FCC Form 854 Application for Antenna Structure Registration

FCC Form 854 FEDERAL COMMUNICATIONS COMMISSION Not Approved by OMB

3060 - 0139

Information and Instructions Est. Avg. Burden

Per Response:

45 minutes

Application for Antenna Structure Registration

NOTICE TO INDIVIDUALS REQUIRED BY THE PRIVACY ACT OF 1974 AND

THE PAPERWORK REDUCTION ACT OF 1995

We have estimated that each response to this collection of information will take on average 45 minutes. Our estimate includes the time to read the instructions, look through existing records, gather and maintain required data, and actually complete and review the form or response. If you have any comments on this estimate, or on how we can improve the collection and reduce the burden it causes you, please write the Federal Communications Commission, AMD-PERM, Washington DC 20554, Paperwork Reduction Project (3060-0139). We will also accept your comments via the Internet if you send them to [email protected]. Please do not send completed application forms to this address.

You are not required to respond to a collection of information sponsored by the Federal government, and the government may not conduct or sponsor this collection unless it displays a currently valid OMB control number with this notice. This collection has been assigned OMB control number 3060-0139.

The FCC is authorized under the Communications Act of 1934, as amended, to collect the personal information we request in this form. We will use the information you provide to determine whether approving this application is in the public interest. If we believe there may be a violation or potential violation of a statute, FCC regulation, rule or order, your application may be referred to the Federal, state, or local agency responsible for investigating, prosecuting, enforcing or implementing the statute, rule, regulation or order. In certain cases, the information in your application may be disclosed to the Department of Justice or a court or adjudicative body when (a) the FCC; or (b) any employee of the FCC; or (c) the United States Government, is a party to a proceeding before the body or has an interest in the proceeding.

All parties and entities doing business with the Commission must obtain a unique identifying number called the FCC Registration Number (FRN) and supply it when doing business with the Commission. Failure to provide the FRN may delay the processing of the application. This requirement is to facilitate compliance with the Debt Collection Improvement Act of 1996 (DCIA). The FRN can be obtained electronically through the FCC webpage at http://wireless.fcc.gov/uls (select the “Register” button near the top of the page to access the FCC’s Commission Registration System {CORES}) or by manually submitting FCC Form 160. FCC Form 160 is available from the FCC’s web site at http://www.fcc.gov/formpage.html, by calling the FCC’s Forms Distribution Center (800) 418-FORM (3676), or from the Federal Communications Commission Fax Information System by dialing (202) 418-0177.

This notice is required by the Privacy Act of 1974, Public law 93-579, December 31, 1974, 5 U.S.C. Section 552a (e) (3) and the Paperwork Reduction Act of 1995, Public law 104-13, October 1, 1995, 44 U.S.C. 3507,

General Instructions

Purpose of form

This FCC form is to be used to register structures used for wire or radio communication service in any area where radio services are regulated by the Commission; to make changes to existing registered structures or pending applications; or to notify the Commission of the completion of construction or dismantlement of structures, as required by Title 47 of the Code of Federal Regulations, Chapter 1, Part 17 (FCC Rules Part 17). Note: This is not an application for authorization to build a radio facility or transmit from it.

Who Must File FCC Form 854 and When

Registration with the Commission is required before any construction or alteration of an antenna structure, which requires notification to the Federal Aviation Administration (FAA). Prior to completing registration with the Commission, an antenna structure owner (or tenant licensee in certain cases where the owner is unable to register see - Title 47 of the Code of Federal Regulations, Chapter 1, Part 17.4(e)) must have notified the FAA (via FAA Form 7460-1) and received a final determination of 'no hazard' from the FAA.

Most FCC Form 854 applications for new antenna structures, and some applications for changes to existing antenna structures, require environmental notification before registration can be granted. See Title 47 of the Code of Federal Regulations, Chapter 1, Section 17.4(c). For purposes of completing environmental notification, FCC Form 854 may be initially filed prior to notifying the FAA and receiving a determination of no hazard. However, the FAA process must be completed before registration can be granted.

FCC Form 854 must also be filed to notify the Commission of the completion of construction of a registered antenna structure, and to notify the Commission of changes to an antenna structure registration or application. A separate FCC Form 854 must be filed to register each antenna structure or each tower of an array. FCC Form 854, in conjunction with Schedule A, may be filed to notify the Commission of changes that affect multiple antenna structure registrations and applications in exactly the same way.

Notification to the FAA (as prescribed in Title 47 of the Code of Federal Regulations, Chapter 1, Part 17.7) and, thus, registration with the Commission is required for any of the following:

1) Any construction or alteration that is more than 60.96 meters (200 feet) in height above ground level at its site.

2) Any construction or alteration that exceeds an imaginary surface extending outward and upward at one of the following slopes:

(a) 100 to 1 for a horizontal distance of 6.10 kilometers (20,000 feet) from the nearest point of the nearest runway of each airport as specified in paragraph 3(a, b, c and d) below with its longest runway more than 0.98 kilometers (3,200 feet) in actual length, excluding heliports.

(b) 50 to 1 for a horizontal distance of 3.05 kilometers (10,000 feet) from the nearest point of the nearest runway of each airport as specified in paragraph 3(a, b, c, and d) below with its longest runway no more than 0.98 kilometers (3,200 feet) in actual length, excluding heliports.

