RECONFIGURATION APPLICATION

CONTACT US:1001 3rd Ave West, Ste. 420, Bradenton, FL, 34205

Phone: 941-757-5010Fax: 941-757-5009

Website:

E-mail inquiries or applications to: Todd Bowman –

COMPLETION OF THIS APPLCIATION IS REQUIRED FOR A RECONFIGURATION OF EQUIPMENT AT A FLORIDA TOWER PARTNERS, LLC SITE. THIS INFORMATION WILL BE USED TO ASSESS AND DETERNMINE FEASIBILITY AND FOR PREPARATION OF THE AMENDMENT. INCOMPLETE APPLICATIONS MAY DELAY PROCESSING.

Date Submitted
Lessee Information (as it should appear on the agreement) / Lessee Legal Notice Information (additional notice)
Company Name: / Company Name:
Street Address: / Point of Contact:
City: / State: / Zip: / Street Address:
Phone: / -- ext. / Fax: / -- / City: / State: / Zip:
Entity Type (Partnership, Corporation., etc): / Phone: / -- ext. / Fax: / --
Carrier Contact Information (market contact of lessee) / Billing Information (if different from lessee information)
Company Name: / Company Name:
Point of Contact: / Point of Contact:
Street Address: / Street Address:
City: / State: / Zip: / City: / State: / Zip:
Phone: / -- ext. / Fax: / -- / Phone: / -- ext. / Fax: / --
E-mail: / @. / E-mail: / @.
Customer Representative/Site Acquisition Contact Information (main point of contact for application information)
Company Name:
Point of Contact:
Street Address:
City: / State: / Zip:
Phone Number: / -- ext. / Fax: / --
E-mail: / @.
Site Information
FTP Site ID: / Lessee Site ID:
FTP Site Name: / Lessee Site Name:
Street Address:
City: / County: / State: / Zip:
Latitude (NAD 83): / --. / Longitude (NAD 83): / --.
Desired Installation Date:
Tenant Call Sign: / FCC License Expiration Date:
Antennas – Currently Leased
Antennas / Antenna 1 / Antenna 2 / Antenna 3 / Antenna 4
Antenna Type: / (Select One)PANELOMNIMW DISHOTHER If Other: / (Select One)PANELOMNIMW DISHOTHER If Other: / (Select One)PANELOMNIMW DISHOTHER If Other: / (Select One)PANELOMNIMW DISHOTHER If Other:
Height: / Feet (Select One)ANT CTRLINEANT BASE (OMNIs) / Feet (Select One)ANT CTRLINEANT BASE (OMNIs) / Feet (Select One)ANT CTRLINEANT BASE (OMNIs) / Feet (Select One)ANT CTRLINEANT BASE (OMNIs)
Quantity
Manufacturer
Model
Dimensions / L ” x W “ x D ” / L ” x W “ x D ” / L ” x W “ x D ” / L ” x W “ x D ”
Weight / lbs / lbs / lbs / lbs
ERP (Watts) / W / W / W / W
Azimuth
Mount Type
Amplifiers, Remote Radio Heads, Etc. – Currently Leased
Other Tower Equipment / Other Twr Equipment 1 / Other Twr Equipment 2 / Other Twr Equipment 3 / Other Twr Equipment 4
Type / (Select One)TMARRHSURGE SUPPRESORRETOTHER If Other: / (Select One)TMARRHSURGE SUPPRESORRETOTHER If Other: / (Select One)TMARRHSURGE SUPPRESORRETOTHER If Other: / (Select One)TMARRHSURGE SUPPRESORRETOTHER If Other:
Quantity
Manufacturer
Model
Dimensions / L L ” x W “ x D ” / L ” x W “ x D ” / L ” x W “ x D ” / L ” x W “ x D ”
Weight / lbs / lbs / lbs / lbs
Transmission Lines - Currently Leased
Transmission Line / Transmission Line 1 / Transmission Line 2 / Transmission Line 3 / Transmission Line 4
Type of Transmission Line / Type (Select One)COAXDCHYBRIDFIBEROTHER
If Other: / Type (Select One)COAXDCHYBRIDFIBEROTHER
If Other: / Type (Select One)COAXDCHYBRIDFIBEROTHER
If Other: / Type (Select One)COAXDCHYBRIDFIBEROTHER
If Other:
Number of Transmission Lines
Diameter of Transmission Lines
GPS Antenna / GPS:(Select)Ice bridgeShelter/CabinetsTower / Mounting Height (if on tower):
Description of Proposed Modification / Special Instructions
Antennas – Final Configuration to be Leased (include existing equipment, if remaining) – ATTACH SPEC SHEETS
Antennas / Antenna 1 / Antenna 2 / Antenna 3 / Antenna 4
Antenna Type: / (Select One)PANELOMNIMW DISHOTHER If Other: / (Select One)PANELOMNIMW DISHOTHER If Other: / (Select One)PANELOMNIMW DISHOTHER If Other: / (Select One)PANELOMNIMW DISHOTHER If Other:
Height: / Feet (Select One)ANT CTRLINEANT BASE (OMNIs) / Feet (Select One)ANT CTRLINEANT BASE (OMNIs) / Feet (Select One)ANT CTRLINEANT BASE (OMNIs) / Feet (Select One)ANT CTRLINEANT BASE (OMNIs)
Quantity
Manufacturer
Model
