TelePacific Communications - 2012-10-25 TelePacific,
C O M M U N I C A T I O N S
Roof Access Authorization For Broadband Data Antenna Installation
As the owner or property manager(or other authorized signatory)of the building located at:
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Name of Property: v"" 1' "`&R. SAP vV "',--c-t)` 1 t c
Address: V IAAQ Iv`tvL CA
12-1P-2-1 —I agree that the tenant[ ], located in Suite/Apt# [ ]of the
above referenced building, may install or cause to be installed an antenna with associated cabling to the tenant's suite for the
purpose of obtaining broadband data access.
I understand that the installation will be performed by a licensed contractor with TelePacificConmunications{"TelePacific")
technicians. P articular attention will be paid to roof visual aesthetics and structural integrity.
I understand that the antenna equipment will not penetrate the roof membrane or in any way impact the roof's structural integrity.I
also understand that the purpose of the antenna is to bring broadband data access to the above-referenced tenant's suite or
apartment.
I understand that TelePacific and its licensed contractors will be solely responsible for the ongoing maintenance of the device
and authorize access to the building and roof for future maintenance as required.
Furthermore,it is understood that TelePacific and its licensed contractors may remove the antenna equipment in the event the
tenant referenced above moves from the building or terminates its service with TelePacific.
Signature
Print Name: ��" WV1 rO ,\
Title: V�O' v M 0,4 -e/V ---
Date: Ld1) 1 v"1Z
Additional information:
The antenna/subscriber unit that TelePacific uses to provide service is a small device mounted on a vertical surface or short free-
standing mast. Below are pictures of some of the common subscriber units. Actual device used depends on installation location
and is not user selectable.
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TelePacific Roof Access Authorization Form V.07.12.12
Flat Panel Subscriber Unit Dimensions Standard Tripod and Non Penetrating Roof Skid
Phcsical Characteristics Suitable for most installations.
Subscriber Unit dimensions:10"x 10"x 4"Weight: 8 34 inches square.sits on the roof(114 inch rubber mat optional).
llbs. Weighted down by cinder blocks with no roof penetration.
1.9'00
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External Dish Unit Standard Vertical Surface Mount
Used for selected long range applications only
Suitable for most instaalations.
24 inch external dish.
Attaches to vertical surface with
no roof penetration
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2 foot dish
1'''' T8l8 c'ific
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