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COM2008-00121 Safeway Addition Remodel - COM Permit / Conditions - 9/21/2009
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N . 3 N Q -O O O O (D C: O N 2' d O 0 � O N N O O N �I 7 3 O `< O0 O n 3. dp C 7 (D 7 n N (D � O O 7r O -w N a n N K CONCRETE MECHANICAL MANUFACTURED HOME IliT o Dais By --_ rn 0o Footings 1 Setback Ribbons M Gas Piping D o Intesiox Date By interir�r-Date BY Date _ _ _�Byw__-_ _, _ _< ry Exterrtsr date By Extprinr-Date B Setup C3N Point Load i Isolated Footings INSULATI [Jets f3 y CA BG 1 SLAB INSULATION -4 Date By data B , FIRE DEPARTMENT Foundation Walls Floors Date By Date By Data By DECKS FRAM 114 Walls Date By Date By Bata By PROPANE TANKS PLUMBING vault Cate By Data By �.....�.,- rn OTHER Groundwork Attie Type Date By. Date By Date dy D.W.11 D RYWA:L L O Type: In4 Brace Wall Date By ic Date By ��� Date By FINAL INSPECTION IN) O Water Line Fire Separation - Date By Data By Date f i— By 00 0 Pass or Request Inspect. o Type of Insp. Fail Date Date Done By Comments 1° `,13 cy fX l.�fsE�l//'/jfl�r�/� �9 ��,..,, S.•/� � ©zl .�1A . G •�✓�r ft> J�/ 4 /j 1 C__- j�SUGr3i/�'' ,$-S -•/� �%ors '" � °i ' r v� c� FRr9»-i%vim- •955- 7IP-o j y ��� .- r 1� -'sKraZan & ASSOCIATES , INC . � GEOTECHNICAL ENGINEERING • ENVIRONMENTAL ENGINEERING CONSTRUCTION TESTING & INSPECTION July 15, 2009 KA Project No.: 106-09040 Safeway, Inc. Seattle Div. Construction Attn: Sharon Bredeson 1121 - 124 h Ave NE Bellevue,WA 98005-0990 RE: Safeway Store# 1571 Remodel&Expansion-Belfair Belfair,WA Dear Ms.Bredeson: In accordance with your request and authorization,the following test data are presented on the following reports, which are enclosed: June 16 Welding Report No. 3497 June 23 Field Report No. 118719 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, 10 Penn Seely,Laboratory Manager Peninsula Division PS: sw Enclosures Cc:Architect-Lu Wei Hoe—luwei@mulvannvG2.com General Contractor Joe McLaughlin—ice@woodmanconstruction.com General Contractor Rick Hendrickson—rickh@woodmanconstruction.com Mason County With Offices Serving The Western United States 1230 Finn Hill Road NW, Suite A•Poulsbo,Washington 98370•(360)598-2126•Fax: (360)598-2127 WELDING AZ=Krazari & Associates , Inc . REPORT NO.: 2> 4 9 0 GEOTECHNICAL ENGINEERING• ENVIRONMENTAL ENGINEERING CONSTRUCTION TESTING AND INSPECTION DATE: CONTRACTOR: L✓dDOA/✓ PROJECT#: 101P 'd 90yD PERMIT NO: O�OD0421 PROJECT: AFZFAZ& 5 E -V INSPECTOR: LOCATION: 84 r > JURISDICTION: A?AS" L'D , A14. KRAZAN PROJECT MANAGER: TS WEATHER: AR' 19 TEMP: AO X FIELD ❑ SHOP WELDING ❑ M.T. ❑ P.T. PC V.T. item(s)inspected: 0 P!/DD«' K SEA y M!F4 /Y G 0s5" RDm�F leer BEnmeCN L r/7 s95 PSR 9----Ar'1✓D» -iPG/ V'/T OP- 5'-?•zA09. (mil .�ri�GD/�G ne'Adae� 3'TF_EL D&� �i?AG/n<G R FFE�y t]'o>sTS Position: FLAT VERITCAL HORIZONT OVERHEAD ❑ Filler Metal: Process: MAW FCAW GMAW SAW ❑ Other: ❑ Weld Type: ILLET C.P. P.P. PLUG ❑ Other: Weld Size 3/16" 1/4" 5116; 3/8" ❑ Other: Codes: AWS AISC TITLE 21 TITLE 24 UBC ASME �✓OR.�fN.SP.C�'TED APP�AR�D SAT/SFAC Tn�tY A3 P�.P Al✓S' l�/,�>vy PLAi✓, )SIN 2 2 2009 i z-3—8 To the best of my knowledge,the above S WAS NOT performed in accordance with the approved plans,specifications,and regulatory requirements. SuperintendenVR sentative: Technician: Serving the Western United States This field report indicates our inspector's observation and testin.9 results based on the site condition and contractor's 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.Some information on this report has been provided by others on site. Revision 1 Effective Date:11/15/07 The information provided in 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. KV� FIELD REPORT NO: razatz & Associates, Inc. GEOTECHNICAL ENGINEERING • ENVIRONMENTAL ENGINEERING CONSTRUCTION TESTING AND INSPECTION DATE: 9-Z3--0 f CONTRACTOR:i.J1WnA2d PROJECT#: %OHO-- ©70V4) JURISDICTION: IU60,t/ WaNTy PROJECT: Vgri IyA R SAFlfubl/ PERMIT M PUZ06-11003-Z LOCATION: 15.g7-RXrR INSPECTOR: 1A/f'0 /7,ClSNO KRAZAN PROJECT MANAGER: WEATHER: 5CA. / TEMP: 7L IV QAJ Sxr.- rw.zs pVrw As AdQaw'en ro k,-AJ3PeC7' CoKrZrAl WAZ.L .Su)*PeXY .C,4JSrAe LATtaN. Su u fN.imzLty 41- I-ou rxeVJ ra r06C01.> Q Sac ffN L/AZ!_ !e 864 5 r X A)n L/95r PjRr.AAL. f014 .4xio /3ofr&4 su POArs .CA/SrAuxl) Ar FouR /taor OW ctsWrZIA - Cg2A)AkarrD,y ra C MM 4IAz-t- Xs FOLLOutS : ZtA-D rt+oT''Cu C1-1,WA1Lf(. A V0 SrKur ''d3T1tA1ffp i✓.rrP :sl expx'-r f3ot; LC N*u �I. )rU0 BOLTS Pmt srRu7" ALL Hac.ds n2,Lcr✓L�n W rl-.4 y-14T3 13lrrrpAJ�cuolsn�� id A DtPfN 04C �rui sAJCNd' ,gZaMT,9 AN,O /3tdtJA� I=Rt�C� a� Dust � W/o ox Ht) 5;r Bot.r3 r15 rCAlm t3� x&&In r atx,-L Au r, xA/sr.4z.t an Pea R )r.T Aln hld cTP �lieru�74�1s. ,rQJL ttL' Cau f-ox„� rz�o i/ kX66"A rp iZ !=I ArrecI-)eO. EquipmenVAsset Number(s): - To the best of my knowledge,the abov AS/WAS NOT performed in accordance with the approved plans,specifications,and regulatory requirements. Superinte den epr ntative: Technician: This report indicates Inspector's observation and testing results based on the site condition and contractor' ivities.This information is subject to review prior to final submittal.By signing this report,our inspector does not d5cept responsibility for validity of the results.Some information on this report may have been provided by others on site. 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&Assoc. Offices Serving the Western United States Bothell (425) 485-5519 Gresham (503)665-3574 Poulsbo (360)598-2126 Puyallup (253)939-2500 DAILY FIELD REPORT 2009.doc EFFECTIVE:4/22/2009 CLIATAitj VJALL-- P/AMINCI A'UrGiLW U15f $RAGING RE(,?t� �t�rr :rtix: Gleep�v�',P- Titpr4 2Fr From -riztAss P�ojec��F.r.FAI �WAyI Project No: jDate: {- Ma •.�� z'x� f ��.- -�� r�y ;,, - '--�-. ;.- -t. �. _ � � " �lac N ;: �; �Zx�- Fir,° +a9•A-u3�- !�- 4i o } 8 IiGkirl�° _ �Sl2'T-33As BOG - . 3 [me-R=e ' P` AV is r tf� • i � tPr6� pl 7 ROM f•L+�R uyJp _ -..f,`-.4'.i`o'7�v —5='� ?TfOry 7-1r r_A K. �R.A�h.0 i. T• O ANC ! Vft ptc H» � FsN w '"�`w9s.svros - m-- aZarz & ASSOCIATES , INC . GEOTECHNICAL ENGINEERING • ENVIRONMENTAL ENGINEERING CONSTRUCTION TESTING & INSPECTION June 26,2009 KA Project No.: 106-09091 RWJJ Inc MAIL TO CLIENT ATTN:John Byerly P.O.Box 2582 Belfair,WA 98528 RE: Belfair Landing Lot D Phase II Belfair WA Dear Mr.Byerly: In accordance with your request and authorization,the following test data are presented on the following reports, which are enclosed: June 22 Field Report No.097349 Compaction Report No.21031 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:jz Enclosures cc: Mason County Bldg Dept. J Bar D-Jesse With Offices Serving The Western United States 1230 Finn Hill Rd NW Ste. A 9 Poulsbo,Washington 98370•(360)598-2126•Fax: (360)598-2127 FIELD REPORT NO: 097349 =� MZM & Associates , Inc . GEOTECHNICAL ENGINEERING • ENVIRONMENTAL ENGINEERING CONSTRUCTION TESTING AND INSPECTION DATE: 'a o24© / CONTRACTOR: S- 13,};Z D PROJECT#:___le eo- 0909/ JURISDICTION: 141 A5 sya Co. PROJECT: t3646-4/9 14n4o/,v6 - L197 PERMIT#: LOCATION: tla Y 3'Ot9E44C141 k2 (.Ja_ INSPECTOR: &JVA/ STEEL y✓ KRAZAN PROJECT MANAGER: SU"� WEATHER: P,*erzY C W"p�-1 TEMP: 60 S ON rS/7F_ -a AER1ee' 1? r Tav-PZV9-c1'C-- 2)KM5-117-V 7F_ 67i11v6 oN --ZAW",Cr 017,7u^t ter- aFcF�t/1e GynrD/n/G - 4a7-.4De 7f+�4 ®,tTr'"G A i3ncD w.t/ $sWO btyn4 T�3r�-/t Z A7, I�NAT��2 i�4L /s 9 T, D.e NF�2 DP7i µ�yL nts99. /vl,4T�.e/Ae /Us s,,0X44/D ,BY Doz/_jZ. AVQ Q� sT6 et- D2&-� yrr3/z qTa'e si Ro LL/�/Z. T��s •��rre.��c /s 71> A fi-?,24 �'.FN7'2+4��R /�s IUD/�/6 i4 �oDo,O .TIJB Dim L�AviN� CakcQ�c�.�.i� 10RAOLE P,oN70cGeFy 7-o P1A1-_G7—,4,v P *.*7,:X 111 A0 R _�B_-7G��'YtiN7�LcN7/G ��i9�NA-6f cSL(JfiGw /5 CD7/I�PG+'_.T.�17. TEST-f -/L/'LS �i�'/Ii ,evLt,�D A7T 4*1y;oeo2 !A/ �4.oP.eexi�-r,�Tl , T�n/N% OFTu�•c B�uGoiyGs. -G 71.=sus 6x cf.��., Equipment/Asset Number(s): oFi2 To the best of my knowledge,the abolo/WAS NOT performed in accordance with the approved plans,specifications,and regulatory requirements. Superintendent/Representative: Technician: Serving the Western United States This field report indicates our inspector's observation and testing results based on the site condition and contractor's activities.This information is subject to review prior to final submittl By signing this report,our inspector does not accept responsibility for validity of results.Some information on this report has been provided by others on site. Revision 2 1502 Field Report.doc Effective Date:11/15/07 COMPACTION 4Un1aza1 & Associates , Inc . REPORT NO.: 2.1031 GEOTECHNICAL ENGINEERING• ENVIRONMENTAL ENGINEERING CONSTRUCTION TESTING AND INSPECTION DATE: ��Xt_ 9 CONTRACTOR: ' PROJECT#: I 9p 9l PERMIT NO: PROJECT: zL'GF�/R L/4Nt7/�!(r - LoT INSPECTOR: FACAN LOCATION: f1�l� .3 ���"a/�i LL/O- JURISDICTION: 04iQT0YL_ eO KRAZAN PROJECT MANAGER: ��L� WEATHER: e-rL r eLb`r� TEMP: O S ❑ WASHINGTON DENSOMETER ❑ SANDCONE )�l NUCLEAR TEST ;K OTHER AR ::P?73Yl LOCATION MAP N ❑ Paved Areas (circle one): Sub/Agg /Asphalt A Building Pad (s) L42— ❑ Other ElTrenches (circleone): Sewer/Water/Storm Drain/Utly � �� Curve Unified Soils Classification Den ty Mo lure Rv *ma W17'/1S/lT ,QyvSL 9 7.0 -0'7. d zi&L "er— .T AR J> I-r Test Elevation Location(Comments) Curve Mode& Density Moist Percent Required Depth % Compaction X—38 7'5'Ts ?,+&A61! AT 165-9 9 /A" /d 7.9 ?. 3 /o 0 9 S �. 1eA v,)oM ovER a•Y d, 3 97 7.s- 9 /37.2 7. 1 boo S, l ?4,4 7. 7 100 4- 9 9 Map Location: Curve Test Method:D_/s3-7 This testing does not preclude the possibility that the soil or hot-mix asphalt may be loosened by future construction activities or rainfall events.The compaction tests were performed at the approximate ❑Attached Daily Avg.Std Q 8 locations and elevations shown and indicate relative compaction at those locations. Horizontal and Count Densities vertical limits of the compacted area were determined by others.Our firm does not guarantee earthwork Daily Avg.Std Count moisture or paving construction, nor does our work relieve the contractor's responsibility to conform to the Gauge# all 3 Y 9 approved project plans and specifications. To the best of my knowledge,the abov WAS WAS NOT performed in accordance with the approved plans,specifications,and regulatory requirements. Superintendent/Representative: Technician: Serving the Western United States 1501 Compaction Report.doc Revision 1 Effective Date:11/3/06 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 Knmen&Associates. 1 (7/10/2009)Terry Ryan - 10609040 20090626.pdf Page 6 Krazan&Associates, Inc. 1230 Finn Hill Rd NW Suite A, Poulsbo,WA 98370(360)-598-2126 Project No. 106-09040 Cyl.Code P16700 Pour Date 6-15-2009 Report No. 33995 Weather OVERCAST Jurisdiction MASON CO Permit No. 08 000121 Project SAFEWAY Engineer Location BELFAIR Architect client WOODMAN contractor WOODMAN Field Data site Mix X Reported Batch Data supplier DESIGN MIX PRO Plant No. Cement Type 1-11 Concrete Mortar Grout X Flex Beams Design Actual X Prisms Grouted Ungrouted Other Mix No. MIX PRO Conc. Air Cem.lbs. 2560 Temp.Temp. Unit F.Ash lbs. - Time Truck# Ticket# %Air Slump (F) (F) Wt. 0815 - - - FLUID 65 60 - C.agg.lbs. - C.agg.lbs.2 - C.agg.lbs.3 - Sand lbs. - Water 32gal Placement Area Admixture - Footings Wails Columns Grade Beams Other - SlablDeck Slab Pilings Other - Air Ent.(oz/cwt.) Grids CMU WALL G/7.0-7.5; R/S CONFORMSTO PLANS Water Added on Job(gals.) 32 SA &S2.4, COURSE 29-33 Field Test Methods Remarks PLACED BY BUCKET AND CONSOL& [ASTMC1064 STM C143 S ASTM C1 RECONSOLIDATEDBY MECH VIBRATION. NSTM C31S. ASTM C173 ❑ ® Other SAMPLED@ G/7.5 Inspector JIM SHULTS Reviewed By Acv Laboratory Data Design Strength 2000 Date Specimens Rec'd. 6-16-2009 Cyl. Test Dia Length Max. Comp. Tested Break Lab Test Method Code Date Age Dim. Area Load Str.(psi) Set# By Type ASTM C39 P16700-06/22/09 7 3X6 11.14 61315 5,500 AT 2 ASTM C109 ❑ P16700- 07/13/09 28 3X6 ASTM C617 ASTM C1231 ❑ P16700-07/13109 28 3X6 ASTM C1019 ❑ P16700- 07/13/09 28 3X6 Other 0 P16700- Compressive X P16700- Flexural P16700- P16700- Test Results Remarks FR#118722 Conforming Non-Conforming Results Reviewed By Ae- Date Reviewed a-zz-G7 Codes for Break Types: 1.Cone 2.Cone&Split 3.Cone&Shear R 4.Shear 5.Columnar(Split) (7/10/2009) Terry Ryan - 10609040 20090626.pdf _-- - — - Page 6 Krazan &Associates,Inc. 1230 Finn Hill Rd NW Suite A, Poulsbo, WA 98370(360)-598-2126 Project No. 106-09040 Cyl.code P16700 Pour Date 6-15-2009 Report No. 33995 weather OVERCAST Jurisdiction MASON CO Permit No. 08 000121 Project SAFEWAY Engineer Location BELFAIR Architect client WOODMAN contractor WOODMAN Field Data site Mix X Reported Batch Data supplier DESIGN MIX PRO Plant No. Cement Type 1-II Concrete Mortar Grout X Flex Beams Design Actual X Prisms Grouted Ungrouted Other Mix No. MIX PRO Conc. Air Cem.lbs. 2560 Temp. Temp. Unit F.Ash lbs. - Time Truck# Ticket# %Air Slump (F) (F) wt. 0815 - - - FLUID 65 60 - C.agg.lbs. - C.agg.lbs.2 - C.agg.lbs.3 - Sand lbs. - Water 32gal Placement Area Admixture - Footings Walls Columns Grade Beams Other Slab/Deck Slab Pilings Other Air Ent(ozlcwt.) Grids CMU WALL G/7.0-7.5; R/S CONFORMSTO PLANS S.1 &S2.4, COURSE 29-33 Water Added on Job(gals.) 32 Field Test Methods Remarks PLACED BY BUCKET AND CONSOL& ASTM C106 ®. ASTM C1 ❑. RECONSOLIDATEDBY MECH VIBRATION. ASTM C N. ASTM C173 ❑. SAMPLED@ G/7.5 ASTM C31 ®. Other E= inspector JIM SHULTS Reviewed By Acv Laboratory Data Design Strength 2000 Date Specimens Rec'd. 6-16-2009 Cyl. Test Dia Length Max. Comp. Tested Break Lab Test Method Code Date Age Dim. Area Load Sir.(psi) Set# By Type ASTM C39 P16700- 06/22/09 7 3X6 11.14 61315 5,500 AT 2 ASTM C109 ❑ P16700-07/13/09 28 3X6 ASTM C617 ASTM C1231 ❑ P16700- 07/13/09 28 3X6 ASTM C1019 ❑ P16700-07/13/09 28 3X6 Other I P16700- Compressive X P16700- Flexural P16700- P16700- Test Results Remarks FR#118722 Conforming Non-Conforming Results Reviewed By Ae Date Reviewed a-Zz---1 Codes for Break Types: 1.Cone ® 2.Cone&Split 3.Cone&Shear 11 4.Shear 5.Columnar(Split) (7/10/2009)Terry Ryan----10609040 20090626.pdf Page 6 Krazan&Associates,Inc. 1230 Finn Hill Rd NW Suite A, Poulsbo,WA 98370(360)-598-2126 Project No. 106-09040 Cyl.Code P16700 Pour Date 6-15-2009 Report No. 33995 Weather OVERCAST Jurisdiction MASON CO Permit No. 08 000121 Project SAFEWAY Engineer Location BELFAIR Architect Client WOODMAN contractor WOODMAN Field Data site Mix X Reported Batch Data Supplier DESIGN MIX PRO Plant No. Cement Type 1-11 Concrete Mortar Grout X Flex Beams Design Actual X Prisms Grouted Ungrouted Other Mix No. MIX PRO Conc. Air Cem.lbs. 2560 Temp. Temp. Unit F.Ash lbs. - Time Truck# Ticket# %Air Slump (F) (F) Wt. 0815 - - - FLUID 65 60 - C.agg.lbs. - C.agg.lbs.2 - C.agg.lbs.3 - Sand lbs. - Water 32gal Placement Area Admixture - Footings Walls Columns Grade Beams Other - Slab/Deck Slab Pilings Other - Air Ent(ozlewt.) Grids CMU WALL G/7.0-7.5; R/S CONFORMSTO PLANS SA &S2.4, COURSE 29-33 Water Added on Job(gals.) 32 Field Test Methods Remarks PLACED BY BUCKET AND CONSOL& ASTM C143 ®. ASTM C1 ❑. ASTM C1064 ®. ASTM C17373 ❑. RECONSOLIDATEDBY MECH VIBRATION. ASTM C31 ® Other SAMPLED@ G/7.5 Inspector JIM SHULTS Reviewed By Acv Laboratory Data Design Strength 2000 Date Specimens Rec'd. 6-16-2009 Cyl. Test Dia Length Max. Comp. Tested Break Lab Test Method Code Date Age Dim. Area Load Str.