HomeMy WebLinkAboutCOM2004-00142 Antenna Attachment - COM Permit / Conditions - 9/9/2004 MASON COUNTY DEPT. OF COMMUNITY DEVELOPMENT Inspection Line(360)127-7262
Mason County Bldg. 3 426 W. Cedar P.O. Box 186 Phone: (360)427-9670,ext.352
Shelton, WA 98584
too
COMMERCIAL BUILDING PERMIT COM2004-00142
OWNER: CINGULAR WIRELESS RECEIVED: 6/29/2004
CONTRACTOR: WESTERN TELECOM LICENSE:WESTETS962LN EXP: 7/22/2005 ISSUED: 9/9/2004
SITE ADDRESS: 26392 NE NORTH SHORE RD TAHUYA EXPIRES: 3/9/2005
PARCEL NUMBER: 323332100000
LEGAL DESCRIPTION: NE NW EXC N 330'SEE SURVEY 11/40
PROJECT DESCRIPTION: DIRECTIONS TO SITE:
ATTACHING ANTENNAS TO EXISTING MONOPOLE, & STATE ROUTE 3 S ONTO STATE ROUTE 300 TO NORTH SHORE ROAD
EQUIPTMENT SHELTER 3.6 MILES R ONTO BELFAIR TAHUYA ROAD FOLLOW SIGNS TO TAHUYA
ST PARK AND DEWATTO 7.5 MILES R ONTO DEWATTO ROAD 3.2 MILES
L ONTO NE NORTH SHORE L
General Information Construction &Occupancy Information
Type of Use: Insp.Area:
No.of Units: Type of Constr.: II fr
Type of Work: NEW Fire Dist.: 8 No.of Bathrooms: Occ. Group: U-2
Valuation: $ 50,000.00 No.of Stories: Occ. Load:
Building Height: 152
Pre-Manufactured Unit Information Square Footage Information
Make: Length: Lot Size:
Model: Width: Building: 230
Year: Serial No.: Basement: Parking Spaces:
Setback Information
Shoreline&Planning Information
Front: Ft. Shoreline: Ft.
Rear: Ft. Slope: Ft. Water Body:none Shoreline Desig.: Not Applicable
Side 1: Ft. SEPA?:Yes Comp.Plan Desig.: Rural
Side 2: Ft.
Fire Protection System Information
Auto Fire Alarm System?: Emergency Key Box?: Standpipe?:
Auto Fire Sprinkler System?: Access Road?: Fire Extinguishers?:
Fixed Fire Suppression System?: Fire Hydrants?: Fire Lanes?:
COM2004-00142 Please refer to the following pages for conditions of this permit. 1 of 4
Plumbing Fixtures Mechanical Fixtures FEES
Type Qty. Type Qty. Type By Date Amount Receipt
Plan Check Fee KC nr94i9nna .P.d1A dd C1gnnAnn
Planning Review Fee KC Fig4ignna PgFri nn g19nnAnn
Address Fee r,Mnnn ai,Anignna aldn nn g99nnann
Building State Fee hARr. 7/1't/9nna Od Fn g99nnAnn
Building Permit Fee Mr. 7/1,A/9nna PRAI 75 R99nnAnn
Total $1,461.69
CASE NOTES FOR
COM2004-00142
CONDITIONS FOR
COM2004-00142
1) Contractor registration laws are governed under RCW 18.27 and enforced by the WA State Dept of Labor and Industries, Contractor Compliance
Division. There are potential risks and monetary liabilities to the homeowner for using an unregistered contractor. Further information can be
obtained at 1-800-64�J-fr?982. The person signing this condition is either the homeowner, agent for the owner or a registered contractor according to
WA state law. X �%``,�7
2) At a tower site, the design of the buildings and related structures shall, to the extent possible, usp materials, colors, textures, screening, and
landscaping that will blend the tower facilities to the natural setting and built environment. X 1 ,
3) All approved plans are required to be on-site for inspection purposes. If inspection is called for and plans are not on site, Approval WILL NOT be
granted. In addition, a reinspection fee, based on the current fee schedule, minimum one-hour vyi�l be charged and collected by the Mason County
Building Department prior to any further inspections being performed or approvals granted. X _
4) PURSUANT TO 1997 UNIFORM BUILDING CODE, ALL SITES MUST HAVE APPROVED NUMBERS OR ADDRESSES PROVIDED IN SUCH A
POSITION AS TO BE PLAINLY VISIBLE AND LEGIBLE FROM THE STREET OR ROAD FRONTING THE PROPERTY. MASON COUNTY
BUILDING DEPARTMENT REQUIRES THAT THIS BE COMPLETED PRIOR TO CALLING FOR ANY SITE INSPECTIONS. A REINSPECTION
FEE, BASED ON RATES AS ADOPTED BY THE JURISDICTION AND THE 1997 UNIFORM BUILDING CODE WILL BE ASSESSED IF
OWNE,RIC NTRACTOR FAILS TO POST ADDRESS ON SITE PRIOR TO REQUESTING INSPECTIONS.