(c) 25 to 1 for a horizontal distance of 1.52 kilometers (5,000 feet) from the nearest point of the nearest landing and takeoff area of each heliport specified in paragraph 3(a, b, c, and d) below.

NOTE: Applicants can access the FCC's TOWAIR program via the Antenna Homepage on the Internet (http://wireless.fcc.gov/antenna) for assistance in determining if a proposed construction or alteration meets the above criteria.

3) Any construction of an antenna structure (or any alteration of an antenna structure that would increase its height) on any of the following airports (including heliports):

(a) A public use airport listed in the Airport/Facility Directory, Alaska Supplement, or Pacific Chart Supplement of the U.S. Government Flight Information Publications;

(b) A military airport under construction or an airport under construction that will be available for public use.

(c) An airport operated by a Federal agency or the Department of Defense (DOD).

(d) An airport or heliport with at least one FAA-approved instrument approach procedure.

Registration with the FCC is not required in the above circumstances if construction or alteration meets one of the following criteria as identified in Title 47 of the Code of Federal Regulations, Chapter 1, Part 17.14:

1. Any object that would be shielded by existing structures of a permanent and substantial character or by natural terrain or topographic features of equal or greater height, and would be located in the congested area of the city, town or settlement where it is evident beyond all reasonable doubt that the structure so shielded will not adversely affect safety in air navigation.

2. Any antenna structure of 6.10 meters (20 feet) or less in height except one that would increase the height of another antenna structure.

3. Any air navigation facility, airport visual approach or landing aid, aircraft arresting device, or meteorological device of a type approved by the Administrator of the Federal Aviation Administration, the location and height of which is fixed by its functional purpose.

Information Current and Complete

Information filed with the FCC must be kept current and complete. The applicant must notify the FCC regarding any substantial and significant changes in the information furnished in the application(s). See Title 47 of the Code of Federal Regulations, Chapter 1, Part 1.65 (47 CFR 1.65).

Applicable Rules and Regulations

Applicants should obtain the relevant parts of the FCC’s rules in Title 47 of the Code of Federal Regulations (47 CFR). Copies of 47 CFR may be purchased from the Superintendent of Documents; Government Printing Office; Washington, DC 20402; (202) 512-1800. Refer also to the Government Printing Office’s Website at http://www.access.gpo.gov. Some FCC rules require applicants to attach one or more exhibits to an application in addition to the information requested in the application form.

Processing Fee and Filing Location

No fee is required to register an antenna structure. In lieu of filing electronically, submit one original, signed FCC Form 854 to the following address (detach and retain the instructions prior to mailing):

Federal Communications Commission

Technologies, Systems and Innovation Division

1270 Fairfield Road

Gettysburg, PA 17325-7245

Hand-deliveries and messenger-deliveries should be delivered to Federal Communications Commission, 1280 Fairfield Road, Gettysburg, PA 17325.

For Assistance

For assistance with this application, contact the Federal Communications Commission, 1270 Fairfield Road, Gettysburg, PA 17325-7245, call (877) 480‑3201 (TTY 717-338-2824); or visit http://esupport.fcc.gov.

Electronic Filers

Information about electronic filing is available at http://wireless.fcc.gov/antenna. Applicants filing electronically should follow procedures contained in online help files. For technical assistance with filing electronically, contact the Federal Communications Commission, Wireless Telecommunications Bureau Technical Support line, (877) 480-3201.

Main Form - Specific Instructions

Purpose of Application

ITEM 1 - Enter the appropriate two-letter purpose code in the brackets provided. Enter only one code.

NE = New Antenna Structure Registration. Enter NE in the brackets to indicate that this is an application to register an antenna structure that has not been registered. New Antenna Structure Registrations ordinarily require environmental notice. See instructions for Item 47.

RE = Replacement Antenna Structure Registration. Enter RE in the brackets to indicate that this is an application to replace an existing antenna structure at the same geographic location, provided the new structure will not use lights if the previous structure was unlighted, the new structure will not use a less preferred FAA Lighting Style as defined in 47 C.F.R. § 17.4(c)(1)(iii), there will be no substantial increase in size as defined in Title 47 of the Code of Federal Regulations, Chapter 1, Appendix B, § I(C)(1)-(3), and there will be no construction or excavation more than 30 feet beyond the existing antenna structure property. An antenna structure meeting these criteria does not require environmental notice. An antenna structure that does not meet these criteria, or requires an Environmental Assessment (EA), is considered a New Antenna Structure Registration (NE).

Enter the seven-digit antenna structure registration number for the existing antenna structure in Item 2A.

Note: A substantial increase in size occurs if: (1) the mounting of the proposed antenna on the tower would increase the existing height of the tower by more than 10%, or by the height of one additional antenna array with separation from the nearest existing antenna not to exceed twenty feet, whichever is greater, except that the mounting of the proposed antenna may exceed these size limits if necessary to avoid interference with existing antennas; or (2) the mounting of the proposed antenna would involve the installation of more than the standard number of new equipment cabinets for the technology involved, not to exceed four, or more than one new equipment shelter; or (3) the mounting of the proposed antenna would involve adding an appurtenance to the body of the tower that would protrude from the edge of the tower more than twenty feet, or more than the width of the tower structure at the level of the appurtenance, whichever is greater, except that the mounting of the proposed antenna may exceed these size limits if necessary to shelter the antenna from inclement weather or to connect the antenna to the tower via cable. See Nationwide Agreement for the Collocation of Wireless Antennas, 47 C.F.R. Part 1, App. B, § I.C.