(psi) Set# By Type ASTM C39 P16700- 06/22/09 7 3X6 11.14 61315 5,500 AT 2 ASTM C109 ❑ 19 P16700 07/13/09 28 3X6 ASTM C617 ASTM C1231 ❑ P16700- 07/13/09 28 3X6 ASTM C1019 11 P16700-07/13/09 28 3X6 Other 0 P16700- Compressive X P16700- Flexural P16700- P16700- Test Results Remarks FR#118722 Conforming Non-Conforming Results Reviewed By Az Date Reviewed &-zz--'l Codes for Break Types: 1.Cone 2.Cone&Split 3.Cone&Shear 4.Shear 5.Columnar(Split) FIELD REPORT NO: �. QKraZan & Associates , Inc . GEOTECHNICAL ENGINEERING • ENVIRONMENTAL ENGINEERING CONSTRUCTION TESTING AND INSPECTION DATE: 6-7,3--O f CONTRACTOR: ,,AIWZ IAA) PROJECT#: %Ora- 67014) JURISDICTION: /`60/J 00UN[Z PROJECT: 1362 Dig 5,f86&1 1Z PERMIT#: PA12ZW6-Q0M5'Z LOCATION: .L INSPECTOR: 1A110 P469ESSM KRAZAN PROJECT MANAGER: J WEATHER:_5u.P .Al- TEMP: ?Z OAS 'Sxed' ry,45 ,D.4r'& re--) Xn13PeC7' CuKrfAl r,✓.4L4. .�u>oPo,ey s�1sr�4GcdlT�iay. Svdk ors r,UsrALL,Sb ,4.r GOcxrrot1fTa rotw,t. s 5oLorg LaLl_ t &_'45r XNn uesf R9ma-4L. ro)O .4No 8errdr� suPPofrs rA)SrRtect) Ar- fourG l�a�s o�v crs�Jt4-& ('��IAk rrC�V 1a C Mu L,ZA4.L AS 66&0tAS M ZJd fo�tr� CNAiW61C AVo STYtrAr "3.r4'A/4(29 t✓.erN : 'S' �'xPi1r15X1S�t! 130tl ((83LM) TUO /.30Lf5 pclR sregr ALL hlbLeS o1ZreiG'y w.crN N.,cr? l��r�tf�cuo�sn�� r 6 A AtvPrH 04C AQUI, S,)CI-IdA A3LUM61,D AAAO 13441d J I-RcZ OF Dust R4,viQ or. HaL52"U,e6 X t( BoLx5 rosrcwm ray x&&,c•r 47tX L L AA)P "5r 4zQ.,o Prsx R �r AN,c� tJ�cr� D�R�sttYc;�1s. Fon_ M61LL tA)r-oxMArl'o.✓ etlreaA. ,lrrz-el�Co0 Equipment/Asset Number(s): Co the best of my knowledge,the abov AS/WAS NOT performed in accordance with the approved plans,specifications,and regulatory requirements. Superinte den epr ntative: Technician: "his report indicates nspectors observation and testing results based on the site condition and contractor' rvities.This information is subject to review prior to final submittal.By signing this report,our ispector does not cept responsibility for validity of the results.Some information on this report may have been provided by others on site. The information provided on this report is prepared for the exclusive use of he client.This report may not be reproduced in any format without the written permission of the client and Krazan&Assoc. Offices Serving the Western United States Bothell (425) 485-5519 Gresham (503)665-3574 Poulsbo (360) 598-2126 Puyallup (253) 939-2500 DAILY FIELD REPORT 2009.doc EFFECTIVE:4/22/2009 t 46���J<raZaZ & ASSOCIATES , INC . GEOTECHNICAL ENGINEERING • ENVIRONMENTAL ENGINEERING CONSTRUCTION TESTING & INSPECTION June 23,2009 KA Project No.: 106-09040 Safeway, Inc. Seattle Div. Construction Attn: Sharon Bredeson 1121 — 124`h Ave NE Bellevue,WA 98005-0990 RE: Safeway Store# 1571 Remodel&Expansion-Belfair Belfair,WA Dear Ms.Bredeson: In accordance with your request and authorization,the following test data are presented on the following reports, which are enclosed: June 10 Concrete Report No.46825—7 Day June 11 Field Report No. It 3691 Field Report No. 113965 Field Report No. 113767 Concrete Report No.33860—7 Day June 12 Field Report No. 116883 Field Report No. 116851 Concrete Report No.46841 —3 Day 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, wT�f Penn Seely,Laboratory Manager Peninsula Division PS: sw Enclosures Cc:Architect-Lu Wei Hoe—luwei@mulvannYG2.com General Contractor Joe McLaughlin—joe@woodmanconstruction.com General Contractor Rick Hendrickson—rickh@woodmanconstruction.com Mason County With Offices Serving The Western United States 1230 Finn Hill Road NW,Suite A•Poulsbo,Washington 98370 9(360)598-2126•Fax: (360)598-2127 Krazan &Astociates, Inc. 1230 Finn Hill Rd NW Suite A, Poulsbo, WA 98370 (360)-598-2126 Project No. 106-09040 Cyl.Code P16657 Pour Date 6-10-2009 Report No. 46825 weather OVERCAST Jurisdiction MASON CO Permit No. 2008-00121 Project SAFEWAY BELFAIR Engineer Location BELFAI R Architect client WOODMAN Contractor WOODMAN Field Data Site Mix Reported Batch Data Supplier KRM Plant No. 4 Cement Type 1-11 Concrete X Mortar Grout Flex Beams Design Actual X Prisms Grouted Ungrouted Other Mix No. M4060B Conc. Air Cem.lbs. C250 560 Temp. Temp. Unit F.Ash lbs. - Time Truck# Ticket# %Air Slump (F) (F) Wt. 0745 69 46491 - 6 74 61 - C.agg.lbs. C220 948 C.agg.lbs.2 C210 948 C.agg.lbs.3 - Sand lbs. C200 1373 Water B282 31gal Placement Area Admixture A340 26.1 oz Footings Walls Columns Grade Beams Other - Slab/Deck X Slab Pilings Other _ Air Ent(oz/cwt.) Grids INTERIOR SLAB 7-8/A-E.5 SAMPLED @7.5/A.5 Water Added on Job(gals.) 1$ Field Test Methods Remarks PLACED BY LINE PUMP, 15 OF 82 yds PLACED ASTM C1 H. ASTM C1 ❑. ASTM C1064 N. ASTM C173 ❑. W/C .46 ASTM C31 ®. Other Inspector LOWELL DAVIS Reviewed By K" Laboratory Data Design Strength 4000 Date Specimens Rec'd. 6-11-2009 Cyl. Test Dia Length Max. Comp. Tested Break Lab Test Method Code Date Age Dim. Area Load Str.(psi) Set# By Type ASTM C39 P16657- 06/17/09 7 4X8 12.56 58385 4,650 ZL 1 ASTM C109 ❑ ❑ P16657- 07/08/09 28 4X8 ASTM C617ASTM C1231 P16657- 07/08/09 28 4X8 ASTM C1019 0 P16657- 07/08/09 28 4X8 Other P16657- Compressive X P16657- Flexural P16657- Test Results P16657- Conforming Remarks FR#116878 Non-Conforming Results Reviewed By W Date Reviewed L•/7-vA Codes for Break Types: 1.Cone 2.Cone&Split 3.Cone&Shear 4. Shear 5.Columnar(Split) W.A.L. aZaZ & ASSOCIATES , INC . GEOTECHNICAL ENGINEERING • ENVIRONMENTAL ENGINEERING CONSTRUCTION TESTING & INSPECTION June 23, 2009 KA Project No.: 106-09040 Safeway, Inc. Seattle Div. Construction Attn: Sharon Bredeson 1121 - 124'Ave NE Bellevue,WA 98005-0990 RE: Safeway Store# 1571 Remodel&Expansion-Belfair Belfair,WA Dear Ms.Bredeson: In accordance with your request and authorization,the following test data are presented on the following reports, which are enclosed: June 2 Field Report No.9040DFR060209-gn June 11 Concrete Report No. 33859—7 Day June 12 Concrete Report No.46826—7 Day Concrete Report No. 35203—7 Day June 15 Concrete Report No.33995—7 Day 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, ovC� Penn Seely,Laboratory Manager Peninsula Division PS: sw Enclosures Cc:Architect-Lu Wei Hoe—luwei@mulvannyG2.com General Contractor Joe McLaughlin—joe@woodmanconstruction.com General Contractor Rick Hendrickson—rickh@woodmanconstruction.com Mason County With Offices Serving The Western United States 1230 Finn Hill Road NW, Suite A 9 Poulsbo,Washington 98370•(360)598-2126 9 Fax: (360)598-2127 tgKrazal�lIELD 11��11 H�A S S O C I ATE E S,INC.I N c REPORT NO.: 9040DFR060209-gn GEOTECHNICAL ENGINEERING•ENVIRONMENTAL ENGINEERING CONSTRUCTION TESTING AND INSPECTION DATE: 6-2-09 CONTRACTOR: Woodman PROJECT#: 106-09040 PERMIT NO: COM 2008-00121 PROJECT: Safeway Belfair INSPECTOR George Naill LOCATION: 23961 State Hwy 3 JURISDICTION: Mason County KRAZAN PROJECT MANAGER: J.B. WEATHER: Partly Cloudy TEMP:57 F Structural Steel Arrived on site as requested by the contractor to perform structural welding inspection, in conformance to project Plans and specs. 1)Met with the contractor to verify inspection and review plans and specs. 2)Performed visual inspection of roof deck welding grid C-F/7-8 found puddle welding and top seam welding To be complete per plans and RFI 17 at this time.Welding performed is found to be in conformance to Project plans and AWS D1.3-04. Equipment/Asset Number(s): To the best of my knowledge,the above WAS®/WAS NOT❑performed in accordance with the approved plans,specifications,and regulatory requirements. Superintendent/Representative: Technician Offices Serving the Western United States Form 1501 r.2 Effective Date:12-20-07 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. Krazan &Associates, Inc. 1230 Finn Hill Rd NW Suite A, Poulsbo, WA 98370 (360)-598-2126 Project No. 106-09040 Cyl.Code P16655 Pour Date 6-11-2009 Report No. 33859 - weather CLEAR Jurisdiction MASON CO Permit No. 08-000121 Project SAFEWAY Engineer Location BELFAIR Architect Client WOODMAN Contractor WOODMAN Field Data Site Mix X Reported Batch Data supplier MUTUAL MATERIALS Plant No. Cement Type 1-II Concrete Mortar Grout X Flex Beams Design Actual X Prisms Grouted Ungrouted Other Mix No. 80# BAGMIX Conc. Air Cem.lbs. - - Temp. Temp. Unit F.Ash lbs. - - Time Truck# Ticket# %Air Slump (F) (F) Wt. 0920 - - - FLUID 74 58 - C.agg.lbs. - - C.agg.lbs.2 - - C.agg.lbs.3 - - Sand lbs. - - Water - - Placement Area Admixture - - Footings walls X Columns Grade Beams Other - - Slab/Deck Slab Pilings Other Air Ent.(oz/cwt.) - - Grids CMU WALL G/7-7.4; FIRST 4' LIFT Water Added on Job(gals.) - Field Test Methods Remarks PLACED BY BUCKET SITE MIX ASTM C143 ®, ASTM C138 ❑. ASTM C1064 S. ASTM C173 ❑. ASTM C31 ® Other Inspector BILL UGOLINI Reviewed By Ac- Laboratory Data Design Strength 2000 Date Specimens Rec'd. 6-12-2009 Cyl. Test Dia Length Max. Comp. Tested Break Lab Test Method Code Date Age Dim. Area Load Str.(psi) Set# By Type ASTM C39 P16655- 06/18/09 7 3X6 11.19 26785 2,390 AT 2 ASTM C109 ❑ P16655- 07/09/09 28 3X6 ASTM C617 ASTM C1231 ❑ P16655- 07/09/09 28 3X6 ASTM C1019 ❑ P16655- 07/09/09 28 3X6 Other P16655- Compressive X P16655- Flexural P16655- P16655- Test Results Conforming Remarks FR# 113695 Non-Conforming Results Reviewed By A-- Date Reviewed e- -L z-c-QT Codes for Break Types: 1.Cone 2. Cone&Split 3.Cone&Shear 4.Shear 5.Columnar(Split) Krazan`&Associates, Inc. 1230 Finn Hill Rd NW Suite A, Poulsbo, WA 98370 (360)-598-2126 Project No. 106-09040 Cyi.Code P16692 Pour Date 6-12-2009 Report No. 46826 weather OVERCAST Jurisdiction MASON CO Permit No. 08-000121 Project SAFEWAY Engineer Location BELFAIR Architect Client WOODMAN Contractor WOODMAN Field Data Site Mix X Reported Batch Data supplier DESIGN MIX PRO Plant No. Cement Type 1-11 Concrete Mortar Grout X Flex Beams Design Actual X Prisms Grouted Ungrouted Other Mix No. - Conc. Air Cem.lbs. 320 Temp. Temp. Unit F.Ash lbs. - Time Truck# Ticket# %Air Slump (F) (F) Wt. 1100 - - - FLUID 76 66 - C.agg.lbs. - C.agg.lbs.2 - C.agg.lbs.3 - Sand lbs. Water 6gal Placement Area Admixture - Footings Walls X Columns Grade Beams Other - Slab/Deck Slab Pilings Other Air Ent.(ozlcwt.) - Grids CMU WALL, 7-8 / G; R/S CONFORMS TO PLANS Water Added on Job(gals.) 6 S1.2 DETAIL7 S2.4 DETAIL 25 COURSE 21 -26 RFI #9, 4-14-09 Field Test Methods Remarks SITE MIX 5-6 GALONS OF WATER PER 320# MIX. ASTM C143 M. ASTM C138 ❑. BY MECHANICAL MIXER TO WORKABLE STATE ASTM C H. ASTM C173 ❑. ASTM C31 ®. Other inspector LOWELL DAVIS Reviewed By Ae— Laboratory Data Design Strength 2000 Date Specimens Rec'd. 6-13-2009 Cyl. Test Dia Length Max. Come Tested Break Lab Test Method Code Date Age Dim. Area Load Str.(psi) Set# By Type ASTM C39 P16692- 06/19/09 7 3X6 11.06 28655 2,590 AT 5 ASTM C109 ❑ P16692- 03/28/10 28 3X6 ASTM C617 ASTM C1231 ❑ P16692- 07/10/09 28 3X6 ASTM C1019 11 P16692- 07/10/09 28 3X6 Other P16692- Compressive X P 16692- Flexural P16692- P16692- Test Results Remarks FR 116883 Conforming Non-Conforming _ Results Reviewed By XQ- Date Reviewed G-a Z-GP1 Codes for Break Types: 1.Cone 2.Cone&Split 3.Cone&Shear 4.ShearF1 5.Columnar(Split) 0 Krazan'&Associates, Inc. 1230 Finn Hill Rd NW Suite A, Poulsbo, WA 98370 (360)-598-2126 Project No. 106-09040 Cyl.Code P16693 Pour Date 6-12-2009 Report No. 35203 weather PT CLOUDY Jurisdiction MASON CO Permit No. 08-000121 Project SAFEWAY Engineer Location BELFAIR Architect client WOODMAN Contractor WOODMAN Field Data site Mix X Reported Batch Data Supplier DESIGN MIX PRO Plant No. Cement Type 1-11 Concrete Mortar Grout X Flex Beams Design Actual X Prisms Grouted Ungrouted Other Mix No. DESIGN MIX PRO Conc. Air Cem.lbs. 320 Temp. Temp. Unit F.Ash lbs. - Time Truck# Ticket# %Air Slump (F) (F) Wt. 0650 - - - FLUID 72 66 - C.agg.lbs. - C.agg.lbs.2 - C.agg.lbs.3 - Sand lbs. - Water 5gal Placement Area Admixture - Footings Walls X Columns Grade Beams Other - Slab/Deck Slab Pilings Other Air Ent(ozlcwt.) I Grids CMU WALL COURSE 15-20 , R/S PER PLANS S1, S2 4 Water Added on Job(gals.) - Field Test Methods Remarks SITE MIX 320# TO 5gal WATER 3-5 MINUTE MIXING. ASTM C143 ®. ASTM C138 ❑. PLACED VIA BUCKET AND CONSOL. 2X ASTM C1064 N. ASTM C173 ❑. ASTM C31 ® Other Inspector AARON CLYDE Reviewed By , Laboratory Data Design Strength 2000 Date Specimens Rec'd. 6-13-2009 Cyl. Test Dia Length Max. Comp. Tested Break Lab Test Method Code Date Age Dim. Area Load Str.(psi) Set# By Type ASTM C39 P16693- 06/19/09 7 3X6 11.06 49785 4,500 AT 2 ASTM C109 O P16693- 07/10/09 28 3X6 ASTM C617 ASTM C1231 ❑ P16693- 07/10/09 28 3X6 ASTM C1019 0 P16693- 07/10/09 28 3X6 Other P16693- Compressive X P16693- Flexural P16693- P16693- Test Results Conforming Remarks Non-Conforming Results Reviewed By h— Date Reviewed G,_zz-c)7 Codes for Break Types: 1.ConeF1 2.Cone&Split 3.Cone&Shear11 4.Shear 0 5.Columnar(Split) Krazan'&Associates, Inc. 1230 Finn Hill Rd NW Suite A, Poulsbo, WA 98370 (360)-598-2126 Project No. 106-09040 Cyl.Code P16700 Pour Date 6-15-2009 Report No. 33995 - Weather OVERCAST Jurisdiction MASON CO Permit No. 08 000121 Project SAFEWAY Engineer Location BELFAIR Architect client WOODMAN contractor WOODMAN Field Data site Mix X Reported Batch Data supplier DESIGN MIX PRO Plant No. Cement Type 1-11 Concrete Mortar Grout X Flex Beams Design Actual X Prisms Grouted Ungrouted Other Mix No. MIX PRO Conc. Air Cem.lbs. 2560 Temp. Temp. Unit F.Ash lbs. - Time Truck# Ticket# %Air Slump (F) (F) Wt. 0815 - - - FLUID 65 60 - C.agg.lbs. - C.agg.lbs.2 - C.agg.lbs.3 - Sand lbs. - Water 32gal Placement Area _ Admixture Footings Walls Columns Grade Beams Other - Slab/Deck Slab Pilings Other Air Ent.