X
5) 3000 PSI CONCRETE WILL REQUIRE SPECIAL INSPECTION IF THE QUANTITY EXCEEDS 50 CUBIC YARDS< LESSER AMOUNTS WILL
REQUIRE AN APPROVED CONCRETE SUPPLIER TO PROVIDE YOU WITH A BATCH TICKETIHAT WILL BE REQUIRED TO BE
SUBMITTED TO THE SITE INSPECTOR FOR THE VERIFICATION OF MATERIAL USED. X - '
6) A structural observation, as defined in section 220 of the Uniform Building Code, shall be provided by the engineer or architect of record
responsible for the structural design or another engineer or architect designated by the engineer or architect or record.
Prior to the final inspection of the structure the structural observer shall submit written stat nts to the Mason County Building Department
indicating that the site visits have been made and identify any reported deficiencies. X %
COM2004-00142 2 of 4
7) 1997 UBC CHAPTER 17, SECTION 1701: IN ADDITION TO THE INSPECTION REQUIRED BY SECTION 108, THE OWNER OR THE
' ENGINEER OR ARCHITECT OF RECORD ACTING AS THE OWNER'S AGENT SHALL EMPLOY ONE OR MORE SPECIAL INSPECTORS
WHO SHALL PROVIDE INSPECTIONS DURING CONSTRUCTION ON THE TYPES OF WORK LISTED UNDER SECTION 1701.5. THE
SPECIAL INSPECTORS DUTIES & RESPONSIBILITIES SHALL BE AS SPECIFIED IN 1701.2 AND 1701.3.
X ,
8) Changes to approved building plans that affect compliance to the current non-residential Energy Code (NREC), ventilation and Indoor Air Quality
Code tVrAQ) Uniform Building/Plumbing/Mechanical Codes and/or Mason County Regulations shall be approved prior to construction.
9) CONSTRUCTION PR�PESS TO BE FIELD CORRECTED AS REQUIRED PER MASON COUNTY BUILDING DEPARTMENT AND UNIFORM
BUILDING CODE.x )
10) All property lines shall be clearly identified at the time of foundation inspection. X L
11) All building permits shall have a final inspection performed and approved by the Mason County Building Department prior to permit expiration. The
failure to request a final inspection or to obtain approval will be documented in the legal property records on file with Mason County as being
nor���mpliant with Mason County ordinances and building regulations.
X - _.�
12) Pressure treated wood manufactured after January 1, 2004 may contain high concentrations of copper which could quickly corrode metal
fastle rs, connectors, and flashing. Install metal connectors approved for contact with the new types of pressure treated material.j<
This permit becomes null and void if work or construction authorized is not commenced within 180 days,or if construction or work is suspended fora period of 180 days at any time after work is
commenced. Evidence of continuat' h of work i a progress inspection within the 180 day period. Final inspection must be approved before building can be occupied. Proof of continuation of
work is by means of a progress in ection.The wner or the agent on the owners behalf,represents that the information provided is accurate and grants employees of Mason County access to
the above described pr a and tructure for r vi w and inspection.
OWN ER OR AGENT: DATE:
COM2004-00142 3 of 4
CONCRETE MECHANICAL MANUFACTURED HOME
w
o Footings / Setbacks Date By Ribbons
o Date By Gas Piping Date By
o Foundation Walls Date B y Set-up
Date By INSULATION Date By
B G / Slab Insulation Floors Final
Date By Date By Date By
FRAMING Walls FIRE DEPT
Date By Date By Date By
PLUMBING Attic OTHER
Groundwork Date By
Date By WALLBOARD NAILING
D.W.V. Date By
Date By FINAL INSPECTION
Water Line Date By
Date By � r �, � ,, ��> Date By
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FORM MUST BE COMPLETED IN INK MASON COUNTY PERMIT'1�. 1 -2( 21 CLt_7_7_'PLEASE PRESS HARD 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 INFOR ATION
Owner s'5 C Ong X;S c9n $Cl AIF tq� (UexV 1 Company Name
Mailing Address 25H5- W-'lIOwS 27 NF }�_ 1110 Mailing Address
City (t DiDONN State OA Zip Code IS 054 City State Zip Code
Phone 2-06 DIS, '184_Other Ph. Phone Other Ph.
