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Obstacle Evaluation : Work Order

Underlined input descriptions are links to Help Information. If you require additional help, please contact us at 678-924-8088. If you do not receive acknowledgement within 1 business day after submitting this request, please contact us at 678-924-8088.

* Indicates Required Field

Complete the following information:

Type Of Request:
Other/Explain:

If applicable:

Company Purchase Order No.		Prior Airspace Design Study No.
Prior FAA Study No.		FCC Registration No.

Requestor Information

Requested by:
Street Address:
City:		State:
Zip/Postal Code:
Telephone:		FAX:
Company Name/MTA/BTA:
Email:

Site Information

Site Number / Name:	/
Nearest City:		Nearest State:

Latitude:	° ' . ''
Longitude:	° ' . ''

Source of coordinate data:	**
NAD:

** If "GPS Survey" or "Land Survey" is selected, please FAX the survey data to 678-924-8006 or e-mail data to ASACAEStudies@jeppesen.com.

Study Type:

	Site Specific Study Request
	Search Area Study Request
Site Ground Elevation:	'AMSL
Search Area Radius:	NM

Total Structure Height:	FT.
	Above Ground Level (AGL) - (Including: Footing, Antenna, Lights, etc.)
Marking and Lighting:
Other Details:
Remarks:

Original Work Orders receive an "Obstruction Evaluation Report" and, if requested, an "Airspace Design Opinion Letter" or "FAA Form 7460-1".

Do you request any of the following products at this time based on the above data? (See Service Description for details.)

Airspace Design Opinion letter ?
FAA Form 7460-1 ?	**

**If applicable, enter FAA Form 7460-1 data below:

FAA 7460-1

Frequency Ranges:

from:	to: MHz	from:	to: MHz
from:	to: MHz	from:	to: MHz
ERP:		ERP:

Microwave:

	GHz	ERP:	Watts	dBm	Azimuth:	°
	GHz	ERP:	Watts	dBm	Azimuth:	°

Name, Title, and phone number of person signing:

Airspace Design Study No.

FAA Study No.

(Please e-mail a copy of the FAA Study, if available to ASACAEStudies@jeppesen.com or FAX a copy to 678-924-8006.)

Type of Structure:

Building
Tower
Tank
Other (explain)

Latitude (Of Record):	° ' . ''
Longitude (Of Record):	° ' . ''

Source of coordinate data:	**
NAD:

**If GPS Survey or Land Survey is selected, please e-mail the survey data, if available, to ASACAEStudes@jeppesen.com or FAX to 678-924-8006.

Site Ground Elevation: (Of Record)	'AMSL (Above Mean Sea Level)
Total Structure Height: (Of Record)	'AGL (Above Ground Level)

Marking and Lighting: (Of Record)
Actual Marking and Lighting on Structure:
Actual Site Ground Elevation:	'AMSL (if different)
Actual Highest Point on Existing Structure:	'AGL (if different)
Your Highest Proposed Antenna Tip Height:	'AGL

CAUTION: FAA recommends that any filing of Existing Structure and/or Alteration of Existing Structure which changes FAA data be made in owner's name in care of requestor.

Owner's Name:
Address:

Telephone Number:
Person Authorizing 7460-1 Name and Title:
Authorizing Person's Email:
Authorizing Person's Phone Number:

Please include in your remarks the e-mail address you would like the 7460 mailed to if different from the information listed on the Work Order Form.

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Questions?

Obstacle Evaluation : Work Order

Complete the following information:

If applicable:

Requestor Information

Site Information

Study Type:

Frequency Ranges:

Microwave:

Obstacle Evaluation Form

Notices & Alerts

Aviation Weather Maps

Customer Satisfaction Survey