The URL can be used to link to this page

Home My WebLink AboutBLD2004-00577 Cancelled Extend Retaining Wall - BLD Application - 4/23/2004 December 24, 2007 This permit was cancelled per written document in parcel file. Should applicant change his/her mind, construction plans are located bottom drawer of case management i for one year. If, after one � year from this date, applicant has not paid for re-instating this permit said plans will be disposed of. FORM MUST BE COMPLETED IN INK MASON COUNTY PERMIT NO. PLEASE PRESS HARD BUILDING PERMIT APPLICATION 426 W. Cedar- P.O. Box 186, Shelton, WA.98584 ' Shelton (360)42779670 - Belfair(360) 275-4467 - Elma (360)482-5269 On the Web www.co.mason.wa.us APPLICANT INFORMATION CONTRACTOR INFORMATIO Owner 7— Contractor Name x��Y_0,Z 0",JE'q Mailing Address t E Mailing Address City<R._iZ.t5ST State Zip Code City State Zip Code Phone (Z,10_)ZS/-ciao Other Ph. ( ) Phone ( ) Other Ph. ( ) Lien/Title Holder AJDIVE Contractor Reg. # Exp. Email Address Email Address SEPTIC/WATER SYSTEM INFORMATION -Connect to New Septic Existing Septic Connect to Sewer System Name of Sewer System Well Water System Name of Water System PARCEL INFORMATION - 12 digit Tax Parcel No. Z�2,ZV pop Fire District Legal Description Site Address (Please include street name, street number and city) o 'g Directions to site u Will tim er be cut and sold in parcel preparation? (Yes/No) Is property located within 200' of saltwater�Lake River/Creek Pond Wetland Seasonal Runoff Stream Slopes or Bluffs PERMANENT RESIDENCE ❑ SEASONAL RESIDENCE TYPE OF JOB-New Add_jt!!� Alt Repair Other Use of Building Is this permit submittal the result of a Stop Work Notice,Correction Notice or othe enf,Qrcement actiorW(Yes/No) Describe Work FX-IrGA�D FCC►Sf �NI�Cz 1�ia-C.` f'1�hyIl !V/aTit Ti4AJJ�.� No. of Bedrooms No. of Bathrooms SQUARE FOOTAGE- 1st Floor 2nd Floor 3rd Floor Loft Basement Deck Other sq. ft. Garage Attached Detached Carport Attached Detached MANUFACTURED HOME INFORMATION -Make Model Model Year Length Width Serial No. No. of Bedrooms No. of Bathrooms _ Type of Heat Purchase Price $ Replacement Unit? (Yes/No) Installer Name Certification No. NOTICE:THIS PERMIT BECOMES NULL&VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT COMMENCED WITHIN 180 DAYS OR IF CONSTRUCTION WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER THE WORK IS COMMENCED. PROOF OF CONTINUATION OF WORK IS BY MEANS OF A PROGRESS INSPECTION. THE OWNER OR AGENT ON OWNER'S BEHALF,REPRESENTS THAT THE INFORMATION PROVIDED IS ACCURATE AND GRANTS EMPLOYEES OF Mason COUNTY ACCESS TO THE ABOVE DESCRIBED PROPERTY AND STRUCTURES FOR REVIEW AND INSPECTION OF THIS PROJECT. OWNER/BUILDER ACKNOWLEDGES SUBMISSION OF INACCURATE INFORMATION MAY RESULT IN A STOP WORK ORDER OR PERMIT REVOCATION.ACKNOWLEDGEMENT OF SUCH IS BY SIGNATURE BELOW: OWNER AFFIDAVIT- I certify that I am exempt from the require- CONTRACTOR'S AFFIDAVIT- I certify that I am currently regis- ment of the Contractor Registration Law RCW 18.27 and am aware tered as a contractor in the State of Washington and that I am aware of the ordinance requirements for which this permit is issued and of the ordinance requirements regulating the work for which this that all work will be done in conformance therewith. No changes permit is issued and all work shall be done in conformance there- shall be ut first obtaining approval. with. No changes shall be made without first obtaining approval. X - Date 4. 