The URL can be used to link to this page

Home My WebLink About1480 Burlingame Avenue - Application� f� HURLIMGAME �. ,,_, COMMUNITY DEVELOPMENT DEPARTMENT • 5O1 PRIMROSE ROAD � BURLINGAME, CA 94010 p: 650.558.T250 • f: 650.696.3790 • www.burlingame.org APPLICATION TO THE PLANNING COMMISSION Type of application: ❑ Design Review ❑ Variance ❑ Parcel #: ❑ Conditional Use Permit ❑ Special Permit ❑ Zoning / Other: PROJECT ADDRESS: irs,r} ,_,�,_s�;_R�`.��/"z,r�4�� ,=',`�E APPLICANT Name: GR�G DAVIS - AGENT �� r3�"& � Address: 350 WAYNE PLACE #, 3 City/State/Zip: �AKLAND C7 g46�� Phone: i415) 830-20fl3 E-mail: 9��visC�j5ip.c��;; ARCHITECT/DESIGNER Name: ��SON OT��3�1�� Address: �Q30 MAIN S�. STE 200 City/State/Zip: �RVINE CA 92614 Phone: E-mail PROPERTY OWNER Name: NEW CINGULAR WIRELESS PCS, LLC' Address: �001 EXECUTIVE PKWY City/State/Zip: ��! �:��,vi� �!i �4��s;j Phone: _ E-mail: 9491 247-7767 EXT. 1 i 2 joffineerC�? i5ip.com Burlingame Business License #: F . °` '}_ :_ �'a..� � �.� � � �,JG � �� 2018 �:'. ; �( O� BURLINGAME - - ,_ . `'��'' _: �`.�.''. Authorization to Reuroduce Proiect Plans: I hereby grant the City of Burlingame the authority to reproduce upon request and/or post plans submitted with this application on the City's website as part of the Planning approval process and waive any claims against the City arising out of or related to such action. (Initials of Architect/Designer) PROJECT DESCRIPTION: Swwap (6) existinq antenna� 4:��i�h ;h) proposed antennas. Swap (61 RRU's �I�:St��l i;;j �1�0��;�u s(�l�il.,'• S nr�r �n�ennas. Instalf assaciatF�� GC7Li;p�f`�1;:r�t snSi[lF �`;;S.it"�Ci @ri?.lii�. �hE;I't�t". AFFIDAVIT/SIGNATURE: I hereby certify under penalty of perjury that the information given herein is true and correct to the best of my knowledge and belief. Applicant's signature: Date: �/2 �i /� g I am aware of the proposed application and hereby authorize the above applicant to submit this application to the Planning Commission. Property owner's signature: s� �7�� ET�� GF /�l Yfi�4�/L�' Dat : Date submitted: 8 Z3 �$ S: �HANQOUTS�VCApplication.doc � at&t AT�T TowKs Progrsm Many�nw�m Offia 5001 E�tecutive Pkwy. l4W750 S�n AartWn. GA 94583 ,.. :�� To: The C'ity of Burlingame LElTER OF AUTHORIZATION APPLICATION FQR ZOtVING/USE%BUtLDiNG PERMIT ,; �=� �Ois � . � - �'! .��=sLfNGr'!ME _;i)1'-i=';_[1i�,1`'�li\'(; ,rl��/ AT&T Corp ("A7&T"), as owner of the betow-described p�operty, does hereby appoint New Cengular Wireless, PCS, LLC, a Delaware timited liability Cornpany ("Mabitity"j, as agent for the purpose of consummating any application necessary to ensure Mobilit�s ability to use and%or construct improvements to the properry leased, or IicensecE, to them for the purpose of canstructing a communications site. AT&T and Mobility both understand that the apptication may be denied, modified, or approved with conditions, and that such conditions ar modifications must be corrtplied with prior to issuance vf building permits. Mobility understands and acicnowledges that any construction of impro�ements is subject to the full execution of a license agreement with AT&T, and that any action on the part of Mobility ta proceed with any applications with governmental agencies is at Mobilit�s sole risk and liability. Mobility shall proteci, defend, indemnify and hold AT&T and its parent, affiliates and its and their directors, officers, employees, successars and assigns free and harnnless from and against any and a!! injury, damage, loss, liability, lien, penaliy, claim or expense ("Liabilities") ir►cluding without limitation, attorneys' fees, expert witness fees and legal costs suffered by reason of any claim, cause af action, suit or judgment, Liabilities