Request For Authorization Form - Bda/das Installation For In-Building Public
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1
2REQUEST FOR AUTHORIZATION
Seattle Dept of Info Technology
Communications Shop
BDA/DAS Installation for In-Building Public
1933 Minor Avenue
Safety Radio System Coverage
Seattle, WA 98101
SECTION 1: Requesting Party Information
I
hereby request authorization to install a BDA/DAS for in-building public safety radio system coverage, according to the specifications below:
Requestor Name:
Requestor Email:
____________________________________________________
__________________________________________________
Phone number:
Date:
____________________________________________________
__________________________________________________
SECTION 2: Information to be Provided by Building Owner or Designee
1.
Company and/or building name: __________________________________________________________________________________________
2.
Address: _____________________________________________________________________________________________________________
3.
Contact name for building owner: _________________________________________________________________________________________
4.
Daytime phone: _______________________________________________________________________________________________________
5.
Email address: ________________________________________________________________________________________________________
6.
24 hour emergency contact name*: _______________________________________________________________________________________
7.
24 hour emergency contact number: ______________________________________________________________________________________
8.
Location of equipment in building (floor and room): __________________________________________________________________________
9.
Designed by: __________________________________________________________________________________________________________
10. Installed by: __________________________________________________________________________________________________________
11. Tested by: ____________________________________________________________________________________________________________
12. Make/model: _________________________________________________________________________________________________________
13. Antenna type (panel, yagi, omni, etc.): _____________________________________________________________________________________
14. Antenna gain (dBd): ____________________________________________________________________________________________________
15. ERP to donor site (dBm): _________________________________________________________________________________________________
16. Antenna coordinates (NAD83): ____________________________________________________________________________________________
17. Antenna height above ground (feet): _______________________________________________________________________________________
18. Date commissioned (first turned on): _______________________________________________________________________________________
19. Projected signal level at donor site (-dBm): __________________________________________________________________________________
*If at any time during or after installation the BDA/DAS system negatively impacts the King County Radio System, the building owner will be required
immediately to turn off the malfunctioning BDA/DAS, until correct functioning is restored.
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