove(3)TMAs,install(3)FRLB radios,(2)FXFC,(1)FBBC,(1)FSMF and(1)ESMB Itemized list of submittal documents: • Cover letter • Certification of Non-Substantial Changes to Wireless Tower • Stamped and sealed final Construction Drawings(including Site Plan) • Stamped and sealed Structural Analysis report • Copy of Memorandum of Lease T-Mobile is committed to working cooperatively with all jurisdictions around the country to secure expeditious approval of requests to modify existing personal wireless service facilities. If you should require more information regarding the Spectrum Act,please do not hesitate to contact me with your questions. Sincerely, i�- Tina Hwang Real Estate Project Manager I Office: 206-336-2881 I Email:Tina.Hwang@CrownCastle.com The Foundation for a Wireless World. Crown Castl e.co m RealQuest.com ® - Report • • Page 1 of 1 Property Detail Report For Property Located At : CoreLogic 2805 CARSON LAKE RD, CHIMACUM,WA 98325 RealQuest Professional Owner Information Owner Name: POPE RESOURCES Mailing Address: 19950 7TH AVE NE#200,POULSBO WA 98370-7405 R022 C/O OLYMPIC RESOURCE MGMT Vesting Codes: // Location Information Legal Description: S12 T28 R1W S1/2 NW,SW1/4 NWSE(S25AC)LESS TAX 10 County: JEFFERSON,WA APN: 801122002 Census Tract/Block: 9503.00/ Alternate APN: Township-Range-Sect: 28-1W-12 Subdivision: Legal Book/Page: Map Reference: 28N-1W-12-NW/ Legal Lot: Tract#: Legal Block: School District: 49 Market Area: School District Name: CHIMACUM Neighbor Code: 3120 Munic/Township: CHIMACUM Owner Transfer Information Recording/Sale Date: / Deed Type: Sale Price: 1st Mtg Document#: Document#: Last Market Sale Information Recording/Sale Date: 11/15/2011/11/04/2011 1st Mtg Amount/Type: $356,250/CONV Sale Price: $375,000 1st Mtg Int.Rate/Type: / Sale Type: 1st Mtg Document#: 563520 Document#: 563519 2nd Mtg Amount/Type: / Deed Type: WARRANTY DEED 2nd Mtg Int.Rate/Type: / Transfer Document#: 6792 Price Per SqFt: New Construction: Multi/Split Sale: MULTI Title Company: JEFFERSON TITLE CO Lender: FRANKLIN AMERICAN MTG CO Seller Name: COX LARRY V Prior Sale Information Prior Rec/Sale Date: / Prior Lender: Prior Sale Price: Prior 1st Mtg Amt/Type: / Prior Doc Number: Prior 1st Mtg Rate/Type: / Prior Deed Type: Property Characteristics Year Built/Eff: / Total Rooms/Offices Garage Area: Gross Area: Total Restrooms: Garage Capacity: Building Area: Roof Type: Parking Spaces: Tot Adj Area: Roof Material: Heat Type: Above Grade: Construction: Air Cond: #of Stories: Foundation: Pool: Other Improvements: Exterior wall: Quality: Basement Area: Condition: Site Information Zoning: Acres: 260.52 County Use: DESIGNATED FOREST LAND(8800) Lot Area: 11,348,251 Lot Width/Depth: x State Use: Land Use: FOREST Commercial Units: Water Type: Site Influence: Sewer Type: Building Class: Tax Information Total Value: $553,815 Assessed Year: 2014 Property Tax: $348.69 Land Value: $553,815 Improved%: Tax Area: 203 Improvement Value: Tax Year: 2015 Tax Exemption: Total Taxable Value: $29,701 http://proclassic.realquest.com/j sp/report.j sp?&client=&action=confirm&type=getreport&m... 6/9/2015 0 • • O oo o D i 33 0 o.� m nom (7 Om , �� ZA 0 O n I I! .0 e f '.\ D p N O x r I . i*7 L. ❑ .� 3 ," p---1 , m min El (n dE _ Nm � h m m 71 71 T N iv w it m • V Ift. • W 77 r I CD ci ill .... izi alo ;! - - r C7 1II o •• /2 >.<_., • IP r -1- 1i! ti n1 cp x x mm W n ---1 n Co C7 1.1-1v -4C)m --a-f, r4 '� _1 p fir, H .-, o D 0 be o ,, E o ° L '4%,.) :'131 Ve �. 