Lien/Title Holder Contractor Reg.# Exp.
Email address KC07nfn--1 70-1 tsS , C)Qa rl E Mail Address
Drivers Lic.# DOB Drivers Lic.# DOB
SEPTIC /WATER SYSTEM:INFORMATION - Connect to New Septic Existing Septic iV IA-
Connect.t Water System � Name of Water System
We►IE✓4Water System Name of Water System
PARCEL INFORMATION - 12 Digit Parcel tQ0000 Fire District
Legal Description k e S
Site Address (Please include street name, street number and city) (Z'D TRhj
Directions to site VtQA, 15te (AW)Aeb Lk B"
Will timber be cut and sold in parcel preparation?Yes/
Is property within 200'of Saltwater 62A Lake LN
River/Creek nl/A Pond N/k
Wetland of/� Seasonal Runoff c✓/A Stream Slopes or Bluffs � 15% /
Is this permit submittal the result of a Stop Work Notice,Correction Notice or other enforcement action?Yes/No
TYPE OF JOB - New Add )( Alt Repair Other PRIMARY RESIDENCE ❑ SEASONAL ❑
Use of Building Describe Work 6� �eleSS jjkS W pX A200p21e
No.of Bedrooms No.of Bathrooms Square Footage - 1st Floor • 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 No.of Bathrooms
Type of Heat Purchase Price $ Replacement Unit? Yes/No
Installer Name Certification No.
OWNER/BUILDER Acknowledges submission of inaccurate information may result in a stop work order or permit revocation.
Acknowledgement of such is by signature below.I declare that I am the owner,owners 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 permis-
sion from all th sary parties.If permission is required from any easement holder or any other party in interest regarding this applica-
tion or the opo:�����ainecl permission from them to pply for this permit and conduct the work proposed.
X Date:
Owner wners Represe ive Contractor (indicate which one)
FOR OFFICIAL USE BEYOND THIS POINT
Accepted by: Planning Pd Ck# Date Bld Pd Receipt No.
DEPARTMENTAL R VI W PEQ, DENIED NOTES
Building Department's 6
Planning Department
Environmental Health Department
Public Works Department
Fire Marshal
FEES
Building Permit Fee Site Ins ection
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
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sExwcFs
10545 WILLOWS RD NE, 110
REDMOND, WA 98052
(425) 278-7427
(425) 497-8029 fax
ZONING: PLANNINGRRS
5 WIILOWS ROAD NE #100
WA 98052
[REDMOND.PHONE: (425) 278-7415
FAX: (425) 278-7404
HOODSPORT
WA0750-B
' I 26390 NE N. SHORE R
N O R TH S H O R E R D . MASONA COUNlY588
' I N88'08'44"W 1160.67' CURRENT ISSUE DATE:
- - - - - - 6-1 1 -04
ISSUED FOR:
CON ULIION
Z 77'45'11"E 165.98,
(E)PROPERTY LINE
(E) BRUSH-&SMALL TREES
(COMMERICAL FOREST LAND) I cARTHUR,JR.
(E) 14-WIDE GRAVEL.ACCESS DRIVE
S1•A I tAk}fRoi�Aes
LEASI
N ZDNRR5 Z ION NG DATE:_
ZONING: m RF ENGINEER: DATE:_
RR5 p
m � � CONSTRUCTION: DATE:_
(N) 11'-6 X20'-0'EQUIPMENT SHELTER I L'J TAG CHECK: DATE-'I I MOUNTED ONTO CONCRETE SLAB
OWNER:Ln
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c� LJ PROJECT NO WA0750-B
DRAWN BY PD
/ i t 1055' Z
o ±241'
a SETBACK CHECKED BY FW
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SITE PLAN
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2nd
SUBMITTALSCALEa w o0 1 = 100
0V 18/2,004 01: 19 425-497-8029 TETRA TECH PAGE 02
ov/16/2004 12:60 FAX 360 427 7706 KASON Co PR,.>FtitIT CM a002
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SOM ON COUNTY SpccW Inspection Authorization
� Dunts+n j Lrrpec�ion
Parnit AtuistY►Ce CMet�
426 W.C*dwp,p.tlwt t so
3eh4ston,WA"S"
rK. (360)Q7467a 1i,:Ow)e27-7794
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Fwj art Name• x e o� ��1 0"seir•a Native:_ iti e
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it. TYPE OW VVOfA,ic.uun dcclted blow squirt Special Iespectiolsa cmmplyinr with IM luallorm
i SgilQlaX Coda Ssedon 1101.See tectiao 1701.5 for actpouns..M locpactise r+eppt't!most be
submimd"d spprarved by the btlidiag otr-trial yrfar to Mastics of a cerdficitc of*=V oncy.
