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N t[] N 3 m -~ 7 Q -a g �G 0) << N O O N ( 0 CD gyp a) c � 3 0 0- CD a CD S M 0- (0 O CD (D o C o C o 3 OCD ani CD CD CD CD K .. y 0 N 0 y CD X Doi a ;L o a•'0 N 8 w 3 3 CD N w -* 7 CD CD 5 .� 0`< 3 3CO p O 0 3 -a O o j 7 CD -{ N C (D CD 0 a' 0 � 0 0 o � O vi 0 ` CONCRETE MECHANICAL MANUFACTURED HOME N o Footings 1 Setbacks Date B y Ribbons ' b Date ,/6 --v By 712 Gas Piping Date B y N Foundation Walls Date B y Set-up 4 Date By INSULATION Date By B G 1 Slab Insulation Floors Final Date By Date By Date By FRAMING Walls FIRE DEPT Date By Date By Date By PLUMBING Attic OTHER Groundwork Date By Date By WALLBOARD NAILING D.W.V. Date By Date By FINAL INSPECTION Water Line Date/Q 7� By D ate By Date By O � o �J r 0 0 N J 0 07/01/2004 20:15 425-497-8029 TETRA TECH PAGE 02 oe/30/2004 10:47 M 3e0 427 7798 MASON CO PERMIT CM 2004 t . FILE MASON COUNTY Special Ins pactiolr►Ndtflon 8unding Inapactlon . p ernR Asslsfsnce Curter 428W.044110.0.Bau 188 Shelton,WA M84 Ph.:(O80}427.9S7o FOX(300)427 7798 1. PROJECT INFORMATION Proldct Name• e 1 Q Owmer's Name•._,. M o k It, TYPE pF RK Itoms oltaegeed below requ ce Special Inspections complying with 1997 uniform Building Code Section IT01. See Section 1701.5 for exceptions. All Inspaxdaell reports must be r submitted and approved by the bctildirrg official prior to Is:garlce of a certificate of occrrpslncx 1. CO CRETE:During the tattling of best specimens and placing of reinforced concrete. See Am 12 for ah p 2- 15OMS INSTALLE121 IN CONCRETE: Prior to and during the placer+1811t 4f concrete around bolts when Stress increases permitted by footnote 5 of Table I G-E or Section 1925 are utilized. t] 3. a _rer MOMLENT-RESISTING NCgM FRAMI=: Az mquilred by Section 1921.9. o 4. R1=INFORCING IfFEL&PRESTRESSI&G MDEEL TENDONS; 4.1. Durmg eli stressing and grouting of tendons in prest ward oonorete, 4.2 During placing of reinforcing steel and prestressing tendons for all concrete requtmd to have special Inspection by Item 1. ❑ S. STRUCTURAL LDING.5.1. GENE During the welding of any member or connection which is designed to resist bads and forces rogtlired by this code. 5.2. SpE9JA6MOMENT RE&tSTING STEEL Fes€$. During the welding of special moment-resisting steel frames- In addition to Item 5.1 requirements above,nondestructive testing as required by Section 1703. 5.3 ZMPING OF REINFORCED SY L During the welding of minfarcing steel, ❑ s. FBI � M I30L INO. As required by Chapter 22,Division IV. Suoh inspeCaons maybe performed on a periodic basis in accordance with the requirements of Section 1701.6. A T. SjRUC'f'L1RAL AAAta`ONRY: 7.1. During preparation and tatdng of any required pdarns ortest specimens, Placing of EA masonry units,placement of reinforcement,inspection of grout space,Immedately prior to closing of cleaneuts,and during all grouting operations. 7.2. See code for requirements on fully grouted open-end hollow-unit masonry. p 8. RtINF RCE:D.GYPSUM CONCRETE: When cast-in-place Cress 0 gypsum concrete is being mixed and placed. ❑ 9. INSULATING CONCRETE Fw!W,: During the application of insula ing concrete fill whah used as part or a strirvtaral system. o 10. SPBbKAPPLIED FIREPR00FIN13:As required by UBC Standard 7-6. ❑ 11. PILING.DRILLED PIE[§.AID CAISSON$: During driving and testing of piles and construction of cast-In place drlllad pile's or caissons. See hems 1 and 4 for concrete and rolnforcing steel inspection. p 12. SHOICRETE: During the taking of test specimens and placing of all shota'ete and as required by Sections 1922-10 and1822.11. 13. SPECIAL GRADING.EXCAVATI0b1AND FILLING: During earthwork excavations,gWing and filling operations Inspection to satisfy requirernonrts of Chapter 19 and Appendix Chapter 33. 