PLEASE RETURN THIS APPLICATION TO: / Eco-Site Site Number:
Eco-Site Site Name:
ECO-SITE, LLC
240 Leigh Farm Rd
Suite 415Durham, NC 27707 / E-Mail:
Office: /
919-636-6810 / Date Received:
Revision Dates:
Install Date:
APPLICANT/CARRIER INFORMATION
Carrier Name: / Contact Name:
Carrier Site Name: / Contact Number:
Carrier Site Number: / Contact Fax:
Carrier Legal Entity Name:
State of Registration:
Type of Entity (LP, LLC, Corp) d/b/a (if applicable): / Contact Address:
Carrier Invoice Address:
Contact Email:
Other:
Carrier Invoice Contact Name:
Title:
Phone No:
ADDITIONAL CARRIER INFORMATION
Leasing Contact Name/Number:
RF Contact Name/Number:
Construction Contact Name/Number:
Emergency Contact Name/Number:
SITE INFORMATION
Latitude: / N / Existing Structure Type:
Longitude: / W / Existing Structure Height:
Site Address:
ANTENNAS & CABLES
Sector / 1 / 2 / 3 / 4
Desired Rad Center (AGL)
Antenna Mount Mounting Height (CL - AGL)
Antenna Mounting Type / T-Frame Sector Platform Low Profile Other:
Antenna Mounting Manufacturer
Antenna Mounting Model No./Part No.
Antenna Quantity
Antenna Manufacturer
Antenna Model (attach spec sheet)
Antenna Dimensions (H”xW”xD”)
Antenna Weight (per antenna)
Antenna Orientation/Azimuth (degrees)
Antenna Mechanical Tilt (degrees)
DC Surge Protector Quantity
DC Surge Protector Dimensions
DC Surge Protector Weight
RRU Quantity
RRU Manufacturer & Model
RRU Dimensions (H”xW”xD”)
RRU Weight
TMA/Diplexer Quantity
TMA/Diplexer Manufacturer & Model
TMA/Diplexer Dimensions (H”xW”xD”)
TMA/Diplexer Weight
Other Equipment Quantity
Other Equipment Manufacturer & Model
Other Equipment Dimensions (H”xW”xD”)
Other Equipment Weight
Quantity of Coax Cables
Diameter of Coax Cables
Quantity of Fiber/Hybrid Cables
Diameter of Fiber/Hybrid Cables
# Of Channels
ERP (watts)
Transmit Frequency
Receive Frequency
Type of Service (i.e. LTE, CDMA, UMTS)
MICROWAVE
Sector / 1 / 2 / 3 / 4
Microwave Desired Rad Center (AGL)
Microwave Mount Mounting Height (AGL)
Microwave Quantity
Microwave Manufacturer
Microwave Model (attach spec sheet)
Microwave Dimensions (diameter)
Microwave Weight (per dish)
Microwave Orientation/Azimuth (degrees)
Microwave Mechanical Tilt (degrees)
ODU Quantity
ODU Manufacturer & Model
ODU Dimensions (H”xW”xD”)
ODU Weight
Quantity of Coax Cables
Diameter of Coax Cables
Quantity of Fiber/Hybrid Cables
Diameter of Fiber/Hybrid Cables
Transmit Frequency
Receive Frequency
GROUND SPACE REQUIREMENTS
Total Ground Area Dimensions (length x width in ft.) / Generator: Diesel Propane Natural Gas (Double click to check) Pad Dimension (L X W X H in ft.):
Size (KW): / Sound Attenuation:
Cabinet Dimensions L x W x D / Cabinet Manufacturer
Shelter Dimensions L x W x D / Shelter Manufacturer
AC POWER REQUIREMENTS
Voltage: / Total Amperage:
BRIEF DESCRIPTION OF WORK TO BE PERFORMED/ADDITIONAL COMMENTS
For Eco-Site Use OnlySALES
Approved / Disapproved / Conditional Approval
Comments:
Signature: / Date:
LEGAL
Approved / Disapproved / Conditional Approval
Comments:
Signature: / Date:
CONSTRUCTION
Approved / Disapproved / Conditional Approval
Comments:
Signature: / Date:
DEVELOPMENT
Approved / Disapproved / Conditional Approval
Comments:
Signature: / Date:
Rev 04-03-2017