Small-Cell-Application-Form-2-6-2020_fillablePage 1 of 6
Remit complete applications to: Service Center (second floor) Attention: Haley Salazar
401 N. Elm St Office: (940) 349-7227
Denton, Texas 76201
WIRELESS NETWORK NODE, FIBER TRANSPORT FACILITY OR SUPPORT POLE
RIGHT OF WAY WORK APPLICATION FORM
NOTE: All pages of this application must be filled out for the application to be considered.
Network Node Fiber Transport Facility Network Node New Pole Network Node Collocation Fiber Transport Facility Support Pole
Address/ Location of Work: ___________________________________________________________________________
Zoning District: _____________________________________________________________________________________
Requested Start Date:________/________/________ Anticipated Completion Date:________/________/________
Month Day Year Month Day Year
SITE LOCATION:
City Right-of-Way State Right-of-Way STRUCTURE HEIGHT: (Including Antenna)
County Right-of-Way Other, Specify________ _____FT______IN
Note: State, County or Other requires written approval
IS THERE AN EXISTING STRUCTURE AT THE SITE?
Yes No
IS THIS A COLLOCATION?
Yes No
Select all Zoning districts/requirements that apply:
In a design district
Within 300 feet of public art
In or near a historic district
In a park
STRUCTURE TYPE:
Support Pole (Applicant-Owned)
City Service Pole Dual Purpose Pole
Municipally Owned Pole (MOU)
MOU Pole MOU Streetlight
Other Structure; specify ownership and type:
______________________________________
In a residential zoning district
Undergrounding requirements
JOB SITE INFORMATION:
SMALL CELL PERMIT TYPE:
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Is applicant an FCC-licensed provider of wireless services? Yes No
If not, please describe: ______________________________________________________________________
Contact Name:__________________________________Company Name:_____________________________________
Address:______________________________________________City:__________________State:______Zip:________
Phone:__________________________Cell Number:___________________________Fax:________________________
Email Address:_____________________________________________________________________________________
Signature ______________________________________
Check if same as above
Contact Name:__________________________________Company Name:_____________________________________
Address:______________________________________________City:__________________State:______Zip:________
Phone:__________________________Cell Number:___________________________Fax:________________________
Email Address:_____________________________________________________________________________________
Signature ______________________________________
Check if same as above (ROW user will be performing work itself)
Project Affiliation:___________________________________________________________________________________
Contact Name:__________________________________Company Name:_____________________________________
Address:______________________________________________City:__________________State:______Zip:________
Phone:__________________________Cell Number:___________________________Fax:________________________
Email Address:_____________________________________________________________________________________
Project Affiliation:___________________________________________________________________________________
Contact Name:__________________________________Company Name:_____________________________________
Address:______________________________________________City:__________________State:______Zip:________
Phone:__________________________Cell Number:___________________________Fax:________________________
Email Address:_____________________________________________________________________________________
ROW USER/ APPLICANT CONTACT:
PROJECT MANAGER CONTACT:
GENERAL CONTRACTOR CONTACT:
OWNER CONTACT:
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Check if same as above (General Contractor will be performing work itself)
Project Affiliation:___________________________________________________________________________________
Contact Name:__________________________________Company Name:_____________________________________
Address:______________________________________________City:__________________State:______Zip:________
Phone:__________________________Cell Number:___________________________Fax:________________________
Email Address:_____________________________________________________________________________________
Check if same as above (General Contractor will be performing work itself)
Type of Sub-Contractor: Irrigator Other________________________
Project Affiliation:___________________________________________________________________________________
Contact Name:__________________________________Company Name:_____________________________________
Address:______________________________________________City:__________________State:______Zip:________
Phone:__________________________Cell Number:___________________________Fax:________________________
Email Address:_____________________________________________________________________________________
*Attach a separate sheet if space for additional contacts or contractors are required*
ELECTRICAL SUB-CONTRACTOR CONTACT:
SUB-CONTRACTOR CONTACT (if applicable):
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Describe intent and scope of work: ________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
Has a carrier study with the City of Denton been completed? Yes No
Does the facility comply with size and volume limitations in the Texas Code? Yes No
Indicate proposed excavation activities:
Directional Bore* Trenching Hand Digging
Excavating paving** Installation of above ground facilities such as signs,
markers, pedestals, poles or other (explain)
Other (explain) __________________________________________________________________
_________________________________________________________________________________________
* If boring or excavating adjacent to a city utility line, include a cross section of all crossings with city utility lines,
demonstrating a minimum separation of 24 inches from nearest edge of city utility pipe/ facility.