as a �esult of injury to or death of any pe►�son, of damage to ar lass ar destruction of any p�operry, violatian af arry laws affecting or concerning any properties owned by AT&T, claims for personal injury, emational distre5s, infringement of any patent, trademark, ccapyright, trade secret or oiher legally protected proprietary right, which arises out of, is occasianed by or in any way attributable to the ads or omissions of Mobility, its agents or contractors in connection with this Letter of Authorization, except to the extent caused by the active negligence or willful misconduct of AT&T, its agents or contractors. Property Lotation: 148� Burlingarn� Ave. Burlingame, CA 94Q10 SBE Number: 279-41-6 _ Signatu of Prop�rty Owt��: AT&T CORP 4�r 1/ 1 ,�` � ` .°�,r�`": c `_� , �� .- a-; _.{r � _ / / � ..� �_ _ . t.�-�r- __ ._,___._.,.r_. _ � - � -. � SY. � ' � �- . 6rett Pete�nan Elizabeth t?o�ing �u�n Notary Public Cobb Courtty, Georgi�t My Camm. Expires Q4IQS/2021 Tiile: Area Manager, Network Engineering & Sales Support ,-. .; �, � Date: ;�,�" �- , - � PHOTOSIMULATION SWAP (6J EXISTING ANTENNAS FOR (6J NEW ANTENNAS, SWAP (6J RRU'S, INSTALL (3J `� NEW RRU'S ON EXISTING ROOFTOP �� 5 SET 1- 6/17/18 CCL00566 1480 Burlingame Ave Burlingame CA 94010 VIEW 1 dt&t I �� a � �� _ �..�.,:�_.�.. _b`.-'�'� EXISTING ANTENNAS s �.--�-.. � � '`,� ��'� -�"`i PROPOSED MODIFICATION � �;y,,, .. � .- .ut.�2�1�tii'- - _- _ f, i ; ,. , . ,��, � - " �_. .�� fM1. y �-�� ;: i , . � �� I ��a,�� '�; �i � � � � ' � PHOTOSIMULATION SWAP (6J EXISTING ANTENNAS FOR (6J NEW ANTENNAS, SWAP (6J RRU'S, INSTALL (3) � � NEW RRU'S ON EXISTING ROOFTOP � 5 SET 1- 6/17/18 CCL00566 1480 Burlingame Ave Burlingame CA 94010 VIEW 2 at&t I I �. i '�� S�' ', --------____ - �W. - - __ —�--�-------_ __ --- '-----� I� � _ �� °"r r�i ,� .,. _ — — —�°-- m �► �. --- �; � ,c. 111 " '� '' "" r,:� � °t r � "�,"�` � —ti-: � �_ __ ��. � �.,�� n �� __, '';_.�� ,,, �� ,�� ,� �' --- •� � z�`'� M1 ( - � � � ' �r � e_ d ;�,�y��. ��a�� `, ��"' �f ��g .. . ,� �� r, : �3'n0� �„ , ay� . r,w -t� � J' ; �� _. ._._. . -- z . .. � �-. �` .,. . ` _ .,� � —. ,�. - .�� :�:�1 _ .. _ ,,. � �v�...-,�. ,, + - . ,, , < , . ,. , �„: � �� i'� Q F c, y � � � _ t w " � � � �'� `'j � � � � � =� � � _ �� , y, . . , ..� - ., � � , `- � �, , ` : • -, , ,_ . � , , " , - - �!r . ' -Y, - �, � x. ; -._ ..'Gn' _ .�,;+�At+. . _ �_ `�� •' �`;s 't�,;� �'t<� �, s s� �. r r �C . ._ k� .. _ __ . . .. . .-. ____ _. __ - - ___ �''-�--"--._-_.�.___._. .. . -.;:,a,�.w�. — �_ � ._ -'_....-�.�--�._.-.._-.-_ -_� _.___ �: _ � �� 1� 'm , . �`�' iti '�" _ m m � ---------------- ,�. ; ,�, 111 : ,_� �'+�,� � ��'x _ ��' �IIi nir .-. ��_ ��r.;�.� ,.. � �. J �� "/ ' 1` n 4 t'' � �,;» �� s� � .ta�°�:z•, � s� v I ' ' �" `�� :y . '±;�� ,�. � .. Q ., =_'+�,..'t,nr-..ar x- ,.. � PHOTOSIMULATION SWAP (6J EXISTING ANTENNAS FOR (6J NEW ANTENNAS, SWAP (6J RRU'S, INSTALL (3) � NEW RRU'S ON EXISTING ROOFTOP � 5 SET 1- 6/17/18 CCL00566 1480 Burlingame Ave Burlingame CA 94010 VIEW 3 at&t I I � -:;r�„, � L� �� 3 ti� I Y 4 � �~x�' � J +1 t _ �� ` iti ,h� ♦ , ' '�. *� . �' . ,.�. �; ��` .,� . ► ��'` "� -�?��,. . Gr� � �� ..`� �' ' �` ' ! ,�.';� Y �T+a �< � � ��"' 'r:++"''��'�'i"'�' .. " G. � �'1�- �3 ,. �'�'�� a�. 1'�" �� W 4 � � � �� `�� - �� \ � � � � � ��, � m t �' 7 ' 4 � ti� � ;j� d r , ~� � f,R"i..,. �� .. ' � �t `.�� • �. �' .. 4 i •, � � `� � � � f�' � � . �.� 4` �� " �pf� � � � � f �~,,�- �. , �.�``` �' � 2��: r� `� ''�� '� ��,,� ,`�.-�'��'� � �`. �� . � �` '""'� � . �.- "� y � � �„ �-� �.� �';ii� � �; � ,d' . �, "` - � ,� �A �� , i .:x '� "' �„ ' � � � � �, � `� �l��. ��•. ��, � � �� r �, ��. � . ,.�.