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BLD2015-00258 - CELL TOWER MOD
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Field Geotechnical Engineering•Environmental Engineering Report NO.: 10616255DFR2102017DW Construction Testing and Inspection DATE: 2/10/2017 Set Count: CONTRACTOR: SAC Wireless PROJECT#: 10616255 PERMIT#: BLD15-00258 PROJECT: SE06106A PT Tarboo Lake Cell Tower INSPECTOR: David Wright LOCATION: 2749 Tarboo Lake Road,Quilcene JURISDICTION: Jefferson County KA P.M.: Wes Mahan WEATHER: Rainy TEMP:42 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-A1M 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. nom lr 0 3 2011 JEFFERSON COUNTY DCD 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 Ina 1/111•01•111.• aZan & Associates, I nc_ Field Geotechnical Engineering•Environmental Engineering Report NO.:10616255DFR2102017DW Construction Testing and Inspection Sample Photos %%Soh Ilk .§ it% IF 0144rt% Ski:41 I 11 11 ik.NI. illatikk. iilko 111111110111114PPPIPIr 11 ak%l w�� � � b tt Yikti 41)AIL tliktil 1! lik fs ` > 1 i, 1%14%% ;1• ,•..• East Antenna New Microwave I I REVIEWED Reviewed By nmQe„y at241pm,Fe,,,,2O17 ASTM Test#: Asset Number(s): To the best of my knowledge,the above WAS performed in accordance with the approved plans,specifications and regulatory requirements. Superintendent/Representative: Technician: /...e //(/‘(—. // 1 1 P ',1 --\ 201 2D , 1 Offices Serving the Western United States Lynnwood (425)485-5519 • Poulsbo (360) 598-2126 • PuYalliEFPEN@MtbUNTY OCD 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. • • Ce"46CROWN Crown Castle 1505 Westlake Avenue North,Suite 800 e..v CASTLE Seattle,WA 98109 February 22,2016 n fr Jefferson County Attn: Dept.of Community Development j F 621 Sheridan Street ,-� Port Townsend,WA 98368 RE: Eligible Facilities Request to modify equipment on a communications Tower Crown Site 826843/Crown Site Name:PT Lake Tarboo T-Mobile Site ID SEo61o6A 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 2749 Tarboo Lake Road,Quilcene,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: • This is a supplemental application to Building Permit No.BLD15-oo258 • In addition to the equipment changes under BLD15-oo258 T-Mobile proposes to remove and replace the existing antenna mounts REVISED Itemized list of submittal documents: FEB© • Cover letter 24 2016 • Stamped and sealed final Construction Drawings(including Site Plan) JEFFLI:S )N tU) N'i'\ 1)CD • Stamped and sealed Structural Analysis report — — • Building Permit Application&Supplement&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, Aaron Hottell Real Estate Specialist I Office:206-336-3225 I Email:Aaron.Hottell@CrownCastle.com The Foundation for a Wireless World. CrownCastle.com •. . • 596337 PGS : 8 MEMO RECORDING REQUESTED BY AND 12/22/2015 10;33 Auditor's UPF CvlCES JernCounWA OffieRose Ann Carroll, Auditor AFTER RECORDING RETURN TO: •i lerdf1111411.1nliPLI�11���,1I1Z�',I i',Iw! '1 , 11111 UPF WASHINGTON INC 12410 E MIRABEAU PKWY#100 SPOKANE VALLEY WA 99216 REF# 142.02 f NO REAL ESTATE /� TAX REQUIRED ' jl n EXCISE � JEFFERSON COUNTY TREASURER CFO 2 �1� � / BY: � _ \ �� . U Document Title: Memorandum of Amended and Restated Site Lease Agreement`r'A"7FNr Reference Number(s)of IA hra o rd ed Related Documents: Lessor(s): Pope Resources, a Delaware limited partnership Lessee(s): T-Mobile West Tower LLC, a Delaware limited liability company Legal Description: Government Lots 1, 2, 3, and 4 and the East 3/4, Section 18, Township 28 North, Range 1 West, W.M., Jefferson County, Washington. Assessor's Tax Parcel ID 801181001 Number: Site ID: PT Lake Tarboo (BUN 826843) ._ The County Auditor will rely on the information provided on this form. The Staff will not read the document to verify the accuracy or completeness of the indexing information provided herein. Sign below only if your document is Non-Standard. 