07/01/2004 20:15 425-497-8029 TETRA TECH PAGE 03 08/30/2004 10:4_FAX 300 427 7798 MASON CO PERMIT CTR @ 008 ' a 14. 8M01cF.UpM'gcoL vie.. _ � 74.1. During ereelionor duct work and prior tovonoealmerlt for the purposes of leakage testing and recording of dvape location_ 14,z Prlorto occupancy and after SUWSM completion for the purposes of pressure difference testing,low Measurements and detection and control verification. (3• 11S. Work Which,in the opinion of the building official,involves unusual hazards or condluans. • Ill. SPECIAL INSPWTOR SELECTION: The Specisii Inspection Agency and Inspector shall be registered by the Washington Association of Building OFR$Ws(WA[3O)for the particular type Of construcpon or operatlon reqquiring special Inspection. such inspectors)shall be selected by the owner's agent and approved by the Suffding Official pdomo issuance of the building permit. The OWNER'S AGEW shag not be acting as or employed by the special Inspection agency or contractor for thls project, N cng of insr,ectlon Resifstration# • b) c) , ©UTTES AND RESPONSIBILITIES OF THE SPECM INSPECTOR: The special inspedor shalt observe the assigned warts for conformance YA the apprav0d design drawings and spW1ffq tiwm The special fnapeobor MAP ftnish inspection reports to the budding aMdA the engineer or aroMeot of record,and other 462WOWd persons. Alf discrepancies shag be brWght to the Ir madfate attantlert ofthe contracWbr eonvdion,then,if uncorrected,to the proper design authority and to the building offiaat The special inepectorehail aubrM s final signed report Ming whetherthe work requiring speolml Inepeetien was,to the hest of the inspector's Tcnowledge,In conformance with the approved plans and Bpadficacees and the applicable wotlarranship provisions of the l ri rm Budding Code as sdopted by Mason County. DUTIES AND RESPONSIBILITY Y OF THR CONTRACTOR The conttadors dtfties include responalblgly for notifying the speck(Inspectorora9aney regarding irxiividual Trtspeclloirs required bythe branding departrimt Adequate notice shalt be provided so that the special tnepector with access to approved plans atthe job$Re and he responsible for retaining atthe job site all speoiaf inspection records sirbrnKtad bythe special inspector,and"providing these ► OOrds tar WOW by the btdlding departneant7s inopeetor upon request Coln*Oon Of this special inspaoNotl fortm eons not g any the eentr�acbors f+espansibility to schedule Inspeetlons by a Mason County bullOng inspector before concealing any work ' OUTIES AND RESPONSIBlUTIES OF THE EMINEER OR ARC(-rmcE OF RECORD: The engineer or architect Of record has many duties and responsWiles related to special Inspection acWmes. They Inchida identifying wMch special inspections are needed. developing a schedule,and assisting in the selection of the special inspector; DUTiM AND RESPONSIBILITIES OF THE PROJEar OVVNE R; The project owner orMe engineer or aftRect of record atdyrtg as the Owner's agent is responsible for funding special Inspection services per 3eetion 1701.1. IV, AUTHORIZATION: I hereby state i am the legal owner(or owner's agent)of this property and agree to i th Tequirements fisted herein. ti rTs Cqnt.x; �y Slg re Name DOwner Agent Data spinspf7Tn48.doc IAASON.CQUNTY PERMIT r1611 PERMIT APPLICATIO - 114 BU QII� p 3 426 , .'Cedar•P.O. Box 186, Shelton,WA 98564 Shelton (360) 427-9670 • Belfair (360) 275-4467• Elm) (360) 482�5269 On the web www.co.masori.wa.us I APPLICANT INFORMATION CONTRACTOR,INFORMATION. _ I Owner i`�r S C 1aX o' ��ek�i f1C (V eXk Company Name C' ' n I� Mailin Address k")'U t� 6115 rZ> UL. i1�2 Mailing Address City n !