5t X Date FOR OFFICIAL USE BEYOND THIS POINT RECEIVED Accepted by Planning Pd Ck# Date Bld Pd. Reciept No. a Building Department Occ Group Type Constr. Planning Department Environmental Health Department Public Works Department Fire Marshal Valuation$ 77 IN No Building Permit Fee Site Inspection Plan Review Fee EH Review Fee Plumbing&Base Fee Planning Review Fee Mechanical&Base Fee Other Wood/Gas/Pellet Stove Fee State Fee Violation Fee Pre-Paid at Submittal ( ) F TOTA L FEES TIP— MASON. COUNTY PERMIT NO. �UILDING PERMIT APPLICATION 426 W. Cedar• P.O. Box 186, Shelton, WA 98584 �•v� Shelton (360)427;9670 • Belfair(360) 275-4467 • Elma (360)482-5269 On the Web www.co.mason.wa.us APPLICANT INFORMATION - CONTRACTOR INFORMATIO Owner r TLT" S S/Ei� Contractor Name L&��- Mailing Address1,9&S' Mailing Address City-y�'jt2L'aGS"T• State Zip Code &yG(,,� City State Zip Code Phone Zga_)S'6j'-qQ Other Ph. ( ) Phone ( ) Other Ph. ( ) Lien /Title Holder "0"451 Contractor Reg. # Exp. Email Address Email Address SEPTIC/WATER SYSTEM INFORMATION -Connect to New Septic Existing Septic Connect to Sewer System Name of Sewer System Well Water System Name of Water System PARCEL INFORMATION - 12 digit Tax Parcel No. Z / S`0 / pqpZo2r Fire District Legal Description Site Address (Please include street name, street number and city) O Val F' ;A4 Directions to site (-," Will tim er be cut and sold in parcel preparation? (Yes/No). Is property located within 200' of saltwater�L Lake River/Creek Pond Wetland Seasonal Runoff ` Stream Slopes or Bluffs PERMANENT RESIDENCE ❑ SEASONAL RESIDENCEAjt TYPE OF JOB - New Add_Z Alt Repair Other Use of Building Is this permit submittal the result of a Stop Work Notice,Correction Notice or othe of rcement actin (Yes/No) Describe Work FX-(mip 4EXiStk4, T1RiIJJn.1C�j W 14w t:� low 5 f;f l g f- 'Ti*AjXS No. of Bedrooms No. of Bathrooms SQUARE FOOTAGE- 1st Floor 2nd Floor 3rd Floor Loft Basement Deck Other sq. ft. Garage Attached Detached Carport Attached Detached MANUFACTURED HOME INFORMATION - Make Model Model Year Length f Width Serial No. No. of Bedrooms No. of Bathrooms Type of Heat Purchase Price $ Replacement Unit? (Yes/No) Installer Name Certification No. NOTICE: THIS PERMIT BECOMES NULL&VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT COMMENCED WITHIN 180 DAYS OR IF CONSTRUCTION WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER THE WORK IS COMMENCED. PROOF OF CONTINUATION OF WORK IS BY MEANS OF A PROGRESS INSPECTION. THE OWNER OR AGENT ON OWNER'S BEHALF,REPRESENTS THAT THE INFORMATION PROVIDED IS ACCURATE AND GRANTS EMPLOYEES OF Mason COUNTY ACCESS TO THE ABOVE DESCRIBED PROPERTY AND STRUCTURES FOR REVIEW AND INSPECTION OF THIS PROJECT. OWNER/BUILDER ACKNOWLEDGES SUBMISSION OF INACCURATE INFORMATION MAY RESULT IN A STOP WORK ORDER OR PERMIT REVOCATION. ACKNOWLEDGEMENT OF SUCH IS BY SIGNATURE BELOW: OWNER AFFIDAVIT-I certify that I am exempt from the require- CONTRACTOR'S AFFIDAVIT - I certify that I am currently regis- ment if the Contractor Registration Law RCW 18.27 and am aware tered as a contractor in the State of Washington and that I am aware 0 of the ordinance requirements for which this permit is issued and of the ordinance requirements regulating the work for which this that all work will be done in conformance therewith. No changes permit is issued and all work shall be done in conformance there- shall be njacije without first obtaining approval. with. No changes shall be maide without first obtaining approval. X Date • 9 X Date FOR OFFICIAL USE BEYOND THIS POINT RECEIVED Accepted by Planning Pd 'Ck# APR 2 2 7004 Date Bid Pd. Reciept No. ' .. Building Department , Occ Group Type Constr. Planning Department - ti Environmental Health Department Public Works Department Fire Marshal y��9►iZt") a t1 i + t / (r1 L 4y r Valuation$ [L Y a Building Permit Fee Site Inspection Plan Review Fee EH Review Fee Plumbing&Base 4ee Planning Review Fee 1 Mechanical&B se Fee j Other Wood/Gas/Pellet Sto a Fee State Fee Violation Fee Pre-Paid at Submittal ( ) TOTAL FEES T�SS�I�� MASON COUNTY PERMIT NO. UILDING PERMIT APPLICATION .