1 am requesting an emergency non-standard 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 parts of the text of the original document. Fee for non-standard processing is$I50. . Signature of Requesting Party 1)0a L jec„meilt ECM MA 6 71e iFP 3 Pte._..-.,.... J_� uwiimst LA•wwll�nr*.ae`� . Mei! Goa. •• • • • MEMORANDUM OF AMENDED AND RESTATED SITE LEASE AGREEMENT This Memorandum of Amended and Restated Site Lease Agreement is made effective this day of Oc &1/43.er , 2015 by and between POPE RESOURCES, a Delaware limited partnership (hereinafter referred to as "Lessor") and T-MOBILE WEST TOWER LLC, a Delaware limited liability company, by and through its Attorney In Fact, CCTMO LLC, a Delaware limited liability company(hereinafter referred to as "Lessee"). 1. Lessor and Lessee's predecessors in interest entered into that certain Site Lease Agreement dated October 22, 1999, as amended by that certain First Amendment to Site Lease Agreement dated April 1, 2011, originally by and between Lessor and Voicestream PCS BTA I Corporation, a Delaware corporation, as agent for Cook Inlet Western Wireless PV/SS PCS, L.P., a Delaware limited partnership, as Lessee (collectively referred to as the"Prior Lease"). 2. Lessor and Lessee have entered into that certain Amended and Restated Site Lease Agreement of approximate date herewith (the "Lease"), of which this is a memorandum, whereby the terms and conditions of the Prior Lease were replaced with the terms and conditions of the Lease. Lessor and Lessee intend that the Lease be a continuation of the Prior Lease. 3. The Lease pertains to certain real property, together with access and utility easements, located in Jefferson County, Washington (the "Premises"), all located within certain real property owned by Lessor ("Property"). The Property, of which the Premises is a part, is more particularly described on Exhibit A attached hereto. The Premises is more particularly described on Exhibit B attached hereto. 4. The Lease has an initial term that commenced on July 1, 2015 and expires on June 30, 2020. The Lease provides for two extensions of five years each(each extension is referred to as a"Renewal Term"). Pursuant to the Lease, the final Renewal Term expires June 30, 2030. Site Name:PT Lake Tarboo 2 Business Unit#:826843 !S . ` 5. The terms, covenants and provisions of the Lease shall extend to and be binding upon the respective executors, administrators,heirs, successors and assigns of Lessor and Lessee. 6. This Memorandum does not contain the social security number of any person. 7. A copy of the Lease is on file with Lessor and Lessee. [Execution Pages Follow] • Site Name:PT Lake Tarboo 3 Business Unit#:826843 .S • .• IN WITNESS WHEREOF,hereunto and to duplicates hereof, Lessor and Lessee have caused this Memorandum to be duly executed on the day and year first written above. LESSOR: POPE RESOURCES, a Delaware limited partnership By: Pope MGP, Inc., a Delaware corporation Its: Managing General Partner By: If ' ;i Print Name: -1(ncxvtgS (N1. m5Q) Title: -Pv-e_sk STATE OF WASHINGTON ) ) ss. COUNTY OF KITSAP ) I certify that I know or have satisfactory evidence that - -c CvY S YYl• RA►ic is the person who appeared before me, and said person acknowledged that said person signed this Memorandum of Amended and Restated Site Lease Agreement, on oath stated that said person was authorized to execute the instrument and acknowledged it as the Wes vic ± of POPE MGP, INC., to be the free and voluntary act of such party for the uses and purposes mentioned in the instrument. DATED: Ock-okaky^ 30 201 S Notary Seal 4,00‘"itttttt14r IP Te c'tARy �� AMP- I. - ' - (Si ature of Notary s foi ‘11;0•114 6-0`t s�� (Legibly Print or Stamp Name of Notary) Notary Public in and for the State of Washington +'rr'rt OFW��`'` Residing atCe_mQi' rl My appointment