Attachment HUB4 Form 854

This document pretains to SES-MOD-20120229-00267 for Modification on a Satellite Earth Station filing.

IBFS_SESMOD2012022900267_941134

Form 854 Page 1 of 2 FCC 854 Approved by OMB Main Form 3060 - 0139 Est. Public Burden per Response: 30 minutes FCC Application for Antenna Structure Registration File Number: A0736710 Purpose of Filing 1. Purpose of this filing: Application for the registration of a new antenna structure 2A. For purpose codes of WD or AM, provide the file number of the pending application currently on file with the FCC: A0736710 2B. If purpose codes of MD, CA, AU, DI, NT, DU or OC provide FCC Antenna Structure Registration Number: 1280484 2C. If purpose code is MD or NT, provide date constructed or Last altered (mmddyyyy): 2D. If purpose code is DI, give date of dismantlement (mmddyyyy): Antenna Structure Ownership Information 3) Owner/Assignee FCC Registration Number (FRN): 0018756155 4) Assignor FCC Registration Number (FRN): 5) Legal Owner of Structure/Assignee First Name (if individual): Middle Initial: Last Name: Suffix: 6) Business Name (if other than Individual): VSAT Systems, LLC 7) Attention To: Michael Kister 8) P. O. Box: And/Or 9) Street Address: 1520 S. Arlington 10) City: Akron 11) State: OH 12) ZIP Code: 44306 13) Telephone Number: 14) E-Mail Address: (330)785-2100 Mkister@vsatsystems.com Contact Representative Information (If the Owner/Assignee is a business or contact representative is different from the Owner/Assignee) 15) First Name: Mario MI:A Last Name: Tomaselli Suffix: 16) Business Name: VSAT Systems, LLC 17) P.O. Box: And/Or 18) Street Address: 1520 S. Arlington 19) City: Akron 20) State: OH 21) Zip Code: 44306 22) Telephone Number: (330)785-2100 23) E-Mail Address: Mtomaselli@vsatsystems.com Antenna Structure 24) NAD83 Antenna Structure Latitude (DD-MM-SS.S): 25) NAD83 Antenna Structure Longitude (DDD-MM-SS.S): 41-01-50.8 ( N )N or S 081-29-34.2 ( W )N or S 26) Address or Geographical Location: 961 East Waterloo 27) City: Akron 28) State: OH 29) Elevation of site above mean sea level (refer to "a" in antenna structure examples): 349.5 meters 30) Overall (highest) height above ground (AGL) of an antenna structure INCLUDING all appurtenances (antennas, dishes, 8.1 lightning rods, obstruction lighting, etc.) (refer to "c" in antenna structure examples): meters 357.6 31) Overall height above mean sea level (sum total of items 29 and 30): meters 32) Overall height above ground level (AGL) of the supporting structure itself WITHOUT appurtenances (refer to "b" in antenna 8.1 structure examples): meters 33) Indicate the code for the type of structure on which antenna will be mounted (i.e., pole, building, water tank, silo, tower, etc.) (See Instructions): TOWER http://jagext.fcc.gov/servlet/ServASRDataEntryApplet 9/14/2011

Form 854 Page 2 of 2 34-35)If type of structure is an Array, provide coordinates for center of the array below: 34) NAD83 Array Center Latitude (DD-MM-SS.S): 35) NAD83 Array Center Longitude (DDD-MM-SS.S): -- ( N )N or S -- ( W )N or S FAA Notification 36) FAA Study Number: 2011-AGL-4388-OE 37) Date Issued (mmddyyyy): 08/22/2011 Environmental Assessment Would a Commission grant of Authorization for this location be an action which may have significant environmental Yes 38) ( N ) effect? See Section 1.1307 of 47 CFR. If 'YES', submit an environmental assessment as required by 47 CFR, Sections No 1.1308 and 1.1311. Certification Statements 1) The applicant certifies that all statements made in this application and in the exhibits, attachments, or documents incorporated by reference are material,are part of this application, and are true, complete, correct, and made in good faith. 2) The applicant certifies that neither the applicant nor any other party to the application is subject to a denial of Federal benefits pursuant to Section 5301 of the Anti-Drug Abuse Act of 1988, 21 U.S.C. § 862, because of a conviction for possession or distribution of a controlled substance. See Section 1.2002(b) of the rules, 47 CFR § 1.2002(b), for the definition of 'party to the application' as used in this certification. Signature 39) Typed or Printed Name of Party Authorized to Sign First Name: Mario MI: A Last Name: Tomaselli Suffix: 40) Title: RF Engineer 41) Signature: Mario A Tomaselli 42) Date (mmddyyyy): 09/14/2011 WILLFUL FALSE STATEMENTS MADE ON THIS FORM OR ANY ATTACHMENTS ARE PUNISHABLE BY FINE AND/OR IMPRISONMENT (U.S. Code, Title 18, Section 1001) AND/OR REVOCATION OF ANY STATION LICENSE OR CONSTRUCTION PERMIT (U.S. Code, Title 47, § 312(a)(1)), AND/OR FORFEITURE (U.S. Code, Title47, § 503). http://jagext.fcc.gov/servlet/ServASRDataEntryApplet 9/14/2011

