220 OLYMPIC BLVD 2022 T MOBILE ANTENNA Plans 2023-02-24

REQUIRED REPORT ITEM APPLICABLE CROWN DOC BRIEF DESCRIPTION PRE® , THIS CHECKLISTSERVES S S � A GUIDELINE FOR THE REQUIRED C�-f�JC�I DOCUMENTS AND X MI CHECKLIST DRAWING CE ®SOW�1007 INSPECTIONS FOR THIS MODIFICATION. ONCE THE PRE -MODIFICATION APPI G IS COMPLETE AND PRIOR TO FABRICATION, THE CONTRACTOR SHALL PROVIDE DETAILED ASSEMBLY DRAWINGS AND/OR SHOP DRAWINGS. THESE INCLUDE, BUT ARE NOT LIMITED TO, A VISUAL LAYOUT OF NEW REINFORCEMENT, EXISTING REINFORCEMENT CONFIGURATION, PORTHOLES, X FOR APPROVED SHOP DRAWINGS C D-S W®10007 MOUNTS, STEP PEGS, SAFETY CLIMBS AND ANY THER MISCELLANEOUS ITEMS WHICH MAY AFFECT SUCCESSFUL INSTALLATION OF MODIFICATIONS ON THE TOWER. THESE DRAWINGS SHALL BE SUBMITTED TO THE FOR FOR APPROVAL. SHOP DRAWINGS SUBMISSION SMALL INCLUDE THE FOR RFI FORM DETAILING ANY CHANGES FROM TIME ORIGINAL DESIGN. A LETTER FROM THE FABRICATOR, STATING THAT THE WORK WAS PERFORMED IN ACCORDANCE WITH X FABRICATION INSPECTION CED®SOW-10 07 INDUSTRY STANDARDS AND THE CONTRACT DOCUMENTS, SHALL BE PROVIDED TO THE MI INSPECTOR FOR INCLUSION IN THE MI REPORT. X FABRICATOR CERTIFIED WELD INSPECTION CED®SOW-100 7 A CWI SMALL INSPECT ALL WELDING PERFORMED ON STRUCTURAL MEMBERS DURING FABRICATION. A CED®STD-100 9 WRITTEN REPORT SHALL BE PROVIDED TO THE Mi INSPECTOR FOR INCLUSION IN THE MI REPORT. MATERIAL TEST REPORTS ( TR) CED-SOW-10007 MATERIAL -TEST REPORTS SMALL BE PROVIDED FOR MATERIAL USED AS REQUIRED PER SECTION 9.3.5 OF CED®SOWm10007. MTRS SHALL BE PROVIDED TO TIME MI INSPECTOR FOR INCLUSION IN THE MI REPORT. CED-SOW-10066 CRITICAL SHOP WELDS THAT REQUIRE TESTING ARE NOTED ON THESE CONTRACT DRAWINGS. A CERTIFIED A FABRICATOR NDE INSPECTION REPORT CED�STD®10069 DTINSPECTORSMALL PERFORM NON-DESTRUCTIVE EXAMINATION AND A REPORT SHALL BE PROVIDED TO THE MI INSPECTOR FOR INCLUSION IN THE MI REPORT. NA NDE OF MONOPOLE BASE PLATE ENG-SOW®10033 A NDE OF THE POLE TO BASE PLATE CONNECTION IS REQUIRED AND A WRITTEN REPORT SHALL BE PROVIDED TO THE MI INSPECTOR FOR INCLUSION IN THE Mi REPORT. X PACKING SLIPS CED-SOW-10007 PACKING/SHIPPING LIST FOR ALL MATERIAL THAT WAS USED DURING THE CONSTRUCTION OF THE MODIFICATION. ADDITIONAL TESTING AND INSPECTIONS: A CONSTRUCTION,,�. A VISUAL OBSERVATION OF THE EXCAVATION AND REBAR SHALL BE PERFORMED BEFORE PLACING THE NA FOUNDATION INSPECTIONS CED®S -10144 CONCRETE. A VISUAL OBSERVATION OF THE REBAR SMALL BE PERFORMED BEFORE PLACING THE EPDXY. A SEALED WRITTEN REPORT SHALL BE PROVIDED TO THE MI INSPECTOR FOR INCLUSION IN THE MI REPORT. NA CONCRETE COMP. STRENGTH AND SLUMP TEST CED-SOW-10144 THE CONCRETE MIX DESIGN, SLUMP TEST, AND COMPRESSIVE STRENGTH VESTS SHALL BE PROVIDED AS PART OF THE FOUNDATION REPORT. NA EARTHWORK