expires: C..0 C'2.6 1P • Site Name:PT Lake Tarboo 4 Business Unit 4:826843 •• LESSEE: T-MOBILE WEST TOWER LLC,a Delaware limited liability company By: CCTMO LLC, a Delaware limited liability company Its: Attorney In Fact • By: A/4i Print NameMatthew Norwood Title: Real Estate Transaction Manager LIMITED LIABILITY COMPANY STATE OF IEMS ) I4AP-6 )SS. COUNTY OF ) I certify that I know or have satisfactory evidence that P4-1h4w N°(woof is the person who appeared before me, and said person acknowledged that said person signed this Memorandum of Amended and Restated Site Lease Agreement, on oath stated that said person • was authorized to execute the instrument and acknowledged it as the i r /lama of CCTMO LLC, to be the free and voluntary act of such party for the uses and purposes mentioned in the instrument. DATED: (O IV 120(5 Notary Seal a4, ���Y�° _ caRa�.YH rMooaEs 7 /'rom- '' MY COMMISSION EXPIRES {Signature of N tary) •,,,y August 28,2017 (Legibly Print or Stamp Name of Notary) Notary Public in and for the State of TX My appointment expires: Site Name:PT Lakc Tarboo 5 Business Unit#:826843 •S • • EXHIBIT A (Legal Description of Lessor's Property) Government Lots 1, 2, 3, and 4 and the East 3/4, Section 18, Township 28 North, Range 1 West, W.M., Jefferson County, Washington. Situate in the County of Jefferson, State of Washington. • 6 Site Name:PT Lake Tarbox Business Unit#:826843 .. • EXHIBIT B (Legal Description of Premises) TOWER LEASE A parcel of land located in Section 18, Township 28 North, Range 1 West, Willamette Meridian, Jefferson County, Washington, more particularly described as follows: Beginning at the southeast corner of the herein described tower lease area located in Section 18, Township 28 North, Range 1 West, Willamette Meridian, from which the southeast corner of said Section 18,bears South 43°29'49"East, a distance of 5016.19 feet; thence North 86°26'54" West, a distance of 60.00 feet; thence North 03°33'06" East, a distance of 60.00 feet; thence South 86°26'54" East, a distance of 60.00 feet; thence South 03°33'06" West, a distance of 60.00 feet to the Point of Beginning; Containing 3,600 square feet or 0.08 acres, more or less SUBJECT TO: Existing rights-of-way and easements of record and or appearing on said above described parcel. ACCESS & UTILITY EASEMENT: A strip of land 20 feet wide, across a parcel of land located in the Section 18, Township 28 North, Range I West, Willamette Meridian, Jefferson County, Washington, being 10 feet wide on each side of the following described centerline, more particularly described as follows: Beginning at the southeast corner of the herein described tower lease area located in Section 18, Township 28 North, Range 1 West, Willamette Meridian, from which the southeast corner of said Section 18, bears South 43°29'49"East,a distance of 5016.19 feet; thence North 86°26'54" West, a distance of 50.00 feet; thence South 03°33'06" West, a distance of 10.00 feet; thence North 86°26'54" West, a distance of 50.46 feet; Site Name:PT Lake Tarboo 7 Business Unit#:826843 • •• thence South 32°49'44" West, a distance of 65.55 feet; thence South 03°25'07" East, a distance of 65.85 feet; thence South 36°41'47" West, a distance of 180.10 feet; thence South 49°38'56"East,a distance of 95.07 feet; thence South 80°19'11" East,a distance of 635.07 feet; thence South 80°13'09" East,a distance of 168.85 feet; thence South 81°05'35" East, a distance of 413.04 feet; thence South 80°00'31" East, a distance of 1371.83 feet to the Point of Terminus; Lengthening and shortening the sidelines of said strip so as to terminate on the westerly right-of-way line of Tarboo Lake Road, and the southerly line of the tower lease. Containing 61,116 square feet or 1.40 acres, more or less SUBJECT TO: Existing rights-of-way and easements of record and or appearing on said above described