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Small Wireless Facility Permit - Pole Specifications and Locations

  1. Application for Small Wireless Facility Permit
    Complete this page for each individual siting.
  2. Pole Location(s)
  3. (Property Address, Lat/Long, Nearest Street Intersection)
  4. Antenna(s)
  5. Equipment (answer all that apply)
  6. Primary Equipment Enclosure:
  7. Check Below if Not Applicable
  8. Secondary Equipment Enclosure:
  9. Check Below if Not Applicable
  10. Other Equipment Enclosure
  11. Check Below if Not Applicable
  12. Traffic Control Information
  13. Contractor Providing Traffic Control:
  14. Check Below if Not Applicable
  15. Required Documents
  16. Please upload the documents below.
  17. • Detailed site and engineering plans showing at a minimum street name(s), the utility pole to be used, elevations of all existing (if applicable) and proposed facilities on the utility pole, existing utilities and other existing items in the vicinity (trees, hydrants, curbs, sidewalk, etc.) and property addresses and lines.
  18. • An area map showing the location of all existing above ground poles and facilities within 1,000 feet and the location or locations of all proposed Small Wireless Facilities proposed in this application. Identify what existing facility will be used or replaced including any identifying numbers for the specific pole or a general description of the location (nearest address, Lat/Long, nearest street intersection).
  19. • Photographs or drawings of the proposed equipment including make, model and color with dimensions.
  20. • Calculations of a load analysis, sealed and signed by a Professional Engineer licensed in the state of Iowa which indicates the pole to which the small wireless facility will be attached will safely support the loads (required for City owned poles or structures only).
  21. • Written documentation from the pole owner authorizing the applicant to utilize the pole. Include the contact name, phone number and email address for pole owner (non-City owned pole or structure).
  22. • Annual fee calculation for City owned poles or structures permissible in the most current FCC regulations ($270 per small wireless facility).
  23. Acknowledgement
    I hereby acknowledge that the wireless facility owner will comply with all of the requirements and that these fees are non-refundable and do not guarantee approval of this request.
  24. Leave This Blank:

  25. This field is not part of the form submission.