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1. Q0NQ=,During the tilting of toot rpecin=3 end patting of rtmforccd Mncrute, Set item 12 for shotareta
I
0 Z,&OLTS JVn6LL=N CONCRETR prior to tmd during tAt plaoem"t of 0"crete wowd born when straw
i incraasar pemt eed by fbobnahm i of TWO9.E of Swflw 1925 are utillmd.
j ❑' 3, CQ=TI3 FFLANIE;As required by Sectiar: 1921-9,
❑ A.it WMrrK4_M. a TZ T�NSt 4,1.Dufing ill orneeeir:=sod graufhtg of
undone in preemod oo.vate.4.2,Duing pladig of min`wing steal wd prew caging idol for all conv vLt
i mquired to httw special itspecdon by iiant 1,
a s-STLM TURAi Wgr DIN I I Al.Outing the welding of MY Rram6 9 of gone don w1doh its
des 4MW to reedit lends v4 fast*e9ntrW by this coda.5.2,
FRAMES,During tIka uveldln9 ofapeeid alormst-tlSlttia$aretl ftetthle,Ia addition to Ilem 3.1 zegp{remeats
r above,r cod"Vueavt testing u rtqurtd by section �703.5.3 2CF"Ti`[2 QZ.16 -M STEEI,During thv
11 walfts of*nr=ing loam,
❑ 6.k'-IIQld-STRENGn B(XnNjQ.As rogatred by ChWer 22,Di A tion IV-sWcit htrPearituta,day be ped'br rd
erg a periodic basin in Accordeaw agth 9ha negtrirwx=t5 of Seetion 1701.6,
Q 1. 7,1.During pttsptrslfon crud tsldng of any required pria m or tat"itnaxa,
i placing of III ussonty Units,placenamat of redtforearwnt,inopoetion of grour epaoe,lmmee:uwaly piior to alosing
of c1cu t uix uW during aU groutitlg opessti=7-2.$art code for rnqufr,m %on fbiiy,grogd opens-and hollow
o"It Mismrry-
a 1, Whca cm-in-pinta Class 13 gypsum cdncretc is being trnzod and
plaaw,
Q 9 ZIN( WNCRI;13 EU-1 I"Amg the Mliowion of inaulat&conmetc Otl wtwn ustd In pan of a
struaturtal systurn,
3 10. - •AA rcavired by UAC SmMard 74,
I Q 1 I. = QLnU drihring ttnd bo inS of piles and eomuction of cW-m
plus drilled piles or cairsoni.Sec[hems 1 and 4 for oonarm and rsinfoi%ina tree'tnapsetion,
❑ 12,IM Dusmi the taking of mt Ipwinwrij and ;]acing of ail shotcrcta and u required by Se Imm
1432,10 sad 1922,11.
f 13,SPECIAL GKAMENO,EX Y-ATION Ahfl2 FjLL2a Durk4 eirtbwo►k tuCivltlona,srmdj4 and filling
/ f*#p*cdon Lo nt3dy Yv9areawnu of Chapter 18 mid Appendix Chapibr 33.
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07/18/2004 01: 19 425-497-8029 TETRA TECH PAGE 03
071ls/ZUUA iZ:aU YXX aen 42T TT95 MASON CO PE"IT CM 14003
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� �� i�„�� •• Ik s!��s irs, 1�a�t�� '
U 14. 1.During.nation of duct work and prior to eeneasIrontt for Rte"cites
asf I1ettw teasing mid roeortiiog of device location.14.2,Prior to oacvWc:y and after aufficW t omtmlatiion for the
purpom of presau t dItlbnenoe tealm&flow maaaesrattsae m sad detection laid Control varifi mtiorL
D 15, SERCIAL rA$88:Work w1',iel>, in the opinion of the biA0ding official,invotvas un-aasml hmatda or
oottdidoua. .