parcel. Site Name:PT Lake Tarboo 8 Business Unit 4:826843 • • • Return Address: VoiceStream PCS BTA I Corporation, as agent for Cook Inlet Western Wireless PV/SS PCS,L.P. 3650-131st Avenue SE,Suite 400 Bellevue, Washington 98006 Attention: PCS Lease Coordinator Phone: (425)586-8700 Fax: (425)586-8040 MEMORANDUM OF LEASE Grantor: Pope Resources Grantee: VoiceStream PCS BTA I Corporation, • as agent for Cook Inlet Western Wireless PV/SS PCS,L.P. Legal Description: ALL 18-28-1W Complete legal description is on page D-4 of document. Assessor's Property Tax Parcel Account Number(s): Jefferson 801-181-001 Site Number: SE-6106-A Site Name: PT Bia Skidder/Tarboo Lake Market: Seattle D-2 • • After recording,please return to: VoiceStream PCS BTA I Corporation, as agent for Cook Inlet Western Wireless PV/SS PCS,L.P. 3650-13151 Avenue SE,Suite 400 Bellevue, Washington 98006 Attention: PCS Lease Coordinator Phone: (425)586-8700 Fax: (425)586-8040 Site Identification: SE-6106-A-PT Biq Skidder/Tarboo Lake Market: Seattle Memorandum of Lease Between Pope Resources("Landlord") and VoiceStream PCS BTA I Corporation,as agent for Cook Inlet Western Wireless PV/SS PCS,L.P.("Tenant") A Site Lease --eptivn ("Lease") dated as of OC) i7t ''Z , 199!by and between Pope Resources ("Landlord") and VoiceStream PCS BTA I Corporation, as agent for Cook Inlet Western Wireless PV/SS PCS,L.P.("Tenant")was made regarding the following premises: See attached Exhibit A. Subject Lease is for a term of five (5) years and will commence on the date as set forth in the Lease(the "Commencement Date")and shall terminate at midnight on the last day of the month in which the 5th anniversary of the Commencement Date shall have occurred. Tenant shall have the right to extend this Lease for two (2)additional five-year terms. 1/4,(54 (n IN WIT S WHERE F,the parties hereto have respectively executed this memorandum on the 'k- day of VC ,199 LANDLORD: Pope Resources By:_ Its: TENANT: VoiceStream PCS BTA I Corporation, as agent or Cook Inlet Western Wirel• /SS PCS,L.P. Its: /1-t/! Site Number: SE-6106-A Site Name: PT Big Skidder/Tarboo Lake Market: Seattle D-3 • [Notary block for Corporation, Partnership,Limited Liability Company] STATE OF (J—YA. -voCS� ) )ss. COUNTY OF I certify that I know or have satisfactory evidence that LCA . (,.G is the person who appeared before me, and said person acknowledged that l* she signed this instrument, on oath stated that he/she was authori to execute the instrument and acknowledged it as Vii-te'S A A (1' of � - 3 to be the free and voluntary act of such party for the uses and purposes mentioned in the instrument. Dated: 10 1a- 11016 ettrav . / ; Notary Public ( •• .� ., el Print Name ,e0) • �V •�c, My commission expires A f ,1 Co. •���� (Use this space fo? pTseaI) STATE OF WASHINGTON ) )ss. COUNTY OF �,nr) ) I certify that I know or have satisfactory evidence that Lauren Venezia is the person who appeared before me, and said person acknowledged that he/she signed this instrument,on Aggi gte,taflittlqiclutpereybLartirized to execute the instrument and acknowledged it as the of VoiceStream PCS BTA 1 Corporation,as agent for Cook Inlet Western Wireless PV/SS PCS,L.P.,to be the free and voluntary act of such party for the uses and purposes mentioned in the instrument.