Changes in longitude or latitude of less than one second do not require a new aeronautical study with an FAA determination. See In the Matter of Streamlining the Commission’s Antenna Structure Clearance Procedure, Report and Order, WT Docket No. 95-5, 11 FCC Rcd 4272, 4287, ¶ 35 (1995). Consequently, a replacement tower located less than one second longitude and latitude from an existing tower is considered to be at the same location. However, any change of one foot or more in tower height requires a new FAA Determination of No Hazard. 

MD = Modification of Registered Antenna Structure. Enter MD in the brackets to indicate that this is an application to change antenna structure information for a structure, which has already been registered with the Commission. Enter the seven-digit antenna structure registration number in Item 2A. Enter the date the antenna structure was constructed in Item 2C. A modification can be filed only if the antenna structure is constructed (i.e., you have previously filed a notification of construction). A modification may require environmental notice. See instructions for Item 47.

CA = Cancel Registration. Enter CA in the brackets to cancel your registered, but not constructed, (project abandoned) antenna structure. Provide the seven-digit antenna structure registration number in Item 2A or, if you are canceling multiple registrations for unconstructed antenna structures, provide the antenna structure registration numbers on FCC Form 854, Schedule A. You may only cancel a registration for an antenna structure that has not been constructed. Canceling a registration does not require environmental notice.

AU = Administrative Update. To request a change of any administrative data on an antenna structure registration. Enter AU in the brackets to request changes to the following: Changes in antenna structure owner's name (without a change in ownership) address, phone number, E-mail, or contact information. Provide the seven-digit antenna structure registration number in Item 2A or, if you are requesting an administrative update to more than one registration, provide the antenna structure registration numbers on FCC Form 854, Schedule A. An administrative update does not require environmental notice.

Dl = Notification of Antenna Structure Dismantlement. Enter Dl in the brackets to indicate that this is an application to notify the Commission that the constructed antenna structure no longer exists. This could be the result of the owner dismantling the structure, natural disaster, erosion, etc. Enter the date the structure was dismantled or destroyed in Item 2D and provide the seven-digit antenna structure registration number in Item 2A. A notification of dismantlement does not require environmental notice.

WD = Withdraw Pending Application. Enter WD in the brackets to indicate that this is a request to withdraw a previously filed, currently pending application. Provide the application file number in Item 2B or, if you are withdrawing multiple pending applications, provide the file numbers on FCC Form 854, Schedule A. Withdrawing a pending application does not require environmental notice.

AM = Amend Pending Application. Enter AM in the brackets to indicate that this is a request to amend a previously filed, currently pending application. Provide the file number of the application being amended in Item 2B. Amending a pending application may require environmental notice. See instructions for Item 47.

NT = Required Construction/Alteration Notification. Enter NT in the brackets to notify the Commission that the construction/alteration has been completed as registered. Provide the seven-digit antenna structure registration number in Item 2A and enter the date of construction or alteration in Item 2C. Notification of construction or alteration does not require environmental notice.

DU = Request for Duplicate Registration. Enter DU in the brackets to request a duplicate of your antenna structure registration. Provide the seven-digit antenna structure registration number in Item 2A or, if you are requesting duplicates of more than one registration, provide the antenna structure registration numbers on FCC Form 854, Schedule A. A request for duplicate registration does not require environmental notice.

OC = Ownership Change. Enter OC in the brackets to indicate that this is an application to notify the Commission of a change in ownership for a registered antenna structure. Provide the seven-digit antenna structure registration number in Item 2A or, if you are requesting an ownership change to more than one registration, provide the antenna structure registration numbers on FCC Form 854, Schedule A. Note: For an ownership change, the assignee (i.e. the entity acquiring ownership of the structure) must provide the new ownership information and sign the form. The only information required of the assignor (i.e. the entity to whom the structure is currently registered) is Item 5. A change in ownership does not require environmental notice.

ITEM 2A – If purpose code is RE, MD, CA, AU, DI, NT, DU, or OC, enter the Antenna Structure Registration Number that this application pertains to.

If applying for purpose code RE, enter the Antenna Structure Registration Number of the tower this application is replacing.

If applying for purpose code CA, AU, DI, DU or OC, and this application pertains to more than one registration, leave Item 2A blank and complete and attach FCC Form 854, Schedule A, Schedule For Changes Affecting Multiple Antenna Structure Registration or File Numbers.

Item 2B – If purpose code is WD or AM, enter File Number that this application pertains to. If applying for purpose code WD, and this application pertains to more than one application, leave Item 2B blank and complete and attach FCC Form 854, Schedule A, Schedule For Changes Affecting Multiple Antenna Structure Registration or File Numbers.

ITEM 2C - If purpose code is MD or NT, enter date constructed or last altered.

ITEM 2D - If purpose code is DI, enter date of dismantlement.