�, ,� . � .,� .. ,I� � ,�� _ �.a,. ,�r f �'?a �y� � � �� ,�,� + 1: f� h��.f• � ` . � �' .. �. . . � � ;y�. '1► � k�' . x �'� �'T� � ,�_ �' ' �� , ` ✓i.�" �� - , `�� `� . �� ' �, � x : '� � '� $ � ,�";� ' � � � "� - � �, 1 '!�. ` � �,�� °� ; � �"� _ `,. f �rr �, t , '�.� �"` ` '� '." � � `�� x�� #� �. '�� / � � �� ' ,�!�',1 �,�. - ti.' ��.,_ '�► :. . - � • r .r;.; ,r,r y " "� � �" f� ��x �g ri; r . ,�� frJ .e'< yM;t' _ y. . �� '. � . � �... ..�I rS" ` ' .. 1, ' ;, � �.,�1 , ;,.�! �' �, 4+w; ;� a ..�r'..� .�. ��. t� �� ' �,� S �: ��' � . , I �`�'�C � �1''�.� `�l � a • �it` f � .r_ �`l�`� � « � _ �s ,/�o �'` �. ` ��r `�,� -. ti ... i � t+ `M��s ` • �►� �,;,;'� f �'� 1F�'' ri • ;� ,�. `�<.,�� 'r � . ��,F � � # ,�1i►� � � � � ` �.�` ,,, �.'��# � � ` ; . 'i .4�. '�� .,y � a wj f � ,k,'.,� p�' `�` � � �� - y �eA � � . , ��,y1F i'(�� L �� j� r l 1 !' B• .. . • .��f : �! �r�,': ��` � , f x � yl - � � �. - � � F x.�, iy ., '� � ' 'F` .�; �,� , � � �� . � :_� ' a; �� - � � � � � � �.f ,� � �:; a .�� ,y , � � �r �_� �� "' 0`.� ` ,f �� • '�, `c¢;. �' � � �`� �� - . � � s� s �, 'n �}'''�.... ) ��`d�-� / qR . � . . . 4:-: . l5' � , ' � � a �*�`� �` � � y, � .. '�� - xe �' � .. �y ' t' •q, �!f: —y��, . _ i'o4 � � ��: Y. '� � �2� �#�', � r ✓ � r °� .0 `T�,H{�r �` . y�,A � �;.r � nM ah.. � 7� f �{� 4 �`-,f � �� . T M �.+�'h.� :`'if�� 9• . � Y' :� p ci , .. � -- �� V" " 1 •� �� 3# �. '� , �`�"'`� � ` �� . eF' '� .. � '� \_ . �.� . �,�' � � a. � � PHOTOSIMULATION � �� 5 CCL00566 1480 Burlingame Ave Burlingame CA 94010 VIEWS dt&t I � ,$� � . �- �,l��.: .- x '> :o. ; �pril 14, 2018 3uilding Inspector C'ity of Burlingame 501 Primrose Rd. Burlingame CA 9401(� Pacifica, CA 9404=� RE: Building Pemut Application Applicant: New Cingular Wireless PCS, LLC ("AT&T") Property Owner: New Cingular Wireless PCS, LLC Properry Address: 1400 Burlingame Ave. Burlingame, CA 94010 Dear Building Inspector: _.�:��, ;i i Y Oi= �-�sl?RLIP: , f-.h_�I �?�;!�!1�1; New Cingular Wireless PCS, LLC {"AT&T") seeks a building permit to modify an e�sting wireless facility at the above-referenced property. Your building permit application form along with the applicable application fee of $ is submitted with this letter. AT&T applies for the building permit under Section 6409 of the federal Middle Class TaY Relief and Job Creation Act of 2012 (47 U.S.C.A. § 1455). That law provides: "a State or local government may not deny, and shall approve, any eligible facilities request for a modification of an existing wireless tower or base station that dces not substantially change the physical dimensions of such tower or base station." To assist with your review, an Eligible Facilities Request (EFR) Application is enclosed that applies the proposed modification to the relevant law and regulations, and it includes information pertinent to your review. As demonstrated in the EFR Application, this modification is an EFR and must be approved. Federal rules provide a 60-day timeline for EFR applications to be processed or they will be deemed approved after written notice on or after Day 61. �T&T respectfully requests that the building permit be issued as soon as possible but no later than 60 days from the date of this letter, so that AT&T can proceed with this modification immediately. If you have any questions regarding this application, please contact me. Respectfully, �� Enclosures: Building Peimit Application Form Eligible Facilities Request Application Building Permit Fee �§��I��D Eligible Facilities Request Application (47 U.S.C. § 1455(a)) Applicant: AT&T Applicant/Agent Contact Information: GREG DAVIS - AGENT FOR AT&T 350 WAYNE PLACE #3 OAKLAND CA 94606 PH: (415) 830-2003 EMAIL: GDAVIS@J51P.COM � �� 2o�s , �:i,= E3�JRLIf�GAME � �_r,; n., �•�;in,ii,: r:�ai _ ,i, i. � . Property Owner: NEW CINGULAR WIRELESS PCS, LLC - 5001 EXECUTIVE PARKWAY SAN RAMON CA 945s3 Property Location (e.g., address, parcel no., GPS COOiC�1T1at2S�: �480 BURLINGAME AVE BURLINGAME CA 94010 Project Descnption: SEE ATTACHED PROJECT DESCRIPTION Date of filing: 30 days after filing: "To tol! the tinzeframe, for incompleteness, the ��evietiving State or local gover�anzent naust provide written notice to the applicant tivithin 30 days of receipt of the application, clearlv and specifica/lY delineating all ntissing docume�7ts or information. Such delineated infa�mation is limited to docurnents or inf'ormation ineeting the stanclard under paragraph (c)(1) of this section. " 47 C.F.R. 1.40001(c)(3)(i). 60 days after filing: "Timefrante for Review. F�'ithin 60 days of the date on whicl� an applicant submits a request seeki�zg approval under this section, the State or local government shall approve the application unless it deter»iines that the application is not covered bv this section. " 47 C.F.R. 1.40001(c)(2). Page 1 of 4 Applicant Initials Is the proposed modification an Eligible Support Structure? Please check the applicable boxes: An "Eligible Support Structure " means `:4ny toiver or base station as defined in this section, provided that it is existing at the time the relevant application is filed ►vith the State or /ocal govenznient under this section. " 47 C.F.R. 1.40001(b)(4). �"Tower" means `Any structure built jor the sole or priniary purpose ofsupporting any Conunission- licensed or authorized antennas and their associated facilities, including structures that are constructed for ivireless comniunications services including, but not limited to, private, broadcast, and public safety services, as well as unlicensed wireless services and fixed tivireless services such as microtivave backhaul, and the associated site. " 47 C.F.R 1.40001(b) (9). �1t• �`Base Station " means A structure or equipment at a fixed location that enables Commission-licensed or authorized wireless communications behveen user equipment and a comntunications nehvork. The term does not enconepass a totiver as defined in this subpart or any equipment associated with a toiver. (i) The term includes, but is not limited to, equipment associated tivith wireless communications services such as private, broadcast, and public safety services, as well as unlicensed tivireless services and fixed wireless services such as microwave backhaul. (ii) The term includes, but is not limited to, radio transceivers, antennas, cocrcial or frber-optic cable, regular and backup potiver supplies, and comparable equipment, regardless of technological configuration (including Distributed Antenna Systems and sntall-cel! nehvorks). (iii) The term includes any structure other than a tower that, at the time the relevant application is frled �vith the State or local government under this section, supports or houses equipnient described in paragraphs (b)(1)(i)-(ii) ojthis section that has been revietived and approved under the applicable zoning or siting process, or under another State or local regulatory revie►v process, even ijthe structure ivas not built jor the sole or primary purpose of providing suclz support. (iv) The term does not include any structure that, at the time the relevant application is filed witlz the State or local government under this section, does not support or house equipment described in paragraphs (b) (1) (i)-(ri) of this section. " 47 C.F.R. 1.40001(b)(1)_ .