(oz/cwt.) - Grids CMU WALL G/7.0 - 7.5; R/S CONFORMSTO PLANS S.1 & S2.4, COURSE 29-33 Water Added on Job(gals.) 32 Field Test Methods Remarks PLACED BY BUCKET AND CONSOL& ASTM C143 I@. ASTM C138 ❑. RECONSOLIDATEDBY MECH VIBRATION. ASTM C ® ASTM C173 ❑. ASTM C31 ® Other SAMPLED@ G/7.5 Inspector JIM SHULTS Reviewed By ki Laboratory Data Design Strength 2000 Date Specimens Rec'd. 6-16-2009 Cyl. Test Dia Length Max. Comp. Tested Break Lab Test Method Code Date Age Dim. Area Load Str.(psi) Set# By Type ASTM C39 P16700- 06/22/09 7 3X6 11.14 61315 5,500 AT 2 ASTM C109 ❑ P16700- 07/13/09 28 3X6 ASTM C617 19 ASTM C1231 ❑ P16700- 07/13/09 28 3X6 ASTM C1019 ❑ P16700- 07/13/09 28 3X6 Other P16700- Compressive X P16700- Flexural P16700- P16700- Test Results Conforming Remarks FR# 118722 Non-Conforming Results Reviewed By A-e-. Date Reviewed Codes for Break Types: 1.Cone 2.Cone&Split 3.Cone&Shear 4.Shear 5.Columnar(Split) FIELD REPORT NO: 1 Associates , Inc . '� ` GEOTECHNICAL ENGINEERING • ENVIRONMENTAL ENGINEERING CONSTRUCTION TESTING AND INSPECTION DATE: 4;e —11—d ! CONTRACTOR: PROJECT#: P ?Wig' JURISDICTION: fiI4 PROJECT: PERMIT#: ;k0oP LOCATION: Of4AWle INSPECTOR: KRAZAN PROJECT MANAGER: /9? WEATHER: ;521h0 TEMP: s2E fly dflk v i-yi �" rb, "10 Y A by Pe"Koego I-)Atto IN s7-iey 1 ;z>: �X�/ Y Equipment/Asset Number(s): To the best of my knowledge,the oboe/WAS NOT performed in accordance with the approved plans,specifications,and regulatory requirements. Superintendent/Representative: Technician: — U Q� Serving the Western United States This field report indicates our inspector's observation and testing results based on the site condition and contractor's activities.This information is subject to review prior to final subW1. By signing this report,our inspector does not accept responsibility for validity of results.Some information on this report has been provided by others on site. Revision 2 IS02 Field Report.doe Effective Date:11/15/07 FIELD REPORT NO: =_W(raZM & Associates , Inc . GEOTECHNICAL ENGINEERING • ENVIRONMENTAL ENGINEERING CONSTRUCTION TESTING AND INSPECTION DATE: ' < C% CONTRACTOR: jt.900 PROJECT#: /D�5- ©e3c 4c> JURISDICTION: /h 4A PROJECT: CS Ii`9t-OAY PERMIT#: e'-0'6-1,n eP065? O 6 12./ LOCATION: YSA4F=41e INSPECTOR: SB/<L �-JGQG./r17 / KRAZAN PROJECT MANAGER: '!XS WEATHER: V GL/y TEMP: !6--p _ A-- OA-) 6/7-A, 1�� � >�rSa� �roman 1. C•P��� ��<� ��, lri(11 7�?�i J ALL ek&i O/E' V i� %F17— GGl,605� efflC 2 7- Equipment/Asset Number(s): To the best of my knowledge,the abovllnV WAS NOT performed in accordance with the approved plans,specifications,and regulatory requirements. Superintendent/Representative: Technician: Serving the Western United States /J This field report indicates our inspector's observation and testing results based on the site condition and contractor's activities.This information is subject to review prior to final sujhal. By signing this report,our inspector does not accept responsibility for validity of results.Some information on this report has been provided by others on site. Revision 2 1502 Field Report.doc Effective Date:I1/15/07 FIELD REPORT NO: 1130 7 7 (xaZaZ & Associates , Inc . GEOTECHNICAL ENGINEERING - ENVIRONMENTAL ENGINEERING CONSTRUCTION TESTING AND INSPECTION DATE: -//-D `'f CONTRACTOR: �OD�ll7fl�J PROJECT M //9 4-- 09040 JURISDICTION: z2L-11211-54 PROJECT- CSA1:--,e6a.J4V PERMIT#: 60/'t'► '�-O0 '—C90 1,;L( LOCATION: INSPECTOR: KRAZAN PROJECT MANAGER: WEATHER: CS TEMP: �F.�S%�jL. Z�t�,-046-�e'TId� /n 1-7" 3- e�V"o�— oC/.v.Zs 7 TO 2� 7Z) 6, 'Fee 41� 7- �} .-W TSSI L/A-'A-)-V�ie5 e \-r'tr40-- ,VT /?7 I&v Icc,400- Equipment/Asset Number(s): To the best of my knowledge,the abovqNVAS.IZAS NOT performed in accordance with the approved plans,specifications,and regulatory requirements. Superintendent/Representative: Technician: Serving the Western United States This field report indicates our inspector's observation and testing results based on the site condition and contractor's activities.This information is subject to review prior to final sub I. By signing this report,our inspector does not accept responsibility for validity of results.Some information on this report has been provided by others on site. Revision 2 1502 Field Report.do Effective Date:11/15/07 Krazan & Associates, Inc. 1230 Finn Hill Rd NW Suite A, Poulsbo, WA 98370 (360)-598-2126 Project No. 106-09046 Cyl.Code P16656 Pour Date 6-11-2009 Report No. 33860 Weather CLEAR Jurisdiction MASON CO Permit No. 2008-00121 Project SAFEWAY Engineer Location BELFAIR Architect client WOODMAN Contractor WOODMAN Field Data Site Mix Reported Batch Data Supplier KRM Plant No. 4 cement Type 1-11 Concrete X Mortar Grout Flex Beams Design Actual X Prisms Grouted Ungrouted Other Mix No. M4060B Conc. Air Cem.lbs. 561 Temp. Temp. Unit F.Ash lbs. - Time Truck# Ticket# %Air Slump (F) (F) Wt. 0710 226 46538 - 5 - 58 - C.agg.lbs. 3/8 948 C.agg.lbs.2 3/4 950 C.agg.lbs.3 - Sand lbs. 1382 Water 28gal Placement Area Admixture POLY 23.6oz Footings Walls Columns Grade Beams Other Slab/Deck X Slab Pilings Other Air Ent.(oz/cwt.) Grids SLAB ON GRADE,7-8/E.5- G. Water Added on Job(gals.) 10 Field Test Methods Remarks PLACED BY PUMP, SAMPLED @ 9 OF 27yds TOTAL ASTM C143 N. ASTM C138 ❑. ASTM C 1064 N. ASTM C 173 ❑. W/C .43 ASTM C31 ®. Other Inspector BILL UGOLINI Reviewed By IV Laboratory Data Design Strength 4000 Date Specimens Rec'd. 6-12-2009 Cyl. Test Dia Length Max. Comp. Tested Break Lab Test Method Code Date Age Dim. Area Load Str.(psi) Set# By Type ASTM C39 P16656- 06/18/09 7 4X8 12.56 48880 3,890 ZL 5 ASTM C109 ❑ P16656- 07/09/09 28 4X8 ASTM C617 ❑ ASTM C1231 P16656- 07/09/09 28 4X8 ASTM C1019 ❑ P16656- 07/09/09 28 4X8 Other P16656- Compressive X P16656- Flexural P16656- Test Results P16656- Conforming Remarks FR# 113767 Non-Conforming Results Reviewed By W Date Reviewed (,41-c" Codes for Break Types: 1.Cone 2.Cone&Split 3.Cone&Shear 4.Shear 5.Columnar(Split) ' FIELD REPORT NO: 1.1168 8 3 --te aKMZM & Associates , Inc . GEOTECHNICAL ENGINEERING , ENVIRONMENTAL ENGINEERING CONSTRUCTION TESTING AND INSPECTION DATE: ©6 //.z /0 9 CONTRACTOR: PROJECT#: JURISDICTION: �� cow Tv PROJECT: r<c-�s�c�. L3�G 4GQ PERMIT#: 0 g LOCATION: X3€4 ,,s- i INSPECTOR: KRAZAN PROJECT MANAGER: 3E Z3 WEATHER: �,9�,¢c T TEMP: � RA."t�4[t! R #�iQ Sf/VT,4T/uE"; ir6 t,,-z, SjooC/-44- Tiyc,tJ cTid.v eoitr i4c.c yF r ge To ;ze Ge FbRe-e/reE,vT „ t TG c-r,nrFoR T[n AD !n/i E[7 dL.4N S Sf/�sT �/ � 1�FT.a[c '7,4,vo cs rz. r-A 2.y ,t7r&W r, A L/N�179.I Somas R� r�RotiT wry g �n i x Fr2 srr A—c,S[,4.1,1C44 G gn N ,S[Tic �/5//� �,OZ�.4r�fJ L�4 Y�U��'�'T �$LL GtLLS t.�iref �cslySc�LlOi4T��Z I3�� M£CfIAAt/c..2L` RAP 4,C--,47- 1l� .S, S 2T7 .9.e.0 A c4ij5,c7X 2.4/n cc 6,onz,7-.a Aya C/nxl SM z /71.g rr n .,4 4- TrJ [�E]' ref ie A"b� n,T, TN �PFacs,F 1//A'< , ����ns Ug'iQE 104 r 911s9 R Fr L2 04i !/:Z eD AjYcA/62 771 /YF--i_.Sc%A1 'qTu nS c 15�4% il Equipment/Asset Number(s): To the best of my knowledge,the abovea WAS NOT performed in accordance with the approved plans,specifications,and regulatory requirements. Superintendent/Representative: Technician: Serving the Western United States This field report indicates our inspector's observation and testing results based on the site condition and contractor's activities.This information is subject to review prior to final By signing this report,our inspector does not accept responsibility for validity of results.Some information on this report has been provided by others on site. e Revision 2 1502 Field Report.doc Effective Date:11/15/07 FIELD REPORT NO: 116851 K,raZM & Associates , Inc . GEOTECHNICAL ENGINEERING • ENVIRONMENTAL ENGINEERING CONSTRUCTION TESTING AND INSPECTION DATE: z---I CONTRACTOR: el.A"1-411 ! PROJECT#: hG -o`tafw JURISDICTION: Go PROJECT: 52RE-0262 PERMIT#: or-cz:)/Z I LOCATION: ?,-v INSPECTOR: '4dl&s d ex-t0 KRAZAN PROJECT MANAGER: I WEATHER: -Pe- 45-e u h TEMP: 6&'0' ��1A2!✓.r,/ ���s-$�+(/?ATiy�e C�s�� �� fe.�L I��$ rl'1I/O lsi?veca T'C.�4�_/Y/c�7r1t G/7-75 e 4c7/�tL� 6IcIZscs >S- Zb iZ yi�itks7� �[ itl`s AG /. S-L /P/f<d P'e�i'PiC-`S !t/�s�c n 1�/� iy i�c/)tc_�- r'�r37Z �c�5 GmSes.2r�LsD G�s'r!i e2r?4 u� /�'�i9� t��5[G/✓ '00Wr7' PRE fnlcS /1�.PS�s�l�y Gr�xc—I tic-M lJ✓fi'4+'��Fi9C.fuf�5 IZuGo��'nJ1�rA.r--iv�/r'e �a'i/D t"�'�,s?t.�'s �/Q 95ntc��( iZ�-�t �Stf1l��� StfiLt t�c.v Fc�n-' Fes:c.y ic�si i9r'��S C/>'�i / S� Equipment/Asset Number(s): To the best of my knowledge,the abo</WAS NOT performed in accordance with the approved plans,specifications,and regulatory requirements. Superintendent/Representative: Technician, Serving the Western United States This field report indicates our inspector's observation and testing results based on the site condition and contractor's activities.This information is subject to review prior to final stttal. By signing this report,our inspector does not accept responsibility for validity of results.Some information on this report has been provided by others on site. Revision 2 1502 Field Repomdoc Effective Date:11/15/07 Krazan &Associates, Inc. 1230 Finn Hill Rd NW Suite A, Poulsbo, WA 98370 (360)-598-2126 Project No. 106-09048 Cyl.Code P16673 Pour Date 6-12-2009 Report No. 46841 Weather PRT CLOUDY Jurisdiction Permit No. Project BRIDGE DECK Engineer Location Architect Client Contractor ZENOVIC AND ASSOC. Field Data Site Mix Reported Batch Data Supplier Plant No. Cement Type Concrete Mortar Grout Flex Beams Design Actual Prisms Grouted Ungrouted Other Mix No. Conc. Air Cem.lbs. Temp. Temp. Unit F.Ash lbs. Time Truck# Ticket# %Air Slump (F) (F) Wt. C.agg.lbs. C.agg.lbs.2 C.agg.lbs.3 Sand lbs. Water Placement Area Admixture Footings Walls Columns Grade Beams Other Slab/Deck Slab Pilings Other Air Ent.(oz/cwL) Grids SAMPLED BY CLIENT Water Added on Job(gals.) Field Test Methods Remarks ASTM C143 ❑. ASTM C138 ❑. ASTM C1064 ❑. ASTM C173 ❑. ASTM C31 ❑ Other I inspector CLIENT Reviewed By Laboratory Data Design Strength 3500 Date Specimens Rec'd. 6-16-2009 Cyl. Test Dia Length Max. Comp. Tested Break Lab Test Method Code Date Age Dim. Area Load Str.(psi) Set# By Type ASTM C39 ❑ P16673- 06/15/09 3 4X8 12.58 45355 3,610 IBF 5 ASTM C109 ❑ P16673- 06/19/09 7 4X8 ASTM C617 11 ASTM C1231 ❑ P16673- 07/10/09 28 4X8 ASTM C1019 11 P16673- 07/10/09 28 4X8 Other P16673- Compressive P16673- Flexural P16673- P16673- Test Results Conforming Remarks Non-Conforming Results Reviewed By Date Reviewed Codes for Break Types: 1.Cone 2.Cone&Split 3.Cone&Shear 4.Shear 5.Columnar(Split) - KraZan & ASSOCIATES , INC . GEOTECHNICAL ENGINEERING • ENVIRONMENTAL ENGINEERING CONSTRUCTION TESTING & INSPECTION June 5, 2009 KA Project No.: 106-09040 Safeway, Inc. Seattle Div. Construction Attn: Sharon Bredeson 1121 — 124`11 Ave NE Bellevue, WA 98005-0990 RE: Safeway Store# 1571 Remodel&Expansion-Belfair Belfair,WA Dear Ms.Bredeson: In accordance with your request and authorization,the following test data are presented on the following reports, which are enclosed: May 6 Concrete Report No. 35165 June 1 Field Report No. 118925 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: sw Enclosures Cc:Architect-Lu Wei Hoe—luwei@mulvannyG2.com General Contractor Joe McLaughlin—joe@woodmanconstruction.com General Contractor Rick Hendrickson—rickh@woodmanconstruction.com Mason County With Offices Serving The Western United States 1230 Finn Hill Road NW, Suite A•Poulsbo, Washington 98370 9(360)598-2126•Fax: (360)598-2127 =QKrazan & Associates, Inc . FIELD REPORT NO: r +" GEOTECHNICAL ENGINEERING • ENVIRONMENTAL ENGINEERING CONSTRUCTION TESTING AND INSPECTION DATE: C/-O? CONTRACTOR: IiOD;41t?�� PROJECT#:1,-)6- 0 70 VO JURISDICTION: AI AWN Co(•1it/Ts!" PROJECT:;SAS AV B41/:4LA PERMIT#: Coli Zoof - Oo!7-1 LOCATION: .;4t INSPECTOR: .i d Me',5 AIIr.L"A) KRAZAN PROJECT MANAGER: WEATHER:-C21I-y1Lr.r5T TEMP: IC,� 4AJ 5rrr -rll-45 nare .4s klla 'W O rd 01.I5rKRUe 9Al XV WCAOX .I.U.srX41.4r-t6. l dn,!!d d� c Pry>IO.� �S AS FDLzdLls ° AW� � Sc�Pf'rr�t?' 13R�ck�f �zr�,r/1' OF SrD�Ce'. �J,L tIQLLIS QXXC(.e6 M d -04EM 0' Sr* XV PINS ,tsp uSACD 40D /340k4d &ee of Q415r AA40 ON., 4a,e2Eremer'. y At, Y/lkeyf 0 9AIC.mzi s; eys rALZxn B3 z ase Otc 1116r5 R t xw cLPDX�_ !4L( !/aC.C4 FzG,,-eD cee&(:'rgy �A.. la ar uor_,Os, Ju, /lnll API 5U1-GF'1Q C,U C0a1P14AVCt' �•J.Lr>! �Pf'lfotJG'!? /°G.4�y=� ANx� .�r/�rCTL'��>5• Equipment/Asset Number(s): To the st f my knowledge,the abo AS/WAS NOT performed in accordance with the approved plans,specifications,and regulatory requirements. Superintend epr ntative: Technician: This report in Icates spector's observation and testing results based on the site condition and contractor' ctivities.This information is subject to review prior to final submittal.By signing this report,our inspector does not acc responsibility for validity of the results.Some information on this report may have been provided by others on site. 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&Assoc. Offices Serving the Western United States Bothell (425) 485-5519 Gresham (503) 665-3574 Poulsbo (360) 598-2126 Puyallup (253) 939-2500 DAILY FIELD REPORT 2009.doc EFFECTIVE:4/22/2009 Crazan & Associates, Inc. 1230 Finn Hill Rd NW Suite A, Poulsbo, WA 98370 (360)-598-2126 rrroject No. 106-09040 Cyl.Code P16448 Pour Date 5-6-2009 Report No. 35165 weather OVERCAST Jurisdiction MASON COUNTY Permit No. COM 2008 00121 Project SAFEWAY Engineer Location BELFAIR Architect client WOODMAN contractor WOODMAN Field Data Site Mix X Reported Batch Data supplier SITE MIX Plant No. Cement Type 1-11 Concrete Mortar Grout Flex Beams Design Actual Prisms Grouted X Ungrouted Other Mix No. Conc. Air Cem.lbs. Temp. Temp. Unit F.Ash lbs. Time Truck# Ticket# %Air Slump (F) (F) Wt. 0930 N/A N/A N/A FLUID 70 50 N/A C.agg.lbs. C.agg.lbs.2 C.agg.lbs.3 Sand lbs. I Water Placement Area Admixture Footings Walls Columns X Grade Beams Other Slab/Deck Slab Pilings Other Air Ent.(oz/cwt.) Grids NORTH COLUMN 1ST LIFT Water Added on Job(gals.) Field Test Methods Remarks DESIGN MIX FINE; PLACE BY BUCKET ASTM C143 ❑. ASTM C138 ❑ ASTM C1064 ® ASTM C173 ❑. ASTM C31 ®. Other Inspector JAMES MEENAN Reviewed By Laboratory Data Design Strength 2000 Date Specimens Rec'd. 5-7-2009 Cyl. Test Dia Length Max. Comp. Tested Break Lab Test Method Code Date Age Dim. Area Load Str. (psi) Set# By Type ASTM C39 09 P16448- 05/13/09 7 3X6 10.81 18370 1,700 AC 3 ASTM C109 11 P16448- 06/03/09 28 3X6 10.86' 63585 5,850 ZL 5 ASTM C617 ASTM C1231 ❑ P16448- 06/03/09 28 3X6 10.86 66115 6,090 ZL 2 ASTM C1019 ❑ P16448- 06/03/09 28 3X6 10.86 64850 5,970 ZL 2 Other P16448- Compressive X P16448- Flexural P16448- Test Results P16448- X Conforming Remarks FR#114189 Non-Conforming Results Reviewed By Date Reviewed Codes for Break Types: 1. Cone 2. Cone&Split 3. Cone&Shear 4. Shear 5.Columnar(Split) t . f�. C '1..