Antenna Structure Ownership Information

ITEM 3 – Owner Entity Type. Indicate the legal entity type of the Owner. Select Individual, Unincorporated Association, Trust, Government Entity, Corporation, Limited Liability Company, General Partnership, Limited Partnership, Limited Liability Partnership, Consortium, or Other. When selecting ‘Other’, provide a description of the legal entity.

ITEM 4 - FCC Registration Number (FRN) of Owner/Assignee. Provide the ten digit FRN assigned by the Commission Registration System (CORES). The FRN is a unique entity identifier for everyone doing business with the Commission. The FRN can be obtained electronically through the FCC web page at http://wireless.fcc.gov/uls (Select the “Register” button near the top of the page to access the FCC’s Commission Registration Number (FRN) Commission Registration System (CORES)) or by manually submitting FCC Form 160. FCC Form 160 is available from the FCC’s web site at http://www.fcc.gov/formpage.html, by calling the FCC’s Forms Distribution Center (800)-418-FORM (3676), or from the Federal Communications Commission Fax Information System by dialing (202) 418-0177.

Note: When filing for an Ownership Change (OC), this would be the new owner’s FRN.

ITEM 5 - FCC Registration Number (FRN) of Assignor. When filing an Ownership Change (OC), please provide the ten-digit FRN of the previous antenna structure owner.

ITEMS 6-8 -Enter the full legal name of the owner/assignee of the antenna structure. If owner/assignee is:

1) An individual, enter First Name, Middle Initial, Last Name, Suffix and do not complete Business Name and Attention To in Items 7 and 8.

2) An individual 'doing business as' (a sole proprietorship), enter First Name, Middle Initial, Last Name, Suffix and do not complete Business Name and Attention To in Items 7 and 8.

3) For any other type of entity, enter the full legal name of the entity in Item 7, Business Name, and do not complete Item 6 with an individual’s name.

If entering a business name in Item 7, complete Items 17-27 with the business contact information.

ITEMS 9-13 - Enter the mailing address of the owner/assignee. You may enter a post office box number in Item 9 or a street address in Item 10, or enter information for both items. Enter the city, state, and ZIP Code in Items 11, 12 and 13, respectively.

ITEM 14 - Enter the area code and telephone number where the owner/assignee can be reached during normal business hours.

ITEM 15 – Enter the area code and number for the FAX of the owner/assignee.

ITEM 16 - Provide an E-Mail address where the owner/assignee can receive electronic mail from the Commission regarding the form.

Contact Representative Information

ITEMS 17-27 - These items identify the contact representative, if different from the owner/assignee or if the owner is a business and are required for all Owner Entity Types. This is usually the headquarters office of a large company, the law firm or other representative of the owner/assignee, or the person or company that prepared or submitted the application on behalf of the owner/assignee. If the owner is an Individual you may complete these items with the same information if the individual does not have a contact representative. If there is a question about the application, an FCC representative will communicate with the applicant's contact representative.

Antenna Structure

ITEMS 28-29 -Enter the geographic coordinates and direction of the location, referenced to the North American Datum of 1983 (NAD83). This data should correspond to the site data listed on your FAA Determination (see Item 43). This information can be determined using a GPS receiver with differential correction, a 7.5 minute topographical quadrangle map of the area, or you may consult the city or county surveyor in your area. Topographical maps may be purchased from the U.S. Geological Survey. For more information or ordering assistance, caIl1-800-HELPMAP; write USGS Information Services, Box 25286, Denver, CO 80225; or visit http://mapping.usgs.gov/esic/to_order.html.

Note: Location coordinates (latitude and longitude) for sites in the Continental United States, Puerto Rico, the U.S. Virgin Islands, Alaska, Hawaii, American Samoa, and Guam must be referenced to the North American Datum of 1983 (NAD83). Coordinates for certain Pacific Island sites should be referenced to the applicable local datum. If the source from which you obtain the coordinates still utilizes an older datum (i.e., NAD27, PRD40), you must convert to NAD83. Conversion routines and instructions for Pacific Island coordinate reporting are available through the Internet at http://wireless.fcc.gov/uls/utilities/nadcon.html.

Enter the latitude using the format DD-MM-SS.S, where the degrees (DD) term can have a value in the range of 0 to 72, minutes (MM) can range from 0 to 59, and seconds (SS.S) can range from 0 to 59.9. Specify the direction as either 'N' for North or 'S' for South.

Enter the longitude using the format DDD-MM-SS.S, where the degrees (DDD) term can have a value in the range of 64 to 180, minutes (MM) can range from 0 to 59, and seconds (SS.S) can range from 0 to 59.9. Specify the direction as either 'E' for East or 'W' for West.

ITEM 30-34 -Enter the requested information about the antenna structure location. If the location of the structure does not have a street address, describe the location in such a way that it can be located readily. For example, if the structure is on a mountain, give the name of the mountain; for structures at rural locations, indicate the route numbers of the nearest highway/intersection and the distance and direction from the nearest town. Post Office Boxes are not acceptable. Enter the city, county/borough/parish, state and ZIP Code in which the antenna structure is actually located.

Example: (Item 30) 100 Upper Mud Run Road

(Item 31) Easton

(Item 32) Northampton

(Item 33) PA

(Item 34) 18040

ENGLISH TO METRIC CONVERSIONS: The following English to Metric equivalents should be used to convert heights and distances, to the nearest tenth, where necessary:

1 foot = 0.3048 meters (Example: 350 feet x 0.3048 = 106.68 meters. Round to 106.7.)