�BJf� �✓ `Existing"— `A constructed tower or base station is existing for purposes of this section if it has been reviewed and approved under the applicable zoning or siting process, or under m�other State or local re�latory review process, provided that a tower that has not been reviewed cuzd approved because it was not in a zoned area tivhen it was built, but ivas lmvfully constructed, is ezisting for purposes of this definition. " 47 C.F.R. 1.40001(b)(S). 2. What is the baseline height of the Eligible Support Structure? Please complete the Baseline Height Worksheet and insert baseline height here 83' . For modifications that will not change the height of the Eligible Support Structure, insert "N/A." Page 2 of 4 -- - - Applicant Initials Is the proposed modification an Eligible Facilities Request? An ` Eligib/e Facilities Request" means `Any rec�uest for nrodification oJan ezisting totiver or base station that does not substantially change the physical dimensions of sarch totiver or base station, involving: (i) collocation of netiv transmission equipment; (ii) rentoval of transmission equipment, or (iii) replacement of transmission equipment. " 47 C.F.R. 1.40001(b)(3); 47 U.S.C.1445(a). "Collocation" means "The mounting or installation of transmission equipment on an eligible support structure for the purpose of trans»eitting and/or receiving radio frequency signals for canmunications purposes. " 47 C.F.R. 1.40001(b)(2). "Transmission equipment" means "Ecluipment that facilitates transmission for any Commission-licensed or authorized wireless communication service, including, but not limited to, radio transceivers, antennas, coazial or fiber-optic cable, and regular and backup potiver supply. The term includes equipment associated with wireless communicatians services including, but not limited to, private, broadcast, and public safety services, as tivell as unlicensed wireless services and fized tivireless services such as microwave backhaul. " 47 C.F.R. 1.40001(b)(8). 3.1 Please check all applicable boxes that describe the proposed modification: �Collocation of new transmission equipment �Removal of transmission equipment �Replacement of transmission equipment 3.2 Please complete the Substantial Change Worksheet to detennine if the proposed modification substantially changes the physical dimensions of the Eligible Support Structure. Based on the Substantial Change Worksheet, will the proposed modification substantially changes the physical dimensions of the Eligible Support Structure? No If you answered "Yes," stop because the application is not an eligible facilities request. 4. Compliance with State and Federal regulations and codes. The proposed modification— � ��c�� rsld �tjf,E��rt�t��lf� �`:s��z�,� �Will comply with FCC regulations regarding human exposure to radio frequency electromagnetic fields �Will comply with Federal Aviation Administration (FAA) and FCC tower lighting requirements �✓ Will comply with applicable state environmental regulations �Will comply with applicable building codes Page 3 of 4 — —__ -- ApplicantInitials_ - �Will comply with applicable fire codes �Will comply with other non-discretionary and generally applicable structural and safety codes �✓ Will comply with Section 106 historic preservation review, if applicable �Will comply with the National Environmental Policy Act (NEPA), if applicable 5. Attachments: �Completed Baseline Height Worksheet �Completed Substantial Change Worksheet ❑✓ Letter of authorization �Applicable non-discretionary permit fees �Building drawings, including site details and plans ❑Documentation of property rights to site ❑✓ Prior approval for Eligible Support Structure �Other: Page 4 of 4 --- _ __ __ __ — ._ APPlicant Initials __ _ _ Baseline Height Worksheet 1. Does the application seek approval for collocation or replacement of transmission equipment? ❑No. Stop, the height will not increase for removal of transmission equipment. Continue to #7 and respond "N/A." ❑✓ Yes. Continue to #2. 