REFERENCE COPY This is not an official FCC license. It is a record of public information contained in the FCC's licensing database on the date that this reference copy was generated. In cases where FCC rules require the presentation, posting, or display of an FCC license, this document may not be used in place of an official FCC license. UNITED STATES OF AMERICA Re FEDERAL COMMUNICATIONS COMMISSION ANTENNA STRUCTURE REGISTRATION OWNER: VSAT SYSTEMS, LLC FCC Registration Number (FRN): 0018756155 fer Antenna Structure ATTN: MICHAEL KISTER Registration Number VSAT SYSTEMS, LLC 1280484 1520 S. ARLINGTON AKRON, OH 44306 Issue Date 09-14-2011 Location of Antenna Structure en Ground Elevation (AMSL) 961 East Waterloo 349.5 meters Akron, OH Overall Height Above Ground (AGL) 8.1 meters Latitude Longitude Overall Height Above Mean Sea Level (AMSL) 41-01-50.8 N 081-29-34.2 W NAD83 357.6 meters Painting and Lighting Requirements: c NONE Paint and Light in Accordance with FAA Circular Number eC Conditions: op This registration is effective upon completion of the described antenna structure and notification to the Commission. YOU MUST NOTIFY THE COMMISSION WITHIN 24 HOURS OF COMPLETION OF CONSTRUCTION OR CANCELLATION OF YOUR PROJECT, please file FCC Form 854. To file electronically, connect to the antenna structure registration system by pointing your web browser to http://wireless.fcc.gov/antenna. Electronic filing is recommended. You may also file manually by submitting a paper copy of FCC Form 854. Use purpose code 0NT1 for notification of completion of construction; use purpose code 0CA1 to cancel your registration. y The Antenna Structure Registration is not an authorization to construct radio facilities or transmit radio signals. It is necessary that all radio equipment on this structure be covered by a valid FCC license or construction permit. You must immediately provide a copy of this Registration to all tenant licensees and permittees sited on the structure described on this Registration (although not required, you may want to use Certified Mail to obtain proof of receipt), and display your Registration Number at the site. See reverse for important information about the Commission0s Antenna Structure Registration rules. FCC 854R Page 1 of 2 August 2007

You must comply with all applicable FCC obstruction marking and lighting requirements, as set forth in Part 17 of the Commission2s Rules (47 C.F.R. Part 17). These rules include, but are not limited to: Re. Posting the Registration Number: The Antenna Structure Registration Number must be displayed in a conspicuous place so that it is readily visible near the base of the antenna structure. Materials used to display the Registration Number must be weather-resistant and of sufficient size to be easily seen at the base of the antenna structure. Exceptions exist for certain historic structures. See 47 C.F.R. 17.4(g)-(h). . Inspecting lights and equipment: The obstruction lighting must be observed at least every 24 hours in order to detect any outages or malfunctions. Lighting equipment, indicators, and associated devices must be inspected at least once every three months. . Reporting outages and malfunctions: When any top steady-burning light or a flashing light (in any position) fer burns out or malfunctions, the outage must be reported to the nearest FAA Flight Service Station, unless corrected within 30 minutes. The FAA must again be notified when the light is restored. The owner must also maintain a log of these outages and malfunctions. . Maintaining assigned painting: The antenna structure must be repainted as often as necessary to maintain good visibility. . Complying with environmental rules: If you certified that grant of this registration would not have a significant environmental impact, you must nevertheless maintain all pertinent records and be ready to en provide documentation supporting this certification and compliance with the rules, in the event that such information is requested by the Commission pursuant to 47 C.F.R. 1.1307(d). . Updating information: The owner must notify the FCC of proposed modifications to this structure; of any change in ownership; or, within 30 days of dismantlement of the structure. Copies of the Code of Federal Regulations (which contain the FCC2s antenna structure registration rules, 47 C.F.R c Part 17) are available from the Government Printing Office (GPO). To purchase CFR volumes, call (202) 512-1800. For GPO Customer Service, call (202) 512-1803. For additional FCC information, consult the Antenna Homepage on the internet at http://wireless.fcc.gov/antenna or call (877) 480-3201 (TTY 717-338-2824). eC op y FCC 854R Page 2 of 2 August 2007


Document Created: 2012-02-29 18:33:24
Document Modified: 2012-02-29 18:33:24
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