1 mile = 1.6093 kilometers (Example: 5 miles x 1.6093 = 8.0465 kilometers. Round to 8.0.)

ITEM 35 - Enter in meters rounded to the nearest tenth, the elevation above mean sea level of the ground at the antenna structure site. This may be obtained from the FAA Final Determination. Be sure to convert feet to meters and round to the nearest tenth. Refer to letter 'a' of the antenna structure examples below.

ITEM 36 -Enter the overall height above ground level (AGL) in meters rounded to the nearest tenth, of the entire antenna structure to the highest point, INCLUDING any appurtenances. You must include antennas, dishes, and obstruction lighting. Refer to letter 'c' of the antenna structure examples below. This may be obtained from the FAA Final Determination. Be sure to convert feet to meters and round to the nearest tenth.

ITEM 37 - Enter the overall height in meters above mean sea level (AMSL) rounded to the nearest tenth. This will be the total of Items 35 and 36. This may be obtained from the FAA Final Determination. Be sure to convert feet to meters and round to the nearest tenth.

ITEM 38 - Enter the height above ground in meters rounded to the nearest tenth, to the highest point of the supporting structure only (WITHOUT appurtenances). Be sure to convert feet to meters and round to the nearest tenth. If your antenna structure consists of a building/tower combination, include any elevator shaft, flagpole, or penthouse in the overall structure height, but not the antenna, tower, pole or mast. If your antenna structure is a tower only, include the height of the tower but not the antenna. Refer to letter 'b' of the antenna structure examples below.

Antenna Structure Examples

ITEM 39 -Enter the code from the following valid structure types for the type of supporting structure on which the antenna is or will be mounted. Refer to letter 'b' of the antenna structure examples in these instructions:

Code Definition

B Building

BANT Building with Antenna on Top

BMAST Building with Mast

BPIPE Building with Pipe

BPOLE Building with Pole

BRIDG Bridge

BTWR Building with Tower

GTOWER Guyed structure used for communication purposes

LTOWER Lattice Tower

MAST Mast

MTOWER Monopole

NNGTANN* Guyed Tower Array

NNLTANN* Lattice Tower Array

NNMTANN* Monopole Array

PIPE Any type of Pipe

POLE Any type of Pole

RIG Oil or other type of Rig

SIGN Any type of Sign or Billboard

SILO Any type of Silo

STACK Smoke Stack

TANK Any type of tank (water, gas. etc.)

TREE When used as a support for an antenna

UPOLE Utility Pole/Tower used to provide service (electric/telephone. etc.)

*Valid Tower Arrays. Code Definition: The first NN indicates the number of towers in an array. The second NN indicates the position of that tower in the array (ex: 3GTA2 would identify the second tower in a three tower array; 14GTA12 would identify the twelfth tower in a fourteen tower array).

ITEMS 40-41 - If the type of structure is an array, enter the geographic coordinates for the 'center' of the array, referenced to the North American Datum of 1983 (NAD83). Enter the latitude, longitude and direction in the same format shown in Items 28 and 29. Each applicable antenna structure within an AM broadcast array must be registered separately with the FCC. In most cases, however, antenna structure arrays are studied by the FAA using a single set of coordinates representing the 'center' of the array, or possibly the structure closest to a nearby airport facility. The coordinates referenced by the FAA in its Determination of No Hazard for an array may differ from the actual coordinates of the antenna structure being registered. (NOTE: Items 28-39 should reflect the location and actual coordinates of the individual structure being registered within the array.)

ITEM 42 – Indicate the marking and/or lighting you propose to utilize on the antenna structure.

* Flashing L-810's / Tier 2 Effective 9/15/2016

Tier 1 - No Lights Tier 2 – No Red Steady Lights Tier 3 – Red Steady Lights

1) None 4) FAA Style B (L-856) 7) FAA Style E / AGL=200'-350' (L-864/L-865/L-810)*

2) Paint Only 5) FAA Style D (L-865) 9) FAA Style A / AGL<=150' (L-810)

3) Other 6) FAA Style C (L-856/L-865) 9) FAA Style A / AGL=150'-350' (L-864/L-810)*

7) FAA Style E / AGL>350' (L-864/L-865)

8) FAA Style F (L-856/L-864/L-865)

9) FAA Style A / AGL>350' (L-864)

10) FAA Style G (L-856/L-864)

FAA Notification

ITEMS 43-44 - Provide the FAA Study Number and Issue Date of the most current FAA Determination of 'No Hazard' issued for this structure. In order to initiate environmental notification, you may submit FCC Form 854 for new proposals or alterations to existing structures prior to receiving an FAA Final Determination. However, FCC Form 854 cannot be completed and registration cannot be granted without the FAA Final Determination. Do not include a copy of the Determination.

Environmental Compliance

Item 45 – If the applicant believes an emergency situation exists such that it should be granted a waiver from the requirement to complete the Environmental Compliance process prior to the proposed antenna structure's construction, the applicant should answer 'Y' here, attach its justification for the requested waiver, and skip Questions 46-49. The Commission will review the application to determine whether to grant the waiver.

ITEM 46A – Indicate whether or not another federal agency is taking responsibility for environmental review of this structure.