( Dated: f0-til) cP a GEOR2Y .PBUC ' IA yI ublirgia LaaPrint <me '( 4 STATE OF WASHINGTON My co ission expires �f C COMMISSION EXPIRES APRIL 28,2003 (Use this space for notary stamp/seal) Site Number: SE-6106-A Site Name: PT Big Skidder/Tarboo Lake Market: Seattle i EXHIBIT A Legal Description yy�� To the Memorandum of Lease dated /O'(iZ q ,between Pope Resources, as Landlord,and VoiceStream PCS BTA I Corporation,as agent for Cook Inlet Western Wireless PV/SS PCS,L.P.,as Tenant. The Property is legally described as follows: ALL OF SECTION 18,TOWNSHIP 28 NORTH,RANGE 1 WEST,W.M. EXCEPTING THEREFROM THAT PORTION OF PREMISES AS CONVEYED TO THE STATE OF WASHINGTON BY DbbD RECORDED UNDER JEFFERSON COUNTY AUDITOR'S FILE NO. 246902. Site Number: SE-6106-A Site Name: PT Bia Skidder/Tarboo Lake Market: Seattle D-4 ' 1 '4' Tr) AIII, ( ,. , ( ) Ato3 /6 1./ 8/25/2015 T-Mobile#SE06106A/PT Lake Tarboo Crown#826843 `' T-Mobile's proposed equipment changes at existing Wireless Communications Facility Site address: 2749 Tarboo Lake Road, Quilcene,WA 98376 T-Mobile is replacing (3) antennas with (3) new Commscope LNX-6515DS-A1M antennas T-Mobile is replacing(1) Microwave with (1) new Commscope VHLP2-18 Microwave T-Mobile is adding(3) new Nokia FRLB remote radio units T-Mobile is adding(1) new FBBC baseband module The above listed equipment will be compliant with Jefferson County code 18.42.090(g) and T-Mobile will be responsible for not exceeding the maximum environmental noise levels set forth in Chapter 173-60 WAC. [ LV / 08/27/2015 Signature Date Maria Emig—Site Development Manager Print Name&Title 7/2Qd2O15 EXCELL SERVICES COMPANY LLC Search;_&I A Washington State Department of Labor & industries EXCELL SERVICES COMPANY LLC Owner or tradesperson 11232 120TH AVE NE,SUITE 103 KIRKLAND,WA 98033 Principals 425-298-0167 HEALY, PATRICK KING County JEROME, PARTNER/MEMBER HEALY, PATRICK JEROME,AGENT Doing business as EXCELL SERVICES COMPANY LLC WA UBI No. Business type 603 359 060 Limited Liability Company Governing persons KATHERINE MCCONVEY PATRICK JOSEPH HEALY; License Verify the contractor's active registration/license/certification(depending on trade)and any past violations. Construction Contractor Active. Meets current requirements. License specialties GENERAL License no. EXCELSC861CF Effective—expiration 02/06/2014—02/06/2016 Bond American Contractors Indem CO $12,000.00 Bond account no. 100274338 Received by L&I Effective date 06/08/2015 06/09/2015 Expiration date Until Canceled Bond history Insurance ............................... Ohio Security Ins Co $1,000,000.00 Policy no. BKS56174454 Received by L&l Effective date 06/18/2015 06/27/2014 Expiration date 06/27/2016 insurance history taps://seoure.fry.wa.gov/verify/Detail.aspx?t1Bt=603359060&LIC=EXCELSC861CF&SAW= 1/2 7/2G2O15 EXCELL SERVICES COMPANY LLC Savings • No savings accounts during the previous 6 year period. Lawsuits against the bond or savings No lawsuits against the bond or savings accounts during the previous 6 year period. L&I Tax debts No L&l tax debts are recorded for this contractor license during the previous 6 year period, but some debts may be recorded by other agencies. License Violations ........................................................... No license violations during the previous 6 year period. Workers' comp Do you know if the business has employees?If so, verify the business is up-to-date on workers'comp premiums. This company has multiple workers' comp accounts. Active accounts L&I Account ID Recently opened account. 529,579-01 No premiums due yet. Doing business as EXCELL SERVICES COMPANY LLC Estimated workers reported N/A L&I account representative T1 /NICHOLE CAROW(360)902-5634-Email:CANI235@lni.wa.gov Track this contractor Workplace safety and health Check for any past safety and health violations found on jobsites this business was responsible for. Citation issue date 04/02/2014 No violations Inspection no. 316978170 Location 18800 Orillia Rd.S. Tukwila,WA 98188 Washington State Dept.of Labor&industries.Use of this site is sullied to the laws of the state of Washington. I s:i/secure.Ery:wa.govlverify/Detail.aspx?tJBC=603359060&LUC=EXCELSC8610E&SAW= 2/2 Uldront Parcel Review 0 �7J 015 arcel 801181001 Printed: July 28, 2015 POPE RESOURCES Site Address(es): C/O OLYMPIC RESOURCE MGMT 1696 HIGHWAY 104 QUILCENE, WA 98376 19950 7TH AVE NE#200 2747 TARBOO LAKE RD QUILCENE, WA 98376 POULSBO, WA 98370 2755 TARBOO