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W rII �; c Ci V 1 f� , 4 Ad00 d9vv®lsno t • • 579279 PGS : fi MULTI 09/23/2013 03:09 PM $149.00 OLD REPUBLIC NATL TITLE INS CO Jefferson County WA Auditor's Office - Donna Eldridge, Auditor 11111 I raf h��Irk clan L'�i�i��;�l�l Id 11111 Return Address: OLD REPUBLIC TITLE 530 South Main Street NO REAL ESTATE 44, Suite 1031 EXCISE TAY -).EouiAFD Akron, OH 44311 JEFFERSO C• NiY;REA;URER BY: Order#01-13054199-01 R Please print or type information WASHINGTON STATE RECORDER'S Cover Sheet (RCW 65.04) Document Title(s)(or transactions contained therein): (all areas applicable to your document must be filled in) MEMORANDUM OF MASTER PREPAID LEASE AND MANAGEMENT AGREEMENT Reference Number(s) of Documents assigned or released: Additional reference#'s on page of document Grantor(s) (Last name, first name, initials) T-MOBILE WEST TOWER LLC Grantee(s) (Last name first, then first name and initials) CCTMO LLC Legal description (abbreviated: i.e. lot, block, plat or section, township, range) PTN NW SW& PTN NW SE 12-28-1E Assessor's Property Tax Parcel/Account Number ❑ Assessor Tax#not yet assigned 801122002 The Auditor/Recorder will rely on the information provided on the form. The staff will not read the document to verify the accuracy or completeness of the indexing information provided herein. I am requesting an emergency nonstandard recording for an additional fee as provided in RCW 36.18.010. I understand that the recording processing requirements may cover up or otherwise obscure some part of the text of the original document. Signature of Requesting Party • MEMORANDUM OF MASTER PREPAID LEASE AND MANAGEMENT AGREEMENT THIS MEMORANDUM OF MASTER PREPAID LEASE AND MANAGEMENT AGREEMENT (this "Memorandum") is made this _ J day of a 2013, by and between T-MOBILE WEST TOWER LLC, a Delaware limited ability ("T- Mobile Lessor"), having a mailing address of 12920 S.E. 38th Street, Bellevue, Washington 98006, and CCTMO LLC, a Delaware limited liability company ("Crown"), having a mailing address of 2000 Corporate Drive, Canonsburg, Pennsylvania 15317, 1. Pope Resources and VoiceStream PCS BTA.I Corporation, as agent for Cook Inlet Western Wireless PV/SS PCS, L.P., ("Original T-Mobile Tenant") entered into that certain Site Lease Agreement dated October 22, 1999 for certain real property as described on Exhibit A attached hereto and incorporated herein by reference (the "Land"). 2. T-Mobile Lessor and Crown are parties to (a) a Master Prepaid Lease (the "MPL") and (b) a Management Agreement (the "MA"), each with an effective date of November 30, 2012, pursuant to which T-Mobile Lessor (as successor to Original T-Mobile Tenant) has granted to Crown and Crown has accepted, either (y) a leasehold or sub-leasehold interest in the Land, together with the telecommunications tower located thereon, and such other improvements as more fully set forth in the MPL or the MA, as applicable (collectively, the "Site"), or (z) an exclusive right to operate, manage and administer the Site, in either case, subject to the terms, conditions and reservations in the MPL or the MA, as applicable. 3. The MPL and the MA each have a term that commenced on November 30, 2012 and shall terminate or expire, with respect to the Site, on the Site Expiration Date or Technical Closing Date, as applicable, and as determined in accordance with the MPL and the MA, but in no event later than December 31, 2049. 4. Crown has an option to purchase T-Mobile Lessor's right, title and interest in the Site in accordance with Section 20 of the MPL. 5. Unless otherwise defined herein, capitalized terms shall have the meaning set forth in the MPL. The MPL and the MA and any and all amendments thereto contain terms and conditions in addition to those set forth in this Memorandum. This Memorandum is not intended to amend or modify the terms and conditions of the MPL or the MA or of any amendments thereto. The parties agree that the terms and conditions of the MPL and the MA, as applicable, shall govern the relationship of the parties under this Memorandum and the MPL and the MA are each incorporated herein by reference. In the event of a conflict or inconsistency between the terms of the MPL or the MA and this Memorandum, the applicable terms of the MPL and the MA shall govern and control. 