� State lJ'A Zip Code q 'uS� City State Z1iip.Co,1de_ T Phone 10k`y43 :' 8�9 Other Ph. Phone Other Ph. Lien/Title Holder Contractor Reg.# Exp. a E mail address 146CAkXA -H--L);r-e`IE S�_l�;r�� E Mail Address Drivers Lic.# DOB [)rivers Lic.# DOB SEPTIC/WATER SYSTEM INFORMATION - Connect to'New Septic Existing Septic ; Connect to Water System Name of Water.System Well Water System_Name of Water System FAROEL INFORMATION 12 Digit Parcel No: Fire District egal{Tesr:<rp Site Address (Please include street name,street number and city)Ail.giltU._,. ��'S+aLE Q,v�t , ��c 3 R Directions to site A n c-- "tit n i. t ;- AA Lodit la.tAkb �r y/ ,v,E. A Will timber be cut,and sold in parcel preparation?Yes Is property within 200'of Saltwater rv/ Lake tiPpo River Creek MBA -Pond s fEI ^f;�^ Wetland Seasonal Runoff i,'!A Stream Slopes or Bluffs 1 15°!° Is thus permit submittal the result of a Stop Work Notice,Correction Notice pr other enforcer>+ent act , n?yesmjo , TYPE OF'JOS -'New Add Alt Repair Other PRIMARY RES113ENCE` SEASONAL [�] Use of Building Describe Work'a LW ��ies5 �a t n;ti� x'S r�10 F No.of Bedrooms—.No.of Bathrooms Square footage- 1st Floor 2nd-Floor 3rd Floor, Basement Deck Covered Deck Other Sq.f# �4t#ached. Detached, -Carport Attached Detached Caraa .�.�.. ,MANUFACTURED HOME INFORMATION'S, ake ModeJ:` Year . Length Width Serial No. No.of Bedrooms No.of Bathrooms Type of'Heat Purchase Price$ Replacement Unit? Yes f No Installer Name Certification No. OWNER/BUNKER Acknowledges submission of inaccurate information may result in a stop work order or permit revocation Acknowledgement of such is by signature below.I declare that I am the owner,owners Iegal,representative,or the cortrector:I further declare that I am entitled to receive this permit and to do the work as proposed in the application.I declare that l have obtained,ihe permis sion from all the nece r 'parties.If permission is required from any easement holder or any other party in interest this appGcar lion or th7rogo- ff sed the application,I have o permission from them to applyfor this permit and conduct the work proposed. X r— f Cr : 3 Qwner wners epres ive Contr or (indicate which one) FOR OFFICIAL USE BEYOND THIS ROINT Accepted by: Planning Pd Ck#` Date Bid Pd Receipt NO. ! TMENTAL=REVIEW AP ED NOTES Department. J U Department Environmental Health Department ». "k,k X 1, f . Pttbkc Works Department xy; Fire Marshal M ti 11* Buildln Permit Fee ` Site Iris ection Plan Review Fee _ EH Reui w tree: Plumbing&Base Fee 'Planning,Review fee Mechanical&Base fee Other Wood/Gas/Pellet Stave Fee State Fee Violation Fee Pre�Paid at Submittal Valuation$ TOTAL FEES or & ASSOCIATES , INC . GEOTECHNICAL ENGINEERING • ENVIRONMENTAL ENGINEERING CONSTRUCTION TESTING & INSPECTION Uctober 26. 2004 KA Project No.: 106-04133 RECEIVED 1 I rn c t OCT 2 7 2004 22717—72id Ave. S. #B 108 426 W; Seattle, WA 98032 CEDAR STD RE: Bel fair Cell Tower-#63-20290/Belfair,WA Dear M . Tultlel: In accordance with your request and authorization, the following test data are presented on the following reports, which are enclosed: .Septembcr 17 Concrete Report No. 00770 Referenced concrete reports and compressive strength data will be mailed following 28-day tests, if applicable. If you have any questions, or if we can be of further assistance,please do not hesitate to contact our office. Respectfully submitted, Penn Seely, Laboratory Manager Peninsula Division PS: ca Enclosures Cc: Mason County—Terry Ryan With Offices Serving The Western United States 20714 State Hwy.305 NE,Suite 3C• Poulsbo,Washington 98370 9(360)598-2126• Fax:(360)598-2127 Krazan &Associates, Inc. 20714 State Hwy. 305 N.E. Suite 3C, Poulsbo, WA 98370 (360)-589-2126 Project