� . : �'�. -�� 426 W. Cedar• P.O. Box 186, Shelton, WA 98584 Shelton (360)427-9670 • Belfair(360) 275-4467 • Elma (360)482-5269 t ;, On the Web www.co.mason.wa.us APPLICANT INFORMATION CONTRACTOR INFORMATION Owner 4441.6,k-r- 7~ —7-,g--S SZ4FR Contractor Name Mailing Addresst'S'Gr C' 'f' Mailing Address City-;�'tR.0 a,,rs- ' StateW&ZipCode !/ City State Zip Code Phone ( ) Other Ph. ( ) Phone ( ) Other Ph. ( ) Lien/Title Holder AJ066_) Contractor Reg. # Exp. Email Address Email Address SEPTIC/WATER SYSTEM INFORMATION -Connect to New Septic Existing Septic Connect to Sewer System Name of Sewer System Well Water System Name of Water System PARCEL INFORMATION - 12 digit Tax Parcel No. Z / / 000 Z&� Fire District Legal Description Site Address (Please include street name, street number and city) 0 91.31 'Ae. Directions to site �. Will timIder be cut and sold in parcel preparation? (Yes/No) Is property located within 200' of saltwater l[�'�Lake River/Creek Pond Wetland Seasonal Runoff Stream Slopes or Bluffs PERMANENT RESIDENCE ❑ SEASONAL RESIDENCEtR TYPE OF JOB -New Add �f Alt Repair Other Use of Building Is this permit submittal the result of a Stop Work Notice,Correction Notice or othe enf rcement actiort?(Yes/No) Describe Work 7 9 !� >�C/ i T No. of Bedrooms No. of Bathrooms SQUARE FOOTAGE- 1st Floor 2nd Floor 3rd Floor Loft Basement Deck Other sq. ft. Garage Attached Detached Carport Attached Detached MANUFACTURED HOME INFORMATION - Make Model Model Year Length Width Serial No. No. of Bedrooms No. of Bathrooms Type of Heat Purchase Price $ Replacement Unit? (Yes/No) Installer Name Certification No. NOTICE:THIS PERMIT BECOMES NULL&VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT COMMENCED WITHIN 180 DAYS OR IF CONSTRUCTION WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER THE WORK IS COMMENCED. PROOF OF CONTINUATION OF WORK IS BY MEANS OF A PROGRESS INSPECTION. THE OWNER OR AGENT ON OWNER'S BEHALF,REPRESENTS THAT THE INFORMATION PROVIDED IS ACCURATE AND GRANTS EMPLOYE,*S OF Mason COUNTY ACCESS TO THE ABOVE DESCRIBED PROPERTY AND STRUCTURES FOR REVIEW AND INSPECTION OF THIS PROJECT. OWNER/BUILDER ACKNOWLEDGES SUBMISSION OF INACCURATE INFORMATION MAY RESULT IN A STOP WORK ORDER OR PERMIT REVOCATION.ACKNOWLEDGEMENT OF SUCH IS BY SIGNATURE BELOW: OWNER AFFIDAVIT- I certify that I am exempt from the require- CONTRACTOR'S AFFIDAVIT - I certify that I am currently regis- ment gf the Contractor Registration Law RCW 18.27 and am aware tered as a contractor in the State of Washington and that I am aware A of the ordinance requirements for which this permit is issued and of the ordinance requirements regulating the work for which this that all work will be done in conformance therewith. No changes permit is issued and all work shall be done in conformance there- shall be made without first obtaining approval. with. No changes shall be mAbe without first obtaining approval. r� X �. Date �. a...4.. �, X Date .- r, � FOR OFFICIAL USE BEYOND THIS POINT RECEIVED Accepted by Planning Pd 'Ck# Date " Bld Pd. Reciept No. ME- d! Building Department Occ Group Type Constr. 