HomeMy WebLinkAboutATC 5110 Dish MIMIA00512B BP app signedATC 5110 Dish MIMIA00512B Collocation
All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
9U
O
° y Building Permit Application
Planning and Development Services
Building and Code Regulation Division Commercial X Residential
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 CBDG Funding
PERMIT APPLICATION FOR:
PROPOSED IMPROVEMENT LOCATION:
Address: 12200 W. Angle Rd., Fort Pierce, FL 34945
Property Tax ID #: 1332-211-0002-000-5 Lot No.
Site Plan Name: Angle Road Block No.
Project Name: ATC 5110 Dish MIMIA00512B Collocation 13719529
DETAILED DESCRIPTION OF WORK:
ATC 5110 Dish MIMIA00512B Collocation to existing cell tower including Reome Level at 278'-0", install (3) panel antennas, (3) Sector Frames, Jumpers, (6) RRUs, (1) OVP
(1) Hybrid Cable, (1) Metal Platfrom, (1) Ice Bridge, (1) PPC Cabinet, (1) Equipment Cabinet, (SI Power Conduit, (1) Telco Conduit, (1)Telco-Fiber Box, (1) GPS Unft,
(1) Safety Switch, (1) Fiber NID, (1) Meter Socket, (1) Voltage Booster. No increase to height of tower. Scope of work will not exceed bounds of compound. See plans for
details.
New Electrical Meter Second Electrical Meter (Affidavit required)
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit— check all that apply:
_Mechanical _ Gas Tank _ Gas Piping _ Shutters _ Windows/Doors _ Pond
Electric _ Plumbing _ Sprinklers _ Generator _ Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ 25,D00 Utilities: —Sewer —Septic Building Height:
OWN ER/LESSEE:
CONTRACTOR:
Name Dish Wireless, LLC Name: Brad Conn
Address: 9601 South Meridian Blvd Company: Mastec Network Solutions
City. Englewood State: co Address: 806 Douglas Rd #1100
Zip Code: 80112 Fax: City: Coral Gables State: FL
Phone No. E- Zip Code: 33134 Fax:
Mail: Phone No 678-477-3773
Fill in fee simple Title Holder on next page (if different E-Mail
from the Owner listed above) State or County License 13006418
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
If value of HAVC is $7,500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: Not Applicable
MORTGAGE COMPANY: _ Not Applicable
Name:
Name:
Address:
Address:
City: State:
City: State:
Zip: Phone
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
BONDING COMPANY: Not Applicable
Name:
Name:
Address:
Address:
City:
City:
Zip: Phone:
Zip: Phone:
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and installation as indicated.
I certify that no work or installation has commenced prior to the issuance of a permit.
St. Lucie County makes no representation that is granting a permit will authorize the permit holder to build the subject structure
which conflicts with any applicable Homeowners Association rules, bylaws or and covenants that may restrict or prohibit such
structure. Please consult with your Homeowners Association and review your deed for any restrictions which may apply.
In consideration of the granting of this requested permit, I do hereby agree that I will, in all respects, perform the work
in accordance with the approved plans, the Florida Building Codes and St. Lucie County Amendments.
The following building permit applications are exempt from undergoing a full concurrency review: room additions,
accessory structures, swimming pools, fences, walls, signs, screen rooms and accessory uses to another non-residential use
WARNING TO OWNER: Your failure to Record a Notice of Commencement may result in paying twice for
improvements to your property. A Notice of Commencement must be recorded in the public records of St.
Lucie County and posted on the jobsite before the first inspection. If you intend to obtain financing, consult
with lender or an attorney before commencing work or recording our Notice of Commencement.
Sign a of Owner/ Lessee/Contractor as Agent for Owner
STATE OF k4GR Alabawta
COUNTY OF JQ-JqFLrSO Yt,
Sworn to (or affirmed) and subscribed before me of /Physical Presence or Online Notarization
thisday of ft-ftibty- 20_.0 by
brialn SI)IIiVaM
Name of person makin KATIE LEANNE KYLE statement.
Personally Known OR Produced Identification Notary Public
'
Type of Ide ication Produced Alabama State at Large
(Signature o Notary Public State (abA.wca.. My Commission Expires
August 13, 2025
Commission No. (Seal)
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
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LETTER OF LIMITED AGENCY
9/13/2021
Dear Sir/Madam:
On March 12112021, DISH Wireless L.L.C. ("DISH") and American Towers LLC ("Contractor") entered
into a Strategic Colocation Agreement ("Agreement") effective as of March 12`h 2021. The Agreement
provided, among other things, for Contractor to provide to DISH site acquisition services (including zoning
and permitting services) for certain ground space and tower space.
With the assistance of Contractor, DISH desires to install wireless communications equipment at
the Site as part of its deployment of a wireless network.
Accordingly, DISH hereby authorizes Contractor and contractors sub (Crafton Communications Inc.)
to act on DISH's behalf in connection with obtaining all applicable use and zoning approvals, permits,
consents, authorizations and other related documents from the applicable government authority ("Zoning
Authority") so as to allow DISH, through its contractors, to install its equipment at a Site (the "Purpose").
DISH hereby acknowledges that Contractor may present this Letter of Limited Agency to the
applicable Zoning Authority, after which Contractor may act on DISH's behalf to effectuate the Purpose.
Contractor may deal directly with the Zoning Authority on all matters pertaining to the Purpose.
The above rights shall be self -operative, and no further documentation shall be necessary to confer
said rights. This Letter of Limited Agency will remain in effect until rescinded in writing by DISH.
Authorized for: Brian Sullivan on behalf of the Miami Market (Dish Wireless)
AGREED
DISH WIRELESS L.L.C.
By:
Name: Sidney G. "Jerry" Pollard
Title: Site Development Manager —Miami Market