No. 106-04133 Cyl.Code P6874 Pour Date 9/17/2004 Report No. 00770 weather OCAST Jurisdiction MASON COUNTY Permit No. COM 2004-00127 .project BELFAIR CELL TOWER Engineer Location BELFAIR Architect Client Contractor WEST TOWER Field Data Site Mix Reported Batch Data supplier HARD ROCK Plant No. Cement Type Concrete X Mortar Grout Flex Beams Design Actual Prisms Grouted Ungrouted Other Mix No. CL3000 Conc. Air Cam.kg. 520 Temp. Temp. Unit F.Ash kg. Time Truck# Ticket# %Air Slump (C) (C) Wt. 12:05 20 200466 4 1/2 68 63 C.agg.kg.. 7/8 1754 1 C.agg.kg.2 C.agg.kg.3 Sand kg. 1381 Water 21 GAL Placement Area Admixture ' Footings Walls Columns Grade Beams j Other Slab/Deck Slab Pilings Other Air Ent.(kg.) 5.2 Grids FOUNDATION SLAB FOR STORAGE VAULT Water Added on 0 Job(L) i Remarks PLACED BY CHUTE AND VIBRATED Items Inspected SAMPLED 7 1/2 CY OF 7 1/2 CY ORDERED W/C = .35 Conforming Inspector SHAUN NYE Reviewed By Non-Conforming Laboratory Data Design Strength 3000 Date Specimens Rec'd. 9/29/04 Cyl. Test Dia Length Max. Comp. Tested Break Test Method Code Date Age Dim. Area Load Str. (mpa) Set# By Type P5874-1 9/24/2Q 7 4X8 12.62 49380 3,910 CJA 1 ASTM C39 P3874-2 10/15/2 28 4X8 12.51 67180 5,370 TA 1 C-1231 P6874-3 10/15/2 28 4X8 12.51 65120 5,210 TA 1 Other P6874-4 H 4X8 12.51 65370 5,230 TA 1 P6874-5 Compressive P6874-6 Flexural P6874-7 Test Results R P6874-8 Conforming Remarks FR 35686 Non-Conforming Results Reviewed By Date Reviewed`a.� 7— Codes for Break Types: 1.Cone 2.Cone&Split 3. Cone&Shear /�\ 4. Shear 5.Columnar(Split) Fli i Tetra Tech Communication Services 10545 Willows Road NE,Suite 110 Redmond,WA 98052 (425)497.8029 fax 5.18.2004 Mason County Department Of Community Development Permit Assistance Center Mason County Building III, 426 West Cedar Shelton, WA 98584 ATTN: Charell Holcomb RE: Nextel Application for Co-location on Existing Monopole located at 24941 NE State Route 3, in Belfair, WA 98528. APN# 1232134 00010 Hi Charell, Please find enclosed, on behalf of my client Nextel Communications,Building Permit application materials for placement of Wireless Antennas on an existing structure: 1) Completed Building Permit Application 2) Plan Check fees 3) 5 Sets of Site Plans (4 full size, 1 reduced) 4) 2 copies of Structural Calculations 5) FAA determination Please contact me with any questions or concerns regarding the enclosed information. Kris Conaxis Zoning Manager Tetra Tech Communications Nextel PNW 206.423.7899 kconaxis@ttwireless.com •/03/2004 08:29 425-497-8029 TETRA TECH PAGE 02 Tetra Tech Communication Services 10545 Willows Road NE,Suite 100 Redmond,WA 9BO52 (425)497.8029 fax 6.02.2004 Mason County Department of Community Development Permit Assistance Center Mason County Building III, 426 West Cedar Shelton.,WA 98584 RE: WA 0167 Belfair/Nextel This project is a co-location on an existing Sprint Monopole located at 24941 NE State Route 3 in Belfair, Washington 98528. This project will require that the existing fenced compound be expanded to accommodate Nextel's radio equipment. Nextel's estimated valuation for this project is$60,000. Please contact me with auy questions or concerns. Sincerely, Kris Cou. is Zoning Manager TetraTech Communications Nextel PNW 206.423.8900 e D r P �Qo 0 M,) lz ►`, mz° � zo ss�z I zm� �z F� I � I ��t"n o Z m o' Z NO Gj I D I �Z° f' �� - - - -__ - - ;gm U R 1 N G T 0 N N p R r � , \ o R A I l R p A 0 H f R \ � wm 110 v O - �� '� om 0 1 J 0 1 sz \ o �� I a) A m j I =m 0 .. p \ ♦ P 0O m I CM)_I M z Z z w ♦ su p _ /♦ vrnTg / \ D zzs \ o Ob rn t \ \ g c ,, --p rri Z \> m g c� z c \ \ z m bi40 p <n oWo �c o \ w $ rn t F i pO \ c A Z m _ 1T O v CC" ? 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