USVI Public Records

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Government of the Virgin Islands Department of Planning and Natural Resources Division of Building Permits 8100 Lindberg Bay, Ste. #61 CEK Airport Term. Bldg. 2" Fir. St. Thomas, VI 00802 Tel: (340) 774-3320 Fax: (340) 714-9532 No. 45 Est. Mars Hill Frederiksted, VI 00840 Tel: (340) 773-1082 Fax : (340) 778-4620 APPLICATION FOR BUILDING PERMIT OF WIRELESS FACILITY AND WIRELESS SUPPORT SERVICES PROJECT INFORMATION APPLICANT NAME: Phone: Mailing Address: Email: PROPERTY OWNER NAME: Phone: Mailing Address: Email: STRUCTURE OWNER NAME: Phone: Mailing Address: Email: PROJECT DESIGNER/ARCHITECT/ENGINEER: License No.: Phone: Mailing Address: Email: CONTRACTOR NAME: License No.: Phone: Mailing Address: Email: ELECTRICIAN: License No.: Phone: Address: Email: PLUMBER: License No.: Phone: Address: Email: PROJECT LOCATION/PLOT NO.: ESTATE: QUARTER: ISLAND: ZONING DISTRICT: PARCEL IDENTIFICATION NO.: PROJECT DESCRIPTION: O SET OF PLANS ATTACHED (When the estimated value of the proposed construction exceeds $1,000, two (2) sets of plans and specifications must be submitted with application forms). APPLICATION REQUIREMENTS (1 Clearance Letter from the State Historic Preservation Office; (] Clearance Letter from Division of Fish and Wildlife; CJ Environmental Assessment Report (EAR); O Federal Aviation Administration (FAA) Approval, if required. CJ Collocation Feasibility Report; CJ Coastal Zone Permit (if located in Tier 1) or Earth Change Permit (if located in Tier 2); L)_ Written proof that the proposed wireless facility will meet FCC radio frequency emission standards; Description of the proposed wireless support structure or the proposed substantial modification of the existing structure, including certification by a US Virgin Islands licensed structural engineer regarding the structural integrity, the structural capacity and evidence of compliance with FOC standards; An inventory of existing structures, wireless facilities, or wireless support structures within a half-mile radius of the base of the proposed wireless support structure, when applicable; Maintenance plan that describes anticipated maintenance needs, including frequency of service, equipment needs, and traffic, noise and safety impacts on such maintenance; A site plan for the wireless support structure or the substantial modification of an existing tower, drawn to scale showing the property's boundaries; the location, to include Plot number, Estate, and Quarter; height and dimensions of existing and proposed buildings or structures on the same and on adjoining lots; adjacent streets or roads; natural or manmade features; topography; fencing; lighting; and landscaping plan; Government of the Virgin Islands Department of Planning and Natural Resources Division of Building Permits Application for Building Permit of Wireless Facility and Wireless Support Services LJ A map showing the area that will be served by the proposed wireless support structure or the substantial modification of an existing tower and the nature of the service to be provided. Description of the output frequency, number of channels and the power output per channel for each antenna, if applicable; L] Documentation of the elevation above grade for all proposed mounting positions for antennas to be co-located on a tower and the minimum distances between antennas; (1 Description of the tower's antenna capacity, by type, number, and elevation; L)_ Description of potential changes or additions to existing structures that would enable them to provide adequate coverage; A copy of the applicant’s FCC license, or if the applicant is not an FCC license holder, a copy of at least one letter of commitment from an FCC license holder to locate at least one antenna on the applicant's wireless support structure or on the substantial modification of an existing tower; LJ A letter of intent committing the owner of a wireless facility and its successors to permit collocation on the wireless support structure consistent with these rules and regulations ; LJ] In the case of an application for additional antennas or other equipment installation on an existing structure, evidence of an executed contract with the owner of the existing wireless facility; J Other information which may reasonably be required by the Commissioner, requested within thirty (30) days of submission of the application, in order to enforce the provisions of these regulations; L] A commercial bond indexed to inflation/deflation or a property bond to the Department in an amount that would be sufficient to cover the costs of removal and disposal of the wireless support structure or existing structure and the wireless facility. The Department shall set the form, duration, and amount of the security. In addition, if the Department requires an engineering assessment in order to set the amount of the bond, the cost shall be borne by the applicant; and {] The applicant shali submit proof of general liability insurance in the appropriate amount of One million Dollars ($1,000,000, 000.00). LEGAL DOCUMENTS REQUIRED: CJ Corporate Resolizion attesting that applicant has the authority to act on behalf of the legal entity. (1 A certified copy of the survey map from the Office of the Lieutenant Governor — Cadastral Office; C1 A copy of the deed for the subject property; LJ Other Total estimated cost of proposed work: $ Has work been started? OYes No UNDER PENALTY OF INTENTIONAL MISREPRESENTATION AND/OR PERJURY, I declare that I have examined and/or made this application and it is true and correct to the best of my knowledge and belief. 1 agree to construct said improvement in compliance with all provisions of the applicable ordinances. I further certify that all easements, deed restrictions, or other encumbrances restricting the use of the property are shown on the site plans submitted with this application. I have been given authorization from the property owner to obtain this permit. I realize that the information that I have affirmed hereon forms a basis for the issuance of the permit herein applied for and approval of plans in connection therewith shall not be construed to permit any construction upon said premises or use thereof in violation of any applicable ordinance or to excuse the owner or his or her successors in title from complying therewith. Signature of Applicant and Date: DEPARTMENT USE ONLY RECEIVED BY: DATE RECEIVED: REVIEWED BY: DATE REVIEWED: REMARKS: Estimated Cost of Construction §$ (] PERMIT APPROVED $ Plan Review C] PERMIT DISAPPROVED $ BP Fee Date: $ Prepaid Amt ate $ Balance Commissioner, DPNR