2. Was the tower or base station subject to previous review and approval by the local jurisdiction (as originally built or as n:odified to its current state)? ❑✓ Yes. Continue to #3. ❑No. Does the application seek to modify a tower or base station that was in a zoned area when built? A. ❑No. Was the tower or base station lawfully constructed? i. �Yes. ii. ❑No. Request Continue to #3. Stop, the application is not an Eligible Facilities B. ❑Yes. Stop, the application is not an Eligible Facilities Request (because the tower or base station is not considered "existing"). 3. Does the application seek to collocate transmission equipment that will be separated horizontally on a base station (such as on a rooftop)? A. ❑✓ Yes. Continue to #7. The baseline height is that of the original support structure (e.g., the height of the rooftop, penthouse). B. _ ❑Na Continue to #4. 4. Has the tower or base station been modified per a previous approval by the local jurisdiction? A. �No. Continue to #7. The baseline height is the originally-approved height of the tower or base station. B. ❑Yes. Continue to #5. Baseline Height Worksheet Page 1 of 2 _ — -- _ _ —_ APPlicant Initials 5. Was the tower or base station modified based on approval by the local jurisdiction issued before February 17, 2012?' A. �Yes. Continue to #6. B. ❑No. Continue to #7. The baseline height is the height of the tower or base station as of February 17, 2012. 6. Was the tower or base station modified to the maximum height approved by the local jurisdiction per any approval(s) before February 17, 2012? A. ❑Yes. Continue to #7. The baseline height is the existing height of the tower or base station. B. ❑No. Continue to #7. The baseline height is the height as approved by the local jurisdiction before February 17, 2012. 7. Insert baseline height here 83� and at item 2 to the Eligible Facilities Request Application. ' The Spectrum Act was passed by Congress on February 17, 2012 and signed into law by the President on February 22, 2012. The FCC's Repod and Order and regulations refer to the date of passage rather than date of enactment as the trigger for the analysis. Approvals issued after February 17, 2012 do not affect the baseline dimensions for determining whether an application proposes a substantial change. Baseline Height Worksheet Page 2 of 2 ---- _ _ - — -- �1PPlicant Initials _ _ Substantial Change Worksheet Definition of "Substantial Change": "Substantial Change" means `A modifrcation substantially changes the physical dimensions of an eligible support structure if it meets any of the following criteria: (i) jor towers other than towers in the public rights-oj-way, it increases the height of the tower by more than 10% or by the height of one additional antenna array �vith separation fron: the nearest existing antenna not to ezceed riventy feet, whichever is greater; for other eligible support structures, it increases the l7eight of the structure by more than 10'� or more tha� ten feet, tivhichever is greater; (A) Changes in height should be measured Jrom the original support sh-ucture in cases where deployments are or will be separated horizontally, such as on buildings'rooJtops; in other circuntstances, changes in height should be measured from the dimensions of the tower or base station, inclusive of originally approved appurtenances and any modifications t/zat �vere approved prior to the passage of the Spectrum Act. (ii) jor towers other than towers in the public rights-of-way, it involves adding an appurtenance to ihe body of the totiver that tivould protrude from the edge