Fillable Small Wireless Facility (City of Morgantown)

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Small Wireless Facility (City of Morgantown)

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The Small Wireless Facility (City of Morgantown) form is 4 pages long and contains:

  • 5 signatures
  • 11 check-boxes
  • 99 other fields

Country of origin: US
File type: PDF

U.S.A. forms for City of Morgantown

BROWSE CITY OF MORGANTOWN (WV) FORMS

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Small Wireless Facility
1. Description of facilities proposed (attach construction and engineering drawings –
include dimensions of all facilities and distances to other right-of-way facilities including
poles, curbs, fire hydrants, benches, intersections, and other features):
2. Location of facilities (include address, nearest street intersection, and GPS coordinates):
3. Attestation that the small wireless facilities will be operational for use by a wireless
provider within one year after the permit issuance date, unless the authority and the
applicant agree to extend this period or delay is caused by lack of commercial power or
communications transport facilities to the site
4. Identify each piece of traffic control equipment within a 150-yard radius of the
proposed location(s) of the facilities.
5. Submit a diagram, including distances, showing the sight lines or clear zones required
for transportation or pedestrians in accordance with state and local law for the area
where facilities are proposed.
6. Identify the dimensions of any sidewalk or pedestrian path or other pedestrian access in
the area where facilities are proposed, and include a statement regarding the
applicant’s review of compliance with the Americans with Disabilities Act as it relates to
the pedestrian access point(s) following placement of the proposed facilities.
7. Attest that the facilities will comply with all relevant Federal Communications
Commission regulations concerning (1) Radiofrequency emissions from radio
transmitters; and (2) Unacceptable interference with the public safety spectrum and CII
spectrum, including compliance with the abatement and resolution procedures for
interference with the public safety spectrum and CII spectrum established by the FCC
set forth in 47 C.F.R. 22.970 through 47 C.F.R. 22.973 and 47 C.F.R. 90.672 through 47
C.F.R. 90.675
____________________________________ _______________________
Signature Date
PLEASE RETURN THIS SIGNED SHEET WITH THE APPLICATION
City of Morgantown Application
Plan Review
Submittal Date
___/___/____
Type of Work: Demo Asbestos New SFD New COMM
Garage Addition Deck Sprinkler Fire Alarm Grading
Remodel or Repair Shed Other
Property Information
Street Address Where Work will be done:
Morgantown, WV
Contact EMAIL:
Square ft of Build Cost of Project Sprinkler Head Count
SIGNATURE OF APPLICANT ADDRESS OF APPLICANT
PRINT NAME PHONE
OFFICE USE ONLY
New SFD:
New COMM:
Garage:
Addition:
Site Plan:
Application Processed By:
DATE
PERMIT:
Total Fee
City of Morgantown Application for Small Wireless Facility
Application Date
___/___/___
Type of Work: Electrical Grading Other
Deadlines – Office Use
10 days - ___/___/____
60 days - ___/___/____
90 days - ___/___/____
Parcel Type:
PROPERTY INFORMATION: Residential Rental/ Commercial Industrial P-ROW
Street Address Where Work is being done:
Morgantown, WV
Zip Code:
Business Name:
GPS:
Applicants First Name:
Last Name:
Phone:
Applicants Address (if different from above address):
CONTRACTORS
INFORMATION:
Contractors Business Name
City License Number
General Contractor
Excavation
Concrete
Carpentry
Electrical
other
SCOPE OF WORK TO BE DONE:
Detailed Description of Work:
MUST ATTACH DETAILED SITE PLAN YES NO Est. Value of Work $
I here by certify that I am the owner of record of the named property, or that the proposed work is authorized by the owner of record and that I have been authorized by
the owner to make this application as his authorized agent and I agree to conform to all applicable laws of this jurisdiction. In addition, if a permit for work described in
this application is issued, I certify that the code official or the code official’s authorized representative shall have the authority to enter areas covered by such permit at
any reasonable hour to enforce the provisions of the code(s) applicable to this permit.
SIGNATURE OF APPLICANT ADDRESS OF APPLICANT PHONE
PRINT NAME:
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OFFICE USE ONLY:
Map/Parcel
Zoning
Ward
Flood Plain
APPROVALS:
Engineering Department Approval Notes:
__________________________________________________________________________________________
Signature of person reviewing: ______________________________________________________________
DATE
Planning Department Approval Notes:
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
Signature of person reviewing: ______________________________________________________________
DATE
Code Enforcement Approval Notes:
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
Signature of person reviewing: ______________________________________________________________
DATE
VALIDATION- CODE ENFORCEMENT USE ONLY:
Permit Number:
Fee
Other:
Fee
Stop Work Order:
Fee
Application Accepted and Processed By:
Approved By:
DATE
Signature of Person Picking Up Building Permit:
DATE
Print Name of Person Picking up Permit:
Project Completion Date: ___/___/____ (1-year after issuance date)
Total Fee
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Small Wireless Facility (City of Morgantown)

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Completed 14 July 2020

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