lli. SPECUL INSPECM S6LSC1'i0M The Special Iaspamon Agency end DMactor shell W regfstmd by the
Washington Anocladoa ofHufldinzOMcials(WAD0)Ibr the putktlattyro ofcannruction or operation
tsQuWq spamw inspection.Such iajPecton'a)chap be selected by the awner,A again and approved by the
Da Wing 00Gal prlvr to inuuwc of eke building pfttttit,The QWNf%S AGENT sha11 not be acts"as or
employed by the tpauW iaapcvtim nway or contractor for We project,
of
s) r S }� L3
oa BstQU
Y?CPI M AND REVONSMILITIES OF THE SPECLRL INS?K'r0 -,The apvoial inege_tor shall oburve the
astigned work for confimanoe-ith the*Moved desire drswinp and tpeciticaWns-The spacial inspector lball
furniaLinsp eotion rayons to the boildins eMciaL the anvam of toahilect ofracord,god odher desipitood persons.KI
discrepaloics awl be tmghr to ow tatr attention of the eanbsetor fat 4*mc%mt tb*N IT=corrected,to the
yroger dealp a AhWIty srd to lb@ building af,Qja).The spacial Inapcctor thatI submit a Strl aipad.apart asatasf
WMthar the work TNUhir9 sperdsl inspe+ottoa wee,to the best of the tmrpactar's knowledge,in eor&xnl=cm Wth*a
appaowdplans mad specAeadanx the Uniibrrn Euildlug Code m
adapted by Masan C50—ty.
DLrr=AND RESPONSt UM"s Of THE CONt)UCM&The oontraetor's dutlea include meafteWl Ity Por
notifying the apeaial inspector or 4mcyrsgrading indivilutl Ingvatiam raquimd by the btaldinS depart;ml
Adegt;ata*at*:bRll be provided to that du qpoaW rector with aaoem to appmved Woos A%0job site slid tr
trapona(We for retautasg 21 the job site el)spacial iaapeation emam l subtlinvd by 04 special inspector,anti provldiq
Ow muds for reviesor by the W WAS departtmetrt's ms;r mtor trpon req%mm,Complet m o:tttts spWal inspection
forts do=cot relieve site omemaar't rsspoeeibiRly to,schedule imp iioos by a Muou County buzzl*ng inspecor
befors cancealtRS env umwp-
DUTM$AND RESPON5WLl Z5 Or,T"ENO L: EU Oft ARC1il'=OF RECOW:The engineer or mrohilect
arnaeetd h m may dudes and mpam bilk%4 n).ted to special inppaatlosl t hvities-7%ey Include ldeotitAng mii ich
1 special ipspectias+a WE needed,davaloping a m4odulc,and a,ssiidng in the wlection drdA special.ksg=sor.
PUT=AND RTsSP0.75T8IL1T Ud3 OF THE pRWBC1'OWN3X,7M prgieat Whet of the m4toaas cr archiroat of
rmrd minx u the owTetr's amt is remorlsible ihr l"rwial impeclign1701.1.
! IV. ALTfIMZhTION+ 1 ataoby#flat 1 am the legxi earner(or owner's sgcrtt)cf this property and agrat to
iy tbs rsgvirsmrnts fista4 aAerein.
fg Name ,t Date
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amecQ
3 a3- 2 - 00&vo
RECEIVED
November 22, 2004
NOV 2 9 2004
4-91 M-14819-1 426 W. CEDAR ST,
Emerald Wireless
12709 268th Avenue Court E.
Buckley, Washington 98321
Attention: Mr. Randy Moore
Subject: Final Summary of Inspection Services
Hoodsport Cell Site Oq
26390 N.E. Northshore Road l
Tahuya, Washington
No..QOM2004-00142
Dear Mr. Moore:
AMEC Earth & Environmental, Inc. (AMEC) respectfully submits this final summary of special
inspection services for the above-referenced project. Our services were performed as
requested and scheduled by Emerald Wireless. Daily Field Reports of our inspections were
prepared at the time our services were provided. AMEC Daily Field Reports and corresponding
Laboratory Test Report, copies of which are attached, form the basis for this final summary
letter.
AMEC performed following special inspection services:
1. Soils Verification (equipment foundation);
2. Reinforced Concrete (equipment foundation);
3. Epoxy Anchor Bolts Installation; and
4. Structural Steel (bolting of antennas on the tower).
AMEC Earth&Environmental,Inc.
11335 N.E. 122nd Way,Suite 100
Kirkland,Washington
USA 98034
Tel (425)820-4669
Fax (425)821-3914
WWW.amec.com W:\_Projects\14000s\14819 Emerald Wireless\Final Summary-I.doc
0
amec
Emerald Wireless 4-91M-14819-1
November 22, 2004 Page 2
The work inspected and referenced above was performed in general conformance with the
approved plans, specifications and changes authorized by the structural engineer. If you have
questions or require additional information, please call at your convenience.
Respectfully submitted,
AMEC Earth & Environmental, Inc.