6. This Memorandum shall not be amended, supplemented or modified in any respect, except pursuant to written agreement duly executed by the parties; provided, however, if the term • • • of both the MPL and MA shall terminate or expire with respect to the Site, the parties shall execute and file a revocation of or amendment to this Memorandum to evidence such termination or expiration. If either party fails to timely execute a revocation of or amendment to this Memorandum promptly after the expiration or termination of both the MPL and MA, then the other party shall have the right to execute such revocation or amendment as attorney in fact for such failing party. [Remainder of page intentionally left blank. Signature and acknowledgments to follow.) y ....,,rrrrrrrrftiorr • • IN WITNESS WHEREOF, the parties hereto have set their hands and seals as of the date first above written. T-MOBILE TENANT: T-MOBILE WEST TOWER LLC, a Delaware limited liability company By: CCTMO LLC, a Delaware I mited liability company Its: Attorn; Fac Name:1'IWDaf rc ` , Dorm Its: Portfolio Services Manager STATE OF I C.+�,��QS ) d►+c4 '(( L 'a. )SS 2Cc.o A-ect 7/I(( (3 COUNTY OF Rams as ) f*- 1-11, ( S I of I certify that I know or have satisfactory evidence that D C,R.. 1 �, is the person who appeared before me, and said person acknowledged that said person signed this instrument, on oath stated th't said erson was authorized to execute the instrument and acknowledged it as theTOr+ 05e,' f' VIC .of CCTMO LLC, a Delaware limited liability company, as Attorney-in-Fact for T-MOBIL EST 'TOWER LLC to be the free and voluntary act of such party for the uses and purposes mentioned in the instrument. DATED: 0,41)tat I .tgal3 7 Notary Seal / (Signat of Notary "ad� JESAHEL TRUJILLO .N1 e%, :' •`�? Notary Public,State of Texas 1 _ �•, .,, My Commiss(on Expires �� "'"•'••'`' December 10, 2016 ''''�[`�,�� 6 (Legibly Print or Stamp Nam-4f Notar Notary Public in and for the State of g Serial Number, if any: i/lq • CROWN: CCTMO LLC, a Delaware ' ited liability company By: 7 - _ __ Name: Da id ', tore- n,: •. STATE OF �e—VAS COUNTY OF 14am )SS I certify that I know or have satisfactory evidence that band, . fr/Oo re , is the person who appeared before me, and said person acknowledged that said person signed this instrument, on oath stated t t}sai person was authorized to execute the instrument and acknowledged it as theI Q l CQSatof CCTMO LLC, a Delaware limited liability company, to be the free and voluntary act of such party for the uses and purposes mentioned in the instrument. DATED: IL, St II 9,013 Notary Seal (Signatur= o rotary JESAHEL TRUJILLO7Zz2 NotaryofTexas a,. :.,z My Commission Expires (Legibly Print or Stamp Name of tarv) %11.vssq;:"' December O. 2016 �� Notary Public in and for the State of_� ) Serial Number, if any: . • • I EXHIBIT "A" An approximately 3,600 square foot portion of the following described real property, together with easements for ingress, egress and utilities thereto: The South one half of the Northwest Quarter, the Southwest Quarter and the South 25 acres of the Northwest Quarter of the Southeast Quarter, of Section 12, Township 28 North, Range 1 West, W.K, Except that portion, if any, lying within the North 15 acres of said Northwest Quarter of the Southeast Quarter: also except Larson Lake Road. Situate in the County of Jefferson, State of