220 OLYMPIC BLVD T MOBILE ANTENNA 2023-06-30

r MI CHECKLIST MODIFICATION INSPECTION NOTES REQUIRED REPORT ITEM APPLICABLE BRIEF DESCRIPTION GENERAL CROWN DOC# PRE-CONSTRUCTION THE MI IS AN ON-SITE VISUAL AND HANDS-ON INSPECTION OF TOWER MODIFICATIONS INCLUDING A REVIEW OF CONSTRUCTION REPORTS AND X MI CHECKLIST DRAWING CED-SOW-10007 THIS CHECKLIST SERVES AS A GUIDELINE FOR THE REQUIRED CONSTRUCTION DOCUMENTS AND ADDITIONAL PERTINENT DOCUMENTATION PROVIDED BY THE GENERAL CONTRACTOR(GC),AS WELL AS ANY INSPECTION DOCUMENTS PROVIDED BY INSPECTIONS FOR THIS MODIFICATION. 3RD PARTY INSPECTORS.THE MI IS TO ENSURE THE INSTALLATION WAS CONSTRUCTED IN ACCORDANCE WITH THE CONTRACT DOCUMENTS,NAMELY ONCE THE PRE-MODIFICATION MAPPING IS COMPLETE AND PRIOR TO FABRICATION,THE CONTRACTOR SHALL THE MODIFICATION DRAWINGS;IN ACCORDANCE WITH APPLICABLE CROWN STANDARDS;AND AS DESIGNED BY THE ENGINEER OF RECORD(EOR). PROVIDE DETAILED ASSEMBLY DRAWINGS AND/OR SHOP DRAWINGS.THESE INCLUDE,BUT ARE NOT LIMITED NO DOCUMENT,CODE OR POLICY CAN ANTICIPATE EVERY SITUATION THAT MAY ARISE.ACCORDINGLY,THIS CHECKLIST IS INTENDED TO SERVE AS A TO,A VISUAL LAYOUT OF NEW REINFORCEMENT,EXISTING REINFORCEMENT CONFIGURATION,PORTHOLES, SOURCE OF GUIDING PRINCIPLES IN ESTABLISHING GUIDELINES FOR MODIFICATION INSPECTION. X EOR APPROVED SHOP DRAWINGS CED-SOW-10007 MOUNTS,STEP PEGS,SAFETY CLIMBS AND ANY OTHER MISCELLANEOUS ITEMS WHICH MAY AFFECT SUCCESSFUL INSTALLATION OF MODIFICATIONS ON THE TOWER. THESE DRAWINGS SHALL BE SUBMITTED TO THE MI IS TO CONFIRM INSTALLATION CONFIGURATION AND WORKMANSHIP ONLY AND IS NOT A REVIEW OF THE MODIFICATION DESIGN ITSELF,AND THE THE EOR FOR APPROVAL.SHOP DRAWINGS SUBMISSION SHALL INCLUDE THE EOR RFI FORM DETAILING ANY MI INSPECTOR DOES NOT TAKE OWNERSHIP OF THE MODIFICATION DESIGN.OWNERSHIP OF THE STRUCTURAL MODIFICATION DESIGN EFFECTIVENESS AND INTEGRITY RESIDES WITH THE EOR AT ALL TIMES.THE MI INSPECTOR SHALL INSPECT AND NOTE CONFORMANCE/NONCONFORMANCE AND PROVIDE CHANGES FROM THE ORIGINAL DESIGN. TO THE CROWN POINT OF CONTACT(CROWN POC)FOR EVALUATION. A LETTER FROM THE FABRICATOR,STATING THAT THE WORK WAS PERFORMED IN ACCORDANCE WITH ALL MI'S SHALL BE CONDUCTED BY A CROWN APPROVED MI INSPECTOR,WORKING FOR A CROWN APPROVED MI VENDOR. SEE CROWN CED-LST-10173, • X FABRICATION INSPECTION CED-SOW-10007 INDUSTRY STANDARDS AND THE CONTRACT DOCUMENTS,SHALL BE PROVIDED TO THE MI INSPECTOR FOR "APPROVED MI VENDORS". INCLUSION IN THE MI REPORT. CED-SOW-10007 ACWI SHALL INSPECT ALL WELDING PERFORMED ON STRUCTURAL MEMBERS DURING FABRICATION. A TO ENSURE THAT THE REQUIREMENTS OF THE MI ARE MET,IT IS VITAL THAT THE GENERAL CONTRACTOR(GC)AND THE MI INSPECTOR BEGIN X FABRICATOR CERTIFIED WELD INSPECTION CED-STD-10069 WRITTEN REPORT SHALL BE PROVIDED TO THE MI INSPECTOR FOR INCLUSION IN THE MI REPORT. 