LAKE RD QUILCENE, WA 98376 Parcel Number: 801181001 S-T-R: 18-28N-1W Total Acreagc 635 Legal Description S18 T28 R1W ALL OF SECTION(LESS TAX 1 &R/W) Land Use: 8800 S/EASE Flood District: Fire District: 0 Planning Area: Flood Map(FIRM)Panel No: School District 48 Zoning: C-F-7--c6C) COMP PLAN DESIGNATION: COMMUNITY PLAN: UGA: UGA Trans 4 Plot plan states "property line" -K] Assessor's Map (Property lines ousubmitted plot plan must match the property lines as identified on the Assessor's 1/4 map) Legal Access to Property ES, NO Parcel Tags or Scanned Documents 04 NO agadmAot --F 1P4_ rt , ESA's: Special Reports Nearby 10 NO {-PA ,nitp r�.a` i f 0141 ttaeinqk i V (- it 't/OC I q • `� Designated Ag YES 0 l>i- Shoreline Designation: YES 6 Shoreline Slope Stability: YES ED Stream Type:_ O , , FWHCA: Wetlands: YES e)C'eU►-(C / u i dk r- I$ , aa, 0-4 c(9 Rare Plants:YES Seismic: YES Landslide: YES Flood: YES 011 Erosion: YES ea Aquifer Rech. •e Area:YES O SIPZ: illit At Risk Hi Risk Coastal CMZ: Oe High Risk Moder e RiskDisconnected CMZ Stormwater site an submitted: YesG [-74 Forest Lands: NO C.- —c-'6'° Adjoining Forest Lands: Commercial/ Rural/ Inholding A...-r--(X)'1-e) i\ r I 54 Mineral Lands: YES ti [>,-} Agricultural Lands: YES CitaK[ Archaeology: YES 8 No Shooting Zone: YES 6) [x]_ Stormwater: New Impervious Surface 0(p f / Land Disturbing Activity ESA's Stormwater Req's:Min Req#2 Min Req 4A l thru#5 Min Req#1 thru#10 Engineering bej. Notice Provisions/Disclosure:Airport YES o MRL YES Forest Lands YE NO s Landscaping Required: Yes p 1-,E).4) y ] Parking Spaces Required NO 2 other ( Building Height: 35' UBC Standard [ ] Impervious Surface cove a5ge percentage: Resource Lands&Public: 0oq al Residential: 25% Rural Industrial: PC Sec 6.7 Rural Commercial: 60% ea of Building Coverage: 60%in Rural Industrial L only bj Total Building (s) Size: // RVC:20,000 SF CC:5,000 V N_Tt C:7 0 gF GE�,000 SF All others:subject to septic&water constraints/None specified ,�50t-ctK . Setbacks: Front:_ ± LTeSide: first,' Right Side: ,,ZS& Rear: ),rj�`�' Shoreline Setback: (�/ LSHA Setback: iv " /A_ jj<t Road Classification: CC t){ K . U.3 55 - Th r6en La Road Approach: EXISTING REQ'D JAP SEPA Required: YES '''EMP 1 a .— -- W )Cq) b4 Flood Certificate: 'v/; [><].__ Existing Case(s)& Condition(s): Violations: Yes fo Recorded Date of Subdivision: ,� / AFN Over 5yrs=UDC Plat Conditions: / �//7 ' <5yrs=Plat Conditions on plat or Old Ordinance [ Lots/Require Declaration of Restrictive Covenant YES submitted: YES NO UGA No Protest Agreement YES /19, 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 801181001 1.) 6yr Mor. on FPA2611840 application approved on 6/28/11. Moratorium 06/29/2012 Non-Forest Permits expires 6/28/18. JCC18.20.160(5)(b) "Mandatory six year development moratorium. For six years after the date of the application the county shall deny any and all applications for permits and approvals, including building permits and subdivision approvals, relating to or for non forestry uses of land subject to the application. Parcel tags found for parcel 801181001 2.) WSRC Coaching- 2011-11-17, CZ 08/23/2013 Other Parcel tags found for parcel 801181001 3.) WSRC Coaching - 2011-02-14, CZ 09/03/2013 Other Parcel tags found for parcel 801181001 4.) WSRC Coaching- 2011-03-29, CZ 09/03/2013 Other Cases Associated with APN 801181001 Review Cases Name Type Status Planner BLD12-00347 SPRINT C Lisa Keller Application Received: 10/25/2012 Permit Issued/Case closed: 11/7/2012 Case Finaled: MODIFICATION TO EXISTING ANTENNAS AND CABINETS BLD13-00219 POPE RESOURCES EXP Colleen Zmolek Application Received: 7/19/2013 Permit Issued/Case closed: 8/7/2013 Case Finaled: ONE NEW MICROWAVE AN I ENNA WITH TWO LINES AND TWO ODU UN EXISTING WIRELESS TOWER BLD13-00258 SPRINT-GENERAL DYNAMICS F Zoe Ann Lamp Application Received: 8/21/2013 Permit Issued/Case