1, Planning Department er Environmental Health Department Public Works Department Fire Ma/shal Valuation$ t 177 Building Permit Fee Site Inspection Plan Review Fee EH Review Fee Plumbing&Base Fee Planning Review Fee Mechanical&Base Fee Other Wood/Gas/Pellet Stove Fee State Fee Violation Fee Pre-Paid at Submittal ) w . TOTAL FEES MASON COUNTY PERMIT NO. BUILDING PERMIT APPLICATION 426 W. Cedar• P.O. Box 186, Shelton,WA 98684 Shelton (360)427-9670 • Belfair(360) 275-4467 • Elma (360)482-5269 = On the Web www.co.mason.wa.us APPLICANT INFORMATION CONTRACTOR INFORMATION Owner Contractor Name Mailing Address Mailing Address City State Zip Code City State Zip Code Phone ( ) Other Ph. ( ) Phone ( ) Other Ph. ( ) Lien/Title Holder Contractor Reg. # Exp. Email Address Email Address SEPTIC/WATER SYSTEM INFORMATION -Connect to New Septic Existing Septic Connect to Sewer System Name of Sewer System Well Water System Name of Water System PARCEL INFORMATION - 12 digit Tax Parcel No. 2 / S 0 / 000 Fire District Legal Description Site Address (Please include street name, street number and city) ® / F �,p Directions to site } �1 <.. c'. y `Y - - \ •, \. " } Will timlier be cut and sold in parcel preparation? (Yes/No). - Is property located within 200' of saltwater Lake River/Creek Pond Wetland Seasonal Runoff Stream. Slopes or Bluffs PERMANENT RESIDENCE ❑ SEASONAL RESIDENCE TYPE OF JOB- New Add— Z Alt Repair Other Use of Building Is this permit submittal:the result of a�S,top Work Notice,Correction Notice or other enff,p rcement actioy(Yes/No) 4 7Describe Work FXAW0 ggX ISI/� l/JJ�C� W A4.V ftl/ Sr1i i C T,4AJ" No. of Bedrooms No. of Bathrooms SQUARE FOOTAGE- 1st Floor 2nd Floor 3rd Floor Loft Basement Deck Other sq. ft. ' Garage Attached Detached Carport Attached Detached MANUFACTURED HOME INFORMATION - Make Model Model Year Length Width Serial No. No. of Bedrooms No. of Bathrooms Type of Heat Purchase Price$ Replacement Unit? (Yes/No) i Installer Name Certification No. i NOTICE: THIS PERMIT BECOMES NULL&VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT COMMENCED WITHIN 180 DAYS OR IF CONSTRUCTION WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER THE WORK IS COMMENCED. PROOF OF CONTINUATION OF WORK IS BY MEANS OF A PROGRESS INSPECTION. THE OWNER OR AGENT ON OWNER'S BEHALF,REPRESENTS THAT THE INFORMATION PROVIDED IS ACCURATE AND GRANTS EMPLOYEES OF Mason COUNTY ACCESS TO THE ABOVE DESCRIBED PROPERTY AND STRUCTURES FOR REVIEW AND f INSPECTION OF THIS PROJECT. OWNER/BUILDER ACKNOWLEDGES SUBMISSION OF INACCURATE INFORMATION MAY i RESULT IN A STOP WORK ORDER OR PERMIT REVOCATION.ACKNOWLEDGEMENT OF SUCH IS BY SIGNATURE BELOW: OWNER AFFIDAVIT-I certify that I am exempt from the require- CONTRACTOR'S AFFIDAVIT - I certify that I am currently regis- ment Qf the Contractor Registration Law RCW 18.27 and am aware tered as a contractor in the State of Washington and that I am aware of the ordinance requirements for which this permit is issued and of the ordinance requirements regulating the work for which this that all work will be done in conformance therewith. No changes permit is issued and all work shall be done in conformance there- shall be maqie without first obtaining approval. with. No changes shall be m.16e without first obtaining approval. X Date 4- 03<>4X Date i FOR OFFICIAL USE BEYOND THIS POINT RECEIVED Accepted by Planning Pd Ck# APR 22004 Date Bld Pd. Reciept No. , /y E Building Department Occ Group Type Constr. t Planning Department + r Environmental Health Department l i Public Works Department i f Fire Marshal Valuation$ . . Nl� IN I Building Permit Fee Site Inspection i l } Plan Review Fee EH Review Fee i r Plumbing&Base Fee Planning Review Fee s Mechanical&B se Fee Other i Wood/Gas/Pellet Stove Fee State Fee Violation Fee Pre-Paid at Submittal ; � TOTAL FEES Mason County Dept. of Community Development Mason County Bldg. 3 (360)427-9670 Local 426 W.Cedar (360)275-4467 Belfair P.O. Box 186 (360)482-5269 Elma i Shelton,WA 98584 Notification of Permit Cancellation October 16, 2006 ROBERT TESSIER 1565 WEATERHVANE CT FIRCREST WA 98466 Case No.: BLD2004-00577 Parcel No.: 322245000026 Proiect Description: EXTEND EXISTING RETAINING WALL Dear Applicant: Upon review of our records, the Mason County