Dimensions / L ” x W “ x D ” / L ” x W “ x D ” / L ” x W “ x D ” / L ” x W “ x D ”
Weight / lbs / lbs / lbs / lbs
ERP (Watts) / W / W / W / W
Azimuth
Mount Type
TMAs, RRHs, Etc. – Final Configuration to be Leased (include existing, remaining equipment, if any) – ATTACH SPEC SHEETS
Other Tower Equipment / Other Twr Equipment 1 / Other Twr Equipment 2 / Other Twr Equipment 3 / Other Twr Equipment 4
Type / (Select One)TMARRHSURGE SUPPRESORRETOTHER If Other: / (Select One)TMARRHSURGE SUPPRESORRETOTHER If Other: / (Select One)TMARRHSURGE SUPPRESORRETOTHER If Other: / (Select One)TMARRHSURGE SUPPRESORRETOTHER If Other:
Quantity
Manufacturer
Model
Dimensions / L L ” x W “ x D ” / L ” x W “ x D ” / L ” x W “ x D ” / L ” x W “ x D ”
Weight / lbs / lbs / lbs / lbs
Transmission Lines - Final Configuration to be Leased ( include existing, remaining equipment, if any) – ATTACH SPEC SHEETS)
Transmission Line / Transmission Line 1 / Transmission Line 2 / Transmission Line 3 / Transmission Line 4
Type of Transmission Line / Type (Select One)COAXDCHYBRIDFIBEROTHER
If Other: / Type (Select One)COAXDCHYBRIDFIBEROTHER
If Other: / Type (Select One)COAXDCHYBRIDFIBEROTHER
If Other: / Type (Select One)COAXDCHYBRIDFIBEROTHER
If Other:
Number of Transmission Lines
Diameter of Transmission Lines
GPS Antenna / GPS:(Select)Ice bridgeShelter/CabinetsTower / Mounting Height (if on tower):
Ground Equipment – Complete Section even if no changes are being made to existing ground configuration
Dimensions of Existing Building or Pad: / L’ x W’ x H’ / Total Existing Lease Area (incl. backup power space): / L’ x W’ / Sq. Ft
Additional Ground Space Required? (Select)YesNo / If yes, dimensions? L’ x W’ / New Total Lease Area (incl. backup power space): / L’ x W’ / Sq. Ft
Power Required (volts): / HVAC Required (BTU): / Required AC Breaker (amps): / Max AC Draw @ Line Voltage (amps):
Back Up Power Required? (Select)NoExistingNew/Additional / Back Up Power Lease Area / ’ x ’ / Generator Dimensions: ’ x ’
Generator Make: / Generator Model: / Kilowatt Output: kW
Fuel/Type Containment:(Select)Diesel - Separate FuelDiesel - Self ContainedGasoline - Separate FuelGasoline - Self ContainedNatural Gas - Separate FuelNatural Gas - Self ContainedPropane - Separate FuelPropane - Self ContainedLP/Natural Gas - Separate FuelLP/Natural Gas - Self Contained / Fuel Tank Capacity: / Fuel Tank Dimension:’ x ’
Frequency (all frequencies of final system to be listed here)
Technology Type / Tx Frequencies / Rx Frequencies / Transmit Power (watts)
PCS / (Select Range)Block A: 1930-1945Block B: 1950-1965Block C: 1975-1990Block C1: 1982.5-1990Block C2: 1975-1982.5Block C3: 1975-1980Block C4: 1980-1985Block C5: 1985-1990Block D: 1945-1950Block E: 1965-1970Block F: 1970-1975
(Select Additional)Block A: 1930-1945Block B: 1950-1965Block C: 1975-1990Block C1: 1982.5-1990Block C2: 1975-1982.5Block C3: 1975-1980Block C4: 1980-1985Block C5: 1985-1990Block D: 1945-1950Block E: 1965-1970Block F: 1970-1975
List Additional Frequencies Here / (Select Range)Block A: 1850-1865Block B: 1870-1875Block C: 1895-1910Block C1: 1902.5-1910Block C2: 1895-1902.5Block C3: 1895-1900Block C4: 1900-1905Block C5: 1905-1910Block D: 1865-1870Block E: 1885-1890Block F: 1890-1895
(Select Additional)Block A: 1850-1865Block B: 1870-1875Block C: 1895-1910Block C1: 1902.5-1910Block C2: 1895-1902.5Block C3: 1895-1900Block C4: 1900-1905Block C5: 1905-1910Block D: 1865-1870Block E: 1885-1890Block F: 1890-1895
List Additional Frequencies Here / W
Cellular / (Select Range)Block A: 869.04-879.99Block A1: 890.01-891.48Block B: 880.02-889.98Block B1: 891.51-893.97
(Select Additional)Block A: 869.04-879.99Block A1: 890.01-891.48Block B: 880.02-889.98Block B1: 891.51-893.97
List Additional Frequencies Here / (Select Range)Block A: 824.04-834.99Block A1 845.01-846.48Block B: 846.51-848.97Block B1: 835.02-844.98
(Select Additional)Block A: 824.04-834.99Block A1 845.01-846.48Block B: 846.51-848.97Block B1: 835.02-844.98
List Additional Frequencies Here / W
(Select Other)BroadcastingLand MobileMicrowavePagingSMR/ESMRWireless Data / W