-.,K,raZan & ASSOCIATES , INC . GEOTECHNICAL ENGINEERING • ENVIRONMENTAL ENGINEERING CONSTRUCTION TESTING & INSPECTION June 3, 2009 KA Project No.: 106-09040 Safeway, Inc. Seattle Div. Construction Attn: Sharon Bredeson 1121 — 124`h Ave NE Bellevue, WA 98005-0990 RE: Safeway Store# 1571 Remodel &Expansion-Belfair Belfair,WA Dear Ms. Bredeson: In accordance with your request and authorization, the following test data are presented on the following reports, which are enclosed: April 24 Concrete Report No. 35095 May 4 Concrete Report No. 35315 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: sw Enclosures Cc:Architect-Lu Wei Hoe—luwei@mulvannyG2.com General Contractor Joe McLaughlin— e@woodmarconstruction.com General Contractor Rick Hendrickson—rickh@woodmanconstruction.com Mason County With Offices Serving The Western United States 1230 Finn Hill Road NW, Suite A 9 Poulsbo, Washington 98370•(360)598-2126•Fax: (360)598-2127 (razan &,Associates, Inc. 1230 Finn Hill Rd NW Suite A, Poulsbo, WA 98370 (360)-598-2126 Project No. 106-09040 Cyl. Code P16446 Pour Date 5/4/2009 Report No. 35315 weather O'CAST Jurisdiction MASON COUNTY Permit No. COM 2008 00121 Project BELFAIR SAFEWAY EXPANSION Engineer Location BELFAIR Architect client WOODMAN contractor WOODMAN Field Data Site Mix Reported Batch Data Supplier KITSAP READY MIX Plant No. 4 Cement Type 1-11 Concrete X Mortar Grout Flex Beams Design Actual X Prisms Grouted Ungrouted Other Mix No. M4060 Conc. Air Cem.lbs. 562 Temp. Temp. Unit F.Ash lbs. Time Truck# Ticket# %Air Slump (F) (F) Wt. 1:15 226 45138 3 58 56 C.agg.lbs. C.agg.lbs.2 1868 C.agg.lbs.3 Sand lbs. 1336 Water 28 GALS Placement Area Admixture 45 OZ Footings X Walls Columns Grade Beams Other Slab/Deck Slab Pilings Other Air Ent.(oz/cwt.) 4 OZ Grids EXTERIOR CANOPY FOOTING AT APPROX. A.4+7.5. REINFORCEMENT PER DETAIL 4 ON S1.2. Water Added on,lob(gals.) 0 Field Test Methods Remarks PLACED BY CHUTE, VIBRATED. SAMPLED 6 OF 6 ASTM C143 ®. ASTM C138 ❑. TOTAL YARDS. W/C .42 ASTM C1064 N. ASTM C173 ❑. ASTM C31 ®. Other Of Inspector PENN SEELY Reviewed By -aboratory Data Ddsign Strength 3000 Date Specimens Rec'd. 5/5/2009 Cyl. Test Dia Length Max. Comp. Tested Break Lab Test Method Code Date Age Dim. Area Load Str. (psi) Set# By Type ASTM C39 :)16446- 05/11/09 7 4X8 12.66 53115 4,200 ZL 2 ASTM C109 11 '16446- 06/01/09 28 4X8 12.62 68070 5,390 JS 4 ASTM C617 11 ASTM C1231 '16446- 06/01/09 28 4X8 12.62 67920 5,380 JS 5 ASTM C1019 ❑ '16446- 06/01/09 28 4X8 12.62 67995 5,390 JS 5 Other :)16446- Compressive X :)16446- Flexural '16446- :)16446- Test Results tmarks FR 116640 X Conforming Non-Conforming tesults Reviewed By Date Reviewed :odes for Break Types: 1. Cone11 2. Cone&Split 3. Cone&Shear11 4. Shear E 5. Columnar(Split) (razan & Associates, Inc. 1230 Finn Hill Rd NW Suite A, Poulsbo, WA 98370 (360)-598-2126 Project No. 106-09040 Cyl.Code P16409 Pour Date 4/24/2009 Report No. 35095 Weather O'CAST Jurisdiction MASON COUNTY Permit No. 47001 Project SAFEWAY Engineer Location BELFAIR Architect Client WOODSON Contractor WOODSON Field Data Site Mix Reported Batch Data Supplier KRM Plant No. 4 Cement Type 1-11 Concrete Mortar Grout X Flex Beams Design Actual X Prisms X Grouted Ungrouted Other Mix No. 565A30.1 Conc. Air Cem.lbs. 611 Temp. Temp. Unit F.Ash lbs. Time Truck# Ticket# %Air Slump (F) (F) Wt. 9:15 211 44824 N/A FLUID 54 44 N/A C.agg.lbs. C.agg.lbs.2 C210 957 C.agg.lbs.3 SAND #2 2212 Sand lbs. 1132 Water 38 GALS Placement Area Admixture A340 36.4 OZ Footings Walls X Columns Grade Beams Other Slab/Deck Slab Pilings Other Air Ent.(oz/cwt.) Grids CMU WALL 8 LINE E.2 TO G @ 7.5 T.O.W. SAMPLE LOCATION SAME. Water Added on,Job(gals.) 5 Field Test Methods Remarks PLACED BY PUMP; CONSOLIDATED TWICE. ASTM C143 N. ASTM C138 SAMPLED 4.5 OF 4.5 YARDS PLACED BY PUMP. ASTM C1064 N. ASTM C173 p. W/C .51 ASTM C31 ® Other Inspector KAMERON BINNS Reviewed By Laboratory Data Design Strength 1500 Date Specimens Rec'd. 4/25/2009 Cyl. Test Dia Length Max. Comp. Tested Break Lab Test Method Code Date Age Dim. Area Load Str. (psi) Set# By Type ASTM C39 P16409- 05/22/09 28 PRISM 60.18 213910 3,550 AC 2 ASTM C109 ❑ P16409- 05/22/09 28 PRISM 60.18 215445 3,580 AC 2 ASTM C617 ASTM C 1231 ❑ P16409- 05/22/09 28 PRISM 60.18 213665 3,550 AC 2 ASTM C1019 ❑ P16409- Other P16409- Compressive X P16409- Flexural P16409- P16409- Test Results Remarks FR 116602 X Conforming Non-Conforming Results Reviewed By Date Reviewed odes for Break Types: 1. Cone 17 2. Cone&Split 3. Cone&ShearF1 4. Shear 5.Columnar(Split) F1 WELDING . Krazarz & Associates , Inc . REPORT NO.: GEOTECHNICAL ENGINEERING • ENVIRONMENTAL ENGINEERING CONSTRUCTION TESTING AND INSPECTION IATE: /`�/ 9 CONTRACTOR: L✓OOD�lAN 'ROJECT#: /06 —U9ay0 PERMITNO: 0,F-0001a1 'ROJECT: INSPECTOR:1Ll -574 ,VT>i{/D OCATION: JURISDICTION: lY,4SON GD A14, :RAZAN PROJECT MANAGER: WEATHER: A/R TEMP: Al!1A - ° FIELD ❑ SHOP WELDING ❑ M.T. ❑ P.T. V.T. item(s)inspected: 0 PvZ>oZC-- K,SEAM e✓�GairvG ate' F p�e� Fr�e �N �'/7 r95 Ann ('F/y ND .PC/ VI/9 Oi' s--?s�09 gen wrd5v 4e 4.57 S.2 5� K a7 sue. Position: FLAT VERITCAL HORIZONT OVERHEAD ❑ Filler Metal: Process: qiMD FCAW GMAW SAW ❑ Other: ❑ Weld Type: ILLET C.P. P.P. PLUG ❑ Other: 8ZPa6:E Weld Size 3/16" 1/4" 5/16" 3/8" ❑ Other: Codes: AWS AISC TITLE 21 TITLE 24 UBC ASME DlQi��NSP��TF"!� APPEARED S4 7>SFAC M&IZ A-:5r 4> 1 A&.,2 PZAiK, N I 1 �L Lei`•:� rn7 U i_ . J i l CfA S b the best of my knowledge,the above S WAS NOT performed in accordance with the approved plans, specifications,and regulatory requirements. luperintendent/R sentative: Technician: Serving the Western United States his field report indicates our inspector's observation and testing results based on the site condition and contractor's activities.This information is subject to review prior to final submittal. iy signing this report,our inspector does not accept responsibility for validity of results.Some information on this report has been provided by others on site. Revision 1 Effective Date:l l/15/07 'the informarinn nrnvided in this renort is orenared for the exclusive use of the client.This report may not be reproduced in anv format without the written permission of the client and Krazan&Associates. e�_ a_ '� == Kr�;an & ASSOCIATES , INC . GEOTECHNICAL ENGINEERING • ENVIRONMENTAL ENGINEERING CONSTRUCTION TESTING & INSPECTION May 29, 2009 KA Project No.: 106-09040 Safeway, Inc. Seattle Div. Construction Attn: Sharon Bredeson 1121 — 124th Ave NE Bellevue, WA 98005-0990 RE: Safeway Store# 1571 Remodel &Expansion-Belfair Belfair,WA Dear Ms. Bredeson: In accordance with your request and authorization,the following test data are presented on the following reports, which are enclosed: April 23 Concrete Report No. 35260—28 Day April 24 Concrete Report No. 35130—28 Day Concrete Report No. 35096—28 Day Concrete Report No. 35097—28 Day April 27 Concrete Report No. 35099 -28 Day May 12 Welding Report No. 3687 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: sw Enclosures Cc:Architect-Lu Wei Hoe—luwei@mulvannvG2.com General Contractor Joe McLaughlin—joe@woodmanconstruction.com General Contractor Rick Hendrickson—rickh@woodmanconstruction.com Mason County With Offices Serving The Western United States 1230 Finn Hill Road NW, Suite A•Poulsbo, Washington 98370 9(360)598-2126 9 Fax: (360)598-2127 (razan &Associates, Inc. 1230 Finn Hill Rd NW Suite A, Poulsbo, WA 98370 (360)-598-2126 Project No. 106-09040 Cyl.Code P16377 Pour Date 4/23/2009 Report No. 35260 weather O'CAST Jurisdiction MASON COUNTY Permit No. 47001 Project SAFEWAY BELFAIR Engineer Location BELFAIR Architect Client WOODMAN Contractor WOODMAN Field Data Site Mix Reported Batch Data Supplier FRED HILL Plant No. Cement Type 1-11 Concrete Mortar Grout X Flex Beams Design Actual X Prisms Grouted Ungrouted Other Mix No. 565A30.1 Conc. Air Cem.lbs. 608 Temp. Temp. Unit F.Ash lbs. Time Truck# Ticket# %Air Slump (F) (F) wt. 7:38 231 44721 FLUID 63 43 C.agg.lbs. 1150 C.agg.lbs.2 924 C.agg.lbs.3 Sand lbs. 1086 Water 36 GALS Placement Area Admixture 31 OZ Footings Walls X Columns Grade Beams Other Slab/Deck Slab Pilings Other Air Ent.(oz/cwt.) Grids CMU WALL FROM 17.4' - 21.4' FROM GRADE. R/S PER PLAN. Water Added on Job(gals.) 10 Field Test Methods Remarks PLACE VIA LINE PUMP AND MECHANICALLY ASTM C143 ®. ASTM C138 ❑. CONSOLIDATED. W/C .49. ASTM C1064 N. ASTM C173 ❑. ASTM C31 ®. Other Inspector AARON CLYDE Reviewed By Laboratory Data Design Strength 2000 Date Specimens Rec'd. 4/24/2009 Cyl. Test Dia Length Max. Comp. Tested Break Lab Test Method Code Date Age Dim. Area Load Str. (psi) Set# By Type ASTM C39 P16377- 04/30/09 7 3X6 11.18 35565 3,180 ZL 2 ASTM C109 ❑ P16377- 05/21/09 28 3X6 10.82 39420 3,640 ZL 2 ASTM C617 19 ASTM C1231 ❑ P16377- 05/21/09 28 3X6 10.82 41770 3,860 ZL 3 ASTM C1019 11 P16377- 05/21/09 28 3X6 10.82 40595 3,750 ZL 3 Other P16377- Compressive X P16377- Flexural P16377- P16377- Test Results X Conforming Remarks FR 113963 Non-Conforming Results Reviewed By Date Reviewed odes for Break Types:_" 1.Cone [1 2. Cone&Split 3. Cone&Shear11 4. Shear11 5.Columnar(Split) (razan & Associates, Inc. 1230 Finn Hill Rd NW Suite A, Poulsbo, WA 98370 (360)-598-2126 Project No. 106-09040 Cyl. Code P16382 Pour Date 4/24/2009 Report No. 35130 weather O'CAST Jurisdiction MASON COUNTY Permit No. 47001 Project SAFEWAY BELFAIR Engineer Location BELFAIR Architect Client WOODMAN Contractor WOODMAN Field Data Site Mix Reported Batch Data supplier FRED HILL Plant No. 4 Cement Type 1-11 Concrete X Mortar Grout Flex Beams Design Actual X Prisms Grouted Ungrouted Other Mix No. M3055.1 Conc. Air Cem.lbs. 517 Temp. Temp. Unit F.Ash lbs. Time Truck# Ticket# %Air Slump (F) (F) Wt. 10:09 66 44765 5 62 43 C.agg.lbs. 1914 C.agg.lbs.2 C.agg.lbs.3 Sand lbs. 1457 Water 29 GALS Placement Area 31 OZ Admixture Footings X Walls Columns Grade Beams Other Slab/Deck Slab Pilings Other Air Ent.(ozlcwt.) Grids FOOTING WEST SIDE OF EXISTING BLDG. R/S PER PLAN. Water Added on Job(gals.) 0 Field Test Methods Remarks PLACE VIA TAILGATE AND MECHANICALLY ASTM C143 ®. ASTM C138 ❑. CONSOLIDATED. ASTM C1064 ® ASTM C173 ❑. ASTM C31 ®. Other Inspector AARON CLYDE Reviewed By -aboratory Data D sign Strength 3000 Date Specimens Rec'd. 4/24/2009 Cyl. Test Dia Length Max. Comp. Tested Break Lab Test Method Code Date Age Dim. Area Load Str.(psi) Set# By Type ASTM C39 '16382- 05/01/09 7 4X8 12.59 49935 3,970 ZL 5 ASTM C109 ❑ '16382- 05/22/09 28 4X8 12.56 63140 5,030 ZL 2 ASTM C617 ❑ ASTM C1231 '16382- 05/22/09 28 4X8 12.56 60645 4,830 ZL 5 ASTM C1019 ❑ :)16382- 05/22/09 28 4X8 12.56 61890 4,930 ZL 2 Other :)16382- Compressive X '16382- Flexural '16382- '16382- Test Results remarks FR 113963 X Conforming Non-Conforming tesults Reviewed By Date Reviewed .odes for Break Types: 1. Cone 2. Cone&Split 3. Cone&Shear 4. Shear 5. Columnar(Split) ►razan & /Associates, Inc. 1230 Finn Hill Rd NW Suite A, Poulsbo, WA 98370 (360)-598-2126 Project No. 106-09040 Cyl.Code P16398 Pour Date 4/24/2009 Report No. 35096 weather O'CAST Jurisdiction MASON COUNTY Permit No. 47001 Project SAFEWAY BELFAIR Engineer Location BELFAIR Architect client WOODMAN Contractor WOODMAN Field Data Site Mix Reported Batch Data Supplier KITSAP READY MIX Plant No. 4 cement Type 1-II Concrete Mortar Grout X Flex Beams Design Actual X Prisms Grouted Ungrouted Other Mix No. 565A30.1 Conc. Air Cem.lbs. 611 Temp. Temp. Unit F.Ash lbs. Time Truck# Ticket# %Air Slump (F) (F) Wt. 9:15 211 44824 FLUID 54 44 C.agg.lbs. C.agg.Ibs.2 C.agg.lbs.3 957 Sand lbs. 2212 Water 38 GALS Placement Area Admixture A340 36.4 Footings Walls X Columns Grade Beams Other Slab/Deck Slab Pilings Other Air Ent.(oz/cwt.) Grids CMU WALL 8 LINE E.2 TO G @ 7.5 T.O.W. SAMPLE LOCATION THE SAME. water Added on.Job(gals.) 5 Field Test Methods Remarks PLACED BY PUMP CONSOLIDATED TWICE. ASTM C143 N. ASTM C138 ❑. SAMPLED 4.5 OF 4.5 TOTAL YARDS PLACED BY ASTM C N. ASTM C173 ❑. ASTM C31 ®. Other PUMP. W/C .51 Inspector KAMERON BINNS Reviewed By Laboratory Data Design Strength 2000 Date Specimens Rec'd. 4/24/2009 Cyl. Test Dia Length Max. Comp. Tested Break Lab Test Method Code Date Age Dim. Area Load Str.(psi) Set# By Type ASTM C39 P16398- 05/ol/o9 7 3X6 11.12 39050 3,510 ZL 1 ASTM C109 ❑ P16398- 05/22/09 28 3X6 11.12 42310 3,800 ZL 3 ASTM C617 ASTM C1231 ❑ P16398- 05/22/09 28 3X6 11.12 44725 4,020 ZL 2 ASTM C1019 ❑ P16398- 05/22/09 28 3X6 11.12 43520 3,910 ZL 3 Other P16398- Compressive X P16398- Flexural P16398- P16398- Test Results X Conforming Remarks FR 116602 Non-Conforming Results Reviewed By `.f Date Reviewed Codes for Break Types: 1. Cone H 2. Cone&Split 3. Cone&Shear [A] 4. Shear 5. Columnar(Split) ;razan & Associates, Inc. 1230 Finn Hill Rd NW Suite A, Poulsbo, WA 98370 (360)-598-2126 Project No. 106-09040 Cyl.Code P16397 Pour Date 4/24/2009 Report No. 35097 Weather O'CAST Jurisdiction MASON COUNTY Permit No. 47001 Project SAFEWAY BELFAIR Engineer Location BELFAIR Architect Client WOODMAN contractor WOODMAN Field Data Site Mix X Reported Batch Data supplier QUICKCRETE Plant No. Cement Type 1-11 Design Actual X Concrete Mortar X Grout Flex Beams Prisms Grouted Ungrouted Other Mix No. MIX 650# Conc. Air Cem.lbs. Temp. Temp. Unit F.Ash lbs. Time Truck# Ticket# %Air Slump (F) (F) Wt. 9:50 48 47 C.agg.lbs. C.agg.lbs.2 i C.agg.lbs.3 Sand lbs. Water 10G Placement Area Admixture Footings Walls X Columns Grade Beams Other Slab/Deck Slab Pilings Other Air Ent.(oz/cwt.) Grids CMU WALL C LINE @ 7.5 T.O.W. SAMPLE LOCATION THE SAME. water Added on Job(gals.) 0 Field Test Methods Remarks MIX 640#WITH 10 GALS OF WATER. MIX 3-5 ASTM C143 ®. ASTM C138 ❑. ASTM C1064 ®. ASTM C173 ❑. MINUTES. ASTM C31 ® Other Inspector KAMERON BINNS Reviewed By Laboratory Data Design Strength 1800 Date Specimens Rec'd. 4/25/2009 Cyl. Test Dia Length Max. Comp. Tested Break Lab Test Method Code Date Age Dim. Area Load Str. (psi) Set# By Type ASTM C39 P16397- 05/01/09 7 2X4 3.14 5800 1,850 ZL 2 ASTM C109 0 P16397- 05/22/09 28 2X4 3.14 8640 2,750 ZL 4 ASTM C617 ASTM C1231 ❑ P16397- 05/22/09 28 2X4 3.14 8905 2,840 ZL 4 ASTM C1019 ❑ P16397- 05/22/09 28 2X4 3.14 8770 2,790 ZL 4 Other P16397- Compressive X P16397- Flexural P16397- Test Results P16397- X Conforming Remarks FR 116602 Non-Conforming Results Reviewed By F..