of the totiver more than hventy jeet, or more than the width of the tower structure at the level of the appurtenance, whichever is greater; for otlzer eligible support structures, it involves adding an appzertenance to the body of the structure that tivould protrudeJrom the edge of the structure by more dzan six feet; (iii) jor a��y eligible support structure, it involves installation of more than the stmzdard number of»ew equipment cabinets for the teclznology involved, but not to exceed jour cabinets; or, jor totivers in tlle public rights-of-tivay a�rd base stations, it invalves installation of any new equipment cabinets on ihe ground rf there are no pre-ezisting ground cabinets associated tivith the structure, or else involves installation of ground cabinets that are more than 10% larger in height or overall volume than any otherground cabinets associated with the structure; (iv) it entails any excavation or deployn�ent outside the current site2; (v) it would defeat the conceabnent elements of the eligible support structure; or (vi) it does not comply with conditions associated tivith ihe siting approval of the construction or modification of the eligible support structure or base station equipment, provided hotivever that this limitation does not apply to any modification that is noncompliant only in a manner that would not exceed the thresholds identified in � 1.40001(b)(7)(i)-(iv). " 47 C.F.R. 1.40001(b)(7). _1__ _ Check-the box that describes the Eligible Support Structure:-- -- ❑✓ Base station. Continue to #2. ❑Tower located in the public right-of-way. Continue to #2. ❑Tower located outside of the public right-of-way. Continue to #3. Z"Site "— "For towers other than towers in the public rights-of-way, the current boundaries of the leased or owned property surrounding the totiver and any access or utility easements curre�ztly relaled to t17e site, and, for other eligible support structures, further restricted to that area in proximity to the structure and to other transmissio�z equipment already deployed az the ground. " 47 C.F.R. 1.40001(b)(6). Substantial Change Worksheet Page 1 of 4 - -- -- -- _ _ APPlicant Initials 2. Answer the following questions about the proposed modification and proceed as instructed: A. Is the baseline height for the Eligible Support Structure greater than 100 feet? �Yes. Continue to item 2B. �o. Continue to item 2C. B. Does the proposed modification increase height by more than 10% of the baseline height? _ �Yes. Continue to item 11. ❑No. Continue to item 2D. C. Does the proposed modification increase height by more than 10 feet? �Yes. Continue to item 1 l. �✓ No. Continue to item 2D. D. Does the proposed modification add any appurtenance that would protrude more than 6 feet from edge of the Eligible Support Structure? �Yes. Continue to item 11. �No. Continue to item 4. 3. Answer the following questions about the proposed modification and proceed as instructed: A. Will the proposed modification increase height by more than 10% of the baseline height of the Eligible Support Structure? �Yes. Continue to item 3B. �No. Continue to item 3C. B. Will the proposed modification increase height by more than the height of one additional antenna array with separation from the nearest existing antenna not to exceed 20 feet? �Yes. Continue to item 11. ❑No. Continue to item 3C. Substantial Change Worksheet Page 2 of 4 - -- --- Applicant Initials — - C. Does the proposed modification add any appurtenance that would protrude more than 20 feet from the edge of the Eligible Support Structure? �Yes. Continue to item 3D. �No. Continue to item 4. D. Does the proposed modification add any appurtenance that would protrude more than the width of the tower structure at the level of the appurtenance? �Yes. Continue to item 11. �No. Continue to item 4. 