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 X MATERIAL TEST REPORTS(MTR) CED-SOW-10007 MATERIAL TEST REPORTS SHALL BE PROVIDED FOR MATERIAL USED AS REQUIRED PER SECTION 9.3.5 OF CONTACT(CROWN POC). CED-SOW-10007. MTRS SHALL BE PROVIDED TO THE MI INSPECTOR FOR INCLUSION IN THE MI REPORT. CRITICAL SHOP WELDS THAT REQUIRE TESTING ARE NOTED ON THESE CONTRACT DRAWINGS. A CERTIFIED REFER TO CROWN CED-SOW-10007,"MODIFICATION INSPECTION SOW, FURTHER DETAILS AND REQUIREMENTS. NA FABRICATOR NDE INSPECTION REPORT CED-SOW-10066 NDT INSPECTOR SHALL PERFORM NON-DESTRUCTIVE EXAMINATION AND A REPORT SHALL BE PROVIDED TO CEO-STD-10069 THE MI INSPECTOR FOR INCLUSION IN THE MI REPORT. SERVICE LEVEL COMMITMENT 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 THE FOLLOWING RECOMMENDATIONS AND SUGGESTIONS ARE OFFERED TO ENHANCE THE EFFICIENCY AND EFFECTIVENESS OF DELIVERING AN MI TO THE MI INSPECTOR FOR INCLUSION IN THE MI REPORT. . REPORT: X PACKING SLIPS CED-SOW-10007 PACKING/SHIPPING LIST FOR ALL MATERIAL THAT WAS USED DURING THE CONSTRUCTION OF THE MODIFICATION. • THE GC SHALL PROVIDE A MINIMUM OF 5 BUSINESS DAYS NOTICE,PREFERABLY 10,TO THE MI INSPECTOR AS TO WHEN THE SITE WILL BE READY FOR THE MI TO BE CONDUCTED. ADDITIONAL TESTING AND INSPECTIONS: • THE GC AND MI INSPECTOR COORDINATE CLOSELY THROUGHOUT THE ENTIRE PROJECT. • WHEN POSSIBLE,IT IS PREFERRED TO HAVE THE GC AND MI INSPECTOR ON-SITE SIMULTANEOUSLY FOR ANY GUY WIRE TENSIONING OR NA RE-TENSIONING OPERATIONS. • WHEN POSSIBLE,IT IS PREFERRED TO HAVE THE GC AND MI INSPECTOR ON-SITE DURING THE MI TO HAVE ANY MINOR DEFICIENCIES CORRECTED CONSTRUCTION DURING THE INITIAL MI. THEREFORE,THE GC MAY CHOOSE TO COORDINATE THE MI CAREFULLY TO ENSURE ALL CONSTRUCTION FACILITIES ARE AT THEIR DISPOSAL WHEN THE MI INSPECTOR IS ON SITE. A VISUAL OBSERVATION OF THE EXCAVATION AND REBAR SHALL BE PERFORMED BEFORE PLACING THE NA FOUNDATION INSPECTIONS CED-SOW-10144 CONCRETE. A VISUAL OBSERVATION OF THE REBAR SHALL BE PERFORMED BEFORE PLACING THE EPDXY.A REQUIRED PHOTOS 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 TESTS SHALL BE PROVIDED AS BETWEEN THE GC AND THE MI INSPECTOR THE FOLLOWING PHOTOGRAPHS,AT A MINIMUM,ARE TO BE TAKEN AND INCLUDED IN THE MI REPORT: PART OF THE FOUNDATION REPORT. FOUNDATION SUB-GRADES SHALL BE INSPECTED AND APPROVED BY AN APPROVED FOUNDATION INSPECTOR • PRE-CONSTRUCT ON GENERAL SITE CONDITION NA EARTHWORK CED-SOW-10144 • PHOTOGRAPHS DURING THE REINFORCEMENT MODIFICATION CONSTRUCTION/ERECTION AND INSPECTION AND RESULTS INCLUDED AS PART OF THE FOUNDATION REPORT. •• RAW MATERIALS MICROPILES/ROCK ANCHORS SHALL BE INSPECTED BY THE FOUNDATION INSPECTION VENDOR AND SHALL BE •• PHOTOS OF ALL CRITICAL DETAILS NA MICROPILE/ROCK ANCHOR CED-SOW-10144 INCLUDED AS PART OF THE FOUNDATION INSPECTION REPORT,ADDITIONAL TESTING AND/OR INSPECTION •• FOUNDATION MODIFICATIONS REQUIREMENTS ARE NOTED IN THESE CONTRACT DOCUMENTS. •• WELD PREPARATION BOLT INSTALLATION CED-SOW-10007 POST INSTALLED ANCHOR ROD VERIFICATION SHALL BE PERFORMED IN ACCORDANCE WITH CROWN •• FINAL INSTALLED CONDITION NA POST-INSTALLED ANCHOR ROD VERIFICATION CED-FRM-10358 REQUIREMENTS AND A REPORT SHALL BE PROVIDED TO THE MI INSPECTOR FOR INCLUSION IN THE MI ••POST CONSTRUCTION COATING NG REPAIR PHOTOGRAPHS REPORT. • •• FINAL INFIELD CONDITION THE GENERAL CONTRACTOR SHALL PROVIDE DOCUMENTATION TO THE MI INSPECTOR THAT CERTIFIES THAT NA BASE PLATE GROUT VERIFICATION ENG-STD-10323 THE GROUT WAS REMOVED AND/OR INSTALLED IN ACCORDANCE WITH CROWN REQUIREMENTS FOR PHOTOS OF ELEVATED MODIFICATIONS TAKEN ONLY FROM THE GROUND SHALL BE CONSIDERED INADEQUATE. INCLUSION IN THE MI REPORT. THIS IS NOT A COMPLETE LIST OF REQUIRED PHOTOS,FOR A COMPLETE LIST OF PHOTOS SEE CROWN DOCUMENT#CEDSOW-10007. A CROWN APPROVED CERTIFIED WELD INSPECTOR SHALL INSPECT AND TEST FIELD WELDS,FOLLOWING ALL NA FIELD CERTIFIED WELD INSPECTION CED-SOW-10066 PROCEDURES SPECIFIED IN CROWN STANDARD DOCUMENTS APPLICABLE TO WELD INSPECTIONS.A REPORT CED-STD-10069 SHALL BE PROVIDED. NDE OF FIELD WELDS SHALL BE PERFORMED AS REQUIRED BY CROWN STANDARDS AND CONTRACT DOCUMENTS. THE NDE REPORT SHALL BE INCLUDED IN THE CWI REPORT. F THE GENERAL CONTRACTOR SHALL PROVIDE WRITTEN AND PHOTOGRAPHIC DOCUMENTATION TO THE MI • wL' X ON-SITE COLD GALVANIZING VERIFICATION ENG-STD-10149 INSPECTOR VERIFYING THAT ANY ON-SITE COLD GALVANIZING WAS APPLIED PER MANUFACTURER CED-FRM-10358 MORRISON HERSHFIELD SPECIFICATIONS AND APPLICABLE STANDARDS. 