� Date Reviewed Codes for Break Types: 1. Cone11 2.Cone&SplitF1 3.Cone&Shear11 4. Shear 5.Columnar(Split) (razan & Associates, Inc. 1230 Finn Hill Rd NW Suite A, Poulsbo, WA 98370 (360)-598-2126 Project No. 106-09040 Cyl.Code P16412 Pour Date 4-27-2009 Report No. 35099 weather O'CAST Jurisdiction MASON CO. Permit No. 47001 Project SAFEWAY Engineer Location BELFAIR, WA Architect Client Contractor WOODSON Field Data Site Mix Reported Batch Data Supplier KRM Plant No. 4 Cement Type I Concrete Mortar Grout X Flex Beams Design Actual X Prisms Grouted Ungrouted Other Mix No. 565A30.1 Conc. Air Cem.lbs. 613 Temp. Temp. Unit F.Ash lbs. - Time Truck# Ticket# %Air Slump (F) (F) wt. 1120 227 44864 - FLUID 62 52 - C.agg.lbs.C.agg.lbs.2 - C.agg.lbs.3 942 Sand lbs. 2235 Water 36 GAL Placement Area Admixture A340 36.2 OZ Footings walls X Columns X Grade Beams Other - Slab/Deck Slab Pilings Other Air Ent.(oz/cwt.) - j Grids CMU WALL B LINE 7-8; 8 LINE B-E.2; COLUMNS A@ 3, 3.75, AND 4.4; SAMPLE LOC: B LINE @ 7-8 TOW water Added on Job(gals.) 10 Field Test Methods Remarks PLACED BY PUMP; 2X CONSOL ASTM C143 N. ASTM C138 ❑. 5TH OF 9 YDS TESTED ASTM C1064 W ASTM C173 ❑. ASTM C31 ® Other W/C= .49 Inspector K BINNS Reviewed By Laboratory Data Design Strength 2000 Date Specimens Rec'd. 4-28-2009 Cyl. Test Dia Length Max. Comp. Tested Break Lab Test Method Code Date Age Dim. Area Load Str.(psi) Set# By Type ASTM C39 P16412- 05/04/09 7 3X6 10.81 26430 2,440 IBF 1 ASTM C109 ❑ P16412- 05/25/09 28 3X6 10.82 32405 2,990 ZL 3 ASTM C617 ASTM C1231 ❑ P16412- 05/25/09 28 3X6 10.82 34290 3,170 ZL 2 ASTM C1019 ❑ P16412- 05/25/09 28 3X6 10.82 33350 3,080 ZL 2 Other P16412- Compressive X P16412- Flexural P16412- P16412- Test Results Remarks FR# 116604 X Conforming Non-Conforming Results Reviewed By Date Reviewed odes for Break Types: 1. ConeF1 2. Cone&Split 0 3. Cone&Shear11 4. ShearF1 5.Columnar(Split) .-,� WELUINU KraZan & Associates , Inc . REPORT NO. n GEOTECHNICAL ENGINEERING • ENVIRONMENTAL ENGINEERING CONSTRUCTION TESTING AND INSPECTION DATE: /Z-6 9 CONTRACTOR: �� �y vN✓jUl.7�� PROJECT#:/e6 -4Po S/O PERMIT N0: PROJECT: t�i9fELl/A�' INSPECTOR: LOCATIONtaU941;ZyF- JURISDICTION: KRAZAN PROJECT MANAGER: WEATHER: TEMP: 5-9'0 ❑ FIELD ❑ SHOP WELDING ❑ M.T. ❑ P.T. ❑ V.T. item(s)inspected: /AJ 7 -W/Tif#r . .Z25400 tAA THE"A!M40 Y�pl ows .p yA 'rsAl ?�R.�s��.�uT.A�Tir�G �Y/SHE d'TEEC �/IECTio�C'o•v'm�vr�.e ©iv f/Osy Tv l�YJU.�t//Y/�vl�ss'L*T 77f/ASF CO/tr/VF;'T/ON,J, /yAS-"C/A*b -rT"D L�o�?TACT 2nww Foe ANA TWQaU6/f Ze,-A-ime V T 7war 7�0�dT'�, I.V�Ot)'.a�CE•vTT"p TNg.aiP.9iGd"T.�lYl �onlnOE�'7edKf T'D i.Ar,14,7 IIrW .4i✓D /JJ.4 BArf- Oiy TwPLmwv -r o ?s�g7�?A6'�', �'�h�l� �� ivy , /Rw AoW4 AoDAcey.IAlAaw eFm F, ❑ Position: FLAT VERITCAL HORIZONTAL OVERHEAD ❑ Filler Metal: ❑ Process: SMAW FCAW GMAW SAW ❑ Other: ❑ Weld Type: FILLET C.P. P.P. PLUG ❑ Other: ❑ Weld Size 3/16" 1/4" 5/16" 3/8" ❑ Other: ❑ Codes: AWS AISC TITLE 21 TITLE 24 UBC ASME To the best of my knowledge,the above WAS/WAS NOT performed in accordance with the approved plans,specifications,and regulatory requirements. Superintendent/Representative: Techni Serving the We ern United States This field report indicates our inspector's observation and testing results based on the site condition and contractor's 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.Some information on this report has been provided by others on site. Revision 1 Effective Date:11/15/07 The information provided in 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. JUL-13-2009 15:28 P.01iO3 a FAX COVER SHEET This is page J.of I page(s). If you do not receive the entire transmission, or experience difficulties, please call Hargis Engineers at (206)448-3376, Company: Mason County Building Department Date: 7:13.09 To: Deborah Coker From: Charlie Musser Project: Safeway 1571 Selfair Project No.: 08114 Subject: Emergency Lighting Fax No.: 360.427.7798 Phone No.: Comments: C� RZEVISED _.�DATE, HARG1S aoo Stewart street t lJ s�je�,1000 Seattle,WA 98101 t 1206.44&3376 f 1206.448."50 w(hirais.b)2 _ ,+.i,,...'....._...._-ENGINEE.•:...._..-- 119 1:(�1J1�7-, tl?1'1 �f R S JI,JL-13-2009 15:28 P.O2/03 Charlie Musser From: Charlie Musser Sent: Thursday, July 09, 2009 9:27 AM To: 'rickh@woodmanconstruction.com' Cc: Michael Logan Subject: SWY 1571 -emergency lighting Rick, Attached is signed PDF sketch of the lighting plan with added emergency lighting in the expansion area of Safeway #1571. Regards, Charles Musser Electrical HARGIS ENGINEERS 600 Stewart Street Suite 1000 Seattle, WA 98101 www.hargis.biz d: 1 206.859.5382 ck' 1 206.448.3376 f 1 206. 448.4450 -----Original message----- From: 10thF1rCopier@hargis.6ea (mailto;10thFlrCopier@hargis.sea] Sent: Thursday, July 09, 2009 9:36 AM To: Charlie Musser; Michael Logan Subject: 10th Floor Copy Machine The following document has been scanned on the Fiery and attached to this email: Sfiery09070909182.pdf l r c V, � 1 - MGM I iI`�11mgI I �ii i I�1 ti► r���■■f� .firm �RM mfw■iff� ir. VAIN CFO `_ �Al NMI IFROM SHEETTITLE LIGHTING FLOOR PLAN SHEET NO. _ �� _""'.' /,'`� `? � 1►1J ell �� , ► r. I FIELD REPORT NO: A*-;5v5M3KraZan & Associates , Inc . GEOTECHNICAL ENGINEERING • ENVIRONMENTAL ENGINEERING CONSTRUCTION TESTING AND INSPECTION DATE: CONTRACTOR: PROJECT#: JURISDICTION: PROJECT: PERMIT#: LOCATION: INSPECTOR: KRAZAN PROJECT MANAGER: WEATHER: TEMP: Equipment/Asset Number(s): To the best of my knowledge,the above WAS{WAS NOT performed in accordance with the approved plans,specifications,and regulatory requirements. Superintendent/Representative: Technician: Serving the Western United States This field report indicates our inspector's observation and testing results based on the site condition and contractor's 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.Some information on this report has been provided by others on site. Revision 2 1502 FieldReoorr.dnc ^" ""'^' woodman C O N S T R U C T 10 NO Request for Information 3 Lake Bellevue Drive#201 Bellevue,WA 98005 P 425.454.3621 F 425.454.6918 Project A 47001-- 1571 Belfair Remodel Project Address: 23961 NE State Route 3 Belfair,WA 98528 RFI A 20-Non Potable water Date:06/02/09 To: From: Lu Wei Hioe Rick Hendrickson Mulvanny G2 Architecture Woodman Construction Inc. 601 SW 2nd Ave,Suite 200 3 Lake Bellevue Dr.,Suite#201 Portland, OR 97204 Bellevue,WA 98005 Phone:503-223-8030 Phone: 425-454-3621 Fax.971-998-1615 Fax: 425-454-6918 Email.luwei.hioe@mulvannyg2.com Email.rickh@woodmanconstruction.com CC., Sharon Bredeson-Safeway,Inc.-Phone:425-201-6405-Fax.425-637-2206, Joe McLaughlin-Woodman Construction Inc.-Phone:425-454-3621-Fax 425-454-6918, Brad Williams-Williams Mechanical,Inc.-Phone:425-303-0928-Fax.425-339-9244 Response Required By. Status: Preferred Return Method: 06/03/09 Initial E E=EMAIL; F=FAX;M=PRINT(MAIL) Submittal#. Drawing#. Addendum: Spec Section: Schedule#. M 1.2 Information Requested: Drawing M1.2 shows 3/4" non potable water line running along grid E in new addition to backs of new produce cases,at grid 7,for manual case wash down.Water supply throughout store is potable water. Was the intent to have these lines labeled filtered water(RO)for the misting system and non filtered water for case wash down? Consultant Response: Non-Potable Tempered Water(NPTW)piping shall be connected to the produce cases for manual wash down. RO(Reverse Osmosis)piping shall be connected to the misting system and shall be PEX piping from the RO unit to the produce cases. Both NPTW and RO piping are routed through RPBA(Reduced Pressure Backflow Assembly)devices and considered dedicated non-potable water after passing through the RPBA devises. See detail 16/M4.1 for piping detail. By:Del Santjer on behalf of Hargis Engineers,INC. Date:June 8,2009 MASON COUNTY PERMIT NO. 8)m , okz[a z/ BUILDING PERMIT APPLICATION 426 W. Cedar•P.O. Box 186, Shelton, WA 98584 Shelton (360) 427-9670•Belfair(360) 275-4467• Elma (360) 482-5269 On the web www.co.mason.wa.us lAPPLICANT INFORMATION CONTRACTOR INFORMATION Owner % W mi l W- Company Name MOOD 14 W CON.S•ttl"G11 ON 1 NC• Mailing Address It Nf . Mailing Address U Citylbp'"Avyta� JoLk Zip Code 0 City 6EL.t.f:�/IPE State .A Zip Code Phone 7C• Other Ph. S Phone 42�C:4g4."z( Other Ph. Lien/Title Holder Contractor Reg.# I1& 0 Exp. E mail address t •&ak, E Mail Address ('e%i"e- W�oaLek DONS-1mC4ian-ctbh Drivers Lic.# DOB Drivers Lic.# JOB SEPTIC/WATER SYSTEM)NFORMATION -Connect to New Se tic Existing Septic Connect to Water System _I/Name of Water System J12S(.4:' IZ InfPrt Ptjff4t T :W 1 Well Water System Name of Water System PARCEL INFORMATION-12 Digit Parcel No 0 10 Fire District Legal Description bLA 1 I 3Z Site Address(Please include street name, streetnumber and city) Z 3 Directions to site s�3 -NlR. �F s�'3 �- OLt� p .1. A�tiR. WN6�Nw/N Will timber be cut and sold in parcel preparation?Yes No Is property within 200'of Saltwater h 1l) Lake It4b River/Creek t40 Pond h'0 . Wetland al0 Seasonal Runoff-_pia,_Stream N O Slopes or Bluffs > 15% Is this rmlt subnektmeI the result of a Stop Work Notice,Correction Notice or other enforcement action?Y o TYPE OF JOB-New Add-,K_Alt Repair Other PRIMARY RESIDENCE SEASONAL ❑ P R•Use of Buildin escrib Work 6- No. of Bedrooms No.of Bathrooms Square Footage- 1 st Floor 00. Oft S11�r 2nd Floor 3rd Floor Basement — Deck Covered Deck — Other Sq.ft.Garage -, Attached - Detached Carport — Attached _ Detached — MANUFACTURED HOME INFORMATION - Make Model Year Length Width Serial No. No. of Bedrooms Type of Heat Purchase Price$ Replacement Unit. Installer Name Certification No. OWNER/BUILDER AcknowkAges submission of inaccurate information may result in a stop work order or permit MdJaMn!A61114MIedgement of such is by signature below.I declare that I am the owner,owners legal representative,or the contractor.I further declare that I am entitled to receive this permit and to do the work as proposed in the application.I declare that I have obtained the permission from all � I i ,ssion is required from any easement holier or any other party in interest regarding this application or the work p m application,I have obtained permission from them to apply for this permit and conduct the work proposed. The owner or agent on owners behalf,represents that the information provided is accurate and grants employees of Mason County access to the above described property and structure for review and inspection. PRO F OF CON INUATION OF ORK IS BY MEANS OF A PROGRESS INSPECTION. Ix — L4L Wl-.t Ww-— MUW)kNWyAZ bttTeen�i��) 10. 1)3. 08 . Own<Owners'R resents e/Contractor indicate which one FOR OFFICIAL USE BEYOND THIS POINT Accepted by: Date DEPARTMENTAL REVIEW APPROVED DENIED NOTES Building Department Planning Department Environmental Health Department Public Works Department Fire Marshal FEES Building Permit Fee Site Ins ection Plan Review Fee EH Review Fee Plumbinq&Base Fee Planning Review Fee Mechanical & Base fee Other Wood/Gas/Pellet Stove Fee State Fee Violation Fee Pre-Paid at Submittal Valuation$ TOTAL FEES MASON COUNTY PERMIT N0.S8)111 k-aQ 1 BUILDING PERMIT APPLICATION 426 W. Cedar• P.O. Box 186, Shelton, WA 98584 Shelton (360) 427-9670• Beifair(360) 275-4467• Elma (360) 482-5269 On the web www.co.mason.wa.us APPLICANT INFORMATION CONTRACTOR INFORMATION Owner I W, ' _ Company Name hL4�?D M AA�V 0 �'ft DN, 1 NC• Mailing Address 1t Nt- . Mailing Address city$g kwigy4 -I&Lk Zip Code 0 City 16F1.t,,G�1!'UP State�._Zip Code Phone 4 �to Other Ph. 0 Phone 454."?d Other Ph. Lien/Title Holder Contractor Reg..# lj(raD6-Exp. E mail address •l.0� E Mail Address et*#- W0 1r "_&1+'N.C�io'n.ctz►1 Drivers Lic.# DOB Drivers Lic.# JOB SEPTIC/WATER SYSTEM)NFORMATION -Connect to New Se tic Existing Septic Connect to Water System V Name of Water System-.92 w� ptfi'C1G GT 1 Well Water System Name of Water System I PARCEL INFORMATI N- 12 Digit Parcel.No of Fire District Le al Descri tion g * T 0z 9 p 1167 Site Address(Please include street name street number and city) s- S Directions to site C.422L I tF,Q. OF Sty -3 9' O L6 1 i1t t4o?' 141 fam PN Will timber be cut and sold in parcel preparation?Yes No Is property within 200'of Saltwater h if) Lake Alb River/Creek AID Pond 110 Wetland #Jo �Seasonal Runoff-JI.Z —Stream Nfl Slopes or Bluffs � 1 %Is this t submittal the result of a Stop Work Notice,Correction Notice or other enforcement action?Yen/No.) _. TYPE OF JOB-New Add-X Alt Repair Other PRIMARY RESIDENCE f 1 SEASONAL ❑ Use of Building 51 per- IIAI LLjbescribe Work p 4p- No.of Bedrooms No. of Bathrooms Square Footage- 1 st Floor YO• 42p S 2nd Floor - 3rd Floor Basement---..-- Deck Covered Deck - Other r Sq.ft. — Garage Attached Detached Carport - Attached Detached — MANUFACTURED HOME INFORMATION - Make Model Year Length Width Serial No. No. of Bedrooms Type of Heat Purchase Price$ Replacement Unit? ad_ Installer Name Certification No. OUVNER/BOLDER Admowledges submission of inaccurate information may result in a stop work order or permit nt of such is by signature below.I declare that I am the owner,owners legal representative,or the contractor.I further declare that I am entitled to receive this permit and to do the work as proposed in the application.I declare that I have obtained the permission from all laIulP ssion is required from any easement holder or any other party in interest regarding this application or the work n application,I have obtained permission from them to apply for this permit and conduct the work proposed. The owner or agent on owners behalf,represents that the information provided is accurate and grants employees of Mason County access to the above described property and structure for review and inspection. PRO F OF CONTINUATION OF ORK IS BY MEANS OF A PROGRESS INSPECTION. X U&Wit WVF__ MULVANN� Z Ala -b�t�ctt�K�.) c0. 0 3. 08 Ownarl�bwners Fie r e/Contractor indicate which one FOR OFFICIAL USE BEYOND THIS POINT Accepted by: Date DEPARTMENTAL REVIEW APPROVED DENIED NOTES Building Department Planning Department Environmental Health Department 07 Public Works Department Fire Marshal FEES Building Permit Fee Site Inspection Plan Review Fee EH Review Fee u C) Plumbing&Base Fee Planning Review Fee Mechanical& Base fee Other t.✓D� d Wood/Gas/Pellet Stove Fee State Fee Violation Fee Pre-Paid at Submittal Valuation$ TOTAL FEES MASON COUNTY PERMIT NO. 8)m 7Xk-:oQ Z I BUILDING PERMIT APPLICATION 426 W. Cedar• P.O. Box 186, Shelton, WA 98584 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, %*"Ii I ir,AG ' Company Name WOODM A4V ,GONS'L2�C'Ct DM a 1 NC• Mailing Address f Mailing Address C Dolly, , to -hLJk Zip Code 0 City PPFIA"UM State _Zip Code Phone • 6 Other Ph. VZm Phone 21 Other Ph. Lien/Title Holder Contractor Reg..