closed: 9/13/2013 Case Finaled: 10/21/2013 ADDITION OF (1) MICkOWAVE DISH (MICROCELL)TO AN EXISTING CELL TOWER BLD14-00031 POPE RESOURCES 1 EXP David Wayne Johnson Application Received: 1/24/2014 Permit Issued/Case closed: 2/25/2014 Case Finaled: Remove 3 GSM antennas, add 6 LI E antennas, & 1 surge suppression unit. Add 1 GPS antenna, install new LTE equipment. \\tidemark\data\forms\R_Parcel_CRMLA.rpt 7/28/2015 Page 2 of 4 BLD14-00318POPE RESOURCES A Tim Woolett Application Received: 9/3/2014 Permit �ed/Case closed: 9/29/2014 Case F d: SPRINT PROPOSED >Z) MODIFY ITS ANTENNA EQUIPMENT I ELECOMMUNICATIONS TOWER. THE OVER ALL HEIGHT OF THE TOWER WILL NOT INCREASE. ADDIND ADDITION OF 3 PANEL ANTENNAS, 3 RRHS, 6 CYLINDERS AND 1 FILTER. THERE ARE NO CHANGES AT THE GROUND LEVEL OR ANY SITE DISTRUBANCE. BLD15-00258 T- MOBLIE P Application Received: 7/28/2015 Permit Issued/Case closed: Case Finaled: CELL TOWER-PROCESSING AND REPLACE 3 ANTENNAS, REPLACE 1 MICROWAVE- INSTALL 3 REMOTE RADIO UNITS AND 1 BASEBAND MODULE BLD00-00360 VOICE STREAM WIRELESS F Application Received: 6/2/2000 Permit Issued/Case closed: 11/17/2000 Case Finaled: 2/20/2001 VOICE STREAM WIRELESS I OWER BLD95-00144 AT&T WIRELESS SERVICES F Application Received: 3/28/1995 Permit Issued/Case closed: 10/31/1995 Case Finaled: 3/26/1996 Cellular One Tower and Equipment Shelter FPA2605256 POPE RESOURCES F Application Received: 4/21/2003 Permit Issued/Case closed: 3/27/2003 Case Finaled: 4/21/2003 Aerial Chemical Applica io FPA2605260 POPE RESOURCES F Application Received: 4/21/2003 Permit Issued/Case closed: 3/28/2003 Case Finaled: 4/21/2003 Aerial Chemical Application FPA2605386 POPE RESOURCES F Application Received: 5/29/2003 Permit Issued/Case closed: 6/2/2003 Case Finaled: 6/6/2003 Aerial Chemical Application FPA2606697 POPE RESOURCES F Application Received: 4/22/2005 Permit Issued/Case closed: Case Finaled: 5/10/2005 TIMBER HARVEST 44 ac FPA2607144 POPE RESOURCES F Application Received: 8/17/2005 Permit Issued/Case closed: 8/28/2005 Case Finaled: 8/28/2005 44 acre harvest. FPA2609454 POPE RESOURCES F Application Received: 7/28/2008 Permit Issued/Case closed: 7/31/2008 Case Finaled: 8/5/2008 568 acre Aerial Chemical application FPA2609824 POPE RESOURCES F Application Received: 4/7/2009 Permit Issued/Case closed: 4/16/2009 Case Finaled: 4/27/2009 1.3 acre timber harvest, 2 stream crossings, 1200 ft road construction, 2150 tt road abandon FPA2611840 POPE RESOURCES F Application Received: 6/19/2012 Permit Issued/Case closed: 6/28/2012 Case Finaled: 6/29/2012 250 yards spoil areas and two culvert removals. BLD94-00457 US WEST NEWVECTOR GROUF F Application Received: 7/11/1994 Permit Issued/Case closed: 4/3/1995 Case Finaled: 6/29/1995 150 ft high cellular communications tower w/1-12'x 12'& 1 12'x 28' utility bldgs BLD97-00651 AIRTOUCH CELLULAR F Application Received: 10/3/1997 Permit Issued/Case closed: 10/9/1997 Case Finaled: 1/5/1999 EXTEND EXISITNG 150' CELLULAR TOWER TO 188'TIP HEIGHT. BLD99-00399 GRIFFIN F Application Received: 6/23/1999 Permit Issued/Case closed: 9/1/1999 Case Finaled: 11/16/1999 construct wireless communication equipment and antennas IZA94-00044 US WEST NEWVECTOR GROUF F Application Received: 7/1/1994 Permit Issued/Case closed: 9/6/1994 Case Finaled: 8/20/1996 to construct a cellular communications facility consisting of 150 ft high self-supporting lattice tower and a 12 ft by 12 ft prefabricated equipment building. PRE99-00040 VOICE STREAM WIRELESS F J SMITH Application Received: 8/18/1999 Permit Issued/Case closed: 9/9/1999 Case Finaled: Voice Stream Wireless proposed construct a 170 foot lattice towerrt a three-sector antenna array with (3) antennas per sector(9 antennas total). M LA01-00574 BLD01-00652 MLA01-00574 OLYMPIC RESOURCE MANAGE I F J SMITH Application Received: 11/20/2001 Permit Issued/Case closed: 11/28/2001 Case