CED-SOW-10144 FOUNDATION SUB -GRADES SMALL BE INSPECTED AND APPROVED BY AN APPROVED FOUNDATION INSPECTOR AND RESULTS INCLUDED AS PART OF THE FOUNDATION REPORT. ICROPILES/ROCK ANCHORS SMALL BE INSPECTED BY THE FOUNDATION INSPECTION VENDOR AND SHALL BE A ICROPILE/ROCK ANCHOR CED-SOW-10144 INCLUDED AS PART OF THE FOUNDATION INSPECTION REPORT, ADDITIONAL TESTING AND/OR INSPECTION REQUIREMENTS ARE NOTED IN THESE CONTRACT DOCUMENTS. - CED®SOW-10007 POST INSTALLED ANCHOR ROD VERIFICATION SHALL BE PERFORMED l ACCORDANCE WITH CROW NA POST -INSTALLED ANCHOR ROD VERIFICATION CED-FR -10 53 REQUIREMENTS AND A REPORT SMALL BE PROVIDED TO THE MI INSPECTOR FOR INCLUSION IN THE MI REPORT. THE GENERAL CONTRACTOR SHALL PROVIDE DOCUMENTATION TO THE MI INSPECTOR THAT CERTIFIES THAT NA BASE PLATE GROUT VERIFICATION ENG-STDm10323 THE GROUT WAS REMOVED AND/OR INSTALLED IN ACCORDANCE WITH CROWN REQUIREMENTS FOR INCLUSION IN THE MI REPORT. A CROWN APPROVED CERTIFIED WELD INSPECTOR SMALL INSPECT AND TEST FIELD WELDS, FOLLOWING ALL CED®S W-10066 PROCEDURES SPECIFIED IN CROWN STANDARD DOCUMENTS APPLICABLE TO WELD INSPECTIONS. A REPORT NA FIELD CERTIFIED WEL®I INSPECTION CE -STD-10069 SHALL BE PROVIDED. NDE OF FIELD WELDS SMALL BE PERFORMED AS REQUIRED BY CROWN STANDARDS AND CONTRACT DOCUMENTS. THE NDE REPORT SHALL BE INCLUDED IN THE C I REPORT. G�STUG1 14 TIME GENERAL CONTRACTOR SMALL PROVIDE WRITTENAND PHOTOGRAPHIC DOCUMENTATION TO THE MI X ON -SITE COLD GALVANIZING VERIFICATIONE CED-FR -1033 INSPECTOR VERIFYING THAT ANY ON -SITE COLD GALVANIZING 11\/AS APPLIED PER MANUFACTURER ' SPECIFICATIONS AND APPLICABLE STANDARDS. A TENSION TWIST AND PLUMB CED-PRC-10132 THE GENERAL CONTRACTOR SHALL PROVIDE A REPORT IN ACCORDANCE WITH APPLICABLE STANDARDS CED-STD-10261 DOCUMENTING TENSION TWIST AND PLUMB. THE GENERAL CONTRACTOR SMALL SUBMIT A LEGIBLE CONY OF THE ORIGINAL DESIGN DRAWINGS EITHER X GC AS -BUILT DRAWINGS CE -SOW-10007 STATING "INSTALLED AS DESIGNED" OR NOTING ANY CHANGES THAT WERE REQUIRED ARID APPROVED BY THEENGINEER OF RECORD. EOR1 FI FORMS APPROVING ALL CHANGES SHALL BE SUBMITTED, ADDITIONAL TESTING AND INSPECTIONS: NA CED-S W-100 7 A LETTER FROM THE GENERAL CONTRACTOR STATING THAT THEWORKMANSHIP AS PERFORMED IN X CONSTRUCTION COMPLIANCE LETTER ACCORDANCE WITH INDUSTRY STANDARDS AND THESE CONTRACT DRAWINGS, INCLUDING LISTING CE -F `10353 ADDITIONAL PARTIES TO THE MODIFICATION PROCESS. NA POST -INSTALLED ANCHOR ROD PULL TESTS CED-PRC-10119 POST -INSTALLED ANCHOR RODS SHALL BE TESTED BY A CROWN APPROVED PULL TEST INSPECTOR AND A REPORT SMALL BE PROVIDED INDICATING TESTING RESULTS. PHOTOGRAPHS SHALL BE SUBMITTED TO THE MI. PHOTOS SHALL DOCUMENT ALL PHASES OF THE X PHOTOGRAPHS CED-SO -100 7 CONSTRUCTION. THE PHOTOS SHALL BE ORGANIZED