Joint-Use Structural Design Criteria
Telecomm Specifications (To be completed by wireless carrier)

Fields marked with an asterisk (*) are required.

 
 
Customer
Customer name *
Contact name *
Site name  
Site address  
City  
State  
Phone * - - ext.
Fax   - -
Email *
 
Specifications
Pole height
(above ground)		   feet
Design wind speed   m.p.h.
Radial ice   inches
Soils report available?   Yes   No
    If "No", please describe soil type
Picture of proposed
site available?		   Yes   No
    If "No", please describe surrounding area
 
Antennas
Mfg./Model no. Quantity RAD center Azimuth
Sectorized
antenna arms?		   Yes   No
    Centerline elevation: feet
    Horizontal separation per antenna: feet
Non-sectorized
antenna arms?		   Yes   No
    Centerline elevation: feet
    Horizontal separation per antenna: feet
“Close mount” brackets?   Yes   No
Twist/sway deflection
requirements		   degrees (at 50 m.p.h. operational wind speed)
 
Microwave Antennas
Mfg./Model no. Quantity RAD center Azimuth
Twist/sway deflection
requirements:		   degrees (at 50 m.p.h. operational wind speed)
 
Options
Cable covers   Metal 8" x 9" 
Metal 3" x 9"
Laminated wood
Bracket paint color   Brown   Green
Pole steps   Removable   Non-removable
Safety cable assembly   Yes   No
Pole drawings   Yes   No
Calculations   Yes   No
Other requests
 
Additional Comments
(Example - cable TV, telephone, etc.)
 
 
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