Washington, • CROWN. •rown Castle 1505 Westlake Avenue North,Suite 800 CASTLE Seattle, WA 98109 March 2, 2016 RViv Jefferson County Attn: Dept.of Community Development 621 Sheridan Street F It50 COUN SY Port Townsend,WA 98368 RE: Request to revise Permit#BLD 15-00234 Crown Site 826842/Crown Site NamePT Hwy 19(Beaver Vly) T-Mobile Site ID SE061o2B Crown Castle on behalf of T-Mobile West LLC would like to request a revision to Building Permit#BLD 15-00234 issued 7/21/2015 to make changes to Transmission Equipment on a telecommunications Tower located at 2805 Larson Lake Road,Port Ludlow in County of Jefferson,WA. T-Mobile now wishes to amend that permit to include an additional Microwave and to replace the antenna mount. Permit#BLD 15-00234 granted permission to: • Replace(3)antennas,remove(3)TMAs,install(3)FRLB radios,(2)FXFC,(1)FXMF,(1)FBBC, T-Mobile would like to revise that permit to include: • Relocate(1)existing Microwave • Install(1)new Microwave • Remove(1)existing Platform • Install(3)new antenna mounts There will be no changes to ground space or the ground equipment. Itemized list of submittal documents: • Narrative • Stamped and sealed final Construction Drawings(including Site Plan)with revision items highlighted • Stamped and sealed Structural Analysis report Please let us know if you have any questions or concerns. Sincerely, Tina Hwang Real Estate Project Manager I Office: 206-336-2881 I Email:Tina.Hwang@CrownCastle.com P tar \i SS cPeCe;Pi— LI°2-(P 2- •Zo(-1/4 a�I RE� 8S �� C� 4U�4 The Foundation for a Wireless World. (� .S/ 7 CrownCastle.com ` lI Front Parcel Review . ecr, l D 3LL Parcel 801122002 Printed: July 14, 2015 POPE RESOURCES Site Address(es): C/O OLYMPIC RESOURCE MGMT 2805 LARSON LAKE RD , WA 19950 7TH AVE NE#200 POULSBO,WA 98370 Parcel Number: 801122002 S-T-R: 12-28N-1W Total Acreage 261 Legal Description S12 T28 R1W Sl/2 NW,SW1/4 NWSE(S25AC)LESS TAX 10 Land Use: 8800 Flood District: Fire District: 0 Planning Area: Flood Map(FIRM)Panel No: School District 49 Zoning: CF' u0 COMP PLAN DESIGNATION: COMMUNITY PLAN: UGA: UGA Trans TA Plot plan states "property line" NAssessor'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 0 NO L r 5011 LaKe R Parcel Tags or Scanned Documents 6 NO f iu eta t Old N ESA's: Special Reports Nearby 0 NO c'A 1 Designated Ag YES CO) [X1 horeline Designation: YES 110 t] Shoreline Slo s- tability: YES 6 Stream Type:ir N, Nil .-`r 5 ■ le r FWHCA: ':$ Wetlands: YES 4• I �� Rare P1ants:YEs 0 L ieismic: . i�I1 Vika ��e c(Iyl I k� - andslide:t'7sle'!� N• ‘CO'1 /r-) lood: YES 41 1." Erosion: YES e Aquifer Rec t ge Areas NO S�S -. SIPZ: • - At Risk High Risk Coastal ri1iW CMZ: High Risk Moderate RiskDisconnected CMZ Stormwater site j2lA submitted: YesNo WA [ Forest Lands: S NO Adjoining Forest Lands: ( _ i 6 Commercial/ Rural/ Inholding [� Mineral Lands: YES iZ r.54 Agricultural Lands: YES Q. [-] Archaeology: YES NO ! ((A- M No Shooting Zone: YES Ne [5/f Stormwater: New Impervious Surface ///A- Land Disturbing Activity ESA's Stormwater Req's:Min Req#2 Min Req#1 thru#5 Min Req#1 thru#10 Engineering [7.. Notice Provisions/Disclosure:Airport YES ro MRL YES No Forest Lands YEs 10 / �j4 Landscaping Required: Yes No Parking Spaces Required NO 2 Other f 1 Building Height: 35' UBC Standard 1 [><.L Impervious Surface coverage percentage: /V/,& Resource Lands&Public: 10% •ural Residential: 25% Rural Industrial UDC Sec 6.7 Rural Commercial: 60% Area of Buildin Coverage: 60%in Rural Industria nds only /1 Total Building (s) Size: N1 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 [>Z1 Setbacks: Front: Left Side: Right Side: /A-Rear: Shoreline Setback: j�+ / LSHA Setback: / v / ] Road Classification: ( 'OO(\f (--C( C, Let} C 50`3007 . Road Approach: EXISTING Q'P RAP ] SEPA Required: YES E Flood Certificate: [] Existing Case(s) & Condition(s): Violations: Yes o) / [)4 Recorded Date of Subdivision: ('/! A AFN Over 5yrs=UDC Plat Conditions: <5yrs=Plat Conditions on plat or Old Ordinance [><] Lots/Require Declaration of Restrictiv covenant YES Z,) submitted: YES NO UGA No Protest Agreement YES 1q61,/,/ submitted: YES NO [ ] Site Visit conducted YES NO [ ] Require Final Zoning Approval YES NO [ ] ADMIN: Setbacks entered in Permit Plan case N/A YES New Parcel Tags entered in Permit Plan N/A YES Special Reports Scanned N/A YES Title Notes Updated Parcel tags found for parcel 801122002 1.) 6yr Mor. on FPA2610420 application approved on 3/22/2010. 07/09/2015 Non-Forest Permits Moratorium expires 3/22/2016. JCC18.20.160(5)(b) "Mandatory six year development moratorium. For six years after the date of the application the county shall deny any and all applications for permits and approvals, including building permits and subdivision approvals, relating to or for non forestry uses of land subject to the application. Cases Associated with APN 801122002 Review Cases Name Type Status Planner BLD00-00361 POPE RESOURCES F Application Received: 6/2/2000 Permit Issued/Case closed: 1/23/2001 Case Finaled: 5/25/2001 VOICE STREAM WIRELESS I ELECOMMUNICATION FACILITY TO CONS I RUCTA 195-FOO I LAI I ICE LOWER TO SUPPORT A THREE (3)SECTOR PANEL ARRAY BLD01-00100 POPE RESOURCES F Application Received: 2/13/2001 Permit Issued/Case closed: 2/13/2001 Case Finaled: 2/28/2001 PROPANE TANK FOR CELL TOWER EMERGENCY POWER BLD15-00234 CROWN CASTLE P Emma Bolin Application Received: 7/9/2015 Permit Issued/Case closed: Case Finaled: REPLACE 3 ANTENNAS, REMOVE 3 TMA'S INSTALL, 3 FRLB RADIOS, 2 FXFC, 1 FXFC, 1 FBBC, 1 FSMR AND 1 ESMB. FP2610433 POPE RESOURCES P Application Received: 3/15/2010 Permit Issued/Case closed: Case Finaled: 8-acre timber harvest and 450 Leet of road construction FPA2604834 POPE RESOURCES F Application Received: 8/20/2002 Permit Issued/Case closed: 8/19/2002 Case Finaled: 8/26/2002 Aerial Chemical Application FPA2605260 POPE RESOURCES F Application Received: 4/21/2003 Permit Issued/Case closed: 3/28/2003 Case Finaled: 4/21/2003 Aerial Chemical Applica iob n FPA2608276 POPE RESOURCES F Application Received: 2/7/2007 Permit Issued/Case closed: 2/16/2007 Case Finaled: 3/6/2007 460 acre fertilizer. \\tidemark\data\forms\R_Parcel_CRMLA.rpt 7/14/2015 Page 2 of 3 FPA2609086 POPE RESOURCES F Application Received: 2/8/2008 Permi ued/Case closed: 2/21/2008 Case led: 2/26/2008 411 acres of chemical spray FPA2610433 POPE RESOURCES F Application Received: 3/29/2010 Permit Issued/Case closed: 3/25/2010 Case Finaled: 3/29/2010 8-acre timber harvest and 450 teet of road construction FPA2613396 POPE RESOURCES NA P Application Received: 1/20/2015 Permit Issued/Case closed: Case Finaled: Harvest 82 acres ZON99-00056 VOICE STREAM WIRELESS F J SMITH Application Received: 12/20/1999 Permit Issued/Case closed: 11/14/2000 Case Finaled: 5/23/2001 Construction of a new 195-foot lattice tower to support a three-sector panel antenna array with three (3)antennas per sector(9 antennas total). The tower will be located within a 60 foot X 60 foot lease area along with a small radio equipment cabinet which will be placed on top of a 10 foot X 15 foot concrete pad. The entire facility will be enclosed within a 6-foot high chain link fence topped with three-(3)strand barb-wire. This lower minor power communications facility will transmit and receive radio signals for digital wireless (PCS)communications. In addition, the applicant may elect to mount three(3) microwave dish antennas onto the tower in the future. \\tidemark\data\forms\R_Parcel_CRMLA.rpt 7/14/2015 Page 3 of 3