IN A MANNER THAT EASILY IDENTIFIES THE EXACT LOCATION OFT E PHOTO, THE Mi INSPECTOR SHALL VERIFY THE INSTALLATION AND TIGHTNESS 10% OF ALL NON PRE -TENSIONED BOLTS INSTALLED AS FART OF THE MODIFICATION. THE MI INSPECTOR SHALL LOOSEN THE NUT AND VERIFY NA BOLT HOLE INSTALLATION VERIFICATION REPORT CED®SOW®10007 THE BOLT DOLE SIZE AND CONDITION. THE MI REPORT SHALL CONTAIN THE COMPLETED BOLT INSTALLATION VERIFICATION REPORT, INCLUDING THE SUPPORTING PHOTOGRAPHS. X PUNCH LIST DEVELOPMENT AND CORRECTION CED-PRC-10233 FINAL PUNCHLIST INDICATING ALL NONCONFORMANCE(S) IDENTIFIED AND THE FINAL RESOLUTION/APPROVAL. DOCUMENTATION CED-FRM-10235 X MI INSPECTOR REDLINE OR RECORD DRAWING(S) CED-SOW-10007 THE M! INSPECTOR SHALL OBSERVE ARID REPORT ANY DISCREPANCIES BETWEEN THE CONTRACTOR'S REDLINE DRAWING AND THE ACTUAL COMPLETED INSTALLATION. ADDITIONAL TESTING AND INSPECTIONS: NA i THE Mi IS AN ON -SITE VISUAL AND D - HAN � ON INSPECTION OF TOWER MODIFICATIONS INCLUDING A REVIEW OF CONSTRUCTION REPORTS AND ADDITIONAL PERTINENT DOCUMENTATION PROVIDED BY THE GENERAL CONTRACTOR (GC), AS WELL AS ANY INSPECTION DOCUMENTS PROVIDED BY 3RD PARTY INSPECTORS. THE MI IS TO ENSURE THE INSTALLATION WAS CONSTRUCTED IN ACCORDANCE WITH THE CONTRACT DOCUMENTS, NAMELY THE MODIFICATION DRAWINGS; IN ACCORDANCE WITH APPLICABLE CROWN STANDARDS, AND AS DESIGNED BY THE ENGINEER OF RECORD (EOR). NO DOCUMENT, CODE OR POLICY CAN ANTICIPATE EVERY SITUATION THAT MAY ARISE. ACCORDINGLY, THIS CHECKLIST IS INTENDED TO SERVE AS A SOURCE OF GUIDING PRINCIPLES IN ESTABLISHING GUIDELINES FOR MODIFICATION INSPECTION. THE Mi IS TO CONFIRM INSTALLATION CONFIGURATION AND WORKMANSHIP ONLY AND IS NOT A REVIEW OF THE MODIFICATION DESIGN ITSELF, AND THE MI INSPECTOR DOES NOT TAKE OWNERSHIP OF THE MODIFICATION DESIGN. OWNERSHIP OF THE STRUCTURAL MODIFICATION DESIGN EFFECTIVENESS AND INTEGRITY RESIDES WITH THE FOR AT ALL TIMES. THE MI INSPECTOR SMALL INSPECT AND NOTE CONFORMANCE/NONCONFORMANCE AND PROVIDE. TO THE CROWN POINT OF CONTACT (CROWN POC) FOR EVALUATION. ALL MI'S SHALL BE CONDUCTED BY A CROWN APPROVED MI INSPECTOR, WORKING FOR A CROWN APPROVED MI VENDOR. SEE CROWN CED-LST-10173, "APPROVED Mi VENDORS". TO ENSURE THAT THE. REQUIREMENTS OF THE MI ARE MET, IT IS VITAL THAT THE GENERAL CONTRACTOR (GC) AND THE MI INSPECTOR BEGIN COMMUNICATING AND COORDINATING AS SOON AS A PURCHASE ORDER (PO) IS RECEIVED. IT IS EXPECTED THAT EACH PARTY WILL BE PROACTIVE IN REACHING OUT TO THE OTHER PARTY. IF CONTACT INFORMATION IS NOT KNOWN THE GC AND/OR INSPECTOR SHALL CONTACT THE CROWN POINT OF CONTACT (CROWN POC). No. I DATE I oescaiPrioN REVISIONS Digitally signed by Yan Wang Date: 2022.03.01 21:06:31-05'00' CITY CI..tr.� / tIFT , r R. � 3. . i . ^ill NEW '1 , SCALE; N.T.S.