CITY OF SAN CLEMENTE
Wireless Communications Facilities Application Screening Form For accommodation under Section 6409(a) of the Middle Class Tax Relief and Job Creation Act of 2012 for facilities outside of the public right of way Project Address: _______________________________________________________________ Applicant/Carrier: _______________________________________________________________ This form serves to assist the City of San Clemente in determining whether a proposed collocation or modification to an existing wireless communications facility qualifies as an eligible facilities request and/or would cause a substantial change as defined by the FCC. Please submit the following:
Completed Application Form Application Fee: $47.57
Letter of Authorization from Wireless Carrier RF Compliance Analysis (if applicable) Digital Copy of Plans (.pdf)
Photosimulations and/or Current Site Photos
1. Is this an existing approved wireless communications facility? If NO, stop filling out this form. The project requires a discretionary permit.
If YES, list previous approvals for cellular installations at the site (include entitlement and building permit numbers).
2. Describe in detail the existing approved facility. Include facility type, size, height, number of existing antennas, existing equipment, etc.
3. Describe in detail the proposed wireless facility modifications. Include number of antennas, remote radio units, cabinets, and/or equipment proposed for removal, replacement, or addition.
4. Describe the proposed concealment elements and/or techniques and how, if at all, the project would alter the existing concealment elements.
Yes No
2M NE of San Clemente San Clemente, CA 92672
Dish Wireless, L.L.C.
Conditional Permit No. C-1021. See attached for prior CUP.
Existing wireless facility tower is 137' tall with (2) horn mounts, (1) 8' dipole, (1) omni antenna, and (2) platforms with handrails. The tower will decrease in size to 70' to meet prior existing approval.
See scope of work on attached site plans for more details.
See scope of work on attached site plans for more details.
The proposed tower will decrease in height by 62.5' to 70'. The project will not affect the existing concealment elements.
The proposed tower height will decrease from 137' to 70'. There will be (3) panel antennas, (3) sector mounts, (6) RRUs, (3) Back to Back mounts, (1) OVP, and (1) Hybrid Cable. (1) Equipment cabinet is proposed.
ELIGIBLE FACILITY CRITERIA
5. Does the project increase the facility height by 10% or more than 20 feet?
6. Does the project increase the width by more than 20 feet or protrude beyond the width of the tower at the level of the appurtenance?
7. Does the project involve the installation of four or more equipment cabinets?
8. Does the project defeat the existing concealment elements of the tower?
9. Does the project include any excavation or new ground equipment outside of the current leased/owned wireless facility area?
10. Is the project inconsistent with the original conditions of approval under which the project site was approved and developed?
If you answered YES to any questions in this section, stop filling out this form. The project requires a discretionary permit.
APPLICANT’S CERTIFICATION
As the Applicant/Representative for the Applicant, I acknowledge that the above information and supporting documents are, to the best of my knowledge, an accurate and complete representation of the proposed project. I understand that the City of San Clemente will rely on my responses to evaluate whether to process this application in accordance with the FCC’s regulations under 47 C.F.R. § 1.40001 et seq., and I acknowledge that any inaccuracies may result in the application being deemed incomplete or the request for approval pursuant to Section 6409(a) being denied.
Applicant Name: _________________________ Company: __________________________ E-Mail Address: ___________________________ Phone No: __________________________ Signature: _______________________________ Date: ______________________________ Yes No
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FOR CITY USE ONLY
Zoning Review No.: _________________________ Submittal Date: _____________________ STAFF DETERMINATION:
APPROVED. This project meets criteria for review under 6409(a). A discretionary planning permit is not required for the proposed collocation/wireless facility modification. Proceed to building plan check.
NOT APPROVED. This project represents a “substantial change” to the existing facility, as defined by the FCC, and is not eligible for review under 6409(a). Approval of a ________________________application is required before the project may be submitted into building plan check.
Signature:____________________________________ Date: ________________________ Planner Name, Title: ____________________________________________________________ Kellie Stremme Tower Engineering Professionals
[email protected] 480-202-5416
9-5-23
WMS23-231 9-5-2023
x
Jonathan Lightfoot, Economic Development Officer
9/5/2023