12276 San Jose Blvd., Suite 122

TowerCom, LLC

———————  ———————.

Jacksonville, FL 32202

Corp. Phone: (904) 880-8887 Corp. Fax: (904) 405-1092

ANTENNA SITE APPLICATION /REQUEST FOR OCCUPANCY (Page 1 of 4)

Please complete one (1) of these “Schedules” for each site you are interested in constructing upon, or which is already installed. This data will then be used for occupancy suitability and preparation of the lease/license agreement and successive site Schedules.

TOWERCOM REPRESENTATIVE:
LESSEE: / Lessee/Tenant:
Address: / City/ST/Zip:
Phone #: / Fax #:
Point of Contact: / Phone/Ext.: #:
Email Address:
Who will sign the lease? Name: / Title:
Site Acquisition Company: / Contact:
Address: / City/ST/Zip:
Phone #: / Fax #:
Email Address:
Entity Type: (Partnership, Corp., etc.) / State of Organization:
SITE INFO: / Tower Site Requested:
Address: / Carrier Site Name/#:
City/State: / County:
Coordinates: / Latitude: N / Longitude: W
How will you be utilizing this site? (i.e.: Paging, Cellular, PCS…)
What technology will you use? (i.e.: CDMA, GSM, TDMA…)
Will you install your own lock on gate(s)?
Combo:

ANTENNA SITE APPLICATION/REQUEST FOR OCCUPANCY (Page 2 of 5)

LESSEE / TENANT:______SITE NAME______STATE: ______

ANTENNA INFORMATION

A) / Total # of Antennas: / Total # of Feedlines:
Antenna #1: / Transmit: / Receive:
ANTENNA (To be Mounted on Tower) / ANTENNA (Currently Mounted on Tower)
Mounting Height: / feet / Azimuth: / Antenna Weight: / lbs.
(Degrees Relative to True North)
Antenna Mfg./Model #: / Antenna Length:
Antenna Mount Mfg./Type: / MountWeight: / lbs.
Feedline: Quantity/Type: / Feedline Diameter:
Antenna #2: / Transmit: / Receive:
ANTENNA (To be Mounted on Tower) / ANTENNA (Currently Mounted on Tower)
Mounting Height: / feet / Azimuth: / Antenna Weight: / lbs.
(Degrees Relative to True North)
Antenna Mfg./Model #: / Antenna Length:
Antenna Mount Mfg./Type: / MountWeight: / lbs.
Feedline: Quantity/Type: / Feedline Diameter:
E-911 Antenna: / Quantity:
ANTENNA (To be Mounted on Tower) / ANTENNA (Currently Mounted on Tower)
Mounting Height: / feet / Azimuth: / Antenna Weight: / lbs.
(Degrees Relative to True North)
Antenna Mfg./Model #: / Antenna Length:
Antenna Mount Mfg./Type: / MountWeight / lbs.
Feedline: Quantity/Type: / Feedline Diameter:

ANTENNA SITE APPLICATION/REQUEST FOR OCCUPANCY (Page 3 of 5)

LESSEE / TENANT:______SITE NAME______STATE: ______

EQUIPMENT INFORMATION

B) / To be Installed in LessorBuilding / (OR) /

To be Installed in Lessee-owned Building / Pad

Currently Installed in Lessor Bldg. / (OR) / Currently Installed in Lessee-owned Bldg. / Pad
Equipment Mfg./Model #: / Analog: / Digital:
Type (Terminal, Transmitter, Repeater, etc.):
# / of / Cabinets / Racks / and Dimensions ( / ” W  / ” D  / ” H )
Floor space requested: / ft.  / ft. (sq ft. / ) (OR) Ground space: / ft.  / ft. (sq ft / )
Telephone line necessary? (yes or no)

GENERATORS

C) / Type of Generator:
GGGGGenerator: / Inside Leased Space: /

Outside Leased Space:

Mfg/Model: / Ground Space Required: /

ft. x

ft.

(sq ft

)

Propane Tank: /

Yes

/ Ground Space Required: /

ft. x

ft.

(sq ft

)

Natural Gas: /

Yes

Other:

AMPLIFIERS (TMA)

D) / Total Number of Amplifiers: / Mounting Height:
Amp Mfg./Model: / Amp Weight (each):
Dimensions: /

” w x ” d x ” h

Amplifiers per Sector:

REMOTE RADIO UNITS (RRU)

E) / Total Number of RRU: / Mounting Height:
RRU Mfg./Model: / RRU Weight (each):
Dimensions: /

” w x ” d x ” h

RRU per Sector:

ANTENNA SITE APPLICATION/REQUEST FOR OCCUPANCY (Page 4 of 5)

LESSEE / TENANT:______SITE NAME______STATE: ______

MICROWAVE DISH(S)

F) / Total Number of Microwaves: / (OR) / Currently Installed
Tower Mounting Height(s):
Mfg./Model #: / Description: / Solid: / Grid: / Size:
Feedline: Quantity/Type: / Feedline Diameter:
Frequencies:

POWER REQUIREMENTS

Power Requirements into Equipment: / Volts / A/C BTU Requirements:
Required AC Circuit Breaker: / Amps / AC Line Voltage: 120 / 240 / Other:
Transmit Power of Equipment Per Channel: / Watts / Effective Radiated Power (ERP): / Watts
Maximum AC Current Draw @ Given Line Voltage: / Amps

H) CHANNELS/ FREQUENCIES

# of Channels/Frequencies:
Transmit Frequencies: (List each channel) / MHz
Receive Frequencies: (List each channel) / MHz
Filters/Duplexers: / GPS:
FCC License / Call Sign: / Expiration:
Market Info / BTA: / MTA: / Other: / Channel Block:

I) INSTALLATION

Date of Anticipated Installation: / (OR) / Now Installed? / YES/DATE:
INSTALLED
Installation/Construction Company:
Contact Name: / PHONE #: / FAX #:

ANTENNA SITE APPLICATION/REQUEST FOR OCCUPANCY (Page 5 of 5)

LESSEE / TENANT:______SITE NAME______STATE: ______

J) COMMENTS

COMMENTS:
COMMENTS:

SIGNATURE:DATE:

STRUCTURAL APRROVAL:______TowerCom VP APPROVAL:______