ITEM 46B – If Item 46A is answered “Yes”, indicate why another federal agency has taken responsibility for the environmental review of this structure:

1. The structure is located on Federal Land and the landholding agency is taking responsibility for the environmental review.

2. Another federal agency has agreed with the FCC in writing to take responsibility for the environmental review.

ITEM 46C – Enter the name of the federal agency taking responsibility for the environmental review.

If Item 46A is answered “Yes,” skip Item 47. answer “Yes” to Item 48, and attach either the Environmental Assessment and Finding of No Significant Impact, or the Environmental Impact Statement and Record of Decision issued by the other federal agency.

ITEM 47 – If environmental notice is required, see Title 47 of the Code of Federal Regulations, Chapter 1, Section 17.4(c), provide the date you are requesting the FCC to post the application on its website. The date selected may not be a weekend or federal holiday. The applicant shall provide local notice in accordance with 47 C.F.R. § 17.4(c)(3) on or before this date. If local notice is provided after this date, the applicant should amend its application to request a new national notice date that is at least one business day after the date the amendment is submitted. The website posting will be extended or restarted so that it will run 30 days from the new national notice date.

Environmental notice is required in any of the following circumstances:

1. The purpose code is NE, unless another federal agency is taking responsibility for environmental review.

2. The purpose code is MD, and an antenna is being placed on an existing tower or non-tower structure and the placement of the antenna involves a substantial increase in size or excavation more than 30 feet beyond the property. Substantial increase in size is defined in the definition of Replacement Tower in Item 1, above.

3. The purpose code is MD, and either lighting is being added to a previously unlit tower, or the existing tower lighting is being modified from a more preferred to a less preferred lighting configuration. The sequence of most preferred to least preferred lighting can be found at 47 C.F.R. § 17.4(c)(1)(iii).

4. The purpose code is AM and the filing involves any change in structure, lighting, or location, other than a reduction in height, the removal of proposed lighting, or a change to a more preferred lighting configuration as described at 47 C.F.R. § 17.4(c)(1)(iii). In such instances, a new local notice containing the amended description of the tower is required.

5. The purpose code is AM, and the filing is being made to add an Environmental Assessment. In such instances, no new local notice is required.

ITEM 48 – This item must be answered, either ‘Y’ or ‘N.’ An Environmental Assessment (EA) must be submitted if the applicant cannot conclude that a Commission grant of this application would not have a significant environmental impact. Applicants should refer to Title 47 of the Code of Federal Regulations, Chapter 1, Section 1.1307(a), (b), and (d), which identify situations in which an EA must be filed. In short, an applicant must submit an EA if any of the following are proposed:

1. The facility is to be located in an officially designated wilderness area or in an officially designated wildlife preserve. NOTE: Facilities in these categories are generally on federal land and require the relevant land management agency’s authorization.

2. The facility is to be located in a floodplain. NOTE: Building permits may be required.

3. The facility’s construction may involve significant change in surface features (e.g., wetland fill, deforestation, or water diversion). NOTE: Permits may be required.

4. The facility’s installation may have an impact on threatened or endangered species, or their designated critical habitats. An EA is also required if the facility would be likely to jeopardize the continued existence of a proposed endangered or threatened species or to destroy or adversely modify a proposed critical habitat. NOTE: Consultation with the U.S. Fish and Wildlife Service may be required.

5. The facility may have an impact on districts, sites, buildings, structures or objects significant in American history, architecture, archeology, engineering, or culture, that are listed or eligible for listing in the National Register of Historic Places. NOTE: Applicants shall determine whether such an impact may exist by following the procedures in the FCC’s Nationwide Programmatic Agreements, 47 C.F.R. Part 1, Appendices B and C.

6. The facility may impact Indian religious sites.

7. The antenna structure would be equipped with high intensity white lights and would be located in a residential neighborhood (as defined by the applicable zoning law).

8. The facility, when operational, would cause human exposure to levels of radiofrequency radiation in excess of Commission limits.

9. The antenna structure’s height would exceed 450 feet Above Ground Level.

If any of these circumstances are present, the applicant must answer Yes (‘Y’) to Item 48 and submit an EA with the application. The applicant should refer to Title 47 of the Code of Federal Regulations, Chapter 1, Section 1.1311 for information on what an EA should contain.

If none of the circumstances are present, the applicant should answer No (‘N’) to Item 48. If it is later determined that an EA is necessary, the applicant may amend the application to add an EA, but doing so will trigger new national notice requirements.

ITEMS 49-50 – Environmental Review Compliance Certification. Prior to an application being approved, an applicant must certify that the proposed antenna structure will not have a significant effect on the environment and state the basis for that determination. If an applicant cannot so certify, an Environmental Impact Statement will be required prior to approval. See Section 1.1314 of the Commission’s Rules. If local notice is required, applicant must also provide the date that it provided that notice.

ITEM 51 – Enter the date that the local notice was provided.

Signature

ITEMS 52-55 - These items must be completed. To be acceptable for filing, applications and amendments must be signed in accordance with Part 1 of the Commission's rules. The signor must be a person authorized to sign the application. Paper originals of applications must bear an original signature. On paper originals, neither rubber-stamped nor photocopied signatures are acceptable. For filers filing electronically, the electronic signature shall consist of the name of the applicant typed on the application as a signature.