**If excavating paving, indicate type (sidewalk, street, driveway approach or curb and gutter etc.) and
approximate length and width for each cut:
LOCATION
(IN STREET, ALLEY, BEHIND CURB, ETC.)
DIMENSIONS
(LENGTH X WIDTH)
MATERIAL
(ASPHALT, CONCRETE, GRAVEL; OR SPECIFY IF OTHER TYPE)
Indicate Traffic Control measures proposed for work:
Lane Closure Road Closure* Detour
Sidewalk closure Bike Lane Closure
Other (explain) __________________________________________________________________
_________________________________________________________________________________________
* Roadway closures must be added to the Street Construction Report for advance notice of civil emergency and
transportation services personnel. Public Inspector must be notified by noon on the Wednesday one week prior
to the road closure.
SCOPE OF WORK:
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Each checkbox below corresponds with a required piece of supporting documentation that must be
uploaded into ProjectDox for the application to be considered complete. Supporting documentation must
be uploaded as individual documents, and named to correspond with appropriate checkbox. If this page
has not been completed this application cannot be considered. All application documents must also
comply with the City of Denton Wireless Services Design Manual.
NOTE: A ROW User must be registered as a contractor with the City of Denton.
Sealed engineered plans and supporting documentation to include:
Zoning verification.
Traffic Control Plan (TCP) in compliance with the Texas Manual of Uniform Traffic Control Devices (TMUTCD).
Engineered non-interference analysis of the proposed facilities operation.
Overview plan of the existing and proposed utilities facilities with or without a direct connection to the overall
network.
Copy of the public notice or flier which the applicant will distribute to notify nearby residents and businesses
of the construction work and any applicable traffic detours.
Copy of the locations where the public notice will be sent.
Additional items needed for collocation on an existing pole:
Third party’s pole or other structure attachment
a statement from the owner of the pole or structure agreeing to allow for co-location of equipment on said pole or structure; to include the facility owner’s company affiliation, full name, address, email and telephone contact information.
MOU pole attachment DME Registration Form and Wireless Installation Permit Form, as submitted to DME for collocation on an
MOU pole. Written clearance for DME for subject collocation attachment (from National Joint Utility Notification System) for an MOU pole.
REQUIRED SUPPORTING DOCUMENTATION
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Applicant to fill out Fee AND Rental portion for application to be considered complete.
Indicate the appropriate amounts. Fees will be collected at the time of permit issuance
APPLICATION FEES (REQUIRED)
$500 for each permit application containing up to five (5) network nodes. Maximum of 30 network nodes perapplication.
$250 for each additional network nodes beyond five (5).
$1,000 for each new network-node-support pole or replacement pole
NUMBER OF FACILITIES: FACILITY TYPE (POLE OR NODE):
APPLICATION FEE: $ DATE RECEIVED:______/______/_________
RECEIVED BY: ______ RECEIPT NUMBER:
ANNUAL RENTAL CHARGE (REQUIRED)
Annual Rental per Network Node or Pole (includes access to public right-of-way and attachment City facility):
Network Node Public Right-of-Way Fee $250 per year per node
MOU Collocation fee $17.82 per month per node
Fiber Transport Facility Right-of-Way Fee $28 per month per node
Service Pole Collocation Fee $20 annually per pole
$ __________
These rates may be adjusted annually pursuant to Texas Code Sec. 284.054(b).
PAYMENT DATE: ______/______/_________
This Permit Application shall be processed within the timelines set forth in the Texas Code: 1004.284.154
City of Denton has 30 days to complete the initial review of each network node permit application and applicants will be notified by the City of Denton Engineering Dept. whether the permit application is incomplete and what specific information
is missing.
Once the application is deemed complete during initial reviews, City of Denton Engineering Dept. will review the entire permit
and notify the applicant of approve or disapprove status as follows:
A. Within 60 days for network nodes.
B. Within 150 days for node support poles.
C. Within 21 days for fiber transport facilities
______