Permit Assistance Center has identified that your building permit application has been inactive since 03/01/2005. Permits must make some progress every six months. If you intend to keep this permit active, you need to contact me within ten (10) working days from the date of this letter. If we do not hear from you within the that time, your permit will be cancelled and a building inspector will make a site visit. In the event that your project has been completed and a permit was never issued, you will be assessed penalties as allowed under Mason County Title 14 and Mason County Title 15. If your project has been cancelled or if you wish to withdraw the permit, please notify me as soon as possible at (360)427-9670, ext. 616. If you feel that you have recieved this notice in error please contact me. Thank you for your cooperation. Sincerely, Charell Holcomb October 16, 2006 BLD2004-00577 b. The destruction or alteration of FWHCA's or their buffers through clearing, harvesting, shading, intentional burning,vegetation removal (terrestrial, freshwater, or marine), or planting of vegetation that would alter the character of the FWHCA or buffer, unless part of a project which has-been permitted pursuant to this section or for which no permit is required. C. New Construction and Major New Development. 1. New residential construction and major new development is not permitted within FWHCA or its buffer,except for the activities listed in this subsection G,or as approved through a variance or reasonable use exception as provided in subsection K. 2. Appurtenant structures not needing building permits,associated with residential development and located in the FWHCA or,buffer may be permitted.A propasel shalt meet the additional review standards of the Mason CcWnWRQwwakne Master Program, Resource Ordinance,and othat *oq nanees. 3. Saltwater Activities: Accessory uses to existing or new development, such as a saltwater pier,dock,or float; boat ramp,or boat lift will need to meet the additional review standards of the Mason County Shoreline Master Program, Resource Ordinance,and other development ordinances. All activities in tidal/saltwater submerged lands shall avoid impacts to eelgrass and kelp beds to the maximum extent. If eel grass or kelp is known or suspected in the vicinity,then an aquatic vegetation survey is required to identify the location of eelgrass or kelp. Unavoidable impacts to these sensitive marine areas shall be addressed in a Habitat Management Plan that presents an acceptable mitigation program. The design and siting of these projects should not adversely impact water quality of receiving waters such as wetlands,streams, rivers, Hood Canal or Puget Sound. In addition, project design should meet or exceed any storm water design requirements to avoid any risk of decertification of shellfish beds or impacts to baitfish(herring, smelt,sand lance,candlefish ,etc.)spawning areas. d. Stream Re%ation: Stream relocations are discouraged except for the purpose of fisheries restoration and require a Habitat Management Plan. Stream relocation shall only be permitted when adhering to the following minimum performance standards and when consistent with Washington State Department of Fish and Wildlife Hydraulic Project Approval. i. The channel, bank and buffer areas shall be replanted with native vegetation that replicates a natural,undisturbed riparian condition;and, ii. For those shorelands and waters designated as Frequently Flooded Areas pursuant to Section 17.01.090,a professional engineer licensed in the State of Washington shall provide information demonstrating that the equivalent base flood storage volume and function will be maintained. III. Relocated stream channels shall be