Vladi Burakovskiy
Project Manager
a---, S� -
..� Tyler McCormick
Business Unit Manager
VB/TM/lad
Attachments: Daily Field Reports(1243, 0787, 2130, 2199)
Concrete Test Reports (15153)
cc: Mason County
Planning and Development Services
426 W. Cedar Box 186
Shelton, Washington 98584
Attn. Permit No. COM2004-00142
W:\ Projects\14000s\14819 Emerald WirelessTinal Summary-Ldoc
amecw
AMEC Earth& Environmental, Inc.
„335 kland, . ,2ington Way,
98034100 Tel (425)821-4669
3914 DAILY FIELD REPORT
Kirkland,Washington 98034 Fax (425)821-3914
PROJECT NAME PROJECT NO. REPORT NO.
Hoodsport Cell Site 4-91 M-14819-1 1243
ADDRESS PERMIT NO. DATE
26390 NE Northshore Rd, Tahuya, WA COM2004-00141 9/22/04
CLIENT WEATHER PAGE(includes Test Reports)
Emerald Wireless Rainy 1 of 1
STRUCTURAL ENGINEER AMEC PROJECT MANAGER/PHONE NO.
Vladi Burakovskiy
ARCHITECT AMEC FIELD REPRESENTATIVE/PAGE NO.
Tetra Tech Robert Hill
CONTRACTOR TYPE OF INSPECTION ® NEW INSPECTION
Emerald Wireless .Soils ❑ RE-INSPECTION
On site to probe test soil of site for footing and slab. Probed around footing and found two spots in stand-
ing water were probe went 4" into ground. Probed about 60 times in a foot wide area were footing is going.
Soil was found to be firm and unyielding expect in noted spots. Contractor is aware of soft spots. The re-
quired bearing capacity is 1500 psf the soil appears to meet or exceed this bearing capacity. Pick up soil
sample for lab testing.
To the best of our knowledge,all items inspected as noted above were in general ®Yes ❑Preliminary Observations
conformance with the approved plans and specifications. ❑ No ❑Deficiency Corrected-Report No.
Robert Hill 9/22/04 7
AMEC FIELD REPRESENTATIVE REVIEWED BY
THIS REPORT IS CONSIDERED PRELIMINARY AND SUBJECT TO CHANGE PENDING REVIEW BY OUR P CT MANAGER
This report is provided solely for the information of our client. This report is not intended to be transmitted to a third party by any mea s, except in full, without
written permission of AMEC, Inc.
AG19372(Rev.6/99)
a
amec�
AMEC Earth& Environmental, Inc.
Kilda N.E. 1 hin0 Way,Suite 100 Tel (425)821-4669
3914 DAILY FIELD REPORT
Kirkland,Washington 98034 Fax (425)821-3914
PROJECT NAME PROJECT NO. REPORT NO.
Hoodsport Cell Site 4-91 M-14819-1 0787
ADDRESS PERMIT NO. DATE
26390 NE Northshore Rd, Tahuya, WA COM2004-00141 9/27/04
CLIENT WEATHER
PAGE(includes Test Reports)
Emerald Wireless Overcast 1 of 2
STRUCTURAL ENGINEER AMEC PROJECT MANAGER/PHONE NO.
Vladi Burakovskiy
ARCHITECT AMEC FIELD REPRESENTATIVE/PAGE NO.
Tetra Tech George Howarth
CONTRACTOR TYPE OF INSPECTION ® NEW INSPECTION
Emerald Wireless R/C ❑ RE-INSPECTION
COMMENTS
AMEC on site at the request of the contractor for reinforced concrete inspection.
The contractor placed approx. 16 yards, 3000 PSI concrete at equipment pad shelter.
Reinforcement was verified and was found conforming to plans and specs. See det 3/A-4.
Concrete was placed by chute and was mechanically consolidated.
SAMPLES OBTAINED:
4 (4x8) concrete
SUMMARY
To the best of our knowledge,all items inspected as noted above were in general ®Yes �❑Preliminary Observations
conformance with the approved plans and specifications. ❑ No ❑Deficiency Corrected—Report No.
George Howarth 9-27-04
AMEC FIELD REPRESENTATIVE REVIEWED BY
THIS REPORT IS CONSIDERED PRELIMINARY AND SUBJECT TO CHANGE PENDING REVIEW BY OUR P CT MANAGER
This report is provided solely for the information of our client. This report is not intended to be transmitted to a third party by any me s, except in full, without
written permission of AMEC, Inc.
AG19372(Rev.6/99)
TEST REPORT amen`'
AMEC Earth&Environmental,Inc.