# j jl. 0(Z Exp. E mail address - E Mail Address e0f_ W WA40 g �!'+'u.C�410'n•COkv~% Drivers Lic.# DOB Drivers Lic.# vOB SEPTIC/WATER SYSTEM)NFORMATION -Connect to New Septic Existing Septic I Connect to Water System mo_Name of Water System,$�XP4�. wpm• dtatttt.cr & t Well Water System Name of Water System PARCEL INFORMATION- 12 Digit Parcel No, 1 I CM OI Fire District Legal Description 32' 47 Site Address(Please include street name,stree number and city) P-MG I A1F, 0R-1 ,SJl`(12-A - &01*AWQ, Directions to site N SR- ®F s�—3 DLO .l,�ArIIR. WM 6rM nl PA/ Will timber be cut and sold in parcel preparation?Yes No Is property within 200'of Saltwater hill Lake 114b River/Creek AID Pond 1f0 Wetland idn Seasonal Runoff NA Stream N O Slopes or Bluffs > 15% Is this pwmtt submittal the result of a Stop Work Notice,Correction Notice or other enforcement action?Yeikfftj TYPE OF JOB-New Add_)! _AltX Repair Other PRIMARY RESIDENCE SEASONAL ❑ j Use of Building 50 VE I1AF1C"Ibescribe Work P `- No. of Bedrooms No. of Bathrooms Square Footage- 1 st Floor Otiv 3t= 2nd Floor 1 ow Kam ad 3rd Floor Basement — Deck " Covered Deck — Other -- Sq.ft. Garage Attached - Detached Carport — Attached - Detached — MANUFACTURED HOME INFORMATION - Make Model Year Length Width Serial No. No. of Bedrooms Type of Heat Purchase Price$ Replacement Unit? Installer Name Certification No. CWNER/BUILDER Admowledges submission of inaccurate information may result in a stop work order or permit of such is by signature below.I declare that I am the owner,owners legal representative,or the contractor.I further declare that I am entitled to receive this permit and to do the work as proposed in the application.I declare that I have obtained the permission from all y Q"NWssion is required from any easement holder or any other party in interest regarding this application or the work p in t e appfication,I have obtained permission from them to apply for this permit and conduct the work proposed. The owner or agent on owners behalf,represents that the information provided is accurate and grants employees of Mason County access to the above described property and stricture for review and inspection. PRO F OF C NUATION OF ORK IS BY MEANS OF A PROGRESS INSPECTION. x I L4&W&t WDF—— MuUV A1NOYA Q�-r ciWIuK Own Owners Re resents e/Contractor indicate which one FOR OFFICIAL USE BEYOND THIS POINT Accepted by: Date DEPARTMENTAL REVIEW APPROVED DENIED NOTE Building Department 0 -5 rg Planning Department Environmental Health Department Public Works Department Fire Marshal FEES Building Permit Fee / 522•06, Site Inspection JFC 4 3 Plan Review Fee 33 EH Review Fee Plumbing& Base Fee Planning Review Fee Mechanical& Base fee v OtherG Wood/Gas/Pellet Stove Fee State Fee Violation Fee Pre-Paid at Submittal C3 Valuation$ `f 1 a TOTAL FEES MASON COUNTY PERMIT NO. 8)m z. azzc /;, BUILDING PERMIT APPLICATION 426 W. Cedar• P.O. Box 186, Shelton, WA 98584 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 S"Wru I Mt. • Company Name W#0014 W C0/019,W,"Ct ow s I NC• Mailing Address f • Mailing Address &t City �w to _%Lk Zip Code D City t/ _State W Ar Zip Code Phone 4 7C, Other Ph.424 1M.El 9 Phone Other Ph. Lien/Title Holder Contractor Reg..# J j` alz Exp. E mail address L E Mail Address IP A W00 a+S•truC4io►+•cq,►% Drivers Lic.# DOB Drivers Lic.# JOB SEPTIC/WATER SYSTEM)NFORMATION-Connect to New Septic— Existing Septic f Connect to Water System I/Name of Water System'�9A-1t:1 F1 W kt oyL t7tsurg4 G4 AV I Well Water S stem Name of Waters stem PARCEL INFORMATION- 12 Digit Parcel No 1z'50 11"0110 Fire District IF Legal Description g T $Z Site Address(Please include street name,street;number and city) ma S Directions to site 1F.Q• OF s2'3 t!- OLAl. +ttilZ. W16.Nw PN Will timber be cut and sold in parcel preparation?Yes No Is property within 200'of Saltwater h 110 Lake alb River/Creek AID Pond- hfO . Wetland . k1Q_Seasonal Runoff 41A Stream #4 O Slopes or Bluffs > 15% Is this g2M submittsl the result of a!!M Work Notice,Correction Notice or other enforcement action?.Y o TYPE OF J -New Adder.' Altk Repair Other PRIMARY RESIDENCE SEASONAL ❑ Use of Building 6V p1rA4� jbescribe Work P j 6- No. of Bedrooms No. of Bathrooms Square Footage- 1 st Floor's• 4ov S l�* 2nd Floor — t 3rd Floor Basement----- Deck Covered Deck — Other Sq.ft.Garage Attached - Detached Carport Attached -- Detached — MANUFACTURED HOME INFORMATION-Make Model Year Length Width Serial No. No. of Bedrooms �°�9 Type of Heat Purchase Price$ Replacement Unit? e ` tTVM Installer Name Certification No. OWNER/BUILDER Adviowledges submission of inaomrate information may result in a stop work order or permit 7ledgernent Of such is by signature below.I declare that I am the owner,owners legal representative,or the contractor.I further declare that I am entitled to receive this permit and to do the work as proposed in the application.I declare that I have obtained the permission from all y W UI ssion is required from any rest easement holder or arty other party in inte regarding this application or the work p in application,I have obtained permission from them to apply for this permit and conduct the work proposed. The owner or agent on owners behalf,represents that the information provided is accurate and grants employees of Mason County access to the above described property and stricture for review and inspection. PR OF CON11NUAIION OF ORK IS BY MEANS OF A PROGRESS INSPECTION. X L.kWo-t Wes— MUL VAN9yA2_ W WTF-C-'W9r—) to. 03, o8 Own Owners Re resents e/Contractor indicate which one FOR OFFICIAL "BEYOND THIS POINT Accepted by: Date DEPARTMENTAL REVIEW APPROVED DENIED NOTES Building Department Planning Department Environmental Health Department Public Works Department Fire Marshal FEES 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 Valuation$ TOTAL FEES MASON COUNTY PERMIT NO. PLUMBING/MECHANICAL PERMIT APPLICATION 426 W. Cedar•P.O. Box 186, Shelton,WA 98584 Shelton(360)427-Z67%•Belfair(360)275-4467•Elma(360)482-5269 n t e wep www.co.mason.wa.us APPLICANT INFORMATION CONTRACTOR INFORMATION Owner We— • Company NameWl A0114GONST12t1GTi ynl,Nir- Mailing Address V Mailing Address City u state W Pr Zip Code City u• State WL Zip Code 45' Phone • I• b 4 Other Ph �-1 •51SZ PhonA •T'�'• �i Other Ph. Lien/Title Holder Contractor Reg. # W OW _ 678 Ex . E mail address E Mail AddressfLft COM c"I • 50". Drivers Lic.# DOB Drivers Lic.# DOB SEPTIC INFORMATION -Connect to New Septic Existing Septic Connect to Sewer System Name of Sewer System PARCEL INFORMATION- 12 Digit Parcel No Fire District Legal Description G - 5 S �rzv E z 6 Site Address(Please include street name,street number and city) Z Directions to site LOR-ItsIM Or- SE-3 b- OLD 2,V14-A4r_ th6gm A Is property within 200'of Saltwater pI fl Lake Na River/Creek N a Pond N 22 Wetland AID Seasonal Runoff AID Stream NO Slopes or Bluffs > 15% iJ0 TYPE OF JOB-New Add X Alt k Repair Other Use of Buildin f'F.�fNI Location of Fixtures/Units- 1st FIooL,2� 2nd Floor Basement — Garage--,—.- Closet PLUMBING IXTUR (Show Number of each) MECHANICAL UNITS Type of Fixture No.of ixtures Fees Fuel Type:Electric_LPG—Natural Gas-,)L-Heat Pump_ Toilets e_ W PVt Type of Unit No.of Units Fees Bathroom Sink Furnace ' Bath Tubs Heatpumps •- Showers Spot Vent Fan Water Heater Propane Tank Clothes Washer Gas Outlets _ Kithen Sinks fi�� E, 2. DaVeLk-r Wood/Gas/PelletStove Dishwasher ( YR"r 4 Iaml — Kitchen Exhaust Hood 2Zi��tS-fIN4) Hosebibs Dryer Vent Other (I f M l I odcq Other-WMF-iML t N row Base Fee V9V*v$'T Basle-Fee TOTAL PLUMBING rrP'C 'LTOTAL MECHANICAL OWNER/BUILDER Acknowledges submission of inaccurate information may result in a op order or pe it revocation.Acknowledgement of such is by signature below.I declare that I am the owner,owners legal representative,or the contractor.I further declare that I am entitled to receive this permit and to do the worts as proposed in the application.I declare that I have obtained the permission from all the necessary parties.If permission is required from any easement holder or any other party in interest regarding this application or the work proposed in the application,I have obtained permission from them to apply for this permit and conduct the work proposed. The owner or agent on owners behalf,represents that the information pro 'clad is accurate and grants employees of Mason County access to the above described property and structure for review and inspection. PR F OF CONTINUATION OF WORK IS BY MEANS OF A PROGRESS INSPECTION. X �1r{. L.f� �Iktibe.- �ULVATtNYC-I�, � tdH'CELZ�P_frs) t'.0 .03 t)$ Owner ners Representati Contractor (indicate which one) FOR OFFICIAL USE BEYOND THIS POINT Accepted by: Planning Pd Ck# Date Bid Pd Receipt No. DEPARTMENTAL REVIEW APPROVED DENIED NOTES Building Department Occ Group—Type Constr. Planning Department Environmental Health Department FEE Plumbing&Base Fee Site Inspection Mechanical & Base fee UFC Plan Review Fee Wood/Gas/Pellet Stove Fee Other Violation Fee TOTAL FEES i PERMIT NO. MASON COUNTY PLUMBING/MECHANICAL PERMIT APPLICATION 426 W.Cedar•P.O.Box 186, Shelton,WA 98584 Shelton(360)427-M •Bel('air(36t))27a-4467•Elma(360)482-5269 the we www t;o.mason.w , APPLICANT INFORMATION CONTRACTOR INFORMATION OwnerINC- • Company NarnewmAw eA4 Mailing Addres ""' Mani Add l lML& plelV City 4-�S to_!tom Zip Code City u _State Zip CodehL Phon 1• bt Other Ph .51 Phone ' .1 Other Ph. Lien/Title Holder Contractor Reg. # o Exp. E mail address 4A14 r► !t •cow, E Mail AddresseALV& W0004"41,,WkSirK.060101 , cDrr. Drivers Lic.# DOB Drivers Lic.# DOB SEPTIC INFORMATION - Connect to New Septic Existing Septic Connect to Sewer System Name of Sewer System PARCEL INFORMATION- 12oDigit Parcel No Fire District XE Legal Description w1RV E i' zkl Site Address(Please include street name, street number and city) Z.11bi tie lQ-3 t2 Directions to site L R W ele- Dr- SL-3 '- OLO bklk 1 Iih6th tl A Is property within 200'of Saltwater A l t7 Lake nm River/Creek A)a Pond Al a Wetland P40 Seasonal Runoff AID_Stream Na Slopes or Bluffs > 15%_ �0 TYPE OF JOB - New Add X Alt X Repair Other Use of Buildi Location of Fixtures/Units- 1 st FlooL.X- 2nd Floor Basement - Garage - Closet -- PLUDBING FIXTURES Show Number of each) MECHANICAL UNITS Type gi Fixtur No, f Fixtures Fees Fuel Type:Electric_LPG—Natural Gas_K_Heat Pump_ Toilets` , C. U,1LLW W11- Type of Unit t i Fees BathrooPq'MWti4-; Furnaceut,p�� Q Bath Tubs - ,(�� Showers Spot Vent Fan Flo Water Heater Propane Tank Clothes Washer - Gas Outlets _ Kithen Sinks 3 —CIM, L PCV6% -, Wood/Gas/PelletStove -• Dishwasher ( YRef, 4 *pt/�— Kitchen Exhaust Hood e: Hosebibs Dryer Vent , Other (I LL1S1 l och Othe?'w Mr-MCA '�C'IF-IT Base Fee e TOTAL PLUMBING i FPT ';TOTAL MECHANICAL 1 CVVNER/BUILDER Acknowledges submission of inaccurate information may result in a op order or anit revocation.Admowledgement of such is by signature below.I declare that I am the owner,owners legal representative,or the contractor.I further declare that I am en*W to receive this permit and to do the work as proposed in the application.I declare that I have obtained the permission from all the necessary parties.If permission is required from any easement holier or any other party in interest regarding this application or the work proposed in the application,I have obtained percussion from them to apply for this permit and conduct the work proposed. The owner or agent on owners behalf,represents that the information Countyprovided is accurate and grants of Mason access to the above described r and structure for review and inspection. PRTDFNUA'f W CONTI N OF employees WO B MY EANS OF p A PROGRESS INSPECTION. X L.k (;.Iktib�e.— NI U WkN N Y Ca Z 'C ZV R1�) l 0 .0 3.0$ Owrie ers Representati Contractor (indicate which one) FOR OFFICIAL USE BEYOND THIS POINT Accepted by: Planning Pd Ck# Date Bid Pd Receipt No.. DEPARTMENTAL REVIEW APPROVED DENIED NOTES Building Department Occ rour)—Type Constr. Planning Department Environmental Health Department FEE Plumbing&Base Fee Site Inspection Mechanical&Base fee UFC Plan Review Fee Wood/Gas/Pellet Stove Fee Other Violation Fee TOTAL FEES Look Up a Contractor, Electrician, Plumber or Elevator Professional License Detail Page 1 of 3 .. ._........ _..._1[ Information in Spanish ( Topic Index ( Contact Info I j _ ,__- 'E Home Safety Claims&Insurance Workplace Rights Trades&Licensing Find a Law(RCW)or Rule(WAC)" ;Get a form or publication Return to List > Start a New Search > Printer friendly General/Specialty Contractor A business registered as a construction contractor with LEH to perform construction work within the scope of its specialty. A General or Specialty construction Contractor must maintain a surety bond or assignment of account and carry general liability insurance. Business and Licensing Information Verify Workers' Comp Premium Status Check for Dept. of Revenue Account Name WOODMAN UBI No. 40 600529580 CONSTRUCTION INC Phone No. (425) 454-3621 Status ACTIVE Address 3 LAKE BELLEVUE DR 201 License No. WOODMC116706 Suite/Apt. License Type jo CONSTRUCTION CONTRACTOR City BELLEVUE Effective Date 9/26/1984 State WA Expiration Date 1/5/2011 Zip 98005 Suspend Date jo County KING Lice Previous WOODMC*172ML nse Business Type CORPORATION Next License Parent Associated Company License Specialty 1 jO GENERAL Specialty 2 jo UNUSED 0 Business Owner Information ® Hide All Name Role Effective Date Expiration Date WOODMAN, PETER J 01/01/1980 WOODMAN, MARTHA C 01/01/1980 https://fortress.wa.gov/lni/bbip/Detail.aspx?License=WOODMCI16706 12/23/2008 MASON COUNTY PUBLIC WORKS DIRECTOR/COUNTY ROAD ENGINEER Shelton, Washington 98584 TO BE KEPT IN THE DATE: Ddecember 16, Zoos PARCEL FILE INTER-DEPARTMENTAL COMMUNICATIONS i TO: Jim Schulz PARCEL# 12329-41-00010 FROM: Fred Penvman/Enaineer Tech III-PW PERMIT NUMBER: Com2008-00121 SUBJECT: Stormwater Review NAME: Safewav Jim, The stormwater checklist for the Safeway Remodel in Belfair has been received and reviewed by Public Works. The package included the checklist explaining where In the report or plans each item on the checklist has been addressed. The checklist is stamped and signed by a licensed engineer. This review has determined that all the minimum requirements, as outlined in the stormwater checklist, have been addressed. However this review is not intended to be a technical review. Mason County Public Works recommends acceptance of the stormwater plan based on the provided checklist. All engineers recommendations, of the stormwater plan and drainage report, should be made conditions of permit issuance. Adequate erosion and sediment control features need to be implemented during land disturbing activities to protect neighboring properties and State waters from adverse stormwater runoff impacts. The migration or release of silty water or mud from the applicant's property will be considered a violation of County and State water quality protection regulations. i Please feel free to contact me at 625 if you have any questions regarding these comments. Sincerely. Fred Perryman i RECEIVED DEC 12 W Y PUBLIC WORKS BUSH, ROED & HITCA NC.trT LETTER OF TRANSMITTAL Civil Engineers/Land Surveyors M 2009 Minor Avenue East Date: December 11,2008 Seattle,WA 98102 EUMPhone:(206)3234144 Job No.: 2000289 Fwc(206)323-7135 To: Fred Perryman Re: Belfair Safeway Mason County Public Works PO Box 1850 Shelton, WA 98584 TO BE KEPT IN THE PARCEL FILE WE ARE SENDING YOU ATTACHED via US MAIL the following items: ❑ Prints ❑ Wars ❑ Vellums ❑ Specifications Contracts ❑ Calculations ❑ Legal documents ® Other COPIES DATE NO. DESCRIPTION 1 Mason County Stormwater Checklist THESE ARE TRANSMITTED as checked below: ❑ For approval ❑ For review and comment ❑ For your information ® For your use ❑ For execution and return ❑ For your file ® As requested ❑ For submittal ❑ Other REMARKS AND INSTRUCTIONS: Fred— Attached please find the original copy of the stormwater checklist that you requested. COPY TO: SIGNED: Jay D.Decker,PE Mason County Stormwater Checklist County Project# IQM 2,O O--0012.1 Project Name Remodel Safeway. Store#1571 Twnsp,Sec,Range TWP 23 N. SE 1/4 SEC 29,RNG 1 W., W.M. Minimum Re uir ments of 1992 Stormwater Manual q e The stormwater checklist identifies the minimum requirements of the 1992 Stormwater Manual. The checklist is intended to identify the locations within the plan that addresses the minimum requirements. Mason County will not perform a technical evaluation of the submittal. Rather,the checklist provides a guide to allow Mason County to review the submittal and determine if the applicant has addressed the minimum features that make up a stormwater plan. It is incumbent upon the applicant and his/her engineer to fulfill all the applicable requirements of the 1992 Stormwater Plan as it relates to the proposed project. Review by Mason County is intended to determine if the plan has addressed the minimum requirements and should not be considered a review for technical accuracy of the plan. During construction of the project,the stormwater plan engineer of record or his/her authorized representative shall inspect the site to ensure the stormwater plan is being implemented as designed. Upon completion of the project,the engineer or his authorized representative shall be required to certify that the stormwater plan has been implemented as designed. Failure to meet the minimum requirements could result in delay or rejection of the application until the deficiencies are corrected. #1: Erosion and Sediment Control.All new development and redevelopment that includes land disturbing activities of one acre or greater shall comply with erosion and sediment control requirements 1 through 14, below. Compliance with the Erosion and Sediment Control Requirements shall be demonstrated through implementation of a large parcel erosion and sediment control plan. All new development and redevelopment that includes land disturbing activities of less than one acre shall comply with the small parcel minimum requirements found in Section 14.48.130, Compliance with the small parcel requirements shall be demonstrated through implementation of a small parcel erosion and sediment control plan. Erosion and Sediment Control Requirement#1: Stabilization and Sediment Trapping. See page/paragraph SEE SHEET C2 &C4. SMALL PARCEL MIN. REQUIREMENTS APPLY. Erosion and Sediment Control Requirement#2: Delineate Clearing and Easement Limits. See page/paragraph SEE SHEET C2&C4. Erosion and Sediment Control Requirement#3: Protection of Adjacent Properties. 1 See page/paragraph SEE SHEET C2&C4. Erosion and Sediment Control Requirement#4:Timing and Stabilization of Sediment Trapping Measures. See page/paragraph SEE SHEET C2 &C4. Erosion and Sediment Control Requirement#5: Cut and Fill Slopes. See page/paragraph SEE SHEET C2& C4. Erosion and Sediment Control Requirement#6: Controlling Off-Site Erosion. See page/paragraph SEE SHEET C2&C4. Erosion and Sediment Control Requirement#7: Stabilization of Temporary Conveyance Channels and Outlets. See page/paragraph SEE SHEET C2 & C4. Erosion and Sediment Control Requirement#8: Storm Drain Inlet Protection. See page/paragraph SEE SHEET C2& C4. Erosion and Sediment Control Requirement#9: Underground Utility Construction. See page/paragraph SEE SHEET C2& C4. Erosion and Sediment Control Requirement#10: Construction Access Routes. See page/paragraph SEE SHEET C2& C4. Erosion and Sediment Control Requirement#11: Removal of Temporary BMPs. See page/paragraph SEE SHEET C2 &C4. Erosion and Sediment Control Requirement#12: Dewatering Construction Sites. See page/paragraph SEE SHEET C2 &C4. Erosion and Sediment Control Requirement#13: Control of Pollutants Other than Sediment on Construction Sites. See page/paragraph SEE SHEET C2 &C4. Erosion and Sediment Control Requirement#14: Maintenance. See page/paragraph SEE SHEET C2 &C4. Erosion and Sediment Control Requirement#15: Financial Liability. See page/paragraph SEE SHEET C2& C4. ❑#2: Preservation of Natural Dminage Systems. Natural drainage patterns shall be maintained, and discharges from the site shall occur at the natural location to the maximum extent practicable. See page/paragraph SEE SHEET Q. ❑#3: Source Control of Pollution.Source control BMPs shall be applied to all projects to the maximum extent practicable. Source control BMPs shall be selected, designed, and maintained according to an approved manual. See page/paragraph SEE SHEET C2 &C4. 2 ❑#4: Runoff Treatment BMPs.All projects shall provide treatment of stormwater. Treatment BMPs shall be sized to capture and treat the water quality storm, defined as the six-month, twenty-four hour storm. The first priority for treatment of stormwater shall be to infiltrate as much as possible of the water quality design storm into the ground. Pretreatment of stormwater prior to infiltration into the ground may be required. See page/paragraph SEE SHEET Q. ❑#5: Streambank Erosion Control.The requirement below applies only to situations where stormwater runoff is discharged directly or indirectly to a stream, and must be met in addition to meeting the requirements in minimum requirement#4, Runoff Treatment BMPs. See page/paragraph SEE SHEET Q. ❑#6: Wetlands.Stormwater discharges to wetlands shall maintain the wetland's natural hydroperiod and flows to the extent needed to preserve or enhance its existing functions and values. Prior to proposing discharge of higher volumes of stormwater to a wetland, alternative discharge, detention, and infiltration practices located in areas outside the wetland shall be evaluated and employed by the project engineer where feasible and practicable. See page/paragraph N.A. ❑#7: Water Quality Sensitive Areas.Where the Mason County commissioners or their designee determine that the minimum requirements do not provide adequate protection of water quality sensitive areas, either on-site or within the basin, more stringent controls shall be required to protect water quality. An adopted and implemented basin plan (minimum requirement#9) may be used to develop requirements for water quality sensitive areas that are tailored to a specific basin. See page/paragraph N.A. ❑#8: Off-Site Analysis and Mitigation. Downstream Analysis May Trigger Additional Requirements. The project engineer shall provide a detailed qualitative analysis of the flow path of the discharge from the project site to the receiving water. This requirement shall apply to all projects where a drainage and erosion control plan is prepared, including those proposing retention facilities. This analysis shall include flow routing, and provide existing pipe and channel sizes and estimated capacities. In addition, the project engineer shall discuss any known or expected downstream erosion, flooding, or water quality problems, including those that may be caused by interflow from the proposed retention facility. The director or designee shall have the discretion to specify the distance and level of detail to be provided by the project engineer. In making this determination, the director or designee shall consider such factors as the relative size of the new development, availability of other hydrologic work for the drainage area, and the extent to which stormwater generated on the project site is to be infiltrated. See page/paragraph STORMWATER FROM PROJECT WILL INFILTRATE. THEREFORE,N.A. ❑#9: Basin Planning. Basin plan supersedes Manual See page/paragraph N.A. ❑#10: Operation and Maintenance.An operation and maintenance schedule shall be provided for all proposed stormwater facilities and BMPs, and the party(or parties) responsible for maintenance and operation shall be identified. An operation and maintenance(O&M)covenant will be required to cover all privately owned and maintained stormwater facilities approved by the director. O&M Covenant forms are available at the Mason County public works office.A copy of the completed instrument shall be recorded with the county auditors'office by the proponent and a copy of the recorded instrument is required to be submitted to the public works department prior to final approval of the completed permanent stormwater facilities. 3 TO BE KEPT IN THE PARCEL FILE see PF, F, AN o&M sEcnoN WILL BE INwum IN DRAINAGE R RT. [11"l:BOOM LMML P Onnamm big,or odw m tumwft shy be requima lbx aN !o OOsure wfh v%w s. See pas"14,Fog> M- U ICE PRf)VIDED Df ACCORDANCE WITH MA�I�t b0ljNiT UA►�+IDM. I that the 3ftmwaa phn m6mWed for tiis puja t fiMls ale qpliceW provisions Of the im Stormaramr Manual. /f o Date � s31195 CISTER�'G I ApplkmM Date I 4 i BUSH, ROED & HITCHINGS, INC. n BFM Civil Engineers and Land Surveyors Ci g � D TO BE KEPT �N TH�TORM DRAINAGE REPORT FILE 13 p ARDEL For: � Safeway#1571 September 30, 2008 Located at: 12361 NE State Route 3 Belfair, Washington Prepared for: Mulvanny G2 Architecture 601 SW Second Avenue, suite 1201 Portland, Or. 97204 By: yw k.M W 31195 �9 r�NAL � i 0 Jay D. Decker, P.E. BRH Job No. 2000289 2009 Minor Avenue East, Seattle, Washington 98102- Phone 206/323-4144; Fax 206/323-7135 1-800-935-0508 Internet: brhinc.com Z_ 6 Safeway#1571 City of Belfair September 30, 2008 TABLE OF CONTENTS I. PROJECT OVERVIEW II. CONDITIONS AND REQUIREMENTS SUMMARY-4 III. OFFSITE ANALYSIS IV. DETENTION SYSTEM ANALYSIS AND DESIGN 60 V. WATER QUALITY ANALYSIS AND DESIGN `7 VI. CONVEYANCE SYSTEM ANALYSIS AND DESIGN VII. SPECIAL REPORTS AND STUDIES LIST OF FIGURES Figure I —Vicinity Map �! Figure 2 - Expansion Areas Exhibit 1Z Safeway#1571 City of Belfair September 30, 2008 I. PROJECT OVERVIEW The 4.69 acre site is located at 12361 NE State Route 3 in Belfair, Washington. (see Figure 1.) Currently there is an existing Safeway store and parking lot on the site. The project proposes to expand the building on the east side of the site. From a stormwater perspective, this project will have a low impact on downstream systems due to the reduction in stormwater flow(by infiltration of the project area) and an improvement in water quality (be reducing the amount of impervious area subject to vehicular traffic.) For the proposed building expansion area, an infiltration system was sized using the i 2005 Department of Ecology"Western Washington Hydrology Model". The infiltration system will be constructed on the northeast comer of the existing building. A. Location and Site Characteristics The project is located just west of State Route 3 and just north of Clifton Lane. See "Figure 1 —Vicinity Map" in the Appendix. The site is completely developed. Currently the proposed building expansion area is asphalt paved and drainage on the surface flows from east to west (toward the building.) At the curb adjacent to the east side of the building, catch basins collect drainage and stormwater passes to the west side of the site to a regional detention pond. B. Technical Information: 1. Project Name— Belfair Safeway Tax Parcel* 12329-41-00010 2. Type of Development: Commercial 3. Drains to Stream/Creek: Drains westerly to a regional detention pond followed by discharge into piped system. 4. Drainage Basin: Hood Canal 5. Wetlands: None 6. FEMA Floodplain Elevation: N.A., Seeps/Springs: No. 7. High Seasonal Groundwater Table Elevation: N.A. 8. Protected Slopes: No. 9. Flow Control System: Infiltration system proposed on northeast comer of building. 10. Water Quality Features: No, only 4,773 square feet of new asphalt area (removed and replaced) is proposed. 