Sar Sam Tanjung Perak

8/11/2019 Sar Sam Tanjung Perak

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Site Number :

: SURABAYA 630156

Access Road Width (meters)

L 5.8 x W 5.8 +

10 years SAR Forecast Lease Date:

Probability of signing the lease agreement ?

1

2

3

4

5

6

Site Condidtion:

4

Type of Site:

33.64Lease Space:

Site Use:

Owner's name:

Access hours:

Type of Ownership:

District/Community:

Postal Code:

Site Acq. Subcontractor:SAR Complete Date:

City/Town:

Street / Plot number:House H. MaskuriJL. Nyamplungan 10 no 46

Building Name:

H. Maskuri

Owner's address:

Fax:

81553474437

SAR Longitude:

24 Hours

Site/Roof height:

630156

Site Acq. Supervisor:

13-Jun-14

SITE ACQUISITION REPORT

Site Acq. Negotiator:

Radio Planner:

Ground Elevation AMSL of Site: Tower/Mast Height :

State/Province:

112,7440

Jawa Timur

Site Name

Surabaya

81553474437

JL. Nyamplungan 10 no 46

-7.2275SAR Latitude:

Duration of the permit process?

Estimated Rent:

Can the Site be Leased?

Number of permits required? Did you talk to a Permit Agent about the Site?

Does the owner have the lease ?

LEASE INFORMATIONTotal sq meters:

PERMIT INFORMATION

Permit Agency NamePermit Name

Can the site be Permitted?

Owner's telephone:

BADAN PENGELOLA MASJID

Contact telephone:

Contact person:

Fax:

outdoor

Network Element (radio equipment)

Location:

Access Road Condition:

Equipment Room Type:

Single Owner

Corporation

Master Agreement Site

Community Association

Goverment

Partnership

Other

GPS MAP

Rooftop Greenfield

Existing Tower Apartement Building House

Chimney Community Commercial Water Tank

New Tower Industrial Building Hospital

Other

Ground near buildin

Rooftop indoor(on roof level)

Roofto outdoor

Ground near tower

Rooftop indoor (not on roof level)

NAVery BadBadOKGoodVery Good

NAVery BadBadOKGoodVery Good

Concrete Shelter

Existing Room

Fiberglass Shelter Metalic Shelter

Other :No Shelter

Yes No Yes No

100% 80% 60% 40%

Revision number: 01Date of issue: 29-Nov-2013 1of11 Document title: SAR HCPT Document number:F-BTS-017


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Site Number :

: SURABAYA 630156

630156


Site Name

Operator Name

1

2

3

4

L x W x

L x W x H

(V/Amp/kW/Phase)

(meters)

on sketch approval required

Access to PTT's fiber network

If there is no access with heavy truck or mobile crane, how will equipment be transported to the roof?

Elevator dimension:

Heavy truck access:

Existing electric supply (V/Amp/kW/Phase)

Earthing/Lightening Protection System

EXISTING INFRASTRUCTURE INFORMATION

Access to any other telecommunications networks

DIRECTIONS TO SITE

photos included

CONSTRUCTION INFORMATION

CO-LOCATION INFORMATION

Are other operators (existing or planned) on the site?

Drilling Allowed?

Staircase dimension:

3 phaseElectric company name:

Length of electrical run:Will existing electric supply be enough to power the site?

Yes No Yes NoYes No

Yes No Yes NoYes No

Yes No Yes NoYes No

Yes No Yes NoYes No

Yes No

Yes No

Yes No

Yes No

Yes No

Yes No Yes No

Yes No



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Site Number :

: SURABAYA 630156

630156


Site Name

a) Is site location in a conservation area? Yes No

If yes, please mention conservation area below:

Designated forestry preserve Designated cultural heritage site

Designated wetlands preserve Others :

Designated wild life preserve

Description:

b) Is site location in a social awareness area? Yes No

If yes, please mention social awareness area below:

Schools Hospitals Churches Other socially sensitive location :

Mosques

Description:

c) Is site location in an environmental awareness area? Yes No

If yes, please mention environmetal awareness area below:

Existing landfill Material fabrication plant Current/former hazardous waste facilities Dense Industrial area

Dry cleaning location Other environmental awareness area :

Description:

ENVIRONMENTAL, SOCIAL AND CULTURAL ASPECTS



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Site Number :

: SURABAYA 630156

630156


Site Name

1

2

3

4

5

6

7

OBSTACLES: DESCRIBE ALL OBSTRUCTING OBSTACLES WITHIN 300 METERS,

WHICH ARE OF A HEIGHT EQUAL TO OR HIGHER THAN THE SITE

# DescriptionAzimuth

(degrees)

Distance

(meters)

Height above

rooftop you are

standing on

ATTACHMENTS

Completely free of obstacles.

(If there are noobstacles, then mark here)

180

45

0

90270

225 135

315

20m 40m 60m 80m 90m 100m

Street Map Ground Level Site Photos

General Roof Photos List of Required Permits

Proposed BTS location photos Antenna Installation and Roof Sketch

Obstacle Map

Panoramic photos

Revision number: 01Date of issue: 29-Nov-2013 4of11 Document title: SAR HCPT Document number:F-BTS


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Site Number :

: SURABAYA 630156

630156


Site Name

STREET MAP



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Site Number :

: SURABAYA 630156

630156


Site Name

GROUND LEVEL PHOTOS

Propose Site (Right View)

Propose Site (Left View) Propose Site (Back View)

6 meters

6 meters

Propose Site (Front View)



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Site Number :

: SURABAYA 630156

630156


Site Name

ACCES TO SITE

Access to Site

Acces to SITE Acces to SITE

Acces to SITE Acces to SITE

Access to Site

Nearest Pole PLN + 10 meter Nearest Trafo + xx meter



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Site Number :

: SURABAYA 630156

630156


Site Name

PANORAMIC PHOTOS

View Direction 0 View Direction 45





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Site Number :

: SURABAYA 630156

630156


Site Name

PANORAMIC PHOTOS




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Site Number :

: SURABAYA 630156

630156


Site Name

PHOTOS OF ENVIRONMENTAL, SOCIAL AND CULTURAL ASPECTS

Conservation Area Photo 1 Conservation Area Photo 2

Social Awareness Area Photo 1 Social Awareness Area Photo 2

Environmental Awareness Area Photo 1 Environmental Awareness Area Photo 2



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Site Number :

: SURABAYA 630156

630156


Site Name

Photo GPS Photo GPS

Surrounding Area Surrounding Area

Surrounding Area Surrounding Area


Sar Sam Tanjung Perak

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