Finaled: 11/12/2002 ADD 4 ft. MICROWAVE DISH 10 EXISTING CELL TOWER @ 110 M LA02-00151 \\tidemark\data\forms\R_Parcel_CRMLA.rpt 7/28/2015 Page 3 of 4 BLD02-00165 MLA02-00151AMERICAN TOWER I F J SMITH Application Received: 3/26/2002 Permit led/Case closed: 4/30/2002 Case FWd: 7/30/2002 COMMERCIAL EQUIPMEN 1 BUILDING M LA02-00157 BLD02-00172 MLA02-00157 CINGULAR WIRELESS I F J SMITH Application Received: 3/27/2002 Permit Issued/Case closed: 7/9/2002 Case Finaled: 4/1/2003 ATTACHMENT OF AN I ENNAS ON EXISTING TOWER M LA02-00250 BLD02-00258 MLA02-00250 AT&T WIRELESS SERVICES I F J SMITH Application Received: 5/2/2002 Permit Issued/Case closed: 8/19/2002 Case Finaled: 3/27/2003 REPLACEMENT OF EXISITNG ANTENNA FACILITIES ON EXIS I ING I OWER MLA08-00395 BLD08-00381 MLA08-00395 VERIZON WIRELESS 1 F Cara Leckenby Application Received: 8/25/2008 Permit Issued/Case closed: 11/18/2008 Case Finaled: 4/16/2009 INSTALL A 2' MICROWAVE DISH AND ELLIPTICAL WAVEGUIDE CABLE I U AN EXISTING WIRELESS COMMUNICATIONS STRUCTURE PRJ08-00107 MLA08-00395 VERIZON WIRELESS P Application Received: 9/3/2008 Permit Issued/Case closed: Case Finaled: M LA09-00208 BLD09-00186 MLA09-00208 POPE RESOURCES I C Michelle Farfan Application Received: 6/25/2009 Permit Issued/Case closed: 9/28/2009 Case Finaled: REPLACE 4 OMNI AN I ENNAS WITH 12 PANEL ANTENNAS - PERMI I CANCELLED DUE TO NON-PYMNT UNDER AMNESTY PROG M LA10-00171 BLD10-00143 MLA10-00171 POPE RESOURCES I C Zoe Ann Lamp Application Received: 5/5/2010 Permit Issued/Case closed: 6/24/2010 Case Finaled: MODIFY TELECOMMUNCAFIONS FACILITY- REMOVE & REPLACE 3 PANEL ANTENNAS, ADD 3 TMA's, 3 RUNS OF COAX CABLE, 6 DIPLEXORS &A RET SYSTEM &ATTACH UMTS RADIO CABINET TO EXISTING SLAB - PERMIT CANCELLED DUE TO NON-PYMNT UNDER AMNESTY PROG M LA11-00093 BLD11-00102 MLA11-00093 VERIZON WIRELESS I F Zoe Ann Lamp Application Received: 4/27/2011 Permit Issued/Case closed: 6/20/2011 Case Finaled: 2/13/2012 MODIFICATION OF EXIS 1 ING WIRELESS FACILITY- REMOVE & REPLACE 4 OMNI ANTENNAS WI I H 12 PANEL ANNTENNAS &ADD 1 MICROWAVE DISH M LA12-00026 BLD12-00043 MLA12-00026 AT&T I C David Wayne Johnson Application Received: 2/13/2012 Permit Issued/Case closed: 11/21/2012 Case Finaled: ADD 2 NEW 4' MICROWAVE DISHES ON EXISTING TOWER&4 NEW LINES OF COAX CABLE ZON99-00058 VOICE STREAM WIRELESS F J SMITH Application Received: 12/20/1999 Permit Issued/Case closed: 11/7/2000 Case Finaled: 4/29/2002 Construct a new 195 foot lattice tower to support a 3 sector panel antenna array with 3 antennas per sector(9 antennas total) . Equipment cabinet to be placed near tower base within a 40'x 40' lease area. In addition, Voice Stream may elect to mount up to three (3) microwave dish antennas onto the tower in the future. ZON95-00004 US WEST NEWVECTOR GROUF F J SMITH Application Received: 2/6/1995 Permit Issued/Case closed: 3/27/1995 Case Finaled: 12/13/1999 to construct a cellular communication facility consisting of one 12 X 12 building, one 12 X 20 building and a 150 foot steel self support antenna tower. \\tidemark\data\forms\R_Parcel_CRMLA.rpt 7/28/2015 Page 4 of 4 1110 } Y 8/25/2015 T-Mobile#SE06106A/PT Lake Tarboo Crown#826843 Aft: HA N OAR QED T-Mobile's proposed equipment changes at existing Wireless Communications Facility Site address: 2749 Tarboo Lake Road, Quilcene, WA 98376 T-Mobile is replacing(3)antennas with (3) new Commscope LNX-6515DS-A1M antennas T-Mobile is replacing(1) Microwave with (1) new Commscope VHLP2-18 Microwave T-Mobile is adding(3) new Nokia FRLB remote radio units T-Mobile is adding(1) new FBBC baseband module The above listed equipment will be compliant with Jefferson County code 18.42.090(g)and T-Mobile will be responsible for not exceeding the maximum environmental noise levels set forth in Chapter 173-60 WAC. 6,R,i L co% 08/27/2015 Signature Date Maria Emig—Site Development Manager Print Name&Title