designed to meet or exceed the functions and values of the stream to be relocated as determined by the monitoring in the Habitat Management Plan. e. Bank Stab//ization:A stream channel and bank, bluff, and shoreline may be stabilized when naturally occurring earth movement threatens existing legal structures(structure is defined for this purpose as those requiring a Building Permit pursuant to the International Building Code), public improvements, unique natural resources, public health, safety or welfare,or the only feasible access to property, and, in the case of streams,when such stabilization results in maintenance of fish habitat,flood control and improved water quality. Bluff, bank and shoreline stabilization shall follow the standards of the Mason County Shoreline Master Program, Landslide Hazard Areas, and any floodplain management plan adopted by the Board of Commissioners. Meson County Resource Ordinance 60 Revised January 10,2005 oN.SU1, MASON COUNTY A o N DEPARTMENT OF COMMUNITY DEVELOPMENT s N Planning Division N T -i P O Box 279,Shelton,WA 98584 Y moo~ (360)427 9670 1864 NOTIFICATION OF INCOMPLETE APPLICATION May 04, 2004 ROBERT TESSIER 1565 WEATERHVANE CT FIRCREST WA 98466 Parcel No.: 322245000026 Project Description: EXTEND EXISTING RETAINING WALL Dear Applicant: You have submitted a permit application (case no. BLD2004-00577)for proposed construction or development in the county. Upon review of your application, I have determined that the contents of the application are incomplete or do not provide enough detail for review. Therefore, review of your application will not proceed until the necessary information is provided (see the comment section of this letter for details.) Once the information is submitted and the application is complete, I will continue to process your application accordingly. If the additional information is not provided to the County within 180 days of this request, the application shall expire and no further action on the proposed development shall take place. Please contact me at (360)427-9670, ext. 577 if you have questions. S" .Ri?Use Lanner Mason County Planni nt 1 5/4/2004 1 of 2 BLD2004-00577 i U7/L'J/LUU3 U/.44 1 JOUo f 4JL/o rMUG Ul P.O.Box M PoWsbo WA.M70 Ready Ph.*"0-874-3iu xi 18 Kitsap Mix Fax#VM?'4-U76 ftx TO. Bob FMM 'Darryl LWSleY Fwx: 263-926-0799 pages: 9 pbsnse 253-820-2133 Dab: .%25W Rs: Shoicrele Subrnkfie CC: ❑UryMt x For Review ❑PNase Commmm !lease Reply ❑please Recycle e Con newb; 7Sk-SW..........$79.50(yd spy, Darryl LWxW y Cell#360-340-1106 426 W- CEDAR ST i 07/L'J7LUU3 U/:44 1Jovof4JL/O f'Hl]t UL r^` P.O.BOX 698•POULSBO,WA 98370 DESIGN MIX NO: 7SK-SHOT DESIGN STRENGTH: 3000 PSI 28 DAYS MATERIAL WEIGHT VOLUME CEMENTITIOUS: 658 LBS 3 .35 CEMENT: 658 LBS FLY ASH: 0 LBS SILICA FUME: 0 LBS COARSE AGG: 1050 LBS 6.23 #467: 0 LBS #67 0 LBS #8 : 1050 LBS FINE AGO: 2000 LBS 11 .96 WATER: 34 GAL 4 .54 AIR: 4 PERCENT 1 .08 AIR ENTRAINMENT: 0.5 OZ/CWT POLYHEED: 0 OZ/CWT POZZOLITH NC534 0 OZ/CWT DELVO: 0 OZ/CWT FC-3000 0 OZ/CWT OTHER 0 OZ/CWT, YIELD. 27. 16 CU FT W/C: 0.43 UNIT WT: 146 . 96 Slump: 2" NOTE: Bmr edon(360)674-3154-ToA Free 1-800-48032%-Fox(360)874327E I National Ready Mixed Concrete Association W Certificate of Conformance cavesm For /ft A-9-0-—a4--W---V Concrete Production Facilities THIS IS TO CERTIFY THAT Plant No. 6, Port Orchard, WA. Kitsap Ready Mix has been inspected by the undersigned registered professional engineer for wnformanw with the requirements of the Chuck List for Ready Mixed Conerate Produdfon Fodlides. As of the inspection date, the facilities met the requirements for production by Central.Mixing with Automatic Batching and Recording o.f Cementitious Materials, Aggregate, Water and Chemical Admixtures o� Siputm of P.E. January 31. 