11. Off-site drainage and/or Maintenance Access Easement Required?: No. Safeway#1571 City of Belfair September 30, 2008 12. Hydrologic Model (software) used in designing the stormwater detention, water quality and conveyance system: 2005 Department of Ecology"Western Washington Hydrology Model" used to size the infiltration facilities. I� Safeway#1571 City of Belfair September 30, 2008 II. CONDITIONS AND REQUIREMENTS SUMMARY A. Conditions and Requirements Summary The design of the new stormwater facilities on the site complies with the 2005 Stormwater Management Manual for the Puget Sound Basin. B. Frontage Improvements There are no improvements proposed to adjacent streets. C. Deviations From Standard Requirements None proposed. Safeway#1571 City of Belfair September 30, 2008 OFF-SITE ANALYSIS A. Downstream Analysis and Map: Since stormwater from the proposed building expansion is proposed to infiltrate at the northeast comer of the building, a downstream analysis was not prepared. In fact the volume and rate of runoff from the existing drainage system that drains to the regional detention pond will be reduced as a result of this project. Therefore, no investigation of the downstream system was performed. B. Upstream Analysis: There is no upstream drainage tributary to the site. 01, Safeway#1571 City of Belfair September 30, 2008 III. DETENTION/INFILTRATION SYSTEM ANALYSIS AND DESIGN The Western Washington Hydrology Model version 3.0 was used for analysis of the drainage system. The infiltration system was sized using a collected roof area of 11,550 square feet which exceeds the actual roof area of 7,493 square feet. See Figure 2. The infiltration rate recommended by the geotechnical engineering report is 9.8- inches per hour. The rate used in the model is 9-inches per hour. The analysis demonstrates that the site requires a 10foot wide by 48 foot long infiltration gallery which contains a 36-inch diameter perforated pipe for additional storage. Safeway#1571 City of Belfair September 30, 2008 IV. WATER QUALITY ANALYSIS AND DESIGN Water Quality treatment is required for new or replaced asphalt surfaces that exceed 5,000 square feet. Since there is only 4,774 square feet of new asphalt area (removed and replaced asphalt), water quality treatment has not been provided. See Figure 2. Note, additional water quality improvement will be realized due to the fact that approximately 8,000 square feet of asphalt will be removed by expansion of the building and construction of perimeter sidewalks. Safeway#1571 City of Belfair September 30, 2008 V. CONVEYANCE SYSTEM ANALYSIS AND DESIGN On- Site Drainage Systems: Pipes on the site are sized for the 100 year storm using the rational method. (j6eAM74A )e) i Safeway#1571 City of Belfair September 30, 2008 VI. SPECIAL REPORTS AND STUDIES N.A. Safeway#1571 City of Belfair September 30, 2008 APPENDIX 100 Ga c^ Z m r r. C_ J OLD BELFAIR HWY. z 0 D CD -� rn D 0 X o D 9� D 0 m 0 -w c 4W46 I - VICINITY MAP BUSH, RIDED & HRCHINW, INC SAFEWAY, INC. CIVIL ENGINEERS & LAND SURVEYORS 2009 MINOR AVE. EAST, SEATTLE, WA 98102 SAFEWAY BELFAIR MASON couNrr WASHING (206) 323-4144 FAX (206) 323-7135 1-800-935-0508 E—MAIL: INFOOBRHINC.COM Ln ICRJin IC: p fi v vSy �0 myO ( Y X=X O \ x ( —n ti6 \ aW N 4 F 1 A 8wW t Y { NEW ASPHALT AREA: 4773.5sq.ft. t� � d c9 A / NO SCALE o / o \ "' / LLJ N v F 6V 0 yam+ m U O c coop / c1�' o W \ ` ° FIGURE 2 EXPANSION AREAS EXHIBIT BUSH, ROED & HITCHINGS, INC o Z $ SAFEWAY, INC. CIVIL ENGINEERS & LAND SURVEYORS co = 2009 MINOR AVE. 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'4/ Belfair Safeway . Building Expansion Infiltration Area Calculation Instructions: Enter all numbers in Red. Bottom El= 103 Top El. = 107 Pond Depth 4 Bottom Dimensions Top Dimensions L= 48 W= 10 L= 48 W= 10 Side Slope= 0 Atop(SF) Abot(SF) Depth (Ft) Volume(CF) 480 430 4 1920,00 0.01101928 0.011019284 "acres" „acres" Blue values are calculated by spreadsheet from inputs 0.3 void ratio Flow Stage Area(Acres) VOL(Acre-Ft.) (CFS) Infiltration Infiltration Rate: 9 in/hr 103 0.011019284 0 0 0.1000 0.000208 ft/sec 103.5 0.011019284 0.002626584 0 0.1000 Length of pipe: 48 104 0.011019284 0.005253168 0 0.1000 Volume in pipe: 339.312 CF 104.5 0.011019284 0.007879752 0 0.1000 0.00779 Acre-ft 105 0.011019284 0.010506336 0 0.1000 0.000974 at each 0.5 105.5 0.011019284 0.01313292 0 0.1000 106 0.011019284 0.015759504 0 0.1000 106.5 0.011019284 0.018386088 0 0.1000 107 0.011019284 0.02101267 0 0.100 (D, ODDZ08I-r✓ VOLUME PROJECT REPORT Project Name: default Site Address: City Report Date : 8/27/2008 Gage Quilcene Data Start . 1955/10/01 Data End 1999/09/30 Precip Scale: 1.22 PREDEVELOPED LAND USE Name Basin 1 Bypass: No Groundwater: No Pervious Land Use Acres Impervious Land Use ROOF TOPS FLAT Element Flows To: Surface Interflow Groundwater SSD Table 1, SSD Table 1, Name SSD Tab le 1 Depth: 107ft. Element Flows To: Outlet 1 Outlet 2 SSD Table Hydraulic Table etage(ft) Area(aar) Volu (aar-ft) Dsahrg(afs) Infilt(afs) 103.0 0.011 0.000 0.000 0.100 103.5 0.011 0.003 0.000 0.100 104.0 0.011 0.005 0.000 0.100 � -ram(1.,L.6 10 PXT 104.5 0.011 0.008 0.000 0.100 �`�•' 105.0 0.011 0.011 0.000 0.100 105.5 0.011 0.013 0.000 0.100 106.0 0.011 0.016 0.000 0.100 106.5 0.011 0.018 0.000 0.100 107.0 0.011 0.021 0.000 0.100 MITIGATED LAND USE ANALYSIS RESULTS Flow Frequency Return Periods for Predeveloped. POC #1 R4.�+ern DmT-i nA VI nm/nfjal 2 5 2 5 year' 0 50 year 0 100 'year 0 Flow Frequency Return Periods for Mitigated. POC #1 Return Period Flow(cfs) 2 year 0 5 year 0 10 year 0 25 year 0 50 year 0 100 year 0 Yearly Peaks for Predeveloped and mitigated. POC #1 Year Predeveloped mitigated Ranked Yearly Peaks for Predeveloped and mitigated. POC #1 Rank Predeveloped mitigated POC #1 The Facility PASSED The Facility PASSED. Flow(CPS) Predev Dev Percentage Pass/Fail 0.0000 0 0 0 Pass 0..0000 0 0 0 Pass 0.0000 0 0 0 Pass 0.0000 0 0 0 Pass 0.0000 0 0 0 Pass 0.0000 0 0 0 Pass 0.0000 0 0 0 Pass 0.0000 0 0 0 Pass 0.0000 0 0 0 Pass 0.0000 0 0 0 Pass 0.0000 0 0 0 Pass 0.0000 0 0 0 Pass 0.0000 0 0 0 Pass 0.0000 0 0 0 Pass 0.0000 0 0 0 Pass 0.0000 0 0 0 Pass 0.0000 0 0 0 Pass 0.0000 0 0 0 Pass 0.0000 0 0 0 Pass 0.0000 0 0 0 Pass 0.0000 0 0 0 Pass 0.0000 0 0 0 Pass 0.0000 0 0 0 Pass 0.0000 0 0 0 Pass 0.0000 0 0 0 Pass 0.0000 0 0 0 Pass 0.0000 0 0 0 Pass 0.0000 0 0 0 Pass 0.0000 0 0 0 Pass 0.0000 0 0 0 Pass 0.0000 0 0 0 Pass 0.0000 0 0 0 Pass 0.0000 0 0 0 Pass 0.0000 0 0 0 Pass 0.0000 0 0 0 Pass 0.0000 0 0 0 Pass 0.0000 0 0 0 Pass 0.0000 0 0 0 Pass 0.0000 0 0 0 Pass 1 010000 0 0 0 Pass 0.00.00 0 0 0 Pass ` 0.0000 0 0 0 Pass 0.0000 0 0 0 Pass 0.0000 0 0 0 Pass 0.0000 0 0 0 Pass 0.0000 0 0 0 Pass 0.0000 0 0 0 Pass 0.0000 0 0 0 Pass 0.0000 0 0 0 Pass 0.0000 0 0 0 Pass 0.0000 0 0 0 Pass 0.0000 0 0 0 Pass 0.0000 0 0 0 Pass 0.0000 0 0 0 Pass 0.0000 0 0 0 Pass 0.0000 0 0 0 Pass 0.0000 0 0 0 Pass 0.0000 0 0 0 Pass 0.0000 0 0 0 Pass 0.0000 0 0 0 Pass 0.0000 0 0 0 Pass 0.0000 0 0 0 Pass 0.0000 0 0 0 Pass 0.0000 0 0 0 Pass 0.0000 0 0 0 Pass 0.0000 0 0 0 Pass 0.0000 0 0 0 Pass 0.0000 0 0 0 Pass 0.0000 0 0 0 Pass 0.0000 0 0 0 Pass 0.0000 0 0 0 Pass 0.0000 0 0 0 Pass 0.0000 0 0 0 Pass 0.0000 0 0 0 Pass 0.0000 0 0 0 Pass 0.0000 0 0 0 Pass 0.0000 0 0 0 Pass 0.0000 0 0 0 Pass 0.0000 0 0 0 Pass 0.0000 0 0 0 Pass 0.0000 0 0 0 Pass 0.0000 0 0 0 Pass 0.0000 0 0 0 Pass 0.0000 0 0 0 Pass 0.0000 0 0 0 Pass 0.0000 0 0 0 Pass 0.0000 0 0 0 Pass 0.0000 0 0 0 Pass 0.0000 0 0 0 Pass 0.0000 0 0 0 Pass 0.0000 0 0 0 Pass 0.0000 0 0 0 Pass 0.0000 0 0 0 Pass 0.0000 0 0 0 Pass 0.0000 0 0 0 Pass 0.0000 0 0 0 Pass Water Quality Me Flow and Volume for POC 1. On-line facility volume: 0 acre-feet on-line facility target flow: 0 ofs. Adjusted for 15 min: 0 ofs. Off-line facility target flow: 0 cfs. Adjusted for 15 min: 0 ofs. PIPE Ao dj Cf U > C /0 =im m I Erz w �i U) � 2U)LL 1 (9CT -p NCMIt WW O m c m E � o wo I �� � ~ N N O O O O � m O MtOON to OD 00) N wiC! - N � M I,: o� Cp (q,0 MO0) � i- U) C4 OOUy 04p1 0 � CO � No 1- oOo1AotA (C oil 11 .� M O m __ geW W E crj N` O J d v > m r' U LL � m r o � c r0+ CV) OIO ti ^ M1� 1O O l0 M p OD � O) r- �F � OOGOON �OI� � �O Qj O (d �O O C O O N r- •- OD O r O N M O s p� CC O I f� Uc g T c a U- o O P.. c E U W ..,v u1t'' cticn ""... a 3 o v(D co Q o Ch a 191,E CA't.0 VLA- w144i r t a C N m l0 a c 0 0 oc Y 0 rn 0 • O t c �p �p cO1� �A00000 � O o� 000O 1` C4 '&- 1� 00 1� O O � O (V N (CCOOuno (i M N � � i^UU II 11 ilN IIC JI I�I,� IIC 1� 11 1�1� 1� 1^ 11 c w adV � � � a $ vim c > c S- a° uLLLE a � J � > o d OC a > LL t u c • �P ✓ �• `lak - �' 04 1 � P s J, -fir IIWF 1 1rip MhI;- i •r � � .,.� '( lid— fill- 11 IN i ISOPLUVIALSu .� • IN TENTHS OF 14 Subw face&;*radon, GeOl*c Hazar 1,and � Be fair Se¢ewaay(OIS71)Addition ' Geatcchnicat Engirxe►in8 Report Mason , Washingion preUmbiwy Design ReeonDnendations , not discharge into the footing drain system, but should be handled by a separate, rigid, tightline drain. Exterior grades adjacent to walls should be sloped downward away from the structures to achieve surface drainage. Final exterior grades should promote free and positive drainage away,from the buildings at all times. Water must not be allowed to pond or to collect adjacent to foundations or within the immediate building areas. It is recommended that a gradient of at least 3 percent for a minimum distance of 10 feet from the building perimeters be provided, except in paved locations. In paved locations, a minimum gradient of 1 percent should be provided unless provisions are included for collection and disposal of surface water adjacent to the structures. Additionally, pavement subgrades should be crowned to provide drainage toward catch basins and pavement edges. Any crawl-space areas should be provided with drains at low points to prevent water from accumulating. 14.0 INFILTRATION TESTING We completed our infiltration tests at the locations shown on Figure 2 to provide infiltration rate data to the project team. The area and depth targeted for infiltration testing were selected by Bush, Roed, and Hitchings, Inc. Both test locations were within the existing paved parking area. Therefore, to reduce the impact to the existing pavement, we modified the Washington State Department of Ecology Pilot Infiltration Test(PIT)by drilling a 15-inch-diameter boring to the target depth with a truck-mounted drill rig. This modification reduced the disturbance to the existing pavement and resulted in a reduction in the scale of the test. The boring was then filled with clean pea gravel of a significantly larger grain-size distribution than the sand to be tested. Each gravel-filled boring was outfitted with a 4-inch-diameter perforated fill pipe and.a 2-inch-diameter observation port. The test results from each location yielded the uncorrected or short-term field infiltration rates shown in Table 1. Table 1 Infiltration Rate Summary Recommended Calculated Field Allowable Test Depth InMration Bate Infiltration Rate loration No. feet (Whr) INF-1 6 7 99 11 INF 2 6 88 9.8 in/hr s inches per hour Sgptmber S,M ASSo TED MM S=VaS.1NC. Page 14 -5 Subsurface Ecploradon, Geologic Hazard,and Belfair Safeway (1�1571)Addition Preliminary Ge+otechnical Engineering Report Mason Sa , (# ton Pre Desi n Reeomma datio u" Since the scale of the infiltration testing was reduced, a correction factor must be applied to the short-term field infiltration rate. The King County Land Use Inspection Section has presented calibration factors to be used for various types of small-scale tests. Based on these factors, we recommend that a calibration factor of at least 9 be applied to the uncorrected or short-term infiltration rates listed in Table 1. Based on our testing and field conditions observed in our infiltration tests and geotechnical exploration borings performed on this site, it is our opinion that infiltration systems that are designed to be 6 feet deep or less should be designed using an allowable infiltration rate of�inc�es Pei' hour. It is our opinion that this design rate has a suitable factor of safety, and the actual rate at which the water will infiltrate from the facility will likely be between the recommended allowable rate and the measured field rates. The infiltration gallery aggregate should be covered by a geotextile filter fabric (Mirafi 180N or equivalent)to separate the aggregate from the pavement base materials. - The contractor must protect the system from untreated/turbid water to prevent plugging or blinding of the infiltratioh surfaces by suspended fines. AESI should be allowed to review the design and observe construction of the infiltration system to verify that subsurface conditions are as anticipated and that the construction conforms to AESI's recommendations. 15.0 PROJECT DESIGN AND CONSTRUCTION MONITORING The recommendations in this report are preliminary because grading plans and construction details were not finalized at the time of this report. We are available to provide additional geotechnical consultation as the project design develops and possibly changes from that upon which this report is based. If significant changes in grading are made, we recommend that AESI perform a geotechnical review of the plans prior to final design completion. In this way, our earthwork and foundation recommendations may be properly interpreted and implemented in the design. We are also available to provide geotechnical engineering and monitoring services during construction. The integrity of the foundations depends on proper site preparation and construction procedures. In addition, engineering decisions may have to be made m the field in the event that variations in subsurface conditions become apparent. Construction monitoring services are not part of this current scope of work. If these services are desired, please let us know, and we will a proposal. prepare September 5, 2008 ASS00ATTsD EARTH SCfENM INC. IMM-KEMOSM3_PAOM1 ,WP Page 15 77��.I3�� ^! + W V.J z- Z i � lit i � g� � . lip z Z gQg CA td ` I.._ .___—._..' � ..�'� dam• V`� i � 1 i Ila a Parcel number 12329 4100010 made 3 copies picked up by Cory 4-20-09 charged$4.50 per page total$13.50 permit number COM2008-00121 4-20-09 RTB TO BE KEPT IN THE PARCEi FILE Al Page 1 of 2 Corey Sisson From: Mahaffie,Alan [amahaffie@simplexgrinnell.com] Sent: Monday,April 20, 2009 12:15 PM To: Corey Sisson Subject: RE: Safeway Belfair Fire Protection As Builds Western States Fire Protection Co.has our permission to copy the As-Built Fire Sprinkler drawings for the Safeway#1571 located at 23961 NE State Route 3 Belfair,WA 98528. Alan Mahaffie District Sprinkler Design Manager SimplexGrinnell Seattle,Washington TO BE KEPT IN THE (206)291-1481 direct APA RC E L FILE (206)291-1400 main (206)291-1500 fax www.sim~nnell..com From:Corey Sisson [mailto:corey.sisson@wsfp.us] Sent: Monday,April 20, 2009 12:08 PM To: Mahaffie, Alan Subject: FW: Safeway Belfair Fire Protection As Builds Alan Can you please respond that it is ok for us to copy the as-built fire sprinkler plans for the Safeway#1571 located at 23961 NE State Route 3 Belfair,WA 98528. Thanks Corey Sisson Project Manager stow Fin ptvtwdm Co. Office 425-881-0100 Cell 425-736-9032 Fax 425-881-3030 corey.sisson@wsfp.us 4/20/2009 ti Page 2 of 2 From:Jonathan Miller[mailto:Jonathan@woodmanconstruction.com] Sent: Monday,April 20, 2009 9:36 AM To: Corey Sisson Cc: Pete Woodman Subject: Safeway Belfair Fire Protection As Builds Corey, Mason County Building Department has the drawings you are requesting.You must contact Grinnell Fire Protection for permission to copy the dwgs.You will probably need an email or something.All contact info below. BLDG DEPT REQUESTED TO CALL BEFORE GOING THERE. Mason County Bldg Department. Rich—360-427-9670 426 W.Cedar Shelton,WA Grinnell Fire Protection Systems—206.859.5066 Dwgs: 12.23.99(Fi, F2)Contract#41.303526-A1 Dwgs:07.14.99 Contract#41.303512-A1 Woodman Construction Inc. 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