1455 Lincoln Parkway,Suite 500 NA TENSION TWIST AND PLUMB CED-PRC-10182 THE GENERAL CONTRACTOR SHALL PROVIDE A REPORT IN ACCORDANCE WITH APPLICABLE STANDARDS Atlanta,GA 30346 CED-STD-10261 DOCUMENTING TENSION TWIST AND PLUMB. Tel:770-379-8500 Fax:770-379-8501 NO. DATE DESCRIPTION BY www.monisonhershfield.com THE GENERAL CONTRACTOR SHALL SUBMIT A LEGIBLE COPY OF THE ORIGINAL DESIGN DRAWINGS EITHER REVISIONS X GC AS-BUILT DRAWINGS CED-SOW-10007 STATING"INSTALLED AS DESIGNED"OR NOTING ANY CHANGES THAT WERE REQUIRED AND APPROVED BY THE ENGINEER OF RECORD.EOR/RFI FORMS APPROVING ALL CHANGES SHALL BE SUBMITTED. SITE NAME:MASONIC CENTER ADDITIONAL TESTING AND INSPECTIONS: BU NUMBER:825709 NA WO NUMBER:2069806 POST-CONSTRUCTION SITE ADDRESS: A LETTER FROM THE GENERAL CONTRACTOR STATING THAT THE WORKMANSHIP WAS PERFORMED IN 220 OLYMPIC BLVD. CED-SOW-10007 EVERETT,WA 98203 X CONSTRUCTION COMPLIANCE LETTER CED-FRM-10358 ACCORDANCE WITH INDUSTRY STANDARDS AND THESE CONTRACT DRAWINGS,INCLUDING LISTING SNOHOMISH COUNTY,USA 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 - AN "WAN REPORT SHALL BE PROVIDED INDICATING TESTING RESULTS. OF WA SAT! ENG/QA BY:KP/TH DATE: 03/01/22 PHOTOGRAPHS SHALL BE SUBMITTED TO THE MI.PHOTOS SHALL DOCUMENT ALL PHASES OF THE 4 X PHOTOGRAPHS CED-SOW-10007 CONSTRUCTION. THE PHOTOS SHALL BE ORGANIZED IN A MANNER THAT EASILY IDENTIFIES THE EXACT 4� � � p�p� DFT/QA BY:MV/MO DATE: 03/01/22 LOCATION OF THE PHOTO. CCC�� THE MI INSPECTOR SHALL VERIFY THE INSTALLATION AND TIGHTNESS 10%OF ALL NON PRE-TENSIONED / BOLTS INSTALLED AS PART OF THE MODIFICATION.THE MI INSPECTOR SHALL LOOSEN THE NUT AND VERIFY a a APRVD BY: YW DATE: 03/01/22 NA BOLT HOLE INSTALLATION VERIFICATION REPORT CED-SOW-10007 r W THE BOLT HOLE SIZE AND CONDITION.THE MI REPORT SHALL CONTAIN THE COMPLETED BOLT INSTALLATION .d VERIFICATION REPORT,INCLUDING THE SUPPORTING PHOTOGRAPHS. fin., ^413 1�- w MH PROJECT:2200039.03/CN10-497R1 X PUNCH LIST DEVELOPMENT AND CORRECTION CED-PRC-10283 FINAL PUNCHLIST INDICATING ALL NONCONFORMANCE(S)IDENTIFIED AND THE FINAL RESOLUTION/APPROVAL. Qn `Z AL E l DOCUMENTATION CED-FRM-10285 Tr... t SCALE:N.T.S. • X MI INSPECTOR REDLINE OR RECORD DRAWINGS) CED-SOW-10007 THE MI INSPECTOR SHALL OBSERVE AND REPORT ANY DISCREPANCIES BETWEEN THE CONTRACTOR'S REDLINE DRAWING AND THE ACTUAL COMPLETED INSTALLATION. MODIFICATION Wally signed by van Wang ADDITIONAL TESTING AND INSPECTIONS: Date: 030721063 °° INSPECTION NA CHECKLIST ^\ REV THE MI CHECKLIST SHALL BE REVIEWED PRIOR TO THE START OF CONSTRUCTION.ALL PARTIES TO THE MODIFICATION SHALL UNDERSTAND CROWN REQUIREMENTS AND INSPECTIONS/DOCUMENTATION THAT ARE APPLICABLE TO THE SCOPE OF WORK THEY ARE S J O PERFORMING.ERRORS ON THE CHECKLIST DO NOT ABSOLVE THE GC OR MI INSPECTOR FROM PERFORMING/COLLECTING DOCUMENTATION. L /� (/� 9