2002 b►speetion Date January 31, 2004 O Certification expiration deft This company will maintain these facilities in compliance with the Check Lisevrequirements and will oorrect promptly any deficiencies which develop. and title of oomparty's principal crroee VC NOTICE: The Check List indicates only that plant facilities are satisfactory for the production of concrete when properly operated. Conformance of the concrete itself with specification requirements must be verified by usual inspection methods in accordance with sales agreements. 01%3.192,2001 National Ready Mixed Concrete Association 900 Spring'Strret 0 Silver Spring 0 MarylanJ UJfc�fc.UU.3 Uf.44 1a000(4Jtf0 ( f"HUt t74 L~t »,<Ci011lellt tin+N.d 7'>'77 Roar Road DeNa,W%ah C*km*ta,V40188 i�EEaELOERGCEMENTGroup P.O.ttox 9so.v4K ass Tal:tiO4 94e.0411 MILL TEST REPORT For.W4.9".2215 cement Type: ASTM Type UN,AASHTO Type I . Low Alkali Portland Cement Plant: Delta, BC certificate,v. 1)2 S 420 Production Period: Jul 012003 Test ASTM AASHTO Jul 312003 Result C110 1N9 speeificadon Spee0ieMiow S102(•/.) AsrMC114 21.2 Mtn.20.0 . A1203(9ii) ASTMC114 4.70 max.6.0 - Fe2O3(•/.) ANUC114 3.75 max.6.0 Coo A$rUC)1J "A Mao (•/6) ASTMC114 0.80 max.6.0 max 6.0 S03 (%) ASYMC114 2.81 Max.3.0 Max,S.0 Na20(%) ASrMC114 0.29 - K20(%) ASTM014 0.26 - - T102(%) ASTMC114 0.27 - - C3S(ye,) ASTMcIJo 66 - C3A(ye,) ASTMCIJO 6.1 Max.d C4AF(%) ASTMCIJO 11.4 - Total Alkalis(ye,) ASTMC114 0.47 Max.0.60 Max.0.60 Lass as Ignition (%) ASTMCII4 1.30 Mar,3 0 max.3.0 lasolspk Residue(%) ASYMC114 0.20 roar.0.75 max.0.73 Free Caleium Oxide (%) ASTMC114 0.33 - - Blalse Flaesess (m2/kg) A TUC204 358 min.280 mils 280 max.400 +325 mesh ASTMCgO 6.6 - - Vkat Scttlae Tiase 191dal ("dautee) ASTMC191 107 min.43 max,VS min.45 mar.373 Final Wastes) A37MCIPI 213 - Air Content(%) ASTM CISJ 8.33 max.12 maz. 12 Autoclave Expansion(ye,) A$MC►s1 -0.03 Max.#80 max.0.to Compressive Strength We I psi 3 Day AsrMC10W100M 24.1 134" min.12.0 min.12.0 7 Day ASTMOW109M 31.314S47 min.19.0 min.19.0 28 Day(previous month) ASWCIoNDW 35.015207 - This will certify that the above described cement meets ASTM Specification C-150 for Type I and Type It Low Alkali Portland Cements and AASHTO Specification M-85 for Type I Low Alkali Portland Cement. Eileen M.1aag August 11,2003 degussa. Construction Chemicals Masbr Builders,Inc. sum too January 30.2003 ISM SW e5"Avwrw Tig"Oregon 97=4 Phone,(503)6244411 Certificate of Conformance Micro-Air Master Builders Air-Entraining Admixture for Concrete TO WHOM IT MAY CONCERN: I,Alice McFarland, Manager,Quality Assurance for Degussa Construction Chemicals and Master Builders,Cleveland, Ohio,certify: That Micro-Air is Master Builders air-entraining admudure for concrete;and That no calcium chloride or chloride based ingredient is used in the manufacture of Micro-Air,and That Micro-Air,based on the chlorides originating horn as the ingredients used in its manufacture, contributes less than 0.0001 percent(1.0 ppm)chloride ions by weight of the cement when used at the rate of 65 ml per 100 kg(1 fluid ounce per 100 pounds)of cement,and That Micro-Air meets the requirements of ASTM C 260-94,Corps of Engineers CRD-C 13-94,and AASHTO M154-89,the Standard Specifications for Air-Entraining Admixtures for Concrete. Alice McFarland 01i" Artki"U. 41k Manager,Quality Assurance Degussa Construction Chemicals P.O.