HOW AND WHERE TO NOTIFY THE FAA

Notify the FAA of the proposed construction or alteration via FAA Form 7460-1 (Notice of Proposed Construction or Alteration). Forward the completed form to the FAA Regional Office having jurisdiction over the area within which the proposed construction or alteration will be located. The geographic area of jurisdiction for each FAA regional office, addresses and phone numbers can be found on the FAA’s internet site http://www.faa.gov/airports/news_information/contact_info/regional/ Note: To obtain paper copies or electronically file the FAA Form 7460-1 link to the FAA's Internet site: https://oeaaa.faa.gov/oeaaa/external/portal.jsp.

FCC Form 854 Approved by OMD – 3060-0139

Main Form See instructions for public burden estimate

Application for Antenna Structure Registration

Purpose of Filing

1) Enter the application purpose: ( ) AM – Amendment of a Pending Application NE – Registration of a New Antenna Structure AU – Administrative Update NT – Required Construction/Alteration Notification CA – Cancellation of an Antenna Structure Registration OC – Ownership Change DI – Notification of an Antenna Structure Dismantlement RE – Registration of a Replacement Antenna Structure DU – Request for a Duplicate Antenna Structure Registration WD – Withdrawal of a Pending Application MD – Modification of a Antenna Structure Registration
2a) If the answer to 1 is AU, CA, DI, DU, MD, NT, OC or RE, provide the FCC Antenna Structure Registration (ASR) Number.	FCC ASR Number:
2b) If the answer to 1 is AM or WD, provide the File Number of the pending application on file.	File Number:
2c) If the answer to 1 is MD or NT, provide the date the Antenna Structure was constructed or the date it was last altered (mm/dd/yyyy).	Date:
2d) If the answer to 1 is DI, provide the date the Antenna Structure was dismantled (mm/dd/yyyy).	Date:

Antenna Structure Ownership Information

3) Select one of the entity types: ( ) Individual ( ) Unincorporated Association ( ) Trust ( ) Government Entity ( ) Corporation ( ) Limited Liability Company ( ) General Partnership ( ) Limited Partnership ( ) Consortium ( ) Limited Liability Partnership ( ) Other: ____________________________________
4) FCC Registration Number (FRN):		5) Assignor FCC Registration Number (FRN):
6) First Name (if individual):	MI:	Last Name:	Suffix:
7) Legal Entity Name (if not an individual):
8) Attention To:		9) P.O. Box:	And/Or
10a) Street Address 1:	10b) Street Address 2:
11) City:	12) State:	13) Zip Code:
14) Telephone Number (xxx-xxx-xxxx):		15) Fax Number: (xxx-xxx-xxxx):
16) E-mail Address:

Contact Representative Information

17) First Name (if individual):	MI:	Last Name:	Suffix:
18) Business Name:
19) Attention To:	20) P.O. Box		And/Or
21a) Street Address 1:		21b) Street Address 2:
22) City:	23) State:	24) Zip Code:
25) Telephone Number (xxx-xxx-xxxx):		26) Fax Number: (xxx-xxx-xxxx):
27) E-mail Address:

Antenna Structure Information

28a) Latitude (DD-MM-SS.S):		28b) North or South:
29a) Longitude (DDD-MM-SS.S):		29b) East or West:
30) Street Address or Geographic Location:		31) City:
32) County:	33) State:		34) Zip Code:
35) Elevation of site above mean sea level (meters):				meters
36) Overall height above ground level (AGL) of the supporting structure without appurtenances:				meters
37) Overall height above ground level (AGL) of the antenna structure including all appurtenances:				meters
38) Overall height above mean sea level (add items 35 and 37 together):				meters
39a) Enter the type of structure on which the antenna will be mounted: ( ) B – Building NNLTANN – Lattice Tower Array BANT – Building with Antenna on Top NNMTANN – Monopole Array BMAST – Building with Mast PIPE – Any type of Pipe BPIPE – Building with Pipe POLE – Any type of Pole BPOLE – Building with Pole RIG – Oil or Other Type of Rig BRIDG – Bridge SIGN – Any type of Sign or Billboard BTWR – Building with Tower SILO – Any type of Silo GTOWER – Guyed Structure Used For Communication Purposes STACK – Smoke Stack LTOWER – Lattice Tower TANK – Any type of Tank (water, gas, etc.) MAST – Mast TREE – When used as a support for an antenna MTOWER – Monopole UPOLE – Utility Pole/Tower used to provide service NNGTANN – Guyed Tower Array (electric, telephone, etc.)
39b) Number of Towers in Array:		39c) Position of this Tower in the Array:
40a) Array Center Latitude (DD-MM-SS.S):		40b) North or South
41a) Array Center Longitude (DDD-MM-SS.S):		41b) East or West:

Proposed Marking and/or Lighting

42) Enter the proposed marking and/or lighting: ( )

See Form 854 Item 42 Instructions for detailed tier and lighting information.