11335 NE 122ntl Way,Suite 100 Tel (425)820-4669
Kirkland,WA 98034 Fax (425)821-3914
CONCRETE ASTM C-39
PROJECT NAME: PROJECT NO.: REPORT NO.:
Hoodsport cell site 4-91 M-14819-1 0787
ADDRESS: DATE: PAGE:
26390 NE Northshore Rd, Tahuya, WA 9-27-04 2 of 2
FIELD DATA BATCH DATA
I
SUPPLIER Hard Rocking TYPE OF CEMENT
MIX NUMBER CL-3000 WEIGHTS PER YARD DESIGN ACTUAL
TICKET NUMBER 201657 CEMENT(LBS) 4672 4680
TRUCK NUMBER 19 FLY ASH(LBS)
BATCH SIZE,YD 9 COARSE AGG.(LBS)7/8 16160 16240
TOTAL PLACED 9 OF 16 YDS COARSE AGG(LBS)
WATER ADDED,GALS 15 COARSE AGG.(LBS)
ALLOWABLE WATER,GALS 20 FINE AGG.(LBS) 12760 12800
DRUM REVOLUTIONS 30 WATER(LBS.) 146 145
BATCH TIME 1155 AIR ENTRAINMENT 47 oz 47 oz1
SAMPLE TIME ADMIXTURE NO. 1
SAMPLE AND TEST DATA
SAMPLE SET 1 OF 1 LABORATORY SET#1 ID#15153
SAMPLE LOCATION: Equiptment Pad
DESIGN STRENGTH 3000 PSI at 28 days `TEST DATA SPECIFIED ACTUAL
TEST AGE(DAYS) 7-28-28-H SLUMP(ASTM C-143) 5 5
SPECIMEN (NO./SIZE/TYPE) 4(4x8)concrete AIR CONT. (ASTM C-173/C-231)
DATE SAMPLED 9-27-04 AMBIENT TEMP.IF 67
DATE RECEIVED 9-28-01 SAMPLE TEMP.(ASTM C-1064) 70
CURING CONDITIONS UNIT WEIGHT(ASTM C-138)
HIGH/LOW TEMPEEATURES YIELD(ASTM C-138)
'Note appropriate test methods if different from those indicated
SAMPLE STORAGE LOCATION AND COMMENTS
THIS REPORT IS CONSIDERED
PRELIMINARY AND SUBJECT TO
George Howarth 9-27-04 CHANGE PENDING REVIEW BY
AMEC FIELD REPRESENTATIVE PROJECT MANAGER. REVIEWED BY
This report is provided solely for the information of our client.This report is not intended to be transmitted to a third party by any means,except in full,without written permssion of AMEC Earth&Envir nmental,Inc.
Report of Compression Test Results
amecl&
Client: EMERALD WIRELESS Report Date: October 25,2004
12709 268TH AVE CT E Project#:4-91 M-14819-1
BUCKLEY, WA 98321- Project Name: HOODSPORT CELL SITE
Address:26390 NE NORTHSHORE ROAD
Attn: MIKE HAGEN-BOFEN TAHUYA, WA
Project Manager:VLADI BURAKOVSKIY
Architect:
Engineer:
Specimen Type: Concrete ASTM-C39
Mix and Field Data
CastDate: 09/27/2004 Contractor: EMERALD WIRELESS
Type of Placement: Equipment Pad
Strength: Required(fc): 3000 psi @ 28 Days Inspector: GEORGE HOWARTH
Mix#: CL3000 Actual Specs
Supplier: HARD ROCK INC Slump(in)ASTM C-143: 5.00 4
Load: of Air Content(%)ASTM C231:
Truck#: 19 Unit Weight
g (pcf)ASTM C-138:
Ticket#: 201659 Sample Temperature(OF)ASTM C-1064: 70
Plant#: Ambient Temperature(OF): 67
Batch Size(cy): 9
Water Added 15
(gal): Clouds Condition:
Admixture: Precipitation:
Time Wind Condition:
Batch Time: 11:55 Remarks: REFERENCE REPORT 0787
Sampled Time: 13:50
Finish Time:
Test Result Nominal Actual
Spec Date Age Specimen Area Compressive Strength Break Field Type of Percent
Lab Id Id Received Test Date (Days) Size (in') (Ibs (psi) Type Cure Cap of Req.
15153 A 09/28/2004 10/04/2004 7 4x8 12.57 46580 3710 ❑ Un 124%
B 09/28/2004 10/25/2004 28 4x8 12.56 60120 4790 ❑ Un 160%
C 09/28/2004 10/25/2004 28 4x8 12.56 62670 4990 Un 166%
D 48 12.57 Hold
Average of 28 Day Breaks: 4888
Break Types: --(Cn)Cone,(CSp)Cone Split,(SCh)Cone Shear,(Sh)Shear,(Co)Columnar
Type of Caps: --(Un)Unbonded, (Su)Sulfur Based Compound,(Gr)Grinding
Reviewed By: �J•
Distribution: Client V File: k Sup r: V Other: Addressee(2)
AMEC Earth Environmental,Inc.