4. Does the proposed modification involve installation of more than standard number of equipment cabinets for the technology involved, not to exceed four? ❑Yes. Continue to item 11. �Na If the Eligible Support Structure is a base station, continue to item 5. If the Eligible Support Structure is a tower in the public right-of-way, continue to item 5. If the Eligible Support Structure is a tower outside of the public right-of- way, continue to item 8. 5. Does the proposed modification involve installation of any new equipment cabinets on the ground? �Yes. Continue to item 6. �o. Continue to item 8. 6. Are there any pre-existing ground cabinets associated with the Eligible Support Structure?_ _ _ _ _ �Yes_ Continue to item 7. ❑No. Continue to item 11. 7. Are the proposed new ground cabinets more than 10% larger in height or overall volume than any other ground cabinets associated with the Eligible Support Structure? ❑Yes. Continue to item 11. �To. Continue to item 8. Substantial Change Worksheet Page 3 of 4 - -- — Applicant Initiais 8. Does the proposed modification involve excavation or deployment outside of the current site3? �Yes. Continue to item 11. �No. Continue to item 9. 9. Will the proposed modification defeat the existing concealment elements of the Eligible Support Structure? �Yes. Continue to item 11. allo. Continue to item 10. 10. Will the proposed modification comply with conditions associated with the siting approval(s)? A. �Yes. Continue to item 12. �No. Describe the non-compliance: Continue to item IOB. ❑Not applicable. Continue to item 12. B. Is the non-compliance with conditions associated with the siting approval(s) based on any of the following: (a) height, (b) protrusion of any appurtenance from edge of the Eligible Support Structure, (c) number of equipment cabinets to be installed, (d) location of excavation, or (e) impact to concealment elements that would not exceed the thresholds outlined above? ❑Yes. Continue to item 12. ❑No. Continue to item 11 _ 11. The proposed modification is a substantial change to the physical dimensions of the existing tower or base station. Insert "Yes" in item 3.2 of the Eligible Facilities Request Application. 12. The proposed modification is not a substantial change to the physical dimensions of the existing tower or base station. Insert "No" in item 3.2 of the Eligible Facilities Request Application. 3 See footnote 2. Substantial Change Worksheet Page 4 of 4 --- — — -- ---- APPlicantInitials__ r :�� ...:,,. y,� p � ,, fi M.,� �`'». fyY' '��..� i t'�r � La�/� .. _. � �') r_•; (! ;' �{ CCL00566 — PROJECT DESCRIPTION = �.�._�ruvGaM� ... _ '.'•i;�,�.��^ �,��,� MODIFICATION TO AN UNMANNED TELECOMMUNICATIONS FACILITY, CONSISTING OF THE FOLLOWING: •SWAP (6) EXISTING PANEL ANTENNAS WITH (6) PROPOSED PANEL ANTENNAS, TYP. (2) PER SECTOR •SWAP (3) RRUS 12+A2 WITH (3} PROPOSED RRUS 4426 B66 NEAR ANTENNAS, TYP. (1) PER SECTOR •SWAP (3) RRUS 11 WITH (3) PROPOSED RRUS 4415 B25 NEAR ANTENNAS, TYP. (1) PER SECTOR •INSTALL (3) PROPOSED RRUS 4478 B14 NEAR ANTENNAS, (1) PER SECTOR •INSTALL (1) PROPOSED STRING OF 155AH BATTERIES •RELOCATE (1) EXISTING PANEL ANTENNA FROM POS. 2 TO POS.4 (SECTOR B ONLY) •RELOCATE (1) EXISTING PANEL ANTENNA FROM POS. 2 TO POS.1 (SECTOR C ONLY) REMOVE (6) EXISTING TMAs, TYP. (2) PER SECTOR REMOVE (12) (E) 7/8" LINES OF UNUSED COAX REUSE (2) EXISTING XMU's AND (1) EXISTING 5216 INSTALL (1) PROPOSED 5216 WITHIN EXISTING RACK INSTALL (1) PROPOSED STAND-OFF MOUNT AT SECTOR 'C' •INSTALL (3} PROPOSED ADJUSTABLE STAND-OFF MOUNTS, (1) AT SECTOR 'B' AND (2) AT SECTOR 'C'