Tier 1 - No Lights Tier 2 – No Red Steady Lights Tier 3 – Red Steady Lights

1) None 4) FAA Style B (L-856) 7) FAA Style E (L-864/L-865/L-810)

2) Paint Only 5) FAA Style D (L-865) 8) FAA Style F (L-856/L-864/L-810)

3) Other ____________________ 6) FAA Style C (L-856/L-865) 9) FAA Style A (L-864/L-810)

10) FAA Style G

FAA Notification

43) FAA Study Number:

44) Date Issued:

Environmental Compliance

45) Does the applicant request a waiver of the Commission’s rules for environmental notice prior to construction due to an emergency situation?	( ) Yes or No
46a) If the answer to 45 is No, is another federal agency taking responsibility for environmental review of the Antenna Structure?	( ) Yes or No
46b) If the answer to 46a is Yes, indicate why: The Antenna Structure is on Federal Land and the landholding agency is taking responsibility for the environmental review of the Antenna Structure. Another federal agency has agreed with the FCC in writing to take responsibility for the environmental review of the Antenna Structure.	( ) 1 or 2
46c) If the answer to 46a is Yes, provide the name of the federal agency taking responsibility for the environmental review of the Antenna Structure.	Name:
47) If the answers to 45 and 46a are No, provide the National Notice Date for the application to be posted on the FCC’s website (mm/dd/yyyy).	Date:
48) Is the applicant submitting an environmental assessment?	( ) Yes or No
49) Does the applicant certify that grant of Authorizations at this location would not have a significant environmental effect pursuant to Section 1.1307 of the FCC’s rules?	( ) Yes or No
50) If the answer to 49 is Yes, select the basis for this certification. The construction is exempt from environmental notification (other than due to another agency’s review) and it does not fall within one of the categories in Section 1.1307(a) or (b) of the FCC’s rules? The construction is exempt from environmental notification due to another agency’s review, and the other agency has issued a Finding of No Significant Impact. 3) The environmental notification has been completed, and the FCC has notified the applicant that an Environmental Assessment is not required under Section 1.1307(c) or (d) of the FCC’s rules, and the Construction does not fall within one of the categories in Section 1.1307(a) or (b) of the FCC’s rules. 4) The FCC has issued a Finding of No Significant Impact.	( ) 1, 2, 3, 4
51) If the answer to 50 is 3 or 4, enter the date that Local Notice was provided (mm/dd/yyyy).	Date:

Certification Statements

1) The applicant certifies that all statements made in this application and in the exhibits, attachments, or documents incorporated by

reference are material, are part of this application, and are true, complete, correct, and made in good faith.

2) The applicant certifies that neither the applicant nor any other party to the application is subject to a denial of Federal benefits

pursuant to Section 5301 of the Anti-Drug Abuse Act of 1988, 21 U.S.C. § 862, because of a conviction for possession or

distribution of a controlled substance. See Section 1.2002(b) of the rules, 47 CFR § 1.2002(b), for the definition of "party to the

application" as used in this certification

Signature (Typed or Printed Name of Party Authorized to Sign)

52) First Name:	MI:	Last Name:		Suffix:
53) Title:
54) Signature:			55) Date:

WILLFUL FALSE STATEMENTS MADE ON THIS FORM OR ANY ATTACHMENTS ARE PUNISHABLE BY FINE AND/OR IMPRISONMENT (U.S. Code, Title 18, Section 1001) AND/OR REVOCATION OF ANY STATION LICENSE OR CONSTRUCTION PERMIT (U.S. Code, Title 47, Section 312(a)(1)), AND/OR FORFEITURE (U.S. Code, Title 47, Section 503).

Instructions for FCC FORM 854, SCHEDULE A

SCHEDULE FOR CHANGES AFFECTING MULTIPLE

ANTENNA STRUCTURE REGISTRATIONS OR FILE NUMBERS

FCC Form 854, Schedule A, is an optional supplementary schedule for use with the Application for Antenna Structure Registration (FCC Form 854, Main Form). Use Schedule A when your purpose of filing (Item 1 on FCC Form 854, Main Form) is DU -Duplicate, WD-Withdrawal, CA-Cancellation, AU-Administrative Update or OC-Ownership Change and the changes being made affect multiple registrations or file numbers in exactly the same way.

FCC Form 854, Main Form, must be completed indicating only one of the purpose codes listed above. Complete Schedule A to indicate each antenna structure registration number or file number that is to be modified according to the changes indicated on the FCC Form 854, Main Form. Do not list any registration numbers or file numbers on FCC Form 854, Main Form, if you are attaching Schedule A. FCC Form 854 Main Form and Schedule A must be submitted together in accordance with the filing procedures outlined in the FCC Form 854 Main Form instructions.

FCC Form 854 Schedule for Changes Affecting Multiple

Schedule A Antenna Structure Registration Numbers or File Numbers

Enter only multiple Antenna Structure Registration Numbers or only multiple File Numbers for the following FCC Form 854 purposes:

WD - Withdraw pending application(s) for registration (File Numbers)

DU - Request for Duplicate Registration

CA - Cancel Registered Structure

AU - Administrative Update or

OC - Ownership Change (Registration Numbers)

Note: FCC Form 854 allows the selection of only one purpose per submission. Each Schedule A or groups of Schedule A filed with the FCC Form 854 must use the same purpose.

Antenna Structure Registration Number or File Number	Antenna Structure Registration Number or File Number	Antenna Structure Registration Number or File Number	Antenna Structure Registration Number or File Number

FCC Form 854 - Page 10

June 2012NEW EDITION DATE