11335 NE 122ND WAY,SUITE 100
KIRKLAND,WA 98033
Tel (425)820-4669
Fax (425)820-3781 www.amec.com
amec�
AMEC Earth&Environmental, Inc.
11335 N.E. 1 ntl Way,Suite 100 Tel (425)82 - DAILY FIELD REPORT
Kirkland,Washington 98034 Fax (425)821-3914 3914
PROJECT NAME PROJECT NO. REPORT NO.
Hoodsport Cell Site 4-91 M-14819-1 2130
ADDRESS PERMIT NO. DATE
26390 NE Northshore Rd, Tahuya, WA COM2004-00142 10-19-04
CLIENT WEATHER PAGE(includes Test Reports)
Emerald Wireless Drizzle 1 of 1
STRUCTURAL ENGINEER AMEC PROJECT MANAGER/PHONE NO.
Vladi Burakovskiy
ARCHITECT AMEC FIELD REPRESENTATIVE/PAGE NO.
Tetra Tech Dave Bernier
CONTRACTOR TYPE OF INSPECTION ®NEW INSPECTION
Emerald Wireless Bolting ❑RE-INSPECTION
COMMENTSAWN 181001*-
AMEC onsite to inspect bolt antenna collar tightening and epoxy anchors for shelter to pad attachment.
Upon arrival we were informed that drill epoxy was not ready.
Bolting: Inspected antenna collar tightening via turn of the nut method with representative using maximum
effort on a-representative percent of installed bolts and observed no movement indicating bolting installed
correct and tight per plans.
l
-SUMMARY� ', }, ,
h''
To the best of our knowledge,all items inspected as noted above were in general ®Yes ❑ Preliminary Observations
conformance with the approved plans and specifications. ❑ No ❑ Deficiency Corrected-Report No.
I
I Dave Bernier 10-19-04 V"
AMEC FIELD REPRESENTATIVE REVIEWED BY
THIS REPORT IS CONSIDERED PRELIMINARY AND SUBJECT TO CHANGE PENDING REVIEW BY OUR PbOJECT MANAGER
This report is provided solely for the information of our client. This report is not intended to be transmitted to a third party by any means, except in full, without
written permission of AMEC,Inc.
AG19372(Rev.6/99)
ame
AMEC Earth& Environmental, Inc.
11335 N.E. 1 n°Way.Suite 100 Tel (425)82 - DAILY FIELD REPORT
Kirkland,Washington 98034 Fax (425)821-3914 3914
PROJECT NAME PROJECT NO. REPORT NO.
Hoodsport Cell Site 4-91 M-14819-1 2199
ADDRESS PERMIT NO. DATE
26390 NE Northshore Rd, Tahuya, WA COM2004-00142 10-26-04
CLIENT WEATHER PAGE(includes Test Reports)
Emerald Wireless __ 1 of 1
STRUCTURAL ENGINEER AMEC PROJECT MANAGER/PHONE NO.
Vladi Burakovskiy
ARCHITECT AMEC FIELD REPRESENTATIVEIPAGE NO.
Tetra Tech Robert Hill
CONTRACTOR TYPE OF INSPECTION ® NEW INSPECTION
Emerald Wireless Bolting ❑RE-INSPECTION
COMMENTS
On site to witness epoxy of anchor bolts. Four anchor bolts (two at each location) were placed. Anchor
bolts were 3/4" all thread in 7/8" holes with Simpson's Set 22 with expiration date of 10/05. All holes were
brushed and blown clean. All work was done per approved plans and verbal conformation with letter to fol-
low by Jim McAuthor site architect that all thread only need to be 3 3/4" embedment not 5" embedment.
SUMMARY N f.. a
To the best of our knowledge,all items inspected as noted above were in general ®Yes ® Preliminary Observations
conformance with the approved plans and specifications. ❑ No ❑ Deficiency Corrected-Report No.
Robert Hill 10-26-04
i
AMEC FIELD REPRESENTATIVE REVIEWED BY
THIS REPORT IS CONSIDERED PRELIMINARY AND SUBJECT TO CHANGE PENDING REVIEW BY OUR PRO MANAGER
This report is provided solely for the information of our client. This report is not intended to be transmitted to a third party by any means, except in full,without
written permission of AMEC, Inc.
AG19372(Rev.6/99)