+ YID' Gradation Test Results Material Concrete Fine Aggregate Source Plant 4- 1-115 Sample Data 01/14/03 Steve e % Betsingd, Passive ASTM C-33 318" 0 100 100 #4 0 '100 95-100 #8 5 95 80-100 #16 26 74 50-85 #30 61 39 25-60 #50 78 22 10-30 #100 95 5 2-10 #200 97.5 2.5 F.M. 2.65 8rwwft(3W)6744154•TON Free/4W4aD,72%-Fox(360)674-3276 i • ` P.O.BOX 6%•POULM,WA 99 M Gradation Test Results Material 3/8" Coarse Aggregate Source Plant 4 1-115 Sample Date 02/06/03 ASTM C-33 Screen Size '/. Retained % P„ a ssinG a 1/2" 0 100 100 3/8" 5.9 94.1 85-100 1/4" 58.2 41.8 ••"« #4 S6.1 13.9 10-30 #8 99.2 0.8 0-10 #16 99.4 _ 0.6 0-5 B WWW(NO)874-3154•TON Fm 14M 4W4M•FaK fAO)674.3276 1 "Mateda! Safety Data Sheet U.S. Depedaw N of Labor May to w.d 10 eon►oM whh OccWaftnM"wW Ne*M AdrMnblralfm ' 06W6 Homo Qam>uM OM Standard. own4atw"Y Fame 29 CFR MO.M. Surd mA be oorwrlNd to ttpKwc raqukananU. QVMV Ms Und an UW&W�rl AbN i�rd►riP prrrMlM /anp N Mt tttttt�0a�r es Calcium Saltsram»��N"R $"Von 1 lrt'sa"pleady Mix, Inc. E36p-614 15q N~ Adom POMW.boot CN Men. and Zr on*) TN PWO Nwrtea br WOW~ P.O. Box 853 360-674-3154 Oft PrfJparW Bremerton WA 98337 4/16/96 Sgndwe of Proporor Atvier" SscUon N — Hwrdous htgredlertts/ldsnlily kOomtetbn Oftr Lwow Hurdm i f3pec c Chem1W ;Comwon Nttrr M OSHA Pet ACONI TLV (Mtaemondod N ftown b Freshly mixed, wMaRened concrete Formula - mixtures of Portland or Blended Cements, concrete aggregates &.chemical admixtures. Portland & Blended Cements: 3CaO-SM (CAS #12.168-85-3) 7CaO-SiO2 (CAS 410034-77-2) 3CaO-A1203 (CAS #23042-78-3) 4Ca0-Al203Fe2O3 (CAS #12068-25-8) CaSO4-2H2O (CAS #7778-18-9) plus traces of Ca0,Mg0,K2SO4 & Na2504 Other ingredients: Concretb aggregates, Inert gravel, sand and rocks admixtures may include fly ash, granulated slag and very Small amounts of organic and inorganic materials which may have no effect on the hazards associated with the use of the product. Seelbn 111 — Phyek Mhen" Cherectedstks .90M9 Pont BpfJcie N/A Oravdtr("so- tl 1.9 to 2.4 Vam Pawwo tfta Hg 1 PAINI 0 Pok N A N/A Vow Dame"t" . t► EvepaMron new N/A Nkdo AceWe- t1 N Go Aft tr w WMW Slight in eater (0.1 - 10A) AppMrmee rtd Oda Gray, Plastic, flowable, granular mud - odorless -- SimNan IV — Fks end Expbsjon Howd Date RNh PhV*d UNdI Fbawe�bb trrw>f LEt UEL none none Ew"qu'�IwrO AMaIn N/A 1� so"Fen Fig rwr I Procodwa N/A unu"Fin Mid twoaon Hvto N/A OSHA 174.Sept. toN tMproduc•loeampl . i i --• --• ---- - -----. .-_-- SoC11on V — Haag" dole MGM URN" ConVWu 10 AvWd se s & rdens in 2 - 8 hrs. and ig no 1 er stse4 hazardous. M�ooniONllIIMy WOMOM ro Av0Mnone . HIMAk"vice IFIS on W SypoOW" none f 1yt u W"Ootur QPW0 p%to Avoid �alrn»n�alian VON Not oeeW x SaCINa VI — Heafth Hatrerd Date No�AM�)ofEnvy. Inhow en? Skint M o no e HUM Haar"(Aaa end Chowl Over expos ire to wet PlaStic, unhardened concrete can dry skin & cause alkali burns. Hypersensitive individuals nay develop an allergic dermatitis. (Cement Demititis) Cement may contain traces of hexavalent chromium- NTP1 1AAC Monoptaphal 05HA NaSulaMdl Cae�noOMrtiM:N/A , IwoV4 SIRWAM of topwo Mod"CWWWM paryraay Ex�oswa Skin abrasions-can be aggravated when in contact with unhardened plastic concrete. EmarW-Mtr NO Fool Ad Fne dw" Irrigate eyes with water. Wash affected areas of body with sod & water. S"N" Vn — p"Mutlem for Sale HandNnq and Us* Spill does noC&increasd hazy d Wash rp�MMhod M Material can be retained until it hardens when it can be disposed of as cannon waste.• AoewiMs b ?akan In MM1AIn/and [Jse Barr er creams, gloves, boots and clothing to protect the skin from roi ed contact with plastic concrete. Precautions and good work practices east be observed ra'd' because cement burns occur with little warning - little heat is sensed. SCCllon VIN COMM Mtasuna ne ed"Wr Feel Venweam Low EMMuM N/A Milk GSer N/A b N/A rrouc Should be worn when in prolonged EN��1°" Not aenerallx required. When placin contact with lactic C Iron a EgviWAN ao wiles should be used. Barric,r ereato - - W�ndl xa efy after working with lasticized concrete rs shou d wash o r shaver with snap and water. rNa_ i