Post Construction Antenna & Coax Certification Form

Date: New & Existing Antennas:

Notes: 1. If Antenna Mfg and Model number are not available, dimensions must be provided (Example: 60"x8"x6" thick for panel, or 3" dia. x 12' for whip) 2. Provide dimensions of Antenna Mounts (Example: 12' T-Frame, or 3' Boom Arm) 3. For Microwave Dishes diameters need to be measured. Also identify type (Example: Standard, HP, Std w/ Radome, or Grid) 4. When listing location of mounts and TX Lines please indicate Face (A, B or C) or Leg (A, B or C) and coordinate w/ diagram on next page. * 5. Elevations should be measured from the base of the tower to the tip, center, and bottom elevation of the antenna. If the antenna mount elevation is different then the antenna centerline elevation, then please specify. 6. Contractor to obtain line and antenna information for all existing carrier installations existing on the tower. Elevation (Tip/Centerline/Bottom) / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / Owner Qty. Azimuth Type Antenna Mfg / Model # (or size) Mount Type & Size Location (Face / Leg) Transmission Line Qty & Size Location (Face / Leg)

Page 1

Existing Antennas:
Elevation (Tip/Centerline/Bottom) / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / Owner Qty. Azimuth Type Antenna Mfg / Model # (or size) Mount Type & Size Location (Face / Leg) Transmission Line Qty & Size Location (Face / Leg)

Page 2

Other Appurtenances (Include Torque arms, Ice Shields, Lightning Rods, Lights etc.)
Elevation Description Size Location (Leg/Face)

Page 3

Transmission Line Distribution:

Show the following on the diagrams below: 1. Label Faces and Legs (Example: A, B and C) 2. Draw existing TX Line distribution (Include Size, Quantity and Top Elevation) 3. If TX Lines are supported by T-Brackets or Round Brackets Please show on Drawing

Page 4